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NPI 1720182835 · Wilmington, DE · Ambulatory Surgical Clinic/Center
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Limestone Medical Center, LLC is a ambulatory surgical clinic/center provider located in Wilmington, Delaware. This profile covers 33 Medicare and 8 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 | Limestone Medical Center, LLC |
| Address | 1941 Limestone Rd Ste 113 |
| City | Wilmington |
| State | DE |
| ZIP | 19808 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | September 11, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.3M |
| Medicaid | $242.7K |
Business profile and service mix align with an ambulatory surgical center that performs high-volume ophthalmology and endoscopy procedures: Medicare top code 66984 (cataract extraction with lens insertion) generated $911.1K revenue (41.1% of Medicare revenue), and Medicare codes for colonoscopy and upper endoscopy (45385 and 43239) together produce substantial revenue, indicating the facility supports both cataract surgery and GI procedural lines. Medicaid billings mirror this mix with 43239 accounting for $92.2K (38.0% of Medicaid revenue) and 62323 (spinal injections) contributing $67.3K, suggesting combined ophthalmology, gastroenterology, and pain-management services are performed in the ASC setting.
Revenue concentration is high for both payers: the top 3 Medicare codes account for 59.6% of the provider’s total Medicare revenue, and the top 3 Medicaid codes account for 79.2% of its total Medicaid revenue. This concentration means a small set of procedural lines (notably cataract surgery and endoscopy) drive the majority of billed volume and revenue for each payer.
Payer mix is heavily skewed toward Medicare in scale: reported lifetime Medicare revenue is $2.3M versus $242.7K in Medicaid, so Medicare is the primary revenue source on record. While Medicaid billing is present across several procedural codes, it represents a substantially smaller share of the provider’s lifetime public-payer revenue.
Competitive standing on national Medicare measures is mixed: the provider is an extreme outlier for colon polypectomy 45385 (ranks #307 of 16310, 98th percentile; described as "extreme outlier, far above typical national volume for this code") and for G0105 colorectal high-risk screening (ranks #120 of 8773, 99th percentile; "extreme outlier"). By contrast, the leading cataract code 66984 (ranks #1925 of 15965, 88th percentile) and several ophthalmic codes (66982 at 98th percentile but described as "typical, unremarkable volume") are high-volume but not uniformly exceptional versus national peers, indicating standout strength in selected GI screening procedures while maintaining solid ophthalmology throughput.
In-state (Medicaid) competitive signals show notable relative strength on targeted services: 62323 (lumbar/sacral epidural injection) ranks #2 of 9 in-state (88th percentile) and is a major Medicaid revenue driver at $67.3K (27.7% of Medicaid revenue), while 43239 ranks #18 of 32 (45th percentile) with $92.2K (38.0% of Medicaid revenue). These ranks indicate the provider is an important regional source for interventional pain injections and upper endoscopy biopsies, even though it is not the dominant statewide leader across all codes.
Statistical outliers and volume signals are concentrated in specific codes rather than across the entire portfolio: Medicare shows "extreme outlier" volume for 45385 and G0105 (colon-related screening and polypectomy), and multiple endoscopy and hand-surgery codes (43239, 64721, 45378) appear at high percentiles described as "notably above typical" or "above typical" national volume. This pattern suggests the ASC has focused service lines with substantially higher-than-typical throughput in GI screening and selective surgical procedures.
Clinical breadth extends beyond ophthalmology and GI to include hand and minor orthopedic procedures: Medicare billing includes 64721 (carpal tunnel neuroplasty) with $71.1K (3.2% of Medicare revenue) and 26055 (trigger finger release) with $61.7K (2.8% of Medicare revenue), both described as "notably above typical national volume." These entries support a multi-specialty ambulatory practice model where ophthalmology and GI are core but podiatry/hand procedures and minor orthopedics contribute meaningful secondary revenue.
Provider tenure indicates established presence in the market: the NPI was enumerated 2006-09-11 (~20 years ago), suggesting long-term operation as an ambulatory surgical clinic/center which aligns with the concentrated procedural mix and accumulated lifetime Medicare and Medicaid billing patterns.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
33 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… | 1,050 | $870 | $911.1K |
| 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… | 500 | $470 | $233.1K |
| 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… | 200 | $870 | $176.5K |
| 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… | 60 | $2,550 | $145.3K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 250 | $430 | $108.8K |
| 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. | 350 | $250 | $86.3K |
| 64721 | Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which… | 110 | $670 | $71.1K |
| 26055 | Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in the tendon may… | 130 | $480 | $61.7K |
| 66180 | The provider implants a shunt in the anterior chamber of the eye to facilitate drainage of aqueous humor, or fluid, in order to reduce intraocular pressure. He uses a graft to reinforce the tissue… | 20 | $2,090 | $50.2K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 110 | $430 | $48.7K |
Showing 1–10 of 33
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 33 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
33 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 3 | 50 | 70 | $590 | $163.6K |
| 66991 | 4 | 10 | 50 | $1,590 | $85.6K |
| 15823 | 5 | 10 | 60 | $550 | $60.3K |
| 66982 | 2 | 20 | 60 | $700 | $60K |
| 45385 | 3 | 60 | 100 | $310 | $44.7K |
| 66821 | 12 | 30 | 140 | $230 | $37.1K |
| 66180 | 2 | 10 | 20 | $1,530 | $30.6K |
| 64721 | 4 | 20 | 40 | $470 | $29.4K |
| 29827 | 18 | 20 | 20 | $1,130 | $28.2K |
| 67966 | 3 | 10 | 50 | $580 | $26.9K |
Showing 1–10 of 33
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.
8 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. | 390 | $240 | $92.2K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 520 | $130 | $67.3K |
| 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… | 70 | $500 | $32.7K |
| 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… | 90 | $280 | $25.5K |
| 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 | $420 | $24.5K |
| 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… | 10 | $50 | $640 |
| 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… | 520 | $0 | $0 |
| V2632 | Posterior chamber intraocular lens | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Delaware providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Delaware median
8 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. | 18 | 30 | 490 | $180 | $168.8K |
| 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… | 8 | 10 | 380 | $300 | $112K |
| 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… | 16 | 20 | 360 | $180 | $96.9K |
| 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… | 10 | 20 | 70 | $220 | $71.8K |
| 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… | 9 | 10 | 70 | $180 | $67.1K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 2 | 10 | 70 | $90 | $56.9K |
| 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… | 3 | 10 | 150 | $0 | $0 |
| V2632 | Posterior chamber intraocular lens | 2 | 10 | 40 | $0 | $0 |
Other providers in the same ZIP code as Limestone Medical Center, LLC, ranked by combined Medicare and Medicaid revenue.
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