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NPI 1104933696 · Clive, IA · Ambulatory Surgical Clinic/Center
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West Lakes Surgery Center LLC is a ambulatory surgical clinic/center provider located in Clive, Iowa. This profile covers 32 Medicare and 9 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 | West Lakes Surgery Center LLC |
| Address | 12499 University Ave |
| City | Clive |
| State | IA |
| ZIP | 50325 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | August 23, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.1M |
| Medicare | $1.1M |
West Lakes Surgery Center reports identical lifetime revenue from Medicare and Medicaid, each listed as $1.1M, indicating a balanced two‑payer footprint rather than single‑payer dependence. This parity suggests the center serves both adult procedural populations (Medicare) and pediatric or low‑income populations (Medicaid) at comparable revenue scale.
Medicaid revenue is highly concentrated: the precomputed top‑3 Medicaid codes account for 96.6% of the provider’s total Medicaid revenue, driven overwhelmingly by 69436 (tympanostomy tube insertion) which alone accounts for $832.6K and 74.2% of Medicaid revenue, and 42820 (tonsil/adenoid removal in children) which contributes $232.5K or 20.7%. Both codes show notably high in‑state standing (69436 ranks #2 of 52, 98th percentile; 42820 ranks #3 of 25, 92nd percentile), signaling a dominant pediatric ENT volume on the Medicaid side.
Medicare revenue is more diffuse but still meaningfully concentrated: the precomputed top‑3 Medicare codes account for 38.5% of total Medicare revenue, with the leading Medicare drivers being 27447 (knee joint replacement), 64590 (neurostimulator generator placement), and 64635 (lumbar neurotomy). Within that mix 64635 is a clear outlier nationally (204 claims, $123.6K revenue; ranks #155 of 5957, 97th percentile, described as notably above typical national volume), while the other two top codes have more typical national volumes.
The provider’s Medicare code mix (notably 64635, 64493, 64483, 62323) indicates a strong procedural focus on image‑guided spinal pain interventions and neuroablative procedures, while concurrent high‑revenue urology codes (52356, 52332, 52648) and orthopedic/arthroscopic codes (27447, 29827) point to a multi‑specialty ambulatory surgical operation. In contrast, the Medicaid mix is concentrated in high‑volume pediatric ENT (69436, 42820), implying the facility operates distinct service lines that draw different payer populations.
From a competitive standpoint in Medicaid, the center is a major in‑state provider for pediatric ENT procedures: 69436 is ranked #2 of 52 in the state (98th percentile, notably above typical state volume) and 42820 is #3 of 25 (92nd percentile, notably above typical state volume), which supports positioning as a regional hub for tympanostomy and pediatric tonsil/adenoid surgery. This in‑state dominance has implications for network contracting and referral patterns in pediatric ENT.
Nationally for Medicare the competitive picture is mixed: the center shows specialty strength in lumbar neurotomy (64635 is notably above typical national volume at the 97th percentile), while other high‑revenue Medicare codes such as 27447 (knee replacement) rank in the mid/low percentiles (#8330 of 12089, 29th percentile) and 64590 shows typical/unremarkable volume. This suggests the center is a notable national outlier for specific pain‑management procedures but remains a more modest participant nationally across other surgical lines.
Operational volume signals reinforce the service‑line split: Medicaid shows very high pediatric throughput with 1.8K claims for 69436 and 419 claims for 42820, whereas Medicare shows concentrated procedural activity in spinal injections and blocks (e.g., 64493 with 245 claims, 64635 with 204 claims) alongside multiple moderate‑volume urologic and orthopedic procedures. These claim counts indicate high patient throughput in discrete service lines that likely require distinct staffing, scheduling, and equipment profiles.
The NPI tenure (enumerated 2006-08-23, ~20 years ago) indicates an established ambulatory surgical clinic/center presence. Combined with sustained high Medicaid pediatric ENT volumes and notable Medicare spine procedure volume, the center appears to be a stable, specialized facility that may be attractive for targeted payer agreements in pediatric ENT and interventional spine/pain 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.
