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Mary L Lalakea, MD

Otolaryngology · San Jose

NPI 1306801469

Medicare standing
Clear
Enrolled, allowed to bill and order, not excluded
Plans that list them
11
4 carriers
Office
1

Offices

1 location · County of Santa Clara · 1,000 clinicians in this group

Looking this up.

Plans that list them

11 plans · 4 carriers

A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Lalakea’s office at (408) 885-5000 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.

11 of 11 plans

Plans whose provider directory lists this clinician
Anthem Full Dual Advantage Aligned (HMO D-SNP)Anthem Blue CrossListedOct 3, 2026
Central Health Classic Care Plan III (HMO)Central Health Medicare PlanListedAug 15, 2026
Central Health Dual Access Plan (HMO D-SNP)Central Health Medicare PlanListedAug 15, 2026
Central Health Embrace Care Plan (HMO C-SNP)Central Health Medicare PlanListed, may be out of dateSep 15, 2025
Central Health Embrace Choice Plan (HMO C-SNP)Central Health Medicare PlanListedAug 15, 2026
Central Health Valor Care Plan (HMO)Central Health Medicare PlanListedAug 15, 2026
SCAN Balance (HMO C-SNP)SCAN Health PlanListedOct 3, 2026
SCAN Classic (HMO)SCAN Health PlanListedOct 3, 2026
SCAN MyChoice (HMO)SCAN Health PlanListedOct 3, 2026
SCAN Strive (HMO C-SNP)SCAN Health PlanListedOct 3, 2026
DualConnect (HMO D-SNP)Santa Clara Family Health PlanListedSep 1, 2026

California Medical Board record

Licence G59969 · Current

Licensed to practise in California · since 1987 · expires 2028-12-31 · Boston University School of Medicine.

No disciplinary actions, convictions, malpractice judgments or citations in this record.

Original Medicare doctor bills

$14,638

Medicare paid this office $14,638 for 161 people.

This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.

Largest Original Medicare bills
Diagnostic exam of voice box using a flexible endoscope38$2,642$59
Short return visit62$1,878$28
New patient visit (30+ min)27$1,859$69
Short return visit (20+ min)19$1,156$48
New patient visit (15+ min)33$1,120$34
See all 6 services
Every Original Medicare service billed
Diagnostic exam of voice box using a flexible endoscope38$2,642$59
Short return visit62$1,878$28
New patient visit (30+ min)27$1,859$69
Short return visit (20+ min)19$1,156$48
New patient visit (15+ min)33$1,120$34
Removal of impacted ear wax26$734$26

Who their Medicare patients are

161 Original Medicare patients in 2024. Average age 72 · Under 65 15% · 85 and older 12% · Women 55% · Also on Medicaid 83% · Health risk score 1.67. Sicker patients than 9 in 10 peers; the typical otolaryngology clinician is at 1.19.

Conditions among them: High blood pressure 69% · Diabetes 35% · Coronary heart disease 19% · Depression 19% · Chronic kidney disease 18% · Heart failure 15% · Cancer 15% · Atrial fibrillation 14% · COPD 12% · Stroke 9% · Dementia 7%.

The office billed $174,483, Medicare allowed $20,568 and paid $14,638; for 264 services of 23 kinds.

Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.

Year by year

Original Medicare by year
2024161264721.67$174,483$14,638
2023184308721.62$298,715$24,910
2022222369711.63$290,460$25,386
2021102214702.15$215,984$21,919
202085149692.18$148,296$14,429
2019205336711.56$306,417$28,577
2018110233671.93$183,222$23,140
2017167314691.80$198,274$26,113
2016109203691.87$180,203$21,902
2015150263662.00$247,582$27,161
2014163289681.43$192,067$25,670
2013116207651.67$158,384$22,948

Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.

