Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #137 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 $281.0K in total Medicare payments ranks in the 90th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 127% 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 | 1.2K | $61.3K | $49.65 | 1.70x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $55.1K | $49.63 | 2.00x |
| 99215 | Office visit, established patient, high complexity | 987 | $49.0K | $49.66 | 1.92x |
| 99395 | Preventive visit, 18-39 years | 864 | $42.9K | $49.64 | 1.57x |
| 99396 | Preventive visit, 40-64 years | 741 | $36.8K | $49.61 | 1.81x |
| 93000 | Electrocardiogram, complete | 617 | $30.6K | $49.65 | 1.77x |
| 71046 | Chest X-ray, 2 views | 494 | $24.5K | $49.61 | 2.04x |
| 80053 | Comprehensive metabolic panel | 370 | $18.4K | $49.68 | 1.79x |
| 85025 | Complete blood count with differential | 247 | $12.3K | $49.61 | 2.11x |
| 36415 | Venipuncture for blood draw | 123 | $6.1K | $49.81 | 2.03x |
This provider submits charges 1.83 times higher than what Medicare actually pays.
A markup ratio of 1.83x means for every $100 Medicare pays, this provider initially charges $183. 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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