MEDICAID POLICY BULLETIN - Michigan will be rejected or disallowed if discovered during a...
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Bulletin Michigan Department of Community Health Bulletin Number: MSA 08-14 Distribution: All Providers Issued: March 1, 2008 Subject: Sanctioned Provider List Effective: March 1, 2008 Programs Affected: Medicaid, Children's Special Health Care Services, Adult Benefits Waiver, MOMS, Plan First and Other MDCH-Administered Health Care Delivery Programs Pursuant to Section 1128 and Section 1902(a)(39) of the Social Security Act, the Medicaid Program will not reimburse a provider for any services or items that were rendered or ordered/prescribed by a sanctioned (e.g., suspended, excluded) provider. The effect of the provider's sanction precludes them from furnishing, ordering, or prescribing services or items to any Medicaid beneficiary. Claims for services/items rendered/ordered/prescribed by a sanctioned provider with dates of service or dispensing after the effective date of this bulletin, or subsequent updates, will be rejected or disallowed if discovered during a post-payment review. Refills of prescriptions written by a sanctioned provider must not be dispensed beyond the effective date of the bulletin. Claims for services/items rendered/ordered/ prescribed by a provider for whom sanctions have been removed will be honored retroactively to the date the sanction ended. Special Billing Instructions For customized durable medical equipment, the equipment must be authorized and ordered prior to the effective date of the notifying bulletin. When billing for these items, the order date must be indicated as the date of service and the delivery date noted in the remarks area of the invoice. Sanctioned Provider List Due to the Implementation of National Provider Identifiers (NPIs) Michigan Department of Community Health (MDCH) has change the way it reports information regarding sanctioned providers. The MDCH Sanctioned Provider List now reflects the sanctioned provider’s name, NPI (if available), license/certification number (if applicable), along with the sanctioning authority, sanction date, and reason for sanction. * A copy of the newly formatted MDCH Sanctioned Provider List is attached for your information. As additions and deletions are made to the list, the changes will be published in Medicaid Policy Bulletins. A current MDCH Sanctioned Provider List will be maintained on the MDCH website at www.michigan.gov/medicaidproviders . Paper copies of the complete MDCH list will no longer be issued. When the sanctioning body enddates a provider’s sanction, that provider is removed from the MDCH Sanctioned Provider List, but is not automatically reenrolled with MDCH. Provider’s wishing to reenroll with MDCH must complete a new application process. * Definitions of HHS sanctions are available at www.ssa.gov/OP_Home/ssact/title11/1100.htm
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Transcript of MEDICAID POLICY BULLETIN - Michigan will be rejected or disallowed if discovered during a...
Bulletin
Michigan Department of Community Health
Bulletin Number: MSA 08-14 Distribution: All Providers Issued: March 1, 2008 Subject: Sanctioned Provider List Effective: March 1, 2008 Programs Affected: Medicaid, Children's Special Health Care Services, Adult Benefits Waiver, MOMS,
Plan First and Other MDCH-Administered Health Care Delivery Programs Pursuant to Section 1128 and Section 1902(a)(39) of the Social Security Act, the Medicaid Program will not reimburse a provider for any services or items that were rendered or ordered/prescribed by a sanctioned (e.g., suspended, excluded) provider. The effect of the provider's sanction precludes them from furnishing, ordering, or prescribing services or items to any Medicaid beneficiary. Claims for services/items rendered/ordered/prescribed by a sanctioned provider with dates of service or dispensing after the effective date of this bulletin, or subsequent updates, will be rejected or disallowed if discovered during a post-payment review. Refills of prescriptions written by a sanctioned provider must not be dispensed beyond the effective date of the bulletin. Claims for services/items rendered/ordered/ prescribed by a provider for whom sanctions have been removed will be honored retroactively to the date the sanction ended. Special Billing Instructions For customized durable medical equipment, the equipment must be authorized and ordered prior to the effective date of the notifying bulletin. When billing for these items, the order date must be indicated as the date of service and the delivery date noted in the remarks area of the invoice. Sanctioned Provider List Due to the Implementation of National Provider Identifiers (NPIs) Michigan Department of Community Health (MDCH) has change the way it reports information regarding sanctioned providers. The MDCH Sanctioned Provider List now reflects the sanctioned provider’s name, NPI (if available), license/certification number (if applicable), along with the sanctioning authority, sanction date, and reason for sanction.* A copy of the newly formatted MDCH Sanctioned Provider List is attached for your information. As additions and deletions are made to the list, the changes will be published in Medicaid Policy Bulletins. A current MDCH Sanctioned Provider List will be maintained on the MDCH website at www.michigan.gov/medicaidproviders. Paper copies of the complete MDCH list will no longer be issued. When the sanctioning body enddates a provider’s sanction, that provider is removed from the MDCH Sanctioned Provider List, but is not automatically reenrolled with MDCH. Provider’s wishing to reenroll with MDCH must complete a new application process.
* Definitions of HHS sanctions are available at www.ssa.gov/OP_Home/ssact/title11/1100.htm
MSA 08-14 Page 2 of 2
Supplemental Sanction Information MDCH makes every effort to publish sanction information related to its enrolled providers. However, since this information often comes from sources outside of MDCH, there may be instances of providers not appearing on the list. In addition, some providers (e.g., Adult Foster Care) are not currently enrolled with MDCH although they provide services for Medicaid beneficiaries. For that reason, the following sources should also be monitored to assure services are not provided by a sanctioned individual or entity.
• Department of Health & Human Services (HHS) sanctioned provider information is available on the following websites: http://exclusions.oig.hhs.gov and http://epls.gov.
• MDCH licensing sanctions for health facilities and professionals are available at http://michigan.gov/bhs and http://michigan.gov/healthlicense.
• Michigan Department of Human Services (MDHS) licensing sanctions for Adult Foster Care and other residential settings licensed by MDHS are available at http://michigan.gov/dhslicensing.
