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NPI 1942851639 · Boyne City, MI · Ambulatory Surgical Clinic/Center
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Northern Michigan Surgical Suites, LLC is a ambulatory surgical clinic/center provider located in Boyne City, Michigan. This profile covers 18 Medicare and 2 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 | Northern Michigan Surgical Suites, LLC |
| Address | 825 Moll Dr |
| City | Boyne City |
| State | MI |
| ZIP | 49712 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | September 24, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $92.7K |
This provider’s billing is heavily Medicare-weighted in scale: reported lifetime Medicare revenue is $1.7M compared with $92.7K in Medicaid revenue, so Medicare is the dominant payer by an order of magnitude. The disparity suggests the center’s primary referral and reimbursement base is fee‑for‑service Medicare rather than Medicaid.
Medicare revenue is highly concentrated in a very small set of high-value procedures: the precomputed top three Medicare codes (27447, 63685, 27130) account for 75.3% of the provider’s total Medicare revenue. Those three codes represent major joint arthroplasty (27447 knee, 27130 hip) and surgical spinal neurostimulator implant (63685), with notably high average paid/claim values reported (for example, $17672 avg paid/claim for 63685 and $6587 avg paid/claim for 27447), underscoring dependence on a few high-reimbursement procedures.
Medicaid billing is almost entirely concentrated in pediatric ENT procedures: the precomputed top-3 share is 100.0%, with 42820 (tonsil/adenoid removal in children) generating $68.4K (73.8% of Medicaid revenue) and 69436 (tympanostomy tube insertion) generating $24.2K (26.2% of Medicaid revenue). Both Medicaid codes rank in the lower third of in-state peers (#36 of 50 and #43 of 60, each at the 29th percentile) and are labeled as typical, unremarkable volume for those codes, so this Medicaid activity appears narrow and not competitively dominant statewide.
Competitive standing across Medicare procedures is mixed: 27447 shows a national rank of #949 of 12089 at the 92th percentile but is described as 'typical, unremarkable volume for this code', while 63685 ranks #319 of 1281 (72th percentile) and 27130 ranks #2803 of 8062 (64th percentile), both also described as typical volumes. This pattern indicates the center achieves above-average national placement for some high-revenue procedures but remains a modest, not dominant, national player overall for its core arthroplasty and neurostimulation services.
There is at least one clear procedural outlier that may indicate a local specialty or referral niche: 29848 (endoscopic carpal tunnel release) is ranked #51 of 1333 providers nationally at the 96th percentile and explicitly flagged as 'notably above typical national volume for this code'. With 116 claims and $56.7K in Medicare revenue (3.3% of Medicare revenue), this high relative volume for an ambulatory endoscopic wrist procedure suggests a concentrated local demand or specialty expertise in hand/wrist surgery.
The center’s code mix shows breadth across orthopedics and interventional pain within an ambulatory surgical clinic taxonomy: high-revenue joint replacements and spinal neurostimulator implants coexist with arthroscopic shoulder/hand procedures and smaller orthopaedic fracture/tenolysis codes (examples include 29827, 29828, 25609, 26440). This combination implies the facility performs both complex, higher-cost implant cases and lower-cost outpatient arthroscopy/hand procedures, consistent with an ASC that handles a spectrum of musculoskeletal surgical services.
NPI tenure is relatively recent — enumerated 2019-09-24 (~7 years ago) — which, combined with the revenue concentration (75.3% of Medicare revenue from the top three codes), suggests the facility’s financial profile could be sensitive to changes in reimbursement or referral patterns for those few high-impact procedures. Given the narrow Medicaid footprint and concentrated Medicare revenue drivers, shifts in arthroplasty or spinal implant billing policies or local competition could materially affect overall revenues.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 100 | $6,590 | $645.5K |
| 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 | $17,670 | $424.1K |
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 30 | $6,790 | $230.8K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 50 | $3,470 | $159.4K |
| 29848 | The provider inserts an endoscope into the wrist joint to divide the transverse carpal ligament and reduce compression on the median nerve in the carpal tunnel that results in pain and numbness. | 120 | $490 | $56.7K |
| 29827 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and… | 30 | $1,510 | $40.8K |
| 29828 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps… | 20 | $2,250 | $38.2K |
| 25609 | The provider surgically repairs a fracture of the lower radius, the larger of the two lower arm bones, beyond the joint or a separation of the radius from the joint through an incision and fixes… | 10 | $3,140 | $37.6K |
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 20 | $750 | $15.8K |
| 64718 | In this procedure, the provider uses an open approach to incise scar tissue or other sources of pressure to relieve tension on the ulnar nerve at the elbow, which an injury or swelling within the… | 30 | $570 | $14.3K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 3 | 40 | 20 | $6,790 | $108.7K |
| 63650 | 13 | 30 | 40 | $1,760 | $80.9K |
| 66984 | 426 | 480 | 70 | $470 | $69.5K |
| 27447 | 10 | 360 | 30 | $1,470 | $50.1K |
| 27130 | 59 | 240 | 20 | $1,410 | $40.8K |
| 25609 | 8 | 10 | 20 | $2,040 | $30.6K |
| 29827 | 17 | 80 | 20 | $1,040 | $24.9K |
| 29848 | 2 | 40 | 40 | $440 | $19.4K |
| 29828 | 10 | 20 | 10 | $1,070 | $18.2K |
| 28285 | 12 | 10 | 30 | $540 | $16.1K |
Showing 1–10 of 18
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.
How this provider's Medicaid billing volume and revenue compare to other Michigan providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Michigan median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 36 | 50 | 150 | $1,300 | $889.5K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 43 | 60 | 170 | $260 | $184.1K |
Other providers in the same ZIP code as Northern Michigan Surgical Suites, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Robert Wedge | MI | Certified Registered Nurse Anesthetist | $26.7K | $0 |
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