Physician

Sapana Mainali, M.D.

According to 2025 Medicare claims, Sapana Mainali, M.D. (NPI: 1235243726) practices internal medicine in the State College, PA market, with the plurality of this provider's patient population coming from Centre, PA. This provider's primary affiliated billing organization is GEISINGER CLINIC (NPI: 1093767915; TIN: 236291113) and primary practice location at 16801-7974. Mainali is affiliated with the Keystone ACO (ACO ID: A1552), participating under the MSSP model.

Mainali's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 326 traditional Medicare patients, billed 1,232 HCPCS/CPT codes, and received $62,906 in Medicare payments. The top billing code was 99215 (Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more). Part D data shows 6,399 prescription claims across 668 beneficiaries totaling $608,669 in drug costs, led by Ozempic (Semaglutide). DME data shows 55 claims. No Open Payments records. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing has moved up and down with repeated peaks and valleys, starting at $82,724 and ending at $62,906. Concurrently, Part D prescription costs have risen steadily, from $389,181 to $608,669. In contrast, DME billing represents a smaller volume and moved sharply higher in recent years, from $2,692 to $7,504.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	358	1,584	$82,724
2016	346	1,161	$72,726
2017	366	1,327	$59,408
2018	353	953	$54,972
2019	345	986	$63,489
2020	218	617	$36,477
2021	296	1,649	$62,225
2022	332	1,349	$68,676
2023	296	772	$56,129
2024	326	1,232	$62,906

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	543	8,706	$389,181
2016	584	9,323	$427,520
2017	517	6,499	$318,591
2018	553	6,440	$391,667
2019	617	6,302	$408,137
2020	564	5,793	$484,088
2021	514	5,280	$423,707
2022	575	6,060	$516,201
2023	612	5,939	$607,639
2024	668	6,399	$608,669

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	N/R	116	$1,792
2016	11	60	$887
2017	N/R	84	$2,052
2018	N/R	110	$2,824
2019	N/R	64	$2,188
2020	11	80	$3,366
2021	N/R	39	$2,123
2022	N/R	77	$8,295
2023	N/R	63	$6,342
2024	N/R	55	$7,166

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
99215	Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	87	114	$116
90662	Influenza vaccine split virus, preservative free	50	51	$82
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	215	325	$80
G0008	Administration of influenza virus vaccine	59	60	$30
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	258	405	$11

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Ozempic	Semaglutide	63	3,640	$117,628
Jardiance	Empagliflozin	60	2,886	$54,818
Trulicity	Dulaglutide	40	1,680	$53,825
Eliquis	Apixaban	31	1,740	$32,952
Spiriva Respimat	Tiotropium Bromide	40	1,686	$28,159

Top 5 DME services in 2024

By Total Medicare Payment Amount.

HCPCS Code	HCPCS Description	Supplier Rental Indicator	Total Supplier Beneficiaries	Total Supplier Claims	Total Medicare Payment Amount
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	N	N/R	25	$6,715
Q0513	Pharmacy dispensing fee for inhalation drug(s); per 30 days	N	N/R	14	$318
J7613	Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg	N	N/R	16	$133

Open Payments Summary

No connected Open Payments records were found for this physician in General Payments, Research Payments, or Ownership / Investment Interests.

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FAQ

What Medicare data is available for Sapana Mainali, M.D.?

Tedicare shows public-source Medicare data for Sapana Mainali, M.D. (NPI 1235243726), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does Sapana Mainali, M.D. have ACO affiliation data?

Sapana Mainali, M.D. is shown with ACO affiliation data for Keystone ACO (MSSP, ACO ID A1552).

What billing organization is linked to Sapana Mainali, M.D.?

Sapana Mainali, M.D. is linked to GEISINGER CLINIC (billing NPI 1093767915) in the available physician profile data.

Does Sapana Mainali, M.D. have Open Payments data?

No connected Open Payments records are shown for this physician in the available General Payments, Research Payments, or Ownership / Investment Interests data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.