Ralph Ryback, MD
General Practice · Lehigh Acres, FLNPI 1831146141
Payments from drug & device makers
Across 19 payments — averaging $91.90 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- AbbVie$247
- Inspire Medical Systems, Inc.$133
- Alkermes, Inc.$124
- Dexcom, Inc.$121
- Sanofi$118
- Intercept Pharmaceuticals, Inc.$117
- plus $886 from 10 others
What the payments were for
- Food & beverage$1,746100%
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 |
|---|---|---|
| AbbVie | 3 | $247 |
| Inspire Medical Systems, Inc. | 1 | $133 |
| Alkermes, Inc. | 1 | $124 |
| Dexcom, Inc. | 1 | $121 |
| Sanofi | 1 | $118 |
| Intercept Pharmaceuticals, Inc. | 1 | $117 |
| AstraZeneca | 1 | $114 |
| Abbott | 1 | $109 |
| Nevro Corp. | 1 | $106 |
| Xeris Pharmaceuticals, Inc. | 1 | $99 |
| Sanofi-aventis U.S. LLC | 1 | $94 |
| Idorsia Pharmaceuticals US Inc | 1 | $93 |
| Boehringer Ingelheim | 2 | $83 |
| Lilly USA, LLC | 1 | $78 |
| Johnson & Johnson | 1 | $68 |
| Medtronic | 1 | $42 |
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.
- ARISTADA$494
- VRAYLAR$220
- Inspire$133
- ARISTADA INITIO$124
- DEXCOM G7 GSS (161)$121
- CERDELGA$118
- CEREZYME$118
- OCALIVA$117
- FARXIGA$114
- FreeStyle Libre 2$109
- Senza$106
How this compares
$1,746 in reported general payments places this provider in the 85th percentile of 6,901 general practice providers in Florida.
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 |
|---|---|---|
| Buprenorphine | 11 | $4,881 |
| Atomoxetine Hcl | 33 | $2,186 |
| Dextroamphetamine-AmphetamineDextroamphetamine/Amphetamine | 37 | $1,205 |
| Disulfiram | 13 | $1,041 |
| Aripiprazole | 27 | $530 |
| Clonazepam | 61 | $498 |
| Lamotrigine | 51 | $384 |
| Trazodone Hcl | 48 | $373 |
| Desvenlafaxine Succinate ErDesvenlafaxine Succinate | 17 | $343 |
| Ziprasidone Hcl | 11 | $314 |
| Lorazepam | 29 | $274 |
| Fluoxetine Hcl | 44 | $252 |
| Prazosin Hcl | 29 | $245 |
| Memantine Hcl | 13 | $201 |
| Mirtazapine | 25 | $186 |
Paid to pharmacies, not to this prescriber.
Other general practice in Lehigh Acres
- Jose CardonaMiami$71M
- Lawrence GalitzMiami Gardens$42.5M
- Armando AcevedoMiami$15.2M
- Jorge AmayaMiami$14.2M
- Frank AlvarezHialeah$13.6M
- Hector RodriguezMiami$12.8M
- Eddie ArmasSouth Miami$12.4M
- Idalia AcostaMiami$11.4M
- Lilia Rodriguez AblesMiami$10.7M
- Jorge Monroy AvellaOcoee$10.6M
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.