LASTNAME,FIRSTNAME,MIDNAME,BUSNAME,GENERAL,SPECIALTY,UPIN,NPI,DOB,ADDRESS,CITY,STATE,ZIP,EXCLTYPE,EXCLDATE,REINDATE,WAIVERDATE,WVRSTATE
"","","","BUCKEYE HEALTH AND RESEARCH, L","DME COMPANY","DME - PROSTHETICS","","1508297854","","65 HIGHVIEW BLVD","COLUMBUS","OH","43207","1128a1","20251218","00000000","00000000",""
"ABDIRAHMAN","BISHARA","SALAT","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","1801673082","19980101","601 1ST AVE NE, APT 216","FARIBAULT","MN","55021","1128a1","20251218","00000000","00000000",""
"ADAMS","KYLE","","","EMPLOYEE - FEDERAL -","EMPLOYEE - MILITARY","","0000000000","19870422","7242 OLD HIGHWAY RD","INEZ","TX","77968","1128a3","20251218","00000000","00000000",""
"ANKENBROCK-CRARY","ARIEL","MARIE","","IND- LIC HC SERV PRO","PHARMACY TECHNICIAN","","0000000000","19860221","323 N HOBACK ST","HELENA","MT","59601","1128b4","20251218","00000000","00000000",""
"ARUNGWA","UZOAMAKA","KAREN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19770428","25 E WAYNE AVE","SILVER SPRING","MD","20901","1128b4","20251218","00000000","00000000",""
"BAILEY","MICHAEL","SCOTT","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1184663445","19630318","1080 VAUGHN ROAD","HUDSON FALLS","NY","12839","1128b4","20251218","00000000","00000000",""
"BAINE","RICHARD","MATTHEW","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830626","902 ROUTE 88","POINT PLEASANT BORO","NJ","08742","1128b4","20251218","00000000","00000000",""
"BANERJEE","KELLEY","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1134473911","19770203","18 GROVE ST","BALDWINSVILLE","NY","13027","1128b4","20251218","00000000","00000000",""
"BARRINGER","RENITA","","","EMPLOYEE - PRIVATE S","CLINIC","","0000000000","19730412","6721 FOXBEND COURT","FLORISSANT","MO","63033","1128a1","20251218","00000000","00000000",""
"BARSTOW","KARIE","DEL","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19610404","144 VISTA GRANDE ROAD","GRAND JUNCTION","CO","81507","1128b4","20251218","00000000","00000000",""
"BINA","MARYAM","","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19650720","1028 TREBBIANO LANE NORTH","WATERTOWN","MN","55388","1128a1","20251218","00000000","00000000",""
"BLAIR","MARIA","","","IND- LIC HC SERV PRO","COUNSELOR","","1104552249","19930307","3337 E LONG LAKE RD","PHOENIX","AZ","85048","1128b4","20251218","00000000","00000000",""
"BOLAND","KAYLEE","JO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19940510","204 S PARK STREET","AVA","IL","62907","1128a4","20251218","00000000","00000000",""
"BONILLA-AGUINADA","EDWARS","D","","EMPLOYEE - PRIVATE S","ASSISTED LIVING FACI","","0000000000","19900319","3324 MADEIRA DRIVE NE","ALBUQUERQUE","NM","87110","1128a2","20251218","00000000","00000000",""
"BOYLE","PHILLIP","CHARLES","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19910119","13298 ALCOTT CIR","BROOMFIELD","CO","80020","1128b4","20251218","00000000","00000000",""
"BRAMMER","KRISTINE","LYNETTE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840910","101 NORTH STREET","CLEARFIELD","IA","50840","1128a4","20251218","00000000","00000000",""
"BROKER","NEETU","N","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19890507","15012 BLACKBURN ROAD","BURTONSVILLE","MD","20866","1128b4","20251218","00000000","00000000",""
