NPI 1104904416
NPI 1104904416DeactivatedUnknown
This NPI was deactivated on Oct 1, 2026. Claims billed under a deactivated NPI are rejected.
This NPI was deactivated in October 2026. Provider. Medicare paid $2,033 for services to 23 patients in 2024.
Overview
| NPI | 1104904416 |
|---|---|
| Status | Deactivated Oct 1, 2026 |
| Entity type | Unknown |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 23 |
|---|---|
| Services billed | 27 across 5 procedure codes |
| Paid by Medicare | $2,033 |