PETROS ASSEFA AYELE, MD Internal Med.

NPI 1720238868, individual, Stafford, VA, Internal Medicine

Evidence tier

informational

score 30 of 100, rank 11536, $151K at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	PETROS ASSEFA AYELE, MD Internal Med.
Type	Individual
Status	Active
NPI issued	September 25, 2008, last updated September 25, 2008
Practice location	2712 JEFFERSON DAVIS HIGHWAY, SUITE 101, Stafford, VA 22554, 540-657-9191
Mailing address	85 S. BRAGG STREET SUITE #100, BLUE NILE MEDICAL CENTER, Alexandria, VA 22312
Specialties	Internal Medicine (207R00000X, primary, license 0101242641 VA)

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
99309	Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	$383K	65%	$32	$21 (top 5% from $84)	72nd percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$174K	30%	$89	$60 (top 5% from $133)	78th percentile
99306	Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more	$12K	2%	$33	$37 (top 5% from $100)	45th percentile
99204	New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$7K	1%	$107	$95 (top 5% from $171)	too few months to rank
99308	Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more	$3K	1%	$9.55	$14 (top 5% from $58)	33rd percentile
36415	Insertion of needle into vein for collection of blood sample	$2K	0%	$1.91	$1.97 (top 5% from $12)	49th percentile
99349	Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	$2K	0%	$45	$30 (top 5% from $115)	too few months to rank
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$1K	0%	$52	$44 (top 5% from $110)	too few months to rank

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
99349	Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	3,012	353	$276K	$300	$122	2.5x	2.0x (90th percentile 3.4x)
99309	Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	2,730	137	$213K	$250	$103	2.4x	2.0x (90th percentile 3.3x)
99483	Assessment of and care planning for patient with impaired thought processing, typically 60 minutes	351	237	$69K	$300	$263	1.1x	1.8x (90th percentile 3.2x)
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	167	58	$15K	$381	$134	2.8x	2.3x (90th percentile 3.8x)
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	79	79	$10K	$150	$128	1.2x	2.3x (90th percentile 4.1x)
G0438	Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	55	55	$9K	$200	$159	1.3x	2.3x (90th percentile 4.2x)
99306	Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more	65	63	$9K	$450	$172	2.6x	1.9x (90th percentile 3.1x)
99344	Residence visit for new patient with moderate level of medical decision making, per day, if using time, at least 60 minutes	71	71	$7K	$350	$137	2.6x	2.1x (90th percentile 3.5x)

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

3 providers in Stafford County, VA carry an indicator in the public record, with $7.3M at stake between them. The most common is paid after a public list action, on 2 of them, followed by more hours than a day holds on 1. 2 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	ADVANCED SPINE AND PAIN CENTERS, PLLC Stafford, VA, ranked 58	$1.3M	Listed on the Medicare revocation list since November 19, 2021. Medicaid still paid claims in 23 later months, $1,327,755 in total.
1	THOMAS RALEY Stafford, VA, ranked 104	$253K	Listed on the Medicare revocation list since November 19, 2021. Medicaid still paid claims in 9 later months, $252,808 in total.
4	NATHER ANSARI Stafford, VA, ranked 8379	$5.7M	Hours beyond a day in 7 months, but with up to 1574 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed.

Recent enforcement in VA

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJChargedJun 23, 2026

U.S. Attorney’s Office announces charges against three defendants in the Eastern District of Virginia as part of national health care fraud takedown

Three defendants were charged with fraudulently billing Medicaid for mental health services that were not provided and with submitting false claims to Medicare through a straw-owned durable medical equipment company.

DOJSentencedJun 5, 2026

Medicaid service providers sentenced for false statements resulting in overbilling

Wright and Winfield instructed CCR employees to falsely claim in progress notes that children received therapeutic day treatment services from 2:00pm to 7:00pm, including providing prefilled progress note templates, resulting in overbilling to Medicaid.

DOJCivil settlementApr 27, 2026

Tri-Area Community Health Agrees to Pay $513,000 to Resolve Medicare Billing Allegations

Tri-Area Community Health billed Medicare for Annual Wellness Visits provided by pharmacists without appropriate physician supervision that were billed under the names of physicians not involved with the visits.

DOJSentencedMar 17, 2026

Six Sentenced in Healthcare Fraud Conspiracy that Stole $10 Million from Medicaid Over Six-Year Period

Six defendants conspired to submit false claims to Virginia Medicaid on behalf of 1st Adult N Pediatric Healthcare Services for nursing and personal care services that were not provided, including falsifying records and paying parents or guardians of patients for blank, signed nursing notes.

DOJIndictedMar 11, 2026

Victim Advisory- Divine Youth Case Updates

Divine Youth Counseling submitted more than $11 million in fraudulent Medicaid claims for Crisis Stabilization and Mobile Crisis services by falsely claiming two mental health professionals provided Team Treatment services and paid more than $470,000 in kickbacks in the form of hotel rooms for Medicaid recipients.

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.

Ask this case

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