Transcription of PROVIDERS EXCLUDED BY - Mississippi Division of …
1 PROVIDERS EXCLUDED BY THE Mississippi Division OF medicaid FROM PARTICIPATING IN THE Mississippi medicaid PROGRAM As of November 8, 2018 FOR A COMPREHENSIVE LISTING OF PROVIDERS EXCLUDED FROM RECEIVING REIMBURSEMENT FOR PROVIDING MEDICARE AND medicaid SERVICES NATIONWIDE, SEE THE OFFICE OF INSPECTOR GENERAL S WEBSITE AT: The effect of an exclusion (not being able to participate) is: No payment will be made by any Federal health care program for any items or services furnished, ordered, or prescribed by an EXCLUDED individual or entity. Federal health care programs include Medicare, medicaid , and all other plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan).
2 For exclusions implemented prior to August 4, 1997, the exclusion covers the following Federal health care programs: Medicare (Title XVIII), medicaid (Title XIX), Maternal and Child Health Services Block Grant (Title V), Block Grants to States for Social Services (Title XX) and State Children's Health Insurance (Title XXI) programs. No program payment will be made for anything that an EXCLUDED person furnishes, orders, or prescribes. This payment prohibition applies to the EXCLUDED person, anyone who employs or contracts with the EXCLUDED person, any hospital or other provider where the EXCLUDED person provides services, and anyone else. The exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the EXCLUDED person.
3 There is a limited exception to exclusions for the provision of certain emergency items or services not provided in a hospital emergency room. See regulations at 42 CFR (c) NAME OF provider EXCLUSION PERIOD A & B Medical Supplies May 15, 2014 - Indefinite 444 Gracie Lane Moscow Mills, MO 63362 Specialty - DME Jody Adams, NP January 11, 2016 - Indefinite 5345 Highway 18 W Jackson, MS 39209 Specialty Nurse Practitioner Lon F. Alexander, MD March 12, 2014 January 15, 2015 1860 Chadwick Drive STE 205 Jackson, MS 39204 Specialty Neurological Surgery 2 Lon F. Alexander, MD PLLC March 12, 2014 January 15, 2015 1860 Chadwick Drive STE 205 Jackson, MS 39204 Specialty Neurological Surgery Walter O.
4 Anderson, MD October 30, 2002 November 19, 2028 5117 HWY 493 N Meridian, MS 39305 Specialty Psychiatric (Child) Hosan Azomani, MD November 26, 2014 - Indefinite 559 Arnold Avenue Suite A Greenville, MS 38701 Specialty - Pediatrics Michael L. Baker August 4, 2017 - Indefinite 20400 Highway 61 Rolling Fork, MS 39159 Specialty - Physician Batesville Emergency Physicians July 2, 2012 - Indefinite 155 Keating Road Batesville, MS 38606 Specialty N/A Batesville Hospital Management Inc. July 2, 2012 - Indefinite Robert Corkern 303 Medical Center Drive Batesville, MS 38606 Specialty N/A Kenneth Beal Jr, DDS March 4, 2016 - Indefinite 37060 Hwy 82 West Itta Bena, MS 38941 Specialty - Dentist Harvey Beasley August 8, 2003 August 7, 2018 4953 Oak Creek Jackson, MS 39212 Specialty Owner (Optical)
5 Beautiful U Boutique March 18, 2017 - Indefinite 1103 Broad Ave, Suite B Gulfport, MS 39501 Specialty - DME 3 Jan Boggs, PhD May 9, 2016 - Indefinite 1508 37th Avenue Meridian, MS 39307 Specialty - Psychologist Annie Borders-Blackwell, DO November 20, 2017 - Indefinite 101 N Edwards Avenue Mound Bayou, MS 38762 Specialty Doctor of Osteopathy Anetha Brown August 8, 2003 August 7, 2018 6551 Abraham Lincoln Jackson, MS 39213 Specialty N/A Nate Brown August 15, 2017 - Indefinite 101 N Edwards Avenue Mound Bayou, MS 38762 Specialty - Physician Caring Hands Family Healthcare Clinic August 5, 2016 - Indefinite 369 Hwy 72 Burnsville, MS 38833 Specialty Group Nursing Services Children s Medical Group November 26, 2014 - Indefinite 559 Arnold Avenue Suite A Greenville, MS 38701 Specialty N/A Children s Medical Group November 26, 2014 - Indefinite 1421 East Peace Street Canton, MS 39046 Specialty N/A Collins and Collins I, LLC October 5, 2012 - Indefinite d\b\a CCI Professional Healthcare Hospice 316 Central Avenue Laurel, MS 39440 Specialty Hospice Columbus Neurosurgical Associates March 12, 2014 January 15, 2015 255 Baptist Blvd STE 401 Columbus, MS 39705 Specialty Neurological Surgery 4 The Comfort Zone DBA Blount Medical January 2, 2016 - Indefinite 132 A Public Square Calhoun City.
