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NPI 1265484810 · Providence, RI · Endoscopy Clinic/Center
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Endoscopy Associates, LLC is a endoscopy clinic/center provider located in Providence, Rhode Island. This profile covers 9 Medicare and 2 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 | Endoscopy Associates, LLC |
| Address | 44 W River St |
| City | Providence |
| State | RI |
| ZIP | 02904 |
| Taxonomy | Endoscopy Clinic/Center |
| NPI Enumerated | May 16, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $526.3K |
| Medicaid | $14.1K |
ENDOSCOPY ASSOCIATES, LLC presents as a procedure-focused endoscopy clinic/center: its top Medicare codes are 45385, 43239, and 45380, which correspond to colonoscopic polypectomy, upper endoscopy with biopsy, and diagnostic colonoscopy with biopsy respectively, indicating a mix of diagnostic and therapeutic GI endoscopy services rather than primary care or non-procedural specialties. This code mix aligns with its taxonomy as an Endoscopy Clinic/Center and suggests workflows centered on same-day endoscopic procedures and pathology specimen handling.
Revenue concentration on Medicare is high: the provider’s top three Medicare codes account for 78.3% of total Medicare revenue, led by 45385 (49.7% of Medicare revenue), followed by 43239 (15.3%) and 45380 (13.3%). This concentration shows the practice derives most Medicare income from a narrow set of endoscopic procedures, with 45385 as the single largest Medicare revenue source.
Medicaid billing is even more concentrated: the provider’s top three Medicaid codes account for 100.0% of its Medicaid revenue, driven entirely by 45385 (74.4% of Medicaid revenue) and 43239 (25.6%). In practice this means Medicaid revenue streams are effectively limited to colonoscopic polypectomy and upper endoscopy with biopsy services.
Payer mix is heavily Medicare-weighted: lifetime Medicare revenue is $526.3K compared with lifetime Medicaid revenue of $14.1K, so Medicare represents the primary payer relationship in scale and revenue generation for this provider. Medicaid appears to be a very small portion of total public-payer volume for this entity based on the reported totals.
National competitive standing on key Medicare codes is strong for several procedural lines: 45385 ranks #258 of 16310 providers nationally (98th percentile; extreme outlier), signaling outsized national volume for colonoscopic polypectomy, and 43239 ranks #649 of 17140 providers (96th percentile; notably above typical national volume). By contrast, 45380 ranks #1012 of 16427 (94th percentile; typical, unremarkable volume), indicating mixed but overall above-peer performance on core endoscopy procedures.
State-level Medicaid standing is modest: for Medicaid 45385 ranks #6 of 7 in-state (17th percentile; typical, unremarkable volume) and 43239 ranks #35 of 37 (0th percentile; typical, unremarkable volume), so despite these codes dominating the provider’s Medicaid revenue, the practice is not a leading statewide Medicaid performer for those services. This suggests stronger traction with Medicare patients than with Medicaid patients in the local market.
The presence of additional Medicare codes for therapeutic and advanced upper-GI procedures (for example 43249 with $17K revenue, 3.2% of Medicare revenue, and 43248 with $5K revenue, 0.9% of Medicare revenue) indicates the practice offers dilation and other interventional upper endoscopy services beyond routine diagnostic scopes. Those smaller but present revenue lines point to capability for a broader procedural mix that complements the high-volume colonoscopy work.
NPI tenure is long-standing: NPI enumerated 2006-05-16 (~20 years ago), indicating an established operation. Combined with the concentrated, procedure-heavy Medicare revenue profile, this suggests a stable, mature endoscopy practice whose financial performance is driven primarily by a small set of high-volume endoscopic 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.
9 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… | 560 | $460 | $261.7K |
| 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. | 330 | $250 | $80.5K |
| 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… | 210 | $330 | $69.9K |
| 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… | 150 | $340 | $51.1K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 60 | $430 | $26K |
| 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. | 30 | $590 | $17K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 20 | $420 | $9.7K |
| 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 | $250 | $5.2K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 20 | $290 | $5K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 9 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.
2 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… | 20 | $440 | $10.5K |
| 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. | 10 | $300 | $3.6K |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
2 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. | 35 | 40 | 70 | $300 | $116.1K |
| 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… | 6 | 10 | 150 | $370 | $44.4K |
Other providers in the same ZIP code as Endoscopy Associates, LLC, ranked by combined Medicare and Medicaid revenue.
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