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    OpenPayerNPI Medicare & MedicaidKalispell Regional Medical Center Inc
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    Kalispell Regional Medical Center Inc — Billing Profile & Reimbursement Data

    NPI 1417945627 · Kalispell, MT · General Acute Care Hospital

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    Kalispell Regional Medical Center Inc is a general acute care hospital provider located in Kalispell, Montana. This profile covers 0 Medicare and 440 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationKalispell Regional Medical Center Inc
    Address310 Sunnyview Ln
    CityKalispell
    StateMT
    ZIP59901
    TaxonomyGeneral Acute Care Hospital
    NPI EnumeratedOctober 11, 2005

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$8.8M
    Medicare$0

    Key Findings

    This provider is effectively single‑payer in the available dataset: there is no Medicare billing on file and all recorded federal payer revenue is Medicaid, with Total Medicaid revenue reported as $8.8M. The absence of any Medicare revenue on file indicates analyses and competitive comparisons should focus on Medicaid activity and in‑state peers rather than national Medicare benchmarks.

    Revenue concentration is meaningful but not extreme: the precomputed top three Medicaid codes (43239, 99283, 99284) account for 25.2% of the provider’s total Medicaid revenue. Those three codes individually include 43239 with $529.8K revenue (9.7% of Medicaid revenue), 99283 with $484.7K revenue (8.9%), and 99284 with $357.9K revenue (6.6%), showing a material share driven by a mix of endoscopic and emergency‑department services.

    The provider’s code mix points to a full‑service acute hospital with strong emergency and procedural throughput: high volumes for ED E/M codes 99283 (21.1K claims, $484.7K) and 99284 (19.9K claims, $357.9K) alongside procedure code 43239 (3.4K claims, $529.8K) for upper endoscopy with biopsy. Additional supporting codes—88305 surgical pathology (14.6K claims, $306.1K) and G0378 observation hours (4.1K claims, $288.5K)—further indicate inpatient/observation and diagnostic pathology capacity consistent with a general acute care hospital.

    KALISPELL REGIONAL MEDICAL CENTER is a statewide leader for certain specialized procedures but a typical competitor for routine ED services: 43239 ranks #1 of 29 providers in‑state at the 100th percentile and is characterized as notably above typical state volume for that code, indicating dominance in endoscopic biopsy volume. By contrast, its ED codes 99283 and 99284 rank in the 86th percentile (#13 of 88 and #11 of 75 respectively), which reflects healthy ED throughput but not outlier status compared with other Montana providers.

    Laboratory testing is a pronounced area of volume concentration: 80053 (CMP) appears with 69.4K claims and $138.8K revenue and ranks #4 of 84 providers in‑state at the 96th percentile (notably above typical state volume), while 85025 (CBC) posts 68.9K claims and $137.8K revenue and ranks #5 of 102 providers at the 96th percentile, labeled an extreme outlier and far above typical state volume. These very large claim counts for routine panels suggest centralized lab processing and significant diagnostic throughput that supports both inpatient and outpatient care.

    Air ambulance transports show outsized per‑claim payments and a nontrivial revenue contribution, signaling either regional transport activity or referral patterns that require costly transfers: A0431 (rotary wing one‑way) yields $273.4K revenue (195 claims, $1402 avg) and ranks #3 of 3 providers in‑state, while A0430 (fixed wing one‑way) yields $254.9K revenue (195 claims, $1307 avg) and ranks #5 of 6 providers. Although these air transport codes involve few claims, their high average paid/claim amounts make them material to the $8.8M Medicaid total and point to a role in long‑distance or critical transfers.

    Imaging and endoscopy services represent another substantive service line: CT abdomen/pelvis with contrast 74177 contributes $311.9K (5K claims) and MRI brain 70551/70553 together contribute over $279K, while colonoscopy with biopsy 45380 contributes $125.5K and ranks #2 of 24 providers at the 91st percentile. This mix of cross‑sectional imaging and procedural endoscopy supports a profile of broad diagnostic capability and suggests the facility handles a wide range of acute and diagnostic caseloads in‑state.

