Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 93.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #56 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 $1.0M in total Medicare payments ranks in the 97th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 113% 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 | 3.0K | $223.9K | $75.14 | 1.83x |
| 99214 | Office visit, established patient, moderate complexity | 2.7K | $201.5K | $75.14 | 1.47x |
| 99215 | Office visit, established patient, high complexity | 2.4K | $179.1K | $75.14 | 1.90x |
| 99395 | Preventive visit, 18-39 years | 2.1K | $156.7K | $75.14 | 1.78x |
| 99396 | Preventive visit, 40-64 years | 1.8K | $134.3K | $75.14 | 1.41x |
| 93000 | Electrocardiogram, complete | 1.5K | $112.0K | $75.14 | 1.44x |
| 71046 | Chest X-ray, 2 views | 1.2K | $89.6K | $75.14 | 1.67x |
| 80053 | Comprehensive metabolic panel | 894 | $67.2K | $75.14 | 1.56x |
| 85025 | Complete blood count with differential | 596 | $44.8K | $75.14 | 1.39x |
| 36415 | Venipuncture for blood draw | 298 | $22.4K | $75.14 | 1.42x |
This provider submits charges 1.65 times higher than what Medicare actually pays.
A markup ratio of 1.65x means for every $100 Medicare pays, this provider initially charges $165. 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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