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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. Thomas Wallace
๐Ÿฉบ
MDIndividual

Thomas Wallace, M.D.

NPI: 1679641666
Modesto, CA
10 years of data
Internal Medicine
$4.1M
Total Payments
31.0K
Beneficiaries
54.7K
Services
2.63x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$4.1M
Specialty median$84.0K

๐Ÿ“‹ Key Findings

1Billed $4.1M over 10 years
22.63x markup ratio (above median)
399th percentile in Internal Medicine by payments
4Payments surged 359% in 2016
56 procedures with >3x markup
โœ“ No flags detected

๐Ÿ”Ž Data Analysis

This provider's $4.1M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.

Medicare payments to this provider grew 692% from 2014 to 2023.

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 359% in 2016

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$263.67$93.172.83x$170.50$80.1K1.3K866
2015$293.76$93.993.13x$199.77$85.3K1.0K724
2016$263.63$91.902.87x$171.73$391.7K5.4K2.9K
2017$262.32$89.152.94x$173.17$548.3K7.8K4.1K
2018$252.04$85.522.95x$166.52$551.2K8.0K4.5K
2019$251.45$91.872.74x$159.58$671.5K9.4K5.1K
2020$265.17$92.312.87x$172.86$312.2K4.1K2.5K
2021$292.65$104.592.80x$188.06$406.8K5.0K2.9K
2022$239.95$90.812.64x$149.14$436.8K5.4K3.2K
2023$262.96$85.783.07x$177.18$634.2K7.3K4.4K

Top Procedures (20)

99232Subsequent hospital inpatient care, typically 25 minutes per day
$1.4M
24.9K services$57.15/svc2.60x markup
99233Subsequent hospital inpatient care, typically 35 minutes per day
$1.0M
12.2K services$84.29/svc2.55x markup
99223Initial hospital inpatient care, typically 70 minutes per day
$709.4K
4.8K services$148.53/svc2.67x markup
99239Hospital discharge day management, more than 30 minutes
$449.7K
5.2K services$85.70/svc2.58x markup
99238Hospital discharge day management, 30 minutes or less
$216.1K
3.7K services$57.87/svc2.58x markup
99222Initial hospital inpatient care, typically 50 minutes per day
$117.2K
1.2K services$101.18/svc2.75x markup
99291Critical care delivery critically ill or injured patient, first 30-74 minutesโš  3.4x markup
$66.9K
396 services$168.83/svc3.38x markup
99231Subsequent hospital inpatient care, typically 15 minutes per dayโš  4.0x markup
$37.0K
1.2K services$30.67/svc4.03x markup
99220Hospital observation care typically 70 minutes per day
$26.6K
187 services$142.04/svc2.73x markup
99497Advance care planning by the physician or other qualified health care professional
$12.7K
206 services$61.76/svc2.83x markup
99217Hospital observation care discharge
$5.3K
96 services$55.19/svc2.81x markup
99498Advance care planning by the physician or other qualified health care professional
$3.2K
54 services$58.38/svc2.62x markup
99205New patient office or other outpatient visit, 60-74 minutesโš  3.7x markup
$3.1K
26 services$119.87/svc3.69x markup
99219Hospital observation care, typically 50 minutes
$3.0K
29 services$104.40/svc2.68x markup
99358Extended patient service without direct patient contact, first hour
$2.9K
34 services$86.58/svc2.45x markup
99356Prolonged inpatient or observation hospital service first hour
$2.9K
41 services$71.44/svc2.55x markup
31500Emergent insertion of breathing tube into windpipe cartilage using an endoscope
$2.7K
24 services$111.90/svc2.42x markup
93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and reportโš  3.3x markup
$2.0K
294 services$6.86/svc3.25x markup
99292Critical care delivery critically ill or injured patientโš  3.1x markup
$1.7K
21 services$81.00/svc3.14x markup
92950Attempt to restart heart and lungsโš  4.4x markup
$1.7K
11 services$150.30/svc4.40x markup
Show detailed table โ–พ
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
99232Subsequent hospital inpatient care, typically 25 minutes per day24.9K$1.4M$57.152.60x
99233Subsequent hospital inpatient care, typically 35 minutes per day12.2K$1.0M$84.292.55x
99223Initial hospital inpatient care, typically 70 minutes per day4.8K$709.4K$148.532.67x
99239Hospital discharge day management, more than 30 minutes5.2K$449.7K$85.702.58x
99238Hospital discharge day management, 30 minutes or less3.7K$216.1K$57.872.58x
99222Initial hospital inpatient care, typically 50 minutes per day1.2K$117.2K$101.182.75x
99291Critical care delivery critically ill or injured patient, first 30-74 minutes396$66.9K$168.833.38x
99231Subsequent hospital inpatient care, typically 15 minutes per day1.2K$37.0K$30.674.03x
99220Hospital observation care typically 70 minutes per day187$26.6K$142.042.73x
99497Advance care planning by the physician or other qualified health care professional206$12.7K$61.762.83x
99217Hospital observation care discharge96$5.3K$55.192.81x
99498Advance care planning by the physician or other qualified health care professional54$3.2K$58.382.62x
99205New patient office or other outpatient visit, 60-74 minutes26$3.1K$119.873.69x
99219Hospital observation care, typically 50 minutes29$3.0K$104.402.68x
99358Extended patient service without direct patient contact, first hour34$2.9K$86.582.45x
99356Prolonged inpatient or observation hospital service first hour41$2.9K$71.442.55x
31500Emergent insertion of breathing tube into windpipe cartilage using an endoscope24$2.7K$111.902.42x
93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report294$2.0K$6.863.25x
99292Critical care delivery critically ill or injured patient21$1.7K$81.003.14x
92950Attempt to restart heart and lungs11$1.7K$150.304.40x

Markup Analysis

Charge-to-Payment Ratio

2.63x

This provider submits charges 2.63 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.63x means for every $100 Medicare pays, this provider initially charges $263. This is higher than the national average.

Location

Modesto, CA

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 Internal Medicine providers in CA for peer comparison.

Thomas Wallace (you)
$4.1M
Aaron Jeng, MD, MPH
$45.6M
Richard Park, M.D.โš ๏ธ
$34.7M
Show detailed table โ–พ
ProviderLocationTotal PaymentsStatus
Aaron Jeng, MD, MPHSan Gabriel, CA$45.6Mโœ“ Clear
Richard Park, M.D.Granada Hills, CA$34.7Mโš ๏ธ Flagged

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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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