Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #436 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 $80.9K in total Medicare payments ranks in the 48th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 126% 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 | 372 | $17.5K | $47.16 | 1.97x |
| 99214 | Office visit, established patient, moderate complexity | 335 | $15.8K | $47.13 | 2.06x |
| 99215 | Office visit, established patient, high complexity | 298 | $14.0K | $47.10 | 1.53x |
| 99232 | Subsequent hospital care, moderate complexity | 261 | $12.3K | $47.05 | 2.14x |
| 99233 | Subsequent hospital care, high complexity | 223 | $10.5K | $47.20 | 1.73x |
| 93000 | Electrocardiogram, complete | 186 | $8.8K | $47.16 | 2.15x |
| 71046 | Chest X-ray, 2 views | 149 | $7.0K | $47.09 | 2.25x |
| 80053 | Comprehensive metabolic panel | 112 | $5.3K | $46.99 | 2.14x |
| 85025 | Complete blood count with differential | 74 | $3.5K | $47.42 | 1.76x |
| 36415 | Venipuncture for blood draw | 37 | $1.8K | $47.41 | 1.50x |
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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