⚠️ This provider averages 974 services per working day — physically unusual for an individual practitioner
Based on 1.9M total services over 8 years (250 working days/year). Learn about impossible service volumes →
This provider's $19.8M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 974 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 32736% from 2016 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 9437% in 2017
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 |
|---|---|---|---|---|---|---|---|
| 2016 | $77.18 | $33.39 | 2.31x | $43.79 | $10.3K | 308 | 8 |
| 2017 | $20.41 | $10.98 | 1.86x | $9.43 | $980.7K | 89.3K | 27 |
| 2018 | $20.44 | $11.07 | 1.85x | $9.37 | $2.8M | 251.4K | 28 |
| 2019 | $20.52 | $10.61 | 1.93x | $9.91 | $3.1M | 296.4K | 29 |
| 2020 | $22.26 | $10.48 | 2.12x | $11.78 | $2.8M | 269.8K | 28 |
| 2021 | $24.70 | $10.56 | 2.34x | $14.14 | $2.8M | 263.9K | 31 |
| 2022 | $26.10 | $9.93 | 2.63x | $16.17 | $3.9M | 391.9K | 38 |
| 2023 | $26.16 | $8.77 | 2.98x | $17.39 | $3.4M | 384.9K | 37 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 311.2K | $4.4M | $14.08 | 2.84x |
| 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) | 101.1K | $4.0M | $39.19 | 1.97x |
| J3262 | Injection, tocilizumab, 1 mg | 896.6K | $3.8M | $4.23 | 1.54x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 61.9K | $2.4M | $38.17 | 3.27x |
| 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) | 423.6K | $2.3M | $5.46 | 2.16x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 8.1K | $653.6K | $80.39 | 1.83x |
| J0897 | Injection, denosumab, 1 mg | 34.3K | $563.1K | $16.43 | 1.47x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 6.1K | $558.8K | $92.17 | 2.44x |
| J9312 | Injection, rituximab, 10 mg | 3.6K | $239.7K | $66.59 | 1.50x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 30.2K | $232.4K | $7.68 | 1.34x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 2.1K | $109.7K | $51.43 | 2.14x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 11.2K | $90.4K | $8.10 | 4.32x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 760 | $84.5K | $111.22 | 1.79x |
| 80076 | Liver function blood test panel | 8.1K | $67.6K | $8.33 | 6.60x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.4K | $66.8K | $48.63 | 2.11x |
| 36415 | Insertion of needle into vein for collection of blood sample | 11.5K | $46.1K | $4.02 | 3.23x |
| 82565 | Blood creatinine level | 8.3K | $42.7K | $5.17 | 5.23x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 1.8K | $37.4K | $20.78 | 4.81x |
| 80053 | Blood test, comprehensive group of blood chemicals | 2.9K | $31.2K | $10.88 | 6.94x |
| 85652 | Red blood cell sedimentation rate, to detect inflammation, automated | 10.9K | $29.9K | $2.75 | 9.60x |
This provider submits charges 2.32 times higher than what Medicare actually pays.
A markup ratio of 2.32x means for every $100 Medicare pays, this provider initially charges $232. 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.
Share this provider's Medicare payment information
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.
Believe this data is inaccurate? Dispute this data