Providers
All 10 in FL
ROXANNE L EDWARDS, MD
NPI 1154468734, individual, New Smyrna Beach, FL, Pediatrics
1
Evidence tier
documented action, then payment
- Listed on the Medicare revocation list since September 30, 2020.
- Medicaid still paid claims in 23 later months, $81,752 in total.
score 95 of 100, rank 157, $82K at stake
Public list actions
Medicare revocation effective October 4, 2020, barred from re-enrolling until October 3, 2030
424.535(a)(10) failure to document, Practitioner - Pediatric Medicine, NC
Medicare revocation effective September 30, 2020, barred from re-enrolling until September 29, 2030
424.535(a)(10) failure to document, Practitioner - Emergency Medicine, FL
Medicare revocation effective September 30, 2020, barred from re-enrolling until September 29, 2030
424.535(a)(10) failure to document, Practitioner - Pediatric Medicine, VA
Medicare revocation effective October 2, 2020, barred from re-enrolling until October 1, 2030
424.535(a)(10) failure to document, Practitioner - Obstetrics/Gynecology, NH
Paid after the action
Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.
| list | identity check | action date | window closed | months paid after | first | last | paid after | 12 months before |
|---|---|---|---|---|---|---|---|---|
| Medicare revocation list 424.535(a)(10) failure to document | Exact NPI, name verified | Oct 2, 2020 | Oct 1, 2030 | 23 | Jul 2021 | Nov 2024 | $82K | $534 |
| Medicare revocation list 424.535(a)(10) failure to document | Exact NPI, name verified | Oct 4, 2020 | Oct 3, 2030 | 23 | Jul 2021 | Nov 2024 | $82K | $534 |
| Medicare revocation list 424.535(a)(10) failure to document | Exact NPI, name verified | Sep 30, 2020 | Sep 29, 2030 | 23 | Jul 2021 | Nov 2024 | $82K | $1K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ROXANNE L EDWARDS, MD |
| Type | Individual |
| Status | Active |
| NPI issued | January 31, 2007, last updated December 16, 2019 |
| Practice location | 2434 S GLENCOE RD, New Smyrna Beach, FL 32168-9360, 285-424-9740 |
| Specialties | Pediatrics (208000000X, primary, license ME0055092 FL) Physical Medicine & Rehabilitation, Pain Medicine (2081P2900X, license ME0055092 FL) |
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 | |
|---|---|---|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $40K | 46% | $114 | $28 (top 5% from $147) | 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 | $18K | 21% | $121 | $44 (top 5% from $110) | 96th percentile | |
| 99441 | Telephone medical discussion with physician, 5-10 minutes | $14K | 16% | $39 | $11 (top 5% from $106) | 79th percentile | |
| 99202 | New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more | $7K | 8% | $131 | $45 (top 5% from $138) | too few months to rank | |
| 99238 | Hospital discharge day management, 30 minutes or less | $3K | 4% | $56 | $48 (top 5% from $80) | too few months to rank | |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | $2K | 3% | $12 | $32 (top 5% from $49) | 14th percentile | |
| 99460 | Medicaid service code | $896 | 1% | $75 | $74 (top 5% from $106) | too few months to rank | |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | $480 | 1% | $40 | $21 (top 5% from $104) | too few months to rank |
In this area
10 providers in Volusia County, FL carry an indicator in the public record, with $24.4M at stake between them. The most common is part of a provider network, on 7 of them, followed by more hours than a day holds on 3.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | JOHN KNOX VILLAGE OF CENTRAL FLORIDA, INC Orange City, FL, ranked 2072 | $0 |
|
| 3 | BG SNF OPCO LLC Holly Hill, FL, ranked 2348 | $0 |
|
| 3 | PINNACLE HOME CARE OF THE VILLAGES, INC. Ormond Beach, FL, ranked 3590 | $0 |
|
| 3 | QUALITY CARE HOME HEALTH, LLC Port Orange, FL, ranked 3706 | $0 |
|
| 3 | ADVENTHEALTH HOME HEALTH AND HOSPICE INC Ormond Beach, FL, ranked 4955 | $0 |
|
| 3 | ADVENTHEALTH HOME HEALTH AND HOSPICE INC Ormond Beach, FL, ranked 5150 | $0 |
|
| 3 | JOHN KNOX VILLAGE OF CENTRAL FLORIDA, INC Orange City, FL, ranked 6730 | $0 |
|
| 5 | ANGELA HANSEN Port Orange, FL, ranked 9794 | $22.6M |
|
Recent enforcement in FL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJPleaded guiltyAug 14, 2026
Ocala Mental Health Counselor Pleads Guilty to Aggravated Identity Theft and Wire Fraud
Forsythe used the names and insurance policy information of 22 individuals without their consent to bill two health insurance companies for counseling services she had not provided.
DOJConvictedAug 12, 2026
Cuban National Convicted of Unlawfully Obtaining US Citizenship After Concealing Healthcare Fraud Scheme
Rodriguez concealed on her naturalization application her participation in a seven-year healthcare fraud conspiracy that resulted in approximately $4.6 million in fraudulent healthcare claims.
DOJCivil settlementAug 3, 2026
Medicare Advantage Provider Complete Health to Pay $14,100,000 to Settle False Claims Act Suit
Complete Health caused the submission of diagnosis codes within HCC 55 and HCC 59 that were not clinically valid, not supported by medical records, and/or not considered in the beneficiary's care, increasing Medicare Advantage risk-adjusted payments from which it received a percentage.
DOJCivil settlementJul 31, 2026
Two Additional Ophthalmology Practices Agree to Pay $2.3M to Resolve Allegations of Fraudulent Claims to Medicare and Medicaid for Cranial Ultrasounds
Two ophthalmology practices billed Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds premised on false diagnoses, with one practice receiving remuneration from a third-party testing company to refer patients for the tests.
DOJCivil settlementJul 31, 2026
Two Additional Ophthalmology Practices Agree to Pay $2.3M to Resolve Allegations of Fraudulent Claims to Medicare and Medicaid for Cranial Ultrasounds
Two ophthalmology practices billed Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds premised on false diagnoses and, as to Floral Park Ophthalmology, resulting from remuneration paid by a third-party testing company to induce referrals.
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.