VIMARIE FLORES
NPI 1124099296, individual, Humacao, PR, Pediatrics, Pediatric Emergency Medicine
- Hours beyond a day in 1 month, but with up to 131 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99233 ($313 per patient-month) sit in the top 5% of every provider billing that code.
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 2024 | More hours than a day holds, even counting one unit per claim line | 25.2 | 50.6 | 33.7 | 48.2 | 104 | 1 | 99223 99233 99239 | $166K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | VIMARIE FLORES |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | January 27, 2006, last updated February 20, 2023 |
| Practice location | 355 AVE FONT MARTELO, Humacao, PR 00791-3249, 939-640-6008 |
| Mailing address | URB MONTEHIEDRA, CALLE ZORZAL 197, San Juan, PR 00926 |
| Specialties | Pediatrics (208000000X, license 14024 PR) Pediatrics, Pediatric Emergency Medicine (2080P0204X, primary, license 14024 PR) |
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.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | $361K | 50% | $90 | $86 (top 5% from $224) | 55th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $197K | 27% | $313 | $96 (top 5% from $249) | 98th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $81K | 11% | $421 | $81 (top 5% from $170) | 100th percentile | |
| 99239 | Hospital discharge day management, more than 30 minutes | $56K | 8% | $274 | $49 (top 5% from $101) | 100th percentile | |
| 99283 | Emergency department visit with low level of medical decision making | $12K | 2% | $47 | $60 (top 5% from $193) | 34th percentile | |
| 99235 | Initial hospital care with same-day admission and discharge with moderate level of medical decision making, per day, if using time, at least 70 minutes | $5K | 1% | $123 | $140 (top 5% from $268) | too few months to rank | |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | $5K | 1% | $27 | $50 (top 5% from $194) | 16th percentile | |
| 99234 | Initial hospital care with same-day admission and discharge with straightforward or low level of medical decision making, per day, if using time, at least 45 minutes | $1K | 0% | $113 | $98 (top 5% from $194) | too few months to rank |
In this area
3 providers in Humacao Municipio County, PR carry an indicator in the public record, with $206K at stake between them. The most common is more hours than a day holds, on 3 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | LEYDA ROMAN NIEVES Humacao, PR, ranked 9702 | $23K |
|
| 5 | GLENDA AYALA-RIVERA Humacao, PR, ranked 10463 | $89K |
|
| 5 | NANCY RIVERA Humacao, PR, ranked 11637 | $94K |
Recent enforcement in PR
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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.