Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #123 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 $500.5K in total Medicare payments ranks in the 94th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 99% 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 | 2.6K | $107.6K | $40.82 | 2.22x |
| 99214 | Office visit, established patient, moderate complexity | 2.4K | $96.8K | $40.81 | 2.06x |
| 99215 | Office visit, established patient, high complexity | 2.1K | $86.1K | $40.82 | 2.10x |
| 99395 | Preventive visit, 18-39 years | 1.8K | $75.3K | $40.83 | 2.00x |
| 99396 | Preventive visit, 40-64 years | 1.6K | $64.6K | $40.81 | 2.55x |
| 93000 | Electrocardiogram, complete | 1.3K | $53.8K | $40.82 | 2.69x |
| 71046 | Chest X-ray, 2 views | 1.1K | $43.0K | $40.80 | 2.25x |
| 80053 | Comprehensive metabolic panel | 791 | $32.3K | $40.81 | 2.04x |
| 85025 | Complete blood count with differential | 527 | $21.5K | $40.84 | 1.96x |
| 36415 | Venipuncture for blood draw | 264 | $10.8K | $40.76 | 2.65x |
This provider submits charges 2.35 times higher than what Medicare actually pays.
A markup ratio of 2.35x means for every $100 Medicare pays, this provider initially charges $235. 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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