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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Providers
  3. Procare Pharmacy Direct, Llc.
⚕️
Organization

Procare Pharmacy Direct, Llc.

NPI: 1043382302
Monroeville, PA
9 years of data
Pharmacy
$37.2M
Total Payments
10
Beneficiaries
15.7M
Services
3.2x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$37.2M
Specialty median$95.7K
Rank #9 of 11 in specialty

📋 Key Findings

1Billed $37.2M over 9 years
23.2x markup ratio (above median)
399th percentile in Pharmacy by payments
41 procedure with >3x markup
✓ No flags detected

🔎 Data Analysis

This provider's $37.2M in total Medicare payments ranks in the 99th percentile of Pharmacy providers nationally.

Medicare payments to this provider grew 219% from 2014 to 2023.

71% of their billing comes from a single procedure code (J7192 — Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified).

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$53.8K$20.7K2.59x$33.1K$2.6M1261
2015$793.13$231.663.42x$561.47$1.9M8.3K1
2016$61.9K$18.1K3.41x$43.8K$2.4M1321
2017$67.4K$20.2K3.34x$47.2K$2.8M1371
2019$3.45$1.003.45x$2.45$3.4M3.3M1
2020$3.56$1.063.36x$2.50$4.1M3.9M1
2021$3.68$1.113.32x$2.57$5.4M4.9M1
2022$107.98$36.242.98x$71.74$6.3M174.5K1
2023$7.64$2.433.14x$5.21$8.3M3.4M2

Top Procedures (2)

J7192Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified⚠ 3.3x markup
$26.4M
15.4M services$1.71/svc3.29x markup
J7170Injection, emicizumab-kxwh, 0.5 mg
$10.8M
292.3K services$37.05/svc2.98x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
J7192Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified15.4M$26.4M$1.713.29x
J7170Injection, emicizumab-kxwh, 0.5 mg292.3K$10.8M$37.052.98x

Markup Analysis

Charge-to-Payment Ratio

3.2x

This provider submits charges 3.2 times higher than what Medicare actually pays.

What This Means

A markup ratio of 3.2x means for every $100 Medicare pays, this provider initially charges $320. This is higher than the national average.

Location

Monroeville, PA

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

Similar Providers

Other Pharmacy providers in PA for peer comparison.

Procare Pharmacy Direct, Llc. (you)
$37.2M
Accredo Health Group Inc
$208.7M
Pentec Health Inc⚠️
$44.2M
Show detailed table ▾
ProviderLocationTotal PaymentsStatus
Accredo Health Group IncWarrendale, PA$208.7M✓ Clear
Pentec Health IncUpper Chichester, PA$44.2M⚠️ Flagged

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Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • National Plan and Provider Enumeration System (NPPES)

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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