6 MS 38916 Specialty - DME Tanaka Conaway September 20, 2017 - Indefinite 305 E Wheeler Street Okolona, MS 38860 Specialty N/A Stefanie Cook December 20, 2017 - Indefinite 200 Kelly Street Collins, MS 39428 Specialty Registered Nurse Robert S. Corkern, July 2, 2012 - Indefinite 107 Eureka Street, Suite A Batesville, MS 38606 Specialty N/A Don S. Davis, MD September 28, 2000 September 28, 2001 5002 HWY 39 North, Bldg. A Meridian, MS 39301 Specialty Otolryngis Albert Diaz, MD June 12, 2018 - Indefinite 1720-A Medical Park Drive Suite 130-A Biloxi, MS 39532 Specialty - Physician Mary Dorsey-Redding, LCSW December 1, 2008 Indefinite 154 East Hill Drive Madison, MS 39110 Specialty Social Worker Duane Dufrene July 11, 2016 - Indefinite St.
7 Luke Missionary Hospice 8814 Veterans Blvd, Suite 3-305 Metairie, LA 70001 Specialty - Hospice Frederic B. Dunn, DDS March 22, 2004 October 20, 2015 3016 21st Street Gulfport, MS 39501 Specialty N/A 5 Angela Dykes, SLP February 7, 2014 - Indefinite 161 Magnolia Road Laurel, MS 39443 Specialty Speech Therapy Dykes Speech Associates February 7, 2014 - Indefinite 161 Magnolia Rd Laurel, MS 39443 Specialty N/A Steven W. Easley, MD March 3, 2016 - Indefinite 409 Tyler Holmes Drive Winona, MS 38967 Specialty Physician Faith Hospice of Mississippi July 2, 2012 - Indefinite 558 Highway 6 East, Suite A Batesville, MS 38606 Specialty N/A Arnold Feldman, MD April 17, 2017 - Indefinite 114 Jefferson Davis Blvd Natchez, MS 39120 Specialty - Anesthesiology Garden of Angels June 22, 2017 - Indefinite 840 East River Place Suite 605 Jackson, MS 39202 Specialty Group Mental Health Paul Gerdes April 12, 2018 November 5, 2018 Clinical Partners, Inc.
8 350 Crossgates Blvd Brandon, MS 39046 Specialty N/A Greenville Emergency Physicians July 2, 2012 - Indefinite 1400 East Union Street Greenville, MS 38703 Specialty N/A Greenville Radiology Inc. April 1, 2013 - Indefinite 1400 East Union Street Greenville, MS 38704 Specialty N/A 6 Grenada Lake Emergency ER July 2, 2012 - Indefinite 960 Avent Drive Grenada, MS 38901 Specialty N/A Clayton Hodge, LCSW February 1, 2012 Indefinite 416 Lynwood Lane Jackson, MS 39206 Specialty N/A Edwin Love Holt, DMD August 27, 2012 - Indefinite 101 Highway 61 South Natchez, MS 39120 Specialty N/A Hospice Care at Home May 15, 2014 - Indefinite 5295 Galaxie Drive Suite F Jackson, MS 39206 Specialty - Hospice David O.
9 Hughes, DDS November 4, 2013 - Indefinite Box 1291 Laurel, MS 39441 Specialty Dental Hughes Orthodontics PLLC November 4, 2013 - Indefinite 140 S 15th Avenue Laurel, MS 39440 Specialty Dental Jackson Rehab and Wellness Center June 10, 2015 - Indefinite 5380 I-55 North Suite 101 Jackson, MS 39211 Specialty N/A Dana Michelle Jenkins Gruhlke James, RN February 7, 2005 February 7, 2010 Central Mississippi Correctional Facility Box 88550 Pearl, MS 39208 Specialty Home Health RN Sandra James, RN August 8, 2003 August 7, 2018 228 Lake of Pines Dr. Jackson, MS 39206 Specialty Registered Nurse 7 Pamela Jefferson June 22, 2017 Indefinite 840 East River Place Suite 605 Jackson, MS 39202 Specialty Group Mental Health Annie Elizabeth Jenkins, NP September 20, 2017 - Indefinite 212 S 13th Ave Laurel, MS 39440 Specialty Nurse Practitioner Larry Jenkins September 20, 2017 - Indefinite P O Box 3949, #20155-043 Pensacola, FL 32516 Specialty Business Owner, DME Barbara Jones July 2, 2014 - Indefinite Clear View Vision Care Inc.
10 4477 North State Street Jackson, MS 39206 Specialty Owner (Optical) Shanika Sherese Keys July 20, 2017 - Indefinite 910 Walters Rd Meridian, MS 39307 Specialty Personal Care Assistant Andre Kirkland April 4, 2017 - Indefinite 1517 Ferris Drive Cleveland, MS 38732 Specialty Business Owner Theresa Lane Fisher PA June 29, 2015 - Indefinite 4436 North State Street Suite A1 Jackson, MS 39206 Specialty N/A Michael Loebenberg, MD February 28, 2018 Indefinite 3890 Bienville Blvd Ocean Springs, MS 39564 Specialty - Physician Alisha Lofton September 20, 2017 - Indefinite 4545 Engram Drive, Apt 4132 Gulfport, MS 39501 Specialty Certified Nursing Assistant 8 Longwind Products & Services, Inc. August 8, 2012 - Indefinite Lonnie Walker Owner 205 West Woodrow Wilson Ave Jackson, MS 39213 Specialty - DME Tashnika Madison April 20, 2010 - Indefinite Box 442 Monticello, MS 39654 Specialty Certified Nursing Assistant Rhonda Yvette Maberry December 20, 2017 - Indefinite 7900 LaFourche Street New Orleans, LA 70127 Specialty Registered Nurse Carolyn McKenzie February 28, 2008 Indefinite The Humphreys Co.
