Medicaid Michigan Sanction Provider List January 18, 2022 ...

1 Entity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReason1st Priority Physical Therapy LLCG roup1134422363 Detroit8/2/2016 MDHHS-OIGS ummary SuspensionAGSS Properties LLCHome Help AgencyAnn Arbor8/29/2017 MDHHSA Dental Center PC - Allen ParkDental GroupAllen Park5/20/2004 HHS1128(a)(1)A Dental Center PC - SouthgateDental GroupSouthgate7/20/20041128(a)(1)A Place Called HomeGoreeJimmieNon Emergency TransportationDetroit6/1/2017 MDHHSA byssinia Love Knot Physical Therapy LLCM edical Group1255667556 Southfield8/3/2016 MDHHS-OIGS ummary Supension Absolute ApothecaryPharmacy/Medical SupplierDetroit53010040655/24/1994 HHS1128(b)(3)Absolute Prescription CenterPharmacy/Medical SupplierDetroit53010045945/23/1994 HHS1128(b)(3)

2 Advanced Care Services Group1811290794 Oak Park12/22/2015 HHSS ummary SuspensionAdvanced Homecare PharmacyPharmacy1710923107 Redford530100828410/14/2015MI-Licensing and Regulatory AffairsVoluntarily SurrenderedAdvanced Sleep Neurodiagnotics PCMedical Group1134143654 Farmington Hills10/15/2017 MDHHS-OIGS ummary SuspensionMedicaid Michigan Sanction Provider List February 12, 2018 Entity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Alam.

3 Waseem MD PCMedical Group1184724114 Bloomfield Hills7/29/2015 Summary SuspensionAli Elhorr Group1558651422 Dearborn5/19/2015 DCH-OIGS ummary SuspensionAllied Geriatric Services PCMedical Group1821196551 Birmingham3/6/2013 DCHS ummary SuspensionAmerican Clinical Lab, of Medicaid False Claim ActAmerican Medical Missionary CareGroup1578600920 Saginaw12/5/2016 MDHHS-OIG1/9/2017 MDHHS-OIGS ummary Suspension TerminationAmericare LLCW illiamsJamesHome HelpSaginaw10/28/2016 MDHHSAndy's Motown PharmacyPharmacyDetroit53010084073/28/20 11MI-Licensing and Regulatory AffairsSuspended Angels Touch Home Health Care LLCHome Health1922252865 Taylor3/6/2013 DCHS ummary IncHome Health Agency1598814501 Livonia7/22/2015 MDHHSS ummary SuspensionA Plus Hospice & Palliative Care.

4 SuspensionApplewood ManorNursing FacilityMcMillan484013/19/1999MI-Licensi ng and Regulatory AffairsLicense RevocationEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Associated Physicians of Southeast Michigan SuspensionAt Home Doctors TerminatedAttarMD PCGroup1275720716 Livonia9/19/2017 MDHHS-OIGS ummary SuspensionAwerbuch.

5 Gavin MD PCGroup1003130352 Saginaw6/19/2014 DCH-OIGS ummary SuspensionB3 Diagnostic Laboratory LLCL aboratory1902287279 Troy9/20/2017 MDHHS-OIGS ummary SuspensionBay City Vascular City9/30/2015 MDHHSS ummary SuspensionBelle Woods Continuing Care CenterNursing FacilityBellville8243910/30/1999MI-Licen sing and Regulatory AffairsLicense Revocation and Summary SuspensionBeval Medical Equipment & SuppliesSupplier1235163551 Royal Oak562580933 06/11/2015 CMSR evokedBirmingham Rehab & Physical Therapy Center, Therapy ServicesDetroit3668712/18/2003 HHS1128(a)(1)BrightSmilesDental Group1508229014 West Bloomfield201534211/26/2017 MDHHST erminatedBrightSmiles PA 161 Dental Group1083848311 Waterfrd201521611/26/2017 MDHHST erminatedBroadstreet Nursing CenterNursing Facility834189/27/2000 Entity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List

