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NPI 1720085657 · Providence, RI · Endoscopy Clinic/Center
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Bayside Endoscopy Center, LLC is a endoscopy clinic/center provider located in Providence, Rhode Island. This profile covers 11 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 | Bayside Endoscopy Center, LLC |
| Address | 33 Staniford St |
| City | Providence |
| State | RI |
| ZIP | 02905 |
| Taxonomy | Endoscopy Clinic/Center |
| NPI Enumerated | July 7, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1M |
| Medicaid | $553.2K |
BAYSIDE ENDOSCOPY CENTER, LLC operates as a focused endoscopy clinic/center: its top Medicare revenue drivers — 45385, 45380 and 43239 — are colonoscopy and upper endoscopy procedures that include therapeutic polypectomy/snare, biopsy specimen retrieval, and dilation, indicating an outpatient GI procedural practice that performs both diagnostic sampling and endoscopic interventions. The mix of codes shows routine EGD with biopsy (43239) alongside high-volume colonoscopy work (45380, 45385), consistent with an ambulatory endoscopy service line.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes account for 74.9% of the provider’s total Medicare revenue, with 45385 (30.2%), 45380 (23.8%) and 43239 (20.8%) comprising the bulk of the $1M in Medicare receipts. This concentration suggests the business is tightly dependent on a small set of GI procedural codes for Medicare-sourced revenue.
Medicaid revenue is even more concentrated: the precomputed top 3 Medicaid codes account for 89.4% of the provider’s $553.2K in Medicaid revenue, driven largely by 43239 (49.1%), 45380 (24.1%) and 45378 (16.2%). The Medicaid mix underscores that EGD with biopsy (43239) and colonoscopy with biopsy/brushings (45380, 45378) dominate the payer-specific case mix.
On payer scale, Medicare ($1M) represents a larger revenue pool than Medicaid ($553.2K) for this provider, so Medicare is the single largest payer source on file even though both payers materially contribute to procedural volume. The presence of substantial revenue from both programs indicates the center serves a mixed Medicare/Medicaid patient base rather than being effectively single-payer.
Competitively on Medicare, the provider posts exceptionally high national volumes for its top codes: 45385 ranks #191 of 16310 providers nationally (99th percentile; extreme outlier), 45380 ranks #112 of 16427 (99th percentile; extreme outlier), and 43239 ranks #78 of 17140 (100th percentile; extreme outlier). Those rank/percentile annotations indicate BAYSIDE ENDOSCOPY CENTER is a major national outlier in Medicare billing for core endoscopy codes and likely operates at much higher Medicare procedural volumes than typical peers.
By contrast, Medicaid rankings show a strong but more regionally typical footprint: 43239 ranks #5 of 37 in-state (89th percentile; typical, unremarkable volume), 45380 is #5 of 15 (71st percentile; typical, unremarkable volume), and 45378 is #2 of 10 (89th percentile; typical, unremarkable volume). These in-state positions indicate the center is a meaningful Medicaid provider in Rhode Island for endoscopy services but not the clear dominant statewide outlier seen in Medicare.
The data present a clear statistical divergence between payers: multiple Medicare codes are labeled as "extreme outlier" nationally while the same or similar codes appear as "typical, unremarkable" within in-state Medicaid rankings. This suggests the provider’s Medicare practice produces unusually high national volumes relative to peers, whereas its Medicaid volumes align more closely with peer norms in-state.
The practice has an established tenure, with its NPI enumerated 2005-07-07 (~21 years ago), indicating long-standing operation that plausibly supports the developed referral relationships and procedural throughput reflected in its billing profile. Given the age of enumeration and the concentrated code mix, the center appears to be a stable, specialized outpatient endoscopy operator with entrenched Medicare procedural volume.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
11 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… | 660 | $460 | $302K |
| 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… | 670 | $360 | $238.6K |
| 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. | 830 | $250 | $208.6K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 220 | $430 | $95.6K |
| 43251 | An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope through the mouth. The physician removes one or more lesions using a snare… | 70 | $600 | $40.8K |
| 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… | 110 | $300 | $33.3K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 70 | $430 | $28.8K |
| 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… | 80 | $340 | $28.2K |
| 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. | 30 | $530 | $13.7K |
| 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. | 30 | $290 | $7.2K |
Showing 1–10 of 11
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 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. | 840 | $330 | $271.7K |
| 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… | 370 | $360 | $133.6K |
| 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… | 250 | $360 | $89.6K |
| 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… | 160 | $360 | $58.6K |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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 | 110 | $460 | $140.3K |
| 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. | 5 | 40 | 70 | $300 | $116.1K |
| 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… | 3 | 10 | 150 | $370 | $44.4K |
| 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 | 70 | $340 | $40.7K |
Other providers in the same ZIP code as Bayside Endoscopy Center, LLC, ranked by combined Medicare and Medicaid revenue.
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