Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #153 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 $531.1K in total Medicare payments ranks in the 95th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 103% 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 | 1.9K | $116.3K | $60.81 | 2.44x |
| 99214 | Office visit, established patient, moderate complexity | 1.7K | $104.6K | $60.81 | 1.67x |
| 99215 | Office visit, established patient, high complexity | 1.5K | $93.0K | $60.80 | 1.67x |
| 99395 | Preventive visit, 18-39 years | 1.3K | $81.4K | $60.83 | 2.32x |
| 99396 | Preventive visit, 40-64 years | 1.1K | $69.8K | $60.82 | 1.73x |
| 93000 | Electrocardiogram, complete | 956 | $58.1K | $60.81 | 2.38x |
| 71046 | Chest X-ray, 2 views | 765 | $46.5K | $60.80 | 1.76x |
| 80053 | Comprehensive metabolic panel | 574 | $34.9K | $60.77 | 2.36x |
| 85025 | Complete blood count with differential | 382 | $23.3K | $60.88 | 1.71x |
| 36415 | Venipuncture for blood draw | 191 | $11.6K | $60.88 | 2.38x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. This is higher 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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