"BROOKS","JOHNNY","RAY","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19771021","4468 MURFREEBORO HWY","MANCHESTER","TN","37355","1128a1","20251218","00000000","00000000",""
"BROWN","MARY","K","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840817","E5647 10TH AVE","DURAND","WI","54736","1128a2","20251218","00000000","00000000",""
"BYRD","JENNY","F","","IND- LIC HC SERV PRO","THERAPIST","","0000000000","19831017","323 W TRUSLER ST","OAKLAND CITY","IN","47660","1128a4","20251218","00000000","00000000",""
"CAMPBELL","CATRINA","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19890527","503 AUTUMN PARK","OXFORD","NC","27565","1128a1","20251218","00000000","00000000",""
"CASTRO","DANIEL","","","EMPLOYEE - FEDERAL -","EMPLOYEE - MILITARY","","0000000000","19871030","9250 TULLEY AVE","OAK LAWN","IL","60453","1128a3","20251218","00000000","00000000",""
"CLAYTON","KENDRA","MARJANI","","EMPLOYEE - ST/LOC/TR","STATE GOV'T","","0000000000","19971122","1339 W GARFIELD BOULEVARD","CHICAGO","IL","60636","1128a1","20251218","00000000","00000000",""
"CLEVELAND","WILLIE","ANN","","BUS OWNER/EXEC","LABORATORY","","0000000000","19830709","1926 24TH AVE E","TUSCALOOSA","AL","35404","1128a1","20251218","00000000","00000000",""
"COLLINS","DONNA","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19571016","3206 MARKET LANE, APT 614","KENOSHA","WI","53144","1128b4","20251218","00000000","00000000",""
"CORNWELL","JEFFREY","PAUL","","EMPLOYEE - PRIVATE S","LABORATORY","","0000000000","19760923","P O BOX 2099","POLLOCK","LA","71467","1128a1","20251218","00000000","00000000",""
"DALTON","CAGNUR","","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1528750304","19830216","8319 S VIA DE ELLSWORTH","TUCSON","AZ","85747","1128b4","20251218","00000000","00000000",""
"DANDY","SHAKEISHA","","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","1871253377","19871224","642 TYSON AVE","DAYTON","OH","45417","1128a1","20251218","00000000","00000000",""
"DANIEL","KIRKLAND","R","","EMPLOYEE - PRIVATE S","ASSISTED LIVING FACI","","0000000000","19891224","1105 BROOKDALE DR","PICAYUNE","MS","39466","1128a2","20251218","00000000","00000000",""
"DAVIS","SHELLEY","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19731211","408 CYPRESS ST","TEAGUE","TX","75860","1128b4","20251218","00000000","00000000",""
"DILLARD","JANETTE","","","INDIVIDUAL (UNAFFILI","RECIPT/BENEFICIARY","","0000000000","19810331","7211 OFALLON LAKE DRIVE","O FALLON","MO","63366","1128a1","20251218","00000000","00000000",""
"DORELUS","JEANADO","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19660919","3627 SOLANUM DR F28","CONROE","TX","77301","1128b4","20251218","00000000","00000000",""
"DOZIER","JILL","SHANAE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19701107","1522 FAIRFIELD DR","FORNEY","TX","75126","1128b4","20251218","00000000","00000000",""
"DUNCAN","ALNETRICE","N","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19791001","102 LEMON STREET, APT 977","WILDWOOD","FL","34785","1128b4","20251218","00000000","00000000",""
"DUNLAP","SUSAN","CARROLL","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19561115","4670 LINKS VILLAGE DR, UNIT B2","PONCE INLET","FL","32127","1128b4","20251218","00000000","00000000",""
"EARLA","JANAKI","RAM","","PHYSICIAN (MD, DO)","INTERNAL MEDICINE","","1336349844","19630929","P O BOX 150","MOUNT MEIGS","AL","36057","1128a2","20251218","00000000","00000000",""
