clia annual laboratory registry 2008 · loris tisocco md, director calumet dermatology associates...

1

CLIA ANNUAL LABORATORY REGISTRY

2008

Once a year the Centers for Medicare and Medicaid Services makes available to physicians and to

the general public specific information (including information provided to CMS by the Office of

the Inspector General) that is useful in evaluating the performance of laboratories. The Clinical

Laboratory Improvement Amendments of 1988 (CLIA) and implementing regulations at 42 CFR

493.1850 require that this listing include the following:

(1) A list of laboratories that have been convicted, under Federal or State laws relating to fraud

and abuse, false billing, or kickbacks.

(2) A list of laboratories that have had their CLIA certificates suspended, limited, or revoked,

and the reasons for the adverse actions.

(3) A list of persons who have been convicted of violating CLIA requirements, as specified in

section 353(1) of the PHS Act, together with circumstances of each case and the penalties

imposed.

(4) A list of laboratories on which alternative sanctions have been imposed, showing--

(i) the effective date of the sanctions;

(ii) the reason for imposing them;

(iii) any corrective action taken by the laboratory;

(iv) if the laboratory has achieved compliance, the verified date of compliance.

(5) A list of laboratories whose accreditation has been withdrawn or revoked and the reasons

for the withdrawal or revocation.

(6) All appeals and hearing decisions.

(7) A list of laboratories against which CMS has brought suit under Section 493.1846 and the

reasons for those actions.

(8) A list of laboratories that have been excluded from participation in Medicare or Medicaid

and the reasons for exclusion.

Civil settlements reached with clinical laboratories are also noted.

The Laboratory Registry is compiled for the calendar year preceding the date the information is

made available and also contains corrections of any erroneous statements of information that

appeared in the previous registry. A final section includes other specific information that may be

useful in evaluating the performance of laboratories, as specified in 42 CFR 493.1850(a). It also

includes information provided by CLIA exempt states.

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2008 CLIA LAB REGISTRY

(AS REQUIRED BY SECTION 353(N) OF THE PUBLIC HEALTH SERVICE ACT)

ACTIVITY 01/01/2008 - 12/31/2008

1. LABORATORIES SUBJECT TO CLIA THAT HAVE BEEN CONVICTED,

UNDER FEDERAL OR STATE LAWS RELATING TO FRAUD AND

ABUSE, FALSE BILLING, OR KICKBACKS.

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2. LABORATORIES THAT HAVE HAD THEIR CLIA CERTIFICATE SUSPENDED,

LIMITED, OR REVOKED, AND THE REASON FOR THE ADVERSE ACTION.

(MEDICARE CANCELLATION, A PRINCIPAL SANCTION, HAS BEEN INCLUDED

IN THIS CATEGORY.)

