(2) (3) (4) (i) · 280 SIERRA COLLEGE DR STE 205 . SPRING HILL, CA 95945 . CLIA ID# 05D0943651 ....
Transcript of (2) (3) (4) (i) · 280 SIERRA COLLEGE DR STE 205 . SPRING HILL, CA 95945 . CLIA ID# 05D0943651 ....
CLIA ANNUAL LABORATORY REGISTRY 2017
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(5) A list of laboratories whose accreditation has been withdrawn or revoked and the reasons for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.
2016 CLIA LAB REGISTRY
(AS REQUIRED BY SECTION 353(N) OF THE PUBLIC HEALTH SERVICE ACT)
ACTIVITY 01/01/2017 - 12/31/2017
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.)
MUHAMMAD RAZA, DIRECTOR
SOLTERRA SUBACUTE SERVICES
1501 E ORANGEWOOD AVE
PHOENIX, AZ 85020
CLIA ID# 03D2071368
SANCTION: Cancel Medicare/Medicaid Approval
Revocation of CLIA Certificate
EFFECTIVE DATE: April 11, 2017
April 11, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance
Revocation of CLIA Certificate
Failure To Submit Acceptable POC or AOC
Lab Owner/Oper Prohibited From Owning Lab
DANIEL YOUNG, DIRECTOR
THERANOS, INC
1365 N SCOTTSDALE RD STE 350
SCOTTSDALE, AZ 85257
CLIA ID# 03D2077896
SANCTION: Suspension of CLIA Certificate
Cancel Medicare/Medicaid Approval
EFFECTIVE DATE: February 4, 2017
March 28, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance with IJ
MARK SCHOLZ MD, DIRECTOR
PROSTATE ONCOLOGY SPECIALIST, INC
4676 ADMIRALTY WAY STE 101
MARINA DEL REY, CA 90292
CLIA ID# 05D0547251
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: November 18, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
AFSHINE EMRANI MD, DIRECTOR
LOS ANGELES HEART SPECIALISTS
18370 BURBANK BLVD STE 401
TARZANA, CA 91356
CLIA ID# 05D0559170
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: October 2, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
GEORGE KIBLER, DIRECTOR
SURPRISE VALLEY HEALTH CARE DISTRICT LABORATORY
741 MAIN ST
CEDARVILLE, CA 96104
CLIA ID# 05D0618601
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: May 19, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
DENISE PHAN MD, DIRECTOR
CENTURY MEDICAL GROUP
15243 VANOWEN ST STE 101
VAN NUYS, CA 91405
CLIA ID# 05D0699902
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: July 28, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance
Unsuccessful PT
KULDIP GILL MD, DIRECTOR
KULDIP S GILL MD
280 SIERRA COLLEGE DR STE 205
SPRING HILL, CA 95945
CLIA ID# 05D0943651
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: September 27, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
MICHAEL CHAIKIN MD, DIRECTOR
GCC LABORATORY
633 AERICK ST
INGLEWOOD, CA 90301
CLIA ID# 05D1078088
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: November 18, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
VASILIKI ECONOMOU MD, DIRECTOR
PLAXGEN INC
1895 MOWRY AVE STE 101D
FREMONT, CA 94538
CLIA ID# 05D2084226
SANCTION: Limitation of CLIA Certificate
Cancel Medicare/Medicaid Approval
Revocation of CLIA Certificate
EFFECTIVE DATE: February 4, 2017
April 28, 2017
April 28, 2017
REASON: 2 Year Prohibition From Owning, Operating and Directing
Medicare Cancellation/Suspension
Condition Level Non-Compliance
Unsuccessful PT
Revocation of CLIA Certificate
Failure To Submit Acceptable POC or AOC
WILLIAM CARRIERE, DIRECTOR
FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC
1215 DUNN AVE
JACKSONVILLE, FL 32218
CLIA ID# 10D0976317
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: January 13, 2017
REASON: Improper PT Testing Referral Activities
KEITH OBRIEN, DIRECTOR
STATLAB MOBILE
19101 SW 108TH AVE STE 4
MIAMI, FL 33157
CLIA ID# 10D2097278
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: November 24, 2017
REASON: Unsuccessful PT
GUIDO RING, DIRECTOR
GUIDO H RING MD
106 4TH AVENUE, WEST
CORDELE, GA 31015
CLIA ID# 11D0968447
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: February 1, 2017
REASON: Cancellation of Medicare Approval Suspension
Unsuccessful PT
GLENN BOYD, DIRECTOR
GLENN H BOYD, MD
1203 MEMORIAL DRIVE
DALTON, GA 30720
CLIA ID# 11D0976435
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: May 25, 2017
REASON: Cancellation of Medicare Approval Suspension
Unsuccessful PT
Failure to Correct Deficiencies
STATUS: Laboratory voluntarily Ceased Testing
JAMES YOST, DIRECTOR
PHYSICIANS IMMEDIATE MED OF BUFORD, PC
3425 BUFORD DRIVE
BUFORD, GA 30519
CLIA ID# 11D1068565
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: February 1, 2017
REASON: Cancellation of Medicare Approval Suspension
Unsuccessful PT
Failure To Submit Acceptable POC or AOC
JOHN ROBACK, DIRECTOR
CASTLE MEDICAL, LLC
5700 HIGHLANDS PARKWAY, SUITE 100
SMYRNA, GA 30082
CLIA ID# 11D2017949
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: October 4, 2017
REASON: Improper PT Testing Referral Activities
KUO LAM LEE M.D., DIRECTOR
MEDCROSS IMAGING, LLC
4375 JOHNS CREEK PKWY, STE 300
SUWANEE, GA 30024
CLIA ID# 11D2105207
SANCTION: Cancel Medicare/Medicaid Approval
Revocation of CLIA Certificate
EFFECTIVE DATE: October 5, 2017
October 5, 2017
REASON: Cancellation of Medicare Approval Revocation
2 Year Prohibition From Owning, Operating and Directing
Condition Level Non-Compliance with IJ
Revocation of CLIA Certificate
Failure To Submit Acceptable POC or AOC
Lab Owner/Oper Prohibited From Owning Lab
STATUS: Revocation of CLIA Certificate
JEREMY HAYMORE, DIRECTOR
PHYSICIANS IMMEDIATE CARE CENTER
260 FALLS AVE #C
TWIN FALLS, ID 83301
CLIA ID# 13D0914355
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: February 13, 2017
REASON: Unsuccessful PT
DELLA HARWOOD MT (ASCP), DIRECTOR
LABORATORY CORPORATION OF AMERICA
914 W IRONWOOD DR #101
COEUR D'ALENE, ID 83814
CLIA ID# 13D1016580
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: July 28, 2017
REASON: Unsuccessful PT
STATUS: Laboratory voluntarily Ceased Testing
CHRISTOPER MORGAN, DIRECTOR
STERLING FAMILY MEDICINE
1404 POMMERELL
BURLEY, ID 83318
CLIA ID# 13D2099992
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: December 23, 2017
REASON: Unsuccessful PT
ENRIQUE ARANA, DIRECTOR
LX HEALTH ADVOCATE CENTER
4906 N WESTERN
CHICAGO, IL 60625
CLIA ID# 14D2089856
SANCTION: Cancel Medicare/Medicaid Approval
Revocation of CLIA Certificate
EFFECTIVE DATE: February 19, 2017
February 19, 2017
REASON: 2 Year Prohibition From Owning, Operating and Directing
STATUS: Revocation of CLIA Certificate
ARNOLD FELDMAN, DIRECTOR
FELDMAN INSTITUTE, THE
455 E AIRPORT DRIVE
BATON ROUGE, LA 70806
CLIA ID# 19D1045136
SANCTION: Cancel Medicare/Medicaid Approval
Suspension of CLIA Certificate
Revocation of CLIA Certificate
EFFECTIVE DATE: February 22, 2017
February 22, 2017
April 11, 2017
REASON: Condition Level Non-Compliance with IJ
Failure to Correct Deficiencies
Revocation of CLIA Certificate
Failure To Submit Acceptable POC or AOC
STATUS: Revocation of CLIA Certificate
JOHN CANGELOSI, DIRECTOR
CYPRUS CLINICAL LABS OF LOUISIANA, LLC
1811 REES ST, SUITE D
BREAUX BRIDGE, LA 70517
CLIA ID# 19D2089617
SANCTION: Cancel Medicare/Medicaid Approval
Suspension of CLIA Certificate
Revocation of CLIA Certificate
EFFECTIVE DATE: March 1, 2017
March 1, 2017
April 25, 2017
REASON: Condition Level Non-Compliance
JOHN CANGELOSI, DIRECTOR
GENTOX LABORATORIES, LLC
1811 REES ST, SUITE C
BREAUX BRIDGE, LA 70517
CLIA ID# 19D2100562
SANCTION: Cancel Medicare/Medicaid Approval
Suspension of CLIA Certificate
Revocation of CLIA Certificate
EFFECTIVE DATE: March 1, 2017
March 1, 2017
April 25, 2017
REASON: Condition Level Non-Compliance with IJ
Failure to Correct Deficiencies
STATUS: Revocation Pending Hearing
Revocation of CLIA Certificate
Appeal Filed By Laboratory
NOTE: The CLIA number was revoked following the resolution of the appeal.
