Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #108 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 $429.4K in total Medicare payments ranks in the 94th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 125% 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 | 2.2K | $92.6K | $42.00 | 3.00x |
| 99214 | Office visit, established patient, moderate complexity | 2.0K | $83.3K | $41.99 | 2.82x |
| 99215 | Office visit, established patient, high complexity | 1.8K | $74.1K | $42.01 | 2.84x |
| 99395 | Preventive visit, 18-39 years | 1.5K | $64.8K | $42.00 | 2.07x |
| 99396 | Preventive visit, 40-64 years | 1.3K | $55.5K | $42.02 | 2.42x |
| 93000 | Electrocardiogram, complete | 1.1K | $46.3K | $42.00 | 2.81x |
| 71046 | Chest X-ray, 2 views | 882 | $37.0K | $41.98 | 2.80x |
| 80053 | Comprehensive metabolic panel | 661 | $27.8K | $42.02 | 2.47x |
| 85025 | Complete blood count with differential | 441 | $18.5K | $41.98 | 2.85x |
| 36415 | Venipuncture for blood draw | 220 | $9.3K | $42.08 | 2.39x |
This provider submits charges 2.55 times higher than what Medicare actually pays.
A markup ratio of 2.55x means for every $100 Medicare pays, this provider initially charges $255. 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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