Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Pennsylvania for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Pennsylvania only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Pennsylvania (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Midlantic Urology Surgery Center, LLC (NPI 1811534555)

Field	Value
Entity Type	Organization
Organization	Midlantic Urology Surgery Center, LLC
Address	Valley Forge Office Center, Suite 100
City	Wayne
State	PA
ZIP	19087
Taxonomy	Ambulatory Surgical Clinic/Center
NPI Enumerated	December 2, 2019

Payer Source	Total Paid
Medicare	$2.9M
Medicaid	$0

Key Findings

MIDLANTIC UROLOGY SURGERY CENTER, LLC is heavily Medicare-focused: lifetime Medicare revenue is $2.9M while there is no Medicaid billing on file, making the practice effectively single-payer (Medicare) in the available claims data. This payer concentration suggests its business and case mix are aligned primarily with Medicare-aged patients and services reimbursed through traditional Medicare.

Revenue concentration is high: the precomputed top 3 Medicare codes by revenue account for 54.8% of the provider's Medicare revenue. That level of concentration around a small set of interventional urology codes indicates that a few procedures drive most of the facility’s Medicare income, increasing dependence on those service lines.

The top-revenue codes indicate a specialized ambulatory surgical profile: procedures like 64590 (neurostimulator pulse generator insertion), C9740 (transprostatic implant), and 55700 (code now deleted) together dominate revenue and reflect focused device- and endoscopy-driven urologic interventions rather than broad primary-care or general outpatient services. The mix includes sacral neurostimulation, transprostatic implantation, and high-volume cystoscopy/stone procedures, consistent with an ambulatory surgical center concentrating on procedural urology.

Several codes show unusually high national standing, signaling regional or niche dominance for specific procedures. 55700 ranks #2 nationally and is labeled an extreme outlier, 52356 ranks #6 and is also an extreme outlier, 50590 ranks #3 (extreme outlier), and 76872 ranks #14 (extreme outlier); these rank/percentile placements indicate the center performs certain lithotripsy, cystoscopy, and ultrasound services at volumes far above typical peers.

Other high-revenue device/procedural codes also appear at above-typical levels but less extremely: 64590 (28.7% of Medicare revenue) ranks #16 of 561 (97th percentile) and C9740 (12.7% of revenue) ranks #19 of 162 (89th percentile), reflecting strong but not unique national presence for sacral/gastric neurostimulator and transprostatic implant work. These placements suggest the center is a significant national-volume performer for several specialized implant and endoscopic services.

Operational intensity is evident in caseloads for both high- and medium-revenue CPTs: examples include 579 claims of 55700 and 577 claims of 76872 in the Medicare lifetime data, which, together with elevated average paid-per-claim amounts for device procedures (e.g., $15,166 for 64590 and $5,662 for C9740), point to a procedure-heavy revenue model that combines moderate-to-high per-claim reimbursement with substantial procedural throughput.

Tenure is modest but established: the NPI was enumerated on 2019-12-02 (about 7 years ago). Given the concentrated revenue mix and high volumes on several codes within that timeframe, the center appears to have scaled specific urology procedural lines relatively quickly since enumeration.

Absence of Medicaid billing is meaningful for payers and network planning: with no Medicaid claims on file, the center will not contribute to Medicaid provider capacity in-network and is unlikely to be a source of Medicaid-covered services; payers should treat this entity as a Medicare-dominant ambulatory surgical clinic when assessing network adequacy or referral patterns.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
64590	The provider inserts or replaces a peripheral, sacral, or gastric neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that…	50	$15,170	$819K
55700	Code deleted December 31, 2025.	580	$660	$380.4K
C9740	Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants	60	$5,660	$362.4K
52356	The provider performs a cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into…	150	$1,730	$261.2K
64561	The provider, under imaging guidance, implants electrodes around nerves in the sacral region to reduce the pain along the path of the nerve.	60	$3,920	$223.2K
50590	Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to destroy calculus (kidney stones) in the kidneys and ureters.	170	$1,060	$184.1K
51715	In this procedure, the provider injects a natural or synthetic material into the submucosal tissue of the urethra and or bladder neck using an endoscope, a stiff or flexible tubular instrument with a…	70	$1,560	$106.1K
52332	The provider performs cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into…	100	$960	$98.9K
55874	Under imaging guidance, the provider inserts a needle through the perineum, the area between the anus and the scrotum, and injects one or more biodegradable materials, i.e., material that decomposes…	20	$2,800	$50.3K
52235	The provider inspects the urethra, prostatic urethra (in men), the interior of the bladder, and ureteric openings using a cystoscope passed through the urethra and into the bladder; he destroys…	40	$1,160	$44K

Showing 1–10 of 26

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Pennsylvania Distribution

Midlantic Urology Surgery Center, LLC — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. state median

26 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
C9740	2	10	20	$5,610	$202.1K
64561	2	20	30	$2,350	$75.1K
64590	1	20	10	$3,280	$55.7K
J0585	128	140	7,600	$1	$47.7K
55874	14	30	20	$1,070	$29.9K
51715	3	10	30	$770	$27.6K
50590	1	30	20	$630	$17.1K
52318	1	10	20	$1,090	$16.3K
52317	1	10	20	$930	$14.9K
55040	1	10	10	$1,300	$14.3K

Showing 1–10 of 26

Nearby Providers

Other providers in the same ZIP code as Midlantic Urology Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scott Schafrank	PA	Specialist	$670.8K	$0
David Bernstein	PA	Foot Surgery Podiatrist	$652.4K	$0
Nikhil Shyam	PA	Dermatology Physician	$468.4K	$0
Jamea Campbell	PA	Specialist	$401.8K	$0
David Manion	PA	Dermatology Physician	$264.9K	$75.9K
Philip Bernstein	PA	Foot & Ankle Surgery Podiatrist	$331.5K	$0
Kenneth Morgenstern	PA	Ophthalmic Plastic and Reconstructive Surgery Physician	$252.6K	$0
Troels Glysing-jensen	PA	Podiatrist	$234.9K	$5.5K
Alexis Curreri	PA	Specialist	$224.8K	$0
Kelli Pokorny	PA	Diagnostic Radiology Physician	$196.4K	$0

Midlantic Urology Surgery Center, LLC — Billing Profile & Reimbursement Data

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Midlantic Urology Surgery Center, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References