Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Puerto Rico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Puerto Rico only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Puerto Rico (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Northwest Pathology Csp (NPI 1467786467)

Key Findings

Field	Value
Entity Type	Organization
Organization	Northwest Pathology Csp
Address	1 Dr Pedro Blanco Lugo
City	Manati
State	PR
ZIP	00674
Taxonomy	Clinical Medical Laboratory
NPI Enumerated	September 23, 2009

Payer Source	Total Paid
Medicaid	$16.9M
Medicare	$0

NORTHWEST PATHOLOGY CSP is effectively a single-payer Medicaid provider: there is no Medicare billing on file and all documented lifetime revenue is from Medicaid totaling $16.9M. This concentration means the provider’s visible commercial footprint is limited to state Medicaid activity rather than mixed Medicare/Medicaid operations.

Revenue is highly concentrated in a small set of pathology services: the precomputed top three Medicaid codes account for 81.3% of the provider’s total Medicaid revenue. Those top three are 88312 ($5.8M, 34.1%), 88341 ($5.3M, 31.3%), and 88305 ($2.7M, 15.9%), showing that a handful of procedure lines drive the majority of income.

The code mix indicates an operational focus on immunohistochemistry and specialized staining plus routine surgical pathology. High-revenue immunostain and special-stain codes 88312 (21.6K claims, $267 avg paid/claim, $5.8M) and 88341 (13.2K claims, $402 avg paid/claim, $5.3M) together dwarf the contribution of base-level surgical pathology; 88305 has much higher claim volume (24.5K claims) but a lower avg paid/claim ($110), yielding $2.7M in revenue. This pattern is consistent with a lab that processes large volumes of specimens and applies costly antibody/special stains as a primary value driver.

State-level competitive standing is strong in immunostaining and special stains: 88341 ranks #1 of 11 providers in-state at the 100th percentile and is described as notably above typical state volume, while 88312 ranks #2 of 25 providers at the 96th percentile and is also notably above typical state volume. By contrast, core surgical pathology code 88305 ranks #5 of 32 providers at the 87th percentile and is characterized as typical or unremarkable volume, indicating dominance in ancillary staining services but a more ordinary position in base pathology reads.

Beyond the top three, the provider also shows elevated state standing on related stain codes: 88313 is $1.1M (6.6%) with 7.4K claims and ranks #1 of 10 providers in-state at the 100th percentile (notably above typical state volume). Other adjunct codes such as 88342 ($975.7K, 13.7K claims, 5.8%) rank #2 of 15 providers at the 93rd percentile and are described as typical or unremarkable in volume, reinforcing a specialization in multi-antibody and follow-up staining workflows.

Claim volume and pricing dynamics drive the revenue mix: 88305 posts the largest claim count among the top three (24.5K claims) but a low avg paid/claim ($110), whereas 88341 posts fewer claims (13.2K) but a much higher avg paid/claim ($402), explaining how 88341 produces nearly as much revenue as 88312 despite fewer claims. These unit-price differences indicate that reimbursement per immunostain is a key determinant of revenue, not just specimen throughput.

The provider has an established presence, with NPI enumeration dated 2009-09-23 (~17 years ago), consistent with the scale and concentration of services observed. This tenure supports the interpretation that the patterns—high-volume staining services and leading state percentile ranks for several codes—reflect an institutional operational model rather than a transient billing anomaly.

The business profile implies both operational specialization and concentration risk: heavy reliance on Medicaid ($16.9M total) and the fact that 81.3% of Medicaid revenue comes from three codes (88312, 88341, 88305) means changes to state Medicaid policy, reimbursement for immunostains/special stains, or competitive shifts in those specific services could materially affect revenue. Analysts should therefore treat the provider as a high-volume, stain-centric pathology lab with meaningful state-market dominance in several immunohistochemistry and special-stain categories.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
88312	The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets…	21,610	$270	$5.8M
88341	The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified…	13,160	$400	$5.3M
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	24,460	$110	$2.7M
88313	The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,…	7,440	$150	$1.1M
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	13,740	$70	$975.7K
88307	The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	3,960	$190	$735.8K
88304	The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	4,670	$30	$135.5K
88309	The physician, typically a pathologist, performs a level VI examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	460	$280	$125.1K
88302	The physician, typically a pathologist, performs a level II examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1,340	$30	$45.7K
88311	The lab analyst performs a decalcification procedure on a specimen. Dissolving the calcium makes it easier to perform certain examinations.	620	$20	$12.9K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.

Claims Volume vs. Puerto Rico Distribution

Northwest Pathology Csp — 3 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	5	30	4,250	$80	$1.3M
88341	The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified…	1	10	1,420	$300	$1.2M
88307	The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6	20	1,210	$190	$535.5K
88312	The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets…	2	30	1,210	$150	$530.3K
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	2	20	2,030	$80	$485.9K
88313	The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,…	1	10	150	$130	$161K
88304	The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	5	20	2,660	$30	$123.8K
88309	The physician, typically a pathologist, performs a level VI examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	2	10	90	$310	$65.2K
88302	The physician, typically a pathologist, performs a level II examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6	10	960	$40	$64.9K
88108	The analyst prepares smears of cytopathology fluids, washings, or brushings, except for cervical or vaginal fluid, using a concentration technique and interprets his findings. Cytopathology is the…	12	10	430	$40	$30.4K

Showing 1–10 of 12

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pci Group LLC	PR	Interventional Cardiology Physician	$0	$9.6M
Centro Cardiovascular De Manati Iii Csp	PR	Cardiovascular Disease Physician	$0	$5.7M
Anestesia Del Norte P.s.c.	PR	Specialist	$0	$5M
Mogic Ob-gyn Psc	PR	Obstetrics & Gynecology Physician	$0	$4.9M
Dorado Health Inc	PR	General Acute Care Hospital	$0	$3.7M
Dentistas Asociados Del Norte	PR	General Practice Dentistry	$0	$3M
Crilomil Corp.	PR	Pediatric Dentistry	$0	$2.8M
Hospitalist Medical Services, Psc	PR	Anesthesiology Physician	$0	$2.7M
Atlantic Pathology	PR	Clinical Medical Laboratory	$0	$2.5M
Centro Imagenes Manati Yvf Psc	PR	Diagnostic Radiology Physician	$0	$2.3M

Northwest Pathology Csp — Billing Profile & Reimbursement Data

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Northwest Pathology Csp — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References