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.

Great Falls Clinic LLC (NPI 1801897780)

Key Findings

Field	Value
Entity Type	Organization
Organization	Great Falls Clinic LLC
Address	3000 15th Ave S
City	Great Falls
State	MT
ZIP	59405
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	August 2, 2005

Payer Source	Total Paid
Medicaid	$11.2M
Medicare	$0

GREAT FALLS CLINIC LLC is effectively a single-payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is $11.2M. The absence of Medicare activity means analyses of Medicare payer mix or cross‑payer shifts are not applicable and this entity’s scale should be assessed primarily within Montana Medicaid results.

Revenue concentration is high: the precomputed top three Medicaid codes account for 73.6% of the provider’s total Medicaid revenue, indicating that a small set of outpatient E/M and preventive codes drive most of the business. Specifically, 99213 accounts for $4.1M (37.8%) and 99214 accounts for $3.5M (31.8%) of Medicaid revenue, with 99392 contributing $450.1K (4.1%).

The code mix (heavy weighting toward 99213 and 99214) signals that the clinic operates primarily as a high-volume outpatient evaluation-and-management practice handling many established patient visits. The large counts for these codes (e.g., 99213 at 57.5K claims and 99214 at 36.3K claims) are consistent with primary care and multi‑specialty ambulatory workflows focused on routine and longitudinal care.

Competitive standing within Montana is strong for core office visit codes: 99213 ranks #6 of 523 providers in-state (99th percentile, labeled an extreme outlier) and 99214 ranks #7 of 532 providers (99th percentile, extreme outlier). These rankings indicate the clinic is a major state-level volume leader for routine established-patient outpatient visits.

Preventive and pediatric services are a meaningful secondary line: 99392 ($450.1K, 4.1% of Medicaid revenue) ranks #7 of 72 providers in-state (92th percentile), and related pediatric well-visit codes 99391/99393/99394 also appear in the top codes. This mix suggests the practice maintains a significant panel of children and adolescents and includes routine preventive care in its service mix.

The provider shows notable activity in vaccination and allergy immunotherapy services beyond core E/M: 90471 (12K claims, $228.8K, 2.1% of revenue) is an extreme outlier statewide (rank #4 of 191, 98th percentile), and 95165 ($302.5K, 2.8% of revenue) ranks #1 of 6 providers in-state (100th percentile, notably above typical). These lines likely supplement primary care revenue and point to on-site immunization and allergy services.

Several supporting specialty services appear at modest volume, including ophthalmology (92004/92014), ENT/audiology testing (92567), and electrocardiography/ECG (93000); each contributes small shares of Medicaid revenue but diversifies the clinic’s ambulatory offerings. None of these codes are extreme outliers statewide, indicating they are ancillary rather than core revenue drivers for this provider.

The practice has an established operational history: the NPI was enumerated on 2005-08-02 (~21 years ago), which supports interpreting the current high-volume Medicaid footprint as the result of long-standing local presence rather than a recent surge. Given the concentration in a few high-volume outpatient E/M codes and its long tenure, the clinic should be characterized as a well‑established, Medicaid-focused ambulatory provider with strong state-level dominance in routine outpatient visits.

Medicaid: Complete Services Breakdown

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

107 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…	57,540	$70	$4.1M
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…	36,270	$100	$3.5M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	4,060	$110	$450.1K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,410	$100	$355.1K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	1,050	$290	$302.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,640	$110	$300.7K
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…	2,180	$140	$300.6K
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…	2,860	$100	$277.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	1,540	$170	$267.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	12,040	$20	$228.8K

Showing 1–10 of 107

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

Great Falls Clinic LLC — 8 of 25 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

107 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	17	30	770	$60	$233.3K
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…	7	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…	6	520	730	$40	$196.4K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	12	30	640	$90	$188.1K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	11	20	190	$280	$137.5K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	12	10	260	$260	$130.4K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	58	130	600	$90	$120.9K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	8	70	420	$80	$111.7K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	7	70	310	$90	$107.1K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	1	10	150	$290	$105.8K

Showing 1–10 of 107

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cmsc, LLC	MT	General Acute Care Hospital	$0	$2.6M
Brandon Mccafferty	MN	Ophthalmology Physician	$1.2M	$0
Thucanh Multerer	PA	Retina Specialist (Ophthalmology) Physician	$862.9K	$139.4K
Ryan O'hara	UT	Vascular & Interventional Radiology Physician	$892.2K	$0
Camtu Jones	CO	Radiation Oncology Physician	$690.9K	$0
Laura Lennon	NY	Cardiovascular Disease Physician	$502.9K	$34.3K
Syed Akbar	IL	Diagnostic Radiology Physician	$280.8K	$223.7K
James Haug	CO	Diagnostic Radiology Physician	$326.9K	$0
Noman Malik	GA	Diagnostic Radiology Physician	$326.1K	$0
Ruslan Soldyshev	MT	Nephrology Physician	$229.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Benefis Hospitals Inc	MT	Multi-Specialty Clinic/Center	$0	$38.2M
Great Falls Public Schools	MT	Local Education Agency (LEA)	$0	$15M
Great Falls Pediatric Dentistry, LLC	MT	Pediatric Dentistry	$0	$14.9M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$13.2M
Easterseals-goodwill Northern Rocky Mountain, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$7.4M
Levi C Maltby Dmd P.C.	MT	Dentist	$0	$6M
Great Falls Emergency Services Inc	MT	Land Ambulance	$842.6K	$4.4M
Benefis Hospitals, Inc.	MT	Air Ambulance	$0	$5.2M
Easterseals Goodwill N. Rocky Mtn	MT	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Benefis Hospitals, Inc.	MT	General Acute Care Hospital	$0	$3.5M

Great Falls Clinic LLC — Billing Profile & Reimbursement Data

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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