reason provider exclusion/t for first gener credenti … medicaid provider... · josephine adams...

NPI Number FULL NAME

FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR

EXCLUSION/TERMINATION

REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

RN.230188-OH Cindy J Disalvio Cindy J Disalvio RN RN

Powhatan

Point OH 5/30/2014

Exclusion by another State's

Medicaid

Tamer M. Gaber Tamer M Gaber MD

Rancho

Cucamonga CA 4/30/2014


Medicaid3340 Broadway Pharmacy,

Inc.

3340 Broadway

Pharmacy, Inc. Pharmacy 8/21/2012


MedicaidMohammad F. Abdel-

Hameed

Mohamma

d F Abdel-Hameed Physician Syracuse NY 5/28/2012


Medicaid

Mohammed Abdi

Mohamma

d Abdi

Reynoldsbur

g OH 4/7/2015


Medicaid

Harry Abolafia Harry Abolafia RPh Pharmacy San Antonio TX 4/12/2012


Medicaid

Wilson Abraham Wilson Abraham 6/13/2012


Medicaid

Absolute Health Medical Care

Absolute Health

Medical Care Group 4/26/2012


Medicaid

Nasir Abubakar Nasir Abubakar Columbus OH 3/2/2015


Medicaid

Miranda C. Ackerley Miranda C Ackerley LPN Nurse Liberty NY 9/20/2012


Medicaid

Adamo Transportation

Adamo

Transportation

Transporta

tion 2/27/2012


Medicaid

Josephine Adams Josephine A Adams RN RN Urbania IL 4/30/2014


Medicaid

Michelle P. Adams-Embrack Michelle P Adams-Embrack RN/LPN Nurse Brooklyn NY 6/26/2012


Medicaid

Andrew Adler Andrew Adler PhD

Psychologi

st Scarsdale NY 7/5/2012


MedicaidAdvantage Medical Health

Care

Advantage Medical

Health Care Group 7/25/2012


Medicaid

Mohammad Fathi Ahmad

Mohamma

d Fathi Ahmad MD Physician 5/28/2012


Medicaid

Peter Joseph Ajemian Peter

Jose

ph Ajemian MD Physician

Rockville

Centre NY 2/21/2012


Medicaid

Debra Aker Debra Aker RN 6/20/2013


Medicaid; 6/30/13 OIG/HHS

Jeffrey A. Akers Jeffrey A Akers RN Nurse

Johnsontow

n NY 6/13/2012


Medicaid

Joseph Akumu Joseph Akumu Bushkill PA 6/4/2012


Medicaid

Patrick Alcindor Patrick Alcindor Pharmacy New York NY 6/4/2012


Medicaid

Patrick Hayes Alden Patrick

Haye

s Alden

Ophthalmi

c

South Glens

Falls NY 6/26/2012


Medicaid

Vincent Alibrandi Vincent Alibrandi RPh Pharmacy

East

Hampton NY 3/18/2012


Medicaid

Brandon Allen Brandon Allen DMD Dental Carlisle KY 6/22/2012


Medicaid

Valerie Allen Valerie Allen C.N.A. Nurse Spencer NY 2/5/2012


Medicaid

Joyce Alonzo Joyce Alonzo Willard OH 9/28/2015


Medicaid

Term-exclusion info other for posting November 2015


FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Tracey Lee Ambrister Tracey Lee Ambrister DDS Dental Westbury NY 5/29/2012


Medicaid

Scott Bruce Amer Scott

Bruc

e Amer DMD Dental Hewlett NY 1/25/2012 TerminationAmericare In Home (owner

Parke Levy)

Americare In

Home

Medical

App. 6/18/2012


Medicaid

An International LLC

An International

LLC LLC 6/7/2012


Medicaid

Chester Andrews Chester Andrews LPN Nurse Bridgeport NY 2/5/2012


Medicaid

Julia Andrews Julia Andrews Marysville OH 3/25/2015


Medicaid

Maria-Lucia Anghel Maria-Lucia Anghel MD Physician

East

Meadows NY 7/31/2012


Medicaid

Juanita Antoine Juanita Antoine RPA New York NY 4/3/2012


Medicaid

Ivette Arroyo Ivette Arroyo Nassau NY 5/28/2012


Medicaid

Vernon T. Atreidis Vernon T. Atreidis MD Physician Miami FL 6/18/2012


Medicaid

Christopher Babcock Christopher Babcock Louisville KY 4/10/2015

Termination by another State's

Medicaid

Christopher Bailey Christopher Bailey Brooklyn NY 2/5/2012


Medicaid

Dorothy Bain Dorothy Bain LPN/RN Nurse Tobyhanna PA 2/5/2012


Medicaid

Shawn M Baird RPh Shawn M Baird RPh Pharmacist Apollo PA 8/20/2013


Medicaid; OIG HHS Exclusion

Dawn Bairhalter Dawn Bairhalter RN Nurse Pittsburgh PA 6/20/2014


Medicaid

William Alfred Baker William

Alfre

d Baker MD Physician 7/2/2012


Medicaid

Lee Adam Balaklaw Lee

Ada

m Balaklaw Physician Louisa KY 5/1/2013



Jude Thaddeus Barbera Jude

Thad

deus Barbera MD Physician Brooklyn NY 9/20/2012


Medicaid

Misty Barnes-Bostwick Misty Barnes-Bostwick Lucasville OH 3/25/2015


Medicaid

Michael Barukhin Michael Barukhin Brooklyn NY 4/25/2012


Medicaid

Fadi Joseph Bejjani Fadi

Jose

ph Bejjani MD Physician Middletown NY 5/21/2012



William S Belfar William S Belfar Physician 8/18/2013


Medicaid

Mark H. Bell Mark H Bell MD Physician Shavertown PA 6/28/2011


Medicaid

Suzanne Benizio Suzanne Benizio Bronx NY 7/30/2012


Medicaid

Matthew A. Bennett Matthew A Bennett MD Physician

N.

Tonawanda NY 9/19/2012


Medicaid

Jo Benoit Jo Benoit Owner Fort Worth TX 8/20/2013





FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Clifford A Berken Clifford A Berken Physician 8/1/2013


Medicaid

Michael Peter Bernardi Michael Peter Bernardi RN 7/15/2013


Medicaid

Althenia Bethel Althenia Bethel Nurse Rochester NY 8/20/2012


MedicaidBG Medical and Diagnostic

PC

BG Medical and

Diagnostic PC Group 4/19/2012


Medicaid

Ajoy S Bhattacharya Ajoy S Bhattacharya MD Physician Brooklyn NY 6/27/2012


Medicaid

Carolyn Billeci Carolyn Billeci RN Nurse

Staten

Island NY 3/18/2012


MedicaidBiofeedback Management

Inc. (owner Rostislav "Steve"

Biofeedback

Management Inc. 8/7/2012


Medicaid

Craig Bittner Craig Bittner Physician 8/20/2013


Medicaid; OIG/HHS Exclusion

Henry Blady Henry Blady MD Physician

Delray

Beach FL 5/17/2012


Medicaid

John Bland John Bland Unknown 7/30/2013


MedicaidTeresa J. Block (aka Powers,

Palmer) Teresa J Block RN Nurse Lafayette NY 6/26/2012


Medicaid

Edward A Bloss Edward A Bloss LCSW

Social

Worker Easton PA 10/14/2014

Terminated by another State's

Medicaid

Marina Bluvstein (aka Linda) Marina Bluvstein Owner Brooklyn NY 3/12/2012


Medicaid

Marina Bonaparte Marina Bonaparte DDS Dental Jamaica NY 2/28/2012


Medicaid

Roman Leonin Bortnik Roman

Leon

in Bortnik Manalapan NJ 2/21/2012


Medicaid

Douglas D Bradley Douglas D Bradley Physician 8/1/2013


Medicaid

Robert R. Bradley, Jr. Robert R Bradley Jr Niagara Falls NY 6/5/2012


Medicaid

Grigory Branfenbrener Grigory Branfenbrener Brooklyn NY 2/2/2012


Medicaid

Lewis R. Brestin Lewis R Brestin DDS Dental Jamaica NY 2/22/2012


Medicaid

Sabrina V. Brewster Sabrina V Brewster LPN Nurse

Queens

Village NY 6/13/2012


Medicaid

Carol Lynne Bringley Carol

Lynn

e Bringley RN Nurse Rochester NY 3/19/2012


Medicaid

Sherri Ann Brinskelle SW Sherri Ann Brinskelle SW Counselor Karthaus PA 7/18/2013



