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NPI 1760907919 · Sun City, AZ · Ambulatory Surgical Clinic/Center
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Banner Sun City West Surgery Center LLC is a ambulatory surgical clinic/center provider located in Sun City, Arizona. This profile covers 19 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 | Banner Sun City West Surgery Center LLC |
| Address | 14416 W Meeker Blvd Ste 103 |
| City | Sun City |
| State | AZ |
| ZIP | 85375 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | August 9, 2017 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.8M |
| Medicaid | $335.6K |
This facility’s payer mix is heavily Medicare-weighted: total Medicare revenue is $2.8M versus total Medicaid revenue of $335.6K, making Medicare the dominant source of billed revenue for the center. The scale difference indicates the center operates primarily in the Medicare market while Medicaid represents a much smaller share of activity and revenue.
Medicare revenue is highly concentrated: the precomputed top three Medicare codes account for 68.2% of the provider’s total Medicare revenue. The top Medicare drivers are 63685 ($1.2M, 44.0% of Medicare revenue, 64 claims, $19141 avg paid/claim), 63650 ($368.9K, 13.2% of Medicare revenue, 97 claims, $3803 avg paid/claim), and 27279 ($304.8K, 10.9% of Medicare revenue, 23 claims, $13250 avg paid/claim).
Medicaid revenue for this provider is entirely concentrated in three codes that together account for 100.0% of its Medicaid revenue: 45380 ($205.7K, 61.3% of Medicaid revenue, 883 claims, $233 avg paid/claim), 43239 ($93.9K, 28.0% of Medicaid revenue, 546 claims, $172 avg paid/claim), and 45385 ($36K, 10.7% of Medicaid revenue, 131 claims, $275 avg paid/claim). This indicates Medicaid activity is narrowly focused on GI endoscopy services.
The code mix shows two clear service lines: high-revenue spine and neuromodulation procedures on the Medicare side and high-volume gastrointestinal endoscopy on both payers. Medicare-dominant spine codes include 63685 (neurostimulator pulse generator insertion), 63650 (epidural electrode placement), 27279 (sacroiliac joint fusion) and 64628 (basivertebral nerve ablation), while GI work is reflected in codes such as 45380, 45385 and 43239 appearing prominently across payers.
The provider demonstrates unusually strong national standing on specific procedures: 63685 ranks #31 of 1281 providers nationally (98th percentile) and is described as "notably above typical national volume for this code," indicating a national-level concentration in spinal neurostimulator generator procedures. Similarly, 45380 ranks #128 of 16427 providers nationally (99th percentile) and is labeled an "extreme outlier, far above typical national volume for this code," signaling exceptionally high colon biopsy/biopsy-related colonoscopy volume compared with peers.
At the state level for Medicaid the provider is a modest-to-moderate participant in GI services: 45380 ranks #33 of 120 providers in-state (73rd percentile) and 43239 ranks #91 of 177 providers in-state (49th percentile). Those positions suggest the center is neither the dominant in-state GI provider nor absent from the market, but it does capture meaningful Medicaid colonoscopy volume.
The center’s procedural revenue concentration creates operational sensitivity to changes in reimbursement or referral patterns: with 68.2% of Medicare revenue tied to the top three Medicare codes and 100.0% of Medicaid revenue tied to the top three Medicaid codes, shifts in utilization or coverage for these specific procedures could materially affect overall revenue. This concentration also defines where payer negotiations or utilization management efforts would have the most leverage.
The provider has an NPI enumeration date of 2017-08-09 (~9 years ago), indicating it is an established ambulatory surgical clinic/center with nearly a decade of billing history. Tenure at this level supports observed specialization in both spine/neurostimulation procedures and GI endoscopy as likely deliberate operational focus areas.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 63685 | The provider inserts or replaces a spinal neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection… | 60 | $19,140 | $1.2M |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 100 | $3,800 | $368.9K |
| 27279 | The provider performs sacroiliac (SI) joint fusion using a percutaneous or minimally invasive approach. The SI joint is where the sacrum (the base of the spine) meets the ilium (part of the pelvic… | 20 | $13,250 | $304.8K |
| 64628 | The provider uses a thermal (heat) method under imaging guidance to destroy an intraosseous basivertebral nerve. Use this code for the first two lumbar or sacral vertebral bodies treated at a session. | 30 | $7,650 | $229.5K |
| 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… | 630 | $340 | $213.6K |
| 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… | 390 | $450 | $175K |
| 0275T | N/A | 30 | $3,730 | $93.3K |
| 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. | 220 | $210 | $45.1K |
| 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. | 50 | $580 | $31K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 50 | $410 | $22.2K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
19 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 2 | 70 | 20 | $10,020 | $200.4K |
| 27279 | 1 | 10 | 20 | $8,580 | $154.4K |
| 63650 | 7 | 70 | 40 | $2,040 | $116K |
| 64628 | 1 | 20 | 10 | $4,880 | $78K |
| 0275T | 3 | 20 | 20 | $2,460 | $51.6K |
| 64483 | 168 | 250 | 90 | $210 | $31K |
| 64635 | 169 | 210 | 60 | $390 | $30.3K |
| 45385 | 14 | 330 | 50 | $290 | $28.4K |
| G0260 | 33 | 40 | 60 | $210 | $22.9K |
| 45380 | 7 | 350 | 60 | $210 | $21.4K |
Showing 1–10 of 19
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 |
|---|---|---|---|---|
| 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… | 880 | $230 | $205.7K |
| 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. | 550 | $170 | $93.9K |
| 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… | 130 | $280 | $36K |
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
3 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. | 91 | 180 | 590 | $250 | $360.9K |
| 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… | 33 | 120 | 330 | $280 | $206.3K |
| 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… | 47 | 80 | 150 | $290 | $157.8K |
Other providers in the same ZIP code as Banner Sun City West Surgery Center LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Banner Del E Webb Medical Center | AZ | General Acute Care Hospital | $0 | $30.8M |
| Brea Emeritus LLC | AZ | Alzheimer Center (Dementia Center) | $0 | $10.7M |
| Abc Children's Eye Specialists PC | AZ | Eyewear Supplier | $0 | $7.1M |
| North County Fire & Medical District | AZ | Land Ambulance | $889.2K | $3M |
| Mitchell Giangobbe | AZ | Surgery Physician | $869.2K | $0 |
| Tarpan Patel | AZ | Interventional Cardiology Physician | $714.5K | $17.7K |
| Katharine Bermingham Cordova | AZ | MOHS-Micrographic Surgery Physician | $700.9K | $0 |
| Arizona Eye Institute & Cosmetic Laser Center LLC | AZ | Ambulatory Surgical Clinic/Center | $684.3K | $0 |
| Mandi Conway | AZ | Retina Specialist (Ophthalmology) Physician | $683.4K | $0 |
| Ralph Bassett | AZ | Otolaryngology Physician | $562.6K | $0 |
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