CLIA Annual Laboratory Registry 2015

CLIA ANNUAL LABORATORY REGISTRY 2015

Once a year the Centers for Medicare and Medicaid Services makes available to physicians and to the general public specific information (including information provided to CMS by the Office of the Inspector General) that is useful in evaluating the performance of laboratories. The Clinical Laboratory Improvement Amendments of 1988 (CLIA) and implementing regulations at 42 CFR 493.1850 require that this listing include the following:

(1) A list of laboratories that have been convicted, under Federal or State laws relating to

fraud and abuse, false billing, or kickbacks. (2) A list of laboratories that have had principal sanctions imposed; their CLIA

certificates suspended, limited, or revoked, and the reasons for the adverse actions. (3) A list of persons who have been convicted of violating CLIA requirements, as specified

in section 353(1) of the PHS Act, together with circumstances of each case and the penalties imposed.

(4) A list of laboratories on which alternative sanctions have been imposed, showing-- (i) the effective date of the sanctions; (ii) the reason for imposing them; (iii) any corrective action taken by the laboratory; (iv) if the laboratory has achieved compliance, the verified date of compliance.

(5) A list of laboratories whose accreditation has been withdrawn or revoked and the

reasons for the withdrawal or revocation. (6) All appeals and hearing decisions.

(7) A list of laboratories against which CMS has brought suit under Section 493.1846

and the reasons for those actions. (8) A list of laboratories that have been excluded from participation in Medicare or

Medicaid and the reasons for exclusion. Civil settlements reached with clinical laboratories are also noted.

The Laboratory Registry is compiled for the calendar year proceeding the date the information is made available and also contains corrections of any erroneous statements of information that appeared in the previous registry. A final section includes other specific information that may be useful in evaluating the performance of laboratories, as specified in 42 CFR 493.1850(a). It also includes information provided by CLIA exempt states.

2015 CLIA LAB REGISTRY

(AS REQUIRED BY SECTION 353(N) OF THE PUBLIC HEALTH SERVICE ACT)

ACTIVITY 01/01/2015 - 12/31/2015

1. LABORATORIES SUBJECT TO CLIA THAT HAVE BEEN CONVICTED, UNDER FEDERAL OR STATE LAWS RELATING TO FRAUD AND ABUSE, FALSE BILLING, OR KICKBACKS.

*** N O D A T A F O U N D ***

2. LABORATORIES THAT HAVE HAD THEIR CLIA CERTIFICATE SUSPENDED, LIMITED, OR REVOKED, AND THE REASON FOR THE ADVERSE ACTION. (MEDICARE CANCELLATION, A PRINCIPAL SANCTION, HAS BEEN INCLUDED IN THIS CATEGORY.)

DERROL DAWKINS MD, DIRECTOR

METRO PEDIATRICS PC

401 VALLEY AVENUE

BIRMINGHAM, AL 35209

CLIA ID# 01D0300948

SANCTION: Limitation of CLIA Certificate

EFFECTIVE DATE: July 22, 2015

REASON: Condition Level Non-Compliance

Unsuccessful PT

STATUS: Laboratory voluntarily Ceased Testing

Letter signed/received from laboratory to voluntarily cease testing due to repeat unsuccessful PT

KAREN WARD, DIRECTOR

AUTUMN ROAD FAMILY PRACTICE, PA

904 AUTUMN ROAD, SUITE 200

LITTLE ROCK, AR 72211

CLIA ID# 04D0467303


EFFECTIVE DATE: November 10, 2015


Unsuccessful PT

EKNATH DEO MD DIRECTOR, DIRECTOR

COAST HEMATOLOGY-ONCOLOGY ASSOCIATES, INC

701 E 28TH ST STE 418

LONG BEACH, CA 90806

CLIA ID# 05D0554051


EFFECTIVE DATE: June 14, 2015

REASON: Cancellation of Medicare Approval Suspension

Condition Level Non-Compliance

Unsuccessful PT

MILO ALLADO MD, DIRECTOR

MTS CLINICAL LABORATORY

7625 HAYVENHURST AVE STE 21

VAN NUYS, CA 91406

CLIA ID# 05D0642836


EFFECTIVE DATE: March 7, 2015

REASON: Medicare Cancellation/Suspension


Unsuccessful PT

SOO CHUNG MD, DIRECTOR

SOO M CHUNG MD, ONCOLOGY/HEMATOLOGY

A PROFESSIONAL CORPORATION

12555 GARDEN GROVE BLVD STE 309

GARDEN GROVE, CA 92843

CLIA ID# 05D0675453

SANCTION: Cancel Medicare/Medicaid Approval

Suspension of CLIA Certificate

Revocation of CLIA Certificate

EFFECTIVE DATE: October 8, 2015

October 8, 2015

October 30, 2015

REASON: 2 Year Prohibition From Owning, Operating and Directing

Medicare Cancellation/Suspension

Condition Level Non-Compliance with IJ


STATUS: Revocation of CLIA Certificate

RICHARD JONES MD, DIRECTOR

JONES PEDIATRIC CENTER

3520 E SHIELDS AVE STE 101

FRESNO, CA 93726

CLIA ID# 05D0706013


EFFECTIVE DATE: February 13, 2015



Unsuccessful PT

PETER CHUNG MD, DIRECTOR

CRESTVIEW CLINICAL LABORATORY

3220 BREA CANYON RD STE B

DIAMOND BAR, CA 91765

CLIA ID# 05D0864416




April 13, 2015




Improper PT Testing Referral Activities


JACK AZAD MD, DIRECTOR

PREMIERE CLINICAL LABORATORY, INC

11900 S AVALON BLVD STE 100

LOS ANGELES, CA 90061

CLIA ID# 05D0930192





February 7, 2015

March 31, 2015



Failure to Correct Deficiencies


Failure To Submit Acceptable POC or AOC

PAUL E KIM, MD INC

PAIN MGMT/DR PAUL KIM

3549 CAMINO DEL RIO SOUTH STE A

SAN DIEGO, CA 92108

CLIA ID# 05D1102345



EFFECTIVE DATE: August 16, 2015

August 16, 2015

REASON: Cancellation of Medicare Approval Revocation

2 Year Prohibition From Owning, Operating and Directing





RICHARD JEFFERIES, MD, DIRECTOR

ONSITE OHS, INC

4707 EXECUTIVE DRIVE 1ST FLOOR

SAN DIEGO, CA 92121

CLIA ID# 05D2088238



EFFECTIVE DATE: April 4, 2015

August 27, 2015





Lab Owner/Oper Prohibited From Owning Lab

STATUS: Revocation Pending Hearing

DINESH KHANNA M.D., DIRECTOR

DINESH KHANNA MD PA

1580 SANTA BARBARA BLVD

THE VILLAGES, FL 32159

CLIA ID# 10D0956954



EFFECTIVE DATE: December 22, 2015

December 22, 2015







SYED HUSSAIN, DIRECTOR

FAMILY MEDICINE AND REHAB INC

7685 103RD ST STE 1

JACKSONVILLE, FL 32210

CLIA ID# 10D0968343



REASON: Unsuccessful PT


HILARIO ISABA M.D., DIRECTOR

SOUTHEAST MEDICAL LABORATORY

6920 NW 72ND AVE

MIAMI, FL 33166

CLIA ID# 10D0984349


EFFECTIVE DATE: September 18, 2015



SHAHID MASOOD MD, DIRECTOR

INTERNAL MEDICINE/FAMILY PRACTICE INC

1719 GLENWOOD AVENUE

JOLIET, IL 60435

CLIA ID# 14D0937860





March 25, 2015

May 10, 2015








Revocation of CLIA certificate.

Ineligible to operate until May 9, 2017

ROBERT BONZANI, DIRECTOR

21ST CENTURY UROLOGY SC

14315 S 108TH AVE, STE 230

ORLAND PARK, IL 60467

CLIA ID# 14D0996606




EFFECTIVE DATE: January 5, 2015

January 5, 2015

February 20, 2015







Ineligible to operate until Feb 19, 2017

ULRICH KLOPFER D.O., DIRECTOR

WOMENS PAVILION

2010 IRONWOOD CIRCLE

SOUTH BEND, IN 46635

CLIA ID# 15D0709934





January 23, 2015

November 25, 2015






TODD STILES M.D., DIRECTOR

RIVERSIDE CYTOLOGY LABORATORY INC

516 MAIN ST STE B

TELL CITY, IN 47586

CLIA ID# 15D1022101




June 30, 2015

REASON: Condition Level Non-Compliance with IJ



STATUS: Compliance Achieved

ABDUL DAHHAN, DIRECTOR

A DAHHAN MD PSC

120 PROFESSIONAL LANE SUITE 101

HARLAN, KY 40831

CLIA ID# 18D0681245




Unsuccessful PT


Red Blood Cell analyte limited from 9/21/2015-3/19/2016.

