Loading...
NPI 1841242542 · Sioux Falls, SD · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Sanford Medical Center is a clinical medical laboratory provider located in Sioux Falls, South Dakota. This profile covers 277 Medicare and 225 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 | Sanford Medical Center |
| Address | 2301 E 60th St N |
| City | Sioux Falls |
| State | SD |
| ZIP | 57104 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $18M |
| Medicare | $1.8M |
SANFORD MEDICAL CENTER is categorized as a Clinical Medical Laboratory and the payer code mix confirms a dual role: routine clinical diagnostics for Medicare and very high-volume infectious disease/molecular testing for Medicaid. On the Medicare side the largest volume codes are routine lab and phlebotomy services (examples: 36415, 80053, 80061), while Medicaid revenue is heavily driven by molecular infectious-agent testing including U0003 and multiple nucleic-acid amplification panels. This distribution indicates a stable core clinical lab operation supplemented by a large-scale infectious disease testing program.
Medicaid dominates this provider’s billing: total Medicaid revenue is $18M versus total Medicare revenue of $1.8M, making Medicaid the overwhelmingly larger payer by scale. The Medicaid dataset shows exceptionally high claim counts and revenues for pandemic-era and multiplex molecular tests (for example U0003: 36.5K claims, $2.8M revenue; 87651: 29.6K claims, $1M revenue), which explains much of the payer skew.
Revenue concentration is material for both payers: the top 3 Medicare codes account for 32.5% of Medicare revenue while the top 3 Medicaid codes account for 35.2% of Medicaid revenue, indicating a modest number of procedures drive a large share of dollars for each payer. For Medicare those high-volume contributing codes include 36415, 80053, and 80061; for Medicaid the top contributors include U0003, 87651, and 87591, underscoring reliance on a small set of high-throughput tests.
SANFORD’s Medicaid competitive standing within South Dakota is dominant across many tests: the provider ranks #1 in-state for U0003 (36.5K claims, $2.8M revenue), 87651 (29.6K claims, $1M revenue), 87591 (24.2K claims, $774K revenue), 87491 (24.2K claims, $773K revenue) and numerous other codes, with many listed as “extreme outlier, far above typical state volume for this code.” These #1 in-state rankings and extreme outlier labels indicate SANFORD is a primary statewide hub for high-throughput infectious and respiratory testing.
Nationally for Medicare services SANFORD shows above-typical volume on several common lab procedures: 36415 ranks #123 of 86467 providers nationally (100th percentile; notably above typical national volume for this code) and multiple routine analytes (80053, 80061, 85025, 84443, 82306) sit in the 97th–100th percentile nationally. That combination of elevated national percentiles for standard lab codes suggests SANFORD operates at a scale larger than many peers for routine clinical testing, not only for state-level molecular work.
The Medicaid revenue mix includes high-paid proprietary and multiplex tests that materially contribute to dollars: 0241U accounts for $739.4K revenue (6K claims at $124 avg paid/claim), 0202U accounts for $545.4K revenue ($383 avg paid/claim), 87507 accounts for $533.7K revenue ($389 avg paid/claim) and 0240U accounts for $475.7K revenue. These PLA and multiplex panels indicate the lab performs complex, higher-price testing in addition to high-volume PCR work, diversifying revenue by test complexity and reimbursement level.
SANFORD’s NPI tenure is long-standing, enumerated 2006-05-17 (~20 years ago), which is consistent with an established laboratory infrastructure capable of supporting both high-volume routine clinical services and scaled molecular testing lines. That duration of operation aligns with the breadth of Medicare clinical codes and the depth of Medicaid molecular volumes reported.
Operational and payer-concentration implications: a large share of Medicaid revenue is tied to pandemic and respiratory testing (U0003 alone is 21.3% of Medicaid revenue) and the top 3 Medicaid codes make up 35.2% of Medicaid dollars, creating sensitivity to shifts in testing demand, public-health cycles, and state reimbursement policies. At the same time the Medicare book is more concentrated in routine lab services (top 3 Medicare codes = 32.5%), so changes in outpatient clinical volume or referral patterns could affect the Medicare stream differently than the Medicaid molecular business.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
277 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 21,390 | $10 | $171.1K |
| 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. | 11,600 | $10 | $116K |
| 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. | 8,790 | $10 | $114.2K |
| 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… | 12,160 | $10 | $97.2K |
| 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… | 5,560 | $20 | $88.9K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 1,850 | $40 | $73.9K |
| 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… | 2,490 | $30 | $72.1K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 6,860 | $10 | $54.8K |
| 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).… | 4,970 | $10 | $49.7K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 4,760 | $10 | $38K |
Showing 1–10 of 277
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 277 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.
225 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 36,530 | $80 | $2.8M |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 29,620 | $40 | $1M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 24,190 | $30 | $774K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 24,160 | $30 | $773K |
| 0241U | N/A | 5,960 | $120 | $739.4K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 115,810 | $10 | $579K |
| 0202U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the… | 1,420 | $380 | $545.4K |
| 87507 | The lab analyst performs a test to detect 12 to 25 types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that affects the gastrointestinal… | 1,370 | $390 | $533.7K |
| 86003 | The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or… | 7,350 | $70 | $506.8K |
| 0240U | N/A | 4,900 | $100 | $475.7K |
Showing 1–10 of 225
How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Dakota median
225 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87507 | The lab analyst performs a test to detect 12 to 25 types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that affects the gastrointestinal… | 1 | 10 | 1,370 | $390 | $533.7K |
| 86003 | The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or… | 1 | 10 | 7,350 | $70 | $507.4K |
| 0202U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the… | 2 | 10 | 170 | $360 | $236.6K |
| 87150 | The lab analyst performs an analysis using amplified DNA or RNA probe technique on a previously isolated and identified organism to categorize the organism more specifically, such as to the taxonomic… | 1 | 10 | 5,450 | $40 | $197.6K |
| 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… | 1 | 30 | 270 | $70 | $138.6K |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 2 | 10 | 230 | $270 | $100K |
| 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. | 1 | 10 | 1,000 | $30 | $83.4K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 1 | 110 | 990 | $20 | $82.9K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 1 | 10 | 420 | $50 | $80.4K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1 | 20 | 520 | $30 | $79.8K |
Showing 1–10 of 225
Other providers in the same ZIP code as Sanford Medical Center, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.