BENJAMIN HESTER MD, DIRECTOR

ETOWAH PEDIATRICS

115 WEST GRAND AVENUE SUITE 90

RAINBOW CITY, AL 35906

CLIA ID# 01D1048892

SANCTION: LIMITATION OF CLIA CERTIFICATE

EFFECTIVE DATE: AUGUST 02, 2008

REASON: CONDITION LEVEL NONCOMPLIANCE

DEBORAH JOHNSON, DIRECTOR

WHITE RIVER MEDICAL CENTER RESPIRATORY DEPARTMENT

1710 HARRISON STREET

BATESVILLE, AR 72503

CLIA ID# 02D0698091

SANCTION: REVOCATION OF CLIA CERTIFICATE



BEATRICE STRONG MD, DIRECTOR

PAGE HOSPITAL

501 N NAVAJO DRIVE

GE, AZ 86040

CLIA ID# 03D0533870

SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL

REVOCATION OF CLIA CERTIFICATE

LIMITATION OF CLIA CERTIFICATE

EFFECTIVE DATE: FEBRUARY 14, 2008

REASON: CANCELLATION OF MEDICARE APPROVAL REVOCATION

CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE

JEOPARDY;IMPROPER PROFICIENCY TESTING REFERRAL

ACTIVITIES REVOCATION OF CLIA CERTIFICATE

4

SESHAGIRIRAO PEMMARAJU, DIRECTOR

ST JOSEPHS MERCY HEALTH CENTER

300 WERNER STREET PO BOX 29001

HOT SPRINGS, AR 71903

CLIA ID# 04D0049541



SUSPENSION OF CLIA CERTIFICATE

EFFECTIVE DATE: MARCH 31, 2008

REASON: IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES

CANCELLATION OF MEDICARE APPROVAL SUSPENSION


DEBORAH JOHNSON, DIRECTOR

WHITE RIVER MEDICAL CENTER

1710 HARRISON

BATESVILLE, AR 72503

CLIA ID# 04D0642309




EFFECTIVE DATE: JUNE 23, 2008



JEOPARDY

KEVIN FALWELL M D, DIRECTOR

KEVIN WADE FALWELL, MD

2000 MCLAIN STREET, SUITE G

NEWPORT, AR 72112

CLIA ID# 04D0723190




UNSUCCESSFUL PROFICIENCY TESTING

5

IVAN MARTINEZ, DIRECTOR

IVAN P MARTINEZ MD INC

500 S ANAHEIM HILLS RD #200

ANAHEIM, CA 92807

CLIA ID# 05D0582781


EFFECTIVE DATE: MAY 30, 2008

REASON: MEDICARE CANCELLATION/SUSPENSION

CONDITION LEVEL NONCOMPLIANCE


SOO CHUNG MD, DIRECTOR

SOO M CHUNG MD, ONCOLOGY/HEMATOLOGY

A PROFESSIONAL CORPORATION

12555 GARDEN GROVE BLVD STE 309

GARDEN GROVE, CA 92843

CLIA ID# 05D0675453


EFFECTIVE DATE: JANUARY 24, 2008




STATUS: SUSPENSION AND LIMITATION LIFTED

STANLEY SCHINKE MD, DIRECTOR

HEMATOLOGY/ONCOLOGY CONSULTANTS

301 NORTH SAN JACINTO STREET

HEMET, CA 92543

CLIA ID# 05D0688544


EFFECTIVE DATE: JULY 03, 2008

REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION



6

MARIO KOHAN, MD, DIRECTOR

LAB-ALL INC

2200 WEST 7TH STREET SUITE 305

LOS ANGELES, CA 90057

CLIA ID# 05D0692916






BAHRAM PARSA MD PHD, DIRECTOR

100 PLAZA CLINICAL LABORATORY

100 UCLA MEDICAL PLAZA #245


CLIA ID# 05D0864476




CONDITION LLEVEL NONCOMPLIANCE


JOHN CRAIG, MD, DIRECTOR

KINDRED HOSPITAL BREA

875 NORTH BREA BOULEVARD

BREA, CA 92821

CLIA ID# 05D0896064




EFFECTIVE DATE: APRIL 28, 2008

REASON: CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE

JEOPARDY IMPROPER PROFICIENCY TESTING REFERRAL

ACTIVITIES MEDICARE CANCELLATION/SUSPENSION

7

GREGORY SKIPITIS MD, DIRECTOR

OBSTETRICS & GYNECOLOGY MEDICAL

ASSOCIATES OF REDDING, INC

2626 EDITH AVENUE, #B

REDDING, CA 96001

CLIA ID# 05D0928170






MICHAEL TAHERY MD, DIRECTOR

MICHAEL TAHERY MD, INC

633 NORTH CENTRAL #309

GLENDALE, CA 91203

CLIA ID# 05D0940223





UNSUCESSFUL PROFICIENCY TESTING

SYED AHMED, MD, DIRECTOR

ONCOLOGY & HEMATOLOGY OF IMPERIAL VALLEY

1410 SOUTH LA BRUCHERIE ROAD #A

EL CENTRO, CA 92243

CLIA ID# 05D0970349






8

MUSTAFA MAHDAVY MD, DIRECTOR

NU ERA CLINICAL LABORATORIES,INC

18341 SHERMAN WAY, #201A

RESEDA, CA 91335

CLIA ID# 05D1055182



EFFECTIVE DATE: DECEMBER 29, 2008



LAB OWNER/OPER PROHIBITED FROM OWNING LAB

MICHAEL SHARON MD, DIRECTOR

MICHAEL R SHARON MD

520 HARTFORD TURNPIKE UNIT P

VERNON, CT 06066

CLIA ID# 07D0093205







FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION

AMERY WIRTSHAFTER MD, DIRECTOR

UROLOGICAL CONSULTANTS OF FLORIDA PA

1400 NE MIAMI GARDENS DRIVE #209

NORTH MIAMI BEACH, FL 33179

CLIA ID# 10D0283815



REASON: UNSUCCESSFUL PROFICIENCY TESTING

STATUS: COMPLIANCE ACHIEVED

9

PRATIBHA DESAI MD, DIRECTOR

PINELLAS HEMATOLOGY & ONCOLOGY PA

1609 PASADENA AVE S #2E

SAINT PETERSBURG, FL 33707

CLIA ID# 10D0291394



REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT

CONDITION LEVEL NONCOMLPIANCE

FAILURE TO CORRECT DEFICIENCES

NORMAN URICH DO, DIRECTOR

NORMAN URICH DO PA

1762 N FORT HARRISON AVE

CLEARWATER, FL 33755

CLIA ID# 10D0296645


EFFECTIVE DATE: SEPTEMBER 22, 2008


JAMES BANNISTER, DIRECTOR

MEDICAL ARTS LABORATORY

257 NORTH CAUSE WAY

