NPI 1902804107
NPI 1902804107DeactivatedUnknown
This NPI was deactivated on Apr 30, 2026. Claims billed under a deactivated NPI are rejected.
This NPI was deactivated in April 2026. Provider. 666 Medicare patients in 2024, $308,093 paid; nearly all of their 1,335 Part D prescriptions were generic (91%).
Overview
| NPI | 1902804107 |
|---|---|
| Status | Deactivated Apr 30, 2026 |
| 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 | 666 |
|---|---|
| Services billed | 2,334 across 17 procedure codes |
| Paid by Medicare | $308,093 |
Part D prescriptions in 2024
| Prescriptions (claims) | 1,335 · 2,897 30-day fills |
|---|---|
| Patients | 236 |
| Total drug cost | $425,030 |
| Generic share | 91% of claims |