⚠️ This provider averages 651 services per working day — physically unusual for an individual practitioner
Based on 1.6M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $24.7M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 651 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 9697% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 6324% in 2015
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 | $59.39 | $26.62 | 2.23x | $32.77 | $32.3K | 1.2K | 11 |
| 2015 | $47.73 | $24.18 | 1.97x | $23.55 | $2.1M | 85.8K | 32 |
| 2016 | $41.29 | $20.44 | 2.02x | $20.85 | $1.8M | 86.5K | 30 |
| 2017 | $37.89 | $19.17 | 1.98x | $18.72 | $2.5M | 128.8K | 31 |
| 2018 | $32.26 | $16.44 | 1.96x | $15.82 | $3.1M | 186.1K | 34 |
| 2019 | $31.60 | $15.10 | 2.09x | $16.50 | $3.2M | 214.7K | 28 |
| 2020 | $27.77 | $12.25 | 2.27x | $15.52 | $2.4M | 199.6K | 27 |
| 2021 | $31.97 | $13.85 | 2.31x | $18.12 | $3.4M | 245.7K | 25 |
| 2022 | $32.18 | $13.06 | 2.46x | $19.12 | $3.1M | 234.3K | 27 |
| 2023 | $30.01 | $12.91 | 2.32x | $17.10 | $3.2M | 245.0K | 27 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 183.1K | $8.6M | $47.02 | 2.30x |
| 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) | 100.0K | $3.7M | $36.67 | 1.57x |
| J0897 | Injection, denosumab, 1 mg | 230.6K | $3.5M | $15.37 | 1.65x |
| J3262 | Injection, tocilizumab, 1 mg | 746.9K | $3.0M | $4.03 | 2.02x |
| J3245 | Injection, tildrakizumab, 1 mg | 12.5K | $1.4M | $108.79 | 1.61x |
| 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) | 237.6K | $1.2M | $5.23 | 2.26x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 9.7K | $797.7K | $82.34 | 2.24x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 6.2K | $674.0K | $108.96 | 5.32x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 40.2K | $521.8K | $12.97 | 2.29x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 2.6K | $148.3K | $57.24 | 2.74x |
| 96372 | Injection of drug or substance under skin or into muscle | 10.4K | $140.6K | $13.56 | 3.13x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.3K | $119.1K | $52.43 | 2.36x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 988 | $118.0K | $119.39 | 2.33x |
| 77080 | Dxa bone density measurement of hip, pelvis, spine | 2.6K | $101.2K | $39.64 | 5.05x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 11.4K | $100.9K | $8.87 | 4.62x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 3.6K | $82.9K | $23.33 | 7.50x |
| 20610 | Aspiration and/or injection of fluid from large joint | 1.8K | $81.0K | $45.19 | 4.23x |
| J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | 806 | $52.9K | $65.67 | 4.19x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 367 | $49.4K | $134.73 | 2.04x |
| 90670 | Pneumococcal vaccine, 13-valent | 171 | $30.9K | $180.42 | 1.11x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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 VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Elena Flagg, M.D. | Williamsburg, VA | $42.6M | ✓ Clear |
| Michael Strachan, M.D. | Richmond, VA | $36.6M | ✓ 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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