MARY LONG, DIRECTOR

PHYSICIAN SERVICES, PSC

1713 NICHOLASVILLE ROAD, SUITE 101 & 103

LEXINGTON, KY 40503

CLIA ID# 18D2070039




March 9, 2015





Laboratory paid fine in 2015

QUANG VU, DIRECTOR

HARVEY MEDCARE

3709 WESTBANK EXPRESSWAY, SUITE 1-B

HARVEY, LA 70058

CLIA ID# 19D0457620





June 9, 2015

June 9, 2015






ROBERT FOOTER MD, DIRECTOR

ROBERT D FOOTER MD

10401 OLD GEORGETOWN RD SUITE 307

BETHESDA, MD 20814

CLIA ID# 21D0212345




Unsuccessful PT

MILLICENT COKER-VANN PH D, DIRECTOR

THE MALARIA & RHEUMATIC DISEASE RESEARCH INST INC

18215-A FLOWER HILL WAY

GAITHERSBURG, MD 20879

CLIA ID# 21D2065315

SANCTION: Suspension of CLIA Certificate


REASON: Failure to Permit Inspection

STEVEN GRANT, DIRECTOR

DOCTORS OF INTERNAL MEDICINE

30335 W 13 MILE RD SUITE 1

FARMINGTON HILLS, MI 48334

CLIA ID# 23D0372125


EFFECTIVE DATE: May 27, 2015


STATUS: Suspension And Limitation Lifted

SRINIVAS BALIGA, DIRECTOR

DR MADAN L GUPTA MD PC

23077 GREENFIELD ROAD SUITE #253

SOUTHFIELD, MI 48075

CLIA ID# 23D0670243





AHMED ARIF, DIRECTOR

FLUSHING ROAD INTERNAL MEDICINE & PEDIATRICS

1201 FLUSHING ROAD

FLINT, MI 48504

CLIA ID# 23D1008641





ROBERT LARBI-ODAM, DIRECTOR

AXIS MEDICAL CENTER

1801 NICOLLET AVE SOUTH

MINNEAPOLIS, MN 55403

CLIA ID# 24D1082806

SANCTION: Suspension of CLIA Certificate





Compliance Achieved

WEIGANG ZHU, DIRECTOR

AMERATHON LLC

DBA AMERICAN HEALTH ASSOCIATES

10126 WOODFIELD LANE

SAINT LOUIS, MO 63132

CLIA ID# 26D0440143





Certificate limited for the specialty of Bacteriology.

CLAYTON MEAD, DIRECTOR

WESTERN MONTANA CLINIC

515 WEST FRONT STREET

MISSOULA, MT 59802

CLIA ID# 27D0410975

SANCTION: Revocation of CLIA Certificate







WESTERN MONTANA CLINIC COMMUNITY

2835 FORT MISSOULA ROAD PHYS BLDG #3

MISSOULA, MT 59802

CLIA ID# 27D0918124



REASON: Improper PT Testing Referral Activities


BENEDICT OKWARA M.D., DIRECTOR

FIRST CARE MEDICAL CLINIC - NATIONS FORD

9040 NATIONS FORD ROAD

CHARLOTTE, NC 28273

CLIA ID# 34D1020355




AWAWU IGBINADOLOR, DIRECTOR

ST MARYS MEDICAL CLINIC

701 EAST ROOSEVELT BOULEVARD, SUITE 800 - A

MONROE, NC 28112

CLIA ID# 34D1078775




Unsuccessful PT

MARK WINTERS DPM, DIRECTOR

NORTH COAST FOOT & DIABETIC WOUND CARE CENTER

1100 N ABBE ROAD SUITE D

ELYRIA, OH 44035

CLIA ID# 36D0946770







ANDRE HARRIS SR, DIRECTOR

HORIZONS WOMEN'S HEALTH CARE LLC

1 ELIZABETH PLACE 5TH FLOOR SUITE M

DAYTON, OH 45417

CLIA ID# 36D1052740



Cancel Medicare/Medicaid Approval



January 15, 2015

January 15, 2015

January 15, 2015

REASON: Failure to Correct Deficiencies


Ineligible to own or operate until January 15, 2017

BRIAN STILL D.O., DIRECTOR

COSHOCTON LABORATORY INTERNATIONAL LLC

660 MAIN STREET

COSHOCTON, OH 43812

CLIA ID# 36D1100195



MARTY LOFGREN, DIRECTOR

ABSENTEE SHAWNEE TRIBAL HEALTH AUTHORITY, INC

ABSENTEE SHAWNEE TRIBE OF OKLAHOMA

2029 S GORDON COOPER DR, BUILDING 17

SHAWNEE, OK 74801

CLIA ID# 37D1092055





JAVID CALCATTI, DIRECTOR

WELLNORTH MEDICAL

1630 MINERAL SPRING AVENUE SUITE 203

NORTH PROVIDENCE, RI 02904

CLIA ID# 41D0709763







TEMISAN ETIKERENTSE, DIRECTOR

HOPE CLINIC NORTH CHARLESTON

5880 RIVERS AVE

NORTH CHARLESTON, SC 29406

CLIA ID# 42D1077950




EDWARD WHITE, DIRECTOR

ONSITE OHS

1225 SPRING ST

DOVER, TN 37058

CLIA ID# 44D2076833




August 27, 2015


STATUS: Hearing Decision Sustained CMS Sanc Determ

GONZALO URIBE-BOTERO, DIRECTOR

ACADEMIC INSTITUTE OF PATHOLOGY

5420 BELLAIRE BOULEVARD SUITE B

BELLAIRE, TX 77401

CLIA ID# 45D0722508







Hearing Decision Sustained CMS Sanc Determ

YING YING WOOD, DIRECTOR

CLINICA DE NINOS, PA

6445 HIGH STAR

HOUSTON, TX 77074

CLIA ID# 45D0952465




Unsuccessful PT


GONZALO URIBE-BOTERO, DIRECTOR

MEDAGENE CLINIC

6655 HILLCROFT SUITE 100 & 105

HOUSTON, TX 77081

CLIA ID# 45D0965514






OANH BUI, DIRECTOR

CYPRESS OB GYN

10680 JONES RD STE 600

HOUSTON, TX 77065

CLIA ID# 45D1050724




September 4, 2015



ALBERTO GONZALEZ, DIRECTOR

SOUTH TEXAS CLINICAL LABORATORY LLP

418 SOUTH 6TH STREET

KINGSVILLE, TX 78363

CLIA ID# 45D1075228




Unsuccessful PT

RAJA MUTYALA, DIRECTOR

ANANTASAI DBA CLINICAL DIAGNOSTIC LABORATORY

3519 TOWN CENTER BLVD SUITE B

SUGAR LAND, TX 77479

CLIA ID# 45D2012059




Unsuccessful PT




BRIAN CARLILE DO, DIRECTOR

ONSITE OHS, INC

2421 WESTPORT PARKWAY #300

FORT WORTH, TX 76177

CLIA ID# 45D2028220









Hearing Decision Sustained CMS Sanc Determ

Hearing Requested

Appeal Filed By Laboratory

GLENWOOD WILBERT III, DIRECTOR

CONSULTANTS IN RADIOLOGY, PA

831 EUREKA ST

WEATHERFORD, TX 76086

CLIA ID# 45D2043795







GLENWOOD WILBERT III, DIRECTOR

CLEBURNE IMAGING LLC

203 WALLS DRIVE SUITE 101

CLEBURNE, TX 76033

CLIA ID# 45D2043796







MURTAZA MUSSAJI, DIRECTOR

SHADOW CREEK MEDICAL CLINIC

11021 SHADOW CREEK PKWY #102

PEARLAND, TX 77584

CLIA ID# 45D2050056





September 9, 2015

September 9, 2015





AYO AJIM M.D., DIRECTOR

GRACE ER

10900 GULF FREEWAY, #B102

HOUSTON, TX 77034

CLIA ID# 45D2066463





STATUS: Revocation Pending Hearing

Appeal Filed By Laboratory

3. A LIST OF PERSONS CONVICTED OF VIOLATING CLIA REQUIREMENTS AS SPECIFIED IN SECTION 353(1) OF THE PUBLIC HEALTH SERVICES ACT, WITH THE CIRCUMSTANCES OF EACH CASE AND THE PENALTIES IMPOSED.

