Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #188 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 $1.2M in total Medicare payments ranks in the 96th percentile of Neurology 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 | 4.4K | $262.5K | $59.23 | 1.67x |
| 99214 | Office visit, established patient, moderate complexity | 4.0K | $236.2K | $59.22 | 2.11x |
| 99215 | Office visit, established patient, high complexity | 3.5K | $210.0K | $59.22 | 1.96x |
| 99232 | Subsequent hospital care, moderate complexity | 3.1K | $183.7K | $59.24 | 1.79x |
| 99233 | Subsequent hospital care, high complexity | 2.7K | $157.5K | $59.23 | 1.98x |
| 93000 | Electrocardiogram, complete | 2.2K | $131.2K | $59.23 | 1.90x |
| 71046 | Chest X-ray, 2 views | 1.8K | $105.0K | $59.22 | 1.59x |
| 80053 | Comprehensive metabolic panel | 1.3K | $78.7K | $59.21 | 1.87x |
| 85025 | Complete blood count with differential | 886 | $52.5K | $59.25 | 1.65x |
| 36415 | Venipuncture for blood draw | 443 | $26.3K | $59.26 | 2.10x |
This provider submits charges 1.88 times higher than what Medicare actually pays.
A markup ratio of 1.88x means for every $100 Medicare pays, this provider initially charges $188. 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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