⚠️

Risk scores are statistical indicators based on prescribing patterns compared to specialty peers. They are NOT allegations of fraud, misconduct, or improper care. Many legitimate medical reasons can explain outlier prescribing.

Read our methodology →

Ralph GuarinoMD

Internal Medicine · Toms River, NJ 8755

NPI: 1134140767

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21

🟡 Moderate

Risk Flags

High antipsychotic prescribing (65+)Opioid + benzodiazepine co-prescriber

Risk indicators are statistical patterns, not allegations. Learn more

8,959

Total Claims

$942K

Drug Cost

1,056

Beneficiaries

$892

Cost/Patient

Risk Score Breakdown 21/100

Low (0)Moderate (15)Elevated (30)High (50+)
Elderly antipsychotic prescribing+10
Opioid + benzodiazepine combo+8

Score components are additive. Read full methodology

Peer Comparison vs. 110,156 Internal Medicine providers

-83%

Opioid rate vs peers

0.4% vs 2.2% avg

-37%

Cost per patient vs peers

$892 vs $1,411 avg

+42%

Brand preference vs peers

15.1% vs 10.6% avg

⚠️ Opioid + Benzodiazepine Co-Prescriber

This provider prescribes both opioids and benzodiazepines. The FDA has issued a Black Box Warning about the life-threatening risks of concurrent use.

🔎 Data Overview

⚠️

This provider co-prescribes opioids and benzodiazepines — a combination carrying an FDA Black Box Warning due to increased risk of respiratory depression and death. While sometimes clinically necessary, this combination requires careful justification.

Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.

Opioid Prescribing

0.4%

Opioid Rate

35

Opioid Claims

$126

Opioid Cost

Long-Acting Rate

Brand vs Generic

85% generic

Brand: 1,341 claims · $774K

Generic: 7,544 claims · $164K

Top Prescribed Drugs

Drug (Generic)ClaimsCost
Apixaban78$72K
Dapagliflozin Propanediol64$66K
Empagliflozin60$56K
Dapaglifloz Propaned/Metformin48$43K
Semaglutide27$36K
Dulaglutide22$33K
Rivaroxaban34$29K
Mirabegron38$25K
Pitavastatin Calcium27$22K
Semaglutide18$22K
Vortioxetine Hydrobromide15$18K
Sitagliptin Phosphate14$17K
Levothyroxine Sodium150$16K
Insulin Glargine,hum.Rec.Anlog16$16K
Fluticasone/Umeclidin/Vilanter18$15K

Prescribing Profile

138

Unique Drugs

$240K

IRA Negotiated Drugs

$91K

GLP-1 Drugs

21.0

Anomaly Score

Patient Profile

81

Avg Age

65%

Female

1.24

Avg Risk Score

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Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations of wrongdoing.Methodology · About · Dispute this data