Ralph Menard, MD
Interventional Pain Medicine · Fredericksburg, TXNPI 1407876014
Payments from drug & device makers
Across 249 payments — averaging $23.02 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Boston Scientific$2K
- Nevro Corp.$733
- Medtronic$708
- Vertiflex, Inc.$421
- Globus Medical$365
- Pacira Pharmaceuticals Incorporated$306
- plus $2K from 21 others
What the payments were for
- Travel & lodging$1613%
- Food & beverage$5,54397%
- Education$290%
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 |
|---|---|---|
| Boston Scientific | 127 | $1,674 |
| Nevro Corp. | 21 | $733 |
| Medtronic(2 entities) | 28 | $708 |
| Vertiflex, Inc. | 6 | $421 |
| Globus Medical | 11 | $365 |
| Pacira Pharmaceuticals Incorporated | 7 | $306 |
| Saluda Medical Americas, Inc. | 2 | $215 |
| AbbVie | 5 | $210 |
| Amgen | 11 | $207 |
| Si-bone, Inc. | 3 | $195 |
| SPR Therapeutics, Inc | 2 | $139 |
| Abbott | 4 | $136 |
| Vertex | 4 | $86 |
| Averitas Pharma Inc. | 2 | $61 |
| Radius Health, Inc. | 2 | $36 |
| Stryker | 1 | $29 |
| Biodelivery Sciences International, Inc. | 2 | $28 |
| Johnson & Johnson | 2 | $27 |
| Novartis | 1 | $22 |
| Relievant Medsystems, Inc. | 1 | $22 |
| Nalu Medical, Inc. | 1 | $21 |
| Spinal Simplicity, LLC | 1 | $18 |
| Travere Therapeutics, Inc. | 1 | $18 |
| Endo Pharmaceuticals Inc. | 1 | $16 |
| Painteq LLC | 1 | $15 |
| Teva Pharmaceuticals USA, Inc. | 1 | $14 |
| Epimed International, Inc | 1 | $11 |
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.
- Senza$280
- Superion ISS$264
- Evoke$169
- Vyrsa V1$165
- iFuse Implant$155
- Iovera$128
- GENERAL PAIN MANAGEMENT$105
- KYPHON Balloon Kyphoplasty$104
How this compares
$5,733 in reported general payments places this provider in the 45th percentile of 287 interventional pain medicine 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 |
|---|---|---|
| OxycontinOxycodone Hcl | 14 | $8,274 |
| Hydrocodone-AcetaminophenHydrocodone/Acetaminophen | 242 | $5,458 |
| Fentanyl | 39 | $3,853 |
| Pregabalin | 69 | $2,299 |
| Gabapentin | 164 | $2,296 |
| Tramadol Hcl ErTramadol Hcl | 13 | $1,376 |
| Morphine Sulfate ErMorphine Sulfate | 43 | $1,277 |
| Duloxetine Hcl | 66 | $865 |
| Oxycodone Hcl | 23 | $470 |
| Tramadol Hcl | 73 | $445 |
| Hydromorphone Hcl | 28 | $310 |
| Zonisamide | 12 | $215 |
| Acetaminophen-CodeineAcetaminophen With Codeine | 15 | $180 |
| Morphine Sulfate | 16 | $168 |
| Prednisone | 34 | $150 |
Paid to pharmacies, not to this prescriber.
Other interventional pain medicine in Fredericksburg
- Gabor RaczLubbock$3M
- Pankaj MehtaKilleen$2.2M
- Genaro GutierrezAustin$1.3M
- Chad StephensSouthlake$1.1M
- Ioannis SkaribasHouston$979K
- Duane GriffithTyler$730K
- Brannon FrankAustin$698K
- Robert WillsRound Rock$692K
- Ankur KhoslaShenandoah$511K
- Brian RichDecatur$245K
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.