Providers
All 14 in NJ
EVELYN VENTURA, MD
NPI 1952487985, individual, Passaic, NJ, Pediatrics
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 1 month, but with up to 2149 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 9210, $507K at stake
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 |
|---|---|---|---|---|---|---|---|---|---|
| Mar 2019 | More hours than a day holds, even counting one unit per claim line | 26.7 | 40.2 | 26.8 | 39.5 | 2149 | 2 | 97802 99203 99212 99213 99214 | $154K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | EVELYN VENTURA, MD |
| Type | Individual |
| Status | Active |
| NPI issued | October 31, 2006, last updated November 19, 2023 |
| Practice location | 913 MAIN AVE, Passaic, NJ 07055-8540, 973-458-8000 |
| Specialties | Pediatrics (208000000X, primary, license 25MA07495300 NJ) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $1.2M | 34% | $71 | $44 (top 5% from $110) | 82nd percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $622K | 17% | $48 | $28 (top 5% from $147) | 79th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $487K | 14% | $97 | $60 (top 5% from $133) | 84th percentile | |
| 99393 | Medicaid service code | $220K | 6% | $89 | $78 (top 5% from $121) | 68th percentile | |
| 99394 | Medicaid service code | $202K | 6% | $98 | $83 (top 5% from $128) | 71st percentile | |
| 99392 | Medicaid service code | $159K | 4% | $90 | $78 (top 5% from $124) | 68th percentile | |
| 99391 | Medicaid service code | $123K | 3% | $82 | $76 (top 5% from $126) | 59th percentile | |
| 90460 | Administration of first vaccine or toxoid component with counseling (18 years or younger) | $117K | 3% | $22 | $26 (top 5% from $54) | 40th percentile |
In this area
14 providers in Passaic County, NJ carry an indicator in the public record, with $30.0M at stake between them. The most common is more hours than a day holds, on 11 of them, followed by part of a provider network on 2. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | MAIN AVENUE PHARMACY CORP Clifton, NJ, ranked 506 | $0 |
|
| 3 | 1120 ALPS ROAD OPERATING COMPANY LLC Wayne, NJ, ranked 1735 | $34 |
|
| 3 | 2020 ROUTE 23 OPERATING COMPANY LLC Wayne, NJ, ranked 4623 | $0 |
|
| 4 | MUHAMMAD IJAZ Clifton, NJ, ranked 7770 | $1.3M |
|
| 4 | HISHAM GADALLA Clifton, NJ, ranked 8305 | $9.0M |
|
| 4 | FOUAD RASHEED Prospect Park, NJ, ranked 8363 | $6.3M |
|
| 4 | MARIO MICO Passaic, NJ, ranked 8584 | $2.8M |
|
| 4 | RAUL ALMANZAR Passaic, NJ, ranked 8652 | $2.4M |
|
Recent enforcement in NJ
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJul 29, 2026
Fraud Division Resolves Fraud Investigation of Eye Care Group Under New Corporate Enforcement Policy; Health Care Executive Charged for Alleged Fraud and Kickbacks
DiDonato allegedly conspired to defraud Medicare by billing for unnecessary and duplicative diagnostic eye tests and paid kickbacks and bribes to ophthalmologists disguised as consulting fees for patient referrals, while Campus Eye received a declination after self-disclosing and agreed to pay back $1 million to victims.
DOJIndictedJul 29, 2026
Founder And Former CEO of New Jersey Based Eye Care Group Charged with Health Care Fraud Conspiracy and Paying Illegal Kickbacks
DiDonato allegedly paid kickbacks disguised as consulting fees to ophthalmologists for patient referrals and billed Medicare approximately $3.4 million for duplicative or unnecessary diagnostic tests performed at his optometry practice and eye surgery center.
DOJChargedJul 9, 2026
Six Individuals, Including a Pharmacist and Doctor, Charged in Connection with $20 Million Healthcare Fraud and Kickback Scheme
A pharmacy owner paid cash kickbacks to a doctor, advanced practice nurses, and an office manager in exchange for medically unnecessary prescriptions for high-reimbursement medications billed to Medicare and Medicaid.
DOJPleaded guiltyJun 24, 2026
Cape May County Psychiatrist Admits to 17 Felony Counts for Unlawful Controlled Substance Prescriptions Linked to Sexual Conduct, Risk of Death, and Serious Bodily Injury
A psychiatrist issued invalid prescriptions for Adderall, Vyvanse, and Xanax to 17 patients outside the usual course of professional practice, with intent to defraud and mislead the dispensing pharmacies and the insurers, government benefits programs, and other third parties who paid for the drugs, sometimes in exchange for sexual activities, images, or videos.
DOJSentencedMay 21, 2026
New Jersey Physical Therapist Sentenced to 12 Months in Prison for Health Care Fraud Scheme Targeting Amtrak
Kim, a licensed physical therapist, allowed her license and business bank accounts to be used to bill Amtrak's health care plan for claims for services that never were provided and were medically unnecessary, in return for a portion of the proceeds.
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.