Providers

VILLALBA MEDICAL TRANSPORT LLC

NPI 1447921648, organization, Juana Diaz, PR, Ambulance, Land Transport

1
Evidence tier
documented action, then payment
  • Listed on the Medicare revocation list since November 2, 2023.
  • Medicaid still paid claims in 1 later month, $909 in total.
score 93 of 100, rank 401, $909 at stake

Public list actions

Medicare revocation effective November 2, 2023, barred from re-enrolling until April 26, 2027
424.535(a)(5) on-site review and 424.535(a)(9) failure to report, Part B Supplier - Ambulance Service Supplier, PR

Paid after the action

Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.

listidentity checkaction datewindow closedmonths paid afterfirstlastpaid after12 months before
Medicare revocation list
424.535(a)(5) on-site review and 424.535(a)(9) failure to report
Exact NPI, name verifiedNov 2, 2023Apr 26, 20271Dec 2023Dec 2023$909$9K

National provider registry

From the CMS NPPES Registry, refreshed daily.

NameVILLALBA MEDICAL TRANSPORT LLC
TypeOrganization
StatusActive
NPI issuedSeptember 27, 2021, last updated September 20, 2023
Practice locationCARR 14 KM 13.2 URB ORTA LOCAL NUM 5, Juana Diaz, PR 00795-0079, 787-210-1400
Mailing addressURB LA VEGA, CALLE B 139, Villalba, PR 00766
Authorized officialKelvin Lora (President)
Specialties
Ambulance, Land Transport (3416L0300X, primary)

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
codewhat it ispaidshareper patient-monthtypicalrank among providers
A0429Ambulance service, basic life support, emergency transport (bls-emergency)$41K81%$233$168 (top 5% from $686)75th percentile
A0425Ground mileage, per statute mile$10K19%$46$33 (top 5% from $223)61st percentile

In this area

81 providers in PR carry an indicator in the public record, with $52.8M at stake between them. The most common is more hours than a day holds, on 71 of them, followed by part of a provider network on 5. 5 are tier 1: documented action, then payment.

tierproviderat stakewhy
1MELVIN MATHEWS BERMUDEZ
Manati, PR, ranked 119
$166K
  • Listed on the Medicare revocation list since January 22, 2020.
  • Medicaid still paid claims in 32 later months, $165,501 in total.
1PHYSICIAN H.M.O. INC.
San Juan, PR, ranked 158
$81K
  • Adjudicated (pleaded guilty) per a Department of Justice release dated July 17, 2025.
  • Medicaid paid $81,097 in the last 12 observed months.
1DIANA GALLARDO
Caguas, PR, ranked 321
$5K
  • Listed on the OIG exclusion list and the Medicare revocation list since July 9, 2021.
  • Medicaid still paid claims in 8 later months, $5,215 in total.
1PHYSICIAN HMO INC.
San Juan, PR, ranked 408
$680
  • Adjudicated (pleaded guilty) per a Department of Justice release dated July 17, 2025.
  • Medicaid paid $680 in the last 12 observed months.
1PHYSICIAN HMO INC.
Rio Piedras, PR, ranked 460
$0
  • Adjudicated (pleaded guilty) per a Department of Justice release dated July 17, 2025.
  • No Medicaid payments in the last 12 observed months.
2YAMIR GARCIA SEGARRA
Caguas, PR, ranked 696
$1.9M
  • Billed more hands-on hours than a day holds in 3 months, peaking at 22.2 hours per day across 3 billing organizations.
  • Medicaid dollars per patient on code 92526 ($630 per patient-month) sit in the top 5% of every provider billing that code.
3CMS HOME CARE NORTE, LLC
Hatillo, PR, ranked 3502
$0
  • Part of provider network D1-00068, ranked 68 nationally.
3CMS HOME CARE OESTE, LLC.
Mayaguez, PR, ranked 3559
$0
  • Part of provider network D1-00068, ranked 68 nationally.
All 81 in PR

Recent enforcement in PR

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJIndictedJun 23, 2026
2026 National Health Care Fraud Takedown
Four defendants were charged in two schemes, one involving the advertising, sale, and distribution of Semaglutide, Mounjaro, steroids, and Tirzepatide that defendants were not authorized to possess and distribute, and the other involving performing dental procedures on patients without a valid dental license and misbranding of devices.
DOJCivil settlementJun 4, 2026
Puerto Rico Pharmacies Agree to Pay $4.6 Million to Federal Authorities in Medicare and Medicaid Fraud Cases
Four pharmacies and their owners agreed to pay $4.6 million to resolve allegations that between January 2021 and January 2024 they billed Medicare and Medicaid for diverted prescriptions sold to patients that had been misrepresented as properly sourced despite unverifiable origins.
DOJPleaded guiltyJul 17, 2025
Physician Assistant who Pretended to be a Licensed Physician Pleads Guilty to Making False Statements to an Agency of the United States
Villalobos-Meléndez, a licensed physician assistant who was never licensed to practice medicine, forged medical license and USMLE documents, worked as a physician in a hospital internship program, and submitted false license information on a CMS-855I form seeking enrollment as a Medicare physician provider with benefits reassigned to Physician HMO.
DOJCivil settlementDec 23, 2024
MMM Holdings, LLC Agrees to Pay 15.2 Million Dollars to Resolve Allegations that it Violated the False Claims Act and Anti-Kickback Statute
MMM Holdings distributed gift cards to administrative assistants of providers to induce the referral, recommendation, or arrangement for enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan and submitted or caused claims for payment to Medicare.
DOJIndictedSep 25, 2024
27 Individuals Indicted for Buying and Selling Wholesale Quantities of Misbranded and Diverted Prescription Drugs Resold to the Public Through Retail Pharmacies in Puerto Rico
Defendants engaged in unlicensed wholesale distribution of misbranded and diverted prescription drugs sold to pharmacy owners and employees who resold them to customers and billed health care benefit plans as if the drugs were authentic and obtained through licensed distribution channels.

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.

Ask this case

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