Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #166 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 $343.1K in total Medicare payments ranks in the 92th percentile of Allergy/Immunology providers nationally.
Medicare payments to this provider grew 91% 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 | 1.8K | $74.1K | $40.19 | 1.80x |
| 99214 | Office visit, established patient, moderate complexity | 1.7K | $66.7K | $40.18 | 2.29x |
| 99215 | Office visit, established patient, high complexity | 1.5K | $59.2K | $40.20 | 1.71x |
| 99232 | Subsequent hospital care, moderate complexity | 1.3K | $51.8K | $40.19 | 1.85x |
| 99233 | Subsequent hospital care, high complexity | 1.1K | $44.4K | $40.18 | 1.84x |
| 93000 | Electrocardiogram, complete | 921 | $37.0K | $40.21 | 1.83x |
| 71046 | Chest X-ray, 2 views | 737 | $29.6K | $40.20 | 2.48x |
| 80053 | Comprehensive metabolic panel | 553 | $22.2K | $40.18 | 2.45x |
| 85025 | Complete blood count with differential | 369 | $14.8K | $40.14 | 2.36x |
| 36415 | Venipuncture for blood draw | 184 | $7.4K | $40.25 | 1.84x |
This provider submits charges 2.12 times higher than what Medicare actually pays.
A markup ratio of 2.12x means for every $100 Medicare pays, this provider initially charges $212. 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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