Providers
All 19 in AL
SONYA ELIZABETH PRITCHARD, M.D.
NPI 1518160506, individual, Birmingham, AL, 2084P0805X
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 6 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99233 ($654 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7800, $1.2M at stake
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 |
|---|---|---|---|---|---|---|---|---|---|
| Mar 2020 | More hours than a day holds at a conservative unit price | 17.5 | 42.6 | 28.4 | 40.0 | 88 | 1 | 99223 99233 99239 | $58K |
| May 2020 | More hours than a day holds at a conservative unit price | 11.9 | 37.1 | 24.7 | 36.5 | 88 | 1 | 99223 99233 99239 | $51K |
| Oct 2020 | More hours than a day holds at a conservative unit price | 12.6 | 36.8 | 24.6 | 34.6 | 97 | 1 | 99223 99233 | $50K |
| Dec 2020 | More hours than a day holds at a conservative unit price | 15.0 | 37.9 | 25.3 | 34.1 | 74 | 1 | 99223 99233 | $51K |
| Jun 2021 | More hours than a day holds at a conservative unit price | 13.5 | 40.7 | 27.2 | 37.0 | 96 | 1 | 99223 99233 99239 | $61K |
| Jul 2021 | More hours than a day holds at a conservative unit price | 12.7 | 36.9 | 24.6 | 34.7 | 95 | 1 | 99223 99233 99239 | $57K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SONYA ELIZABETH PRITCHARD, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 7, 2007, last updated July 8, 2007 |
| Practice location | 619 19TH ST S, Birmingham, AL 35249-1900, 205-934-5038 |
| Specialties | (2084P0805X, primary, license 26032 AL) |
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 | |
|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $966K | 49% | $654 | $96 (top 5% from $249) | 100th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $595K | 30% | $155 | $60 (top 5% from $133) | 97th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $124K | 6% | $310 | $81 (top 5% from $170) | 100th percentile | |
| 90792 | Psychiatric diagnostic evaluation with medical services | $103K | 5% | $196 | $112 (top 5% from $313) | 85th percentile | |
| 99205 | New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | $60K | 3% | $221 | $128 (top 5% from $249) | 90th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $56K | 3% | $106 | $67 (top 5% from $174) | 79th percentile | |
| 99239 | Hospital discharge day management, more than 30 minutes | $26K | 1% | $157 | $49 (top 5% from $101) | 99th percentile | |
| 99245 | Medicaid service code | $15K | 1% | $324 | $153 (top 5% from $281) | too few months to rank |
In this area
19 providers in Jefferson County, AL carry an indicator in the public record, with $18.0M at stake between them. The most common is more hours than a day holds, on 18 of them, followed by paid after a public list action on 1. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | CARE COMPLETE MEDICAL CLINIC(CCMC)LLC Birmingham, AL, ranked 313 | $6K |
|
| 4 | PATRICK TAPIA Birmingham, AL, ranked 7745 | $1.5M |
|
| 4 | WALDEMAR CARLO Birmingham, AL, ranked 7796 | $1.2M |
|
| 4 | LINDY WINTER Birmingham, AL, ranked 7822 | $1.1M |
|
| 4 | JOSEPH PHILIPS Birmingham, AL, ranked 7901 | $673K |
|
| 4 | JEGEN KANDASAMY Birmingham, AL, ranked 7937 | $505K |
|
| 4 | CHARITHARTH LAL Birmingham, AL, ranked 7945 | $485K |
|
| 4 | JESSE MARTINEZ Birmingham, AL, ranked 8012 | $243K |
|
Recent enforcement in AL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementJun 23, 2026
Alabama Provider Pays $300,000 to Resolve False Claims as Part of 2026 National Health Care Fraud Takedown
A Phenix City-based provider billed Alabama Medicaid for Basic Living Skills services for at-risk children that were not actually rendered.
DOJSentencedApr 2, 2026
Former Medicaid Provider Sentenced to Federal Prison for Health Care Fraud and Aggravated Identity Theft
Pulliam, a child and family therapist enrolled as an Alabama Medicaid provider, submitted claims for counseling services that were never provided using beneficiaries' identifying information without consent.
DOJCivil judgmentMar 19, 2026
Mississippi Man Ordered to Pay $31 Million for Role in Healthcare Kickback Scheme
Crites and others referred patients, primarily TRICARE beneficiaries, to Cloverland Pharmacy in exchange for kickbacks paid by the pharmacy for each referral.
DOJCivil settlementFeb 21, 2025
Saad Healthcare Agrees to Pay $3M to Settle False Claims Act Allegations That It Billed Medicare for Ineligible Hospice Patients
Saad submitted, or caused the submission of, false claims to Medicare between 2013 and 2020 for 21 hospice patients who were not terminally ill and thus ineligible for the Medicare hospice benefit.
DOJCivil settlementFeb 21, 2025
Saad Healthcare Agrees to Pay $3M to Settle False Claims Act Allegations That It Billed Medicare for Ineligible Hospice Patients
Saad Healthcare submitted, or caused the submission of, false claims to Medicare between 2013 and 2020 for 21 hospice patients who were not terminally ill and were ineligible for the Medicare hospice benefit.
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.