updated leie information - office of inspector generalupdated leie information january 2020 update:...

Updated LEIE Information

February 2020

UPDATE: DOB

LASTNAME ACHAVAL

FIRSTNAME MARIA

MIDNAME

BUSNAME

GENERAL IND- LIC HC SERV PRO

SPECIALTY PSYCHOLOGY

UPIN

NPI 1609921972

DOB 19600602

ADDRESS 1238 KAAHUMANU ST, #302

CITY AIEA

STATE HI

ZIP 967010000

EXCLTYPE 1128a1

EXCLDATE 20150420

UPDATE: DOB

LASTNAME AHMAD

FIRSTNAME NAVEED

MIDNAME

BUSNAME

GENERAL PHYSICIAN (MD, DO)

SPECIALTY GENERAL PRACTICE

UPIN B12704

NPI 1669412946

DOB 19500103

ADDRESS 48 SUYDUM RD

CITY SOMERSET

STATE NJ

ZIP 088737305

EXCLTYPE 1128a1

EXCLDATE 20161220

UPDATE: DOB

LASTNAME ARCHINIHU

FIRSTNAME JOHN

MIDNAME SPENCER CGUJEZU

BUSNAME



UPIN

NPI 1124052352

DOB 19581224

ADDRESS P O BOX 782070

CITY ORLANDO

STATE FL

ZIP 328780000

EXCLTYPE 1128a3

EXCLDATE 20160519

UPDATE: DOB, GENERAL and SPECIALTY

LASTNAME AZEEZ

FIRSTNAME GANIYU

MIDNAME M

BUSNAME


SPECIALTY THERAPIST

UPIN

NPI 1982808747

DOB 19661108

ADDRESS 11852 COQUILLE DRIVE

CITY FRANKFORT

STATE IL

ZIP 604230000

EXCLTYPE 1128a1

EXCLDATE 20090219

UPDATE: DOB

LASTNAME CWIBEKER

FIRSTNAME MELVIN

MIDNAME

BUSNAME


SPECIALTY CHIROPRACTIC

UPIN T52279

NPI 1336210475

DOB 19541201

ADDRESS P O BOX 1000, 381663-053

CITY OTISVILLE

STATE NY

ZIP 109630000

EXCLTYPE 1128a1

EXCLDATE 20170620

UPDATE: DOB

LASTNAME DANIELS

FIRSTNAME STACY

MIDNAME L

BUSNAME


SPECIALTY NURSE/NURSES AIDE

UPIN

NPI 1457483513

DOB 19740607

ADDRESS 3005 COLUMBUS RD, APT 1

CITY SPRINGFIELD

STATE OH

ZIP 455033290

EXCLTYPE 1128a1

EXCLDATE 20160320

UPDATE: MIDNAME, DOB

LASTNAME DENNIS

FIRSTNAME JAMES

MIDNAME ALFRED, JR

BUSNAME



UPIN C24988

NPI 1891882437

DOB 19411008

ADDRESS 127 SHELBY YARD ST, P O BOX 58

CITY SHELBIANA

STATE KY

ZIP 415620000

EXCLTYPE 1128b4

EXCLDATE 20130820

UPDATE: DOB

LASTNAME DISCENZA

FIRSTNAME RONALD

MIDNAME R

BUSNAME



UPIN

NPI 1528137882

DOB 19500526

ADDRESS 2578 WOLF HOLLOW ROAD

CITY ANDES

STATE NY

ZIP 137310000

EXCLTYPE 1128a4

EXCLDATE 20170320

UPDATE: DOB

LASTNAME GREEN

FIRSTNAME LEONARD

MIDNAME J

BUSNAME


SPECIALTY GYN/OBS

UPIN

NPI 1639299738

DOB 19490922

ADDRESS 9369 KUNGSHOLM DR, APT B4

CITY INDIANAPOLIS

STATE IN

ZIP 462500000

EXCLTYPE 1128a2

EXCLDATE 20130718

UPDATE: DOB

LASTNAME HANSEN

FIRSTNAME JOSEPH

MIDNAME W

BUSNAME


SPECIALTY PSYCHOLOGY

UPIN

NPI 1134119613

DOB 19700420

ADDRESS 2472 HIDDEN VALLEY LN

CITY STILLWATER

STATE MN

ZIP 550825463

EXCLTYPE 1128b4

EXCLDATE 20170518

UPDATE: DOB

LASTNAME KATSCHKE

FIRSTNAME ADAM

MIDNAME PAUL

BUSNAME


SPECIALTY PHARMACIST

UPIN

NPI 1053344036

DOB 19720912

ADDRESS 4 HAYSTACK LANE

CITY CALIENTE

STATE NV

ZIP 890080000

EXCLTYPE 1128a1

EXCLDATE 20170620

UPDATE: DOB

LASTNAME KHOURY

FIRSTNAME THERESE

MIDNAME MARIE

BUSNAME


SPECIALTY PHYSICIAN ASSISTANT

UPIN S80934

NPI 1336260157

DOB 19581009

ADDRESS 4 PALISADES DRIVE, STE 100

CITY ALBANY

STATE NY

ZIP 122050000

EXCLTYPE 1128b4

EXCLDATE 20081218

UPDATE: DOB

LASTNAME LAUGHNER

FIRSTNAME JOHN

MIDNAME GERALD, JR

BUSNAME



UPIN

NPI 1558519843

DOB 19471013

ADDRESS 426 WATER ST EXT, APT A4

CITY JOHNSONBURG

STATE PA

ZIP 158450000

EXCLTYPE 1128b4

EXCLDATE 20121120

UPDATE: DOB and DECEASED

LASTNAME DIWAN

FIRSTNAME SATYENDRA

MIDNAME KUMAR

BUSNAME


SPECIALTY PSYCHIATRY

UPIN B35466

NPI 1013908482

DOB 19430113

ADDRESS 211 N MONROE ST, 2754

CITY MEDIA

STATE PA

ZIP 190630000

EXCLTYPE 1128b4

EXCLDATE 20130120

UPDATE: DOB

LASTNAME OKEREKE

FIRSTNAME EDOZIE

MIDNAME

BUSNAME



UPIN U66647

NPI 1568458198

DOB 19560515

ADDRESS P O BOX 34550, #15303-035

CITY MEMPHIS

STATE TN

ZIP 381840000

EXCLTYPE 1128a1

EXCLDATE 20131120

UPDATE: SSN, DOB and DECEASED

LASTNAME GORDON

FIRSTNAME JACQUELINE

MIDNAME

BUSNAME

GENERAL NURSING FIRM


UPIN

NPI 0000000000

DOB 19520829

ADDRESS 412 DERSAM STREET

CITY MCKEESPORT

STATE PA

ZIP 151330000

EXCLTYPE 1128b4

EXCLDATE 19910307

UPDATE: DOB

LASTNAME MANTOURA

FIRSTNAME AMIRA

MIDNAME

BUSNAME


SPECIALTY PODIATRY

UPIN T22256

NPI 1700801610

DOB 19620910

ADDRESS 37 EDGEWATER DRIVE

CITY OLD GREENWICH

STATE CT

ZIP 068701907

EXCLTYPE 1128a1

EXCLDATE 20151007

UPDATE: DOB

LASTNAME MATTINGLY

FIRSTNAME MICHAEL

MIDNAME ALLEN

BUSNAME


SPECIALTY DENTIST

UPIN

NPI 1720200165

DOB 19521209

ADDRESS 3255 LYNDALE AVE S, APT 5

CITY MINNEAPOLIS

STATE MN

ZIP 554083647

EXCLTYPE 1128b4

EXCLDATE 20130820

UPDATE: DOB

LASTNAME MERKLE

FIRSTNAME BOBBY

MIDNAME C

BUSNAME



UPIN

NPI 1417938663

DOB 19360124

ADDRESS 1 HAMBURG ROAD

CITY UNIONTOWN

STATE AL

ZIP 367860000

EXCLTYPE 1156

EXCLDATE 20160711

UPDATE: DOB

LASTNAME MOFFAT

FIRSTNAME ROBERT

MIDNAME JOHN

BUSNAME


SPECIALTY INTERNAL MEDICINE

UPIN G42070

NPI 1235277104

DOB 19660119

ADDRESS 3800 PIKE RD, APT 12202

CITY LONGMONT

STATE CO

ZIP 805030000

EXCLTYPE 1128a2

EXCLDATE 20120820

UPDATE: DOB

LASTNAME NILSSON

