Statistical flag only — not an accusation of fraud
This provider's $2.9M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
Their average markup ratio of 12.36x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 70/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $146.84 | $11.88 | 12.36x | $134.96 | $201.8K | 17.0K | 83 |
| 2015 | $146.84 | $11.88 | 12.36x | $134.96 | $219.1K | 18.4K | 90 |
| 2016 | $146.84 | $11.88 | 12.36x | $134.96 | $236.4K | 19.9K | 97 |
| 2017 | $146.84 | $11.88 | 12.36x | $134.96 | $253.7K | 21.4K | 104 |
| 2018 | $146.84 | $11.88 | 12.36x | $134.96 | $271.0K | 22.8K | 111 |
| 2019 | $146.84 | $11.88 | 12.36x | $134.96 | $288.3K | 24.3K | 118 |
| 2020 | $146.84 | $11.88 | 12.36x | $134.96 | $305.6K | 25.7K | 125 |
| 2021 | $146.84 | $11.88 | 12.36x | $134.96 | $322.9K | 27.2K | 132 |
| 2022 | $146.84 | $11.88 | 12.36x | $134.96 | $340.2K | 28.6K | 139 |
| 2023 | $146.84 | $11.88 | 12.36x | $134.96 | $357.5K | 30.1K | 147 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 82.8K | $984.3K | $11.88 | 10.32x |
| 99214 | Office/outpatient visit, est patient, moderate | 41.4K | $492.1K | $11.88 | 11.88x |
| 99215 | Office/outpatient visit, est patient, high | 27.6K | $328.1K | $11.88 | 13.94x |
| 99223 | Initial hospital care, high complexity | 20.7K | $246.1K | $11.88 | 10.52x |
| 99232 | Subsequent hospital care, moderate | 16.6K | $196.9K | $11.88 | 12.21x |
| 93000 | Electrocardiogram, complete | 13.8K | $164.0K | $11.88 | 11.14x |
| 71046 | Chest X-ray, 2 views | 11.8K | $140.6K | $11.88 | 13.69x |
| 80053 | Comprehensive metabolic panel | 10.4K | $123.0K | $11.88 | 13.20x |
| 85025 | Complete blood count (CBC) | 9.2K | $109.4K | $11.88 | 10.77x |
| 36415 | Venipuncture | 8.3K | $98.4K | $11.88 | 11.99x |
This provider submits charges 12.36 times higher than what Medicare actually pays.
A markup ratio of 12.36x means for every $100 Medicare pays, this provider initially charges $1236. This is higher than the national average.
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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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