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NPI 1780830737 · Carolina, PR · Anatomic Pathology & Clinical Pathology Physician
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Coreplus Servicios Clinicos Y Patologicos LLC is a anatomic pathology & clinical pathology physician provider located in Carolina, Puerto Rico. This profile covers 37 Medicare and 92 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 | Coreplus Servicios Clinicos Y Patologicos LLC |
| Address | Avenida Sanchez Vilella Esq. Pr-190 |
| City | Carolina |
| State | PR |
| ZIP | 00983 |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| NPI Enumerated | August 11, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $13M |
| Medicare | $110.9K |
This provider is heavily Medicaid‑weighted: reported Medicaid revenue is $13M compared with Medicare revenue of $110.9K, so Medicaid clearly dominates the payer mix and drives the enterprise scale. Medicare receipts are small in absolute terms relative to Medicaid, indicating the practice functions primarily as a Medicaid-facing laboratory/provider.
Revenue concentration is material at the code level for both payers: the top three Medicare codes account for 47.8% of Medicare revenue, led by 88312 (24.7%), G0416 (12.8%), and 88305 (10.2%), which suggests Medicare dollars are concentrated in a handful of pathology and prostate biopsy services. On the Medicaid side the top three codes account for 44.0% of Medicaid revenue, with 88305 (19.6%), 88312 (13.3%), and 87624 (11.2%) together driving nearly half of reported Medicaid receipts.
The code mix indicates a core anatomic/clinical pathology operation with high-volume infectious-disease molecular testing: major pathology codes such as 88305 and 88312 appear prominently alongside large volumes of HPV and STI testing (87624, 87591, 87491) and SARS‑CoV‑2 testing (87635, U0002, 87426). Medicaid claim counts underline this hybrid model — for example, 87624 has 36.6K claims and 88142 has 41.5K claims — consistent with a lab that combines surgical/cytology pathology with high-throughput molecular assays and specimen collection.
Within the Medicaid market the provider is a major in‑state contender for several infectious and cytology services: 87635 ranks #2 in-state at the 100th percentile and is labeled an "extreme outlier," 87591 and 87491 are at the 99th percentile and also flagged as "extreme outlier," and the provider is #1 in-state for codes like 87529, 88112, and 88108. Those state-level rankings indicate the provider has unusually large Medicaid volumes for specific infectious-disease and cytopathology assays compared with in-state peers, which is relevant for contracting or regional capacity analyses.
Medicare competitive standing is mixed: the provider posts high national percentiles on several technical pathology and test-preparation codes (88312 at the 90th percentile, 88304 at the 96th, 87635 at the 96th, and 88311 at the 97th), but other Medicare ranks are modest (88305 at the 26th percentile). Taken together with the modest absolute Medicare revenue ($110.9K), this profile suggests the practice is a visible but not dominant national Medicare participant focused on specific technical services rather than broad Medicare service volume.
Operational throughput for specimen processing and collection is a clear capability: Medicaid shows 41.5K claims for 88142 ($829.4K) and 15.7K claims for G2023 ($329.1K), plus 20.9K claims for 85025 ($125.2K). These figures imply sustained, high-volume cytology and specimen-collection activity under Medicaid, reinforcing the lab-style business model rather than a low-volume pathology consult practice.
Several Medicaid codes carry explicit statistical flags that should prompt deeper examination of capacity and service mix rather than implying impropriety: multiple tests are described as "extreme outlier" or "notably above typical" in-state (for example, 87635 at 100th percentile "extreme outlier," U0002 at 99th percentile "extreme outlier," and 86328 at 99th percentile "extreme outlier"). These labels indicate the provider's in-state volumes for certain infectious and COVID‑related assays are far above typical peers and merit operational review for lab capacity, supply chain, and payer contracting impact.
The provider is an established entity with an NPI enumerated on 2008-08-11 (~18 years ago), suggesting longevity and potential integration into regional lab referral networks. Given the long tenure plus very large Medicaid volumes, analysts should consider the provider a stable, high-volume Medicaid laboratory/cytology pathology operation when assessing competitive positioning, network coverage, or contracting opportunities.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
37 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… | 300 | $90 | $26.4K |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 50 | $270 | $13.7K |
| 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… | 200 | $60 | $10.9K |
| 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… | 300 | $30 | $9.8K |
| 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… | 190 | $50 | $9.4K |
| 88311 | The lab analyst performs a decalcification procedure on a specimen. Dissolving the calcium makes it easier to perform certain examinations. | 280 | $20 | $4.5K |
| 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… | 80 | $50 | $4.2K |
| 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… | 50 | $70 | $3.8K |
| 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,… | 30 | $130 | $3.6K |
| 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… | 70 | $30 | $2.2K |
Showing 1–10 of 37
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 37 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.
92 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… | 17,240 | $140 | $2.4M |
| 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… | 13,110 | $120 | $1.6M |
| 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. | 36,640 | $40 | $1.4M |
| 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… | 23,810 | $50 | $1.1M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 25,630 | $30 | $845.7K |
| 88142 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 41,470 | $20 | $829.4K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 25,780 | $30 | $825K |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | 7,740 | $50 | $371.6K |
| 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,… | 9,950 | $30 | $338.2K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 15,670 | $20 | $329.1K |
Showing 1–10 of 92
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
92 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… | 8 | 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… | 9 | 10 | 1,420 | $300 | $1.2M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 6 | 10 | 4,190 | $30 | $655.7K |
| 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. | 4 | 30 | 910 | $40 | $638.8K |
| 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… | 3 | 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,… | 10 | 20 | 2,030 | $80 | $485.9K |
| 88142 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 4 | 50 | 370 | $20 | $247.3K |
| 88173 | The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate and then interprets and reports the results. | 8 | 10 | 1,220 | $120 | $238.7K |
| 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,… | 4 | 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… | 6 | 20 | 2,660 | $30 | $123.8K |
Showing 1–10 of 92
Other providers in the same ZIP code as Coreplus Servicios Clinicos Y Patologicos LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Jose Lozada | PR | Gynecology Physician | $1.2K | $777.8K |
| Monserrate Imaging Center Psc | PR | Body Imaging Physician | $0 | $753.9K |
| Luis Ortiz-espinosa | PR | Dermatology Physician | $183.3K | $0 |
| Elena Nogales Perez | PR | Dermatology Physician | $15.7K | $93.7K |
| Walgreen Co | PR | Pharmacy | $99.2K | $0 |
| Lynette Rios Rodriguez | PR | Physical Therapist | $29.9K | $46.8K |
| Ricardo Jaen | PR | Podiatrist | $11.6K | $25.7K |
| Walgreen Co | PR | Pharmacy | $34.4K | $0 |
| Signet Puerto Rico | PR | Nuclear Medicine Physician | $18K | $10.7K |
| Cesar Gomez | PR | Physical Medicine & Rehabilitation Physician | $27K | $0 |
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