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.

Kalispell Regional Medical Center, Inc (NPI 1992395180)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kalispell Regional Medical Center, Inc
Address	1287 Burns Way
City	Kalispell
State	MT
ZIP	59901
Taxonomy	Clinic/Center
NPI Enumerated	January 21, 2021

Payer Source	Total Paid
Medicaid	$6.2M
Medicare	$0

KALISPELL REGIONAL MEDICAL CENTER, INC has no Medicare billing on file and is effectively a single-payer Medicaid outpatient clinic in our dataset, with lifetime Medicaid revenue reported at $6.2M. The absence of Medicare activity suggests its current reimbursement exposure and growth opportunities are concentrated in the Medicaid population rather than dual-eligible or fee-for-service Medicare markets.

Revenue concentration is heavily skewed to a very small set of evaluation-and-management codes: 99213 and 99214 together account for $3.7M and $1.8M respectively, and the top three Medicaid codes by revenue collectively represent 92.4% of the provider’s total Medicaid revenue. This indicates that routine office/outpatient visits make up the overwhelming majority of clinical revenue, with minimal diversification into other procedure lines.

Service-line implications from the top codes point to a primary care–oriented outpatient clinic model focused on established patient visits and longitudinal management. High volumes for 99213 and 99214 (combined 56.5K claims) reflect a steady stream of follow-up and moderate-complexity management visits rather than procedural specialties, while smaller but notable entries for preventive visits (99391/99392/99393/99394) and immunizations (90471/90472) indicate a mixed primary care and preventive services offering.

Competitive standing within Montana for key E/M codes is strong: 99213 ranks #12 of 523 providers in-state (98th percentile) and 99214 ranks #20 of 532 (96th percentile), both described as notably above typical state volume or unremarkable but high percentile. These ranks position the provider as a major in-state deliverer of routine established-patient outpatient care, suggesting it is a high-volume primary care access point in the KALISPELL market.

There are specific code-level outlier signals in manual therapy, where 98929 (1.8K claims, $156.2K revenue) and 98927 (429 claims, $27K revenue) each rank at the top in-state (100th percentile) and are labeled notably above typical state volume. While relatively small in dollar terms versus the E/M codes, the prominence of these manual therapy codes indicates a service mix that includes frequent hands-on musculoskeletal care or allied health procedures that are unusually concentrated at this clinic compared with peers.

Volume and unit-pay patterns show standard Medicaid reimbursement levels for outpatient care: average paid per claim for 99213 is $91 and for 99214 is $116, which, combined with very high claim counts (40.8K for 99213; 15.7K for 99214), create the dominant revenue stream. The provider’s billing profile therefore scales by visit volume more than by high per-claim reimbursement, consistent with a high-throughput ambulatory clinic.

Preventive and pediatric well-visit codes (99392, 99394, 99393, 99391) and routine lab/testing codes (87635, 87880, 87804) appear throughout the top code list at modest revenue levels, indicating that well-child/adolescent care and on-site point-of-care testing are part of the outpatient mix but are not primary revenue drivers. These codes support a comprehensive primary care offering but do not materially change the revenue concentration behind the two dominant E/M codes.

The provider’s NPI was enumerated on 2021-01-21 (~5 years ago), establishing a relatively recent tenure in the public registry. Given the concentrated Medicaid revenue and rapid attainment of top-state ranks for key codes within that timeframe, the organization appears to have scaled outpatient visit volume quickly in the Medicaid market since enumeration.

Medicaid: Complete Services Breakdown

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

47 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…	40,820	$90	$3.7M
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…	15,710	$120	$1.8M
98929	The provider performs controlled manual pressure in nine to ten body regions to treat somatic and nonsomatic disorders.	1,840	$90	$156.2K
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,…	1,690	$60	$101.1K
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…	300	$130	$39.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	1,870	$20	$37.4K
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…	250	$130	$32.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	230	$140	$31.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	220	$130	$27.6K
98927	The provider performs controlled manual pressure in five to six body regions to treat somatic and nonsomatic disorders.	430	$60	$27K

Showing 1–10 of 47

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

Kalispell Regional Medical Center, Inc — 4 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

47 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…	20	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…	12	520	730	$40	$196.4K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,168	1,200	750	$80	$143.2K
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…	47	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…	37	70	310	$90	$107.1K
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…	77	160	250	$110	$85.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	34	80	130	$80	$43.2K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	166	230	300	$30	$38.1K
98929	The provider performs controlled manual pressure in nine to ten body regions to treat somatic and nonsomatic disorders.	1	10	300	$70	$37.2K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	31	40	630	$10	$33.8K

Showing 1–10 of 47

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
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$6.8M
Kiddsteeth PLLC	MT	Pediatric Dentistry	$0	$6.7M
Kalispell Public Schools	MT	Local Education Agency (LEA)	$0	$6M
Sunburst Community Service Foundation, Inc	MT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.3M
Oxytocin	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$4.8M
Glacier Grins Pediatric Dentistry, PLLC	MT	Dental Clinic/Center	$0	$3.8M
Kalispell Rehabilitation Associates, Inc	MT	Physical Therapist	$0	$3.6M

Kalispell Regional Medical Center, Inc — Billing Profile & Reimbursement Data

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Kalispell Regional Medical Center, Inc — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kalispell Regional Medical Center Inc	MT	General Acute Care Hospital	$0	$8.8M
Kalispell Regional Medical Center Inc	MT	Psychiatry Physician	$0	$5.9M
Kalispell Regional Medical Center Inc	MT	Emergency Medicine Physician	$0	$5.4M
Kalispell Regional Medical Center Inc	MT	Primary Care Clinic/Center	$0	$4.5M
Kalispell Regional Medical Center Inc	MT	Pediatrics Physician	$0	$3.7M
Kalispell Regional Medical Center Inc	MT	Clinic/Center	$0	$2.1M
Kalispell Regional Medical Center Inc	MT	Clinic/Center	$0	$2.1M
Kalispell Regional Medical Center Inc	MT	Neurology Physician	$0	$1.7M
Kalispell Regional Medical Center, Inc	MT	Multi-Specialty Clinic/Center	$0	$1.4M
Kalispell Regional Medical Center, Inc	MT	Clinic/Center	$0	$1.3M