This provider's $4.0M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 217% from 2014 to 2023.
65% of their billing comes from a single procedure code (99309 — Subsequent nursing facility visit, typically 25 minutes per day).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 64% in 2019
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 | $171.36 | $88.52 | 1.94x | $82.84 | $229.1K | 3.2K | 619 |
| 2015 | $156.07 | $72.82 | 2.14x | $83.25 | $357.7K | 5.2K | 633 |
| 2016 | $146.43 | $67.80 | 2.16x | $78.63 | $266.6K | 5.0K | 590 |
| 2017 | $180.18 | $76.17 | 2.37x | $104.01 | $129.5K | 2.1K | 445 |
| 2018 | $214.58 | $84.43 | 2.54x | $130.15 | $208.9K | 3.2K | 458 |
| 2019 | $202.27 | $81.96 | 2.47x | $120.31 | $343.3K | 4.6K | 474 |
| 2020 | $190.00 | $83.02 | 2.29x | $106.98 | $456.7K | 6.4K | 465 |
| 2021 | $190.00 | $86.85 | 2.19x | $103.15 | $589.0K | 7.9K | 647 |
| 2022 | $182.50 | $78.52 | 2.32x | $103.98 | $683.0K | 9.5K | 574 |
| 2023 | $185.71 | $91.93 | 2.02x | $93.78 | $726.2K | 8.5K | 422 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 33.5K | $2.6M | $77.09 | 2.11x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 11.7K | $659.9K | $56.17 | 2.61x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 1.5K | $173.6K | $112.55 | 1.73x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.1K | $115.3K | $53.70 | 2.72x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 818 | $112.4K | $137.44 | 1.82x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.9K | $109.0K | $58.34 | 2.73x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 1.9K | $67.8K | $35.53 | 2.31x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 299 | $49.1K | $164.16 | 1.88x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 483 | $40.4K | $83.69 | 2.25x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 472 | $28.3K | $60.01 | 2.72x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 123 | $12.8K | $104.38 | 1.83x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 144 | $10.8K | $75.28 | 2.00x |
| 99238 | Hospital discharge day management, 30 minutes or less | 165 | $9.7K | $58.72 | 2.71x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple | 158 | $6.9K | $43.58 | 3.33x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 66 | $5.2K | $78.77 | 2.89x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 25 | $4.6K | $185.44 | 1.62x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 13 | $1.8K | $142.11 | 2.11x |
| G0179 | Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im | 13 | $440.42 | $33.88 | 3.78x |
This provider submits charges 2.21 times higher than what Medicare actually pays.
A markup ratio of 2.21x means for every $100 Medicare pays, this provider initially charges $221. 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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