Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #364 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 $157.5K in total Medicare payments ranks in the 82th 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 | 826 | $33.9K | $41.08 | 2.07x |
| 99214 | Office visit, established patient, moderate complexity | 744 | $30.5K | $41.04 | 1.77x |
| 99215 | Office visit, established patient, high complexity | 661 | $27.1K | $41.06 | 2.06x |
| 99395 | Preventive visit, 18-39 years | 578 | $23.8K | $41.09 | 2.45x |
| 99396 | Preventive visit, 40-64 years | 496 | $20.4K | $41.04 | 1.99x |
| 93000 | Electrocardiogram, complete | 413 | $17.0K | $41.08 | 2.01x |
| 71046 | Chest X-ray, 2 views | 330 | $13.6K | $41.12 | 1.95x |
| 80053 | Comprehensive metabolic panel | 248 | $10.2K | $41.04 | 2.46x |
| 85025 | Complete blood count with differential | 165 | $6.8K | $41.13 | 2.25x |
| 36415 | Venipuncture for blood draw | 83 | $3.4K | $40.88 | 2.10x |
This provider submits charges 2.11 times higher than what Medicare actually pays.
A markup ratio of 2.11x means for every $100 Medicare pays, this provider initially charges $211. 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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