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NPI 1649271354 · Silver Spring, MD · Dermatology Physician
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Derm Associates LLC is a dermatology physician provider located in Silver Spring, Maryland. This profile covers 10 Medicare and 4 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 | Derm Associates LLC |
| Address | 10313 Georgia Ave |
| City | Silver Spring |
| State | MD |
| ZIP | 20902 |
| Taxonomy | Dermatology Physician |
| NPI Enumerated | August 3, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.1M |
| Medicaid | $11K |
This provider's billing is overwhelmingly Medicare-driven: the profile shows $5.1M in total Medicare revenue versus only $11K in total Medicaid revenue, making Medicare the de facto primary payer by scale. Medicaid revenue is effectively negligible relative to Medicare, so any financial analysis or contracting review should treat this entity as Medicare-dominant rather than a balanced dual-payer practice.
Medicare revenue is highly concentrated in a small set of lab/pathology and testing codes: the top three Medicare codes (88305, K1034, 88342) account for 91.3% of total Medicare revenue. Specifically, 88305 accounts for $2.3M (45.6%), K1034 for $2M (39.6%), and 88342 for $313.6K (6.1%), indicating that a handful of services drive nearly all Medicare dollars.
The specific code mix (high-volume 88305 surgical pathology, immunohistochemistry codes such as 88342/88341, and mass COVID test provisioning via K1034) points to a strong laboratory/dermatopathology orientation to this provider's operations despite its Dermatology Physician taxonomy. In other words, billing activity resembles a lab-focused practice or dermatopathology service line more than purely office-based dermatologic care, and the large K1034 volume signals substantial COVID test provisioning or distribution activity during the measurement window.
Several Medicare pathology codes place this provider well above typical national volumes: 88305 is an extreme outlier nationally (ranks #25 of 14580, 100th percentile; extreme outlier), 88342 also ranks near the top nationally (ranks #51 of 11370, 100th percentile; extreme outlier), and K1034 ranks #134 of 30143 (100th percentile; notably above typical national volume). These rankings characterize the provider as a nationally dominant biller for specific pathology and testing services rather than a typical local-volume dermatologist.
Medicaid billing is concentrated in routine outpatient evaluation-and-management visits: the top three Medicaid codes (99202, 99213, 99203) together account for 96.1% of the provider's $11K in Medicaid revenue. The Medicaid mix (183 claims for 99202 producing $5.7K, 127 claims for 99213 producing $2.7K, and 51 claims for 99203 producing $2.1K) looks like conventional office visit activity, but at very low absolute Medicaid dollars.
State-level competitive standing for Medicaid is modest to below-average for office visits: 99202 ranks #76 of 192 in-state (61th percentile; typical, unremarkable volume), while 99213 and 99203 are lower in-state (ranks #2410 of 3275, 26th percentile; and #469 of 730, 36th percentile, respectively), indicating this provider is not a major Medicaid E/M participant in Maryland. The Medicaid 88305 activity is also small relative to in-state peers (140 claims, $420 revenue; ranks #91 of 123, 26th percentile; typical), reinforcing the view that Medicaid is a minor channel here.
The concentration of high Medicare pathology and testing revenue alongside minimal Medicaid receipts has implications for contracting and network value: the provider will represent outsized Medicare lab/testing volume (important for Medicare lab-network negotiations), but offers limited Medicaid panel access or E/M volume for payers seeking Medicaid network capacity. Payers should therefore evaluate lab/testing reimbursement and program-level controls for the specific high-volume CPT/HCPCS codes rather than relying on this entity to expand Medicaid office-visit capacity.
This NPI has long tenure: it was enumerated on 2005-08-03 (~21 years ago), indicating an established billing history. The long-enumeration period combined with the extreme national ranks on several pathology/testing codes suggests entrenched operational patterns (laboratory/dermatopathology and high-volume COVID test activity) rather than a short-term spike in billing behavior.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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… | 39,150 | $60 | $2.3M |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 169,860 | $10 | $2M |
| 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,… | 3,450 | $90 | $313.6K |
| 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… | 2,530 | $80 | $202.4K |
| 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… | 1,610 | $100 | $164.4K |
| 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… | 1,280 | $40 | $47.2K |
| 88344 | The lab analyst applies a single multiplex antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 140 | $160 | $21.1K |
| 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,… | 160 | $80 | $12.6K |
| 88323 | A qualified provider, typically a pathologist, provides consultation and a report on referred material, such as a tissue block, and prepares and stains slides. A unit of service is the surgical case… | 10 | $100 | $1.4K |
| 88321 | A qualified provider, typically a pathologist, provides consultation and a report on slides prepared elsewhere. A unit of service is the surgical case regardless of the number of slides received. | 20 | $70 | $1.3K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 180 | $30 | $5.7K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 130 | $20 | $2.7K |
| 99203 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider… | 50 | $40 | $2.1K |
| 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… | 140 | $1 | $420 |
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 2,410 | 3,280 | 610 | $80 | $296.1K |
| 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… | 91 | 120 | 850 | $60 | $186.4K |
| 99203 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider… | 469 | 730 | 110 | $70 | $81.9K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 76 | 190 | 80 | $50 | $31.4K |
Other providers in the same ZIP code as Derm Associates LLC, ranked by combined Medicare and Medicaid revenue.
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