Loading...
NPI 1902141500 · Spokane, WA · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Providence Health & Services Washington is a clinical medical laboratory provider located in Spokane, Washington. This profile covers 99 Medicare and 104 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 | Providence Health & Services Washington |
| Address | 820 S Mcclellan St Ste Ll10 |
| City | Spokane |
| State | WA |
| ZIP | 99204 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | December 7, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $9.3M |
| Medicare | $1.6M |
PROVIDER is heavily Medicaid‑weighted: this entity reports $9.3M in total Medicaid revenue versus $1.6M in total Medicare revenue, indicating Medicaid is the dominant payer by scale for this NPI. Analysts should treat Medicaid billing patterns as the primary driver of overall revenue and capacity signals for this provider.
Medicare revenue is concentrated in a small set of routine and specimen codes: the top 3 Medicare codes account for 36.1% of this provider's total Medicare revenue, led by 36415 ($222.9K, 15.9%), 80053 ($142.7K, 10.2%), and 80061 ($138.6K, 9.9%). This concentration shows a substantial share of Medicare dollars comes from venipuncture and common chemistry panels rather than high‑margin molecular assays.
Medicaid revenue shows even greater concentration in infectious disease testing: the top 3 Medicaid codes account for 42.8% of total Medicaid revenue, led by 87636 ($1.7M, 20.3%), 87651 ($976.5K, 11.6%), and U0003 ($912.1K, 10.9%). These three codes alone represent a large portion of the Medicaid business and point to a Medicaid book driven by SARS‑CoV‑2 and respiratory pathogen molecular testing.
The code mix signals a dual operational model: large‑scale molecular infectious testing plus routine clinical lab services. High Medicaid volumes and revenue for 87636 (12.6K claims, $1.7M), 87651 (27.9K claims, $976.5K), U0003 (12.3K claims, $912.1K) and 87502 (8.4K claims, $751.9K) indicate substantial capacity for high‑throughput nucleic acid testing, while Medicare line items such as 80053, 80061, 85025 and 84443 reflect ongoing chronic‑care monitoring and core lab work.
Despite modest aggregate Medicare revenue ($1.6M), this provider shows nationally high testing volumes on many common lab codes: 36415 ranks #100 of 86467 providers nationally (100th percentile; notably above typical national volume) and multiple routine panels (e.g., 80053, 80061, 84443) sit at or near the 99th–100th national percentiles. That pattern suggests a nationally competitive testing footprint for routine services even if Medicare dollars are a smaller share of total revenue.
At the state level the provider is a dominant molecular testing presence: 87651 ranks #1 of 83 providers in‑state (100th percentile; extreme outlier) and 87502 ranks #1 of 99 providers in‑state (100th percentile; extreme outlier), with 87634 also #1 of 29 providers in‑state (100th percentile; extreme outlier). These in‑state #1 ranks mark the provider as a major, outsized source of Medicaid molecular testing for respiratory and streptococcal diagnostics in Washington.
Several codes are flagged as statistically exceptional in the supplied data and should be prioritized in competitive and utilization reviews: Medicare 36415 is described as "notably above typical national volume," while Medicaid 87651 and 87502 are labeled "extreme outlier" at the state level and 87636 and U0003 are large contributors to Medicaid revenue. Those statistical labels align with the raw claim counts and revenue shares and indicate areas where this provider’s activity materially departs from peer norms.
The NPI tenure is established: the provider was enumerated on 2012-12-07 (~14 years ago). Combined with large Medicaid molecular volumes and a broad set of routine panel codes, that tenure supports an interpretation of an established, centralized laboratory operation that handles both steady chronic‑care testing and episodic high‑volume infectious disease workflows.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
99 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. | 27,860 | $10 | $222.9K |
| 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. | 14,270 | $10 | $142.7K |
| 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. | 10,660 | $10 | $138.6K |
| 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… | 7,840 | $20 | $125.5K |
| 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… | 3,700 | $30 | $107.2K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 660 | $140 | $90.8K |
| 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… | 8,990 | $10 | $71.9K |
| 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).… | 7,000 | $10 | $63K |
| 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. | 1,300 | $40 | $52K |
| 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… | 940 | $50 | $47.2K |
Showing 1–10 of 99
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 99 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.
104 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 12,610 | $140 | $1.7M |
| 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. | 27,900 | $40 | $976.5K |
| 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… | 12,330 | $70 | $912.1K |
| 87502 | The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly… | 8,450 | $90 | $751.9K |
| 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… | 10,710 | $50 | $524.8K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 11,460 | $30 | $378K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 11,460 | $30 | $378K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 79,150 | $1 | $316.6K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 9,080 | $30 | $299.6K |
| 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… | 9,710 | $30 | $291.2K |
Showing 1–10 of 104
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
104 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 18 | 100 | 1,940 | $70 | $1M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 17 | 120 | 2,040 | $30 | $464.9K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 17 | 120 | 2,020 | $30 | $441.1K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 8 | 40 | 1,080 | $70 | $362.2K |
| 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… | 9 | 90 | 1,030 | $30 | $246.3K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 7 | 60 | 1,340 | $30 | $208.1K |
| 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. | 44 | 240 | 2,430 | $10 | $194.2K |
| 83013 | The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining. | 12 | 20 | 130 | $50 | $174.2K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 14 | 40 | 290 | $40 | $148.9K |
| 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… | 12 | 90 | 880 | $20 | $136.6K |
Showing 1–10 of 104
Other providers in the same ZIP code as Providence Health & Services Washington, 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.