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NPI 1538110713 · Tupelo, MS · Ambulatory Surgical Clinic/Center
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Center For Digestive Health LLC is a ambulatory surgical clinic/center provider located in Tupelo, Mississippi. This profile covers 19 Medicare and 8 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 | Center For Digestive Health LLC |
| Address | 589 Garfield St |
| City | Tupelo |
| State | MS |
| ZIP | 38801 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | May 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.7M |
| Medicare | $1.6M |
CENTER FOR DIGESTIVE HEALTH LLC operates as an ambulatory surgical clinic/center with a procedure mix dominated by gastrointestinal endoscopy—high-volume colonoscopy and upper endoscopy codes such as 45385, 45380, and 43239 drive its case mix, supplemented by related codes (e.g., 43235, 45378) that reflect both diagnostic and therapeutic endoscopic services. This pattern is consistent with a facility focused on outpatient GI procedures rather than broad multispecialty surgical care.
Medicare revenue is concentrated in a small set of GI procedures: the top three Medicare codes (45385, 45380, 43239) account for 61.3% of the provider’s total Medicare revenue, with code-level contributions of $440.7K (45385, 27.6%), $301.8K (45380, 18.9%), and $235.7K (43239, 14.8%). This concentration indicates that a few endoscopic procedures constitute the bulk of the practice’s Medicare business.
Medicaid billing is even more concentrated: the top three Medicaid codes (43239, 45380, 45385) represent 81.1% of this provider’s total Medicaid revenue, led by $692.5K from 43239 (40.3%), $354.1K from 45380 (20.6%), and $348.1K from 45385 (20.2%). For Medicaid payers, the provider’s revenue is heavily dependent on a narrow set of endoscopy services.
The provider’s payer mix is roughly balanced: total Medicare revenue is $1.6M while total Medicaid revenue is $1.7M, meaning the practice is effectively a dual-payer operation with a slight tilt toward Medicaid in absolute dollars. Analysts should treat this entity as neither Medicare- nor Medicaid-exclusive when assessing network capacity or negotiating rates.
On national Medicare benchmarks this provider is a clear outlier for key GI codes: 45385, 45380, and 43239 all rank in the 100th percentile (described in the data as “extreme outlier”), and 43235 ranks #3 of 7405 providers (100th percentile). These rankings signal exceptionally high national procedural volume for several colonoscopy and EGD codes compared with typical Medicare peers.
Within Mississippi Medicaid volumes the provider is a dominant state-level performer: 43239 ranks #4 of 73 providers (96th percentile), 45380 ranks #2 of 31 providers (97th percentile), 45385 ranks #2 of 26 providers (96th percentile), and 43235 ranks #1 of 14 providers (100th percentile). This establishes the clinic as a major in-state capacity node for both diagnostic and therapeutic endoscopy.
Observed claim counts underline throughput and utilization intensity: examples include 4.9K Medicaid claims for 43239 and 2.1K Medicaid claims for 45385, alongside Medicare counts such as 1.1K claims for 45385 and 1.0K claims for 43239. These high claim volumes, paired with the percentile labels reported (e.g., “extreme outlier”, “notably above typical”), indicate sustained, high-frequency delivery of endoscopic procedures rather than sporadic high-dollar events.
The provider’s NPI was enumerated on 2006-05-13 (~20 years ago), indicating long tenure in the market as an ambulatory GI surgical center; combined longevity and concentrated procedural volume suggest an established operational model and stable referral streams for endoscopy services. This tenure should be factored into competitive assessments and capacity planning for both Medicare and Medicaid 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.
19 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… | 1,130 | $390 | $440.7K |
| 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… | 950 | $320 | $301.8K |
| 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. | 1,020 | $230 | $235.7K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 300 | $370 | $110.6K |
| 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. | 400 | $230 | $93.3K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 250 | $360 | $89.1K |
| 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… | 210 | $280 | $58.4K |
| 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. | 110 | $490 | $54K |
| 45384 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions using hot biopsy… | 130 | $370 | $48.1K |
| 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. | 140 | $260 | $37.1K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 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.
8 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. | 4,880 | $140 | $692.5K |
| 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… | 2,460 | $140 | $354.1K |
| 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… | 2,100 | $170 | $348.1K |
| 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… | 960 | $180 | $176.3K |
| 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. | 1,150 | $130 | $144.8K |
| 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. | 70 | $50 | $3.7K |
| 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… | 2,230 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 2,230 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Mississippi providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Mississippi median
8 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. | 4 | 70 | 200 | $180 | $200.4K |
| 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… | 2 | 30 | 420 | $210 | $165.6K |
| 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 | 30 | 170 | $190 | $89.5K |
| 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 | 30 | 80 | $200 | $58K |
| 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. | 1 | 10 | 80 | $160 | $40.5K |
| 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. | 7 | 10 | 140 | $60 | $17.9K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 5 | 40 | 140 | $1 | $590 |
| 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 | 60 | 520 | $1 | $200 |
Other providers in the same ZIP code as Center For Digestive Health LLC, ranked by combined Medicare and Medicaid revenue.
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