NPI 1104930619
NPI 1104930619DeactivatedUnknown
This NPI was deactivated on Jun 12, 2025. Claims billed under a deactivated NPI are rejected.
This NPI was deactivated in June 2025. Provider. Their prescriptions cost Medicare Part D more than their services did: $138,788 for 555 claims, against $35,339 paid for services in 2024.
Overview
| NPI | 1104930619 |
|---|---|
| Status | Deactivated Jun 12, 2025 |
| 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 | 182 |
|---|---|
| Services billed | 617 across 19 procedure codes |
| Paid by Medicare | $35,339 |
Part D prescriptions in 2024
| Prescriptions (claims) | 555 · 822 30-day fills |
|---|---|
| Patients | 115 |
| Total drug cost | $138,788 |
| Generic share | 46% of claims |