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NPI 1366449571 · Lakewood, NJ · Ambulatory Surgical Clinic/Center
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Shore Outpatient Surgicenter LLC is a ambulatory surgical clinic/center provider located in Lakewood, New Jersey. This profile covers 33 Medicare and 4 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 | Shore Outpatient Surgicenter LLC |
| Address | 360 Route 70 |
| City | Lakewood |
| State | NJ |
| ZIP | 08701 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 1, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.7M |
| Medicaid | $2.5M |
Payer mix is roughly balanced: this ASC reported $2.7M in Medicare revenue and $2.5M in Medicaid revenue, so neither payer is overwhelmingly dominant and the facility is effectively a dual-payer operator rather than single-payer reliant. This near-parity suggests contracting and utilization patterns that matter to both Medicare and Medicaid networks.
The code mix points to a specialty outpatient surgical center focused on gastrointestinal endoscopy and urology/stone procedures: high-revenue Medicare codes include 45380 and 45385 (colonoscopy with biopsy and polypectomy), 43239 (upper endoscopy with biopsy), and 50590 (ESWL for kidney stones). These procedure-level revenues are consistent with an ambulatory surgical clinic/center that performs both diagnostic and therapeutic endoscopic and urologic services.
Medicare revenue is concentrated among a small set of procedures: the provider’s top 3 Medicare codes account for 30.1% of its total Medicare revenue, with 45380, 45385, and 50590 prominent among those top earners. That concentration indicates meaningful dependence on a few high-volume/high-revenue services for Medicare patients.
Medicaid billing is even more concentrated in a very small set of GI procedures: the top 3 Medicaid codes account for 85.8% of total Medicaid revenue, with 43239 (EGD with biopsy), 45380 (colonoscopy with biopsy), and 45378 (colonoscopy with brushings/washings) driving the bulk of Medicaid receipts. This pattern implies the provider’s Medicaid business is heavily weighted toward routine diagnostic and screening endoscopy.
On Medicare measures the provider is a high-volume outlier for multiple codes: several Medicare codes are labeled “extreme outlier” or at the 99th–100th percentile (for example, 45380 and 45385 are at the 99th percentile and 50590 is at the 100th percentile), and select urology services (52005) rank at the very top nationally. These rankings characterize the facility as a nationally high-volume performer for specific endoscopic and stone procedures.
By contrast, the provider’s Medicaid ranking within New Jersey is elevated but more typical: 43239 ranks #20 of 284 in-state (93rd percentile, noted as typical), 45380 ranks #23 of 169 (87th percentile, typical), and 45378 ranks #21 of 109 (81st percentile, typical). These in-state percentiles indicate the center is a meaningful regional participant for GI procedures without the same extreme outlier status seen in some Medicare measures.
Medicare billing also shows a broader mix that includes urologic therapeutic procedures and higher-paid interventional codes (examples include 52356, 52240, 52235), whereas Medicaid revenue is heavily skewed to diagnostic and screening endoscopy codes (43239, 45380, 45378, 45385). This divergence suggests different service utilization by payer—Medicaid visits skew toward diagnostic/screening colonoscopy and EGD, while Medicare volume includes a larger share of interventional urology and ESWL.
The provider has a long tenure in the Medicare system (NPI enumerated 2005-07-01, ~21 years ago), indicating an established ambulatory surgical operation. Coupled with the high national percentiles for several codes and concentrated Medicaid endoscopy revenue, the profile is consistent with a longstanding ASC specializing in endoscopy and urology services that commands high procedure volumes in its specialty lines.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
33 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 720 | $390 | $280K |
| 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… | 590 | $470 | $277.7K |
| 50590 | Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to destroy calculus (kidney stones) in the kidneys and ureters. | 190 | $1,220 | $234.5K |
| 55700 | Code deleted December 31, 2025. | 330 | $680 | $224K |
| 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. | 810 | $270 | $219.5K |
| 52005 | The provider performs a cystourethroscopy, inspection of the interior areas of the bladder, urethra, and ureteric pelvis; he may or may not irrigate the bladder, instill fluids, or perform imaging of… | 290 | $590 | $171.4K |
| 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… | 80 | $1,850 | $140.4K |
| 52240 | The provider inspects the urethra, prostatic urethra (in men), the interior of the bladder, and ureteric openings using a cystoscope passed through the urethra and into the bladder; he destroys… | 60 | $1,820 | $107.4K |
| 52235 | The provider inspects the urethra, prostatic urethra (in men), the interior of the bladder, and ureteric openings using a cystoscope passed through the urethra and into the bladder; he destroys… | 90 | $1,180 | $102.3K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 20 | $5,910 | $94.5K |
Showing 1–10 of 33
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 33 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
33 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| C9740 | 2 | 10 | 20 | $5,870 | $99.8K |
| J0585 | 52 | 110 | 6,100 | $1 | $45.6K |
| 45385 | 8 | 560 | 50 | $320 | $25.4K |
| 45380 | 6 | 590 | 60 | $230 | $21.3K |
| 50590 | 1 | 70 | 20 | $710 | $19.1K |
| 43239 | 5 | 610 | 80 | $160 | $18.5K |
| 52240 | 1 | 10 | 20 | $820 | $17.3K |
| 52000 | 26 | 290 | 70 | $190 | $15.5K |
| 52601 | 2 | 30 | 10 | $830 | $14.9K |
| 52235 | 1 | 10 | 20 | $650 | $14.9K |
Showing 1–10 of 33
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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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. | 3,330 | $350 | $1.2M |
| 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… | 1,760 | $340 | $598.4K |
| 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… | 920 | $410 | $375.1K |
| 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… | 970 | $360 | $354.5K |
How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Jersey median
4 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. | 20 | 280 | 360 | $560 | $567.5K |
| 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… | 23 | 170 | 200 | $470 | $313.6K |
| 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… | 21 | 110 | 250 | $540 | $292.2K |
| 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… | 11 | 100 | 110 | $400 | $150.1K |
Other providers in the same ZIP code as Shore Outpatient Surgicenter LLC, ranked by combined Medicare and Medicaid revenue.
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