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NPI 1972532539 · Wilton, CT · Ambulatory Surgical Clinic/Center
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Wilton Surgery Center LLC is a ambulatory surgical clinic/center provider located in Wilton, Connecticut. This profile covers 19 Medicare and 6 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 | Wilton Surgery Center LLC |
| Address | 195 Danbury Road |
| City | Wilton |
| State | CT |
| ZIP | 06897 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 3, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.8M |
| Medicaid | $405.1K |
WILTON SURGERY CENTER LLC appears to operate primarily as an ophthalmic ambulatory surgery center: its top Medicare revenue driver is 66984 (cataract extraction with intraocular lens) which accounts for $951.1K and 53.6% of Medicare revenue, and the provider also bills high-volume ophthalmic follow-up and implant codes such as J1096 and 66991. Medicaid billing mirrors this ophthalmic emphasis with 66984 contributing $200.9K and 49.7% of Medicaid revenue, indicating cataract surgery is the clinic’s core service across payers. These code-level patterns are consistent with the listed taxonomy Ambulatory Surgical Clinic/Center and with a surgical suite configured for intraocular procedures and related drug/device administration.
Revenue concentration is high on both payers: precomputed figures show the top 3 Medicare codes account for 76.6% of total Medicare revenue, and the top 3 Medicaid codes account for 99.1% of total Medicaid revenue. This level of concentration signals that the facility’s financial performance is heavily dependent on a narrow set of procedures—primarily cataract surgery and a small number of ancillary ophthalmic and endoscopy services—making payer-rate changes or volume shifts in those codes materially impactful.
Payer mix is Medicare-dominant in scale: Total Medicare revenue is $1.8M versus Total Medicaid revenue of $405.1K, so Medicare is the clear primary revenue source for the center. Medicaid still represents a meaningful secondary stream concentrated in the same high-revenue cataract code plus gastrointestinal endoscopy codes, but it is much smaller in absolute dollars.
Competitive standing for key ophthalmic codes is solid but not monopolistic: for Medicare, 66984 ranks #1946 of 15965 (88th percentile) and 66991 ranks #170 of 1445 (88th percentile), both described as typical, unremarkable volume for these codes nationally, indicating above-average activity but not dominance. For Medicaid, 66984 ranks #10 of 39 in-state (76th percentile), which places the facility among the higher-volume state providers for cataract cases but still within a competitive band rather than as a clear statewide leader; gastrointestinal codes such as 43239 and 45380 show lower in-state percentiles (30th and 35th, respectively), indicating more modest standing in endoscopy.
The facility’s code mix indicates a dual service-line footprint: ophthalmology (high-volume cataract extraction and intraocular lens procedures plus adjuncts like J1096 dexamethasone lacrimal insert and procedures coded 66821, 66982) is dominant, while gastrointestinal endoscopy (43239, 45380, 45385) represents a secondary but significant Medicaid revenue source. This suggests the ASC either hosts multiple specialties or contracts with GI and ophthalmology providers to run discrete procedural blocks that generate the bulk of non-ophthalmic revenue.
Tenure is long-established: the NPI was enumerated on 2006-07-03 (~20 years ago), indicating sustained operation over multiple Medicare/Medicaid payment cycles which can be relevant when assessing historical relationships with payers and local referral patterns. Longevity combined with a concentrated service mix implies institutional experience in cataract workflows and payer billing for those procedures.
Several individual-code percentiles point to differentiated strength within ophthalmology: codes like 66821 rank in the 90th percentile nationally (described as typical, unremarkable volume) and 66984 sits at the 88th percentile, which together indicate consistently higher-than-median activity on common ophthalmic procedures. By contrast, certain complex or less-frequent procedures such as 66986 rank at the 8th percentile nationally, showing that lens-exchange cases or other lower-volume cataract-related surgeries are not a core part of this provider’s throughput.
Administrative/quality-reporting codes show non-revenue billing patterns on Medicaid: G8907 and G8918 appear with multiple claims but $0 average paid/claim and $0 revenue, consistent with their function as documentation/quality codes rather than revenue drivers. These entries are typical for facility reporting and should not be conflated with clinical revenue, but they do reflect engagement with required safety and preoperative documentation workflows.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,030 | $930 | $951.1K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 2,190 | $100 | $216.6K |
| 66991 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction. The provider also inserts one or more anterior segment aqueous drainage devices in… | 70 | $2,720 | $190.2K |
| 66982 | The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing… | 60 | $930 | $58.6K |
| 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… | 120 | $420 | $48.5K |
| J7351 | Injection, bimatoprost, intracameral implant, 1 microgram | 270 | $160 | $43.7K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 180 | $230 | $41.8K |
| 67036 | The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. | 20 | $1,680 | $35.3K |
| 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… | 60 | $490 | $29K |
| 66174 | The provider expands the aqueous outflow (drainage) canal of the eye to help relieve pressure in the eye. The procedure does not include leaving a device or stent in place. | 20 | $1,620 | $27.5K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
19 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1096 | 1 | 10 | 2,090 | $100 | $143.4K |
| 66984 | 8 | 150 | 90 | $400 | $87.8K |
| J7351 | 3 | 10 | 600 | $160 | $82.5K |
| 66991 | 2 | 10 | 30 | $1,920 | $73K |
| 66982 | 5 | 40 | 30 | $740 | $27.5K |
| 66174 | 3 | 10 | 20 | $1,030 | $22.6K |
| 45385 | 84 | 240 | 50 | $290 | $19.3K |
| 15823 | 6 | 10 | 30 | $600 | $18.8K |
| 67036 | 2 | 10 | 20 | $970 | $18.4K |
| 64483 | 44 | 70 | 60 | $220 | $17.7K |
Showing 1–10 of 19
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.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,660 | $120 | $200.9K |
| 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. | 440 | $290 | $126.1K |
| 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… | 230 | $320 | $73.8K |
| 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… | 10 | $270 | $3.4K |
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer… | 280 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 90 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 43 | 70 | 570 | $480 | $626.7K |
| 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. | 58 | 80 | 990 | $260 | $592K |
| 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… | 53 | 60 | 370 | $460 | $368K |
| 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… | 10 | 40 | 380 | $310 | $334K |
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer… | 10 | 30 | 110 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 8 | 20 | 90 | $0 | $0 |
Other providers in the same ZIP code as Wilton Surgery Center LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Connec-totalk,llc | CT | Speech-Language Pathologist | $0 | $6.1M |
| Kristina Bikoulova | CT | Family Nurse Practitioner | $1.9M | $0 |
| Wilton Volunteer Ambulance Corps Inc | CT | Land Ambulance | $245.4K | $131K |
| Tracey Velo | CT | Family Nurse Practitioner | $330.5K | $0 |
| Mark Fletcher | CT | Orthopaedic Surgery Physician | $268.8K | $0 |
| Connecticut Cvs Pharmacy, L.L.C. | CT | Pharmacy | $184.7K | $0 |
| Jeffrey Deluca | CT | Orthopaedic Surgery Physician | $182.8K | $0 |
| Southwest Connecticut Surgery Center, LLC | CT | Ambulatory Surgical Clinic/Center | $154.8K | $0 |
| Robert Brady | CT | Orthopaedic Surgery Physician | $153.8K | $0 |
| Paul Protomastro | CT | Orthopaedic Hand Surgery Physician | $131.1K | $0 |
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