CARL R GRAY, M.D.
NPI 1598873382, individual, Ogden, UT, Internal Medicine, Hematology & Oncology
- Hours beyond a day in 3 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99214 ($2051 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 2021 | More hours than a day holds at a conservative unit price | 1.1 | 36.2 | 24.1 | 32.9 | 49 | 1 | 99214 | $161K |
| Dec 2021 | More hours than a day holds at a conservative unit price | 1.0 | 36.9 | 24.6 | 33.2 | 46 | 1 | 99214 | $170K |
| Jan 2022 | More hours than a day holds at a conservative unit price | 1.4 | 56.7 | 37.8 | 55.8 | 70 | 1 | 99214 | $251K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | CARL R GRAY, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | August 29, 2006, last updated July 8, 2007 |
| Practice location | 5405 S 500 E STE 202, Ogden, UT 84405-7419, 801-476-1777 |
| Mailing address | 4403 HARRISON BLVD STE 1685, Ogden, UT 84403-3274 |
| Specialties | Internal Medicine, Hematology & Oncology (207RH0003X, primary, license 5553369-1205 UT) |
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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $4.1M | 72% | $2K | $60 (top 5% from $133) | 100th percentile | |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $1.3M | 23% | $652 | $5.69 (top 5% from $25) | 100th percentile | |
| 80053 | Blood test, comprehensive group of blood chemicals | $134K | 2% | $489 | $8.38 (top 5% from $44) | 100th percentile | |
| 96372 | Injection of drug or substance under skin or into muscle | $76K | 1% | $398 | $12 (top 5% from $49) | 100th percentile | |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | $47K | 1% | $101 | $120 (top 5% from $408) | 39th percentile | |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | $23K | 0% | $220 | $85 (top 5% from $264) | 92nd percentile | |
| 96367 | Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less | $7K | 0% | $27 | $48 (top 5% from $185) | 23rd percentile | |
| 96523 | Irrigation of implanted venous access drug delivery device | $222 | 0% | $19 | $29 (top 5% from $92) | 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 |
|---|---|---|---|---|---|---|---|---|
| J9299 | Injection, nivolumab, 1 mg | 71,260 | 27 | $1.8M | $50 | $31 | 1.6x | 2.6x (90th percentile 3.8x) |
| J9271 | Injection, pembrolizumab, 1 mg | 27,000 | 19 | $1.2M | $90 | $56 | 1.6x | 2.5x (90th percentile 3.3x) |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 19,440 | 11 | $761K | $76 | $49 | 1.5x | 2.8x (90th percentile 3.6x) |
| Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | 12,763 | 13 | $585K | $115 | $58 | 2.0x | 3.1x (90th percentile 3.9x) |
| J0897 | Injection, denosumab, 1 mg | 21,540 | 60 | $440K | $35 | $25 | 1.4x | 1.8x (90th percentile 3.1x) |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 1,161 | 151 | $109K | $299 | $118 | 2.5x | 3.6x (90th percentile 6.1x) |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 780 | 206 | $105K | $255 | $170 | 1.5x | 2.4x (90th percentile 4.1x) |
| J1627 | Injection, granisetron, extended-release, 0.1 mg | 14,500 | 28 | $64K | $11 | $6 | 2.0x | 2.3x (90th percentile 3.7x) |
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
5 providers in Weber County, UT carry an indicator in the public record, with $6.5M at stake between them. The most common is part of a provider network, on 4 of them, followed by more hours than a day holds on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | IVY LANE PEDIATRICS, LLC South Ogden, UT, ranked 767 | $5.1M |
|
| 3 | KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT Washington Terrace, UT, ranked 2872 | $0 |
|
| 3 | BRISTOL HOSPICE - UTAH, L.L.C. Ogden, UT, ranked 3817 | $0 |
|
| 3 | AVALON CARE CENTER - VA OGDEN LLC Ogden, UT, ranked 4796 | $0 |
|
| 5 | RICHARD ARBOGAST Ogden, UT, ranked 10043 | $1.4M |
|
Recent enforcement in UT
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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.