Providers
All 35 in RI
SIMON FENSTERSZAUB, D.O.
NPI 1003077322, individual, Bristol, RI, Family Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 3 months, but with up to 9190 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 9047, $835K at stake
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Nov 2022 | More hours than a day holds, even counting one unit per claim line | 31.5 | 1.7 | 1.1 | 1.6 | 3966 | 1 | 99202 99211 99305 99308 | $9K |
| Mar 2023 | More hours than a day holds, even counting one unit per claim line | 68.4 | 43.0 | 28.7 | 38.6 | 9190 | 1 | 99202 99211 99212 99214 99305 | $287K |
| Apr 2023 | More hours than a day holds, even counting one unit per claim line | 41.5 | 33.5 | 22.3 | 33.5 | 5624 | 1 | 99202 99211 99212 99214 99305 | $220K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SIMON FENSTERSZAUB, D.O. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | June 19, 2008, last updated June 19, 2026 |
| Practice location | 7 CREEK LN, Bristol, RI 02809-2401, 718-964-6161 |
| Mailing address | 250 SKILLMAN ST STE 202, Brooklyn, NY 11205-1218 |
| Specialties | Family Medicine (207Q00000X, primary, license 249846 NY) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
Medicaid, largest codes
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | $1.7M | 20% | $39 | $20 (top 5% from $39) | 95th percentile | |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | $1.6M | 20% | $147 | $75 (top 5% from $185) | too few months to rank | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $1.0M | 12% | $78 | $44 (top 5% from $110) | 87th percentile | |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within | $821K | 10% | $42 | $21 (top 5% from $38) | too few months to rank | |
| 99211 | Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | $691K | 8% | $28 | $16 (top 5% from $128) | 73rd percentile | |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | $414K | 5% | $71 | $12 (top 5% from $18) | 100th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $284K | 3% | $86 | $60 (top 5% from $133) | 76th percentile | |
| 99392 | Medicaid service code | $154K | 2% | $113 | $78 (top 5% from $124) | 92nd percentile |
Medicare Part B 2024, largest codes
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 8,171 | 2,542 | $404K | $200 | $62 | 3.2x | 1.8x (90th percentile 2.9x) |
| 99484 | Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional | 6,538 | 2,448 | $283K | $111 | $55 | 2.0x | 2.0x (90th percentile 3.4x) |
| 99439 | Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month | 5,352 | 2,067 | $202K | $89 | $47 | 1.9x | 1.9x (90th percentile 3.1x) |
| 99493 | Follow-up psychiatric collaborative care management, subsequent calendar month, first 60 minutes | 925 | 474 | $103K | $365 | $139 | 2.6x | 2.2x (90th percentile 3.8x) |
| 99492 | Initial psychiatric collaborative care management, first calendar month, first 70 minutes | 462 | 460 | $57K | $375 | $155 | 2.4x | 2.4x (90th percentile 3.9x) |
| 99494 | Psychiatric collaborative care management per calendar month, each additional 30 minutes | 946 | 506 | $45K | $200 | $60 | 3.3x | 2.8x (90th percentile 4.0x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 230 | 84 | $24K | $275 | $146 | 1.9x | 2.3x (90th percentile 3.8x) |
| G2214 | Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care | 470 | 452 | $22K | $165 | $58 | 2.8x | 2.4x (90th percentile 3.4x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
35 providers in RI carry an indicator in the public record, with $49.3M at stake between them. The most common is part of a provider network, on 17 of them, followed by more hours than a day holds on 15. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | CARE CENTER RHODE ISLAND LLC East Providence, RI, ranked 100 | $270K |
|
| 3 | BEACON HOSPICE, LLC East Providence, RI, ranked 989 | $1.7M |
|
| 3 | ODYSSEY HEALTHCARE OPERATING B LP Warwick, RI, ranked 1050 | $955K |
|
| 3 | ROYAL MIDDLETOWN NURSING CENTER LLC Middletown, RI, ranked 1073 | $816K |
|
| 3 | VISITING NURSE SERVICES OF NEWPORT AND BRISTOL COUNTIES Middletown, RI, ranked 1291 | $177K |
|
| 3 | CORTLAND PLACE REHAB CENTER LLC Greenville, RI, ranked 1385 | $75K |
|
| 3 | EDEN HOSPICE LLC Warwick, RI, ranked 2934 | $0 |
|
| 3 | OVERLOOK EDEN OPERATIONS, LLC Pascoag, RI, ranked 3154 | $0 |
|
Recent enforcement in RI
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJun 24, 2026
Two Charged in District of Rhode Island as Part of National Fraud Takedown
Two defendants were charged by indictment with using the identity of another person to obtain benefits, including approximately $28,236.42 and $24,018.86 in Rhode Island Medicaid benefits.
DOJOtherFeb 17, 2026
Zynex, Inc. Agrees to Criminal Resolution Addressing Claims of Millions of Dollars of Health Care Fraud, Securities Fraud and Related Offenses
Zynex admitted to submitting excessive and improper claims for medical devices and supplies, including medically unnecessary electrode supplies in excess quantities, to government and private health care payors and patients, and to concealing from investors that its revenues were driven by fraudulent billing.
DOJIndictedJan 21, 2026
Former Zynex, Inc. Executives Charged with Health Care and Securities Fraud and Related Offenses
The indictment alleges that from at least 2017 through late 2025 the former CEO and COO of Zynex, Inc. caused the company to submit fraudulent billings to government and private health care payors and patients for medical devices and supplies that were not medically necessary, not covered, and not agreed to by patients, and used those billings to inflate the company's financial reporting and stock price.
DOJIndictedApr 7, 2025
Pain Management Clinic Owners and Operators Indicted on Health Care Fraud Charges
The owners and operators of a pain management clinic allegedly submitted fraudulent claims to Medicare, Medicare Advantage, Medicaid Managed Care, and four private insurers for purportedly medically necessary services, including acupuncture, physical therapy, and office visits, that were not actually provided to patients, in order to collect payment for massage therapy and other services not provided.
DOJSentencedMar 5, 2025
Addiction Treatment Center Supervisor Sentenced in Scheme to Defraud Federal, State, and Private Health Care Insurers
A clinical social worker supervisor at an addiction treatment center devised and executed a scheme to submit false claims for 45-minute psychotherapy and counseling sessions that lasted only 5-10 minutes or did not occur as billed, defrauding Medicare, Medicaid, and other health insurers of more than $3.5 million.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.