clia annual laboratory registry 2008 · loris tisocco md, director calumet dermatology associates...
TRANSCRIPT
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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(5) A list of laboratories whose accreditation has been withdrawn or revoked and the reasons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
EFFECTIVE DATE: AUGUST 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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
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SESHAGIRIRAO PEMMARAJU, DIRECTOR
ST JOSEPHS MERCY HEALTH CENTER
300 WERNER STREET PO BOX 29001
HOT SPRINGS, AR 71903
CLIA ID# 04D0049541
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 31, 2008
REASON: IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES
CANCELLATION OF MEDICARE APPROVAL SUSPENSION
REVOCATION OF CLIA CERTIFICATE
DEBORAH JOHNSON, DIRECTOR
WHITE RIVER MEDICAL CENTER
1710 HARRISON
BATESVILLE, AR 72503
CLIA ID# 04D0642309
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 23, 2008
REASON: IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES
CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE
JEOPARDY
KEVIN FALWELL M D, DIRECTOR
KEVIN WADE FALWELL, MD
2000 MCLAIN STREET, SUITE G
NEWPORT, AR 72112
CLIA ID# 04D0723190
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 12, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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IVAN MARTINEZ, DIRECTOR
IVAN P MARTINEZ MD INC
500 S ANAHEIM HILLS RD #200
ANAHEIM, CA 92807
CLIA ID# 05D0582781
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 30, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 24, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
STANLEY SCHINKE MD, DIRECTOR
HEMATOLOGY/ONCOLOGY CONSULTANTS
301 NORTH SAN JACINTO STREET
HEMET, CA 92543
CLIA ID# 05D0688544
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JULY 03, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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MARIO KOHAN, MD, DIRECTOR
LAB-ALL INC
2200 WEST 7TH STREET SUITE 305
LOS ANGELES, CA 90057
CLIA ID# 05D0692916
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 29, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
BAHRAM PARSA MD PHD, DIRECTOR
100 PLAZA CLINICAL LABORATORY
100 UCLA MEDICAL PLAZA #245
LOS ANGELES, CA 90095
CLIA ID# 05D0864476
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 30, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LLEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
JOHN CRAIG, MD, DIRECTOR
KINDRED HOSPITAL BREA
875 NORTH BREA BOULEVARD
BREA, CA 92821
CLIA ID# 05D0896064
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 28, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE
JEOPARDY IMPROPER PROFICIENCY TESTING REFERRAL
ACTIVITIES MEDICARE CANCELLATION/SUSPENSION
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GREGORY SKIPITIS MD, DIRECTOR
OBSTETRICS & GYNECOLOGY MEDICAL
ASSOCIATES OF REDDING, INC
2626 EDITH AVENUE, #B
REDDING, CA 96001
CLIA ID# 05D0928170
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 09, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
MICHAEL TAHERY MD, DIRECTOR
MICHAEL TAHERY MD, INC
633 NORTH CENTRAL #309
GLENDALE, CA 91203
CLIA ID# 05D0940223
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 07, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 29, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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MUSTAFA MAHDAVY MD, DIRECTOR
NU ERA CLINICAL LABORATORIES,INC
18341 SHERMAN WAY, #201A
RESEDA, CA 91335
CLIA ID# 05D1055182
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 29, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
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
SANCTION: REVOCATION OF CLIA CERTIFICATE
LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 22, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
REVOCATION OF CLIA CERTIFICATE
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: COMPLIANCE ACHIEVED
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PRATIBHA DESAI MD, DIRECTOR
PINELLAS HEMATOLOGY & ONCOLOGY PA
1609 PASADENA AVE S #2E
SAINT PETERSBURG, FL 33707
CLIA ID# 10D0291394
SANCTION: REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JULY 28, 2008
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 22, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
JAMES BANNISTER, DIRECTOR
MEDICAL ARTS LABORATORY
257 NORTH CAUSE WAY
NEW SMYRNA BEACH, FL 32169
CLIA ID# 10D0645062
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 30, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: CERTIFICATE REINSTATED
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EUGENE WILLIAMS JR MD, DIRECTOR
COLUMBUS WOMEN'S HEALTH ORGANIZATION
3850 ROSEMONT DRIVE
COLUMBUS, GA 31904
CLIA ID# 11D0266568
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
STEVEN GARNER MD, DIRECTOR
MEDICAL CENTER,THE
908 HILLCREST PKWY
DUBLIN, GA 31021
CLIA ID# 11D0699024
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
FAILURE TO CORRECT DEFICIENCIES
CANCELLATION OF MEDICARE APPROVAL SUSPENSION
STATUS: COMPLIANCE ACHIEVED
DOUGLAS GRESHAM, DIRECTOR
DOUGLAS G GRESHAM MD
340 EISENHOWER DR BLDG 1600
SAVANNAH, GA 31406
CLIA ID# 11D0724287
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 22, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
CERTIFICATE REINSTATED
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ROHIT DESAI, DIRECTOR
STONE MOUNTAIN FAMILY MEDICINE
1183 A S HAIRSTON ROAD
STONE MOUNTAIN, GA 30088
CLIA ID# 11D0855841
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 26, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
W MERRILL HICKS JR MD, DIRECTOR
NEPHROLOGY CONSULTANTS PC
334 SMITH AVENUE
THOMASVILLE, GA 31792
CLIA ID# 11D0895468
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
COLLIER GLADIN JR MD, DIRECTOR
