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NPI 1386796332 · Toledo, OH · Clinic/Center
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Toledo Clinic Incorporated is a clinic/center provider located in Toledo, Ohio. This profile covers 49 Medicare and 11 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 | Toledo Clinic Incorporated |
| Address | 4235 Secor Rd |
| City | Toledo |
| State | OH |
| ZIP | 43623 |
| Taxonomy | Clinic/Center |
| NPI Enumerated | January 18, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $812.9K |
TOLEDO CLINIC INCORPORATED has a mixed interventional and endoscopy-centered service mix: Medicare billing is led by neuromodulation and pain interventions (63685 and 63650) and dialysis access procedures (36902), while Medicaid volume is dominated by upper endoscopy and colonoscopy services (43239, 45380, 45385). The specific codes reported (e.g., 63685, 63650, 36902, 43239, 45380, 45385) indicate the provider performs surgical implantations, image‑guided vascular interventions, and high-volume GI diagnostic/therapeutic procedures rather than being limited to a single ambulatory specialty. This combination suggests an operation that integrates surgical, interventional radiology/vascular access, pain management, and GI/endoscopy capabilities.
Revenue concentration differs markedly by payer: the top 3 Medicare codes by revenue account for 43.2% of the provider's Medicare revenue, with 63685, 63650, and 36902 the primary drivers of the $2.4M in Medicare receipts. On the Medicaid side the top 3 codes account for 86.9% of Medicaid revenue, indicating an even stronger concentration where 43239, 45380, and 45385 together dominate the $812.9K in Medicaid receipts. These precomputed shares show Medicare revenue is more distributed across procedures while Medicaid billing is heavily concentrated in a few high-volume endoscopy codes.
The payer mix is Medicare‑weighted: the provider reports $2.4M in Medicare revenue versus $812.9K in Medicaid revenue, so Medicare represents the larger portion of its public-payer billing. Analysts should treat this entity as more dependent on Medicare cashflow while recognizing Medicaid still supports substantial GI/endoscopy volume. This is not a single‑payer operation, but Medicare materially outweighs Medicaid in scale.
Competitive standing across payers is mixed by service line. For Medicare GI codes the provider is a national high-volume outlier — 43239 ranks in the 99th percentile (extreme outlier, far above typical national volume) and 45385 ranks in the 98th percentile (notably above typical national volume) — indicating a national-scale presence in upper endoscopy and polypectomy services. By contrast, Medicare leadership codes tied to neuromodulation (63685 at the 70th percentile and 63650 at the 83rd percentile) are described as typical or unremarkable national volumes, so the provider is a modest participant for those services at the national level.
Within the state Medicaid market the provider shows strong relative volume for endoscopy but not uniformly across all service lines: 43239 ranks #53 of 280 in-state (81st percentile) and 45380 ranks #24 of 175 (86th percentile), both characterized as typical, unremarkable volume relative to state peers despite representing the majority of Medicaid revenue. In contrast, interventional dialysis code 36902 ranks poorly in-state (#23 of 28, 19th percentile), signaling that the provider's dialysis access interventions are not a leading Medicaid service within Ohio. These distinctions indicate local competitive strength in GI procedures but limited state market share for some vascular/interventional services.
Several codes appear as statistical outliers or unusually concentrated administrative/quality reporting in Medicaid: G8918 and G8907 each show large claim counts with $0 revenue and are labeled extreme outliers in-state, while other zero‑paid G‑codes appear in top Medicaid claims. These entries reflect high-volume reporting of quality or process measure codes rather than fee-for-service revenue; analysts should not conflate those counts with reimbursed clinical revenue but should flag them as atypical reporting patterns relative to peers.
Operational implications from the code mix include a case mix that supports both ambulatory surgical procedures (e.g., 66984 cataract extraction, 47562 laparoscopic cholecystectomy) and high-throughput endoscopy units (43239, 45380, 45385). The presence of vascular access and tunneled catheter services (36821, 36561, 36581) alongside interventional radiology codes (36902, 36903) suggests the clinic likely manages hemodialysis access and related perioperative care rather than only diagnostic endoscopy. Payers considering network contracting should evaluate capacity across these distinct service lines rather than treating the provider as a single‑service clinic.
