Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #198 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 $598.6K in total Medicare payments ranks in the 93th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 104% 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 | 2.3K | $128.8K | $55.44 | 1.49x |
| 99214 | Office visit, established patient, moderate complexity | 2.1K | $116.0K | $55.45 | 1.83x |
| 99215 | Office visit, established patient, high complexity | 1.9K | $103.1K | $55.44 | 1.92x |
| 99232 | Subsequent hospital care, moderate complexity | 1.6K | $90.2K | $55.43 | 1.98x |
| 99233 | Subsequent hospital care, high complexity | 1.4K | $77.3K | $55.45 | 1.68x |
| 93000 | Electrocardiogram, complete | 1.2K | $64.4K | $55.44 | 1.94x |
| 71046 | Chest X-ray, 2 views | 929 | $51.5K | $55.47 | 2.01x |
| 80053 | Comprehensive metabolic panel | 697 | $38.7K | $55.45 | 1.93x |
| 85025 | Complete blood count with differential | 465 | $25.8K | $55.42 | 1.96x |
| 36415 | Venipuncture for blood draw | 232 | $12.9K | $55.53 | 1.60x |
This provider submits charges 1.77 times higher than what Medicare actually pays.
A markup ratio of 1.77x means for every $100 Medicare pays, this provider initially charges $177. This is lower 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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