Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #466 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 $1.7M in total Medicare payments ranks in the 98th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 123% 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 | 7.5K | $367.5K | $48.95 | 2.01x |
| 99214 | Office visit, established patient, moderate complexity | 6.8K | $330.7K | $48.95 | 1.89x |
| 99215 | Office visit, established patient, high complexity | 6.0K | $294.0K | $48.95 | 1.97x |
| 99395 | Preventive visit, 18-39 years | 5.3K | $257.2K | $48.95 | 2.18x |
| 99396 | Preventive visit, 40-64 years | 4.5K | $220.5K | $48.94 | 1.93x |
| 93000 | Electrocardiogram, complete | 3.8K | $183.7K | $48.95 | 1.56x |
| 71046 | Chest X-ray, 2 views | 3.0K | $147.0K | $48.95 | 1.72x |
| 80053 | Comprehensive metabolic panel | 2.3K | $110.2K | $48.96 | 1.61x |
| 85025 | Complete blood count with differential | 1.5K | $73.5K | $48.93 | 1.81x |
| 36415 | Venipuncture for blood draw | 751 | $36.7K | $48.93 | 2.22x |
This provider submits charges 1.9 times higher than what Medicare actually pays.
A markup ratio of 1.9x means for every $100 Medicare pays, this provider initially charges $190. 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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