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NPI 1629145685 · Idaho Falls, ID · Ambulatory Surgical Clinic/Center
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Idaho Eye Center PA is a ambulatory surgical clinic/center provider located in Idaho Falls, Idaho. This profile covers 7 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 | Idaho Eye Center PA |
| Address | 2025 E 17th St |
| City | Idaho Falls |
| State | ID |
| ZIP | 83404 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | November 28, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.5M |
| Medicaid | $591.7K |
Clinical/service-line profile: IDAHO EYE CENTER PA functions as an ambulatory surgical center focused on ophthalmic surgery, with revenue dominated by cataract extraction and intraocular lens placement procedures. The Medicare top code 66984 (cataract extraction with lens insertion) alone accounts for $1.2M of Medicare revenue and is complemented by cataract/IOL and aqueous outflow procedures such as 66991 and 66174, indicating the site performs high-volume cataract surgery with some glaucoma-related interventions.
Medicare revenue concentration: the practice shows extreme Medicare concentration, with the top 3 Medicare codes by revenue accounting for 97.0% of its total Medicare revenue. Within that mix, 66984 represents $1.2M (83.1% of Medicare revenue), 66991 accounts for $169.3K (11.5%), and 66174 contributes $37.1K (2.5%), signaling a narrow set of high-revenue services driving overall Medicare performance.
Medicaid revenue concentration and state position: Medicaid revenue is effectively single-procedure driven — the top 3 Medicaid codes by revenue account for 100.0% of Medicaid revenue and that entire Medicaid revenue is represented by 66984 (1.4K claims, $411 avg paid/claim, $592.3K revenue). The provider ranks #3 of 15 in-state for 66984 (86th percentile; notably above typical state volume), which positions it as a leading Medicaid cataract surgery provider within Idaho.
Payer mix and scale: the provider reports $1.5M in total Medicare revenue versus $591.7K in total Medicaid revenue, so Medicare is the larger payer relationship by scale while Medicaid still represents a material secondary revenue stream concentrated in the same cataract service line. This pattern makes the practice effectively dependent on surgical procedures reimbursed by both programs, with Medicare representing the primary revenue base.
Competitive standing nationally (Medicare): for its flagship procedure 66984 the provider ranks #1428 of 15965 nationally (91th percentile), and for 66991 it ranks #162 of 1445 (88th percentile), indicating above-typical national volume for core cataract and complex IOL/drainage procedures but not broad dominance across a wide set of ophthalmic codes. Lower percentiles on some ancillary codes (for example 66174 at the 69th percentile) suggest a strong niche in cataract/IOL work rather than a large-scale, full-service ophthalmic surgical center across many subspecialty procedures.
Operational and revenue implications: high claim counts for cataract code 66984 on both payers (1.5K Medicare claims and 1.4K Medicaid claims) imply a steady surgical throughput and predictable case mix centered on cataract surgery, which creates a concentrated revenue stream but exposes the provider to reimbursement or volume shifts in a small number of CPTs. Note the average paid/claim disparity for 66984 between Medicare ($798 avg paid/claim) and Medicaid ($411 avg paid/claim) highlights payer-level reimbursement differences that materially affect revenue per-case.
Documentation/administrative codes in Medicaid: the Medicaid data show large counts for G8918 (814 claims) and G8907 (813 claims) with $0 average paid/claim and $0 revenue; these entries appear to be administrative or quality/documentation codes rather than revenue drivers. Their presence at non-negligible in-state ranks (G8918 #4 of 11, G8907 #6 of 20) suggests routine reporting of perioperative documentation measures in the Medicaid claims stream rather than an impact on overall reimbursement.
Tenure and stability: the NPI was enumerated on 2006-11-28 (~20 years ago), indicating a long-established provider presence in Idaho Falls. Combined with concentrated but substantial Medicare ($1.5M) and Medicaid ($591.7K) revenues and above-typical state standing for cataract procedures, the profile is consistent with a stable, specialty ambulatory surgical clinic centered on cataract care.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
7 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… | 1,540 | $800 | $1.2M |
| 66991 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction. The provider also inserts one or more anterior segment aqueous drainage devices in… | 70 | $2,390 | $169.3K |
| 66174 | The provider expands the aqueous outflow (drainage) canal of the eye to help relieve pressure in the eye. The procedure does not include leaving a device or stent in place. | 40 | $860 | $37.1K |
| 66982 | The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing… | 20 | $790 | $14.2K |
| 66825 | The provider adjusts the already positioned intraocular lens prosthesis keeping the intraocular pressure intact. | 10 | $790 | $11.1K |
| 15823 | In this procedure, the provider surgically trims excessive skin that weighs down the upper eyelid, typically to improve the cosmetic appearance of the face and due to the interference of the tissue… | 20 | $460 | $9.7K |
| 65426 | During this procedure, the provider excises or transposes the pterygium to improve patient comfort and vision and also performs a graft. | 10 | $650 | $9.1K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 CPT/HCPCS codes.
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 |
|---|---|---|---|---|
| 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… | 1,440 | $410 | $592.3K |
| 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… | 810 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 810 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Idaho providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Idaho median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 3 | 20 | 150 | $360 | $178.3K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 4 | 10 | 260 | $1 | $740 |
| 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… | 6 | 20 | 210 | $1 | $680 |
Other providers in the same ZIP code as Idaho Eye Center PA, ranked by combined Medicare and Medicaid revenue.
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