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

Methodologyโ€ขDownload Data
  1. Home
  2. Providers
  3. Pinehurst Medical Clinic Inc
๐Ÿ”ช
Organization

Pinehurst Medical Clinic Inc

NPI: 1356421853
Pinehurst, NC
10 years of data
Ambulatory Surgical Center
$13.5M
Total Payments
47.9K
Beneficiaries
48.7K
Services
3.48x
Markup Ratio

Peer Comparison

98th
percentile in specialty
This provider$13.5M
Specialty median$657.1K

๐Ÿ“‹ Key Findings

1Billed $13.5M over 10 years
23.48x markup ratio (above median)
398th percentile in Ambulatory Surgical Center by payments
411 procedures with >3x markup
โœ“ No flags detected

๐Ÿ”Ž Data Analysis

This provider's $13.5M in total Medicare payments ranks in the 98th percentile of Ambulatory Surgical Center providers nationally.

This provider's billing patterns fall within normal ranges for their specialty.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

Submitted Charges vs. Medicare Payments

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

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$914.41$240.803.80x$673.61$1.0M4.3K4.2K
2015$914.36$254.413.59x$659.95$1.2M4.7K4.6K
2016$933.38$267.193.49x$666.19$1.5M5.8K5.7K
2017$925.18$271.923.40x$653.26$1.4M5.5K5.4K
2018$930.24$267.833.47x$662.41$1.4M5.3K5.2K
2019$933.63$273.743.41x$659.89$1.5M5.5K5.4K
2020$935.12$311.963.00x$623.16$1.2M4.3K4.2K
2021$924.03$320.932.88x$603.10$1.4M4.6K4.5K
2022$949.59$347.472.73x$602.12$1.4M4.5K4.4K
2023$943.81$344.302.74x$599.51$1.4M4.2K4.1K

Top Procedures (20)

45385Removal of polyps or growths of large bowel using an endoscope
$5.1M
14.8K services$342.72/svc2.92x markup
43239Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscopeโš  4.9x markup
$2.1M
10.4K services$203.53/svc4.91x markup
45380Biopsy of large bowel using an endoscopeโš  4.0x markup
$2.0M
8.3K services$248.02/svc4.03x markup
G0105Colorectal cancer screening; colonoscopy on individual at high riskโš  3.0x markup
$947.4K
2.9K services$329.75/svc3.03x markup
43450Dilation of esophagus
$812.9K
3.4K services$239.08/svc2.93x markup
G0121Colorectal cancer screening; colonoscopy on individual not meeting criteria for high riskโš  3.0x markup
$585.2K
1.8K services$328.55/svc3.04x markup
45378Diagnostic examination of large bowel using an endoscopeโš  4.0x markup
$368.8K
1.5K services$249.56/svc4.01x markup
43235Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscopeโš  3.3x markup
$364.6K
1.7K services$211.23/svc3.31x markup
43248Insertion of guide wire with dilation of esophagus using an endoscopeโš  4.0x markup
$334.3K
1.3K services$247.82/svc4.04x markup
43251Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope
$293.1K
644 services$455.16/svc2.20x markup
43249Balloon dilation of esophagus using an endoscope
$149.9K
331 services$452.92/svc2.21x markup
45381Injections of large bowel using an endoscopeโš  5.4x markup
$106.0K
571 services$185.69/svc5.39x markup
45390Removal of large bowel tissue using an endoscope
$93.0K
180 services$516.50/svc1.99x markup
45331Biopsy of large bowel using an endoscope
$82.3K
353 services$233.15/svc3.00x markup
43255Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope
$64.4K
142 services$453.47/svc2.21x markup
43236Injections of esophagus, stomach, and/or upper small bowel using an endoscopeโš  7.0x markup
$17.8K
125 services$142.60/svc7.01x markup
45330Diagnostic examination of large bowel using an endoscopeโš  8.1x markup
$17.2K
199 services$86.65/svc8.10x markup
45382Control of bleeding in large bowel using an endoscopeโš  3.9x markup
$17.2K
67 services$256.11/svc3.90x markup
43245Dilation of stomach outlet using an endoscope
$6.6K
15 services$439.32/svc2.28x markup
45338Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation
$4.6K
13 services$350.76/svc2.00x markup
Show detailed table โ–พ
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
45385Removal of polyps or growths of large bowel using an endoscope14.8K$5.1M$342.722.92x
43239Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope10.4K$2.1M$203.534.91x
45380Biopsy of large bowel using an endoscope8.3K$2.0M$248.024.03x
G0105Colorectal cancer screening; colonoscopy on individual at high risk2.9K$947.4K$329.753.03x
43450Dilation of esophagus3.4K$812.9K$239.082.93x
G0121Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk1.8K$585.2K$328.553.04x
45378Diagnostic examination of large bowel using an endoscope1.5K$368.8K$249.564.01x
43235Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope1.7K$364.6K$211.233.31x
43248Insertion of guide wire with dilation of esophagus using an endoscope1.3K$334.3K$247.824.04x
43251Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope644$293.1K$455.162.20x
43249Balloon dilation of esophagus using an endoscope331$149.9K$452.922.21x
45381Injections of large bowel using an endoscope571$106.0K$185.695.39x
45390Removal of large bowel tissue using an endoscope180$93.0K$516.501.99x
45331Biopsy of large bowel using an endoscope353$82.3K$233.153.00x
43255Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope142$64.4K$453.472.21x
43236Injections of esophagus, stomach, and/or upper small bowel using an endoscope125$17.8K$142.607.01x
45330Diagnostic examination of large bowel using an endoscope199$17.2K$86.658.10x
45382Control of bleeding in large bowel using an endoscope67$17.2K$256.113.90x
43245Dilation of stomach outlet using an endoscope15$6.6K$439.322.28x
45338Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation13$4.6K$350.762.00x

Markup Analysis

Charge-to-Payment Ratio

3.48x

This provider submits charges 3.48 times higher than what Medicare actually pays.

What This Means

A markup ratio of 3.48x means for every $100 Medicare pays, this provider initially charges $348. This is higher than the national average.

Location

Pinehurst, NC

Provider Verification

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

Similar Providers

Other Ambulatory Surgical Center providers in NC for peer comparison.

Pinehurst Medical Clinic Inc (you)
$13.5M
The Eye Surgery Center Of The Carolinas Lp
$33.8M
Show detailed table โ–พ
ProviderLocationTotal PaymentsStatus
The Eye Surgery Center Of The Carolinas LpSouthern Pines, NC$33.8Mโœ“ Clear

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Data Sources

  • โ€ข Centers for Medicare & Medicaid Services (CMS)
  • โ€ข Medicare Provider Utilization and Payment Data (2014-2023)
  • โ€ข 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.

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