Luis Nieves Garrastegui, MD
Pulmonary Disease · Rio Piedras, PRNPI 1255344859
Payments from drug & device makers
What this record shows
This record is dominated by speaking fees: $109,100 of the $121,088 with a category attached, or 90.1%. GSK accounts for 84.7% of it on its own, with 17 other manufacturers making up the rest. Reporting peaked in 2019 at $33,463 and has fallen 97.4% since, to $878 in 2025. Among pulmonary disease clinicians in PR 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 275 payments — averaging $440.32 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- GSK$103K
- Boehringer Ingelheim$10K
- Merck$3K
- AstraZeneca$2K
- E.r. Squibb & Sons, L.L.C.$2K
- Bayer$725
- plus $1K from 12 others
What the payments were for
- Consulting fees$2,9372%
- Speaking & faculty fees$109,10090%
- Travel & lodging$1,2901%
- Food & beverage$7,7146%
- Education$460%
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 |
|---|---|---|
| GSK | 133 | $102,554 |
| Boehringer Ingelheim | 40 | $9,551 |
| Merck | 9 | $3,203 |
| AstraZeneca | 53 | $2,161 |
| E.r. Squibb & Sons, L.L.C. | 2 | $1,603 |
| Bayer | 4 | $725 |
| Sanofi | 7 | $350 |
| Jazz Pharmaceuticals Inc. | 3 | $217 |
| Amgen | 5 | $121 |
| Genentech USA, Inc. | 3 | $115 |
| Mallinckrodt Hospital Products Inc. | 1 | $102 |
| Shire North American Group Inc | 1 | $98 |
| PBG Puerto Rico LLC | 4 | $87 |
| Gilead | 4 | $71 |
| Pfizer | 2 | $50 |
| Johnson & Johnson | 2 | $35 |
| Eli Lilly Export S.A. Puerto Rico Branch | 1 | $25 |
| Sanofi-aventis U.S. LLC | 1 | $20 |
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
$121,088 in reported general payments places this provider in the 95th percentile of 138 pulmonary disease providers in Puerto Rico.
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 | 643 | $428,533 |
| OfevNintedanib Esylate | 26 | $340,008 |
| Spiriva RespimatTiotropium Bromide | 556 | $305,916 |
| Breo ElliptaFluticasone/Vilanterol | 468 | $195,968 |
| AdempasRiociguat | 12 | $164,845 |
| Stiolto RespimatTiotropium Br/Olodaterol Hcl | 174 | $86,853 |
| Levalbuterol Tartrate HfaLevalbuterol Tartrate | 651 | $38,039 |
| Wixela InhubFluticasone Propion/Salmeterol | 227 | $33,469 |
| Breztri AerosphereBudesonide/Glycopyr/Formoterol | 39 | $25,296 |
| Anoro ElliptaUmeclidinium Brm/Vilanterol Tr | 41 | $19,540 |
| Budesonide-Formoterol FumarateBudesonide/Formoterol Fumarate | 89 | $18,991 |
| Fluticasone Propionate HfaFluticasone Propionate | 68 | $15,738 |
| SymbicortBudesonide/Formoterol Fumarate | 57 | $12,165 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 214 | $10,049 |
| Montelukast Sodium | 848 | $8,292 |
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 |
|---|---|---|
| Boehringer IngelheimOfev, Spiriva Respimat, Stiolto Respimat | $9,551 | $732,777756 claims |
| GSKTrelegy Ellipta, Breo Ellipta, Anoro Ellipta, Incruse Ellipta | $102,554 | $651,5051,173 claims |
| BayerAdempas | $725 | $164,84512 claims |
| AstraZenecaBreztri Aerosphere, Symbicort | $2,161 | $37,46196 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 95th percentile of 138 pulmonary disease providers in Puerto Rico.
Other pulmonary disease in Rio Piedras
- Alvaro Aranda RodriguezGuaynabo$725K
- Luis Garcia BarretoCoamo$393K
- Jahaira Serrano DominguezArecibo$102K
- William Villanueva-BosqueArecibo$67K
- Domingo Chardon FelicianoPonce$45K
- Joel Nieves ScharonSan Juan$43K
- George FahedPonce$16K
- Luis Gerena MontanoSan Juan$15K
- Rafael Franjul JuliaoSan Juan$15K
- Roberto Martinez QuintanaSan Juan$12K
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.