Medicare Enrolled
Dr. Ralph Guarino, MD
Internal Medicine · Toms River, NJ
Practice pattern: Clinical Cardiology
— Primarily office-based clinical cardiology
Low-engagement
Very High
DATA COVERAGE
Data in 4 of 4 federal sources
Measures public federal data availability — not provider quality
Informational, not a quality rating.
This page presents federal public records about Dr. Guarino from CMS (NPPES, Open Payments, Medicare Provider Utilization, PECOS). It is not medical advice, an endorsement, or a judgment of clinical quality. Always consult the provider directly and a licensed clinician for medical decisions. Read methodology →
Are you Dr. Guarino?
Request a correction or review of any data shown here. Provider portal →
What this data tells you about Dr. Guarino
Dr. Ralph Guarino is an internal medicine specialist in Toms River, NJ, with 19 years of NPI registration. Based on federal Medicare data, Dr. Guarino performed 4,706 Medicare services across 2,572 unique beneficiaries.
Between the years covered by Open Payments, Dr. Guarino received a total of $24,785 from 49 pharmaceutical and/or device companies across 1074 individual payments. These payments are legal, publicly disclosed under the federal Sunshine Act, and common in internal medicine. Most payments are for meals and travel — low-value interactions common across virtually all practicing physicians. Patients may wish to discuss these relationships with their provider.
The Data Coverage level for Dr. Guarino is Very High — reflecting how much public federal data is available about this provider. Patients are encouraged to use this data as one of several factors when choosing a healthcare provider.
✓ 19 years in practice
▲ Top 6% volume in NJ
$24,785 industry payments
Medicare Practice Summary
Medicare Utilization ↗4,706
Medicare services
Top 6% in NJ for internal medicine
2,572
Unique beneficiaries
$53
Avg. Medicare payment
Medicare patients only (65+ / disabled) · How to read this →
~248 Medicare services per year of practice
Top procedures by volume
Ranked by number of services performed for Medicare patients. Avg. submitted charge is what the provider billed; avg. Medicare payment is what CMS paid.
| Procedure | Volume | Avg. paid | Avg. submitted |
|---|---|---|---|
| Office visit, established patient (20-29 min) An office visit for an existing patient lasting between 20 and 29 minutes. The visit involves medical evaluation and management of the patient's condition. |
2,217 | $71 | $101 |
| Betamethasone steroid injection An injection containing a combination of betamethasone acetate and betamethasone sodium phosphate. |
558 | $5 | $10 |
| Drug injection, under skin or into muscle A procedure involving the administration of a medication or substance via injection into the subcutaneous tissue or muscle. |
380 | $12 | $19 |
| Office visit, established patient (30-39 min) A follow-up office visit for an existing patient lasting between 30 and 39 minutes. The visit involves medical evaluation and management of the patient's condition. |
340 | $98 | $145 |
| Ketorolac injection, per 15 mg An injection of ketorolac tromethamine, a nonsteroidal anti-inflammatory drug, administered in doses measured per 15 mg. |
260 | $0 | $5 |
| Flu vaccine, high-dose High-dose seasonal influenza vaccine for adults aged 65 and older. Contains four times the antigen of standard-dose flu vaccines (60 mcg per strain), split-virus formulation, preservative-free, single-dose syringe. |
259 | $72 | $80 |
| Flu vaccine administration This procedure involves the administration of the influenza virus vaccine. It covers the process of delivering the vaccine to the patient. |
259 | $33 | $35 |
| Electrocardiogram (EKG), 12-lead A standard heart rhythm test using at least 12 leads to record electrical activity. A healthcare provider interprets the results and provides a written report. |
132 | $12 | $18 |
| Prothrombin time test (blood clotting) A laboratory test that measures how long it takes for blood to clot. This procedure evaluates the body's coagulation process. |
81 | $4 | $5 |
| Ultrasound of head and neck blood flow, bilateral An ultrasound exam that uses sound waves to visualize and assess blood flow in the vessels of both the head and the neck. |
76 | $164 | $235 |
| Office visit, established patient (10-19 min) An office visit for an existing patient lasting 10 to 19 minutes. The visit involves medical evaluation and management of the patient's condition. |
74 | $45 | $65 |
| New patient office visit (45-59 min) An initial office visit for a new patient lasting between 45 and 59 minutes. This code covers the total time spent by the physician or qualified healthcare professional on the date of the encounter. |
31 | $135 | $192 |
| Home health plan of care certification Certification by a physician or allowed practitioner for Medicare-covered home health services under a home health plan of care. This includes contacting the home health agency and reviewing reports of patient status required by physicians. |
26 | $43 | $75 |
| Ultrasound of leg arteries or grafts An imaging test that uses sound waves to create pictures of the blood vessels in the legs or any surgical grafts present. |
13 | $203 | $290 |
How to read this data: This reflects Medicare patients only (typically 65+). Payment amounts are what Medicare paid the provider, not your out-of-pocket cost. A higher procedure volume generally indicates more experience with that procedure.