The provider has an established operational tenure: the NPI was enumerated on 2007-01-18 (~19 years ago), indicating long‑running participation in Medicare/Medicaid programs. That longevity, combined with concentrated Medicaid endoscopy volume and national outlier status in specific Medicare GI codes, points to sustained specialization in endoscopy services while maintaining a diversified set of interventional and surgical offerings. Analysts should pair this tenure information with utilization trends to assess stability or shifts in service emphasis over time.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
49 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 20 | $17,960 | $413.1K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 80 | $3,480 | $289K |
| 36902 | The provider introduces a needle and/or catheter under fluoroscopic guidance (live X–rays that can be viewed on a monitor) and injects contrast material into the dialysis access point to visualize… | 150 | $1,670 | $256.7K |
| 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… | 270 | $780 | $206.7K |
| 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… | 420 | $390 | $163.5K |
| 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. | 600 | $220 | $131.4K |
| 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… | 350 | $280 | $98.8K |
| 49650 | The provider performs laparoscopic repair of an initial inguinal hernia. | 50 | $1,590 | $74.9K |
| 36903 | The provider introduces a needle and/or catheter under fluoroscopic guidance (live X–rays that can be viewed on a monitor) and injects contrast material into the dialysis access point to visualize… | 10 | $4,950 | $69.3K |
| 52281 | The provider uses a cystoscope to view inside the urethra and bladder of a male or female patient. The procedure must include calibrating or dilating a urethral stricture or stenosis. The procedure… | 100 | $610 | $60.3K |
Showing 1–10 of 49
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 49 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
49 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 9 | 30 | 20 | $5,480 | $109.6K |
| 66984 | 233 | 530 | 210 | $110 | $92.8K |
| 63650 | 7 | 30 | 50 | $1,480 | $88.7K |
| 36902 | 8 | 50 | 40 | $890 | $65.1K |
| J0585 | 53 | 100 | 7,600 | $1 | $52.1K |
| 36903 | 8 | 10 | 20 | $2,820 | $45.1K |
| 66982 | 78 | 150 | 30 | $470 | $24.9K |
| 45385 | 17 | 670 | 50 | $270 | $22.9K |
| 36581 | 14 | 20 | 20 | $770 | $22.3K |
| G0260 | 7 | 30 | 40 | $200 | $17.5K |
Showing 1–10 of 49
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.
11 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. | 1,710 | $260 | $440.9K |
| 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… | 840 | $180 | $146.3K |
| 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… | 380 | $310 | $117.6K |
| 36902 | The provider introduces a needle and/or catheter under fluoroscopic guidance (live X–rays that can be viewed on a monitor) and injects contrast material into the dialysis access point to visualize… | 110 | $560 | $59.4K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 160 | $230 | $37.3K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 30 | $260 | $7.6K |
| 36589 | In this procedure, the provider removes a tunneled central venous access device without the subcutaneous port or pump. | 10 | $180 | $2.2K |
| 64494 | In this add–on procedure, the provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that… | 30 | $0 | $0 |
| 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… | 1,880 | $0 | $0 |
| G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | 30 | $0 | $0 |
Showing 1–10 of 11
How this provider's Medicaid billing volume and revenue compare to other Ohio providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Ohio median
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 36902 | The provider introduces a needle and/or catheter under fluoroscopic guidance (live X–rays that can be viewed on a monitor) and injects contrast material into the dialysis access point to visualize… | 23 | 30 | 430 | $350 | $286.1K |
| 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. | 53 | 280 | 570 | $250 | $276.5K |
| 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… | 24 | 180 | 190 | $320 | $139.3K |
| 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… | 35 | 150 | 140 | $450 | $129.5K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 49 | 100 | 170 | $240 | $84.7K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 76 | 110 | 70 | $190 | $63.5K |
| 36589 | In this procedure, the provider removes a tunneled central venous access device without the subcutaneous port or pump. | 7 | 10 | 80 | $220 | $24.1K |
| 64494 | In this add–on procedure, the provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that… | 72 | 100 | 80 | $30 | $9.4K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1 | 40 | 40 | $1 | $100 |
| 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 | $60 |
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Other providers in the same ZIP code as Toledo Clinic Incorporated, ranked by combined Medicare and Medicaid revenue.
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