Providers
All 44 in NY
JOSE RUIZ, PMHNP,RN, LMSW
NPI 1265733455, individual, New York, NY, Nurse Practitioner, Psych/Mental Health
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 7 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99215 ($434 per patient-month) sit in the top 5% of every provider billing that code.
- 65% of Medicaid dollars are on codes with a history of abuse.
score 57 of 100, rank 7330, $832K 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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2024 | More hours than a day holds, even counting one unit per claim line | 28.3 | 25.1 | 16.7 | 22.6 | 266 | 2 | 90836 99215 | $87K |
| Jun 2024 | More hours than a day holds, even counting one unit per claim line | 31.6 | 29.7 | 19.8 | 29.7 | 269 | 1 | 90836 99213 99215 | $99K |
| Jul 2024 | More hours than a day holds, even counting one unit per claim line | 28.6 | 27.3 | 18.2 | 24.5 | 307 | 1 | 90836 99213 99215 | $94K |
| Aug 2024 | More hours than a day holds, even counting one unit per claim line | 29.9 | 28.3 | 18.9 | 26.6 | 291 | 1 | 90833 90836 99213 99215 | $98K |
| Sep 2024 | More hours than a day holds, even counting one unit per claim line | 36.1 | 34.3 | 22.9 | 32.7 | 295 | 1 | 90833 90836 99215 | $115K |
| Oct 2024 | More hours than a day holds, even counting one unit per claim line | 32.5 | 30.6 | 20.4 | 27.5 | 321 | 1 | 90833 90836 99215 | $107K |
| Nov 2024 | More hours than a day holds, even counting one unit per claim line | 35.8 | 33.8 | 22.5 | 32.2 | 308 | 1 | 90833 90836 99215 | $115K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JOSE RUIZ, PMHNP,RN, LMSW |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | November 4, 2010, last updated March 28, 2021 |
| Practice location | 132 THOMPSON ST, APT-25, New York, NY 10012-5308, 212-844-9259 |
| Specialties | Social Worker (104100000X, license 11089101 NY) Registered Nurse (163W00000X, license 22-542744 NY) Nurse Practitioner, Psych/Mental Health (363LP0808X, primary, license F400966-01 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 | |
|---|---|---|---|---|---|---|---|
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or morehistory of abuse | $800K | 65% | $434 | $88 (top 5% from $210) | 98th percentile | |
| 90836 | Psychotherapy with evaluation and management visit, 45 minutes | $350K | 29% | $222 | $72 (top 5% from $190) | 97th percentile | |
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | $32K | 3% | $111 | $49 (top 5% from $109) | too few months to rank | |
| 90838 | Psychotherapy with evaluation and management visit, 1 hour | $15K | 1% | $239 | $87 (top 5% from $222) | too few months to rank | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $14K | 1% | $166 | $60 (top 5% from $133) | 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 | $12K | 1% | $129 | $44 (top 5% from $110) | too few months to rank |
In this area
44 providers in New York County, NY carry an indicator in the public record, with $152.7M at stake between them. The most common is more hours than a day holds, on 36 of them, followed by named in an enforcement record on 6. 6 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | BLUE MEDICAL SERVICES, P.C. New York, NY, ranked 171 | $62K |
|
| 1 | ROMAN JOHNSON New York, NY, ranked 437 | $194 |
|
| 1 | E-GREEN PHARMACY INC New York, NY, ranked 471 | $0 |
|
| 1 | BROADWAY RX ENTERPRISES INC New York, NY, ranked 477 | $0 |
|
| 1 | HARLEM SUPER PHARMACY INC New York, NY, ranked 485 | $0 |
|
| 1 | CLEARMD New York, NY, ranked 554 | $0 |
|
| 3 | HARLEM EYE CARE, INC New York, NY, ranked 955 | $2.6M |
|
| 3 | ALI RASHAN New York, NY, ranked 5078 | $0 |
|
Recent enforcement in NY
All releasesDepartment 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
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.