581 W 161St St
New York NY 10032
Medical School: Mount Sinai School Of Medicine Of City University Of New York - 1988
Accepts Medicare: No
Participates In eRX: Yes
Participates In PQRS: No
Participates In EHR: No
License #: 1850751
Request Appointment Information
Awards & Recognitions
Dr. Hector Perez is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:93224||Description:Ecg monit/reprt up to 48 hrs||Average Price:$356.50||Average Price Allowed
|HCPCS Code:93306||Description:Tte w/doppler complete||Average Price:$329.49||Average Price Allowed
|HCPCS Code:93701||Description:Bioimpedance cv analysis||Average Price:$232.50||Average Price Allowed
|HCPCS Code:93925||Description:Lower extremity study||Average Price:$301.57||Average Price Allowed
|HCPCS Code:99215||Description:Office/outpatient visit est||Average Price:$347.20||Average Price Allowed
|HCPCS Code:G0439||Description:PPPS, subseq visit||Average Price:$300.00||Average Price Allowed
|HCPCS Code:99214||Description:Office/outpatient visit est||Average Price:$258.85||Average Price Allowed
|HCPCS Code:76536||Description:Us exam of head and neck||Average Price:$212.00||Average Price Allowed
|HCPCS Code:99213||Description:Office/outpatient visit est||Average Price:$172.05||Average Price Allowed
|HCPCS Code:93978||Description:Vascular study||Average Price:$184.75||Average Price Allowed
|HCPCS Code:93880||Description:Extracranial study||Average Price:$179.11||Average Price Allowed
|HCPCS Code:76700||Description:Us exam abdom complete||Average Price:$129.38||Average Price Allowed
|HCPCS Code:Q2036||Description:Flulaval vacc, 3 yrs & >, im||Average Price:$60.00||Average Price Allowed
|HCPCS Code:77080||Description:Dxa bone density axial||Average Price:$70.69||Average Price Allowed
|HCPCS Code:90471||Description:Immunization admin||Average Price:$62.00||Average Price Allowed
|HCPCS Code:95861||Description:Muscle test 2 limbs||Average Price:$103.10||Average Price Allowed
|HCPCS Code:93005||Description:Electrocardiogram tracing||Average Price:$37.20||Average Price Allowed
|HCPCS Code:36415||Description:Routine venipuncture||Average Price:$23.25||Average Price Allowed
|HCPCS Code:94010||Description:Breathing capacity test||Average Price:$38.82||Average Price Allowed
|HCPCS Code:77082||Description:Dxa bone density vert fx||Average Price:$32.56||Average Price Allowed
|HCPCS Code:93010||Description:Electrocardiogram report||Average Price:$24.80||Average Price Allowed
|HCPCS Code:95903||Description:Motor nerve conduction test||Average Price:$58.12||Average Price Allowed
|HCPCS Code:95904||Description:Sense nerve conduction test||Average Price:$47.63||Average Price Allowed
|HCPCS Code:95934||Description:H-reflex test||Average Price:$49.71||Average Price Allowed
|HCPCS Code:G0008||Description:Admin influenza virus vac||Average Price:$36.98||Average Price Allowed
HCPCS Code Definitions
- Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
- External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional
- Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only
- Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
- Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
- Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)
- Ultrasound, abdominal, real time with image documentation; complete
- Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation
- Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
- Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
- Duplex scan of extracranial arteries; complete bilateral study
- Bioimpedance-derived physiologic cardiovascular analysis
- Needle electromyography; 2 extremities with or without related paraspinal areas
- Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
- Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
- Administration of influenza virus vaccine
Medical Malpractice Cases
Medical Board Sanctions
*These referrals represent the top 10 that Dr. Perez has made to other doctors
"Not Unless It's a Life or Death Thing": A Qualitative Study of the Health Care Experiences of Adults Who Stutter. - Journal of general internal medicine
For adults who stutter, communication difficulties can impact many spheres of life. Previous studies have not examined how stuttering might impact patient's experiences with the medical system.Our objective was to understand the range and depth of experiences with the medical system among adults who stutter.This was a qualitative study using age-stratified focus groups.Sixteen adults who stutter were recruited at a national conference about stuttering.We conducted three focus groups. Participants also completed a written questionnaire about sociodemographic characteristics, health status, and the impact of stuttering on their life [using the St. Louis Inventory of Life Perspectives Scale (SL-ILP-S) Total Effect Score]. We analyzed data using an iterative, thematic analysis, with an inductive approach, at a semantic level.Participants were mostly (75Â %) male and resided throughout the United States. The mean SL-ILP-S Total Effect Score was 27.3, indicating that stuttering caused minimal concern in participants' lives. Despite this, we identified five themes that characterize ways in which stuttering affects interactions with the medical system. Participants described (1) discomfort speaking with office staff and physicians, which resulted in (2) avoiding health care interactions because of stuttering, and (3) relying on a third party to navigate the medical system. During visits with physicians, participants felt that (4) discussing stuttering with physicians required trust and rapport, and (5) speaking assertively with physicians required self-acceptance of their stuttering.We identified ways in which stuttering affects medical interactions. These results highlight the need for increased awareness and training for medical staff and physicians when caring for persons who stutter. Future studies among diverse samples of stutterers can determine the effects of stuttering on medical interactions, and inform the development of interventions to provide high quality health care for adults who stutter.
