Providers
All 59 in KY
JOHN PAUL SULLIVAN, M.D.
NPI 1356355531, individual, Louisville, KY, Psychiatry & Neurology, Child & Adolescent Psychiatry
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 10 months, but with up to 561 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 99232 ($265 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7709, $1.8M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Feb 2018 | More hours than a day holds, even counting one unit per claim line | 29.5 | 40.4 | 26.9 | 37.7 | 482 | 1 | 90792 90834 90837 99213 99214 99221 99232 99238 | $50K |
| Mar 2018 | More hours than a day holds, even counting one unit per claim line | 29.6 | 40.9 | 27.3 | 38.5 | 542 | 1 | 90791 90792 90834 90837 99213 99214 99221 99232 99238 | $56K |
| Apr 2018 | More hours than a day holds, even counting one unit per claim line | 34.5 | 45.4 | 30.3 | 43.2 | 561 | 1 | 90792 90834 90837 99213 99214 99221 99231 99232 99238 | $59K |
| May 2018 | More hours than a day holds, even counting one unit per claim line | 35.6 | 48.8 | 32.5 | 43.8 | 555 | 1 | 90791 90792 90834 90837 99213 99214 99221 99232 99238 | $66K |
| Jun 2018 | More hours than a day holds, even counting one unit per claim line | 26.8 | 38.1 | 25.4 | 36.3 | 483 | 1 | 90792 90834 90837 99213 99214 99221 99232 99238 | $52K |
| Jul 2018 | More hours than a day holds, even counting one unit per claim line | 25.9 | 30.9 | 20.6 | 29.0 | 457 | 1 | 90792 90832 90834 90837 99214 99221 99232 99238 | $45K |
| Sep 2018 | More hours than a day holds, even counting one unit per claim line | 24.1 | 41.3 | 27.5 | 41.3 | 534 | 1 | 90792 90837 99213 99214 99221 99231 99232 99238 | $55K |
| Oct 2018 | More hours than a day holds at a conservative unit price | 23.2 | 38.1 | 25.4 | 34.2 | 495 | 1 | 90792 90837 99213 99214 99221 99232 99238 | $53K |
| Nov 2018 | More hours than a day holds at a conservative unit price | 20.6 | 36.4 | 24.2 | 33.1 | 446 | 1 | 90792 90837 99213 99214 99221 99232 99238 | $48K |
| Jan 2019 | More hours than a day holds at a conservative unit price | 23.9 | 37.4 | 24.9 | 33.6 | 485 | 1 | 90837 99213 99214 99221 99231 99232 99238 | $53K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JOHN PAUL SULLIVAN, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 27, 2006, last updated January 9, 2020 |
| Practice location | 4011 GARDINER POINT DR STE 101, Louisville, KY 40213-1988, 502-451-5121 |
| Specialties | Psychiatry & Neurology, Child & Adolescent Psychiatry (2084P0804X, primary, license KY21704 KY) Psychiatry & Neurology, Psychiatry (2084P0800X, license KY21704 KY) |
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 | |
|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $2.0M | 70% | $265 | $67 (top 5% from $174) | 99th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $446K | 15% | $63 | $60 (top 5% from $133) | 53rd percentile | |
| 99238 | Hospital discharge day management, 30 minutes or less | $87K | 3% | $52 | $48 (top 5% from $80) | 57th percentile | |
| 90837 | Psychotherapy, 1 hourhistory of abuse | $86K | 3% | $115 | $191 (top 5% from $442) | 17th percentile | |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | $71K | 2% | $52 | $50 (top 5% from $194) | 52nd percentile | |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | $52K | 2% | $40 | $37 (top 5% from $103) | 54th percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $50K | 2% | $79 | $63 (top 5% from $137) | 67th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $39K | 1% | $44 | $44 (top 5% from $110) | 51st percentile |
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 |
|---|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 63 | 14 | $4K | $150 | $99 | 1.5x | 2.3x (90th percentile 3.8x) |
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
59 providers in Jefferson County, KY carry an indicator in the public record, with $99.3M at stake between them. The most common is more hours than a day holds, on 45 of them, followed by paid after a public list action on 6. 4 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | MAJA CUPAC Louisville, KY, ranked 65 | $9K |
|
| 1 | BAKER CHIROPRACTIC CENTER PSC Louisville, KY, ranked 139 | $119K |
|
| 1 | MICHAEL BAKER Louisville, KY, ranked 140 | $119K |
|
| 1 | JORDAN EDELEN Louisville, KY, ranked 261 | $14K |
|
| 3 | CHRISTIAN BERKHAHN Louisville, KY, ranked 1301 | $161K |
|
| 3 | LAWRENCE PETERS Louisville, KY, ranked 1509 | $16K |
|
| 3 | MATTHEW ELKINS Louisville, KY, ranked 1571 | $7K |
|
| 3 | LOUISVILLE KY OPCO LLC Louisville, KY, ranked 1885 | $0 |
|
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.