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NPI 1447233861 · Arecibo, PR · Clinical Medical Laboratory
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Laboratorio Clinico Toledo, LLC is a clinical medical laboratory provider located in Arecibo, Puerto Rico. This profile covers 79 Medicare and 178 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Laboratorio Clinico Toledo, LLC |
| Address | 51 Palma St |
| City | Arecibo |
| State | PR |
| ZIP | 00612 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 21, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $11.9M |
| Medicare | $83.2K |
This entity is heavily Medicaid‑centric: Total Medicaid revenue is $11.9M versus Total Medicare revenue of $83.2K, so the provider’s billed volume and revenue are overwhelmingly driven by Medicaid rather than Medicare. The imbalance indicates the lab operates primarily as a Medicaid-serving clinical laboratory rather than as a Medicare-focused lab.
The provider’s Medicaid code mix points to a service line built around infectious disease and high-volume SARS‑CoV‑2 testing plus HIV monitoring: top Medicaid codes include 87536 ($1.4M), U0002 ($888.9K), and G2023 ($886.9K), and the top three Medicaid codes by revenue account for 34.0% of the provider’s total Medicaid revenue. Several of those Medicaid codes are labeled as extreme outlier volumes in-state (for example, 87536 ranks #2 of 42 providers in-state (98th percentile; extreme outlier, far above typical state volume for this code) and U0002 ranks #1 of 178 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code)), consistent with a high-throughput infectious-disease testing operation.
Medicare revenue is concentrated in routine clinical chemistry and hematology: the provider’s Medicare top codes include 84443 ($6.2K), 80061 ($6.1K), and 82306 ($5.9K), and the top three Medicare codes by revenue account for 28.3% of the provider’s total Medicare revenue. Those Medicare code ranks are generally high‑percentile but described as typical or unremarkable volumes nationally (for example, 84443 ranks #1966 of 19722 providers nationally (90th percentile; typical, unremarkable volume for this code)), indicating a modest, steady participation in standard lab panels for Medicare.
Revenue concentration is meaningful for both payers: the top three Medicare codes represent 28.3% of Medicare revenue while the top three Medicaid codes represent 34.0% of Medicaid revenue, which implies that a relatively small set of tests (notably SARS‑CoV‑2 and HIV-related assays on Medicaid, and routine panels on Medicare) drive a large share of the business. That concentration increases operational and payer exposure to changes in reimbursement or demand for those specific tests.
State-level competitive standing is dominant for key Medicaid services: multiple Medicaid codes are characterized as extreme outliers or notably above typical state volume (for example, G2023 has 38.6K claims and ranks #2 of 587 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), and 87635 has 17.9K claims and ranks #5 of 366 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code)). These rankings and claim volumes indicate the lab is a major in‑state provider for COVID testing and HIV viral-load services.
National competitive standing on Medicare is modest: while some Medicare codes fall in high percentiles (for example, 36415 ranks #4168 of 86467 providers nationally (95th percentile; typical, unremarkable volume for this code)), most Medicare code descriptions and ranks mark the provider as a routine national participant rather than a dominant national lab. That pattern suggests the provider’s strategic advantage and market share are primarily state‑focused through Medicaid work rather than broad national Medicare dominance.
Operational throughput and collection activity are substantial on the Medicaid side: specimen-collection and high-volume testing codes show very large claim counts (for example, G2023 with 38.6K claims and 36415 with 34.4K claims on Medicaid), and both codes are labeled as extreme outliers in-state. These data imply significant logistics and specimen-collection capacity, supporting sustained high-volume testing workflows.
The provider has long tenure in the NPI database (NPI enumerated (registered): 2005-11-21 (~21 years ago)), which supports the interpretation of an established clinical laboratory operation with an entrenched Medicaid testing footprint in Puerto Rico. Combined with the Medicaid-dominant revenue profile, the longevity suggests institutional stability centered on state payer relationships.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
79 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 390 | $20 | $6.2K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 470 | $10 | $6.1K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 210 | $30 | $5.9K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 830 | $10 | $5.8K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 520 | $10 | $5.2K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 510 | $10 | $4.1K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 310 | $10 | $3.1K |
| 80197 | The lab analyst performs the technical lab test to analyze a specimen to quantitate the total amount of tacrolimus present, which is an immunosuppressant drug patients often use to prevent rejection… | 200 | $10 | $2.6K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 30 | $70 | $2.2K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 30 | $80 | $2.1K |
Showing 1–10 of 79
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 79 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
178 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 17,360 | $80 | $1.4M |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | 17,430 | $50 | $888.9K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 38,560 | $20 | $886.9K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 17,920 | $50 | $878.1K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 20,110 | $40 | $824.4K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 30,790 | $20 | $492.7K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 30,150 | $10 | $392K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 34,630 | $10 | $346.3K |
| 86360 | The lab analyst performs a test to measure the number of CD4 and CD8 cells, typically in a blood specimen, including a calculation of the ratio between the two. The provider may order a CD4, CD8 and… | 7,860 | $40 | $345.8K |
| 80074 | The lab analyst performs an acute hepatitis panel; the panel must include tests for hepatitis A IgM antibody, hepatitis B core IgM antibody, hepatitis B surface antigen, and hepatitis C antibody. | 7,110 | $50 | $334.4K |
Showing 1–10 of 178
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
178 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 12 | 30 | 910 | $40 | $638.8K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 2 | 40 | 250 | $80 | $140.8K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 4 | 650 | 1,260 | $40 | $93.7K |
| 87490 | The lab analyst performs a test for Chlamydia trachomatis using direct nucleic acid probe technique. Chlamydia trachomatis causes a common sexually transmitted disease and certain eye infections. | 2 | 70 | 150 | $20 | $71.9K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 9 | 770 | 2,520 | $20 | $65.5K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 2 | 590 | 1,440 | $20 | $65.4K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 5 | 370 | 370 | $50 | $63.3K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 2 | 10 | 180 | $30 | $63.1K |
| 87590 | The lab analyst performs a test for Neisseria gonorrhoeae, a bacteria, using direct nucleic acid probe technique. | 3 | 80 | 150 | $20 | $59.4K |
| 86360 | The lab analyst performs a test to measure the number of CD4 and CD8 cells, typically in a blood specimen, including a calculation of the ratio between the two. The provider may order a CD4, CD8 and… | 1 | 30 | 320 | $40 | $58.5K |
Showing 1–10 of 178
Other providers in the same ZIP code as Laboratorio Clinico Toledo, LLC, ranked by combined Medicare and Medicaid revenue.
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