North Dakota Provider Exclusion List Updated …

1 ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Abdilnour, GeorgeContact DHS Program Integrity Unit to verify305 8th Ave Apt. 5 Cando, NDN/AR35497L10270 Registered Nurse/Licensed Practical NurseNDTermination 9/18/2014 The Office of Inspector General has excluded George Abdilnour from participating in any capacity in Medicare, Medicaid, and all Federal Health Care Programs. Angel Hands HealthcareOwner: Susan LakodukContact DHS/HCBS Unit to VerifyMinot, ND N/AN/AQualified Service ProviderNDTermination 1/7/2015 Not in compliance with rules and regulations. Federal offense chargesAos, DouglasContact DHS Program Integrity Unit to verify508 Highland StRolette, NDN/A1356551840 PharmacistNDTermination 8/20/2013 The Department received a notice from the Office of Inspector General, Exclusions Director in reference to this Provider being excluded from all programs.

2 These include Medicare, Medicaid, and all federal health care programs. Baker, BrittniContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 6/26/13 Failure to comply with rules and regulations. On 05/30/14 the Department received notification from the OIG that this Provider has been officially excluded from participation in the Medicare, Medicaid, and all Federal health care programs. Page 1 of 22ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Ballou, StephanieContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 7/19/13 Failure to comply with rules and regulations.

3 On 07/31/14 the Department received notification form the OIG that this Provider has been officially exluded from participation in the Medicare, Medicaid, and all Federal health care programs. Barlage, CindyContact DHS Program Integrity Unit to verify2740 West Market StLima, OHN/AN/AOHT ermination 8/31/2013 For questions regarding exclusions and suspensions from the Ohio Medicaid program, send an email to "Exclusions" in the subject line and include the individual's full name (including middle initial) and the last four digits of their Social Security number to: Barron, TammyContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 10/7/13 Failure to comply with rules and regulations. On 05/30/14 the Department received notification from the OIG that this Provider has been officially excluded from participation in the Medicare, Medicaid, and all Federal health care programs.

4 Beattie, Robert Contact Program Integrity Unit to Verify401 6th Street W Lemmon SD 57638N/AN/AMD License #5931ND4/20/2016 The Office of Inspector General has excluded this Provider from participating in any capacity in Medicare, Medicaid and all Federal Health care 2 of 22ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Berge, Robyn Contact DHS Program Integrity Unit to verify2847 Parkview Drive S Fargo ND 58103N/AR38304 and L9540 Registered Nurse/Licensed Practical NurseNDTermination 2/19/2016 The Office of Inspector General has excluded this Provider from participating in any capacity in Medicare, Medicaid, and all Federal Health Care , CarolynContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 11/25/13 Failure to comply with rules and regulations.

5 On 06/30/14 the Department received notification from the OIG that this Provider has been officially excluded from participation in the Medicare, Medicaid, and all Federal health care programs. Blake, Amanda Contact DHS Program Integrity Unit to verify424 8th Street NW Valley City ND 58072N/AN/ALicensed Practical Nurse L11010ND Termination 7/19/2015 The Department received a notice from the Office of Inspector General, Exclusions Director in reference to this Provider being excluded from all programs. These include Medicare, Medicaid, and all federal health care programsBlue, Joanne Cecile Blue Contact DHS Program Integrity Unit to verify9291 HWY 23, Unit 3 New Town, ND 58763N/AR27051 Registered Nurse NDTermination 3/19/2015 The Office of Inspector General has excluded this Provider from participating in any capacity in Medicare, Medicaid, and all Federal Health Care.

6 ZashannaContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 8/06/14 Failure to comply with rules and 3 of 22ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Bressi, JamesContact DHS Program Integrity Unit to verify4302 Allen Road, Suite 300 Stow, OHN/AN/AOHT ermination 8/15/2013 For questions regarding exclusions and suspensions from the Ohio Medicaid program, send an email to "Exclusions" in the subject line and include the individual's full name (including middle initial) and the last four digits of their Social Security number to: Brooks, JoelineContact DHS HCBS Unit to verifyQualified Service ProviderNDTermination April 10, 2018 Failure to comply with rules and , KatherineContact DHS Program Integrity Unit to verify221 6th St.

