Providers
STEPHEN MICHAEL COOPER, MD
NPI 1114002565, individual, Elkins Park, PA, Pediatrics
5
Evidence tier
informational
- Medicaid dollars per patient on code 99394 ($212 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 10016, $1.6M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | STEPHEN MICHAEL COOPER, MD |
| Type | Individual |
| Status | Active |
| NPI issued | October 26, 2006, last updated August 19, 2026 |
| Practice location | 1939 W CHELTENHAM AVE, Elkins Park, PA 19027-1046, 215-884-5715 |
| Specialties | Pediatrics (208000000X, primary, license MD494553 PA) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $2.9M | 48% | $212 | $44 (top 5% from $110) | 99th percentile | |
| 99391 | Medicaid service code | $730K | 12% | $206 | $76 (top 5% from $126) | 99th percentile | |
| 99392 | Medicaid service code | $670K | 11% | $201 | $78 (top 5% from $124) | 99th percentile | |
| 99393 | Medicaid service code | $645K | 11% | $200 | $78 (top 5% from $121) | 99th percentile | |
| 99394 | Medicaid service code | $424K | 7% | $205 | $83 (top 5% from $128) | 99th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $212K | 4% | $222 | $60 (top 5% from $133) | 99th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $136K | 2% | $186 | $28 (top 5% from $147) | 97th percentile | |
| T1015 | Medicaid service code | $122K | 2% | $190 | $182 (top 5% from $488) | 53rd percentile |
In this area
4 providers in Wicomico County, PA carry an indicator in the public record, with $5.4M at stake between them. The most common is more hours than a day holds, on 4 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | WALTER GIANELLE Salisbury, MD, ranked 8401 | $5.2M |
|
| 4 | KATHLEEN MIRSKY Salisbury, MD, ranked 9588 | $79K |
|
| 4 | JANET O'BRIEN Salisbury, MD, ranked 9589 | $78K |
|
| 5 | JETHALAL HARKHANI Salisbury, MD, ranked 10457 | $96K |
|
Recent enforcement in PA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedAug 4, 2026
The Fraud Division Announces Charges Against 19 Defendants for Medicaid Home Health Aid Schemes
Nineteen defendants, including owners and employees of home care companies, home health aides, and Medicaid recipients, were charged with submitting claims for home care services that were not provided, including claims for hours when purported aides were incarcerated, hospitalized, working other jobs, or traveling overseas.
DOJIndictedJun 23, 2026
Two Doctors, Physician’s Assistant Charged With Unlawfully Distributing Controlled Substances Via Voicemail “Refill Line”
From January 2020 through March 2025 the defendants allegedly operated a voicemail refill line that allowed patients to receive refills of Schedule II controlled substance prescriptions, namely oxycodone and amphetamine, without interacting with a licensed prescriber, and submitted prescriptions in another medical professional's name to deceive pharmacies.
DOJChargedJun 23, 2026
Scranton Woman Charged With Conspiracy To Commit Bank Fraud With Funds Derived From Federal Health Care Programs
Beaubrun is alleged to have stolen and appropriated checks intended by Entity #1 for various payees, including funds derived from Medicare and Medicaid, and endorsed them to herself, causing a loss of over $300,000.
DOJCivil settlementJun 10, 2026
Ahold Delhaize USA Inc. to Pay $40M for Allegedly Reporting Inflated Drug Prices on Claims to Federal Healthcare Programs
Ahold Delhaize's in-store retail pharmacies operated prescription savings programs offering discounted prices but failed to report those discounted prices as their "usual and customary" prices on claims to Medicare Part D, Medicaid and TRICARE, causing those programs to pay inflated amounts.
DOJCivil settlementJun 10, 2026
Ahold Delhaize USA Inc. to Pay $40M for Allegedly Reporting Inflated Drug Prices on Claims to Federal Healthcare Programs
Ahold Delhaize supermarket pharmacies operated prescription savings programs offering discounted prices but failed to report those discounted prices as their "usual and customary" prices on claims to Medicare Part D, Medicaid, and TRICARE, causing those programs to pay inflated amounts.
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.