Statistical flag only — not an accusation of fraud
This provider's $2.1M in total Medicare payments ranks in the 99th percentile of Pediatric Medicine providers nationally.
Medicare payments to this provider grew 77% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 66/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $109.22 | $68.26 | 1.60x | $40.96 | $146.3K | 2.1K | 2.1K |
| 2015 | $109.20 | $68.25 | 1.60x | $40.95 | $158.8K | 2.3K | 2.3K |
| 2016 | $109.18 | $68.24 | 1.60x | $40.94 | $171.4K | 2.5K | 2.5K |
| 2017 | $109.22 | $68.26 | 1.60x | $40.96 | $183.9K | 2.7K | 2.7K |
| 2018 | $109.22 | $68.26 | 1.60x | $40.96 | $196.4K | 2.9K | 2.9K |
| 2019 | $109.20 | $68.25 | 1.60x | $40.95 | $209.0K | 3.1K | 3.0K |
| 2020 | $109.18 | $68.24 | 1.60x | $40.94 | $221.5K | 3.2K | 3.2K |
| 2021 | $109.22 | $68.26 | 1.60x | $40.96 | $234.1K | 3.4K | 3.4K |
| 2022 | $109.20 | $68.25 | 1.60x | $40.95 | $246.6K | 3.6K | 3.6K |
| 2023 | $109.20 | $68.25 | 1.60x | $40.95 | $259.1K | 3.8K | 3.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 10.5K | $713.5K | $68.25 | 1.49x |
| 99214 | Office/outpatient visit, est patient, moderate | 5.2K | $356.7K | $68.25 | 1.32x |
| 99215 | Office/outpatient visit, est patient, high | 3.5K | $237.8K | $68.24 | 1.77x |
| 99223 | Initial hospital care, high complexity | 2.6K | $178.4K | $68.26 | 1.37x |
| 99232 | Subsequent hospital care, moderate | 2.1K | $142.7K | $68.24 | 1.79x |
| 93000 | Electrocardiogram, complete | 1.7K | $118.9K | $68.26 | 1.58x |
| 71046 | Chest X-ray, 2 views | 1.5K | $101.9K | $68.27 | 1.60x |
| 80053 | Comprehensive metabolic panel | 1.3K | $89.2K | $68.24 | 1.82x |
| 85025 | Complete blood count (CBC) | 1.2K | $79.3K | $68.22 | 1.44x |
| 36415 | Venipuncture | 1.0K | $71.3K | $68.28 | 1.89x |
This provider submits charges 1.6 times higher than what Medicare actually pays.
A markup ratio of 1.6x means for every $100 Medicare pays, this provider initially charges $160. 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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