VICKI THOMSON M.D., DIRECTOR
EDINA PEDIATRICS
7025 FRANCE AVE
EDINA, MN 55435
CLIA ID# 24D0403126
SANCTION: Cancel Medicare/Medicaid Approval
EFFECTIVE DATE: December 2, 2017
REASON: 2 Year Prohibition From Owning, Operating and Directing
Condition Level Non-Compliance
Failure to Correct Deficiencies
Revocation of CLIA Certificate
Failure to Submit Acceptable POC or AOC
DELIA SMITH M.D., DIRECTOR
MIDDLE MISSISSIPPI ANALYTICAL SERVICES
114 JEFFERSON DAVIS BLVD
NATCHEZ, MS 39120
CLIA ID# 25D0700329
SANCTION: Cancel Medicare/Medicaid Approval
Revocation of CLIA Certificate
EFFECTIVE DATE: October 22, 2017
October 22, 2017
REASON: Cancellation of Medicare Approval Revocation
2 Year Prohibition From Owning, Operating and Directing
Revocation of CLIA Certificate
Lab Owner/Oper Prohibited From Owning Lab
STATUS: Revocation of CLIA Certificate
T BART SHAW, DIRECTOR
TEXAS COUNTY MEMORIAL HOSPITAL
1333 S SAM HOUSTON BLVD
HOUSTON, MO 65483
CLIA ID# 26D0446923
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: May 15, 2017
REASON: Unsuccessful PT
STATUS: Laboratory voluntarily Ceased Testing
WILLIAM BLANK, DIRECTOR
STE GENEVIEVE COUNTY MEM HOSPITAL
800 STE GENEVIEVE DRIVE
SAINTE GENEVIEVE, MO 63670
CLIA ID# 26D0652158
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: March 21, 2017
REASON: Unsuccessful PT
STATUS: Suspension and Limitation Lifted
AINA SILENIEKS, DIRECTOR
JEFFERSON COMMUNITY HEALTH CENTER INC
2200 H STREET
FAIRBURY, NE 68352
CLIA ID# 28D0047585
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: August 1, 2017
REASON: Unsuccessful PT
STATUS: Laboratory Voluntarily Ceased Testing
EDDIE PIERCE M.D., DIRECTOR
KEARNEY COUNTY HEALTH SERVICES
727 EAST 1ST STREET
MINDEN, NE 68959
CLIA ID# 28D0047880
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: January 9, 2017
REASON: Unsuccessful PT
STATUS: Compliance Achieved
GASTON MACHADO JR MD, DIRECTOR
HEALTHFIRST RAPID CARE
1675 N MAIN ST
SUMMERVILLE, SC 29483
CLIA ID# 42D1078836
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: May 23, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance
Unsuccessful PT
Failure to Correct Deficiencies
Failure To Submit Acceptable POC or AOC
SHERE CONWAY, DIRECTOR
COVENANT MEDICAL GROUP
DBA FAMILY CLINIC OF OAK RIDGE
100 VERMONT AVENUE
OAK RIDGE, TN 37830
CLIA ID# 44D0311959
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: September 19, 2017
REASON: Medicare Cancellation/Suspension
Unsuccessful PT
TOSHIO YAMAUCHI, DIRECTOR
TOSHIO YAMAUCHI MD
16651 SOUTHWEST FREEWAY #150
SUGAR LAND, TX 77479
CLIA ID# 45D0495838
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: January 18, 2017
REASON: Failure to Correct Deficiencies
Failure To Submit Acceptable POC or AOC
C LYNN ANDERSON JR, DIRECTOR
VALLEY DAY AND NIGHT CLINIC
1755 W PRICE RD
BROWNSVILLE, TX 78520
CLIA ID# 45D1047501
SANCTION: Limitation of CLIA Certificate
EFFECTIVE DATE: August 23, 2017
REASON: Condition Level Non-Compliance
Unsuccessful PT
AARON LEFEBVRE Ph.D., DIRECTOR
UNITED TOXICOLOGY, LLC
5710 LBJ FREEWAY, SUITE 215
DALLAS, TX 75240
CLIA ID# 45D2023963
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: October 3, 2017
REASON: Condition Level Non-Compliance with IJ
Improper PT Testing Referral Activities
Revocation of CLIA Certificate
STATUS: Revocation of CLIA Certificate
AARON LEFEBVRE Ph.D., DIRECTOR
AMERICAN LABORATORIES GROUP, LLC
5710 LBJ FREEWAY, SUITE 203
DALLAS, TX 75240
CLIA ID# 45D2100510
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: October 3, 2017
REASON: Condition Level Non-Compliance with IJ
Improper PT Testing Referral Activities
Revocation of CLIA Certificate
STATUS: Revocation of CLIA Certificate
HEALTH FIRST LABS, LLC
2801 BRAZOS BLVD, SUITE 4309
EULESS, TX 76039
CLIA ID# 45D2106109
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: September 11, 2017
REASON: Condition Level Non-Compliance with IJ
Revocation of CLIA Certificate
CHARLOTTE VDOVYCHENKO, DIRECTOR
CHARLEY STANLEY LABORATORIES, LLC
2801 BRAZOS BLVD, #4309
EULESS, TX 76039
CLIA ID# 45D2108388
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: January 4, 2017
REASON: 2 Year Prohibition From Owning, Operating and Directing
Condition Level Non-Compliance with IJ
Revocation of CLIA Certificate
Lab Owner/Oper Prohibited From Owning Lab
STATUS: Revocation of CLIA Certificate
MAHMOOD AIJAZI M.D., DIRECTOR
CAPITAL DIAGNOSTIC LABORATORY, LLC
14 PIDGEON HILL DRIVE - SUITE 150
STERLING, VA 20165
CLIA ID# 49D1107549
SANCTION: Suspension of CLIA Certificate
Revocation of CLIA Certificate
EFFECTIVE DATE: October 4, 2017
November 28, 2017
REASON: Cancellation of Medicare Approval Suspension
Cancellation of Medicare Approval Revocation
2 Year Prohibition From Owning, Operating and Directing
Medicare Cancellation/Suspension
Condition Level Non-Compliance with IJ
Failure to Correct Deficiencies
Revocation of CLIA Certificate
Failure To Submit Acceptable POC or AOC
Lab Owner/Oper Prohibited From Owning Lab
STATUS: Revocation of CLIA Certificate
NOTE: Revocation of CLIA Certificate effective Nov 28, 2017. Suspension and cancellation of Medicare approval effective Oct 4, 2017. Lab Owner and Lab Director prohibited from owning, operating and directing a CLIA lab from Nov 28, 2017 through Nov 28, 2019.
SAFIQUE AHMED, DIRECTOR
LOGAN HEMATOLOGY ONCOLOGY INC
KRUGER BUILDING SUITE 301
LOGAN, WV 25601
CLIA ID# 51D1003218
SANCTION: Cancel Medicare/Medicaid Approval
Revocation of CLIA Certificate
EFFECTIVE DATE: May 11, 2017
May 11, 2017
REASON: Failure to Correct Deficiencies
Failure To Submit Acceptable POC or AOC
STATUS: Revocation of CLIA Certificate
BRUCE HYDE, DIRECTOR
PHARMASAN LABS, INC
375 280TH ST BLDG A
OSCEOLA, WI 54020
CLIA ID# 52D0914898
SANCTION: Suspension of CLIA Certificate
Revocation of CLIA Certificate
EFFECTIVE DATE: May 26, 2017
December 26, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Revocation of CLIA Certificate
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
MUHAMMAD RAZA, DIRECTOR
SOLTERRA SUBACUTE SERVICES
1501 E ORANGEWOOD AVE
PHOENIX, AZ 85020
CLIA ID# 03D2071368
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: February 25, 2017
February 25, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance
Failure To Submit Acceptable POC or AOC
Lab Owner/Oper Prohibited From Owning Lab
DANIEL YOUNG, DIRECTOR
THERANOS, INC
1365 N SCOTTSDALE RD STE 350
SCOTTSDALE, AZ 85257
CLIA ID# 03D2077896
SANCTION: Directed Portion Plan of Correction (DPPOC)
Suspension of All of Medicare/Medicaid
EFFECTIVE DATE: February 1, 2017
February 4, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance with IJ
STEPHEN LOCKE, DIRECTOR
MISSISSIPPI COUNTY HOSPITAL SYSTEM
SMC REGIONAL MEDICAL CENTER
611 WEST LEE MAIN BUILDING 1ST FLOOR
OSCEOLA, AR 72370
CLIA ID# 04D0049871
SANCTION: Civil Money Penalty
EFFECTIVE DATE: February 6, 2017
REASON: Condition Level Non-Compliance
Failure to Correct Deficiencies
STATUS: Appeal Filed By Laboratory
MARK SCHOLZ MD, DIRECTOR
PROSTATE ONCOLOGY SPECIALIST, INC
4676 ADMIRALTY WAY STE 101
MARINA DEL REY, CA 90292
CLIA ID# 05D0547251
SANCTION: Suspension of Part of Medicare/Medicaid
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: November 18, 2017
November 30, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
AFSHINE EMRANI MD, DIRECTOR
LOS ANGELES HEART SPECIALISTS
18370 BURBANK BLVD STE 401
TARZANA, CA 91356
CLIA ID# 05D0559170
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: September 29, 2017
October 2, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
PHILIP BOSCH MD, DIRECTOR
PHILIP C BOSCH MD
651 E PENNSYLVANIA AVE STE 201
ESCONDIDO, CA 92025
CLIA ID# 05D0566728
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: October 27, 2017
REASON: Condition Level Non-Compliance
Unsuccessful PT
GEORGE KIBLER, DIRECTOR
SURPRISE VALLEY HEALTH CARE DISTRICT LABORATORY
741 MAIN ST
CEDARVILLE, CA 96104
CLIA ID# 05D0618601
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: May 13, 2017
May 19, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
DENISE PHAN MD, DIRECTOR
CENTURY MEDICAL GROUP
15243 VANOWEN ST STE 101
VAN NUYS, CA 91405
CLIA ID# 05D0699902
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: July 26, 2017
July 26, 2017
July 28, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance
Unsuccessful PT
KULDIP GILL MD, DIRECTOR
KULDIP S GILL MD
280 SIERRA COLLEGE DR STE 205
SPRING HILL, CA 95945
CLIA ID# 05D0943651
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: September 25, 2017
September 27, 2017
REASON: Condition Level Non-Compliance
Unsuccessful PT
DAVID BRYSON MD, DIRECTOR
BRYSON CANCER CARE INC
5345 W HILLSDALE DR
VISALIA, CA 93291
CLIA ID# 05D1036874
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: October 28, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
MICHAEL CHAIKIN MD, DIRECTOR
GCC LABORATORY
633 AERICK ST
INGLEWOOD, CA 90301
CLIA ID# 05D1078088
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: November 16, 2017
November 18, 2017
REASON: Cancellation of Medicare Approval Suspension
Condition Level Non-Compliance
Unsuccessful PT
VASILIKI ECONOMOU MD, DIRECTOR
PLAXGEN INC
1895 MOWRY AVE STE 101D
FREMONT, CA 94538
CLIA ID# 05D2084226
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
Directed Portion Plan of Correction (DPPOC)
EFFECTIVE DATE: February 2, 2017
February 2, 2017
February 4, 2017
March 14, 2017
