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 #249 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 $834.8K in total Medicare payments ranks in the 97th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 109% 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 | 4.6K | $178.1K | $38.67 | 1.85x |
| 99214 | Office visit, established patient, moderate complexity | 4.1K | $160.3K | $38.67 | 2.05x |
| 99215 | Office visit, established patient, high complexity | 3.7K | $142.5K | $38.67 | 1.83x |
| 99395 | Preventive visit, 18-39 years | 3.2K | $124.7K | $38.67 | 2.36x |
| 99396 | Preventive visit, 40-64 years | 2.8K | $106.8K | $38.67 | 2.00x |
| 93000 | Electrocardiogram, complete | 2.3K | $89.0K | $38.66 | 1.94x |
| 71046 | Chest X-ray, 2 views | 1.8K | $71.2K | $38.67 | 2.17x |
| 80053 | Comprehensive metabolic panel | 1.4K | $53.4K | $38.66 | 2.04x |
| 85025 | Complete blood count with differential | 921 | $35.6K | $38.67 | 2.53x |
| 36415 | Venipuncture for blood draw | 461 | $17.8K | $38.63 | 1.87x |
This provider submits charges 2.2 times higher than what Medicare actually pays.
A markup ratio of 2.2x means for every $100 Medicare pays, this provider initially charges $220. 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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