Michelle Mangual Garcia, MD
Endocrinology, Diabetes & Metabolism · San Juan, PRNPI 1518292960
Payments from drug & device makers
What this record shows
The money is spread across several categories — speaking fees (57.0%), food and beverage and travel and lodging — rather than concentrated in one kind of arrangement. 24 manufacturers reported payments, led by AstraZeneca at 28.5% of the total. Reporting peaked in 2019 at $30,160 and has fallen 79.2% since, to $6,265 in 2025. Among endocrinology, diabetes & metabolism 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 793 payments — averaging $109.98 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- AstraZeneca$25K
- Lilly USA, LLC$24K
- Eli Lilly Export S.A. Puerto Rico Branch$12K
- Merck$7K
- Boehringer Ingelheim$3K
- Johnson & Johnson$3K
- plus $14K from 18 others
Across 52 payments — averaging $12,903 each. Payments tied to a research study. These frequently flow through the physician to a hospital or research institution rather than to the physician personally.
- Eli Lilly Export S.A. Puerto Rico Branch$395K
- AbbVie$258K
- Eli Lilly$18K
What the payments were for
- Consulting fees$6,0707%
- Speaking & faculty fees$49,71357%
- Travel & lodging$7,9129%
- Food & beverage$23,51427%
- Education$90%
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(2 entities) | 108 | $24,838 |
| Lilly USA, LLC | 40 | $23,647 |
| Eli Lilly Export S.A. Puerto Rico Branch | 63 | $11,775 |
| Merck | 49 | $6,779 |
| Boehringer Ingelheim | 95 | $3,363 |
| Johnson & Johnson | 34 | $3,057 |
| Sanofi-aventis U.S. LLC | 64 | $2,759 |
| Amgen(2 entities) | 43 | $2,628 |
| Medtronic(2 entities) | 29 | $1,853 |
| Novo Nordisk | 57 | $1,194 |
| Abbott | 57 | $1,113 |
| Bayer | 17 | $988 |
| PBG Puerto Rico LLC | 33 | $617 |
| Dexcom, Inc. | 32 | $610 |
| AbbVie | 18 | $583 |
| Bayer Puerto Rico Inc. | 22 | $426 |
| Novartis | 17 | $409 |
| Corcept Therapeutics | 3 | $293 |
| Radius Health, Inc. | 4 | $100 |
| Rhythm Pharmaceuticals, Inc. | 3 | $68 |
| Insulet Corporation | 2 | $47 |
| Caris MPI, Inc. | 1 | $25 |
| Boston Scientific | 1 | $23 |
| Pfizer Pharmaceuticals LLC | 1 | $22 |
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
$87,217 in reported general payments places this provider in the 95th percentile of 143 endocrinology, diabetes & metabolism providers in Puerto Rico.
See all endocrinology, diabetes & metabolism 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 |
|---|---|---|
| TrulicityDulaglutide | 438 | $467,449 |
| OzempicSemaglutide | 428 | $435,514 |
| MounjaroTirzepatide | 206 | $227,592 |
| Trijardy XrEmpaglifloz/Linaglip/Metformin | 271 | $201,602 |
| Synjardy XrEmpagliflozin/Metformin Hcl | 167 | $131,476 |
| GlyxambiEmpagliflozin/Linagliptin | 130 | $93,289 |
| JardianceEmpagliflozin | 99 | $89,421 |
| FarxigaDapagliflozin Propanediol | 108 | $83,260 |
| Xigduo XrDapaglifloz Propaned/Metformin | 132 | $80,841 |
| RybelsusSemaglutide | 74 | $75,968 |
| Soliqua 100-33Insulin Glargine/Lixisenatide | 66 | $58,631 |
| SynthroidLevothyroxine Sodium | 592 | $58,412 |
| Toujeo Max SolostarInsulin Glargine,hum.Rec.Anlog | 65 | $45,024 |
| TradjentaLinagliptin | 66 | $44,416 |
| Repatha SureclickEvolocumab | 74 | $42,341 |
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, LLCTrulicity, Mounjaro, Humalog | $23,647 | $719,131778 claims |
| Boehringer IngelheimTrijardy Xr, Synjardy Xr, Glyxambi, Jardiance, Tradjenta | $3,363 | $587,623782 claims |
| Novo NordiskOzempic, Rybelsus | $1,194 | $511,482502 claims |
| AstraZenecaFarxiga | $24,838 | $83,260108 claims |
| Sanofi-aventis U.S. LLCSoliqua 100-33, Lantus | $2,759 | $79,264277 claims |
| AbbVieSynthroid | $583 | $58,412592 claims |
| MerckJanumet Xr | $6,779 | $20,89521 claims |
| BayerKerendia | $988 | $18,02027 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 143 endocrinology, diabetes & metabolism providers in Puerto Rico.
Other endocrinology, diabetes & metabolism in San Juan
- Manuel Alegre-HernandezSan Juan$156K
- Monica Ortiz-RiveraSan Juan$148K
- Alex Gonzalez BossoloSan Juan$110K
- Meliza Martinez RodriguezSan Juan$80K
- Jorge de Jesus MirandaSan Juan$30K
- Zahira Lugo LopezSan Juan$29K
- Oscar Ruiz BermudezSan Juan$27K
- Margarita Ramirez-VickSan Juan$15K
- Yanira Marrero McFalineSan Juan$14K
- Alfredo Sanchez CruzSan Juan$13K
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.