Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #284 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 $283.5K in total Medicare payments ranks in the 90th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 94% 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 | 1.0K | $61.1K | $59.12 | 1.97x |
| 99214 | Office visit, established patient, moderate complexity | 931 | $55.0K | $59.09 | 1.77x |
| 99215 | Office visit, established patient, high complexity | 827 | $48.9K | $59.13 | 1.81x |
| 99395 | Preventive visit, 18-39 years | 724 | $42.8K | $59.10 | 2.26x |
| 99396 | Preventive visit, 40-64 years | 621 | $36.7K | $59.06 | 2.21x |
| 93000 | Electrocardiogram, complete | 517 | $30.6K | $59.12 | 1.65x |
| 71046 | Chest X-ray, 2 views | 414 | $24.5K | $59.06 | 1.92x |
| 80053 | Comprehensive metabolic panel | 310 | $18.3K | $59.16 | 2.12x |
| 85025 | Complete blood count with differential | 207 | $12.2K | $59.06 | 1.55x |
| 36415 | Venipuncture for blood draw | 103 | $6.1K | $59.35 | 1.85x |
This provider submits charges 1.92 times higher than what Medicare actually pays.
A markup ratio of 1.92x means for every $100 Medicare pays, this provider initially charges $192. 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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