Additions to Current Sanctioned Provider List The attached list contains the following addition:
PROVIDER NAME PROVIDER
NPI LICENSE NUMBER
SANCTION BEGIN DATE
SANCTIONING AUTHORITY
REASON FOR SANCTION
Paupore, Joseph Thomas, D.O. 1841285467 51-01-012057 2/12/08 HHS Summary suspended
Manual Maintenance This bulletin may be discarded after review. Refer to the List of Sanctioned Providers at the website noted above. Questions Any questions regarding this bulletin should be directed to Provider Inquiry, Department of Community Health, P.O. Box 30731, Lansing, Michigan 48909-8231, or e-mail at [email protected]. When you submit an e-mail, be sure to include your name, affiliation, and phone number so you may be contacted if necessary. Providers may phone toll-free 1-800-292-2550. Approved Paul Reinhart, Director Medical Services Administration
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 1 of 29
Provider Categories:
Ancillary = (Audiologist, Chiropractic Group, Chiropractor, Laboratory, Optical Company, Optometrist, Physical Therapist, Rehab Therapy Services) Dentists/Dental Clinics = (Dentist, Dental Groups) MH/SA = Substance Abuse Treatment Nursing Facility = Nursing Facilities Pharmacy/Medical Supplier/Orthotist/Prostetist = (Medical Supplier, Orthotist/Prosthetist, Pharmacy, Pharmacy/Medical Supplier) Physicians (MD, DO, DPM), NP, CRNA, CNM) = (Nurse, Physician, Physician Group, Podiatrist, Podiatrist/Medical Supplier, Podiatry Group) Transportation = (Transportation)
Ancillary
Allie A. Adray DC Dearborn NPI: License: 2301006500
Date: 7/4/1996 by HHS Reason: 1128(b)(14)
Gerald L. Berbaum DC Brighton NPI: License: 2301002246
Date: 5/20/2001 by HHS Reason: 1128(a)(3)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 2 of 29
William H. Bischoff DC Fenton NPI: License: 2301002126
Date: 12/22/1991 by HHS Reason:
Bradley Willis Branham DC Coldwater NPI: License: 2301007189
Date: 9/20/2001 by HHS Reason: 1128(a)(3)
Daniel Bruce Cohen DC Southfield NPI: 1043386733 License: 2301006936
Date: 12/16/2002 by HHS Reason: 1128(b)(14)
Mathew Gene Faris DC Flint NPI: 1235297227 License: 2301004722
Date: 9/19/2002 by HHS Reason: 1128(a)(3)
Date: 12:00:00 AM by HHS Reason:
Morey H. Firestone OD Dearborn NPI: License: 4901001455
Date: 11/19/1997 by HHS Reason: 1128(a)(2)
Sandra L. Forte DC Detroit NPI: License: 2301005177
Date: 1/6/1997 by HHS Reason: 1128(b)(14)
Bamidele Gabriel Gbogi PT Battle Creek NPI: License: 5501005180
Date: 8/18/2005 by HHS Reason: 1128(a)(1)
Brian L. Grappin DC Flushing NPI: 1003931999 License: 2301002891
Date: 9/19/2002 by HHS Reason: 1128(a)(3)
William A. Greenberg OD Harper Woods NPI: License: 4901002254
Date: 10/19/2006 by HHS Reason: 1128(a)(2)
Raymond C. Gress DC Lake City NPI: License: 2301004963
Date: 4/10/1997 by HHS Reason: 1128(b)(14)
Daniel Halaberda DC Wayne NPI: 1437273364 License: 2301004191
Date: 12/21/1989 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 12/17/1989 by HHS Reason: 1128(b)(1)
Donald L. Hudson DC E. Lansing NPI: 1255488615 License: 2301005765
Date: 2/2/2006 by HHS Reason: 1128(b)(14)
John F. Kay DC Westland NPI: License: 2301005309
Date: 11/8/1994 by HHS Reason: 1128(b)(14)
Robert M. Kazma DC Detroit NPI: License: 2301002964
Date: 9/20/2001 by HHS Reason: 1128(a)(1)
Judith Rose Keen-Centofanti DC Imlay City NPI: License: 2301006875
Date: 3/6/1997 by HHS Reason: 1128(b)(14)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 3 of 29
Alan Klein DC Detroit NPI: License: 2301004270
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 12/16/1986 by HHS Reason: 1128(a)(1)
John Nicholas Koffeman DC Ann Arbor NPI: License: 2301004912
Date: 12/19/1998 by HHS Reason: 1128(b)(14)
Daniel J. Lavengood DC Hastings NPI: 1972670248 License: 2301006758
Date: 4/9/1994 by HHS Reason: 1128(b)(14)
Marcelino Joel Leitson DC Oak Park NPI: License: 2301005098
Date: 2/19/1998 by HHS Reason: 1128(b)(1)
Tommy G. Lindsey DC Mt. Morris NPI: License: 2301002099
Date: 5/20/1998 by HHS Reason: 1128(b)(4)
Joel Allen Mazer OD Flint NPI: License: 4901003693
Date: 9/20/2004 by HHS Reason: 1128(a)(2)
Mark R. Melton PT Gaylord NPI: 1861504425 License: 5501009879
Date: 12/28/2007 by Bureau of Health Professionals Reason: Summary Suspended
Roger Wayne Nelson DC Pontiac NPI: License: 2301006600
Date: 10/10/1995 by HHS Reason: 1128(b)(14)
Neil James Richardson DC Grand Rapids NPI: License: 2301006727
Date: 7/6/1997 by HHS Reason: 1128(b)(14)
Gary L. Roshy DC Ludington NPI: License: 2301005366
Date: 12/7/2004 by HHS Reason: 1128(b)(14)
Gary J. Schwartz DC Jackson NPI: 1326249624 License: 2301002137
Date: 6/8/1994 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Bernard C. Schwarz DC Wyandotte NPI: License: 2301005101
Date: 12/7/1994 by HHS Reason: 1128(b)(14)
Stephen L. Slusher DC Escanaba NPI: License: 2301007042
Date: 1/20/2003 by HHS Reason: 1128(a)(4)
Michael N. Stetz DC Lansing NPI: License: 2301006648
Date: 4/20/2003 by HHS Reason: 1128(a)(3)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 4 of 29
American Clinical Lab, Inc. Flint NPI: License:
Date: 7/1/1988 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Birmingham Rehab & Physical Therapy Center, Inc. Detroit NPI: License: 36687
Date: 12/18/2003 by HHS Reason: 1128(a)(1)
Chiropractic Associates, Inc. Ludington NPI: License:
Date: 5/6/1996 by HHS Reason: 1128(b)(8)
Jordan Clinical Laboratory Thomas Truss Detroit NPI: License:
Date: 11/15/1986 by HHS Reason: 1128(a)(1)
Macomb Professional Lab, Inc Sterling Hts NPI: License:
Date: 8/18/1988 by HHS Reason: 1128(a)(1)
Metric Medical Lab Carl Marcus Southfield NPI: License:
Date: 3/1/1992 by HHS Reason: 1128(a)(1)
Quality Clinical Lab Detroit NPI: License:
Date: 6/11/1991 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 12/23/1991 by HHS Reason: 1128(a)(1)
Superior Bio-Medical Lab Larry Luckett Detroit NPI: License:
