WALDEMAR ALBERTO CARLO, M.D.
NPI 1225072770, individual, Birmingham, AL, Pediatrics, Neonatal-Perinatal Medicine
- Hours beyond a day in 1 month, but with up to 134 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 ($732 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 |
|---|---|---|---|---|---|---|---|---|---|
| Feb 2024 | More hours than a day holds at a conservative unit price | 19.7 | 42.0 | 28.0 | 38.6 | 125 | 1 | 99233 99238 | $96K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | WALDEMAR ALBERTO CARLO, M.D. (also WALLY CARLO) |
| Type | Individual |
| Status | Active |
| NPI issued | June 15, 2006, last updated March 16, 2022 |
| Practice location | 1700 6TH AVE S STE 9380, Birmingham, AL 35233-1802, 205-934-4680 |
| Specialties | Pediatrics, Neonatal-Perinatal Medicine (2080N0001X, primary, license 15593 AL) |
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 | |
|---|---|---|---|---|---|---|---|
| 99472 | Medicaid service code | $3.1M | 33% | $3K | $1K (top 5% from $3K) | 94th percentile | |
| 99479 | Medicaid service code | $2.1M | 22% | $732 | $347 (top 5% from $691) | 96th percentile | |
| 99469 | Medicaid service code | $2.0M | 21% | $2K | $1K (top 5% from $2K) | 91st percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $1.4M | 14% | $603 | $96 (top 5% from $249) | 100th percentile | |
| 99468 | Medicaid service code | $444K | 5% | $1K | $815 (top 5% from $1K) | 94th percentile | |
| 99478 | Medicaid service code | $271K | 3% | $729 | too few months to rank | ||
| 99238 | Hospital discharge day management, 30 minutes or less | $117K | 1% | $112 | $48 (top 5% from $80) | 99th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $80K | 1% | $282 | $81 (top 5% from $170) | 99th percentile |
In this area
19 providers in Jefferson County, AL carry an indicator in the public record, with $18.0M at stake between them. The most common is more hours than a day holds, on 18 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 | CARE COMPLETE MEDICAL CLINIC(CCMC)LLC Birmingham, AL, ranked 313 | $6K |
|
| 4 | PATRICK TAPIA Birmingham, AL, ranked 7745 | $1.5M |
|
| 4 | SONYA PRITCHARD Birmingham, AL, ranked 7800 | $1.2M |
|
| 4 | LINDY WINTER Birmingham, AL, ranked 7822 | $1.1M |
|
| 4 | JOSEPH PHILIPS Birmingham, AL, ranked 7901 | $673K |
|
| 4 | JEGEN KANDASAMY Birmingham, AL, ranked 7937 | $505K |
|
| 4 | CHARITHARTH LAL Birmingham, AL, ranked 7945 | $485K |
|
| 4 | JESSE MARTINEZ Birmingham, AL, ranked 8012 | $243K |
|
Recent enforcement in AL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
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.