FIRSTNAME KRISTEN

MIDNAME E

BUSNAME

GENERAL EMPLOYEE - PRIVATE S

SPECIALTY CONSULTING FIRM

UPIN

NPI 1982947248

DOB 19800610

ADDRESS 601 N SHADOWOOD CIR, UNIT A

CITY WASILLA

STATE AK

ZIP 996540000

EXCLTYPE 1128a1

EXCLDATE 20170820

UPDATE: DOB

LASTNAME NORBERGS

FIRSTNAME D ANDA

MIDNAME

BUSNAME


SPECIALTY ONCOLOGY

UPIN

NPI 1164636932

ADDRESS 262 HERMOSITA DRIVE

CITY ST PETE BEACH

STATE FL

ZIP 337062802

EXCLTYPE 1128a1

EXCLDATE 20171220

UPDATE: DOB

LASTNAME PATEL

FIRSTNAME ARVIND

MIDNAME S

BUSNAME



UPIN D90201

NPI 1437217601

DOB 19440401

ADDRESS 3812 WABEEK LAKE DRIVE W

CITY BLOOMFIELD HILLS

STATE MI

ZIP 483020000

EXCLTYPE 1128a1

EXCLDATE 20170420

UPDATE: DOB

LASTNAME ROCKETT

FIRSTNAME CARL

MIDNAME

BUSNAME


SPECIALTY PAIN MANAGEMENT

UPIN

NPI 1912093741

DOB 19570818

ADDRESS 11107 PEMBRIDGE DR, APT 503

CITY HOUSTON

STATE TX

ZIP 770712023

EXCLTYPE 1128b4

EXCLDATE 20170220

UPDATE: DECEASED

LASTNAME BURRIS

FIRSTNAME JULIE

MIDNAME RENEE

BUSNAME


SPECIALTY FAMILY PRACTICE

UPIN G69492

NPI 1134157969

DOB 19681003

ADDRESS 11862 ROLLING HILLS COURT

CITY WICHITA

STATE KS

ZIP 672120000

EXCLTYPE 1128b4

EXCLDATE 20121120

UPDATE: DOB

LASTNAME RODRIGUEZ

FIRSTNAME JOSE

MIDNAME JOAQUIN

BUSNAME

GENERAL MEDICAL PRACTICE, MD

SPECIALTY PEDIATRICS

UPIN H53055

NPI 1316959349

DOB 19590502

ADDRESS 5703 NW 7TH ST

CITY MIAMI

STATE FL

ZIP 331260000

EXCLTYPE 1128a1

EXCLDATE 20081120

UPDATE: DOB

LASTNAME SAADIA

FIRSTNAME SAMUEL

MIDNAME

BUSNAME


SPECIALTY DENTIST

UPIN

NPI 1447550736

DOB 19631212

ADDRESS 309 AVENUE U

CITY BROOKLYN

STATE NY

ZIP 112230000

EXCLTYPE 1128b14

EXCLDATE 20130520

UPDATE: DOB

LASTNAME SCARBOROUGH

FIRSTNAME CHARLES

MIDNAME DUNN

BUSNAME



UPIN

NPI 1205854312

DOB 19361009

ADDRESS 4599 OLD HOBOKEN ROAD

CITY BLACKSHEAR

STATE GA

ZIP 315160000

EXCLTYPE 1128a1

EXCLDATE 20140520

UPDATE: DOB

LASTNAME SCHAFFNER

FIRSTNAME STEPHEN

MIDNAME HOWARD

BUSNAME


SPECIALTY COUNSELOR

UPIN

NPI 1689965147

DOB 19800601

ADDRESS P O BOX 1000, #58266-037

CITY PETERSBURG

STATE VA

ZIP 238040000

EXCLTYPE 1128b4

EXCLDATE 20160420

UPDATE: DOB

LASTNAME SERRO

FIRSTNAME ROBIN

MIDNAME OYSTER

BUSNAME



UPIN

NPI 1154842987

DOB 19861124

ADDRESS 1810 MOBILE ROAD

CITY LYNCHBURG

STATE VA

ZIP 245030000

EXCLTYPE 1128b4

EXCLDATE 20181220

UPDATE: DOB

LASTNAME SILVERS

FIRSTNAME FREDERICK

MIDNAME MICHAEL

BUSNAME


SPECIALTY PSYCHIATRY

UPIN

NPI 1720155419

DOB 19420808

ADDRESS 10921 WILSHIRE BLVD, NO 514

CITY LOS ANGELES

STATE CA

ZIP 900240000

EXCLTYPE 1128b4

EXCLDATE 20180118

UPDATE: DOB

LASTNAME SZALAVETZ

FIRSTNAME GEORGE

MIDNAME

BUSNAME

GENERAL DENTAL PRACTICE

SPECIALTY DENTIST

UPIN

NPI 1861663213

DOB 19470119

ADDRESS 110 COUNTRY CLUB DR

CITY MONROE

STATE NJ

ZIP 088310000

EXCLTYPE 1128a1

EXCLDATE 20100120

UPDATE: DOB

LASTNAME TRAN

FIRSTNAME THANG

MIDNAME Q

BUSNAME



UPIN

NPI 1720083272

DOB 19620806

ADDRESS 6 PLUMERIA

CITY IRVINE

STATE CA

ZIP 926207901

EXCLTYPE 1128b4

EXCLDATE 20140520

UPDATE: DECEASED

LASTNAME AARON

FIRSTNAME BARBARA

MIDNAME KAY

BUSNAME

GENERAL NURSING PROFESSION


UPIN

NPI 0000000000

DOB 19650914

ADDRESS 5911 OLD PINEYWOODS RD

CITY JASPER

STATE AL

ZIP 355045146

EXCLTYPE 1128b4

EXCLDATE 20061120

UPDATE: DECEASED

LASTNAME ABRAM

FIRSTNAME KELLY

MIDNAME ANN

BUSNAME



UPIN

NPI 0000000000

DOB 19620528

ADDRESS 6601 ROYAL PALM BLVD

CITY MARGATE

STATE FL

ZIP 330632108

EXCLTYPE 1128b4

EXCLDATE 20070220

UPDATE: DECEASED

LASTNAME ABREU-GONZALEZ

FIRSTNAME JOSE

MIDNAME

BUSNAME

GENERAL INDIVIDUAL (UNAFFILI

SPECIALTY NO KNOWN AFFILIATION

UPIN

NPI 0000000000

DOB 19631004

ADDRESS 9674 NW 10 AVE, LOT B237

CITY MIAMI

STATE FL

ZIP 331500000

EXCLTYPE 1128a1

EXCLDATE 20130320

UPDATE: DECEASED

LASTNAME ACHEY

FIRSTNAME LORI

MIDNAME B

BUSNAME

GENERAL SKILLED NURSING FAC


UPIN

NPI 0000000000

DOB 19720518

ADDRESS 149 PALM CITY PARK

CITY ANNVILLE

STATE PA

ZIP 170030000

EXCLTYPE 1128b4

EXCLDATE 20000720

UPDATE: DOB

LASTNAME NAZON

FIRSTNAME YVON

MIDNAME

BUSNAME


SPECIALTY GYN/OBS

UPIN H65690

NPI 1023413382

DOB 19280610

ADDRESS 195 N HARBOR DRIVE, APT 4105

CITY CHICAGO

STATE IL

ZIP 606017536

EXCLTYPE 1128b4

EXCLDATE 20170220

UPDATE: DECEASED

LASTNAME PEAVY

FIRSTNAME LEONARD

MIDNAME

BUSNAME


SPECIALTY REPRESENTATIVE PAYEE

UPIN

NPI 1821325648

DOB 19490624

ADDRESS 3855 WOODLAND AVE, #4

CITY DES MOINES

STATE IA

ZIP 503140000

EXCLTYPE 1128a1

EXCLDATE 20130919

UPDATE: DOB

LASTNAME LAUER

FIRSTNAME NORMA

MIDNAME

BUSNAME


SPECIALTY HOME HEALTH AGENCY

UPIN

NPI 1598084113

DOB 19470912

ADDRESS 512 ALLIS PLACE E

CITY REYNOLDSBURG

STATE OH

ZIP 430689471

EXCLTYPE 1128a1

EXCLDATE 20170920

UPDATE: DOB

LASTNAME LEE

FIRSTNAME JEFFERY

MIDNAME W

BUSNAME

GENERAL BUS OWNER/EXEC

SPECIALTY OPTOMETRIC PRACTICE

UPIN

NPI 1891987673

DOB 19640913

ADDRESS 30 CISCO DRIVE

CITY TONKAWA, OK 74653