NEW SMYRNA BEACH, FL 32169

CLIA ID# 10D0645062




STATUS: CERTIFICATE REINSTATED

10

EUGENE WILLIAMS JR MD, DIRECTOR

COLUMBUS WOMEN'S HEALTH ORGANIZATION

3850 ROSEMONT DRIVE

COLUMBUS, GA 31904

CLIA ID# 11D0266568




STATUS: LAB VOLUNTARILY CEASED TESTING

STEVEN GARNER MD, DIRECTOR

MEDICAL CENTER,THE

908 HILLCREST PKWY

DUBLIN, GA 31021

CLIA ID# 11D0699024




FAILURE TO CORRECT DEFICIENCIES



DOUGLAS GRESHAM, DIRECTOR

DOUGLAS G GRESHAM MD

340 EISENHOWER DR BLDG 1600

SAVANNAH, GA 31406

CLIA ID# 11D0724287





CERTIFICATE REINSTATED

11

ROHIT DESAI, DIRECTOR

STONE MOUNTAIN FAMILY MEDICINE

1183 A S HAIRSTON ROAD

STONE MOUNTAIN, GA 30088

CLIA ID# 11D0855841






W MERRILL HICKS JR MD, DIRECTOR

NEPHROLOGY CONSULTANTS PC

334 SMITH AVENUE

THOMASVILLE, GA 31792

CLIA ID# 11D0895468





COLLIER GLADIN JR MD, DIRECTOR

COLLIER B GLADIN JR MD

FAMILY MEDICINE

140 NORTH CREST BOULEVARD

MACON, GA 31210

CLIA ID# 11D0948963






SUSPENSION AND LIMITATION LIFTED

12

RUTH SARMIENTO, DIRECTOR

PREMIER HEMATOLOGY AND CANCER CARE PC

7823 SPIVEY STATION BOULEVARD SUITE 300

JONESBORO, GA 30236

CLIA ID# 11D1011807




ROBERT BENSON MD, DIRECTOR

EAST GEORGIA URGENT CARE

4451 COUNTRY CLUB ROAD SUITE 3 A

STATESBORO, GA 30458

CLIA ID# 11D1052555




GREEN CLYDE OCTAVIUS MD, DIRECTOR

ATLANTA CLINICAL LABORATORIES INCORPORATE

1122 GRAY HIGHWAY SUITE 3

MACON, GA 31211

CLIA ID# 11D1064487




JOHN KALAMARIS MD, DIRECTOR

TINLEY PRIMARY CARE LTD

17148 S HARLEM AVE

TINLEY PARK, IL 60477

CLIA ID# 14D0982226






MEDICARE CANCELLATION/SUSPENSION



13

LORIS TISOCCO MD, DIRECTOR

CALUMET DERMATOLOGY ASSOCIATES SC

275 US RT 30/JOLIET ROAD SUITE 225

DYER, IN 46311

CLIA ID# 15D1073490

SANCTION: CANCELLATION OF MEDICARE/MEDICAID APPROVAL





JAMES CREWS, DIRECTOR

JAMES P CREWS MD

207 N DIXIE HWY BOX 486

CAVE CITY, KY 42127

CLIA ID# 18D0325880




UNSUCCESSFUL PROIFICENCY TESTING




MARCUS BLACK, DIRECTOR

HEMATOLOGY & ONCOLOGY SERVICE LLC

4224 HOUMA BOULEVARD, SUITE 300

METAIRIE, LA 70006

CLIA ID# 19D0457265





2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT

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ANTHONY PALAZZO, DIRECTOR

ANTHONY J PALAZZO, MD, APMC

THE PEDIATRIC CLINIC

405 AVENUE F

BOGALUSA, LA 70427

CLIA ID# 19D0460154



REASON: FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION



ABDALLA ELIAS MD, DIRECTOR

CALDWELL MEMORIAL HOSPITAL

411 MAIN STREET

COLUMBIA, LA 71418

CLIA ID# 19D0465005






JEOPARDY CANCELLATION OF MEDICARE APPROVAL


JAMES FORTINO, DIRECTOR

JAMES M FORTINO, MD

1301 WHITNEY AVENUE

GRETNA, LA 70056

CLIA ID# 19D0675393


EFFECTIVE DATE: OCTOBER 29, 2008




COMPLIANCE ACHIEVED

15

AGUSTIN SUAREZ, DIRECTOR

HEMATOLOGY AND ONCOLOGY SPECIALISTS,

LLC

1045 FLORIDA AVE

SLIDELL, LA 70458

CLIA ID# 19D0722517

SANCTION: CANCELLATION OF MEDICARE/MEDICAD APPROVAL





AGUSTIN SUAREZ, DIRECTOR

HEMATOLOGY AND ONCOLOGY SPECIALISTS, LLC

39 STARBRUSH CIRCLE

COVINGTON, LA 70433

CLIA ID# 19D0722518






KATHERINE MCCORMICK, DIRECTOR

HEMATOLOGY AND ONCOLOGY SERVICES, LLC

3525 PRYTANIA STREET STE 302

NEW ORLEANS, LA 70115

CLIA ID# 19D0883278






16

MARK OPERARIO, MD, DIRECTOR

RURAL HEALTH CLINIC OF LOUISIANA

421 MAIN STREET

COLUMBIA, LA 71418

CLIA ID# 19D0891507





ROBERT KESSLER MD, DIRECTOR

HEMATOLOGY AND ONCOLOGY SERVICES LLC

1111 MEDICAL CENTER BLVD SUITE S-630

MARRERO, LA 70072

CLIA ID# 19D0939261


REVOCATION OF CERTIFICATE




CHAD HEINEN MD, DIRECTOR

CHAD N HEINEN, MD

4419 HWY 7 NORTH

HOT SPRINGS VILLAGE, AR 71910

CLIA ID# 19D0963943







ELIZABETH PHILLIPS, MD, DIRECTOR

PHILLIPS MEDICAL CORPORATION

101 MADISON SQUARE

MINDEN, LA 71055

CLIA ID# 19D0977062




17

AMY HOLMES, MD, DIRECTOR

STAT LAB I, INC

7922 SUMMA AVENUE, SUITE A

BATON ROUGE, LA 70809

CLIA ID# 19D0990153





JEAPORDY REVOCATION OF CLIA CERTIFICATE

STATUS: HEARING REQUESTED

DAVID DESHOTELS, DIRECTOR

GULF COAST RESEARCH ASSOCIATES, INC

4416 JOHNSTON STREET SUITE 2

LAFAYETTE, LA 70503

CLIA ID# 19D1038631





DAVID DESHOTELS, DIRECTOR

GULF COAST RESEARCH ASSOCIATES INC

2133 SILVERSIDE DRIVE SUITE D


CLIA ID# 19D1038632





18

CHARLES REED, DIRECTOR

WISNER RURAL HEALTH CLINIC

176 WATSON STREET

WISNER, LA 71378

CLIA ID# 19D1057488





LINDA BABIN, DIRECTOR

GULF COAST RESEARCH LLC

7049 PERKINS ROAD


