Noridian Medical Directors - JE Part B
Noridian Medical Directors
Smitha Ballyamanda, MD, CAQSM
Smitha Ballyamanda, MD, CAQSM, joined Noridian Healthcare Solutions in September 2018 as a Durable Medical Equipment Contractor Medical Director. Dr. Ballyamanda completed her Family Medicine Residency and Primary Care Sports Medicine Fellowship training at Drexel University in Philadelphia, PA. Board-certified in Family Medicine and Primary Care Sports Medicine, Dr. Ballyamanda brings 12 years of practice experience in Family Medicine, Sports Medicine, Occupational Medicine, and Urgent Care services. She also has five years of Medicare experience in physician reviews, medical policy, and Administrative Law Judge case work. Dr. Ballyamanda continues to practice clinical medicine in the medical, occupational and orthopedic urgent care setting.
Felice Caldarella, MD, MBA, FACP, CDES, FACE
Felice Caldarella, MD, MBA, FACP, CDES, FACE joined Noridian Healthcare Solutions in August 2022 as a Durable Medical Equipment Contractor Medical Director. Dr. Caldarella completed his medical degree at SUNY Upstate Medical University. He then completed his internal medicine residency at Brown University Internal Medical Residency Program. He then went to University of Medicine and Dentistry of New Jersey in Newark for endocrinology fellowship. He is board-certified in Endocrinology, Diabetes and Metabolism. Dr. Caldarella brings 18 years of practice experience in caring for people with diabetes, endocrine disorders, and obesity. Dr. Caldarella also had a master’s in business in administration from DeSales University with a concentration in healthcare administration. Dr. Caldarella was President of the American Association of Clinical Endocrinology after serving on the Board of Directors, Secretary, Treasurer, Vice-President, and President-Elect roles. In his leadership roles he chaired and served on numerous committees including as representative of AACE to Relative Value Update (RUC) Committee.
Raeann Capehart, MD
Raeann Capehart, MD, joined Noridian as a Contractor Medical Director in September 2020. Raeann graduated from the University of Oklahoma College of Medicine and trained in a General Surgery at the Medical College of Virginia with subsequent fellowships in Vascular Transplant and Surgical Oncology (MCV). She is a Diplomate of the American Board of Surgery with over 30 years of active practice in academic and private clinical facilities in North Texas and Virginia. Practice experience includes all aspects of Vascular and Transplant Surgery, Surgical Oncology, Bariatric Surgery, Oncoplastic Breast Surgery, Trauma and Wound Care. She has been an active member of multiple specialty societies, as well as Local, State and National Medical Associations. She has served as a Qualified Independent Reviewer in the Medical Care Ombudsman Program and Policy Review, with over 20 years of Medicare experience with eight years as a Medicare Contractor Medical Director.
Larry Clark, MD, FACP
Larry Clark, MD, FACP, joined Noridian as a Contractor Medical Director in spring 2019. Dr. Clark is a graduate of the Georgetown University School of Medicine. He completed his Internal Medicine training as an intern with the S.U.N.Y. Stony Brook program, and residency with the Georgetown University- Washington Veterans Administration Medical Center program. During his 34 years of internal medicine practice in Alexandria, VA, he served as the President of the Medical Staff of Mount Vernon Hospital, as the President of the Virginia Society of Internal Medicine, and on the Governor’s Council of the VA chapter of the American College of Physicians.
He served as the Internal Medicine alternate for VA on the inaugural Medicare Carrier Advisory Committee for the DC Metro Area. Eventually, he became the co-chair of the Committee, and then stepped down to serve as a regional consultant for TrailBlazer Medicare. He served as a Medicare Medical Director for TrailBlazer in the Mid-Atlantic region for almost a decade, and subsequently served in the same role for Highmark, while also continuing in clinical practice. This was followed by seven years with NGS, as medical director for New York and New England. Dr. Clark continues to practice clinical medicine as the volunteer medical director of the Carpenters Shelter clinic, a homeless shelter in the City of Alexandria. His interests remain in medical policy development and clinical outcomes.
Anitra Graves, MD, MMM, FCCP, FAASM
Anitra Graves, MD, MMM, FCCP, FAASM, joined Noridian Healthcare Solutions in September 2020. Dr. Graves graduated from Northeast Ohio Medical University (NEOMED) and completed her Internal Medicine Residency and Pulmonary/Critical Care Medicine Fellowship training at Emory University. She is Board Certified in Pulmonary, Critical Care, and Sleep Medicine and has been recognized as one of Atlanta's Top Doctors in multiple years of her clinical career. She also earned a Masters of Medical Management (MMM) at Carnegie Mellon University. She has seven prior years of Medicare experience as a MAC CMD. Dr. Graves continues to practice in Pulmonary/Critical Care Medicine as an affiliate faculty member for the Southwest Indiana Internal Medicine Residency Program.