Date: 7/1/1988 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 5/26/1989 by HHS Reason: 1128(b)(4)
Zagerman Enterprises, Inc. Clawson NPI: License:
Date: 10/20/1995 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 5 of 29
Dentists/Dental Clinics
Sherman Lavelle Allen DDS Lansing NPI: License: 2901016612
Date: 6/28/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Thomas R. Anderson DDS Middleville NPI: License: 2901010998
Date: 7/20/1999 by HHS Reason: 1128(a)(1)
Sami Suheil Bilani DDS Hamtramck NPI: 1821140187 License: 290116822
Date: 4/12/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/20/2001 by HHS Reason: 1128(a)(1)
Richard L. Blanding DDS Detroit NPI: License: 2901010938
Date: 7/3/1988 by HHS Reason: 1128(a)(1)
Frederick R. Bonds Jr. DDS Yale NPI: License: 2901013565
Date: 2/5/1997 by HHS Reason: 1128(b)(14)
Danny H. Byl DDS Potterville NPI: License: 2901013592
Date: 8/18/1997 by HHS Reason: 1128(b)(4)
Keith H. Callahan DDS Flint NPI: License: 2901014674
Date: 5/25/1997 by HHS Reason: 1128(b)(3)
Clarence L. Camp Jr. DDS Detroit NPI: 1649347212 License: 2901015197
Date: 10/20/1999 by HHS Reason: 1128(b)(14)
Bruce Devlon Duckett DDS Flint NPI: License: 2901015928
Date: 3/30/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 11/20/2002 by HHS Reason: 1128(a)(1)
Ronald C. Eckert DDS Okemos NPI: 1851504138 License: 2901007642
Date: 2/26/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/20/2001 by HHS Reason: 1128(a)(1)
Kenneth M. Friedman DDS Roseville NPI: License: 2901014795
Date: 10/20/2003 by HHS Reason: 1128(a)(2)
Frank W. Harris Jr. DDS Detroit NPI: License: 2901008049
Date: 5/26/1997 by HHS Reason: 1128(b)(4)
Ben J. Hearns DDS Detroit NPI: License: 2901014305
Date: 2/5/1997 by HHS Reason: 1128(b)(14)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 6 of 29
Richard M. Henderson DDS N. Pontiac NPI: License: 2901006073
Date: 2/4/1992 by HHS Reason: 1128(a)(1)
Mohamad Hijazi DDS Dearborn NPI: License: 2901014717
Date: 11/11/1992 by HHS Reason: 1128(a)(1)
Nathaniel Holloway Jr. DDS Ypsilanti NPI: License: 2901006451
Date: 8/7/1997 by HHS Reason: 1128(a)(1)
Craig Taylor Holyway DDS Southfield NPI: License: 2901016274
Date: 12/7/1994 by HHS Reason: 1128(a)(1)
Date: 9/7/1994 by DCH Medicaid Reason: Violation of Medicaid False Claims Act
Crayton C. Kidd DDS Saginaw NPI: 1407075641 License: 2901015441
Date: 5/18/2000 by HHS Reason: 1128(b)(14)
Carl L. Leftwich DDS Detroit NPI: License: 2901007003
Date: 8/1/1990 by HHS Reason: 1128(b)(4)
Carthan Lagrant Moody DDS Kalamazoo NPI: License: 2901014263
Date: 1/20/2004 by HHS Reason: 1128(a)(1)
Charzetta Moore DDS Detroit NPI: License: 2901014832
Date: 10/20/1999 by HHS Reason: 1128(b)(8)
Kevin V. Murphy DDS Royal Oak NPI: License: 2901012979
Date: 4/28/1997 by HHS Reason: 1128(b)(14)
Leonard Nosal DDS White Lake NPI: 1427254069 License: 2901011174
Date: 7/20/2004 by HHS Reason: 1128(a)(4)
David J. Petipren DDS Capac NPI: License: 2901008794
Date: 6/13/1990 by HHS Reason: 1128(b)(4)
Glenn E. Petroelje DDS Holland NPI: License: 2901007127
Date: 7/28/1986 by HHS Reason: 1128(a)(1)
Ivan Dennis Potocsky DDS Melvindale NPI: License: 2901017288
Date: 9/20/2004 by HHS Reason: 1128(b)(15)
Rani Prabha Raju DDS Southfield NPI: License: 2901015924
Date: 2/18/1999 by HHS Reason: 1128(b)(14)
David B. Schroeter DDS Marcellus NPI: License: 2901011501
Date: 11/20/1997 by HHS Reason: 1128(b)(4)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 7 of 29
Duane A. Senior DDS Detroit NPI: 1841354545 License: 2901014215
Date: 2/5/1997 by HHS Reason: 1128(b)(14)
James Vernon Simpson DDS St. Helen NPI: License: 2901015390
Date: 11/8/1994 by HHS Reason: 1128(b)(3)
Eugene Sklar DDS Gaylord NPI: License: 2901008434
Date: 11/4/1990 by HHS Reason: 1128(b)(4)
Karen Lynne Smereck DDS Allen Park NPI: 1316026917 License: 2901016800
Date: 10/20/2004 by HHS Reason: 1128(a)(1)
Kaye A. Souvenir DDS Detroit NPI: License: 2901012399
Date: 8/15/1993 by HHS Reason: 1128(a)(1)
Michael S. Urbanik DDS Detroit NPI: License: 2901013979
Date: 5/6/2003 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 5/20/2003 by HHS Reason: 1128(a)(1)
Wallace Lee Walker Jr. DDS Detroit NPI: 1780712109 License: 2901012881
Date: 7/20/2004 by HHS Reason: 1128(a)(1)
Keith A. West DDS Wyandotte NPI: 1598805798 License: 2901012345
Date: 10/20/2004 by HHS Reason: 1128(a)(3)
Rudolph Delano Wheaton DDS Flint NPI: License: 2901011646
Date: 8/6/1997 by HHS Reason: 1128(b)(4)
Daniel D. White DDS Grand Rapids NPI: License: 2901011156
Date: 10/8/1999 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 10/20/2002 by HHS Reason: 1128(a)(1)
John Arthur White, Jr. DDS Detroit NPI: 1407066244 License: 2901012365
Date: 1/11/2008 by Bureau of Health Professions Reason: License Suspended
A Dental Center PC - Allen Park Allen Park NPI: License:
Date: 5/20/2004 by HHS Reason: 1128(a)(1)
A Dental Center PC - Southgate Southgate NPI: License:
Date: 7/20/2004 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 8 of 29
Bilani, Sami S., DDS, PC (aka Family Dentist PC) Sami Suheil Bilani DDS Hamtramck NPI: License:
Date: 4/12/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/20/2001 by HHS Reason: 1128(a)(1)
Dental Health Care Clinics, Inc. Detroit NPI: License:
Date: 4/11/1995 by HHS Reason: 1128(a)(1)
Dr. Waltz Denture Service Robert I. Waltz DDS Beaverton NPI: License: 2901006537
Date: 9/5/2002 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/19/2002 by HHS Reason: 1128(a)(1)
Enjoy Dental Care PC Detroit NPI: License:
Date: 5/20/2004 by HHS Reason: 1128(a)(1)
First Care Hamtramck Dental PC Sami Suheil Bilani DDS Hamtramck NPI: License:
Date: 4/12/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/20/2001 by HHS Reason: 1128(a)(1)
Jefferson Family Dental Center PC Detroit NPI: License:
Date: 6/6/1988 by HHS Reason: 1128(a)(1)
Mancewicz & White DDS, PC Grand Rapids NPI: License:
