Providers
All 15 in RI
PAULO R PINA, M.D.
NPI 1609974740, individual, Providence, RI, Pediatrics
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 34 months, but with up to 2513 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 90686 ($268 per patient-month) sit in the top 5% of every provider billing that code.
score 56 of 100, rank 7365, $12.0M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Oct 2020 | More hours than a day holds at a conservative unit price | 9.4 | 41.7 | 27.8 | 39.2 | 1008 | 1 | 99203 99211 99212 99213 99214 | $163K |
| Nov 2020 | More hours than a day holds at a conservative unit price | 9.3 | 43.7 | 29.1 | 41.6 | 1055 | 1 | 99203 99211 99212 99213 99214 | $168K |
| Dec 2020 | More hours than a day holds at a conservative unit price | 8.4 | 40.8 | 27.2 | 36.7 | 1066 | 1 | 90832 99211 99212 99213 99214 | $165K |
| Jan 2021 | More hours than a day holds at a conservative unit price | 9.7 | 48.9 | 32.6 | 48.2 | 1276 | 1 | 99211 99212 99213 99214 | $207K |
| Feb 2021 | More hours than a day holds at a conservative unit price | 8.7 | 44.1 | 29.4 | 41.1 | 1125 | 1 | 90832 99211 99212 99213 99214 | $172K |
| Mar 2021 | More hours than a day holds at a conservative unit price | 11.5 | 59.1 | 39.4 | 53.1 | 1420 | 1 | 90832 99211 99212 99213 99214 | $248K |
| Apr 2021 | More hours than a day holds at a conservative unit price | 9.2 | 60.2 | 40.1 | 54.7 | 1364 | 1 | 90832 99202 99211 99212 99213 99214 | $292K |
| May 2021 | More hours than a day holds at a conservative unit price | 11.5 | 67.4 | 44.9 | 66.3 | 1545 | 1 | 90832 99202 99211 99212 99213 99214 | $342K |
| Jun 2021 | More hours than a day holds at a conservative unit price | 11.5 | 63.0 | 42.0 | 57.3 | 1406 | 1 | 90832 90846 99202 99211 99212 99213 99214 | $303K |
| Sep 2021 | More hours than a day holds at a conservative unit price | 13.6 | 56.0 | 37.3 | 50.9 | 1124 | 1 | 90832 99202 99203 99211 99212 99213 99214 | $246K |
| Oct 2021 | More hours than a day holds at a conservative unit price | 14.6 | 73.4 | 49.0 | 72.3 | 1227 | 1 | 99202 99203 99211 99212 99213 99214 | $339K |
| Nov 2021 | More hours than a day holds at a conservative unit price | 12.8 | 70.7 | 47.2 | 64.3 | 1106 | 1 | 99202 99203 99211 99212 99213 99214 | $312K |
| Dec 2021 | More hours than a day holds at a conservative unit price | 10.8 | 64.0 | 42.7 | 57.5 | 1074 | 1 | 99202 99203 99211 99212 99213 99214 | $292K |
| Jan 2022 | More hours than a day holds at a conservative unit price | 13.3 | 77.7 | 51.8 | 76.5 | 1259 | 1 | 99202 99203 99211 99212 99213 99214 | $345K |
| Feb 2022 | More hours than a day holds at a conservative unit price | 10.6 | 62.9 | 41.9 | 58.7 | 997 | 1 | 99202 99203 99211 99212 99213 99214 | $259K |
| Mar 2022 | More hours than a day holds at a conservative unit price | 15.7 | 90.5 | 60.3 | 81.3 | 1396 | 1 | 99202 99203 99211 99212 99213 99214 | $407K |
| Apr 2022 | More hours than a day holds at a conservative unit price | 10.3 | 61.6 | 41.0 | 58.6 | 996 | 1 | 99202 99211 99212 99213 99214 | $275K |
| May 2022 | More hours than a day holds at a conservative unit price | 14.5 | 86.8 | 57.8 | 81.5 | 1353 | 1 | 99202 99211 99212 99213 99214 | $397K |
| Jun 2022 | More hours than a day holds at a conservative unit price | 10.4 | 62.0 | 41.4 | 56.4 | 1021 | 1 | 99202 99211 99212 99213 99214 | $274K |
| Sep 2022 | More hours than a day holds at a conservative unit price | 8.4 | 48.7 | 32.4 | 44.2 | 791 | 1 | 90832 99202 99203 99211 99212 99213 99214 | $209K |