See the services billed each year

2023: 6 services

Original Medicare services billed in 2023
Diagnostic exam of voice box using a flexible endoscope40$2,576$60
Short return visit80$2,207$27
Return visit (30+ min)16$1,716$90
Short return visit (20+ min)27$1,358$44
New patient visit (15+ min)25$1,110$44
Removal of impacted ear wax35$914$23

2022: 5 services

Original Medicare services billed in 2022
Short return visit (20+ min)59$3,564$53
Short return visit109$3,099$27
Diagnostic exam of voice box using a flexible endoscope48$2,971$54
Return visit (30+ min)22$2,288$82
Removal of impacted ear wax39$1,112$27

2021: 5 services

Original Medicare services billed in 2021
Short return visit (20+ min)41$2,885$59
Diagnostic exam of voice box using a flexible endoscope40$2,806$62
Return visit (30+ min)23$2,719$94
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes19$1,838$97
Short return visit13$469$31

2020: 4 services

Original Medicare services billed in 2020
Short return visit (20+ min)31$1,794$45
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes15$1,602$107
Diagnostic exam of voice box using a flexible endoscope14$804$57
Telephone medical discussion with physician, 11-20 minutes14$728$52

2019: 8 services

Original Medicare services billed in 2019
Diagnostic exam of voice box using a flexible endoscope50$3,048$55
Short return visit (20+ min)42$2,273$44
New patient visit (15+ min)61$1,897$31
New patient visit (30+ min)34$1,863$55
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes17$1,551$91
Return visit (30+ min)15$1,297$68
Removal of impacted ear wax20$444$22
Short return visit14$279$20

2018: 6 services

Original Medicare services billed in 2018
Diagnostic exam of voice box using a flexible endoscope50$3,042$55
New patient visit (30+ min)29$1,971$68
New patient visit (15+ min)25$1,088$44
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes13$1,078$83
Short return visit (20+ min)21$968$37
Return visit (30+ min)11$918$71

2017: 6 services

Original Medicare services billed in 2017
Diagnostic exam of voice box using a flexible endoscope54$3,693$60
Short return visit (20+ min)66$3,332$41
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes21$1,704$81
Return visit (30+ min)15$1,199$67
New patient visit (30+ min)15$950$63
Short return visit42$874$20

2016: 5 services

Original Medicare services billed in 2016
Short return visit (20+ min)49$2,296$38
Diagnostic exam of voice box using a flexible endoscope28$2,112$66
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes19$1,689$89
Return visit (30+ min)20$1,319$57
Short return visit19$408$21

2015: 5 services

Original Medicare services billed in 2015
Short return visit (20+ min)90$3,294$34
Return visit (30+ min)36$2,437$62
Diagnostic exam of voice box using a flexible endoscope39$2,414$60
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes12$1,039$87
Short return visit16$329$19

2014: 6 services

Original Medicare services billed in 2014
Diagnostic exam of voice box using a flexible endoscope41$3,140$68
Short return visit (20+ min)69$3,132$39
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes13$1,250$89
New patient visit (30+ min)22$1,100$50
Return visit (30+ min)14$932$62
Short return visit40$845$19

2013: 5 services

Original Medicare services billed in 2013
Diagnostic exam of voice box using a flexible endoscope35$2,488$62
Short return visit (20+ min)44$1,955$38
Return visit (30+ min)16$1,061$59
New patient visit (30+ min)14$882$63
Short return visit20$322$16

Medicaid work

$17,238 in 2024

Medicaid paid $17,238 for 2,336 billed services this clinician did in 2024, up to 92 people in a month for one service.

Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.

