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NPI 1053562959 · Waukesha, WI · Ambulatory Surgical Clinic/Center
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Prohealth Aligned LLC is a ambulatory surgical clinic/center provider located in Waukesha, Wisconsin. This profile covers 16 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 | Organization |
| Organization | Prohealth Aligned LLC |
| Address | 1111 Delafield St Ste 100 |
| City | Waukesha |
| State | WI |
| ZIP | 53188 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 9, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $802.9K |
| Medicaid | $0 |
PROHEALTH ALIGNED LLC is operating as an ambulatory surgical clinic/center with a clear ophthalmic focus: its top Medicare codes are cataract and anterior-segment ophthalmology procedures and related ophthalmic irrigation, led by 66984 (405 claims, $846 avg paid/claim) and J1097 (1.8K claims, $76 avg paid/claim). The mix of high-volume cataract extraction (66984) and a large volume of ophthalmic irrigation product billing (J1097) indicates the site is structured around cataract surgical throughput and associated supply usage rather than broad multispecialty inpatient care.
Revenue concentration is high: the provider reports Total Medicare revenue of $802.9K and the precomputed top-3 Medicare codes account for 67.3% of that Medicare revenue, with 66984 alone representing 42.7% and J1097 17.4%. This concentration signals dependence on a narrow set of ophthalmic services for the majority of Medicare receipts.
Payer mix is effectively single-payer Medicare: the record shows Total Medicaid revenue of $0, meaning all documented public-payer volume in the dataset is Medicare. This makes the provider’s financial exposure and competitive profile tightly coupled to Medicare reimbursement and patient access patterns.
Competitive standing is mixed across codes: for primary revenue driver 66984 the provider ranks #3334 of 15965 nationally (79th percentile) which is a solid but described-as-typical national volume for cataract extraction; by contrast the intraocular-lens-plus-drainage code 66991 ranks #964 of 1445 (30th percentile), indicating relatively low national activity for that more complex procedure. Notably, code 15822 (upper eyelid skin excision) ranks #2 of 31 providers nationally (97th percentile) and is flagged as notably above typical national volume, suggesting a local specialization in eyelid surgical work on top of cataract services.
Operational details in the code mix point to a procedure-driven ambulatory surgery model: presence of numerous ophthalmic surgery codes (66984, 66982, 66991) alongside high-volume drug/device irrigation billing (J1097) and eyelid/blepharoplasty codes (15822, 67900, 67908) is consistent with a freestanding eye surgery center that also performs anterior-segment and cosmetic eyelid procedures. Less frequent listings of ENT, hernia, urology, and endovenous codes show some ancillary or contracted services but do not materially drive revenue.
Several statistical outliers and low-percentile codes are present and should guide analyst follow-up: 15822 is a positive outlier (97th percentile; notably above typical national volume for this code) indicating unusually high eyelid surgery volume, while codes such as 52224 (rank #326 of 377, 4th percentile) and 76872 (rank #4302 of 4483, 0th percentile) sit at the low end of national distributions and reflect minimal activity in those areas. The record also includes code 55700 with a note that the code was deleted December 31, 2025, which may affect historical-to-current comparability.
Tenure is long enough to suggest established operations: the NPI was enumerated on 2008-10-09 (~18 years ago), so this clinic has been on file for nearly two decades, supporting the interpretation that its cataract-focused service line is a mature part of the local market. This longevity combined with concentrated Medicare receipts suggests stability but also a narrow revenue base sensitive to shifts in ophthalmic reimbursement or referral patterns.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
16 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 410 | $850 | $342.6K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 1,840 | $80 | $139.6K |
| 66991 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction. The provider also inserts one or more anterior segment aqueous drainage devices in… | 20 | $2,530 | $58.1K |
| 15822 | In this procedure, the provider surgically trims excess skin from below the upper eyelid, typically to improve the cosmetic appearance of the face. | 100 | $440 | $45.1K |
| 66982 | The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing… | 40 | $850 | $36.6K |
| 31267 | In this procedure, the provider inserts an endoscope into the nasal cavity. She then gains access to the maxillary sinus through a cut in the uncinate process. The provider opens the maxillary sinus… | 20 | $1,280 | $29.4K |
| 55700 | Code deleted December 31, 2025. | 40 | $640 | $28.2K |
| 49650 | The provider performs laparoscopic repair of an initial inguinal hernia. | 20 | $1,750 | $28K |
| 31254 | Partial surgical anterior ethmoidectomy involves the removal of the uncinate process (infundibulotomy), opening of the bulla, and partial removal of the anterior ethmoid cells. | 20 | $1,000 | $23.9K |
| 36475 | In this procedure, the provider inserts a specially designed radiofrequency probe through the skin and destroys the wall of a diseased vein in an extremity. The provider reports this code for… | 20 | $980 | $15.6K |
Showing 1–10 of 16
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
16 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1097 | 3 | 10 | 1,030 | $80 | $88.9K |
| 66984 | 153 | 310 | 350 | $50 | $66.4K |
| 66991 | 20 | 30 | 30 | $1,270 | $53.3K |
| 15822 | 1 | 10 | 100 | $440 | $45.2K |
| 31254 | 1 | 10 | 20 | $1,000 | $23.9K |
| 36475 | 5 | 10 | 20 | $640 | $22.3K |
| 66982 | 21 | 80 | 20 | $490 | $21.7K |
| 31267 | 2 | 10 | 20 | $990 | $19.8K |
| 67908 | 2 | 10 | 20 | $550 | $11K |
| 67900 | 8 | 20 | 20 | $380 | $10.9K |
Showing 1–10 of 16
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 |
|---|---|---|---|---|
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer… | 290 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer… | 14 | 40 | 130 | $0 | $0 |
Other providers in the same ZIP code as Prohealth Aligned LLC, ranked by combined Medicare and Medicaid revenue.
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