Date: 6/20/2002 by HHS Reason: 1128(a)(1)
Michkovits, John F. PC John F. Michkovits DDS South Haven NPI: License: 2901008784
Date: 3/19/1999 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 6/17/1999 by HHS Reason: 1128(a)(1)
Morton, Lawrence A. DDS, PC Lawrence S. Morton DDS Southfield NPI: License: 2901008335
Date: 3/22/2006 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 4/19/2007 by HHS Reason: 1128(a)(1)
Washington Blvd. Detroit NPI: License:
Date: 9/20/2007 by HHS Reason: 1128(a)(1)
Racette, Wendell A. DDS, PC Wendell A. Racette DDS Lansing NPI: License: 2901010020
Date: 6/13/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 10/18/2001 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 9 of 29
Weiner & Belkin DDS, PC Detroit NPI: License:
Date: 2/8/1994 by HHS Reason: 1128(a)(1)
MH/SA
Behavioral Dynamics PC Thomas McCloud Ph.D. Detroit NPI: License:
Date: 7/29/1985 by HHS Reason: 1128(a)(1)
Elrose Health Services, Inc. Detroit NPI: License: 020731
Date: 4/17/1995 by DCH Licensing Reason:
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
Elrose Health Services, Inc. Detroit NPI: License: 021391
Date: 4/17/1995 by DCH Licensing Reason:
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
Elrose Health Services, Inc. Detroit NPI: License: 021431
Date: 4/17/1995 by DCH Licensing Reason:
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
New Era Alternative Treatment Center, Inc. (NEAT) Highland Park NPI: License: 021310
Date: 9/20/2001 by HHS Reason:
New Era Alternative Treatment Center, Inc. (NEAT) Flint NPI: License: 050219
Date: 9/20/2001 by HHS Reason:
Propelled Therapeutic Services, Inc. Detroit NPI: License: 021423
Date: 8/20/2003 by HHS Reason: 1128(a)(1)
W.D. Lee Center for Life Management, Inc. Detroit NPI: License: 021242
Date: 4/18/2002 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 10 of 29
We Care Living Enrichment Center, Inc. Marcia Stacy Saginaw NPI: License: 030128
Date: 7/20/1999 by HHS Reason: 1128(a)(1)
Nursing Facility
Applewood Manor McMillian NPI: License: 48401
Date: 3/19/1999 by DCH Licensing Reason: license revocation
Belle Woods Continuing Care Center Belleville NPI: License: 82439
Date: 10/30/1999 by DCH Licensing Reason: license revocation & summary suspension
Broadstreet Nursing Center Detroit NPI: License: 83418
Date: 9/27/2000 by DCH Licensing Reason: license revocation & summary suspension
Cedar Knoll Care Center Grass Lake NPI: License:
Date: 3/7/2007 by DCH Licensing Reason: license revocation
Eaton Manor, Inc. Salvatore D. Benisatto Charlotte NPI: License:
Date: 7/20/2004 by HHS Reason: 1128(a)(1)
EB James Nursing Center Detroit NPI: License: 83422
Date: 2/12/2002 by DCH Licensing Reason: license revocation & summary suspension
Friendship Manor Nursing Home Detroit NPI: License:
Date: 3/21/2006 by DCH Licensing Reason: license revocation & summary suspension
L & L Nursing Center, Inc. Detroit NPI: License: 83430
Date: 10/8/1998 by DCH Licensing Reason: license revocation
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 11 of 29
Lakeland Convalescent Center David S. Midenberg Detroit NPI: License: 83451
Date: 9/20/2000 by HHS Reason: 1128(a)(2)
LaSalle Nursing Home Detroit NPI: License: 83453
Date: 11/14/2003 by DCH Licensing Reason: license revocation & decertification
Litchfield Nursing Centre Litchfield NPI: License:
Date: 5/4/2007 by HHS Reason: decertification
Rosewood Living Center Detroit NPI: License: 83447
Date: 8/14/2003 by DCH Licensing Reason: license revocation & summary suspension
Rosewood Manor Grand Rapids NPI: License: 41415
Date: 8/3/1999 by DCH Licensing Reason: decertified
Venoy Nursing Center Wayne NPI: License: 28447
Date: 5/15/1998 by DCH Licensing Reason: license revocation & summary suspension
White Oak Manor Mio NPI: License: 68402
Date: 1/13/1999 by DCH Licensing Reason: license revocation
Woodward Nursing Center etroit NPI: License: 83444
Date: 9/3/2004 by Reason: decertified
Pharmacy/Medical Supplier/Orthotist/Prostetist
Absolute Apothecary Dennis Veal R.Ph. Detroit NPI: License: 5301004065
Date: 5/24/1994 by HHS Reason: 1128(b)(3)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 12 of 29
Absolute Prescription Center Dennis Veal R.Ph. Detroit NPI: License: 5301004594
Date: 5/23/1994 by HHS Reason: 1128(b)(3)
Action Sales & Rental Company Joanne Aronoff Detroit NPI: License:
Date: 8/29/1994 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 4/10/1996 by HHS Reason: 1128(b)(5)
Acton Rental & Sales Company Larry Aronoff Detroit NPI: License:
Date: 10/24/1989 by HHS Reason: 1128Aa
Alpha Medical Equipment, Inc. Antaran Fausto Woodhaven NPI: License:
Date: 7/25/1990 by HHS Reason: 1128(a)(1)
American Medical Supply, Inc. Michael O. Kinsella Detroit NPI: License:
Date: 7/29/1996 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
American Orthopedic Service, Inc. Lawrence L. Gaskins Bay City NPI: License:
Date: 11/25/1991 by HHS Reason: 1128(a)(1)
Cascade Pharmacy Charles J. Leen R.Ph. Grand Rapids NPI: License: 5301002313
Date: 5/8/1991 by HHS Reason: 1128(b)(4)
Certified Air Respiratory Equipment, Inc. dba CARE, Inc.) Southfield NPI: License:
Date: 7/4/1996 by HHS Reason: 1128(a)(1)
Corner Drugstore of Detroit Detroit NPI: License: 5301003862
Date: 8/19/1988 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Dearborn Pharmacy, Inc. Dearborn NPI: License:
Date: 2/20/2006 by HHS Reason: 1128(a)(3)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 13 of 29
Detroit Plaza II Pharmacy George Pylar R.Ph. Detroit NPI: License: 5301003640
Date: 6/8/1988 by HHS Reason: 1128(b)(3)
East Side Pharmacy, Inc. Calvin R. Lazar R.Ph. Flint NPI: License:
Date: 12/17/1997 by HHS Reason: 1128(b)(1)
Date: 1/4/1984 by HHS Reason: 1128(a)(1)
Fredal Pharmacy Thomas Fredal R.Ph. Grosse Pte Farms NPI: License: 5301004236
Date: 5/23/1994 by HHS Reason: 1128(b)(3)