7 SAneta, NDN/AL12363 LPNNDT ermination 9/18/2014 The Office of Inspector General has excluded Katherine Carlisle from participation in any capacity in Medicare, Meicaid and all Federall Health Care Programs. Cervantes, JackieContact DHS Program Integrity Unit to verify408 West 6th StreetManchester, OHN/AN/AHealth Care AideOHTermination 9/12/2014 For questions regarding exclusions and suspensions from the Ohio Medicaid program, send an email to "Exclusions" in the subject line and include the individual's full name (including middle initial) and the last four digits of their Social Security number to: Charette, CarlContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDDenial 6/22/2011 Direct bearing offense. Page 4 of 22ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Charvat, TanaTontact DHS HCBS UnitN/AN/AN/AQualified Service ProviderNDTermination 2/8/18 Failture to comply with rules and regulationsCheauma, MarlettaContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 8/09/14 Failure to comply with rules and , CharlesContact DHS Program Integrity Unit to verifyGrand Forks/Northwood, NDN/A1083674337 PhysicianND6/25/2015 Medicare Exclusion /RevocationCofer.

8 KellyContact DHS Program Integrity Unit to verifyN/AN/AN/ARegistered Nurse R32728 NDTermination 5/20/2014 The Office of Inspector General has excluded Kelly Cofer from participating in any capacity in Medicare, Medicaid, and all Federal Health Care Programs. Conway, JessicaContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDDenial 1/3/2014 Direct bearing offense. Cota, Manuel Contact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderND Termination 1/1/15 Faillure to comply with rules and , AaronContact DHS/HBCS Unit N/AN/AN/AQualified Service ProviderNDTermination 1/2/2018 Failure to comply with rules and regulationsCrissler, Angela Contract DHS/HCBS Unit to Verify N/AN/AN/AQualified Service ProviderNDTerminiation 2/27/15 Failure to comply with rules and regulationsCruz, EmilioContact DHS Program Integrity Unit to verify(Federal Bureau of Prisons)G399541669551610 PhysicianND7/20/14 The Office of Inspector General has excluded Emilio Cruz from participating in any capacity in Medicare, Medicaid, and all Federal Health Care Programs.

9 Page 5 of 22ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Dallman-Holeton, AntonetteContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 7/5/2014 Failure to comply with rules and regulations. Day, SandraContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDTermination 11/25/13 Failure to comply with rules and regulations. On 06/30/14 the Department received notification from the OIG that this Provider has been officially excluded from participation in the Medicare, Medicaid, and all Federal health care programs. Degelder, JeannaContact DHS Program Integrity Unit to verifyN/AN/AN/ARegistered Nurse R32728 NDTermination 5/20/2014 The Office of Inspector General has excluded Jenna Degelder from participating in any capacity in Medicare, Medicaid, and all Federal Health Care Programs.

10 Dubois, CalvinContact DHS/HBCS Unit N/AN/AN/AQualified Service ProviderNDTermination 1/2/2018 Failure to comply with rules and regulationsPage 6 of 22ND Dept of Human ServicesMedical Services DivisionNorth Dakota Provider Exclusion ListUpdated 10/01/2018 - Provider Name ProviderverificationBusiness Nameand TypeStateExclusionDateReason for Exclusion easo Duttenhefer, DoreenContact DHS Program Integrity Unit to verifyN/AN/AN/ALicensed Practical Nurse L13783ND Termination 5/20/2014 The Office of Inspector General has excluded Doreen Duttenhefer from participating in any capacity in Medicare, Medicaid, and all Federal Health Care Programs. Dykema, NicoleContact DHS ProgramIntegrity Unit to verify9467 11th Ave SE Strasburg NDN/AR36276 Registered NurseNDTermination 9/20/2015 The Department received a notice from the Office of Inspector General, Exclusions Director in reference to Elmore, James Frank Contact DHS/HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDDenial 1/15/2015 Direct Bearing , JamieContact DHS HCBS Unit to verifyN/AN/AN/AQualified Service ProviderNDDenial 12/24/2011 Failure to comply with rules and Life Home Care Owners.