STATE OK

ZIP 746530000

EXCLTYPE 1128a1

EXCLDATE 20160218

January 2020

UPDATE: DECEASED

LASTNAME BROWN

FIRSTNAME GEORGE

MIDNAME VERNON

BUSNAME

GENERAL DME COMPANY

SPECIALTY OWNER/OPERATOR

UPIN

NPI 0000000000

DOB 19410914

ADDRESS 8275 LOUISIANA ST, #220

CITY MERRILLVILLE

STATE IN

ZIP 464100000

EXCLTYPE 1128a1

EXCLDATE 20070520

REINDATE 00000000

UPDATE: SSN AND DECEASED

LASTNAME SOWERS

FIRSTNAME JOSEPH

MIDNAME MARK BRITTON

BUSNAME


SPECIALTY GENERAL PRACTICE/FP

UPIN C78491

NPI 0000000000

DOB 19321231


CITY FULTON

STATE KY

ZIP 420410000

EXCLTYPE 1128b3

EXCLDATE 19970415

REINDATE 00000000

UPDATE: DOB AND SSN

LASTNAME STRICKMAN

FIRSTNAME IRA

MIDNAME

BUSNAME

GENERAL OSTEOPATHIC PRAC

SPECIALTY OSTEOPATHY

UPIN

NPI 0000000000

DOB 19460208

ADDRESS 110 RABY AVE, #56032-004

CITY PENSACOLA

STATE FL

ZIP 325090000

EXCLTYPE 1128a1

EXCLDATE 20041118

REINDATE 000000000

UPDATE: SSN

LASTNAME SWAB

FIRSTNAME JOHN

MIDNAME C

BUSNAME

GENERAL HOSPITAL


UPIN

NPI 0000000000

DOB 19520106

ADDRESS 27 MAKALANI PLACE, #A

CITY MAKAWAO

STATE HI

ZIP 967688909

EXCLTYPE 1128b4

EXCLDATE 20030720

REINDATE 00000000

UPDATE: SSN

LASTNAME THOMAS

FIRSTNAME WALTER

MIDNAME LEE

BUSNAME

GENERAL PSYCHOLOGIC PRACTICE

SPECIALTY EMPLOYEE

UPIN

NPI 0000000000

DOB 19380714

ADDRESS 7400 SOUTH COLLEGE

CITY FORT COLLINS

STATE CO

ZIP 805250000

EXCLTYPE 1128a1

EXCLDATE 19940526

REINDATE 00000000

UPDATE: SSN

LASTNAME THOMPSON


MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19690531

ADDRESS 1115 LAIDLAW AVE

CITY CINCINNATI

STATE OH

ZIP 452370000

EXCLTYPE 1128a2

EXCLDATE 20030619

REINDATE 00000000

UPDATE: SSN

LASTNAME TITZEL

FIRSTNAME DANIEL

MIDNAME W

BUSNAME


SPECIALTY DENTIST

UPIN U06703

NPI 0000000000

DOB 19290613

ADDRESS 100 LOGAN BOULEVARD

CITY ALTOONA

STATE PA

ZIP 166020000

EXCLTYPE 1128a1

EXCLDATE 19940427

REINDATE 00000000

UPDATE: SSN

LASTNAME TRIANA

FIRSTNAME NICHOLAS

MIDNAME J

BUSNAME

GENERAL PODIATRY PRACTICE

SPECIALTY PODIATRY

UPIN

NPI 0000000000

DOB 19581206

ADDRESS 1026 PEARL RD, STE #4

CITY BRUNSWICK

STATE OH

ZIP 442120000

EXCLTYPE 1128a1

EXCLDATE 19991020

REINDATE 00000000

UPDATE: SSN

LASTNAME TRIANA

FIRSTNAME NICHOLAS

MIDNAME JOSEPH

BUSNAME


SPECIALTY PODIATRY

UPIN T49791

NPI 0000000000

DOB 19581206

ADDRESS P O BOX 779800 FCI

CITY MIAMI

STATE FL

ZIP 331770000

EXCLTYPE 1128a1

EXCLDATE 20051020

REINDATE 00000000


LASTNAME TOWNS

FIRSTNAME CHARLES

MIDNAME M

BUSNAME


SPECIALTY DENTIST

UPIN

NPI 0000000000

DOB 19360114

ADDRESS 6400 ROSSVILLE BLVD

CITY BALTIMORE

STATE MD

ZIP 212370000

EXCLTYPE 1128a1

EXCLDATE 19831125

REINDATE 00000000


LASTNAME TURNER

FIRSTNAME OTWA

MIDNAME LEE

BUSNAME

GENERAL TRANSPORTATION CO


UPIN

NPI 0000000000

DOB 19400408

ADDRESS 806 MAIN STREET

CITY DANVILLE

STATE VA

ZIP 245410000

EXCLTYPE 1128a1

EXCLDATE 19890620

REINDATE 00000000

UPDATE: SSN

LASTNAME VAFAEE

FIRSTNAME MOHAMMAD

MIDNAME ALI

BUSNAME

GENERAL CHIROPRACTIC PRACT


UPIN U70654

NPI 0000000000

DOB 19650428

ADDRESS 214 26TH STREET

CITY SANTA MONICA

STATE CA

ZIP 904020000

EXCLTYPE 1128b14

EXCLDATE 20050119

REINDATE 00000000


LASTNAME VALDIVIA

FIRSTNAME RODOLFO

MIDNAME CARLOS

BUSNAME

GENERAL OSTEOPATHIC PRAC

SPECIALTY OSTEOPATHY

UPIN

NPI 0000000000

DOB 19250617


CITY EL PASO

STATE TX

ZIP 799133523

EXCLTYPE 1128a2

EXCLDATE 20010920

REINDATE 00000000

UPDATE: SSN

LASTNAME VAUGHAN

FIRSTNAME TAMMY

MIDNAME O'BERRY

BUSNAME


SPECIALTY PERSONAL CARE PROVID

UPIN

NPI 0000000000

DOB 19721007

ADDRESS 4301 E PARHAM RD, #401064

CITY HENRICO

STATE VA

ZIP 232280000

EXCLTYPE 1128a1

EXCLDATE 20160120

REINDATE 00000000


LASTNAME VICARIA

FIRSTNAME CARLOS

MIDNAME CONCEPCION

BUSNAME



UPIN

NPI 0000000000

DOB 19341208

ADDRESS 2121 N BAYSHORE DR

CITY MIAMI

STATE FL

ZIP 331370000

EXCLTYPE 1128a1

EXCLDATE 19981119

REINDATE 00000000

UPDATE: SSN

LASTNAME VICK

FIRSTNAME SHANNON

MIDNAME

BUSNAME

GENERAL INSURANCE COMPANY

SPECIALTY CLERK/OTHER CLERICAL

UPIN

NPI 0000000000

DOB 19710415

ADDRESS RURAL ROUTE E, BOX 483E

CITY ADEL

STATE GA

ZIP 316209605

EXCLTYPE 1128a1

EXCLDATE 20100218

REINDATE 00000000

UPDATE: SSN

LASTNAME WALKER

FIRSTNAME MARY

MIDNAME

BUSNAME

GENERAL INTER CARE FACILITY


UPIN

NPI 0000000000

DOB 19570830

ADDRESS 10 COUNTY RD

CITY RIENZI

STATE MS

ZIP 388650000

EXCLTYPE 1128a2

EXCLDATE 20040420

REINDATE 00000000

UPDATE: SSN

LASTNAME WARD

FIRSTNAME JOHN

MIDNAME MICHAEL

BUSNAME

GENERAL HOSPITAL

SPECIALTY ADMINISTRATOR

UPIN

NPI 0000000000

DOB 19441004

ADDRESS 110 RABY AVE, 319241-018

CITY PENSACOLA

STATE FL

ZIP 325090000

EXCLTYPE 1128a1

EXCLDATE 20031020

REINDATE 00000000

UPDATE: SSN

LASTNAME WASHINGTON

FIRSTNAME TERESA

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19511213

ADDRESS 474 RIDGEWAY AVENUE

CITY ROCHESTER

STATE NY

ZIP 146150000

EXCLTYPE 1128a1

EXCLDATE 20060518

