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NPI 1760467732 · Germantown, TN · Endoscopy Clinic/Center
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G I Diagnostic And Therapeutic Center LLC is a endoscopy clinic/center provider located in Germantown, Tennessee. This profile covers 22 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 | G I Diagnostic And Therapeutic Center LLC |
| Address | 1310 Wolf Park Dr |
| City | Germantown |
| State | TN |
| ZIP | 38138 |
| Taxonomy | Endoscopy Clinic/Center |
| NPI Enumerated | December 13, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.2M |
| Medicaid | $8.6K |
G I DIAGNOSTIC AND THERAPEUTIC CENTER LLC is a dedicated endoscopy clinic/center (NPI enumerated 2005-12-13, ~21 years ago) with its Medicare billing dominated by colonoscopy and upper endoscopy services. Its three largest Medicare codes — 45380 (3.9K claims, $1.4M revenue, 32.7% of Medicare revenue), 45385 (2.4K claims, $1M revenue, 23.7%), and 43239 (2.6K claims, $528.7K revenue, 12.5%) — together account for 68.9% of the provider’s total Medicare revenue, signaling a concentrated procedural footprint in GI diagnostic and therapeutic work.
The provider’s code mix shows a combination of screening, diagnostic, and therapeutic endoscopy. High-volume screening codes G0105 (919 claims, $353.8K revenue, 8.4%) and G0121 (726 claims, $278.8K revenue, 6.6%) alongside therapeutic colonoscopy codes such as 45385 indicate the operation is oriented toward both population screening and lesion removal rather than only consultative or diagnostic visits.
Medicaid billing is minimal relative to Medicare: total Medicaid revenue is $8.6K versus $4.2M in Medicare revenue, so the practice is effectively Medicare-dominant. On Medicaid the code mix is narrowly concentrated — the top three Medicaid codes account for 100.0% of Medicaid revenue — with 43239 (863 claims, $6K revenue, 69.1%) and 45380 (541 claims, $2.7K revenue, 30.9%) representing essentially all reported Medicaid receipts.
The provider is a national high-volume outlier on multiple Medicare codes. 45380 ranks #1 of 16427 providers nationally (100th percentile; extreme outlier), 45385 ranks #2 of 16310 (100th percentile; extreme outlier), and 43239 ranks #1 of 17140 (100th percentile; extreme outlier), which together indicate dominant procedural volume for these services compared with national peers.
By contrast, the provider’s Medicaid standing is modest within Tennessee. For Medicaid, 43239 ranks #52 of 170 in-state (70th percentile; typical) and 45380 ranks #19 of 82 (78th percentile; typical), suggesting normal-to-above-average participation in the state Medicaid market but not the same outsized position seen in Medicare.
Operational scale is evident from claim volumes on core procedures: thousands of Medicare claims for single CPTs (3.9K for 45380, 2.6K for 43239, 2.4K for 45385) indicate sustained endoscopy throughput and dedicated procedural capacity. The presence of therapeutic and dilation codes (for example, 45385 snare polypectomy and 43248 esophageal dilation) points to capability for both screening and interventional treatment in an ambulatory setting.
Analysts should note the stark reimbursement and payer-mix dynamics: Medicare revenue ($4.2M) dwarfs Medicaid revenue ($8.6K), and Medicaid average paid amounts recorded in the file are very low (for example, $7 avg paid/claim for 43239 and $5 avg paid/claim for 45380), which could affect network-contracting leverage and margins if Medicaid volumes change. The heavy revenue concentration in a few high-volume Medicare codes also creates sensitivity to changes in reimbursement policy or referral patterns for those specific CPTs.
From a competitive and network-planning perspective, this provider should be treated as a major Medicare endoscopy site nationally for specific procedures but a routine, modest Medicaid participant in-state. The combination of national extreme-outlier rankings on key Medicare codes and minimal Medicaid revenue suggests strategies focused on Medicare referral relationships, capacity planning, and monitoring of reimbursement policy for colonoscopy and EGD services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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… | 3,880 | $360 | $1.4M |
| 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… | 2,420 | $420 | $1M |
| 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. | 2,550 | $210 | $528.7K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 920 | $390 | $353.8K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 730 | $380 | $278.8K |
| 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… | 490 | $250 | $120.3K |
| 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… | 390 | $290 | $113.2K |
| 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. | 190 | $530 | $100.5K |
| 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. | 480 | $210 | $99.2K |
| 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… | 220 | $300 | $65.9K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 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. | 860 | $10 | $6K |
| 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… | 540 | $10 | $2.7K |
| 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… | 20 | $0 | $0 |
| 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… | 1,600 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,820 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee 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. | 52 | 170 | 340 | $190 | $206.8K |
| 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… | 19 | 80 | 70 | $200 | $121.4K |
| 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… | 40 | 50 | 100 | $150 | $32.5K |
| 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… | 11 | 70 | 160 | $1 | $10 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 4 | 50 | 100 | $0 | $0 |
Other providers in the same ZIP code as G I Diagnostic And Therapeutic Center LLC, ranked by combined Medicare and Medicaid revenue.
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