⚠️ This provider averages 822 services per working day — physically unusual for an individual practitioner
Based on 2.1M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $22.2M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 822 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 546% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 64% in 2015
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 | $26.06 | $13.21 | 1.97x | $12.85 | $652.1K | 49.4K | 29 |
| 2015 | $28.21 | $15.14 | 1.86x | $13.07 | $1.1M | 70.4K | 25 |
| 2016 | $26.07 | $14.27 | 1.83x | $11.80 | $1.2M | 85.5K | 26 |
| 2017 | $25.28 | $13.20 | 1.92x | $12.08 | $1.4M | 104.5K | 24 |
| 2018 | $23.99 | $12.16 | 1.97x | $11.83 | $1.5M | 126.0K | 22 |
| 2019 | $25.18 | $10.57 | 2.38x | $14.61 | $1.9M | 178.7K | 23 |
| 2020 | $25.04 | $11.19 | 2.24x | $13.85 | $2.3M | 201.8K | 25 |
| 2021 | $25.95 | $11.13 | 2.33x | $14.82 | $3.6M | 319.3K | 26 |
| 2022 | $26.23 | $9.77 | 2.68x | $16.46 | $4.4M | 451.1K | 26 |
| 2023 | $25.11 | $8.99 | 2.79x | $16.12 | $4.2M | 468.8K | 27 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 1.2M | $6.3M | $5.15 | 2.36x |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 108.4K | $4.0M | $36.56 | 2.03x |
| J0897 | Injection, denosumab, 1 mg | 168.5K | $2.7M | $15.87 | 2.15x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 17.6K | $1.6M | $91.75 | 2.47x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 36.5K | $1.4M | $39.45 | 3.09x |
| J3262 | Injection, tocilizumab, 1 mg | 238.8K | $1.0M | $4.35 | 2.20x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 135.1K | $990.6K | $7.33 | 1.92x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 8.4K | $585.8K | $69.88 | 2.33x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 43.0K | $558.3K | $13.00 | 3.11x |
| 20610 | Aspiration and/or injection of fluid from large joint | 8.9K | $504.5K | $56.58 | 3.10x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.3K | $412.0K | $126.58 | 2.86x |
| J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | 4.3K | $281.1K | $65.25 | 2.33x |
| J7324 | Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose | 2.1K | $264.1K | $126.38 | 2.68x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 3.9K | $252.1K | $64.31 | 2.55x |
| J7320 | Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg | 17.2K | $221.4K | $12.87 | 1.71x |
| J7322 | Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg | 11.3K | $218.4K | $19.40 | 2.92x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.5K | $202.0K | $133.54 | 2.68x |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | 11.4K | $160.3K | $14.11 | 2.08x |
| J9310 | Injection, rituximab, 100 mg | 222 | $128.3K | $578.00 | 1.31x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 386 | $52.2K | $135.26 | 2.51x |
This provider submits charges 2.37 times higher than what Medicare actually pays.
A markup ratio of 2.37x means for every $100 Medicare pays, this provider initially charges $237. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Rheumatology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Elena Flagg, M.D. | Williamsburg, VA | $42.6M | ✓ Clear |
| Michael Strachan, M.D. | Richmond, VA | $36.6M | ✓ Clear |
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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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