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NPI 1306843222 · Phoenix, AZ · Ambulatory Surgical Clinic/Center
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St. Joseph's Outpatient Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Phoenix, Arizona. This profile covers 42 Medicare and 23 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 | St. Joseph's Outpatient Surgery Center, LLC |
| Address | 240 W Thomas Rd |
| City | Phoenix |
| State | AZ |
| ZIP | 85013 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 7, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $14.5M |
| Medicare | $2.9M |
This provider’s payer mix is heavily skewed toward Medicaid: Total Medicaid revenue is $14.5M compared with Total Medicare revenue of $2.9M, indicating the center operates at a substantially larger scale in the Medicaid population. The disparity suggests Medicaid-driven case volume and/or contracting is a primary revenue driver for the business.
Revenue concentration is high on Medicare: the precomputed data show the top 3 Medicare codes by revenue account for 68.5% of this provider's total Medicare revenue, led by 61886 ($847.2K, 30.6% of Medicare revenue) and 69930 ($815.9K, 29.5% of Medicare revenue). That concentration indicates a small number of high-reimbursement implant procedures dominate the Medicare book of business.
Medicaid revenue is likewise concentrated: the top 3 Medicaid codes by revenue account for 66.2% of this provider's total Medicaid revenue, driven by 42820 ($4.4M, 30.6% of Medicaid revenue), 30140 ($3.7M, 25.3% of Medicaid revenue), and 43239 ($1.5M, 10.3% of Medicaid revenue). These three codes alone represent two-thirds of the Medicaid revenue stream, pointing to a narrow set of high-volume services in the state payer mix.
The procedure mix implies a dual focus on implantable neuro/audiologic devices and high-volume ENT procedures: Medicare top codes 61886, 69930, and 63685 correspond to cranial pulse generators, cochlear implantation, and spinal neurostimulators, which are specialized implant services, while both payers show heavy volume for ENT and endoscopic sinus procedures such as 30140, 31267, and 31276. This combination indicates the ambulatory surgery center performs advanced implant and otolaryngology work alongside routine pediatric ENT and endoscopy cases.
National competitive standing on selected Medicare implants is mixed: 69930 ranks #9 of 176 providers nationally (95th percentile; notably above typical national volume), and 61886 ranks #14 of 131 (90th percentile; typical), showing unusually strong national activity for cochlear implantation and above-typical activity for related implant procedures. At the same time, 63685 ranks #904 of 1281 (21th percentile), signaling the provider is not a leading national performer for spinal neurostimulator generator procedures.
At the state level the provider is a clearly dominant contributor for several Medicaid services: 30140 ranks #1 of 18 in-state (100th percentile; notably above typical state volume), 42820 ranks #2 of 39 (97th percentile; notably above typical state volume), and 45380 ranks #3 of 120 (98th percentile; extreme outlier). These ranks indicate the center is a major in-state site for turbinate surgery, tonsil/adenoid procedures, and therapeutic colonoscopy work.
Several codes are flagged as statistical outliers or notably above typical volume and reinforce service-line specialization: Medicare 31267 and 31276 are described as extreme outliers (100th percentile), Medicare/Medicaid 30140 and Medicaid 30520 are 100th percentile extreme outliers in-state for turbinate/Septoplasty services, and multiple GI and ENT codes (e.g., 43239, 45380) are listed as notably above typical state volume. Together these labels suggest unusually high relative volume for endoscopic sinus and select endoscopy procedures compared with peers.