Fritz the Druggist Joseph Milder R.Ph. Muskegon Hts NPI: License: 5301000030
Date: 4/24/1986 by HHS Reason: 1128(a)(1)
Fullerton Pharmacy Fairview NPI: License: 5301006260
Date: 3/10/1998 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Grand Blanc Apothecary, Inc. Grand Blanc NPI: License: 5301004983
Date: 11/18/1999 by HHS Reason: 1128(b)(4)
Heartside Pharmacy Charles J. Leen R.Ph. Grand Rapids NPI: License: 5301003879
Date: 5/8/1991 by HHS Reason: 1128(b)(4)
Hinman Pharmacy (dba Medical Arts Pharmacy) William Hinman Grand Blanc NPI: License: 5301004202
Date: 1/3/1989 by HHS Reason: 1128(a)(1)
Howard City Plaza, Inc. Bruce Schroeder R.Ph. Howard City NPI: License: 5301002282
Date: 12/23/1991 by HHS Reason: 1128(a)(1)
Inkster Community Pharmacy Charles P. Quisenberry R.Ph. Inkster NPI: License:
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 14 of 29
Inkster Pharmacy Donald J. Bennett R.Ph. Inkster NPI: License: 5301004725
Date: 1/24/1994 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/10/1994 by HHS Reason: 1128(a)(1)
Krempel's Pharmacy William Krempel R.Ph. Sault Ste. Marie NPI: License: 5301000395
Date: 9/5/1985 by HHS Reason: 1128(a)(1)
Lexington Pharmacy Detroit NPI: License: 5301000141
Date: 6/27/1991 by HHS Reason: 1128(b)(4)
M & M Pharmacy, Inc. Maggie Varner Detroit NPI: License: 5301004011
Date: 6/13/1990 by HHS Reason: 1128(b)(1)
Med Pharmacy, Inc. Ypsilanti NPI: License: 5301000072
Date: 8/19/1988 by HHS Reason: 1128(b)(3)
Medicap Pharmacy Flint NPI: License: 5301006828
Date: 1/19/2006 by HHS Reason: 1128(b)(4)
Metro Pharmacy Detroit NPI: License: 5301003024
Date: 2/7/1994 by HHS Reason: 1128(a)(1)
Modern Pharmacy, Inc. Maurice B. Eustice R.Ph. Onaway NPI: License: 5301002064
Date: 5/4/1992 by HHS Reason: 1128(a)(1)
Motor City Nutritional Support Dennis Makowski R.Ph. Hamtramck NPI: License:
Date: 6/4/1995 by HHS Reason: 1128(a)(1)
Nestell's Pharmacy Saginaw NPI: License: 5301000078
Date: 9/26/1985 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 15 of 29
Neuhoff Drugs, Inc. Detroit NPI: License: 5301004598
Date: 8/24/1989 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Neuhoff Drugs, Inc. Detroit NPI: License: 5301004058
Date: 8/24/1989 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Prescription Management Service Ypsilanti NPI: License: 5301006292
Date: 1/24/1997 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Savco Pharmacy, Inc. Maggie Varner Detroit NPI: License: 5301004595
Date: 6/13/1990 by HHS Reason: 1128(b)(1)
Shelle's Pharmacy, Inc. Shelle R. Miles Pontiac NPI: License: 5301004588
Date: 3/20/1990 by HHS Reason: 1128(a)(1)
Southfield Family Pharmacy Charles P. Quisenberry R.Ph. Southfield NPI: License: 5301003940
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
Towne Pharmacy Donald R. McManaway R.Ph. Monroe NPI: License: 5301001358
Date: 7/17/1985 by HHS Reason: 1128(a)(1)
Trio-Camburn Drugs James W. Russell R.Ph. Flint NPI: License:
Date: 4/20/1998 by HHS Reason: 1128(b)(1)
U.S. Medical Supply, Inc. Hussein M. Amr Livonia NPI: License:
Date: 11/5/2002 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/20/2004 by HHS Reason: 1128(a)(1)
Unarex of Lincoln Park, Inc. Lincoln Park NPI: License: 5301000166
Date: 9/5/1988 by HHS Reason: 1128(b)(3)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 16 of 29
Village Pharmacy AuGres NPI: License: 5301003265
Date: 7/28/1988 by HHS Reason: 1128(a)(1)
Waldrake Pharmacy, Inc. West Bloomfield NPI: License: 5301004125
Date: 8/19/1988 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Weidman Pharmacy Louis J. Fiorillo Weidman NPI: License: 5301002898
Date: 6/22/1994 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/10/1994 by HHS Reason: 1128(a)(1)
Weisel Clinic Pharmacy Charles P. Quisenberry R.Ph. Monroe NPI: License: 5301003536
Date: 10/20/1998 by HHS Reason: DELETE--NOT ON HHS LIST/NO DCH ACTION
Weisel Drug Company Charles P. Quisenberry R.Ph. Monroe NPI: License:
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
Date: 11/14/1995 by HHS Reason: 1128(a)(1)
Weisel Newport Pharmacy Charles P. Quisenberry R.Ph. Newport NPI: License: 5301004763
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
Weisel Pharmacy, Inc. (dbs Cross Drug Store) Charles P. Quisenberry R.Ph. Menominee NPI: License: 5301004621
Date: 10/20/1998 by HHS Reason: 1128(a)(1)
Physicians (MD, DO, DPM), NP, CRNA, CNM)
Syed Arif Ahmed MD Marlette NPI: License: 4301038826
Date: 7/22/1991 by HHS Reason: 1128(b)(4)
Muhannad Alajrad MD Trenton NPI: License: 4301061516
Date: 5/6/1997 by HHS Reason: 1128(b)(4)
Glenn Walter Andrews MD Detroit NPI: License: 4301407042
Date: 5/26/1997 by HHS Reason: 1128(b)(4)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 17 of 29
Inamul Hag Ansari MD Detroit NPI: License: 4301044238
Date: 8/29/1993 by HHS Reason: 1128(a)(1)
Date: 10/11/1993 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Raul E. Aranda MD Detroit NPI: License: 4301038425
Date: 3/15/1990 by HHS Reason: 1128(b)(3)
William J. Arnold Jr. MD Detroit NPI: License: 4301015572
Date: 9/19/2002 by HHS Reason: 1128(a)(3)
Sunitha Atluri MD Auburn Hills NPI: License: 4301062120
Date: 3/21/2007 by DCH Licensing Reason: License Suspended
Jeffrey A. August DPM Clawson NPI: License: 5901001206
Date: 10/22/1991 by HHS Reason: 1128(b)(4)
Banga M. Balakrishna MD Southfield NPI: License: 4301031899
Date: 5/18/2000 by HHS Reason: 1128(a)(1)
Nicholas William Bartz DO Jackson NPI: License: 5101008283
Date: 4/27/2000 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/20/2000 by HHS Reason: 1128(a)(a)
Regis A. Benton Sr. DO Flint NPI: License: 5101003906
Date: 9/19/2002 by HHS Reason: 1128(a)(3)
Harvey A. Bergran DO Muskegon NPI: License: 5101005122
Date: 6/28/1992 by HHS Reason: 1128(b)(3)
Richard I. Berk DPM Ann Arbor NPI: License: 5901001060
Date: 11/7/2000 by HHS Reason: 1128(b)(14)
Edward A. Blanzy DO Allen Park NPI: 1740332600 License: 5101010788
