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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
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Methodology•Download Data
  1. Home
  2. Providers
  3. Michael Sumsion
👁️
MDIndividual

Michael Sumsion, MD

NPI: 1699725507
Redding, CA
10 years of data
Ophthalmology
$27.1M
Total Payments
311
Beneficiaries
218.9K
Services
2.54x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$27.1M
Specialty median$383.7K

📋 Key Findings

1Billed $27.1M over 10 years
22.54x markup ratio (above median)
399th percentile in Ophthalmology by payments
488 services/day — unusually high
53 procedures with >3x markup

This provider averages 88 services per working day

Based on 218.9K total services over 10 years (250 working days/year). Learn about impossible service volumes →

🔎 Data Analysis

This provider's $27.1M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.

Averaging 88 services per working day raises questions about billing patterns.

Medicare payments to this provider grew 71% 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

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$223.21$79.552.81x$143.66$1.8M22.6K35
2015$264.28$96.012.75x$168.27$2.1M21.5K33
2016$261.50$99.512.63x$161.99$2.4M24.5K33
2017$268.10$110.112.43x$157.99$3.1M27.7K33
2018$371.63$152.642.43x$218.99$3.4M22.2K35
2019$364.10$148.462.45x$215.64$3.3M21.9K31
2020$355.13$143.332.48x$211.80$2.6M18.2K28
2021$340.51$137.062.48x$203.45$2.5M18.5K27
2022$342.15$133.922.55x$208.23$2.8M21.1K27
2023$389.99$149.532.61x$240.46$3.1M20.6K29

Top Procedures (20)

J0178Injection, aflibercept, 1 mg
$14.8M
20.0K services$740.15/svc2.12x markup
66984Removal of cataract with insertion of prosthetic lens⚠ 4.3x markup
$1.7M
3.4K services$496.90/svc4.26x markup
92014Established patient complete exam of visual system
$1.4M
16.3K services$84.21/svc2.53x markup
67028Injection of drug into eye⚠ 6.4x markup
$1.2M
14.8K services$83.88/svc6.42x markup
92134Imaging of retina
$1.2M
37.4K services$32.75/svc2.24x markup
92012Established patient problem focused exam of visual system
$1.2M
18.4K services$64.46/svc2.32x markup
66982Complex removal of cataract with insertion of prosthetic lens⚠ 3.3x markup
$669.8K
1.0K services$639.76/svc3.31x markup
66821Removal of recurring cataract in lens capsule using a laser
$466.4K
1.7K services$269.28/svc2.09x markup
99204New patient office or other outpatient visit, 45-59 minutes
$442.1K
4.1K services$108.43/svc2.55x markup
83861Microfluid analysis of tears
$383.9K
17.4K services$22.08/svc1.59x markup
92083Exam of visual field with extended testing
$380.9K
7.9K services$48.44/svc2.31x markup
J7312Injection, dexamethasone, intravitreal implant, 0.1 mg
$301.1K
1.9K services$156.98/svc2.04x markup
99213Established patient office or other outpatient visit, 20-29 minutes
$283.6K
5.0K services$56.95/svc2.29x markup
99214Established patient office or other outpatient visit, 30-39 minutes
$280.5K
3.0K services$92.85/svc2.32x markup
92133Imaging of optic nerve
$222.2K
7.4K services$29.84/svc2.32x markup
92136Measurement of corneal curvature and depth of eye
$220.5K
5.0K services$44.44/svc2.42x markup
83516Analysis of substance using immunoassay technique, multiple step method
$206.1K
17.0K services$12.13/svc2.06x markup
J3490Unclassified drugs
$194.1K
110 services$1.8K/svc2.02x markup
92235Exam of retinal blood vessels using a special camera after injection of a dye
$190.7K
2.2K services$85.87/svc2.45x markup
J2781Injection, pegcetacoplan, intravitreal, 1 mg
$139.0K
1.2K services$120.36/svc2.64x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
J0178Injection, aflibercept, 1 mg20.0K$14.8M$740.152.12x
66984Removal of cataract with insertion of prosthetic lens3.4K$1.7M$496.904.26x
92014Established patient complete exam of visual system16.3K$1.4M$84.212.53x
67028Injection of drug into eye14.8K$1.2M$83.886.42x
92134Imaging of retina37.4K$1.2M$32.752.24x
92012Established patient problem focused exam of visual system18.4K$1.2M$64.462.32x
66982Complex removal of cataract with insertion of prosthetic lens1.0K$669.8K$639.763.31x
66821Removal of recurring cataract in lens capsule using a laser1.7K$466.4K$269.282.09x
99204New patient office or other outpatient visit, 45-59 minutes4.1K$442.1K$108.432.55x
83861Microfluid analysis of tears17.4K$383.9K$22.081.59x
92083Exam of visual field with extended testing7.9K$380.9K$48.442.31x
J7312Injection, dexamethasone, intravitreal implant, 0.1 mg1.9K$301.1K$156.982.04x
99213Established patient office or other outpatient visit, 20-29 minutes5.0K$283.6K$56.952.29x
99214Established patient office or other outpatient visit, 30-39 minutes3.0K$280.5K$92.852.32x
92133Imaging of optic nerve7.4K$222.2K$29.842.32x
92136Measurement of corneal curvature and depth of eye5.0K$220.5K$44.442.42x
83516Analysis of substance using immunoassay technique, multiple step method17.0K$206.1K$12.132.06x
J3490Unclassified drugs110$194.1K$1.8K2.02x
92235Exam of retinal blood vessels using a special camera after injection of a dye2.2K$190.7K$85.872.45x
J2781Injection, pegcetacoplan, intravitreal, 1 mg1.2K$139.0K$120.362.64x

Markup Analysis

Charge-to-Payment Ratio

2.54x

This provider submits charges 2.54 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.54x means for every $100 Medicare pays, this provider initially charges $254. This is higher than the national average.

Location

Redding, 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 Ophthalmology providers in CA for peer comparison.

Michael Sumsion (you)
$27.1M
Nathan Steinle, M.D.
$63.1M
Stephen Couvillion, MD
$47.7M
Margaret Chang, M.D.
$47.6M
David Boyer, MD
$47.5M
Alessandro Castellarin, M.D.
$46.9M
Show detailed table ▾
ProviderLocationTotal PaymentsStatus
Nathan Steinle, M.D.Santa Barbara, CA$63.1M✓ Clear
Stephen Couvillion, MDSanta Barbara, CA$47.7M✓ Clear
Margaret Chang, M.D.Sacramento, CA$47.6M✓ Clear
David Boyer, MDLos Angeles, CA$47.5M✓ Clear
Alessandro Castellarin, M.D.Santa Barbara, CA$46.9M✓ Clear

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Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • 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.

Believe this data is inaccurate? Dispute this data