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Medicaid Michigan Sanction Provider ListJune 03, uspensionDental GroupAllen Park5/20/2004HHS1128(a)(1)A Dental Center PC - SouthgateAcadian Diagnostic LaboratoriesLLCDental GroupSouthgate7/20/2004Laboratory1316370950Baton Rouge, LAAdvanced Care ServicesGroup1811290794Oak Park12/22/2015 HHSMI-LicensingandRegulatory10/14/2015 AffairsEntity NameLast NameFirst NameMiddleNameProvider CategoryNPI#City1st Priority Physical Therapy LLCGroup1134422363A.N.N. IncHome Health Agency1598814501A Dental Center PC - Allen ate21128(a)(1)MDHHS6/8/2018Advanced Homecare PharmacyAdvanced Medical Services PLLCdba Advanced Sleep Diagnosticof MichiganAdvanced SleepNeurodiagnostics /16/2018Group1134143654Farmington Hills10/15/2017 MDHHS-OIGAlam, Waseem MD PCMedical Group1184724114Bloomfield Hills7/29/2015MDHHS-OIG11/8/2018Ali Elhorr M.D.P.C.Medical l American Pharmacy LLCPharmacy1609151109Flint2/14/2018Allied Geriatric Services PCMedical G DHHS-OIG OIG TerminatedSummarySuspensionMDHHS-OIG TerminatedVolunatarilySurrendered yAffairsLicense OnlySummarySuspensionDCH10/29/2018 MDHHS-OIG Terminated

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameAmerican Home Care AssistantsLLCAmerican Medical MissionaryCareLast NameFirst NameMiddleNameProvider CategoryNPI#Home Help AgencyHome Help HHS-OIG TerminationReasonSummarySuspensionAndy's Motown PharmacyAngels Touch Home Health CareLLCPharmacy1053355271DetroitHome Health1922252865Taylor3/6/2013DCHAt Home Doctors P.C.Group1851627053Lansing5/23/2013DCH-OIGAttarMD , Gavin MD PCb3 Diagnostic Laboratory /19/20145/15/2021DCH-OIGMDHHSBan Mecheal MD PCGruup1033301569Livonia9/17/2019MDHHS-OIGBay City Vascular P.C.Group1346424009Bay spensionMDHHS-OIG s6/14/18Bennett Family Chiropractic PLLCBenstar Pharmacy LLCBeval Medical Equipment &SuppliesBirmingham Rehab & PhysicalTherapy Center, Inc.Chiropractic Group1386881191530100840723D2097180Auburn HillsPharmacy1255679924DetroitSupplierRehab TherapyServices1235163551Royal SuspendedVolunatrilySurrenderedMDHHS-OIG Terminated06/11/2015 CMSRevoked12/18/2003 HHS1128(a)(1)

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameLast NameBreakthrough Believers Recoveryand Healing CenterBrightSmilesBrightSmiles PA 161Broadstreet Nursing CenterFirst NameMiddleNameProvider eGroupDental GroupDental Group137686616015082290141083848311Grand RapidsWest 5095Nursing spensionTerminatedTerminatedCanton Urgent Care P.C.Group1992830863CantonCarpenter PharmacyPharmacy1578655627HamtramckCedar Knoll Care CenterNursing FacilityGrass LakeCenter Light Home Help CareHome Help AgencyDetroitCentrad Healthcare LLCGroup1346243979Naperville, ILChristina L Kimbrough /2016 MDHHS-OIG 1/18/2021 MDHHS-OIG TerminationControlledSubstance C3FacilityMI-LicensingMI-Licensing license /2018 Affairs10/10/2018 y5/12/2020 MDHHS-OIGSuspensionSummary11/14/2017 OIG 12/21/2018 MDHHS-OIG TerminatedClinical Psychiatric Medicine e Township PharmacyCommunity RehabiltationServicesPharmacy1851616452Commerce Township8/31/2011DCHGroup1669424776Rose City7/13/2016MDHHS-OIGCompassionate Doctors PCComplete Health, LLC ia7/30/20136/21/2011DCH-OIGHHSCounseling Solutions 016SuspendedSummarySuspensionMDHHS-OIG sion

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameLast NameFirst NameMiddleNameProvider CategoryNPI#CityCreams N CapsPharmacy1386972859SouthfieldCutting Edge Orthopaedics LLCGroup1295070746Sylvania, gulatory10/14/2015 enport PharmacyDearborn Pharmacy, 20112/20/2006DCH-OIGHHS5/23/2016MDHHS-OIGDearborn Family MedicineCenterMedical S-OIGDearborn Nuro Clinic 18MDHHS-OIGDearborn Podiatric Surgeons 018 ryAffairs12/13/2017HHS7/30/2013DCH-OIGDearborn Rx PharmacyDetroit Diverse Care, Inc.GroupPhysician Group1982054383DearbornDetroitDetroit Medical ClinicMedical NCPDP 23747248/19/2011DCHDivine Pharmacy HS-OIGDoctors Creative CareMedical taryTermination1128(a)(1)Summary10/31/2019 MDHHS-OIG 14055811MI-LicensingandRegulatoryAffairs12/19/2018 MDHHS-OIGPharmacyPhysician onSummarySuspensionSummarySuspensionDiamond PharmacyDownriver Medical AssociatesPLCReasonDCH6/2/201611/13/18MDHHSDCH

