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 #77 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 $981.8K in total Medicare payments ranks in the 97th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 102% 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 | 2.8K | $207.8K | $75.29 | 1.83x |
| 99214 | Office visit, established patient, moderate complexity | 2.5K | $187.0K | $75.29 | 1.58x |
| 99215 | Office visit, established patient, high complexity | 2.2K | $166.2K | $75.29 | 2.02x |
| 99395 | Preventive visit, 18-39 years | 1.9K | $145.5K | $75.29 | 2.05x |
| 99396 | Preventive visit, 40-64 years | 1.7K | $124.7K | $75.29 | 1.64x |
| 93000 | Electrocardiogram, complete | 1.4K | $103.9K | $75.29 | 1.53x |
| 71046 | Chest X-ray, 2 views | 1.1K | $83.1K | $75.29 | 1.93x |
| 80053 | Comprehensive metabolic panel | 828 | $62.3K | $75.29 | 2.23x |
| 85025 | Complete blood count with differential | 552 | $41.6K | $75.29 | 1.80x |
| 36415 | Venipuncture for blood draw | 276 | $20.8K | $75.29 | 2.08x |
This provider submits charges 1.87 times higher than what Medicare actually pays.
A markup ratio of 1.87x means for every $100 Medicare pays, this provider initially charges $187. 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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