REASON: 2 Year Prohibition From Owning, Operating and Directing
Medicare Cancellation/Suspension
Condition Level Non-Compliance
Unsuccessful PT
Failure To Submit Acceptable POC or AOC
DAVID BASWELL M.D., DIRECTOR
PEDIATRIC ASSOCIATES, PC
6190 BARNES RD
COLORADO SPRINGS, CO 80922
CLIA ID# 06D0517592
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: June 9, 2017
REASON: Unsuccessful PT
STATUS: Laboratory Voluntarily Ceased Testing
SHAHLA MASOOD, DIRECTOR
SHANDS JACKSONVILLE MEDICAL CENTER
655 W 8TH STREET
JACKSONVILLE, FL 32209
CLIA ID# 10D0268926
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: December 21, 2017
REASON: Improper PT Testing Referral Activities
STATUS: Compliance Achieved
WILLIAM CARRIERE, DIRECTOR
FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC
6484 FT CAROLINE RD
JACKSONVILLE, FL 32277
CLIA ID# 10D0269060
SANCTION: Directed Plan of Correction (DPOC)
Civil Money Penalty
EFFECTIVE DATE: January 13, 2017
March 14, 2017
REASON: Improper PT Testing Referral Activities
WILLIAM CARRIERE, DIRECTOR
FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC
1215 DUNN AVE
JACKSONVILLE, FL 32218
CLIA ID# 10D0976317
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
Civil Money Penalty
EFFECTIVE DATE: January 13, 2017
January 13, 2017
March 14, 2017
REASON: Improper PT Testing Referral Activities
KEITH OBRIEN, DIRECTOR
STATLAB MOBILE
19101 SW 108TH AVE STE 4
MIAMI, FL 33157
CLIA ID# 10D2097278
SANCTION: Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: November 24, 2017
REASON: Unsuccessful PT
ROBERT SIEGEL, DIRECTOR
GWINNETT MEDICAL CENTER DULUTH
3620 HOWELL FERRY ROAD
DULUTH, GA 30096
CLIA ID# 11D0256605
SANCTION: Civil Money Penalty
EFFECTIVE DATE: September 27, 2017
REASON: Improper PT Testing Referral Activities
STATUS: Compliance Achieved
GUIDO RING, DIRECTOR
GUIDO H RING MD
106 4TH AVENUE, WEST
CORDELE, GA 31015
CLIA ID# 11D0968447
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: February 1, 2017
February 1, 2017
REASON: Cancellation of Medicare Approval Suspension
Unsuccessful PT
Failure to Correct Deficiencies
GLENN BOYD, DIRECTOR
GLENN H BOYD, MD
1203 MEMORIAL DRIVE
DALTON, GA 30720
CLIA ID# 11D0976435
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: May 16, 2017
May 25, 2017
REASON: Cancellation of Medicare Approval Suspension
Unsuccessful PT
JAMES YOST, DIRECTOR
PHYSICIANS IMMEDIATE MED OF BUFORD, PC
3425 BUFORD DRIVE
BUFORD, GA 30519
CLIA ID# 11D1068565
SANCTION: Suspension of All of Medicare/Medicaid
EFFECTIVE DATE: January 1, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance
Unsuccessful PT
JOHN ROBAK, DIRECTOR
CASTLE MEDICAL, LLC
5700 HIGHLANDS PARKWAY, SUITE 100
SMYRNA, GA 30082
CLIA ID# 11D2017949
SANCTION: Civil Money Penalty
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: October 4, 2017
October 4, 2017
REASON: Medicare Cancellation/Suspension
Improper PT Testing Referral Activities
KUO LAM LEE M.D., DIRECTOR
MEDCROSS IMAGING, LLC
4375 JOHNS CREEK PKWY, STE 300
SUWANEE, GA 30024
CLIA ID# 11D2105207
SANCTION: Directed Portion Plan of Correction (DPPOC)
Suspension of All of Medicare/Medicaid
EFFECTIVE DATE: October 5, 2017
November 1, 2017
REASON: Medicare Cancellation/Suspension
Condition Level Non-Compliance with IJ
Failure To Submit Acceptable POC or AOC
STATUS: Revocation of CLIA Certificate
JEREMY HAYMORE, DIRECTOR
PHYSICIANS IMMEDIATE CARE CENTER
260 FALLS AVE #C
TWIN FALLS, ID 83301
CLIA ID# 13D0914355
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: February 13, 2017
REASON: Unsuccessful PT
DELLA HARWOOD MT (ASCP), DIRECTOR
LABORATORY CORPORATION OF AMERICA
914 W IRONWOOD DR #101
COEUR D'ALENE, ID 83814
CLIA ID# 13D1016580
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: July 28, 2017
July 28, 2017
REASON: Unsuccessful PT
CHRISTOPER MORGAN, DIRECTOR
STERLING FAMILY MEDICINE
1404 POMMERELL
BURLEY, ID 83318
CLIA ID# 13D2099992
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: December 23, 2017
REASON: Unsuccessful PT
DINO VALLERA MD, DIRECTOR
HINSDALE HOSPITAL LABORATORY
120 N OAK STREET
HINSDALE, IL 60521
CLIA ID# 14D0668275
SANCTION: Civil Money Penalty
EFFECTIVE DATE: October 3, 2017
REASON: Improper PT Testing Referral Activities
NOTE: CMP
MICHELLE GERDES, DIRECTOR
FAMILY DERMATOLOGY SPECIALISTS, LLC
3421 N CAUSEWAY BOULEVARD SUITE 202
METAIRIE, LA 70002
CLIA ID# 19D0456688
SANCTION: Civil Money Penalty
EFFECTIVE DATE: June 5, 2017
REASON: Condition Level Non-Compliance with IJ
Failure to Correct Deficiencies
STATUS: Compliance Achieved
NOTE: History of CLIA noncompliance
GARY ANZALONE M.D., DIRECTOR
CLAIBORNE MEMORIAL HOSPITAL
620 EAST COLLEGE STREET
HOMER, LA 71040
CLIA ID# 19D0463216
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: November 6, 2017
STACEY SPARKS, DIRECTOR
ACORN TO OAK PEDIATRICS
1025 HWY 80 E
HAUGHTON, LA 71037
CLIA ID# 19D2122735
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: August 11, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Compliance Achieved
RACHEED GHANAMI M.D., DIRECTOR
SOUTHERN VASCULAR ASSOCIATES
5000 AMBASSADOR CAFFERY PKWY, BLDG 1, STE 100
LAFAYETTE, LA 70508
CLIA ID# 19D2125826
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: October 3, 2017
REASON: Condition Level Non-Compliance
GERALD YUKEVICH MD, DIRECTOR
VINEYARD MEDICAL CARE, LLC
364 STATE RD
VINEYARD HAVEN, MA 02568
CLIA ID# 22D2086441
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: March 13, 2017
REASON: Unsuccessful PT
STATUS: Compliance Achieved
JOSE AYALA, DIRECTOR
NORTHSIDE PEDIATRICS PC
265 FREMONT STREET SUITE 1
BATTLE CREEK, MI 49017
CLIA ID# 23D0377479
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: February 8, 2017
REASON: Unsuccessful PT
STATUS: Compliance Achieved
VICKI THOMSON M.D., DIRECTOR
EDINA PEDIATRICS
7025 FRANCE AVE
EDINA, MN 55435
CLIA ID# 24D0403126
SANCTION: Directed Plan of Correction (DPOC)
Suspension of All of Medicare/Medicaid
EFFECTIVE DATE: December 2, 2017
December 2, 2017
REASON: 2 Year Prohibition from Owning, Operating and Directing
Condition Level Non-Compliance
Failure to Correct Deficiencies
Revocation of CLIA Certificate
Failure to Submit Acceptable POC or AOC
STATUS: Revocation of CLIA Certificate
MELISSA TEPE, DIRECTOR
AFFINIA HEALTHCARE-BIDDLE
1717 BIDDLE AVE
SAINT LOUIS, MO 63106
CLIA ID# 26D1046060
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: July 5, 2017
July 20, 2017
REASON: Improper PT Referral Activities
Improper PT Referral Activities
STATUS: Compliance Achieved
Compliance Achieved
MELISSA TEPE M.D., DIRECTOR
AFFINIA HEALTHCARE
2524 HADLEY STREET
SAINT LOUIS, MO 63106
CLIA ID# 26D2080015
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: July 5, 2017
July 20, 2017
REASON: Improper PT Testing Referral Activities
STATUS: Compliance Achieved
ANIL DEWAN, DIRECTOR
SOUTHERN NH MEDICAL CENTER
8 PROSPECT STREET
NASHUA, NH 03060
CLIA ID# 30D0085147
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: January 9, 2017
REASON: Improper PT Testing Referral Activities.
NOTE: Laboratory engaged in Improper Proficiency Testing Referral.
JASON SPROUSE, DIRECTOR
MISSION HOSPITAL LABORATORY - MEMORIAL CAMPUS
509 BILTMORE AVENUE
ASHEVILLE, NC 28801
CLIA ID# 34D0248285
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: February 7, 2017
REASON: Improper PT Testing Referral Activities
STATUS: Compliance Achieved
WILLIAM HANCOCK, DIRECTOR
LABORATORY CORPORATION OF AMERICA HOLDINGS, INC
1447 YORK COURT
BURLINGTON, NC 27215
CLIA ID# 34D0655059
SANCTION: Civil Money Penalty
EFFECTIVE DATE: February 10, 2017
REASON: Improper PT Testing Referral Activities
STATUS: Compliance Achieved
ARUNDHATI CHATTERJEE, DIRECTOR
LABCORP OF AMERICA HOLDINGS
1912 ALEXANDER DRIVE
RESEARCH TRIANGLE PARK, NC 27709
CLIA ID# 34D0655205
SANCTION: Civil Money Penalty
EFFECTIVE DATE: February 10, 2017
REASON: Improper PT Testing Referral Activities
STATUS: Compliance Achieved
BRYAN DYE, MD, DIRECTOR
PURCELL MUNICIPAL HOSPITAL
1500 N GREEN AVE
PURCELL, OK 73080
CLIA ID# 37D0470030
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: January 3, 2017
REASON: Condition Level Non-Compliance
STATUS: Compliance Achieved
BRYCE BLISS, DIRECTOR
PUSHMATAHA HOSPITAL LABORATORY
510 E MAIN
ANTLERS, OK 74523
CLIA ID# 37D0475409
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: January 3, 2017
REASON: Condition Level Non-Compliance
STATUS: Compliance Achieved
LAURI BLESCH, MD, DIRECTOR
UTICA PARK CLINIC - OWASSO
10512 N 110TH EAST AVE, SUITE 300
OWASSO, OK 74055
CLIA ID# 37D0670093
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: November 9, 2017
November 27, 2017
DAVID MINOR, MD, DIRECTOR
DAVID B MINOR, MD, PC
1516 SOUTH YORKTOWN PLACE
TULSA, OK 74104
CLIA ID# 37D0924065
SANCTION: Directed Portion Plan of Correction (DPPOC)
EFFECTIVE DATE: September 5, 2017
REASON: Condition Level Non-Compliance
STATUS: Compliance Achieved
JESSICA PAGANA DEFAZIO D.O., DIRECTOR
PAGANA & PAGANA-DEFAZIO FAMILY PRACTICE LLC
1072 MARKET STREET
SUNBURY, PA 17801
CLIA ID# 39D0189114
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: October 3, 2017
October 8, 2017
REASON: Condition Level Non-Compliance
Improper PT Testing Referral Activities
STATUS: Compliance Achieved
NOTE: Facility engaged in Type II Improper PT referral activiity; Condition non-compliance found on complaint survey and facility paid a Civil Money Penalty of $13,000 and complied with a Directed Plan of Correction.
