JOHN M. DOWNES, M.D.
NPI 1407881774, individual, Little Rock, AR, Psychiatry & Neurology, Psychiatry
- Medicaid dollars per patient on code 90833 ($160 per patient-month) sit in the top 5% of every provider billing that code.
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JOHN M. DOWNES, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 12, 2006, last updated July 8, 2007 |
| Practice location | 600 S MCKINLEY ST STE 400, Little Rock, AR 72205-5222, 501-663-4673 |
| Mailing address | 62 CARMEL DR, Little Rock, AR 72212-4401 |
| Specialties | Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license C-5784 AR) |
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 | |
|---|---|---|---|---|---|---|---|
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | $754K | 41% | $160 | $49 (top 5% from $109) | 98th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $721K | 39% | $150 | $67 (top 5% from $174) | 92nd percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $359K | 20% | $126 | $81 (top 5% from $170) | 84th percentile | |
| 99238 | Hospital discharge day management, 30 minutes or less | $471 | 0% | $5.47 | $48 (top 5% from $80) | 2nd percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 197 | 48 | $11K | $120 | $72 | 1.7x | 2.6x (90th percentile 4.3x) |
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | 180 | 47 | $8K | $110 | $60 | 1.8x | 2.1x (90th percentile 3.5x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 27 | 26 | $3K | $275 | $158 | 1.7x | 3.0x (90th percentile 5.6x) |
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
8 providers in Pulaski County, AR carry an indicator in the public record, with $18.7M at stake between them. The most common is more hours than a day holds, on 6 of them, followed by named in an enforcement record on 2.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | KRAMEELAH BANKS Little Rock, AR, ranked 2462 | $0 |
|
| 3 | ARKANSAS BEHAVIORAL CENTER (ABC), LLC Little Rock, AR, ranked 5190 | $0 |
|
| 4 | CARL RIDDELL Little Rock, AR, ranked 7402 | $7.3M |
|
| 4 | NAVEEN PATIL Little Rock, AR, ranked 7428 | $5.9M |
|
| 4 | LAWRENCE LABBATE Little Rock, AR, ranked 7599 | $2.7M |
|
| 4 | BRIAN SIMPSON Little Rock, AR, ranked 7646 | $2.3M |
|
| 4 | SHANE SPARKS Little Rock, AR, ranked 7948 | $479K |
|
| 4 | NKECHI UGWUH-MOSS Little Rock, AR, ranked 9584 | $81K |
|
Recent enforcement in AR
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.