Rachel Perl, DPM
Foot & Ankle Surgery · Middletown, NYNPI 1043555352
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 100.0% of the total across 32 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. Smith+Nephew accounts for 63.9% of it on its own, with 8 other manufacturers making up the rest. 2025 is the largest year on record at $695, 6.7 times the $103 reported in 2019. That places this record below the midpoint for foot & ankle surgery clinicians in NY, where the typical reported total is $2,113.
Across 32 payments — averaging $36.06 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Smith+Nephew$738
- Treace Medical Concepts, Inc.$180
- Zimmer Biomet$96
- Stryker$36
- Medtronic$22
- Sandoz$22
- plus $60 from 3 others
What the payments were for
- Food & beverage$1,154100%
Most of this is food and beverage — typically meals provided during product presentations at a clinic or hospital. Nationally that is the single largest category of reported payments by count.
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 |
|---|---|---|
| Smith+Nephew | 23 | $738 |
| Treace Medical Concepts, Inc. | 2 | $180 |
| Zimmer Biomet | 1 | $96 |
| Stryker | 1 | $36 |
| Medtronic | 1 | $22 |
| Sandoz | 1 | $22 |
| Melinta Therapeutics, LLC | 1 | $21 |
| Orthofix Medical, Inc. | 1 | $21 |
| Bioventus LLC | 1 | $18 |
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
$1,154 in reported general payments places this provider in the 35th percentile of 652 foot & ankle surgery 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 |
|---|---|---|
| Ciclopirox | 68 | $2,259 |
| Ketoconazole | 66 | $2,140 |
| Ammonium Lactate | 114 | $1,975 |
| CiclopiroxCiclopirox Olamine | 72 | $1,970 |
| Clotrimazole-BetamethasoneClotrimazole/Betamethasone Dip | 56 | $1,805 |
| Terbinafine Hcl | 58 | $432 |
| Methylprednisolone | 47 | $364 |
| Diclofenac Sodium | 14 | $287 |
| SsdSilver Sulfadiazine | 12 | $184 |
| Silver Sulfadiazine | 11 | $184 |
| Oxycodone-AcetaminophenOxycodone Hcl/Acetaminophen | 12 | $60 |
| Sulfamethoxazole-TrimethoprimSulfamethoxazole/Trimethoprim | 18 | $51 |
Paid to pharmacies, not to this prescriber.
Other foot & ankle surgery in Middletown
- James McWilliamHarrison$4.7M
- Jonathan DelandNew York$4M
- George Vitole Roy$2.5M
- Constantine DemetracopoulosNew York$888K
- Anne JohnsonNew York$815K
- Scott EllisNew York$597K
- John KennedyNew York$534K
- Michael KellerKingston$532K
- Judith BaumhauerRochester$328K
- Stuart MogulNew York$131K
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.