Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #175 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 $335.7K in total Medicare payments ranks in the 87th percentile of Neurology providers nationally.
Medicare payments to this provider grew 129% 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 | $72.8K | $45.17 | 1.88x |
| 99214 | Office visit, established patient, moderate complexity | 1.5K | $65.5K | $45.17 | 1.67x |
| 99215 | Office visit, established patient, high complexity | 1.3K | $58.3K | $45.16 | 1.70x |
| 99232 | Subsequent hospital care, moderate complexity | 1.1K | $51.0K | $45.15 | 1.46x |
| 99233 | Subsequent hospital care, high complexity | 967 | $43.7K | $45.18 | 1.91x |
| 93000 | Electrocardiogram, complete | 806 | $36.4K | $45.17 | 1.68x |
| 71046 | Chest X-ray, 2 views | 645 | $29.1K | $45.16 | 1.69x |
| 80053 | Comprehensive metabolic panel | 484 | $21.8K | $45.14 | 1.53x |
| 85025 | Complete blood count with differential | 322 | $14.6K | $45.23 | 1.58x |
| 36415 | Venipuncture for blood draw | 161 | $7.3K | $45.23 | 1.51x |
This provider submits charges 1.79 times higher than what Medicare actually pays.
A markup ratio of 1.79x means for every $100 Medicare pays, this provider initially charges $179. 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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