COLLIER B GLADIN JR MD
FAMILY MEDICINE
140 NORTH CREST BOULEVARD
MACON, GA 31210
CLIA ID# 11D0948963
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 16, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
SUSPENSION AND LIMITATION LIFTED
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RUTH SARMIENTO, DIRECTOR
PREMIER HEMATOLOGY AND CANCER CARE PC
7823 SPIVEY STATION BOULEVARD SUITE 300
JONESBORO, GA 30236
CLIA ID# 11D1011807
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 23, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
ROBERT BENSON MD, DIRECTOR
EAST GEORGIA URGENT CARE
4451 COUNTRY CLUB ROAD SUITE 3 A
STATESBORO, GA 30458
CLIA ID# 11D1052555
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 16, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
GREEN CLYDE OCTAVIUS MD, DIRECTOR
ATLANTA CLINICAL LABORATORIES INCORPORATE
1122 GRAY HIGHWAY SUITE 3
MACON, GA 31211
CLIA ID# 11D1064487
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 22, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
JOHN KALAMARIS MD, DIRECTOR
TINLEY PRIMARY CARE LTD
17148 S HARLEM AVE
TINLEY PARK, IL 60477
CLIA ID# 14D0982226
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: JULY 17, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL REVOCATION
MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
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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
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 07, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: LAB VOLUNTARILY CEASED TESTING
JAMES CREWS, DIRECTOR
JAMES P CREWS MD
207 N DIXIE HWY BOX 486
CAVE CITY, KY 42127
CLIA ID# 18D0325880
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 23, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROIFICENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
SUSPENSION AND LIMITATION LIFTED
CERTIFICATE REINSTATED
MARCUS BLACK, DIRECTOR
HEMATOLOGY & ONCOLOGY SERVICE LLC
4224 HOUMA BOULEVARD, SUITE 300
METAIRIE, LA 70006
CLIA ID# 19D0457265
SANCTION: CANCELLATION OF MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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
SANCTION: REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 07, 2008
REASON: FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
REVOCATION OF CLIA CERTIFICATE
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
ABDALLA ELIAS MD, DIRECTOR
CALDWELL MEMORIAL HOSPITAL
411 MAIN STREET
COLUMBIA, LA 71418
CLIA ID# 19D0465005
SANCTION: CANCELLATION OF MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 08, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE
JEOPARDY CANCELLATION OF MEDICARE APPROVAL
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
JAMES FORTINO, DIRECTOR
JAMES M FORTINO, MD
1301 WHITNEY AVENUE
GRETNA, LA 70056
CLIA ID# 19D0675393
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
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AGUSTIN SUAREZ, DIRECTOR
HEMATOLOGY AND ONCOLOGY SPECIALISTS,
LLC
1045 FLORIDA AVE
SLIDELL, LA 70458
CLIA ID# 19D0722517
SANCTION: CANCELLATION OF MEDICARE/MEDICAD APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
AGUSTIN SUAREZ, DIRECTOR
HEMATOLOGY AND ONCOLOGY SPECIALISTS, LLC
39 STARBRUSH CIRCLE
COVINGTON, LA 70433
CLIA ID# 19D0722518
SANCTION: CANCELLATION OF MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
KATHERINE MCCORMICK, DIRECTOR
HEMATOLOGY AND ONCOLOGY SERVICES, LLC
3525 PRYTANIA STREET STE 302
NEW ORLEANS, LA 70115
CLIA ID# 19D0883278
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
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MARK OPERARIO, MD, DIRECTOR
RURAL HEALTH CLINIC OF LOUISIANA
421 MAIN STREET
COLUMBIA, LA 71418
CLIA ID# 19D0891507
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: AUGUST 12, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
ROBERT KESSLER MD, DIRECTOR
HEMATOLOGY AND ONCOLOGY SERVICES LLC
1111 MEDICAL CENTER BLVD SUITE S-630
MARRERO, LA 70072
CLIA ID# 19D0939261
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CERTIFICATE
EFFECTIVE DATE: MARCH 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
CHAD HEINEN MD, DIRECTOR
CHAD N HEINEN, MD
4419 HWY 7 NORTH
HOT SPRINGS VILLAGE, AR 71910
CLIA ID# 19D0963943
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 14, 2008
REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
CONDITION LEVEL NONCOMPLIANCE
ELIZABETH PHILLIPS, MD, DIRECTOR
PHILLIPS MEDICAL CORPORATION
101 MADISON SQUARE
MINDEN, LA 71055
CLIA ID# 19D0977062
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JULY 07, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
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AMY HOLMES, MD, DIRECTOR
STAT LAB I, INC
7922 SUMMA AVENUE, SUITE A
BATON ROUGE, LA 70809
CLIA ID# 19D0990153
SANCTION: REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 29, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE
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
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 04, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
DAVID DESHOTELS, DIRECTOR
GULF COAST RESEARCH ASSOCIATES INC
2133 SILVERSIDE DRIVE SUITE D
BATON ROUGE, LA 70808
CLIA ID# 19D1038632
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 28, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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CHARLES REED, DIRECTOR
WISNER RURAL HEALTH CLINIC
176 WATSON STREET
WISNER, LA 71378
CLIA ID# 19D1057488
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: AUGUST 12, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
LINDA BABIN, DIRECTOR
GULF COAST RESEARCH LLC
7049 PERKINS ROAD
BATON ROUGE, LA 70808
CLIA ID# 19D1067462
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 28, 2008
REASON: CONITION LEVEL NONCOMPLIANCE
AYUB YOUSUFI PHD, DIRECTOR
AMERICAN DIAGNOSTIC LABORATORIES INC
15749 CRABBS BRANCH WAY
ROCKVILLE, MD 20855
