Karl Guter, MD
Hematology & Oncology · Great Falls, MTNPI 1437150331
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 94.2% of the total across 427 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. It is spread thinly across 58 manufacturers, the largest accounting for just 11.5% — the pattern of someone who eats at a lot of different presentations. Reporting peaked in 2024 at $2,481 and has fallen 56.7% since, to $1,076 in 2025.
Across 427 payments — averaging $20.18 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- E.r. Squibb & Sons, L.L.C.$991
- AstraZeneca$958
- Merck$667
- Johnson & Johnson$664
- Amgen$480
- Pharmacyclics LLC, An Abbvie Company$393
- plus $4K from 52 others
Across 40 payments — averaging $4786.41 each. Payments tied to a research study. These frequently flow through the physician to a hospital or research institution rather than to the physician personally.
- Amicus Therapeutics, Inc.$145K
- Novartis$46K
What the payments were for
- Consulting fees$1752%
- Food & beverage$8,12194%
- Education$3234%
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.
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.
How this compares
$8,619 in reported general payments places this provider in the 85th percentile of 37 hematology & oncology 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 |
|---|---|---|
| IbrancePalbociclib | 12 | $187,953 |
| JakafiRuxolitinib Phosphate | 16 | $132,344 |
| Abiraterone Acetate | 16 | $73,424 |
| BrukinsaZanubrutinib | 12 | $45,285 |
| EliquisApixaban | 37 | $43,353 |
| OpfoldaMiglustat | 12 | $3,773 |
| Letrozole | 74 | $1,952 |
| Imatinib Mesylate | 12 | $1,576 |
| Hydroxyurea | 17 | $505 |
| Losartan Potassium | 39 | $409 |
| Hydrocodone-AcetaminophenHydrocodone/Acetaminophen | 24 | $384 |
| Metoprolol Succinate | 33 | $375 |
| Atorvastatin Calcium | 36 | $371 |
| Omeprazole | 28 | $341 |
| Levothyroxine Sodium | 23 | $308 |
Paid to pharmacies, not to this prescriber.
Companies that both paid and supply prescribed drugs
These companies both reported payments to this provider and make drugs the provider prescribed under Medicare Part D in 2024. For most specialties this overlap is expected — a cardiologist who is paid by a cardiology drugmaker also treats heart disease. It is shown so the reader can see it, not because it implies anything on its own.
| Company | Paid to this provider | Part D cost of their drugs |
|---|---|---|
| PfizerIbrance, Eliquis | $341 | $231,30649 claims |
| Incyte CorporationJakafi | $109 | $132,34416 claims |
| Beigene USA, Inc.Brukinsa | $293 | $45,28512 claims |
Reading this fairly. The Part D column is what drug plans and patients paid pharmacies — this provider received none of it, and it reflects how many patients they treat and what those drugs cost. Against peers, this provider's reported payments sit in the 85th percentile of 37 hematology & oncology providers in Montana.
Other hematology & oncology in Great Falls
- Thomas WarrGreat Falls$8K
- Patrick TangGreat Falls$7K
- Jessica KaaeGreat Falls$6K
- Jennifer CarterGreat Falls$3K
- Grant HarrerGreat Falls$214
- Donald BerdeauxGreat Falls$35
- Patrick CobbBillings$21K
- Thomas WeinerHelena$14K
- Aaron FrankeSidney$11K
- Carolyn AksHavre$9K
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.