JOSEPH B PHILIPS, M.D.
NPI 1235175662, individual, Birmingham, AL, Pediatrics, Neonatal-Perinatal Medicine
- Hours beyond a day in 1 month, but with up to 116 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 ($3910 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 |
|---|---|---|---|---|---|---|---|---|---|
| Aug 2018 | More hours than a day holds at a conservative unit price | 10.1 | 36.1 | 24.1 | 32.4 | 116 | 1 | 99233 99238 | $54K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JOSEPH B PHILIPS, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 22, 2006, last updated July 8, 2007 |
| Practice location | 525 NHB, 619 SOUTH 19TH STREET, Birmingham, AL 35249-0001, 205-996-2244 |
| Mailing address | PO BOX 55823, Birmingham, AL 35255-5823 |
| Specialties | Pediatrics, Neonatal-Perinatal Medicine (2080N0001X, primary, license 9332 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 | $2.9M | 42% | $4K | $1K (top 5% from $3K) | 98th percentile | |
| 99469 | Medicaid service code | $1.7M | 24% | $2K | $1K (top 5% from $2K) | 97th percentile | |
| 99479 | Medicaid service code | $955K | 14% | $918 | $347 (top 5% from $691) | 98th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $688K | 10% | $664 | $96 (top 5% from $249) | 100th percentile | |
| 99468 | Medicaid service code | $454K | 6% | $1K | $815 (top 5% from $1K) | 96th percentile | |
| 99478 | Medicaid service code | $140K | 2% | $836 | too few months to rank | ||
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $92K | 1% | $295 | $81 (top 5% from $170) | 99th percentile | |
| 99238 | Hospital discharge day management, 30 minutes or less | $51K | 1% | $112 | $48 (top 5% from $80) | 99th percentile |
In this area
19 providers in Jefferson County, AL carry an indicator in the public record, with $18.5M 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 | WALDEMAR CARLO Birmingham, AL, ranked 7796 | $1.2M |
|
| 4 | SONYA PRITCHARD Birmingham, AL, ranked 7800 | $1.2M |
|
| 4 | LINDY WINTER Birmingham, AL, ranked 7822 | $1.1M |
|
| 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.