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 #307 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 $255.4K in total Medicare payments ranks in the 89th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 118% 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 | 1.1K | $54.8K | $52.11 | 1.96x |
| 99214 | Office visit, established patient, moderate complexity | 946 | $49.3K | $52.15 | 1.69x |
| 99215 | Office visit, established patient, high complexity | 841 | $43.9K | $52.15 | 1.44x |
| 99395 | Preventive visit, 18-39 years | 736 | $38.4K | $52.14 | 1.71x |
| 99396 | Preventive visit, 40-64 years | 631 | $32.9K | $52.13 | 1.54x |
| 93000 | Electrocardiogram, complete | 526 | $27.4K | $52.11 | 1.91x |
| 71046 | Chest X-ray, 2 views | 421 | $21.9K | $52.09 | 1.60x |
| 80053 | Comprehensive metabolic panel | 315 | $16.4K | $52.21 | 1.79x |
| 85025 | Complete blood count with differential | 210 | $11.0K | $52.21 | 1.46x |
| 36415 | Venipuncture for blood draw | 105 | $5.5K | $52.21 | 1.52x |
This provider submits charges 1.64 times higher than what Medicare actually pays.
A markup ratio of 1.64x means for every $100 Medicare pays, this provider initially charges $164. 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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