Nicholas Silvestri, MD
Neuromuscular Medicine · Buffalo, NYNPI 1073783858
Payments from drug & device makers
What this record shows
The money is spread across several categories — consulting fees (50.7%), speaking fees and travel and lodging — rather than concentrated in one kind of arrangement. 32 manufacturers reported payments, led by Argenx US, Inc. at 28.9% of the total. Reporting peaked in 2024 at $219,824 and has fallen 55.1% since, to $98,619 in 2025. Among neuromuscular medicine clinicians in NY 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 627 payments — averaging $1108.35 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Argenx US, Inc.$201K
- AstraZeneca$196K
- UCB, Inc.$115K
- UCB SA$78K
- Johnson & Johnson$23K
- Amgen$14K
- plus $68K from 26 others
Across 8 payments — averaging $2375.00 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.
- Regeneron$11K
- Janssen Research & Development, LLC$8K
What the payments were for
- Consulting fees$352,56751%
- Speaking & faculty fees$264,87938%
- Travel & lodging$60,8599%
- Food & beverage$16,4772%
- Education$1520%
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 |
|---|---|---|
| Argenx US, Inc. | 177 | $200,915 |
| AstraZeneca | 190 | $195,851 |
| UCB, Inc. | 115 | $115,098 |
| UCB SA | 21 | $78,486 |
| Johnson & Johnson(2 entities) | 19 | $22,920 |
| Amgen(2 entities) | 14 | $13,922 |
| Takeda Pharmaceuticals U.S.A., Inc. | 6 | $11,603 |
| Janssen Scientific Affairs, LLC | 7 | $11,160 |
| F. Hoffmann-la Roche AG | 4 | $7,603 |
| Strongbridge US Inc. | 7 | $5,768 |
| Genentech USA, Inc. | 2 | $4,565 |
| Xeris Pharmaceuticals, Inc. | 4 | $4,067 |
| Genentech, Inc. | 2 | $3,934 |
| Biogen | 7 | $3,736 |
| Regeneron | 2 | $3,500 |
| Sarepta Therapeutics, Inc. | 3 | $3,078 |
| Janssen Global Services, LLC | 2 | $2,910 |
| Merck Kgaa | 1 | $2,480 |
| Vertex | 7 | $2,375 |
| CSL Behring | 8 | $214 |
| Pfizer | 7 | $153 |
| AbbVie | 5 | $122 |
| Sanofi | 2 | $80 |
| Ipsen Biopharmaceuticals, Inc | 2 | $73 |
| Neurocrine Biosciences, Inc. | 3 | $65 |
| Eisai Inc. | 2 | $64 |
| Grifols USA, LLC | 2 | $51 |
| Novartis | 2 | $46 |
| EMD Serono, Inc. | 1 | $29 |
| NS Pharma, Inc. | 1 | $27 |
| Acorda Therapeutics, Inc | 1 | $21 |
| PTC Therapeutics, Inc. | 1 | $19 |
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
$694,934 in reported general payments places this provider in the 95th percentile of 25 neuromuscular medicine providers in New York.
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 |
|---|---|---|
| VyvgartEfgartigimod Alfa-Fcab | 18 | $874,060 |
| GammaplexImmun Glob G(Igg)/Gly/Iga 0-50 | 15 | $652,070 |
| Gamunex-CImmune Globul G/Gly/Iga Avg 46 | 43 | $453,121 |
| PrivigenImmun Glob G(Igg)/Pro/Iga 0-50 | 21 | $371,297 |
| AgamreeVamorolone | 11 | $213,180 |
| Gammagard LiquidImmun Glob G(Igg)/Gly/Iga Ov50 | 18 | $209,137 |
| Avonex (4 Pack)Interferon Beta-1a | 13 | $107,026 |
| Mycophenolate Mofetil | 89 | $12,989 |
| Pyridostigmine Bromide | 124 | $6,667 |
| Carbamazepine ErCarbamazepine | 19 | $5,465 |
| Advair HfaFluticasone Propion/Salmeterol | 11 | $5,015 |
| Pregabalin | 78 | $3,889 |
| Gabapentin | 162 | $2,757 |
| Baclofen | 50 | $1,846 |
| Azathioprine | 36 | $1,815 |
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 |
|---|---|---|
| Argenx US, Inc.Vyvgart | $200,915 | $874,06018 claims |
| Grifols USA, LLCGamunex-C | $51 | $453,12143 claims |
| CSL BehringPrivigen | $214 | $371,29721 claims |
| Takeda Pharmaceuticals U.S.A., Inc.Gammagard Liquid | $11,603 | $209,13718 claims |
| BiogenAvonex (4 Pack) | $3,736 | $107,02613 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 25 neuromuscular medicine providers in New York.
Other neuromuscular medicine in Buffalo
- Alexander BaderBuffalo$838
- Patrick KwonBrooklyn$98K
- Ikjae LeeNew York$16K
- Luisa RojasAmherst$15K
- Samuel MackenzieRochester$12K
- Leslie DelfinerBronx$7K
- David OberSuffern$4K
- Aaron ZelikovichNew York$4K
- Anna KoganBrooklyn$3K
- Christoforos KoumasYorktown Heights$2K
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.