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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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Methodology•Download Data
  1. Home
  2. Providers
  3. James Michail
⚕️
MDIndividual

James Michail, M.D.

NPI: 1760879217
Granada Hills, CA
7 years of data
Geriatric Medicine
$29.3M
Total Payments
171
Beneficiaries
96.5K
Services
1.76x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$29.3M
Specialty median$81.7K

📋 Key Findings

1Billed $29.3M over 7 years
21.76x markup ratio
399th percentile in Geriatric Medicine by payments
455 services/day — unusually high
5Payments surged 1001% in 2018
64 procedures with >3x markup

This provider averages 55 services per working day

Based on 96.5K total services over 7 years (250 working days/year). Learn about impossible service volumes →

🔎 Data Analysis

This provider's $29.3M in total Medicare payments ranks in the 99th percentile of Geriatric Medicine providers nationally.

Averaging 55 services per working day raises questions about billing patterns.

Medicare payments to this provider grew 51138% from 2017 to 2023.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

📈

Notable: Payments increased 1001% in 2018

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 — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2017$256.03$98.712.59x$157.32$39.8K4035
2018$255.36$104.092.45x$151.27$438.1K4.2K13
2019$238.84$95.772.49x$143.07$571.1K6.0K12
2020$215.72$83.212.59x$132.51$568.6K6.8K27
2021$250.34$90.252.77x$160.09$1.2M12.9K34
2022$422.07$213.961.97x$208.11$6.1M28.7K44
2023$856.77$543.261.58x$313.51$20.4M37.5K36

Top Procedures (20)

Q4236Carepatch, per square centimeter
$12.4M
12.8K services$967.12/svc1.38x markup
Q4253Zenith amniotic membrane, per square centimeter
$4.1M
5.5K services$741.70/svc1.28x markup
Q4188Amnioarmor, per square centimeter
$3.1M
4.8K services$632.48/svc1.28x markup
Q4158Kerecis omega3, per square centimeter
$2.6M
5.6K services$469.32/svc1.27x markup
97610Therapy procedure using ultrasound⚠ 4.2x markup
$1.3M
3.2K services$390.89/svc4.22x markup
99349Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes⚠ 3.8x markup
$850.8K
8.1K services$104.95/svc3.81x markup
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
$614.8K
7.0K services$88.18/svc2.55x markup
11043Removal of muscle and/or tissue, 20.0 sq cm or less
$601.2K
3.2K services$187.69/svc2.72x markup
99308Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes
$534.1K
9.4K services$56.55/svc2.33x markup
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes
$483.6K
7.9K services$61.60/svc2.60x markup
99223Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes
$303.4K
1.8K services$165.42/svc2.66x markup
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes⚠ 3.1x markup
$215.6K
2.8K services$77.51/svc3.15x markup
99239Hospital discharge day management, more than 30 minutes
$184.9K
2.0K services$91.64/svc2.62x markup
15271Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less⚠ 3.6x markup
$179.9K
1.5K services$123.68/svc3.61x markup
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes
$179.4K
1.6K services$113.96/svc2.63x markup
11044Removal of bone, 20.0 sq cm or less
$150.3K
557 services$269.84/svc2.58x markup
99306Initial nursing facility visit per day, typically 45 minutes
$141.7K
1.0K services$139.16/svc2.52x markup
99291Critical care delivery critically ill or injured patient, first 30-74 minutes
$135.1K
725 services$186.30/svc2.47x markup
11042Removal of skin and tissue, 20.0 sq cm or less
$123.6K
1.4K services$90.90/svc2.91x markup
99497Advance care planning, first 30 minutes
$108.5K
1.6K services$66.96/svc1.87x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
Q4236Carepatch, per square centimeter12.8K$12.4M$967.121.38x
Q4253Zenith amniotic membrane, per square centimeter5.5K$4.1M$741.701.28x
Q4188Amnioarmor, per square centimeter4.8K$3.1M$632.481.28x
Q4158Kerecis omega3, per square centimeter5.6K$2.6M$469.321.27x
97610Therapy procedure using ultrasound3.2K$1.3M$390.894.22x
99349Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes8.1K$850.8K$104.953.81x
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes7.0K$614.8K$88.182.55x
11043Removal of muscle and/or tissue, 20.0 sq cm or less3.2K$601.2K$187.692.72x
99308Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes9.4K$534.1K$56.552.33x
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes7.9K$483.6K$61.602.60x
99223Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes1.8K$303.4K$165.422.66x
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes2.8K$215.6K$77.513.15x
99239Hospital discharge day management, more than 30 minutes2.0K$184.9K$91.642.62x
15271Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less1.5K$179.9K$123.683.61x
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes1.6K$179.4K$113.962.63x
11044Removal of bone, 20.0 sq cm or less557$150.3K$269.842.58x
99306Initial nursing facility visit per day, typically 45 minutes1.0K$141.7K$139.162.52x
99291Critical care delivery critically ill or injured patient, first 30-74 minutes725$135.1K$186.302.47x
11042Removal of skin and tissue, 20.0 sq cm or less1.4K$123.6K$90.902.91x
99497Advance care planning, first 30 minutes1.6K$108.5K$66.961.87x

Markup Analysis

Charge-to-Payment Ratio

1.76x

This provider submits charges 1.76 times higher than what Medicare actually pays.

What This Means

A markup ratio of 1.76x means for every $100 Medicare pays, this provider initially charges $176. This is lower than the national average.

Location

Granada Hills, CA

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

  • • 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.

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