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NPI 1093960700 · Issaquah, WA · Ambulatory Surgical Clinic/Center
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Proliance Surgeons Inc P S is a ambulatory surgical clinic/center provider located in Issaquah, Washington. This profile covers 39 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 | Proliance Surgeons Inc P S |
| Address | 510 8th Ave Ne |
| City | Issaquah |
| State | WA |
| ZIP | 98029 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | November 21, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $680 |
PROLIANCE SURGEONS INC P S is categorized as an Ambulatory Surgical Clinic/Center and its Medicare billing profile is dominated by major orthopedic procedures, with knee and hip arthroplasty and shoulder arthroscopy appearing as the core service lines. The presence of high-revenue codes such as 27447, 27130, and 29827 indicates the practice operates as an outpatient surgical provider that routinely performs joint replacement and arthroscopic repairs in an ambulatory setting. These procedure types align with an ASC model focused on musculoskeletal surgery rather than primary care or chronic disease management.
Medicare revenue totals $2.4M and shows strong concentration in a small number of high-value codes: 27447 accounts for $817.3K (36.7% of this provider's total Medicare revenue), 27130 for $324.8K (14.6%), and 29827 for $145.4K (6.5%). Precomputed figures confirm the top three Medicare codes together account for 57.8% of Medicare revenue, signaling a heavy revenue dependence on arthroplasty and arthroscopy services.
The payer mix is effectively single‑payer at scale: Medicare accounts for the overwhelming majority of lifetime billed revenue ($2.4M) while Medicaid activity is de minimis at $676 total. Medicaid billing is concentrated entirely in a single code, 87426 (reported $680 for that code and shown as 100.0% of Medicaid revenue), meaning the entity has virtually no Medicaid-based surgical volume to offset Medicare dependence.
On competitive standing, PROLIANCE reports several codes where its Medicare volume is unusually high relative to national peers. For knee arthroplasty 27447 the provider ranks #817 of 12089 (93th percentile) and is described as notably above typical national volume, and shoulder repair 29827 ranks #92 of 3445 (97th percentile) also noted as notably above typical national volume; additionally code 20680 ranks #13 of 601 (98th percentile) and is identified as notably above typical national volume, indicating the practice is a high-volume national outlier for multiple surgical procedures.
By contrast, its Medicaid competitive footprint is minimal and not prominent in-state: the Medicaid code 87426 ranks #144 of 157 providers in-state (7th percentile) and is labeled typical, unremarkable volume. This suggests the provider is not a significant participant in Medicaid-funded SARS‑CoV‑2 testing or related outpatient lab billing within Washington.
Beyond arthroplasty and arthroscopy, the Medicare code mix shows procedural breadth across plastic/reconstructive (14301, 21235), hand and nerve procedures (64721, 26123, 26480), foot and ankle surgery (28297, 28750), and select spine procedures (63047). These additional procedure lines each contribute smaller shares (for example, 14301 at $73.5K and 64721 at $59.3K) but together reflect a diversified surgical service offering in the ambulatory setting rather than a single-procedure clinic.
From a business-risk perspective, the practice’s reliance on a few high-revenue arthroplasty codes (top 3 = 57.8% of Medicare revenue) concentrates financial exposure to volume and reimbursement changes affecting joint replacement and arthroscopy. Any payer policy changes, site‑of‑service shifts, or changes in referral patterns for these specific procedures could disproportionately affect overall revenue given the Medicare-centric mix ($2.4M) and negligible Medicaid revenue.
The provider’s NPI was enumerated on 2008-11-21 (~18 years ago), indicating a relatively long tenure in the market. That duration, combined with high national percentile rankings on several procedure codes, supports the interpretation of an established ambulatory surgical operation with sustained specialty volume rather than a newly formed practice.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
39 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 110 | $7,780 | $817.3K |
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 40 | $7,920 | $324.8K |
| 29827 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and… | 70 | $2,240 | $145.4K |
| 27446 | In this procedure, the provider reconstructs the diseased or damaged medial or lateral compartment of the knee along with the femoral condyles and tibial plateaus to relieve pain and improve the… | 10 | $7,570 | $106K |
| 14301 | The provider replaces the lesions in any area with the healthy tissues from an adjacent site. This code represents a defect of 30.1 cm2 to 60.0 cm2. | 70 | $1,050 | $73.5K |
| 25609 | The provider surgically repairs a fracture of the lower radius, the larger of the two lower arm bones, beyond the joint or a separation of the radius from the joint through an incision and fixes… | 20 | $3,750 | $71.2K |
| 23430 | In this procedure, the provider surgically cleans the long tendon of the biceps from its damaged fragment and fixes the tendon to the upper end of the humerus to improve the stability of the joint.… | 20 | $3,500 | $70.1K |
| 64721 | Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which… | 90 | $660 | $59.3K |
| 28750 | In this procedure, the provider surgically immobilizes the metatarsophalangeal joint of the great toe. A metatarsophalangeal joint is a joint between the first metatarsal of the foot and the first… | 20 | $3,600 | $57.7K |
| 28297 | The provider removes bone from a bunion, a foot deformity that causes a bump near where the big toe joins the foot. The procedure includes fusing the joint between the foot’s first metatarsal bone… | 20 | $3,820 | $57.3K |
Showing 1–10 of 39
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 39 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
39 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 28297 | 1 | 10 | 10 | $3,730 | $52.2K |
| 27447 | 15 | 320 | 30 | $1,190 | $46.3K |
| 25609 | 2 | 10 | 20 | $2,720 | $46.2K |
| 27446 | 12 | 20 | 20 | $2,200 | $44K |
| 27130 | 65 | 230 | 30 | $1,060 | $37.1K |
| 28750 | 4 | 10 | 20 | $2,020 | $36.3K |
| 21235 | 3 | 10 | 20 | $1,090 | $34.8K |
| 14301 | 4 | 30 | 20 | $850 | $26.3K |
| 15731 | 2 | 10 | 30 | $910 | $26.3K |
| 29827 | 4 | 90 | 20 | $1,130 | $26.1K |
Showing 1–10 of 39
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 |
|---|---|---|---|---|
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 20 | $40 | $680 |
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
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 144 | 160 | 260 | $20 | $23.4K |
Other providers in the same ZIP code as Proliance Surgeons Inc P S, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Swedish Health Services | WA | General Acute Care Hospital | $0 | $13.3M |
| Eastside Emergency Physicians PLLC | WA | Emergency Medicine Physician | $0 | $5M |
| Michael Sailer | WA | Orthopaedic Surgery Physician | $199.1K | $0 |
| Ryan Nathe | WA | Orthopaedic Surgery Physician | $180.3K | $0 |
| Alexander Arzeno | WA | Orthopaedic Surgery of the Spine Physician | $180K | $0 |
| James Spiegel | WA | Radiation Oncology Physician | $103.5K | $0 |
| Craig Villari | WA | Otolaryngology Physician | $87.9K | $0 |
| Jamie Mcintosh | WA | Physical Therapist | $72.8K | $0 |
| Wilson Chang | WA | Physical Medicine & Rehabilitation Physician | $66.4K | $0 |
| Bryce Munson | WA | Family Medicine Physician | $37.4K | $0 |
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