Industry Payment Transparency
Open Payments through 2024 ↗$24,785
Total received (2018-2024)
Avg $3,541/year across 7 years
Top 3% in NJ for internal medicine
A higher payment rank reflects disclosed industry relationships (consulting, research, speaking) common among subspecialists — not wrongdoing.
49
Companies
1,074
Individual payments
All payments are legal and publicly reported · Not evidence of wrongdoing · How to interpret →
Payment profile
Industry payments classified by relationship type. Not all payments are equal — research and consulting reflect different relationships than speaking programs or meals.
Meals & Travel
Food, beverages, travel, and lodging — typically low-value
$24,507 (98.9%)
Speaking / Promotional
Speaker programs, honoraria, and industry-sponsored educational events
$279 (1.1%)
Payment trend by year
Annual totals from pharmaceutical and medical device companies.
2024
$4,488
2023
$3,039
2022
$2,847
2021
$5,100
2020
$2,624
2019
$4,185
2018
$2,502
Payments by company (2024)
Consulting
Speaking
Meals & Travel
Research
AstraZeneca Pharmaceuticals LP
$2,321
ABBVIE INC.
$626
GlaxoSmithKline, LLC.
$389
Bayer Healthcare Pharmaceuticals Inc.
$201
Novo Nordisk Inc
$188
Amgen Inc.
$125
Boehringer Ingelheim Pharmaceuticals, Inc.
$118
AIMMUNE THERAPEUTICS, INC.
$113
PFIZER INC.
$103
Salix Pharmaceuticals, a division of Bausch Health US, LLC
$76
Sumitomo Pharma America, Inc.
$63
Phathom Pharmaceuticals, Inc.
$60
Corcept Therapeutics
$43
Medtronic, Inc.
$31
SANOFI PASTEUR INC.
$17
Eisai Inc.
$13
Top 3 companies account for 74.3% of 2024 payments
All-time payments by company (2018-2024) ›
AstraZeneca Pharmaceuticals LP
$7,468
GlaxoSmithKline, LLC.
$2,758
Novo Nordisk Inc
$2,230
E.R. Squibb & Sons, L.L.C.
$1,226
ABBVIE INC.
$1,219
Boehringer Ingelheim Pharmaceuticals, Inc.
$1,069
PFIZER INC.
$974
Janssen Pharmaceuticals, Inc
$910
Lilly USA, LLC
$858
Amgen Inc.
$817
Salix Pharmaceuticals, a division of Bausch Health US, LLC
$647
Astellas Pharma US Inc
$603
AbbVie Inc.
$366
Amarin Pharma Inc.
$356
Takeda Pharmaceuticals U.S.A., Inc.
$230
SANOFI-AVENTIS U.S. LLC
$207
Novartis Pharmaceuticals Corporation
$205
Merck Sharp & Dohme Corporation
$202
Bayer Healthcare Pharmaceuticals Inc.
$201
Eisai Inc.
$200
Daiichi Sankyo Inc.
$199
ARBOR PHARMACEUTICALS, INC.
$175
Biohaven Pharmaceutical Holding Company Ltd.
$161
Kowa Pharmaceuticals America, Inc.
