Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Montana for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Montana only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Montana (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Kalispell Regional Medical Center Inc (NPI 1053798710)

Field	Value
Entity Type	Organization
Organization	Kalispell Regional Medical Center Inc
Address	210 Sunnyview Ln
City	Kalispell
State	MT
ZIP	59901
Taxonomy	Maternal & Fetal Medicine Physician
NPI Enumerated	May 1, 2015

Payer Source	Total Paid
Medicaid	$700.6K
Medicare	$0

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	2,710	$110	$289.8K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	1,580	$80	$132.6K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	530	$160	$86.6K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	1,320	$60	$72.7K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	990	$60	$63.4K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	420	$90	$36.5K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	230	$30	$6.8K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	60	$80	$5.1K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	230	$10	$2K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	10	$110	$1.6K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.

Claims Volume vs. Montana Distribution

Kalispell Regional Medical Center Inc — 0 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	157	530	580	$70	$224.6K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	235	520	730	$40	$196.4K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	4	20	970	$100	$148K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	6	10	260	$180	$130.6K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	111	160	250	$110	$85.9K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	7	20	100	$90	$60.9K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	8	10	670	$50	$38.5K
76801	In this procedure, the provider performs a real time or live image, ultrasound of a pregnant uterus for examination of the first or a single fetus and mother during the first trimester, or less than…	17	20	130	$70	$28.4K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	22	20	200	$60	$25.8K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	67	100	60	$40	$10.3K

Showing 1–10 of 14

Related Providers

Other providers that share a Tax Identification Number (TIN) with Kalispell Regional Medical Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kalispell Regional Medical Center Inc	MT	General Acute Care Hospital	$0	$8.8M
Kalispell Regional Medical Center, Inc	MT	Clinic/Center	$0	$6.2M
Kalispell Regional Medical Center Inc	MT	Psychiatry Physician	$0	$5.9M
Kalispell Regional Medical Center Inc	MT	Emergency Medicine Physician	$0	$5.4M
Kalispell Regional Medical Center Inc	MT	Primary Care Clinic/Center	$0	$4.5M
Kalispell Regional Medical Center Inc	MT	Pediatrics Physician	$0	$3.7M
Kalispell Regional Medical Center Inc	MT	Clinic/Center	$0	$2.1M
Kalispell Regional Medical Center Inc	MT	Clinic/Center	$0	$2.1M
Kalispell Regional Medical Center Inc	MT	Neurology Physician	$0	$1.7M
Kalispell Regional Medical Center, Inc	MT	Multi-Specialty Clinic/Center	$0	$1.4M

Nearby Providers

Other providers in the same ZIP code as Kalispell Regional Medical Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Flathead Industries	MT	Community/Behavioral Health Agency	$0	$40.7M
A Plus Health Care Inc	MT	In Home Supportive Care Agency	$0	$28.2M
Gabriel Dawson	MT	Pediatric Dentistry	$0	$10.7M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$6.8M
Kiddsteeth PLLC	MT	Pediatric Dentistry	$0	$6.7M
Kalispell Public Schools	MT	Local Education Agency (LEA)	$0	$6M
Sunburst Community Service Foundation, Inc	MT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.3M
Oxytocin	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$4.8M
Glacier Grins Pediatric Dentistry, PLLC	MT	Dental Clinic/Center	$0	$3.8M
Kalispell Rehabilitation Associates, Inc	MT	Physical Therapist	$0	$3.6M

Kalispell Regional Medical Center Inc — Billing Profile & Reimbursement Data

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Kalispell Regional Medical Center Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References