Miguel Pirela-Cruz, MD
Hand Surgery · El Paso, TXNPI 1386604767
Payments from drug & device makers
What this record shows
The money is spread across several categories — travel and lodging (60.0%), food and beverage and consulting fees — rather than concentrated in one kind of arrangement. 18 manufacturers reported payments, led by Exactech, Inc. at 31.8% of the total.
Across 50 payments — averaging $212.18 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Exactech, Inc.$3K
- Aptis Medical, LLC$2K
- Trimed, Inc.$2K
- Encore Medical, LP$1K
- Skeletal Dynamics Inc$390
- Stryker$248
- plus $993 from 12 others
What the payments were for
- Consulting fees$1001%
- Travel & lodging$6,36360%
- Food & beverage$4,14639%
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 |
|---|---|---|
| Exactech, Inc. | 9 | $3,379 |
| Aptis Medical, LLC | 2 | $2,433 |
| Trimed, Inc. | 5 | $2,127 |
| Encore Medical, LP | 6 | $1,039 |
| Skeletal Dynamics Inc | 4 | $390 |
| Stryker | 4 | $248 |
| Checkpoint Surgical, Inc | 4 | $238 |
| Shoulder Innovations, Inc. | 1 | $178 |
| Johnson & Johnson(2 entities) | 2 | $121 |
| Innovation Technologies Inc | 1 | $101 |
| Acumed LLC | 1 | $100 |
| Ultragenyx Pharmaceutical Inc. | 3 | $77 |
| Axogen | 1 | $60 |
| Fidia Pharma USA Inc. | 2 | $42 |
| Smith+Nephew | 2 | $33 |
| AbbVie | 1 | $20 |
| Amgen | 1 | $14 |
| Amniox Medical, Inc. | 1 | $10 |
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.
- EQUINOXE$3,373
- DJO SURGICAL$522
- DJO Surgical AltiVate Reverse$428
- InSet System$178
- Scheker DRUJ$177
- VARIAX$161
- Checkpoint Stimulators$160
- Geminus$151
- Align$151
- IJS$151
- Implate$151
- Irrisept$101
- Tools - WFS$100
- Acutrak Headless Compression Screw System$100
How this compares
$10,609 in reported general payments places this provider in the 70th percentile of 170 hand surgery 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 |
|---|---|---|
| Naproxen | 41 | $687 |
| Acetaminophen-CodeineAcetaminophen With Codeine | 18 | $118 |
| Hydrocodone-AcetaminophenHydrocodone/Acetaminophen | 11 | $101 |
Paid to pharmacies, not to this prescriber.
Other hand surgery in El Paso
- Douglas CromackEl Paso$77K
- Ahmed ElhessyEl Paso$11K
- David RingAustin$536K
- Kourosh JafarniaHouston$278K
- Brendan MackayLubbock$274K
- John FaillaceWoodway$212K
- Daniel KoehlerDallas$208K
- Timothy NiacarisArlington$160K
- Steven NiedermeierArlington$152K
- William PientkaFort Worth$113K
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.