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NPI 1851923544 · Idaho Falls, ID · Community/Retail Pharmacy
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Rocky Mountain Pharmacy, LLC is a community/retail pharmacy provider located in Idaho Falls, Idaho. This profile covers 7 Medicare and 8 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 | Rocky Mountain Pharmacy, LLC |
| Address | 3910 Washington Pkwy Ste A |
| City | Idaho Falls |
| State | ID |
| ZIP | 83404 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | February 10, 2020 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $342.2K |
| Medicare | $30.1K |
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 90677 | This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the… | 30 | $280 | $9.3K |
| 91320 | This code represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 30 mcg/0.3 mL. | 70 | $130 | $8.3K |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 80 | $80 | $6.3K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 70 | $40 | $2.5K |
| G0008 | Administration of influenza virus vaccine | 80 | $30 | $2.4K |
| G0009 | Administration of pneumococcal vaccine | 30 | $30 | $920 |
| 0124A | N/A | 10 | $40 | $420 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 CPT/HCPCS codes.
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 1,570 | $190 | $296.9K |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 100 | $200 | $19.8K |
| A4224 | Supplies for maintenance of insulin infusion catheter, per week | 300 | $50 | $14.4K |
| A4225 | Supplies for external insulin infusion pump, syringe type cartridge, sterile, each | 330 | $30 | $8.1K |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 20 | $130 | $2.2K |
| A4215 | Needle, sterile, any size, each | 10 | $30 | $380 |
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips | 30 | $10 | $350 |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 10 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Idaho providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Idaho median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 1 | 20 | 200 | $200 | $64.6K |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 4 | 10 | 100 | $170 | $39.5K |
| A4224 | Supplies for maintenance of insulin infusion catheter, per week | 1 | 10 | 300 | $50 | $14.4K |
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips | 96 | 110 | 270 | $20 | $9K |
| A4225 | Supplies for external insulin infusion pump, syringe type cartridge, sterile, each | 1 | 10 | 330 | $30 | $8.3K |
| A4215 | Needle, sterile, any size, each | 35 | 40 | 60 | $30 | $4.5K |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 1 | 10 | 20 | $130 | $2.2K |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 1 | 10 | 10 | $0 | $0 |
Other providers in the same ZIP code as Rocky Mountain Pharmacy, LLC, ranked by combined Medicare and Medicaid revenue.
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