Physician

Paul C. Durbin, M.D.

According to 2025 Medicare claims, Paul Durbin, M.D. (NPI: 1255361218) practices internal medicine in the Racine-Mount Pleasant, WI market, with the plurality of this provider's patient population coming from Racine, WI. This provider's primary affiliated billing organization is ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC (NPI: 1609881077; TIN: 391791586) and primary practice location at 53405-1667. Durbin is affiliated with the Ascension Care Management Health Partners Wisconsin, LLC (ACO ID: A5329), participating under the MSSP model.

Durbin's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 347 traditional Medicare patients, billed 1,218 HCPCS/CPT codes, and received $84,295 in Medicare payments. The top billing code was G0439 (Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit). Part D data shows 15,542 prescription claims across 904 beneficiaries totaling $1,430,321 in drug costs, led by Eliquis (Apixaban). DME data shows 317 claims. Open Payments data shows 2 records totaling $44. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing has changed little. Concurrently, Part D prescription costs have risen steadily, from $1,054,035 to $1,430,321. For DME billing, reported payments moved up and down with repeated peaks and valleys, starting at $20,964 and ending at $28,156.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	436	1,303	$76,379
2016	442	1,403	$84,228
2017	436	1,374	$83,541
2018	440	1,446	$94,266
2019	425	1,402	$89,769
2020	403	1,177	$72,636
2021	390	1,262	$97,689
2022	361	1,194	$92,265
2023	355	1,225	$90,781
2024	347	1,218	$84,295

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	597	13,751	$1,054,035
2016	596	13,821	$1,067,501
2017	643	14,725	$1,075,790
2018	726	15,386	$1,231,118
2019	763	15,651	$1,397,460
2020	775	15,097	$1,332,421
2021	801	14,816	$1,426,293
2022	828	15,052	$1,546,945
2023	913	15,591	$1,672,425
2024	904	15,542	$1,430,321

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	104	497	$19,294
2016	130	629	$15,038
2017	142	528	$10,966
2018	144	431	$9,469
2019	167	490	$12,009
2020	159	466	$19,660
2021	146	423	$20,614
2022	156	513	$28,907
2023	106	375	$21,575
2024	81	317	$25,960

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	264	264	$122
99215	Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	27	33	$94
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	335	692	$59
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	26	31	$46
93010	Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only	45	46	$5

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Eliquis	Apixaban	260	12,419	$245,401
Ozempic	Semaglutide	177	7,366	$240,342
Mounjaro	Tirzepatide	80	2,748	$101,749
Jardiance	Empagliflozin	93	4,788	$94,017
Trelegy Ellipta	Fluticasone/Umeclidin/Vilanter	104	3,840	$82,936

Top 5 DME services in 2024

By Total Medicare Payment Amount.

HCPCS Code	HCPCS Description	Supplier Rental Indicator	Total Supplier Beneficiaries	Total Supplier Claims	Total Medicare Payment Amount
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	N	N/R	35	$16,632
A7034	Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap	N	12	33	$1,574
A7032	Cushion for use on nasal mask interface, replacement only, each	N	N/R	15	$1,436
A7031	Face mask interface, replacement for full face mask, each	N	N/R	13	$1,220
A7033	Pillow for use on nasal cannula type interface, replacement only, pair	N	N/R	15	$1,209

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	2	$44	Exact Sciences Corporation
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

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FAQ

What Medicare data is available for Paul C. Durbin, M.D.?

Tedicare shows public-source Medicare data for Paul C. Durbin, M.D. (NPI 1255361218), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does Paul C. Durbin, M.D. have ACO affiliation data?

Paul C. Durbin, M.D. is shown with ACO affiliation data for Ascension Care Management Health Partners Wisconsin, LLC (MSSP, ACO ID A5329).

What billing organization is linked to Paul C. Durbin, M.D.?

Paul C. Durbin, M.D. is linked to ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC (billing NPI 1609881077) in the available physician profile data.

Does Paul C. Durbin, M.D. have Open Payments data?

Paul C. Durbin, M.D. has 2 connected Open Payments records in the available 2024 summary data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.