Julie Flesch, APRN
Family · Helena, MTNPI 1881955755
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 100.0% of the total across 119 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. 15 manufacturers reported payments, led by E.r. Squibb & Sons, L.L.C. at 27.4% of the total. Among family clinicians in MT with any reported payments, this total sits in the top 10% — high for the specialty, which is a reason to read the composition above rather than the number alone.
Across 119 payments — averaging $18.33 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- E.r. Squibb & Sons, L.L.C.$598
- Amgen$391
- Lilly USA, LLC$217
- Sanofi$204
- Novartis$191
- AbbVie$130
- plus $450 from 9 others
What the payments were for
- Food & beverage$2,181100%
Most of this is food and beverage — typically meals provided during product presentations at a clinic or hospital. Nationally that is the single largest category of reported payments by count.
General payments by program year
Who reported the general payments
Companies are grouped under their corporate parent — a single manufacturer often files under several CMS reporting entities. Research and ownership payments are counted separately and are not in this table.
| Company | Payments | Total |
|---|---|---|
| E.r. Squibb & Sons, L.L.C. | 33 | $598 |
| Amgen | 21 | $391 |
| Lilly USA, LLC | 13 | $217 |
| Sanofi | 10 | $204 |
| Novartis | 9 | $191 |
| AbbVie | 8 | $130 |
| Johnson & Johnson | 7 | $116 |
| Regeneron Healthcare Solutions, Inc. | 5 | $109 |
| Incyte Corporation | 5 | $87 |
| Boehringer Ingelheim | 2 | $40 |
| Pfizer | 2 | $27 |
| Arcutis Biotherapeutics, Inc. | 1 | $20 |
| Genentech USA, Inc. | 1 | $19 |
| LEO Pharma Inc. | 1 | $17 |
| Galderma Laboratories, L.p. | 1 | $16 |
What the payments were tied to
Products named in the reported payments. Only payments of $100 or more are attributed here — the typical reported payment nationally is a meal worth about $16, and listing those product-by-product would be noise.
- Otezla$102
How this compares
$2,181 in reported general payments places this provider in the 90th percentile of 481 family providers in Montana.
Medicare billing
What this is not: this is the amount Original Medicare Part B allowed for services this provider billed in 2024. It is not their income. It excludes Medicare Advantage — now more than half of all Medicare enrollment — along with Medicaid and all commercial insurance, and it is gross practice revenue before staff, rent, supplies and malpractice premiums. CMS also suppresses any figure covering ten or fewer patients, so low-volume providers appear smaller than they are.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| Ketoconazole | 100 | $1,767 |
| Tretinoin | 14 | $1,464 |
| Clobetasol Propionate | 40 | $1,454 |
| Metronidazole | 26 | $1,261 |
| Fluocinonide | 30 | $1,067 |
| Clindamycin Phosphate | 31 | $817 |
| Triamcinolone Acetonide | 64 | $687 |
| Doxycycline Hyclate | 18 | $446 |
| ValacyclovirValacyclovir Hcl | 14 | $142 |
| Hydrocortisone | 12 | $95 |
Paid to pharmacies, not to this prescriber.
Other family in Helena
- Kara AddisonHelena$50K
- Jessica HavensHelena$11K
- Tara WellsHelena$10K
- Mary MiddaghHelena$6K
- Megan GittingsHelena$4K
- Jeannie FahlquistHelena$3K
- Christopher VanhorssenHelena$3K
- Willow SheehanHelena$3K
- Leigha ShilhanekHelena$3K
- Lindsay McCarthyHelena$2K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Billing: Medicare Physician & Other Practitioners, data year 2024. Original Medicare Part B only.
- Identity: NPPES NPI Registry, July 2026.