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NPI 1508839473 · Newark, DE · Ambulatory Surgical Clinic/Center
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Newark Endoscopy Asc 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 | Newark Endoscopy Asc LLC |
| Address | 1090 Old Churchmans Rd |
| City | Newark |
| State | DE |
| ZIP | 19713 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | February 9, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $970K |
Taxonomy and service mix: As an Ambulatory Surgical Clinic/Center, NEWARK ENDOSCOPY ASC LLC’s billed activity is concentrated in GI endoscopy procedures — the top Medicare and Medicaid codes are colonoscopy with polypectomy (45385), diagnostic/biopsy colonoscopy (45380), and upper endoscopy with biopsy (43239). The presence of screening codes G0105 and G0121 on the Medicare side alongside therapeutic codes such as 45385 indicates the facility performs both screening and interventional endoscopy workflows.
Medicare revenue concentration: Medicare receipts total $1.4M and are heavily concentrated in a small set of procedures — the precomputed top three Medicare codes account for 74.4% of Medicare revenue, driven by 45385 ($522.3K, 38.2%), 45380 ($264.9K, 19.4%), and 43239 ($229.1K, 16.8%). This concentration shows that a few high-volume endoscopy services dominate the provider’s Medicare financial profile.
Medicaid revenue concentration: Medicaid receipts total $970K and are even more concentrated, with the precomputed top three Medicaid codes accounting for 87.6% of Medicaid revenue; 43239 ($440K, 45.4%), 45385 ($207.4K, 21.4%), and 45380 ($202K, 20.8%) together drive most Medicaid billing. The Medicaid mix mirrors Medicare but with a larger share going to upper endoscopy biopsies (43239).
Payer mix and scale: The practice reports $1.4M in Medicare revenue versus $970K in Medicaid revenue, so Medicare is the larger single payer but Medicaid represents a substantial portion of total public-payer receipts; this is not a single-payer operation but rather one with significant dual public-payer reliance. Analysts should expect operational sensitivity to reimbursement differences across these two payers.
Competitive standing — Medicare national outlier: For Medicare the provider is a national-volume outlier on its core procedures — 45385 ranks in the 100th percentile (described as "extreme outlier"), 45380 in the 99th percentile ("extreme outlier"), and 43239 in the 100th percentile ("extreme outlier"). These ranks indicate the facility bills far above typical national volumes for its principal colonoscopy and upper endoscopy services.
Competitive standing — Medicaid in-state leader: In-state Medicaid ranks show the provider as a top regional performer for key services: 43239 ranks #2 of 32 providers (97th percentile; "notably above typical"), 45385 ranks #2 of 17 providers (94th percentile; "typical, unremarkable" volume relative to the state list), and 45380 ranks #3 of 16 providers (87th percentile). These positions make the ASC one of the highest-volume Medicaid endoscopy sites in Delaware, particularly for upper endoscopy biopsies.
Reimbursement and revenue-per-claim patterns: Average paid per claim differs by payer for the same services — for example, 43239 shows $256 avg paid/claim in Medicare versus $151 avg paid/claim in Medicaid, and 45385 shows $471 avg paid/claim in Medicare versus $231 avg paid/claim in Medicaid. These per-claim differences imply that Medicaid volume must be relatively higher to generate comparable revenue and that payer mix will materially affect realized revenue per procedure.
Tenure and stability: The NPI was enumerated on 2006-02-09 (~20 years ago), indicating roughly two decades of enrollment and suggesting an established ambulatory endoscopy operation with a long-standing presence in the local market and payer networks.
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… | 1,110 | $470 | $522.3K |
| 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 | $370 | $264.9K |
| 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. | 900 | $260 | $229.1K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 350 | $430 | $151.3K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 160 | $430 | $69.1K |
| 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. | 70 | $600 | $40.9K |
| 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… | 100 | $340 | $32.7K |
| 43251 | An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope through the mouth. The physician removes one or more lesions using a snare… | 30 | $610 | $18.8K |
| 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. | 50 | $280 | $14.6K |
| 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… | 50 | $250 | $11.8K |
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. | 2,910 | $150 | $440K |
| 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… | 900 | $230 | $207.4K |
| 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… | 1,010 | $200 | $202K |
| 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… | 580 | $210 | $120.2K |
| 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… | 60 | $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. | 2 | 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… | 3 | 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… | 2 | 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… | 3 | 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… | 8 | 10 | 150 | $0 | $0 |
Other providers in the same ZIP code as Newark Endoscopy Asc LLC, ranked by combined Medicare and Medicaid revenue.
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