REINDATE 00000000


LASTNAME WEINBERG

FIRSTNAME SHELDON

MIDNAME

BUSNAME

GENERAL CLINIC


UPIN

NPI 0000000000

DOB 19240821

ADDRESS BOX 149

CITY ATTICA

STATE NY

ZIP 140110000

EXCLTYPE 1128a1

EXCLDATE 19900926

REINDATE 00000000

UPDATE: SSN

LASTNAME WELCH

FIRSTNAME SUSAN

MIDNAME E

BUSNAME



UPIN

NPI 0000000000

DOB 19521021

ADDRESS TORONTO, ONTARIO

CITY CANADA

STATE TX

ZIP 782400000

EXCLTYPE 1128b4

EXCLDATE 19950216

REINDATE 00000000


LASTNAME WEST

FIRSTNAME JUDITH

MIDNAME ANNE

BUSNAME



UPIN

NPI 0000000000

DOB 19460612

ADDRESS 428 W MOSIER

CITY NORMAN

STATE OK

ZIP 730690000

EXCLTYPE 1128b4

EXCLDATE 19911110

REINDATE 00000000

UPDATE: SSN

LASTNAME WHITE

FIRSTNAME BRENDA

MIDNAME RENEE

BUSNAME



UPIN

NPI 0000000000

DOB 19641128

ADDRESS 3806 DORIS STREET

CITY MOSS POINT

STATE MS

ZIP 395630000

EXCLTYPE 1128a2

EXCLDATE 19920503

REINDATE 00000000

UPDATE: DOB, SSN AND DECEASED

LASTNAME WIESMAN

FIRSTNAME ALBERT

MIDNAME

BUSNAME


SPECIALTY PODIATRY

UPIN T31164

NPI 0000000000

DOB 19330420

ADDRESS 12605 ORCHARD BROOK TERR

CITY ROCKVILLE

STATE MD

ZIP 208540000

EXCLTYPE 1128b4

EXCLDATE 19930412

REINDATE 00000000

UPDATE: SSN

LASTNAME WILCOX

FIRSTNAME SUSAN

MIDNAME ALEEN

BUSNAME



UPIN

NPI 0000000000

DOB 19600831

ADDRESS 1820 N SHERIDAN AVE

CITY N PLATT

STATE NE

ZIP 691012166

EXCLTYPE 1128b4

EXCLDATE 20000620

REINDATE 00000000

UPDATE: SSN

LASTNAME WILLIAMS

FIRSTNAME NICOLE

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19740122

ADDRESS 2572 SARVIS, #6

CITY CINCINNATI

STATE OH

ZIP 452140000

EXCLTYPE 1128a2

EXCLDATE 20050420

REINDATE 00000000

UPDATE: SSN

LASTNAME WILLIAMSON

FIRSTNAME HELEN

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19811104

ADDRESS 41 ATLANTIS AVENUE

CITY MANAHAWKIN

STATE NJ

ZIP 080500000

EXCLTYPE 1128a2

EXCLDATE 20080220

REINDATE 00000000

UPDATE: DOB

LASTNAME BRIDGES

FIRSTNAME PATRICE

MIDNAME MARIE

BUSNAME

GENERAL HOME HEALTH AGENCY

SPECIALTY CLERK/OTHER CLERICAL

UPIN

NPI 0000000000

DOB 19660614

ADDRESS 16568 SNOWDEN

CITY DETROIT

STATE MI

ZIP 482350000

EXCLTYPE 1128a1

EXCLDATE 20020919

REINDATE 00000000

UPDATE: EXCLDATE

LASTNAME MCWILLIAMS

FIRSTNAME MARK

MIDNAME D

BUSNAME



UPIN

NPI 0000000000

DOB 19610926

ADDRESS 2392 SW RACQUET CLUB DRIVE

CITY PALM CITY

STATE FL

ZIP 349902665

EXCLTYPE 1128b7

EXCLDATE 20191118

REINDATE 00000000


LASTNAME WILLINGHAM

FIRSTNAME WINBORN

MIDNAME B JR

BUSNAME



UPIN B01168

NPI 0000000000

DOB 19381202

ADDRESS 4405 WILSON ROAD

CITY SIGNAL MOUNTAIN

STATE TN

ZIP 373770000

EXCLTYPE 1128b4

EXCLDATE 19911126

REINDATE 00000000


LASTNAME WOODS

FIRSTNAME JIM

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19420616

ADDRESS COASTAL CORR INST - BOX 7

CITY GARDEN CITY

STATE GA

ZIP 310480000

EXCLTYPE 1128a1

EXCLDATE 19920803

REINDATE 00000000

UPDATE: SSN

LASTNAME YAMINI

FIRSTNAME DORIAN

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19720427

ADDRESS 20206 OVERLAND TRAIL

CITY OLYMPIA FIELDS

STATE IL

ZIP 604610000

EXCLTYPE 1128b5

EXCLDATE 20040819

REINDATE 00000000

UPDATE: SSN

LASTNAME YATES

FIRSTNAME JUDITH

MIDNAME ANN OCHSNER

BUSNAME



UPIN

NPI 0000000000

DOB 19500725

ADDRESS 3803 YARDLEY CT, UNIT 20

CITY LOUISVILLE

STATE KY

ZIP 402990000

EXCLTYPE 1128b4

EXCLDATE 20141020

REINDATE 00000000

UPDATE: DOB AND SSN

LASTNAME YOUMANS

FIRSTNAME CARTEINA

MIDNAME

BUSNAME


SPECIALTY NON-PROFIT ORGANIZAT

UPIN

NPI 0000000000

DOB 19790331

ADDRESS 113 WILLOW CREEK DRIVE

CITY COLUMBIA

STATE SC

ZIP 292230000

EXCLTYPE 1128a2

EXCLDATE 20140320

REINDATE 00000000


LASTNAME ZIMMERMAN

FIRSTNAME RAYMOND

MIDNAME

BUSNAME



UPIN D57418

NPI 0000000000

DOB 19370910

ADDRESS 108 ANNWOOD RD

CITY PALM HARBOR

STATE FL

ZIP 346550000

EXCLTYPE 1128a1

EXCLDATE 20010719

REINDATE 00000000

UPDATE: SSN

LASTNAME ZUERCHER

FIRSTNAME KATHY

MIDNAME ANNA

BUSNAME



UPIN

NPI 0000000000

DOB 19520410

ADDRESS 2609 S E 145TH AVE, #4

CITY PORTLAND

STATE OR

ZIP 972360000

EXCLTYPE 1128a1

EXCLDATE 19970904

REINDATE 00000000

UPDATE: SSN

LASTNAME BROWN

FIRSTNAME TARA

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19880810

ADDRESS 7345 PEPPERMILL LANE

CITY MEMPHIS

STATE TN

ZIP 381250000

EXCLTYPE 1128a1

EXCLDATE 20180520

REINDATE 00000000

December 2019

UPDATE: DECEASED

LASTNAME FREENEY

FIRSTNAME ALFREDA

MIDNAME DELORES

BUSNAME



UPIN

NPI 0000000000

DOB 19560524

ADDRESS 919 JULIA STREET

CITY DAYTONA BEACH

STATE FL

ZIP 321140000

EXCLTYPE 1128a2

EXCLDATE 19910606

REINDATE 00000000

UPDATE: SSN

LASTNAME LITTON

FIRSTNAME LARRY

MIDNAME F

BUSNAME



UPIN

NPI 0000000000

DOB 19500614

ADDRESS 189 WINDY HILLS ROAD

CITY BRISTOL

STATE TN

ZIP 376200000

EXCLTYPE 1128a2

EXCLDATE 20040720

REINDATE 00000000


LASTNAME LIVELY

FIRSTNAME INDREA

MIDNAME F

BUSNAME



UPIN

NPI 0000000000

DOB 19460908


CITY JASPER

STATE AL

ZIP 355010000

EXCLTYPE 1128b4

