Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #193 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 $453.4K in total Medicare payments ranks in the 94th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 101% 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 | 2.3K | $97.4K | $41.70 | 1.68x |
| 99214 | Office visit, established patient, moderate complexity | 2.1K | $87.7K | $41.71 | 2.02x |
| 99215 | Office visit, established patient, high complexity | 1.9K | $77.9K | $41.70 | 1.57x |
| 99395 | Preventive visit, 18-39 years | 1.6K | $68.2K | $41.71 | 2.25x |
| 99396 | Preventive visit, 40-64 years | 1.4K | $58.4K | $41.69 | 1.86x |
| 93000 | Electrocardiogram, complete | 1.2K | $48.7K | $41.70 | 1.79x |
| 71046 | Chest X-ray, 2 views | 934 | $39.0K | $41.72 | 2.25x |
| 80053 | Comprehensive metabolic panel | 701 | $29.2K | $41.69 | 1.60x |
| 85025 | Complete blood count with differential | 467 | $19.5K | $41.72 | 1.66x |
| 36415 | Venipuncture for blood draw | 234 | $9.7K | $41.63 | 1.70x |
This provider submits charges 1.95 times higher than what Medicare actually pays.
A markup ratio of 1.95x means for every $100 Medicare pays, this provider initially charges $195. 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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