*** N O D A T A F O U N D ***

4. A LIST OF LABORATORIES ON WHICH ALTERNATIVE SANCTIONS HAVE BEEN IMPOSED, SHOWING -

(I) THE EFFECTIVE DATE OF THE SANCTIONS

(II) THE REASON FOR IMPOSING THEM

(III) ANY CORRECTIVE ACTION TAKEN BY THE LABORATORY AND

(IV) IF LABORATORY HAS ACHIEVED COMPLIANCE, THE VERIFIED DATE OF THE COMPLIANCE

DERROL DAWKINS MD, DIRECTOR

METRO PEDIATRICS PC

401 VALLEY AVENUE

BIRMINGHAM, AL 35209

CLIA ID# 01D0300948

SANCTION: Directed Plan of Correction (DPOC)

Suspension of Part of Medicare/Medicaid


July 22, 2015


Unsuccessful PT

Letter signed/received from laboratory to voluntarily cease testing due to repeat unsuccessful PT

CURT BUCHHOLZ, DIRECTOR

CENTRAL PENINSULA GENERAL HOSPITAL

250 HOSPITAL PLACE

SOLDOTNA, AK 99669

CLIA ID# 02D0066328

SANCTION: Civil Money Penalty

Directed Plan of Correction (DPOC)


September 11, 2015


AMIT GHOSHAL Ph.D., DIRECTOR

PROGRESSIVE PAIN MANAGEMENT INC

301 E COTTONWOOD LANE, STE 1

CASA GRANDE, AZ 85122

CLIA ID# 03D2017811


Directed Portion Plan of Correction (DPPOC)


December 24, 2015






MICHAEL ANREDER, DIRECTOR

DE QUEEN REGIONAL MEDICAL CENTER, INC LABORATORY

1306 WEST COLLIN RAYE DRIVE

DE QUEEN, AR 71832

CLIA ID# 04D0465706




July 6, 2015



KAREN WARD, DIRECTOR

AUTUMN ROAD FAMILY PRACTICE, PA

904 AUTUMN ROAD, SUITE 200

LITTLE ROCK, AR 72211

CLIA ID# 04D0467303

SANCTION: Suspension of Part of Medicare/Medicaid



Unsuccessful PT

EKNATH DEO MD DIRECTOR, DIRECTOR

COAST HEMATOLOGY-ONCOLOGY ASSOCIATES, INC

701 E 28TH ST STE 418

LONG BEACH, CA 90806

CLIA ID# 05D0554051




June 14, 2015

REASON: Cancellation of Medicare Approval Suspension


Unsuccessful PT

ALFREDO ASUNCION JR, DIRECTOR

QUEST DIAGNOSTICS INC

ATTN QA DEPT

967 MABURY ROAD

SAN JOSE, CA 95133

CLIA ID# 05D0608832




May 5, 2015


MILO ALLADO MD, DIRECTOR

MTS CLINICAL LABORATORY

7625 HAYVENHURST AVE STE 21

VAN NUYS, CA 91406

CLIA ID# 05D0642836




March 7, 2015



Unsuccessful PT

ALFREDO ASUNCION JR, DIRECTOR

QUEST DIAGNOSTICS

3714 NORTHGATE BLVD

SACRAMENTO, CA 95834

CLIA ID# 05D0644209




May 5, 2015


SOO CHUNG MD, DIRECTOR

SOO M CHUNG MD, ONCOLOGY/HEMATOLOGY

A PROFESSIONAL CORPORATION

12555 GARDEN GROVE BLVD STE 309

GARDEN GROVE, CA 92843

CLIA ID# 05D0675453




October 5, 2015








THOMAS COOPER, JR., MD, DIRECTOR

MEDICAL CLINICAL LABORATORIES INC

2216 SANTA MONICA BLVD STE 101

SANTA MONICA, CA 90404

CLIA ID# 05D0704107




Unsuccessful PT

RICHARD JONES MD, DIRECTOR

JONES PEDIATRIC CENTER

3520 E SHIELDS AVE STE 101

FRESNO, CA 93726

CLIA ID# 05D0706013




February 13, 2015



Unsuccessful PT

PETER CHUNG MD, DIRECTOR

CRESTVIEW CLINICAL LABORATORY

3220 BREA CANYON RD STE B

DIAMOND BAR, CA 91765

CLIA ID# 05D0864416

SANCTION: Directed Portion Plan of Correction (DPPoC)








JACK AZAD MD, DIRECTOR

PREMIERE CLINICAL LABORATORY, INC

11900 S AVALON BLVD STE 100


CLIA ID# 05D0930192




February 4, 2015






MICHAEL QUIGLEY MD, DIRECTOR

SCRIPPS CLINIC MEDICAL LABORATORIES

9535 WAPLES ST STE 150

SAN DIEGO, CA 92121

CLIA ID# 05D1071362




March 24, 2015



MISAL KHAN, DIRECTOR

MISAL KHAN MD FRCS (ED) PA

3808 E 3RD ST

PANAMA CITY, FL 32401

CLIA ID# 10D0270499




January 3, 2015


Unsuccessful PT

HILARIO ISABA M.D., DIRECTOR

SOUTHEAST MEDICAL LABORATORY

6920 NW 72ND AVE

MIAMI, FL 33166

CLIA ID# 10D0984349




September 18, 2015



ERNESTO ESTOR MD, DIRECTOR

OAKCREST LABORATORY SERVICES INC

10 ORLAND SQUARE DR, STE 1A


CLIA ID# 14D0418588





ROBERT REUTER, DIRECTOR

SHELBY MEMORIAL HOSPITAL LABORATORY

200 S CEDAR ST

SHELBYVILLE, IL 62565

CLIA ID# 14D0435278





MINA GABRAWY MD, DIRECTOR

HARDIN COUNTY GEN HOSP

FERRELL RD PO BOX 2467

ROSICLARE, IL 62982

CLIA ID# 14D0436747




June 18, 2015



CMP Imposed

MOIRA ARIANO MD, DIRECTOR

MOIRA C ARIANO MD SC

2323 NAPERVILLE RD STE 120

NAPERVILLE, IL 60563

CLIA ID# 14D0901570




August 3, 2015



SHAHID MASOOD MD, DIRECTOR

INTERNAL MEDICINE/FAMILY PRACTICE INC

1719 GLENWOOD AVENUE

JOLIET, IL 60435

CLIA ID# 14D0937860




March 25, 2015

REASON: Failure To Submit Acceptable POC or AOC

ROBERT BONZANI, DIRECTOR

21ST CENTURY UROLOGY SC

14315 S 108TH AVE, STE 230


CLIA ID# 14D0996606



REASON: Failure To Submit Acceptable POC or AOC


AMY BUDKE M D, DIRECTOR

GASTROINTESTINAL CLINIC QUAD CITIES

4340 7TH STREET

MOLINE, IL 61265

CLIA ID# 14D1075492


Suspension of All of Medicare/Medicaid



October 16, 2015

October 23, 2015



TODD STILES M.D., DIRECTOR

RIVERSIDE CYTOLOGY LABORATORY INC

516 MAIN ST STE B

TELL CITY, IN 47586

CLIA ID# 15D1022101







ABDUL DAHHAN, DIRECTOR

A DAHHAN MD PSC

120 PROFESSIONAL LANE SUITE 101

HARLAN, KY 40831

CLIA ID# 18D0681245




July 22, 2015


Unsuccessful PT

Red Blood Cell analyte limited from 9/21/2015-3/19/2016.

