Physician

John Michalak, M.D.

According to 2025 Medicare claims, John Michalak, M.D. (NPI: 1295174928) practices urology in the Pinehurst-Southern Pines, NC market, with the plurality of this provider's patient population coming from Moore, NC. This provider's primary affiliated billing organization is PINEHURST SURGICAL CLINIC PA (NPI: 1962434324; TIN: 560942061) and primary practice location at 28374-9495. Michalak is affiliated with the Carolinas HealthCare System ACO, LLC (ACO ID: A3675), participating under the MSSP model.

Michalak's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 815 traditional Medicare patients, billed 9,809 HCPCS/CPT codes, and received $437,090 in Medicare payments. The top billing code was 99214 (Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more). Part D data shows 2,264 prescription claims across 636 beneficiaries totaling $668,208 in drug costs, led by Xtandi (Enzalutamide). DME data shows 83 claims. Open Payments data shows 50 records totaling $1,116. 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 did not follow a clear longitudinal pattern. Concurrently, Part D prescription costs have moved sharply higher in recent years, from $4,928 to $668,208. For DME billing, this provider has fewer than 5 years of reported data, so a reliable trend cannot be assigned.

Part B Carrier Billing Trend

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

Year	Patients	Clm Lines	Payment
2015	N/R	N/R	N/R
2016	N/R	N/R	N/R
2017	N/R	N/R	N/R
2018	318	1,777	$107,141
2019	740	7,140	$409,363
2020	767	9,027	$612,516
2021	833	10,106	$775,353
2022	820	9,874	$564,042
2023	836	11,790	$547,363
2024	815	9,809	$437,090

Part D Events Trend

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

Year	Patients	Claims	Drug Cost
2015	69	123	$4,928
2016	61	118	$7,534
2017	83	141	$5,679
2018	145	269	$12,777
2019	372	1,028	$85,612
2020	430	1,264	$135,927
2021	455	1,409	$415,821
2022	541	1,760	$954,532
2023	569	2,179	$969,826
2024	636	2,264	$668,208

DME Billing Trend

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

Year	Patients	Claims	Payment
2015	N/R	N/R	N/R
2016	N/R	N/R	N/R
2017	N/R	N/R	N/R
2018	N/R	N/R	N/R
2019	29	48	$389
2020	52	126	$15,529
2021	51	143	$8,010
2022	53	197	$7,660
2023	N/R	94	$5,649
2024	N/R	83	$31,415

* / # = 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
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	532	789	$86
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	380	438	$12
51798	Ultrasound measurement of bladder capacity after voiding	484	644	$8
81001	Manual urinalysis test with examination using microscope, automated	376	498	$3
81003	Automated urinalysis test	265	307	$2

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Xtandi	Enzalutamide	26	780	$371,320
Gemtesa	Vibegron	149	8,003	$125,794
Myrbetriq	Mirabegron	145	7,138	$106,048
Tamsulosin Hcl	Tamsulosin Hcl	512	38,886	$6,845
Methenamine Hippurate	Methenamine Hippurate	80	4,560	$6,797

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
A4352	Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each	N	N/R	36	$30,218
A4357	Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each	N	N/R	17	$665
A4358	Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each	N	N/R	16	$389
A4333	Urinary catheter anchoring device, adhesive skin attachment, each	N	N/R	14	$143

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	50	$1,116	Sumitomo Pharma America, Inc.
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

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FAQ

What Medicare data is available for John Michalak, M.D.?

Tedicare shows public-source Medicare data for John Michalak, M.D. (NPI 1295174928), 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 John Michalak, M.D. have ACO affiliation data?

John Michalak, M.D. is shown with ACO affiliation data for Carolinas HealthCare System ACO, LLC (MSSP, ACO ID A3675).

What billing organization is linked to John Michalak, M.D.?

John Michalak, M.D. is linked to PINEHURST SURGICAL CLINIC PA (billing NPI 1962434324) in the available physician profile data.

Does John Michalak, M.D. have Open Payments data?

John Michalak, M.D. has 50 connected Open Payments records in the available 2024 summary 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.