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.

Providence Health & Services Mt (NPI 1427096585)

Providence Health & Services Mt is a pulmonary disease physician provider located in Missoula, Montana. This profile covers 0 Medicare and 14 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Providence Health & Services Mt
Address	500 W Broadway St
City	Missoula
State	MT
ZIP	59802
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	June 2, 2006

Payer Source	Total Paid
Medicaid	$394K
Medicare	$0

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
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	5,310	$50	$254.8K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	9,610	$10	$67.3K
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…	810	$60	$50K
93000	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	520	$10	$5.8K
93248	After a patient has worn an electrocardiographic, or ECG recorder, for more than seven days, up to 15 days, to detect abnormal heart rates and rhythm, the provider completes a review and…	170	$20	$3.9K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	100	$40	$3.9K
93018	The provider analyzes and interprets the recording of the electrical activity of the heart to examine for any abnormality in its functioning, including blood pressure and electrocardiograph readings…	310	$10	$2.5K
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…	60	$40	$2.2K
93298	The provider, who is a physician or other qualified healthcare professional, evaluates the data from a previously implanted subcutaneous cardiac rhythm monitor system via telemetric communication for…	70	$20	$1.4K
93299	N/A	70	$20	$1.3K

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

Providence Health & Services Mt — 3 of 13 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…	226	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…	430	520	730	$40	$196.4K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	4	40	430	$70	$91.3K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	10	40	630	$10	$33.8K
93320	The provider performs a complete Doppler echocardiography, which uses high–frequency sound waves to create a two–dimensional image of the heart, while the use of Doppler technology allows…	10	10	350	$40	$27K
93000	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	10	20	220	$10	$14.4K
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	13	20	80	$20	$12.1K
99152	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, in a patient five years of age or…	14	20	350	$1	$2.8K
93248	After a patient has worn an electrocardiographic, or ECG recorder, for more than seven days, up to 15 days, to detect abnormal heart rates and rhythm, the provider completes a review and…	1	10	90	$20	$2.1K
93018	The provider analyzes and interprets the recording of the electrical activity of the heart to examine for any abnormality in its functioning, including blood pressure and electrocardiograph readings…	2	10	160	$10	$1.8K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Consumer Direct District Of Columbia	MT	In Home Supportive Care Agency	$0	$393.2M
Youth Homes	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$9.7M
Western Montana Clinic PC	MT	Multi-Specialty Clinic/Center	$0	$8.7M
Providence Surgery Center	MT	Ambulatory Surgical Clinic/Center	$1.6M	$3.5M
Partnership For Children	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$4.7M
Gary Wingfield	MT	Assisted Living Facility	$0	$4.7M
Western Montana Clinic PC	MT	Clinical Medical Laboratory	$668.9K	$1.7M
Blue Mountain Clinic, Inc.	MT	Family Medicine Physician	$0	$1.4M
Youth Homes	MT	Community/Behavioral Health Agency	$0	$972.2K
Partnership For Children	MT	Community/Behavioral Health Agency	$0	$937.8K

Providence Health & Services Mt — Billing Profile & Reimbursement Data

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Providence Health & Services Mt — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services Mt	MT	Emergency Medicine Physician	$0	$8.2M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$5.7M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$4.9M
Scott Guess	MT	Ophthalmology Physician	$2.7M	$72.4K
Providence Health & Services Mt	MT	General Acute Care Hospital	$0	$2.4M
Melody Nelsen	MT	Rheumatology Physician	$2M	$0
Providence Health & Services Mt	MT	Psychiatric/Mental Health Nurse Practitioner	$0	$1.8M
Rebecca Belsom	MT	Rheumatology Physician	$1.4M	$0
Rebecca Danforth	MT	Rheumatology Physician	$396K	$0
Providence Health & Services Mt	MT	Medical Oncology Physician	$0	$392.7K