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameDr Henderson Judy MD FamilyMedicine PLLCDurand Clinic dical nsingandRegulatoryAffairsNPI#CityGroupPhysician Group1841737277Dwight E. Smith MD PCPhysician GroupDynasty Health Solutions IncEast Village PharmacyElrington Medical Center PLLCElrose Health Services, Inc.Elrose Health Services, Inc.Elrose Health Services, Inc.Enjoy Dental Care PCFirst NameMiddleNameProvider CategoryEB James Nursing CenterLast NameNursing FacilityMedical SupplyCompanyDetroit1205875697SA TreatmentDetroitSA TreatmentDental Group83422RedfordDetroitSA TreatmentLicense#DetroitDetroitExpress Discount PharmacyPharmacy1225537962DetroitEZ Sleep Supplies LLCMedical eLicenseRevocationand SummarySuspensionSummarySuspension10/22/2013 Affairs10/20/1998 latoryAffairs10/20/1998 ngandRegulatoryAffairs10/20/1998 18SuspendedSummarySuspensionMDHHS-OIG Terminated

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameLast NameFirst NameMiddleNameProvider sFleth Discount Pharmacy LLCPharmacy1245670447WarrenFour Leaf Clover IncFrancis Street Medical AssociaesP.C.Medical Group1750451357Westland7/29/2015MDHHS-OIGMedical Group1730245499Jackson6/29/2016MDHHS-OIGFriendz ndship Manor Nursing HomeGeneral Medicine PCNursing 19DCHMDHHSGeorgetown Poidatric SurgeonsPCGroup1508905985Sterling Heights12/3/2017MDHHS-OIGGlen Saperstein LLCMedical Group1184045296Saginaw3/15/2017MDHHS-OIGGlobal Health 18MDHHS-OIGGracee PharmacyPharmacy129512124Highland Park53010114305/31/2021MDHHS-OIGGreater Detroit Physical Therapy& Rehabilitation 19MDHHS-OIGGreen Cross Medical Center 018MDHHS-OIGHappy Hearts Home Care AgencyHome Help AgencyJackson5/26/2020MDHHS-OIGHarmony InterationalHarmony Turning Point d1/16/2013 DCH-OIG10/20/2013 HHS1/16/2013DCHHarper Dermatology IGMDHHS-OIGReason12/26/2018 MDHHS-OIGLicenseRevocationand atedExcludedSummarySuspensionTerminated

Medicaid Michigan Sanction Provider ListJune 03, Group1871779025Coldwater4/29/2015DCH-OIGHelp U Hear nd Park PharmacyPharmacy1104097781WarrenHi-Tech Home Health Care INC.Home Clinic P.C.Home Health AgencyGroup16697025931962645689Farmington HillsSouthfieldEntity NameLast NameFirst NameMiddleNameProvider CategoryNPI#CityHartford Chiropractic ClinicGroup1699882951Hatem Ataya M.D. PCGroupHealing Hands Chiropractic ClinicLLCLicense#8/31/2011 rySuspensionMDHHS-OIG OIG OIG Terminated7/28/2016 HHS12/29/2015 ensionTerminatedSummarySuspensionHome Physician Services 09/2016 MDHHS-OIGHomecare Doctors 8 MDHHS-OIGHouse Calls Physicians PLLCHugs of Love Home Health CareLLCGroup1033273008Allen 7/2020MDHHS-OIGIndependent Care Pharmacy LLCPharmacyAmbulatory 23/2016MDHHS-OIG1013385046Warren12/26/2018 MDHHS-OIG1/9/2017SummarySuspensionMDHHS-OIG TernminatedInterventional Pain Center PLLCJefferson Medical Industrial ClinicP.C.Home Health AgencyGroup1407178627Detroit7/4/2016MDHHS-OIG