"ECHETABU","ELIZABETH","NJIDEKA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19621229","1410 WESTGLEN DR","SACHSE","TX","75048","1128b4","20251218","00000000","00000000",""
"EFFIONG","UTIBE","","","PHYSICIAN (MD, DO)","INTERNAL MEDICINE","","1104210582","19790305","P O BOX 779800","MIAMI","FL","33177","1128a1","20251218","00000000","00000000",""
"ERASMUS","MARK","D","","PHYSICIAN (MD, DO)","NEUROLOGY","","1407879513","19510825","PO BOX 6979","ALBUQUERQUE","NM","87197","1128b4","20251218","00000000","00000000",""
"EYZAGUIRRE","ROBERT","DEL GRANADO","","PHYSICIAN (MD, DO)","GENERAL PRACTICE","","1588784508","19470126","16702 FAYSMITH AVE","TORRANCE","CA","90504","1128a1","20251218","00000000","00000000",""
"FERRANTE","LORRAINE","P","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1568932366","19530522","461 W CENTER ST","SNOWFLAKE","AZ","85937","1128b4","20251218","00000000","00000000",""
"FINCH","JB","","","IND- LIC HC SERV PRO","COUNSELOR","","1700437712","19860829","4328 E 5TH STREET","TULSA","OK","74112","1128a1","20251218","00000000","00000000",""
"FLOREA","ROBERT","ANDREI","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1376723684","19750708","15708 MCCONNELSVILLE RD","CALDWELL","OH","43724","1128a1","20251218","00000000","00000000",""
"FOWLER","JESSICA","RENEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19860922","2524 LYNN DRIVE","TYLER","TX","75702","1128a2","20251218","00000000","00000000",""
"FREEMAN","CANDICE","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830426","2044 SOUTHERNWOOD LANE","INDIANAPOLIS","IN","46231","1128a4","20251218","00000000","00000000",""
"FRIDAY","DWAYNE","DERRICK","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19620910","96146 BLACKROCK HAMMOCK DR","YULEE","FL","32097","1128b4","20251218","00000000","00000000",""
"FULLWOOD","REGINALD","JR","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19650419","MAXWELL AIR FORCE BASE","MONTGOMERY","AL","36112","1128a1","20251218","00000000","00000000",""
"GARY","WANDA","","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19730713","16 BERMUDA DR","LAURENS","SC","29360","1128a2","20251218","00000000","00000000",""
"GATES","TIFFANY","","","EMPLOYEE - PRIVATE S","REHAB FACILITY - GEN","","0000000000","19741024","1845 SPRING GROVE LN","MIDDLETOWN","OH","45044","1128a2","20251218","00000000","00000000",""
"GIBBS","KENNETH","","","EMPLOYEE - PRIVATE S","MENTAL/BEHAVIORAL HE","","0000000000","19610214","111 DR D L CONNER DRIVE","STARKVILLE","MS","39759","1128a2","20251218","00000000","00000000",""
"GIBERSON","BETHANY","JO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19641116","164 ROUTE 108","RUMFORD","ME","04276","1128b4","20251218","00000000","00000000",""
"GISLASON","IRVING","LEE","","PHYSICIAN (MD, DO)","PSYCHIATRY","","1013180355","19430721","7404 E SADDLEHILL TRL","ORANGE","CA","92869","1128b4","20251218","00000000","00000000",""
"GONZALES","FRANCES","","","EMPLOYEE - PRIVATE S","ADULT HOME","","0000000000","19600114","1515 CALLE DEFINA","ESPANOLA","NM","87532","1128a2","20251218","00000000","00000000",""
"GRANGER","DEANNA","CHAPMAN","","IND- LIC HC SERV PRO","COUNSELOR","","1689947186","19680718","104 TYWOOD CT","SLIDELL","LA","70461","1128a1","20251218","00000000","00000000",""
"GRANGER","GEORGE","W JR","","BUS OWNER/EXEC","MENTAL/BEHAVIORAL HE","","0000000000","19711116","104 TYWOOD CT","SLIDELL","LA","70461","1128a1","20251218","00000000","00000000",""
