ANTONIA I NIEVES SANCHEZ, PsyD
NPI 1467509521, individual, Ponce, PR, Psychologist, Clinical
- Hours beyond a day in 1 month, but with up to 104 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- 76% of Medicaid dollars are on codes with a history of abuse.
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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2024 | More hours than a day holds at a conservative unit price | 4.0 | 39.3 | 26.2 | 35.3 | 101 | 1 | 90837 | $17K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ANTONIA I NIEVES SANCHEZ, PsyD |
| Type | Individual |
| Status | Active |
| NPI issued | January 4, 2007, last updated March 26, 2024 |
| Practice location | 396 CALLE DR LUIS F. SALAS, URB IND REPARADA 2, Ponce, PR 00717, 787-840-2575 |
| Mailing address | PO BOX 7004, Ponce, PR 00732-7004 |
| Specialties | Psychologist, Clinical (103TC0700X, primary, license 2344 PR) |
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 | |
|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hourhistory of abuse | $254K | 76% | $136 | $191 (top 5% from $442) | 25th percentile | |
| 98968 | Telephone medical discussion provided by nonphysician professional, 21-30 minutes | $68K | 21% | $70 | $38 (top 5% from $253) | 73rd percentile | |
| 90834 | Psychotherapy, 45 minutes | $7K | 2% | $42 | $101 (top 5% from $318) | 17th percentile | |
| 90832 | Psychotherapy, 30 minutes | $3K | 1% | $56 | $59 (top 5% from $239) | too few months to rank | |
| 96127 | Assessment of emotional or behavioral problems | $80 | 0% | $0.33 | $4.12 (top 5% from $19) | 17th percentile |
In this area
8 providers in Ponce Municipio County, PR carry an indicator in the public record, with $9.1M at stake between them. The most common is more hours than a day holds, on 7 of them, followed by part of a provider network on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | CMS HOME CARE SUR, LLC. Ponce, PR, ranked 5147 | $0 |
|
| 4 | DAISY COSTAS VARGAS Ponce, PR, ranked 8326 | $7.7M |
|
| 4 | SHAIRA LOPEZ ACEVEDO Ponce, PR, ranked 9129 | $634K |
|
| 4 | NATALIA DIEPPA LOPEZ DE VICTORIA Ponce, PR, ranked 9530 | $138K |
|
| 5 | JOSE RAMIREZ-MARTINEZ Coto Laurel, PR, ranked 10328 | $358K |
|
| 5 | JOMAYRA NEGRON BANKS Ponce, PR, ranked 10706 | $40K |
|
| 5 | AXEL REYES VAZQUEZ Ponce, PR, ranked 10752 | $27K |
|
| 5 | LUIS LOPEZ DEL POZO Ponce, PR, ranked 11476 | $191K |
Recent enforcement in PR
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.