Largest Medicaid services in 2024
Diagnostic flexible fiberoptic laryngoscopy180$4,888
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES244$4,312
OFF/OP CONSLTJ NEW/EST SF 20323$4,037
Service38$1,605
Short return visit (20+ min)86$1,133
Short return visit60$666
Removal of impacted ear wax62$438
Service15$159
Service13$0
Pain severity quantified; pain present (COA) (ONC)15$0
Pain severity quantified; no pain present (COA) (ONC)57$0
Medication list documented in medical record (COA)662$0
Medicaid work by year
20242,3361692$17,238
20231,4521050$15,501
20221,1951045$15,276
2021682824$11,768
2020466629$6,457
20191,299837$14,953
20181,081730$15,696
See the largest Medicaid services in earlier years

2023

Largest Medicaid services in 2023
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES265$5,148
Diagnostic flexible fiberoptic laryngoscopy229$3,475
OFF/OP CONSLTJ NEW/EST SF 20366$3,337
Short return visit (20+ min)222$2,150
New patient visit (30+ min)31$391
Removal of impacted ear wax111$388
Return visit (30+ min)30$331
Short return visit143$280
Most recent hemoglobin A1c (HbA1c) level less than 7.0% (DM)43$0
OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES12$0

2022

Largest Medicaid services in 2022
Diagnostic flexible fiberoptic laryngoscopy214$4,667
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES223$3,867
OFF/OP CONSLTJ NEW/EST SF 20402$3,413
Short return visit (20+ min)207$1,610
Service25$853
Short return visit55$367
Return visit (30+ min)17$364
Removal of impacted ear wax28$136
Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)12$0
Developmental screening12$0

2021

Largest Medicaid services in 2021
Diagnostic flexible fiberoptic laryngoscopy131$2,983
Service83$2,830
OFF/OP CONSLTJ NEW/EST SF 20144$1,938
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES93$1,655
Short return visit (20+ min)160$1,555
Return visit (30+ min)45$807
Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)12$0
Most recent diastolic blood pressure less than 80 mm Hg (HTN, CKD, CAD) (DM)14$0

2020

Largest Medicaid services in 2020
Short return visit (20+ min)156$1,832
Diagnostic flexible fiberoptic laryngoscopy67$1,440
OFF/OP CONSLTJ NEW/EST SF 20109$1,224
Service30$1,023
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES90$834
Short return visit14$104

2019

Largest Medicaid services in 2019
Service139$4,740
Diagnostic flexible fiberoptic laryngoscopy288$4,604
OFF/OP CONSLTJ NEW/EST SF 20287$2,374
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES225$1,831
Short return visit (20+ min)264$981
Return visit (30+ min)29$174
Short return visit53$172
New patient visit (30+ min)14$78

2018

Largest Medicaid services in 2018
Service144$4,910
Diagnostic flexible fiberoptic laryngoscopy185$3,486
Service75$2,611
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES204$1,841
OFF/OP CONSLTJ NEW/EST SF 20249$1,806
Short return visit (20+ min)178$674
Service46$368

Money from drug and device companies

$35 in 2025

Industry payments by year
202511None$35
202311None$16

Paid work is consulting, speaking, honoraria and royalties, as opposed to meals and travel.

A payment is not proof that care is biased.

Payments by company
Smith+NephewTula$35
1 payment
  • Meals for Tula · 2025-02-13 · $35
See the published payment
Every published payment
Smith+NephewMeals · 2025-02-13Tula$35
See earlier years (2023)

2023: $16

Payments by company in 2023
KLS-Martin L.P.None$16
1 payment
  • Meals · 2023-08-23 · $16

Checkups this office reported

Medicare did not publish checkup rates for this clinician.

Medicare’s overall office score
80.6 / 100
Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.

Professional record

NPI
1306801469
Licence
CA G59969California G59969: Current · expires 2028-12-31
Trained
Boston University School of Medicine, 1985
Gender
Female
More record details
Sole proprietor
No
Medicaid ID
CA 00G599690
Taxonomy
Otolaryngology (207Y00000X)
Mailing address
751 S Bascom Ave, San Jose, CA, 95128
NPI first listed
2006-04-19
NPI last updated
2007-09-12

This is when the NPI record was last certified, not a medical board exam.