STANLEY LEVINSON, DIRECTOR

PHYSICIAN SERVICES, PSC

1721 NICHOLASVILLE ROAD

LEXINGTON, KY 40503

CLIA ID# 18D0952397




June 23, 2015




HOWARD MARTIN III M.D., DIRECTOR

PERFORMANCE LABS, LLC

50 EAST COURT, SUITE 8

MANDEVILLE, LA 70471

CLIA ID# 19D2065079





December 30, 2015

December 30, 2015

ROBERT FOOTER MD, DIRECTOR

ROBERT D FOOTER MD

10401 OLD GEORGETOWN RD SUITE 307

BETHESDA, MD 20814

CLIA ID# 21D0212345




Unsuccessful PT

MILLICENT COKER-VANN PH D, DIRECTOR

THE MALARIA & RHEUMATIC DISEASE RESEARCH INST INC

18215-A FLOWER HILL WAY

GAITHERSBURG, MD 20879

CLIA ID# 21D2065315




PAUL LYSIAK, DIRECTOR

EMERSON HOSPITAL

133 OLD ROAD TO NINE ACRE CORNER (ORNAC)

CONCORD, MA 01742

CLIA ID# 22D0070561




October 23, 2015



RICHARD KAUFMAN M.D., DIRECTOR

BRIGHAM & WOMEN'S HOSPITAL TRANSFUSION SERVICE AND

KRAFT FAMILY BLOOD DONOR CENTER

75 FRANCIS STREET, AMORY 260

BOSTON, MA 02115

CLIA ID# 22D1008129


Civil Money Penalty


May 8, 2015



STEVEN GRANT, DIRECTOR

DOCTORS OF INTERNAL MEDICINE

30335 W 13 MILE RD SUITE 1

FARMINGTON HILLS, MI 48334

CLIA ID# 23D0372125




May 27, 2015



SRINIVAS BALIGA, DIRECTOR

DR MADAN L GUPTA MD PC

23077 GREENFIELD ROAD SUITE #253


CLIA ID# 23D0670243




January 23, 2015



AHMED ARIF, DIRECTOR

FLUSHING ROAD INTERNAL MEDICINE & PEDIATRICS

1201 FLUSHING ROAD

FLINT, MI 48504

CLIA ID# 23D1008641


Suspension of All of Medicare/Medicaid


May 29, 2015



ROBERT LARBI-ODAM, DIRECTOR

AXIS MEDICAL CENTER

1801 NICOLLET AVE SOUTH

MINNEAPOLIS, MN 55403

CLIA ID# 24D1082806



REASON: Condition level non compliance

Failure to submit an acceptable AOC


WESTERN MONTANA CLINIC

515 WEST FRONT STREET

MISSOULA, MT 59802

CLIA ID# 27D0410975





BENEDICT OKWARA M.D., DIRECTOR

FIRST CARE MEDICAL CLINIC - NATIONS FORD

9040 NATIONS FORD ROAD

CHARLOTTE, NC 28273

CLIA ID# 34D1020355




October 4, 2015


Unsuccessful PT

AWAWU IGBINADOLOR, DIRECTOR

ST MARYS MEDICAL CLINIC

701 EAST ROOSEVELT BOULEVARD, SUITE 800 - A

MONROE, NC 28112

CLIA ID# 34D1078775




Unsuccessful PT

KENNETH WHINERY M.D., DIRECTOR

SAYRE MEMORIAL HOSPITAL

911 HOSPITAL DR

SAYRE, OK 73662

CLIA ID# 37D0472457





JENNIFER RUSSELL, DIRECTOR

MERCY HOSPITAL WATONGA

500 N CLARENCE NASH BLVD

WATONGA, OK 73772

CLIA ID# 37D0472727





RICKY REAVES, DIRECTOR

MEMORIAL HOSPITAL OF TEXAS COUNTY

520 MEDICAL DRIVE

GUYMON, OK 73942

CLIA ID# 37D0472824






SHIRIL HOMBAL, DIRECTOR

ATOKA COUNTY MEDICAL CENTER

1200 WEST LIBERTY ROAD

ATOKA, OK 74525

CLIA ID# 37D0475417





DENISE JOHNSON, DIRECTOR

OKLAHOMA VETERANS CENTER-CLINTON DIVISION

1701 SOUTH HIGHWAY 183

CLINTON, OK 73601

CLIA ID# 37D0665426






LI-SI-WI-NWI HEALTH INC

15951 LITTLE AXE DRIVE

NORMAN, OK 73026

CLIA ID# 37D0906177




April 30, 2015





ABSENTEE SHAWNEE TRIBAL HEALTH AUTHORITY, INC

ABSENTEE SHAWNEE TRIBE OF OKLAHOMA

2029 S GORDON COOPER DR, BUILDING 17

SHAWNEE, OK 74801

CLIA ID# 37D1092055





March 9, 2015

April 30, 2015




JAMES MACLOWRY MD, DIRECTOR

UNIVERSITY HOSPITALS & CLINICS POCT

LABORATORY

3181 SW SAM JACKSON PK RD L471

PORTLAND, OR 97239

CLIA ID# 38D0906671




April 13, 2015


TEMISAN ETIKERENTSE, DIRECTOR

HOPE CLINIC NORTH CHARLESTON

5880 RIVERS AVE

NORTH CHARLESTON, SC 29406

CLIA ID# 42D1077950




October 3, 2015


Unsuccessful PT

LINH NGUYEN, DIRECTOR

PRIMA HEALTH CLINIC

3555 W WALNUT ST SUITE A

GARLAND, TX 75042

CLIA ID# 45D0476599





JYOTSNAMOY CHAUDHURI, DIRECTOR

ENDOCRINE ASSOCS OF DALLAS PA LAB

10260 NORTH CENTRAL EXPRESSWAY

DALLAS, TX 75231

CLIA ID# 45D0480679




JAMES DUFF, DIRECTOR

STEPHENS MEMORIAL HOSPITAL

200 SOUTH GENEVA ST

BRECKENRIDGE, TX 76424

CLIA ID# 45D0484993




September 25, 2015

OSCAR DEVALLE, DIRECTOR

CLINICA HISPANA

2028 WIRT RD

HOUSTON, TX 77055

CLIA ID# 45D0492184





MANON CHILDERS III, DIRECTOR

CHILDERS-SIEWERT CLINIC

3006 GARRETT DRIVE

PERRYTON, TX 79070

CLIA ID# 45D0506710







YING YING WOOD, DIRECTOR

CLINICA DE NINOS, PA

6445 HIGH STAR

HOUSTON, TX 77074

CLIA ID# 45D0952465

SANCTION: Suspension of All of Medicare/Medicaid



Unsuccessful PT


AMANULLAH KHAN MD PHD, DIRECTOR

CANCER CENTER ASSOCIATES

4201 MEDICAL CENTER DR STE 180

MCKINNEY, TX 75069

CLIA ID# 45D0996059




September 14, 2015




SHARON KUYKENDALL, DIRECTOR

ACCUTOX, INC/STAT LAB

105 IH 10 SOUTH

BEAUMONT, TX 77702

CLIA ID# 45D0999705






OSCAR DE VALLE, DIRECTOR

CLINICA HISPANA II, PA

8410 FONDREN

HOUSTON, TX 77074

CLIA ID# 45D1012480






CODY MIHILLS, DIRECTOR

CODY L MIHILLS,MD PA

1001 S SOUTHLAKE BLVD

SOUTHLAKE, TX 76092

CLIA ID# 45D1061285






ALBERTO GONZALEZ, DIRECTOR

SOUTH TEXAS CLINICAL LABORATORY LLP


KINGSVILLE, TX 78363

CLIA ID# 45D1075228




Unsuccessful PT

YOLANDA LAWSON, MD, DIRECTOR

MADEWELL OB GYN

YOLANDA LAWSON, MD, PA

3310 LIVE OAK, SUITE 210

DALLAS, TX 75204

CLIA ID# 45D1085262





QUIN SUN, DIRECTOR

TEXAS PAIN SOLUTIONS

3074 COLLEGE PARK DRIVE

THE WOODLANDS, TX 77384

CLIA ID# 45D1095162






JAMES JACKSON, DIRECTOR

EMERGI CARE

2409 FALCON PASS SUITE 100

HOUSTON, TX 77062

CLIA ID# 45D2000895





MARIO QUINTANILLA, DIRECTOR

BELLAIRE ER

5302 BELLAIRE BLVD

BELLAIRE, TX 77401

CLIA ID# 45D2043149




MURTAZA MUSSAJI, DIRECTOR

SHADOW CREEK MEDICAL CLINIC

11021 SHADOW CREEK PKWY #102

PEARLAND, TX 77584

CLIA ID# 45D2050056




DEBRA SMITH, DIRECTOR

MEN'S PERFORMANCE HEALTH

525 OAK CENTRE DRIVE, STE 230

SAN ANTONIO, TX 78258

CLIA ID# 45D2069709




September 14, 2015




GEORGE CHANG, DIRECTOR

UNITED MEDICAL LABS INC

1980 GALLOWS RD - SUITE 300

VIENNA, VA 22182

CLIA ID# 49D0222887







ALBERT HERRERA M.D., DIRECTOR

MOUNT VERNON INTERNAL MEDICINE

8109 HINSON FARM ROAD - SUITE 504

ALEXANDRIA, VA 22306

CLIA ID# 49D0224457




Unsuccessful PT


ADNAN ALGHADBAN MD, DIRECTOR

MED PLUS LLC

48 VIP WAY PLEASANT VALLEY ROAD

FAIRMONT, WV 26554

CLIA ID# 51D1053306


Civil Money Penalty


June 2, 2015


Unsuccessful PT



5. LABORATORIES WHOSE ACCREDITATION HAS BEEN WITHDRAWN OR REVOKED AND THE REASON FOR THE WITHDRAWAL OR REVOCATION. (INCLUDES ALL OTHER ADVERSE ACTIONS TAKEN BY THE ACCREDITATION ORGANIZATIONS)

JOSHUA VACIK MD, DIRECTOR

MEDICAL ASSOCIATES OF THE SHOALS

1120 S JACKSON HWY SUITE 300

SHEFFIELD, AL 35660

CLIA ID# 01D0302711 COLA

SANCTION: Cease Testing for Free Thyroxine (FT4)



STATUS: Test Was Reinstated on November 16, 2015.

GARY MCCULLOCH MD, DIRECTOR

ECLECTIC FAMILY CARE LLC

575 CLAUD ROAD SUITE 1000

ECLECTIC, AL 36024


SANCTION: Cease Testing for RBC



STATUS: As of December 31, 2015 Cease Testing Still in Effect.

BRUCE KIESSLING, DIRECTOR

US HEALTHWORKS MEDICAL GROUP OF ALASKA, LLC

4100 LAKE OTIS PARKWAY SUITE 322

ANCHORAGE, AK 99508


SANCTION: Cease Testing for Streptococcus Group A



STATUS: On October 20, 2015 Laboratory Removed the Test From Their Test Menu.

JAMES TIESIGNA, DIRECTOR

SAMUEL SIMMONDS MEMORIAL HOSPITAL LAB

7000 UULA ST

BARROW, AK 99723

CLIA ID# 02D0641844 CAP

SANCTION: Cease Testing for Compatibility Testing



STATUS: Laboratory Allowed To Resume Testing On

December 23, 2015.

ARNOLD LOERA, DIRECTOR

BRISTOL BAY AREA HEALTH CORPORATION

6000 KANAKANAK ROAD

DILLINGHAM, AK 99576


SANCTION: Probation


REASON: Quality and Severity of Deficiencies is Significant Enough

to Question Ability to Sustain Corrections; Corrective

Actions Fails to Support Implementation and Prevention of

Recurrence in One or More Areas of the Laboratory.

STATUS: As of February 12, 2016 Probation Still In Effect.

DHIREN JOSHIPURA M.D., DIRECTOR

COLMED COLLECTION SERVICES, LLC

1724 W 4TH ST

TEMPE, AZ 85281


SANCTION: Cease Testing for Triiodothyronine (T3U)



STATUS: On November 23, 2015 The Laboratory Withdrew From

COLA. Laboratory Is No Longer Accredited By COLA.

