JESSE MARTINEZ
NPI 1518257575, individual, Birmingham, AL, Psychiatry & Neurology, Child & Adolescent Psychiatry
- Hours beyond a day in 1 month, but with up to 149 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99232 ($317 per patient-month) sit in the top 5% of every provider billing that code.
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 |
|---|---|---|---|---|---|---|---|---|---|
| Sep 2019 | More hours than a day holds at a conservative unit price | 8.6 | 36.3 | 24.2 | 34.6 | 149 | 1 | 99223 99231 99232 99238 | $48K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JESSE MARTINEZ |
| Type | Individual |
| Status | Active |
| NPI issued | April 12, 2011, last updated June 29, 2023 |
| Practice location | 1717 6TH AVE S, Birmingham, AL 35233-1801, 800-822-8816 |
| Specialties | Psychiatry & Neurology, Child & Adolescent Psychiatry (2084P0804X, primary, license 32129 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.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 99245 | Medicaid service code | $1.6M | 59% | $317 | $153 (top 5% from $281) | 98th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $381K | 14% | $245 | $67 (top 5% from $174) | 98th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $142K | 5% | $275 | $96 (top 5% from $249) | 96th percentile | |
| 99255 | Medicaid service code | $136K | 5% | $293 | $106 (top 5% from $213) | 97th percentile | |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or morehistory of abuse | $131K | 5% | $176 | $88 (top 5% from $210) | 91st percentile | |
| 99244 | Medicaid service code | $128K | 5% | $245 | $128 (top 5% from $223) | 97th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $58K | 2% | $295 | $81 (top 5% from $170) | 99th percentile | |
| 99285 | Emergency department visit with high level of medical decision making | $53K | 2% | $402 | $100 (top 5% from $264) | too few months to rank |
| 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 | 43 | 25 | $2K | $210 | $72 | 2.9x | 2.6x (90th percentile 4.3x) |
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
19 providers in Jefferson County, AL carry an indicator in the public record, with $19.0M 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 | SONYA PRITCHARD Birmingham, AL, ranked 7800 | $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 |
|
Recent enforcement in AL
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.