Scott P. Broderick Scott P Broderick RN Nurse 5/8/2012


Medicaid

Brooklyn Anti Aging Center

Brooklyn Anti

Aging Center

Physician

Group 7/28/2013


Medicaid

Briona Brown Briona Brown

Personal

Care Buffalo NY 2/2/2012


Medicaid

Jacqueline M Brown Jacqueline M Brown LPN 7/24/2013


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Sean Dewey Brown Sean DeweyBrown LPN/RN 7/15/2013


Medicaid

Stacy Brown Stacy Brown Shiloh OH 8/24/2015


Medicaid

Joan Brueckheimer Joan Bruckheimer RN 6/20/2013


Medicaid; OIG/HHS exclusion

Joseph Budry Joseph Budry RPA Brooklyn NY 4/2/2012


Medicaid

Angela C Burek Angel C Burek LPN 7/15/2013


Medicaid

Margaret Burger Margaret Burger

Health

Care Aide Philadelphia PA 7/18/2013



Thomas Burlingame Thomas Burlingame Bloomfield NY 5/23/2012


Medicaid

Georgianna Burns Georgianna Burns MD Physician Monroe LA 6/30/2005

License surrendered effective June

30, 2005

Jill Butler Jill Butler RN Nurse Walton NY 7/2/2012


Medicaid

Marcaius L. Butler, Sr. Marcaius L Butler Sr McKeesport PA 8/16/2011


Medicaid

Brenda Calhoun Brenda Calhoun Aide

Personal

Care Ithaca NY 6/22/2012


Medicaid

Brenda Calhoun Brenda Calhoun

Home

Health 6/28/2012



Laurette Cantelmo Laurette Cantelmo RN Nurse 1/10/2012


Medicaid

Carl Canty Carl Canty Unknown 7/24/2013


Medicaid

Enrico P Caprioni Enrico P Caprioni DPM Podiatrist 8/12/2013


Medicaid

Kenneth C. Carlson Kenneth C Carlson MD Physician

New

Rochelle NY 8/14/2012


Medicaid

Mario J. Caruso, Jr. Mario J Caruso Jr Pharmacy Astoria NY 2/27/2012


Medicaid

Zona Castellano Zona Castellano Other 12/29/2009



Marlon F. Castillo Marlon F Castillo MD Physician Bronx NY 6/27/2012


MedicaidGloria Castro MD aka Gloria E

Castro Torres Gloria Castro MD Physician Philadelphia PA 9/19/2013



Robert V. Cattani Robert V Cattani MD Physician

Staten

Island NY 12/6/2011 Termination

Robert Vincent Cattani Robert VincentCattani Physician 8/1/2013


Medicaid

Stella Chalough Stella Chalough RPA Brooklyn NY 4/3/2012


Medicaid

Charles Chandler Charles Chandler RPA Jersey City NJ 4/2/2012


Medicaid

Chris Chang Chris Chang RPh Pharmacy Flushing NY 3/21/2012


Medicaid

Suk Chul Chang MD Suk Chul Chang MD Physician Wynnwood PA 5/6/2013


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENTChang Ho Lee Brooklyn

Medic

Chang Ho Lee

Brooklyn Medic

Physician

Group 7/28/2013


Medicaid

Chaparral Services LTD

Chaparral Services

LTD Company 4/20/2012


Medicaid

Zafar Chaundhry Zafar Chaudhry Owner Brooklyn NY 5/20/2012


Medicaid

Eugene Chin Eugene Chin Physician Las Vegas NV 6/26/2011


Medicaid

Evelyn Veitch Chin Evelyn

Veitc

h Chin LPN/RN Nurse Baldwin NY 4/17/2012


Medicaid

Kingsley Richard Chin Kingsley

Rich

ard Chin MD Physician

West Palm

Beach FL 3/7/2012


Medicaid

Duk Kyoon Choi Duk

Kyoo

n Choi MD Physician Elmira NY 2/28/2012


Medicaid

Francis Choi Francis Choi Other 7/28/2013


Medicaid

Leonard E. Clark Leonard E Clark C.N.A. Nurse Schenectady NY 1/16/2012


Medicaid

Laronda Clark-Wallace Laronda Clark-Wallace

Home

Health Pottstown PA 3/26/2013


Medicaid

William A. Cobb William A Cobb MD Physician Hopatcong NJ 3/11/2011


Medicaid

Paul Cohen Paul Cohen LPN/RN 7/29/2013


Medicaid

Joseph Cohens Joseph Cohens Sonyea NY 2/13/2012


Medicaid

Mary Cohens Mary Cohens Geneva NY 2/2/2012


Medicaid

Rashaad Coleman Rashaad Coleman

Personal

Care Philadelphia PA 8/20/2013



Eric J Collins LPN Eric J Collins LPN Nurse Warren PA 9/19/2013



Kathleen A Collins Kathleen A Collins LPN 7/30/2013


Medicaid

Reynaldo Colon Reynaldo Colon Minersville PA 5/29/2012


Medicaid

Tara Colvin Tara Colvin Albany NY 6/22/2012


Medicaid

Complete Chiropractic

Complete

Chiropractic Office 7/24/2012


Medicaid

Hope Connolly Hope Connolly

Home Care

Aide Eastlake OH 12/3/2014


Medicaid

William Joseph Conway William

Jose

ph Conway MD Physician Baldwin NY 9/19/2012


Medicaid

William Joseph Conway William JosephConway Physician 7/29/2013


Medicaid

Balisa D Cooke Balisa DeweyCooke C N A 7/24/2013


Medicaid

Stephen M. Costa Stephen M Costa agent Tampa FL 4/12/2012


Medicaid

D Daniell Courtney Debra DanielleCourtney RN 7/24/2013


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Timothy Alan Courtney Timothy Alan Courtney LPN Nurse Ayers MA 9/20/2012


Medicaid

Michael Cowen Michael Cowen

DME

Owner Miami FL 9/3/2009


Medicaid

John Everett Crews III MD John EverettCrews III MD Physician Philadelphia PA 5/18/2012


Medicaid

Toya Croley Toya Croley Albany NY 6/22/2012


Medicaid

Lisa M Czyzyk RN Lisa M Czyzyk RN

Nurse/nurs

es aide Trenton NJ 8/20/2013



D. S. Reddy Physician PC

D. S. Reddy

Physician PC Group 5/23/2012


Medicaid

Jennie E. Damon Jennie E Damon LPN Nurse Cortland NY 6/7/2012


Medicaid

Michael Danilovich Michael Danilovich Brooklyn NY 4/25/2012


Medicaid

Roberto David Roberto David MD Physician New York NY 7/19/2012


Medicaid

Oleg A Davie Oleg A Davie Physician 7/31/2013


Medicaid

Nikita C. Davis Joseph Nikita C Davis Joseph C.N.A. Nurse Central Islip NY 9/17/2012


Medicaid

Shari Degraw Sheri Degraw

Pharmacist

(Supv) 7/8/2013


Medicaid

Robert Della Badia Robert Della Badia MD Physician Brooklyn NY 4/26/2012


Medicaid

Carlos Delos-Reyes Carlos Delos-Reyes MD Physician Waverly NY 3/5/2012


Medicaid

Eugene Demczuk Eugene Demczuk MD Physician Brooklyn NY 8/13/2012


Medicaid

Kathleen Dent Kathleen Dent Other 7/24/2013


Medicaid

Dental Wheels Dental Wheels Dental 2/8/2012


Medicaid

Melvina Denton Melvina Denton

Home

Health Philadelphia PA 9/19/2013



Vincent Depanicis Vincent Depanicis Dental Blue Bell PA 3/20/2012


Medicaid

Bakula I. Desai Bakula I Desai Physician Bronx NY 9/20/2012


MedicaidCathleen Agnes Deschetler

(Boyd) Cathleen

Agne

s Deschetler NP Nurse Highland NY 7/16/2012


Medicaid

Rools Deslouches Rools Deslouches NP Nurse Amityville NY 7/30/2012


Medicaid

Mauro V Dibenedetto Mauro V Dibenedetto Dentist 8/20/2013



Tammi Diemer Tammi Diemer Ottawa OH 2/5/2015


Medicaid

Cindy Jo DiSalvio (Hess) Cindy J Disalvio (Hess) RN Nurse

Powhatan

Point OH 6/20/2014


Medicaid

Satyendra Kumar Diwan Satyendra

Kum

ar Diwan MD Physician

Newton

Square PA 12/27/2011


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Bella Dorman Bella Dorman PhD