EXCLDATE 20000420

REINDATE 00000000

UPDATE: SSN

LASTNAME LOWRANCE

FIRSTNAME VICKY

MIDNAME J

BUSNAME



UPIN U12043

NPI 0000000000

DOB 19520426

ADDRESS C/O 620 S CASCADE AVE, #1

CITY COLORADO SPNGS

STATE CO

ZIP 809034039

EXCLTYPE 1128a1

EXCLDATE 19980219

REINDATE 00000000

UPDATE: SSN AND DOB

LASTNAME LUCAS

FIRSTNAME EDGAR

MIDNAME J

BUSNAME



UPIN

NPI 0000000000

DOB 19570915

ADDRESS 2646 APPIAN WAY #18

CITY PINOLE

STATE CA

ZIP 945640000

EXCLTYPE 1128a1

EXCLDATE 19930802

REINDATE 00000000

UPDATE: SSN AND DOB

LASTNAME MABRY

FIRSTNAME DONNIE

MIDNAME ALENE

BUSNAME



UPIN

NPI 0000000000

DOB 19220822

ADDRESS 121 SHIELDS ROAD

CITY MERIDIAN

STATE MS

ZIP 393019140

EXCLTYPE 1128b4

EXCLDATE 20081020

REINDATE 00000000

UPDATE: SSN

LASTNAME MCCLINTON

FIRSTNAME CELENA

MIDNAME ALEXIS

BUSNAME



UPIN

NPI 0000000000

DOB 19790104

ADDRESS 90 GIRARD AVE, APT 191

CITY NEWPORT

STATE RI

ZIP 028401132

EXCLTYPE 1128b4

EXCLDATE 20080520

REINDATE 00000000

UPDATE: LAST NAME AND ADDRESS

LASTNAME MILLER

FIRSTNAME SAMANTHA

MIDNAME S

BUSNAME



UPIN

NPI 0000000000

DOB 19820828

ADDRESS 682 STONINGTON CIRCLE

CITY CENTERVILLE

STATE OH

ZIP 454580000

EXCLTYPE 1128a1

EXCLDATE 20160620

REINDATE 00000000

UPDATE: MIDNAME, SSN AND DECEASED

LASTNAME LOPEZ

FIRSTNAME MARCO

MIDNAME A

BUSNAME



UPIN D67289

NPI 0000000000

DOB 19140918

ADDRESS 6039 COLLINS AVE, APT 437

CITY MIAMI BEACH

STATE FL

ZIP 331400000

EXCLTYPE 1128a1

EXCLDATE 19970101

REINDATE 00000000

UPDATE: SSN

LASTNAME MEDEROS

FIRSTNAME RAYMOND

MIDNAME R

BUSNAME

GENERAL DME COMPANY


UPIN

NPI 0000000000

DOB 19430321

ADDRESS 12006 WOODHOOLM COURT

CITY TEGA CAY

STATE SC

ZIP 297150000

EXCLTYPE 1128a1

EXCLDATE 19990617

REINDATE 00000000

UPDATE: SSN

LASTNAME MEDIOUS

FIRSTNAME SHERRAY

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19620306

ADDRESS 1117 PLATS TERRACE

CITY LOUISVILLE

STATE KY

ZIP 402110000

EXCLTYPE 1128a2

EXCLDATE 20110818

REINDATE 00000000

UPDATE: SSN

LASTNAME MEYER

FIRSTNAME LESTER

MIDNAME

BUSNAME

GENERAL PHARMACY


UPIN

NPI 0000000000

DOB 19450927

ADDRESS 11 PORTMORE LANE

CITY FRAMINGHAM

STATE MA

ZIP 017010000

EXCLTYPE 1128a1

EXCLDATE 19910109

REINDATE 00000000

UPDATE: SSN

LASTNAME MIGNOLA

FIRSTNAME ANNE

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19351125

ADDRESS 109 LIBERTY AVE

CITY NEW ROCHELLE

STATE NY

ZIP 108050000

EXCLTYPE 1128a1

EXCLDATE 20021020

REINDATE 00000000

UPDATE: SSN AND DOB

LASTNAME MILLER

FIRSTNAME JOSEPH

MIDNAME ALSTON

BUSNAME


SPECIALTY DENTIST

UPIN T89606

NPI 0000000000

DOB 19300817

ADDRESS POST OFFICE BOX 1008

CITY GREENWOOD

STATE SC

ZIP 296480000

EXCLTYPE 1128a2

EXCLDATE 19900725

REINDATE 00000000

UPDATE: SSN

LASTNAME MIRANDA-SOLARI

FIRSTNAME ARTEMIO

MIDNAME

BUSNAME



UPIN D76288

NPI 0000000000

DOB 19440715

ADDRESS 889 W LOMBARD STREET

CITY BALTIMORE

STATE MD

ZIP 212010000

EXCLTYPE 1128b4

EXCLDATE 20001220

REINDATE 00000000

UPDATE: SSN

LASTNAME MITCHELL

FIRSTNAME AMY

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19770919


CITY ROANOKE

STATE AL

ZIP 362741452

EXCLTYPE 1128a3

EXCLDATE 20041220

REINDATE 00000000

UPDATE: SSN

LASTNAME MITCHELL

FIRSTNAME VALERIE

MIDNAME E

BUSNAME



UPIN

NPI 0000000000

DOB 19691231

ADDRESS 4350 HIGHWAY 360

CITY VONORE

STATE TN

ZIP 378850000

EXCLTYPE 1128b4

EXCLDATE 20110620

REINDATE 00000000

UPDATE: SSN

LASTNAME MOLDEN

FIRSTNAME CAROLYN

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19500227

ADDRESS 248 LEE STREET

CITY BILOXI

STATE MS

ZIP 395300000

EXCLTYPE 1128a2

EXCLDATE 19970317

REINDATE 00000000

UPDATE: SSN, DOB AND DECEASED

LASTNAME MOORE

FIRSTNAME DOUGLAS

MIDNAME B

BUSNAME



UPIN

NPI 0000000000

DOB 19420225

ADDRESS 2406 LINDENWOOD DR

CITY BETTENDORF

STATE IA

ZIP 527220000

EXCLTYPE 1128b14

EXCLDATE 19990120

UPDATE: SSN

LASTNAME MORALES

FIRSTNAME JESUS

MIDNAME

BUSNAME

GENERAL HOSPITAL


UPIN

NPI 0000000000

DOB 19681126

ADDRESS 426 GREENWOOD DRIVE

CITY SANTA CLARE

STATE CA

ZIP 950540000

EXCLTYPE 1128b4

EXCLDATE 20050420

REINDATE 00000000

UPDATE: SSN

LASTNAME MORGAN

FIRSTNAME MICHAEL

MIDNAME JAMES

BUSNAME



UPIN C72634

NPI 0000000000

DOB 19530722

ADDRESS 1274 GREGORY STREET

CITY MONTGOMERY

STATE AL

ZIP 361110000

EXCLTYPE 1128b4

EXCLDATE 19960611

REINDATE 00000000


LASTNAME MURDERS

FIRSTNAME HERMAN

MIDNAME D

BUSNAME

GENERAL DME COMPANY


UPIN

NPI 0000000000

DOB 19380705

ADDRESS 922 LOUISVILLE RD

CITY HARLEM

STATE GA

ZIP 308140000

EXCLTYPE 1128a1

EXCLDATE 19970305

REINDATE 00000000

UPDATE: SSN

LASTNAME MURPHY

FIRSTNAME SUSANNE

MIDNAME MARIE

BUSNAME

GENERAL HOSPITAL


UPIN

NPI 0000000000

DOB 19700914

ADDRESS 8308 ZANE AVE, N, #208NA

CITY MINNEAPOLIS

STATE MN

ZIP 554430000

EXCLTYPE 1128b4

EXCLDATE 20011018

REINDATE 00000000


LASTNAME MUSA

FIRSTNAME MARCO

MIDNAME M

BUSNAME

GENERAL OPTICAL PRACTICE

SPECIALTY OPTICIAN