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameLast NameFirst NameMiddleNameProvider 015 MDHHS-OIG TerminatedSummarySuspension6/8/2018MDHHS-OIG TerminatedSummarySuspensionSummarySuspensionJoe's Discount PharmacyPharmacy1770953234DetroitJohn R. Verbovsky D.O. P.C.Dental Group1508153909Sterling Heights3/10/2015MDHHS-OIGJones Psychological Services PLLCMedical Group1295092310Port Huron5/9/2018MDHHS-OIGJosephson Nursing HomeNursing Facility1700891504Ironwood4/18/2012DCHJulia McGowen- Bienkowski LLCKalamazoo Footcare SpecialistsPCGroup1750902912Clinton twood PharmacyPharmacy1346419892Grand Rapids11/24/2010 MDHHS-OIG5/23/2016MDHHS-OIGKentwood PharmacyPharmacy1558478610Grand Rapids11/24/2010 MDHHS-OIG5/23/2016MDHHS-OIGKentwood PharmacyPharmacy1841446192Shepherd11/24/2010 MDHHS-OIG5/23/2016MDHHS-OIGKentwood PharmacyPharmacy1548426992Alma11/24/2010 MDHHS-OIG5/23/2016MDHHS-OIGKentwood PharmacyKirk Anthony DPM PCPharmacyGroup17606380191578872438Saint LouisGrand Rapids11/24/2010 MDHHS-OIG7/18/2013 DCH-OIG5/23/2016MDHHS-OIGKrish Pharmacy /18/2016MDHHS- eRevocationPodiatry natedSuspendedSummarilySuspendedTerminatedL & L Nursing Center, Inc.Lake MI Doctors Housecalls(D/B/A Lake MI Mobile Doctors,P.C)Nursing ummarySuspendedLakeshore Diagnostic GExcluded

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameLast NameFirst NameMiddleNameProvider -LicensingandRegulatory11/14/2003 AffairsSanctionDate2LaSalle Nursing HomeNursing FacilityLiberty Express 17Life Care Sleep & Health /15/2018Nursing FacilityPharmacy1457774366LitchfieldGarden 16/2015DCH-OIGLitchfield Nursing CentreLiteMed Rx IncLittle Traverse Bay FamilyMedicineDetroitLicense#Livernois Family Medical ServiceLivernois Family DetroitLivestrong PharmacyPharmacy1275925950DetroitLivonia Care PharmacyPharmacy1942560529Port HuronMadison Pharmacy IncMancewicz & White DDS, PCPharmacyDental Group1790961118Madison HeightsGrand RapidsMedaplex Dental CenterMetric Lab Services LLCDental GroupLaboratory13263435421699287300Oak ParkRidgeland, cationSummarySuspensionSummarySuspensionMDHHS-OIG 12/25/2017 MDHHS-OIG5301009802SanctionSource6/15/2018Metro Mobile G9/30/2019Michigan Brain and SpineOhysicians Group, 2017SummarySuspensionMDHHS-OIG ionMDHHS-OIG TerminatedTerminatedSummarySuspensionMDHHS-OIG TerminationSummarySuspensionMDHHS-OIG Terminated

Medicaid Michigan Sanction Provider ListJune 03, omfield 9864Warren7/3/2013DCH-OIG5/5/2016MDHHS-OIGMidwest Prostate & MDHHS-OIG8/31/2018MDHHS-OIGMillner, Joel A MD PCMedical Group1265715700Ferndale6/20/2014DCH-OIGMonroe Geriatric Evaluation andManagement Services PLLCGroup1215117023Monroe3/21/2013DCH-OIGEntity NameNPI#CityMichigan Diagnostic Services Inc.Group1497923858Midwest Family Diagnostics PLCGroupMidwest Family Practice PLCMykal Discount PharmacyMyKal Discount Pharmacy #2First NameMiddleNameProvider CategoryMonroe Medical Clinic PLLCMoss, David M., DPM, PCLast 1780992750License#DurandGarden 0094233/18/20113/18/201111/13/2018 H-OIGHHSDCHDCHMy Visiting Physicians PCGroup1740512201Southfield1/16/2013DCH-OIGNat LabLaboratory1861934168Detroit12/25/2017 MDHHS-OIGNational Laboratories IncLaboratory1144645235Detroit12/25/2017 MDHHS-OIGNew Center Medical PCGroup1316482870Detroit12/18/2017 erminated7/11/2016SummarySuspensionMDHHS-OIG Termination7/11/2016SummarySuspensionMDHHS-OIG pensionSummarySuspensionSummarySuspension

Medicaid Michigan Sanction Provider ListJune 03, 2021MDHHS-SanctionProviderList@michigan.govEntity NameLast NameFirst NameMiddleNameProvider eNew Era Alternative TreatmentCenter, Inc. (NEAT)SA TreatmentFlint502199/20/2001HHSNew Era Alternative TreatmentCenter, Inc. (NEAT)SA TreatmentHighland toryAffairsNorthside Medical Clinic PCNorthwest Industrial & MedicalServices PCNottingham 646191730209743DetroitDetroitOmega PharmacyPharmacy1508299710PontiacOne on One Care 2017 MDHHS-OIGOURLABLaboratory1760461909Nashville, TN11/25/2013 State of TNOval DentalDental Group1215476387Westland12/19/2018 MDHHS-OIGPark Dental of Okemos P.C.Park Medical Clinic PCDental GroupMedical Group1477890689OkemosTroy7/6/20167/29/1997Patient Choice Internal MedicinePeople Pharmacy anctionSource1/10/2019SummarySuspensionMDHHS-OIG sion10/31/2019 MDHHS -OIG TerminatedMDHHS9/30/2019SummarySuspensionMDHHS-OIG egulatory11/20/2018 Affairs6/11/20195301008586Suspended/debarred fromstate of spensionSummaryMDHHS-OIG Suspension