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NPI 1518995513 · Vadnais Heights, MN · Ambulatory Surgical Clinic/Center
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Affiliated Endoscopy Centers, LLC is a ambulatory surgical clinic/center provider located in Vadnais Heights, Minnesota. This profile covers 13 Medicare and 6 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 | Affiliated Endoscopy Centers, LLC |
| Address | 3588 Arcade St # 100 |
| City | Vadnais Heights |
| State | MN |
| ZIP | 55127 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $2M |
| Medicare | $967.7K |
Taxonomy and code mix identify this entity as an ambulatory endoscopy center: the provider is listed as Ambulatory Surgical Clinic/Center and billing is dominated by colonoscopy and upper endoscopy procedures such as 45385, 45380, and 43239, indicating the site primarily performs diagnostic and therapeutic GI endoscopy (polypectomy, biopsy, and routine colonoscopy/EGD). The procedure mix is consistent with an ASC model focused on throughput of routine and interventional endoscopic procedures rather than broad surgical subspecialty services.
Medicare revenue is concentrated in a small set of endoscopy codes: total Medicare revenue is $967.7K and the provider’s top three Medicare codes account for 77.1% of that Medicare revenue, led by 45385 (44.6%), 45380 (19.9%), and 43239 (12.6%). This level of concentration indicates that Medicare billing is heavily dependent on a narrow set of high-volume GI procedures.
Medicaid revenue shows an even stronger concentration: total Medicaid revenue is $2M and the top three Medicaid codes account for 95.3% of Medicaid revenue, with 43239 (43.1%), 45385 (26.1%), and 45380 (26.1%) driving nearly all reported Medicaid payments. Operationally, that pattern signals the provider’s Medicaid business is almost entirely composed of upper and lower endoscopy services.
Payer mix tilts toward Medicaid in scale: reported Medicaid revenue ($2M) is larger than Medicare revenue ($967.7K), so this provider is not Medicare-dominant and appears to rely more heavily on Medicaid volume for overall throughput and revenue. Analysts evaluating contracting or network impact should treat Medicaid volumes as a primary revenue driver for this entity.
National competitive standing for Medicare procedures is unusually high: the provider’s Medicare ranks place several core codes as national outliers — 45385 at #80/16310 (100th percentile; extreme outlier), 45380 at #193/16427 (99th percentile; extreme outlier), and 43239 at #314/17140 (98th percentile; extreme outlier). These standings indicate exceptionally high national procedure volume for these codes relative to peers and suggest the provider is a major national source of billed Medicare endoscopy services.
In-state competitive posture for Medicaid is strong but not extreme: Medicaid ranks for core codes show 43239 at #3 of 44 (95th percentile; typical, unremarkable volume), 45385 at #6 of 19 (72th percentile; typical, unremarkable volume), and 45380 at #5 of 21 (80th percentile; typical, unremarkable volume). That profile implies meaningful local market share for Medicaid endoscopy without the same national outlier status seen in Medicare.
Longstanding enrollment supports continuity of operations: the NPI was enumerated on 2006-06-29 (≈20 years ago), indicating a sustained market presence. Combined with persistent, concentrated billing for core endoscopy CPTs across both payers, this suggests established referral pathways and operational stability in GI procedural throughput.
The juxtaposition of national ‘‘extreme outlier’’ Medicare volumes for multiple core endoscopy codes and in-state ‘‘typical, unremarkable’’ Medicaid percentiles suggests different competitive dynamics by payer; payers and network managers may prioritize targeted contract terms or utilization management for Medicare relationships while approaching Medicaid engagement with recognition of the provider’s sizable but regionally typical capacity.
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… | 900 | $480 | $431.6K |
| 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… | 540 | $360 | $192.4K |
| 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. | 480 | $250 | $121.7K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 170 | $440 | $76.1K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 90 | $440 | $40K |
| 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… | 90 | $320 | $26.9K |
| 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 | $320 | $19.9K |
| 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… | 50 | $350 | $16.6K |
| 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. | 30 | $580 | $16.2K |
| 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… | 40 | $250 | $9.8K |
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.
6 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. | 2,180 | $400 | $868.2K |
| 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 | $526.9K |
| 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… | 1,000 | $530 | $526.9K |
| 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… | 210 | $440 | $94.1K |
| 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… | 80 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 80 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Minnesota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Minnesota median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 6 | 20 | 110 | $240 | $253.2K |
| 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… | 5 | 20 | 220 | $190 | $189.2K |
| 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… | 6 | 10 | 210 | $210 | $148.8K |
| 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. | 3 | 40 | 100 | $140 | $148.2K |
| 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… | 9 | 20 | 130 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 4 | 10 | 80 | $0 | $0 |
Other providers in the same ZIP code as Affiliated Endoscopy Centers, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Suite Living Senior Care Of Vadnais Heights | MN | Assisted Living Facility | $0 | $4.6M |
| Vadnais Heights Surgery Center LLC | MN | Ambulatory Surgical Clinic/Center | $1.7M | $0 |
| Olaf Rustad | MN | Dermatology Physician | $282.9K | $0 |
| Ruth Rustad | MN | Dermatology Physician | $120.1K | $0 |
| Catherine Choi | MN | Pain Medicine (Physical Medicine & Rehabilitation) Physician | $108.4K | $0 |
| Sherri Long | MN | Dermatology Physician | $93.7K | $0 |
| Abigail Tracy | MN | Physician Assistant | $81.6K | $0 |
| Eliza Abraham | MN | Medical Physician Assistant | $75.5K | $0 |
| Peter Dahlstrom | MN | Family Medicine Physician | $71.1K | $0 |
| Jacqueline St. John | MN | Surgical Physician Assistant | $71K | $0 |
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