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NPI 1770020018 · Holyoke, MA · Clinical Medical Laboratory
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Total Wellness Centers, LLC is a clinical medical laboratory provider located in Holyoke, Massachusetts. This profile covers 7 Medicare and 20 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 | Total Wellness Centers, LLC |
| Address | 59 Bobala Rd |
| City | Holyoke |
| State | MA |
| ZIP | 01040 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 25, 2017 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $77.2M |
| Medicare | $1.9M |
TOTAL WELLNESS CENTERS, LLC operates as a clinical medical laboratory with a clear operational focus on toxicology testing: the Medicare and Medicaid top revenue drivers are 80307 (presumptive drug testing) and G0480 (definitive drug testing), together accounting for the lion’s share of billings on both payers. On Medicare 80307 generated $1.3M (70.0% of Medicare revenue) from 21.5K claims and G0480 generated $534.5K (28.6% of Medicare revenue) from 4.8K claims; on Medicaid 80307 produced $59.9M (78.5% of Medicaid revenue) from 1.4M claims and G0480 produced $13.7M (17.9% of Medicaid revenue) from 279.2K claims. This code mix is characteristic of a high-volume toxicology testing operation rather than a general diagnostic lab.
Revenue is highly concentrated in a very small set of codes on both payers: the precomputed top-3 Medicare codes account for 99.2% of this provider's total Medicare revenue, and the precomputed top-3 Medicaid codes account for 97.4% of this provider's total Medicaid revenue. That level of concentration indicates the business is effectively centered on a narrow group of services (primarily drug testing) and that revenue exposure is heavily dependent on continued payment and referral volume for those specific codes.
The provider is effectively Medicaid-dominant in scale: lifetime Medicaid revenue is $77.2M compared with total Medicare revenue of $1.9M. This disparity shows the organization’s financial footprint and referral network are overwhelmingly driven by Medicaid volume rather than Medicare.
TOTAL WELLNESS is a clear outlier on its top toxicology codes. For Medicare, 80307 ranks #6 of 4760 providers nationally (100th percentile; extreme outlier, far above typical national volume for this code) and G0480 ranks #28 of 1590 providers nationally (98th percentile; notably above typical national volume for this code). In-state for Medicaid, 80307 ranks #1 of 372 providers (100th percentile; extreme outlier, far above typical state volume for this code) and G0480 ranks #3 of 202 providers (99th percentile; extreme outlier, far above typical state volume for this code), signaling dominant market share for toxicology testing within Massachusetts.
Beyond toxicology, the provider bills a substantial volume of infectious disease screening codes on Medicaid — 87389 (HIV) appears with 42.5K claims and $679.5K revenue, 86803 (Hepatitis C antibody) with 42.7K claims and $427K revenue, and 87340 (HBsAg) with 43.6K claims and $305K revenue. These figures indicate routine, high-volume infectious disease screening is bundled into the organization’s service mix, consistent with a collection/diagnostic center that performs both drug testing and standard public-health laboratory screens.
Medicaid billing also includes non-lab evaluation-and-management activity that suggests patient-facing clinical services or specimen-collection tied to primary care workflows: 99214 has 7.6K claims and $762.8K revenue and 99213 has 5.5K claims and $391K revenue. The presence of E/M codes alongside lab codes implies the operation may run or contract clinic visits, point-of-care collection, or integrated services rather than only billing as a remote reference laboratory.
Several mid-volume codes are described as having typical or unremarkable volumes despite elevated claim counts, which supports a specialization rather than anomalous billing across unrelated services. Examples labeled as typical include Medicare 87389 and 86803 (each described as typical, unremarkable volume nationally) and multiple Medicaid codes (e.g., 87389, 86803) that rank highly in-state but are characterized in the source as typical for those services; this pattern suggests the provider’s exceptional standing is concentrated specifically in drug-testing codes rather than across all laboratory services.
The provider has been enumerated since 2017-01-25 (~9 years ago), and within that tenure it has built a large Medicaid toxicology footprint. Given the combination of long-tenure enumeration, extreme high-volume ranking on 80307 and G0480, and concentrated revenue reliance on those codes, analysts should view this entity as a specialized, high-volume toxicology and specimen-collection operator with near-term revenue sensitivity tied to policy or reimbursement changes affecting those specific codes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 21,460 | $60 | $1.3M |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 4,770 | $110 | $534.5K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 540 | $20 | $12.9K |
| 86803 | Qualitative or Semiquantitative Immunoassays; Hepatitis C antibody | 550 | $10 | $7.8K |
| 87340 | The lab analyst performs a test to detect hepatitis B surface antigen, also called HBsAg, using an immunoassay technique, such as EIA. | 580 | $10 | $5.8K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 40 | $10 | $290 |
| 80076 | The lab analyst performs a hepatic function panel test in which he measures the blood levels of total protein, albumin, alkaline phosphatase, bilirubin, both total and direct, and liver enzymes. | 40 | $10 | $290 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 CPT/HCPCS codes.
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.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 1,427,320 | $40 | $59.9M |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 279,180 | $50 | $13.7M |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 7,630 | $100 | $762.8K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 42,470 | $20 | $679.5K |
| 86803 | Qualitative or Semiquantitative Immunoassays; Hepatitis C antibody | 42,700 | $10 | $427K |
| 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… | 5,510 | $70 | $391K |
| 87340 | The lab analyst performs a test to detect hepatitis B surface antigen, also called HBsAg, using an immunoassay technique, such as EIA. | 43,570 | $10 | $305K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 920 | $50 | $48K |
| 80076 | The lab analyst performs a hepatic function panel test in which he measures the blood levels of total protein, albumin, alkaline phosphatase, bilirubin, both total and direct, and liver enzymes. | 15,490 | $1 | $46.5K |
| ATP07 | N/A | 6,270 | $10 | $31.3K |
Showing 1–10 of 20
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
20 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 1 | 370 | 500 | $40 | $605.1K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 1,612 | 1,620 | 580 | $80 | $599.6K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 3 | 200 | 450 | $30 | $511.5K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 263 | 5,040 | 200 | $70 | $209.5K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 7 | 110 | 590 | $10 | $207.5K |
| 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… | 432 | 5,300 | 230 | $60 | $164.5K |
| 90791 | In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. | 338 | 600 | 90 | $110 | $106.8K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 196 | 570 | 400 | $40 | $106.7K |
| 99204 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider… | 747 | 870 | 90 | $100 | $82K |
| 86803 | Qualitative or Semiquantitative Immunoassays; Hepatitis C antibody | 6 | 170 | 210 | $10 | $67.5K |
Showing 1–10 of 20
Other providers in the same ZIP code as Total Wellness Centers, LLC, ranked by combined Medicare and Medicaid revenue.
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