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 #228 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 $2.5M in total Medicare payments ranks in the 96th percentile of Interventional Pain Management providers nationally.
Medicare payments to this provider grew 109% 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 | 11.7K | $556.0K | $47.58 | 2.31x |
| 99214 | Office visit, established patient, moderate complexity | 10.5K | $500.4K | $47.58 | 2.77x |
| 99215 | Office visit, established patient, high complexity | 9.3K | $444.8K | $47.58 | 2.20x |
| 99232 | Subsequent hospital care, moderate complexity | 8.2K | $389.2K | $47.58 | 2.55x |
| 99233 | Subsequent hospital care, high complexity | 7.0K | $333.6K | $47.58 | 2.22x |
| 93000 | Electrocardiogram, complete | 5.8K | $278.0K | $47.58 | 2.76x |
| 71046 | Chest X-ray, 2 views | 4.7K | $222.4K | $47.58 | 2.21x |
| 80053 | Comprehensive metabolic panel | 3.5K | $166.8K | $47.59 | 2.18x |
| 85025 | Complete blood count with differential | 2.3K | $111.2K | $47.58 | 2.37x |
| 36415 | Venipuncture for blood draw | 1.2K | $55.6K | $47.60 | 2.00x |
This provider submits charges 2.39 times higher than what Medicare actually pays.
A markup ratio of 2.39x means for every $100 Medicare pays, this provider initially charges $239. 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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