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 #314 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 $586.5K in total Medicare payments ranks in the 92th percentile of Infectious Disease providers nationally.
Medicare payments to this provider grew 100% 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 | 1.9K | $124.6K | $66.23 | 1.90x |
| 99214 | Office visit, established patient, moderate complexity | 1.7K | $112.1K | $66.23 | 2.28x |
| 99215 | Office visit, established patient, high complexity | 1.5K | $99.7K | $66.22 | 1.94x |
| 99232 | Subsequent hospital care, moderate complexity | 1.3K | $87.2K | $66.22 | 2.68x |
| 99233 | Subsequent hospital care, high complexity | 1.1K | $74.7K | $66.21 | 2.13x |
| 93000 | Electrocardiogram, complete | 941 | $62.3K | $66.20 | 2.60x |
| 71046 | Chest X-ray, 2 views | 752 | $49.8K | $66.27 | 1.92x |
| 80053 | Comprehensive metabolic panel | 564 | $37.4K | $66.27 | 2.25x |
| 85025 | Complete blood count with differential | 376 | $24.9K | $66.27 | 2.16x |
| 36415 | Venipuncture for blood draw | 188 | $12.5K | $66.27 | 1.91x |
This provider submits charges 2.29 times higher than what Medicare actually pays.
A markup ratio of 2.29x means for every $100 Medicare pays, this provider initially charges $229. 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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