Providers
All 11 in MD
SIDNEY NELSON, M.D.
NPI 1033152541, individual, Pikesville, MD, Internal Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 1 month, but with up to 615 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 8564, $3.0M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Mar 2024 | More hours than a day holds, even counting one unit per claim line | 25.5 | 25.7 | 17.1 | 25.3 | 579 | 1 | 99214 99215 99222 99223 99232 99233 | $80K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SIDNEY NELSON, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 13, 2006, last updated January 15, 2019 |
| Practice location | 1840 REISTERSTOWN RD, Pikesville, MD 21208-1305, 757-222-0300 |
| Mailing address | 2900 SABRE ST STE 300, Virginia Beach, VA 23452-7380 |
| Specialties | Hospitalist (208M00000X, license D63298 MD) Internal Medicine (207R00000X, primary, license D63298 MD) |
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 | |
|---|---|---|---|---|---|---|---|
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $1.9M | 51% | $138 | $81 (top 5% from $170) | 89th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $415K | 11% | $100 | $96 (top 5% from $249) | 53rd percentile | |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or morehistory of abuse | $396K | 10% | $138 | $88 (top 5% from $210) | 80th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $349K | 9% | $94 | $60 (top 5% from $133) | 82nd percentile | |
| 80307 | Testing for presence of drug, by chemistry analyzers | $317K | 8% | $44 | $45 (top 5% from $110) | 47th percentile | |
| 99205 | New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | $156K | 4% | $164 | $128 (top 5% from $249) | 70th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $78K | 2% | $67 | $44 (top 5% from $110) | 79th percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $45K | 1% | $104 | $63 (top 5% from $137) | 85th 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 |
|---|---|---|---|---|---|---|---|---|
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 391 | 249 | $53K | $259 | $185 | 1.4x | 3.0x (90th percentile 5.6x) |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 263 | 135 | $25K | $156 | $126 | 1.2x | 2.6x (90th percentile 4.7x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 172 | 86 | $18K | $294 | $135 | 2.2x | 2.3x (90th percentile 3.8x) |
| 80307 | Testing for presence of drug, by chemistry analyzers | 144 | 95 | $9K | $70 | $61 | 1.1x | 3.2x (90th percentile 7.6x) |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 48 | 38 | $6K | $203 | $193 | 1.1x | 2.4x (90th percentile 4.1x) |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 28 | 28 | $4K | $490 | $174 | 2.8x | 2.4x (90th percentile 3.9x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 36 | 30 | $3K | $208 | $96 | 2.2x | 2.2x (90th percentile 3.8x) |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 16 | 16 | $1K | $172 | $139 | 1.2x | 2.7x (90th percentile 4.4x) |
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
11 providers in Baltimore County, MD carry an indicator in the public record, with $29.1M at stake between them. The most common is more hours than a day holds, on 9 of them, followed by paid after a public list action on 1. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | QOL COMMUNICATION SERVICES, LLC Owings Mills, MD, ranked 73 | $729K |
|
| 2 | ROXANNE FUENTES Pikesville, MD, ranked 720 | $3.0M |
|
| 3 | MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC. Baltimore, MD, ranked 969 | $2.1M |
|
| 4 | DEEPAK SETH Baltimore, MD, ranked 7423 | $6.1M |
|
| 4 | CARA BALTIMORE Owings Mills, MD, ranked 7444 | $5.2M |
|
| 4 | OLADIPO OLALEYE Windsor Mill, MD, ranked 7458 | $4.8M |
|
| 4 | JULIANA NWAKAMMA Windsor Mill, MD, ranked 7613 | $2.5M |
|
| 4 | EMU OHWOBETE Rosedale, MD, ranked 7877 | $784K |
|
Recent enforcement in MD
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementMar 20, 2026
Health Care Management Corporation Agrees to Pay $4 Million to Resolve False Claims Act Allegations
CVR knowingly submitted claims to Medicare, Medicaid, and TRICARE for sclerotherapy, radiofrequency ablation, and endovenous laser ablation procedures to treat chronic venous insufficiency that were not clinically indicated and were medically unnecessary between January 1, 2010, and December 31, 2016.
DOJCivil settlementNov 20, 2025
Diagnostic Laboratory Agrees to Pay More Than $1 Million to Settle Alleged False Claims Act Violations
GTI agreed to pay $1.635 million to resolve allegations that it submitted Medicare claims for respiratory pathogen panels that were medically unnecessary or obtained through kickbacks paid under a marketing services agreement with an infection prevention company for laboratory test referrals from long-term care facilities.
DOJSentencedNov 13, 2025
Baltimore County Woman Sentenced for Impersonating Nurses and Aggravated Identity Theft
Amponsah used stolen nursing licenses and false educational and professional histories to obtain employment as a purported licensed nurse at no less than 40 facilities in Maryland that billed health care benefit programs including Medicare and Medicaid for services she provided, earning more than $145,000 in wages.
DOJPleaded guiltyAug 14, 2025
Baltimore County Woman Admits to Impersonating Nurses, Pleads Guilty to Aggravated Identity Theft
Amponsah used stolen nursing licenses and false educational and professional histories to obtain employment as a purported licensed nurse at no less than 40 facilities in Maryland, which billed health care benefit programs including Medicare and Medicaid for services she provided.
DOJCivil judgmentAug 11, 2025
United States Obtains More Than $1.4 Million Judgment Against Family Medical Practitioner for Fraudulent Billing
Akoto billed Medicare for auricular stimulation (P-Stim) devices using a code for a surgically implanted neurostimulator device, which Medicare does not reimburse as acupuncture.
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.