MARSHALL FICHMAN, DIRECTOR

MARSHALL FICHMAN MD

8635 W 3RD #292W



SANCTION: Denial of Accreditation


REASON: Failure to Adhere to COLA Imposed Required

Improvements

STATUS: Laboratory No Longer Accredited By COLA.

MARK SCHOLZ, DIRECTOR

PROSTATE ONCOLOGY SPECIALIST, INC

4676 ADMIRALTY WAY STE 101

MARINA DEL REY, CA 90292





Improvements

STATUS: Laboratory No Longer Accredited by COLA.

LEONARD LAZARUS, MD, DIRECTOR

BIRD ROCK LABORATORY

6515 LA JOLLA BLVD

LA JOLLA, CA 92037


SANCTION: Cease Testing for Sodium



STATUS: As Of December 31, 2015 Cease Testing Still In Effect.

ART HUFFAKER, MD, DIRECTOR

SHARP CORNADO HOSP & HEALTHCARE CENTER

250 PROSPECT PL

CORONADO, CA 92118





STATUS: Laboratory Allowed To Resume Testing On

April 23, 2015.

ERNEST HOLBERT, DIRECTOR

SOUTHWEST HEALTHCARE SYSTEM CLINICAL

LABORATORY

36485 INLAND VALLEY DRIVE

WILDOMAR, CA 92595


SANCTION: Probation







ROBERT JAMES MD, DIRECTOR

SANTA PAULA HOSPITAL,A CAMPUS OF VENTURA COUNTY

MEDICAL CENTER LABORATORY

825 NORTH TENTH STREET

SANTA PAULA, CA 93060


SANCTION: Probation






STATUS: Laboratory Removed From Probation November 10, 2015.

RADHEY BANSAL, MD, DIRECTOR

COMPREHENSIVE MEDICAL GROUPOF KERN COUNTY

1230 JEFFERSON ST

DELANO, CA 93215





Improvements


ROBERT ROSSER MD, DIRECTOR

DESERT REGIONAL MEDICAL CENTER CLINICAL LAB

1150 N INDIAN CANYON DRIVE

PALM SPRINGS, CA 92262


SANCTION: Probation







ROBERT JAMES III MD PHD, DIRECTOR

VENTURA COUNTY MEDICAL CENTER LAB

3291 LOMA VISTA ROAD

VENTURA, CA 93003


SANCTION: Probation







RAYMUNDO PUNZALAN, DIRECTOR

SIERRA ENDOCRINE ASSOCIATES MED GROUP

7230 NORTH MILLBROOK AVENUE

FRESNO, CA 93720






DENNIS LEWIS, MD, DIRECTOR

SCV QUALITY CARE

23823 VALENCIA BLVD, SUITE 160

VALENCIA, CA 91355


SANCTION: Cease Testing for Influenza A/B



STATUS: On November 20, 2015 The Laboratory Removed The Test

From Their Test Menu.

ANTHONY GIORGIO MD, DIRECTOR

ANTHONY J GIORGIO MD HEMATOLOGY

1360 WEST 6TH STREET # G

SAN PEDRO, CA 90732


SANCTION: Cease Testing for WBC Differential



STATUS: On September 23, 2015 The Laboratory Withdrew From

COLA. Laboratory Is No Longer Accredited By COLA.

NELSON KANEISHI, DIRECTOR

SUTTER SURGICAL HOSPITAL - NORTH VALLEY

455 PLUMAS BLVD

YUBA CITY, CA 95991


SANCTION: Cease Testing for Prothrombin Time



STATUS: As Of February 12, 2016 Cease Testing Still In Effect.

HELEN STOSEL, MD, DIRECTOR

HELEN STOSEL, MD INC

25982 PALA STE 140

MISSION VIEJO, CA 92691





Improvements


CRAIG SHAPIRO, DIRECTOR

PARKVIEW MEDICAL CENTER/RESP CARE

400 W 16TH ST

PUEBLO, CO 81003


SANCTION: Cease Testing for Glucose, Whole Blood




BRIAN PECK MD DIRECTOR, DIRECTOR

ARTHRITIS CENTER OF CONNECTICUT

RHEUMATOLOGY DIVISION

1389 W MAIN ST STE 120

WATERBURY, CT 06708


SANCTION: Cease Testing for WBC

Denial of Accreditation


December 23, 2015


Failure to Comply with Reasonable Requests of COLA.

STATUS: Laboratory was Denied Accreditation on December 23,

2015. Laboratory No Longer Accredited by COLA.

CHRISTOPHER BRETON, DIRECTOR

PFIZER NEW HAVEN CRU SAFETY LABORATORY

1 HOWE STREET

NEW HAVEN, CT 06511


SANCTION: Cease Testing for HIV 1&2 Antibodies, Hepatitis B

Surface Antigen (HBsAg)



STATUS: On October 26, 2015 The Laboratory Removed The Test


RONALD GIFFLER M.D., DIRECTOR

HENDRY REGIONAL MEDICAL CENTER CLINICAL LABORATORY

524 W SAGAMORE AVE

CLEWISTON, FL 33440


SANCTION: Probation




Action Fails to Support Implementation and Prevention of


STATUS: Laboratory Removed From Probation On January 12, 2016.

ANGELICA RAMIREZ, DIRECTOR

ANGELICA RAMIREZ MD PA

880 NW 13TH ST STE 3-B

BOCA RATON, FL 33486


SANCTION: Cease Testing for Chloride



STATUS: As of December 31, 2015 Cease Testing Still In Effect.

JANINA BANAS-STYPEREK, DIRECTOR

JANUARIUSZ L STYPEREK MD PA

2314 S SEACREST BLVD STE 102

BOYNTON BEACH, FL 33435





Improvements.


ELIZABETH REILLY-HAYS M.D., DIRECTOR

MARIANO D CIBRAN MD CORP D/B/A

ST PETERSBURG PEDIATRIC

1012 4TH ST S

SAINT PETERSBURG, FL 33701


SANCTION: Cease Testing for RBC and Hematocrit




LOUIS SNYDER M.D., DIRECTOR

CARDIOLOGY CENTER OF PALM BEACH COUNTY INC, THE

16244 S MILITARY TRL STE 560

DELRAY BEACH, FL 33484


SANCTION: Cease Testing for Hematocrit




FREDERIC PORCASE JR D.O., DIRECTOR

FAMILY MEDICAL CENTERS

14011 BEACH BLVD STE 120

JACKSONVILLE, FL 32250





STATUS: Test Was Reinstated On July 6, 2015.

JOSHUA SHIPLEY M.D., DIRECTOR

PRIMARY CARE OF THE TREASURE COAST INC

1265 36TH ST

VERO BEACH, FL 32960


SANCTION: Cease Testing for Aerobic &/or Anaerobic Organisms –

Unlimited Sources




MICHAEL GLICK M.D., DIRECTOR

MICHAEL GLICK MD PA

1501 HWY 441 N STE 1102

THE VILLAGES, FL 32159



Cease Testing for Creatine Kinase


December 21, 2015



RAVI GUPTA M.D., DIRECTOR

MID FLORIDA PRIMARY CARE PA

401 N BLVD W

LEESBURG, FL 34748


SANCTION: Cease Testing for Thyroid Stimulating Hormone (TSH)




DANIEL JACOBS, DIRECTOR

CM LAB INC

20861 JOHNSON ST #117

PEMBROKE PINES, FL 33029


SANCTION: Cease Testing for Rotavirus, Giardia Lambia,

Cryptosporidium, All Conventional Organism

Identification (ID) – Aerobic &/or Anaerobic Organisms –

Blood Cultures.




GUY STRAUSS, DIRECTOR

SOUTHERN INTERNAL MEDICINE PLLC

404 HALL OF FAME DRIVE

LAKE CITY, FL 32055


SANCTION: Cease Testing for Rheumatoid Factor (RF)



STATUS: On June 16, 2015 The Laboratory Removed The Test From

Their Test Menu.

KURT STONESIFER, DIRECTOR

FLORIDA HOSPITAL AT CONNERTON LONG TERM

ACUTE CARE HOSPITAL

9441 HEALTH CENTER DR

LAND O LAKES, FL 34637


SANCTION: Cease Testing for Estimated Hemoglobin



STATUS: Laboratory Permanently Ceased Testing For Analyte On

October 19, 2015.

RICARDO ESTAPE M.D., DIRECTOR

RICHARDO ESTAPE LLC

8585 SUNSET DR STE 202

MIAMI, FL 33143


SANCTION: Cease Testing for Lactate Dehydrogenase (LDH)




MARIANO CIBRAN, DIRECTOR

EVENING PEDIATRICS INC

12190 SEMINOLE BLVD

LARGO, FL 33778






MARC ZUMBERG, DIRECTOR

NCF DIAGNOSTICS & DNA TECHNOLOGIES

12085 RESEARCH DR

ALACHUA, FL 32615


SANCTION: Probation







WAYNE CAI M.D., DIRECTOR

WHOLE HEALTH LLC

1705 S FEDERAL HWY STE A4

DELRAY BEACH, FL 33483






SHAZIA ZAFAR M.D., DIRECTOR

SHAZIA ZAFAR MD LLC

603 N FLAMINGO DR STE 260

PEMBROKE PINES, FL 33028


SANCTION: Cease Testing for WBC (Diff), WBC, RBC, Hemoglobin,

Hematocrit, Platelet Count




MAURIN JIMENEZ M.D., DIRECTOR

THE MEDICAL CITY

3595 W 20TH AVE # 145

HIALEAH, FL 33012







MICHAEL RUBIN, DIRECTOR

CARDIAC CATH LAB OF FORT MYERS LP

1550 BARKLEY CIR STE 110

FORT MYERS, FL 33907


SANCTION: Cease Testing for Hemoglobin




STEPHEN ADAMS DO, DIRECTOR

DOCTORS HOSPITAL OF AUGUSTA

3651 WHEELER ROAD

AUGUSTA, GA 30909


SANCTION: Cease Testing for Parasitology



STATUS: Laboratory Allowed To Resume Testing On May 29, 2015.

