Providers
DOUGLAS E COHEN, M.D.
NPI 1932127248, individual, Mill Valley, CA, Internal Medicine
5
Evidence tier
informational
score 31 of 100, rank 11323, $342K at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | DOUGLAS E COHEN, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | July 17, 2006, last updated May 19, 2025 |
| Practice location | 655 REDWOOD HWY FRONTAGE RD STE 375, Mill Valley, CA 94941-3041, 415-968-1888 |
| Mailing address | 336 BON AIR CTR # 427, Greenbrae, CA 94904-3017 |
| Specialties | Hospitalist (208M00000X, license G75866 CA) Internal Medicine (207R00000X, primary, license G75866 CA) |
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 | |
|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $159K | 31% | $122 | $96 (top 5% from $249) | 66th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $130K | 25% | $89 | $81 (top 5% from $170) | 57th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $117K | 23% | $115 | $67 (top 5% from $174) | 83rd percentile | |
| 99239 | Hospital discharge day management, more than 30 minutes | $63K | 12% | $70 | $49 (top 5% from $101) | 76th percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $40K | 8% | $80 | $63 (top 5% from $137) | 68th percentile | |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | $7K | 1% | $153 | $37 (top 5% from $103) | too few months to rank | |
| 99291 | Critical care, first 30-74 minutes | $4K | 1% | $260 | $175 (top 5% from $536) | 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 | $0 | 0% | $0.00 | $14 (top 5% from $58) | 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 |
|---|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 315 | 156 | $30K | $420 | $122 | 3.4x | 2.6x (90th percentile 4.7x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 129 | 124 | $17K | $695 | $179 | 3.9x | 3.0x (90th percentile 5.6x) |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 192 | 110 | $12K | $311 | $82 | 3.8x | 2.6x (90th percentile 4.3x) |
| 99239 | Hospital discharge day management, more than 30 minutes | 108 | 107 | $10K | $465 | $121 | 3.9x | 2.8x (90th percentile 5.6x) |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 62 | 61 | $6K | $468 | $134 | 3.5x | 2.7x (90th percentile 4.4x) |
| 99291 | Critical care, first 30-74 minutes | 16 | 16 | $3K | $1K | $214 | 4.7x | 4.7x (90th percentile 10.0x) |
| 99238 | Hospital discharge day management, 30 minutes or less | 32 | 31 | $2K | $250 | $85 | 2.9x | 2.6x (90th percentile 4.7x) |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 21 | 11 | $807 | $132 | $51 | 2.6x | 2.4x (90th percentile 4.0x) |
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
6 providers in Marin County, CA carry an indicator in the public record, with $60K at stake between them. The most common is part of a provider network, on 4 of them, followed by named in an enforcement record on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | SAN RAFAEL OPERATING COMPANY LP San Rafael, CA, ranked 1542 | $0 |
|
| 3 | SUTTER VISITING NURSE ASSOCIATION AND HOSPICE Novato, CA, ranked 1602 | $4K |
|
| 3 | DAVID BRODY San Anselmo, CA, ranked 2028 | $0 |
|
| 3 | NORTH BAY POST ACUTE, LLC Petaluma, CA, ranked 2986 | $0 |
|
| 3 | NORTHGATE POSTACUTE CARE San Rafael, CA, ranked 4269 | $0 |
|
| 5 | VARINDERJIT KAUR Kentfield, CA, ranked 11732 | $56K |
Recent enforcement in CA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJPleaded guiltyAug 27, 2026
Anaheim Woman Pleads Guilty to Submitting More Than $2.2 Million in Fraudulent Hospice Care Claims to Medicare
Galbraith submitted approximately $2,266,694 in claims to Medicare for hospice services for beneficiaries who did not have a terminal illness with a life expectancy of six months or less, and Medicare paid her company approximately $2,140,606.
DOJCivil settlementAug 26, 2026
DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests
DermTech Inc. submitted claims to Medicare for skin cancer tests conducted with an unvalidated positive control range and for tests lacking sufficient patient RNA, and did not retract results or adequately refund Medicare.
DOJCivil settlementAug 26, 2026
DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests
DermTech Inc. billed Medicare for skin cancer tests conducted using an unvalidated positive control range and for tests with insufficient patient RNA, and did not retract the results or adequately refund Medicare.
DOJCivil settlementAug 24, 2026
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit
Monogram knowingly submitted diagnosis codes in four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to Medicare Advantage Organizations.
DOJCivil settlementAug 24, 2026
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4M to Settle False Claims Act Suit
Monogram Health knowingly submitted diagnosis codes within four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to MAOs.
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.