Douglas Joyce
Vascular Surgery · Punta Gorda, FLNPI 1255310579
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. Cashflow Solutions, LLC accounts for 66.1% of it on its own, with 1 other manufacturer making up the rest. 2025 is the largest year on record at $103, 4.7 times the $22 reported in 2020. That places this record below the midpoint for vascular surgery clinicians in FL, where the typical reported total is $6,364.
Across 12 payments — averaging $24.09 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Cashflow Solutions, LLC$191
- Medtronic$98
What the payments were for
- Food & beverage$289100%
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 |
|---|---|---|
| Cashflow Solutions, LLC | 8 | $191 |
| Medtronic(2 entities) | 4 | $98 |
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
$289 in reported general payments places this provider in the 5th percentile of 385 vascular surgery 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 |
|---|---|---|
| Amoxicillin | 114 | $248 |
| Clarithromycin | 11 | $52 |
Paid to pharmacies, not to this prescriber.
Other vascular surgery in Punta Gorda
- Samuel TapperStuart$1.3M
- Mariano ArosemenaBradenton$472K
- Manuel Perez IzquierdoOrlando$302K
- Erin MooreJacksonville$300K
- Rajesh MalikNaples$237K
- Charles BaileyTampa$162K
- Joseph WasselleMelbourne$161K
- Joseph RicottaDelray Beach$156K
- Murray ShamesTampa$144K
- K Dean ArnaoutakisTampa$115K
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.