This provider's $4.4M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 307% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 92% 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 | $135.40 | $54.28 | 2.49x | $81.12 | $286.7K | 4.9K | 2.2K |
| 2015 | $156.72 | $64.53 | 2.43x | $92.19 | $323.1K | 5.3K | 2.2K |
| 2016 | $147.88 | $58.54 | 2.53x | $89.34 | $267.7K | 4.5K | 1.9K |
| 2017 | $141.14 | $60.01 | 2.35x | $81.13 | $257.3K | 4.1K | 1.8K |
| 2018 | $179.12 | $62.99 | 2.84x | $116.13 | $282.0K | 4.7K | 1.6K |
| 2019 | $195.60 | $73.64 | 2.66x | $121.96 | $414.3K | 6.3K | 2.2K |
| 2020 | $193.33 | $75.93 | 2.55x | $117.40 | $418.3K | 6.0K | 2.3K |
| 2021 | $218.29 | $92.92 | 2.35x | $125.37 | $412.3K | 5.4K | 2.1K |
| 2022 | $201.45 | $80.32 | 2.51x | $121.13 | $606.3K | 7.4K | 2.1K |
| 2023 | $208.06 | $89.08 | 2.34x | $118.98 | $1.2M | 12.6K | 3.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 14.8K | $1.3M | $87.23 | 2.25x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 19.4K | $1.1M | $56.21 | 2.67x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.6K | $610.1K | $92.39 | 2.62x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 1.8K | $250.8K | $142.57 | 2.50x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.6K | $229.5K | $145.98 | 2.19x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 1.1K | $138.1K | $123.62 | 2.36x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.9K | $118.6K | $60.94 | 2.69x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 585 | $96.5K | $165.04 | 3.18x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 491 | $68.5K | $139.45 | 1.85x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 765 | $55.0K | $71.91 | 2.67x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 628 | $52.6K | $83.70 | 2.02x |
| 90662 | Vaccine for influenza for injection into muscle | 933 | $48.6K | $52.12 | 1.27x |
| 99350 | Established patient home visit, typically 60 minutes | 286 | $41.8K | $146.14 | 2.59x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 655 | $39.2K | $59.87 | 2.61x |
| G0008 | Administration of influenza virus vaccine | 1.1K | $31.2K | $28.09 | 2.21x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 412 | $22.3K | $54.03 | 1.81x |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | 381 | $22.2K | $58.39 | 2.14x |
| 90670 | Pneumococcal vaccine for injection into muscle | 124 | $22.2K | $178.87 | 1.62x |
| 99483 | Assessment of and care planning for patient with impaired thought processing, typically 50 minutes | 81 | $17.9K | $221.20 | 2.50x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 103 | $16.5K | $159.81 | 2.82x |
This provider submits charges 2.46 times higher than what Medicare actually pays.
A markup ratio of 2.46x means for every $100 Medicare pays, this provider initially charges $246. 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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