This provider's $6.0M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 412% from 2014 to 2023.
77% 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 104% in 2021
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 | $220.14 | $88.97 | 2.47x | $131.17 | $328.0K | 4.2K | 881 |
| 2015 | $204.30 | $77.23 | 2.65x | $127.07 | $356.5K | 4.8K | 1.0K |
| 2016 | $229.48 | $78.39 | 2.93x | $151.09 | $360.8K | 4.9K | 1.0K |
| 2017 | $264.70 | $74.29 | 3.56x | $190.41 | $381.8K | 5.2K | 1.0K |
| 2018 | $320.39 | $90.87 | 3.53x | $229.52 | $462.4K | 6.0K | 1.4K |
| 2019 | $151.53 | $69.07 | 2.19x | $82.46 | $262.1K | 4.0K | 1.5K |
| 2020 | $225.19 | $87.67 | 2.57x | $137.52 | $314.5K | 4.0K | 642 |
| 2021 | $241.33 | $99.22 | 2.43x | $142.11 | $641.4K | 7.6K | 746 |
| 2022 | $255.38 | $96.94 | 2.63x | $158.44 | $1.2M | 15.8K | 1.0K |
| 2023 | $263.11 | $115.01 | 2.29x | $148.10 | $1.7M | 19.7K | 794 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 62.5K | $4.6M | $74.38 | 2.68x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 5.6K | $590.4K | $106.07 | 2.73x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 1.9K | $251.8K | $131.19 | 2.67x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 2.8K | $150.4K | $53.03 | 2.55x |
| 99337 | Established patient assisted living visit, typically 60 minutes | 976 | $150.0K | $153.72 | 2.66x |
| 99350 | Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes | 433 | $62.8K | $145.06 | 2.48x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 504 | $42.8K | $85.02 | 2.56x |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 289 | $29.0K | $100.34 | 2.59x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 263 | $26.6K | $101.23 | 2.78x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 164 | $17.0K | $103.51 | 2.55x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 362 | $11.1K | $30.68 | 1.97x |
| 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 | 212 | $8.8K | $41.28 | 3.87x |
| 99328 | New patient assisted living visit, typically 75 minutes | 43 | $7.5K | $174.01 | 2.94x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 31 | $5.1K | $164.90 | 1.52x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 87 | $5.0K | $57.31 | 2.64x |
| 99335 | Established patient assisted living visit, typically 25 minutes | 31 | $2.3K | $75.60 | 3.49x |
| 99407 | Smoking and tobacco use intensive counseling, greater than 10 minutes | 63 | $1.7K | $27.65 | 1.81x |
| 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 imp | 22 | $718.52 | $32.66 | 3.55x |
| 99406 | Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes | 11 | $137.28 | $12.48 | 1.12x |
This provider submits charges 2.67 times higher than what Medicare actually pays.
A markup ratio of 2.67x means for every $100 Medicare pays, this provider initially charges $267. 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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