NPI 1629007158
NPI 1629007158DeactivatedUnknown
This NPI was deactivated on Sep 18, 2025. Claims billed under a deactivated NPI are rejected.
This NPI was deactivated in September 2025. Provider. 313 Medicare patients in 2024, $33,998 paid; all of their 80 Part D prescriptions were generic.
Overview
| NPI | 1629007158 |
|---|---|
| Status | Deactivated Sep 18, 2025 |
| Entity type | Unknown |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 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 | 313 |
|---|---|
| Services billed | 905 across 26 procedure codes |
| Paid by Medicare | $33,998 |
Part D prescriptions in 2024
| Prescriptions (claims) | 80 · 89 30-day fills |
|---|---|
| Patients | 48 |
| Total drug cost | $885.87 |
| Generic share | 100% of claims |