ALBA NYDIA MENDEZ MORALES, M.D.
NPI 1992914147, individual, Peapack, NJ, Pediatrics
- Hours beyond a day in 1 month, but with up to 916 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2024 | More hours than a day holds, even counting one unit per claim line | 26.5 | 3.6 | 2.4 | 3.2 | 351 | 1 | 99213 | $13K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ALBA NYDIA MENDEZ MORALES, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | May 22, 2007, last updated July 29, 2010 |
| Practice location | 65 HIGHLAND AVENUE, Peapack, NJ 07977, 908-234-0011 |
| Specialties | Pediatrics (208000000X, primary, license 25MA08761000 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.
| 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 | $856K | 64% | $41 | $44 (top 5% from $110) | 46th percentile | |
| 99393 | Medicaid service code | $78K | 6% | $33 | $78 (top 5% from $121) | 18th percentile | |
| 90471 | Administration of vaccine | $76K | 6% | $12 | $10 (top 5% from $23) | 58th percentile | |
| 90472 | Administration of vaccine, each additional vaccine | $67K | 5% | $21 | $14 (top 5% from $40) | 71st percentile | |
| 99392 | Medicaid service code | $53K | 4% | $33 | $78 (top 5% from $124) | 17th percentile | |
| 99394 | Medicaid service code | $51K | 4% | $31 | $83 (top 5% from $128) | 20th percentile | |
| 90460 | Administration of first vaccine or toxoid component with counseling (18 years or younger) | $26K | 2% | $26 | $26 (top 5% from $54) | 51st percentile | |
| 36415 | Insertion of needle into vein for collection of blood sample | $20K | 1% | $2.48 | $1.97 (top 5% from $12) | 61st percentile |
In this area
3 providers in Somerset County, NJ carry an indicator in the public record, with $29K at stake between them. The most common is named in an enforcement record, on 1 of them, followed by part of a provider network on 1. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | EXPRESS DIAGNOSTICS LLC Somerset, NJ, ranked 640 | $0 |
|
| 3 | SOMERSET WOODS REHABILITATION AND NURSING CENTER LLC Somerset, NJ, ranked 1681 | $540 |
|
| 5 | MICHAEL SOLIMAN Somerset, NJ, ranked 11835 | $29K |
Recent enforcement in NJ
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.