Providers
SERGIO I MACIAS, PT
NPI 1578570081, individual, San Luis, AZ, Physical Therapist
5
Evidence tier
informational
score 32 of 100, rank 10692, $5.0M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SERGIO I MACIAS, PT |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | August 1, 2006, last updated October 24, 2014 |
| Practice location | 1233 N MAIN STREET, SUITE 10, 11 & 12, San Luis, AZ 85349-9999, 928-722-6050 |
| Mailing address | PO BOX 5841, Yuma, AZ 85366-2490 |
| Specialties | Physical Therapist (225100000X, primary, license 4229 AZ) Durable Medical Equipment & Medical Supplies (332B00000X, license C001071 AZ) |
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 | |
|---|---|---|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $3.9M | 56% | $259 | $76 (top 5% from $314) | 92nd percentile | |
| 97140 | Therapy procedure using manual technique, each 15 minutes | $744K | 10% | $77 | $47 (top 5% from $120) | 81st percentile | |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $592K | 8% | $105 | $59 (top 5% from $187) | 83rd percentile | |
| 97014 | Medicaid service code | $413K | 6% | $56 | $24 (top 5% from $71) | 92nd percentile | |
| 97162 | Evaluation for physical therapy, typically 30 minutes | $231K | 3% | $68 | $48 (top 5% from $145) | 77th percentile | |
| 97035 | Application of ultrasound, each 15 minutes | $219K | 3% | $34 | $21 (top 5% from $107) | 74th percentile | |
| L3807 | Medicaid service code | $177K | 2% | $204 | $135 (top 5% from $243) | 84th percentile | |
| L1820 | Medicaid service code | $111K | 2% | $117 | $85 (top 5% from $141) | 83rd 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 |
|---|---|---|---|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 1,993 | 56 | $36K | $50 | $23 | 2.2x | 2.9x (90th percentile 4.8x) |
| 97140 | Therapy procedure using manual technique, each 15 minutes | 412 | 46 | $6K | $40 | $20 | 2.0x | 3.2x (90th percentile 5.0x) |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 219 | 20 | $5K | $35 | $30 | 1.2x | 2.5x (90th percentile 4.2x) |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | 588 | 48 | $4K | $30 | $9 | 3.5x | 4.1x (90th percentile 7.2x) |
| 97162 | Evaluation for physical therapy, typically 30 minutes | 47 | 44 | $3K | $125 | $97 | 1.3x | 1.7x (90th percentile 2.9x) |
| 97035 | Application of ultrasound, each 15 minutes | 24 | 20 | $181 | $25 | $10 | 2.4x | 3.4x (90th percentile 6.1x) |
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
6 providers in Yuma County, AZ carry an indicator in the public record, with $9.0M at stake between them. The most common is more hours than a day holds, on 6 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | ENGIDA ALEMU Yuma, AZ, ranked 7987 | $331K |
|
| 4 | MALLAPPA NEELAPPA Yuma, AZ, ranked 8585 | $2.8M |
|
| 4 | CARL MALMQUIST Yuma, AZ, ranked 8806 | $1.6M |
|
| 4 | REBECCA DOWNS Yuma, AZ, ranked 8987 | $993K |
|
| 5 | OLIVIA WILSON Yuma, AZ, ranked 10101 | $1.1M |
|
| 5 | MARIA MACIAS San Luis, AZ, ranked 10793 | $2.2M |
Recent enforcement in AZ
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
District of Arizona Announces Charges Involving Over $1.2 Billion in False or Fraudulent Claims as Part of National Health Care Fraud Takedown
Four defendants were charged in connection with alleged schemes involving over $1.2 billion in false or fraudulent claims for amniotic wound allografts procured through kickbacks and for substance abuse treatment services billed to Arizona Medicaid that were not provided as billed.
DOJSentencedJun 4, 2026
New River Couple Sentenced for $12 Million AHCCCS Fraud Scheme
The Currys submitted a fraudulent AHCCCS provider enrollment application concealing Thvoughn Curry's ownership role and then billed AHCCCS through 1 Family Clinic, LLC for behavioral health and substance abuse therapy services that were not provided, receiving more than $12 million.
DOJCivil settlementMar 12, 2026
Arizona Cardiology Group to Pay $4.75M to Resolve Allegations of Unnecessary Vein Ablations
Tri-City Cardiology and three physicians allegedly violated the False Claims Act by performing medically unnecessary ablations on perforator veins and incorrectly measuring or documenting blood flow duration, vein diameter, patient symptoms, and conservative therapy measures to make the procedures appear justified.
DOJConvictedFeb 27, 2026
New River Couple Convicted of $12 Million AHCCCS Fraud Scheme
The Currys submitted a fraudulent AHCCCS provider enrollment application concealing Thvoughn Curry's ownership and then billed AHCCCS for behavioral health services that were not actually provided through 1 Family Clinic, LLC, receiving more than $12 million.
DOJSentencedFeb 27, 2026
Mesa Residents Sentenced to Prison for Fraud Targeting AHCCCS
Riley and Gooch, through their behavioral health clinic New Horizons Behavioral Health, exploited AHCCCS's American Indian Health Program between 2020 and 2022 by falsely billing for services that were not provided, obtaining approximately $3.3 million.
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.