Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #62 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 $399.9K in total Medicare payments ranks in the 93th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 129% 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 | 2.0K | $85.8K | $42.92 | 2.34x |
| 99214 | Office visit, established patient, moderate complexity | 1.8K | $77.2K | $42.90 | 2.94x |
| 99215 | Office visit, established patient, high complexity | 1.6K | $68.6K | $42.90 | 2.08x |
| 99395 | Preventive visit, 18-39 years | 1.4K | $60.1K | $42.90 | 2.15x |
| 99396 | Preventive visit, 40-64 years | 1.2K | $51.5K | $42.90 | 2.44x |
| 93000 | Electrocardiogram, complete | 1.0K | $42.9K | $42.90 | 2.65x |
| 71046 | Chest X-ray, 2 views | 800 | $34.3K | $42.90 | 2.54x |
| 80053 | Comprehensive metabolic panel | 600 | $25.7K | $42.90 | 2.83x |
| 85025 | Complete blood count with differential | 400 | $17.2K | $42.90 | 2.39x |
| 36415 | Venipuncture for blood draw | 200 | $8.6K | $42.90 | 2.45x |
This provider submits charges 2.54 times higher than what Medicare actually pays.
A markup ratio of 2.54x means for every $100 Medicare pays, this provider initially charges $254. 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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