Karla Guerra, DO
Dermatology · Roanoke, VANPI 1508356734
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 100.0% of the total across 49 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. 13 manufacturers reported payments, led by AbbVie at 35.6% of the total. Reporting peaked in 2022 at $748 and has fallen 87.2% since, to $96 in 2024. That places this record below the midpoint for dermatology clinicians in VA, where the typical reported total is $1,785.
Across 49 payments — averaging $27.15 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- AbbVie$474
- Sanofi$300
- Stemline Therapeutics Inc.$123
- Pfizer$98
- Lilly USA, LLC$96
- Amgen$62
- plus $177 from 7 others
What the payments were for
- Food & beverage$1,331100%
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 |
|---|---|---|
| AbbVie | 17 | $474 |
| Sanofi | 13 | $300 |
| Stemline Therapeutics Inc. | 1 | $123 |
| Pfizer | 6 | $98 |
| Lilly USA, LLC | 1 | $96 |
| Amgen | 2 | $62 |
| LEO Pharma Inc. | 2 | $52 |
| Regeneron Healthcare Solutions, Inc. | 2 | $44 |
| Johnson & Johnson | 1 | $20 |
| Galderma Laboratories, L.p. | 1 | $18 |
| Biofrontera Inc. | 1 | $17 |
| Sun Pharmaceutical Industries Inc. | 1 | $15 |
| Incyte Corporation | 1 | $12 |
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.
- Skyrizi$132
How this compares
$1,331 in reported general payments places this provider in the 45th percentile of 396 dermatology providers in Virginia.
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 |
|---|---|---|
| Cosentyx Sensoready (2 Pens)Secukinumab | 22 | $191,570 |
| Humira(Cf) PenAdalimumab | 12 | $81,739 |
| Dupixent PenDupilumab | 18 | $65,353 |
| Fluorouracil | 30 | $2,848 |
| Clobetasol Propionate | 73 | $2,080 |
| Doxycycline Hyclate | 55 | $1,899 |
| Tretinoin | 13 | $1,316 |
| Doxepin Hcl | 13 | $1,065 |
| Fluocinonide | 23 | $983 |
| Ketoconazole | 66 | $929 |
| Triamcinolone Acetonide | 86 | $784 |
| Minoxidil | 47 | $469 |
| Clindamycin Phosphate | 11 | $392 |
| Imiquimod | 14 | $375 |
| Spironolactone | 23 | $348 |
Paid to pharmacies, not to this prescriber.
Other dermatology in Roanoke
- Naiem IssaVienna$2M
- Saurabh SinghFairfax$1.7M
- Diego DasilvaVirginia Beach$1.1M
- Vishal PatelLeesburg$719K
- Cyndi Torosky TommasoVirginia Beach$717K
- Daniel HurdBlacksburg$545K
- Jonathan SchreiberNorfolk$330K
- Robert BaerSuffolk$303K
- David PariserNorfolk$261K
- Hema SundaramFairfax$181K
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.