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NPI 1558456459 · Portland, ME · Ambulatory Surgical Clinic/Center
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Portland Endoscopy Center is a ambulatory surgical clinic/center provider located in Portland, Maine. This profile covers 10 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 | Portland Endoscopy Center |
| Address | 161 Marginal Way |
| City | Portland |
| State | ME |
| ZIP | 04101 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.1M |
| Medicare | $730.1K |
PORTLAND ENDOSCOPY CENTER’s billing mix is tightly focused on gastrointestinal endoscopic procedures consistent with its Ambulatory Surgical Clinic/Center taxonomy; the highest-revenue Medicare and Medicaid codes are 45385, 45380, and 43239, which correspond to colonoscopy with polypectomy, diagnostic/biopsy colonoscopy, and upper endoscopy with biopsy respectively. This pattern indicates the site operates primarily as an outpatient endoscopy suite delivering diagnostic and therapeutic GI procedures rather than a broad multispecialty clinic.
Medicare revenue is concentrated in a very small set of codes: the top three Medicare codes account for 72.4% of the provider’s total Medicare revenue, driven most heavily by 45385 (45.5% of Medicare revenue, $332.2K). That single code also shows very high national volume for this provider (45385 ranks #156 of 16310 nationally, 99th percentile; labeled an "extreme outlier"), signaling that polypectomy colonoscopies are the primary Medicare revenue driver.
On the Medicaid side the concentration is even higher: the top three Medicaid codes account for 89.4% of total Medicaid revenue, led by 45385 (37.7%, $424.1K) and 43239 (36.2%, $407.3K). The Medicaid mix shows large absolute Medicaid volumes in both lower- and upper-endoscopy codes, with 45378 adding another material share (10.6%, $119.6K) and ranking notably high in-state (#2 of 11, 90th percentile).
The provider’s payer mix is skewed toward Medicaid in scale: lifetime Medicaid revenue is $1.1M versus lifetime Medicare revenue of $730.1K, so Medicaid represents the larger single-payer revenue stream while Medicare remains a substantial but smaller contributor. This split means business performance and margins may be more sensitive to state Medicaid reimbursement and referral patterns than to Medicare alone.
PORTLAND ENDOSCOPY CENTER shows differing competitive standings across payers and codes: nationally the provider is a dominant outlier for 45385 (rank #156/16310, 99th percentile, "extreme outlier"), while other high-Medicare codes like 43239 (rank #741/17140, 96th percentile) and 45380 (rank #823/16427, 95th percentile) indicate above-typical to high-but-typical national volumes. In-state Medicaid rankings are generally strong but less extreme—45385 is #4 of 22 in Maine (86th percentile, typical) and 43239 is #8 of 31 (77th percentile), showing the center is among the higher-volume state providers but not universally the top operator across all codes.
The code-level statistical characterizations in the data underscore the asymmetry between national and state comparisons: a code like 45385 is an "extreme outlier" nationally for this provider while being "typical, unremarkable" within Maine (86th percentile). Conversely, 45378 is flagged as "notably above typical" state volume (rank #2 of 11, 90th percentile) on Medicaid even though it contributes a smaller share of total Medicare revenue, highlighting different competitive dynamics by payer and procedure type.
The center has an established operating history with an NPI enumeration date of 2006-10-04 (~20 years ago), indicating long-tenured participation in Medicare/Medicaid networks. That tenure together with the concentrated procedural mix suggests an experienced outpatient endoscopy operation likely relying on steady referral flows for screening and diagnostic colonoscopies.
High revenue concentration around a few endoscopy codes represents an operational and reimbursement sensitivity: top-three-code concentration is 72.4% of Medicare revenue and 89.4% of Medicaid revenue, so changes to screening guidelines, referral patterns, or reimbursement for colonoscopy/upper endoscopy services could disproportionately affect overall revenue. Analysts should therefore treat the provider as a specialized outpatient endoscopy center with concentrated clinical and payer exposure rather than a broadly diversified ambulatory provider.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 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… | 720 | $460 | $332.2K |
| 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… | 240 | $460 | $110.6K |
| 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. | 300 | $280 | $86.1K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 160 | $420 | $68.5K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 110 | $420 | $44.3K |
| 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. | 70 | $590 | $38.6K |
| 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. | 60 | $280 | $16.1K |
| 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… | 50 | $320 | $14.9K |
| 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… | 50 | $310 | $14.7K |
| 45331 | In this procedure, the provider examines the inner part of the rectum and the sigmoid colon using a sigmoidoscope, a flexible, narrow tube with a camera at its one end. He then takes one or more… | 10 | $330 | $4.3K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 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 |
|---|---|---|---|---|
| 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… | 1,340 | $320 | $424.1K |
| 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. | 1,760 | $230 | $407.3K |
| 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 | $340 | $174.1K |
| 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… | 380 | $320 | $119.6K |
| 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… | 1,120 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 40 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Maine providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maine median
6 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. | 8 | 30 | 200 | $250 | $316.8K |
| 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… | 4 | 20 | 260 | $370 | $262.4K |
| 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… | 9 | 20 | 150 | $400 | $256.3K |
| 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… | 2 | 10 | 30 | $330 | $39.6K |
| 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 | 10 | 270 | $1 | $1 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 9 | 10 | 260 | $0 | $0 |
Other providers in the same ZIP code as Portland Endoscopy Center, ranked by combined Medicare and Medicaid revenue.
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