$129
Celgene Corporation
$125
Nestle HealthCare Nutrition Inc.
$119
NESTLE HEALTHCARE NUTRITION INC.
$114
AIMMUNE THERAPEUTICS, INC.
$113
Allergan Inc.
$109
AbbVie, Inc.
$106
Azurity Pharmaceuticals, Inc.
$97
Corcept Therapeutics
$75
Allergan, Inc.
$66
Medtronic, Inc.
$64
Sumitomo Pharma America, Inc.
$63
Phathom Pharmaceuticals, Inc.
$60
Horizon Therapeutics plc
$42
Bausch Health US, LLC
$42
SANOFI PASTEUR INC.
$34
Merck Sharp & Dohme LLC
$28
Noden Pharma USA Inc
$23
Medtronic Vascular, Inc.
$14
Seqirus USA Inc
$13
Ironwood Pharmaceuticals, Inc
$12
IRONWOOD PHARMACEUTICALS, INC
$12
Amneal Pharmaceuticals LLC
$12
PORTOLA PHARMACEUTICALS, INC.
$12
Philips Electronics North America Corporation
$12
Sanofi Pasteur Inc.
$11
Top 3 companies account for 50.3% of all-time payments
Associated products mentioned in payments ›
AIRSUPRA · ANORO · ANORO ELLIPTA · APLENZIN · AREXVY · Aimovig · Amitiza · BASAGLAR · BELSOMRA · BEVESPI AEROSPHERE · BEVYXXA · BREO · BREZTRI · BREZTRI AEROSPHERE · BYSTOLIC · BYVALSON · CHANTIX · CLOSUREFAST · COLOGUARD DNA CAPTURE REAGENTS · ClosureFast · DUZALLO · Dayvigo · Dexilant · ELIQUIS · EMGALITY · ENTRESTO · EUCRISA · Edarbi · Edarbyclor · Entyvio · FARXIGA · FASENRA · FLUZONE HIGH-DOSE · Fluad · GEMTESA · HUMIRA · Humira · INJECTAFER · INVOKANA · JANUVIA · JARDIANCE · KRYSTEXXA · Kerendia · Korlym · LINZESS · LOKELMA · LYRICA · Leqembi · Linzess · Livalo · MOUNJARO · MYRBETRIQ · Movantik · NURTEC ODT · Otezla · Ozempic · PREVNAR - 13 · PREVNAR 13 · PREVNAR 20 · Prolia · QULIPTA · RINVOQ · RYBELSUS · Repatha · Rinvoq · Rybelsus · SHINGRIX · SKYRIZI · SOLIQUA 100/33 · STIOLTO RESPIMAT · SYMBICORT · SYNTHROID · TEKTURNA · TEZSPIRE · TOUJEO · TRADJENTA · TRELEGY ELLIPTA · TRINTELLIX · TRULANCE · TRULICITY · Tresiba · Trintellix · UBRELVY · UNITHROID · VIBERZI · VOQUEZNA · VRAYLAR · Vascepa · Victoza · WELLBUTRIN · Welchol · Wellcentive Undiv · XARELTO · XIFAXAN · Xultophy 100/3.6 · ZENPEP
Should you be concerned? Payments from pharmaceutical and device companies are legal and common — 57% of U.S. physicians receive at least one. They often reflect legitimate consulting, research, or education. What matters is whether a recommended drug or device appears in your doctor's payment records. If so, consider asking your doctor about it. How to interpret this data →
Most payments (99%) are for meals and travel — low-value interactions that are common across virtually all practicing physicians. Total industry engagement is in the top 3% for internal medicine in NJ.
Geographic Context
Internal medicine physicians within 10 mi
623
Per 100K population
96.4
County median income
$86,411
Nearest hospital
COMMUNITY MEDICAL CENTER
0.0 mi
0.0 mi
Data Sources
| Provider Registry | ✓ NPPES | Weekly updates |
| Medicare Enrollment | ✓ PECOS | Monthly updates |
| Practice Data | ✓ Medicare Util. | Annual (CY lag) |
| Industry Payments | ✓ Open Payments | CY 2024 |
| Disciplinary History | — Not public | N/A |
This provider has data in 4 of 4 available federal datasets, with a Data Coverage level of Very High. This reflects how much public data is available about a provider. How we calculate this →
Summary
Dr. Guarino is a clinical cardiology specialist, with above-average Medicare volume (top 6% in NJ), with low-engagement industry engagement in the top 3% of NJ peers, with 19 years of NPI registration.