GEORGE JOUR, DIRECTOR
SKINSMART DERMATOLOGY
65 E BUTLER AVENUE, STE 203
NEW BRITAIN, PA 18901
CLIA ID# 39D1084296
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: February 21, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Compliance Achieved
Laboratory voluntarily Ceased Testing
GASTON MACHADO JR MD, DIRECTOR
HEALTHFIRST RAPID CARE
1675 N MAIN ST
SUMMERVILLE, SC 29483
CLIA ID# 42D1078836
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: May 23, 2017
May 23, 2017
REASON: Condition Level Non-Compliance
Unsuccessful PT
SHERE CONWAY, DIRECTOR
COVENANT MEDICAL GROUP
DBA FAMILY CLINIC OF OAK RIDGE
100 VERMONT AVENUE
OAK RIDGE, TN 37830
CLIA ID# 44D0311959
SANCTION: Directed Plan of Correction (DPOC)
Suspension of Part of Medicare/Medicaid
EFFECTIVE DATE: September 19, 2017
September 19, 2017
REASON: Medicare Cancellation/Suspension
Unsuccessful PT
CARLA LYN-BOSWELL, DIRECTOR
LA CLINICA CAMELLIA
3030 COVINGTON PIKE STE 200
MEMPHIS, TN 38128
CLIA ID# 44D2040070
SANCTION: Civil Money Penalty
EFFECTIVE DATE: May 3, 2017
REASON: Improper PT Testing Referral Activities
MICHAEL COHEN, DIRECTOR
ST JOSEPH REGIONAL HEALTH CENTER (SJRHC) LABORATORY
2801 FRANCISCAN DRIVE
BRYAN, TX 77802
CLIA ID# 45D0498326
SANCTION: Civil Money Penalty
EFFECTIVE DATE: June 2, 2017
REASON: Condition Level Non-Compliance
Improper PT Testing Referral Activities
STATUS: Compliance Achieved
Appeal Filed By Laboratory
JORGE KUTUGATA, DIRECTOR
RAINBOW PEDIATRIC CLINIC
902 S AIRPORT DRIVE STE 1
WESLACO, TX 78596
CLIA ID# 45D0503928
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: December 26, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Compliance Achieved
PHILLIP CONLIN, DIRECTOR
MARTIN COUNTY HOSPITAL DISTRICT
600 EAST I-20
STANTON, TX 79782
CLIA ID# 45D0509186
SANCTION: Civil Money Penalty
EFFECTIVE DATE: August 30, 2017
REASON: Condition Level Non-Compliance
Unsuccessful PT
STATUS: Compliance Achieved
JOSE PENA, DIRECTOR
DONNA DAY AND NIGHT CLINIC
2010 EAST BUSINESS HIGHWAY 83
DONNA, TX 78537
CLIA ID# 45D0952509
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: December 26, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Compliance Achieved
ERIC PEARLMAN D.O., DIRECTOR
COPPELL FIRE DEPT
265 EAST PARKWAY BLVD
COPPELL, TX 75019
CLIA ID# 45D1038621
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: January 3, 2017
REASON: Condition Level Non-Compliance with IJ
Failure To Submit Acceptable POC or AOC
C LYNN ANDERSON JR, DIRECTOR
VALLEY DAY AND NIGHT CLINIC
1755 W PRICE RD
BROWNSVILLE, TX 78520
CLIA ID# 45D1047501
SANCTION: Suspension of All of Medicare/Medicaid
EFFECTIVE DATE: August 23, 2017
REASON: Condition Level Non-Compliance
Unsuccessful PT
NOTE: CMP was paid
SAMER SUKI, DIRECTOR
MILLENNIUM PHYSICIANS ASSOCIATION, PLLC
22710 PROFESSIONAL DRIVE SUITE 102
KINGWOOD, TX 77339
CLIA ID# 45D2003185
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: April 10, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Compliance Achieved
KEVIN ROSENBLATT, DIRECTOR
MEDICUS LABORATORIES, LLC
5710 LBJ FREEWAY
DALLAS, TX 75240
CLIA ID# 45D2010531
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: August 1, 2017
August 18, 2017
REASON: Condition Level Non-Compliance with IJ
Improper PT Testing Referral Activities
Failure To Submit Acceptable POC or AOC
AARON LEFEBVRE Ph.D., DIRECTOR
UNITED TOXICOLOGY, LLC
5710 LBJ FREEWAY, SUITE 215
DALLAS, TX 75240
CLIA ID# 45D2023963
SANCTION: Civil Money Penalty
EFFECTIVE DATE: August 1, 2017
REASON: Condition Level Non-Compliance with IJ
Improper PT Testing Referral Activities
Revocation of CLIA Certificate
STATUS: Revocation of CLIA Certificate
BRUCE WARDLAY, DIRECTOR
BRUCE E WARDLE DO PA
546 W SEMINARY
FORT WORTH, TX 76115
CLIA ID# 45D2040604
SANCTION: Civil Money Penalty
EFFECTIVE DATE: May 17, 2017
REASON: Condition Level Non-Compliance with IJ
BRIDGET HERSCHAP, DIRECTOR
WESTSIDE SURGICAL HOSPITAL
4200 TWELVE OAKS DRIVE
HOUSTON, TX 77027
CLIA ID# 45D2051920
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: June 22, 2017
REASON: Condition Level Non-Compliance
STATUS: Compliance Achieved
CHAU VU, DIRECTOR
FRIENDSWOOD DERMATOLOGY
COSMETIC & SKIN CANCER CENTER
1111 S FREINDSWOOD DRIVE, STE 107
FRIENDSWOOD, TX 77546
CLIA ID# 45D2070536
SANCTION: Civil Money Penalty
EFFECTIVE DATE: December 12, 2017
REASON: Condition Level Non-Compliance
STATUS: Compliance Achieved
OSCAR MANGINI, DIRECTOR
WEIMAR MEDICAL HOLDINGS DBA WEIMAR MEDICAL CENTER
400 YOUENS DRIVE
WEIMAR, TX 78962
CLIA ID# 45D2093884
SANCTION: Directed Plan of Correction (DPOC)
EFFECTIVE DATE: April 10, 2017
REASON: Condition Level Non-Compliance with IJ
STATUS: Laboratory voluntarily Ceased Testing
NOTE: The hospital laboratory voluntarily closed on October 12, 2017. The laboratory did not correct the deficiencies.
AARON LEFEBVRE Ph.D., DIRECTOR
AMERICAN LABORATORIES GROUP, LLC
5710 LBJ FREEWAY, SUITE 203
DALLAS, TX 75240
CLIA ID# 45D2100510
SANCTION: Civil Money Penalty
EFFECTIVE DATE: August 18, 2017
REASON: Condition Level Non-Compliance with IJ
Improper PT Testing Referral Activities
Revocation of CLIA Certificate
STATUS: Revocation of CLIA Certificate
JULIO DELGADO, DIRECTOR
ARUP LABORATORIES, INC
500 CHIPETA WAY
SALT LAKE CITY, UT 84108
CLIA ID# 46D0523979
SANCTION: Civil Money Penalty
Directed Plan of Correction (DPOC)
EFFECTIVE DATE: April 18, 2017
June 11, 2017
REASON: Improper PT Testing Referral Activities
MAHMOOD AIJAZI M.D., DIRECTOR
CAPITAL DIAGNOSTIC LABORATORY, LLC
14 PIDGEON HILL DRIVE - SUITE 150
STERLING, VA 20165
CLIA ID# 49D1107549
SANCTION: Suspension of All of Medicare/Medicaid
EFFECTIVE DATE: October 4, 2017
REASON: Cancellation of Medicare/Medicaid
Medicare Cancellation/Suspension
Condition Level Non-Compliance with IJ
Failure to Correct Deficiencies
Failure to Submit Acceptable POC and AOC
STATUS: Revocation of CLIA Certificate
NOTE: Revocation of CLIA Certificate effective Nov 28, 2017. Suspension and cancellation of Medicare approval effective Oct 4, 2017. Lab Owner and Lab Director prohibited from owning, operating and directing a CLIA lab from Nov 28, 2017 through Nov 28, 2019.
BRUCE HYDE, DIRECTOR
PHARMASAN LABS, INC
375 280TH ST BLDG A
OSCEOLA, WI 54020
CLIA ID# 52D0914898
SANCTION: Civil Money Penalty
EFFECTIVE DATE: May 26, 2017
REASON: Condition Level Non-Compliance with IJ
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)
BRIAN RAGLAND, DIRECTOR
LABORATORY CORPORATION OF AMERICA HOLDING
1801 FIRST AVE SOUTH
BIRMINGHAM, AL 35233
CLIA ID# 01D0301471 CAP
SANCTION: Cease testing for CK2 (CK-MB), quant/qual.
EFFECTIVE DATE: November 27, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing still in effect.
RONALD MCCOY, DIRECTOR
AVALON MEDICAL CENTER PC
2400 EAST AVALON AVENUE SUITE C
MUSCLE SHOALS, AL 35661
CLIA ID# 01D0302664 COLA
SANCTION: Cease testing for Platelet Count.
EFFECTIVE DATE: July 18, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Platelet Count still in effect.
DAVID RHYNE, DIRECTOR
PROFESSIONAL MEDICAL ASSOCIATES PC
101 EAST BRUNSON ST SUITE 200
ENTERPRISE, AL 36330
CLIA ID# 01D0304937 COLA
SANCTION: Cease testing for Cholesterol.
Cease testing for White Blood Cell Differential
EFFECTIVE DATE: January 23, 2017
May 19, 2017
REASON: Unsuccessful PT
STATUS: Testing for Cholesterol was reinstated on 08/29/2017.
As of 12/31/2017 cease testing for WBC Diff still in effect.
MAMOUN NAJJAR, DIRECTOR
URGENT CARE OF MADISON
3751 SULLIVAN STREET
MADISON, AL 35758
CLIA ID# 01D2035222 COLA
SANCTION: Failure to adhere to COLA imposed required improvements.
EFFECTIVE DATE: September 27, 2017
REASON: Denial of Accreditation
STATUS: No longer accredited by COLA.
BRIAN POIRIER, DIRECTOR
LABORATORY CORPORATION OF AMERICA
5005 S 40TH ST, STE 1200
PHOENIX, AZ 85040
CLIA ID# 03D0528350 CAP
SANCTION: Cease testing for T3 (Triiodothyronine).