Peter Gurk, MD, CPE, CHCQM
Peter Gurk, MD, CPE, CHCQM, joined Noridian Healthcare Solutions in February 2015 as a Durable Medical Equipment Contractor Medical Director. Dr. Gurk is a Family Practice physician by training. He has more than 11 years of diverse clinical experience, having worked in a physician-owned group family practice, in urgent care/emergency room settings in both Illinois and Kentucky. His experience as a medical director spans over 16 years, both as a Medical Director of a commercial insurance plan and ten years in Medicare for both Parts A/B and DME.
Dr. Gurk came to Noridian from a position as Senior Medical Director at the Medicare Recovery Auditor (RAC) HealthDataInsights (HDI) in Las Vegas. His primary role was participation in ALJ hearings, providing an intensive background in Medicare law, regulations and manual requirements as well as in appeals processes.
Dr. Gurk participates in Noridian’s Nevada IMPAC meetings. He also is an active member of the American Academy of Family Practice, and the Nevada chapter of the AAFP. Peter is a diplomate of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
Angela Jenny, DO
Angie Jenny, DO, joined Noridian Healthcare Solutions as a Durable Medical Equipment Contractor Medical Director in August 2019. Dr. Jenny graduated from Lake Erie College of Osteopathic Medicine and completed her Family Medicine residency at a combined program with St. Louis University and Scott Air Force Base in Belleville, IL. Board-certified in Family Medicine, Dr. Jenny brings 16 years of clinical experience split between time as an Air Force family physician and more recently in the urgent-care setting. Dr. Jenny continues to practice clinical family medicine part time.
Janet I. Lawrence, MD, MS, FACP
Janet Lawrence, MD, MS, FACP, joined Noridian Healthcare Solutions as a Contractor Medical Director in October 2018. She is a physician with18 years of medical review experience dating all the way back to the old Health Care Financing Administration (now known as CMS). Her experience includes serving as the U.S. Army deputy command surgeon in Birmingham, AL. She also spent five years at the Qualified Independent Contractor for Medicare DME. Prior to that, she was at National Government Services as a MAC contractor medical director. Dr. Lawrence is a board-certified internal medicine physician with an M.S. in strategic studies from the U.S. Army War College.
Arthur Lurvey, MD, FACP, FACE
Dr. Lurvey received his Doctor of Medicine from the University of Illinois, Chicago Campus, and completed his internal medicine residency and endocrinology fellowship at Los Angeles County-USC Medical Center. Dr. Lurvey brings to Noridian 25 years of Medicare medical director experience.
As a Medicare medical director, Dr. Lurvey provided guidance and medical expertise to the Part A Medicare Integrity Program areas and Medicare contractors. He wrote local coverage determinations (LCDs) for both Part A and Part B aspects of Medicare, and worked with Medicare review at each contract to oversee claims, reviews, and appeals. Dr. Lurvey educated the nurse reviewers and assisted in redeterminations and administrative law judge (ALJ) situations. To increase awareness and understanding of Medicare programs, Dr. Lurvey developed educational programs for physicians, specialty societies, institutional providers, and others in the states and jurisdictions managed by the contractors. Programs included home health and hospice in eight states, and most recently in Jurisdiction 1 while working for Palmetto GBA.
He actively participates in professional activities, serving as the liaison for Medicare issues to key professional societies including the California Medical Association, the American Medical Association, the American College of Physicians, and the American Association of Clinical Endocrinologists. Dr. Lurvey also has experience in administration, serving for six years as the director for utilization management at Midway Hospital in Los Angeles. He published 10 articles on various endocrinology topics between 1969 and 1985.
Fred Mamuya, MD, PhD
Wilfred (Fred) Mamuya, MD, PhD, is Vice President of Medical Policy, providing policy oversight and leading medical director collaboration for Noridian's Jurisdictions A, D, E, F, and Supplemental Medical Review Contractor (SMRC) contracts. A graduate of Boston University School of Medicine, Dr. Mamuya completed his medical residency and fellowship in cardiovascular medicine at the Brigham & Women's Hospital, Boston, MA. He is board certified in internal medicine, specializing in cardiovascular disease. He is licensed to practice medicine in Massachusetts, and remains clinically active.
Eileen Moynihan, MD, FACP, MACRh
Dr. Moynihan received her Doctor of Medicine from Temple University School of Medicine in Philadelphia, Penn. She completed rheumatology fellowships and internal medicine residencies at Hahnemann Hospital and Albert Einstein Medical Center, both in Philadelphia. Dr. Moynihan has worked with Medicare A/B and DME programs for more 25 years. She is a board-certified, practicing rheumatologist for the past 35 years, Dr. Moynihan is licensed by the states of New Jersey and Pennsylvania.