    The provider’s tenure and operational footprint are established: the NPI was enumerated on 2005-10-11 (~21 years ago), indicating multi‑year presence in the market. Coupled with sizable observation billing (G0378 $288.5K) and the spread of high‑volume lab and ED codes, the data support characterization of KALISPELL REGIONAL MEDICAL CENTER as an established regional acute care hospital with sustained Medicaid reliance rather than a small specialty clinic or outpatient‑only provider.

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    440 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    43239The 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.3,440$150$529.8K
    99283The 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.21,070$20$484.7K
    99284The 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.19,880$20$357.9K
    97530The 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.12,770$30$332.1K
    74177The 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.5,030$60$311.9K
    88305The 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…14,570$20$306.1K
    G0378Hospital observation service, per hour4,120$70$288.5K
    A0431Ambulance service, conventional air services, transport, one way (rotary wing)200$1,400$273.4K
    A0430Ambulance service, conventional air services, transport, one way (fixed wing)200$1,310$254.9K
    99285The 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.6,210$40$236K

    Showing 1–10 of 440

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

    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

    440 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    A0430Ambulance service, conventional air services, transport, one way (fixed wing)5101,080$1,310$1.2M
    A0435Fixed wing air mileage, per statute mile5101,080$1,000$956.2K
    A0431Ambulance service, conventional air services, transport, one way (rotary wing)310520$1,230$770.5K
    A0436Rotary wing air mileage, per statute mile310520$860$541.2K
    99285The 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.15602,160$80$526.7K
    99284The 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.11802,770$60$471K
    99283The 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.13902,330$40$281.3K
    92507The 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…231502,760$40$224.3K
    88305The 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…6303,780$40$222.6K
    97530The 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.162001,110$60$207.2K

    Showing 1–10 of 440

    • More pages

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Kalispell Regional Medical Center, IncMTClinic/Center$0$6.2M
    Kalispell Regional Medical Center IncMTPsychiatry Physician$0$5.9M
    Kalispell Regional Medical Center IncMTEmergency Medicine Physician$0$5.4M
    Kalispell Regional Medical Center IncMTPrimary Care Clinic/Center$0$4.5M
    Kalispell Regional Medical Center IncMTPediatrics Physician$0$3.7M
    Kalispell Regional Medical Center IncMTClinic/Center$0$2.1M
    Kalispell Regional Medical Center IncMTClinic/Center$0$2.1M
    Kalispell Regional Medical Center IncMTNeurology Physician$0$1.7M
    Kalispell Regional Medical Center, IncMTMulti-Specialty Clinic/Center$0$1.4M
    Kalispell Regional Medical Center, IncMTClinic/Center$0$1.3M

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Flathead IndustriesMTCommunity/Behavioral Health Agency$0$40.7M
    A Plus Health Care IncMTIn Home Supportive Care Agency$0$28.2M
    Gabriel DawsonMTPediatric Dentistry$0$10.7M
    Benefis Community Care, Inc.MTCase Management Agency$0$6.8M
    Kiddsteeth PLLCMTPediatric Dentistry$0$6.7M
    Kalispell Public SchoolsMTLocal Education Agency (LEA)$0$6M
    Sunburst Community Service Foundation, IncMTMental Health Clinic/Center (Including Community Mental Health Center)$0$5.3M
    OxytocinMTSubstance Use Disorder Rehabilitation Clinic/Center$0$4.8M
    Glacier Grins Pediatric Dentistry, PLLCMTDental Clinic/Center$0$3.8M
    Kalispell Rehabilitation Associates, IncMTPhysical Therapist$0$3.6M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. Montana Providers
    6 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Montana Distribution
    Kalispell Regional Medical Center Inc — 4 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Montana