D DELAY, DIRECTOR

DALTON FAMILY PRACTICE PC

1114 PROFESSIONAL BLVD

DALTON, GA 30720






JACKSON GATES, DIRECTOR

K & S CLINICAL DIAGNOSTICS

5607 GLENRIDGE DRIVE, SUITE 150

ATLANTA, GA 30342


SANCTION: Revocation of Accreditation


REASON: Laboratory Performance Does Not Meet CAP Standards of

Accreditation

STATUS: As Of February 12, 2016 Laboratory Not Accredited By

CAP.

JEROME KALTMAN MD, DIRECTOR

LAKE FOREST PEDIATRICS

917 SHERWOOD DR

LAKE BLUFF, IL 60044


SANCTION: Cease Testing for Adenovirus



STATUS: On February 23, 2015 The Laboratory Removed The Test

From Their Test Menu. On September 23, 2015 The

Laboratory Voluntarily Withdrew From COLA.

Laboratory Is No Longer Accredited By COLA.


LAKE FOREST PEDIATRICS - VERNON HILLS OFFICE

870 WEST END CT, STE 100

VERNON HILLS, IL 60061









JEREMIAH PLACIDO MD, DIRECTOR

KISHWAUKEE COMMUNITY HOSPITAL

ONE KISH HOSPITAL DRIVE

DEKALB, IL 60115


SANCTION: Probation







ROBERT NASH MD, DIRECTOR

RICHLAND MEMORIAL HOSPITAL

800 E LOCUST

OLNEY, IL 62450

CLIA ID# 14D0434892 AOA - HFAP

SANCTION: Cease Testing for NT-Pro BNP



STATUS: Laboratory Resumed Testing For NT-Pro BNP On August

24, 2015


LAKE FOREST PEDIATRICS

2592 WEST GRAND AVENUE

LINDENHURST, IL 60046









ENRIQUE ARANA MD, DIRECTOR

FULLERTON-KIMBALL MEDICAL SURGICAL CTR

3412 W FULLERTON AVE

CHICAGO, IL 60647


SANCTION: Cease Testing for Total Bilirubin



June 25, 2015



STATUS: Laboratory Was Denied Accreditation On June 25, 2015.

Laboratory No Longer Accredited By COLA.

EMAD JABER, DIRECTOR

O'HARE CLINICAL LAB SERVICES INC

1922 PLAINFIELD ROAD

CREST HILL, IL 60435


SANCTION: Cease Testing for Cholesterol




HISHAM GREISS, DIRECTOR

FERTILITY & CRYOGENICS LAB

8635 LEMONT RD

DOWNERS GROVE, IL 60516


SANCTION: Cease Testing for Chloride

Probation


September 22, 2015


Quality and Severity of Deficiencies is Significant Enough




STATUS: Laboratory Allowed To Resume Testing On September 9,

2015.

As of February 12, 2016 Laboratory Probation Still in Effect.

JAMIE WEYDERT, DIRECTOR

MCFARLAND CLINIC PC-AMES

1215 DUFF AVENUE

AMES, IA 50010


SANCTION: Cease Testing for Rubella




MATTHEW HERRMANN M.D., DIRECTOR

UNITYPOINT CLINIC

FAMILY MEDICINE - WEST DES MOINES

6010 MILLS CIVIC PARKWAY, SUITE 200

WEST DES MOINES, IA 50266



Hematocrit, Platelet Count, Streptococcus Group A




SALVATORE CILIBERTI MD, DIRECTOR

GREATER LOUISVILLE INTERNAL MEDICINE PSC

250 E LIBERTY STREET STE 410

LOUISVILLE, KY 40202


SANCTION: Cease Testing for Endocrinology – Triiodothyroxine

(T3U), Thyroxine (T4), Thyroid Stimulating Hormone

(TSH), Free Thyroxine (FT4)




ROBERT GOODMAN MD, DIRECTOR

ARTHRITIS & RHEUMATOLOGY CLINIC APMC

740 JORDAN

SHREVEPORT, LA 71101


SANCTION: Cease Testing for T Uptake



STATUS: Test Was Reinstated On November 19, 2015.

DIRK RAINWATER, DIRECTOR

LOUISIANA FAMILY MEDICINE CLINIC

103 WATTS STREET

JONESBORO, LA 71251


SANCTION: Cease Testing for Estradiol, Folate, Follicle Stimulating

Hormone (FSH), Luteinizing Hormone (LH), Progesterone,

Prolactin, Thyroid Stimulating Hormone (TSH), Free

Thyroxine (FT4), Free Triiodothyronine (FT3), B-Type

Natriuretic Peptide (BNP), Anti-Citrullinated Cyclic

Peptide (Anti-CCP), Ferritin, Prostatic Specific Antigen

(PSA), Thyroid Stimulating Hormone (TSH), Testosterone,

Vitamin B12.




DALE DENNIS, DIRECTOR

ST CATHERINE LTAC

14500 HAYNE BOULEVARD 1FIRST FLOOR ABG LAB

NEW ORLEANS, LA 70128


SANCTION: Cease Testing for PO2




RONALD SROKA MD, DIRECTOR

CROFTON FAMILY PRACTICE

1684 VILLAGE GREEN

CROFTON, MD 21114


SANCTION: Cease Testing for Aerobic &/or Anaerobic Organisms –

Unlimited Resources



STATUS: Test Was Reinstated On December 10, 2015.

VICTOR PRIEGO, DIRECTOR

CENTER FOR CANCER AND BLOOD DISORDERS PC

6410 ROCKLEDGE DR STE 660

BETHESDA, MD 20817


SANCTION: Probation






STATUS: Revocation Of Accreditation On January 12, 2016.

JOON YIM, DIRECTOR

THERANOSTIX INC

8000 VIRGINIA MANOR ROAD STE 170

BELTSVILLE, MD 20705


SANCTION: Probation







JULIANA SZAKACS, DIRECTOR

DEDHAM MEDICAL ASSOCIATES-NORWOOD

1177 PROVIDENCE HIGHWAY

NORWOOD, MA 02062


SANCTION: Cease Testing for Bacteriology



STATUS: Laboratory Permanently Ceased Testing For Specialty On

December 8, 2015.

GARY FALLER, DIRECTOR

GOOD SAMARITAN MEDICAL CENTER

235 NORTH PEARL STREET

BROCKTON, MA 02301


SANCTION: Probation






STATUS: Laboratory Removed From Probation On September 8,

2015.

ROXANNE LATIMER, DIRECTOR

DRX NATICK PC DBA DOCTORS EXPRESS

945 WORCESTER ST

NATICK, MA 01760






A MARTIN LERNER, DIRECTOR

A MARTIN LERNER MD

32804 PIERCE ROAD

BEVERLY HILLS, MI 48025





STATUS: On October 19, 2015 The Laboratory Voluntarily

Withdrew From COLA. Laboratory Is No Longer

Accredited By COLA.

GOBIND GARG, DIRECTOR

PHYSICIAN OFFICE LABORATORY SERVICES, LLC

24361 GREENFIELD ROAD SUITE 109



SANCTION: Cease Testing for Iron




SAIMA KHAN, DIRECTOR

FAMILY PRACTICE CARE PLLC

28351 SCHOENHERR ROAD

WARREN, MI 48088


SANCTION: Cease Testing for Sodium, Potassium, Free Thyroxine

(FT4), Triiodothyronine (T3) and Thyroid Stimulating

Hormone – high sens (TSH-HS)



STATUS: FT4, T3 And TSH-HS Were Reinstated On December 21,

2015. As of December 31, 2015 Cease Testing Still In

Effect For Sodium And Potassium.

AYMAN SOUBANY, DIRECTOR

HARPER UNIVERSITY HOSPITAL

3990 JOHN R STREET

DETROIT, MI 48201





Accreditation


CAP.

KAMAL OSMAN, PH D, DIRECTOR

FORD BIO MEDICAL LABORTORY

5601 SCHAEFER ROAD

DEARBORN, MI 48126






A BALA SETTY, DIRECTOR

A BALA SETTY, MD, PC

33116 PALMER ROAD, SUITE D

WESTLAND, MI 48186


SANCTION: Cease Testing for Iron




NAVEED MAHFOOZ, DIRECTOR

CARO HEALTH PLAZA

1525 W CARO ROAD

CARO, MI 48723


SANCTION: Cease Testing for Chloride, Glucose, Potassium, Sodium,

Direct Bilirubin, Total Bilirubin, CO2, Cholesterol, Total

Protein, Albumin, Creatinine, Triglyceride, Calcium,

Aspartate Aminotransferase (AST)(SGOT), Alanine

Aminotransferase (ALT)(SGPT), Urea (BUN), Alkaline

Phosphatase (ALP), HDL Cholesterol, Glycosylated

Hemoglobin (Hgb A1C), WBC (Diff), WBC, RBC,

Hemoglobin, Hematocrit, Platelet Count.




