LASTNAME,FIRSTNAME,MIDNAME,BUSNAME,GENERAL,SPECIALTY,UPIN,NPI,DOB,ADDRESS,CITY,STATE,ZIP,EXCLTYPE,EXCLDATE,REINDATE,WAIVERDATE,WVRSTATE
"","","","ONE STOP SCOOTER SHOP & MEDICA","DME COMPANY","DME - GENERAL","","1174745533","","80 DEREK LANE","LA PLACE","LA","70068","1128a1","20160320","20240103","00000000",""
"ALMAWALDI","MOUTAZ","MOHAMAD","","PHYSICIAN (MD, DO)","INTERNAL MEDICINE","","1750390027","19610626","47033 KENTWELL PLACE","STERLING","VA","20165","1128b4","20220920","20240112","00000000",""
"ARMBRUSTER","YVONNE","G","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19650331","3837 LOVELL AVE, UNIT 2","CINCINNATI","OH","45211","1128b4","20170920","20240123","00000000",""
"BADIK","MICHAEL","DAVID","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1720253438","19810612","6341 N TOWNSHIP RD  63","FOSTORIA","OH","44830","1128b4","20231019","20240110","00000000",""
"BENTLEY","LAURABETH","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830727","4220 GWALTNEY ROAD","MORGANTON","NC","28655","1128b4","20231019","20240104","00000000",""
"BENTZ","WILLIAM","JOSEPH","","MEDICAL PRACTICE, MD","INTERNAL MEDICINE","G34577","1649915851","19660423","6110 HIGHLAND DR","JOPLIN","MO","64804","1128a4","20050320","20240110","00000000",""
"BENVENUTTO","ROBERTO","CARLOS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19681212","14982 S SOFT WHISPER WAY","HERRIMAN","UT","84096","1128b1","20190418","20240123","00000000",""
"BRANCH","LOGAN","CHASE","","IND- LIC HC SERV PRO","PHYSICAL THERAPY","","0000000000","19931114","134 FIREFLY CT","DOTHAN","AL","36301","1128b4","20240118","20240118","00000000",""
"BROOKS","CHRISTOPHER","","","EMPLOYEE - PRIVATE S","INTER CARE FACILITY","","0000000000","19840127","1614 SANSING DR","CLARKSDALE","MS","38614","1128a1","20160519","20240123","00000000",""
"CALDWELL","WILLIAM","G","","DENTAL PRACTICE","DENTIST","","1023198025","19610516","8 CADWICK CIR, APT F","NASHUA","NH","03062","1128b14","20020320","20240130","00000000",""
"CHAMBERLAIN","HOLLIE","R","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19960618","15 E WASHINGTON ST","ELLICOTTVILLE","NY","14731","1128a2","20171120","20240123","00000000",""
"CLINE","REBEKAH","BUTTERWORTH","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19710614","221 MIZELLE MEADOW COURT","HOLLY SPRINGS","NC","27540","1128b4","20161020","20240108","00000000",""
"COKER","ADETOUN","OLUFADEBI","","HOME HEALTH AGENCY","NURSE/NURSES AIDE","","1992878136","19670213","4113 FALLGOLD PARKWAY N","BROOKLYN PARK","MN","55443","1128a1","20090219","20240123","00000000",""
"COLLINS","DEMECIA","DENISE","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19871006","2588 GROVE WAY","CASTRO VALLEY","CA","94546","1128a1","20181220","20240103","00000000",""
"COOPER","MICHELLE","MAYLENE","","BUS OWNER/EXEC","HOME HEALTH AGENCY","","0000000000","19670322","977 COTTONWOOD LANE","HAMPTON","GA","30228","1128a1","20140120","20240104","00000000",""
"DAWSON","MYYAHHNNA","S","","BUS OWNER/EXEC","MENTAL/BEHAVIORAL HE","","1851714604","19760623","193 BETTY RUBY DR","GRAY","LA","70359","1128a1","20181220","20240112","00000000",""
"DEMERCHANT","HERBERT","LAWRENCE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19720310","10 STATE ROAD","BATH","ME","04530","1128b4","20211020","20240103","00000000",""
"DUNN","KELLI","MICHELE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19801005","25828 COOSA COUNTY RD 29","SYLACAUGA","AL","35151","1128b4","20171019","20240103","00000000",""
