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NPI 1609968478 · Clive, IA · Ambulatory Surgical Clinic/Center
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Iowa Endoscopy Center, Inc. is a ambulatory surgical clinic/center provider located in Clive, Iowa. This profile covers 10 Medicare and 5 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 | Iowa Endoscopy Center, Inc. |
| Address | 1378 Nw 124th St |
| City | Clive |
| State | IA |
| ZIP | 50325 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | September 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.5M |
| Medicare | $774K |
The provider’s CPT mix is concentrated in gastrointestinal endoscopy services: high-volume colonoscopy and polypectomy codes (45385, 45380) plus screening colonoscopy codes (G0105, G0121) and upper endoscopy with biopsy (43239) dominate both Medicare and Medicaid billing. This pattern is consistent with its listed taxonomy as an Ambulatory Surgical Clinic/Center and indicates the facility operates primarily as a GI endoscopy center performing diagnostic and therapeutic endoscopic procedures.
Revenue concentration is high on both payers: the top three Medicare codes account for 66.1% of the provider’s Medicare revenue, and the top three Medicaid codes account for 87.9% of Medicaid revenue. For Medicaid the concentration is particularly acute, with 43239, 45380, and 45378 together representing most Medicaid revenue, while Medicare revenue is concentrated among 45385, 45380, and G0105.
Payer mix favors Medicaid in scale: total Medicaid revenue ($1.5M) exceeds total Medicare revenue ($774K), so the provider appears to rely more on Medicaid volume for overall topline collections. Both payers are active, but the unit and dollar volumes reported to Medicaid are larger in absolute terms.
Medicare competitive standing is nationally prominent for core colonoscopy services: 45385 and 45380 rank in the 98th percentile nationally (45385 ranks #262 of 16310; 45380 ranks #303 of 16427) and G0105 ranks at the 99th percentile (rank #80 of 8773). These rank positions, described in the source as “extreme outlier,” indicate this facility bills substantially above typical national volume for these colonoscopy and high-risk screening services.
On Medicaid the provider is a major in-state performer for key procedures: 43239 ranks #3 of 56 in-state (96th percentile; described as notably above typical state volume), 45380 ranks #2 of 23 in-state (95th percentile), and 45378 ranks #2 of 11 in-state (90th percentile). These standings position the center as one of the leading Medicaid-billed endoscopy sites in its state for both upper endoscopy with biopsy and colonoscopy services.
Individual code revenue highlights underscore operational focus: for Medicare, 45385 generated $241.1K (31.1% of Medicare revenue) and 45380 generated $157.7K (20.4% of Medicare revenue); for Medicaid, 43239 generated $695.2K (47.8% of Medicaid revenue) and 45380 generated $370.9K (25.5% of Medicaid revenue). These single-code contributions show a small number of procedures drive a large share of each payer’s revenue.
The provider’s billing footprint includes several codes flagged as statistical outliers or notably above typical volume, which in plain terms indicates unusually high throughput for those specific procedures rather than routine facility-level volumes. In particular, multiple colonoscopy codes are labeled “extreme outlier” or “notably above typical,” consistent with concentrated procedural throughput in colorectal diagnostics and therapeutic polypectomy work.
The NPI enumeration date is 2006-09-29 (approximately 20 years ago), indicating the facility has an established operational history; combined with the concentrated, high-percentile code mix, this suggests long-standing specialization in ambulatory GI endoscopy services rather than a new or diversifying outpatient 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.
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… | 560 | $430 | $241.1K |
| 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… | 440 | $360 | $157.7K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 290 | $390 | $113.2K |
| 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. | 400 | $280 | $110.1K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 160 | $400 | $61.2K |
| 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. | 80 | $540 | $42.8K |
| 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. | 70 | $290 | $20.5K |
| 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… | 60 | $290 | $16.1K |
| 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… | 20 | $250 | $5.7K |
| 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. | 20 | $290 | $5.7K |
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.
5 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. | 2,200 | $320 | $695.2K |
| 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… | 1,190 | $310 | $370.9K |
| 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… | 580 | $370 | $212.5K |
| 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… | 520 | $340 | $175.2K |
| 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… | 40 | $0 | $0 |
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
5 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. | 3 | 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… | 2 | 20 | 90 | $270 | $85.7K |
| 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 | $340 | $68.9K |
| 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… | 3 | 30 | 60 | $280 | $43.2K |
| 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… | 7 | 10 | 50 | $0 | $0 |
Other providers in the same ZIP code as Iowa Endoscopy Center, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Iowa Family Assistants | IA | Home Health Agency | $0 | $18M |
| Iowa Radiology, P C | IA | Diagnostic Radiology Physician | $0 | $5.2M |
| Mercy Clinics, Inc. | IA | Primary Care Clinic/Center | $0 | $2.9M |
| Iowa Diagnostic Imaging & Procedure Center, L C | IA | Diagnostic Radiology Physician | $0 | $2.5M |
| West Lakes Surgery Center LLC | IA | Ambulatory Surgical Clinic/Center | $1.1M | $1.1M |
| Mercy Clinics Inc | IA | Clinic/Center | $0 | $1.7M |
| Tara Graff | IA | Medical Oncology Physician | $1.4M | $0 |
| Catholic Health Initiatives-iowa Corp | IA | Diagnostic Radiology Physician | $594.7K | $594.4K |
| Phippsburger Inc | IA | Home Health Agency | $0 | $1.1M |
| Uhs Midwest Behavioral Health LLC | IA | Psychiatry Physician | $0 | $979.3K |
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