OpenMedicare
Start Here
Explore
Fraud
Investigations
Data
Tools
About

Footer

OpenMedicare

Independent Medicare data journalism

Sister Sites

  • OpenMedicaid
  • OpenFeds
  • OpenSpending
  • OpenImmigration
  • OpenLobby
  • VaccineWatch
  • OpenSubsidies
  • WarCosts
  • OpenPrescriber

Explore

  • Providers
  • Procedures
  • States
  • Specialties
  • Search

Fraud Analysis

  • Still Out There (AI)
  • Fraud Overview
  • Fraud Watchlist
  • Deep Dive Profiles
  • Impossible Numbers
  • Report Fraud

Investigations

  • The Algorithm Knows
  • How We Built the Model
  • Internal Medicine Crisis
  • Florida & California Fraud
  • Million Dollar Flagged
  • All Investigations

Tools

  • Provider Lookup
  • Compare
  • Cost Calculator
  • Your Medicare Dollar
  • Downloads

About

  • About OpenMedicare
  • Methodology
  • Glossary
  • Data Sources
  • API Docs
  • Updates
Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
Sister Sites: OpenMedicaid · OpenFeds · OpenSpending · OpenImmigration · OpenLobby · VaccineWatch · OpenSubsidies · WarCosts

© 2026 OpenMedicare. Independent data journalism. Built by TheDataProject.ai

Methodology•Download Data
  1. Home
  2. Providers
  3. James Rothstein
🔪
MDIndividual

James Rothstein, MD

NPI: 1265419584
Prestonsburg, KY
8 years of data
Vascular Surgery
$19.6M
Total Payments
13.2K
Beneficiaries
17.6K
Services
2.24x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$19.6M
Specialty median$184.1K

📋 Key Findings

1Billed $19.6M over 8 years
22.24x markup ratio (above median)
399th percentile in Vascular Surgery by payments
4Payments surged 101069% in 2019
53 procedures with >3x markup
✓ No flags detected

🔎 Data Analysis

This provider's $19.6M in total Medicare payments ranks in the 99th percentile of Vascular Surgery providers nationally.

Medicare payments to this provider grew 2814% from 2014 to 2022.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

📈

Notable: Payments increased 101069% in 2019

Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$462.87$120.393.84x$342.48$82.3K1.2K1.1K
2015$845.91$205.434.12x$640.48$132.7K1.3K891
2016$356.09$92.383.85x$263.71$18.5K198172
2017$287.07$84.823.38x$202.25$7.2K8577
2019$4.1K$2.0K2.06x$2.1K$7.2M5.2K3.7K
2020$4.9K$2.3K2.12x$2.6K$4.6M3.5K2.6K
2021$4.9K$2.3K2.12x$2.6K$5.1M3.9K2.8K
2022$3.6K$1.4K2.49x$2.1K$2.4M2.2K1.8K

Top Procedures (20)

37225Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure
$8.6M
979 services$8.8K/svc2.31x markup
37229Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure
$7.8M
844 services$9.2K/svc2.17x markup
37252Ultrasound evaluation of blood vessel during diagnosis or treatment
$1.4M
1.2K services$1.1K/svc2.26x markup
37227Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure
$652.4K
45 services$14.5K/svc1.88x markup
37253Ultrasound evaluation of blood vessel during diagnosis or treatment
$210.8K
1.2K services$178.07/svc2.19x markup
75716Radiological supervision and interpretation of imaging of arteries of both arms or legs
$187.9K
1.4K services$135.38/svc2.10x markup
75625Radiological supervision and interpretation X-ray of abdominal aorta
$142.9K
1.4K services$101.66/svc2.05x markup
36247Insertion of catheter into abdominal pelvic or leg artery
$127.4K
84 services$1.5K/svc1.85x markup
37221Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure
$75.1K
35 services$2.1K/svc2.85x markup
99152Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes
$68.8K
1.4K services$49.07/svc1.90x markup
99214Established patient office or other outpatient, visit typically 25 minutes
$49.5K
608 services$81.38/svc2.56x markup
37233Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure
$39.8K
31 services$1.3K/svc2.10x markup
76937Ultrasound guidance for accessing into blood vessel
$38.8K
1.4K services$28.68/svc1.79x markup
37224Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure
$36.7K
12 services$3.1K/svc2.29x markup
35301Removal of blood clot and portion of artery of neck⚠ 3.6x markup
$26.6K
32 services$830.97/svc3.57x markup
99204New patient office or other outpatient visit, typically 45 minutes
$19.5K
149 services$130.70/svc2.57x markup
36821Relocation of arm vein with connection to arm artery, open procedure⚠ 3.9x markup
$18.0K
33 services$546.31/svc3.85x markup
36475Destruction of insufficient vein of arm or leg, accessed through the skin
$18.0K
13 services$1.4K/svc2.03x markup
93880Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck⚠ 4.7x markup
$16.9K
261 services$64.63/svc4.69x markup
37232Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure
$14.9K
15 services$993.33/svc2.21x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
37225Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure979$8.6M$8.8K2.31x
37229Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure844$7.8M$9.2K2.17x
37252Ultrasound evaluation of blood vessel during diagnosis or treatment1.2K$1.4M$1.1K2.26x
37227Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure45$652.4K$14.5K1.88x
37253Ultrasound evaluation of blood vessel during diagnosis or treatment1.2K$210.8K$178.072.19x
75716Radiological supervision and interpretation of imaging of arteries of both arms or legs1.4K$187.9K$135.382.10x
75625Radiological supervision and interpretation X-ray of abdominal aorta1.4K$142.9K$101.662.05x
36247Insertion of catheter into abdominal pelvic or leg artery84$127.4K$1.5K1.85x
37221Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure35$75.1K$2.1K2.85x
99152Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes1.4K$68.8K$49.071.90x
99214Established patient office or other outpatient, visit typically 25 minutes608$49.5K$81.382.56x
37233Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure31$39.8K$1.3K2.10x
76937Ultrasound guidance for accessing into blood vessel1.4K$38.8K$28.681.79x
37224Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure12$36.7K$3.1K2.29x
35301Removal of blood clot and portion of artery of neck32$26.6K$830.973.57x
99204New patient office or other outpatient visit, typically 45 minutes149$19.5K$130.702.57x
36821Relocation of arm vein with connection to arm artery, open procedure33$18.0K$546.313.85x
36475Destruction of insufficient vein of arm or leg, accessed through the skin13$18.0K$1.4K2.03x
93880Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck261$16.9K$64.634.69x
37232Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure15$14.9K$993.332.21x

Markup Analysis

Charge-to-Payment Ratio

2.24x

This provider submits charges 2.24 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.24x means for every $100 Medicare pays, this provider initially charges $224. This is higher than the national average.

Location

Prestonsburg, KY

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

Related

Browse
← Back to Provider Directory
State
All providers in KY →
Specialty
All Vascular Surgery providers →
Tool
Compare this provider →
Analysis
Fraud Watchlist →
Search
Search all providers →

Share This Provider

Share this provider's Medicare payment information

Share:

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • National Plan and Provider Enumeration System (NPPES)

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