This provider's $3.7M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 297% from 2014 to 2023.
63% of their billing comes from a single procedure code (99308 — Subsequent nursing facility visit, typically 15 minutes per day).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 59% in 2020
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 | $123.38 | $59.85 | 2.06x | $63.53 | $191.4K | 3.1K | 1.0K |
| 2015 | $159.42 | $67.74 | 2.35x | $91.68 | $216.3K | 3.6K | 928 |
| 2016 | $162.91 | $71.19 | 2.29x | $91.72 | $184.1K | 3.0K | 697 |
| 2017 | $140.19 | $74.37 | 1.89x | $65.82 | $268.8K | 4.1K | 661 |
| 2018 | $190.45 | $78.58 | 2.42x | $111.87 | $298.4K | 4.5K | 611 |
| 2019 | $219.54 | $93.21 | 2.36x | $126.33 | $247.4K | 3.4K | 740 |
| 2020 | $167.66 | $79.37 | 2.11x | $88.29 | $394.0K | 5.6K | 927 |
| 2021 | $146.51 | $75.97 | 1.93x | $70.54 | $559.7K | 8.2K | 912 |
| 2022 | $173.75 | $73.39 | 2.37x | $100.36 | $620.5K | 9.2K | 1.0K |
| 2023 | $154.14 | $82.85 | 1.86x | $71.29 | $760.5K | 10.4K | 1.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 37.1K | $2.4M | $63.48 | 2.32x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 11.1K | $910.6K | $82.12 | 2.09x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.8K | $159.1K | $56.95 | 2.55x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 747 | $112.6K | $150.78 | 1.47x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 298 | $35.1K | $117.77 | 1.68x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 382 | $31.7K | $82.96 | 2.46x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 331 | $31.2K | $94.34 | 2.27x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 374 | $23.9K | $63.99 | 2.23x |
| 99238 | Hospital discharge day management, 30 minutes or less | 229 | $14.9K | $64.95 | 3.22x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 201 | $13.7K | $68.25 | 1.85x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 108 | $13.1K | $121.65 | 2.47x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 70 | $12.6K | $180.26 | 2.34x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 220 | $8.4K | $38.17 | 2.82x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 27 | $3.1K | $114.98 | 2.17x |
| 93000 | Routine EKG using at least 12 leads including interpretation and report | 206 | $2.6K | $12.74 | 5.72x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 126 | $2.6K | $20.68 | 3.69x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 25 | $2.4K | $95.28 | 2.23x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 25 | $2.0K | $79.32 | 2.37x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 35 | $1.5K | $43.35 | 1.34x |
| 99441 | Physician telephone patient service, 5-10 minutes of medical discussion | 84 | $1.5K | $17.83 | 2.50x |
This provider submits charges 2.25 times higher than what Medicare actually pays.
A markup ratio of 2.25x means for every $100 Medicare pays, this provider initially charges $225. 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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