Heather Rafal
Foot & Ankle Surgery · Wilmington, DENPI 1023346335
Payments from drug & device makers
What this record shows
This record is dominated by food and beverage: $3,054 of the $3,608 with a category attached, or 84.7%. It is spread thinly across 37 manufacturers, the largest accounting for just 17.0% — the pattern of someone who eats at a lot of different presentations.
Across 106 payments — averaging $34.04 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Smith+Nephew$615
- Liberty Surgical Inc.$476
- Stryker$391
- Sandoz$235
- Bioventus LLC$156
- Medtronic$139
- plus $2K from 31 others
What the payments were for
- Food & beverage$3,05485%
- Education$55315%
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 |
|---|---|---|
| Smith+Nephew | 13 | $615 |
| Liberty Surgical Inc. | 2 | $476 |
| Stryker(2 entities) | 4 | $391 |
| Sandoz | 15 | $235 |
| Bioventus LLC | 4 | $156 |
| Medtronic | 7 | $139 |
| Kerecis Limited | 4 | $128 |
| Organogenesis Inc. | 3 | $124 |
| Convatec Inc. | 1 | $122 |
| GRT US Holding, Inc. | 5 | $93 |
| Ortho Dermatologics, A Division Of Bausch Health US, LLC | 5 | $87 |
| Rikco International, LLC | 2 | $85 |
| Paratek Pharmaceuticals, Inc. | 3 | $70 |
| Aroa Biosurgery Incorporated | 1 | $63 |
| Osteomed LLC | 2 | $62 |
| Biotissue Holdings Inc. | 2 | $61 |
| Melinta Therapeutics, LLC | 4 | $60 |
| Acumed LLC | 2 | $54 |
| Sebela Pharmaceuticals Inc. | 3 | $52 |
| Next Science LLC | 2 | $52 |
| Orthofix Medical, Inc. | 2 | $44 |
| Eclipse Technology Solutions Inc. | 1 | $44 |
| Reapplix Inc. | 2 | $43 |
| Avita Medical Americas, LLC | 1 | $39 |
| Solventum Corporation | 2 | $37 |
| Mimedx Group, Inc. | 2 | $35 |
| Kowa Pharmaceuticals America, Inc. | 2 | $29 |
| Polynovo North America LLC | 1 | $26 |
| AbbVie | 1 | $25 |
| Treace Medical Concepts, Inc. | 1 | $24 |
| Zimmer Biomet | 1 | $23 |
| KCI USA, Inc. | 1 | $23 |
| Heron Therapeutics, Inc. | 1 | $21 |
| Dynasplint Systems Inc. | 1 | $21 |
| AstraZeneca | 1 | $18 |
| Nevro Corp. | 1 | $17 |
| Johnson & Johnson | 1 | $15 |
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.
- STRAVIX MESH$415
- AUGMENT INJECTABLE$141
- EASYFUSE$138
- GRAFIX PL$136
- Stravix$136
- InnovaMatrix AC$122
How this compares
$3,608 in reported general payments places this provider in the 55th percentile of 32 foot & ankle surgery providers in Delaware.
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 |
|---|---|---|
| Ketoconazole | 20 | $714 |
| Cephalexin | 23 | $619 |
| Econazole Nitrate | 22 | $503 |
| Mupirocin | 49 | $390 |
| Amoxicillin-Clavulanate PotassAmoxicillin/Potassium Clav | 22 | $274 |
| Clindamycin Hcl | 16 | $192 |
| Methylprednisolone | 18 | $123 |
| Sulfamethoxazole-TrimethoprimSulfamethoxazole/Trimethoprim | 17 | $78 |
| Meloxicam | 21 | $65 |
| Prednisone | 20 | $59 |
Paid to pharmacies, not to this prescriber.
Other foot & ankle surgery in Wilmington
- Cody BowersWilmington$14K
- Korey DuboisWilmington$7K
- Katrin HeinemanWilmington$6K
- Katherine PersckyWilmington$6K
- David HaleyWilmington$6K
- Rachel NovickWilmington$5K
- Joseph BakanasWilmington$3K
- Joseph CiampoliWilmington$2K
- Ginny Rishel HuangWilmington$2K
- Kristina BystrakWilmington$2K
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.