An association between organophosphate pesticides exposure and Parkinsonism amongst people in an agricultural area in Ubon Ratchathani Province, Thailand. - Roczniki PaÅ„stwowego ZakÅ‚adu Higieny
Parkinson's disease (PD) is a ubiquitous disease. However, PDs prevalence in the population of agricultural communities lacks understanding and there has been no epidemiological study on the association between pesticides exposure factors and risk for PD.To investigate the potential association between organophosphate pesticides exposure and Parkinsonism by using a screening questionnaire in agricultural areas.Ninety elderly people living in agricultural areas participated in a cross-sectional study conducted at Tambon Hua-Rua Health Promoting Hospital in April 2014. Screening questionnaires for Parkinson's disease, Test-mate ChE (Model 400) for blood cholinesterase (ChE) levels of both blood enzymes erythrocyte cholinesterase (AChE), and plasma cholinesterase (PChE) were used as measurement tools. Descriptive statistics for frequencies and percentage distributions were used primarily to summarize and describe the data. Sensitivity, specificity, positive and negative predictive values were calculated.The age range of the participants was 50 to 59 years old, with an average age of 53.9Â±2.87 years. The majority of the participants were female (62.2%), 82.2% of respondents were farmers. Most of participants (76.7%) reported that they applied insecticides in their farms. Ninety persons participated and completed the 11-item questionnaire. Of these, 17 (18.9%) felt that they lost balance when turning or that they needed to take a few steps to turn right around and 16.7% of participants indicated that they felt the need to move slowly or stiffly. The study found the prevalence of abnormal AChE levels was 28.9% (95%CI=19.81-39.40) and 17.8% of PChE levels (95%CI=10.52-27.26). To predict Parkinsonism, AChE, and PChE level, with a cutoff score of 5 or higher there had to be a sensitivity of 0.31, specificity of 1.00, positive predictive value (PPV) of 1.00 and negative predictive value (NPV) of 0.78 for AChE. While PChE, the score value of 5 or more had a sensitivity of 0.19, specificity of 0.93, PPV of 0.38 and NPV of 0.84.This study described an association between pesticides exposure and Parkinsonism. The questionnaire appears to be useful for Thai agriculturists as a screening tool for Parkinsonism and cholinesterase levels regarding to pesticides exposure.organophosphate, pesticides exposure, Parkinsonism, cholinesterase activity.
Development of hypertension in a cohort of Cuban adolescents. - MEDICC review
Primary hypertension has its origins in childhood and is a risk factor for atherosclerosis; it is considered an important health problem because of its high prevalence worldwide.Describe the development of hypertension during adolescence, including some factors that influence its persistence and progression in Cuban adolescents.A cohort study was conducted in an intentional sample of 252 apparently healthy adolescents from the catchment area of the HÃ©roes del Moncada Polyclinic in Plaza de la RevoluciÃ³n Municipality, Havana. They were assessed in two cross-sectional studies in 2004 and 2008. Mean age at first assessment was 13.2 years, 17.1 years at the second. Variables were weight, height, body mass index, waist circumference, blood pressure, smoking, family history of hypertension and birth weight. Correlation coefficients and growth curve analyses were applied to assess blood pressure persistence. Risk of developing prehypertension and hypertension was estimated in the second assessment, based on predictors identified in the 2004 cut. Forecasting models with these factors were developed using classification trees as analytical tools.Of the six adolescents categorized as hypertensive in the first assessment, five still showed blood pressure alterations after four years. The main factors related to hypertension in those aged 16-19 were blood pressure itself and a body mass index >90th percentile, followed by low birth weight and abdominal obesity. Prognostic models for predicting this condition at the end of adolescence demonstrated the importance of blood pressure alterations at age 12-15 years.High rates of persistence and progression of hypertension during adolescence highlights the need for systematic blood pressure screening at the primary health care level and adoption of primary prevention strategies beginning in childhood.
