Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #259 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 $147.8K in total Medicare payments ranks in the 81th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 106% 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 | 592 | $32.5K | $54.90 | 1.84x |
| 99214 | Office visit, established patient, moderate complexity | 533 | $29.2K | $54.87 | 1.95x |
| 99215 | Office visit, established patient, high complexity | 474 | $26.0K | $54.85 | 1.73x |
| 99395 | Preventive visit, 18-39 years | 415 | $22.7K | $54.82 | 2.38x |
| 99396 | Preventive visit, 40-64 years | 355 | $19.5K | $54.93 | 1.82x |
| 93000 | Electrocardiogram, complete | 296 | $16.2K | $54.90 | 2.47x |
| 71046 | Chest X-ray, 2 views | 237 | $13.0K | $54.85 | 2.43x |
| 80053 | Comprehensive metabolic panel | 178 | $9.7K | $54.77 | 2.15x |
| 85025 | Complete blood count with differential | 118 | $6.5K | $55.08 | 2.11x |
| 36415 | Venipuncture for blood draw | 59 | $3.3K | $55.08 | 2.07x |
This provider submits charges 2.14 times higher than what Medicare actually pays.
A markup ratio of 2.14x means for every $100 Medicare pays, this provider initially charges $214. 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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