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NPI 1952852873 · Bellingham, WA · Ambulatory Surgical Clinic/Center
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Pacific Northwest Urology Specialists, PLLC is a ambulatory surgical clinic/center provider located in Bellingham, Washington. This profile covers 15 Medicare and 1 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 Northwest Urology Specialists, PLLC |
| Address | 3232 Squalicum Pkwy |
| City | Bellingham |
| State | WA |
| ZIP | 98225 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 14, 2016 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $41.4K |
PACIFIC NORTHWEST UROLOGY SPECIALISTS, PLLC presents as an ambulatory surgical clinic focused on interventional urology: its top Medicare codes are device and endoscopy-heavy (64590, C9740, 64561) alongside high-volume cystoscopy services such as 52000 and intravesical procedures like 52287 and J0585, indicating a procedural mix centered on neuromodulation, implantable devices, and bladder-directed endoscopic therapy. The presence of multiple implant codes and specialized cystoscopic injections suggests the practice performs same-day surgical and device procedures consistent with an ambulatory surgery center/clinic taxonomy rather than primarily office-based medical management.
Revenue concentration on Medicare is substantial and concentrated in a few procedural codes: total Medicare revenue is $1.7M and the provider’s top 3 Medicare codes (64590, C9740, 64561) account for 56.6% of that Medicare revenue, pointing to dependence on a small set of high-reimbursement surgical services for the bulk of its Medicare income. This concentration implies that changes in reimbursement or referral patterns for these procedures would materially affect the provider’s Medicare revenue.
Cystoscopic and bladder-directed services are a major operational focus: 52000 contributes $133.7K (8.1% of Medicare revenue) and 52287 contributes $175K (10.6% of Medicare revenue), while J0585 contributes $138.8K (8.4% of Medicare revenue). Both 52287 and 52000 are labeled as extreme outliers in national Medicare comparisons (52287 ranks #5 of 1443, 100th percentile; 52000 ranks #60 of 8548, 99th percentile), indicating exceptionally high national-volume performance in cystoscopy and intravesical treatments compared with peers.
The practice’s position on implantable neuromodulation and transprostatic implants is solid but not dominant nationally: 64590 (23.9% of Medicare revenue) ranks #122 of 561 (76th percentile, typical), C9740 (17.5%) ranks #32 of 162 (80th percentile, typical), and 64561 (15.2%) ranks #85 of 564 (85th percentile, typical). These percentile placements describe a provider with meaningful procedural market share in device implantation locally or regionally, but not a national leader across the implant codes.
Medicaid activity is minimal relative to Medicare: total Medicaid revenue is $41.4K, and the entire Medicaid revenue stream comes from a single code, 52000, which represents 100.0% of Medicaid revenue. 52000 ranks #9 of 24 in-state (65th percentile), indicating only a typical in-state Medicaid cystoscopy volume and an overall Medicaid footprint that is negligible compared with Medicare.
The payer mix is heavily Medicare-skewed: with $1.7M in Medicare revenue versus $41.4K in Medicaid revenue the practice is effectively Medicare-dominant in scale and likely relies on Medicare referrals and reimbursements for its financial base. This lopsided mix suggests limited exposure to Medicaid patient flow and rate-setting dynamics.
Operational tenure supports established procedural volume: the provider’s NPI was enumerated on 2016-10-14 (~10 years ago), consistent with several years of claims history to accumulate the high-volume cystoscopy and implant procedure counts reported. That duration is sufficient to have developed referral relationships and procedural throughput reflected in the extreme national-volume signals for select codes.
Statistical outliers are concentrated in cystoscopic neurolytic and diagnostic codes: 52287 is an extreme outlier nationally (100th percentile) and several cystoscopy-related codes (notably 52000) are also extreme outliers in Medicare volumes, while other high-revenue implant codes sit at typical-to-notably-above-typical percentiles. This pattern indicates specialized high-capacity delivery of particular bladder interventions (e.g., neurolytic injections and diagnostic/therapeutic cystoscopy) rather than uniformly elevated volumes across all urology services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 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… | 20 | $16,500 | $396.1K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 50 | $6,160 | $289.6K |
| 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 | $4,260 | $251.3K |
| 52287 | The provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystoscope. He then inserts a needle and injects a neurolytic drug into the… | 240 | $720 | $175K |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 27,750 | $10 | $138.8K |
| 52000 | In this procedure, the provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystourethroscope, a thin flexible or rigid tube with a… | 570 | $240 | $133.7K |
| 55700 | Code deleted December 31, 2025. | 120 | $720 | $83.3K |
| 52601 | During transurethral resection of the prostate (TURP), the surgeon inserts a resectoscope via the urethra and removes a portion of the prostate. This procedure includes several other urological… | 20 | $1,930 | $38.6K |
| 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… | 20 | $1,740 | $31.4K |
| 52204 | 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 and takes biopsies… | 50 | $680 | $30.7K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 52000 | In this procedure, the provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystourethroscope, a thin flexible or rigid tube with a… | 200 | $210 | $41.4K |
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 52000 | In this procedure, the provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystourethroscope, a thin flexible or rigid tube with a… | 9 | 20 | 110 | $400 | $143K |
Other providers in the same ZIP code as Pacific Northwest Urology Specialists, PLLC, ranked by combined Medicare and Medicaid revenue.
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