Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #16 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 $652.3K in total Medicare payments ranks in the 96th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 117% 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 | 2.3K | $142.6K | $62.98 | 1.67x |
| 99214 | Office visit, established patient, moderate complexity | 2.0K | $128.4K | $62.99 | 2.40x |
| 99215 | Office visit, established patient, high complexity | 1.8K | $114.1K | $62.98 | 2.39x |
| 99395 | Preventive visit, 18-39 years | 1.6K | $99.9K | $63.00 | 1.77x |
| 99396 | Preventive visit, 40-64 years | 1.4K | $85.6K | $62.98 | 2.29x |
| 93000 | Electrocardiogram, complete | 1.1K | $71.3K | $63.01 | 1.86x |
| 71046 | Chest X-ray, 2 views | 906 | $57.1K | $62.98 | 2.32x |
| 80053 | Comprehensive metabolic panel | 679 | $42.8K | $63.03 | 1.86x |
| 85025 | Complete blood count with differential | 453 | $28.5K | $62.98 | 1.89x |
| 36415 | Venipuncture for blood draw | 226 | $14.3K | $63.12 | 1.92x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. 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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