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NPI 1407836315 · Newark, DE · Ambulatory Surgical Clinic/Center
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Spine Care Delaware, LLC is a ambulatory surgical clinic/center provider located in Newark, Delaware. This profile covers 10 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 | Spine Care Delaware, LLC |
| Address | 4102 Ogletown Stanton Rd Ste B |
| City | Newark |
| State | DE |
| ZIP | 19713 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | January 18, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $764.5K |
| Medicaid | $142.4K |
SPINE CARE DELAWARE, LLC presents as a highly procedure-focused ambulatory surgical clinic specializing in interventional spine care: its top Medicare and Medicaid codes are predominantly epidural and facet injections plus targeted nerve destruction procedures (notably 64483, 64628, 64635), which together indicate an operation oriented to image-guided pain interventions and ablative spine procedures rather than broad outpatient medical management. The taxonomy listing as an Ambulatory Surgical Clinic/Center aligns with this code mix and suggests most activity occurs in a procedural, clinic-based setting.
Medicare revenue is heavily concentrated in a very small set of procedures: the provider's top 3 Medicare codes (64483, 64628, 64635) account for 74.8% of its total Medicare revenue. Individually, 64483 contributes $244.6K (32.0%), 64628 contributes $237.2K (31.0%), and 64635 contributes $89.9K (11.8%) of the $764.5K total Medicare revenue, indicating reliance on a narrow set of high-volume/high-value spine interventions.
Medicaid billing is even more concentrated: the precomputed top-3 Medicaid codes account for 100.0% of this provider's Medicaid revenue. That concentration is dominated by 64483, which comprises $133.9K (94.2%) of the $142.4K total Medicaid revenue, with 64493 making up the remainder at $8.3K (5.8%), showing near-exclusive Medicaid exposure to transforaminal epidural injection services.
The payer mix is skewed toward Medicare in scale: the provider reports $764.5K in lifetime Medicare revenue versus $142.4K in lifetime Medicaid revenue, so Medicare represents the materially larger revenue stream for this entity. This pattern indicates the clinic’s commercial and reimbursement footprint is driven primarily by Medicare beneficiaries while still maintaining a smaller Medicaid caseload.
For specific codes the provider is a notable outlier nationally on Medicare for at least one service: 64483 ranks #51 of 8202 providers nationally (99th percentile; extreme outlier), marking the practice as a national high-volume provider of transforaminal epidural injections. Additionally, 64635 ranks #304 of 5957 (95th percentile; notably above typical national volume) and 64628 ranks #45 of 247 (81th percentile; typical), together signaling unusually high activity on select interventional spine procedures compared with peers.
In-state competitive standing on Medicaid is moderate rather than dominant: 64483 ranks #4 of 9 providers in-state (63th percentile; typical) and 64493 ranks #5 of 7 (33th percentile; typical), indicating the clinic is an active Medicaid provider for these injections but not a clear market leader within Delaware. The contrast between national Medicare prominence for 64483 and middling in-state Medicaid ranks suggests the practice draws a substantial Medicare volume beyond what its local Medicaid rankings alone would imply.
The provider’s payment profile shows high-value procedures are part of its mix: for example, 64628 posts an average paid per claim of $7906 (30 claims, $237.2K revenue) on Medicare, highlighting that basivertebral nerve ablation is a significant revenue driver when performed. This high average allowed amount for 64628, combined with concentration in a few codes, suggests revenue sensitivity to procedural mix and utilization of higher-reimbursement spine ablation services.
SPINE CARE DELAWARE has an established operational history, with its NPI enumerated 2006-01-18 (~20 years ago), which supports interpretation of these patterns as mature and sustained rather than a short-term anomaly. The long tenure plus pronounced specialization in image-guided injections and neurolytic procedures implies the organization has developed a stable niche in interventional spine care 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.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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). | 830 | $300 | $244.6K |
| 64628 | The provider uses a thermal (heat) method under imaging guidance to destroy an intraosseous basivertebral nerve. Use this code for the first two lumbar or sacral vertebral bodies treated at a session. | 30 | $7,910 | $237.2K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 160 | $580 | $89.9K |
| 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… | 250 | $270 | $68.6K |
| 64479 | 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 cervical or thoracic). | 120 | $330 | $38.3K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 100 | $250 | $26.4K |
| 64490 | The provider injects a diagnostic or therapeutic substance into a single cervical or thoracic paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging… | 80 | $250 | $20K |
| 64633 | In this procedure, the provider destroys the facet joint nerve of a cervical or thoracic spinal segment using neurolytic agents like heat, electric current, or a chemical compound. He makes use of… | 30 | $620 | $16.7K |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | 70 | $220 | $14.3K |
| 62321 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the cervical (neck) or thoracic (upper and middle back)… | 30 | $250 | $8.5K |
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
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 |
|---|---|---|---|---|
| 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). | 510 | $260 | $133.9K |
| 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 | $270 | $8.3K |
How this provider's Medicaid billing volume and revenue compare to other Delaware providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Delaware median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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). | 4 | 10 | 340 | $140 | $79.7K |
| 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… | 5 | 10 | 150 | $60 | $35.8K |
Other providers in the same ZIP code as Spine Care Delaware, LLC, ranked by combined Medicare and Medicaid revenue.
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