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NPI 1740364017 · Missoula, MT · Clinical Medical Laboratory
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Western Montana Clinic PC is a clinical medical laboratory provider located in Missoula, Montana. This profile covers 78 Medicare and 70 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 | Western Montana Clinic PC |
| Address | 500 W Broadway St |
| City | Missoula |
| State | MT |
| ZIP | 59802 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 24, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.7M |
| Medicare | $668.9K |
WESTERN MONTANA CLINIC PC operates as a clinical medical laboratory with a testing mix that blends routine phlebotomy and chemistry panels with surgical pathology services. Its top Medicare revenue drivers — 36415 (12K claims, $95.7K), 88305 (3.7K claims, $95.6K), and 80053 (7.6K claims, $75.8K) — point to a workflow that includes high-volume specimen collection, in-house analytic chemistry, and pathologist-reviewed surgical pathology. This combination is consistent with a lab that services ambulatory providers for both point-of-care specimen collection and downstream diagnostic interpretation.
Medicare revenue is moderately concentrated: the precomputed top three Medicare codes account for 44.1% of the provider’s total Medicare revenue. Those three codes (36415, 88305, 80053) each contribute materially to the $668.9K in lifetime Medicare revenue and together indicate that a few high-use lab services drive nearly half of Medicare receipts for this entity. That concentration suggests payer negotiations or utilization-management efforts focused on a small set of high-volume codes would materially affect Medicare income.
On the Medicaid side, the top three Medicaid codes account for 23.0% of total Medicaid revenue, reflecting a broader distribution of services across more codes. High Medicaid revenue items include 84443 ($119K), 88305 ($113.3K), and 87591 ($111.9K), alongside large claim volumes for panels and phlebotomy (for example, 80053 at 13.7K claims and 36415 at 27.4K claims). This spread indicates Medicaid revenue is driven by many discrete test types rather than being dominated by the same narrow set of codes that dominate Medicare.
The provider’s payer mix is skewed toward Medicaid in scale: lifetime Medicaid revenue is $1.7M compared with $668.9K in Medicare. In dollar terms the clinic derives more than twice as much lifetime revenue from Medicaid as from Medicare, which implies strategic importance of Medicaid contracting, state reimbursement rates, and Medicaid referral sources for sustaining volume and revenue. Analysts should treat the entity as effectively Medicaid-focused in terms of revenue exposure.
Competitive standing for routine laboratory testing on Medicare is strong by national measures: 36415 ranks #186 of 86467 providers nationally (100th percentile) and 80053 ranks #259 of 26416 providers nationally (99th percentile), though both entries are described as "typical, unremarkable volume" in the source taxonomy. Surgical pathology (88305) also shows above-average national placement at #890 of 14580 providers (94th percentile), indicating the practice is a notable national contributor for common lab services while remaining within expected operational patterns for such providers.
In-state competitive position on Medicaid shows pockets of above-typical volume for specific services: 36415 is ranked #10 of 185 in-state (95th percentile) and explicitly labeled "notably above typical state volume," and vitamin D testing 82306 is #9 of 50 (84th percentile). Other Medicaid code ranks such as 84443 at #14 of 67 (80th percentile) and 80053 at #19 of 84 (78th percentile) reinforce that the clinic is a top regional provider for many routine tests, while its pathology code 88305 sits nearer the state median at #16 of 32 (52nd percentile).
The Medicaid claim mix shows a sizable emphasis on infectious disease and public-health related molecular testing: high Medicaid claim counts and revenues for 87591 (3.4K claims, $111.9K), 87491 (3.4K claims, $111.8K), 87624 (2.9K claims, $94.2K), and COVID PCR U0003 (759 claims, $52.4K) indicate capacity for high-throughput NAAT and nucleic-acid based assays. This pattern suggests the lab supports community screening and STI/HIV/hepatitis testing programs in addition to routine chemistry and hematology.
The NPI was enumerated on 2006-10-24 (~20 years ago), indicating long-standing enrollment and operational tenure. Combined with sustained, high claim counts across many routine codes (for example, 85025 at 6.4K Medicare claims and 14.1K Medicaid claims, and 36415 at 12K Medicare claims and 27.4K Medicaid claims), the data point to an established regional laboratory footprint with consistent throughput across both payers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
78 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 11,970 | $10 | $95.7K |
| 88305 | The 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… | 3,680 | $30 | $95.6K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 7,580 | $10 | $75.8K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 3,440 | $20 | $55K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 4,090 | $10 | $53.2K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 6,370 | $10 | $50.9K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 1,200 | $30 | $34.8K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 2,540 | $10 | $22.8K |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 1,090 | $20 | $20.6K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 1,700 | $10 | $13.6K |
Showing 1–10 of 78
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 78 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
70 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 5,950 | $20 | $119K |
| 88305 | The 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… | 3,910 | $30 | $113.3K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 3,390 | $30 | $111.9K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 3,390 | $30 | $111.8K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 4,490 | $20 | $107.7K |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 4,180 | $20 | $100.2K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 13,690 | $10 | $95.8K |
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 2,940 | $30 | $94.2K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 27,430 | $1 | $82.3K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 1,350 | $50 | $72.7K |
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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
70 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 88305 | The 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… | 16 | 30 | 3,780 | $40 | $222.6K |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 5 | 10 | 4,210 | $10 | $61.7K |
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 5 | 10 | 2,700 | $10 | $33K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 10 | 20 | 610 | $10 | $30.1K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 13 | 30 | 940 | $10 | $20K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 19 | 80 | 2,870 | $1 | $16.2K |
| 87502 | The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly… | 30 | 50 | 190 | $20 | $14.7K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 44 | 80 | 300 | $10 | $14.4K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 8 | 10 | 1,050 | $1 | $12.6K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 9 | 30 | 940 | $10 | $12.6K |
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Other providers in the same ZIP code as Western Montana Clinic PC, ranked by combined Medicare and Medicaid revenue.
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