NAVEED MAHFOOZ, DIRECTOR

GREAT LAKE LABORATORIES LLC

1525 W CARO ROAD

CARO, MI 48723







LYN CHAPMAN, DIRECTOR

CHILDREN'S CLINIC NETWORK

3910 EXCELSIOR BOULEVARD

SAINT LOUIS PARK, MN 55416






DONALD GUNDERSON, DIRECTOR

NE IA SHING CLINIC

43500 MIGIZI DRIVE

ONAMIA, MN 56359





STATUS: Test Was Reinstated On September 24, 2015.

BHAVINI CARNS, DIRECTOR

MAYO CLINIC HEALTH SYSTEM IN FARIBAULT

924 FIRST STREET NE

FARIBAULT, MN 55021






JOHN CHRISTOPHER HANCOCK, DIRECTOR

UMMC - DEPARTMENT OF PATHOLOGY

2500 NORTH STATE STREET

JACKSON, MS 39216


SANCTION: Probation






STATUS: As Of February 12, 2016 Probation Still In Effect.

AUSTIN TINSLEY MD, DIRECTOR

POPLAR BLUFF REGIONAL MEDICAL CTR-NORTH CAMPUS

3100 OAK GROVE RD

POPLAR BLUFF, MO 63901


SANCTION: Cease Testing for pCO2




From Their Test Menu. On December 1, 2015 The



AMIL DUBEY, DIRECTOR

MID-MISSOURI REPRODUCTIVE MEDICINE & SURGERY, INC

1506 EAST BROADWAY SUITE 220

COLUMBIA, MO 65201


SANCTION: Probation






STATUS: Laboratory Removed From Probation On February 9, 2016.

STEVEN COLLUM, MD, DIRECTOR

MERCY HOSPITAL & CAMPUS NON-WAIVED POCT

SPRINGFIELD

1235 E CHEROKEE

SPRINGFIELD, MO 65804





STATUS: Laboratory Allowed To Resume Testing On February 18,

2015.

ADAM CLAPPER MD, DIRECTOR

LANDMARK HOSPITAL OF COLUMBIA, LLC

604 OLD HWY 63 NORTH

COLUMBIA, MO 65201


SANCTION: Cease Testing for Blood Gases




ROBERT BATES, DIRECTOR

BLACKFEET COMMUNITY HOSPITAL LAB

760 HOSPITAL CIRCLE

BROWNING, MT 59417





Accreditation


CAP.

YASHPAL DHARMAPAL AGRAWAL, DIRECTOR

NEVADA STATE PUBLIC HEALTH LABORATORY

1660 N VIRGINIA ST MS 0385

RENO, NV 89503


SANCTION: Cease Testing for Mycology




SAMAR SHAMI, DIRECTOR

DERMATOPATHOLOGY INSTITUTE OF NJ

225 STATE ROUTE 35 SUITE 201

RED BANK, NJ 07701


SANCTION: Probation







FARHAD SETOODEH, DIRECTOR

INFINITY DIAGNOSTIC LABORATORIES

370 NORTH STREET

TETERBORO, NJ 07608


SANCTION: Probation






STATUS: Accreditation Terminated Due To Voluntary Withdrawal

From Accreditation Program On December 16, 2015.

JOHN JACOBY, DIRECTOR

METRO MED

466 MAIN ST

NEW ROCHELLE, NY 10801





Improvements


BARTON COHEN, DIRECTOR

NORTH SHORE MEDICAL SPECIALITIES GROUP PC

ONE HOLLOW LANE, SUITE 312

LAKE SUCCESS, NY 11042


SANCTION: Cease Testing for Glucose



STATUS: On August 12, 2015 The Laboratory Removed The Test

From Their Test Menu. On August 10, 2015 The



MANJULA VARA M.D., DIRECTOR

CONEY ISLAND HOSPITAL

2601 OCEAN PARKWAY

BROOKLYN, NY 11235


SANCTION: Probation







PATRICK KO, DIRECTOR

UNION SQUARE URGENT MEDICAL CARE

110 WEST 14TH STREET

NEW YORK, NY 10011


SANCTION: Cease Testing for RBC




RICHARD BURDICK MD, DIRECTOR

WILSON MEDICAL ASSOCIATES PA

200 GLENDALE DRIVE

WILSON, NC 27893






JAN VAN RAVESTEYN, DIRECTOR

WINECOFF FAMILY PRACTICE PLLC

304 WINECOFF SCHOOL RD

CONCORD, NC 28027


SANCTION: Cease Testing for Infectious Mononucleosis Antibodies

(Mono) and hCG, Serum Qualitative




JAMES GARDNER MD, DIRECTOR

FAMILY PRACTICE CENTER

2370 SE BLVD

SALEM, OH 44460


SANCTION: Cease Testing for All Antimicrobial Susceptibility

Cease Testing for Aerobic &/or Anaerobic Organisms –

Unlimited Sources


September 4, 2015


Unsuccessful PT


DEBORAH WARD, DIRECTOR

HIGHLAND DISTRICT HOSPITAL

1275 NORTH HIGH STREET

HILLSBORO, OH 45133


SANCTION: Probation






STATUS: Accreditation Terminated Due To Voluntary Withdrawal

From Accreditation Program On December 16, 2015.

RICHARD PLUMB DO, DIRECTOR

UPPER VALLEY FAMILY CARE INC

700 S STANFIELD ROAD SUITE A

TROY, OH 45373


SANCTION: Cease Testing for Free Triiodothyronine (FT3)




CARL WEHRI MD, DIRECTOR

DELPHOS FAMILY PHYSICIANS INC

1775 E 5TH ST PO BOX 458

DELPHOS, OH 45833


SANCTION: Cease Testing for Urine Culture - ID





BARRY ROCKLER MD, DIRECTOR

PERRY MEMORIAL HOSPITAL

501 14TH STREET

PERRY, OK 73077


SANCTION: Cease Testing for Donor/Recipient Compatibility




BRIAN BOCK, DIRECTOR

MUSKOGEE REGIONAL MEDICAL CENTER, LLC

D/B/A EASTAR HEALTH SYSTEM, MAIN CAMPUS LAB

300 E ROCKEFELLER DRIVE

MUSKOGEE, OK 74401


SANCTION: Probation






STATUS: Laboratory Removed From Probation On October 27,

2015.

JOHN KOONTZ MD, DIRECTOR

FAMILY HEALTH CENTER SOUTH

10021 SOUTH WESTERN

OKLAHOMA CITY, OK 73139


SANCTION: Cease Testing for HDL Cholesterol




JOHN PERKINS, DIRECTOR

FAMILY PRACTICE OF ELK CITY INC

601 WEST 3RD STREET

ELK CITY, OK 73644






AKINOLA OGUNDIPE, DIRECTOR

CANCER AND BLOOD CARE PC

ATTN LORI

PONCA CITY, OK 74601





STATUS: On September 14, 2015 The Laboratory Voluntarily


Accredited By COLA.

RUTH ONESON, DIRECTOR

COMMUNITY HOSPITAL

3100 SW 89TH STREET

OKLAHOMA CITY, OK 73159



Probation


December 8, 2015






STATUS: Laboratory Allowed To Resume Testing On August 18,

2015; Revocation Of Accreditation On January 12, 2016.

ROBERT MIDDLEBERG PHD, DIRECTOR

NATIONAL MEDICAL SERVICES INC

D/B/A NMS LABS

3701 WELSH ROAD

WILLOW GROVE, PA 19090


SANCTION: Cease Testing for Calcium, Total



STATUS: Laboratory Permanently Ceased Testing For Analyte On

December 17, 2015.

DEBORAH CARROLL MD, DIRECTOR

GENESIS DIAGNOSTICS

900 TOWNE CENTER DRIVE

LANGHORNE, PA 19047


SANCTION: Probation







STEPHEN BEAUPRE MD, DIRECTOR

MIDLAND MEDICAL ASSOCS

1312 OAKLAWN AVENUE

CRANSTON, RI 02920


SANCTION: Cease Testing for Urea (BUN)




BRIAN LECHER MD, DIRECTOR

FASTER CARE

3440 DECLARATION BLVD

SUMTER, SC 29154






CYNTHIA JONES R.N., DIRECTOR

AFC DOCTORS EXPRESS COLUMBIA

3304 FOREST DRIVE

COLUMBIA, SC 29204





Improvements

STATUS: Laboratory No Longer Accredited By COLA

SUSAN MARTIN, DIRECTOR

LABTECH DIAGNOSTIC LLC

1502 E GREENVILLE ST

ANDERSON, SC 29621


SANCTION: Cease Testing for Treponema Pallidum Antibodies

(includes Reagin), Ammonia, Herpes Simplex 1&2




JEFFREY ROUX, DIRECTOR

METHODIST LEBONHEUR HEALTHCARE

GERMANTOWN HOSPITAL LABORATORY

7691 POPLAR AVE

GERMANTOWN, TN 38138


SANCTION: Cease Testing for Leukocyte, Erythrocyte Count, Platelet

Count & Hematocrit



STATUS: Laboratory Allowed To Resume Testing On March 5,

2015.

