NINO A ELIZONDO, LCSW

NPI 1164608188, individual, Marlboro, NY, Social Worker, Clinical

Evidence tier

structure or single-organization volume

Hours beyond a day in 2 months under one organization, which can be supervisory billing.
Records needed.
Medicaid dollars per patient on code 90839 ($407 per patient-month) sit in the top 5% of every provider billing that code.

score 55 of 100, rank 7865, $854K 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	27.5	25.9	17.3	25.5	353	1	90791 90834 90837 90838 99349	$81K
Oct 2024	More hours than a day holds, even counting one unit per claim line	24.5	19.3	12.9	17.3	342	2	90791 90832 90834 90837	$64K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	NINO A ELIZONDO, LCSW
Type	Individual
Status	Active
NPI issued	January 22, 2008, last updated July 8, 2013
Practice location	45 CRICCHIO DR, Marlboro, NY 12542-6321, 703-927-6322
Specialties	Social Worker, Clinical (1041C0700X, primary, license 072214 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
90837	Psychotherapy, 1 hourhistory of abuse	$822K	40%	$227	$191 (top 5% from $442)	64th percentile
99347	Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes	$578K	28%	$407	$10 (top 5% from $326)	97th percentile
90834	Psychotherapy, 45 minutes	$303K	15%	$158	$101 (top 5% from $318)	75th percentile
90839	Psychotherapy for crisis, first hour	$157K	8%	$394	$116 (top 5% from $266)	99th percentile
90791	Psychiatric diagnostic evaluation	$55K	3%	$115	$105 (top 5% from $228)	62nd percentile
90840	Psychotherapy for crisis, each additional 30 minutes	$54K	3%	$318	$93 (top 5% from $298)	99th percentile
99341	Residence visit for new patient with straightforward medical decision making, per day, if using time, at least 15 minutes	$40K	2%	$147	$9.86 (top 5% from $1K)	73rd percentile
99349	Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	$23K	1%	$173	$30 (top 5% from $115)	97th percentile

In this area

3 providers in Ulster County, NY carry an indicator in the public record, with $1.3M at stake between them. The most common is more hours than a day holds, on 2 of them, followed by part of a provider network on 1.

tier	provider	at stake	why
3	NCRNC LLC Lake Katrine, NY, ranked 3638	$0	Part of provider network D1-00091, ranked 91 nationally.
5	DEENA BLOOM Kingston, NY, ranked 9848	$934K	Medicaid dollars per patient on code 90837 ($491 per patient-month) sit in the top 5% of every provider billing that code. 92% of Medicaid dollars are on codes with a history of abuse.
5	RICCARDO ESPOSITO Kingston, NY, ranked 10302	$412K	Medicaid dollars per patient on code 99232 ($268 per patient-month) sit in the top 5% of every provider billing that code.

Recent enforcement in NY

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJIndictedAug 20, 2026

Four Members Of The “War Room” Charged In Connection With $12 Million Medicaid Fraud Scheme

Members of a Bronx-based racketeering organization known as the "War Room" fabricated ride data for methadone clinic transportation using a GPS spoofing application, paid Medicaid patients kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in claims to Medicaid, and laundered the proceeds.

DOJIndictedAug 20, 2026

Four Members of the “War Room” Charged in Connection with $12M Medicaid Fraud Scheme

Four members of a Bronx racketeering organization known as the "War Room" fabricated medical transportation ride data using a ride-tracking app and GPS spoofing, paid Medicaid patients at methadone clinics kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in Medicaid claims, and laundered the proceeds.

DOJCivil settlementAug 17, 2026

Safire nursing homes agree to pay $9 million to resolve fraudulent Medicare and Medicaid billing allegations

The United States alleged that Safire submitted false claims to Medicare and Medicaid for skilled rehabilitative therapy services that were not reasonable or necessary, not supported by medical records, not documented as provided, or not provided at all, including by scheduling therapy based on insurer reimbursement policies, pressuring therapists and residents, and manufacturing or altering therapy referrals and medical records.

DOJSentencedJul 21, 2026

Owner of Long Island Ambulette Services Company Sentenced to Prison for Multimillion Dollar Healthcare Fraud Scheme

Arshad and co-conspirators paid kickbacks to Medicaid beneficiaries to order transportation through his companies and billed Medicaid over $19 million for medical transportation rides that were not provided, including for individuals who were deceased, hospitalized or incarcerated, and inflated reimbursements with false pickup addresses and distant treatment centers.

DOJIndictedJul 2, 2026

Two Defendants Charged with Multi-Million Dollar Health Care Fraud Scheme

The defendants, who owned and operated Tri-Hamlet Taxi Inc., allegedly paid kickbacks to Medicaid beneficiaries and submitted more than $35 million in claims to Medicaid for ambulette trips that were not provided or whose costs were inflated by using false pickup or drop-off addresses.

Referral packet

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