"ESCAMILLA","ANDRES","ALONSO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19701219","410 SW 4TH AVE","BOYNTON BEACH","FL","33435","1128b4","20201220","20240112","00000000",""
"ETIENNE","LOURDES","M","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19920729","860 N MONTELLO ST, APT 1","BROCKTON","MA","02301","1128a3","20160218","20240110","00000000",""
"FARRELL","ANGELA","D","","NURSING PROFESSION","NURSE/NURSES AIDE","","0000000000","19650926","72 SALEM CHURCH RD","MILAN","TN","38358","1128b4","20071018","20240123","00000000",""
"FITCHETT","DEBBIE","JEANNE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19620307","2416 STARLIGHT GLEN","ESCONDIDO","CA","92026","1128b4","20150520","20240110","00000000",""
"FRANE","NICOLE","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19810822","1407 4TH AVE, NORTH","GRAND FORKS","ND","58203","1128b4","20230720","20230720","00000000",""
"GORDON","JOHN","THOMAS","","IND- LIC HC SERV PRO","DENTIST","","1801999719","19661214","111 CARLETON AVENUE, SUITE 1","ISLIP TERRACE","NY","11752","1128a4","20190120","20240104","00000000",""
"HALE","MIRIAM","GREENE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19771111","1580 BUCKFORD ROAD","SHELBY","NC","28152","1128b4","20150219","20240104","00000000",""
"JAMIL","IRTAFA","","","PHARMACY","TECHNICIAN","","0000000000","19580828","5 W CHESTNUT ST","FARMINGDALE","NY","11735","1128a1","20000420","20240108","00000000",""
"JONES","SHAVON","ANISSA","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1437214376","19760416","10204 EYELET COURT","CLINTON","MD","20735","1128a1","20190120","20240110","00000000",""
"KERBY","SHAWN","MICHAEL","","IND- LIC HC SERV PRO","DENTIST","","1851447304","19781018","803 WEST MAIN","WASHINGTON","IA","52353","1128a4","20181220","20240103","00000000",""
"KULP","DONNA","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19630210","210 KIT LANE","MEBANE","NC","27302","1128b4","20180920","20240123","00000000",""
"LANGFORD","SHESHALLA","M","","PHARMACY","TECHNICIAN","","0000000000","19710510","611 S 9TH ST","POPLAR BLUFF","MO","63901","1128b4","20001220","20240123","00000000",""
"MALOLOT","MARJORIE","","","IND- LIC HC SERV PRO","PHYSICAL THERAPY","","1306137583","19781017","1736 SUNSET DRIVE","HAMILTON","OH","45013","1128a1","20181018","20240103","00000000",""
"MCCANTS","ALEATHA","S","","NURSING PROFESSION","NURSE/NURSES AIDE","","0000000000","19731205","2404 TEMPLE CIRCLE","HAINES CITY","FL","33844","1128b1","20060620","20240103","00000000",""
"MCNARY","AISHA","","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","0000000000","19790708","7617 YORKHOUSE ROAD","COLUMBIA","SC","29223","1128a1","20180419","20240110","00000000",""
"MIREE","JARREAU","","","IND- LIC HC SERV PRO","HEALTH CARE AIDE","","1083973424","19801012","2387 LEE ROAD","CLEVELAND","OH","44118","1128a1","20180920","20240123","00000000",""
"MORRIS","EMILY","BRETT","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19861214","9275 V HIGHWAY","MYRTLE","MO","65778","1128b4","20190418","20240123","00000000",""
"MUSGROVE","FRANKIE","","","REHAB FACILITY - GEN","BUSINESS MANAGER","","0000000000","19660124","409 S LOCUST ST","MESQUITE","TX","75149","1128a3","20090420","20240108","00000000",""
"OKORIE","UCHENNA","OBIOMA","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","1336426402","19790112","12112 SYLVESTER DRIVE","OKLAHOMA CITY","OK","73162","1128a1","20181220","20240103","00000000",""
