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NPI 1497751747 · Newark, DE · Ambulatory Surgical Clinic/Center
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Mid-atlantic Endoscopy Center, LLC is a ambulatory surgical clinic/center provider located in Newark, Delaware. This profile covers 13 Medicare and 5 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 | Mid-atlantic Endoscopy Center, LLC |
| Address | 4923 Ogletown Stanton Rd |
| City | Newark |
| State | DE |
| ZIP | 19713 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 22, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.1M |
| Medicare | $851.8K |
MID-ATLANTIC ENDOSCOPY CENTER, LLC presents as a focused ambulatory surgical/endoscopy clinic: its top paid CPTs are procedural GI codes such as 45385 (colonoscopic polypectomy), 45380 (colonoscopy with biopsy), and 43239 (EGD with biopsy), with Medicare entries showing $359.5K from 45385 (760 claims, $473 avg paid/claim), $183.8K from 45380 (498 claims, $369 avg paid/claim) and $124.4K from 43239 (514 claims, $242 avg paid/claim). The code mix indicates the operation is driven by both diagnostic and therapeutic lower- and upper-GI endoscopic procedures rather than broad outpatient surgical variety.
Revenue is highly concentrated in a small set of endoscopy codes: the top three Medicare codes account for 78.4% of total Medicare revenue and the top three Medicaid codes account for 81.2% of total Medicaid revenue. This concentration signals that a few procedure lines (colonoscopies with polypectomy/biopsy and EGDs with biopsy) drive the majority of the facility’s payer revenue.
Payer mix is Medicaid-weighted in scale: lifetime Medicaid revenue is $1.1M versus lifetime Medicare revenue of $851.8K, so Medicaid represents the larger single-payer revenue source on file. Both payers are meaningful, however, and the facility cannot be characterized as single-payer given the six-figure presence of each.
National Medicare competitive standing for the center’s top codes is unusually strong: 45385 ranks #137 of 16,310 providers (99th percentile; labeled an extreme outlier), 45380 ranks #227 of 16,427 (99th percentile; extreme outlier), and 43239 ranks #266 of 17,140 (98th percentile; extreme outlier). These rankings indicate the provider operates at far higher than typical national volume for its core colonoscopy and EGD procedures.
State-level Medicaid positioning shows the center is a leading in-state performer for select procedures: 43239 is 2,7K claims and $461.4K revenue, ranking #3 of 32 in-state (94th percentile; notably above typical state volume), while 45380 is #2 of 16 in-state (93rd percentile) with $253.1K from 1.1K claims. Other Medicaid top codes such as 45378 (942 claims, $218.5K; rank #2 of 14, 92nd percentile) and 45385 (872 claims, $216.3K; rank #3 of 17, 88th percentile) also contribute materially, supporting a strong in-state footprint for GI procedures.
There are striking differences in claim counts and payment levels between payers for the same procedures: for 43239 the center reports 514 Medicare claims ($124.4K, $242 avg paid/claim) versus 2.7K Medicaid claims ($461.4K, $169 avg paid/claim), showing substantially higher Medicaid procedure volume but lower average Medicaid payment per claim. Analysts should note both the volume-driven Medicaid revenue and the higher per-claim payments from Medicare when modeling profitability by payer and procedure.
The provider’s tenure is long-established: the NPI was enumerated 2005-06-22 (~21 years ago), which supports the likelihood of entrenched referral relationships and operational stability that could explain sustained high volumes on a narrow set of endoscopy codes. Long tenure combined with high ranking on national Medicare volumes suggests this facility is a stable regional/endoscopy hub.
Operational and reimbursement risk is concentrated: because a small group of endoscopy CPTs produce most revenue (top-3 shares of 78.4% Medicare and 81.2% Medicaid), changes in reimbursement policy, screening guidelines, or referral patterns for colonoscopy/EGD services would have outsized impact on overall revenue. Additionally, Medicaid’s larger share of lifetime revenue but lower per-claim payments (e.g., Medicare $473 avg for 45385 vs Medicaid $248 avg for 45385) means shifts in payer mix could materially change margin profiles.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 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… | 760 | $470 | $359.5K |
| 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… | 500 | $370 | $183.8K |
| 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. | 510 | $240 | $124.4K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 140 | $430 | $58.9K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 80 | $430 | $36.4K |
| 43450 | The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing. | 100 | $280 | $26.4K |
| 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… | 50 | $340 | $16.3K |
| 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. | 60 | $260 | $14.2K |
| 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. | 20 | $600 | $11.4K |
| 45381 | The provider inserts a flexible endoscope into the anus and navigates the scope through the entire colon. The provider performs one or more injections into the submucosa (the tissue below the mucous… | 30 | $250 | $7.3K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 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.
5 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. | 2,730 | $170 | $461.4K |
| 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… | 1,090 | $230 | $253.1K |
| 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… | 940 | $230 | $218.5K |
| 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… | 870 | $250 | $216.3K |
| 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… | 50 | $0 | $0 |
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
5 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. | 3 | 30 | 490 | $180 | $168.8K |
| 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… | 2 | 20 | 360 | $180 | $96.9K |
| 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… | 3 | 20 | 70 | $220 | $71.8K |
| 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 | 10 | 70 | $180 | $67.1K |
| 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… | 9 | 10 | 150 | $0 | $0 |
Other providers in the same ZIP code as Mid-atlantic Endoscopy Center, LLC, ranked by combined Medicare and Medicaid revenue.
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