Psychologi

st Brooklyn NY 8/13/2012


Medicaid

Ernst Ducena Ernst Ducena MD Physician Baldwin NY 6/14/2012


Medicaid

Bret A Dunning DO Bret A Dunning DO Physician

Prestonsbur

g KY 5/13/2013


Medicaid

Beverly JP. Edwards Beverly JP Edwards MD Physician Ahoskie NC 2/22/2012


Medicaid

Cynthia Edwards Cynthia Edwards Therapist

Occupation

al Th. 7/5/2012


Medicaid

Michael L Eisenberg Michael L Eisenberg Physician 7/30/2013


Medicaid

Michael L. Eisenberg Michael L Eisenberg MD Physician Syossett NY 9/20/2012


Medicaid

Saleh Elahwal Saleh Elahwal DDS Dental Brooklyn NY 4/30/2012 Termination

Cheray Elam Cheray Elam

Personal

Care Chester PA 6/19/2014


Medicaid

Jean G Elie Jean G Elie Physician 7/24/2013


Medicaid

Brandon Ellis Brandon Ellis IP IP Cleveland OH 8/20/2014


Medicaid

John Eremita John Eremita RPh Pharmacy Verona NJ 8/20/2012


Medicaid

Pedro Espada Jr Pedro Espada Jr Other 1/10/2011


Medicaid

Pedro Gautier Espada III Pedro GautierEspada III Other 1/10/2011


Medicaid

Brandon Evans Brandon Evans Toledo OH 2/10/2015


Medicaid

Jacki Lynn Everett Jacki Lynn Everett LPN Nurse

College

Point NY 6/7/2012


Medicaid

Peter Fabulian Peter Fabulian DO Physician Strasburg PA 12/21/2011


Medicaid

Keith Wayne Factor Keith

Way

ne Factor DPM Podatrist Brooklyn NY 4/30/2012 Termination

Barry Fagin Barry Fagin DPM Podatrist Brooklyn NY 4/15/2012


Medicaid

Jalon E Faherty Jalon E Faherty Employee

Tarpon

Springs FL 9/19/2013



Lindsay C. Farnsworth Lindsay C Farnsworth LPN Nurse

Newton

Falls NY 6/12/2012


Medicaid

Rebecca L. Ferguson Rebecca L Ferguson RN Nurse 3/20/2012


Medicaid

Ronald Willard Ferguson, Jr. Ronald

Willa

rd Ferguson Jr DPM Podiatry

North

Huntingdon PA 11/10/2011


Medicaid

Adalgisa Ferreira-Perez Adalgisa Ferreira-Perez Physician New York NY 9/20/2012


Medicaid

Dawn Marie Ferrigno Dawn

Mari

e Ferrigno LPN/RN Nurse Brooklyn NY 3/12/2012


Medicaid

Fidelity Wholesale, LLC

Fidelity Wholesale,

LLC

Prescriptio

n 4/17/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Dawn M. Figurilli Dawn M Figurilli

Office

Manager Niagara Falls NY 5/30/2012


Medicaid

Shannon I. Figurilli Shannon I Figurilli Niagara Falls NY 5/30/2012


Medicaid

Christopher D Finley Jr Christopher D Finley Jr Other 9/3/2013


Medicaid

Sabrina Anne Fornwalt RN Sabrina Anne Fornwalt RN

Nurse/nurs

e aide Philadelphia PA 8/20/2013



Ashley Fose Ashley Fose Niagara Falls NY 6/5/2012


Medicaid

Eileen C. Fox Eileen C Fox RN Nurse Bronx NY 5/16/2012


Medicaid

Paul Lewis Fox Paul Lewis Fox Physician 7/29/2013


Medicaid

Sandra Franklin Sandra Franklin

Private

Citizen Coatesville PA 7/18/2013



Tammy Freedline Tammy Freedline

Personal

Care Gibsonia PA 4/2/2013


Medicaid

Zelma Freedline Zelma Freedline

Attendant

Care Kittanning PA 4/2/2013


MedicaidFried and Kohler, Inc (owner

Jeanne Prosper)

Fried and Kohler,

Inc Optician 2/9/2012


Medicaid

Josseph Fritz Joseph Fritz RN Nurse Easton PA 9/19/2013



David J. Funari (of David S.) David J Funari PhD

Psychologi

st Hudson Falls NY 9/17/2012


Medicaid

Tatyana Gabinskaya Tatyana Gabinskaya MD Physician Elmhurst NY 4/25/2012


Medicaid

Sergey Gabinsky Sergey Gabinsky MD Physician 6/4/2012


Medicaid

Michael H. Gabriel Michael H Gabriel MD Physician Proctorville OH 2/22/2012


Medicaid

Algirdas Gamziukas Algirdas Gamziukas MD Physician Buffalo NY 1/10/2012


Medicaid

Teresa R. Gansworth Teresa R Gansworth Sanborn NY 6/5/2012


Medicaid

Laura Garadedian Laura Garabedian MD Physician 3/5/2012


Medicaid

Ahmed Gardaad Ahmed Gardaad Columbus OH 2/12/2015


Medicaid

Gardiner Chiropractic PC

Gardiner

Chiropractic PC Office 7/25/2012


Medicaid

Michael J. Garrett Michael J Garrett MD Physician Oneida NY 2/15/2012


Medicaid

Eva Gateva Eva Gateva MD Physician Brooklyn NY 5/21/2012


Medicaid

Joseph R. Gaudio Joseph R Gaudio MD Physician New York NY 2/21/2012


Medicaid

Stephen Gawronski Stephen Gawronski MD Physician

Bowmansvill

e NY 8/7/2012


Medicaid

Scott D. Geise Scott D Geise DDS Dental Newfane NY 9/20/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Emmanuel Gelin Emmanual Gelin MD Physician Baldwin NY 6/14/2012


Medicaid

Anil T. George Anil T George RN Nurse

New Hyde

Park NY 3/19/2012


Medicaid

Kevin W. George Kevin W George MD Physician Schenectady NY 2/15/2012


Medicaid

Billy Nabil Geris Billy Nabil Geris MD Physician

Staten

Island NY 4/26/2012


Medicaid

Get Well Medical PC

Get Well Medical

PC Group 5/15/2012


Medicaid

Robert Gevedon MD Robert Gevedon MD Physician Cynthiana KY 11/28/2012


Medicaid

Jan W. Gilbert Jan W Gilbert DDS Dental Lawrence NY 8/20/2012


Medicaid

Dawn H Gillard Dawn Gillard IP IP Columbus OH 8/20/2014


Medicaid

Graciela O. Giorgelli Graciela O Giorgelli RPN Nurse 5/22/2012


Medicaid

Groven Glenn Groven Glenn C N A 7/28/2013


Medicaid

Glenn Schabel, Inc. Glenn Schabel, Inc. Company 4/17/2012


Medicaid

Judit Goldner-Rado Judit Goldnerr-Rado DDS Dental Jamaica NY 4/26/2012


Medicaid

Geroge W. Gordon George W Gordon Bethlehem PA 1/23/2012


Medicaid

Sandor Emerich Gorog Sandor

Eme

rich Gorog RN Nurse 6/26/2012


Medicaid

Caroline Goss Caroline Goss RN Nurse Mattituck NY 4/5/2012 Termination

Peter Barrie Gray Peter BarrieGray Dentist 7/18/2013



John R Grayovski John R Grayovski

Certified

Nurse Aide 10/29/2012



Gail M Green Gail M Green RN Nurse 9/3/2013


Medicaid

Loletha Green Loletha Green

HCSS

Worker 10/31/2012


Medicaid;7/18/13 OIG/HHS

Chad Edward Greenshiner Chad

Edw

ard Greenshiner

Chiropracti

c Manalapan NJ 6/5/2012


Medicaid

William M. Griefer William M Griefer DDS Dental Brooklyn NY 8/13/2012


Medicaid

Hellen Griffin-Shelley Hellen Griffin-Shelley LSW

Social

Worker

Lafayette

Hill PA 7/12/2011


Medicaid

Craig A Grimes Craig A Grimes Researcher

Bennettsvill

e SC 8/20/2013



Terri L Groover RN Terri L Groover RN

Nurse/Nur

se aide Philadelphia PA 8/20/2013



Ira J. Gross Ira J Gross Pharmacy

New Hyde

Park NY 4/12/2012


Medicaid

Lauretta Grzegorczyk Lauretta Grzegorczyk MD Physician

Staten

Island NY 4/25/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Jamie Guerrero Jamie Guerrero Physician Louisville KY 4/10/2015


