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 #208 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 $152.6K in total Medicare payments ranks in the 82th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 114% 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 | 626 | $32.8K | $52.42 | 2.42x |
| 99214 | Office visit, established patient, moderate complexity | 564 | $29.5K | $52.36 | 1.97x |
| 99215 | Office visit, established patient, high complexity | 501 | $26.3K | $52.40 | 1.84x |
| 99395 | Preventive visit, 18-39 years | 438 | $23.0K | $52.44 | 2.01x |
| 99396 | Preventive visit, 40-64 years | 376 | $19.7K | $52.36 | 2.05x |
| 93000 | Electrocardiogram, complete | 313 | $16.4K | $52.42 | 2.49x |
| 71046 | Chest X-ray, 2 views | 251 | $13.1K | $52.29 | 2.06x |
| 80053 | Comprehensive metabolic panel | 188 | $9.8K | $52.36 | 2.12x |
| 85025 | Complete blood count with differential | 125 | $6.6K | $52.50 | 2.38x |
| 36415 | Venipuncture for blood draw | 63 | $3.3K | $52.08 | 2.19x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. 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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