Statistical flag only — not an accusation of fraud
⚠️ This provider averages 888 services per working day — physically unusual for an individual practitioner
Based on 2.2M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $23.7M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
Averaging 888 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 865% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 76/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 57% 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 | $33.88 | $13.83 | 2.45x | $20.05 | $565.1K | 40.9K | 25 |
| 2015 | $27.46 | $13.47 | 2.04x | $13.99 | $856.3K | 63.6K | 23 |
| 2016 | $28.80 | $13.74 | 2.10x | $15.06 | $1.1M | 81.8K | 20 |
| 2017 | $27.13 | $13.92 | 1.95x | $13.21 | $1.2M | 85.3K | 19 |
| 2018 | $30.48 | $14.82 | 2.06x | $15.66 | $1.3M | 90.9K | 17 |
| 2019 | $28.90 | $14.50 | 1.99x | $14.40 | $1.7M | 119.0K | 21 |
| 2020 | $19.15 | $9.92 | 1.93x | $9.23 | $2.7M | 273.8K | 15 |
| 2021 | $17.28 | $9.41 | 1.84x | $7.87 | $4.2M | 451.1K | 17 |
| 2022 | $17.37 | $9.54 | 1.82x | $7.83 | $4.5M | 467.8K | 14 |
| 2023 | $17.77 | $9.97 | 1.78x | $7.80 | $5.5M | 546.8K | 16 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0897 | Injection, denosumab, 1 mg | 769.7K | $11.4M | $14.84 | 1.57x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 1.4M | $10.3M | $7.53 | 1.70x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 14.5K | $683.6K | $47.28 | 2.95x |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | 28.1K | $266.9K | $9.50 | 1.95x |
| 96372 | Injection of drug or substance under skin or into muscle | 16.6K | $159.1K | $9.58 | 19.02x |
| 20610 | Aspiration and/or injection of fluid from large joint | 3.4K | $155.4K | $46.11 | 7.93x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 2.8K | $122.8K | $43.92 | 5.43x |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | 8.6K | $120.9K | $14.09 | 1.86x |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 1.1K | $118.1K | $112.35 | 2.29x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.5K | $105.4K | $70.09 | 2.70x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 3.6K | $96.0K | $26.96 | 3.44x |
| J3590 | Unclassified biologics | 62 | $46.3K | $746.09 | 1.68x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 539 | $35.6K | $66.07 | 2.92x |
| 99202 | New patient office or other outpatient visit, 15-29 minutes | 503 | $21.1K | $42.02 | 3.56x |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 1.4K | $10.4K | $7.20 | 3.72x |
| 73564 | X-ray of knee, 4 or more views | 884 | $6.8K | $7.65 | 21.54x |
| 29075 | Application of cast, elbow to finger (short arm) | 57 | $3.2K | $55.85 | 4.04x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 25 | $2.5K | $99.88 | 3.90x |
| 72114 | X-ray lower and sacral spine including bending views minimum 6 views | 206 | $2.2K | $10.66 | 25.85x |
| 72110 | X-ray of lower and sacral spine, minimum of 4 views | 192 | $2.1K | $10.74 | 16.30x |
This provider submits charges 1.9 times higher than what Medicare actually pays.
A markup ratio of 1.9x means for every $100 Medicare pays, this provider initially charges $190. This is lower 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.
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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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