Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #390 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 $555.3K in total Medicare payments ranks in the 95th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 102% 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 | 2.9K | $118.8K | $40.83 | 2.00x |
| 99214 | Office visit, established patient, moderate complexity | 2.6K | $106.9K | $40.83 | 1.94x |
| 99215 | Office visit, established patient, high complexity | 2.3K | $95.0K | $40.83 | 2.23x |
| 99395 | Preventive visit, 18-39 years | 2.0K | $83.1K | $40.84 | 2.38x |
| 99396 | Preventive visit, 40-64 years | 1.7K | $71.3K | $40.84 | 1.95x |
| 93000 | Electrocardiogram, complete | 1.5K | $59.4K | $40.85 | 2.64x |
| 71046 | Chest X-ray, 2 views | 1.2K | $47.5K | $40.85 | 2.47x |
| 80053 | Comprehensive metabolic panel | 873 | $35.6K | $40.82 | 2.48x |
| 85025 | Complete blood count with differential | 582 | $23.8K | $40.82 | 2.06x |
| 36415 | Venipuncture for blood draw | 291 | $11.9K | $40.82 | 2.25x |
This provider submits charges 2.31 times higher than what Medicare actually pays.
A markup ratio of 2.31x means for every $100 Medicare pays, this provider initially charges $231. 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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