Switching to nevirapine-based regimens after undetectable viral load is not associated with increased risk of discontinuation due to toxicity. - Journal of the International AIDS Society
Due to its good tolerability, favourable cardiovascular risk-profile, low-pill burden and cost, nevirapine-based regimens are an attractive simplification strategy for patients with suppressed viral load (VL). However, current guidelines recommend caution if nevirapine (NVP) is prescribed in males and females with CD4 counts above 400 or 250 cells/ÂµL, respectively. The aim of this study is to determine the prevalence and risk factors associated with development of toxicity or treatment discontinuation in patients switching to NVP-based regimens.Retrospective chart review of HIV-infected patients with suppressed VL who switched from a PI-based regimen to a NVP-based regimen in four HIV clinics in Argentina, between 1997 and 2013. Bivariate and multivariate analyses were performed to explore factors associated with treatment discontinuation. High CD4 count was defined as CD4-cell count â‰¥400 or 250 cells/ÂµL in males and females, respectively.Of 218 patients included, 165 (75.7%) were male; 21 (9.6%) were co-infected with HCV and/or HBV. Median baseline (BSL) CD4 count: 138 cells/ÂµL (IQR: 64-276). At switch, patients had a median age of 38 years (IQR: 33.4-43.8) and had been suppressed for a median of 1.4 years (IQR: 0.6-2.2); 138 patients (63.3%) had high CD4-cell counts: among females, median CD4 count at switch was 462 (IQR: 330-709) cells/ÂµL; among males, 433 (IQR: 305-595) cells/ÂµL. Thirty-six patients (13.5%) presented NVP-related toxicity (30 skin toxicity, 6 hepatic toxicity), 29 (13.3%) discontinued NVP. Median time to development to toxicity: 32 days (IQR: 15-75). In bivariate analysis, chronic hepatitis was the only variable associated with development of toxicity (OR: 2.90, 95% CI 1.08-7.78). In multivariate analysis, no statistical significant associations were observed between either development of toxicity or treatment discontinuation and gender, chronic hepatitis, age or CD4-cell count at BSL or at switch (all p>0.05).In our study, switching to a NVP-based regimen in patients with undetectable VL was associated with a low incidence of skin or liver toxicity, and treatment discontinuation. Moreover, these were unrelated to the CD4-cell count. Our findings suggest that, in contrast with ART-naÃ¯ve patients, switching to NVP-based regimens could be a safe strategy for patients with suppressed viremia regardless of the CD4-cell count.
Routine HIV testing among hospitalized patients in Argentina. is it time for a policy change? - PloS one
The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated.We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires.Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed.Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population.Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.
Characterizing Ipomopsis rubra (Polemoniaceae) germination under various thermal scenarios with non-parametric and semi-parametric statistical methods. - Planta
Time-to-event analysis represents a collection of relatively new, flexible, and robust statistical techniques for investigating the incidence and timing of transitions from one discrete condition to another. Plant biology is replete with examples of such transitions occurring from the cellular to population levels. However, application of these statistical methods has been rare in botanical research. Here, we demonstrate the use of non- and semi-parametric time-to-event and categorical data analyses to address questions regarding seed to seedling transitions of Ipomopsis rubra propagules exposed to various doses of constant or simulated seasonal diel temperatures. Seeds were capable of germinating rapidly to >90 % at 15-25 or 22/11-29/19 Â°C. Optimum temperatures for germination occurred at 25 or 29/19 Â°C. Germination was inhibited and seed viability decreased at temperatures â‰¥30 or 33/24 Â°C. Kaplan-Meier estimates of survivor functions indicated highly significant differences in temporal germination patterns for seeds exposed to fluctuating or constant temperatures. Extended Cox regression models specified an inverse relationship between temperature and the hazard of germination. Moreover, temperature and the temperature Ã— day interaction had significant effects on germination response. Comparisons to reference temperatures and linear contrasts suggest that summer temperatures (33/24 Â°C) play a significant role in differential germination responses. Similarly, simple and complex comparisons revealed that the effects of elevated temperatures predominate in terms of components of seed viability. In summary, the application of non- and semi-parametric analyses provides appropriate, powerful data analysis procedures to address various topics in seed biology and more widespread use is encouraged.