Cease testing for RBC Count, Body Fluids
EFFECTIVE DATE: June 9, 2017
August 31, 2017
REASON: Unsuccessful PT
STATUS: Allowed to resume testing on 01/02/2018
SUSAN WARD-JONES, DIRECTOR
HEALTHY PARTNERS
605 N 2ND STREET
BLYTHEVILLE, AR 72315
CLIA ID# 04D1100296 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC DIff).
EFFECTIVE DATE: June 1, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
JOSEPH LOEWY, DIRECTOR
JOSEPH LOEWY
8631 W 3RD ST STE 825E
LOS ANGELES, CA 90048
CLIA ID# 05D0544724 COLA
SANCTION: Failure to comply with the reasonable requests of COLA.
EFFECTIVE DATE: November 27, 2017
REASON: Denial of Accreditation
STATUS: Laboratory no longer accredited by COLA.
KEITH AGRE, DIRECTOR
KEITH AGRE MD MED CORP
1125 S BEVERLY DR, STE 110
LOS ANGELES, CA 90035
CLIA ID# 05D0546307 COLA
SANCTION: Cease testing for Sodium.
EFFECTIVE DATE: January 23, 2017
REASON: Unsuccessful PT
STATUS: Testing for Sodium was reinstated on 08/02/2017.
LUKE WATSON, DIRECTOR
COMMUNITY AND MISSION HOSPITAL OF HUNTINGTON PARK
2623 E SLAUSON AVE
HUNTINGTON PARK, CA 90255
CLIA ID# 05D0548135 AOA
SANCTION: Cease testing for Antibody Identification.
EFFECTIVE DATE: December 14, 2017
REASON: Unsuccessful PT
STATUS: As of 1/24/2018 cease testing still in effect.
ILONA KLEINER, DIRECTOR
PEDIATRIC ASSOCIATES MEDICAL GROUP INC
4330 FULTON AVENUE
SHERMAN OAKS, CA 91423
CLIA ID# 05D0560868 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: March 1, 2017
REASON: Unsuccessful PT
STATUS: WBC DIff testing was reinstated on 11/20/2017.
YIQIONG MAO, DIRECTOR
KAISER FOUNDATION HOSPITAL FONTANA LABORATORY
9961 SIERRA AVE ROOM 1208
FONTANA, CA 92335
CLIA ID# 05D0573388 CAP
SANCTION: Probation
EFFECTIVE DATE: January 10, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 probation still in effect.
DUYET VO, DIRECTOR
SOUTHWEST HEALTHCARE SYSTEM CLINICAL LABORATORY
36485 INLAND VALLEY DRIVE
WILDOMAR, CA 92595
CLIA ID# 05D0574725 CAP
SANCTION: Probation
EFFECTIVE DATE: September 12, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 probation still in effect.
RICHARD MACK D.O., DIRECTOR
KINDRED HOSPITAL-SF BAY AREA
2800 BENEDICT DR
SAN LEANDRO, CA 94577
CLIA ID# 05D0600653 JC
SANCTION: Cease testing for pCO2.
EFFECTIVE DATE: December 8, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing still in effect.
ANDREA EDWARDS, DIRECTOR
ANDREA GAYE EDWARDS, MD INC
1663 DOMINICAN WAY STE 210
SANTA CRUZ, CA 95065
CLIA ID# 05D0606808 COLA
SANCTION: Cease testing for Hemoglobin
Denial of Accreditation
EFFECTIVE DATE: July 18, 2017
September 8, 2017
REASON: Unsuccessful PT
Failure to adhere to COLA imposed required improvements.
STATUS: Laboratory no longer accredited by COLA.
JAMES DRURY, DIRECTOR
DAVIDSON, DRURY, & CHANG INC
8635 WEST 3RD STREET, SUITE 1050-W
LOS ANGELES, CA 90048
CLIA ID# 05D0670787 COLA
SANCTION: Cease testing for Prothrombin Time (PT)
EFFECTIVE DATE: June 15, 2017
REASON: Unsuccessful PT
STATUS: On 06/27/2017 laboratory voluntarily withdrew from COLA.
Laboratory no longer accredited by COLA.
STEVEN STRUVE, DIRECTOR
MERCY MED CENTR RESPIRATORY CARE DEPT
2175 ROSALINE AVE
REDDING, CA 96001
CLIA ID# 05D0683521 JC
SANCTION: Cease testing for Routine Chemistry (pH, pO2, pCO2).
EFFECTIVE DATE: October 2, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing still in effect.
CONRAD LU, DIRECTOR
ST VINCENT MED CTR PULM/ABG LAB
2131 WEST THIRD STREET
LOS ANGELES, CA 90057
CLIA ID# 05D0867804 CAP
SANCTION: Probation
EFFECTIVE DATE: February 14, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Laboratory removed from probation on 11/14/2017.
EKNATH DEO, DIRECTOR
COAST HEMATOLOGY ONCOLOGY ASSOCIATES, INC
3300 E. SOUTH STREET STE #209
LONG BEACH, CA 90805
CLIA ID# 05D0925506 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff), White Blood Cell Count (Leukocyte Count)(WBC), Red Blood Cell Count (Erythrocyte Count)(RBC), Hemoglobin, Hematocrit, Platelet Count.
EFFECTIVE DATE: January 4, 2017
REASON: Unsuccessful PT
STATUS: On 06/15/2017 the laboratory voluntarily withdrew from COLA.
Laboratory no longer accredited by COLA.
DONALD SIMPSON MD, DIRECTOR
CALIFORNIA DIAGNOSTIC LABORATORIES
7316 DEERING AVE
CANOGA PARK, CA 91303
CLIA ID# 05D0928967 COLA
SANCTION: Cease testing for Infectious Mononucleosis Antibodies (Mono).
EFFECTIVE DATE: March 30, 2017
REASON: Unsuccessful PT
STATUS: On 08/30/2017 the laboratory removed Infectious Mononucleosis Antibodies testing from their test menu.
MITCHELL BECKER, DIRECTOR
PHYSICIANS OFFICE LABORATORY
2336 SANTA MONICA BLVD STE 201
SANTA MONICA, CA 90404
CLIA ID# 05D1002957 COLA
SANCTION: Cease testing for Aspartate Aminotransferase (AST)
EFFECTIVE DATE: October 20, 2017
REASON: Unsuccessful PT
STATUS: On 12/15/2017 the laboratory voluntarily withdrew from COLA.
Laboratory no longer accredited by COLA.
HOLLY YAMADA, DIRECTOR
HEMEDIAGNOSTICS LAB, INC
2119 SOUTH MYRTLE AVE
MONROVIA, CA 91016
CLIA ID# 05D1021148 CAP
SANCTION: Revocation of accreditation
EFFECTIVE DATE: November 3, 2017
REASON: Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2018 laboratory not accredited by CAP.
VEENA SINGH, DIRECTOR
BIOCEPT INC
5810 NANCY RIDGE DR
SAN DIEGO, CA 92121
CLIA ID# 05D1029526 CAP
SANCTION: Probation
EFFECTIVE DATE: December 12, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 Probation still in effect.
LEENA ZOPEY M.D., DIRECTOR
MLK JR. OUTPATIENT CENTER
1670 E 120TH ST
LOS ANGELES, CA 90059
CLIA ID# 05D1075508 CAP
SANCTION: Cease testing for pO2.
EFFECTIVE DATE: July 31, 2017
REASON: Unsuccessful PT
STATUS: Permanently ceased testing for pO2 on 08/15/2017.
LEONARD LAZARUS, DIRECTOR
SDXRAY & LAB INC
8772 CUYAMACA ST, STE 102
SANTEE, CA 92071
CLIA ID# 05D1078086 COLA
SANCTION: Denial of Accreditation
EFFECTIVE DATE: January 19, 2017
REASON: Failure to adhere to COLA imposed required improvements.
STATUS: Laboratory no longer accredited by COLA.
TERESA WIESAK, DIRECTOR
ACACIO FERTILITY CENTER
27882 FORBES RD STE 200
LAGUNA NIGUEL, CA 92677
CLIA ID# 05D1082557 CAP
SANCTION: Probation
EFFECTIVE DATE: December 19, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 Probation still in effect.
AARON SASSOON, DIRECTOR
CHOC CHILDRENS HOSPITAL OF ORANGE COUNTY
1201 W LAVETA AVE
ORANGE, CA 92868
CLIA ID# 05D2050461 CAP
SANCTION: Probation
EFFECTIVE DATE: January 10, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from Probation on 10/31/2017.
RICHARD SAFRIN, DIRECTOR
APPLIED PROTEOMICS
3545 JOHN HOPKINS CT STE 150
SAN DIEGO, CA 92121
CLIA ID# 05D2074504 CAP
SANCTION: Probation
EFFECTIVE DATE: August 22, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from Probation on 01/09/2018.
WILLIAM PAXTON, MD, DIRECTOR
SERAMETRIX
2235 FARADAY AVE STE N
CARLSBAD, CA 92008
CLIA ID# 05D2112400 CAP
SANCTION: Denial of Accreditation
EFFECTIVE DATE: March 14, 2017
REASON: Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2018 laboratory not accredited by CAP.
MICHELLE KROPOTSCH, DIRECTOR
ST VINCENT GENERAL HOSPITAL DISTRICT LAB
822 W 4TH ST
LEADVILLE, CO 80461
CLIA ID# 06D0644384 COLA
SANCTION: Cease testing for Albumin.
EFFECTIVE DATE: July 18, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Albumin still in effect.
ALEX CUDKOWICZ, DIRECTOR
UPPER SAN JUAN HEALTH SERVICE DISTRICT
95 SOUTH PAGOSA BLVD
PAGOSA SPRINGS, CO 81147
CLIA ID# 06D1078562 COLA
SANCTION: Cease testing for Sodium.
EFFECTIVE DATE: March 13, 2017
REASON: Unsuccessful PT
STATUS: Sodium testing was reinstated on 10/06/2017.
JAYASHREE KRISHNAN, DIRECTOR
WASHINGTON HOSPITAL CENTER
MAIN LABORATORY
110 IRVING STREET NW
WASHINGTON, DC 20010
CLIA ID# 09D0208070 CAP
SANCTION: Probation
EFFECTIVE DATE: January 31, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from Probation on 06/27/2017.
MICHAEL WEITZ, DIRECTOR
WEITZ & RITTER MD PA
7190 SW 87TH AVE STE 304
MIAMI, FL 33173
CLIA ID# 10D0672283 COLA
SANCTION: Denial of Accreditation
EFFECTIVE DATE: November 27, 2017
REASON: Failure to adhere to COLA imposed required improvements.
STATUS: Laboratory no longer accredited by COLA.
