Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #262 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 $588.0K in total Medicare payments ranks in the 93th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 122% 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 | 3.1K | $128.2K | $41.02 | 2.22x |
| 99214 | Office visit, established patient, moderate complexity | 2.8K | $115.3K | $41.02 | 1.67x |
| 99215 | Office visit, established patient, high complexity | 2.5K | $102.5K | $41.03 | 2.00x |
| 99232 | Subsequent hospital care, moderate complexity | 2.2K | $89.7K | $41.02 | 2.11x |
| 99233 | Subsequent hospital care, high complexity | 1.9K | $76.9K | $41.01 | 1.71x |
| 93000 | Electrocardiogram, complete | 1.6K | $64.1K | $41.02 | 1.99x |
| 71046 | Chest X-ray, 2 views | 1.3K | $51.3K | $41.01 | 2.19x |
| 80053 | Comprehensive metabolic panel | 937 | $38.4K | $41.03 | 1.80x |
| 85025 | Complete blood count with differential | 625 | $25.6K | $41.01 | 1.63x |
| 36415 | Venipuncture for blood draw | 312 | $12.8K | $41.07 | 1.55x |
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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