This provider's $3.2M in total Medicare payments ranks in the 95th percentile of Rheumatology providers nationally.
Medicare payments to this provider grew 123% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
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 | $195.56 | $77.98 | 2.51x | $117.58 | $225.9K | 3.3K | 1.5K |
| 2015 | $168.67 | $64.96 | 2.60x | $103.71 | $175.5K | 2.4K | 1.1K |
| 2016 | $170.07 | $67.35 | 2.53x | $102.72 | $191.9K | 2.8K | 1.2K |
| 2017 | $164.62 | $61.93 | 2.66x | $102.69 | $238.5K | 3.5K | 1.7K |
| 2018 | $173.62 | $68.30 | 2.54x | $105.32 | $355.4K | 4.8K | 2.4K |
| 2019 | $182.62 | $74.80 | 2.44x | $107.82 | $313.6K | 4.2K | 1.9K |
| 2020 | $172.81 | $77.97 | 2.22x | $94.84 | $391.5K | 4.7K | 2.4K |
| 2021 | $174.98 | $80.94 | 2.16x | $94.04 | $385.4K | 4.4K | 2.2K |
| 2022 | $166.51 | $72.88 | 2.28x | $93.63 | $449.4K | 5.4K | 2.9K |
| 2023 | $173.79 | $75.40 | 2.30x | $98.39 | $503.4K | 6.7K | 3.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 9.2K | $888.3K | $96.12 | 2.43x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.6K | $253.0K | $70.47 | 1.89x |
| 93923 | Ultrasound study of arteries of both arms and legs | 2.0K | $248.5K | $121.80 | 2.36x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 2.0K | $226.2K | $113.02 | 2.20x |
| 93922 | Ultrasound study of arteries of both arms and legs | 1.8K | $144.4K | $78.41 | 5.10x |
| 99349 | Established patient home visit, typically 40 minutes | 1.2K | $142.2K | $114.39 | 2.55x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 1.8K | $134.3K | $73.26 | 1.51x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 814 | $114.3K | $140.36 | 1.43x |
| 98926 | Osteopathic manipulative treatment to 3-4 body regions | 2.9K | $113.0K | $39.52 | 5.06x |
| 96130 | Psychological testing evaluation by qualified health care professional, first 60 minutes | 1.1K | $112.7K | $105.35 | 1.43x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 656 | $75.5K | $115.08 | 2.43x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 405 | $69.7K | $172.07 | 2.03x |
| 99328 | New patient assisted living visit, typically 75 minutes | 335 | $62.9K | $187.82 | 2.13x |
| 99335 | Established patient assisted living visit, typically 25 minutes | 744 | $60.0K | $80.70 | 1.86x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 412 | $56.4K | $136.84 | 2.19x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 992 | $54.6K | $55.08 | 4.54x |
| 99498 | Advance care planning by the physician or other qualified health care professional | 720 | $47.3K | $65.74 | 2.26x |
| 96136 | Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes | 1.1K | $42.6K | $39.88 | 3.78x |
| 99348 | Established patient home visit, typically 25 minutes | 567 | $41.6K | $73.32 | 2.42x |
| 90662 | Vaccine for influenza for injection into muscle | 705 | $41.4K | $58.77 | 1.22x |
This provider submits charges 2.48 times higher than what Medicare actually pays.
A markup ratio of 2.48x means for every $100 Medicare pays, this provider initially charges $248. 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 NY for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Barry Gruber, M.D. | Babylon, NY | $33.9M | ✓ 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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