ELIZABETH REILLY HAYS, DIRECTOR
MARIANO D CIBRAN MD CORP D/B/A
ST PETERSBURG PEDIATRIC
7500 PARK BLVD
PINELLAS PARK, FL 33781
CLIA ID# 10D0927893 COLA
SANCTION: Cease testing for Hematocrit.
EFFECTIVE DATE: November 21, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Hematocrit still in effect.
ALBERT TAWIL, DIRECTOR
ALBERT TAWIL MD PA
508 S HABANA AVE STE 360
TAMPA, FL 33609
CLIA ID# 10D0929658 COLA
SANCTION: Cease testing for Hematocrit.
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: Hematocrit testing was reinstated on 09/25/2017.
MARIO ALMEIDA, DIRECTOR
MARIO A ALMEIDA MD
7000 SW 62ND AVE STE 605
SOUTH MIAMI, FL 33143
CLIA ID# 10D0975605 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC DIff), White Blood Cell Count (WBC Ct), Red Blood Cell Count (RBC Ct), Platelet Count, Hemoglobin, Hematocrit.
EFFECTIVE DATE: June 20, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff, WBC Ct, RBC Ct, Platelet Ct, Hemoglobin & Hematocrit still in effect.
JORGE CACERES, DIRECTOR
FIRST QUALITY LABORATORY
11460 INTER CHANGE CIRCLE NORTH
MIRAMAR, FL 33025
CLIA ID# 10D1056759 COLA
SANCTION: Cease testing for Immunoglobulins IgM.
EFFECTIVE DATE: June 15, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Immunoglobulin IgM still in effect.
HOWARD LINZER, DIRECTOR
AFTER HOURS PEDIATRICS INC
6250 LANTANA RD STE 12
LAKE WORTH, FL 33463
CLIA ID# 10D1062008 COLA
SANCTION: Cease testing for Platelet Count.
EFFECTIVE DATE: August 29, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Platelet Count still in effect.
MOHAMMAD KAMAL M.D., DIRECTOR
OCALA CANCER INSTITUTE
2820 SE 3RD CT STE 200
OCALA, FL 34471
CLIA ID# 10D1067684 COLA
SANCTION: Cease testing for Hemoglobin, Red Blood Cell Count (RBC Count).
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: On 04/13/2017 the laboratory voluntarily withdrew from COLA.
Laboratory no longer accredited by COLA.
ALINA BUDEJEN, DIRECTOR
CENTURY CLINICAL LAB
1395 SHOTGUN RD
SUNRISE, FL 33326
CLIA ID# 10D1101362 COLA
SANCTION: Cease testing for Hepatitis B Core Antibody.
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: Hepatitis B Core Antibody testing was reinstated on 11/09/2017.
SANGITA SAHAY, DIRECTOR
DIAGNOSTIC & CLINICAL CARE SERVICES INC DBA
DOCCS - LABORATORY
2100 WICKHAM RD
MELBOURNE, FL 32935
CLIA ID# 10D2033677 COLA
SANCTION: Cease testing for Chloride.
EFFECTIVE DATE: March 2, 2017
REASON: Unsuccessful PT
STATUS: Chloride testing was reinstated on 11/08/2017.
SHURUN ZHOA, DIRECTOR
MEDICAL TOX LABS LLC
3450 FLETCHER AVE STE 230B
TAMPA, FL 33613
CLIA ID# 10D2087368 COLA
SANCTION: Cease testing for Sodium.
EFFECTIVE DATE: May 3, 2017
REASON: Unsuccessful PT
STATUS: Sodium testing was reinstated 11/20/2017.
JOHN HAMYING, DIRECTOR
CENTRAL FLORIDA HEALTH CARE INC-MULBERRY
106 NW 9TH AVE
MULBERRY, FL 33860
CLIA ID# 10D2095794 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC DIff).
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: On 02/10/2017 the laboratory removed WBC Diff testing from their test menu.
NICHOLAS LANCIA, DIRECTOR
CHI MEMORIAL HOSPITAL - GEORGIA
100 GROSS CRESCENT CIRCLE
FORT OGLETHORPE, GA 30742
CLIA ID# 11D0021688 CAP
SANCTION: Probation
EFFECTIVE DATE: January 24, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 Probation still in effect.
HELENLOUISE MOORE, DIRECTOR
CORNERSTONE MEDICAL ASSOC- PEDIATRIC ASSOC
116 SOUTH HOUSTON RD
WARNER ROBINS, GA 31088
CLIA ID# 11D0263875 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: June 1, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
JOHN INMAN III M.D., DIRECTOR
VERANDA, PC, THE
2701 MEREDYTH DRIVE
ALBANY, GA 31707
CLIA ID# 11D0265843 CAP
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: November 16, 2017
REASON: Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2017 Laboratory not accredited by CAP.
ANTHONY MOSER, DIRECTOR
PHOEBE WORTH MEDICAL CENTER
807 SOUTH ISABELLA STREET
SYLVESTER, GA 31791
CLIA ID# 11D0266246 CAP
SANCTION: Probation
EFFECTIVE DATE: March 14, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from probation on 12/12/2017.
HANS GROSSNIKLAUS, DIRECTOR
EMORY CLINIC AMBULATORY SURGERY CENTER
1365 CLIFTON ROAD BUILDING B
ATLANTA, GA 30322
CLIA ID# 11D0645879 JC
SANCTION: Cease testing for Hematology (Hematocrit, Hemoglobin).
EFFECTIVE DATE: September 26, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing still in effect.
EDWARD MEIER MD, DIRECTOR
REDMOND FAMILY CARE CENTER - WEST ROME
2112 SHORTER AVENUE, SUITE 200
ROME, GA 30165
CLIA ID# 11D0925477 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
BERNADETTE MANDES WILDEMORE, DIRECTOR
LABSOLUTIONS
1451 NORTHSIDE DRIVE, NW
ATLANTA, GA 30318
CLIA ID# 11D2065318 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: November 6, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
OLARONKE OGUNREMI, DIRECTOR
MEMORIAL HOSPITAL
1900 STATE STREET
CHESTER, IL 62233
CLIA ID# 14D0434236 CAP
SANCTION: Cease Testing for ABO Group.
EFFECTIVE DATE: January 9, 2017
REASON: Unsuccessful PT
STATUS: Allowed to resume testing on 01/30/2017.
JOAN GUITART, DIRECTOR
NORTHWESTERN MEDICAL FACULTY FOUND INC
DEPT OF DERMATOLOGY
676 N ST CLAIR ST, STE 1765 (ARKES)
CHICAGO, IL 60611
CLIA ID# 14D1006092 CAP
SANCTION: Probation
EFFECTIVE DATE: March 28, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 Probation still in effect.
KATIE ALDIS, DIRECTOR
ASSOCIATES IN FAMILY CARE OF OLATHE
15435 W. 134 ST, STE 103
OLATHE, KS 66062
CLIA ID# 17D0448491 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff)
EFFECTIVE DATE: March 30, 2017
REASON: Unsuccessful PT
STATUS: WBC Diff testing was reinstated on 11/09/2017.
JILL RANSDELL, DIRECTOR
JAMES B HAGGIN MEMORIAL HOSPITAL,THE
464 LINDEN AVE
HARRODSBURG, KY 40330
CLIA ID# 18D0322385 COLA
SANCTION: Cease testing for Thyroxine(T4) and Triiodothyronine (T3).
EFFECTIVE DATE: July 26, 2017
REASON: Unsuccessful PT
STATUS: On 08/29/2017 laboratory removed T3 & T4 tests from their test menu.
ANN MARSHALL, DIRECTOR
ROCKCASTLE HOSP
145 NEWCOMB AVE
MOUNT VERNON, KY 40456
CLIA ID# 18D0648496 CAP
SANCTION: Probation
EFFECTIVE DATE: January 24, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from probation on 11/14/2017.
OTIS BARNUM, DIRECTOR
NATCHITOCHES MEDICAL SPECIALISTS
1029 KEYSER AVENUE
NATCHITOCHES, LA 71457
CLIA ID# 19D2002311 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: June 1, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
RONALD SROKA, DIRECTOR
CROFTON FAMILY PRACTICE
1684 VILLAGE GREEN
CROFTON, MD 21114
CLIA ID# 21D0215484 COLA
SANCTION: Cease testing for Aerobic &/or Anaerobic Organisms-unlimited sources (Microbiology/Bacteriology).
EFFECTIVE DATE: November 21, 2017
REASON: Unsuccessful PT
STATUS: On 12/07/2017 the laboratory removed Microbiology/Bacteriology testing from their test menu.
WILLIAM CRAIG, DIRECTOR
JOHNS HOPKINS IMAGING AT WHITE MARSH
4924 CAMPBELL BLVD, STE 110
BALTIMORE, MD 21236
CLIA ID# 21D0981025 CAP
SANCTION: Cease testing for Creatinine.
EFFECTIVE DATE: May 18, 2017
REASON: Unsuccessful PT
STATUS: Allowed to resume testing for Creatinine on 10/05/2017.
JOHN HANSON, DIRECTOR
COASTAL LAB PARTNERS, LLC
747 MAIN ST
CONCORD, MA 01742
CLIA ID# 22D2085574 CAP
SANCTION: Probation
EFFECTIVE DATE: December 12, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2017 Probation still in effect.
THOMAS GRAVES, DIRECTOR
BAY AREA FAMILY PHYSICIANS
34301 23 MILE ROAD SUITE 100
NEW BALTIMORE, MI 48047
CLIA ID# 23D0363983 COLA
SANCTION: Cease testing for Cholesterol, HDL Cholesterol & Triglyceride.
EFFECTIVE DATE: April 10, 2017
REASON: Unsuccessful PT
STATUS: Testing for Cholesterol, HDL Cholesterol & Triglyceride was reinstated on 08/29/2017.
SAIMAN KAHN, DIRECTOR
FAMILY PRACTICE CARE, PLLC
28351 SCHOENHERR RD.
WARREN, MICHIGAN 48088
CLIA ID# 23D0365545 COLA
SANCTION: Denial of Accreditation
EFFECTIVE DATE: November 27, 2017
REASON: Failure to adhere to COLA imposed required improvements
STATUS: Laboratory no longer accredited by COLA.
NAZAR SARAFA, DIRECTOR
GARDEN CITY MEDICAL CLINIC
1715 MIDDLEBELT ROAD
GARDEN CITY, MI 48135
CLIA ID# 23D0367601 COLA
SANCTION: Cease testing for Thyroid Stimulating Hormone (TSH).
EFFECTIVE DATE: April 10, 2017
REASON: Unsuccessful PT
STATUS: On 12/04/2017 the laboratory voluntarily withdrew from COLA. Laboratory no longer accredited by COLA.
