Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #343 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 $299.6K in total Medicare payments ranks in the 86th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 126% 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 | 994 | $65.4K | $65.79 | 2.07x |
| 99214 | Office visit, established patient, moderate complexity | 895 | $58.9K | $65.76 | 2.04x |
| 99215 | Office visit, established patient, high complexity | 795 | $52.3K | $65.81 | 2.31x |
| 99232 | Subsequent hospital care, moderate complexity | 696 | $45.8K | $65.77 | 2.27x |
| 99233 | Subsequent hospital care, high complexity | 596 | $39.2K | $65.83 | 1.86x |
| 93000 | Electrocardiogram, complete | 497 | $32.7K | $65.79 | 2.25x |
| 71046 | Chest X-ray, 2 views | 398 | $26.2K | $65.72 | 2.08x |
| 80053 | Comprehensive metabolic panel | 298 | $19.6K | $65.84 | 2.03x |
| 85025 | Complete blood count with differential | 199 | $13.1K | $65.72 | 1.78x |
| 36415 | Venipuncture for blood draw | 99 | $6.5K | $66.06 | 1.97x |
This provider submits charges 1.97 times higher than what Medicare actually pays.
A markup ratio of 1.97x means for every $100 Medicare pays, this provider initially charges $197. 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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