CLIA ID# 19D1067462




REASON: CONITION LEVEL NONCOMPLIANCE

AYUB YOUSUFI PHD, DIRECTOR

AMERICAN DIAGNOSTIC LABORATORIES INC

15749 CRABBS BRANCH WAY

ROCKVILLE, MD 20855

CLIA ID# 21D0909442





THOMAS DOBBINS, DIRECTOR

MARSHALL MEDICAL ASSOCIATES PC

1174 W MICHIGAN AVENUE

MARSHALL, MI 49068

CLIA ID# 23D0377802





19

THOMAS DOBBINS, DIRECTOR

ALBION MEDICAL ASSOCIATES

214 E MICHIGAN AVE

ALBION, MI 49224

CLIA ID# 23D0378714





REASON: CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATED

JEOPARDY

GARY PUSATERI, DIRECTOR

LAC VIEUX DESERT TRIBAL HEALTH CLINIC

E-23970 CHOATE ROAD

WATERSMEET, MI 49969

CLIA ID# 23D0382454





DAVID SOVA, DO, DIRECTOR

EAST PARIS FAMILY PRACTICE, PLLC

4551 CASCADE ROAD SE SUITE D

GRAND RAPIDS, MI 49546

CLIA ID# 23D0963679





JEOPARDY FAILURE TO SUBMIT ACCEPTABLE PLAN OF

CORRECTION

STATUS: RESCISSION OF MEDICARE CANCEL/CLIA SUSPENSION

20

STANLEY LEVY MD, DIRECTOR

ASSOCIATED INTERNISTS, PC

26206 W TWELVE MILE ROAD SUITE 300

SOUTHFIELD, MI 48034

CLIA ID# 23D0983891




IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES

GUY FARMER MD, DIRECTOR

CALHOUN CITY MEDICAL CLINIC - GUY FARMER MD

120 BURK-CC ROAD P O BOX 599

CALHOUN CITY, MS 38916

CLIA ID# 25D0317218





ISAAC AULTMAN, DIRECTOR

ISAAC AULTMAN MD

2747 OLD CANTON RD

JACKSON, MS 39216

CLIA ID# 25D0318374





21

GREGORY ALLEN MT, DIRECTOR

COASTAL FAMILY HEALTH CENTER-GULFPORT

15024 MARTIN LUTHER KING JR BOULEVARD

GULFPORT, MS 39501

CLIA ID# 25D0319607






THOMAS BLANKS, DIRECTOR

MEDICAL FOUNDATION OF SOUTH MS MAIN LAB AT

BROAD AVENUE INTERNAL MEDICINE

1110 BROAD AVENUE SUITE 700

GULFPORT, MS 39501

CLIA ID# 25D0932837






JAMES ROBERTS, DIRECTOR

DR JAMES E ROBERTS MD PA

439 NORTH JACKSON STREET

BROOKHAVEN, MS 39602

CLIA ID# 25D0954341




22

JOHN FULLENWIDER MD, DIRECTOR

CPC REFERENCE LABORATORIES INC

109 W BANKHEAD STREET

NEW ALBANY, MS 38652

CLIA ID# 25D0980066


SUSPENSION OF CLIA CERITFICATE




CONDITION LEVEL NONCOMPLIANCE WITH

IMMEDIATE JEOPARDY REVOCATION OF CLIA

CERTIFICATE

MICHAEL VINCENT, DIRECTOR

DIAGNOSTIC & TREATMENT CENTER

1475 BERGEN BLVD

FORT LEE, NJ 07024

CLIA ID# 31D0104097




DONALD WARKENTIN PHD, DIRECTOR

EXCELL CLINICAL LABORATORY

1 ETHEL ROAD BLDG 103 SUITE B

EDISON, NJ 08817

CLIA ID# 31D1048389



REASON: CONDITION LEVEL NONCOMPLIANCE WITH

IMMEDIATED JEOPARDY FAILURE TO CORRECT DEFICIENCIES


23

JULENE MOORE MD, DIRECTOR

MINERS COLFAX MEDICAL CENTER

200 HOSPITAL DRIVE

RATON, NM 87740

CLIA ID# 32D0536877





MICHAEL SERGEANT MD, DIRECTOR

HMS-MED SQUARE

114 W 11TH STREET

SILVER CITY, NM 88061

CLIA ID# 32D0537243






COMPLIANCE ACHIEVED

OLITSA ROTH, DIRECTOR

OLITSA ROTH MD

5211 15TH AVENUE

BROOKLYN, NY 11219

CLIA ID# 33D0146454




24

ANDREW GOLDSTEIN, DIRECTOR

ANDREW M GOLDSTEIN MD

128 HEWLETT AVE

MERRICK, NY 11566

CLIA ID# 33D0154394




YONGMEI YIN, DIRECTOR

LONG ISLAND GASTROINTESTINAL GROUP PC

131 W MERRICK RD STE 1

MERRICK, NY 11566

CLIA ID# 33D0154446




CARY LEVINE MD, DIRECTOR

SOUTHSHORE MEDICAL ASSOCIATES PC

291 SUNRISE HWY

LINDENHURST, NY 11757

CLIA ID# 33D0157976





25

ROMEO BALAGOT, DIRECTOR

ROMEO D BALAGOT MD

4277 HEMPSTEAD TPKE

BETHPAGE, NY 11714

CLIA ID# 33D0698051




REZKALLAH TORO, DIRECTOR

ONEIDA PEDIATRIC GROUP PC

421 MAIN STREET

ONEIDA, NY 13421

CLIA ID# 33D0855598





LEV PAUKMAN, DIRECTOR

LEV J PAUKMAN MD

396 AVE X

BROOKLYN, NY 11223

CLIA ID# 33D0858630





26

THOMAS POWERS, DIRECTOR

MARINE PARK PEDIATRICS PC

3123 QUENTIN ROAD

BROOKLYN, NY 11234

CLIA ID# 33D0971175






COMPLIANCE ACHIEVED

ROOPA KHURANA, DIRECTOR

HEALTH CARE MEDICAL ASSOCIATES PC

2 PERLMAN DRIVE SUITE 101

SPRING VALLEY, NY 10977

CLIA ID# 33D1015554

SANCTION: SUSPENSION OF CLIA CERTIFICATE




COMPLIANCE ACHIEVED

YOSHIRO MATSUO, DIRECTOR

BROOME ONCOLOGY PLLC

DBA NORTHERN CATSKILL CANCER CENTER

ONE FOXCARE DRIVE, SUITE 310

ONEONTA, NY 13820

CLIA ID# 33D1059955


EFFECTIVE DATE: NOVEMBER 01, 2008



27

ENRICO JONES MD, DIRECTOR

FRIENDLY URGENT AND FAMILY CARE

5409 W FRIENDLY AVE

GREENSBORO, NC 27410

CLIA ID# 34D0979446






JOHN JACKSON DO, DIRECTOR

JACKSON FAMILY CLINIC

410 EAST CHEROKEE

WAGONER, OK 74467

CLIA ID# 37D0475332






COMPLIANCE ACHIEVED

ANA ORTIZ, DIRECTOR

LABORATORIO CLINICO SANTA ANA

CARR 107 KM 2 2 BO BORINQUEN

AGUADILLA, PR 00603