Leptomeningeal metastasis from non-small cell lung cancer: survival and the impact of whole brain radiotherapy. - Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
Leptomeningeal metastasis (LM), or leptomeningeal carcinomatosis, is a devastating complication of non-small cell lung cancer (NSCLC), and the optimal therapeutic approach remains challenging. A retrospective review was carried out to assess the impact of whole brain radiotherapy (WBRT), intrathecal therapy (IT), and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on outcomes.Patients with newly diagnosed LM from NSCLC from January 2002 to December 2009 were identified through institutional databases and medical records reviewed. Survival was assessed by Kaplan-Meier and landmark analyses by administered treatment to minimize selection bias.We identified 125 patients (45 men, 80 women) with LM from NSCLC, median age 59 years (range, 28-87 years). Almost all (123 [98%]) patients have died and median overall survival was 3.0 months (95% confidence interval, 2.0-4.0). No differences in survival were seen between patients who were treated with WBRT (n =46) and those who were not (n =59, p =0.84) in a landmark analysis. In the seven patients selected to receive IT chemotherapy, median survival was 18 months (range, 5-33 months) and appeared superior to those not selected for this treatment (p =0.001) in a landmark analysis. The median survival of the nine patients with known EGFR mutations (all of whom received TKIs at some point) was 14 months (range, 1-28 months).This retrospective study, the largest published series, demonstrates the poor survival of LM from NSCLC. In this study, survival was not improved by WBRT. The survival of patients selected for IT chemotherapy and those with EGFR mutations treated with TKIs highlights the importance of developing novel agents.
Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters. - Journal of the International AIDS Society
Diagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial.Our objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients.Among 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively.In Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.
Defining and targeting health care access barriers. - Journal of health care for the poor and underserved
The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented. This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities. The model describes three categories of modifiable health care access barriers: financial, structural, and cognitive. The three types of barriers are reciprocally reinforcing and affect health care access individually or in concert. These barriers are associated with screening, late presentation to care, and lack of treatment, which in turn result in poor health outcomes and health disparities. By targeting those barriers that are measurable and modifiable the model facilitates root-cause analysis and intervention design.
Sensitivity and specificity of the pictorial Pediatric Symptom Checklist for psychosocial problem detection in a Mexican sample. - Revista de investigaciÃ³n clÃnica; organo del Hospital de Enfermedades de la NutriciÃ³n
Written questionnaires have been developed to assess children's risks of psychosocial problems based on parents' responses. However, the effectiveness of these questionnaires is limited in populations with low literacy rates, which are also among the most in need of improved mental health screening and care. The present study compared the sensitivity and specificity of a version of the Pediatric Symptom Checklist (PSC)--which contained pictorial descriptions in addition to written text--against the "gold standard" Child Behavior Checklist. We retrospectively analyzed 240 sets of questionnaires completed by the mothers or stepmothers of children who visited clinics in a Community Center in Ciudad Juarez, Mexico, between May and December 2007, under the Seguro Popular insurance program provided to Mexicans with the lowest socioeconomic status. Over 95% of the parental participants had less than a high school level of education. The pictorial PSC was a useful tool for screening for psychosocial impairment, with improved sensitivity and specificity in comparison to previous assessments of the written PSC in similar populations within the U.S. Optimal sensitivity and specificity were achieved when the threshold for clinical follow-up was lowered from 28 to 22 points. Questionnaires that include pictorial descriptions may be valuable for improvements of health screening in communities with low education levels.
Map & Directions
581 W 161St St New York, NY 10032
622 W 168Th St Ph4-124
1051 Riverside Dr Unit 24
3959 Broadway Morgan Stanley Children's Hospital