Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #338 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 $130.0K in total Medicare payments ranks in the 79th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 124% 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 | 686 | $28.4K | $41.44 | 1.86x |
| 99214 | Office visit, established patient, moderate complexity | 617 | $25.6K | $41.47 | 1.96x |
| 99215 | Office visit, established patient, high complexity | 549 | $22.7K | $41.43 | 2.02x |
| 99395 | Preventive visit, 18-39 years | 480 | $19.9K | $41.46 | 2.32x |
| 99396 | Preventive visit, 40-64 years | 411 | $17.1K | $41.50 | 2.35x |
| 93000 | Electrocardiogram, complete | 343 | $14.2K | $41.44 | 2.11x |
| 71046 | Chest X-ray, 2 views | 274 | $11.4K | $41.50 | 2.06x |
| 80053 | Comprehensive metabolic panel | 206 | $8.5K | $41.40 | 1.87x |
| 85025 | Complete blood count with differential | 137 | $5.7K | $41.50 | 2.38x |
| 36415 | Venipuncture for blood draw | 69 | $2.8K | $41.20 | 2.13x |
This provider submits charges 2.25 times higher than what Medicare actually pays.
A markup ratio of 2.25x means for every $100 Medicare pays, this provider initially charges $225. 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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