"GREEN","ASIA","IMANI","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19950813","2705 KATHRYN AVE","LAKELAND","FL","33805","1128b4","20251218","00000000","00000000",""
"GREUNER","DAVID","ANTHONY","","PHYSICIAN (MD, DO)","SURGERY","","1063627347","19760630","124 E 13TH ST, FL 12","NEW YORK","NY","10003","1128b4","20251218","00000000","00000000",""
"GRONBECK","DONALD","A","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1235366709","19800612","307 S CENTRAL AVE","FAIRBORN","OH","45324","1128a2","20251218","00000000","00000000",""
"HAMMRICH","RACHAEL","EMMA","","IND- LIC HC SERV PRO","COUNSELOR","","1407282130","19860915","1708 S 1ST AVENUE","SIOUX FALLS","SD","57105","1128a1","20251218","00000000","00000000",""
"HARRELL","ASHLEY","MARIE","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19890815","4468 MURFREESBORO HWY","MANCHESTER","TN","37355","1128a1","20251218","00000000","00000000",""
"HARTLEY","ZACHARY","HOWARD","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","20010125","4817 KOLLMAN ROAD","INDIANAPOLIS","IN","46241","1128a3","20251218","00000000","00000000",""
"HILTON","WILLIAM","MARTIN","","PHYSICIAN (MD, DO)","UROLOGY","","1285827006","19680330","353 W LOWRANCE AVE","MOORESVILLE","NC","28115","1128b4","20251218","00000000","00000000",""
"HOBERMAN","RENEE","SHARON","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1124456983","19880323","P O BOX 329002","BROOKLYN","NY","00000","1128b4","20251218","00000000","00000000",""
"HUBBELL","TARRAH","JEAN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830127","222 MASSACHUSETTS AVE","PENSACOLA","FL","32505","1128b4","20251218","00000000","00000000",""
"HUGHES","PAUL","MATTHEW","","BUS OWNER/EXEC","PSYCHOLOGIC PRACTICE","","1336775360","19880116","P O BOX 6000","FLORENCE","CO","81226","1128a3","20251218","00000000","00000000",""
"JACKSON","ROSEVELT","","","EMPLOYEE - PRIVATE S","MENTAL/BEHAVIORAL HE","","0000000000","19850124","260 FOSTER ROAD","FLORENCE","MS","39073","1128a2","20251218","00000000","00000000",""
"JACKSON","TRACIE","","","BUS OWNER/EXEC","MARKETING FIRM","","0000000000","19700315","P O BOX 3725","ADELANTO","CA","92301","1128a1","20251218","00000000","00000000",""
"KARR","MEDEA","REVERELLY","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1487719597","19690206","3130 S GLENROSE RD","SPOKANE","WA","99223","1128b4","20251218","00000000","00000000",""
"KESTNER","MICHAEL","","","BUS OWNER/EXEC","CLINIC","","0000000000","19520115","MAXWELL AIR FORCE BASE","MONTGOMERY","AL","36112","1128a1","20251218","00000000","00000000",""
"LAWRENCE","ADRON","","","EMPLOYEE - PRIVATE S","ADULT HOME","","0000000000","19680127","4407 CREEK AVE","LAUREL","MS","39440","1128a2","20251218","00000000","00000000",""
"LEE","CHERILYN","G JR","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1417366865","19520221","8306 WILSHIRE BLVD, STE 451","BEVERLY HILLS","CA","90211","1128b4","20251218","00000000","00000000",""
"LEWIS","DAVEY","EARL","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19630513","5372 SW 132ND TER","MIRAMAR","FL","33027","1128b4","20251218","00000000","00000000",""
"LEYCO","ELIZALDY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19680905","5225 RETABLO AVE, APT D","LAS VEGAS","NV","89103","1128b4","20251218","00000000","00000000",""
