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NPI 1518957729 · Traverse City, MI · Ambulatory Surgical Clinic/Center
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Northwest Michigan Surgery Center LLC is a ambulatory surgical clinic/center provider located in Traverse City, Michigan. This profile covers 40 Medicare and 13 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 | Northwest Michigan Surgery Center LLC |
| Address | 4100 Park Forest Drive |
| City | Traverse City |
| State | MI |
| ZIP | 49684 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 27, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.9M |
| Medicaid | $1.5M |
As an Ambulatory Surgical Clinic/Center, the provider’s paid claims mix centers on outpatient procedural specialties: high-volume GI endoscopy (codes 45385, 45380, 43239/43248), ophthalmology/cataract surgery (66984, 66982, 66991), and implantable pain/spinal procedures (63685, 63650). This combination of codes indicates the site supports same-day procedural workflows across multiple specialties rather than being limited to a single surgical focus.
Revenue concentration on Medicare is substantial: the top 3 Medicare codes by revenue account for 58.4% of this provider's total Medicare revenue, driven by 66984 (27.2% of Medicare revenue, $737K), 63685 (15.7%, $423.9K), and 45385 (15.5%, $420.1K). This level of concentration means a small number of high-reimbursement procedures disproportionately shape the provider’s Medicare topline.
Medicaid revenue is even more concentrated in GI services: the top 3 Medicaid codes by revenue account for 86.4% of this provider's total Medicaid revenue, comprised of 45385 (30.2%, $443.5K), 45380 (28.3%, $415.9K), and 43239 (27.8%, $407.9K). That concentration signals the provider’s Medicaid activity is effectively dominated by endoscopy and related diagnostic/interventional upper GI procedures.
On payer mix, Medicare scale exceeds Medicaid: reported lifetime Medicare revenue is $2.9M versus Medicaid revenue of $1.5M, so the practice generates larger absolute revenue from Medicare while maintaining a meaningful Medicaid presence. Both payers are active, but Medicare is the larger single source of recorded payments.
National competitive standing on key Medicare codes is mixed: for colon polypectomy 45385 the provider ranks #58 of 16310 providers (100th percentile) and is labeled an "extreme outlier, far above typical national volume"; upper endoscopy 43239 also ranks highly (#272 of 17140, 98th percentile, extreme outlier). By contrast, cataract code 66984 (rank #2005 of 15965, 87th percentile) and spinal neurostim 63685 (rank #319 of 1281, 72th percentile) are high-volume but fall into more typical national ranges. This pattern suggests national-level dominance in certain GI procedures while other service lines are closer to peer norms.
State-level (Medicaid) competitive standing is solid but not dominant: for Medicaid the three GI leaders rank in-state at #23 of 106 (79th percentile) for 45385, #34 of 153 (78th percentile) for 45380, and #56 of 216 (74th percentile) for 43239. These placements indicate above-average regional volume for GI services within Michigan but not the same extreme outlier status seen in the national Medicare comparison.
The Medicaid dataset contains substantial claim counts with $0 avg paid/claim for several codes (for example A4649: 873 claims $0, 87635: 601 claims $0, 81025: 940 claims $0). Those high-count, zero-paid entries may reflect bundled payments, capitated arrangements, or administrative/reporting practices for supplies and common lab tests, and they warrant caution when using raw Medicaid claim counts to infer revenue or service intensity.
The provider’s NPI was enumerated 2005-10-27 (~21 years ago), indicating long-tenure operation in Traverse City, MI. Combined with the multi-specialty procedural mix and the observed revenue concentrations, this longevity is consistent with an established ambulatory surgical center that has developed stable referral and procedure volumes 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.
40 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 970 | $760 | $737K |
| 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 | $17,660 | $423.9K |
| 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… | 1,010 | $420 | $420.1K |
| 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… | 440 | $310 | $136.7K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 30 | $3,520 | $112.5K |
| 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. | 510 | $210 | $108.6K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 190 | $390 | $73.9K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 50 | $1,410 | $73.1K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 250 | $270 | $64.9K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 160 | $390 | $61K |
Showing 1–10 of 40
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 40 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
40 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 3 | 40 | 20 | $6,790 | $108.7K |
| C9740 | 2 | 10 | 20 | $5,090 | $106.8K |
| 63650 | 24 | 30 | 40 | $1,760 | $80.9K |
| 66984 | 9 | 480 | 70 | $470 | $69.5K |
| 66991 | 22 | 30 | 30 | $1,460 | $51.2K |
| 67904 | 9 | 40 | 30 | $570 | $29.3K |
| 65820 | 5 | 60 | 20 | $880 | $25.6K |
| 15823 | 7 | 50 | 30 | $540 | $23.7K |
| 66982 | 18 | 130 | 30 | $630 | $22.2K |
| 66180 | 4 | 10 | 20 | $1,230 | $19.7K |
Showing 1–10 of 40
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.
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… | 1,160 | $380 | $443.5K |
| 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… | 1,250 | $330 | $415.9K |
| 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. | 1,740 | $230 | $407.9K |
| 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… | 130 | $690 | $86.3K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 170 | $260 | $43.8K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 130 | $300 | $37.4K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 10 | $2,150 | $27.9K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 20 | $290 | $4.6K |
| 81025 | The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout. | 940 | $0 | $0 |
| 82962 | Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained… | 10 | $0 | $0 |
Showing 1–10 of 13
How this provider's Medicaid billing volume and revenue compare to other Michigan providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Michigan median
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 44 | 50 | 150 | $1,300 | $889.5K |
| 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… | 34 | 50 | 310 | $400 | $267.7K |
| 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. | 56 | 220 | 440 | $180 | $249.7K |
| 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… | 34 | 150 | 240 | $280 | $214.5K |
| 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… | 23 | 110 | 300 | $270 | $207.5K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 34 | 60 | 170 | $260 | $184.1K |
| A4649 | Surgical supply; miscellaneous | 3 | 20 | 270 | $100 | $120.7K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 35 | 40 | 100 | $330 | $117.5K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 5 | 10 | 170 | $160 | $80.3K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 168 | 410 | 350 | $30 | $50.2K |
Showing 1–10 of 13
Other providers in the same ZIP code as Northwest Michigan Surgery Center LLC, ranked by combined Medicare and Medicaid revenue.
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