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NPI 1528643285 · Fletcher, NC · Ambulatory Surgical Clinic/Center
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Summit Health Partners LLC is a ambulatory surgical clinic/center provider located in Fletcher, North Carolina. This profile covers 12 Medicare and 3 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 | Summit Health Partners LLC |
| Address | 30 Airport Park Rd Apt Suite |
| City | Fletcher |
| State | NC |
| ZIP | 28732 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | March 15, 2021 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.2M |
| Medicaid | $527K |
This provider is Medicare-dominant in scale: reported total Medicare revenue is $2.2M compared with total Medicaid revenue of $527K, so Medicare constitutes the larger payer relationship for this entity. Both payers are active on file, but Medicare drives the bulk of overall billed revenue.
Service-line mix reflects a surgical ambulatory center with strong ophthalmology and large-joint arthroplasty activity: Medicare top codes include 66984 (1.1K claims, $849.9K revenue, 38.4% of Medicare revenue), 27447 (97 claims, $644.5K revenue, 29.1% of Medicare revenue), and 27130 (61 claims, $413.3K revenue, 18.7% of Medicare revenue). These high-revenue procedures indicate the site performs cataract extraction/implantation and major orthopedic procedures (knee and hip replacements) as primary revenue drivers consistent with its Ambulatory Surgical Clinic/Center taxonomy.
Revenue concentration is high on both payers: the top three Medicare codes account for 86.1% of this provider's total Medicare revenue, and the top three Medicaid codes account for 100.0% of its Medicaid revenue. This degree of concentration signals a narrow set of procedures that comprise nearly all reimbursed activity — an important consideration for payer contracting and utilization review.
Medicare competitive standing is moderate-to-strong but not dominant nationally for its headline procedures: 66984 ranks #1882 of 15965 providers nationally (88th percentile, characterized as typical/unremarkable volume), 27447 ranks #968 of 12089 (92th percentile, typical/unremarkable volume), and 27130 ranks #991 of 8062 (87th percentile, typical/unremarkable volume). These percentiles indicate above-average volume versus peers but not market dominance, suggesting the provider is a meaningful regional participant for these surgeries.
Medicaid activity is concentrated in pediatric ENT: 69436 (tympanostomy with tube) shows 1.1K claims and $346.3K revenue (65.7% of Medicaid revenue) and ranks #15 of 88 in-state (84th percentile), while 42820 (tonsil/adenoid removal <12 y) has 482 claims and $173.5K revenue (32.9% of Medicaid revenue) and ranks #11 of 55 in-state (81th percentile). Those claim counts and in-state ranks portray the provider as a notable Medicaid pediatric ENT site in North Carolina.
The provider shows specific statistical outliers in elective ENT procedures relative to national peers: code 30520 is listed as an extreme outlier (46 claims, $32K revenue) and ranks #13 of 559 providers nationally (98th percentile), and code 30140 is notably above typical national volume (78 claims, $32.8K revenue) and ranks #30 of 646 (95th percentile). These flags point to unusually high septoplasty and inferior turbinate procedure volumes that augment the center's ENT footprint beyond its orthopedic and ophthalmic case mix.
Tenure is relatively recent: the NPI was enumerated on 2021-03-15 (~5 years ago). Despite this shorter operating history, the organization has established concentrated surgical throughput across distinct lines (ophthalmology, orthopedics, and pediatric ENT), which may influence near-term contracting leverage and operational risk profiles for payers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 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… | 1,100 | $770 | $849.9K |
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 100 | $6,640 | $644.5K |
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 60 | $6,780 | $413.3K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 1,460 | $80 | $111K |
| 63047 | The provider performs a laminectomy (excision of the thin bony plate at the back of a vertebra), facetectomy (excision of an area of a vertebra characterized by its smooth surface), and foraminotomy… | 30 | $2,180 | $63.1K |
| 31267 | In this procedure, the provider inserts an endoscope into the nasal cavity. She then gains access to the maxillary sinus through a cut in the uncinate process. The provider opens the maxillary sinus… | 30 | $1,180 | $34.1K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 80 | $420 | $32.8K |
| 30520 | Septoplasty is most often performed for a deviated septum which can be either C–shaped, S–shaped, or a cartilaginous deviation. | 50 | $700 | $32K |
| 29881 | The provider examines the inside of the knee joint with an arthroscope. She repairs the joint by removing the meniscus, a crescent shaped cartilage cushion, from either the medial or lateral… | 10 | $980 | $12.8K |
| 29880 | In this procedure, the provider performs arthroscopic examination of the knee joint. She removes the damaged and torn meniscus from the medial and lateral compartments of the knee joint along with… | 10 | $1,010 | $12.1K |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
12 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1097 | 7 | 10 | 1,240 | $80 | $151.9K |
| 66984 | 179 | 580 | 230 | $70 | $73.7K |
| 27447 | 33 | 460 | 30 | $1,000 | $41.8K |
| 27130 | 36 | 320 | 30 | $990 | $30.8K |
| 31267 | 5 | 20 | 20 | $810 | $18.6K |
| 29880 | 18 | 20 | 20 | $810 | $17K |
| 29881 | 20 | 30 | 10 | $820 | $15.6K |
| C9290 | 11 | 20 | 10,110 | $1 | $14.3K |
| 63047 | 26 | 150 | 20 | $570 | $13.1K |
| 30140 | 1 | 20 | 20 | $320 | $9.9K |
Showing 1–10 of 12
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 1,120 | $310 | $346.3K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 480 | $360 | $173.5K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 20 | $400 | $7.2K |
How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Carolina median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 15 | 90 | 120 | $350 | $184.9K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 11 | 60 | 100 | $390 | $123.1K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 15 | 20 | 90 | $410 | $79.3K |
Other providers in the same ZIP code as Summit Health Partners LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Reach For Independence, Inc | NC | Community/Behavioral Health Agency | $0 | $37.9M |
| Paul Kim | NC | Hematology & Oncology Physician | $300.1K | $0 |
| Duncan Scott | NC | Pain Medicine (Anesthesiology) Physician | $146.3K | $8.2K |
| Lawrence Cull | NC | Psychologist | $90.6K | $0 |
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