Bryce Karulak, DPM
Foot & Ankle Surgery · San Antonio, TXNPI 1538407473
Payments from drug & device makers
What this record shows
This record is dominated by consulting fees: $9,925 of the $15,794 with a category attached, or 62.8%. 14 manufacturers reported payments, led by Heron Therapeutics, Inc. at 36.3% of the total. Reporting peaked in 2022 at $7,006 and has fallen 90.0% since, to $701 in 2025.
Across 83 payments — averaging $190.29 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Heron Therapeutics, Inc.$6K
- Medical Device Business Services, Inc.$5K
- Arthrex$2K
- Medinc Of Texas$2K
- Johnson & Johnson$302
- Stryker$291
- plus $777 from 8 others
What the payments were for
- Consulting fees$9,92563%
- Travel & lodging$1,0627%
- Food & beverage$2,19914%
- Education$2,60817%
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 |
|---|---|---|
| Heron Therapeutics, Inc. | 18 | $5,736 |
| Medical Device Business Services, Inc. | 4 | $4,600 |
| Arthrex | 9 | $2,401 |
| Medinc Of Texas | 6 | $1,687 |
| Johnson & Johnson | 9 | $302 |
| Stryker(2 entities) | 6 | $291 |
| Mission Medical Distribution, LLC | 3 | $192 |
| Bioventus LLC | 1 | $126 |
| Organogenesis Inc. | 15 | $118 |
| Melinta Therapeutics, LLC | 7 | $117 |
| Osteomed LLC | 1 | $84 |
| Biocomposites Inc | 1 | $75 |
| GRT US Holding, Inc. | 2 | $40 |
| Trilliant Surgical LLC. | 1 | $26 |
What the payments were tied to
Products named in the reported payments. Only payments of $100 or more are attributed here — the typical reported payment nationally is a meal worth about $16, and listing those product-by-product would be noise.
How this compares
$15,794 in reported general payments places this provider in the 80th percentile of 684 foot & ankle surgery providers in Texas.
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 |
|---|---|---|
| Gabapentin | 32 | $545 |
| Hydrocodone-AcetaminophenHydrocodone/Acetaminophen | 39 | $303 |
| Amoxicillin-Clavulanate PotassAmoxicillin/Potassium Clav | 11 | $174 |
| Acetaminophen-CodeineAcetaminophen With Codeine | 26 | $146 |
Paid to pharmacies, not to this prescriber.
Other foot & ankle surgery in San Antonio
- Ian BarronSan Antonio$162K
- Walter StrashSan Antonio$86K
- Thomas ZgonisSan Antonio$79K
- Collin PehdeSan Antonio$49K
- William McGarveyKaty$3.5M
- Eugene CurryDallas$3.1M
- Graham HamiltonEdinburg$2.1M
- Mark DaltonAustin$1.9M
- Kevin VarnerHouston$1.1M
- Paul KimDallas$928K
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.