Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #434 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 $363.2K in total Medicare payments ranks in the 83th percentile of Pulmonary Disease 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 | 1.5K | $79.1K | $53.35 | 1.78x |
| 99214 | Office visit, established patient, moderate complexity | 1.3K | $71.2K | $53.34 | 1.56x |
| 99215 | Office visit, established patient, high complexity | 1.2K | $63.3K | $53.37 | 1.54x |
| 99232 | Subsequent hospital care, moderate complexity | 1.0K | $55.4K | $53.36 | 1.63x |
| 99233 | Subsequent hospital care, high complexity | 890 | $47.5K | $53.34 | 1.82x |
| 93000 | Electrocardiogram, complete | 742 | $39.6K | $53.32 | 2.05x |
| 71046 | Chest X-ray, 2 views | 593 | $31.6K | $53.37 | 1.48x |
| 80053 | Comprehensive metabolic panel | 445 | $23.7K | $53.34 | 1.96x |
| 85025 | Complete blood count with differential | 297 | $15.8K | $53.28 | 2.12x |
| 36415 | Venipuncture for blood draw | 148 | $7.9K | $53.46 | 1.81x |
This provider submits charges 1.83 times higher than what Medicare actually pays.
A markup ratio of 1.83x means for every $100 Medicare pays, this provider initially charges $183. 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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