Providers
DANIEL SUSSMAN, M.D.
NPI 1275575870, individual, Paducah, KY, Psychiatry & Neurology, Psychiatry
5
Evidence tier
informational
score 30 of 100, rank 11593, $124K at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | DANIEL SUSSMAN, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 11, 2006, last updated June 21, 2012 |
| Practice location | 1530 LONE OAK RD, Paducah, KY 42003-7901, 270-444-2481 |
| Mailing address | 181 MONT BLANC WAY, MT Charleston, NV 89124-9122 |
| Specialties | Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license 10116 NV) Psychiatry & Neurology, Psychiatry (2084P0800X, license 35565 KY) Psychiatry & Neurology, Addiction Psychiatry (2084P0802X, license 3148 AK) Psychiatry & Neurology, Addiction Psychiatry (2084P0802X, license 01055808A IN) (2084P0805X, license XS6928886 TN) |
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 | |
|---|---|---|---|---|---|---|---|
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | $98K | 16% | $39 | $30 (top 5% from $134) | 61st percentile | |
| 90876 | Psychophysiological therapy with biofeedback 45 min | $93K | 16% | $392 | $392 (top 5% from $816) | 51st percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $67K | 11% | $85 | $60 (top 5% from $133) | 74th percentile | |
| 99348 | Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes | $61K | 10% | $583 | $17 (top 5% from $105) | too few months to rank | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $30K | 5% | $163 | $96 (top 5% from $249) | 82nd percentile | |
| 97535 | Training for self-care or home management, each 15 minutes | $25K | 4% | $225 | $48 (top 5% from $459) | too few months to rank | |
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | $22K | 4% | $38 | $49 (top 5% from $109) | 35th percentile | |
| 95812 | Measurement of brain wave activity (eeg), 41-60 minutes | $19K | 3% | $265 | $69 (top 5% from $513) | too few months to rank |
Medicare Part B 2024, largest codes
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 95957 | Measurement of brain wave activity (eeg), digital analysis | 131 | 40 | $10K | $99 | $98 | 1.0x | 2.0x (90th percentile 3.7x) |
| 96158 | Treatment of behavior impacting health, initial 30 minutes | 24 | 12 | $836 | $44 | $44 | 1.0x | 3.4x (90th percentile 6.4x) |
| 93272 | Electrocardiogram (ecg) up to 30 days continuous with symptom monitoring, transmission and review and report by health care professional | 13 | 13 | $108 | $11 | $10 | 1.0x | 3.5x (90th percentile 7.1x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
7 providers in McCracken County, KY carry an indicator in the public record, with $9.1M at stake between them. The most common is more hours than a day holds, on 5 of them, followed by part of a provider network on 2.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | BAPTIST HEALTH HOME CARE KY LLC Paducah, KY, ranked 2409 | $0 |
|
| 3 | PROVIDENCE POINT HEALTHCARE, INC. Paducah, KY, ranked 5958 | $0 |
|
| 4 | LAURIE BALLEW Paducah, KY, ranked 7655 | $2.3M |
|
| 4 | SHELLY BAER Paducah, KY, ranked 8478 | $3.8M |
|
| 4 | GRETCHEN ROOF Paducah, KY, ranked 8664 | $2.3M |
|
| 4 | SAMANTHA JONES Paducah, KY, ranked 9288 | $387K |
|
| 4 | DEREK RATLIFF Paducah, KY, ranked 9317 | $349K |
|
Recent enforcement in KY
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedAug 27, 2026
Kentucky Medical Biller Indicted for Healthcare Fraud and Money Laundering Charges
Sanders recruited individuals to open behavioral health entities, handled their Kentucky Medicaid credentialing and enrollment, and directed submission of fraudulent Medicaid claims across ten behavioral health providers for services never provided, including for incarcerated, hospitalized, or deceased members, using licensed professionals' NPIs without authorization.
DOJChargedJun 23, 2026
5 Individuals and 2 Companies Charged as Part of Department of Justice National Health Care Fraud Takedown
Seven defendants were charged in four cases with schemes including billing Kentucky Medicaid for peer support and psychoeducation services that were fraudulent, unauthorized, or not rendered using providers' NPIs, using a DEA number to order controlled substances in others' names, credentialing a company with Medicare and billing for services not rendered using a doctor's NPI, and stealing controlled substances from hospitals and falsely documenting administration.
DOJCivil settlementJun 23, 2026
Civil Settlements Reached as Part of Department of Justice National Health Care Fraud Takedown
Three Home and Community Based Waiver providers and their owners, who had shared financial interests, referred Medicaid waiver beneficiaries for attendant care services and billed Medicaid for attendant care hours that were not fully provided or not provided at all.
DOJCivil judgmentMay 15, 2026
Operators of Day Treatment Program for Children Agree to $15.2 Million Civil Judgment to Resolve Medicaid Fraud Allegations
The Government alleged that from August 2022 through June 2025 the Recovery Centers sought Medicaid payments for time children spent on education, recreation, and lunch breaks at the Aspire Day Program and that Recovery Center of Kentucky falsely represented clinician qualifications to obtain higher reimbursements.
DOJSentencedApr 24, 2026
Former Sober Home Owner and Operator Sentenced for Kickback Conspiracy and Health Care Fraud
Jordan solicited and received kickbacks in exchange for referring urine drug testing from her sober home company to three labs, and Serenity Keepers billed Medicaid for peer support services not provided by licensed peer support specialists, with Williams reporting that residents received six hours of peer support services per day knowing that was not true.
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.