Medicaid

Carl Guilford Carl Guilford Bronx NY 5/29/2012


MedicaidRangarao Venkat

Gummadapu Rangarao

Venk

at Gummadapu MD Physician Selma AL 2/13/2012


Medicaid

Michael Curtis Haben Michael Curtis Haben Physician 7/31/2013


MedicaidHaben Practice for Voice &

Laryng

Haben Practice for

Voice & Laryng

Physician

Group 7/31/2013


Medicaid

Karen A. Hamm Karen A Hamm RN/LPN Nurse 4/9/2012


Medicaid

Adolph Harper Jr Adolph Harper Copley OH 2/27/2015


Medicaid

Adria Harper Adria Harper Akron OH 2/5/2015


Medicaid

Courtney Harris Courtney Harris

Health

Care Aide Cincinatti OH 12/3/2014


Medicaid

Russell E Hartman Jr Russell E Hartman Jr

Personal

Care Kittanning PA 4/2/2013


Medicaid;

Shaikh Monirul Hasan Shaikh

Moni

rul Hasan MD Physician Brooklyn NY 9/20/2012


Medicaid

Mary L. Hayes Mary L Hayes 11/2/2011


Medicaid

Tabitha Hearn Tabitha Hearn LPN LPN West Park NY 7/2/2012


Medicaid

Suresh K. Hemrajani Suresh K Hemrajani MD Physician New York NY 8/13/2012


Medicaid

Lenny Hernandez Lenny Hernandez Bronx NY 5/29/2012


MedicaidHighway Medical Diagnostic

PC

Highway Medical

Diagnostic PC Group 5/16/2012


Medicaid

Chantal Theresa Hilaire Chantal

Ther

esa Hilaire MD Physician

Queens

Village NY 7/31/2012


MedicaidMary Hoffner (Hoffner-

Miller) Mary

Hoffner (Hoffner-

Miller) MD Physician Berea KY 2/20/2012


Medicaid

Neil Howard Hollander Neil

How

ard Hollander DC

Chiropracti

c

Huntingdon

Valley PA 2/17/2011


Medicaid

Robert F. Hosty Robert F Hosty MD Physician Brooklyn NY 2/13/2012 Termination

Charlotte Hovey MD Charlotte Hovey MD Physician St John's FL 9/21/2012


Medicaid

Tyra Howard Tyra Howard Dayton OH 9/9/2015


Medicaid

David Lee Yan Hsu David

Lee

Yan Hsu MD Physician Centerport NY 2/14/2012


Medicaid

Marshall J. Hubsher Marshall J Hubsher MD Physician Sands Point NY 5/30/2012


Medicaid

Sue A. Huling Sue A Huling LPN Nurse Waterloo NY 5/16/2012


Medicaid

Caroline Paulin Ibale Caroline

Pauli

n Ibale Brooklyn NY 4/15/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Arthur Ibragimov Arthur Ibragimov Owner Queens NY 6/7/2012


Medicaid

David Ibragimov David Ibragimov Owner Flushing NY 6/22/2012


Medicaid

Integrity Trade Corp.

Integrity Trade

Corp. Company 4/20/2012


Medicaid

Mikhail Isakov Mikhail Isakov Manager Queens NY 6/22/2012


Medicaid

Yelena Ivanova Yelena Ivanova Physician 7/31/2013



Frank Izzo Frank Izzo DDS Dental Schenectady NY 3/8/2012


Medicaid

Nikia Jackson Nikia Jackson

Health

Care Aide Canton OH 12/17/2014


Medicaid

Eric Jacobson Eric Jacobson Physician

Kew

Gardens NY 9/20/2012


Medicaid

Kishore K. Jadhau Kishore K Jadhau MD Physician KY 5/17/2012


Medicaid

Junior Jaquez Junior Jaquez New York NY 5/29/2012


Medicaid

Omar Jaraki Omar Jaraki MD Physician

Staten

Island NY 5/23/2012


Medicaid

Tara Lynn Jennings Tara Lynn Jennings RN Nurse Rocky Point NY 6/13/2012


Medicaid

Gail E. Jensen Gail E Jensen LPN Nurse Penn Yan NY 5/21/2012


Medicaid

Stacey Anne Johnson Stacey Anne Johnson LPN Nurse 2/5/2013



Jessie Joiner Jessie Joiner LPN Nurse Jamaica NY 6/7/2012


Medicaid

James H. Jones James H Jones C.N.A. Nurse Lockport NY 2/5/2012


Medicaid

Lisa Jordan Lisa Jordan Columbus OH 4/15/2015


Medicaid

Harry T. Josifidis Harry T Josifidis MD Physician New York NY 9/19/2012


Medicaid

Harry Theodore Josifidis Harry TheodoreJosifidis Physician 7/28/2013


Medicaid

Matthew J Kachinas Matthew J Kachinas Physician 7/15/2013


Medicaid

Nalini R. Kakulavaram Nalini R Kakulavaram MD Physician Coffeyville KS 9/8/2008


Medicaid

Oleg Kam Oleg Kam Owner

Staten

Island NY 3/26/2012


Medicaid

Kathleen Elizabeth Kane Kathleen

Eliza

beth Kane LPN/RN Nurse Walton NY 6/26/2012


Medicaid

Kevin John Kanya DDS Kevin John Kanya DDS Dentist York PA 8/20/2013



Michelle Kaplan Michelle Kaplan Unknown 7/28/2013


Medicaid

Alisa R. Kasachkoff Alisa R Kasachkoff PhD

Psychologi

st New York NY 4/15/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Stephanie Kaufman Stephanie Kaufman RN Nurse

Washington

ville NY 4/17/2012


Medicaid

Rubin Kaykov Rubin Kaykov DME Rego Park NY 2/14/2012


Medicaid

Jacqueline Keller-Lasher Jacqueline Keller-Lasher LPN/RN Nurse 2/14/2012


Medicaid

Deborah Kendig Deborah Kendig

Waiver

Service Willoughby OH 12/18/2014


Medicaid

Tami Kennedy Tami Kennedy Niagara Falls NY 7/30/2012


Medicaid

Samir Khalil Samir Khalil Physician 7/24/2013


Medicaid

Mohamad A Khan Mohamad A Khan MD Physician Reading PA 3/19/2014


Medicaid

Vladimir Khmelnitski Vladimir Khmelnitski Brooklyn NY 2/15/2012


Medicaid

Whan Sil Kim Whan Sil Kim Physician 6/24/2013


Medicaid

Seritta Klass Seritta Klass Employee Brooklyn NY 3/12/2012


Medicaid

Gail Klein Gail Klein LPN Nurse

Mechanicvill

e NY 8/14/2012


Medicaid

Nelson I Kohn Nelson I Kohn Physician 7/29/2013


Medicaid

Anatoly Kraiter Anatoly Kraiter Owner Brooklyn NY 1/16/2012


Medicaid

Michael Kremerman Michael Kremerman

Staten

Island NY 4/25/2012


Medicaid

Joseph Kubacki Joseph Kubacki Physician Philadelphia PA 8/20/2012


Medicaid

Anastasia Kucharski Anastasia Kucharski MD Physician New York NY 5/16/2012


Medicaid

Richard Kulak Richard Kulak DO Physician Liverpool NY 1/16/2012


Medicaid

Pavel Kulik Pavel Kulik MD Physician Brooklyn NY 2/15/2012


Medicaid

Philip Yi-Pu Kuo Philip Yi-Pu Kuo DMD Dental Selden NY 1/25/2012 Termination

William Kinghan Kwik William

King

han Kwik OD

Optometris

t Rochester NY 2/15/2012


Medicaid

Philina Lamb Philina Lamb MD Physician Sacremento CA 12/20/2011


Medicaid

Rebecca Rice Lamp Rebecca Rice Lamp CRNP Nurse

New

Cumberland WV 12/17/2014


Medicaid

Emanuel Lamprou Emanuel Lamprou Jr MD Physician Wynnwood PA 7/3/2012


Medicaid

Karl W. Lanks Karl W Lanks MD Physician

Staten

Island NY 8/13/2012


Medicaid

Felix Lanting Felix Lanting MD Physician

Staten

Island NY 5/29/2012


Medicaid

Joseph Jean Lanza Joseph Jean Lanza MD Physician Middletown NY 3/5/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

