Tamara Guerra Alfonso
Psychiatry · Cutler Bay, FLNPI 1154810661
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 91.6% of the total across 233 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. It is spread thinly across 19 manufacturers, the largest accounting for just 19.9% — the pattern of someone who eats at a lot of different presentations. Reporting peaked in 2021 at $1,509 and has fallen 72.6% since, to $414 in 2025.
Across 233 payments — averaging $21.60 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Teva Pharmaceuticals USA, Inc.$1K
- Otsuka America Pharmaceutical, Inc.$832
- AbbVie$503
- ITI, Inc. (d/b/a Intra-cellular Therapies, Inc.)$481
- Alkermes, Inc.$450
- Lundbeck LLC$395
- plus $1K from 13 others
Across 8 payments — averaging $27,609 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.
- Bioxcel Therapeutics, Inc.$221K
What the payments were for
- Food & beverage$4,60992%
- Education$4248%
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 |
|---|---|---|
| Teva Pharmaceuticals USA, Inc. | 35 | $1,001 |
| Otsuka America Pharmaceutical, Inc. | 45 | $832 |
| AbbVie(2 entities) | 35 | $503 |
| ITI, Inc. (d/b/a Intra-cellular Therapies, Inc.) | 21 | $481 |
| Alkermes, Inc. | 22 | $450 |
| Lundbeck LLC | 17 | $395 |
| Neurocrine Biosciences, Inc. | 11 | $265 |
| Axsome Therapeutics, Inc. | 11 | $248 |
| Supernus Pharmaceuticals, Inc. | 7 | $240 |
| Indivior Inc. | 9 | $201 |
| Johnson & Johnson | 5 | $101 |
| Ironshore Pharmaceuticals Inc. | 4 | $85 |
| Tris Pharma Inc | 3 | $64 |
| Almatica Pharma LLC | 2 | $45 |
| Takeda Pharmaceuticals U.S.A., Inc. | 2 | $39 |
| Corium, LLC | 1 | $25 |
| Tempus AI, Inc | 1 | $21 |
| Exact Sciences | 1 | $21 |
| Idorsia Pharmaceuticals US Inc | 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
$5,033 in reported general payments places this provider in the 85th percentile of 2,059 psychiatry providers in Florida.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| RexultiBrexpiprazole | 20 | $29,092 |
| Aripiprazole | 84 | $4,714 |
| Desvenlafaxine Succinate ErDesvenlafaxine Succinate | 23 | $2,522 |
| Escitalopram Oxalate | 255 | $2,158 |
| Memantine Hcl | 150 | $1,948 |
| Mirtazapine | 204 | $1,866 |
| Quetiapine Fumarate | 134 | $1,693 |
| Olanzapine | 25 | $1,666 |
| Buspirone Hcl | 145 | $1,352 |
| Quetiapine Fumarate ErQuetiapine Fumarate | 29 | $1,267 |
| Venlafaxine Hcl ErVenlafaxine Hcl | 34 | $1,228 |
| Duloxetine Hcl | 26 | $1,017 |
| Bupropion XlBupropion Hcl | 38 | $481 |
| Clonazepam | 60 | $481 |
| Sertraline Hcl | 223 | $464 |
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 |
|---|---|---|
| Otsuka America Pharmaceutical, Inc.Rexulti | $832 | $29,09220 claims |
| Almatica Pharma LLCSertraline Hcl | $45 | $464223 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 85th percentile of 2,059 psychiatry providers in Florida.
Other psychiatry in Cutler Bay
- Andrew CutlerLakewood Ranch$5.7M
- Richard JacksonBoca Raton$3.6M
- Ilan MelnickCoral Gables$2.8M
- Todd BroderSt Augustine$1.6M
- Heather LuingSaint Augustine$1.5M
- Todd GatesWest Melbourne$1.2M
- Lawrence ReccoppaGainesville$968K
- Thomas ValenteLeesburg$967K
- Michelle ScargleClearwater$926K
- David SheehanTampa$631K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Identity: NPPES NPI Registry, July 2026.