This summary is auto-generated from federal data, describing data availability and patterns. Read our methodology →
Frequently Asked Questions
Is Dr. Guarino experienced with office visit, established patient (20-29 min)?
Based on Medicare claims data, Dr. Guarino performed 2,217 office visit, established patient (20-29 min) services. Research suggests that higher procedure volume is often associated with better outcomes, particularly for complex procedures. Note that Medicare data only captures patients aged 65 and older, so the total practice volume across all patients is likely higher.
Does Dr. Guarino receive payments from pharmaceutical companies?
Yes. Dr. Guarino received a total of $24,785 from 49 companies across 1,074 individual payments. These payments are legal, publicly disclosed under the federal Sunshine Act, and common among physicians — 57% of all U.S. physicians receive at least one industry payment. Patients may wish to ask their doctor about these relationships, especially if a recommended drug or device appears in the payment records.
How do Dr. Guarino's costs compare to other internal medicine physicians in Toms River?
Dr. Guarino's average Medicare payment per service is $53. Note that these figures represent what Medicare pays, not your out-of-pocket cost, which depends on your specific insurance plan and deductible. Procedure-level data above shows both what was submitted and what Medicare paid for each service type.
What does Data Coverage mean?
Data Coverage (currently Very High for Dr. Guarino) measures how much public federal data is available about a provider. It is not a quality rating. A "Very High" or "High" level means the provider has data across multiple federal sources (NPPES, PECOS, Medicare Utilization, Open Payments), indicating a long track record of practice, Medicare participation, and industry disclosure. A "Low" or "Moderate" level may simply mean the provider is newer, does not see Medicare patients, or has not received any industry payments — none of which are inherently negative. Read our full methodology →
Is this data up to date?
Each data source has its own update cycle. Provider registry data (NPPES) is updated weekly. Medicare enrollment (PECOS) is updated monthly. Medicare practice data has a ~2 year lag — the most recent available is typically 2 years prior. Industry payment data (Open Payments) is published annually, usually in June, covering the prior calendar year. We display the data date prominently on each section so you always know how current it is. See our data freshness policy →
Explore related providers
Same specialty & city
Internal Medicine Physicians in Toms River
Browse internal medicine physicians in Toms River ranked by procedure volume and transparency data.
Highest volume
Top Internal Medicine Physicians in NJ
Internal medicine physicians ranked by total Medicare services performed statewide.
Industry payments
Pharma Payments to Internal Medicine Physicians in NJ
Which NJ internal medicine physicians receive the most from drug and device companies.
By company
AstraZeneca Pharmaceuticals LP Payments to Doctors
See all physicians who received payments from AstraZeneca Pharmaceuticals LP.
By company
GlaxoSmithKline, LLC. Payments to Doctors
See all physicians who received payments from GlaxoSmithKline, LLC.
By company
Novo Nordisk Inc Payments to Doctors
See all physicians who received payments from Novo Nordisk Inc.
About this page
All data on this page is sourced verbatim from public federal records published by the U.S. Centers for Medicare & Medicaid Services (CMS): NPPES ↗, Open Payments ↗, Medicare Provider Utilization ↗, and PECOS. Publication is mandated by the Physician Payments Sunshine Act (§6002 ACA, 42 U.S.C. §1320a-7h) and the Freedom of Information Act.
This page is not medical advice, an endorsement, a recommendation, or a quality rating. Data Coverage reflects data completeness — how much federal information exists for this provider — not clinical performance, patient outcomes, or quality of care. Always verify information directly with the provider and consult a licensed clinician before making medical decisions.
Provider corrections: Provider portal · Privacy questions: Privacy Policy · Terms: Terms of Use · Methodology: Methodology