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NPI 1548842180 · Waterloo, IA · Ambulatory Surgical Clinic/Center
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Digestive Health Center LLC is a ambulatory surgical clinic/center provider located in Waterloo, Iowa. This profile covers 15 Medicare and 4 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 | Digestive Health Center LLC |
| Address | 1015 S Hackett Rd Ste B |
| City | Waterloo |
| State | IA |
| ZIP | 50701 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | April 23, 2021 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $852K |
| Medicaid | $613K |
DIGESTIVE HEALTH CENTER LLC operates as an ambulatory surgical clinic/center with a clear gastroenterology endoscopy focus: its highest-revenue Medicare codes are 45385 (polypectomy), 43249 (esophageal dilation), and 45380 (colonoscopy with biopsy/excision), and its Medicaid mix is similarly dominated by endoscopy codes including 43239 (EGD with biopsy) and 45380. The prevalence of therapeutic and diagnostic endoscopic CPTs indicates the site is delivering both routine diagnostic EGDs/colonoscopies and higher-acuity therapeutic services (polypectomy, dilation).
Revenue concentration is high on a very small set of procedures: the top 3 Medicare codes by revenue account for 68.5% of total Medicare revenue, and the top 3 Medicaid codes by revenue account for 93.4% of total Medicaid revenue. This concentration means a handful of endoscopic procedure lines drive the bulk of the practice’s payer revenue.
Payer mix shows Medicare scale exceeding Medicaid in absolute dollars: total Medicare revenue is $852K versus total Medicaid revenue of $613K, so Medicare is the larger single payer but Medicaid still represents a substantial portion of the practice’s volume. Both payers are material to the operation rather than the provider being effectively single-payer.
Nationally for Medicare the practice posts unusually high volumes on multiple codes: 45385 generated $265.4K (31.2% of Medicare revenue) and ranks #194 of 16310 providers (99th percentile; extreme outlier), 43249 generated $161.5K (19.0%) and ranks #6 of 3500 providers (100th percentile; extreme outlier), and 45380 generated $156.7K (18.4%) and ranks #218 of 16427 providers (99th percentile; extreme outlier). These rank/percentile signals indicate the practice is a very high-volume national outlier for several advanced endoscopic procedures, not just a marginal local operator.
In-state Medicaid competitive standing is also elevated for several endoscopy codes: 45385 brought $111.6K (18.2% of Medicaid revenue) and ranks #2 of 25 providers in-state (96th percentile; notably above typical state volume), while 43249 ranks #1 of 6 providers in-state (100th percentile; notably above typical state volume). By contrast, 43239 accounted for $292.9K (47.8% of Medicaid revenue) but ranks #10 of 56 in-state (84th percentile; typical, unremarkable volume), so the provider combines both standout and more typical in-state positions depending on the specific CPT.
The assortment of other billed services underscores procedural breadth within GI: Medicare entries include 43239 ($111K), 49082 ($27.7K for paracentesis), 47000 ($8.1K for liver biopsy), and 43244 ($7.9K for band ligation), revealing that the center performs therapeutic endoscopy, diagnostic biopsy work, and some ancillary abdominal procedures consistent with an ambulatory surgical clinic. This mix supports a workflow that pairs diagnostic scopes with same-setting therapeutic interventions.
Operational risk and sensitivity are notable given the revenue concentration: with top-3 codes supplying 68.5% of Medicare revenue and 93.4% of Medicaid revenue, fluctuations in GI procedure volume, changes in clinical referral patterns, or reimbursement policy changes for those specific CPTs could materially affect overall revenue. Payers and network managers should treat the practice as dependent on a narrow set of high-volume endoscopic services.
The provider’s NPI was enumerated on 2021-04-23 (~5 years ago), yet it has already achieved high-volume status on multiple national Medicare CPT benchmarks and strong in-state rankings on key Medicaid codes. This relatively short tenure combined with outsized procedural volumes suggests rapid scaling of endoscopy capacity rather than a long-established low-volume clinic.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 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… | 650 | $410 | $265.4K |
| 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. | 310 | $520 | $161.5K |
| 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… | 510 | $310 | $156.7K |
| 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. | 490 | $230 | $111K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 120 | $380 | $45.9K |
| 49082 | In this procedure, the provider withdraws an abnormal buildup of fluid from the abdominal cavity to relieve pressure and pain or to obtain a sample to submit to a laboratory for analysis. He… | 90 | $300 | $27.7K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 50 | $380 | $17.9K |
| 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. | 50 | $290 | $15.3K |
| 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… | 40 | $300 | $11.5K |
| 47000 | The provider removes a small sample of tissue from the liver through a small incision in the skin. The provider commonly performs this service to diagnose liver disease, to assess the severity of a… | 20 | $450 | $8.1K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 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.
4 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. | 1,140 | $260 | $292.9K |
| 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… | 640 | $260 | $168.1K |
| 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… | 530 | $210 | $111.6K |
| 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. | 300 | $130 | $40.3K |
How this provider's Medicaid billing volume and revenue compare to other Iowa providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Iowa median
4 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. | 10 | 60 | 260 | $210 | $109.2K |
| 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 | 90 | $270 | $85.7K |
| 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 | 60 | $280 | $43.2K |
| 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. | 1 | 10 | 80 | $310 | $32K |
Other providers in the same ZIP code as Digestive Health Center LLC, ranked by combined Medicare and Medicaid revenue.
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