UPIN

NPI 0000000000

DOB 19620401

ADDRESS 3460 SOUTH CONGRESS AVE

CITY LAKE WORTH

STATE FL

ZIP 334610000

EXCLTYPE 1128b4

EXCLDATE 19900306

REINDATE 00000000


LASTNAME NESKORIK

FIRSTNAME MICHAEL

MIDNAME STANLEY

BUSNAME



UPIN

NPI 0000000000

DOB 19560320

ADDRESS 1006 W CUSTER ST

CITY SEYMOUR

STATE TX

ZIP 763803911

EXCLTYPE 1128b4

EXCLDATE 20010419

REINDATE 00000000


LASTNAME NEWBERRY

FIRSTNAME LAWRENCE

MIDNAME

BUSNAME


SPECIALTY EMPLOYEE

UPIN

NPI 0000000000

DOB 19521104

ADDRESS 2225 HALLEY BARBOUR PKWY

CITY SIOUX CITY

STATE MS

ZIP 391940000

EXCLTYPE 1128a1

EXCLDATE 19980120

REINDATE 00000000

UPDATE: SSN

LASTNAME MASSAQUOI

FIRSTNAME MARTHA

MIDNAME MUNDA

BUSNAME


SPECIALTY PHYSICIAN ASSISTANT

UPIN

NPI 0000000000

DOB 19440110

ADDRESS 815 S WALNUT ST, APT 15

CITY INGLEWOOD

STATE CA

ZIP 903010000

EXCLTYPE 1128a1

EXCLDATE 19940605

REINDATE 00000000


LASTNAME MATHIS

FIRSTNAME NELSON

MIDNAME D

BUSNAME


SPECIALTY BUSINESS MANAGER

UPIN

NPI 0000000000

DOB 19581229

ADDRESS 502 W ALLEN ST, #8

CITY HENDERSONVILLE

STATE NC

ZIP 287390000

EXCLTYPE 1128a1

EXCLDATE 20010220

REINDATE 00000000

UPDATE: SSN

LASTNAME NEWTON

FIRSTNAME KIM

MIDNAME I

BUSNAME

GENERAL RADIOLOGY FACILITY

SPECIALTY TECHNICIAN

UPIN

NPI 0000000000

DOB 19590623

ADDRESS 4 CENTRAL STREET, APT 3

CITY RANDOLPH

STATE VT

ZIP 050601034

EXCLTYPE 1128b4

EXCLDATE 20070520

REINDATE 00000000

UPDATE: SSN

LASTNAME NICHOLS

FIRSTNAME DANIEL

MIDNAME G

BUSNAME


SPECIALTY DENTIST

UPIN

NPI 0000000000

DOB 19601202

ADDRESS 2815 SEGOVIA STREET

CITY CORAL GABLES

STATE FL

ZIP 331340000

EXCLTYPE 1128b4

EXCLDATE 20070419

REINDATE 00000000


LASTNAME NIETUPSKI

FIRSTNAME THOMAS

MIDNAME J

BUSNAME


SPECIALTY DENTIST

UPIN

NPI 0000000000

DOB 19361102

ADDRESS #08349-026, P O BOX 500

CITY OXFORD

STATE WI

ZIP 539520000

EXCLTYPE 1128b3

EXCLDATE 19920629

REINDATE 00000000


LASTNAME NORMAN

FIRSTNAME SHIRLEY

MIDNAME

BUSNAME

GENERAL DME COMPANY

SPECIALTY SALES/MARKET/RETAIL

UPIN

NPI 0000000000

DOB 19400531

ADDRESS 567 ROOSEVELT STREET

CITY TRENTON

STATE NJ

ZIP 986180000

EXCLTYPE 1128a1

EXCLDATE 19911016

REINDATE 00000000

UPDATE: SSN

LASTNAME NWAKWO

FIRSTNAME RAYMOND

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19600414

ADDRESS 5750 CERRITOS AVE, #1

CITY LONG BEACH

STATE CA

ZIP 908050000

EXCLTYPE 1128a1

EXCLDATE 20030919

REINDATE 00000000

UPDATE: SSN

LASTNAME OCLINARIA

FIRSTNAME DAVID

MIDNAME K

BUSNAME

GENERAL UNIVERSITY/COLLEGE

SPECIALTY HEALTH CARE AIDE

UPIN

NPI 0000000000

DOB 19660607

ADDRESS 85340 FARR HIGHWAY, #2

CITY WAIANAE

STATE HI

ZIP 967920000

EXCLTYPE 1128a2

EXCLDATE 20040420

REINDATE 00000000

UPDATE: SSN

LASTNAME OTT

FIRSTNAME RICHARD

MIDNAME M

BUSNAME

GENERAL PHARMACY


UPIN

NPI 0000000000

DOB 19620622


CITY ST PETERSBURG

STATE FL

ZIP 337430492

EXCLTYPE 1128b4

EXCLDATE 20020520

REINDATE 00000000

UPDATE: SSN

LASTNAME MADDEN

FIRSTNAME TONI

MIDNAME JO

BUSNAME



UPIN

NPI 0000000000

DOB 19690519

ADDRESS 3837 STRATFORD BLVD

CITY STEUBENVILLE

STATE OH

ZIP 439520000

EXCLTYPE 1128a1

EXCLDATE 20160120

REINDATE 00000000

UPDATE: SSN

LASTNAME MARTIN

FIRSTNAME CASSANDRA

MIDNAME

BUSNAME

GENERAL HOME HEALTH AGENCY


UPIN

NPI 0000000000

DOB 19710507

ADDRESS 168-30 105TH AVE

CITY JAMAICA

STATE NY

ZIP 114330000

EXCLTYPE 1128a1

EXCLDATE 20001120

REINDATE 00000000

UPDATE: GENERAL, SPECIALTY AND SSN

LASTNAME MARTINEZ

FIRSTNAME REBECCA

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19650510

ADDRESS 443 1/2 N VIRGIL AVE

CITY LOS ANGELES

STATE CA

ZIP 900040000

EXCLTYPE 1128a3

EXCLDATE 20020418

REINDATE 00000000

UPDATE: SSN

LASTNAME MARTINEZ

FIRSTNAME RITA

MIDNAME C

BUSNAME

GENERAL MENTAL HEALTH FAC


UPIN

NPI 0000000000

DOB 19481208

ADDRESS P O BOX 1029, FCI

CITY COLEMAN

STATE FL

ZIP 335210000

EXCLTYPE 1128a1

EXCLDATE 20020516

UPDATE: SSN

LASTNAME MASKARON

FIRSTNAME MICHAEL

MIDNAME P

BUSNAME



UPIN B20344

NPI 0000000000

DOB 19380217

ADDRESS 2112 AVENUE P

CITY BROOKLYN

STATE NY

ZIP 112290000

EXCLTYPE 1128b5

EXCLDATE 19960813

REINDATE 00000000


LASTNAME MAURER

FIRSTNAME NELSON

MIDNAME H

BUSNAME


SPECIALTY PODIATRY

UPIN T11484

NPI 0000000000

DOB 19540404

ADDRESS 710 LIGHTHOUSE AVE

CITY PACIFIC GROVE

STATE CA

ZIP 939500000

EXCLDATE 19971007

REINDATE 00000000


LASTNAME PACK

FIRSTNAME CARL

MIDNAME DAVID

BUSNAME

GENERAL DME COMPANY

SPECIALTY DME - GENERAL

UPIN

NPI 0000000000

DOB 19430314

ADDRESS 1024 W ROSE ROAD

CITY ASHLAND

STATE KY

ZIP 411020000

EXCLTYPE 1128b1

EXCLDATE 19930708

UPDATE: SSN

LASTNAME PAKCHAR

FIRSTNAME SETH

MIDNAME LANE

BUSNAME

GENERAL PHARMACY


UPIN

NPI 0000000000

DOB 19481209

ADDRESS 814 N 82ND STREET, #G-8

CITY SCOTTSDALE

STATE AZ

ZIP 852570000

EXCLTYPE 1128b4

EXCLDATE 19981020

REINDATE 00000000


LASTNAME PARKER

FIRSTNAME RICK

MIDNAME ALLEN

BUSNAME

GENERAL ADULT HOME


UPIN

