This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 107% from 2014 to 2023.
64% of their billing comes from a single procedure code (99310 — Subsequent nursing facility visit, typically 35 minutes per day).
AI-generated analysis based on Medicare payment data.
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 | $85.31 | $45.56 | 1.87x | $39.75 | $220.0K | 3.5K | 1.8K |
| 2015 | $91.33 | $46.29 | 1.97x | $45.04 | $311.6K | 4.4K | 2.0K |
| 2016 | $103.13 | $47.59 | 2.17x | $55.54 | $326.3K | 4.4K | 1.8K |
| 2017 | $98.00 | $43.15 | 2.27x | $54.85 | $470.9K | 6.3K | 2.3K |
| 2018 | $136.53 | $63.97 | 2.13x | $72.56 | $604.2K | 7.3K | 2.5K |
| 2019 | $111.68 | $51.46 | 2.17x | $60.22 | $567.5K | 7.0K | 2.6K |
| 2020 | $116.77 | $58.33 | 2.00x | $58.44 | $471.2K | 6.2K | 2.4K |
| 2021 | $128.93 | $67.96 | 1.90x | $60.97 | $485.6K | 5.5K | 1.9K |
| 2022 | $150.19 | $67.18 | 2.24x | $83.01 | $539.0K | 6.1K | 1.9K |
| 2023 | $144.75 | $75.96 | 1.91x | $68.79 | $455.5K | 4.7K | 1.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 28.8K | $2.8M | $98.52 | 2.06x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 4.7K | $553.9K | $118.56 | 2.04x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 7.9K | $358.8K | $45.58 | 2.54x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 3.9K | $251.3K | $64.46 | 2.19x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.9K | $185.1K | $64.93 | 2.04x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.5K | $106.8K | $42.44 | 2.07x |
| 99441 | Physician telephone patient service, 5-10 minutes of medical discussion | 938 | $30.0K | $31.95 | 1.56x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 271 | $29.6K | $109.08 | 1.45x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 279 | $17.0K | $60.93 | 2.38x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 182 | $16.8K | $92.46 | 2.00x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 241 | $12.8K | $53.17 | 1.41x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 123 | $12.1K | $98.14 | 1.78x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 746 | $9.9K | $13.22 | 3.03x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 123 | $9.3K | $75.80 | 1.32x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 99 | $8.5K | $85.85 | 2.47x |
| 85610 | Blood test, clotting time | 732 | $3.7K | $5.01 | 1.60x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 71 | $2.7K | $38.70 | 2.79x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 12 | $2.0K | $162.60 | 1.83x |
| 99354 | Prolonged office or other outpatient service first hour | 24 | $1.9K | $79.11 | 1.32x |
| 36415 | Insertion of needle into vein for collection of blood sample | 404 | $1.2K | $3.05 | 1.64x |
This provider submits charges 2.1 times higher than what Medicare actually pays.
A markup ratio of 2.1x means for every $100 Medicare pays, this provider initially charges $210. This is higher than the national average.
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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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