Joseph Karam, MD
Surgery · San Antonio, TXNPI 1497999718
Payments from drug & device makers
What this record shows
This record is dominated by education: $217,800 of the $293,156 with a category attached, or 74.3%. Intuitive Surgical accounts for 97.5% of it on its own, with 13 other manufacturers making up the rest. Reporting peaked in 2020 at $65,370 and has fallen 74.6% since, to $16,604 in 2025. Among surgery clinicians in TX with any reported payments, this total sits in the top 5% — high for the specialty, which is a reason to read the composition above rather than the number alone.
Across 442 payments — averaging $663.25 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Intuitive Surgical$286K
- Davol Inc.$3K
- TELA Bio, Inc.$2K
- Medical Device Business Services, Inc.$1K
- Phathom Pharmaceuticals, Inc.$250
- GSK$228
- plus $991 from 8 others
What the payments were for
- Speaking & faculty fees$43,30015%
- Travel & lodging$16,3056%
- Food & beverage$15,7525%
- Education$217,80074%
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 |
|---|---|---|
| Intuitive Surgical | 380 | $285,737 |
| Davol Inc. | 28 | $3,031 |
| TELA Bio, Inc. | 11 | $1,892 |
| Medical Device Business Services, Inc. | 7 | $1,027 |
| Phathom Pharmaceuticals, Inc. | 2 | $250 |
| GSK | 2 | $228 |
| Stryker | 2 | $146 |
| Medtronic | 3 | $145 |
| Johnson & Johnson(2 entities) | 2 | $144 |
| Globus Medical | 1 | $133 |
| AbbVie | 1 | $125 |
| Dexcom, Inc. | 1 | $122 |
| Lilly USA, LLC | 1 | $117 |
| BD | 1 | $58 |
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.
- Da Vinci Surgical System$272,119
- DA VINCI SP$8,550
- Phasix Mesh$2,454
- OviTex Reinforced Bioscaffold With Permanent Polymer (OviTex)$1,424
- OviTex 2S$270
- VOQUEZNA$250
- MAKO$136
- Senza$133
- XARELTO$129
- VRAYLAR$125
- DEXCOM G6 TRANSMITTER$122
- Ovitex$121
- AREXVY$121
- ZEPBOUND$117
- SHINGRIX$108
- ProGrip$100
How this compares
$293,156 in reported general payments places this provider in the 95th percentile of 1,830 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 |
|---|---|---|
| Tramadol Hcl | 146 | $457 |
| Methocarbamol | 61 | $276 |
| Acetaminophen-CodeineAcetaminophen With Codeine | 27 | $266 |
| Bethanechol Chloride | 35 | $168 |
| Tamsulosin Hcl | 23 | $101 |
Paid to pharmacies, not to this prescriber.
Other surgery in San Antonio
- Richard PetersonSan Antonio$323K
- John PilcherSan Antonio$214K
- John MeterskySan Antonio$158K
- Kent van SickleSan Antonio$143K
- Richard EnglehardtSan Antonio$107K
- Guillermo Portillo RamilaSan Antonio$102K
- Michael HarkinsTomball$2.7M
- Douglas StoddardAustin$1.4M
- Steven FassAustin$989K
- Vineet ChoudhryAustin$851K
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.