JOHN BLAKE III, DIRECTOR

SPECIALISTS IN PAIN MANAGEMENT

PARKRIDGE MEDICAL CENTER PLAZA TWO

2339 MCCALLIE AVENUE SUITE #309

CHATTANOOGA, TN 37404


SANCTION: Cease Testing for Phenobarbitual



STATUS: On December 15, 2015 The Laboratory Removed The Test

Menu From Their Test Menu.

JACOB VADAKEKALAM, DIRECTOR

DIABETES & GLANDULAR DISEASE CLINIC PA

5107 MEDICAL DRIVE



SANCTION: Cease Testing for HDL Cholesterol and Creatine Kinase

(CK)




RAVI SARODE MD, DIRECTOR

UNIV TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

D/B/A UT SOUTHWESTERN ZALE LIPSHY HOSPITAL

LABORATORY 3RD FLOOR

DALLAS, TX 75390


SANCTION: Probation






STATUS: Laboratory Removed From Probation On July 28, 2015.

MARK POLLOCK, MD, DIRECTOR

HENDRICK REGIONAL LABORATORIES

1900 PINE STREET

ABILENE, TX 79601


SANCTION: Cease Testing for Mycology




RAVI SARODE, DIRECTOR

WILLIAM P CLEMENTS JR UNIVERSITY HOSPITAL

6201 HARRY HINES BLVD

DALLAS, TX 75390


SANCTION: Probation






STATUS: Laboratory Removed From Probation On July 28, 2015.

ALLAN SPENCE MD, DIRECTOR

SPENCE CLINIC


RAYMONDVILLE, TX 78580


SANCTION: Cease Testing for WBC Differential, Urea (BUN),

Creatinine, Alkaline Phosphatase (ALP)




WILLIAM LESLIE M.D., DIRECTOR

LAKE POINTE OPERATING COMPANY,LLC DBA

LAKE POINTE MEDICAL CENTER-BLOOD GAS

6800 SCENIC DRIVE

ROWLETT, TX 75088


SANCTION: Cease Testing for pO2




GLENN BUGAY MD, DIRECTOR

GLENN BUGAY MD

CORPUS CHRISTI MEDICAL ASSOCIATES

6200 SARATOGA UNIT 5

CORPUS CHRISTI, TX 78414


SANCTION: Cease Testing for Prothrombin Time (PT)




C JAMES CHUONG, DIRECTOR

COOPER INSTITUTE REPRODUCTIVE LAB

7500 BEECHNUT, SUITE 308

HOUSTON, TX 77074





Accreditation.

STATUS: As OF February 12, 2016 Laboratory Not Accredited By

CAP.

SALIL TREHAN, DIRECTOR

SALIL K TREHAN, MD PA

#12 CARE CIRCLE

AMARILLO, TX 79124


SANCTION: Cease Testing for Virology




J TRACE WORRELL, DIRECTOR

USMD HOSPITAL AT ARLINGTON

801 WEST I20

ARLINGTON, TX 76017


SANCTION: Cease Testing for Protime

Probation


July 28, 2015






STATUS: Laboratory Allowed To Resume Testing On July 7, 2015.

Laboratory Removed from Probation on January 12, 2016

AUGUSTO CASTRILLON, DIRECTOR

CASTRILLON FAMILY CLINIC

1300 SOUTH BRYAN ROAD SUITE 100

MISSION, TX 78572


SANCTION: Cease Testing for Free Thyroxine (FT4), Alanine

Aminotransferase (ALT)(SGPT), Thyroid Stimulating Hormone (TSH)




EDUARDO SANCHEZ, DIRECTOR

CLINICA DEL NORTE PEDIATRICS PLLC

102 BABCOCK ROAD SUITE A








OR BROOKER MD, DIRECTOR

PRIMARY HEALTHCARE PHYSICIANS

11880 VISTA DEL SOL

EL PASO, TX 79936


SANCTION: Cease Testing Creatinine




TODD NISHIMOTO, DIRECTOR

REGENCY HOSPITAL OF FORT WORTH, LLLP

6801 OAKMONT BOULEVARD

FORT WORTH, TX 76132





STATUS: On May 21, 2015 The Laboratory Removed The Test From

Their Test Menu.

DANIEL KELLUM JR MD, DIRECTOR

KELLUM PHYSICIAN PARTNERS

3401 FM 3009

SCHERTZ, TX 78154






November 25, 2015


Failure to Comply with Reasonable Requests of COLA

STATUS: Laboratory Was Denied Accreditation November 25, 2015.

No Longer Accredited By COLA.

FAUSTO RODRIGUEZ M.D., DIRECTOR

Q MED LABORATORY LLC

11355 MONTWOOD STREET SUITE E

EL PASO, TX 79936





Improvements


PETER PLATTEBORZE, DIRECTOR

CONSULTANTS IN PAIN MEDICINE PA

5368 FREDERICKSBURG STE 310



SANCTION: Cease Testing for Ritalinic Acids, Noroxymorphone,

O-desmethyl tramadol, Tapentadol, Gabapetin, Pregabalin




DAVID WELLS, DIRECTOR

PREMIER PAIN CONSULTANTS PA

2425 BABCOCK ROAD STE 108



SANCTION: Cease Testing of D-Methyltapentadol, Pregabalin,

Methylone, Retalinic Acid




BENTON MIDDLEMAN, MD, DIRECTOR

FOREST PARK MEDICAL CENTER, LLC

DBA FOREST PARK MEDICAL CENTER

11990 N CENTRAL EXPRESSWAY

DALLAS, TX 75243


SANCTION: Probation






STATUS: Accreditation Terminated Due To Closure Of The

Laboratory On November 16, 2015.

MAHFUZUL HUQ, DIRECTOR

SUNSHINE PEDIATRICS PA

5428 S JACKSON

EDINBURG, TX 78539






STATUS: Tests Were Reinstated On September 9, 2015.

ASIT CHOKSI, DIRECTOR

APOLLO HOSPITAL LAB-CONROE

3251 INTERSTATE 45 NORTH

CONROE, TX 77304


SANCTION: Cease Testing for pO2




ROSANNE LACOMBE, DIRECTOR

EMERUS/BHS SA - OVERLOOK PARKWAY LLC

DBA - BAPTIST EMERGENCY HOSPITAL - OVERLOOK PKWY

25615 N US HIGHWAY 281







KEANE HUNG, DIRECTOR

AUSTIN EMERGENCY CENTER

3563 FAR WEST BLVD ,SUITE 110

AUSTIN, TX 78731






ALEXEI ARKIPOV, DIRECTOR

ALEXEI ARKIPOV

7390 BARLITE BLVD, SUITE 100



SANCTION: Cease Testing for Magnesium, Lactate Dehydrogenase

(LDH)





MARK FUNG, DIRECTOR

UNIVERSITY OF VERMONT MEDICAL CENTER-MCHV CAMPUS

111 COLCHESTER AVE

BURLINGTON, VT 05401


SANCTION: Probation







RICHARD FICO MD, DIRECTOR

WINCHESTER OB GYN

1330A AMHERST ST

WINCHESTER, VA 22601







NAYER HASSAN M.D., DIRECTOR

INOVA HEALTHCARE SERVICES DBA INOVA LABORATORIES

2832 JUNIPER STREET

FAIRFAX, VA 22031


SANCTION: Probation







JOHN PIATT, DIRECTOR

DOCTORS EXPRESS URGENT CARE

18012 W VALLEY HIGHWAY STE 101

KENT, WA 98032


SANCTION: Cease Testing for WBC



STATUS: On December 1, 2015 The Laboratory Voluntarily


Accredited By COLA.

6. ALL APPEALS AND HEARING DECISIONS. FOR DETAILED INFORMATION REGARDING THE FOLLOWING LISTING SEE CLIA HEARING DECISION INDEX AT HTTP://WWW.CMS.GOV/CLIA/HEARINGGROUP.ASP

*** N O D A T A F O U N D ***

7. A LIST OF LABORATORIES AGAINST WHICH CMS HAS BROUGHT SUIT UNDER SECTION 493.1846 AND THE REASON FOR THOSE ACTIONS.

*** N O D A T A F O U N D ***

8. A LIST OF LABORATORIES THAT HAVE BEEN EXCLUDED FROM PARTICIPATION IN MEDICARE OR MEDICAID AND THE REASON FOR EXCLUSION.

*** N O D A T A F O U N D ***

9. CORRECTION OF ANY ERRONEOUS STATEMENTS OF INFORMATION THAT APPEARED IN THE 2002 REGISTRY.

*** N O D A T A F O U N D ***

10. OTHER ACTIONS. THIS SECTION INCLUDES OTHER SPECIFIC INFORMATION THAT MAY BE USEFUL IN EVALUATING THE PERFORMANCE OF LABORATORIES AS SPECIFIED IN 493 CFR 1859(A). IT ALSO INCLUDES INFORMATION PROVIDED BY CLIA EXEMPT STATES.

*** N O D A T A F O U N D ***

CLIA Annual Laboratory Registry 2015

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