Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #67 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 $219.9K in total Medicare payments ranks in the 87th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 119% 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 | 1.2K | $47.6K | $40.51 | 2.43x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $42.8K | $40.53 | 2.46x |
| 99215 | Office visit, established patient, high complexity | 940 | $38.1K | $40.51 | 2.34x |
| 99395 | Preventive visit, 18-39 years | 822 | $33.3K | $40.54 | 2.42x |
| 99396 | Preventive visit, 40-64 years | 705 | $28.6K | $40.51 | 2.27x |
| 93000 | Electrocardiogram, complete | 587 | $23.8K | $40.55 | 2.46x |
| 71046 | Chest X-ray, 2 views | 470 | $19.0K | $40.51 | 2.03x |
| 80053 | Comprehensive metabolic panel | 352 | $14.3K | $40.57 | 2.16x |
| 85025 | Complete blood count with differential | 235 | $9.5K | $40.51 | 1.89x |
| 36415 | Venipuncture for blood draw | 117 | $4.8K | $40.68 | 1.84x |
This provider submits charges 2.15 times higher than what Medicare actually pays.
A markup ratio of 2.15x means for every $100 Medicare pays, this provider initially charges $215. 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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