Brenda Juan-Guardela, MD
Pulmonary Disease · Naples, FLNPI 1225322902
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 100.0% of the total across 12 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. 5 manufacturers reported payments, led by United Therapeutics Corporation at 32.1% of the total. Reporting peaked in 2021 at $152 and has fallen 70.8% since, to $45 in 2025. That places this record below the midpoint for pulmonary disease clinicians in FL, where the typical reported total is $2,936.
Across 12 payments — averaging $32.14 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- United Therapeutics Corporation$124
- GSK$105
- Boehringer Ingelheim$82
- Actelion Pharmaceuticals US, Inc.$47
- Vapotherm Inc$28
Across 17 payments — averaging $2029.57 each. Payments tied to a research study. These frequently flow through the physician to a hospital or research institution rather than to the physician personally.
- Dompe Farmaceutici S.p.a.$35K
What the payments were for
- Food & beverage$386100%
Most of this is food and beverage — typically meals provided during product presentations at a clinic or hospital. Nationally that is the single largest category of reported payments by count.
General payments by program year
Who reported the general payments
Companies are grouped under their corporate parent — a single manufacturer often files under several CMS reporting entities. Research and ownership payments are counted separately and are not in this table.
| Company | Payments | Total |
|---|---|---|
| United Therapeutics Corporation | 1 | $124 |
| GSK | 6 | $105 |
| Boehringer Ingelheim | 1 | $82 |
| Actelion Pharmaceuticals US, Inc. | 3 | $47 |
| Vapotherm Inc | 1 | $28 |
How this compares
$386 in reported general payments places this provider in the 20th percentile of 953 pulmonary disease providers in Florida.
Medicare billing
What this is not: this is the amount Original Medicare Part B allowed for services this provider billed in 2024. It is not their income. It excludes Medicare Advantage — now more than half of all Medicare enrollment — along with Medicaid and all commercial insurance, and it is gross practice revenue before staff, rent, supplies and malpractice premiums. CMS also suppresses any figure covering ten or fewer patients, so low-volume providers appear smaller than they are.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| Prolastin CAlpha-1-Proteinase Inhibitor | 11 | $108,644 |
| Breztri AerosphereBudesonide/Glycopyr/Formoterol | 57 | $49,639 |
| Trelegy ElliptaFluticasone/Umeclidin/Vilanter | 54 | $40,744 |
| Spiriva HandihalerTiotropium Bromide | 19 | $17,929 |
| Anoro ElliptaUmeclidinium Brm/Vilanterol Tr | 18 | $13,141 |
| Advair HfaFluticasone Propion/Salmeterol | 13 | $7,672 |
| DuleraMometasone/Formoterol | 17 | $6,537 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 64 | $2,038 |
| BreynaBudesonide/Formoterol Fumarate | 11 | $2,024 |
| Wixela InhubFluticasone Propion/Salmeterol | 11 | $1,278 |
| Xopenex HfaLevalbuterol Tartrate | 13 | $1,054 |
| Azelastine Hcl | 21 | $718 |
| Fluticasone Propionate | 34 | $546 |
| Montelukast Sodium | 52 | $476 |
| Azithromycin | 18 | $262 |
Paid to pharmacies, not to this prescriber.
Companies that both paid and supply prescribed drugs
These companies both reported payments to this provider and make drugs the provider prescribed under Medicare Part D in 2024. For most specialties this overlap is expected — a cardiologist who is paid by a cardiology drugmaker also treats heart disease. It is shown so the reader can see it, not because it implies anything on its own.
| Company | Paid to this provider | Part D cost of their drugs |
|---|---|---|
| GSKTrelegy Ellipta, Anoro Ellipta | $105 | $53,88472 claims |
Reading this fairly. The Part D column is what drug plans and patients paid pharmacies — this provider received none of it, and it reflects how many patients they treat and what those drugs cost. Against peers, this provider's reported payments sit in the 20th percentile of 953 pulmonary disease providers in Florida.
Other pulmonary disease in Naples
- Edward SalernoNaples$154K
- Franck RahaghiWeston$1.2M
- Michael OttEglin Afb$909K
- Ali JiwaniOrlando$859K
- Anas HadehWeston$800K
- Jennifer FultonJacksonville$665K
- Ricardo Restrepo-JaramilloTampa$555K
- Mark RumbakTampa$528K
- Jose Soto SotoJacksonville$504K
- Javier Perez FernandezMiami$496K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Billing: Medicare Physician & Other Practitioners, data year 2024. Original Medicare Part B only.
- Identity: NPPES NPI Registry, July 2026.