Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #388 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 $767.4K in total Medicare payments ranks in the 86th percentile of Dermatology providers nationally.
Medicare payments to this provider grew 113% 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 | 2.8K | $168.7K | $59.44 | 1.85x |
| 99214 | Office visit, established patient, moderate complexity | 2.6K | $151.8K | $59.44 | 1.91x |
| 99215 | Office visit, established patient, high complexity | 2.3K | $134.9K | $59.42 | 1.59x |
| 99232 | Subsequent hospital care, moderate complexity | 2.0K | $118.1K | $59.43 | 1.61x |
| 99233 | Subsequent hospital care, high complexity | 1.7K | $101.2K | $59.43 | 2.10x |
| 93000 | Electrocardiogram, complete | 1.4K | $84.3K | $59.44 | 1.96x |
| 71046 | Chest X-ray, 2 views | 1.1K | $67.5K | $59.45 | 2.01x |
| 80053 | Comprehensive metabolic panel | 851 | $50.6K | $59.47 | 1.77x |
| 85025 | Complete blood count with differential | 568 | $33.7K | $59.40 | 1.74x |
| 36415 | Venipuncture for blood draw | 284 | $16.9K | $59.39 | 1.83x |
This provider submits charges 1.98 times higher than what Medicare actually pays.
A markup ratio of 1.98x means for every $100 Medicare pays, this provider initially charges $198. 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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