Date: 12/6/2007 by DCH Licensing Reason: License Suspended
Hubert Bobb-Semple DPM Highland Park NPI: License: 5901000976
Date: 11/12/1990 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Michael J. Brazil DO Riverview NPI: License: 5101012432
Date: 10/19/1996 by HHS Reason: 1128(a)(1)
Zack B. Brown MD Detroit NPI: 1447331160 License: 4301036091
Date: 10/15/1988 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 18 of 29
Leo D. Brubaker DO Muskegon Hts NPI: License: 5101003994
Date: 3/21/1990 by HHS Reason: 1128(b)(4)
Robert F. Buszek DO Highland Park NPI: License: 5101006226
Date: 10/6/1994 by HHS Reason: 1128(b)(4)
Steven K. Campbell MD Flint NPI: License: 4301048115
Date: 4/10/1991 by HHS Reason: 1128(b)(4)
Bradford G. Capper DO Detroit NPI: License: 5101006432
Date: 9/5/1984 by HHS Reason: 1128(a)(1)
Richard P. Capriccioso MD Detroit NPI: License: 4301047689
Date: 11/11/1992 by HHS Reason: 1128(a)(2)
Kirishna Cham MD Detroit NPI: License:
Date: 8/10/1994 by HHS Reason: 1128(a)(1)
Joon Young Choi MD Allen Park NPI: 1275551624 License: 4301035474
Date: 4/13/1998 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/20/1998 by HHS Reason: 1128(a)(1)
Frank L. Clark MD Petoskey NPI: License: 4301042015
Date: 7/8/1993 by HHS Reason: 1128(b)(3)
Abbott B. Cohen DPM Alpena NPI: License: 5901001980
Date: 8/19/2004 by HHS Reason: 1128(a)(4)
Jeffrey S. Cooke DPM Centerville NPI: License: 5901001109
Date: 7/20/2005 by HHS Reason: 1128(a)(1)
Date: 8/20/2007 by HHS Reason: 1128(a)(1)
Denice M. Cornelius DO Lansing NPI: License: 5101009416
Date: 5/20/2001 by HHS Reason: 1128(a)(4)
Linda K. Cross MD Lansing NPI: License: 4301041641
Date: 10/22/1991 by HHS Reason: 1128(b)(4)
George Czertko MD Detroit NPI: License: 4301033892
Date: 2/20/2001 by HHS Reason: 1128(b)(4)
James H. Dallman MD Muskegon NPI: License: 4301055294
Date: 6/17/1999 by HHS Reason: 1128(a)(1)
Jasubhai K. Desai MD Highland Park NPI: License: 4301031425
Date: 2/27/1997 by HHS Reason: 1128(b)(4)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 19 of 29
Steven B. Dewilde DO Plymouth NPI: License: 5101009688
Date: 9/20/2005 by HHS Reason: 1128(a)(4)
Michael F. Dougovito CRNA Newberry NPI: License: 4704107350
Date: 4/20/2000 by HHS Reason: 1128(b)(4)
Donald S. Dreyfuss DO Bloomfield Hills NPI: License: 5101005825
Date: 9/20/2000 by HHS Reason: 1128(a)(1)
Randy E. Drumm DO Edmore NPI: License: 5101009214
Date: 1/20/2003 by HHS Reason: 1128(b)(4)
Grover R. Fattic MD Niles NPI: License: 4301017283
Date: 7/15/1988 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 4/18/1989 by HHS Reason: 1128(b)(5)
Thomas M. Flake MD NPI: License: 4301019917
Date: 9/3/1991 by HHS Reason: 1128(b)(3)
Thomas P. Floyd DO Lakeview NPI: 1992887905 License: 5101012617
Date: 10/18/2001 by HHS Reason: 1128(a)(4)
Date: 2/20/2002 by HHS Reason: 1128(b)(14)
Newland C. Fort DPM Detroit NPI: License: 5901000496
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 4/21/1988 by HHS Reason: 1128(a)(1)
Joel E. Freedland DO Lincoln Park NPI: License: 5101007189
Date: 8/7/1987 by HHS Reason: 1128(a)(1)
Richard F. Freeman MD Detroit NPI: License: 4301026316
Date: 5/20/1998 by HHS Reason: 1128(b)(4)
James R. Frew Jr. MD Traverse City NPI: License: 4301044056
Date: 6/20/2000 by HHS Reason: 1128(b)(4)
Kenneth W. Frye DO Byron Ctr NPI: License: 5101003654
Date: 9/2/1997 by HHS Reason: 1128(b)(4)
Felma Jimenez Fuentes MD Flint NPI: 1376755199 License: 4301035481
Date: 8/27/1986 by HHS Reason: 1128(a)(1)
Leo Maupo Fuentes MD Detroit NPI: 1487873303 License: 4301034718
Date: 10/28/1981 by HHS Reason: 1128(a)(1)
Richard P. Gorosh DPM Lansing NPI: License: 5901001179
Date: 2/20/2001 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 20 of 29
James E. Gotham MD Detroit NPI: License: 4301022173
Date: 10/11/1990 by HHS Reason: 1128(a)(1)
Theodore N. Graham MD Detroit NPI: License: 4301024579
Date: 7/30/1990 by HHS Reason: 1128(a)(1)
Everette Bernard Hambric MD Detroit NPI: License: 4301057900
Date: 3/20/2005 by HHS Reason: 1128(a)(1)
Andrew Hardy Jr. MD Traverse City NPI: 1710101688 License: 4301046774
Date: 11/20/2002 by HHS Reason: 1128(a)(1)
Julia Anne Hedgecorth MD Albion NPI: License: 4301045086
Date: 4/2/2001 by HHS Reason: 1128(b)(14)
Robert A. Hemphill DO Saginaw NPI: 1073608774 License: 5101006231
Date: 8/20/2002 by HHS Reason: 1128(a)(3)
Jeffrey Phillip Hendricks MD Muskegon NPI: 1164446860 License: 4301075714
Date: 5/20/2002 by HHS Reason: 1128(a)(4)
Golden Goye Higgwe DPM Southfield NPI: License: 5901001783
Date: 10/20/2003 by HHS Reason: 1128(a)(3)
Henry Mark Hildebrandt MD Ypsilanti NPI: License: 4301021381
Date: 12/20/2005 by HHS Reason: 1128(b)(1)
Syed Tanweerul Hoda MD Trenton NPI: License: 4301060045
Date: 10/20/2005 by HHS Reason: 1128(b)(4)
Jason L. Hollady MD Traverse City NPI: 1154470565 License: 4301043634
Date: 5/26/2000 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 9/20/2001 by HHS Reason: 1128(a)(3)
Lawrence M. Holloway Jr. DO Flint NPI: License: 5101008603
Date: 11/19/1997 by HHS Reason: 1128(b)(4)
Danial Hopkins MD Mt. Pleasant NPI: License: 4301405717
Date: 5/20/2001 by HHS Reason: 1128(a)(1)
Clarence G. Howe DO Detroit NPI: License: 5101003031
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 21 of 29
Elleen E. Hunter DO Mt. Clemens NPI: License: 5101004385
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 10/13/1990 by HHS Reason: 1128(a)(1)
Robert H. Hydrick MD Grand Rapids NPI: License: 4301019228
Date: 5/20/1998 by HHS Reason: 1128(b)(4)
Samuel J. Hyman MD Wayne NPI: License: 4301012805
Date: 6/30/1988 by HHS Reason: 1156(b)
Paul J. Jakubiak MD Lansing NPI: License: 4301027820
Date: 3/20/2003 by HHS Reason: 1128(b)(4)
Waymon D. Jerkins DPM Detroit NPI: License: 5901000834
Date: 7/6/1993 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 7/29/1997 by HHS Reason: 1128(a)(1)
