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NPI 1972908499 · Houston, TX · Primary Care Nurse Practitioner
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Tiffany Lopez is a primary care nurse practitioner provider located in Houston, Texas. This profile covers 7 Medicare and 1 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 | Individual |
| Organization | Tiffany Lopez |
| Address | 2323 Polk St Apt 307 |
| City | Houston |
| State | TX |
| ZIP | 77003 |
| Taxonomy | Primary Care Nurse Practitioner |
| NPI Enumerated | October 27, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.2M |
| Medicaid | $0 |
This provider’s commercial footprint is effectively single-payer: recorded lifetime Medicare revenue is $5.2M while lifetime Medicaid revenue is $0, indicating the practice’s billed activity on file is concentrated exclusively in Medicare. The provider’s NPI was enumerated on 2014-10-27 (~12 years ago), so this pattern reflects roughly a decade-plus of Medicare-facing billing activity rather than a new entrant profile.
Revenue is highly concentrated in a very small set of services: the precomputed top 3 Medicare codes account for 99.8% of total Medicare revenue, and a single code, Q4236, alone represents $5.2M or 99.4% of the provider’s Medicare revenue. This level of concentration means the provider’s financial profile is driven almost entirely by one supply/procedure line rather than a broad portfolio of E/M services.
The code mix signals a wound-care / skin-substitute orientation rather than general primary care: Q4236 (Carepatch, per square centimeter) dominates revenue, and complementary CPTs 15275 and 15271 (skin substitute coverage for face/scalp and trunk/limbs, respectively) appear among the top codes. Together these codes are consistent with an operation that bills primarily for skin substitute products and related wound-coverage procedures rather than routine office-based primary care.
Operational profile by claim volume and unit price is consistent with supply-heavy billing: Q4236 shows 5.2K claims with $1012 avg paid/claim, whereas the other high-ranking skin substitute and home-visit codes are much smaller (for example, 15275 is 85 claims at $107 avg paid/claim and 15271 is 58 claims at $101 avg paid/claim). This contrast indicates most Medicare dollars are driven by frequent, higher-dollar Q4236 supply units while other services contribute minimal revenue.
Competitive standing on Q4236 is notable within a narrow cohort: the provider ranks #8 of 79 nationally for Q4236 (91th percentile) yet the record labels the volume for this code as "typical, unremarkable volume for this code," suggesting the provider is a top-10 biller among a relatively small set of specialized suppliers but remains within the customary utilization range for that procedure. For 15275 the provider ranks #261 of 888 (70th percentile), reflecting an above-average but not dominant presence for that skin-substitute procedure.
The provider also bills some home/residence E/M services, indicating a hybrid service model: 99350 appears with 74 claims and $115 avg paid/claim and 99345 with 20 claims and $136 avg paid/claim, both described as "typical, unremarkable volume" at their national percentiles (99350 rank #3098 of 7304, 57th percentile; 99345 rank #1844 of 3167, 39th percentile). These codes suggest occasional home-based visits for complex cases alongside the dominant supply provisioning.
From a payer-analytic perspective, the combination of extreme Medicare concentration ($5.2M driven largely by Q4236) and no Medicaid revenue presents a single-payer exposure risk: any policy, coverage, or reimbursement changes affecting Q4236 or skin-substitute supplies could materially impact this provider’s Medicare revenue stream. Additionally, none of the top codes are flagged as extreme outliers in the supplied labels—most top codes are characterized as "typical, unremarkable volume" and the remaining percentiles (for example, 15271 at 40th, 99345 at 39th, 99497 at 53th, 99443 at 38th) place the provider mostly in mid-range national participation for those services.
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 |
|---|---|---|---|---|
| Q4236 | Carepatch, per square centimeter (add-on, list separately in addition to primary procedure) | 5,160 | $1,010 | $5.2M |
| 15275 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to… | 90 | $110 | $9.1K |
| 99350 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves high medical decision making or the provider spends at least 60… | 70 | $120 | $8.5K |
| 15271 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2. | 60 | $100 | $5.9K |
| 99345 | The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends at least 75… | 20 | $140 | $2.7K |
| 99497 | The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30… | 50 | $50 | $2.4K |
| 99443 | N/A | 20 | $70 | $1.6K |
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99343 | N/A | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99343 | N/A | 19 | 30 | 60 | $100 | $301.5K |
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