Ethan Karle
Pulmonary Disease · Keene, NHNPI 1114456290
Payments from drug & device makers
What this record shows
This record is dominated by food and beverage: $507 of the $587 with a category attached, or 86.4%. It is spread thinly across 9 manufacturers, the largest accounting for just 21.8% — the pattern of someone who eats at a lot of different presentations. Reporting peaked in 2022 at $161 and has fallen 73.1% since, to $43 in 2025.
Across 11 payments — averaging $53.37 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Actelion Pharmaceuticals US, Inc.$128
- AstraZeneca$91
- GSK$90
- Sanofi-aventis U.S. LLC$80
- Regeneron Healthcare Solutions, Inc.$74
- Intuitive Surgical$58
- plus $66 from 3 others
What the payments were for
- Food & beverage$50786%
- Education$8014%
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 |
|---|---|---|
| Actelion Pharmaceuticals US, Inc. | 1 | $128 |
| AstraZeneca | 1 | $91 |
| GSK | 1 | $90 |
| Sanofi-aventis U.S. LLC | 1 | $80 |
| Regeneron Healthcare Solutions, Inc. | 3 | $74 |
| Intuitive Surgical | 1 | $58 |
| United Therapeutics Corporation | 1 | $32 |
| Philips North America LLC | 1 | $17 |
| AbbVie | 1 | $16 |
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
$587 in reported general payments places this provider in the 60th percentile of 78 pulmonary disease providers in New Hampshire.
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 |
|---|---|---|
| Trelegy ElliptaFluticasone/Umeclidin/Vilanter | 70 | $73,067 |
| Breztri AerosphereBudesonide/Glycopyr/Formoterol | 72 | $65,799 |
| Dupixent PenDupilumab | 13 | $48,242 |
| Breo ElliptaFluticasone/Vilanterol | 28 | $14,249 |
| Combivent RespimatIpratropium/Albuterol Sulfate | 14 | $11,392 |
| Bevespi AerosphereGlycopyrrolate/Formoterol Fum | 18 | $10,771 |
| Spiriva RespimatTiotropium Bromide | 12 | $6,158 |
| Advair HfaFluticasone Propion/Salmeterol | 11 | $4,794 |
| Incruse ElliptaUmeclidinium Bromide | 12 | $4,085 |
| Fluticasone Propionate | 48 | $2,337 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 75 | $1,833 |
| Ventolin HfaAlbuterol Sulfate | 15 | $774 |
| Azelastine Hcl | 26 | $614 |
| Omeprazole | 11 | $211 |
| Prednisone | 38 | $133 |
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, Breo Ellipta, Incruse Ellipta | $90 | $91,400110 claims |
| AstraZenecaBreztri Aerosphere, Bevespi Aerosphere | $91 | $76,57090 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 60th percentile of 78 pulmonary disease providers in New Hampshire.
Other pulmonary disease in Keene
- Donald MahlerLebanon$411K
- Bianca MonteiroDover$43K
- Jeffrey StewartLebanon$30K
- Erik SwensonLebanon$29K
- Elliot BackerLebanon$24K
- H ParkerLebanon$13K
- Christopher DaigleNashua$12K
- Danilo AblanPortsmouth$10K
- Alex GiffordLebanon$8K
- Naim AounNashua$6K
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.