Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #295 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 $210.0K in total Medicare payments ranks in the 87th 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 | 1.4K | $45.3K | $32.62 | 1.51x |
| 99214 | Office visit, established patient, moderate complexity | 1.2K | $40.7K | $32.63 | 1.63x |
| 99215 | Office visit, established patient, high complexity | 1.1K | $36.2K | $32.64 | 1.67x |
| 99395 | Preventive visit, 18-39 years | 971 | $31.7K | $32.62 | 1.77x |
| 99396 | Preventive visit, 40-64 years | 832 | $27.1K | $32.63 | 1.64x |
| 93000 | Electrocardiogram, complete | 693 | $22.6K | $32.65 | 1.78x |
| 71046 | Chest X-ray, 2 views | 555 | $18.1K | $32.61 | 1.66x |
| 80053 | Comprehensive metabolic panel | 416 | $13.6K | $32.63 | 1.79x |
| 85025 | Complete blood count with differential | 277 | $9.1K | $32.67 | 1.97x |
| 36415 | Venipuncture for blood draw | 139 | $4.5K | $32.55 | 1.90x |
This provider submits charges 1.8 times higher than what Medicare actually pays.
A markup ratio of 1.8x means for every $100 Medicare pays, this provider initially charges $180. 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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