NPI 0000000000

DOB 19580705

ADDRESS 875 CLEAR LAKE AVE

CITY WINCHESTER BAY

STATE OR

ZIP 973030000

EXCLTYPE 1128a1

EXCLDATE 19970904

REINDATE 00000000


LASTNAME PELINO

FIRSTNAME MILDRED

MIDNAME PATRICIA

BUSNAME

GENERAL CLINIC


UPIN

NPI 0000000000

DOB 19300228

ADDRESS 5025 LONGVIEW DR

CITY TROY

STATE MI

ZIP 480980000

EXCLTYPE 1128a1

EXCLDATE 19970807

REINDATE 00000000

UPDATE: SSN

LASTNAME PEOPLES

FIRSTNAME BARBARA

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19510801

ADDRESS ROUTE 1, BOX 61

CITY SYRACUSE

STATE MO

ZIP 653540000

EXCLTYPE 1128a2

EXCLDATE 19970630

REINDATE 00000000


LASTNAME PEREZ

FIRSTNAME RENE

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19300928

ADDRESS 6161 E 3RD AVENUE

CITY HIALEAH

STATE FL

ZIP 330130000

EXCLTYPE 1128a1

EXCLDATE 20020620

REINDATE 00000000

UPDATE: SSN

LASTNAME PET

FIRSTNAME DONALD

MIDNAME

BUSNAME


SPECIALTY NEPHROLOGY

UPIN D02510

NPI 0000000000

DOB 19360617

ADDRESS 93 BETTE DRIVE

CITY MANCHESTER

STATE CT

ZIP 060400000

EXCLTYPE 1128b4

EXCLDATE 19911121

REINDATE 00000000

UPDATE: SSN

LASTNAME PHILLIPS

FIRSTNAME JONI

MIDNAME MICHELLE

BUSNAME



UPIN

NPI 0000000000

DOB 19770706

ADDRESS 1022 HUNTERS MOUNTAIN PKWY

CITY TROY

STATE AL

ZIP 360790000

EXCLTYPE 1128b4

EXCLDATE 20150820

REINDATE 00000000

UPDATE: SSN, ADDRESS AND DECEASED

LASTNAME PIZZI

FIRSTNAME WILSON

MIDNAME B

BUSNAME


SPECIALTY SURGERY

UPIN C26052

NPI 0000000000

DOB 19180218

ADDRESS 900 BONAR AVENUE

CITY WAYNESBURG

STATE PA

ZIP 153700000

EXCLTYPE 1128a1

EXCLDATE 19950104

REINDATE 00000000


LASTNAME POIRIER


MIDNAME

BUSNAME



UPIN T31600

NPI 0000000000

DOB 19270502

ADDRESS 307 TURNER ROAD

CITY AUBURN

STATE ME

ZIP 042100000

EXCLTYPE 1128a1

EXCLDATE 19930714

REINDATE 00000000


LASTNAME PRAGER

FIRSTNAME HARRIS

MIDNAME J

BUSNAME


SPECIALTY PODIATRY

UPIN T77341

NPI 0000000000

DOB 19600723

ADDRESS 420 S CRAIN HIGHWAY

CITY GLEN BURNIE

STATE MD

ZIP 210610000

EXCLTYPE 1128b4

EXCLDATE 19940630

REINDATE 00000000

UPDATE: SSN

LASTNAME PHAM

FIRSTNAME MO

MIDNAME THI

BUSNAME

GENERAL DME COMPANY

SPECIALTY EMPLOYEE

UPIN

NPI 0000000000

DOB 19561012

ADDRESS P O BOX 5700, #28899-112

CITY ADELANTO

STATE CA

ZIP 923010000

EXCLTYPE 1128a1

EXCLDATE 20100120

REINDATE 00000000

UPDATE: SSN

LASTNAME RANDOLPH

FIRSTNAME AMANDA

MIDNAME MOYE

BUSNAME

GENERAL BUS OWNER/EXEC


UPIN

NPI 0000000000

DOB 19730117

ADDRESS P O BOX 14500, #19158-084

CITY LEXINGTON

STATE KY

ZIP 405120000

EXCLTYPE 1128a1

EXCLDATE 20160720

REINDATE 00000000

UPDATE: SSN, DOB AND DECEASED

LASTNAME RANES

FIRSTNAME RAYMOND

MIDNAME D

BUSNAME



UPIN C70343

NPI 0000000000

DOB 19270122

ADDRESS 245 N E 36TH AVENUE

CITY OCALA

STATE FL

ZIP 336130000

EXCLTYPE 1128b4

EXCLDATE 19941205

REINDATE 00000000

UPDATE: SSN

LASTNAME REESE

FIRSTNAME SUSAN

MIDNAME R

BUSNAME



UPIN

NPI 0000000000

DOB 19460721

ADDRESS 7014 MAPLE DRIVE

CITY URBANDALE

STATE IA

ZIP 503220000

EXCLTYPE 1128b4

EXCLDATE 19910811

REINDATE 00000000

UPDATE: SSN

LASTNAME REYES

FIRSTNAME ARISTEO

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19630903

ADDRESS 304 N LAUREL, #A

CITY SANTA ANA

STATE CA

ZIP 927030000

EXCLTYPE 1128b4

EXCLDATE 20030619

REINDATE 00000000

UPDATE: SSN

LASTNAME REYES

FIRSTNAME JUNIOR

MIDNAME BRAVO

BUSNAME


SPECIALTY SKILLED NURSING FAC

UPIN

NPI 0000000000

DOB 19890128

ADDRESS 7900 RANCH ROAD 2338

CITY GEORGETOWN

STATE TX

ZIP 786334103

EXCLTYPE 1128a3

EXCLDATE 20120620

REINDATE 00000000

UPDATE: SSN

LASTNAME REYES

FIRSTNAME MARTHA

MIDNAME GOMEZ

BUSNAME



UPIN

NPI 0000000000

DOB 19630410

ADDRESS 18 KENDALL ST

CITY GEORGETOWN

STATE TX

ZIP 786267795

EXCLTYPE 1128a3

EXCLDATE 20120320

REINDATE 00000000

UPDATE: SSN

LASTNAME REYNOLDS

FIRSTNAME KATHLEEN

MIDNAME DAWN

BUSNAME



UPIN

NPI 0000000000

DOB 19530522

ADDRESS 916 S MAPLE STREET

CITY LITTLE ROCK

STATE AR

ZIP 722042135

EXCLTYPE 1128b4

EXCLDATE 20120419

REINDATE 00000000


LASTNAME RIVERA

FIRSTNAME PATRICIA

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19400711

ADDRESS 425 MELROSE AVENUE

CITY MERION HEIGHTS

STATE PA

ZIP 178320000

EXCLTYPE 1128b4

EXCLDATE 19910905

REINDATE 00000000

UPDATE: SSN AND ADDRESS

LASTNAME ROBBINS-FITZGERALD

FIRSTNAME LYNN

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19541115

ADDRESS 1488 AMSTERDAM AVE, #1A

CITY NEW YORK

STATE NY

ZIP 100318945

EXCLTYPE 1128a1

EXCLDATE 20040120

REINDATE 00000000

UPDATE: SSN AND DOB

LASTNAME RODRIGUEZ

FIRSTNAME MARTHA

MIDNAME L

BUSNAME



UPIN

NPI 0000000000

DOB 19630616

ADDRESS 708 MEADOW CREEK

CITY ROUND ROCK

STATE TX

ZIP 785640000

EXCLTYPE 1128a3

EXCLDATE 20120320

UPDATE: SSN

LASTNAME ROGERS

FIRSTNAME KATHLEEN

MIDNAME JOANN

BUSNAME



UPIN

NPI 0000000000

DOB 19540430

ADDRESS 5419 FLAGSTONE STREET

CITY LONG BEACH

STATE CA

ZIP 908080000

EXCLTYPE 1128b4

EXCLDATE 20030919

REINDATE 00000000

