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 1497868335)

Field	Value
Entity Type	Organization
Organization	Providence Health & Services Mt
Address	500 W. Broadway
City	Missoula
State	MT
ZIP	59802
Taxonomy	Emergency Medicine Physician
NPI Enumerated	August 16, 2006

Payer Source	Total Paid
Medicaid	$8.2M
Medicare	$0

Key Findings

This provider has no Medicare billing on file while reporting $8.2M in lifetime Medicaid revenue, making its observed billing footprint effectively single‑payer (Medicaid) in scope rather than dual‑payer. The absence of Medicare activity means comparisons and competitive statements should be limited to the Medicaid universe.

Revenue is highly concentrated: the top three Medicaid codes (99285, 99284, 99283) account for 99.8% of this provider's total Medicaid revenue. Those three codes alone represent virtually all billed Medicaid dollars, indicating few other services materially contribute to Medicaid revenue.

The provider’s taxonomy is Emergency Medicine Physician and the code mix — dominated by 99285 (24.6K claims, $148 avg paid/claim, $3.6M revenue, 44.4% of total), 99284 (25.1K claims, $111 avg paid/claim, $2.8M revenue, 33.9% of total), and 99283 (26.8K claims, $66 avg paid/claim, $1.8M revenue, 21.6% of total) — is consistent with a high-throughput emergency department operation managing a full acuity spectrum from low to high medical decision making. The higher average payment for 99285 versus 99283 aligns with a meaningful share of higher-acuity ED encounters driving revenue.

On competitive standing within Montana, the provider is a major in-state participant for its top ED codes: 99285 ranks #5 of 55 providers (93th percentile; notably above typical state volume), 99284 ranks #4 of 75 providers (96th percentile; notably above typical state volume), and 99283 ranks #7 of 88 providers (93th percentile; notably above typical state volume). These rankings indicate the provider is among the higher-volume statewide reporters for ED evaluation-and-management services.

Claim volumes for the top codes are large in absolute terms (24.6K–26.8K claims for 99285–99283), which signals sustained ED visit throughput rather than occasional or sporadic reporting. Those volumes, paired with the high in-state percentiles, support characterization of an established emergency-service operation handling frequent patient flow.

Lower-volume codes make negligible Medicaid contributions: 99282 has 348 claims, $42 avg paid/claim, $14.6K revenue (0.2% of total) and ranks #47 of 70 providers (33th percentile; typical, unremarkable volume), while 99291 shows 13 claims, $128 avg paid/claim, $1.7K revenue (0.0% of total) and ranks #19 of 21 providers (0th percentile; typical, unremarkable volume). These figures indicate critical care and the lowest-level ED E/M code are not material revenue drivers for this provider.

The extreme concentration in three ED E/M codes (99.8% of Medicaid revenue) implies revenue exposure is closely tied to Medicaid ED reimbursement and visit mix; any changes to Medicaid policy or shifts in ED acuity/volume would disproportionately affect this provider's revenue base. Given the lack of Medicare billing, the provider’s financial and operational profile appears particularly sensitive to Medicaid dynamics.

The provider’s NPI was enumerated on 2006-08-16 (~20 years ago), indicating long-standing enrollment in federal systems. Combined with the high in-state rankings and large Medicaid claim volumes, this tenure supports that the entity is an established emergency care presence in Missoula, MT.

Medicaid: Complete Services Breakdown

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

5 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.	24,620	$150	$3.6M
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.	25,060	$110	$2.8M
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.	26,820	$70	$1.8M
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.	350	$40	$14.6K
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…	10	$130	$1.7K

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 — 1 of 5 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

5 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.	5	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.	4	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.	7	90	2,330	$40	$281.3K
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…	19	20	100	$160	$100.9K
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.	47	70	860	$20	$50.8K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Providence Health & Services Mt, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
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	Pulmonary Disease Physician	$0	$394K
Providence Health & Services Mt	MT	Medical Oncology Physician	$0	$392.7K

Nearby Providers

Other providers in the same ZIP code as Providence Health & Services Mt, ranked by combined Medicare and Medicaid revenue.

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

Sign up for Providence Health & Services Mt — Billing Profile & Reimbursement Data policy alerts

Providence Health & Services Mt — Billing Profile & Reimbursement Data

Sign up for Providence Health & Services Mt — Billing Profile & Reimbursement Data policy alerts

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