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NPI 1861404121 · East Providence, RI · Clinical Medical Laboratory
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East Side Clinical Laboratory, Inc. is a clinical medical laboratory provider located in East Providence, Rhode Island. This profile covers 280 Medicare and 295 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 | East Side Clinical Laboratory, Inc. |
| Address | 10 Risho Ave |
| City | East Providence |
| State | RI |
| ZIP | 02914 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | August 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $48.6M |
| Medicare | $4.1M |
This entity is heavily Medicaid‑driven: reported total Medicaid revenue is $48.6M compared with total Medicare revenue of $4.1M, indicating Medicaid is the dominant payer in lifetime billing for this NPI. The scale of Medicaid activity suggests the provider operates largely as an in‑state lab services hub rather than a Medicare-focused provider.
The provider has long tenure on file, with NPI enumeration dated 2006-08-13 (~20 years ago), consistent with an established clinical laboratory operation that has accumulated sustained volume across multiple test types. This longevity supports interpretation of its high cumulative claim counts as an operating pattern rather than a short-term surge.
Medicare activity is concentrated in routine specimen collection and basic diagnostic panels: top Medicare codes include 36415 (49.2K claims, $393.3K revenue), 80061 (21.9K claims, $284.7K revenue), and 84443 (17K claims, $271.4K revenue), and the precomputed top‑3 Medicare codes account for 31.8% of the provider’s Medicare revenue. These code types—phlebotomy, lipid panels, and TSH testing—signal a business model built around high‑volume ambulatory specimen collection and common chemistry/endocrinology testing.
Medicaid revenue shows even higher concentration in a small set of high‑revenue services: U0003 ($5.7M, 17.0%), 80050 ($5.1M, 15.2%), and 80061 ($2.8M, 8.4%) are leading Medicaid codes, and the precomputed top‑3 Medicaid codes together represent 40.5% of Medicaid revenue. The presence of U0003 at $5.7M and 80.8K claims highlights a substantial COVID PCR testing line alongside broad general health panels and lipid testing as major revenue drivers.
Competitive standing differs by payer: on Medicare the provider appears as a national high‑volume outlier for several specimen and routine test codes (for example, 36415 ranks #72 of 86467 nationally — 100th percentile; extreme outlier — and 85025 ranks #91 of 32833 — 100th percentile; notably above typical national volume). On Medicaid the lab is frequently the top in‑state performer, with many codes ranking #1 in Rhode Island (for example, 80050 ranks #1 of 48 in‑state — 100th percentile; extreme outlier, and 80061 ranks #1 of 157 — 100th percentile; extreme outlier), indicating statewide dominance for a broad set of tests.
The provider displays numerous statistical outliers across both payers that point to specialized capacity beyond basic panels: Medicaid items such as U0005 (50.1K claims, $852.5K revenue; ranks #2 of 58 in‑state; 98th percentile; extreme outlier), 87637 (3.6K claims, $502.2K revenue; ranks #1 of 28 in‑state; 100th percentile; extreme outlier), and 86003 (7.5K claims, $668.6K revenue; ranks #1 of 7 in‑state; 100th percentile; notably above typical state volume) demonstrate molecular respiratory, multiplex and allergen testing capability. These higher‑paid, lower‑count codes imply reference‑level laboratory services complementing routine high‑frequency testing.
Revenue concentration creates operational sensitivity: with 31.8% of Medicare revenue and 40.5% of Medicaid revenue coming from the precomputed top‑3 codes, the provider’s financial performance is materially driven by a compact set of tests (phlebotomy and common chemistry/diagnostic panels on Medicare; PCR and panel codes on Medicaid). That concentration suggests potential exposure to reimbursement or demand shifts in those specific services but also highlights clear levers (e.g., volume or contracting on U0003 and 80050) for payer negotiations.
Across the dataset the lab demonstrates both scale and breadth: extraordinarily high claim counts for specimen collection and routine panels (for example, Medicaid 36415 at 303.8K claims, $1.2M revenue — ranks #1 of 237 in‑state; extreme outlier) coexist with substantial specialized testing lines (definitive drug testing G0480 at 16.9K claims, $743.7K revenue; ranks #2 of 28 in‑state; 96th percentile). For payers and network planners, this profile signals a provider that can service large volumes of community specimen collection and also absorb more complex molecular and confirmatory testing workstreams within-state.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
280 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. | 49,160 | $10 | $393.3K |
| 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. | 21,900 | $10 | $284.7K |
| 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… | 16,960 | $20 | $271.4K |
| 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… | 8,920 | $30 | $258.7K |
| 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… | 31,950 | $10 | $255.6K |
| 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. | 21,810 | $10 | $218.1K |
| G0471 | Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) | 18,990 | $10 | $189.9K |
| 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… | 19,720 | $10 | $157.8K |
| 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).… | 14,010 | $10 | $140.1K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 5,790 | $20 | $86.9K |
Showing 1–10 of 280
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 280 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
280 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| G0480 | 2 | 10 | 11,720 | $110 | $1.3M |
| 80307 | 2 | 10 | 30 | $60 | $268.7K |
| G0471 | 1 | 10 | 18,990 | $10 | $196.7K |
| P9603 | 1 | 10 | 82,210 | $1 | $79.3K |
| 84153 | 1 | 10 | 2,030 | $20 | $36.5K |
| 82306 | 1 | 10 | 110 | $30 | $27.3K |
| 87086 | 1 | 10 | 220 | $10 | $23.8K |
| 84443 | 1 | 20 | 130 | $20 | $21.8K |
| 87637 | 1 | 10 | 150 | $140 | $20.7K |
| 86480 | 1 | 10 | 330 | $60 | $20.2K |
Showing 1–10 of 280
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.
295 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… | 80,820 | $70 | $5.7M |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 105,820 | $50 | $5.1M |
| 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. | 198,950 | $10 | $2.8M |
| 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… | 87,170 | $30 | $2.4M |
| 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. | 35,550 | $40 | $1.6M |
| 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… | 237,970 | $10 | $1.4M |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 303,830 | $1 | $1.2M |
| 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. | 144,150 | $10 | $1.2M |
| 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… | 85,290 | $10 | $1.1M |
| 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).… | 136,920 | $10 | $1.1M |
Showing 1–10 of 295
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
295 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0481 | 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… | 5 | 10 | 310 | $100 | $4.2M |
| 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… | 2 | 30 | 260 | $60 | $3.4M |
| 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. | 4 | 50 | 330 | $50 | $2.7M |
| 84484 | The lab analyst performs the technical lab test typically using serum, plasma, or whole blood to quantitate troponin. Troponin is a protein labs commonly measure to verify a myocardial infarction and… | 7 | 20 | 1,500 | $110 | $327.5K |
| 83735 | The lab analyst performs a test to measure the amount of magnesium in a patient specimen. | 1 | 30 | 790 | $60 | $216.6K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 4 | 10 | 60 | $190 | $213.7K |
| 83690 | The lab analyst measures the amount of lipase enzyme in the patient specimen. Lipase is an enzyme that the pancreas secretes to help in the absorption of fat. | 2 | 20 | 710 | $80 | $204.1K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 3 | 10 | 340 | $170 | $202.7K |
| 83605 | The lab analyst measures the lactate, most often in a blood or plasma sample. Lactate, also known as lactic acid, is the end product of anaerobic carbohydrate metabolism produced primarily by muscle… | 9 | 10 | 580 | $150 | $189K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 1 | 50 | 50 | $50 | $168.1K |
Showing 1–10 of 295
Other providers in the same ZIP code as East Side Clinical Laboratory, Inc., ranked by combined Medicare and Medicaid revenue.
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