James Lau James Lau RPh Pharmacy Brooklyn NY 3/21/2012


Medicaid

Patricia Laughman Patricia Laughman Barberton OH 1/30/2015


Medicaid

John Gerald Laughner, Jr. John

Gera

ld Laughner Jr DO Physician

Johnsonbur

g PA 1/13/2010


Medicaid

Mitchell Allen Lavenda Mitchell Allen Lavenda Pharmacy Brooklyn NY 8/22/2012


Medicaid

Chang Ho Lee Chang Ho Lee Physician 7/28/2013


Medicaid

Michelle Lee Michelle Lee Other 7/28/2013


Medicaid

Valerie Chong Lee Valerie

Chon

g Lee RN Nurse Massapequa NY 6/18/2012


Medicaid

Teresa Leeth Teresa Leeth Piketon OH 9/8/2015


Medicaid

Legacy Entertainment

Legacy

Entertainment Company 4/20/2012


Medicaid

Marlon Legaspi Marlon Legaspi LPN Nurse

Valley

Cottage NY 10/8/2012


Medicaid

Lenox Wellcare Medical

Lenox Wellcare

Medical

Medical

Office 2/22/2012


Medicaid

Peter Joseph Lesniewski Peter

Jose

ph Lesniewski MD Physician Bronx NY 2/21/2012


MedicaidAlexander Levy (dba First City

Med) Alexander Levy DME Owner

Staten

Island NY 6/7/2012



Parke M. Levy Parke M Levy DME Employee 5/20/2012


Medicaid

Andron J. Lewis Andron J Lewis

New

Rochelle NY 6/22/2012


Medicaid

Clementina E Lewis Clementina E Lewis Physician 7/29/2013


Medicaid

Lexington Family Clinic

Lexington Family

Clinic Paris KY 7/14/2012 Closed by the State

Alicia J. S. Lindo (aka Mohan) Alicia J. S. Lindo LPN/RN Nurse Bay Shore NY 6/13/2012


Medicaid

Reginald Lindsay Reginald Lindsay

Personal

Care

Vestavia

Hills AL 8/20/2013



Jennie Maria Lipari Jennie

Mari

a Lipari NP-C

Nurse

Practitione Forest Hills NY 6/18/2012


Medicaid

Abigail List Abigail List LCSW

Social

Worker New York NY 4/5/2012 Termination

Augusto G. Lizarazo Augusto G Lizarazo MD Physician

Long Island

City NY 6/28/2012


Medicaid

Frank M. Lobacz Frank MI Lobacz MD Physician Bay Shore NY 1/10/2012


Medicaid

Krysta M Logsdon Krysta M Logsdon RN 7/29/2013


Medicaid

Wayne Longmore Wayne Longmore MD Physician Woodstock NY 8/14/2013


Medicaid

Jene Love Jene Love Warrensville OH 4/9/2015


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Johnny Jian Q. Luo Johnny

Jian

Q Luo RPh Pharmacy Flushing NY 3/21/2012


Medicaid

MA Concord LLC MA Concord LLC Company 7/10/2012


Medicaid

Michael C. Macatol Michael C Macatol MD Physician Vero Beach FL 1/5/2012


Medicaid

Jason K. MacLaughlin Jason K MacLaughlin OD

Optometris

t Amherst NY 1/25/2012 Termination

Jason K. MacLaughlin Jason K MacLaughlin OD 8/1/2013


Medicaid

Javid I Malik Javid M Malik RPh Pharmacist 8/14/2013


Medicaid

Mohammed Amir Malik Mohammed Amir Malik Other 8/12/2013


MedicaidManhattan Beach Internal

Medicine

Manhattan Beach

Internal Medicine

Physician

Group 8/1/2013


Medicaid

Michael Marchese DMD Michael Marchese DMD Dentist

Hummelsto

wn PA 1/25/2013


Medicaid

Christina Marji Christina Marji Brooklyn NY 2/22/2012


Medicaid

Antonio Martinez Antonio Martinez New York NY 5/29/2012


Medicaid

Tammy Marvin Tammy Marvin LPN Nurse

Bedford

Hills NY 5/14/2012


Medicaid

Patricia M. Marx Patricia M Marx LPN Nurse

Mastic

Beach NY 9/17/2012


Medicaid

Tanya Le Mase Tanya Le Mase RN Nurse Latrole PA 6/20/2012


Medicaid

Rick Mason Rick Mason

Personal

Care Sicklerville NJ 8/20/2013



Lynn Denise Maxwell Lynn

Deni

se Maxwell LPN Nurse Oswego NY 3/19/2012


Medicaid

Gracia Louis Mayard Gracia Louis Mayard Physician 8/18/2013


Medicaid

MB Globus LLC MB Globus LLC LLC 6/21/2012


Medicaid

Robin McCant Robin McCant Holland OH 9/11/2015


Medicaid

April McCarty April McCarty LPN LPN Charleston SC 8/20/2014


Medicaid

Olubunmi McClendon Olubunmi McClendon LPN Nurse Yonkers NY 4/30/2012 Termination

Mary McConnell Mary McConnell RN Nurse Baldwin NY 6/22/2012


Medicaid

Phyllis A McCoy Phyllis A Mccoy

Personal

Care UpperDarby PA 8/20/2013



Shirley McElroy Shirley McElroy Alliance OH 3/2/2015


Medicaid

Kevin T McGinnis MD Kevin T McGinnis MD Physician Edgewood Ky 5/23/2013


Medicaid

Niall McGinnis Niall McGinnis PAC Boise ID 4/26/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Bari L. McHugh Bari L McHugh Niagara Falls NY 6/5/2012


Medicaid

Alisia D. McIntyre Alisia D McIntyre RN/LPN Nurse 6/13/2012


Medicaid

Bruce McNeil Bruce McNeil

Personal



Medicaid; OIG HHS ExclusionMedical Solutions

Management, Inc.

Medical Solutions

Management, Inc.

Medical

Appliance 8/14/2013


Medicaid

Hany Mekhael Hany Mekhael PT

Physical

Therapy

Staten

Island NY 6/5/2012


Medicaid

Mohamed R. Mekki Mohamed R Mekki Therapist

Physical

Therapy Brooklyn NY 8/28/2012


Medicaid

Pedrito Melecio Pedrito Melecio RPN Nurse Bronx NY 9/20/2012


Medicaid

Brenda Mencer Brenda Mencer

West

Lafayette OH 3/12/2015


Medicaid

Metar Medical PC Metar Medical PC Group 5/15/2012


Medicaid

Corey J. Meyers Corey J Meyers MD Physician Hudson NY 1/11/2012 Termination

Helen Michel Helen Michel Owner 1/19/2008


Medicaid

Mary Miller Mary Miller RN Nurse

Fredericksb

urg TX 5/21/2012


Medicaid

Michael Miller Michael Miller Lynchburg OH 8/21/2015


Medicaid

William Harry Miller William

Harr

y Miller LPN Nurse Oneida NY 9/19/2012


Medicaid

Misty Miller Misty Miller LPN LPN Homerville OH 8/20/2014


Medicaid

Robert B. Millman Robert B Millman MD Physician New York NY 1/10/2012


Medicaid

Vadim Miloradovich Vadim Miloradovich MD Physician New York NY 3/12/2012


Medicaid

Jehan Mir Jehan Mir Physician 8/1/2013


Medicaid

Tahir U. Mir Tahir U Mir MD Physician Pittsburgh PA 6/19/2014


Medicaid

Boris Mirochnik Boris Mirochnik LCSW

Social

Worker

Staten

Island NY 8/13/2012 Termination

Sabrina Marie Mitchell Sabrina M Mitchell LPN Nurse Erie PA 6/19/2014


Medicaid

John M. Mohr John M Mohr DMD Dental Union City PA 3/9/2012


Medicaid

Diamond Mondl Diamond Mondl Tallmadge OH 3/2/2015


Medicaid

Chris Morel Chris Morel Other 7/15/2013


Medicaid

Ebony Morgan Ebony Morgan Philadelphia PA 10/24/2011


Medicaid

Michael M. Morgan Michael M Morgan Therapist

Physical

Therapy Bronx NY 5/22/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Iliya Mugerman Iliya Mugerman

Staten

Island NY 2/9/2012


Medicaid

Sophia Mulle Sophia Mulle Columbus OH 3/6/2015


Medicaid

Karen G. Murray Karen G Murray C.N.A. Nurse Brooklyn NY 3/12/2012


Medicaid

Patricia M. Murray Patricia M Murray Employee Brooklyn NY 3/12/2012


Medicaid

NA Continental Group

NA Continental

Group LLC 6/26/2012


Medicaid

Jacinto Gasmin Nalos Jacinto

Gas

min Nalos RN/LPN Nurse

Jackson

Heights NY 5/23/2012


Medicaid

David Naugle OD David Naugle OD

Optometris

t Hazelton PA 10/11/2013


Medicaid

Mary Nauseef Mary Nauseef LPN Nurse Cincinnaatus NY 6/7/2012


Medicaid

Victor Neal Victor Neal

Personal




Richard Nebiosini Richard Nebiosini DC

Chiropract

or 3/7/2013



Angela Nelson Angela Nelson Akron OH 3/6/2015


Medicaid

Amy Neubacher Amy Neubacher Bucyrus OH 3/25/2015


Medicaid

New House Finance Corp.