CLIA ID# 21D0909442
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 28, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
THOMAS DOBBINS, DIRECTOR
MARSHALL MEDICAL ASSOCIATES PC
1174 W MICHIGAN AVENUE
MARSHALL, MI 49068
CLIA ID# 23D0377802
SANCTION: REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 04, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
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THOMAS DOBBINS, DIRECTOR
ALBION MEDICAL ASSOCIATES
214 E MICHIGAN AVE
ALBION, MI 49224
CLIA ID# 23D0378714
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 30, 2008
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 12, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
DAVID SOVA, DO, DIRECTOR
EAST PARIS FAMILY PRACTICE, PLLC
4551 CASCADE ROAD SE SUITE D
GRAND RAPIDS, MI 49546
CLIA ID# 23D0963679
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH IMMEDIATE
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 24, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 12, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
ISAAC AULTMAN, DIRECTOR
ISAAC AULTMAN MD
2747 OLD CANTON RD
JACKSON, MS 39216
CLIA ID# 25D0318374
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: CERTIFICATE REINSTATED
-
21
GREGORY ALLEN MT, DIRECTOR
COASTAL FAMILY HEALTH CENTER-GULFPORT
15024 MARTIN LUTHER KING JR BOULEVARD
GULFPORT, MS 39501
CLIA ID# 25D0319607
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 28, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
MEDICARE CANCELLATION/SUSPENSION
STATUS: LAB VOLUNTARILY CEASED TESTING
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 18, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
JAMES ROBERTS, DIRECTOR
DR JAMES E ROBERTS MD PA
439 NORTH JACKSON STREET
BROOKHAVEN, MS 39602
CLIA ID# 25D0954341
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
-
22
JOHN FULLENWIDER MD, DIRECTOR
CPC REFERENCE LABORATORIES INC
109 W BANKHEAD STREET
NEW ALBANY, MS 38652
CLIA ID# 25D0980066
SANCTION: LIMITATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERITFICATE
EFFECTIVE DATE: JANUARY 08, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
MEDICARE CANCELLATION/SUSPENSION
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 03, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
DONALD WARKENTIN PHD, DIRECTOR
EXCELL CLINICAL LABORATORY
1 ETHEL ROAD BLDG 103 SUITE B
EDISON, NJ 08817
CLIA ID# 31D1048389
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 03, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATED JEOPARDY FAILURE TO CORRECT DEFICIENCIES
STATUS: SUSPENSION AND LIMITATION LIFTED
-
23
JULENE MOORE MD, DIRECTOR
MINERS COLFAX MEDICAL CENTER
200 HOSPITAL DRIVE
RATON, NM 87740
CLIA ID# 32D0536877
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 17, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
MICHAEL SERGEANT MD, DIRECTOR
HMS-MED SQUARE
114 W 11TH STREET
SILVER CITY, NM 88061
CLIA ID# 32D0537243
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
OLITSA ROTH, DIRECTOR
OLITSA ROTH MD
5211 15TH AVENUE
BROOKLYN, NY 11219
CLIA ID# 33D0146454
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 24, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
-
24
ANDREW GOLDSTEIN, DIRECTOR
ANDREW M GOLDSTEIN MD
128 HEWLETT AVE
MERRICK, NY 11566
CLIA ID# 33D0154394
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
YONGMEI YIN, DIRECTOR
LONG ISLAND GASTROINTESTINAL GROUP PC
131 W MERRICK RD STE 1
MERRICK, NY 11566
CLIA ID# 33D0154446
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: AUGUST 02, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
CARY LEVINE MD, DIRECTOR
SOUTHSHORE MEDICAL ASSOCIATES PC
291 SUNRISE HWY
LINDENHURST, NY 11757
CLIA ID# 33D0157976
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 03, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: COMPLIANCE ACHIEVED
-
25
ROMEO BALAGOT, DIRECTOR
ROMEO D BALAGOT MD
4277 HEMPSTEAD TPKE
BETHPAGE, NY 11714
CLIA ID# 33D0698051
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
REZKALLAH TORO, DIRECTOR
ONEIDA PEDIATRIC GROUP PC
421 MAIN STREET
ONEIDA, NY 13421
CLIA ID# 33D0855598
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 09, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
LEV PAUKMAN, DIRECTOR
LEV J PAUKMAN MD
396 AVE X
BROOKLYN, NY 11223
CLIA ID# 33D0858630
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 21, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
-
26
THOMAS POWERS, DIRECTOR
MARINE PARK PEDIATRICS PC
3123 QUENTIN ROAD
BROOKLYN, NY 11234
CLIA ID# 33D0971175
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 24, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
CONDITION LEVEL NONCOMPLIANCE
STATUS: SUSPENSION AND LIMITATION LIFTED
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
EFFECTIVE DATE: MARCH 25, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
YOSHIRO MATSUO, DIRECTOR
BROOME ONCOLOGY PLLC
DBA NORTHERN CATSKILL CANCER CENTER
ONE FOXCARE DRIVE, SUITE 310
ONEONTA, NY 13820
CLIA ID# 33D1059955
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 01, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
-
27
ENRICO JONES MD, DIRECTOR
FRIENDLY URGENT AND FAMILY CARE
5409 W FRIENDLY AVE
GREENSBORO, NC 27410
CLIA ID# 34D0979446
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 23, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
JOHN JACKSON DO, DIRECTOR
JACKSON FAMILY CLINIC
410 EAST CHEROKEE
WAGONER, OK 74467
CLIA ID# 37D0475332
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 23, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
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
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 20, 2008
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 20, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
RAFAEL GARCIA, DIRECTOR
LAB CLINICO GARCIA
CALLE 65 INFANTERIA #67
ANASCO, PR 00610
CLIA ID# 40D0693411
