North Dakota Provider Exclusion List Updated 1/31/2022 ...

1 ND Dept of Human Services North Dakota Provider Exclusion List Updated 10/01/2018 - Medical Services Division e Medicare Provider Business Name Exclusion a Provider Name Provider Provider Type State Reason for Exclusion verification and Address Date s Number o The Office of Inspector General has excluded George Abdilnour from participating in any capacity in Contact DHS Program 305 8th Ave Apt. 5 R35497 Registered Nurse/Licensed Medicare, Medicaid, and all Federal Abdilnour, George N/A ND Termination 9/18/2014. Integrity Unit to verify Cando, ND L10270 Practical Nurse Health Care Programs.

2 Angel Hands Healthcare Contact DHS/HCBS Not in compliance with rules and Owner: Susan Lakoduk Unit to Verify regulations. Federal offense charges Minot, ND N/A N/A Qualified Service Provider ND Termination 1/7/2015. The Department received a notice from the Office of Inspector General, Exclusions Director in reference to 508 Highland St this Provider being excluded from all Contact DHS Program Aos, Douglas Rolette, ND N/A 1356551840 Pharmacist ND Termination 8/20/2013 programs. These include Medicare, Integrity Unit to verify Medicaid, and all federal health care programs.

3 Failure to comply with rules and regulations. On 05/30/14 the Department received notification from the OIG that this Provider has Contact DHS HCBS Unit Baker, Brittni N/A N/A N/A Qualified Service Provider ND Termination 6/26/13 been officially excluded from to verify participation in the Medicare, Medicaid, and all Federal health care programs. Page 1 of 22. ND Dept of Human Services North Dakota Provider Exclusion List Updated 10/01/2018 - Medical Services Division e Medicare Provider Business Name Exclusion a Provider Name Provider Provider Type State Reason for Exclusion verification and Address Date s Number o Failure to comply with rules and regulations.

4 On 07/31/14 the Department received notification Contact DHS HCBS Unit form the OIG that this Provider has Ballou, Stephanie N/A N/A N/A Qualified Service Provider ND Termination 7/19/13. to verify been officially exluded from participation in the Medicare, Medicaid, and all Federal health care programs. For questions regarding exclusions and suspensions from the Ohio Medicaid program, send an email to "Exclusions" in the subject line and Contact DHS Program 2740 West Market St include the individual's full name Barlage, Cindy N/A N/A OH Termination 8/31/2013.

5 Integrity Unit to verify Lima, OH (including middle initial) and the last four digits of their Social Security number to: Failure to comply with rules and regulations. On 05/30/14 the Department received notification Contact DHS HCBS Unit from the OIG that this Provider has Barron, Tammy N/A N/A N/A Qualified Service Provider ND Termination 10/7/13. to verify been officially excluded from participation in the Medicare, Medicaid, and all Federal health care programs. The Office of Inspector General has th excluded this Provider from Contact Program 401 6 Street W Lemmon SD.

6 Beattie, Robert N/A N/A MD License #5931 ND 4/20/2016 participating in any capacity in Integrity Unit to Verify 57638. Medicare, Medicaid and all Federal Health care programs. Page 2 of 22. ND Dept of Human Services North Dakota Provider Exclusion List Updated 10/01/2018 - Medical Services Division e Medicare Provider Business Name Exclusion a Provider Name Provider Provider Type State Reason for Exclusion verification and Address Date s Number o The Office of Inspector General has excluded this Provider from Contact DHS Program 2847 Parkview Drive S R38304 and Registered Nurse/Licensed Berge.

7 Robyn N/A ND Termination 2/19/2016 participating in any capacity in Integrity Unit to verify Fargo ND 58103 L9540 Practical Nurse Medicare, Medicaid, and all Federal Health Care Programs. Failure to comply with rules and regulations. On 06/30/14 the Department received notification Contact DHS HCBS Unit from the OIG that this Provider has Black, Carolyn N/A N/A N/A Qualified Service Provider ND Termination 11/25/13. to verify been officially excluded from participation in the Medicare, Medicaid, and all Federal health care programs.

8 The Department received a notice from the Office of Inspector General, Exclusions Director in reference to Contact DHS Program 424 8th Street NW Licensed Practical Nurse Blake, Amanda N/A N/A ND Termination 7/19/2015 this Provider being excluded from all Integrity Unit to verify Valley City ND 58072 L11010. programs. These include Medicare, Medicaid, and all federal health care programs The Office of Inspector General has excluded this Provider from Contact DHS Program 9291 HWY 23, Unit 3. Blue, Joanne Cecile Blue N/A R27051 Registered Nurse ND Termination 3/19/2015 participating in any capacity in Integrity Unit to verify New Town, ND 58763.

9 Medicare, Medicaid, and all Federal Health Care Programs. Contact DHS HCBS Unit Failure to comply with rules and Booth-Keys, Zashanna N/A N/A N/A Qualified Service Provider ND Termination 8/06/14. to verify regulations. Page 3 of 22. ND Dept of Human Services North Dakota Provider Exclusion List Updated 10/01/2018 - Medical Services Division e Medicare Provider Business Name Exclusion a Provider Name Provider Provider Type State Reason for Exclusion verification and Address Date s Number o For questions regarding exclusions and suspensions from the Ohio Medicaid program, send an email to "Exclusions" in the subject line and Contact DHS Program 4302 Allen Road, Suite 300 include the individual's full name Bressi, James N/A N/A OH Termination 8/15/2013.

10 Integrity Unit to verify Stow, OH (including middle initial) and the last four digits of their Social Security number to: Contact DHS HCBS Unit Termination April 10, Failure to comply with rules and Brooks, Joeline Qualified Service Provider ND. to verify 2018 regulations. The Office of Inspector General has excluded Katherine Carlisle from participation in any capacity in Contact DHS Program 221 6th St. S Medicare, Meicaid and all Federall Carlisle, Katherine N/A L12363 LPN ND Termination 9/18/2014. Integrity Unit to verify Aneta, ND Health Care Programs.