Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #372 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 $501.8K in total Medicare payments ranks in the 95th 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 | 1.5K | $108.5K | $73.89 | 2.16x |
| 99214 | Office visit, established patient, moderate complexity | 1.3K | $97.7K | $73.90 | 2.12x |
| 99215 | Office visit, established patient, high complexity | 1.2K | $86.8K | $73.91 | 1.54x |
| 99395 | Preventive visit, 18-39 years | 1.0K | $76.0K | $73.92 | 2.17x |
| 99396 | Preventive visit, 40-64 years | 881 | $65.1K | $73.93 | 2.01x |
| 93000 | Electrocardiogram, complete | 734 | $54.3K | $73.94 | 2.15x |
| 71046 | Chest X-ray, 2 views | 587 | $43.4K | $73.97 | 1.77x |
| 80053 | Comprehensive metabolic panel | 441 | $32.6K | $73.84 | 1.60x |
| 85025 | Complete blood count with differential | 294 | $21.7K | $73.84 | 1.74x |
| 36415 | Venipuncture for blood draw | 147 | $10.9K | $73.84 | 1.61x |
This provider submits charges 1.84 times higher than what Medicare actually pays.
A markup ratio of 1.84x means for every $100 Medicare pays, this provider initially charges $184. 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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