Ralph Garcia-Pacheco, MD
Pulmonary Disease · Bakersfield, CANPI 1093923088
Payments from drug & device makers
Across 109 payments — averaging $53.71 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Intuitive Surgical$4K
- E.r. Squibb & Sons, L.L.C.$228
- Actelion Pharmaceuticals US, Inc.$136
- Astellas Pharma US Inc$135
- Pfizer$125
- Johnson & Johnson$119
- plus $848 from 22 others
What the payments were for
- Travel & lodging$3,91367%
- Food & beverage$1,94133%
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 |
|---|---|---|
| Intuitive Surgical | 11 | $4,264 |
| E.r. Squibb & Sons, L.L.C. | 19 | $228 |
| Actelion Pharmaceuticals US, Inc. | 5 | $136 |
| Astellas Pharma US Inc | 8 | $135 |
| Pfizer | 9 | $125 |
| Johnson & Johnson | 12 | $119 |
| AstraZeneca | 6 | $108 |
| ZOLL Services LLC (a/k/a ZOLL Lifecor Corp) | 6 | $95 |
| AbbVie(2 entities) | 4 | $86 |
| EMD Serono, Inc. | 5 | $65 |
| Inari Medical, Inc. | 1 | $47 |
| Alkermes, Inc. | 2 | $42 |
| Novartis | 2 | $40 |
| Boehringer Ingelheim | 2 | $39 |
| Eisai Inc. | 2 | $37 |
| Otsuka America Pharmaceutical, Inc. | 2 | $36 |
| Merck | 2 | $35 |
| Bayer | 1 | $26 |
| Takeda Pharmaceuticals U.S.A., Inc. | 1 | $25 |
| Cvrx, Inc. | 1 | $23 |
| Bard Access Systems, Inc. | 1 | $20 |
| Deciphera Pharmaceuticals Inc. | 1 | $20 |
| Mayne Pharma Commercial LLC | 1 | $20 |
| Amgen | 1 | $19 |
| Coloplast | 1 | $18 |
| Advanced Respiratory, Inc | 1 | $17 |
| Epizyme, Inc. | 1 | $16 |
| Morphosys, US Inc. | 1 | $13 |
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.
- Da Vinci Surgical System$4,225
How this compares
$5,855 in reported general payments places this provider in the 70th percentile of 1,261 pulmonary disease providers in California.
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 |
|---|---|---|
| Trelegy ElliptaFluticasone/Umeclidin/Vilanter | 39 | $27,201 |
| Incruse ElliptaUmeclidinium Bromide | 17 | $10,003 |
| Breo ElliptaFluticasone/Vilanterol | 14 | $7,295 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 92 | $3,864 |
| Advair HfaFluticasone Propion/Salmeterol | 11 | $2,440 |
| BreynaBudesonide/Formoterol Fumarate | 12 | $2,297 |
| Ventolin HfaAlbuterol Sulfate | 12 | $643 |
| Fluticasone Propionate | 12 | $168 |
| Omeprazole | 20 | $103 |
| Atorvastatin Calcium | 14 | $86 |
| Prednisone | 39 | $67 |
| Tramadol Hcl | 15 | $23 |
Paid to pharmacies, not to this prescriber.
Other pulmonary disease in Bakersfield
- Toby MaherLos Angeles$27.6M
- David PhamWestminster$5.9M
- Andrew WachtelLos Angeles$5.9M
- Aaron WeinbergIrvine$5.1M
- Michael RothLos Angeles$4.5M
- Namita SoodSacramento$3.7M
- Edward FedermanSan Diego$3.6M
- Sanjay VadgamaSherman Oaks$3.3M
- Rajan SaggarLos Angeles$3.3M
- Samuel LouieSacramento$2.8M
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.