Medicaid Michigan Sanction Provider List September 20, 2021 [email protected] Middle Sanction Sanction Sanction Sanction Entity Name Last Name First Name Name Provider Category NPI# City License# Date1 Source Date2 Source Reason Summary 1st Priority Physical Therapy LLC Group 1134422363 Detroit 8/2/2016 MDHHS-OIG Suspension Summary A.N.N. Inc Home Health Agency 1598814501 Livonia 7/22/2015 MDHHS-OIG Suspension A Dental Center PC - Allen Park Dental Group Allen Park 5/20/2004 HHS 1128(a)(1) A Dental Center PC - Southgate Dental Group Southgate 7/20/2004 1128(a)(1) Acadian Diagnostic Laboratories LLC Laboratory 1316370950 Baton Rouge, LA 19D2062876 5/15/2021 MDHHS Terminated Summary Suspension Advanced Care Services Group 1811290794 Oak Park 12/22/2015 HHS 6/8/2018 MDHHS-OIG Terminated MI-Licensing and Regulatory Voluntarily Advanced Homecare Pharmacy Pharmacy 1710923107 Redford 5301008284 10/14/2015 Affairs Surrendered Advanced Medical Services PLLC Summary dba Advanced Sleep Diagnostic Suspension of Michigan Group 1922451632 Lansing 7/16/2018 MDHHS-OIG 8/15/2018 MDHHS-OIG Terminated Advanced Sleep Summary Neurodiagnostics PC Group 1134143654 Farmington Hills 10/15/2017 MDHHS-OIG Suspension Summary Suspension Alam, Waseem MD PC Medical Group 1184724114 Bloomfield Hills 7/29/2015 MDHHS-OIG 11/8/2018 MDHHS-OIG Terminated Summary Suspension Ali Elhorr M.D.P.C. Medical Group 1558651422 Dearborn 5/19/2015 DCH-OIG 11/1/2019 MDHHS-OIG Terminated Volunatarily Surrendered - MI-Licensing Controlled and Substance Regulatory Facilty All American Pharmacy LLC Pharmacy 1609151109 Flint 2/14/2018 Affairs License Only Summary Suspension Allied Geriatric Services PC Medical Group 1821196551 Birmingham 3/6/2013 DCH 10/29/2018 MDHHS-OIG Terminated Medicaid Michigan Sanction Provider List September 20, 2021 [email protected] Middle Sanction Sanction Sanction Sanction Entity Name Last Name First Name Name Provider Category NPI# City License# Date1 Source Date2 Source Reason American Home Doctors PC Medical Group 1740623222 Warren 8/21/2021 HHS Revokjed American Home Care Assistants Summary LLC Home Help Agency Detroit 8/17/2020 MDHHS-OIG Suspension Summary American Medical Missionary Suspension Care Home Help Agency 1578600920 Saginaw 12/5/2016 MDHHS-OIG 1/9/2017 MDHHS-OIG Termination MI-Licensing and Regulatory Andy's Motown Pharmacy Pharmacy 1053355271 Detroit 5301008407 3/28/2011 Affairs Suspended Angels Touch Home Health Care Summary LLC Home Health 1922252865 Taylor 3/6/2013 DCH Suspension Suspended At Home Doctors P.C. Group 1851627053 Lansing 5/23/2013 DCH-OIG DCH-OIG Terminated Summary AttarMD PC Group 1275720716 Livonia 9/19/2017 MDHHS-OIG Suspension Summary Suspension Awerbuch, Gavin MD PC Group 1003130352 Saginaw 6/19/2014 DCH-OIG 11/6/2018 MDHHS-OIG Terminated b3 Diagnostic Laboratory LLC Laboratory 1902287279 Troy 23D2097180 5/15/2021 MDHHS Terminated Summary Ban Mecheal MD PC Gruup 1033301569 Livonia 9/17/2019 MDHHS-OIG Suspension Summary Bay City Vascular P.C. Group 1346424009 Bay City 9/30/2015 MDHHS-OIG Suspension Summary Suspension and Bennett Family Chiropractic PLLC Chiropractic Group 1386881191 Auburn