Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #148 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 $185.8K in total Medicare payments ranks in the 85th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 119% 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 | 855 | $39.9K | $46.66 | 1.45x |
| 99214 | Office visit, established patient, moderate complexity | 769 | $35.9K | $46.69 | 1.96x |
| 99215 | Office visit, established patient, high complexity | 684 | $31.9K | $46.66 | 1.98x |
| 99395 | Preventive visit, 18-39 years | 598 | $27.9K | $46.70 | 1.73x |
| 99396 | Preventive visit, 40-64 years | 513 | $23.9K | $46.66 | 1.71x |
| 93000 | Electrocardiogram, complete | 427 | $19.9K | $46.71 | 1.93x |
| 71046 | Chest X-ray, 2 views | 342 | $16.0K | $46.66 | 1.57x |
| 80053 | Comprehensive metabolic panel | 256 | $12.0K | $46.75 | 1.68x |
| 85025 | Complete blood count with differential | 171 | $8.0K | $46.66 | 1.80x |
| 36415 | Venipuncture for blood draw | 85 | $4.0K | $46.93 | 1.59x |
This provider submits charges 1.76 times higher than what Medicare actually pays.
A markup ratio of 1.76x means for every $100 Medicare pays, this provider initially charges $176. 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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