Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #287 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 $435.0K in total Medicare payments ranks in the 94th 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 | 1.6K | $92.8K | $57.78 | 2.08x |
| 99214 | Office visit, established patient, moderate complexity | 1.4K | $83.5K | $57.79 | 2.12x |
| 99215 | Office visit, established patient, high complexity | 1.3K | $74.2K | $57.77 | 2.35x |
| 99395 | Preventive visit, 18-39 years | 1.1K | $65.0K | $57.79 | 2.17x |
| 99396 | Preventive visit, 40-64 years | 964 | $55.7K | $57.75 | 2.38x |
| 93000 | Electrocardiogram, complete | 803 | $46.4K | $57.78 | 1.61x |
| 71046 | Chest X-ray, 2 views | 642 | $37.1K | $57.81 | 1.71x |
| 80053 | Comprehensive metabolic panel | 482 | $27.8K | $57.76 | 2.24x |
| 85025 | Complete blood count with differential | 321 | $18.6K | $57.81 | 2.04x |
| 36415 | Venipuncture for blood draw | 161 | $9.3K | $57.63 | 2.13x |
This provider submits charges 2 times higher than what Medicare actually pays.
A markup ratio of 2x means for every $100 Medicare pays, this provider initially charges $200. 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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