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NPI 1982793709 · Fairfield, CT · Ambulatory Surgical Clinic/Center
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Gastroenterology Associates Of Fairfield PC is a ambulatory surgical clinic/center provider located in Fairfield, Connecticut. This profile covers 10 Medicare and 3 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 | Gastroenterology Associates Of Fairfield PC |
| Address | 425 Post Rd |
| City | Fairfield |
| State | CT |
| ZIP | 06824 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 12, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $685.5K |
| Medicaid | $0 |
This provider is effectively single‑payer in the public programs: lifetime Medicare revenue is $685.5K while reported Medicaid revenue is $0, and the practice is registered under the Ambulatory Surgical Clinic/Center taxonomy. That payer mix implies Medicare policies and rate changes will drive the majority of public-revenue performance for this entity.
Revenue is highly concentrated in a small set of endoscopy codes: 45385 ($258.4K, 37.7% of Medicare revenue), 43239 ($152.3K, 22.2% of Medicare revenue), and 45380 ($114.1K, 16.6% of Medicare revenue) collectively account for 76.5% of the provider's total Medicare revenue. This concentration means a few procedural services—polypectomy, EGD with biopsy, and diagnostic/therapeutic colonoscopy—dominate billed Medicare dollars.
The procedural mix (high volumes of 45385 with 558 claims, 43239 with 540 claims, and 45380 with 317 claims) indicates the operation functions primarily as a high-throughput endoscopy/colonoscopy practice consistent with its Ambulatory Surgical Clinic/Center taxonomy. Average paid per claim for these top codes ($463 for 45385, $282 for 43239, $360 for 45380) further reflects reliance on Medicare procedural reimbursements rather than evaluation-and-management or ancillary non-procedural revenue.
Competitive standing for key services is nationally strong: 45385 ranks #262 of 16310 providers (98th percentile) and is labeled an "extreme outlier," while 43239 ranks #234 of 17140 providers (99th percentile) and is also an "extreme outlier." 45380 ranks #546 of 16427 providers (97th percentile, "notably above typical national volume"), so the provider is a major national outlier on its highest-revenue colonoscopy and upper-endoscopy procedures.
Colorectal cancer screening is a material part of the mix: G0105 appears with 162 claims and $74.5K in revenue (10.9% of Medicare revenue) and ranks #316 of 8773 providers (96th percentile; "notably above typical national volume"). This suggests a significant focus on high‑risk screening colonoscopies in addition to diagnostic/therapeutic cases.
Given the near-zero Medicaid billing and Medicare-dominated revenue, the provider’s public-program exposure is concentrated in Medicare policy, utilization, and reimbursement trends for endoscopic procedures. Any shifts in Medicare coverage or coding guidance for colonoscopy and EGD services would therefore disproportionately affect this entity’s public-revenue performance.
Operational throughput is implied by sustained, high claim counts for core procedures (558 claims for 45385 and 540 claims for 43239). Those volumes are consistent with an established, procedure-focused ambulatory surgery center capable of handling large numbers of endoscopic cases on a recurring basis.
The NPI was enumerated on 2006-10-12 (~20 years ago), indicating long tenure in the market; combined with the high national percentiles on multiple core codes, this suggests an established provider with a specialized, high-volume practice profile rather than a low-volume or new entrant.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 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… | 560 | $460 | $258.4K |
| 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. | 540 | $280 | $152.3K |
| 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… | 320 | $360 | $114.1K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 160 | $460 | $74.5K |
| 43249 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum and dilates (widens) the esophagus with a balloon less than 30 mm in diameter. | 40 | $630 | $23.4K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 40 | $460 | $18.9K |
| 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… | 50 | $340 | $16.8K |
| 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. | 40 | $320 | $12.1K |
| 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… | 20 | $630 | $11.3K |
| 45381 | The provider inserts a flexible endoscope into the anus and navigates the scope through the entire colon. The provider performs one or more injections into the submucosa (the tissue below the mucous… | 20 | $260 | $3.8K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 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.
3 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. | 230 | $0 | $0 |
| 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… | 1,010 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,010 | $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
3 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. | 64 | 80 | 990 | $260 | $592K |
| 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… | 1 | 30 | 110 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1 | 20 | 90 | $0 | $0 |
Other providers in the same ZIP code as Gastroenterology Associates Of Fairfield PC, ranked by combined Medicare and Medicaid revenue.
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