6 February 12, 2018 Canton Urgent Care SuspensionCedar Knoll Care CenterNursing FacilityGrass Lake3/7/2007 DCHL icense RevocationCentrad Healthcare LLCG roup1346243979 Naperville, IL11/14/2017 MDHHS-OIGS ummary SuspensionCertified Air Respiratory Equipment, Inc. (aka CARE, Inc.)Medical SupplierSouthfield7/4/1996 HHS1128(a)(1)Chiropractic Associates, GroupLudington5/6/1996 HHS1128(b)(8)Clinical Psychiatric Medicine PCGroup1386677185 Grandville7/18/2013 DCH-OIGS uspendedCommerce Township PharmacyPharmacy1851616452 Commerce Township8/31/2011 DCH5/30/2016 MDHHS-OIGS ummary Suspension TerminatedCommunity Rehabiltation ServicesGroup1669424776 Rose City7/13/2016 MDHHS-OIGS ummary SuspensionCompassionate Doctors PCGroup1326153578 Southfield7/30/2013 DCH-OIG1128(a)(2)

7 Complete Health, LLC GroupGroup1083801500 Livonia6/21/2011 HHSC orner Drugstore of DetroitPharmacyDetroit53010038628/19/198 8 DCHV iolation of Medicaid False Claim ActEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12.

8 2018 Courtyard Manor Farmington Hills, INCG roupWalled Lake9/24/2012 HHS1128(a)(2)Creams N CapsPharmacy1386972859 Southfield530101057010/14/2015MI-Licensi ng and Regulatory AffairsVoluntarily SurrenderedCutting Edge Orthopaedics LLCG roup1295070746 Sylvania, OH9/15/2015 MDHHS-OIGS uspendedDai Care Services LLCHome Help AgencyFarmington Hills1/18/2017 MDHHS-OIGS ummary SuspensionDaneshvar, Gerald MD PLLCM edical Group1316347917 West Bloomfield7/29/2015 DCH-OIGS ummary Suspension Davenport PharmacyPharmacy1548585136 Saginaw8/31/2011 DCH-OIG5/23/2016 MDHHS-OIGS ummary Suspension TerminationDearborn Family Medicine CenterMedical Group1467407080 Dearborn7/8/2013 DCH-OIG5/5/2016 MDHHS-OIGS ummary Suspension TerminatedDearborn Internist Group1023314341 Dearborn3/14/2017 MDHHS-OIGS ummary SuspensionDearborn Pharmacy, (a)(3)

9 Dearborn Podiatric Surgeons PCGroup1447467485 Dearborn12/3/2017 MDHHS-OIGS ummary SuspensionEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Dearborn Nuro Clinic PCGroup1568638088 Dearborn12/1/2016 MDHHS-OIGS ummary SuspensionDearborn Rx PharmacyGroup1982054383 Dearborn7/26/2017MI-Licensing and Regulatory Affairs12/13/2017MI-Licensing and Regulatory AffairsSummary Suspension Voluntary TerminationDental Health Care Clinics, GroupDetroit4/11/1995 HHS1128(a)(1)Detroit Diverse Care, GroupDetroit3/16/1997 HHS1128(a)(1)

10 Detroit Medical ClinicMedical Group1245244110 Detroit7/30/2013 DCH-OIGS ummary SuspensionDiamond Pharmacy`Pharmacy1720380140 KalamazooNCPDP 23747248/19/2011 DCH6/2/2016 MDHHSS ummary Suspension TerminationDownriver Medical Associates PLCP hysician Group1114055811 Monroe3/21/2013 DCH3/21/2013 DCHS ummary Suspension TerminationDurand Clinic PCPhysician GroupDurand9/20/2001 HHS1128(a)(3)Dwight E. Smith MD PCPhysician Group1003849753 Detroit5/29/2012 DCHS ummary SuspensionEast Village PharmacyPharmacy1982928818 Dearborn8/29/2016 MDHHS-OIGS ummary SuspensionEB James Nursing CenterNursing FacilityDetroit834222/12/2002MI-Licensin g and Regulatory AffairsLicense revocation and summary suspensionEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List