32 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… | 20 | $6,800 | $142.9K |
| 64590 | The provider inserts or replaces a peripheral, sacral, or gastric neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that… | 10 | $12,910 | $142K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 200 | $610 | $123.6K |
| 52356 | The provider performs a cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into… | 50 | $1,630 | $84.7K |
| 52648 | Transurethral resection of the prostate is performed in cases of BPH (benign prostate hyperplasia) which commonly occurs in middle–aged and elderly men, often causing lower urinary symptoms, with… | 50 | $1,600 | $84.6K |
| 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… | 250 | $300 | $74.5K |
| 50590 | Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to destroy calculus (kidney stones) in the kidneys and ureters. | 60 | $920 | $51.7K |
| 52332 | The provider performs cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into… | 50 | $1,000 | $51.1K |
| 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). | 160 | $310 | $50.6K |
| 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)… | 150 | $240 | $36.1K |
Showing 1–10 of 32
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 32 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
32 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 64590 | 10 | 10 | 10 | $5,600 | $83.9K |
| 27447 | 152 | 190 | 40 | $870 | $41.7K |
| 15823 | 14 | 20 | 30 | $520 | $29.4K |
| G0260 | 1 | 10 | 110 | $200 | $22K |
| 64635 | 3 | 40 | 40 | $340 | $21.8K |
| 52235 | 2 | 10 | 20 | $1,000 | $19.9K |
| 67900 | 6 | 10 | 30 | $430 | $19.7K |
| 29827 | 25 | 40 | 20 | $950 | $18.1K |
| 28285 | 20 | 20 | 30 | $430 | $17.6K |
| 52356 | 3 | 50 | 20 | $650 | $16.8K |
Showing 1–10 of 32
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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 1,760 | $470 | $832.6K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 420 | $560 | $232.5K |
| 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)… | 80 | $230 | $18.7K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 30 | $540 | $15.7K |
| 15769 | The provider excises (harvests) fat, dermis, fascia, or other tissue and uses the soft tissue to fill in a defect elsewhere on the body of the same patient during the same operative session. | 10 | $910 | $11.9K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 30 | $160 | $4K |
| 69631 | The provider reconstructs the tympanic membrane, or eardrum, to repair a perforation. This might involve reconstruction of the ear canal, an incision into the tympanic attic and or other surgeries on… | 20 | $250 | $3.8K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 10 | $200 | $2.4K |
| 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… | 50 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Iowa providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Iowa median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 2 | 50 | 170 | $410 | $153.8K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 3 | 30 | 60 | $750 | $96.1K |
| 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)… | 12 | 20 | 80 | $140 | $34.2K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 2 | 10 | 30 | $400 | $13.2K |
| 15769 | The provider excises (harvests) fat, dermis, fascia, or other tissue and uses the soft tissue to fill in a defect elsewhere on the body of the same patient during the same operative session. | 1 | 10 | 10 | $910 | $11.9K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 2 | 10 | 40 | $220 | $8.8K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 2 | 10 | 20 | $190 | $4K |
| 69631 | The provider reconstructs the tympanic membrane, or eardrum, to repair a perforation. This might involve reconstruction of the ear canal, an incision into the tympanic attic and or other surgeries on… | 1 | 10 | 20 | $250 | $3.8K |
| 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… | 6 | 10 | 50 | $0 | $0 |
Other providers in the same ZIP code as West Lakes Surgery Center LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Iowa Family Assistants | IA | Home Health Agency | $0 | $18M |
| Iowa Radiology, P C | IA | Diagnostic Radiology Physician | $0 | $5.2M |
| Mercy Clinics, Inc. | IA | Primary Care Clinic/Center | $0 | $2.9M |
| Iowa Diagnostic Imaging & Procedure Center, L C | IA | Diagnostic Radiology Physician | $0 | $2.5M |
| Iowa Endoscopy Center, Inc. | IA | Ambulatory Surgical Clinic/Center | $774K | $1.5M |
| Mercy Clinics Inc | IA | Clinic/Center | $0 | $1.7M |
| Tara Graff | IA | Medical Oncology Physician | $1.4M | $0 |
| Catholic Health Initiatives-iowa Corp | IA | Diagnostic Radiology Physician | $594.7K | $594.4K |
| Phippsburger Inc | IA | Home Health Agency | $0 | $1.1M |
| Uhs Midwest Behavioral Health LLC | IA | Psychiatry Physician | $0 | $979.3K |
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