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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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Methodologyโ€ขDownload Data
  1. Home
  2. Providers
  3. Nisha Sethi
๐Ÿฉบ
MDIndividual

Nisha Sethi, MD

NPI: 1669437224
Hempstead, NY
10 years of data
Internal Medicine
$4.3M
Total Payments
19.5K
Beneficiaries
59.1K
Services
2.26x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$4.3M
Specialty median$84.0K

๐Ÿ“‹ Key Findings

1Billed $4.3M over 10 years
22.26x markup ratio (above median)
399th percentile in Internal Medicine by payments
4Payments surged 63% in 2022
51 procedure with >3x markup
โœ“ No flags detected

๐Ÿ”Ž Data Analysis

This provider's $4.3M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.

Medicare payments to this provider grew 137% from 2014 to 2023.

72% of their billing comes from a single procedure code (99232 โ€” Subsequent hospital inpatient care, typically 25 minutes per day).

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

๐Ÿ“ˆ

Notable: Payments increased 63% in 2022

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 โ€” the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$211.82$89.452.37x$122.37$234.6K3.4K1.4K
2015$194.00$82.542.35x$111.46$264.5K3.8K1.6K
2016$215.04$91.302.36x$123.74$390.3K5.4K2.0K
2017$211.50$86.382.45x$125.12$342.5K5.0K1.8K
2018$222.50$96.802.30x$125.70$535.8K7.7K2.6K
2019$215.00$94.732.27x$120.27$634.2K8.9K2.8K
2020$214.96$94.012.29x$120.95$571.3K7.3K2.2K
2021$241.67$114.502.11x$127.17$309.5K3.9K1.3K
2022$233.57$109.402.14x$124.17$504.0K6.6K1.9K
2023$267.53$114.642.33x$152.89$555.4K6.9K1.8K

Top Procedures (14)

99232Subsequent hospital inpatient care, typically 25 minutes per day
$3.1M
47.0K services$66.27/svc2.26x markup
99222Initial hospital inpatient care, typically 50 minutes per day
$556.2K
4.4K services$125.59/svc2.39x markup
99221Initial hospital inpatient care, typically 30 minutes per day
$442.3K
4.8K services$92.08/svc2.01x markup
99233Subsequent hospital inpatient care, typically 35 minutes per day
$64.6K
674 services$95.84/svc2.30x markup
99223Initial hospital inpatient care, typically 70 minutes per day
$56.2K
311 services$180.82/svc2.21x markup
99213Established patient office or other outpatient visit, typically 15 minutes
$42.6K
663 services$64.27/svc2.33x markup
99231Subsequent hospital inpatient care, typically 15 minutes per day
$25.2K
718 services$35.08/svc2.85x markup
99214Established patient office or other outpatient, visit typically 25 minutes
$17.7K
181 services$97.98/svc2.35x markup
99238Hospital discharge day management, 30 minutes or lessโš  3.0x markup
$5.1K
78 services$65.64/svc3.05x markup
99308Subsequent nursing facility visit, typically 15 minutes per day
$5.1K
83 services$61.25/svc1.63x markup
99443Physician telephone patient service, 21-30 minutes of medical discussion
$5.0K
68 services$73.25/svc2.93x markup
99212Established patient office or other outpatient visit, typically 10 minutes
$1.8K
48 services$38.26/svc2.74x markup
99204New patient office or other outpatient visit, typically 45 minutes
$1.7K
11 services$150.50/svc2.59x markup
99203New patient office or other outpatient visit, typically 30 minutes
$1.1K
11 services$97.18/svc2.83x markup
Show detailed table โ–พ
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
99232Subsequent hospital inpatient care, typically 25 minutes per day47.0K$3.1M$66.272.26x
99222Initial hospital inpatient care, typically 50 minutes per day4.4K$556.2K$125.592.39x
99221Initial hospital inpatient care, typically 30 minutes per day4.8K$442.3K$92.082.01x
99233Subsequent hospital inpatient care, typically 35 minutes per day674$64.6K$95.842.30x
99223Initial hospital inpatient care, typically 70 minutes per day311$56.2K$180.822.21x
99213Established patient office or other outpatient visit, typically 15 minutes663$42.6K$64.272.33x
99231Subsequent hospital inpatient care, typically 15 minutes per day718$25.2K$35.082.85x
99214Established patient office or other outpatient, visit typically 25 minutes181$17.7K$97.982.35x
99238Hospital discharge day management, 30 minutes or less78$5.1K$65.643.05x
99308Subsequent nursing facility visit, typically 15 minutes per day83$5.1K$61.251.63x
99443Physician telephone patient service, 21-30 minutes of medical discussion68$5.0K$73.252.93x
99212Established patient office or other outpatient visit, typically 10 minutes48$1.8K$38.262.74x
99204New patient office or other outpatient visit, typically 45 minutes11$1.7K$150.502.59x
99203New patient office or other outpatient visit, typically 30 minutes11$1.1K$97.182.83x

Markup Analysis

Charge-to-Payment Ratio

2.26x

This provider submits charges 2.26 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.26x means for every $100 Medicare pays, this provider initially charges $226. This is higher than the national average.

Location

Hempstead, NY

Provider Verification

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

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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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