Hills 5/27/2020 MDHHS-OIG Termination Summary MI-Licensing Suspended and Volunatrily Regulatory 2/14/18 Surrendered Benstar Pharmacy LLC Pharmacy 1255679924 Detroit 5301010006 11/2/2017 Affairs 6/14/18 MDHHS-OIG Terminated Beval Medical Equipment & Supplies Supplier 1235163551 Royal Oak 562580933 06/11/2015 CMS Revoked Birmingham Rehab & Physical Rehab Therapy Therapy Center, Inc. Services Detroit 36687 12/18/2003 HHS 1128(a)(1) Medicaid Michigan Sanction Provider List September 20, 2021 [email protected] Middle Sanction Sanction Sanction Sanction Entity Name Last Name First Name Name Provider Category NPI# City License# Date1 Source Date2 Source Reason Breakthrough Believers Recovery Summary and Healing Center Group 1376866160 Grand Rapids 3/31/2021 MDHHS-OIG Suspension BrightSmiles Dental Group 1508229014 West Bloomfield 20153421 1/26/2017 MDHHS Terminated BrightSmiles PA 161 Dental Group 1083848311 Waterfrd 20152161 1/26/2017 MDHHS Terminated Broadstreet Nursing Center Nursing Facility 83418 9/27/2000 Summary Suspension Canton Urgent Care P.C. Group 1992830863 Canton 5/18/2016 MDHHS-OIG 1/18/2021 MDHHS-OIG Termination Controlled Substance C3- Facility MI-Licensing MI-Licensing license only and and summary Regulatory Regulatory suspended Carpenter Pharmacy Pharmacy 1578655627 Hamtramck 5315015095 6/14/2018 Affairs 10/10/2018 Affairs Suspended License Cedar Knoll Care Center Nursing Facility Grass Lake 3/7/2007 DCH Revocation Summary Center Light Home Help Care Home Help Agency Detroit 5/12/2020 MDHHS-OIG Suspension Summary Centrad Healthcare LLC Group 1346243979 Naperville, IL 11/14/2017 MDHHS-OIG Suspension Summary Suspension Christina L Kimbrough PLLC Group 1770933194 Southfield 5/1/2018 MDHHS-OIG 12/21/2018 MDHHS-OIG Terminated Clinical Psychiatric Medicine PC Group 1386677185 Grandville 7/18/2013 DCH-OIG Suspended Summary Suspension Commerce Township Pharmacy Pharmacy 1851616452 Commerce Township 8/31/2011 DCH 5/30/2016 MDHHS-OIG Terminated Community Rehabiltation Summary Services Group 1669424776 Rose City 7/13/2016 MDHHS-OIG Suspension Compassionate Doctors PC Group 1326153578 Southfield 7/30/2013 DCH-OIG 1128(a)(2) Complete Health, LLC Group Group 1083801500 Livonia 6/21/2011 HHS Summary Counseling Solutions Centers Group 1770021602 Troy 4/12/2021 MDHHS-OIG Suspension Medicaid Michigan Sanction Provider List September 20, 2021 [email protected] Middle Sanction Sanction Sanction Sanction Entity Name Last Name First Name Name Provider Category NPI# City License# Date1 Source Date2 Source Reason MI-Licensing and Regulatory Voluntarily Creams N Caps Pharmacy 1386972859 Southfield 5301010570 10/14/2015 Affairs Surrendered Cutting Edge Orthopaedics LLC Group 1295070746 Sylvania, OH 9/15/2015 MDHHS-OIG Suspended Summary Suspension Davenport Pharmacy Pharmacy 1548585136 Saginaw 8/31/2011 DCH-OIG 5/23/2016 MDHHS-OIG Termination Dearborn Pharmacy, Inc. Pharmacy Dearborn 2/20/2006 HHS 1128(a)(3) Summary Dearborn Family Medicine Suspension Center Medical Group 1467407080 Dearborn 7/8/2013 DCH-OIG 5/5/2016 MDHHS-OIG Terminated Summary Suspension Dearborn Nuro Clinic PC Group 1568638088 Dearborn 12/1/2016 