Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #182 out of 500 highest-risk providers analyzed. This is a statistical prediction, not a determination of fraud.
ML model prediction — not an accusation of fraud
This provider's $161.0K in total Medicare payments ranks in the 83th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 115% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office visit, established patient, low complexity | 592 | $34.7K | $58.56 | 2.18x |
| 99214 | Office visit, established patient, moderate complexity | 533 | $31.2K | $58.54 | 2.09x |
| 99215 | Office visit, established patient, high complexity | 474 | $27.7K | $58.51 | 2.46x |
| 99395 | Preventive visit, 18-39 years | 415 | $24.3K | $58.48 | 2.25x |
| 99396 | Preventive visit, 40-64 years | 355 | $20.8K | $58.60 | 1.95x |
| 93000 | Electrocardiogram, complete | 296 | $17.3K | $58.56 | 2.39x |
| 71046 | Chest X-ray, 2 views | 237 | $13.9K | $58.51 | 2.30x |
| 80053 | Comprehensive metabolic panel | 178 | $10.4K | $58.43 | 2.26x |
| 85025 | Complete blood count with differential | 118 | $6.9K | $58.76 | 1.70x |
| 36415 | Venipuncture for blood draw | 59 | $3.5K | $58.76 | 2.40x |
This provider submits charges 2.05 times higher than what Medicare actually pays.
A markup ratio of 2.05x means for every $100 Medicare pays, this provider initially charges $205. 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.
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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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