BENIGNO LOPEZ, MD

NPI 1215017819, individual, Caguas, PR, Orthopaedic Surgery

Evidence tier

informational

score 30 of 100, rank 11754, $49K at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	BENIGNO LOPEZ, MD (also BENIGNO LOPEZ)
Type	Individual, sole proprietor
Status	Active
NPI issued	October 17, 2006, last updated July 9, 2007
Practice location	EDIF. HIMA SAN PABLO CIRUGIA AMBULATORIA, CALLE MUNOZ RIVERA NUM. 1 FINAL OFIC. 203, Caguas, PR 00726, 787-744-4654
Mailing address	PO BOX 760, Caguas, PR 00726
Specialties	Orthopaedic Surgery (207X00000X, primary, license 4588 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.

Medicaid, largest codes

code	what it is	paid	share	per patient-month	typical	rank among providers
99204	New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$581K	40%	$102	$95 (top 5% from $171)	58th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$371K	25%	$69	$44 (top 5% from $110)	82nd percentile
97110	Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	$153K	10%	$147	$76 (top 5% from $314)	78th percentile
97032	Application of electrical stimulation with therapist present, each 15 minutes	$104K	7%	$100	$27 (top 5% from $109)	94th percentile
97035	Application of ultrasound, each 15 minutes	$104K	7%	$100	$21 (top 5% from $107)	94th percentile
29425	Application of walking cast covering below knee to toe	$30K	2%	$63		too few months to rank
29515	Application of short leg splint from calf to foot	$29K	2%	$64	$36 (top 5% from $192)	70th percentile
97010	Medicaid service code	$21K	1%	$39	$7.53 (top 5% from $79)	89th percentile

In this area

9 providers in Caguas, PR carry an indicator in the public record, with $8.7M at stake between them. The most common is more hours than a day holds, on 8 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	DIANA GALLARDO Caguas, PR, ranked 321	$5K	Listed on the OIG exclusion list and the Medicare revocation list since July 9, 2021. Medicaid still paid claims in 8 later months, $5,215 in total.
2	YAMIR GARCIA SEGARRA Caguas, PR, ranked 696	$1.9M	Billed more hands-on hours than a day holds in 3 months, peaking at 22.2 hours per day across 3 billing organizations. Medicaid dollars per patient on code 92526 ($630 per patient-month) sit in the top 5% of every provider billing that code.
4	FRANCISCO ALVARADO MELENDEZ Caguas, PR, ranked 8033	$198K	Hours beyond a day in 1 month under one organization, which can be supervisory billing. Records needed. and 1 more
4	NYDIA GONZALEZ LOPEZ Caguas, PR, ranked 8408	$5.1M	Hours beyond a day in 28 months, but with up to 641 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed.
5	LUIS JIMENEZ REYES Caguas, PR, ranked 10147	$809K	Medicaid dollars per patient on code 99232 ($276 per patient-month) sit in the top 5% of every provider billing that code.
5	ALWIN VARGAS Caguas, PR, ranked 10350	$279K	Medicaid dollars per patient on code 97140 ($121 per patient-month) sit in the top 5% of every provider billing that code.
5	JOSE PEREZ YORDAN Caguas, PR, ranked 10384	$212K	Medicaid dollars per patient on code 99214 ($179 per patient-month) sit in the top 5% of every provider billing that code.
5	LEONARDO PIRILLO Caguas, PR, ranked 10460	$94K	Medicaid dollars per patient on code 99223 ($253 per patient-month) sit in the top 5% of every provider billing that code.

All 9 in PR

Recent enforcement in PR

All releases

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

DOJIndictedJun 23, 2026

2026 National Health Care Fraud Takedown

Four defendants were charged in two schemes, one involving the advertising, sale, and distribution of Semaglutide, Mounjaro, steroids, and Tirzepatide that defendants were not authorized to possess and distribute, and the other involving performing dental procedures on patients without a valid dental license and misbranding of devices.

DOJCivil settlementJun 4, 2026

Puerto Rico Pharmacies Agree to Pay $4.6 Million to Federal Authorities in Medicare and Medicaid Fraud Cases

Four pharmacies and their owners agreed to pay $4.6 million to resolve allegations that between January 2021 and January 2024 they billed Medicare and Medicaid for diverted prescriptions sold to patients that had been misrepresented as properly sourced despite unverifiable origins.

DOJPleaded guiltyJul 17, 2025

Physician Assistant who Pretended to be a Licensed Physician Pleads Guilty to Making False Statements to an Agency of the United States

Villalobos-Meléndez, a licensed physician assistant who was never licensed to practice medicine, forged medical license and USMLE documents, worked as a physician in a hospital internship program, and submitted false license information on a CMS-855I form seeking enrollment as a Medicare physician provider with benefits reassigned to Physician HMO.

DOJCivil settlementDec 23, 2024

MMM Holdings, LLC Agrees to Pay 15.2 Million Dollars to Resolve Allegations that it Violated the False Claims Act and Anti-Kickback Statute

MMM Holdings distributed gift cards to administrative assistants of providers to induce the referral, recommendation, or arrangement for enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan and submitted or caused claims for payment to Medicare.

DOJIndictedSep 25, 2024

27 Individuals Indicted for Buying and Selling Wholesale Quantities of Misbranded and Diverted Prescription Drugs Resold to the Public Through Retail Pharmacies in Puerto Rico

Defendants engaged in unlicensed wholesale distribution of misbranded and diverted prescription drugs sold to pharmacy owners and employees who resold them to customers and billed health care benefit plans as if the drugs were authentic and obtained through licensed distribution channels.

Referral packet

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