⚠️ This provider averages 1.1K services per working day — physically unusual for an individual practitioner
Based on 2.7M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $55.8M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 1.1K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 65% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
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 | $41.58 | $22.68 | 1.83x | $18.90 | $4.0M | 178.0K | 26 |
| 2015 | $43.22 | $21.22 | 2.04x | $22.00 | $3.9M | 182.6K | 26 |
| 2016 | $54.47 | $22.96 | 2.37x | $31.51 | $4.3M | 185.5K | 24 |
| 2017 | $52.07 | $23.39 | 2.23x | $28.68 | $4.6M | 196.9K | 23 |
| 2018 | $56.34 | $27.03 | 2.08x | $29.31 | $5.8M | 212.8K | 28 |
| 2019 | $49.75 | $23.36 | 2.13x | $26.39 | $6.3M | 269.5K | 24 |
| 2020 | $47.44 | $22.25 | 2.13x | $25.19 | $6.1M | 274.1K | 25 |
| 2021 | $44.66 | $20.80 | 2.15x | $23.86 | $7.3M | 349.7K | 28 |
| 2022 | $37.55 | $16.79 | 2.24x | $20.76 | $6.9M | 413.0K | 26 |
| 2023 | $31.10 | $14.06 | 2.21x | $17.04 | $6.6M | 472.3K | 25 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9312 | Injection, rituximab, 10 mg | 164.8K | $11.6M | $70.44 | 1.75x |
| J9310 | Injection, rituximab, 100 mg | 18.6K | $11.5M | $616.50 | 1.60x |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 163.9K | $6.2M | $38.11 | 1.96x |
| J3262 | Injection, tocilizumab, 1 mg | 1.5M | $6.0M | $3.87 | 1.88x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 110.2K | $5.9M | $53.55 | 3.30x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 287.3K | $4.5M | $15.72 | 3.43x |
| J3245 | Injection, tildrakizumab, 1 mg | 29.0K | $3.2M | $108.65 | 1.56x |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | 12.9K | $1.9M | $144.18 | 2.25x |
| J0897 | Injection, denosumab, 1 mg | 61.8K | $953.3K | $15.42 | 1.90x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 104.4K | $799.8K | $7.66 | 1.57x |
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 165.2K | $787.4K | $4.77 | 2.99x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 11.4K | $649.5K | $56.78 | 2.91x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 5.9K | $630.9K | $107.62 | 2.65x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 7.9K | $433.5K | $55.19 | 2.32x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 6.4K | $154.1K | $24.02 | 6.69x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.1K | $134.3K | $121.66 | 2.39x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 2.5K | $81.9K | $32.89 | 3.09x |
| 96375 | Injection of additional new drug or substance into vein | 4.2K | $60.5K | $14.55 | 2.75x |
| M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromise | 257 | $41.8K | $162.71 | 1.69x |
| 96372 | Injection of drug or substance under skin or into muscle | 3.6K | $40.8K | $11.45 | 5.14x |
This provider submits charges 2.15 times higher than what Medicare actually pays.
A markup ratio of 2.15x means for every $100 Medicare pays, this provider initially charges $215. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Rheumatology providers in CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Shariar Cohen-Gadol, M.D. | Thousand Oaks, CA | $49.5M | ⚠️ Flagged |
| Gerald Ho, M.D. | La Palma, CA | $45.8M | ✓ Clear |
| Arash Horizon, M.D. | Los Angeles, CA | $45.0M | ✓ Clear |
| Daniel Watrous, M.D. | Visalia, CA | $41.6M | ✓ Clear |
| Eric Lee, M.D. | Upland, CA | $37.5M | ✓ Clear |
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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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