MDHHS-OIG 4/12/2018 MDHHS-OIG Terminated Summary Suspension Dearborn Podiatric Surgeons PC Group 1447467485 Dearborn 12/3/2017 MDHHS-OIG 12/26/2018 MDHHS-OIG Terminated MI-Licensing MI-Licensing Summary and and Suspension Regulatory Regulatory Voluntary Dearborn Rx Pharmacy Group 1982054383 Dearborn 5301010958 7/26/2017 Affairs 12/13/2017 Affairs Termination Detroit Diverse Care, Inc. Physician Group Detroit 3/16/1997 HHS 1128(a)(1) Summary Detroit Medical Clinic Medical Group 1245244110 Detroit 7/30/2013 DCH-OIG 10/31/2019 MDHHS-OIG Suspension Summary Suspension Diamond Pharmacy Pharmacy 1720380140 Kalamazoo NCPDP 2374724 8/19/2011 DCH 6/2/2016 MDHHS Termination MI-Licensing Summary and SuspensionV Regulatory oluntarily Divine Pharmacy LLC Pharmacy 1003273202 Detroit 5301010794 4/13/2020 MDHHS-OIG 6/9/2021 Affairs Surrendered Medicaid Michigan Sanction Provider List September 20, 2021 [email protected] Middle Sanction Sanction Sanction Sanction Entity Name Last Name First Name Name Provider Category NPI# City License# Date1 Source Date2 Source Reason Summary Downriver Medical Associates Suspension PLC Physician Group 1114055811 Monroe 3/21/2013 DCH 11/13/18 DCH Termination Dr Henderson Judy MD Family Summary Medicine PLLC Group 1841737277 Niles 6/1/2021 MDHHS-OIG Suspension Durand Clinic PC Physician Group Durand 9/20/2001 HHS 1128(a)(3) Summary Dwight E. Smith MD PC Physician Group 1003849753 Detroit 5/29/2012 DCH Suspension Summary Dynasty Health Solutions Inc Medical Group 1326586942 FErndale 8/4/2020 MDHHS-OIG Suspension Summary East Village Pharmacy Pharmacy 1982928818 Dearborn 8/29/2016 MDHHS-OIG Suspension MI-Licensing License and Revocation Regulatory and Summary EB James Nursing Center Nursing Facility Detroit 83422 2/12/2002 Affairs Suspension Medical Supply Summary Elrington Medical Center PLLC Company 1205875697 Redford 10/22/2013 DCH-OIG Suspension MI-Licensing and Regulatory 10/20/98: Elrose Health Services, Inc. SA Treatment Detroit 21431 4/17/1995 Affairs 10/20/1998 HHS 1128(a)(1) MI-Licensing and Regulatory 10/20/98: Elrose Health Services, Inc. SA Treatment Detroit 21391 4/17/1995 Affairs 10/20/1998 HHS 1128(a)(1) MI-Licensing and Regulatory 10/20/98: Elrose Health Services, Inc. SA Treatment Detroit 20731 4/17/1995 Affairs 10/20/1998 HHS 1128(a)(1) Enjoy Dental Care PC Dental Group Detroit 5/20/2004 HHS 1128(a)(1) MI-Licensing and Regulatory Express Discount Pharmacy Pharmacy 1225537962 Detroit 5301011289 1/8/2021 Affairs Suspended Medicaid Michigan Sanction Provider List September 20, 2021 [email protected] Middle Sanction Sanction Sanction Sanction Entity Name Last Name First Name Name Provider Category NPI# City License# Date1 Source Date2 Source Reason Summary Suspension EZ Sleep Supplies LLC Medical Supplier 1871640383 Okemos 7/16/2018 MDHHS-OIG 8/15/2018 MDHHS-OIG Terminated MI-Licensing and Regulatory Fleth Discount Pharmacy LLC Pharmacy 1245670447 Warren 5301010191 3/5/2018 Affairs Revoked Summary Four Leaf Clover Inc Medical Group 1750451357 Westland 7/29/2015 MDHHS-OIG Suspension Francis Street Medical Associaes Summary P.C. Medical Group 1730245499 Jackson 6/29/2016