An accomplished, highly respected physician with memberships in multiple medical associations and honor societies, Dr. Moynihan connects routinely with medical experts both nationally and globally. As such, she has the unique opportunity to collaborate on medical policy issues face-to-face with experts in all fields of medicine. For example, as a member of the American Medical Association (AMA), Dr. Moynihan is part of several coalitions, which gives her direct access to physicians in all types of specialty groups. She has worked previously with the U.S. Bone and Joint Initiative after representing the Board of the American College of Rheumatology as its liaison. Working with diverse groups of physicians as well as her experience in rendering care to patients provides her with a great advantage of understanding medical practice as well as the science and clinical issues behind medical policies enabling her to have the skills e to build consensus on policy among physicians.
The physician community's trust in Dr. Moynihan's judgment and fairness is evident, as she has been appointed by physician organizations to critical roles. She was elected by the Board of Trustees of the AMA to serve as the vice co-chair of the Relative Value Update Committee of the AMA for the AMA, having initially served as a relative value update advisor and then an alternate delegate for the American College of Rheumatology (ACR) to that body. Meetings include working with the national specialty society representatives, the AMA staff, and CMS. In addition, the ACR advanced Dr. Moynihan to the position of delegate, having initially selected her as an alternate delegate at the national AMA meetings, where she represents the organization in meetings with other specialty societies and state representatives. She chaired the Committee on Rheumatologic Care for three years for the American College of Rheumatology and served on the Board of Directors for that same organization. She has also previously been elected president of both her county and state medical societies.
Gary Oakes, MD, FAAFP
Dr. Oakes received his Doctor of Medicine from the University of Tennessee College of Medicine in Memphis, TN., and completed his post-graduate family practice residency and family practice internship at Naval Hospital in Jacksonville, FL. He came to Noridian with more than 25 years of experience as a practicing physician and 16 years of experience as a medical director, including eight years in Medicare experience. In addition to his previous experience, Dr. Oakes has been employed as a CMD for Noridian since November 2012.
A seasoned medical director who is fervent about and dedicated to the delivery of appropriate and efficient medical care, Dr. Oakes is a strong physician and employee leader. He is well-respected by peers and subordinates for ethical and diverse work standards. His fair but sometimes tough strategic and tactical decisions result in practical solutions and “Win-Win” outcomes that assure the proper patient care. Dr. Oakes was awarded the Navy Commendation Medal for exemplary service rendered in support of Desert Storm.
Dr. Oakes has been a board-certified Doctor of Medicine since 1986, and never been sanctioned or excluded from the Medicare Program. Recently, he successfully completed the American Board of Family Medicine (ABFM) board recertification examination requirement and remains fully vetted as a Diplomat with the ABFM.
Manuel Pubillones, MD
Dr. Manuel Pubillones is a Medical Director for Noridian’s SMRC. He received his medical degree in psychiatry from the University of Puerto Rico, and is also a medical technologist specializing in parasitology. Before joining Noridian, Dr. Pubillones worked at the San Juan Veterans Administration Medical Center, which had 240 inpatient psychiatric beds. He then served as Medical Director for the Puerto Rico State Psychiatric Hospital for seven years before joining the Puerto Rico Medicare program as Medical Director for Part A services.
Ann Marie Sun, MD
Ann Marie Sun, M.D., joined Noridian Healthcare Solutions in April 2019 as a Part A/B Contractor Medical Director. Dr. Sun graduated from the University of Missouri-Columbia and completed her residency in emergency medicine at Maricopa County Medical Center in Phoenix, AZ. As a board-certified emergency medicine physician, Dr. Sun brings clinical experience in both emergency medicine and primary care/urgent care medicine. Having previously served as medical director for several large health care systems, she also has expertise in hospital utilization, health plan utilization management, and population health.
Richard Whitten, MD, MBA, FACP
Dr. Richard Whitten is Senior Medical Director for Noridian's Supplemental Medical Review Contractor (SMRC). He received his MD from Northwestern in Chicago, completed his internal medicine residency at the University of Washington (UW) and specialized is internal medicine/critical care.
Dick was the CMD liaison to both the American Medical Association (AMA) Current Procedural Terminology (CPT) and Resource Based Relative Value System (RBRVS) Update Committee (RUC) processes, was on the RUC for 12 years, and its Vice Chair for six. He holds an MBA with a focus on human behavior in health care organizations from Harvard Business School in Cambridge, Mass., has 30+ years of medical director experience and more than 30 years of clinical practice which continue at UW/Harborview in Seattle.
Last Updated Fri, 09 Dec 2022 19:35:47 +0000