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NPI 1154318103 · Everett, WA · Ambulatory Surgical Clinic/Center
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Optum Care Washington PLLC is a ambulatory surgical clinic/center provider located in Everett, Washington. This profile covers 27 Medicare and 8 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 | Optum Care Washington PLLC |
| Address | 3927 Rucker Ave |
| City | Everett |
| State | WA |
| ZIP | 98201 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 4, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $937.1K |
OPTUM CARE WASHINGTON PLLC is categorized as an Ambulatory Surgical Clinic/Center and its top-billed services are procedural: high-volume colorectal endoscopy (multiple colonoscopy and polypectomy codes including 45385 and 45390), upper endoscopy with biopsy (43239), and cataract extraction with intraocular lens insertion (66984). The presence of arthroscopy and other minor surgical codes (e.g., 29828, 29827, 29848) indicates the facility performs a mix of same-day surgical specialties consistent with an ASC model rather than only diagnostic outpatient care.
Medicare revenue is concentrated in a few procedural codes: 45385, 66984, and 45390 together account for 57.9% of the provider’s total Medicare revenue. Individually, 45385 contributes $433.8K (26.2% of Medicare revenue), 66984 contributes $373.4K (22.6%), and 45390 contributes $150.2K (9.1%), which shows the ASC’s Medicare business is driven primarily by GI endoscopy and cataract surgery.
On the Medicaid side the revenue concentration is even higher: the top three Medicaid codes (45385, 43239, 45380) account for 87.3% of total Medicaid revenue. Those codes generate $334.1K (35.6%), $274.6K (29.2%), and $210.9K (22.5%) of Medicaid revenue respectively, signaling that Medicaid billing is overwhelmingly centered on colonoscopy and upper endoscopy services.
In payer-mix scale, Medicare represents the larger pool with Total Medicare revenue of $1.7M versus Total Medicaid revenue of $937.1K; both payers are meaningful to the practice’s overall volumes but Medicare is the single largest source of billed revenue. This pattern indicates the ASC operates across both public payers but depends more on Medicare for total dollar volume.
Nationally, the provider is an outlier on specific Medicare GI codes: 45385 ranks #64 of 16310 providers (100th percentile; extreme outlier) and 45390 ranks #7 of 802 providers (99th percentile; extreme outlier), indicating unusually high national volume in colonoscopic polypectomy and mucosal excision relative to peers. By contrast, 66984 (cataract insertion) sits at the 79th percentile (#3312 of 15965) — a solid but not exceptional national position for ophthalmic surgery.
Within Washington State Medicaid billing, the facility shows strong in-state positioning for endoscopy: 45385 ranks #10 of 90 providers (90th percentile), 43239 ranks #32 of 119 (74th percentile), and 45380 ranks #24 of 97 (76th percentile). These in-state percentiles indicate the ASC is a major regional provider of GI endoscopy services for Medicaid patients, even if the state ranks are more typical than the pronounced national outlier status seen for some Medicare codes.
The Medicaid file includes large counts of quality/process G-codes with $0 paid but high claim volumes and top state ranks (G8907: 8.7K claims, rank #1 of 52 in-state; G8916: 1.6K claims, rank #1 of 5 in-state; G8918: 7K claims, rank #1 of 27 in-state). These entries suggest extensive reporting of preoperative and perioperative quality/measure items in Medicaid submissions rather than material revenue, consistent with an ASC that records and submits large volumes of operative-process documentation.
The provider’s NPI was enumerated on 2005-10-04 (~21 years ago), signaling an established operating history. Coupled with the high procedural volumes and payer mix above, this tenure supports a view of a long-standing ambulatory surgical operation focused on high-throughput endoscopy and cataract services with ancillary orthopedic and minor surgical procedures.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
27 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 960 | $450 | $433.8K |
| 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 | $910 | $373.4K |
| 45390 | The provider performs flexible colonoscopy along with excision of mucous membrane tissue using an endoscope. | 150 | $1,040 | $150.2K |
| 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… | 480 | $300 | $142.8K |
| 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. | 410 | $260 | $104.8K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 130 | $460 | $61.4K |
| 29828 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps… | 20 | $2,670 | $40K |
| 49650 | The provider performs laparoscopic repair of an initial inguinal hernia. | 20 | $1,640 | $39.4K |
| 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… | 20 | $1,770 | $35.3K |
| 29848 | The provider inserts an endoscope into the wrist joint to divide the transverse carpal ligament and reduce compression on the median nerve in the carpal tunnel that results in pain and numbness. | 60 | $590 | $35K |
Showing 1–10 of 27
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
27 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 46 | 460 | 50 | $560 | $97.5K |
| 45385 | 2 | 380 | 70 | $290 | $31K |
| 29828 | 14 | 30 | 20 | $1,240 | $28.4K |
| 66982 | 99 | 120 | 30 | $720 | $27.3K |
| 29827 | 33 | 90 | 20 | $1,130 | $26.1K |
| 29881 | 18 | 30 | 20 | $950 | $20K |
| 64721 | 53 | 70 | 30 | $450 | $19.7K |
| 29848 | 8 | 60 | 30 | $470 | $17.2K |
| 45380 | 8 | 370 | 60 | $190 | $16.4K |
| 45390 | 1 | 20 | 20 | $550 | $14.9K |
Showing 1–10 of 27
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 2,090 | $160 | $334.1K |
| 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. | 2,080 | $130 | $274.6K |
| 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… | 1,520 | $140 | $210.9K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 360 | $240 | $87.2K |
| 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… | 580 | $60 | $32.1K |
| 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… | 8,730 | $0 | $0 |
| G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | 1,610 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 7,040 | $0 | $0 |
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
8 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. | 32 | 120 | 590 | $230 | $331.2K |
| 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… | 24 | 100 | 390 | $260 | $244.5K |
| 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… | 10 | 90 | 260 | $300 | $208.5K |
| 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… | 20 | 50 | 410 | $180 | $154K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 8 | 50 | 90 | $400 | $102.5K |
| G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | 1 | 10 | 180 | $1 | $10 |
| 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… | 1 | 50 | 90 | $1 | $1 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1 | 30 | 120 | $0 | $0 |
Other providers in the same ZIP code as Optum Care Washington PLLC, ranked by combined Medicare and Medicaid revenue.
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