The practice has an established operating history—NPI enumerated 2005-07-07 (~21 years ago)—which, coupled with the concentrated, high-volume Medicaid caseload, suggests a stable ambulatory surgery center with long-term specialization in pediatric ENT, sinus endoscopy, and selected implantable device procedures rather than a broad multi-specialty outpatient footprint.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
42 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 61886 | The provider makes an incision and implants or replaces a direct or inductive cranial pulse generator or receiver in a subcutaneous pocket for connection to two or more electrode arrays, often one on… | 50 | $18,830 | $847.2K |
| 69930 | The external parts include microphone, speech processor, and a transmitter. The implant is surgically placed under the skin behind the ear. The internal parts are a receiver and stimulator which are… | 40 | $23,310 | $815.9K |
| 63685 | The provider inserts or replaces a spinal neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection… | 10 | $17,800 | $231.4K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 40 | $3,800 | $140.7K |
| 31267 | In this procedure, the provider inserts an endoscope into the nasal cavity. She then gains access to the maxillary sinus through a cut in the uncinate process. The provider opens the maxillary sinus… | 100 | $1,060 | $107.8K |
| 31276 | In this procedure, the provider inserts an endoscope into the frontal sinus to explore it for abnormalities. The provider may also remove bone, scar tissue, polyps, or other tissue from the frontal… | 70 | $1,270 | $82.4K |
| 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 | $1,140 | $75.2K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 110 | $460 | $49.6K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 110 | $410 | $44.6K |
| 31259 | The provider performs a complete excision of the ethmoid air cells (anterior and posterior) and widens the opening of the sphenoid sinus cavity via surgical nasal/sinus endoscopy. The procedure is… | 50 | $840 | $42.1K |
Showing 1–10 of 42
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 42 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
42 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 46 | 70 | 20 | $10,020 | $200.4K |
| 61886 | 2 | 10 | 10 | $5,180 | $186.4K |
| 69930 | 2 | 10 | 30 | $5,240 | $136.4K |
| 63650 | 46 | 70 | 40 | $2,040 | $116K |
| 30469 | 3 | 10 | 30 | $1,980 | $115.1K |
| 14301 | 10 | 40 | 40 | $730 | $74.9K |
| 45385 | 326 | 330 | 50 | $290 | $28.4K |
| 69631 | 1 | 10 | 10 | $1,970 | $27.6K |
| 31267 | 1 | 20 | 20 | $860 | $23.9K |
| 64721 | 70 | 70 | 40 | $440 | $23.5K |
Showing 1–10 of 42
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.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 2,680 | $1,660 | $4.4M |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 5,630 | $650 | $3.7M |
| 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. | 6,480 | $230 | $1.5M |
| 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… | 4,060 | $280 | $1.1M |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 2,160 | $460 | $995.4K |
| 30520 | Septoplasty is most often performed for a deviated septum which can be either C–shaped, S–shaped, or a cartilaginous deviation. | 2,200 | $320 | $692.1K |
| 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… | 2,030 | $260 | $530.5K |
| 31267 | In this procedure, the provider inserts an endoscope into the nasal cavity. She then gains access to the maxillary sinus through a cut in the uncinate process. The provider opens the maxillary sinus… | 540 | $960 | $520.2K |
| 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… | 2,320 | $210 | $491K |
| 31276 | In this procedure, the provider inserts an endoscope into the frontal sinus to explore it for abnormalities. The provider may also remove bone, scar tissue, polyps, or other tissue from the frontal… | 130 | $1,230 | $163.3K |
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How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
23 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 2 | 40 | 210 | $1,710 | $1.2M |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | 34 | 50 | 450 | $920 | $775.4K |
| L8699 | Prosthetic implant, not otherwise specified | 2 | 20 | 560 | $570 | $405.3K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 1 | 20 | 230 | $440 | $397.7K |
| 20680 | Skeletal deformities or injuries such as fractures often require the use of skeletal fixation devices, like pins, rods, wires, bands, or plates, to join skeletal parts and maintain their normal… | 5 | 10 | 40 | $2,340 | $391.3K |
| 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. | 6 | 180 | 590 | $250 | $360.9K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 4 | 40 | 190 | $540 | $334.2K |
| 31267 | In this procedure, the provider inserts an endoscope into the nasal cavity. She then gains access to the maxillary sinus through a cut in the uncinate process. The provider opens the maxillary sinus… | 1 | 10 | 320 | $910 | $290.2K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 4 | 10 | 70 | $980 | $221.6K |
| 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… | 3 | 120 | 330 | $280 | $206.3K |
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Other providers in the same ZIP code as St. Joseph's Outpatient Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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