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 21, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
WILLIAM RIOS VELEZ, DIRECTOR
HOSPITAL EL BUEN PASTOR
AVE DE DIEGO #52
ARECIBO, PR 00612
CLIA ID# 40D0716971
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 20, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
ELLIOT ACEVEDO SOTO, DIRECTOR
LABORATORIO CLINICO PUJOLS
CARR PR-111 KM 17 HM 9 BO GUATEMALA
SAN SEBASTIAN, PR 00685
CLIA ID# 40D0982044
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
-
29
IFEDIORA AFULUKWE M D, DIRECTOR
HEATH SPRINGS MEDICAL CENTER
209 SOUTH COLLEGE ST
HEATH SPRINGS, SC 29058
CLIA ID# 42D0958536
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 15, 2008
REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
CONDITION LEVEL NONCOMPLIANCE
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
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 13, 2008
REASON: FAILURE TO SUBMIT ACCEPTABLE POC
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
BRETT WAYNE DARWIN MD, DIRECTOR
PHOENIX MEDICAL GROUP PLLC
740 CONFERENCE DR
GOODLETTSVILLE, TN 37072
CLIA ID# 44D0965109
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 16, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: COMPLIANCE ACHIEVED
-
30
JOHN HOOD, DIRECTOR
VILLAGE MEDICAL CENTER
6201 MATLOCK RD #139
ARLINGTON, TX 76002
CLIA ID# 45D0484813
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 23, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
MARGARET PAYNE, DIRECTOR
PAYNE PEDIATRIC ASSOCIATES LTD LLP
6400 FANNIN, SUITE 2020
HOUSTON, TX 77004
CLIA ID# 45D0491544
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: AUGUST 14, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
DEVEN BHACHAWAT MD, DIRECTOR
LONE STAR CANCER AND BLOOD DISORDER PA
515 NORTH KING SUITE 104
SEGUIN, TX 78155
CLIA ID# 45D0500257
SANCTION: CANCEL OF MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 22, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
-
31
DEVEN BHACHAWAT MD, DIRECTOR
LONE STAR CANCER AND BLOOD DISORDER PA
925 SAN PEDRO AVENUE SUITE B
SAN ANTONIO, TX 78212
CLIA ID# 45D0501716
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 11, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIECNY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
JAMES HUMPHREYS, MD, DIRECTOR
MIDLAND HEALTH & SENIOR SERVICES
3303 WEST ILLINOIS, SPACE 22
MIDLAND, TX 79701
CLIA ID# 45D0679743
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 01, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
-
32
AJIT DAVE MD, DIRECTOR
AJIT DAVE MD PA
3327 COLORADO BOULEVARD SUITE 200
DENTON, TX 76210
CLIA ID# 45D0716753
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 03, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
HAROLD PEAN, DIRECTOR
MISSION INTERNAL MEDICINE
909 BUSINESS PARK SUITE #6
MISSION, TX 78572
CLIA ID# 45D0884401
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 01, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
IVAN MCLENDEZ, DIRECTOR
SCIENTIFIC MEDICAL LABORATORY
2704-A EAST GRIFFIN PARKWAY
MISSION, TX 78572
CLIA ID# 45D0888276
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 24, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
FAILURE TO CORRECT DEFICIENCIES
-
33
IYABO ELEMUREN, DIRECTOR
FAMILY MEDICINE CLINIC
740 SOUTH AMY LANE
HARKER HEIGHTS, TX 76548
CLIA ID# 45D0967024
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 19, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
JAMES BRUCE, DIRECTOR
DICKERSON MEMORIAL HOSPITAL
1001 DICKERSON DRIVE
JASPER, TX 75951
CLIA ID# 45D0977340
SANCTION: CANCEL OF MEDICARE/MEDICAID APPROVAL
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: JUNE 23, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STATUS: LAB VOLUNTARILY CEASED TESTING
PRATHIVADI RAMAMANI MD, DIRECTOR
CLINICA MEDICA DE DALLAS
4811A COLUMBIA AVENUE
DALLAS, TX 75226
CLIA ID# 45D0989088
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 30, 2008
REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
FAILURE TO CORRECT DEFICIENCIES
-
34
JOSE CISNEROS MD, DIRECTOR
JOSE S CISNEROS MD
1001 CALLE MILAGROS
BROWNSVILLE, TX 78526
CLIA ID# 45D0991702
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 15, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
MARTIN MCGONAGLE MD, DIRECTOR
MARTIN MCGONAGLE MD PA
510 E HIGHWAY 377
GRANBURY, TX 76048
CLIA ID# 45D0992081
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 20, 2008
REASON: IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
MARTIN MCGONAGLE MD, DIRECTOR
MARTIN MCGONAGLE MD PA
107 B SOUTHPARK DRIVE
BROWNWOOD, TX 76801
CLIA ID# 45D0992084
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 10, 2008
REASON: IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES
2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
-
35
LUIS ANDRADE, DIRECTOR
ANDRE LABORATORY
1570 LOMALAND ST C
EL PASO, TX 79935
CLIA ID# 45D1015553
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: MARCH 04, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEAPORDY
PHILLIP MCELVAINE MD, DIRECTOR
PAISANO PLAZA LABORATORY
5301 ALAMEDA AVE SUITE 111
EL PASO, TX 79905
CLIA ID# 45D1052488
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 19, 2008
REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEAPORDY
ERNEST MAYFIELD PHD, DIRECTOR
TEXAS LABS LTD
7271 WURZBACH RD SUITE 118
SAN ANTONIO, TX 78240
CLIA ID# 45D1052872
SANCTION: REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 19, 2008
REASON: LAB OWNER/OPER PROHIBITED FROM OWNING LAB
CONDITION LEVEL NONCOMLPIANCE WITH
IMMEDIATE JEAPORDY
-
36
DEVEN BHACHAWAT MD, DIRECTOR
LONE STAR CANCER AND BLOOD DISORDER PA
116 GALLERY CIRCLE SUITE 101
SAN ANTONIO, TX 78258
CLIA ID# 45D1067217
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 11, 2008
REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
CONDITION LEVEL NONCOMPLIANCE
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.