CLIA ID# 40D0657981

SANCTION: LIMITATION OF CLIA CERTIFICATE CANCELLATION OF

MEDICARE/MEDICAID APPROVAL



REASON: UNSUCCESSFUL PROFICIENCY TESTING FAILURE

TO SUBMIT ACCEPTABLE PLAN OF CORRECTION

28

LUZ DE LA CRUZ, DIRECTOR

LABORATORIO CLINICO HORMIGUEROS

3 RUIZ BELVIS ST

HORMIGUEROS, PR 00660

CLIA ID# 40D0658103






COMPLIANCE ACHIEVED

RAFAEL GARCIA, DIRECTOR

LAB CLINICO GARCIA

CALLE 65 INFANTERIA #67

ANASCO, PR 00610

CLIA ID# 40D0693411




WILLIAM RIOS VELEZ, DIRECTOR

HOSPITAL EL BUEN PASTOR

AVE DE DIEGO #52

ARECIBO, PR 00612

CLIA ID# 40D0716971




ELLIOT ACEVEDO SOTO, DIRECTOR

LABORATORIO CLINICO PUJOLS

CARR PR-111 KM 17 HM 9 BO GUATEMALA

SAN SEBASTIAN, PR 00685

CLIA ID# 40D0982044




29

IFEDIORA AFULUKWE M D, DIRECTOR

HEATH SPRINGS MEDICAL CENTER

209 SOUTH COLLEGE ST

HEATH SPRINGS, SC 29058

CLIA ID# 42D0958536







STATUS: REVOCATION OF CLIA CERTIFICATE

APPEAL FILED BY LAB

HEARING DECISION SUSTAINED CMS SANCTION DETERMINED

MARK JOSOVITZ MD, DIRECTOR

STONES RIVER MEDICAL GROUP PC

726 S CHURCH STREET

MURFREESBORO, TN 37130

CLIA ID# 44D0956234

SANCTION: CANCEL OF MEDICARE/MEDICAID APPROVAL



REASON: FAILURE TO SUBMIT ACCEPTABLE POC


BRETT WAYNE DARWIN MD, DIRECTOR

PHOENIX MEDICAL GROUP PLLC

740 CONFERENCE DR

GOODLETTSVILLE, TN 37072

CLIA ID# 44D0965109





30

JOHN HOOD, DIRECTOR

VILLAGE MEDICAL CENTER

6201 MATLOCK RD #139

ARLINGTON, TX 76002

CLIA ID# 45D0484813






COMPLIANCE ACHIEVED

MARGARET PAYNE, DIRECTOR

PAYNE PEDIATRIC ASSOCIATES LTD LLP

6400 FANNIN, SUITE 2020

HOUSTON, TX 77004

CLIA ID# 45D0491544





DEVEN BHACHAWAT MD, DIRECTOR

LONE STAR CANCER AND BLOOD DISORDER PA

515 NORTH KING SUITE 104

SEGUIN, TX 78155

CLIA ID# 45D0500257






IMMEDIATE JEOPARDY

31



925 SAN PEDRO AVENUE SUITE B

SAN ANTONIO, TX 78212

CLIA ID# 45D0501716





WITH IMMEDIATE JEOPARDY

2 YEAR PROHIBIT FROM OWN, OPERATE OR DIRECT

LUZ CANDELARIA, DIRECTOR

CANDELARIA MEDICAL CENTER

8269 NORTH LOOP DRIVE

EL PASO, TX 79907

CLIA ID# 45D0509818




UNSUCCESSFUL PROFICIECNY TESTING


COMPLIANCE ACHIEVED

JAMES HUMPHREYS, MD, DIRECTOR

MIDLAND HEALTH & SENIOR SERVICES

3303 WEST ILLINOIS, SPACE 22

MIDLAND, TX 79701

CLIA ID# 45D0679743






32

AJIT DAVE MD, DIRECTOR

AJIT DAVE MD PA

3327 COLORADO BOULEVARD SUITE 200

DENTON, TX 76210

CLIA ID# 45D0716753






IMMEDIATE JEOPARDY

HAROLD PEAN, DIRECTOR

MISSION INTERNAL MEDICINE

909 BUSINESS PARK SUITE #6

MISSION, TX 78572

CLIA ID# 45D0884401






COMPLIANCE ACHIEVED

IVAN MCLENDEZ, DIRECTOR

SCIENTIFIC MEDICAL LABORATORY

2704-A EAST GRIFFIN PARKWAY

MISSION, TX 78572

CLIA ID# 45D0888276






33

IYABO ELEMUREN, DIRECTOR

FAMILY MEDICINE CLINIC

740 SOUTH AMY LANE

HARKER HEIGHTS, TX 76548

CLIA ID# 45D0967024





IMMEDIATE JEOPARDY

JAMES BRUCE, DIRECTOR

DICKERSON MEMORIAL HOSPITAL

1001 DICKERSON DRIVE

JASPER, TX 75951

CLIA ID# 45D0977340





IMMEDIATE JEOPARDY


PRATHIVADI RAMAMANI MD, DIRECTOR

CLINICA MEDICA DE DALLAS

4811A COLUMBIA AVENUE

DALLAS, TX 75226

CLIA ID# 45D0989088






IMMEDIATE JEOPARDY


34

JOSE CISNEROS MD, DIRECTOR

JOSE S CISNEROS MD

1001 CALLE MILAGROS

BROWNSVILLE, TX 78526

CLIA ID# 45D0991702





MARTIN MCGONAGLE MD, DIRECTOR

MARTIN MCGONAGLE MD PA

510 E HIGHWAY 377

GRANBURY, TX 76048

CLIA ID# 45D0992081






MARTIN MCGONAGLE MD, DIRECTOR

MARTIN MCGONAGLE MD PA

107 B SOUTHPARK DRIVE

BROWNWOOD, TX 76801

CLIA ID# 45D0992084






35

LUIS ANDRADE, DIRECTOR

ANDRE LABORATORY

1570 LOMALAND ST C

EL PASO, TX 79935

CLIA ID# 45D1015553






IMMEDIATE JEAPORDY

PHILLIP MCELVAINE MD, DIRECTOR

PAISANO PLAZA LABORATORY

5301 ALAMEDA AVE SUITE 111

EL PASO, TX 79905

CLIA ID# 45D1052488







IMMEDIATE JEAPORDY

ERNEST MAYFIELD PHD, DIRECTOR

TEXAS LABS LTD

7271 WURZBACH RD SUITE 118


CLIA ID# 45D1052872



REASON: LAB OWNER/OPER PROHIBITED FROM OWNING LAB

CONDITION LEVEL NONCOMLPIANCE WITH

IMMEDIATE JEAPORDY

36



116 GALLERY CIRCLE SUITE 101


CLIA ID# 45D1067217






STATUS: REVOCATION OF CERTIFICATE

THE REVOCATION OF THIS CERTIFICATE IS BASED ON THE OWNER BEING PROHIBITED

FROM OWNING A LAB FOR TWO YEARS DUE TO A PREVIOUS CERTIFICATE REVOCATION OF

ANOTHER LAB.

37

3. A LIST OF PERSONS CONVICTED OF VIOLATING CLIA

REQUIREMENTS AS SPECIFIED IN SECTION 353(1) OF THE PUBLIC

HEALTH SERVICES ACT, WITH THE CIRCUMSTANCES OF EACH

CASE AND THE PENALTIES IMPOSED.

