Providers
JAMES FREDERICK GUENTHER, D.O.
NPI 1417933490, individual, Lancaster, OH, Internal Medicine, Addiction Medicine
5
Evidence tier
informational
- Medicaid dollars per patient on code 99204 ($186 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 9931, $2.7M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JAMES FREDERICK GUENTHER, D.O. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | December 21, 2005, last updated August 4, 2023 |
| Practice location | 1319 E MAIN ST, Lancaster, OH 43130-4005, 740-653-9411 |
| Mailing address | 4600 MONTGOMERY RD STE 400, Cincinnati, OH 45212-2600 |
| Specialties | Obstetrics & Gynecology (207V00000X, license 34.004690 OH) Internal Medicine, Addiction Medicine (207RA0401X, primary, license 34.004690 OH) |
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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $3.1M | 51% | $152 | $60 (top 5% from $133) | 97th percentile | |
| 80307 | Testing for presence of drug, by chemistry analyzers | $523K | 9% | $73 | $45 (top 5% from $110) | 82nd percentile | |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms | $420K | 7% | $166 | $146 (top 5% from $318) | 60th percentile | |
| S5000 | Medicaid service code | $327K | 5% | $351 | $178 (top 5% from $615) | 77th percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $324K | 5% | $186 | $95 (top 5% from $171) | 97th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $269K | 4% | $116 | $44 (top 5% from $110) | 96th percentile | |
| T1502 | Medicaid service code | $194K | 3% | $242 | $89 (top 5% from $1K) | too few months to rank | |
| 99406 | Smoking and tobacco use intensive counseling, 4-10 minutes | $167K | 3% | $12 | $7.24 (top 5% from $18) | 80th 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 | 21 | 12 | $1K | $163 | $98 | 1.7x | 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
4 providers in Fairfield County, OH carry an indicator in the public record, with $2.1M at stake between them. The most common is part of a provider network, on 2 of them, followed by more hours than a day holds on 2.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | ANTIMA HOME HEALTH CARE LLC Pickerington, OH, ranked 3182 | $0 |
|
| 3 | CV OPERATING LLC Lancaster, OH, ranked 6755 | $0 |
|
| 4 | STEVEN COX Lancaster, OH, ranked 7726 | $1.7M |
|
| 4 | JUSTINE SIMPSON Lancaster, OH, ranked 9275 | $407K |
|
Recent enforcement in OH
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementJun 23, 2026
Ohio Dentist Agrees to Pay $500,000 to Resolve Allegations of Submitting False Claims to Medicaid
Meckler billed the Ohio Department of Medicaid for services provided by Ball, who was excluded from the Medicaid program, by listing Meckler as the rendering provider instead of Ball.
DOJSentencedJun 15, 2026
Ohio Doctor Ordered to Pay Nearly $1M for Facilitating Fraud on Medicare
A physician working as an independent contractor for a telemedicine company signed doctor's orders for durable medical equipment braces and genetic testing without meaningfully reviewing patient records or performing required in-person assessments, and those orders were used to bill Medicare more than $1,842,524.
DOJCivil settlementApr 2, 2026
Trinity Hospital Agrees to Pay $1.7M to Resolve Alleged Stark Law Violations
Trinity agreed to pay $1.7 million to resolve allegations that from 2014 through 2020 it made improper financial contributions to two referring physicians through office space rental arrangements that exceeded fair market value, in violation of the Stark Law.
DOJComplaint filedFeb 20, 2026
Justice Department Sues OhioHealth for Anticompetitive Healthcare Contracts That Increase Costs for Ohio Patients
The Justice Department and Ohio Attorney General filed a civil antitrust complaint alleging OhioHealth used its market power to impose contractual restrictions that prevent insurers from offering lower-cost health plans and limit access to price information.
DOJSentencedJan 14, 2026
Ohio Doctor Sentenced to Prison for $14M Healthcare Fraud Scheme
A licensed Ohio physician employed by two Florida telemedicine companies signed pre-completed orders for durable medical equipment and cancer genetic testing, falsely affirming he had examined the patients, causing more than $14.5 million in fraudulent Medicare claims.
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.