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 1376598714)

Key Findings

Field	Value
Entity Type	Organization
Organization	Billings Clinic
Address	801 N 29th St
City	Billings
State	MT
ZIP	59101
Taxonomy	General Practice Physician
NPI Enumerated	May 24, 2006

Payer Source	Total Paid
Medicaid	$53.8M
Medicare	$0

BILLINGS CLINIC reports no Medicare billing on file and $53.8M in lifetime Medicaid revenue, meaning its current claims footprint is effectively single‑payer Medicaid; this concentration creates both revenue dependency on Medicaid reimbursement levels and program policies and a concentrated operational focus on Medicaid-covered services.

Revenue is highly concentrated in office/outpatient evaluation and management: the top three Medicaid codes (99213, 99214, 99215) account for 63.7% of the provider's total Medicaid revenue, led by 99213 at $12.9M (29.5%) and 99214 at $12.5M (28.5%), with 99215 contributing $2.5M (5.7%). This mix signals that routine and higher‑complexity established patient visits are the primary drivers of income.

The raw claim volumes for core E/M codes are very large—99213 has 155.5K claims and 99214 has 113.6K claims—paired with high state ranks, which together point to a high‑throughput ambulatory primary care operation; complementary preventive and pediatric codes (99392, 99391) and vaccine administration (90460 with 32.9K claims and $1.6M revenue) reinforce a full‑spectrum primary care and preventive services platform, including pediatric immunizations.

On statewide competitive standing, BILLINGS CLINIC is a dominant Medicaid provider for multiple high‑volume codes: 99213 ranks #1 of 523 providers (100th percentile; extreme outlier) and 99214 ranks #2 of 532 providers (100th percentile; extreme outlier), with 99215 also ranking #1 where measured—these ranks indicate activity far above typical state volumes for its core ambulatory services.

The code mix shows substantial inpatient and high‑acuity activity under Medicaid as well: 99232 (16.3K claims, $1.1M, 2.5%) and 99233 (8.8K claims, $957K, 2.2%) for subsequent hospital visits and 99291 (3.9K claims, $763.2K, 1.7%) for critical care suggest the provider delivers both outpatient primary care and significant hospital‑based or acute care services.

BILLINGS CLINIC also reports meaningful diagnostic, imaging, and pathology revenue lines—88305 ($916.9K), 93306 ($823.3K), 74177 ($685.7K), and 70450 ($315.6K)—and most of these codes rank high statewide (many at or near the 90–100th percentiles), indicating in‑house or closely integrated ancillary services that support its clinical volume.

Several ancillary throughput indicators stand out as statistical outliers: 36415 (84.6K claims, $338.2K) ranks #2 of 185 providers (99th percentile; extreme outlier) and 90460 ranks #1 of 48 providers (100th percentile; extreme outlier), which together imply very high visit volumes and operational capacity for specimen collection and immunization workflows.

The provider has a long tenure in enrollment—NPI enumerated 2006-05-24 (~20 years ago)—which is consistent with the sustained, large Medicaid presence and the breadth of services billed; this longevity supports the interpretation that the organization operates at system or multi‑site scale rather than as a small single‑site practice.

Medicaid: Complete Services Breakdown

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

327 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	155,530	$80	$12.9M
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…	113,640	$110	$12.5M
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…	14,980	$170	$2.5M
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…	10,780	$150	$1.7M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	32,950	$50	$1.6M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	10,510	$120	$1.3M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	10,600	$110	$1.2M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	16,310	$70	$1.1M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	8,780	$110	$957K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	15,810	$60	$916.9K

Showing 1–10 of 327

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 — 14 of 25 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

327 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.	28	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.	37	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.	47	90	2,330	$40	$281.3K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	3	30	770	$60	$233.3K
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…	2	530	580	$70	$224.6K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	80	150	2,760	$40	$224.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	4	30	3,780	$40	$222.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	52	200	1,110	$60	$207.2K
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…	1	520	730	$40	$196.4K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3	30	640	$90	$188.1K

Showing 1–10 of 327

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Billings Clinic	MT	Emergency Care Clinic/Center	$0	$15.7M
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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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