SARA ANN MICHAELS, MD
NPI 1790774552, individual, Shiprock, NM, Family Medicine
- Hours beyond a day in 1 month, but with up to 499 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 99213 ($612 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 |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2022 | More hours than a day holds at a conservative unit price | 3.0 | 45.8 | 30.6 | 45.1 | 499 | 1 | 99212 99213 | $329K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SARA ANN MICHAELS, MD |
| Type | Individual |
| Status | Active |
| NPI issued | October 14, 2005, last updated August 10, 2021 |
| Practice location | US HIGHWAY 491 N, Shiprock, NM 87420, 505-368-7010 |
| Mailing address | PO BOX 160, Shiprock, NM 87420-0160 |
| Specialties | Family Medicine (207Q00000X, primary, license MD00037775 WA) |
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 | |
|---|---|---|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $867K | 80% | $612 | $28 (top 5% from $147) | 99th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $175K | 16% | $488 | $44 (top 5% from $110) | 100th percentile | |
| 87635 | Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | $14K | 1% | $158 | $44 (top 5% from $70) | too few months to rank | |
| G0463 | Medicaid service code | $12K | 1% | $704 | $73 (top 5% from $142) | too few months to rank | |
| Q3014 | Telehealth originating site facility fee | $9K | 1% | $758 | $21 (top 5% from $84) | too few months to rank | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $3K | 0% | $14 | $60 (top 5% from $133) | 8th percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 162 | 91 | $10K | $153 | $87 | 1.8x | 2.3x (90th percentile 3.8x) |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 14 | 11 | $2K | $254 | $138 | 1.8x | 2.4x (90th percentile 4.1x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 19 | 14 | $839 | $87 | $55 | 1.6x | 2.2x (90th percentile 3.8x) |
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 San Juan County, NM carry an indicator in the public record, with $2.7M at stake between them. The most common is more hours than a day holds, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | CHRISTOPHER PERCY Shiprock, NM, ranked 7661 | $2.2M |
|
| 5 | HEATHER KOVICH Shiprock, NM, ranked 10257 | $506K |
|
Recent enforcement in NM
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
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.