"LIKELY","ANGELIKA","J","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1942814835","19920826","397 LAIRD AVENUE SE","WARREN","OH","44483","1128a3","20251218","00000000","00000000",""
"LINDAMAN","LYNN","MELVIN","","PHYSICIAN (MD, DO)","ORTHOPEDICS","","1477525038","19501215","2700 CORAL RIDGE AVE","CORALVILLE","IA","52241","1128b4","20251218","00000000","00000000",""
"LOHOS","YUSUF","HUSSEIN","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","0000000000","19770101","850 SPRING ROAD, APT 304","FARIBAULT","MN","55021","1128a1","20251218","00000000","00000000",""
"LOVICK","VIVIAN","NOTTINGHAM","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19640425","4032 MCLANE DR","TAMPA","FL","33610","1128b4","20251218","00000000","00000000",""
"LOVING","NADIA","DANELLE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19921218","1626 OAK ST","BRAINERD","MN","56401","1128a1","20251218","00000000","00000000",""
"LUWEI","UDUAK","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19790929","7310 SABINAL CREEK DR","RICHMOND","TX","77407","1128b4","20251218","00000000","00000000",""
"MAES","EARL","B III","","PHYSICIAN (MD, DO)","RADIOLOGY","","1699717363","19720127","1249 E MONTCLAIR ST","SPRINGFIELD","MO","65804","1128a1","20251218","00000000","00000000",""
"MANGAN","WILLIAM","THOMAS JR","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1851392195","19551021","4595 DONERAIL PL, APT 3D","OKEMOS","MI","48864","1128b7","20251112","00000000","00000000",""
"MARESSA","JULIAN","MARK","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1275643116","19610913","1175 CHEW RD","WATERFORD WORKS","NJ","08089","1128b4","20251218","00000000","00000000",""
"MATLOCK","MATTHEW","COREY","","IND- LIC HC SERV PRO","PHYSICAL THERAPY","","1013994417","19740621","5231 NW 90TH TERRACE","POMPANO BEACH","FL","33067","1128b4","20251218","00000000","00000000",""
"MEIS","STEPHEN","RICHARD","","PHYSICIAN (MD, DO)","GENERAL PRACTICE","","1013975846","19521128","10556 COMBIE ROAD, APT 6486","AUBURN","CA","95602","1128b1","20251218","00000000","00000000",""
"MELLER","ELIZABETH","ALDINGER","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1932887130","19811229","P O BOX 8280","PHILADELPHIA","PA","19101","1128b4","20251218","00000000","00000000",""
"MILLER","JEFFREY","LEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19710430","6632 W DESERT COVE AVE","GLENDALE","AZ","85304","1128b4","20251218","00000000","00000000",""
"MILLNER","MARCUS","ANTHONY","","BUS OWNER/EXEC","COUNSELING CENTER","","0000000000","19880507","8176 CALPENA AVENUE","LAS VEGAS","NV","89113","1128a1","20251218","00000000","00000000",""
"MOHAMED","NUSAYBA","","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19931224","2178 LONDIN LN E, APT 327","SAINT PAUL","MN","55119","1128a1","20251218","00000000","00000000",""
"MOORE","LATOYA","","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","1144956608","19960704","801 PENNSYLVANIA AVE, APT 13","YOUNGSTOWN","OH","44504","1128a1","20251218","00000000","00000000",""
"MORITZ","JOHN","RICHARD","","PHYSICIAN (MD, DO)","GENERAL PRACTICE","","1306891916","19621008","4175 N AMARILLO DR","BEVERLY HILLS","FL","34465","1128b4","20251218","00000000","00000000",""
"MORRIS","ALYSSA","PAIGE","","EMPLOYEE - PRIVATE S","SKILLED NURSING FAC","","0000000000","19991216","514 MCARTHUR ST","CHESNEE","SC","29323","1128a2","20251218","00000000","00000000",""