New House

Finance Corp. Company 4/20/2012


Medicaid

Robert Newberry Robert Newberry LPN 7/18/2013



Newfane Family Dentistry

Newfane Family

Dentistry Dental Newfane NY 9/24/2012


Medicaid

Tracy Ann Niemi Tracy Ann Niemi LPN Nurse Batavia NY 2/22/2012


Medicaid

Sandra Nieves Sandra Nieves

Home

Attendant

Cheecktowa

ga NY 2/3/2012


Medicaid

Manuel B. Nigalan Manuel B Nigalan MD Physician Northfield NJ 10/14/2010


Medicaid

Nuline Pharmaceuticals, Inc.

Nuline

Pharmaceuticals,

Prescriptio

n 4/17/2012


Medicaid

Oksa Medical PC Oksa Medical PC 2/15/2012


Medicaid

Lola Olanrewaju Lola Olanrewaju

Unlicensed

HHA

Staten

Island NY 6/7/2012


Medicaid

Bonnie L. Oliver Bonnie L Oliver LPN Nurse

Baldwinsvill

e NY 2/20/2012


Medicaid

Optimus Wholesale, LLC

Optimus

Wholesale, LLC

Prescriptio

n 4/17/2012


Medicaid

Barbara Osborne Barbara Osborne RN Nurse

Watkins

Glen NY 3/18/2012


Medicaid

Ike Osuji Ike Osuji MD MD Columbus OH 8/22/2014


Medicaid

Owais, Inc Owais, Inc. Pharmacy 8/14/2013


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Astrid Paez-Avis Astrid Paez-Avis DPM Podiarist Hershey PA 3/20/2012


Medicaid

Tanisha Paige Tanisha Paige Cincinnati OH 3/12/2015


Medicaid

Mikalyn Paolucci Mikalyn Paolucci Columbus OH 2/5/2015


Medicaid

Jessica L. Paradiso Jessica L Paradiso Aide

Personal

Care Albany NY 6/21/2012


Medicaid

Lular Parker Lular Parker Geneva NY 2/2/2012


Medicaid

Tami Rae Parsons Tami Rae Parsons RN Nurse 3/14/2013



Chiman Ishwerbhai Patel Chiman

Ishw

erbh Patel MD Physician Carmel NY 1/2/2012


MedicaidPavel Kulik Phyician PC

(owner Pavel Kulik)

Pavel Kulik

Phyician PC

Physician

& Office 2/15/2012


Medicaid

Jimmy Pearl Jimmy Pearl

North

Baldwin NY 7/30/2012


Medicaid

Cheryl L Pedone Cheryl L Pedone RN 7/15/2013


Medicaid

Carol Peirce-Ellis Carol Peirce-Ellis RD LD/N Nutrition Coleman FL 6/8/2012


Medicaid

Iris Perez Iris Perez

Social

Worker

Mount

Vernon NY 8/14/2012


Medicaid

Paul Perez Paul Perez Unknown 7/24/2013


Medicaid

Perfect Health Medical

Perfect Health

Medical Group 4/26/2012


Medicaid

James Blaine Perrine James

Blain

e Perrine Franklin PA 10/11/2011


Medicaid

Peter Joseph Ajemian MD PC

Peter Joseph

Ajemian MD PC MD

Physician

Group 8/18/2013


Medicaid

Seth Peyser Seth Peyser CH

Chiropract

or Gardiner NY 2/21/2012


Medicaid

Elgina Phillips Elgina Phillips E Cleveland OH 8/24/2015


Medicaid

Eileen P. Philips Eileen P Philips RN/LPN Nurse Lake Carmel NY 4/15/2012


Medicaid

Paula A. Phillip Paula A Phillip Brooklyn NY 3/12/2012


Medicaid

Thaddeus Phillips Thaddeus Phillips DDS Dental Cleveland OH 7/19/2012


Medicaid

Nedjie Marie Pierre Nedjie

Mari

e Pierre DPM Podatrist Brooklyn NY 2/5/2012


MedicaidPM Pediatrics Associates

PLLC

PM Pediatrics

Associates PLLC Group 5/15/2012


Medicaid

Jackie A. Pokuwaah Jackie A Pokuwaah

Home

Health Bronx NY 7/24/2012


Medicaid

Markita Pope Markita Pope Toledo OH 3/17/2015


Medicaid

Jose M. Poulose Jose M Poulose MD Physician

Williston

Park NY 2/27/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Paul Poznansky Paul Poznansky RN Nurse Brooklyn NY 5/27/2012


Medicaid

Joshua M. Prensky Joshua M Prensky DDS Dental Bronx NY 6/14/2012


Medicaid

Mikhail L Presman Mikhail L Presman Physician 7/28/2013


Medicaid

Virginia Prewitt Virginia Prewitt RN Nurse

South

Plymouth NY 10/8/2012


Medicaid

Ronald Prijic Ronald Prijic MD Physician Oneonta NY 2/27/2012


MedicaidPrime Movers Physical

Therapy

Prime Movers

Physical Therapy

Physical

Therapy 6/4/2012


Medicaid

Darlene M. Printup Darlene M Printup Lewiston NY 6/13/2012


MedicaidJeanne Prosper (Owner of

Fried & Kohler) Jeanne Prosper Owner

Technician

/Ocularist New York NY 8/7/2012


Medicaid

Shams Qureshi Shams Qureshi MD Physician Clifton NJ 8/13/2012


Medicaid

Brian Racey Brian Racey

Employee

DME North Wales PA 8/20/2013



Philip M Rafiy Philip M Rafiy Physician 8/18/2013


Medicaid

Joan Raimondi LPN Joan Raimondi LPN

Nurse/Nur

se aide

Williamspor

t PA 8/20/2013



Rainbow Medical PC

Rainbow Medical

PC Office Brooklyn NY 9/24/2012


Medicaid

Dov Rand, MD Dov Rand MD Physician

West

Orange NJ 2/13/2013


Medicaid

Paul D Ravener Paul D Ravener

Chiropract

or 8/1/2013


Medicaid

Barry Keith Ray, Jr. Barry Keith Ray Jr MD Physician Pittsburgh PA 3/12/2012


Medicaid

RMS Group Inc. RBS Group Inc. Pharmacy 3/21/2012


Medicaid

Traci L. Recino Traci L Recino LPN Nurse Webster NY 1/10/2012


Medicaid

James A. Respress James A Respress Niagara Falls NY 6/5/2012


Medicaid

Judith Reynolds Judith Reynolds RN 7/24/2013


Medicaid

Frank Hilton Richardson Frank

Hilto

n Richardson DDS Dental New York NY 6/28/2012


Medicaid

Matthew M. Riffee Matthew M Riffee DDS Dental

Lexington

Park MD 7/13/2009 License Surrendered

Mindie Riggall Mindie Riggall C.N.A. Nurse Phoenix NY 2/13/2012


Medicaid

Carmen J. Rivera Carman J Rivera Attendant

Home

Health Buffalo NY 4/17/2012


Medicaid

Debora Lynn Rivera Debora Lynn Rivera LPN Nurse Bay Shore NY 9/17/2012


Medicaid

Enrique Rivera-Mass Enrique Rivera-Mass MD Physician San Juan PR 2/21/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Madeline Rivera-Vergara Madeline Rivera-Vergara Buffalo NY 4/16/2012