| Oct 2022 | More hours than a day holds at a conservative unit price | 9.4 | 55.1 | 36.8 | 54.3 | 893 | 1 | 90832 99202 99203 99211 99212 99213 99214 | $244K |
| Nov 2022 | More hours than a day holds at a conservative unit price | 12.7 | 72.9 | 48.6 | 66.3 | 1181 | 1 | 90832 99202 99203 99211 99212 99213 99214 | $307K |
| Dec 2022 | More hours than a day holds at a conservative unit price | 11.6 | 65.4 | 43.6 | 61.5 | 1016 | 1 | 90832 90834 99202 99203 99212 99213 99214 | $276K |
| Jan 2023 | More hours than a day holds at a conservative unit price | 16.5 | 86.9 | 58.0 | 81.7 | 1211 | 1 | 90832 90834 99202 99203 99212 99213 99214 | $333K |
| Feb 2023 | More hours than a day holds at a conservative unit price | 18.3 | 97.0 | 64.6 | 90.5 | 1203 | 1 | 90832 90834 99202 99203 99212 99213 99214 | $332K |
| Mar 2023 | More hours than a day holds, even counting one unit per claim line | 27.2 | 144.4 | 96.2 | 129.7 | 1923 | 1 | 90832 90834 99202 99203 99211 99212 99213 99214 | $552K |
| Apr 2023 | More hours than a day holds at a conservative unit price | 16.6 | 86.6 | 57.8 | 86.6 | 1193 | 1 | 90832 90834 99202 99203 99211 99212 99213 99214 | $320K |
| May 2023 | More hours than a day holds, even counting one unit per claim line | 27.2 | 141.6 | 94.4 | 127.3 | 1940 | 1 | 90832 99202 99203 99204 99211 99212 99213 99214 | $551K |
| Jun 2023 | More hours than a day holds at a conservative unit price | 14.8 | 74.3 | 49.5 | 67.6 | 1044 | 1 | 90832 90834 99203 99212 99213 99214 | $274K |
| Sep 2023 | More hours than a day holds at a conservative unit price | 22.5 | 118.2 | 78.8 | 112.6 | 1666 | 1 | 90832 90834 99202 99203 99204 99211 99212 99213 99214 | $446K |
| Oct 2023 | More hours than a day holds, even counting one unit per claim line | 34.9 | 207.3 | 138.2 | 194.7 | 2513 | 1 | 90832 90834 99202 99203 99204 99211 99212 99213 99214 | $809K |
| Nov 2023 | More hours than a day holds, even counting one unit per claim line | 31.9 | 186.9 | 124.6 | 169.9 | 2204 | 1 | 90832 90834 99202 99203 99204 99211 99212 99213 99214 | $700K |
| Dec 2023 | More hours than a day holds at a conservative unit price | 22.0 | 133.0 | 88.7 | 130.9 | 1726 | 1 | 90832 90834 99202 99203 99211 99212 99213 99214 | $519K |
| Jan 2024 | More hours than a day holds at a conservative unit price | 18.0 | 97.1 | 64.8 | 87.3 | 1369 | 1 | 90832 90834 99202 99203 99211 99212 99213 99214 | $406K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | PAULO R PINA, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | September 20, 2006, last updated December 14, 2023 |
| Practice location | 593 EDDY STREET, HASBRO LOWER LEVEL, Providence, RI 02903-4923, 401-444-4471 |
| Mailing address | 117 ELLENFIELD ST STE 101, Providence, RI 02905-4541 |
| Specialties | Pediatrics (208000000X, primary, license MD19578 RI) Pediatrics (208000000X, license 224827 NY) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $5.0M | 32% | $256 | $44 (top 5% from $110) | 99th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $4.8M | 30% | $268 | $28 (top 5% from $147) | 98th percentile | |
| 99211 | Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | $1.3M | 8% | $150 | $16 (top 5% from $128) | 97th percentile | |
| 90686 | Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage | $654K | 4% | $167 | $2.30 (top 5% from $20) | 100th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $594K | 4% | $229 | $60 (top 5% from $133) | 99th percentile | |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | $566K | 4% | $212 | $12 (top 5% from $18) | 100th percentile | |