"MUER","MEGAN","ELIZABETH","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19831219","7324 WOODHOLLOW ROAD","SPRING HILL","FL","34606","1128b4","20251218","00000000","00000000",""
"MURDOCK","HAYLEY","DAWN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19950905","220 SUMMIT BLVD, UNIT 140","BROOMFIELD","CO","80021","1128b4","20251218","00000000","00000000",""
"MURRAY","SHANITA","","","EMPLOYEE - PRIVATE S","HOME HEALTH AGENCY","","0000000000","19780602","12320 LOCKE AVE UPPR","CLEVELAND","OH","44108","1128a1","20251218","00000000","00000000",""
"NELSON","KENDRA","M","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830407","831 FREESTONE DRIVE","INDIANAPOLIS","IN","46239","1128b1","20251218","00000000","00000000",""
"OBAZE","CHRISTOPHER","","","IND- LIC HC SERV PRO","PHARMACIST","","0000000000","19600718","P O BOX 1000","OXFORD","WI","53952","1128a4","20251218","00000000","00000000",""
"OKPALOR","JANE","CHIBUZO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19710408","24 MCGUIRE ST","METUCHEN","NJ","08840","1128b4","20251218","00000000","00000000",""
"OSIPOWICZ","MICHAEL","WESLEY","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19860625","2847 BROWNING CT","ABINGDON","MD","21009","1128b4","20251218","00000000","00000000",""
"OWENS","TERESA","RENEE","","BUS OWNER/EXEC","HOME HEALTH AGENCY","","0000000000","19640924","1050 LENOX PARK BLVD NE, APT 7","ATLANTA","GA","30319","1128a1","20251218","00000000","00000000",""
"OZUZU","THEODORE","CHIJIOKE SR","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19680217","8915 BROADWAY ST","HOUSTON","TX","77061","1128b4","20251218","00000000","00000000",""
"PANIGRAHY","ASHOK","R","","PHYSICIAN (MD, DO)","RADIOLOGY","","1174559108","19710924","P O BOX 1000","MILAN","MI","48160","1128b4","20251218","00000000","00000000",""
"PARIGIAN","KELLY","KARLENE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19591230","P O BOX 35","MIDPINES","CA","95345","1128b4","20251218","00000000","00000000",""
"PATEL","GORDHAN","","","OWNER/EXEC-GOVT GRAN","CMS","","0000000000","19450602","54 SIERRA BLVD","MAMMOTH LAKES","CA","93546","1128a1","20251218","00000000","00000000",""
"PERKINS","KATRINA","MONEQUE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19731021","233 GILMORE RD","FORSYTH","GA","31029","1128a2","20251218","00000000","00000000",""
"PRICE","EBONY","R","","INDIVIDUAL (UNAFFILI","RECIPT/BENEFICIARY","","0000000000","19820223","5854 SELBER CT, APT 1E","SAINT LOUIS","MO","63120","1128a1","20251218","00000000","00000000",""
"PROTAIN","BRITTANY","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19851016","3107 66TH AVENUE CT","GREELEY","CO","80634","1128b4","20251218","00000000","00000000",""
"RENODAIN","ENANTE","SIME","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19671026","3630 SW 167TH AVE","HOLLYWOOD","FL","33027","1128b4","20251218","00000000","00000000",""
"RICHEY","BRIAN","","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1427385004","19820319","2325 NASHVILLE PIKE, APT 1227","GALLATIN","TN","37066","1128a1","20251218","00000000","00000000",""
"RITTER","MICHELE","","","PHYSICIAN (MD, DO)","INTERNAL MEDICINE","","1780616540","19580415","P O BOX 5000","PEKIN","IL","61555","1128a4","20251218","00000000","00000000",""
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