Medicaid

Joffre Robalino Joffre Robalino MD Physician 9/3/2012


Medicaid

Elizabeth Lacey Roberts Elizabeth

Lace

y Roberts LPN Nurse Olean NY 4/15/2012


Medicaid

Felix Rodriguez Felix Rodriguez MD Physician New York NY 8/14/2013


Medicaid

David P. Rosen David P Rosen Owner Harrison NY 1/17/2012


Medicaid

Theresa A Rossi-Chesla Theresa A Rossi-Chesla

Richmond

Heights 3/16/2015


Medicaid

Amy Rothert Amy Rothert DME Hamilton OH 1/22/2015


Medicaid

Joseph Rothkopf Joseph Rothkopf RPh Pharmacy Patchogue NY 5/14/2012


Medicaid

Kafi Roundtree Kafi Roundtree Philadelphia PA 12/21/2011


Medicaid

Khalika A. Rowe Khalika A Rowe DC

Chiropracti

c Brooklyn NY 3/25/2012


Medicaid

Bela Rud Bela Rud LCSW

Social

Worker Brooklyn NY 2/3/2012


Medicaid

Wanda Rust Wanda Rust LPN Nurse Rochester NY 4/17/2012


Medicaid

64953755Richard Ryan

Richard Ryan MD MD Cincinnati OH 8/20/2014


Medicaid 8/10/2011

Zuheir J. Said Zuheir J Said MD Physician Bronx NY 5/15/2012


Medicaid

Franmi Saleta Franmi Saleta Bronx NY 5/29/2012


Medicaid

Eufemia Fe Salomon-Flores Eufemia Fe Salomon-Flores RN Nurse New York NY 4/16/2012


Medicaid

Anne Nellie B. Salvant Anne

Nelli

e B Salvant LPN Nurse

Spring

Valley NY 9/17/2012


Medicaid

Benjamin Sanchez Benjamin Sanchez MD Physician Mt. Kisco NY 9/20/2011


Medicaid

Terra L. Sanders Terra L Sanders Jeannette PA 12/1/2011


Medicaid

Manuel G. Sanguily Manuel G Sanguily MD Physician New York NY 7/31/2012


Medicaid

Richard David Saulle Richard

Davi

d Saulle MD Physician Yonkers NY 2/8/2012


Medicaid

Johnna Scanlon-Howland Johnna Scanlon-Howland Bookeeper 1/2/2013


Medicaid

Glenn George Schabel Glenn

Geor

ge Schabel RPh Pharmacy Melville NY 4/12/2012


Medicaid

Issac Schapiro Issac Schapiro

Administra

tor 8/14/2013


Medicaid

Ellen Scharaga Ellen Scharaga RPh Pharmacy Farmingdale NY 2/8/2012


Medicaid

Valerie Schecher Valerie Schecher DC

Chiropract

or 1/20/2013


Medicaid;OIG/HHS Exclusion



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Paul Schienberg Paul Schienberg PhD

Psychologi

st New York NY 2/23/2012 Termination

Jane I. Schlecker Jane I Schlecker MD Physician Belle Harbor NY 5/21/2012


Medicaid

Gregory Scott Gregory Scott Pharmacy Kings Park NY 8/13/2012


Medicaid

Viktor (Victor) Semerik

Viktor

(Victor) Semerik owner Brooklyn NY 2/13/2012


Medicaid

Donna Sergio Donna Sergio

Nurse

Practitione 9/4/2013


Medicaid

Albert Seville Albert Seville Bronx NY 2/2/2012


Medicaid

Lorraine Sgarlata Lorraine Sgarlata LPN Nurse 3/5/2012


Medicaid

David E. Shaffer David E Shaffer DPM Podatrist 7/6/2012


Medicaid

Dawn Shannon Dawn Shannon Hamersville OH 3/12/2015


Medicaid

Mark Allan Shapiro Mark Allan Shapiro MD Physician

Port

Jefferson NY 4/25/2012


Medicaid

Bhupinder Kumar Sharma Bhupinder

Kum

ar Sharma Manager

Palisades

Park NJ 7/30/2012


Medicaid

Larisa Shelabodova Larisa Shelabodova Brooklyn NY 1/17/2012


Medicaid

Aleksey Shteyman Aleksey Shteyman Owner

Staten

Island NY 2/5/2012


Medicaid

Maksim Shvedkin Maksim Shvedkin Corona NY 2/13/2012


Medicaid

Si Preimer Enterprises LLC

Si Preimer

Enterprises LLC LLC 6/12/2012


Medicaid

Christina Sieracki Christina Sieracki RN 7/29/2013


Medicaid

Antonio Silva Antonio Silva MD Physician Binghamton NY 2/27/2012


Medicaid

James Silverblatt James Silverblatt IP IP Mentor OH 8/20/2014


Medicaid

Ernest Lee Simms Ernest Lee Simms MD Physician Alameda CA 5/23/2012


Medicaid

Deborah Sims Deborah Sims

Health

Care Aide Dayton OH 12/12/2014


Medicaid

Tammi H Skoff RN Tammi H Skoff RN

Nurse/Nur

se aide Gibsonia PA 8/20/2013



Dmitry Slobodyansky Dmitry Slobodyansky DC

Chiropracti



Medicaid

SMC Distributors, LLC

SMC Distributors,

LLC

Prescriptio

n 4/17/2012


Medicaid

Alla Smirnov (aka Jennifer) Alla Smirnov Owner Brooklyn NY 3/12/2012


Medicaid

Anneikkia Durham Smith Anneikkia

Durh

am Smith Pottstown PA 10/18/2012


Medicaid

David E Smith David E Smith Jr MD Physician Paducah KY 6/20/2011


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Gregory Smithers Gregory Smithers Manager Ogdensburg NY 6/6/2012


Medicaid

Elvira Evangelista Solis Elvira

Evan

gelis Solis RN Nurse 2/2/2012


Medicaid

Ashley Dawn Solomon RN Ashley Dawn Solomon RN

Nurse/Nur

se aide

Fort

Lauderdale FL 8/20/2013



Mohammed Zulfikar Somji

Mohamme

d

Zulfi

kar Somji Pharm.D. Pharmacy Levittown NY 7/5/2012


Medicaid

Shashibala Soni (aka Sehgal) Shashibala Soni (aka Sehgal) MD Physician

East

Brunswick NJ 6/15/2012


Medicaid

Soundview Health Center

Soundview Health

Center

D & T

Center 2/19/2012


Medicaid

Veronica Spears Veronica Spears

Personal

Care

Vestavia

Hills AL 8/20/2013



Bruce Speiser Bruce Speiser DDS Dental Jamaica NY 9/17/2012


Medicaid

Jerry Spiegel Jerry Spiegel RPN Nurse 5/20/2012


Medicaid

St. John Medical St. John Medical

Medical

Office 2/22/2012


MedicaidSt. Marks Physical Therapy

PC

St. Marks Physical

Therapy PC

Physical

Therapy 6/4/2012


Medicaid

Leonard I. Stambler Leonard I Stambler MD Physician Brooklyn NY 1/16/2012


Medicaid

Erik Stanley Erik Stanley

N.

Middleton NJ 9/24/2012


Medicaid

Danette Stefanelli Danette Stefanelli DC

Chiropract

or Roseland NJ 2/14/2012


Medicaid

Donna Grinstead Stephenson Donn G Stephenson C.N.A. C.N.A. Marion VA 4/30/2014


Medicaid

Gerson Marc Sternstein Gerson Marc Sternstein MD Physician White Plains NY 7/2/2012


Medicaid

Celeste Stevens Celeste Stevens C N A 5/7/2013


Medicaid;7/18/13 OIG/HHS

Arthur Stewart, RN Arthur Stewart RN

Nurse/Nur

se aide Philadelphia PA 8/20/2013



Sarah Stewart Sarah Stewart RN Nurse Rochester NY 4/16/2012


Medicaid

Jennifer Ann Stiles Jennifer Ann Stiles RN Nurse 3/14/2013



Michelle Glick Stites Michelle Glick Stites

Acupunct

urist Duluth MN 5/27/2012


Medicaid

Chantel Stypick Chantel Stypick Niagara Falls NY 6/5/2012


Medicaid

Denise J. Sutton Denise J Sutton RN Nurse Walden NY 3/11/2012


Medicaid

Roman Mark Tabakman Roman Mark Tabakman MD Physician Brooklyn NY 11/2/2011


Medicaid

Nejat Mansur Tajen Nejat

Man

sur Tajen MD Physician Knoxville TN 3/14/2011

License surrendered effective

March 14, 2011

Edward Tanza Edward Tanza DC

Chiropracti

c

St.

