Marcel Twahirwa, MD
Endocrinology, Diabetes & Metabolism · Mission, TXNPI 1841381167
Payments from drug & device makers
Across 190 payments — averaging $970.18 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Astrazeneca UK Limited$70K
- Novo Nordisk$27K
- AstraZeneca$21K
- Kowa Research Institute, Inc.$20K
- Boehringer Ingelheim$15K
- Lilly USA, LLC$11K
- plus $21K from 10 others
What the payments were for
- Consulting fees$2,9254%
- Speaking & faculty fees$70,94588%
- Travel & lodging$3,5914%
- Food & beverage$3,4294%
- Education$140%
- Gifts$590%
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 UK Limited | 5 | $69,801 |
| Novo Nordisk | 26 | $27,228 |
| AstraZeneca | 34 | $21,246 |
| Kowa Research Institute, Inc. | 9 | $19,825 |
| Boehringer Ingelheim | 31 | $14,662 |
| Lilly USA, LLC | 13 | $10,851 |
| Janssen Research & Development, LLC | 1 | $6,866 |
| Merck | 16 | $4,485 |
| Novo Nordisk AS | 2 | $4,268 |
| Mannkind Corporation | 44 | $2,867 |
| Sanofi US Services Inc. | 1 | $1,899 |
| Dexcom, Inc. | 3 | $154 |
| Ultragenyx Pharmaceutical Inc. | 2 | $96 |
| Abbott | 1 | $43 |
| Tandem Diabetes Care, Inc. | 1 | $29 |
| Amgen | 1 | $14 |
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
$184,334 in reported general payments places this provider in the 85th percentile of 658 endocrinology, diabetes & metabolism providers in Texas.
See all endocrinology, diabetes & metabolism 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 |
|---|---|---|
| OzempicSemaglutide | 1,173 | $1,650,445 |
| JardianceEmpagliflozin | 603 | $735,404 |
| TrulicityDulaglutide | 313 | $552,520 |
| FarxigaDapagliflozin Propanediol | 403 | $415,985 |
| SynjardyEmpagliflozin/Metformin Hcl | 246 | $311,027 |
| Tresiba Flextouch U-100Insulin Degludec | 421 | $285,174 |
| MounjaroTirzepatide | 178 | $266,982 |
| Tresiba Flextouch U-200Insulin Degludec | 185 | $188,946 |
| Humulin R U-500 KwikpenInsulin Regular, Human | 106 | $146,169 |
| Xigduo XrDapaglifloz Propaned/Metformin | 126 | $138,993 |
| Bydureon BciseExenatide Microspheres | 83 | $124,156 |
| Synjardy XrEmpagliflozin/Metformin Hcl | 110 | $116,507 |
| Toujeo SolostarInsulin Glargine,hum.Rec.Anlog | 117 | $96,235 |
| RybelsusSemaglutide | 40 | $82,837 |
| JanuviaSitagliptin Phosphate | 67 | $71,458 |
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 |
|---|---|---|
| Novo NordiskOzempic, Rybelsus, Fiasp | $27,228 | $1,744,7501,226 claims |
| Boehringer IngelheimJardiance, Synjardy, Synjardy Xr, Tradjenta, Trijardy Xr | $14,662 | $1,254,8591,057 claims |
| Lilly USA, LLCTrulicity, Mounjaro | $10,851 | $819,501491 claims |
| AstraZenecaFarxiga | $21,246 | $415,985403 claims |
| MerckJanuvia, Janumet | $4,485 | $97,04193 claims |
| Mannkind CorporationAfrezza | $2,867 | $28,93012 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 85th percentile of 658 endocrinology, diabetes & metabolism providers in Texas.
Other endocrinology, diabetes & metabolism in Mission
- Julio RosenstockDallas$24.9M
- Michelle WelchShavano Park$17.3M
- Maria CabanillasHouston$16.4M
- Sumana GangiMesquite$13.2M
- Damaris VegaHouston$12.3M
- Mark KipnesSan Antonio$10.3M
- Amer Al KaradshehHouston$8.8M
- Ildiko LingvayDallas$8.2M
- Eduardo LunaEdinburg$7.6M
- Thomas BlevinsAustin$7.4M
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.