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.

Western Montana Clinic PC (NPI 1942253182)

Key Findings

Field	Value
Entity Type	Organization
Organization	Western Montana Clinic PC
Address	500 West Broadway
City	Missoula
State	MT
ZIP	59802
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$8.7M
Medicare	$0

WESTERN MONTANA CLINIC PC is effectively a Medicaid-focused provider: there is no Medicare billing on file while total Medicaid revenue is $8.7M, indicating the clinic’s payer exposure is concentrated in state Medicaid programs rather than in Medicare fee-for-service. The absence of any Medicare revenue suggests analyses of Medicare trends or peer comparisons are not applicable for this entity.

Revenue concentration is high: the precomputed note indicates the top three Medicaid codes by revenue account for 60.4% of the provider’s total Medicaid revenue, meaning a majority of the $8.7M Medicaid receipts are driven by a small set of services and the clinic’s financial performance is sensitive to utilization or payment changes for those codes.

Primary service mix reflects high-volume outpatient E/M and cardiology imaging: the largest Medicaid revenue lines are 99213 ($2.6M, 30.8% of Medicaid revenue) and 99214 ($1.8M, 21.6%), which together reflect routine established outpatient evaluation and management visits, while significant revenue from 93303 ($680.2K, 8.0%) and 93306 ($534.4K, 6.3%) indicates an in-house echocardiography service line with both professional and technical components. This pattern suggests the clinic operates as a multi-specialty outpatient center combining general ambulatory care with substantive cardiac diagnostic capacity.

Competitive standing in-state is strong for several high-volume codes: the provider ranks in the 97th percentile for 99213 and 99214, and is the state leader for 93303 (100th percentile) and 93320 (100th percentile), indicating it is a dominant performer for common office E/M visits and select echocardiography services in Montana. Several additional codes (90471, 90472, 96110, 93000, 93325) are marked as notably above typical state volume, reinforcing its role as a high-volume pediatric/immunization and cardiac diagnostic site.

Operational implications: the mix of large volumes of mid-level E/M codes (99213, 99214) plus substantial preventive care codes (99391, 99392) and vaccine administration (90471, 90472, 90686) implies a broad primary care footprint that captures routine chronic and preventive care, while the echocardiography-related codes and ranks imply invested imaging equipment and staffing to support cardiology diagnostics on-site. This combination supports a model serving both primary care panels and referral-based cardiac testing.

Tenure and market presence: the NPI was enumerated ~2006-05-18 (approximately 20 years ago), indicating long-standing registration and likely established referral relationships in MISSOULA and statewide Medicaid networks; that longevity aligns with the high-volume ranks observed across many codes.

Statistical outliers and state-level specialization: several services are explicitly flagged as notably above typical state volume or as the state top-ranked provider (e.g., 93303, 93320, 93325, 93356), which characterizes the clinic as an outlier within Montana for echocardiography and related cardiac imaging. These labels indicate the provider’s activity in these services exceeds typical peer activity rather than signaling any coding anomaly.

Service risk profile: because 60.4% of Medicaid revenue is concentrated in the top three codes and a few cardiac imaging lines dominate state rankings, the provider’s near-term revenue outlook may be sensitive to shifts in Medicaid utilization patterns, reimbursement policy for E/M or echocardiography codes, or referral flows to cardiac diagnostics; payers evaluating network design or rate changes should note this concentration when assessing financial impact.

Medicaid: Complete Services Breakdown

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

77 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…	31,450	$80	$2.6M
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…	17,430	$110	$1.8M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	3,270	$210	$680.2K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	2,440	$220	$534.4K
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…	2,600	$180	$470.1K
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…	3,300	$110	$372.4K
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…	2,420	$120	$280.3K
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…	2,260	$110	$241.4K
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…	1,190	$180	$211.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	10,490	$20	$209.8K

Showing 1–10 of 77

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

Western Montana Clinic PC — 12 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

77 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…	18	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…	17	520	730	$40	$196.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	4	10	100	$920	$141.8K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	1	10	280	$200	$139.4K
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,…	19	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.	8	10	260	$260	$130.4K
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…	9	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…	11	70	310	$90	$107.1K
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…	17	20	100	$160	$100.9K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	8	40	430	$70	$91.3K

Showing 1–10 of 77

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Western Montana Clinic PC	MT	Clinical Medical Laboratory	$668.9K	$1.7M
Melody Nelsen	MT	Rheumatology Physician	$2M	$0
Rebecca Belsom	MT	Rheumatology Physician	$1.4M	$0
Ann Corsi	MT	Rheumatology Physician	$656.8K	$0
Kristen Townley	MT	MOHS-Micrographic Surgery Physician	$547.1K	$0
Erika Hagstrom	MT	Dermatology Physician	$511K	$0
Rebecca Danforth	MT	Rheumatology Physician	$396K	$0
James Maddux	MT	Interventional Cardiology Physician	$219.4K	$0
Andrew Tegeder	MT	Dermatology Physician	$206.3K	$0
Jacob Inda	MT	Dermatology Physician	$175.8K	$0

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
Providence Health & Services Mt	MT	Emergency Medicine Physician	$0	$8.2M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$5.7M
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
Providence Health & Services Mt	MT	General Acute Care Hospital	$0	$2.4M
Providence Health & Services Mt	MT	Psychiatric/Mental Health Nurse Practitioner	$0	$1.8M
Blue Mountain Clinic, Inc.	MT	Family Medicine Physician	$0	$1.4M

Western Montana Clinic PC — Billing Profile & Reimbursement Data

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Western Montana Clinic PC — 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