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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 ***
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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
EFFECTIVE DATE: AUGUST 02, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
BEATRICE STRONG MD, DIRECTOR
PAGE HOSPITAL
501 N NAVAJO DRIVE
PAGE, AZ 86040
CLIA ID# 03D0533870
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 14, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL
CONDITION LEVEL NONCOMPLIANCE WITH
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
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 12, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
-
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
EFFECTIVE DATE: APRIL 10, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
IMPROPER PRPOFICIENCY TESTING REFERRAL ACTIVITIES
STATUS: COMPLIANCE ACHIEVED
LAB VOLUNTARILY CEASED TESTING
SAMUEL PRICE D O, DIRECTOR
MEDISERVE SYCAMORE
117 E SYCAMORE
FAYETTEVILLE, AR 72703
CLIA ID# 04D0878062
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: AUGUST 06, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
ROBERT BEARMAN MD, DIRECTOR
CHINO VALLEY MEDICAL CENTER
5451 WALNUT AVENUE
CHINO, CA 91710
CLIA ID# 05D0562204
SANCTION: CIVIL MONEY PENALTY
DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: APRIL 15, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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40
IVAN MARTINEZ, DIRECTOR
IVAN P MARTINEZ MD INC
500 S ANAHEIM HILLS RD #200
ANAHEIM, CA 92807
CLIA ID# 05D0582781
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MAY 30, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
DAYTON MISFELDT MD, DIRECTOR
DAYTON S MISFELDT MD
725 EAST SANTA CLARA STREET, #304
SAN JOSE, CA 95112
CLIA ID# 05D0607262
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JANUARY 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 24, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY
STATUS: SUSPENSION AND LIMITATION LIFTED
-
41
STANLEY SCHINKE MD, DIRECTOR
HEMATOLOGY/ONCOLOGY CONSULTANTS
301 NORTH SAN JACINTO STREET
HEMET, CA 92543
CLIA ID# 05D0688544
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JULY 03, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
MARIO KOHAN, MD, DIRECTOR
LAB-ALL INC
2200 WEST 7TH STREET SUITE 305
LOS ANGELES, CA 90057
CLIA ID# 05D0692916
SANCTION: CIVIL MONEY PENALTY OF $3,000 PER DAY
DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 29, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
BAHRAM PARSA MD PHD, DIRECTOR
100 PLAZA CLINICAL LABORATORY
100 UCLA MEDICAL PLAZA #245
LOS ANGELES, CA 90095
CLIA ID# 05D0864476
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MAY 30, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
-
42
GREGORY SKIPITIS MD, DIRECTOR
OBSTETRICS & GYNECOLOGY MEDICAL
ASSOCIATES OF REDDING, INC
2626 EDITH AVENUE, #B
REDDING, CA 96001
CLIA ID# 05D0928170
SANCTION: CIVIL MONEY PENALTY OF $3,000 PER DAY
DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 09, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
MICHAEL TAHERY MD, DIRECTOR
MICHAEL TAHERY MD, INC
633 NORTH CENTRAL #309
GLENDALE, CA 91203
CLIA ID# 05D0940223
SANCTION: CIVIL MONEY PENALTY OF $3,000 PER DAY
DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 07, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
DANIEL LAMA MD, DIRECTOR
F M CHU MD/SAN BERNARDINO UROLOGICAL
489 EAST 21ST STREET
SAN BERNARDINO, CA 92404
CLIA ID# 05D0941157
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JULY 09, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
-
43
SYED AHMED, MD, DIRECTOR
ONCOLOGY & HEMATOLOGY OF IMPERIAL VALLEY
1410 SOUTH LA BRUCHERIE ROAD #A
EL CENTRO, CA 92243
CLIA ID# 05D0970349
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MAY 29, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
OLUKEMI WALLACE MD, DIRECTOR
HEALING HANDS ONCOLOGY & MEDICAL CARE
4455 W 117TH STREET, SUITE 402
HAWTHORNE, CA 90250
CLIA ID# 05D1010183
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: MAY 20, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
MICHAEL SHARON MD, DIRECTOR
MICHAEL R SHARON MD
520 HARTFORD TURNPIKE UNIT P
VERNON, CT 06066
CLIA ID# 07D0093205
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: MAY 07, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
REVOCATION OF CLIA CERTIFICATE
FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
-
44
AMERY WIRTSHAFTER MD, DIRECTOR
UROLOGICAL CONSULTANTS OF FLORIDA PA
1400 NE MIAMI GARDENS DRIVE #209
NORTH MIAMI BEACH, FL 33179
CLIA ID# 10D0283815
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MAY 15, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: COMPLIANCE ACHIEVED
NORMAN URICH DO, DIRECTOR
NORMAN URICH DO PA
1762 N FORT HARRISON AVE
CLEARWATER, FL 33755
CLIA ID# 10D0296645
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 07, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
JAMES BANNISTER, DIRECTOR
MEDICAL ARTS LABORATORY
257 NORTH CAUSEWAY
NEW SMYRNA BEACH, FL 32169
CLIA ID# 10D0645062
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MAY 15, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: CERTIFICATE REINSTATED
-
45
EUGENE WILLIAMS JR MD, DIRECTOR
COLUMBUS WOMEN'S HEALTH ORGANIZATION
3850 ROSEMONT DRIVE
COLUMBUS, GA 31904
CLIA ID# 11D0266568
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
STEVEN GARNER MD, DIRECTOR
MEDICAL CENTER,THE
908 HILLCREST PKWY
DUBLIN, GA 31021
CLIA ID# 11D0699024
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JUNE 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
FAILURE TO CORRECT DEFICIENCIES
CANCELLATION OF MEDICARE APPROVAL SUSPENSION