TANVIR QURESHI, DIRECTOR
TANVIR I QURESHI MD PC
5290 WEST BROOKSHIRE COURT
MONROE, MI 48161
CLIA ID# 23D0368252 COLA
SANCTION: Cease testing for Triglyceride.
EFFECTIVE DATE: January 23, 2017
REASON: Unsuccessful PT
STATUS: Triglyceride testing was reinstated on 08/29/2017.
SYED DANISH, DIRECTOR
SOUTHGATE MEDICAL CLINIC
13819 TRENTON RD
SOUTHGATE, MI 48195
CLIA ID# 23D0708436 COLA
SANCTION: Cease testing for Cortisol, Thyroid Stimulating Hormone (TSH), Thyroxine Free (FT4), Triiodothyronine (T3), Cholesterol, HDL Cholesterol, Triglyceride & Rheumatoid Factor (RF).
EFFECTIVE DATE: October 6, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Cortisol, TSH, FT4, T3, Cholesterol, HDL Cholesterol, Triglyceride & RF still in effect.
SETH FORMAN, DIRECTOR
WEST BLOOMFIELD PEDIATRICS PLLC
6400 FARMINGTON RD STE 10
WEST BLOOMFIELD, MI 48322
CLIA ID# 23D0709791 COLA
SANCTION: Cease testing for Streptococcus Group A.
EFFECTIVE DATE: January 23, 2017
REASON: Unsuccessful PT
STATUS: On 08/29/2017 the laboratory removed Streptococcus Group A testing from their test menu.
RIZWAN DANISH, DIRECTOR
GENESEE CANCER & BLOOD DISEASE
TREATMENT CENTER PC/DR DANISH
302 KENSINGTON AVENUE
FLINT, MI 48503
CLIA ID# 23D0923923 COLA
SANCTION: Cease testing for Platelet Count.
EFFECTIVE DATE: July 26, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Platelet Count still in effect.
HARRY SHECTER, DIRECTOR
FORD BIO MEDICAL LABORTORY
5601 SCHAEFER ROAD
DEARBORN, MI 48126
CLIA ID# 23D0960256 COLA
SANCTION: Cease testing for Bilirubin, Total.
EFFECTIVE DATE: June 15, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Bilirubin Total still in effect.
JANET POULIK, DIRECTOR
CHILDREN'S HOSPITAL OF MICHIGAN SPECIALTY CENTER
3950 BEAUBIEN
DETROIT, MI 48201
CLIA ID# 23D2045808 CAP
SANCTION: Probation
EFFECTIVE DATE: September 12, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from probation on 01/09/2018.
PAUL LAPPINGA, DIRECTOR
SANFORD BEMIDJI MEDICAL CENTER
ATTN LABORATORY
BEMIDJI, MN 56601
CLIA ID# 24D0041382 CAP
SANCTION: Probation
EFFECTIVE DATE: October 24, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 Probation still in effect.
FRED APPLE Ph.D., DIRECTOR
HENNEPIN COUNTY MEDICAL CENTER
701 PARK AVE - LABORATORY 812
MINNEAPOLIS, MN 55415
CLIA ID# 24D0401928 CAP
SANCTION: Cease testing for Digoxin & Theophylline.
EFFECTIVE DATE: November 8, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing for Digoxin and Theophylline still in effect.
VICKI THOMSON M.D., DIRECTOR
EDINA PEDIATRICS
7025 FRANCE AVE
EDINA, MN 55435
CLIA ID# 24D0403126 COLA
SANCTION: Cease testing for Hemoglobin, White Blood Cell Differential.
Denial of Accreditation.
EFFECTIVE DATE: January 23, 2017
May 18, 2017
REASON: Unsuccessful PT
Failure to adhere to COLA imposed required improvements
STATUS: Laboratory no longer accredited by COLA.
ROBERT BRITT, DIRECTOR
KINGS DAUGHTERS MEDICAL CENTER -BLOOD GAS LAB
427 HIGHWAY 51 NORTH
BROOKHAVEN, MS 39601
CLIA ID# 25D0030284 CAP
SANCTION: Probation
EFFECTIVE DATE: December 12, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 Probation still in effect.
TOMEKIA POPE, DIRECTOR
MERCY FAMILY MEDICAL CLINIC
1306 HARDY STREET
HATTIESBURG, MS 39401
CLIA ID# 25D2121787 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff), White Blood Cell Count (WBC Ct), Red Blood Cell Count (RBC Ct), Platelet Count, Hemoglobin, Hematocrit.
Cease testing for Neisseria gonorrhoeae, Chlamydia.
EFFECTIVE DATE: December 19, 2017
December 28, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff, WBC Ct, RBC Ct, Platelet Count, Hemoglobin, Hematocrit Neisseria gnorrhoeae & Chlamydia still in effect.
ZAHID KALEEM, DIRECTOR
PARKLAND HEALTH CENTER-BONNE TERRE
7245 RAIDER ROAD
BONNE TERRE, MO 63628
CLIA ID# 26D0666581 CAP
SANCTION: Cease testing for hCG Serum & TSH.
EFFECTIVE DATE: November 8, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing still in effect.
KONNI EINFALT MT ASCP, DIRECTOR
REGIONAL WEST PHYSICIANS CLINIC SOUTH PLAZA
3911 AVENUE B SUITE 1100
SCOTTSBLUFF, NE 69361
CLIA ID# 28D0456612 COLA
SANCTION: Cease testing for Prothrombin Time (PT)
EFFECTIVE DATE: April 10, 2017
REASON: Unsuccessful PT
STATUS: PT testing was reinstated on 11/20/2017.
RONALD SLAUGHTER, DIRECTOR
LAB EXPRESS LLC
4550 E CHARLESTON BLVD
LAS VEGAS, NV 89104
CLIA ID# 29D1056752 COLA
SANCTION: Cease testing for Prothrombin Time (PT)
EFFECTIVE DATE: August 29, 2017
REASON: Unsuccessful PT
STATUS: On 12/07/2017 the laboratory removed Prothrombin Time testing from their test menu.
MICHAEL MARKOFF, DIRECTOR
MIDDLETOWN PEDIATRICS PA
529 HIGHWAY 35
RED BANK, NJ 07701
CLIA ID# 31D0114900 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: August 29, 2017
REASON: Unsuccessful PT
STATUS: On 11/10/2017 the laboratory voluntarily withdrew from COLA. Laboratory no longer accredited by COLA.
JAMES SPIGEL, DIRECTOR
TRICORE REFERENCE LABORATORIES - LCMC
211 SUDDERTH DRIVE
RUIDOSO, NM 88345
CLIA ID# 32D0653322 CAP
SANCTION: Cease testing for Compatibility Testing.
EFFECTIVE DATE: August 17, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing for Compatibility Testing still in effect.
RICHARD BLAU, DIRECTOR
RICHARD H BLAU MD-ARTHRITIS INSTITUTE
120 BETHPAGE ROAD
HICKSVILLE, NY 11801
CLIA ID# 33D0155403 COLA
SANCTION: Cease testing for Immunoglobulins IgA.
EFFECTIVE DATE: September 27, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Immunoglobulins IgA still in effect.
NORMAN TUROWSKY, DIRECTOR
NORMAN TUROWSKY MD PC
3601 HEMPSTEAD TPKE SUITE 121
LEVITTOWN, NY 11756
CLIA ID# 33D0156242 COLA
SANCTION: Cease testing for Thyroxine free (FT4), Triiodothyronine (T3), Thyroid Stimulating Hormone (TSH).
EFFECTIVE DATE: July 18, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for FT4, T3 & TSH still in effect.
RICHARD GOLD, DIRECTOR
SMITHTOWN MEDICAL SPECIALISTS PC
215 EAST MAIN STREET
SMITHTOWN, NY 11787
CLIA ID# 33D0663082 COLA
SANCTION: Cease testing for HDL Cholesterol & Sodium.
Cease testing for Cholesterol.
EFFECTIVE DATE: March 30, 2017
October 20, 2017
REASON: Unsuccessful PT
STATUS: HDL Cholesterol & Sodium testing were reinstated on 10/20/2017.
As of 12/31/2017 cease testing for Cholesterol still in effect.
VERONICA SANTILLI, DIRECTOR
BROOK-ISLAND PEDIATRIC GROUP PC
312 AVENUE U
BROOKLYN, NY 11223
CLIA ID# 33D0680083 COLA
SANCTION: Cease testing for Streptococcus Group A.
EFFECTIVE DATE: January 4, 2017
REASON: Unsuccessful PT
STATUS: Streptococcus Group A testing was reinstated on 08/30/2017.
ROHITH SARAVANAN M.D., DIRECTOR
MASH URGENT CARE - OLEAN
A DIVISION OF MEDFIRST URGENT CARE, PLLC
921 WAYNE ST
OLEAN, NY 14760
CLIA ID# 33D2015558 COLA
SANCTION: Cease testing for Red Blood Cell Count (RBC Ct)
EFFECTIVE DATE: September 20, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for RBC Ct still in effect.
ANGELICTA RUSHING, DIRECTOR
BOICE WILLIS CLINIC IMMEDIATE CARE LAB
921 NORTH WINSTEAD AVENUE
ROCKY MOUNT, NC 27804
CLIA ID# 34D0695219 COLA
SANCTION: Cease testing for Infectious mononucleosis (Mono).
EFFECTIVE DATE: February 21, 2017
REASON: Unsuccessful PT
STATUS: Mono testing was reinstated on 09/25/2017.
SAMMUEL SUN Ph.D., DIRECTOR
NCCRM MAIN LAB
400 ASHVILLE AVENUE, SUITE 200
CARY, NC 27511
CLIA ID# 34D0863609 CAP
SANCTION: Probation
Revocation of CLIA Certificate
EFFECTIVE DATE: February 14, 2017
November 16, 2017
REASON: Failure To Submit Acceptable POC or AOC
Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2018 Laboratory not accredited by CAP.
ESSAM ESKANDER, DIRECTOR
CAROLINA MEDICAL CENTER PA
102 SEVENTH AVENUE
CHADBOURN, NC 28431
CLIA ID# 34D0904138 COLA
SANCTION: Cease testing for Glucose.
EFFECTIVE DATE: March 30, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Glucose still in effect.
JAMES PRIDGEN, DIRECTOR
HOLLY RIDGE HEALTHCARE, PA
308 US HIGHWAY 17 NORTH
HOLLY RIDGE, NC 28445
CLIA ID# 34D0955955 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: April 10, 2017
REASON: Unsuccessful PT
STATUS: On 10/16/2017 the laboratory removed WBC Diff testing from their test menu.