Keithley E. Johnson MD Dearborn NPI: License: 4301032641
Date: 8/14/1995 by HHS Reason: 1128(b)(3)
Thomas Foley Kabisch DO Detroit NPI: 1295800498 License: 5101012147
Date: 6/20/2001 by HHS Reason: 1128(b)(14)
Sudheer Kaza MD Detroit NPI: License: 4301047113
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Donald R. Kennedy DO Flint NPI: License: 5101003922
Date: 4/12/1993 by HHS Reason: 1128(a)(1)
Lakshmi Kenue MD Detroit NPI: License: 4301050782
Date: 3/29/1990 by HHS Reason:
Dong Irl Kim MD Holland NPI: License: 4301039383
Date: 6/20/2000 by HHS Reason: 1128(b)(4)
Jaspal S. Kohli MD Warren NPI: License: 4301038647
Date: 8/3/1994 by HHS Reason: 1128(a)(1)
Glenn David Krieger MD West Bloomfield NPI: 1528018827 License: 4301059322
Date: 1/4/2008 by Bureau of Health Professions Reason: Summary Suspended
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 22 of 29
Dan Fredrick Kreuzer DO Wayland NPI: 1053463646 License: 5101008291
Date: 3/9/1994 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/10/1994 by HHS Reason: 1128(a)(1)
Richard C. Kucinski MD Utica NPI: License: 4301407406
Date: 9/1/2007 by DCH Licensing Reason: License Suspended
Joseph H. Ladaga DO Dowagiac NPI: License: 5101009602
Date: 9/11/1996 by HHS Reason: 1128(a)(2)
Carlos M. Lauchu MD Saline NPI: License: 4301029754
Date: 3/16/1995 by HHS Reason: 1128(b)(4)
Yolanda G. Leamon CNM Battle Creek NPI: License: 4704106771
Date: 7/20/2000 by HHS Reason: 1128(b)(4)
Edith J. Lee MD Highland Park NPI: License: 4301022981
Date: 8/14/1986 by HHS Reason: 1128(a)(1)
Michael John Len MD Detroit NPI: 1164565271 License: 4301049651
Date: 7/20/2003 by HHS Reason: 1128(a)(4)
Ira Stephen Lieberman DO North Branch NPI: License:
Date: 8/20/2006 by HHS Reason: 1128(a)(4)
Arthur S. Lightfoot MD Burton NPI: License: 4301023700
Date: 3/1/1990 by HHS Reason: 1128(b)(4)
William A. Lucas CRNA Dearborn NPI: License: 4704127471
Date: 4/20/2000 by HHS Reason: 1128(b)(4)
Charles A. MacLean MD Owosso NPI: License: 4301025670
Date: 8/29/1995 by HHS Reason: 1128(b)(4)
Mukhtar Ahmad Malik MD Madison Hts NPI: License: 4301033579
Date: 9/2/1997 by HHS Reason: 1128(b)(3)
Avelino Marbella Mape MD Detroit NPI: License: 4301036423
Date: 9/23/1983 by HHS Reason: 1128(a)(1)
Boitshoko P. Marang MD Detroit NPI: License: 4301407569
Date: 2/15/1995 by HHS Reason: 1128(b)(4)
Date: 4/10/1996 by HHS Reason: 1128(a)(1)
James R. McCartney MD Bay City NPI: License: 4301041608
Date: 7/30/1986 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 23 of 29
David W. McKinney III MD Detroit NPI: License: 4301031076
Date: 8/15/1990 by HHS Reason: 1128(b)(4)
William L. McPhail MD Detroit NPI: License: 4301030183
Date: 7/30/1990 by HHS Reason: 1128(a)(1)
Samuel Mendoza MD Dearborn NPI: License: 4301020703
Date: 5/6/1997 by HHS Reason: 1128(b)(4)
David H. Middleton MD Ann Arbor NPI: License: 4301024480
Date: 7/1/1997 by HHS Reason: 1128(b)(4)
Lloyd Livingston Miller MD Livonia NPI: License: 4301047699
Date: 2/9/1989 by HHS Reason: 1128(b)(3)
Leon R. Miral DO Detroit NPI: License: 5101005657
Date: 5/26/1988 by HHS Reason: 1128(a)(1)
Munir Ahmed Munshey MD Yppsilanti NPI: License: 4301032297
Date: 9/11/1996 by HHS Reason: 1128(a)(1)
Atiya Murtuza MD Centerline NPI: License: 4301042165
Date: 4/12/1993 by HHS Reason: 1128(a)(1)
Frank Nali MD Warren NPI: License: 4301047701
Date: 2/3/1994 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/10/1994 by HHS Reason: 1128(a)(1)
Christopher S. Nelson MD St. Joseph NPI: 1922041615 License: 4301090162
Date: 9/29/2007 by DCH Licensing Reason: License Suspended
Sandor L. Olah DO Hamilton NPI: License: 5101007317
Date: 6/20/2000 by HHS Reason: 1128(a)(2)
George Hansing Ong MD Kalamazoo NPI: License: 4301030442
Date: 12/12/1995 by HHS Reason: 1128(a)(1)
Francis M. Osher DO Birch Run NPI: License: 5101005370
Date: 6/29/1992 by HHS Reason: 1128(b)(3)
Rameshbhai F. Patel MD Huntington Woods NPI: License: 4301036995
Date: 7/15/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 12/23/1991 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 24 of 29
Sharadchandra D. Patel MD Saginaw NPI: License: 4301033216
Date: 5/21/1999 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 6/17/1999 by HHS Reason: 1128(a)(1)
Joseph T. Paupore DO Livonia NPI: 1841285467 License: 5101012057
Date: 2/12/2008 by Bureau of Health Professions Reason: Summary Suspension
Lauren Joan Pfeifer MD Caro NPI: License: 4301056619
Date: 5/20/2004 by HHS Reason: 1128(b)(4)
David Chaffee Phillips MD Allegan NPI: License: 4301046887
Date: 3/20/2003 by HHS Reason: 1128(b)(4)
Joseph A. Pitts DO Detroit NPI: License: 5101006636
Date: 10/18/2001 by HHS Reason: 1128(b)(15)
Sethavarangura Pornpichit,MD Detroit NPI: License: 4301033113
Date: 9/27/2007 by DCH Licensing Reason: License Suspended
Calvin U. Price DO Flint NPI: License: 5101004559
Date: 7/22/1991 by HHS Reason: 1128(a)(1)
Roberto G. Quizon MD Detroit NPI: 1538237482 License: 4301033614
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Ogus K. Ramadan MD Grand Blanc NPI: License: 4301030567
Date: 7/12/1992 by HHS Reason: 1128(a)(1)
Paul H. Ribbentrop DO St. Clair Shores NPI: License: 5101003921
Date: 5/20/2003 by HHS Reason: 1128(a)(4)
Humberto Rojas MD Owosso NPI: License: 4301044894
Date: 10/20/2002 by HHS Reason: 1128(a)(4)
John W. Rutherford DO River Rouge NPI: License: 5101005008
Date: 7/24/1986 by HHS Reason: 1128(a)(1)
Saeed Saleh MD Dearborn NPI: License: 4301031271
Date: 6/19/2003 by HHS Reason: 1128(b)(4)
Fabian Salinas MD Ann Arbor NPI: License: 4301076437
Date: 9/20/2005 by HHS Reason: 1128(a)(2)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 25 of 29
Ali H. Sawaf MD Escanaba NPI: License: 4301033342
Date: 8/19/2004 by HHS Reason: 1128(a)(4)
Tony F. Scalici DO Wyoming NPI: License: 5101007093
Date: 12/23/1990 by HHS Reason: 1128(b)(3)
Date: 5/5/1994 by HHS Reason: 1128(b)(3)
