Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Rhode Island for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Rhode Island only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Rhode Island (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

East Bay Endoscopy Center LLC (NPI 1235348335)

Field	Value
Entity Type	Organization
Organization	East Bay Endoscopy Center LLC
Address	109 Clock Tower Square
City	Portsmouth
State	RI
ZIP	02871
Taxonomy	Endoscopy Clinic/Center
NPI Enumerated	May 22, 2007

Payer Source	Total Paid
Medicare	$330.2K
Medicaid	$0

Key Findings

This practice is specialized in endoscopic GI procedures: its top Medicare revenue codes are for colonoscopy with polypectomy (45385), colonoscopy with biopsy (45380), and upper endoscopy with biopsy (43239), which together reflect a focus on diagnostic and therapeutic endoscopy services typical of an endoscopy center rather than a broad ambulatory surgery mix. The presence of screening-specific codes G0105 and G0121 further indicates it performs both diagnostic and preventive colorectal services for Medicare beneficiaries.

Revenue is highly concentrated in a small set of services: the precomputed measure shows the top 3 Medicare codes account for 71.3% of the provider’s total Medicare revenue, signaling dependence on a narrow set of endoscopic procedures for most Medicare income. This concentration suggests that shifts in reimbursement or referral patterns for these specific codes would materially affect the provider’s revenue.

The provider’s Medicare activity is meaningful but not dominant nationally for its lead codes: 45385 and 45380 each rank at the 94th percentile nationally, described as "typical, unremarkable volume for this code," indicating steady, above-average throughput compared with peers but not an extreme outlier. Other commonly billed codes such as 43239 rank at the 86th percentile and G0105 at the 87th percentile, which together portray the center as a solid regional performer in routine endoscopy without unusually high national concentration.

This entity appears effectively single-payer from the available data: Total Medicare revenue is $330.2K while there is no Medicaid billing on file, so Medicaid does not contribute to the observable payer mix. Analysts should treat the practice as Medicare-dependent for the periods covered and expect limited or no Medicaid-driven volume in state-level network analyses.

Operational profile and procedure mix indicate both therapeutic and screening emphasis: sizable revenue shares come from therapeutic polypectomy (45385) and diagnostic/biopsy colonoscopy (45380), while discrete screening codes G0105 and G0121 together contribute a nontrivial portion of revenue. This mix is consistent with an endoscopy center that manages both symptomatic/diagnostic referrals and routine colorectal cancer screening for high-risk and average-risk Medicare patients.

National ranking details show modest variability across CPTs and point to typical peer-level volumes rather than exceptional specialization: examples include 45385 and 45380 at the 94th percentile (typical volume), 43239 at the 86th percentile (typical volume), and several other codes clustered between the 57th and 87th percentiles. No code is flagged as an extreme statistical outlier; instead the pattern is a concentrated but conventionally scaled endoscopy practice.

Tenure in the Medicare program is long-standing: the NPI was enumerated on 2007-05-22 (~19 years ago), indicating nearly two decades of presence in the Medicare data stream and suggesting established referral relationships and operational stability in the local market.

Procedure-level revenue magnitudes show which services drive dollars: 45385 generated $117.2K (35.5% of Medicare revenue) and 45380 generated $80K (24.2% of Medicare revenue), while 43239 contributed $37.9K (11.5%); these code-level dollar values corroborate that polypectomy and biopsy-driven colonoscopy are the primary revenue drivers at this center.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

10 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…	250	$470	$117.2K
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…	220	$360	$80K
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.	160	$240	$37.9K
G0105	Colorectal cancer screening; colonoscopy on individual at high risk	80	$430	$32.7K
G0121	Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	40	$430	$18.5K
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…	40	$320	$12K
43450	The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing.	40	$290	$11K
43249	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum and dilates (widens) the esophagus with a balloon less than 30 mm in diameter.	20	$600	$10.2K
43235	The provider inserts an endoscope through the mouth and down into the esophagus, stomach, and duodenum for diagnostic purposes; the provider may collect specimens by brushing or washing.	20	$230	$5.5K
45381	The provider inserts a flexible endoscope into the anus and navigates the scope through the entire colon. The provider performs one or more injections into the submucosa (the tissue below the mucous…	20	$240	$5K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Rhode Island Distribution

East Bay Endoscopy Center LLC — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. state median

10 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
45385	4	60	60	$310	$27.9K
45380	4	60	60	$210	$17.9K
43239	7	60	60	$130	$12.3K
G0105	3	40	20	$300	$10.8K
G0121	3	20	20	$310	$8.4K
43249	8	10	20	$250	$6.4K
43450	2	10	40	$150	$6.2K
45378	6	40	20	$200	$5.1K
45381	1	10	20	$190	$3.4K
43235	7	20	20	$110	$2.8K

Nearby Providers

Other providers in the same ZIP code as East Bay Endoscopy Center LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Looking Upwards, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$136.2M
Looking Upwards, Inc.	RI	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$15.7M
Looking Upwards, Inc.	RI	Multi-Specialty Clinic/Center	$0	$7.4M
Girls And Boys Town Of New England	RI	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$5.9M
Newport County Regional Special Education	RI	Local Education Agency (LEA)	$0	$1.5M
Tom Swanson	RI	Pediatric Dentistry	$0	$1.3M
Gina Digati	RI	Adult Psychiatric/Mental Health Clinical Nurse Specialist	$12.3K	$817.1K
Lighthouse Counseling Associates	RI	Clinical Social Worker	$0	$343.5K
Town Of Portsmouth	RI	Land Ambulance	$265.6K	$75.3K
Julie Deleo	RI	Internal Medicine Physician	$156.9K	$4.4K

East Bay Endoscopy Center LLC — Billing Profile & Reimbursement Data

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East Bay Endoscopy Center LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References