Providers
CARL DOUGLAS PORTER, MD
NPI 1720087463, individual, Springfield, OH, Physical Medicine & Rehabilitation
5
Evidence tier
informational
- Medicaid dollars per patient on code 90791 ($373 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 10065, $1.2M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | CARL DOUGLAS PORTER, MD |
| Type | Individual |
| Status | Active |
| NPI issued | July 15, 2005, last updated April 12, 2016 |
| Practice location | 100 MEDICAL CENTER DR, Springfield, OH 45504-2687, 937-523-1034 |
| Specialties | Physical Medicine & Rehabilitation (208100000X, primary, license 35064697 OH) |
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 | |
|---|---|---|---|---|---|---|---|
| 90834 | Psychotherapy, 45 minutes | $840K | 43% | $373 | $101 (top 5% from $318) | 97th percentile | |
| 90853 | Group psychotherapyhistory of abuse | $514K | 27% | $306 | $60 (top 5% from $332) | 94th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $268K | 14% | $282 | $105 (top 5% from $228) | 98th percentile | |
| 90832 | Psychotherapy, 30 minutes | $146K | 8% | $265 | $59 (top 5% from $239) | 96th percentile | |
| 95911 | Nerve conduction, 9-10 studies | $64K | 3% | $98 | $130 (top 5% from $264) | 26th percentile | |
| 95886 | Needle measurement of electrical activity in arm or leg muscles, complete study | $48K | 2% | $45 | $81 (top 5% from $202) | 19th percentile | |
| 80305 | Testing for presence of drug, read by direct observation | $20K | 1% | $8.42 | $9.23 (top 5% from $22) | 44th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $19K | 1% | $73 | $67 (top 5% from $174) | 56th 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 |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 1,104 | 200 | $62K | $104 | $71 | 1.5x | 2.6x (90th percentile 4.3x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 220 | 199 | $26K | $291 | $156 | 1.9x | 3.0x (90th percentile 5.6x) |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 267 | 108 | $23K | $149 | $107 | 1.4x | 2.6x (90th percentile 4.7x) |
| 99239 | Hospital discharge day management, more than 30 minutes | 219 | 198 | $18K | $154 | $103 | 1.5x | 2.8x (90th percentile 5.6x) |
| 95886 | Needle measurement of electrical activity in arm or leg muscles, complete study | 95 | 53 | $6K | $168 | $84 | 2.0x | 3.0x (90th percentile 6.3x) |
| 95911 | Nerve conduction, 9-10 studies | 33 | 33 | $5K | $371 | $187 | 2.0x | 3.1x (90th percentile 6.8x) |
| 95910 | Nerve conduction, 7-8 studies | 18 | 18 | $2K | $311 | $155 | 2.0x | 3.2x (90th percentile 7.0x) |
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
2 providers in Clark County, OH carry an indicator in the public record, with $0 at stake between them. The most common is part of a provider network, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | THE OHIO MASONIC HOME Springfield, OH, ranked 4165 | $0 |
|
| 3 | VANCREST OF NEW CARLISLE, LLC New Carlisle, OH, ranked 6815 | $0 |
|
Recent enforcement in OH
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementJun 23, 2026
Ohio Dentist Agrees to Pay $500,000 to Resolve Allegations of Submitting False Claims to Medicaid
Meckler billed the Ohio Department of Medicaid for services provided by Ball, who was excluded from the Medicaid program, by listing Meckler as the rendering provider instead of Ball.
DOJSentencedJun 15, 2026
Ohio Doctor Ordered to Pay Nearly $1M for Facilitating Fraud on Medicare
A physician working as an independent contractor for a telemedicine company signed doctor's orders for durable medical equipment braces and genetic testing without meaningfully reviewing patient records or performing required in-person assessments, and those orders were used to bill Medicare more than $1,842,524.
DOJCivil settlementApr 2, 2026
Trinity Hospital Agrees to Pay $1.7M to Resolve Alleged Stark Law Violations
Trinity agreed to pay $1.7 million to resolve allegations that from 2014 through 2020 it made improper financial contributions to two referring physicians through office space rental arrangements that exceeded fair market value, in violation of the Stark Law.
DOJComplaint filedFeb 20, 2026
Justice Department Sues OhioHealth for Anticompetitive Healthcare Contracts That Increase Costs for Ohio Patients
The Justice Department and Ohio Attorney General filed a civil antitrust complaint alleging OhioHealth used its market power to impose contractual restrictions that prevent insurers from offering lower-cost health plans and limit access to price information.
DOJSentencedJan 14, 2026
Ohio Doctor Sentenced to Prison for $14M Healthcare Fraud Scheme
A licensed Ohio physician employed by two Florida telemedicine companies signed pre-completed orders for durable medical equipment and cancer genetic testing, falsely affirming he had examined the patients, causing more than $14.5 million in fraudulent Medicare claims.
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.