Arthur James Schiefelbein DPM Highland Park NPI: License: 5901000899
Date: 2/4/1999 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 5/20/1999 by HHS Reason: 1128(a)(1)
Steven M. Schreier DPM Southfield NPI: License: 5901400211
Date: 11/19/1998 by HHS Reason: 1128(a)(1)
Richard E. Snyder DO Detroit NPI: License: 5101009381
Date: 12/18/1997 by HHS Reason: 1128(b)(4)
Jeffrey H. Soffa DO Clawson NPI: 1588640854 License: 5101007116
Date: 9/19/2002 by HHS Reason: 1128(a)(4)
Phillip M. Sorensen MD Lansing NPI: License: 4301031657
Date: 4/20/2003 by HHS Reason: 1128(a)(3)
Marcelino Sorongon MD Saginaw NPI: License: 4301031149
Date: 4/30/1999 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 5/18/2000 by HHS Reason: 1128(a)(1)
Veera Sripinyo MD Warren NPI: License: 4301031589
Date: 5/6/1997 by HHS Reason: 1128(b)(4)
Robert Martin Stang DO Monroe NPI: License: 5101012881
Date: 10/19/2006 by HHS Reason: 1128(a)(2)
Marion David Sutton MD Sanford NPI: License: 4301033071
Date: 7/8/1993 by HHS Reason: 1128(a)(2)
Richard E. Tapert DO Detroit NPI: License:
Date: 10/20/1999 by HHS Reason: 1128(b)(4)
James S. Tashjian MD Birmingham NPI: License: 4301028804
Date: 4/30/1992 by HHS Reason: 1128(b)(1)
Clark E. Taylor DO Cheboygan NPI: License: 5101005560
Date: 12/18/1997 by HHS Reason: 1128(b)(4)
Roosevelt Taylor DO Flint NPI: License: 5101004568
Date: 6/28/1992 by HHS Reason: 1128(b)(3)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 26 of 29
Peter Tocco III DO Pontiac NPI: License: 5101006837
Date: 3/8/1994 by HHS Reason: 1128Aa
Jose M. Tombo MD Detroit NPI: License: 4301033662
Date: 1/10/1991 by HHS Reason: 1128(b)(4)
Jonathan D. Tunis MD Carson City NPI: License: 4301065350
Date: 3/20/2000 by HHS Reason: 1128(b)(4)
Erol Ucer MD Flint NPI: License: 4301031131
Date: 6/4/1995 by HHS Reason: 1128(b)(1)
Jose V. Valdez MD Detroit NPI: License: 4301030159
Date: 9/2/1997 by HHS Reason: 1128(a)(2)
Luis G. Valle MD Grand Rapids NPI: License: 4301064984
Date: 10/20/2005 by HHS Reason: 1128(a)(2)
Wanda ENID Velez-Ruiz MD Detroit NPI: 1023123858 License: 4301045752
Date: 11/10/1993 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 8/10/1994 by HHS Reason: 1128(a)(1)
Antonio Q. Villarta MD Adrian NPI: License: 4301033470
Date: 2/20/2001 by HHS Reason: 1128(b)(4)
Peter B. Vlcko DO Oak Park NPI: License: 5101009612
Date: 6/4/1995 by HHS Reason: 1128(a)(2)
Samuel G. Watts MD Detroit NPI: License: 4301030543
Date: 3/18/1987 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Michael S. Weisenfeld MD Marshall NPI: License: 4301029508
Date: 6/18/1998 by HHS Reason: 1128(a)(1)
Raymond J. Weitzman MD West Bloomfield NPI: 1669680872 License: 4301030107
Date: 5/16/2001 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 5/20/2004 by HHS Reason: 1128(a)(1)
Alex West DPM Dearborn Hts NPI: License: 5901001051
Date: 9/19/2003 by HHS Reason: 1128(a)(3)
Kurt A. Westly MD Rochester NPI: 1376562645 License: 4301042330
Date: 8/17/2007 by DCH Licensing Reason: License Surrendered
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 27 of 29
Clarence W. Wilson DO Flint NPI: License: 5101004539
Date: 9/2/1997 by HHS Reason: 1128(b)(3)
Stanley J. Woollams MD Ann Arbor NPI: License: 4301023228
Date: 5/6/1996 by HHS Reason: 1128(b)(4)
Abington Family Medical Center Inc. Edwin Dyke Detroit NPI: License:
Date: 10/12/1993 by HHS Reason: 1128(a)(1)
All Care Medical Center Inc. Michael Kemp MD Detroit NPI: License:
Date: 8/29/1990 by HHS Reason: 1128(a)(1)
Detroit Diverse Care, Inc. Detroit NPI: License:
Date: 3/16/1997 by HHS Reason: 1128(a)(1)
Durand Clinic PC Jason Hollady MD Durand NPI: License:
Date: 9/20/2001 by HHS Reason: 1128(a)(3)
Emergency Medical Clinic, Inc. Hamtramck NPI: License:
Date: 12/23/1991 by HHS Reason: 1128(a)(1)
Geha, James G. DPM, PC James G. Geha DPM Madison Hts NPI: License: 5901001042
Date: 3/18/1999 by HHS Reason: 1128(a)(1)
Harbor Medical Diagnostic Clinic, Inc. Robert H. Povlitz Keego Harbor NPI: License:
Date: 4/11/1991 by HHS Reason: 1128(a)(1)
J & J Sleep, Inc. Jack Kingen Duran NPI: License:
Date: 4/8/2004 by DCH Medicaid Reason: violation of Medicaid False Claim Act
Kalamazoo Footcare Specialists PC Kalamazoo NPI: License:
Date: 4/10/2007 by HHS Reason: 1128(b)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 28 of 29
Kaufman, Jack A. DPM, PC (aka Novi Footcare Associates PC)Jack A. Kaufman DPM Novi NPI: License: 5901000903
Date: 9/19/2003 by HHS Reason: 1128(a)(1)
Date: 2/20/2006 by HHS Reason: 1128(a)(1)
Khan, Walayata MD, PC Walayata A. Khan MD Ypsilanti NPI: License: 4301042910
Date: 2/11/1996 by HHS Reason: 1128(a)(1)
Kompus, Larry L., MD, PC Larry L. Kompus MD Pontiac NPI: License: 4301026816
Date: 3/25/1991 by HHS Reason: 1128(a)(1)
Moss, David M., DPM, PC Garden City NPI: License:
Date: 8/20/2003 by HHS Reason: 1128(a)(1)
Nu Care Medical PC Harish Cham Detroit NPI: License:
Date: 5/4/1992 by HHS Reason: 1128(a)(1)
Orzame & Orzame, MD, PLLC Gabriel Sagun Orzame MD Watervliet NPI: License: 4301044937
Date: 8/20/1998 by HHS Reason: 1128(a)(1)
Park Medical Clinic PC Detroit NPI: License:
Date: 7/30/1997 by HHS Reason: 1128(a)(1)
Parkside Mental Health, Inc. Marie Victoria Mayberry Detroit NPI: License:
Date: 11/19/1998 by HHS Reason: 1128(a)(1)
Plucer, Mark G., DO, PC Mark G. Plucer DO Flint NPI: License: 5101006481
Date: 9/13/2002 by DCH Medicaid Reason: Violation of Medicaid False Claim Act
Date: 1/20/2003 by HHS Reason: 1128(a)(1)
Plymouth Medical Center Edwin Dyke Detroit NPI: License:
Date: 10/12/1993 by HHS Reason: 1128(a)(1)
March 1, 2008 Michigan Department of Community Health SANCTIONED PROVIDER LIST
Revision Date: 03-01-08 Page 29 of 29
Sapala, James A., MD PC James A. Sapala MD Detroit NPI: License: 4301030372
Date: 5/4/1992 by HHS Reason: 1128(a)(1)
Transportation
Michigan Ambulance Service, Inc. Shan Sawyer Detroit NPI: License: 025000
Date: 10/22/1991 by HHS Reason: 1128(a)(1)
