Loakhnauth Ramkishun, MD
Internal Medicine · Orlando, FLNPI 1831222694
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 98.0% of the total across 158 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. 23 manufacturers reported payments, led by AstraZeneca at 45.2% of the total. Among internal medicine clinicians in FL with any reported payments, this total sits in the top 10% — high for the specialty, which is a reason to read the composition above rather than the number alone.
Across 158 payments — averaging $43.61 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- AstraZeneca$3K
- Novo Nordisk$1K
- Lilly USA, LLC$547
- Boehringer Ingelheim$412
- AbbVie$410
- GSK$242
- plus $1K from 17 others
What the payments were for
- Food & beverage$6,75498%
- Education$1362%
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 |
|---|---|---|
| AstraZeneca | 55 | $3,116 |
| Novo Nordisk | 16 | $1,054 |
| Lilly USA, LLC | 27 | $547 |
| Boehringer Ingelheim | 7 | $412 |
| AbbVie | 14 | $410 |
| GSK | 4 | $242 |
| Johnson & Johnson | 3 | $231 |
| Abbott | 5 | $177 |
| Sanofi-aventis U.S. LLC | 2 | $139 |
| Exact Sciences | 5 | $107 |
| Scilex Pharmaceuticals Inc. | 5 | $85 |
| Ironwood Pharmaceuticals, Inc | 1 | $85 |
| Novartis | 2 | $47 |
| Kowa Pharmaceuticals America, Inc. | 2 | $45 |
| Silk Road Medical, Inc. | 1 | $42 |
| Salix Pharmaceuticals, A Division Of Bausch Health US, LLC | 2 | $25 |
| Bayer | 1 | $24 |
| Xeris Pharmaceuticals, Inc. | 1 | $23 |
| Romark Laboratories, LC | 1 | $22 |
| Biohaven Pharmaceuticals, Inc. | 1 | $19 |
| Ascensia Diabetes Care US Inc. | 1 | $14 |
| Arbor Pharmaceuticals, Inc. | 1 | $12 |
| IBSA Pharma Inc. | 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.
- FARXIGA$1,175
- BREZTRI$736
- AIRSUPRA$344
- Ozempic$342
- RYBELSUS$227
- ZEPBOUND$125
- QULIPTA$125
- UBRELVY$125
- SOLIQUA 100/33$125
- TRELEGY ELLIPTA$123
- INVOKANA$123
- Wegovy$122
- Tresiba$122
- FreeStyle Libre Pro$100
How this compares
$6,890 in reported general payments places this provider in the 90th percentile of 8,530 internal medicine 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 |
|---|---|---|
| MounjaroTirzepatide | 44 | $49,201 |
| OzempicSemaglutide | 40 | $40,309 |
| EliquisApixaban | 48 | $37,660 |
| FarxigaDapagliflozin Propanediol | 28 | $32,157 |
| Oxycodone-AcetaminophenOxycodone Hcl/Acetaminophen | 384 | $11,779 |
| Lidocaine | 49 | $8,303 |
| Novolog Mix 70-30 FlexpenInsulin Aspart Prot/Insuln Asp | 12 | $6,596 |
| SymbicortBudesonide/Formoterol Fumarate | 14 | $5,621 |
| Breo ElliptaFluticasone/Vilanterol | 12 | $4,825 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 125 | $4,622 |
| Humalog Kwikpen U-100Insulin Lispro | 15 | $4,516 |
| Hydrocodone-AcetaminophenHydrocodone/Acetaminophen | 214 | $3,738 |
| Diclofenac Sodium | 97 | $3,055 |
| Tacrolimus | 14 | $2,924 |
| Clonidine | 22 | $2,819 |
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 |
|---|---|---|
| Lilly USA, LLCMounjaro | $547 | $49,20144 claims |
| Novo NordiskOzempic | $1,054 | $40,30940 claims |
| AstraZenecaFarxiga, Symbicort | $3,116 | $37,77842 claims |
| GSKBreo Ellipta | $242 | $4,82512 claims |
| AbbVieSynthroid | $410 | $1,91323 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 90th percentile of 8,530 internal medicine providers in Florida.
Other internal medicine in Orlando
- Haytham ElgammalMiami$2.2M
- Keith RubinFort Lauderdale$2M
- Michael SensionFort Lauderdale$1M
- Quang NguyenOcala$434K
- Luis Correa LunaSanford$412K
- Michael OleksykFort Myers$365K
- Andrew KuykendallTampa$322K
- Howard FederoffCoconut Grove$302K
- Bianka EperjesiovaGainesville$260K
- Julio ConradoFort Myers$247K
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.