Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #280 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 $426.1K in total Medicare payments ranks in the 94th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 93% 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 | 1.4K | $93.1K | $65.45 | 1.68x |
| 99214 | Office visit, established patient, moderate complexity | 1.3K | $83.8K | $65.49 | 1.53x |
| 99215 | Office visit, established patient, high complexity | 1.1K | $74.5K | $65.47 | 1.77x |
| 99395 | Preventive visit, 18-39 years | 996 | $65.2K | $65.46 | 1.97x |
| 99396 | Preventive visit, 40-64 years | 854 | $55.9K | $65.43 | 1.62x |
| 93000 | Electrocardiogram, complete | 711 | $46.6K | $65.50 | 1.61x |
| 71046 | Chest X-ray, 2 views | 569 | $37.3K | $65.47 | 1.85x |
| 80053 | Comprehensive metabolic panel | 427 | $27.9K | $65.44 | 1.70x |
| 85025 | Complete blood count with differential | 285 | $18.6K | $65.36 | 1.71x |
| 36415 | Venipuncture for blood draw | 142 | $9.3K | $65.59 | 1.52x |
This provider submits charges 1.89 times higher than what Medicare actually pays.
A markup ratio of 1.89x means for every $100 Medicare pays, this provider initially charges $189. 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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