*** NO D A T A F O U N D ***

38

4. A LIST OF LABORATORIES ON WHICH ALTERNATIVE SANCTIONS HAVE

BEEN IMPOSED, SHOWING -

(I) THE EFFECTIVE DATE OF THE SANCTIONS

(II) THE REASON FOR IMPOSING THEM

(III) ANY CORRECTIVE ACTION TAKEN BY THE LABORATORY AND

(IV) IF LABORATORY HAS ACHIEVED COMPLIANCE, THE VERIFIED DATE OF

THE COMPLIANCE

BENJAMIN HESTER MD, DIRECTOR

ETOWAH PEDIATRICS

115 WEST GRAND AVENUE SUITE 90

RAINBOW CITY, AL 35906

CLIA ID# 01D1048892

SANCTION: DIRECTED PLAN OF CORRECTION

SUSPENSION PART OF MEDICARE/MEDICAID



BEATRICE STRONG MD, DIRECTOR

PAGE HOSPITAL

501 N NAVAJO DRIVE

PAGE, AZ 86040

CLIA ID# 03D0533870

SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID


REASON: CANCELLATION OF MEDICARE APPROVAL


IMMEDIATE JEOPARDY IMPROPER PROFICIENCY

TESTING REFERRAL ACTIVITIES

KEVIN FALWELL M D, DIRECTOR

KEVIN WADE FALWELL, MD

2000 MCLAIN STREET, SUITE G

NEWPORT, AR 72112

CLIA ID# 04D0723190





39

ROBERT JOHNSON MD, DIRECTOR

ADVANCED CARE HOSPITAL-RESPIRATORY LAB

300 WERNER STREET

HOT SPRINGS, AR 71913

CLIA ID# 04D0724015

SANCTION: CIVIL MONEY PENALTY OF $3,000 PER DAY

DIRECTED PLAN OF CORRECTION



IMPROPER PRPOFICIENCY TESTING REFERRAL ACTIVITIES


LAB VOLUNTARILY CEASED TESTING

SAMUEL PRICE D O, DIRECTOR

MEDISERVE SYCAMORE

117 E SYCAMORE

FAYETTEVILLE, AR 72703

CLIA ID# 04D0878062




IMMEDIATE JEOPARDY

ROBERT BEARMAN MD, DIRECTOR

CHINO VALLEY MEDICAL CENTER

5451 WALNUT AVENUE

CHINO, CA 91710

CLIA ID# 05D0562204

SANCTION: CIVIL MONEY PENALTY




40

IVAN MARTINEZ, DIRECTOR

IVAN P MARTINEZ MD INC

500 S ANAHEIM HILLS RD #200

ANAHEIM, CA 92807

CLIA ID# 05D0582781






DAYTON MISFELDT MD, DIRECTOR

DAYTON S MISFELDT MD

725 EAST SANTA CLARA STREET, #304

SAN JOSE, CA 95112

CLIA ID# 05D0607262





SOO CHUNG MD, DIRECTOR

SOO M CHUNG MD, ONCOLOGY/HEMATOLOGY

A PROFESSIONAL CORPORATION

12555 GARDEN GROVE BLVD STE 309

GARDEN GROVE, CA 92843

CLIA ID# 05D0675453






UNSUCCESSFUL PROFICIENCY


41

STANLEY SCHINKE MD, DIRECTOR

HEMATOLOGY/ONCOLOGY CONSULTANTS

301 NORTH SAN JACINTO STREET

HEMET, CA 92543

CLIA ID# 05D0688544




REASON: CANCELLATION OF MEDICARE APPROVAL



MARIO KOHAN, MD, DIRECTOR

LAB-ALL INC

2200 WEST 7TH STREET SUITE 305


CLIA ID# 05D0692916








BAHRAM PARSA MD PHD, DIRECTOR

100 PLAZA CLINICAL LABORATORY

100 UCLA MEDICAL PLAZA #245


CLIA ID# 05D0864476







42

GREGORY SKIPITIS MD, DIRECTOR

OBSTETRICS & GYNECOLOGY MEDICAL

ASSOCIATES OF REDDING, INC

2626 EDITH AVENUE, #B

REDDING, CA 96001

CLIA ID# 05D0928170








MICHAEL TAHERY MD, DIRECTOR

MICHAEL TAHERY MD, INC

633 NORTH CENTRAL #309

GLENDALE, CA 91203

CLIA ID# 05D0940223








DANIEL LAMA MD, DIRECTOR

F M CHU MD/SAN BERNARDINO UROLOGICAL

489 EAST 21ST STREET

SAN BERNARDINO, CA 92404

CLIA ID# 05D0941157




43

SYED AHMED, MD, DIRECTOR

ONCOLOGY & HEMATOLOGY OF IMPERIAL VALLEY

1410 SOUTH LA BRUCHERIE ROAD #A

EL CENTRO, CA 92243

CLIA ID# 05D0970349







OLUKEMI WALLACE MD, DIRECTOR

HEALING HANDS ONCOLOGY & MEDICAL CARE

4455 W 117TH STREET, SUITE 402

HAWTHORNE, CA 90250

CLIA ID# 05D1010183





MICHAEL SHARON MD, DIRECTOR

MICHAEL R SHARON MD

520 HARTFORD TURNPIKE UNIT P

VERNON, CT 06066

CLIA ID# 07D0093205







44

AMERY WIRTSHAFTER MD, DIRECTOR

UROLOGICAL CONSULTANTS OF FLORIDA PA

1400 NE MIAMI GARDENS DRIVE #209

NORTH MIAMI BEACH, FL 33179

CLIA ID# 10D0283815






NORMAN URICH DO, DIRECTOR

NORMAN URICH DO PA

1762 N FORT HARRISON AVE

CLEARWATER, FL 33755

CLIA ID# 10D0296645





JAMES BANNISTER, DIRECTOR

MEDICAL ARTS LABORATORY

257 NORTH CAUSEWAY

NEW SMYRNA BEACH, FL 32169

CLIA ID# 10D0645062






45

EUGENE WILLIAMS JR MD, DIRECTOR

COLUMBUS WOMEN'S HEALTH ORGANIZATION

3850 ROSEMONT DRIVE

COLUMBUS, GA 31904

CLIA ID# 11D0266568






STEVEN GARNER MD, DIRECTOR

MEDICAL CENTER,THE

908 HILLCREST PKWY

DUBLIN, GA 31021

CLIA ID# 11D0699024









DOUGLAS GRESHAM, DIRECTOR

DOUGLAS G GRESHAM MD

340 EISENHOWER DR BLDG 1600

SAVANNAH, GA 31406

CLIA ID# 11D0724287







46

ROHIT DESAI, DIRECTOR

STONE MOUNTAIN FAMILY MEDICINE

1183 A S HAIRSTON ROAD

STONE MOUNTAIN, GA 30088

CLIA ID# 11D0855841





UNSUCCESSFUL PROFICIENCY TESTIMG


W MERRILL HICKS JR MD, DIRECTOR

NEPHROLOGY CONSULTANTS PC

334 SMITH AVENUE

THOMASVILLE, GA 31792

CLIA ID# 11D0895468






COLLIER GLADIN JR MD, DIRECTOR

COLLIER B GLADIN JR MD

FAMILY MEDICINE

140 NORTH CREST BOULEVARD

MACON, GA 31210

CLIA ID# 11D0948963








47

RUTH SARMIENTO, DIRECTOR

PREMIER HEMATOLOGY AND CANCER CARE PC

7823 SPIVEY STATION BOULEVARD SUITE 300

JONESBORO, GA 30236

CLIA ID# 11D1011807