STATUS: COMPLIANCE ACHIEVED
SUSPENSION AND LIMITATION LIFTED
DOUGLAS GRESHAM, DIRECTOR
DOUGLAS G GRESHAM MD
340 EISENHOWER DR BLDG 1600
SAVANNAH, GA 31406
CLIA ID# 11D0724287
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 07, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
CERTIFICATE REINSTATED
-
46
ROHIT DESAI, DIRECTOR
STONE MOUNTAIN FAMILY MEDICINE
1183 A S HAIRSTON ROAD
STONE MOUNTAIN, GA 30088
CLIA ID# 11D0855841
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 26, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTIMG
STATUS: SUSPENSION AND LIMITATION LIFTED
W MERRILL HICKS JR MD, DIRECTOR
NEPHROLOGY CONSULTANTS PC
334 SMITH AVENUE
THOMASVILLE, GA 31792
CLIA ID# 11D0895468
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MAY 15, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
COLLIER GLADIN JR MD, DIRECTOR
COLLIER B GLADIN JR MD
FAMILY MEDICINE
140 NORTH CREST BOULEVARD
MACON, GA 31210
CLIA ID# 11D0948963
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 31, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
SUSPENSION AND LIMITATION LIFTED
-
47
RUTH SARMIENTO, DIRECTOR
PREMIER HEMATOLOGY AND CANCER CARE PC
7823 SPIVEY STATION BOULEVARD SUITE 300
JONESBORO, GA 30236
CLIA ID# 11D1011807
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 07, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
ROBERT BENSON MD, DIRECTOR
EAST GEORGIA URGENT CARE
4451 COUNTRY CLUB ROAD SUITE 3 A
STATESBORO, GA 30458
CLIA ID# 11D1052555
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 31, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
GREEN CLYDE OCTAVIUS MD, DIRECTOR
ATLANTA CLINICAL LABORATORIES INCORPORATED
1122 GRAY HIGHWAY SUITE 3
MACON, GA 31211
CLIA ID# 11D1064487
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 07, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
-
48
JOHN KALAMARIS MD, DIRECTOR
TINLEY PRIMARY CARE LTD
17148 S HARLEM AVE
TINLEY PARK, IL 60477
CLIA ID# 14D0982226
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JULY 17, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL REVOCATION
MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
JAMES CREWS, DIRECTOR
JAMES P CREWS MD
207 N DIXIE HWY BOX 486
CAVE CITY, KY 42127
CLIA ID# 18D0325880
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 07, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY
STATUS: LAB VOLUNTARILY CEASED TESTING
SUSPENSION AND LIMITATION LIFTED
CERTIFICATE REINSTATED
BARRY BREAUX, MD, DIRECTOR
RIVER PARISHES HOSPITAL
RIVER PARISHES HOSPITAL LLC
500 RUE DE SANTE
LAPLACE, LA 70068
CLIA ID# 19D0457803
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: AUGUST 18, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
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
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: NOVEMBER 04, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
DEBORAH LASTRAPES, MD, DIRECTOR
ACADIA-ST LANDRY HOSPITAL PATHOLOGY
810 SOUTH BROADWAY STREET
CHURCH POINT, LA 70525
CLIA ID# 19D0461133
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: SEPTEMBER 05, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STEVEN NORMAN, MD, DIRECTOR
DE QUINCY MEMORIAL HOSPITAL
110 WEST 4TH STREET
DEQUINCY, LA 70633
CLIA ID# 19D0461924
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: SEPTEMBER 08, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
DONALD HAYNES MD, DIRECTOR
CLAIBORNE FAMILY MEDICAL CLINIC
912 WEST MAIN
HOMER, LA 71040
CLIA ID# 19D0463210
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: SEPTEMBER 02, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
-
50
FRANCIS RODWIG, JR, MD, DIRECTOR
OCHSNER MEDICAL CENTER BATON ROUGE
EAST BATON ROUGE MEDICAL CENTER LLC
17000 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
CLIA ID# 19D0649201
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JUNE 09, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
JAMES BELUE, DIRECTOR
J MICHAEL BELUE
411 E VAUGHN AVENUE, SUITE 105
RUSTON, LA 71270
CLIA ID# 19D0666942
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: SEPTEMBER 02, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
REVOCATION OF CLIA CERTIFICATE
LAB OWNER/OPER PROHIBITED FROM OWNING LAB
JAMES FORTINO, DIRECTOR
JAMES M FORTINO, MD
1301 WHITNEY AVENUE
GRETNA, LA 70056
CLIA ID# 19D0675393
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: OCTOBER 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
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
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JUNE 06, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
ELIZABETH PHILLIPS, MD, DIRECTOR
PHILLIPS MEDICAL CORPORATION
ELIZABETH F PHILLIPS, MD
101 MADISON SQUARE
MINDEN, LA 71055
CLIA ID# 19D0977062
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JULY 07, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
TOM SENFF, MD, DIRECTOR
TOM P SENFF, MD, APMC
1534 ELIZABETH 2ND FLOOR
SHREVEPORT, LA 71101
CLIA ID# 19D1005683
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: OCTOBER 21, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
WITH IMMEDIATE JEOPARDY
TY HARGRODER, MD, DIRECTOR
ACADIA-ST LANDRY HOSPITAL
RESPIRATORY THERAPY DEPARTMENT
810 SOUTH BROADWAY
CHURCH POINT, LA 70525
CLIA ID# 19D1015749
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: SEPTEMBER 05, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
-
52
ANDRE GVOZDEN MD, DIRECTOR
ANDRE B GVOZDEN MD
8601 VETERANS HIGHWAY SUITE 200
MILLERSVILLE, MD 21108
CLIA ID# 21D0923216
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: APRIL 15, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
JOSEPH REILLY MD, DIRECTOR
CATTAIL RIVER HEMATOLOGY & ONCOLOGY
3418 OLANDWOOD COURT #111
OLNEY, MD 20832
