JOSE A VENTURA, MD, FHM, FAAFP

NPI 1932337763, individual, Topsham, ME, Family Medicine

Evidence tier

informational

score 30 of 100, rank 11656, $88K at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	JOSE A VENTURA, MD, FHM, FAAFP (also JOSE VENTURA LOPEX)
Type	Individual, sole proprietor
Status	Active
NPI issued	July 1, 2009, last updated February 12, 2026
Practice location	4 UNION PARK RD # 8, Topsham, ME 04086-1711, 207-200-5907
Mailing address	47 BEECHWOOD DR, Topsham, ME 04086-5524
Specialties	Family Medicine (207Q00000X, primary, license MD19207 ME)

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
99308	Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more	$141K	63%	$57	$14 (top 5% from $58)	95th percentile
99309	Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	$39K	17%	$36	$21 (top 5% from $84)	76th percentile
99306	Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more	$17K	8%	$68	$37 (top 5% from $100)	81st percentile
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	$10K	4%	$56	$81 (top 5% from $170)	23rd percentile
99307	Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	$8K	3%	$26	$7.86 (top 5% from $34)	92nd percentile
99439	Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	$4K	2%	$16	$5.60 (top 5% from $40)	79th percentile
99310	Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	$2K	1%	$63	$30 (top 5% from $134)	too few months to rank
99453	Remote monitoring of physiologic parameters, initial set-up and patient education on use of equipment	$1K	1%	$19	$7.06 (top 5% from $23)	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
99309	Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	518	191	$42K	$202	$103	2.0x	2.0x (90th percentile 3.3x)
99439	Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	578	98	$21K	$66	$46	1.5x	1.9x (90th percentile 3.1x)
99490	Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	437	101	$20K	$121	$60	2.0x	1.8x (90th percentile 2.9x)
99349	Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	123	40	$11K	$239	$119	2.0x	2.0x (90th percentile 3.4x)
99308	Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more	171	128	$9K	$142	$71	2.0x	2.0x (90th percentile 3.4x)
99454	Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days	221	104	$8K	$92	$45	2.0x	2.6x (90th percentile 4.2x)
99310	Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	66	55	$8K	$287	$147	1.9x	2.0x (90th percentile 3.4x)
99458	Management using the results of remote vital sign monitoring per calendar month, each additional 20 minutes	165	45	$5K	$57	$37	1.5x	2.2x (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

10 providers in ME carry an indicator in the public record, with $19.6M at stake between them. The most common is more hours than a day holds, on 9 of them, followed by part of a provider network on 1.

tier	provider	at stake	why
3	AFFINITY CARE OF MAINE LLC South Portland, ME, ranked 1675	$596	Part of provider network D1-00113, ranked 113 nationally.
5	KATHERINE MARBLE Auburn, ME, ranked 9801	$9.4M	Medicaid dollars per patient on code T1013 ($425 per patient-month) sit in the top 5% of every provider billing that code. 77% of Medicaid dollars are on codes with a history of abuse.
5	KIMBERLY LOIKA-SMITH South Portland, ME, ranked 10395	$190K	Medicaid dollars per patient on code H2012 ($5129 per patient-month) sit in the top 5% of every provider billing that code.
5	JAMIE ROSE South Portland, ME, ranked 10441	$125K	Medicaid dollars per patient on code H2012 ($4556 per patient-month) sit in the top 5% of every provider billing that code.
5	KAREN BACKMAN Westbrook, ME, ranked 10587	$873K	100% of Medicaid dollars are on codes with a history of abuse.
5	JACQUELYN POULIN Presque Isle, ME, ranked 10654	$116K	100% of Medicaid dollars are on codes with a history of abuse.
5	CARLA STOCKDALE Winthrop, ME, ranked 10677	$7.5M
5	CHERYL DAVIS Augusta, ME, ranked 11087	$837K

All 10 in ME

Recent enforcement in ME

All releases

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

DOJComplaint filedJun 30, 2025

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DOJCivil settlementFeb 14, 2025

Saint Vincents Catholic Medical Centers of New York Agrees to Pay $29M to Resolve Alleged False Claims Act Violations

Saint Vincent knowingly retained erroneously inflated capitated payments from the Defense Health Agency under the Uniformed Services Family Health Plan, concealed the overpayments, continued submitting invoices at inflated rates, and conspired to avoid repaying the funds.

DOJSentencedJan 24, 2024

Corinna Counselor Ordered to Pay MaineCare $13,087.62 for Submitting Bogus Treatment Records

Between April and December 2020, McKinney falsified appointment details and session notes in therapy service records and used the falsified records to bill and receive funds from MaineCare.

DOJSentencedJan 5, 2024

Woodville Woman Ordered to Repay $103,596.91 after Committing Yearslong Fraud to Obtain Benefits

Austin-Kimball lied to the Social Security Administration and Maine DHHS about her husband's presence in her household and failed to report alimony payments to fraudulently appear eligible for SSI, MaineCare, and SNAP benefits for herself and her minor child.

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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