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.

Billings Clinic (NPI 1326104845)

Key Findings

Field	Value
Entity Type	Organization
Organization	Billings Clinic
Address	2800 10th Ave N
City	Billings
State	MT
ZIP	59101
Taxonomy	Emergency Care Clinic/Center
NPI Enumerated	December 29, 2006

Payer Source	Total Paid
Medicaid	$15.7M
Medicare	$0

This provider is effectively single‑payer at the claims level: there is no Medicare billing on file while Medicaid accounts for $15.7M in lifetime revenue, indicating the provider’s billing activity on this dataset is concentrated in Medicaid rather than split across traditional Medicare/Medicaid payers. Analysts should treat this profile as Medicaid‑centric when modeling payer mix or network access for public programs.

Revenue is extremely concentrated in three emergency department E/M codes: 99285, 99284, and 99283 together account for 98.2% of the provider’s total Medicaid revenue. Specifically, 99285 is reported as 42.4K claims, $165 avg paid/claim, $7M revenue (44.5% of Medicaid revenue); 99284 is 48.3K claims, $121 avg paid/claim, $5.8M revenue (37.2%); and 99283 is 38.7K claims, $67 avg paid/claim, $2.6M revenue (16.5%).

The code mix and taxonomy (Emergency Care Clinic/Center) indicate an emergency department–centric operation: the bulk of billing is for ED evaluation and management at high, moderate, and low decision‑making levels (99285/99284/99283). Ancillary imaging and diagnostic codes appear only as minor revenue contributors, which is consistent with a high‑volume ED that bills primary E/M services as the core revenue driver rather than procedural or inpatient care.

Competitive standing within Montana is dominant for high‑acuity ED visits: 99285 ranks #1 of 55 providers in‑state at the 100th percentile and is labeled an "extreme outlier," while 99284 ranks #2 of 75 (99th percentile, "extreme outlier") and 99283 ranks #3 of 88 (98th percentile, "notably above typical" state volume). These rankings indicate the provider is a major statewide player for emergency department E/M volume, particularly at higher acuity levels.

Although the ED E/M codes drive nearly all Medicaid revenue, downstream critical care and specialty codes are minimal: 99291 appears only 40 claims for $7.2K revenue (0.0% of Medicaid revenue) and ranks #14 of 21 providers in‑state at the 30th percentile. This suggests that while the site handles very large volumes of ED visits, it bills little in formally coded critical care time relative to its E/M activity.

Imaging and routine diagnostics are present but represent a small share of Medicaid revenue and largely typical in‑state volumes: examples include 74177 (1.1K claims, $85 avg paid/claim, $91K revenue; 0.6% of Medicaid revenue) and 70450 (2K claims, $38 avg paid/claim, $75.7K revenue; 0.5%). These ancillary services appear complementary to ED throughput rather than being significant standalone revenue lines.

The differential in average paid/claim across the three primary ED codes underscores acuity weighting in revenue: 99285 at $165 avg paid/claim generates the largest single code revenue ($7M), compared with $121 for 99284 ($5.8M) and $67 for 99283 ($2.6M). For payers modeling cost per visit or acuity mix, this skew toward higher‑paid, high‑acuity ED visits will materially affect per‑encounter spend assumptions.

The provider has a long tenure in the NPI registry (enumerated 2006-12-29, ~20 years ago), which combined with its outsized Medicaid ED volumes suggests an established emergency care presence in Billings, MT; longevity strengthens the interpretation that the high ED volumes and state outlier status reflect persistent operational scale rather than a short‑term reporting anomaly.

Medicaid: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	42,380	$170	$7M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	48,260	$120	$5.8M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	38,680	$70	$2.6M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	1,070	$90	$91K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	1,990	$40	$75.7K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	5,830	$10	$40.8K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	3,070	$10	$30.6K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	440	$50	$20K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	40	$180	$7.2K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	700	$10	$6.3K

Showing 1–10 of 17

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

Billings Clinic — 3 of 17 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

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	1	60	2,160	$80	$526.7K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	2	80	2,770	$60	$471K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	3	90	2,330	$40	$281.3K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	28	50	1,150	$50	$119.8K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	14	20	100	$160	$100.9K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	22	50	50	$140	$61K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	19	50	1,430	$20	$54.3K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	43	70	860	$20	$50.8K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	11	40	630	$10	$33.8K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	35	60	1,280	$10	$19.7K

Showing 1–10 of 17

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Billings Clinic	MT	General Practice Physician	$0	$53.8M
Billings Clinic	MT	General Acute Care Hospital	$0	$3.1M
Omar Ahmed	NY	Neurology Physician	$1M	$1.8M
Billings Clinic	MT	Durable Medical Equipment & Medical Supplies	$0	$2.4M
Applied Health Services Incorporated	MT	Durable Medical Equipment & Medical Supplies	$0	$2.2M
Pamela Smith	KY	Hematology & Oncology Physician	$1.8M	$0
Charles Mayron	TX	Retina Specialist (Ophthalmology) Physician	$1.4M	$16.8K
Basel Skeif	AZ	Cardiovascular Disease Physician	$990.8K	$0
Benjamin Citrin	AL	Interventional Cardiology Physician	$442.8K	$0
Roger Barth	MT	Ophthalmology Physician	$422.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rimrock Foundation	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$44.9M
Scl Health Medical Group - Billings LLC	MT	Clinic/Center	$0	$32.2M
Residential Support Services	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$30.6M
Billings Public School District 2	MT	Local Education Agency (LEA)	$0	$19.2M
South Central Montana Regional Mental Health Center	MT	Clinic/Center	$0	$16.6M
Community Solutions Incorporated	MT	Clinical Medical Laboratory	$0	$14.1M
Scl Health Montana	MT	General Acute Care Hospital	$0	$13.5M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$10.8M
American Medical Response Ambulance Service Inc	MT	Ambulance	$2.1M	$6.7M
Yellowstone Pathology Institute, Inc.	MT	Clinical Medical Laboratory	$777.4K	$4.4M

Billings Clinic — Billing Profile & Reimbursement Data

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Billings Clinic — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References