CLIA ID# 21D0933626
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: APRIL 28, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
GISELLE MERY, DIRECTOR
CANCER QUALITY CARE LLC
4416 EAST WEST HIGHWAY
STE 410
BETHESDA, MD 20814
CLIA ID# 21D1057105
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JANUARY 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
-
53
GARY PUSATERI, DIRECTOR
LAC VIEUX DESERT TRIBAL HEALTH CLINIC
E-23970 CHOATE ROAD
WATERSMEET, MI 49969
CLIA ID# 23D0382454
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 12, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
STATUS: SUSPENSION AND LIMITATION LIFTED
STANLEY LEVY MD, DIRECTOR
ASSOCIATED INTERNISTS, PC
26206 W TWELVE MILE ROAD SUITE 300
SOUTHFIELD, MI 48034
CLIA ID# 23D0983891
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 06, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES
STATUS: SUSPENSION AND LIMITATION LIFTED
FARID FATA, DIRECTOR
MICHIGAN HEMATOLOGY ONCOLOGY PC
1295 BARRY DRIVE SUITE C
LAPEER, MI 48446
CLIA ID# 23D1080311
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: AUGUST 21, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
IMPROPER PROFICIENCY TESTING REFERRAL ACTIVITIES
-
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
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 12, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
ISAAC AULTMAN, DIRECTOR
ISAAC AULTMAN MD
2747 OLD CANTON RD
JACKSON, MS 39216
CLIA ID# 25D0318374
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: CERTIFICATE REINSTATED
GREGORY ALLEN MT, DIRECTOR
COASTAL FAMILY HEALTH CENTER-GULFPORT
15024 MARTIN LUTHER KING JR BOULEVARD
GULFPORT, MS 39501
CLIA ID# 25D0319607
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 28, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
MEDICARE CANCELLATION/SUSPENSION
STATUS: LAB VOLUNTARILY CEASED TESTING
-
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
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: APRIL 30, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
JAMES ROBERTS, DIRECTOR
DR JAMES E ROBERTS MD PA
439 NORTH JACKSON STREET
BROOKHAVEN, MS 39602
CLIA ID# 25D0954341
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 10, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
JOHN FULLENWIDER MD, DIRECTOR
CPC REFERENCE LABORATORIES INC
109 W BANKHEAD STREET
NEW ALBANY, MS 38652
CLIA ID# 25D0980066
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JULY 03, 2008
REASON: 2 YEAR PROHIBIT FROM OWN, OPERATE, OR DIRECT
MEDICARE CANCELLATION/SUSPENSION
CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
REVOCATION OF CLIA CERTIFICATE
-
56
SHABBIR SAFDAR, DIRECTOR
UNIVERSITY HEMATOLOGY ONCOLOGY, INC
2210 BARRON ROAD, STE 117
POPLAR BLUFF, MO 63901
CLIA ID# 26D1076757
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: AUGUST 20, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
MICHAEL VINCENT, DIRECTOR
DIAGNOSTIC & TREATMENT CENTER
1475 BERGEN BLVD
FORT LEE, NJ 07024
CLIA ID# 31D0104097
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: OCTOBER 03, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
DEBORAH CARROLL MD, DIRECTOR
AMERICAN CLINICAL SERVICES
205 CHUBB AVENUE
LYNDHURST, NJ 07071
CLIA ID# 31D1021478
SANCTION: CIVIL MONEY PENALTY
EFFECTIVE DATE: NOVEMBER 06, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: COMPLIANCE ACHIEVED
-
57
DONALD WARKENTIN PHD, DIRECTOR
EXCELL CLINICAL LABORATORY
1 ETHEL ROAD BLDG 103 SUITE B
EDISON, NJ 08817
CLIA ID# 31D1048389
SANCTION: CIVIL MONEY PENALTY
DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: OCTOBER 03, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
FAILURE TO CORRECT DEFICIENCIES
STATUS: SUSPENSION AND LIMITATION LIFTED
JULENE MOORE MD, DIRECTOR
MINERS COLFAX MEDICAL CENTER
200 HOSPITAL DRIVE
RATON, NM 87740
CLIA ID# 32D0536877
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: MARCH 12, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
EDUARDO CASTREJON MD, DIRECTOR
EDUARDO A CASTREJON MD PA
1205 SOUTH SOLANO
LAS CRUCES, NM 88011
CLIA ID# 32D0536994
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: OCTOBER 06, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
-
58
YOUNG ENG, DIRECTOR
YOUNG F ENG MD
11 RALPH PL
STATEN ISLAND, NY 10304
CLIA ID# 33D0134807
SANCTION: CIVIL MONEY PENALTY
EFFECTIVE DATE: SEPTEMBER 04, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: RESCISSION OF MEDICARE CANCEL/CLIA SUSPENSION
LAB VOLUNTARILY CEASED TESTING
LEIZL VILLAVERDE, DIRECTOR
LIEZL VILLAVERDE MD PC
105 BYRNE AVENUE
STATEN ISLAND, NY 10314
CLIA ID# 33D0135489
SANCTION: CIVIL MONEY PENALTY
EFFECTIVE DATE: JULY 22, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STATUS: COMPLIANCE ACHIEVED
LAWRENCE WASSER, DIRECTOR
HEARTLAND MEDICAL SERVICES
251 RICHMOND HILL ROAD
PO BOX 141280
STATEN ISLAND, NY 10314
CLIA ID# 33D0135556
SANCTION: CIVIL MONEY PENALTY
DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: SEPTEMBER 15, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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
SANCTION: CIVIL MONEY PENALTY
EFFECTIVE DATE: SEPTEMBER 22, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: MEDICARE CANCELLATION RESCINDED
OLITSA ROTH, DIRECTOR
OLITSA ROTH MD
5211 15TH AVENUE
BROOKLYN, NY 11219
CLIA ID# 33D0146454
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: OCTOBER 24, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
ANDREW GOLDSTEIN, DIRECTOR
ANDREW M GOLDSTEIN MD
128 HEWLETT AVE
MERRICK, NY 11566
CLIA ID# 33D0154394
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: DECEMBER 30, 2008
REASON: UNSUCCESSFUL PROFICIENCT TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
-
60
YONGMEI YIN, DIRECTOR
