Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #95 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 $186.3K in total Medicare payments ranks in the 85th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 103% 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 | 763 | $39.8K | $52.18 | 1.61x |
| 99214 | Office visit, established patient, moderate complexity | 687 | $35.8K | $52.15 | 1.48x |
| 99215 | Office visit, established patient, high complexity | 611 | $31.8K | $52.12 | 1.77x |
| 99395 | Preventive visit, 18-39 years | 534 | $27.9K | $52.19 | 1.62x |
| 99396 | Preventive visit, 40-64 years | 458 | $23.9K | $52.15 | 2.02x |
| 93000 | Electrocardiogram, complete | 382 | $19.9K | $52.11 | 1.45x |
| 71046 | Chest X-ray, 2 views | 305 | $15.9K | $52.21 | 1.90x |
| 80053 | Comprehensive metabolic panel | 229 | $11.9K | $52.15 | 1.51x |
| 85025 | Complete blood count with differential | 153 | $8.0K | $52.04 | 2.06x |
| 36415 | Venipuncture for blood draw | 76 | $4.0K | $52.38 | 1.92x |
This provider submits charges 1.78 times higher than what Medicare actually pays.
A markup ratio of 1.78x means for every $100 Medicare pays, this provider initially charges $178. 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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