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 #426 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 $176.9K in total Medicare payments ranks in the 84th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 124% 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 | 726 | $38.6K | $53.15 | 2.36x |
| 99214 | Office visit, established patient, moderate complexity | 654 | $34.7K | $53.10 | 2.22x |
| 99215 | Office visit, established patient, high complexity | 581 | $30.9K | $53.13 | 2.70x |
| 99395 | Preventive visit, 18-39 years | 508 | $27.0K | $53.17 | 2.36x |
| 99396 | Preventive visit, 40-64 years | 436 | $23.2K | $53.10 | 1.92x |
| 93000 | Electrocardiogram, complete | 363 | $19.3K | $53.15 | 2.56x |
| 71046 | Chest X-ray, 2 views | 291 | $15.4K | $53.04 | 1.94x |
| 80053 | Comprehensive metabolic panel | 218 | $11.6K | $53.11 | 1.91x |
| 85025 | Complete blood count with differential | 145 | $7.7K | $53.23 | 2.19x |
| 36415 | Venipuncture for blood draw | 73 | $3.9K | $52.86 | 2.19x |
This provider submits charges 2.3 times higher than what Medicare actually pays.
A markup ratio of 2.3x means for every $100 Medicare pays, this provider initially charges $230. 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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