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NPI 1093352908 · Louisville, KY · Ambulatory Surgical Clinic/Center
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Baptist Healthcare System, Inc. is a ambulatory surgical clinic/center provider located in Louisville, Kentucky. This profile covers 28 Medicare and 12 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 | Baptist Healthcare System, Inc. |
| Address | 2400 Eastpoint Pkwy |
| City | Louisville |
| State | KY |
| ZIP | 40223 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | December 10, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.2M |
| Medicaid | $183.5K |
BAPTIST HEALTHCARE SYSTEM, INC. is categorized as an Ambulatory Surgical Clinic/Center and the billed procedure mix confirms two primary service lines: interventional spine/pain interventions (multiple fluoroscopic/CT-guided facet and epidural procedures such as 64635, 64493, 64483, G0260, 62323) and gastrointestinal endoscopy (codes such as 45385, 45380, 43239). The presence of both high-volume image-guided spine injections/ablations and colonoscopy/EGD biopsy codes indicates the facility operates procedure suites with imaging/fluoroscopy capability alongside endoscopy capacity.
Medicare revenue is concentrated in a small set of services: the precomputed top three Medicare codes account for 41.4% of the provider's total Medicare revenue, led by 64635 ($212.6K, 17.3%), 64493 ($174.1K, 14.2%), and 45385 ($122.2K, 10.0%). This concentration signals that a few high-yield procedures are driving a large share of the $1.2M in Medicare revenue on file.
Medicaid billing is extremely concentrated: the precomputed top three Medicaid codes account for 98.5% of this provider's total Medicaid revenue, driven primarily by 43239 ($117K, 63.8%) and 45380 ($57.4K, 31.3%), with 45385 contributing $6.3K (3.4%). With total Medicaid revenue of $183.5K, nearly all Medicaid dollars are tied to endoscopy/EGD biopsy and colonoscopy services rather than the interventional spine mix.
The provider's payer scale is Medicare-dominant: reported Medicare revenue is $1.2M versus Medicaid revenue of $183.5K, so Medicare represents the clear bulk of billed dollars. Analysts should treat this entity as primarily Medicare-driven for revenue and utilization trends while recognizing a secondary, tightly focused Medicaid endoscopy business.
Competitive standing on Medicare shows extreme national concentration for some pain codes: 64635 ranks #26 of 5957 providers (100th percentile; extreme outlier) and 64493 ranks #18 of 7519 providers (100th percentile; extreme outlier), while 45385 ranks #705 of 16310 (96th percentile; notably above typical national volume). In plain terms, the practice is a national outlier for select image-guided spine procedures and a high-volume, above-typical provider for several endoscopy codes, indicating relative market strength in those Medicare service lines.
By contrast, Medicaid ranking is modest within state peers: 43239 ranks #118 of 174 in-state (32th percentile; typical, unremarkable volume), 45380 ranks #62 of 122 (50th percentile; typical), and 45385 ranks #86 of 105 (17th percentile; typical). These ranks indicate the provider is not a dominant Medicaid outpatient endoscopy center statewide but rather a mid- to lower-tier participant for the same GI services it bills to Medicaid.
The mix of high-volume, image-guided spine procedures alongside substantial EGD/colonoscopy volumes implies specific operational infrastructure — dedicated fluoroscopy or CT guidance capability and staffed endoscopy suites — which can inform contracting and network placement decisions. Given the reliance on these procedural capabilities, shifts in reimbursement or utilization policy for codes like 64635, 64493, 45385, and 43239 could meaningfully affect revenue flow.
The NPI was enumerated 2019-12-10 (~7 years ago), so the provider has a relatively recent enrollment history but a multi-year claims footprint. Combined with the concentrated revenue profile, this tenure suggests a focused, established ambulatory operation that analysts should monitor for stability of the two dominant service lines rather than broad diversification across many CPTs.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
28 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 430 | $490 | $212.6K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 710 | $250 | $174.1K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 290 | $420 | $122.2K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 370 | $320 | $120.1K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 420 | $280 | $115.1K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 360 | $220 | $79.8K |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | 270 | $200 | $55.9K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 20 | $3,570 | $53.6K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 210 | $240 | $50.7K |
| 64633 | In this procedure, the provider destroys the facet joint nerve of a cervical or thoracic spinal segment using neurolytic agents like heat, electric current, or a chemical compound. He makes use of… | 90 | $490 | $42.3K |
Showing 1–10 of 28
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 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.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 670 | $180 | $117K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 280 | $200 | $57.4K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 30 | $220 | $6.3K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 20 | $140 | $2.7K |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 60 | $0 | $0 |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 360 | $0 | $0 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 20 | $0 | $0 |
| J1596 | Injection, glycopyrrolate, 0.1 mg | 20 | $0 | $0 |
| J2003 | Injection, lidocaine hydrochloride, 1 mg | 60 | $0 | $0 |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 90 | $0 | $0 |
Showing 1–10 of 12
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
12 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 118 | 170 | 1,300 | $230 | $441K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 62 | 120 | 300 | $320 | $215.2K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 86 | 110 | 230 | $340 | $175.7K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 19 | 20 | 120 | $120 | $136.4K |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 66 | 70 | 6,060 | $10 | $67.7K |
| J2704 | Injection, propofol, 10 mg | 69 | 80 | 2,120 | $10 | $54.7K |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 79 | 80 | 3,330 | $1 | $27.6K |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 77 | 90 | 1,950 | $1 | $14.3K |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 428 | 470 | 310 | $1 | $5.6K |
| J1596 | Injection, glycopyrrolate, 0.1 mg | 28 | 30 | 290 | $10 | $2.1K |
Showing 1–10 of 12
Other providers in the same ZIP code as Baptist Healthcare System, Inc., ranked by combined Medicare and Medicaid revenue.
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