NPI 1790196350
NPI 1790196350DeactivatedUnknown
This NPI was deactivated on Dec 18, 2025. Claims billed under a deactivated NPI are rejected.
This NPI was deactivated in December 2025. Provider. 386 Medicare patients in 2024, $174,878 paid; nearly all of their 254 Part D prescriptions were generic (99%).
Overview
| NPI | 1790196350 |
|---|---|
| Status | Deactivated Dec 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 | 386 |
|---|---|
| Services billed | 4,782 across 78 procedure codes |
| Paid by Medicare | $174,878 |
Part D prescriptions in 2024
| Prescriptions (claims) | 254 · 322 30-day fills |
|---|---|
| Patients | 98 |
| Total drug cost | $7,090 |
| Generic share | 99% of claims |