Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #203 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 $682.1K in total Medicare payments ranks in the 96th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 115% 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 | 4.0K | $145.7K | $36.09 | 2.27x |
| 99214 | Office visit, established patient, moderate complexity | 3.6K | $131.1K | $36.10 | 2.20x |
| 99215 | Office visit, established patient, high complexity | 3.2K | $116.6K | $36.09 | 2.97x |
| 99395 | Preventive visit, 18-39 years | 2.8K | $102.0K | $36.09 | 2.18x |
| 99396 | Preventive visit, 40-64 years | 2.4K | $87.4K | $36.10 | 3.20x |
| 93000 | Electrocardiogram, complete | 2.0K | $72.9K | $36.09 | 2.81x |
| 71046 | Chest X-ray, 2 views | 1.6K | $58.3K | $36.09 | 2.65x |
| 80053 | Comprehensive metabolic panel | 1.2K | $43.7K | $36.10 | 2.69x |
| 85025 | Complete blood count with differential | 807 | $29.1K | $36.11 | 2.98x |
| 36415 | Venipuncture for blood draw | 404 | $14.6K | $36.07 | 2.83x |
This provider submits charges 2.7 times higher than what Medicare actually pays.
A markup ratio of 2.7x means for every $100 Medicare pays, this provider initially charges $270. 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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