Providers
ANTHONY PIROUZ, PA-C
NPI 1366833923, individual, Fortuna, CA, Physician Assistant
5
Evidence tier
informational
- Medicaid dollars per patient on code 99213 ($140 per patient-month) sit in the top 5% of every provider billing that code.
score 34 of 100, rank 10415, $157K at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ANTHONY PIROUZ, PA-C |
| Type | Individual |
| Status | Active |
| NPI issued | February 17, 2015, last updated September 2, 2026 |
| Practice location | 930 S FORTUNA BLVD, Fortuna, CA 95540-3009, 707-923-2783 |
| Mailing address | PO BOX 769, Redway, CA 95560-0769 |
| Specialties | Physician Assistant (363A00000X, primary, license 52315 CA) Physician Assistant (363A00000X, license PA-1963 ID) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $137K | 46% | $140 | $44 (top 5% from $110) | 97th percentile | |
| T1015 | Medicaid service code | $91K | 31% | $176 | $182 (top 5% from $488) | 47th percentile | |
| 99205 | New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | $28K | 9% | $263 | $128 (top 5% from $249) | 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 | $21K | 7% | $58 | $60 (top 5% from $133) | 47th percentile | |
| T1014 | Medicaid service code | $10K | 3% | $8.36 | $14 (top 5% from $123) | 35th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $8K | 3% | $88 | $28 (top 5% from $147) | too few months to rank | |
| 90686 | Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage | $267 | 0% | $18 | $2.30 (top 5% from $20) | too few months to rank |
In this area
4 providers in Humboldt County, CA carry an indicator in the public record, with $6.6M at stake between them. The most common is more hours than a day holds, on 4 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | CAROL GRIFFIN Arcata, CA, ranked 7727 | $1.7M |
|
| 4 | MARISSA KUMMERLING Eureka, CA, ranked 8670 | $2.3M |
|
| 4 | MALIA HONDA Eureka, CA, ranked 8732 | $2.0M |
|
| 5 | ELIZABETH MICKS Arcata, CA, ranked 10197 | $669K |
|
Recent enforcement in CA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJPleaded guiltyAug 27, 2026
Anaheim Woman Pleads Guilty to Submitting More Than $2.2 Million in Fraudulent Hospice Care Claims to Medicare
Galbraith submitted approximately $2,266,694 in claims to Medicare for hospice services for beneficiaries who did not have a terminal illness with a life expectancy of six months or less, and Medicare paid her company approximately $2,140,606.
DOJCivil settlementAug 26, 2026
DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests
DermTech Inc. submitted claims to Medicare for skin cancer tests conducted with an unvalidated positive control range and for tests lacking sufficient patient RNA, and did not retract results or adequately refund Medicare.
DOJCivil settlementAug 26, 2026
DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests
DermTech Inc. billed Medicare for skin cancer tests conducted using an unvalidated positive control range and for tests with insufficient patient RNA, and did not retract the results or adequately refund Medicare.
DOJCivil settlementAug 24, 2026
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit
Monogram knowingly submitted diagnosis codes in four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to Medicare Advantage Organizations.
DOJCivil settlementAug 24, 2026
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4M to Settle False Claims Act Suit
Monogram Health knowingly submitted diagnosis codes within four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to MAOs.
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.