Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #320 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 $323.4K in total Medicare payments ranks in the 91th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 107% 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 | 1.5K | $70.1K | $46.68 | 1.85x |
| 99214 | Office visit, established patient, moderate complexity | 1.4K | $63.1K | $46.67 | 1.73x |
| 99215 | Office visit, established patient, high complexity | 1.2K | $56.1K | $46.70 | 1.74x |
| 99395 | Preventive visit, 18-39 years | 1.1K | $49.1K | $46.70 | 1.65x |
| 99396 | Preventive visit, 40-64 years | 901 | $42.1K | $46.69 | 2.37x |
| 93000 | Electrocardiogram, complete | 751 | $35.1K | $46.68 | 2.31x |
| 71046 | Chest X-ray, 2 views | 601 | $28.0K | $46.67 | 2.38x |
| 80053 | Comprehensive metabolic panel | 451 | $21.0K | $46.64 | 1.80x |
| 85025 | Complete blood count with differential | 300 | $14.0K | $46.74 | 2.17x |
| 36415 | Venipuncture for blood draw | 150 | $7.0K | $46.74 | 1.73x |
This provider submits charges 2.01 times higher than what Medicare actually pays.
A markup ratio of 2.01x means for every $100 Medicare pays, this provider initially charges $201. 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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