This provider's $5.9M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 200% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 55% in 2022
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $142.83 | $47.69 | 2.99x | $95.14 | $384.5K | 5.8K | 4.2K |
| 2015 | $162.22 | $59.80 | 2.71x | $102.42 | $471.9K | 6.6K | 4.5K |
| 2016 | $167.09 | $59.39 | 2.81x | $107.70 | $572.2K | 7.6K | 5.5K |
| 2017 | $167.14 | $63.27 | 2.64x | $103.87 | $569.7K | 7.6K | 5.2K |
| 2018 | $185.15 | $68.27 | 2.71x | $116.88 | $541.0K | 6.9K | 4.9K |
| 2019 | $268.88 | $82.86 | 3.24x | $186.02 | $531.8K | 6.6K | 4.7K |
| 2020 | $304.53 | $95.88 | 3.18x | $208.65 | $461.1K | 5.6K | 4.4K |
| 2021 | $295.48 | $98.51 | 3.00x | $196.97 | $492.4K | 5.1K | 4.3K |
| 2022 | $95.81 | $45.05 | 2.13x | $50.76 | $762.6K | 15.0K | 11.8K |
| 2023 | $76.82 | $42.35 | 1.81x | $34.47 | $1.2M | 25.9K | 18.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 38.0K | $2.8M | $74.01 | 3.29x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 12.8K | $1.5M | $113.75 | 2.25x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 1.5K | $237.2K | $159.93 | 1.64x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.8K | $195.3K | $109.46 | 3.04x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.0K | $188.7K | $95.10 | 3.77x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.3K | $165.7K | $49.95 | 3.37x |
| 90670 | Pneumococcal vaccine for injection into muscle | 903 | $162.8K | $180.33 | 2.10x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 661 | $104.8K | $158.51 | 1.86x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 960 | $82.3K | $85.74 | 2.86x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 2.7K | $44.7K | $16.46 | 1.52x |
| 82306 | Vitamin d-3 level | 1.3K | $38.6K | $28.99 | 1.75x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 2.9K | $37.9K | $13.12 | 2.08x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 271 | $36.9K | $136.35 | 3.05x |
| 80053 | Blood test, comprehensive group of blood chemicals | 3.1K | $32.4K | $10.36 | 2.07x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 153 | $30.5K | $199.07 | 2.41x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 197 | $27.8K | $141.28 | 3.10x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 292 | $26.7K | $91.36 | 2.14x |
| G0009 | Administration of pneumococcal vaccine | 1.2K | $26.3K | $21.78 | 2.02x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 3.0K | $23.2K | $7.62 | 2.14x |
| 36415 | Insertion of needle into vein for collection of blood sample | 3.7K | $22.8K | $6.09 | 1.62x |
This provider submits charges 2.81 times higher than what Medicare actually pays.
A markup ratio of 2.81x means for every $100 Medicare pays, this provider initially charges $281. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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