Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #413 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 $2.1M in total Medicare payments ranks in the 99th percentile of Allergy/Immunology providers nationally.
Medicare payments to this provider grew 130% 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 | 7.2K | $457.7K | $64.01 | 2.19x |
| 99214 | Office visit, established patient, moderate complexity | 6.4K | $411.9K | $64.01 | 1.54x |
| 99215 | Office visit, established patient, high complexity | 5.7K | $366.1K | $64.01 | 1.78x |
| 99232 | Subsequent hospital care, moderate complexity | 5.0K | $320.4K | $64.01 | 1.98x |
| 99233 | Subsequent hospital care, high complexity | 4.3K | $274.6K | $64.01 | 1.74x |
| 93000 | Electrocardiogram, complete | 3.6K | $228.8K | $64.01 | 2.04x |
| 71046 | Chest X-ray, 2 views | 2.9K | $183.1K | $64.01 | 2.12x |
| 80053 | Comprehensive metabolic panel | 2.1K | $137.3K | $64.01 | 2.04x |
| 85025 | Complete blood count with differential | 1.4K | $91.5K | $64.01 | 2.03x |
| 36415 | Venipuncture for blood draw | 715 | $45.8K | $64.01 | 1.61x |
This provider submits charges 1.88 times higher than what Medicare actually pays.
A markup ratio of 1.88x means for every $100 Medicare pays, this provider initially charges $188. 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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