Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #191 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 $86.8K in total Medicare payments ranks in the 68th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 105% 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 | 412 | $19.0K | $46.17 | 1.59x |
| 99214 | Office visit, established patient, moderate complexity | 370 | $17.1K | $46.27 | 2.26x |
| 99215 | Office visit, established patient, high complexity | 329 | $15.2K | $46.25 | 2.07x |
| 99395 | Preventive visit, 18-39 years | 288 | $13.3K | $46.23 | 2.03x |
| 99396 | Preventive visit, 40-64 years | 247 | $11.4K | $46.20 | 2.21x |
| 93000 | Electrocardiogram, complete | 206 | $9.5K | $46.17 | 1.87x |
| 71046 | Chest X-ray, 2 views | 165 | $7.6K | $46.11 | 1.83x |
| 80053 | Comprehensive metabolic panel | 123 | $5.7K | $46.39 | 2.17x |
| 85025 | Complete blood count with differential | 82 | $3.8K | $46.39 | 1.99x |
| 36415 | Venipuncture for blood draw | 41 | $1.9K | $46.39 | 1.96x |
This provider submits charges 1.96 times higher than what Medicare actually pays.
A markup ratio of 1.96x means for every $100 Medicare pays, this provider initially charges $196. 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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