ROBERT BENSON MD, DIRECTOR

EAST GEORGIA URGENT CARE

4451 COUNTRY CLUB ROAD SUITE 3 A

STATESBORO, GA 30458

CLIA ID# 11D1052555






GREEN CLYDE OCTAVIUS MD, DIRECTOR

ATLANTA CLINICAL LABORATORIES INCORPORATED

1122 GRAY HIGHWAY SUITE 3

MACON, GA 31211

CLIA ID# 11D1064487





48

JOHN KALAMARIS MD, DIRECTOR

TINLEY PRIMARY CARE LTD

17148 S HARLEM AVE

TINLEY PARK, IL 60477

CLIA ID# 14D0982226







JAMES CREWS, DIRECTOR

JAMES P CREWS MD

207 N DIXIE HWY BOX 486

CAVE CITY, KY 42127

CLIA ID# 18D0325880





UNSUCCESSFUL PROFICIENCY




BARRY BREAUX, MD, DIRECTOR

RIVER PARISHES HOSPITAL

RIVER PARISHES HOSPITAL LLC

500 RUE DE SANTE

LAPLACE, LA 70068

CLIA ID# 19D0457803




IMMEDIATE JEOPARDY

49

JOSEPH PECOT, JR, MD, DIRECTOR

ST MARTIN HOSPITAL

GENERAL ACUTE CARE HOSPITAL

210 CHAMPAGNE BLVD

BREAUX BRIDGE, LA 70517

CLIA ID# 19D0461104




IMMEDIATE JEOPARDY

DEBORAH LASTRAPES, MD, DIRECTOR

ACADIA-ST LANDRY HOSPITAL PATHOLOGY

810 SOUTH BROADWAY STREET

CHURCH POINT, LA 70525

CLIA ID# 19D0461133




IMMEDIATE JEOPARDY

STEVEN NORMAN, MD, DIRECTOR

DE QUINCY MEMORIAL HOSPITAL

110 WEST 4TH STREET

DEQUINCY, LA 70633

CLIA ID# 19D0461924




IMMEDIATE JEOPARDY

DONALD HAYNES MD, DIRECTOR

CLAIBORNE FAMILY MEDICAL CLINIC

912 WEST MAIN

HOMER, LA 71040

CLIA ID# 19D0463210




IMMEDIATE JEOPARDY

50

FRANCIS RODWIG, JR, MD, DIRECTOR

OCHSNER MEDICAL CENTER BATON ROUGE

EAST BATON ROUGE MEDICAL CENTER LLC

17000 MEDICAL CENTER DRIVE


CLIA ID# 19D0649201




IMMEDIATE JEOPARDY

JAMES BELUE, DIRECTOR

J MICHAEL BELUE

411 E VAUGHN AVENUE, SUITE 105

RUSTON, LA 71270

CLIA ID# 19D0666942




IMMEDIATE JEOPARDY


LAB OWNER/OPER PROHIBITED FROM OWNING LAB

JAMES FORTINO, DIRECTOR

JAMES M FORTINO, MD

1301 WHITNEY AVENUE

GRETNA, LA 70056

CLIA ID# 19D0675393






COMPLIANCE ACHIEVED

51

NANCY SMITH MD, DIRECTOR

NORTHERN LOUISIANA MEDICAL CENTER

RUSTON LOUISIANA HOSPITAL COMPANY LLC

401 EAST VAUGHN STREET

RUSTON, LA 71270

CLIA ID# 19D0696771




ELIZABETH PHILLIPS, MD, DIRECTOR

PHILLIPS MEDICAL CORPORATION

ELIZABETH F PHILLIPS, MD

101 MADISON SQUARE

MINDEN, LA 71055

CLIA ID# 19D0977062




TOM SENFF, MD, DIRECTOR

TOM P SENFF, MD, APMC

1534 ELIZABETH 2ND FLOOR

SHREVEPORT, LA 71101

CLIA ID# 19D1005683




WITH IMMEDIATE JEOPARDY

TY HARGRODER, MD, DIRECTOR

ACADIA-ST LANDRY HOSPITAL

RESPIRATORY THERAPY DEPARTMENT

810 SOUTH BROADWAY

CHURCH POINT, LA 70525

CLIA ID# 19D1015749




IMMEDIATE JEOPARDY

52

ANDRE GVOZDEN MD, DIRECTOR

ANDRE B GVOZDEN MD

8601 VETERANS HIGHWAY SUITE 200

MILLERSVILLE, MD 21108

CLIA ID# 21D0923216




JOSEPH REILLY MD, DIRECTOR

CATTAIL RIVER HEMATOLOGY & ONCOLOGY

3418 OLANDWOOD COURT #111

OLNEY, MD 20832

CLIA ID# 21D0933626




GISELLE MERY, DIRECTOR

CANCER QUALITY CARE LLC

4416 EAST WEST HIGHWAY

STE 410

BETHESDA, MD 20814

CLIA ID# 21D1057105




53

GARY PUSATERI, DIRECTOR

LAC VIEUX DESERT TRIBAL HEALTH CLINIC

E-23970 CHOATE ROAD

WATERSMEET, MI 49969

CLIA ID# 23D0382454







STANLEY LEVY MD, DIRECTOR

ASSOCIATED INTERNISTS, PC

26206 W TWELVE MILE ROAD SUITE 300

SOUTHFIELD, MI 48034

CLIA ID# 23D0983891






FARID FATA, DIRECTOR

MICHIGAN HEMATOLOGY ONCOLOGY PC

1295 BARRY DRIVE SUITE C

LAPEER, MI 48446

CLIA ID# 23D1080311





54

GUY FARMER MD, DIRECTOR

CALHOUN CITY MEDICAL CLINIC - GUY FARMER MD

120 BURK-CC ROAD P O BOX 599

CALHOUN CITY, MS 38916

CLIA ID# 25D0317218





ISAAC AULTMAN, DIRECTOR

ISAAC AULTMAN MD

2747 OLD CANTON RD

JACKSON, MS 39216

CLIA ID# 25D0318374





GREGORY ALLEN MT, DIRECTOR

COASTAL FAMILY HEALTH CENTER-GULFPORT

15024 MARTIN LUTHER KING JR BOULEVARD

GULFPORT, MS 39501

CLIA ID# 25D0319607






55

THOMAS BLANKS, DIRECTOR

MEDICAL FOUNDATION OF SOUTH MS MAIN LAB AT

BROAD AVENUE INTERNAL MEDICINE

1110 BROAD AVENUE SUITE 700

GULFPORT, MS 39501

CLIA ID# 25D0932837







JAMES ROBERTS, DIRECTOR

DR JAMES E ROBERTS MD PA

439 NORTH JACKSON STREET

BROOKHAVEN, MS 39602

CLIA ID# 25D0954341




JOHN FULLENWIDER MD, DIRECTOR

CPC REFERENCE LABORATORIES INC

109 W BANKHEAD STREET

NEW ALBANY, MS 38652

CLIA ID# 25D0980066






IMMEDIATE JEOPARDY


56

SHABBIR SAFDAR, DIRECTOR

UNIVERSITY HEMATOLOGY ONCOLOGY, INC

2210 BARRON ROAD, STE 117

POPLAR BLUFF, MO 63901

CLIA ID# 26D1076757




MICHAEL VINCENT, DIRECTOR

DIAGNOSTIC & TREATMENT CENTER

1475 BERGEN BLVD

FORT LEE, NJ 07024

CLIA ID# 31D0104097





DEBORAH CARROLL MD, DIRECTOR

AMERICAN CLINICAL SERVICES

205 CHUBB AVENUE

LYNDHURST, NJ 07071

CLIA ID# 31D1021478





57

DONALD WARKENTIN PHD, DIRECTOR

EXCELL CLINICAL LABORATORY

1 ETHEL ROAD BLDG 103 SUITE B

EDISON, NJ 08817

