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NPI 1902052350 · Franklin, WI · Ambulatory Surgical Clinic/Center
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Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Franklin, Wisconsin. This profile covers 21 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 | Surgery Center, LLC |
| Address | 3111 W Rawson Ave |
| City | Franklin |
| State | WI |
| ZIP | 53132 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | August 15, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.3M |
| Medicaid | $277K |
Medicare dominates this provider's public-payer revenue: total Medicare revenue is $1.3M versus total Medicaid revenue of $277K, indicating Medicare is the larger payer relationship by scale for this entity. The NPI was enumerated on 2008-08-15 (~18 years ago), so the billing footprint reflects a long-tenured ambulatory surgical clinic/center.
The provider's Medicare billing is heavily concentrated in implantable neuromodulation and peripheral nerve stimulation procedures: the top three Medicare codes 63685, 63650, and 64555 together account for 58.5% of this provider's total Medicare revenue. Individual shares show 63685 at 24.9%, 63650 at 24.7%, and 64555 at 8.9%, which signals a service line emphasis on spinal neurostimulator pulse generator implantation, epidural electrode placement, and peripheral nerve stimulator implantation.
Beyond implants, the Medicare code mix includes high-volume, image-guided spine and facet procedures, suggesting an integrated pain-management practice model. Several injection and neurolytic codes appear with large claim counts and high national percentiles (for example, 62323 at 341 claims and 6.5% of Medicare revenue ranks #223 of 7397 providers nationally, 97th percentile — notably above typical national volume; 64635 ranks #273 of 5957, 95th percentile — notably above typical national volume; and 64493 ranks #263 of 7519, 96th percentile — notably above typical national volume).
Competitive standing on Medicare is mixed by service: for high-revenue implants the provider is a typical-volume participant (63685 ranks #590 of 1281 providers nationally, 48th percentile — typical, unremarkable volume; 63650 ranks #218 of 1371, 84th percentile — typical, unremarkable volume), while for many image-guided injection procedures the provider is a national high-volume outlier. The combination means this center is a modest national player for device implantation but a comparatively strong provider of interventional spine/injection services.
Medicaid billing is highly concentrated and reflects a different procedural focus than Medicare: the top three Medicaid codes 43239, 62323, and 64483 account for 98.8% of this provider's total Medicaid revenue. In particular, 43239 (EGD with biopsy) alone represents 71.4% of Medicaid revenue ($197.8K), while 62323 and 64483 contribute 19.3% and 8.1% respectively, indicating Medicaid volume is dominated by gastrointestinal endoscopy plus some interventional spine injections.
State-level competitive standing for Medicaid services is moderate to strong in specific lines: 43239 ranks #41 of 116 in-state (65th percentile — typical, unremarkable volume) so the provider is not a statewide leader in EGD volume, but 62323 ranks #9 of 51 in-state (84th percentile — typical, unremarkable volume) indicating relatively strong in-state positioning for lumbar image-guided injections billed to Medicaid. The presence of both GI and spine procedure volumes suggests the center serves mixed referral pathways for Medicaid patients.
Revenue concentration across both payers creates operational sensitivity to a small set of codes and referral relationships: with Medicare top-3 concentration at 58.5% and Medicaid top-3 concentration at 98.8%, changes in utilization, payer policy, or referral sources for these specific services could materially affect overall revenue. This profile increases the importance of maintaining strong referral networks and payer contracting for those core codes.
The combined payer picture and code mix imply an ambulatory surgical center that has evolved into a dual-focused operation: a neuromodulation/interventional pain hub on the Medicare side and an EGD-dominant outpatient endoscopy volume on the Medicaid side. The long NPI tenure (~18 years) supports an established local presence, but competitive strength varies by service line and payer, so analysts should treat the provider as a specialized, service-line-dependent facility rather than a broad-based multi-specialty center.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
21 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… | 20 | $19,100 | $324.8K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 90 | $3,800 | $322.8K |
| 64555 | A neurostimulator includes electrodes which are inserted under the skin and induced by a generator to stimulate the nerve tissue. Use of this stimulator involves implantation of electrodes around a… | 30 | $4,320 | $116.6K |
| 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)… | 340 | $250 | $84.6K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 160 | $520 | $83.1K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 270 | $270 | $71.3K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 220 | $310 | $67K |
| 0275T | N/A | 10 | $3,730 | $41K |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | 180 | $220 | $39.8K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 100 | $250 | $25.7K |
Showing 1–10 of 21
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 6 | 30 | 10 | $7,060 | $105.9K |
| 63650 | 1 | 20 | 50 | $1,720 | $86.2K |
| 64555 | 6 | 10 | 30 | $2,050 | $73.9K |
| 0275T | 6 | 10 | 10 | $1,410 | $21.1K |
| 15823 | 11 | 30 | 30 | $540 | $19.4K |
| 67904 | 13 | 20 | 20 | $590 | $18.9K |
| G0260 | 3 | 20 | 50 | $210 | $16.8K |
| 29827 | 40 | 40 | 20 | $750 | $12.7K |
| 64635 | 3 | 130 | 30 | $320 | $12.3K |
| 64721 | 54 | 80 | 30 | $390 | $12.3K |
Showing 1–10 of 21
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 |
|---|---|---|---|---|
| 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. | 990 | $200 | $197.8K |
| 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)… | 580 | $90 | $53.5K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 180 | $120 | $22.4K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 30 | $130 | $3.4K |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
4 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. | 41 | 120 | 400 | $180 | $186.8K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 23 | 60 | 140 | $130 | $51.8K |
| 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)… | 9 | 50 | 120 | $110 | $34.3K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 12 | 20 | 30 | $130 | $8.1K |
Other providers in the same ZIP code as Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Milwaukee Surgicenter LLC | WI | Ambulatory Surgical Clinic/Center | $1.2M | $253.7K |
| City Of Franklin | WI | Land Ambulance | $293.3K | $609.3K |
| Tracy Nelson | WI | Family Nurse Practitioner | $714.9K | $0 |
| Robert Matteucci | WI | Foot & Ankle Surgery Podiatrist | $163.9K | $39K |
| Catalina Hamilton Martinez | WI | Physical Therapist | $128.4K | $57.6K |
| Oh Hoon Kwon | WI | Radiation Oncology Physician | $167.3K | $0 |
| David Clark | WI | Orthopaedic Hand Surgery Physician | $154.4K | $0 |
| Glsd Medical LLC | WI | Ambulatory Surgical Clinic/Center | $1.6K | $144.5K |
| William Pennington | WI | Orthopaedic Surgery Physician | $107.9K | $0 |
| Jennifer Riley | WI | Physical Therapist | $96.2K | $0 |
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