Augustine FL 7/16/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Antonio Tavarez Antonio Tavarez Manager Pharmacy Haverstraw NY 7/31/2012


Medicaid

Frank Telang Frank Telang MD Physician Patchogue NY 2/27/2012


Medicaid

Frank Telang Frank Telang Physician 7/29/2013


Medicaid

Autumn Thabet Autumn Thabet LPN/RN Nurse 5/17/2012


Medicaid

Leslie D. Theodore Leslie D Theodore MD Physician Brooklyn NY 3/12/2012


Medicaid

Christmas Jerrel Thomas Christmas

Jerre

l Thomas RPA

Queens

Village NY 4/3/2012


Medicaid 1/1/2013

Never

sanctioned

Shiju Abraham Thomas Shiju

Abra

ham Thomas RN Nurse

East

Meadow NY 6/13/2012


Medicaid

Srinath Thoompally Srinath Thoompally Pharmacy New York NY 1/16/2012


Medicaid

Maxine Thurman Maxine Thurman Cleveland OH 8/24/2015


Medicaid

Michelle Timothee Michelle Timothee Pomona NY 9/17/2012


Medicaid

Top Strata Medical PC

Top Strata Medical

PC 6/12/2012


Medicaid

Artur Torian Artur Torian MD Physician Troy NY 8/7/2012


Medicaid

Mary Jane Torres Mary Jane Torres LPN Nurse 5/29/2012


Medicaid

Rashad R. Trabulsi Rashad R Trabulsi DC

Chiropracti

c

Staten

Island NY 5/27/2012


Medicaid

Transact Distribution LLC

Transact

Distribution LLC Company 4/20/2012


Medicaid

Tristate Medical Care PC

Tristate Medical

Care PC Physician 6/8/2012


Medicaid

Shelley R. Trombetto Shelley R Trombetto LPN Nurse Clarence NY 6/22/2012


Medicaid

Sean P. Trujillo Sean P Trujillo DC

Chiropracti

c Setauket NY 6/26/2012


Medicaid

Maurice Turner Maurice Turner Philadelphia PA 9/23/2011


Medicaid

Dawn M. Turshon Dawn M Turshon MD MD Columbus OH 8/20/2014


Medicaid

Christina Tustin Christina Tustin

Personal




Utter Enterprises Utter Enterprises Other 7/30/2013


Medicaid

Jose Gilberto Gomez Valencia Jose

Gilbe

rto Valencia MD Physician Hudson FL 4/11/2003 License in an inactive status

Patricia Valera Patricia Valera Other 8/18/2013


Medicaid

Doreen Varrichio-Prine Doreen Varrichio-Prine RN Nurse Hicksville NY 3/5/2012


Medicaid

Christopher Vassalluzzo Christopher Vassalluzzo DO Physician Easton PA 1/17/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENTJacqueline Vaughan-

Moscaiello Jacqueline

Vaughan-

Moscatiello RN Nurse Mastic NY 4/30/2012 Termination

V. Rao Veeramachaneni V Rao Veeramachaneni Pharmacy Brooklyn NY 3/20/2009


Medicaid

V. Rao Veeramachaneni V Rao Veeramachaneni

Pharmacist

(Supv) 7/15/2013


Medicaid

Robert Verkey Robert Verkey Therapist

Physical

Therapy Pittsford NY 4/5/2012 Termination

Neal Victor Neal Victor

Personal



MedicaidRostislav "Steve" Vilshsteyn

(owner of Biofeedback Rostislav

"Ste

ve" Vilshsteyn

Staten

Island NY 8/13/2012


Medicaid

Joseph M. Vitoulis Joseph M Vitoulis DO Physician

Valley

Stream NY 4/26/2012


Medicaid

Michael J Vogini DO Michael J Vogini DO Physician Mercer PA 8/20/2013



Constantine Voytenko

Constantin

e Voytenko DC

Chiropracti



Medicaid

VVT Pharmacy VVT Pharmacy Pharmacy 1/16/2012


Medicaid

Larren Wade MD Larren Wade MD Physician Washington DC 8/20/2013



David A Wait David A Wait MD Physician

New

Cumberland PA 8/27/2014


Medicaid

Tanika H. Walker Tanika H Walker LPN Nurse Rochester NY 2/28/2012


Medicaid

Donata Washington Donata Washington HH HH

Canal

Winchester OH 8/20/2014


Medicaid

Thomas Jude Wasilko DDS Thomas Jude Wasilko DDS Dentist Elizabeth PA 9/19/2013



Norman J. Wayte II Norman J Wayte II Service Watertown NY 6/5/2012


Medicaid

John E. Weisberg John E Weisberg

Chiropracti

c East Aurora NY 9/20/2012


Medicaid

Lenwood B. Wert Lenwood B Wertz DO Physician Lansdowne PA 8/13/2014


Medicaid

Shelly Renee Wertz Shelly

Rene

e Wertz

Home

Health Salix PA 7/18/2013



Erika White Erika White

Maple

Heights OH 3/17/2015


Medicaid

Paul White Paul White HH HH Columbus OH 8/20/2014


MedicaidWhite Plains Road Medical

PC

White Plains Road

Medical PC Group 5/16/2012


Medicaid

White's Pharmacy White's Pharmacy Pharmacy 3/18/2012


Medicaid

Ellanora Whiting Ellanora Whiting NP NP Columbus OH 8/20/2014


Medicaid

Rohan Lalith Wijetilaka Rohan Wijetilaka MD Physician Yonkers NY 7/5/2012


Medicaid

Rohan Lalith Wijetilaka Rohan

Lalit

h Wijetilaka MD Physician Yonkers NY 9/19/2012


Medicaid



FIRST

NAME MI LAST NAME

GENER

ATION

CREDENTI

ALS

PROVIDER

TYPE/SPEC

IALTY CITY

STA

TE

EXCLUSION/T

ERMINATION

DATE

REASON FOR


REINSTATE

MENT DATE

REASON

FOR

REINSTATE

MENT

Rohan Lalith Wijetilaka Roahn L Wijetilaka Physician 7/31/2013


Medicaid

Andre Williams Andre Williams LPN Nurse Newark NJ 5/22/2012


Medicaid

James Williams James Williams RN 7/24/2013


Medicaid

Danielle Williams Danielle Williams DME Columbus OH 1/27/2015


Medicaid

Diana L. Williamson Diana L Williamson MD Physican New York NY 5/28/2012


Medicaid

Timnah Wills Timnah Wills

Huber

Heights OH 3/9/2015


Medicaid

Melodi Wilson Melodi Wilson MD Physician Chantilly VA 12/20/2011


Medicaid

Nicole Renate Wingen Nicole

Rena

te Wingen RN Nurse Westtown NY 8/14/2012


Medicaid

Jessica Wise Jessica Wise Columbus OH 2/3/2015


Medicaid

Charles Wolff Charles Wolff RN Ph 3/5/2012


Medicaid

Bruce Stuart Wollman Bruce

Stua

rt Wollman Therapist

Physical

Therapy New York NY 3/19/2012


Medicaid

Jeffrey H Wong Jeffrey H Wong Physician 8/1/2013


Medicaid

Glenn Wurtzel Glenn Wurtzel RN/NP Nurse New York NY 5/16/2012


Medicaid

XO Urology PLLC XO Urology PLLC Physician Elmhurst NY 9/20/2012


Medicaid

Robert L. Yarwood Robert L Yarwood MD Physician Fitchburg MA 2/28/2012


Medicaid

Mehran Zamani Mehran Zamani DDS Dental Stamford CT 8/1/2012


Medicaid

Alexander Zaretser Alexander Zaretser Brooklyn NY 1/16/2012


Medicaid

Yuriy Y. Zayonts Yuriy Y Zayonts

Staten

Island NY 4/25/2012


Medicaid

Michael Zemlyansky Michael Zemlyansky Hewlett NY 4/25/2012


Medicaid

Carrie Zuti Carrie Zuti RN Nurse

Poughkeepsi

e NY 3/18/2012


Medicaid

Laverne Henry Laverne Henry DME

Cleveland

Hghts OH 1/27/2015


Medicaid


reason provider exclusion/t for first gener credenti … medicaid provider... · josephine adams...

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