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NPI 1841316841 · Pearl City, HI · Ambulatory Surgical Clinic/Center
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Pacific Endoscopy Center, LLC is a ambulatory surgical clinic/center provider located in Pearl City, Hawaii. This profile covers 12 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 | Pacific Endoscopy Center, LLC |
| Address | 1029 Makolu Street |
| City | Pearl City |
| State | HI |
| ZIP | 96782 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | March 21, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $2M |
| Medicare | $610.3K |
PACIFIC ENDOSCOPY CENTER presents a procedural mix focused on lower and upper GI endoscopy: the Medicare top codes are 45385, 45380 and 43239, which correspond to colonoscopic polypectomy, colonoscopy with biopsy, and EGD with biopsy respectively. This mix indicates the center operates as an ambulatory endoscopy clinic providing both diagnostic and therapeutic GI procedures rather than primary care or non-procedural specialties.
Revenue is highly concentrated in a few procedure lines for both payers: the top 3 Medicare codes account for 74.4% of this provider's total Medicare revenue, while the top 3 Medicaid codes account for 93.1% of this provider's total Medicaid revenue. That concentration means changes in reimbursement or referral patterns for those specific codes (45385, 45380, 43239) would have outsized impact on overall revenue.
Payer mix is skewed toward Medicaid in scale: reported lifetime Medicaid revenue is $2M compared with total Medicare revenue of $610.3K, so Medicaid represents the larger revenue stream for this provider. Operational and contracting strategy should therefore prioritize state Medicaid relationships and utilization trends in addition to Medicare.
On Medicare, PACIFIC ENDOSCOPY CENTER shows a strong national footprint for key colonoscopy services: 45385 ranks #448 of 16310 providers nationally (97th percentile; notably above typical national volume) and 45380 ranks #311 of 16427 (98th percentile; extreme outlier, far above typical national volume), while 43239 ranks #694 of 17140 (96th percentile; notably above typical national volume). These percentile standings indicate the provider is a major national-volume performer for common colonoscopy and EGD biopsy codes billed to Medicare.
Within the state Medicaid market the center is a leading endoscopy provider: 45385 ranks #2 of 19 providers in-state (94th percentile; notably above typical state volume) and 43239 ranks #3 of 31 (93rd percentile; notably above typical state volume), with 45378 ranking #1 of 8 providers in-state (100th percentile; notably above typical state volume). These in-state ranks signal a dominant or near-dominant position in Medicaid-paid colonoscopy services locally.
The presence of advanced upper-GI codes billed to Medicare — including 43252 (endomicroscopy) and EUS-related codes 43242 and 43259 — alongside high-volume diagnostic codes suggests capability to deliver more complex diagnostic and therapeutic endoscopic procedures. Volumes for those advanced codes are smaller or more typical (for example, 43252 ranks #24 of 65 providers nationally, 61th percentile; typical, unremarkable volume), which indicates the center performs these procedures but concentrates most revenue on routine diagnostic and therapeutic scopes.
Procedure-level Medicaid volumes are substantial and outpace Medicare volumes for the same codes: for Medicaid the center reported 1.6K claims for 43239 and 1.3K claims for 45385, whereas Medicare claims for those codes are 314 and 390 respectively. This pattern reinforces that the practice’s procedural throughput and revenue are driven primarily by Medicaid-paid encounters in-state, even as it maintains notable Medicare volumes for the same services.
The provider has a long operational tenure, with an NPI enumerated on 2007-03-21 (~19 years ago), indicating an established presence in PEARL CITY, HI. Combined with the strong state rankings and concentrated procedure mix, that tenure suggests an entrenched ambulatory endoscopy operation likely supported by stable referral relationships and payer contracts.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 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… | 390 | $510 | $198.5K |
| 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… | 430 | $410 | $175.4K |
| 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. | 310 | $260 | $80.4K |
| 43252 | An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of a flexible endoscope passed through the mouth. The provider uses an endomicroscopy system to… | 40 | $1,370 | $54.8K |
| 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… | 90 | $370 | $33.5K |
| 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… | 30 | $680 | $18.4K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 30 | $490 | $15K |
| 43242 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where, under endoscopic ultrasound guidance, he carries out a fine needle aspiration or… | 10 | $690 | $9.6K |
| 43259 | An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope through the mouth. During this procedure, the physician uses endoscopic… | 10 | $680 | $8.9K |
| 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. | 20 | $320 | $7.7K |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 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 |
|---|---|---|---|---|
| 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… | 1,340 | $650 | $869.1K |
| 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. | 1,600 | $390 | $621.6K |
| 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… | 1,050 | $350 | $371.3K |
| 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… | 290 | $480 | $138.4K |
How this provider's Medicaid billing volume and revenue compare to other Hawaii providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Hawaii median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 2 | 20 | 90 | $550 | $222.1K |
| 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… | 4 | 20 | 190 | $340 | $177.3K |
| 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. | 3 | 30 | 100 | $280 | $111.1K |
| 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… | 1 | 10 | 90 | $450 | $45.5K |
Other providers in the same ZIP code as Pacific Endoscopy Center, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| David C. Ching,d.m.d.,llc | HI | Pediatric Dentistry | $0 | $5.1M |
| Apria Healthcare LLC | HI | Durable Medical Equipment & Medical Supplies | $0 | $2.7M |
| Jason R. Ching Dds LLC | HI | Dentist | $0 | $2.4M |
| Jojie Reyes | HI | Case Management Registered Nurse | $0 | $824.1K |
| Above And Beyond Case Management | HI | Case Management Registered Nurse | $0 | $475.1K |
| Travis Nishioka | HI | General Practice Dentistry | $0 | $467.1K |
| Longs Drug Stores California LLC | HI | Community/Retail Pharmacy | $426K | $32.2K |
| Pearl Family Dental Care, Inc | HI | General Practice Dentistry | $0 | $421.7K |
| Longs Drug Stores California, L.L.C. | HI | Pharmacy | $278.5K | $30.2K |
| Us Med Urgent Care | HI | Urgent Care Clinic/Center | $0 | $256.1K |
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