"ONWUCHURUBA","DARYL","NNAMDI","","IND- LIC HC SERV PRO","COUNSELOR","","1811234453","19880605","16117 JULIET DRIVE","EDMOND","OK","73013","1128a1","20181220","20240123","00000000",""
"PHILLIPS","RAYLONDA","MICHELLE","","NURSING PROFESSION","NURSE/NURSES AIDE","","0000000000","19821115","4420 MARIGOLD PLACE NW, APT H","ROCHESTER","MN","55901","1128a2","20100520","20240108","00000000",""
"PITTS","ANIKA","DESHAN","","BUS OWNER/EXEC","DME - DIETARY SUPPLI","","0000000000","19750208","80 DEREK LANE","LA PLACE","LA","70068","1128a1","20160320","20240103","00000000",""
"POLLACK","TRACY","A","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1588890727","19790419","2860 SHERWOOD ROAD","PALMYRA","NY","14522","1128a1","20180719","20240104","00000000",""
"RATAJCZAK","KIMBERLY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19750109","5651 YOUNG ROAD","LOCKPORT","NY","14094","1128a1","20190120","20240103","00000000",""
"RICHARDS","ABRAHAM","JIMENEZ","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19900307","4650 E 29TH ST","TUCSON","AZ","85711","1128b4","20161020","20240110","00000000",""
"RUPPERT","WENDY","JEAN","","NURSING PROFESSION","NURSE/NURSES AIDE","","0000000000","19690214","415 BEAUMONT RD","YORK","PA","17403","1128a4","20020320","20240123","00000000",""
"SHIFLETT","KEVIN","J","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19711118","18 STANDISH ST","PLATTSBURGH","NY","12901","1128b4","20170720","20240108","00000000",""
"SLOAN","TERRA","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19800322","341 MILLIKEN AVE","SHARPSVILLE","PA","16150","1128a3","20140420","20240123","00000000",""
"SMITH","HAILEY","L","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19891115","102 WINDING CREEK","MADISONVILLE","KY","42431","1128a1","20150520","20240103","00000000",""
"SORENSEN","MARK","CHRISTIAN","","MEDICAL PRACTICE, MD","EMERGENCY MEDICINE","B96814","0000000000","19481218","1204 S 15TH ST","PHILADELPHIA","PA","19146","1128b4","20070320","20240123","00000000",""
"STUART","CLAUDETTE","","","DENTAL PRACTICE","DENTIST","U50680","1972707313","19581101","3902 DIAMOND GROVE CT","HOUSTON","TX","77059","1128b14","20010620","20240108","00000000",""
"THORNTON","JULISA","ROBINSON","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19910428","642 BRANCH STREET","SIMMESPORT","LA","71369","1128a1","20181120","20240104","00000000",""
"TOKLE","HAROLD","R JR","","IND- LIC HC SERV PRO","COUNSELOR","","1134315161","19611109","792 SLATE BRANCH ROAD","CRAB ORCHARD","KY","40419","1128a1","20170620","20240104","00000000",""
"VANDERSLUIS","MICHAEL","ALBERT","","CHIROPRACTIC PRACT","CHIROPRACTIC","U40284","1699820241","19660815","2186 PARKER DR","WAYLAND","MI","49348","1128b7","19990616","20240108","00000000",""
"VANDERSLUIS","MICHAEL","ALBERT","","CHIROPRACTIC PRACT","CHIROPRACTIC","U40284","1699820241","19660815","2186 PARKER DR","WAYLAND","MI","49348","1128a1","19990616","20240108","00000000",""
"WALKER","JULISA","M","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19910212","15097 GOLDENEYE ROAD","WEEKI WACHEE","FL","34614","1128b4","20140820","20240104","00000000",""
"YOUNG","BRITANY","NICOLE","","IND- LIC HC SERV PRO","HEALTH CARE AIDE","","0000000000","19860731","600 PLAINFIELD RD, APT 306","WEST LAFAYETTE","OH","43845","1128a1","20130820","20240108","00000000",""