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NPI 1407860745 · Missoula, MT · Ambulatory Surgical Clinic/Center
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Providence Surgery Center is a ambulatory surgical clinic/center provider located in Missoula, Montana. This profile covers 14 Medicare and 8 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 | Providence Surgery Center |
| Address | 902 N Orange St |
| City | Missoula |
| State | MT |
| ZIP | 59802 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $3.5M |
| Medicare | $1.6M |
Payer mix and scale: This facility reports $1.6M in total Medicare revenue and $3.5M in total Medicaid revenue, so Medicaid accounts for the larger share of reported public-payer receipts. The presence of meaningful activity on both payers indicates it is not a single-payer operation, with Medicaid revenue exceeding Medicare in scale based on the provided totals.
Medicare revenue concentration and service lines: The top three Medicare codes (27130, 64483, 63685) account for 54.6% of the provider's Medicare revenue, pointing to a mixed orthopedics and interventional spine/pain profile. 27130 (hip replacement) is a major Medicare revenue contributor alongside high-volume spinal injection work coded as 64483 and occasional higher-cost neuromodulation procedures coded as 63685, suggesting the center combines joint replacement or orthopedics with a substantial pain-management service line.
Medicaid revenue concentration and service lines: The top three Medicaid codes (41899, G0330, 64483) account for 97.9% of the provider's Medicaid revenue, indicating extreme concentration by procedure type on the Medicaid side. The Medicaid mix is dominated by dental-related services—41899 (73.4% of Medicaid revenue) and G0330 (13.7%)—with interventional spine injections (64483, 10.7%) as a secondary but material component, which implies the center operates as a significant dental rehabilitation/anesthesia site for Medicaid patients while also delivering pain procedures.
Medicaid competitive standing by code: 41899 is responsible for 73.4% of Medicaid revenue and ranks #2 of 7 in-state (83th percentile; typical, unremarkable volume), while G0330 ranks #1 of 3 in-state (100th percentile; typical, unremarkable volume) and 64483 ranks #1 of 16 in-state (100th percentile; extreme outlier, far above typical state volume). These in-state ranks indicate the provider is a leading in-state site for dental rehabilitation facility services and an out-sized provider of transforaminal epidural injections within Montana's peer set.
Medicare competitive standing and outlier signals: On Medicare, 64483 appears as an extreme outlier nationally (rank #58 of 8202, 99th percentile; extreme outlier, far above typical national volume) and 64493 also ranks very highly (rank #123 of 7519, 98th percentile; extreme outlier). Other spine-related codes like 64635 rank in the 97th percentile (notably above typical national volume), whereas 27130 (hip replacement) sits at the 87th percentile (typical, unremarkable volume) and 63685 (spinal neurostimulator pulse generator) is relatively modest nationally (11th percentile; typical, unremarkable volume), so the center is a national high-volume hub for certain spinal injection services but a more typical-volume center for joint replacement and device implants.
Business implications of mixed high-cost and high-volume codes: The coexistence of very high-volume image-guided injection codes (e.g., 64483, 64493, 64635) with less frequent high-unit-cost device work (63685) implies an operational model that combines procedural throughput for injections with episodic higher-complexity surgical or implant cases. This mix affects staffing, imaging and anesthesia needs and suggests the facility must support both repetitive ambulatory pain procedures and occasional operative device placement.
Concentration risk and revenue resilience: Medicaid revenue is highly concentrated—top code 41899 alone accounts for 73.4% of Medicaid revenue and the top three codes make up 97.9%—which creates dependency on a small set of services and payers for the majority of Medicaid receipts. By contrast, Medicare revenue is less concentrated (top three = 54.6%), offering relatively more diversification across procedure types and payer sources.
Tenure and operational maturity: The provider's NPI was enumerated on 2006-07-29 (~20 years ago), indicating long-standing enrollment and suggesting established operational processes and payer relationships over roughly two decades of activity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 60 | $7,160 | $429.5K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 790 | $280 | $223.9K |
| 63685 | The provider inserts or replaces a spinal neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection… | 10 | $18,610 | $223.4K |
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 30 | $7,010 | $189.3K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 50 | $3,700 | $184.8K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 200 | $500 | $100.7K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 380 | $260 | $100.3K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 140 | $240 | $34.7K |
| 62321 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the cervical (neck) or thoracic (upper and middle back)… | 140 | $250 | $33.2K |
| 64490 | The provider injects a diagnostic or therapeutic substance into a single cervical or thoracic paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging… | 90 | $300 | $26.4K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 27447 | 54 | 80 | 40 | $1,080 | $60.6K |
| 63650 | 2 | 10 | 50 | $1,150 | $55.1K |
| 27130 | 14 | 50 | 40 | $1,150 | $54.1K |
| 63685 | 5 | 10 | 20 | $3,110 | $46.6K |
| 64635 | 2 | 30 | 30 | $320 | $15.4K |
| G0260 | 1 | 10 | 70 | $210 | $14.8K |
| 64483 | 1 | 40 | 40 | $170 | $14.2K |
| 64493 | 1 | 30 | 50 | $160 | $12.4K |
| 62323 | 4 | 40 | 60 | $130 | $9K |
| C9088 | 1 | 10 | 15,000 | $1 | $8.3K |
Showing 1–10 of 14
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 1,340 | $1,920 | $2.6M |
| G0330 | Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an… | 300 | $1,590 | $481.8K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 1,420 | $270 | $377.8K |
| 62321 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the cervical (neck) or thoracic (upper and middle back)… | 190 | $210 | $39.7K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 240 | $150 | $34.9K |
| 64484 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection in the lumbar or sacral region. The code applies to each additional level… | 10 | $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… | 150 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 40 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 2 | 10 | 210 | $1,680 | $959.9K |
| G0330 | Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an… | 1 | 10 | 300 | $1,760 | $373.4K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 1 | 20 | 30 | $180 | $28.5K |
| 62321 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the cervical (neck) or thoracic (upper and middle back)… | 1 | 10 | 50 | $140 | $8.2K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 1 | 10 | 30 | $110 | $5.4K |
| 64484 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection in the lumbar or sacral region. The code applies to each additional level… | 1 | 10 | 10 | $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… | 4 | 10 | 140 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 3 | 10 | 40 | $0 | $0 |
Other providers in the same ZIP code as Providence Surgery Center, ranked by combined Medicare and Medicaid revenue.
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