This provider's $3.8M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 142% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 135% in 2023
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 | $144.43 | $56.86 | 2.54x | $87.57 | $249.1K | 4.3K | 1.3K |
| 2015 | $207.12 | $78.14 | 2.65x | $128.98 | $264.6K | 4.4K | 1.4K |
| 2016 | $197.61 | $76.04 | 2.60x | $121.57 | $385.6K | 6.6K | 1.9K |
| 2017 | $201.73 | $77.73 | 2.60x | $124.00 | $471.1K | 7.5K | 2.1K |
| 2018 | $220.93 | $83.71 | 2.64x | $137.22 | $550.7K | 8.7K | 2.0K |
| 2019 | $211.90 | $82.71 | 2.56x | $129.19 | $460.3K | 7.4K | 1.8K |
| 2020 | $180.75 | $76.44 | 2.36x | $104.31 | $301.5K | 5.0K | 1.3K |
| 2021 | $153.55 | $74.31 | 2.07x | $79.24 | $206.8K | 3.0K | 1.4K |
| 2022 | $177.50 | $80.76 | 2.20x | $96.74 | $257.4K | 3.5K | 1.6K |
| 2023 | $218.94 | $91.78 | 2.39x | $127.16 | $603.8K | 5.7K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 21.7K | $1.2M | $56.90 | 2.64x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.2K | $937.4K | $83.59 | 2.51x |
| 99310 | Follow-up nursing facility visit per day, typically 35 minutes | 3.6K | $454.8K | $125.07 | 2.73x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 1.7K | $186.2K | $107.56 | 1.86x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 1.8K | $137.4K | $76.48 | 2.64x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 798 | $103.0K | $129.09 | 2.36x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 701 | $81.2K | $115.87 | 2.34x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 763 | $65.8K | $86.26 | 3.48x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 340 | $63.3K | $186.24 | 2.42x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 305 | $62.8K | $205.97 | 1.78x |
| G0008 | Administration of influenza virus vaccine | 1.7K | $40.5K | $24.29 | 1.61x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 229 | $38.5K | $168.12 | 2.38x |
| 93306 | Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function | 202 | $35.2K | $174.43 | 3.46x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 226 | $32.9K | $145.40 | 1.83x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple | 741 | $31.9K | $43.05 | 3.51x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 219 | $29.7K | $135.56 | 2.20x |
| 99239 | Hospital discharge day management, more than 30 minutes | 287 | $25.3K | $88.28 | 2.83x |
| 90674 | Vaccine for influenza for administration into muscle, 0.5 ml dosage | 780 | $22.4K | $28.68 | 1.88x |
| 82947 | Blood glucose (sugar) level | 4.3K | $20.3K | $4.74 | 5.32x |
| 99220 | Hospital observation care typically 70 minutes per day | 130 | $19.9K | $153.41 | 2.28x |
This provider submits charges 2.56 times higher than what Medicare actually pays.
A markup ratio of 2.56x means for every $100 Medicare pays, this provider initially charges $256. 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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