LONG ISLAND GASTROINTESTINAL GROUP PC
131 W MERRICK RD STE 1
MERRICK, NY 11566
CLIA ID# 33D0154446
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 02, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
CARY LEVINE MD, DIRECTOR
SOUTHSHORE MEDICAL ASSOCIATES PC
291 SUNRISE HWY
LINDENHURST, NY 11757
CLIA ID# 33D0157976
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: DECEMBER 03, 2008
REASON: UNSUCCESSFUL PROIFICENY TESTING
ROMEO BALAGOT, DIRECTOR
ROMEO D BALAGOT MD
4277 HEMPSTEAD TPKE
BETHPAGE, NY 11714
CLIA ID# 33D0698051
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: DECEMBER 30, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
-
61
LEV PAUKMAN, DIRECTOR
LEV J PAUKMAN MD
396 AVE X
BROOKLYN, NY 11223
CLIA ID# 33D0858630
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MARCH 21, 2008
REASON: UNSUCCESSFUL PROFICIECNY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
THOMAS POWERS, DIRECTOR
MARINE PARK PEDIATRICS PC
3123 QUENTIN ROAD
BROOKLYN, NY 11234
CLIA ID# 33D0971175
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: OCTOBER 24, 2008
REASON: UNSUCCESSFUL PROFICIENCY TESTING
CONDITION LEVEL NONCOMPLIANCE
STATUS: SUSPENSION AND LIMITATION LIFTED
ROOPA KHURANA, DIRECTOR
HEALTH CARE MEDICAL ASSOCIATES PC
2 PERLMAN DRIVE SUITE 101
SPRING VALLEY, NY 10977
CLIA ID# 33D1015554
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MARCH 25, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL SUSPENSION
CONDITION LEVEL NONCOMPLIANCE
STATUS: SUSPENSION AND LIMITATION LIFTED
-
62
DEMETRIOS GABRIEL MD, DIRECTOR
GABRIEL PEDIATRICS PC
1779 RICHMOND AVENUE
STATEN ISLAND, NY 10314
CLIA ID# 33D1020164
SANCTION: CIVIL MONEY PENALTY
EFFECTIVE DATE: SEPTEMBER 15, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
RAJAN GULATI MD, DIRECTOR
IMMEDIATE MEDICAL CARE
112 SHOPRITE PLAZA, SHOPRITE BOULEVARD
ELLENVILLE, NY 12428
CLIA ID# 33D1057117
SANCTION: CIVIL MONEY PENALTY
EFFECTIVE DATE: OCTOBER 01, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
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
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: NOVEMBER 01, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
-
63
ENRICO JONES MD, DIRECTOR
FRIENDLY URGENT AND FAMILY CARE
5409 W FRIENDLY AVE
GREENSBORO, NC 27410
CLIA ID# 34D0979446
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: FEBRUARY 07, 2008
REASON: MEDICARE CANCELLATION/SUSPENSION
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
HUBERT WATTY, MD, DIRECTOR
AGAPE FAMILY PRACTICE PLLC
202 N 37TH STREET WEST
MUSKOGEE, OK 74401
CLIA ID# 37D1046001
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: MARCH 31, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STATUS: LAB VOLUNTARILY CEASED TESTING
ANA ORTIZ, DIRECTOR
LABORATORIO CLINICO SANTA ANA
CARR 107 KM 2 2 BO BORINQUEN
AGUADILLA, PR 00603
CLIA ID# 40D0657981
SANCTION: CIVIL MONEY PENALTY
DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: NOVEMBER 05, 2008
REASON: CANCELLATION OF MEDICARE APPROVAL REVOCATION
UNSUCCESSFUL PROFICIENCY TESTING
FAILURE TO SUBMIT ACCEPTABLE PLAN OF CORRECTION
-
64
LUZ DE LA CRUZ, DIRECTOR
LABORATORIO CLINICO HORMIGUEROS
3 RUIZ BELVIS ST
HORMIGUEROS, PR 00660
CLIA ID# 40D0658103
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: MARCH 20, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
COMPLIANCE ACHIEVED
BRETT WAYNE DARWIN MD, DIRECTOR
PHOENIX MEDICAL GROUP PLLC
740 CONFERENCE DR
GOODLETTSVILLE, TN 37072
CLIA ID# 44D0965109
SANCTION: DIRECTED PLAN OF CORRECTION
SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: JANUARY 31, 2008
REASON: UNSUCCESSFUL PROFICIENCY
LINH NGUYEN, DIRECTOR
PRIMA HEALTH CLINIC
3555 W WALNUT ST SUITE A
GARLAND, TX 75042
CLIA ID# 45D0476599
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: OCTOBER 14, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
-
65
JAMES CALABRIA, DIRECTOR
STEVENS PARK CLINIC
2100 W COLORADO BLVD
DALLAS, TX 75211
CLIA ID# 45D0479352
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JANUARY 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
JOHN HOOD, DIRECTOR
VILLAGE MEDICAL CENTER
6201 MATLOCK RD #139
ARLINGTON, TX 76002
CLIA ID# 45D0484813
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: APRIL 23, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
STATUS: SUSPENSION AND LIMITATION LIFTED
MARGARET PAYNE, DIRECTOR
PAYNE PEDIATRIC ASSOCIATES LTD LLP
6400 FANNIN, SUITE 2020
HOUSTON, TX 77004
CLIA ID# 45D0491544
SANCTION: SUSPENSION PART OF MEDICARE/MEDICAID
EFFECTIVE DATE: AUGUST 14, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
-
66
UMA KANOJIA, DIRECTOR
UMA M KANOJIA MD
3455 STAGG DRIVE SUITE 101
BEAUMONT, TX 77701
CLIA ID# 45D0497906
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: AUGUST 29, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STATUS: LAB VOLUNTARILY CEASED TESTING
DAVID CLARKE MD, DIRECTOR
FAMILY MEDICINE CTR OF CANYON
911 23RD STREET
CANYON, TX 79015
CLIA ID# 45D0506538
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JUNE 28, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
RAJA ATAYA MD, DIRECTOR
RAJA ATAYA MD
3070 COLLEGE ST SUITE 302
BEAUMONT, TX 77701
CLIA ID# 45D0665024
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: NOVEMBER 17, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE
-
67
DEBORAH LEHMANN MD, DIRECTOR
DEBORAH K LEHMANN MD
6420 SOUTHWEST BOULEVARD SUITE 128
FORT WORTH, TX 76109
CLIA ID# 45D0674883
SANCTION: DIRECTED PLAN OF CORRECTION
EFFECTIVE DATE: JANUARY 08, 2008
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STATUS: LAB VOLUNTARILY CEASED TESTING
HIMATLAL GORANIA MD, DIRECTOR
PERMIAN BASIN PHYSICIAN GROUP MIDLAND PA
3400 ANDREWS HWY
MIDLAND, TX 79703
CLIA ID# 45D0678295
SANCTION: DIRECT