CLIA ID# 31D1048389






IMMEDIATE JEOPARDY



JULENE MOORE MD, DIRECTOR

MINERS COLFAX MEDICAL CENTER

200 HOSPITAL DRIVE

RATON, NM 87740

CLIA ID# 32D0536877






COMPLIANCE ACHIEVED

EDUARDO CASTREJON MD, DIRECTOR

EDUARDO A CASTREJON MD PA

1205 SOUTH SOLANO

LAS CRUCES, NM 88011

CLIA ID# 32D0536994




IMMEDIATE JEOPARDY

58

YOUNG ENG, DIRECTOR

YOUNG F ENG MD

11 RALPH PL

STATEN ISLAND, NY 10304

CLIA ID# 33D0134807




STATUS: RESCISSION OF MEDICARE CANCEL/CLIA SUSPENSION

LAB VOLUNTARILY CEASED TESTING

LEIZL VILLAVERDE, DIRECTOR

LIEZL VILLAVERDE MD PC

105 BYRNE AVENUE


CLIA ID# 33D0135489




IMMEDIATE JEOPARDY


LAWRENCE WASSER, DIRECTOR

HEARTLAND MEDICAL SERVICES

251 RICHMOND HILL ROAD

PO BOX 141280


CLIA ID# 33D0135556





STATUS: MEDICARE CANCELLATION RESCINDED

RESCISSION OF MEDICARE CANCEL/CLIA SUSPENSION

59

GEORGE MOSKOWITZ, DIRECTOR

GEORGE MOSKOWITZ MD

1318 42ND STREET

BROOKLYN, NY 11219

CLIA ID# 33D0146407




STATUS: MEDICARE CANCELLATION RESCINDED

OLITSA ROTH, DIRECTOR

OLITSA ROTH MD

5211 15TH AVENUE

BROOKLYN, NY 11219

CLIA ID# 33D0146454






ANDREW GOLDSTEIN, DIRECTOR

ANDREW M GOLDSTEIN MD

128 HEWLETT AVE

MERRICK, NY 11566

CLIA ID# 33D0154394




REASON: UNSUCCESSFUL PROFICIENCT TESTING


60

YONGMEI YIN, DIRECTOR

LONG ISLAND GASTROINTESTINAL GROUP PC

131 W MERRICK RD STE 1

MERRICK, NY 11566

CLIA ID# 33D0154446




CARY LEVINE MD, DIRECTOR

SOUTHSHORE MEDICAL ASSOCIATES PC

291 SUNRISE HWY

LINDENHURST, NY 11757

CLIA ID# 33D0157976



REASON: UNSUCCESSFUL PROIFICENY TESTING

ROMEO BALAGOT, DIRECTOR

ROMEO D BALAGOT MD

4277 HEMPSTEAD TPKE

BETHPAGE, NY 11714

CLIA ID# 33D0698051






61

LEV PAUKMAN, DIRECTOR

LEV J PAUKMAN MD

396 AVE X

BROOKLYN, NY 11223

CLIA ID# 33D0858630



REASON: UNSUCCESSFUL PROFICIECNY TESTING


THOMAS POWERS, DIRECTOR

MARINE PARK PEDIATRICS PC

3123 QUENTIN ROAD

BROOKLYN, NY 11234

CLIA ID# 33D0971175







ROOPA KHURANA, DIRECTOR

HEALTH CARE MEDICAL ASSOCIATES PC

2 PERLMAN DRIVE SUITE 101

SPRING VALLEY, NY 10977

CLIA ID# 33D1015554






62

DEMETRIOS GABRIEL MD, DIRECTOR

GABRIEL PEDIATRICS PC

1779 RICHMOND AVENUE


CLIA ID# 33D1020164




RAJAN GULATI MD, DIRECTOR

IMMEDIATE MEDICAL CARE

112 SHOPRITE PLAZA, SHOPRITE BOULEVARD

ELLENVILLE, NY 12428

CLIA ID# 33D1057117




STATUS: RESCISSION OF MEDICARE SUSPENSION

MEDICARE CANCELLATION RESCINDED

YOSHIRO MATSUO, DIRECTOR

BROOME ONCOLOGY PLLC

DBA NORTHERN CATSKILL CANCER CENTER

ONE FOXCARE DRIVE, SUITE 310

ONEONTA, NY 13820

CLIA ID# 33D1059955






63

ENRICO JONES MD, DIRECTOR

FRIENDLY URGENT AND FAMILY CARE

5409 W FRIENDLY AVE

GREENSBORO, NC 27410

CLIA ID# 34D0979446







HUBERT WATTY, MD, DIRECTOR

AGAPE FAMILY PRACTICE PLLC

202 N 37TH STREET WEST

MUSKOGEE, OK 74401

CLIA ID# 37D1046001




IMMEDIATE JEOPARDY


ANA ORTIZ, DIRECTOR

LABORATORIO CLINICO SANTA ANA

CARR 107 KM 2 2 BO BORINQUEN

AGUADILLA, PR 00603

CLIA ID# 40D0657981







64

LUZ DE LA CRUZ, DIRECTOR

LABORATORIO CLINICO HORMIGUEROS

3 RUIZ BELVIS ST

HORMIGUEROS, PR 00660

CLIA ID# 40D0658103






COMPLIANCE ACHIEVED

BRETT WAYNE DARWIN MD, DIRECTOR

PHOENIX MEDICAL GROUP PLLC

740 CONFERENCE DR

GOODLETTSVILLE, TN 37072

CLIA ID# 44D0965109




REASON: UNSUCCESSFUL PROFICIENCY

LINH NGUYEN, DIRECTOR

PRIMA HEALTH CLINIC

3555 W WALNUT ST SUITE A

GARLAND, TX 75042

CLIA ID# 45D0476599




IMMEDIATE JEOPARDY

65

JAMES CALABRIA, DIRECTOR

STEVENS PARK CLINIC

2100 W COLORADO BLVD

DALLAS, TX 75211

CLIA ID# 45D0479352




IMMEDIATE JEOPARDY

JOHN HOOD, DIRECTOR

VILLAGE MEDICAL CENTER

6201 MATLOCK RD #139

ARLINGTON, TX 76002

CLIA ID# 45D0484813






MARGARET PAYNE, DIRECTOR

PAYNE PEDIATRIC ASSOCIATES LTD LLP

6400 FANNIN, SUITE 2020

HOUSTON, TX 77004

CLIA ID# 45D0491544





66

UMA KANOJIA, DIRECTOR

UMA M KANOJIA MD

3455 STAGG DRIVE SUITE 101

BEAUMONT, TX 77701

CLIA ID# 45D0497906




IMMEDIATE JEOPARDY


DAVID CLARKE MD, DIRECTOR

FAMILY MEDICINE CTR OF CANYON

911 23RD STREET

CANYON, TX 79015

CLIA ID# 45D0506538




IMMEDIATE JEOPARDY

RAJA ATAYA MD, DIRECTOR

RAJA ATAYA MD

3070 COLLEGE ST SUITE 302

BEAUMONT, TX 77701

CLIA ID# 45D0665024




67

DEBORAH LEHMANN MD, DIRECTOR

DEBORAH K LEHMANN MD

6420 SOUTHWEST BOULEVARD SUITE 128

FORT WORTH, TX 76109

CLIA ID# 45D0674883




IMMEDIATE JEOPARDY


HIMATLAL GORANIA MD, DIRECTOR

PERMIAN BASIN PHYSICIAN GROUP MIDLAND PA

3400 ANDREWS HWY

MIDLAND, TX 79703

CLIA ID# 45D0678295

SANCTION: DIRECT

clia annual laboratory registry 2008 · loris tisocco md, director calumet dermatology associates...

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