Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #179 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 $407.1K in total Medicare payments ranks in the 93th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 131% 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 | 1.6K | $87.9K | $53.61 | 2.26x |
| 99214 | Office visit, established patient, moderate complexity | 1.5K | $79.1K | $53.61 | 2.17x |
| 99215 | Office visit, established patient, high complexity | 1.3K | $70.3K | $53.61 | 2.18x |
| 99395 | Preventive visit, 18-39 years | 1.1K | $61.5K | $53.61 | 1.74x |
| 99396 | Preventive visit, 40-64 years | 984 | $52.7K | $53.61 | 1.77x |
| 93000 | Electrocardiogram, complete | 820 | $44.0K | $53.61 | 2.06x |
| 71046 | Chest X-ray, 2 views | 656 | $35.2K | $53.61 | 2.47x |
| 80053 | Comprehensive metabolic panel | 492 | $26.4K | $53.61 | 1.89x |
| 85025 | Complete blood count with differential | 328 | $17.6K | $53.61 | 1.82x |
| 36415 | Venipuncture for blood draw | 164 | $8.8K | $53.60 | 2.46x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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