Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #351 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 $370.0K in total Medicare payments ranks in the 93th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 113% 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 | 1.9K | $80.2K | $41.43 | 2.15x |
| 99214 | Office visit, established patient, moderate complexity | 1.7K | $72.1K | $41.41 | 1.74x |
| 99215 | Office visit, established patient, high complexity | 1.5K | $64.1K | $41.43 | 1.92x |
| 99395 | Preventive visit, 18-39 years | 1.4K | $56.1K | $41.41 | 1.81x |
| 99396 | Preventive visit, 40-64 years | 1.2K | $48.1K | $41.43 | 1.90x |
| 93000 | Electrocardiogram, complete | 968 | $40.1K | $41.40 | 1.73x |
| 71046 | Chest X-ray, 2 views | 774 | $32.1K | $41.43 | 1.88x |
| 80053 | Comprehensive metabolic panel | 581 | $24.0K | $41.39 | 1.80x |
| 85025 | Complete blood count with differential | 387 | $16.0K | $41.43 | 2.37x |
| 36415 | Venipuncture for blood draw | 194 | $8.0K | $41.32 | 2.32x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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