| 36415 | Insertion of needle into vein for collection of blood sample | $287K | 2% | $203 | $1.97 (top 5% from $12) | 99th percentile | |
| 90832 | Psychotherapy, 30 minutes | $272K | 2% | $376 | $59 (top 5% from $239) | 99th percentile |
In this area
15 providers in Providence County, RI carry an indicator in the public record, with $17.6M 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 6. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | CARE CENTER RHODE ISLAND LLC East Providence, RI, ranked 100 | $270K |
|
| 3 | BEACON HOSPICE, LLC East Providence, RI, ranked 989 | $1.7M |
|
| 3 | CORTLAND PLACE REHAB CENTER LLC Greenville, RI, ranked 1385 | $75K |
|
| 3 | OVERLOOK EDEN OPERATIONS, LLC Pascoag, RI, ranked 3154 | $0 |
|
| 3 | VIOLET SNF HOLDCO LLC Pawtucket, RI, ranked 4230 | $0 |
|
| 3 | CL OPERATING LLC Pascoag, RI, ranked 4389 | $0 |
|
| 3 | FRIENDLY EDEN OPERATIONS LLC Woonsocket, RI, ranked 7098 | $0 |
|
| 4 | CATHERINE ALLEN Providence, RI, ranked 7285 | $7.2M |
|
Recent enforcement in RI
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJun 24, 2026
Two Charged in District of Rhode Island as Part of National Fraud Takedown
Two defendants were charged by indictment with using the identity of another person to obtain benefits, including approximately $28,236.42 and $24,018.86 in Rhode Island Medicaid benefits.
DOJOtherFeb 17, 2026
Zynex, Inc. Agrees to Criminal Resolution Addressing Claims of Millions of Dollars of Health Care Fraud, Securities Fraud and Related Offenses
Zynex admitted to submitting excessive and improper claims for medical devices and supplies, including medically unnecessary electrode supplies in excess quantities, to government and private health care payors and patients, and to concealing from investors that its revenues were driven by fraudulent billing.
DOJIndictedJan 21, 2026
Former Zynex, Inc. Executives Charged with Health Care and Securities Fraud and Related Offenses
The indictment alleges that from at least 2017 through late 2025 the former CEO and COO of Zynex, Inc. caused the company to submit fraudulent billings to government and private health care payors and patients for medical devices and supplies that were not medically necessary, not covered, and not agreed to by patients, and used those billings to inflate the company's financial reporting and stock price.
DOJIndictedApr 7, 2025
Pain Management Clinic Owners and Operators Indicted on Health Care Fraud Charges
The owners and operators of a pain management clinic allegedly submitted fraudulent claims to Medicare, Medicare Advantage, Medicaid Managed Care, and four private insurers for purportedly medically necessary services, including acupuncture, physical therapy, and office visits, that were not actually provided to patients, in order to collect payment for massage therapy and other services not provided.
DOJSentencedMar 5, 2025
Addiction Treatment Center Supervisor Sentenced in Scheme to Defraud Federal, State, and Private Health Care Insurers
A clinical social worker supervisor at an addiction treatment center devised and executed a scheme to submit false claims for 45-minute psychotherapy and counseling sessions that lasted only 5-10 minutes or did not occur as billed, defrauding Medicare, Medicaid, and other health insurers of more than $3.5 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.