Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #71 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 $293.9K in total Medicare payments ranks in the 91th percentile of Family Practice 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 | 1.2K | $64.2K | $52.54 | 1.85x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $57.8K | $52.53 | 1.95x |
| 99215 | Office visit, established patient, high complexity | 978 | $51.4K | $52.51 | 2.26x |
| 99395 | Preventive visit, 18-39 years | 856 | $44.9K | $52.50 | 1.92x |
| 99396 | Preventive visit, 40-64 years | 733 | $38.5K | $52.55 | 2.27x |
| 93000 | Electrocardiogram, complete | 611 | $32.1K | $52.54 | 2.39x |
| 71046 | Chest X-ray, 2 views | 489 | $25.7K | $52.51 | 2.21x |
| 80053 | Comprehensive metabolic panel | 367 | $19.3K | $52.48 | 1.84x |
| 85025 | Complete blood count with differential | 244 | $12.8K | $52.62 | 2.18x |
| 36415 | Venipuncture for blood draw | 122 | $6.4K | $52.62 | 2.38x |
This provider submits charges 2.03 times higher than what Medicare actually pays.
A markup ratio of 2.03x means for every $100 Medicare pays, this provider initially charges $203. 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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