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.

Evergreen Clinic PC (NPI 1538390844)

Evergreen Clinic PC is a clinic/center provider located in Kalispell, Montana. This profile covers 0 Medicare and 11 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	Evergreen Clinic PC
Address	2181 Highway 2 East
City	Kalispell
State	MT
ZIP	59901
Taxonomy	Clinic/Center
NPI Enumerated	August 4, 2009

Payer Source	Total Paid
Medicaid	$359.1K
Medicare	$0

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

11 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…	4,350	$70	$313.1K
99203	The provider sees a new 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 provider…	180	$110	$18.7K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	1,290	$10	$10.3K
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…	100	$100	$10.2K
99204	The provider sees a new 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 provider…	20	$150	$2.5K
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	20	$60	$1.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	20	$60	$1.1K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	10	$60	$900
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	20	$30	$510
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	10	$20	$250

Showing 1–10 of 11

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

Evergreen Clinic PC — 0 of 11 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

11 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…	392	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…	107	520	730	$40	$196.4K
99204	The provider sees a new 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 provider…	105	130	100	$120	$49.4K
99203	The provider sees a new 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 provider…	84	190	130	$70	$37.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	88	110	80	$60	$13.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	227	240	170	$1	$10.3K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	95	100	180	$10	$5.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	141	190	950	$1	$4.9K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	72	80	150	$10	$4.6K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	13	40	450	$1	$1.8K

Showing 1–10 of 11

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Flathead Industries	MT	Community/Behavioral Health Agency	$0	$40.7M
A Plus Health Care Inc	MT	In Home Supportive Care Agency	$0	$28.2M
Gabriel Dawson	MT	Pediatric Dentistry	$0	$10.7M
Kalispell Regional Medical Center Inc	MT	General Acute Care Hospital	$0	$8.8M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$6.8M
Kiddsteeth PLLC	MT	Pediatric Dentistry	$0	$6.7M
Kalispell Regional Medical Center, Inc	MT	Clinic/Center	$0	$6.2M
Kalispell Public Schools	MT	Local Education Agency (LEA)	$0	$6M
Kalispell Regional Medical Center Inc	MT	Psychiatry Physician	$0	$5.9M
Kalispell Regional Medical Center Inc	MT	Emergency Medicine Physician	$0	$5.4M

Evergreen Clinic PC — Billing Profile & Reimbursement Data

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Evergreen Clinic PC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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