UPDATE: SSN

LASTNAME ROSS

FIRSTNAME ANGELA

MIDNAME DENISE

BUSNAME

GENERAL INTER CARE FACILITY

SPECIALTY EMPLOYEE

UPIN

NPI 0000000000

DOB 19710104

ADDRESS 3408 S W 17TH ST

CITY OKLAHOMA

STATE OK

ZIP 731090000

EXCLTYPE 1128a2

EXCLDATE 19970317

REINDATE 00000000


LASTNAME ROWAN

FIRSTNAME ALOYSIUS

MIDNAME IGNATIUS

BUSNAME



UPIN D22188

NPI 0000000000

DOB 19230904

ADDRESS 1279 QUARI ST

CITY AURORA

STATE CO

ZIP 800116224

EXCLTYPE 1128b4

EXCLDATE 19980720

REINDATE 00000000


LASTNAME RUSNOCK

FIRSTNAME EUGENE

MIDNAME

BUSNAME

GENERAL LABORATORY


UPIN

NPI 0000000000

DOB 19380515

ADDRESS 231 S MAIN ST, STE 310

CITY GREENSBURG

STATE PA

ZIP 156010000

EXCLTYPE 1128a1

EXCLDATE 19890727

REINDATE 00000000

UPDATE: SSN

LASTNAME SANCHEZ

FIRSTNAME MARY

MIDNAME ANTONIA

BUSNAME



UPIN

NPI 0000000000

DOB 19560209

ADDRESS P O BOX 622

CITY MOUNTAIN VIEW

STATE CA

ZIP 940420000

EXCLTYPE 1128a1

EXCLDATE 20120520

REINDATE 00000000

UPDATE: SSN

LASTNAME SAWYER

FIRSTNAME STARLA

MIDNAME S

BUSNAME

GENERAL HOSPITAL


UPIN

NPI 0000000000

DOB 19510903

ADDRESS 1777 W 30TH ST

CITY YUMA

STATE AZ

ZIP 853640000

EXCLTYPE 1128b4

EXCLDATE 20020718

REINDATE 00000000

UPDATE: SSN

LASTNAME SCHONBRUN

FIRSTNAME DAVID

MIDNAME

BUSNAME

GENERAL DME COMPANY


UPIN

NPI 0000000000

DOB 19420910

ADDRESS 803 LEW STREET

CITY WOODBRIDGE

STATE NY

ZIP 127890000

EXCLTYPE 1128a1

EXCLDATE 19950216

REINDATE 00000000


LASTNAME SCHOPFER

FIRSTNAME RALPH

MIDNAME E

BUSNAME


SPECIALTY ANESTHESIOLOGY

UPIN B96074

NPI 0000000000

DOB 19202021

ADDRESS 712 VALLAMONT DRIVE

CITY WILLIAMSPORT

STATE PA

ZIP 177010000

EXCLTYPE 1128a1

EXCLDATE 19880630

REINDATE 00000000

UPDATE: SSN

LASTNAME SHELBY

FIRSTNAME CRAIG

MIDNAME T

BUSNAME


SPECIALTY EMPLOYEE

UPIN

NPI 0000000000

DOB 19551220

ADDRESS 6102 GREAT OAKS DR

CITY LITHONIA

STATE GA

ZIP 300580000

EXCLTYPE 1128a1

EXCLDATE 20021020

REINDATE 00000000

UPDATE: SSN

LASTNAME SHERIDAN

FIRSTNAME CHARMAYNE

MIDNAME T

BUSNAME



UPIN

NPI 0000000000

DOB 19421014

ADDRESS 2828 SUMMERFIELD ROAD

CITY FALLS CHURCH

STATE VA

ZIP 220420000

EXCLTYPE 1128b4

EXCLDATE 19891221

REINDATE 00000000

UPDATE: SSN

LASTNAME SMETANA

FIRSTNAME DENNIS

MIDNAME G

BUSNAME


SPECIALTY OPHTHALMOLOGY

UPIN B13039

NPI 0000000000

DOB 19470219

ADDRESS 324 E 41ST ST, #1002C

CITY NEW YORK

STATE NY

ZIP 100170000

EXCLTYPE 1128b4

EXCLDATE 20060119

REINDATE 00000000

UPDATE: SSN

LASTNAME SMITH

FIRSTNAME CAROL

MIDNAME ANN

BUSNAME



UPIN

NPI 0000000000

DOB 19470729

ADDRESS 15438 FUGALE COURT

CITY MORENO VALLEY

STATE CA

ZIP 925510000

EXCLTYPE 1128b4

EXCLDATE 20040219

REINDATE 00000000

UPDATE: SSN AND DOB

LASTNAME MABRY

FIRSTNAME DONNIE

MIDNAME ALENE

BUSNAME



UPIN

NPI 0000000000

DOB 19220822

ADDRESS 121 SHIELDS ROAD

CITY MERIDIAN

STATE MS

ZIP 393019140

EXCLTYPE 1128b4

EXCLDATE 20081020

REINDATE 00000000


LASTNAME PARRI

FIRSTNAME BERNADETTE

MIDNAME

BUSNAME



UPIN

NPI 0000000000

DOB 19520420

ADDRESS 322 VIRGINIA AVENUE

CITY PECKVILLE

STATE PA

ZIP 184520000

EXCLTYPE 1128a4

EXCLDATE 20000518

REINDATE 00000000

UPDATE: SSN

LASTNAME PASHA

FIRSTNAME MAHZAR

MIDNAME

BUSNAME

GENERAL DME COMPANY


UPIN

NPI 0000000000

DOB 19520901

ADDRESS MAXWELL AFB, #56741-019

CITY MONTGOMERY

STATE AL

ZIP 361120000

EXCLTYPE 1128a1

EXCLDATE 20050818

REINDATE 00000000


LASTNAME PATRICK

FIRSTNAME SHARON

MIDNAME LOUISE

BUSNAME

GENERAL PRIVATE CIT/ENTITY


UPIN

NPI 0000000000

DOB 19460811

ADDRESS 8139 SUNSET AVE, #250

CITY FAIR OAKS

STATE CA

ZIP 956280000

EXCLTYPE 1128a1

EXCLDATE 19990520

REINDATE 00000000

UPDATE: SSN

LASTNAME PATTERSON

FIRSTNAME CAROLYN

MIDNAME E

BUSNAME

GENERAL HOSPITAL


UPIN

NPI 0000000000

DOB 19550627

ADDRESS 5601 CAMPBELL AVE

CITY RICHMOND

STATE VA

ZIP 232310000

EXCLTYPE 1128b4

EXCLDATE 20020820

REINDATE 00000000

UPDATE: SSN

LASTNAME PATTERSON

FIRSTNAME RICHARD

MIDNAME J

BUSNAME



UPIN C29863

NPI 0000000000

DOB 19300811

ADDRESS P O BOX 303

CITY ELTON

STATE PA

ZIP 159340000

EXCLTYPE 1128b3

EXCLDATE 19910627

REINDATE 00000000

UPDATE: SSN

LASTNAME PAULSON

FIRSTNAME MARION

MIDNAME E

BUSNAME



UPIN

NPI 0000000000

DOB 19410127

ADDRESS 5330 COLFAX STREET, NORTH

CITY MINNEAPOLIS

STATE MN

ZIP 554300000

EXCLTYPE 1128b4

EXCLDATE 19920907

REINDATE 00000000


LASTNAME PAYNE

FIRSTNAME JOHN

MIDNAME H

BUSNAME



UPIN

NPI 0000000000

DOB 19521204

ADDRESS 1812 NW 39TH ST, APT 106

CITY OKLAHOMA CITY

STATE OK

ZIP 731180000

EXCLTYPE 1128b4

EXCLDATE 19910613

REINDATE 00000000


LASTNAME PEACE

FIRSTNAME TAMMY

MIDNAME JUNE

BUSNAME



UPIN

NPI 0000000000

DOB 19681110

ADDRESS P O BOX 111

CITY CAWOOD

STATE KY

ZIP 408150000

EXCLTYPE 1128b4

EXCLDATE 20031020

REINDATE 00000000

updated leie information - office of inspector generalupdated leie information january 2020 update:...

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