TIMOTHY BARKER, DIRECTOR
PIEDMONT HEALTHCARE PA DBA LAKE NORMAN FAMILY PRAC
357 WILLIAMSON ROAD
MOORESVILLE, NC 28117
CLIA ID# 34D0962153 COLA
SANCTION: Cease testing for Red Blood Cell Count (RBC Ct) & Hematocrit.
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: RBC Ct & Hematocrit testing were reinstated on 09/14/2017.
PHIL RADFORD, DIRECTOR
RADEAS, LLC
11635 NORTH PARK DRIVE SUITE 340
WAKE FOREST, NC 27587
CLIA ID# 34D2055932 COLA
SANCTION: Cease testing for Lithium.
EFFECTIVE DATE: August 18, 2018
REASON: Unsuccessful PT
STATUS: On 11/10/2017 the laboratory removed Lithium testing from their test menu.
EDWARD LIPFORD, DIRECTOR
CAROLINAS HEALTHCARE SYSTEMS LABORATORY
5040 AIRPORT CENTER PARKWAY
CHARLOTTE, NC 28208
CLIA ID# 34D2084481 CAP
SANCTION: Cease testing for Complement C3.
EFFECTIVE DATE: May 24, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing for Complement C3 still in effect.
HENRY EMERY JR, DIRECTOR
LIBERTY FAMILY PHYSICIANS
1928 WEDDINGTON ROAD
WEDDINGTON, NC 28104
CLIA ID# 34D2088863 COLA
SANCTION: Cease testing for hCG, Beta Serum Quantitative.
EFFECTIVE DATE: August 18, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for hCG, Beta Serum Quantitative still in effect.
BRANDON GUTHERY, DIRECTOR
MCALESTER REG HLTH CTR - S BERNARD LAB
1 CLARK BASS BOULEVARD PO BOX 1228
MCALESTER, OK 74501
CLIA ID# 37D0475386 CAP
SANCTION: Probation
EFFECTIVE DATE: February 28, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Removed from probation on 01/23/2018.
RALPH NELSON, DIRECTOR
IMMEDIATE CARE OF OKLAHOMA-HEALTHPLEX
3400 W TECUMSEH RD SUITE 100
NORMAN, OK 73072
CLIA ID# 37D1102844 COLA
SANCTION: Denial of Accreditation
EFFECTIVE DATE: March 30, 2017
REASON: Failure to adhere to COLA imposed required improvements.
STATUS: Laboratory no longer accredited by COLA.
NICHOLE STEIDLER, DIRECTOR
VISTA PATHOLOGY LABORATORY LLC
1032 E JACKSON STREET
MEDFORD, OR 97504
CLIA ID# 38D2036013 CAP
SANCTION: Probation
EFFECTIVE DATE: May 9, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: Laboratory removed from Probation 10/10/2017.
HERBERT AUERBACH D.O., DIRECTOR
ABINGTON MEMORIAL HOSPITAL
PATHOLOGY DEPT 1200 OLD YORK RD
ABINGTON, PA 19001
CLIA ID# 39D0194459 CAP
SANCTION: Cease testing for Complement C3.
EFFECTIVE DATE: May 24, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing for Complement C3 still in effect.
WILLIAM SIMS, DIRECTOR
JEFFERSON REGIONAL MEDICAL CENTER
RESPIRATORY LAB
575 COAL VALLEY ROAD
JEFFERSON HILLS, PA 15025
CLIA ID# 39D0684887 CAP
SANCTION: Cease testing for Chloride & Sodium.
EFFECTIVE DATE: July 31, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing for Chloride & Sodium still in effect.
DAVID KYLE JR, DIRECTOR
CORNERSTONE FAMILY MEDICINE
801 E GREENVILLE STREET
ANDERSON, SC 29621
CLIA ID# 42D0252717 COLA
SANCTION: Cease testing for Platelet Count, White Blood Cell Count (WBC Ct), Hemoglobin, Hamatocrit, Red Blood Cell Count (RBC Ct), White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: On 03/08/2017 the laboratory voluntarily withdrew from COLA. Laboratory is no longer accredited by COLA.
STEVEN BANDER, DIRECTOR
BSW PRIMARY CARE WYLIE
2300 FM, 544 #270
WYLIE, TX 75098
CLIA ID# 45D0476749 COLA
SANCTION: Cease testing for Red Blood Cell Count (RBC Ct)
Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: January 23, 2017
February 1, 2017
REASON: Unsuccessful PT
STATUS: RBC Ct & WBC Diff testing were reinstated on 08/29/2017.
JOHN WRIGHT, DIRECTOR
PORT LAVACA CLINIC ASSOCS PA
1200 N VIRGINIA
PORT LAVACA, TX 77979
CLIA ID# 45D0498906 COLA
SANCTION: Cease testing Sodium.
EFFECTIVE DATE: October 20, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Sodium still in effect.
HARRY HERNANDEZ, DIRECTOR
HARRY HERNANDEZ DO
1339 FAIR AVENUE
SAN ANTONIO, TX 78223
CLIA ID# 45D0500984 COLA
SANCTION: Cease testing for Hematocrit.
EFFECTIVE DATE: March 30, 2017
REASON: Unsuccessful PT
STATUS: Hematocrit testing was reinstated 10/10/2017.
JAVIER BOCANEGRA, DIRECTOR
COMMUNITY FAMILY MEDICINE PA
1616 CALLAGHAN ROAD
SAN ANTONIO, TX 78228
CLIA ID# 45D0501127 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: August 29, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
GARY MADDEN, DIRECTOR
UNIFIED WOMEN'S HEALTHCARE OF TEXAS, PLLC
DBA MIDLAND WOMEN'S CLINIC
2500 WEST ILLINOIS AVE SUITE 100
MIDLAND, TX 79701
CLIA ID# 45D0508682 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: January 23, 2017
REASON: Unsuccessful PT
STATUS: WBC Diff testing was reinstated on 09/07/2017.
CHARLES BURNS, DIRECTOR
MEDICAL CENTER HOSPITAL LABORATORY
ATTN MAIN LAB
ODESSA, TX 79761
CLIA ID# 45D0508933 CAP
SANCTION: Cease testing for Fibrinogen.
EFFECTIVE DATE: July 12, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2017 cease testing for Fibrinogen still in effect.
JUAN HERRERA, DIRECTOR
PROMISE HOSPITAL OF DALLAS
7955 HARRY HINES BOULEVARD
DALLAS, TX 75235
CLIA ID# 45D0659580 COLA
SANCTION: Cease testing for Prothrombin Time (PT/INR).
EFFECTIVE DATE: February 14, 2017
REASON: Unsuccessful PT
STATUS: PT/INR testing was reinstated on 08/24/2017.
MARION RUNDELL MD, DIRECTOR
CLEAR LAKE REGIONAL MEDICAL CENTER
500 MEDICAL CENTER BOULEVARD
WEBSTER, TX 77598
CLIA ID# 45D0668568 CAP
SANCTION: Cease testing for Compatibility Testing.
EFFECTIVE DATE: August 5, 2017
REASON: Unsuccessful PT
STATUS: As of 02/13/2018 cease testing for Compatibility Testing still in effect.
DR GOIN, DIRECTOR
CALVARY MED PA
8484 WILL CLAYTON PKWY
HUMBLE, TX 77339
CLIA ID# 45D0980081 COLA
SANCTION: Cease testing for Bilirubin, Total.
EFFECTIVE DATE: July 18, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Bilirubin, Total still in effect.
KELLY LE, DIRECTOR
PREMIER MEDICINE
6800 ALMA DRIVE
PLANO, TX 75023
CLIA ID# 45D1010586 COLA
SANCTION: Denial of Accreditation
EFFECTIVE DATE: April26, 2017
REASON: Failure to adhere to COLA imposed required improvements.
STATUS: Laboratory no longer accredited by COLA.
CRAIG MANIFOLD, DIRECTOR
SAN ANTONIO AIRLIFE
4502 MEDICAL DRIVE
SAN ANTONIO, TX 78229
CLIA ID# 45D1029054 COLA
SANCTION: Cease testing for pH (Blood Gases), PCO2, PO2, Lactic Acid (Lactate).
EFFECTIVE DATE: January 24, 2017
REASON: Unsuccessful PT
STATUS: On 07/26/2017 the laboratory voluntarily withdrew from COLA. Laboratory no longer accredited by COLA.
JAMES MAPES, DIRECTOR
MYRIAD RBM, INC
3300 DUVAL RD STE 110
AUSTIN, TX 78759
CLIA ID# 45D1037483 COLA
SANCTION: Cease testing for Immunoglobulins IgE.
EFFECTIVE DATE: September 12, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for Immunoglobulins IgE still in effect.
SUMANA GANGI, DIRECTOR
SOUTHERN ENDOCRINOLOGY ASSOCIATES
1621 N BELTLINE ROAD, SUITE A
MESQUITE, TX 75149
CLIA ID# 45D1059323 COLA
SANCTION: Cease testing for Sodium.
EFFECTIVE DATE: April 10, 2017
REASON: Unsuccessful PT
STATUS: Sodium testing was reinstated on 11/20/2017.
ROBERT BREDT, DIRECTOR
ATRIUM MEDICAL CENTER
11929 W AIRPORT BLVD STE 110
STAFFORD, TX 77477
CLIA ID# 45D1068959 CAP
SANCTION: Probation
EFFECTIVE DATE: May 9, 2017
REASON: Failure To Submit Acceptable POC or AOC
STATUS: As of 02/13/2018 probation still in effect.
OLUTOLA ADETONA, DIRECTOR
PRACTICAL APPROACH PEDIATRICS PLLC
9480 HUEBNER ROAD SUITE 400
SAN ANTONIO, TX 78240
CLIA ID# 45D2028691 COLA
SANCTION: Cease testing for PCO2, PO2, Blood Gases.
EFFECTIVE DATE: March 30, 2017
REASON: Unsuccessful PT
STATUS: PCO2, PO2, Blood Gases testing was reinstated on 11/09/2017.
VICTOR DE LA TORRE, DIRECTOR
MOHAMMED IDRIS MD
5405 N MCCOLL
MCALLEN, TX 78504
CLIA ID# 45D2044967 COLA
SANCTION: Cease testing for Thyroid Stimulating Hormone (TSH).
EFFECTIVE DATE: March 30, 2017
REASON: Unsuccessful PT
STATUS: On 04/20/2017 the laboratory voluntarily withdrew from COLA. Laboratory no longer accredited by COLA.
NOE MEDINA, DIRECTOR
TAVAREZ MEDICAL CLINIC
1801 S 5TH STREET SUITE 101
MCALLEN, TX 78503
CLIA ID# 45D2052536 COLA
SANCTION: Cease testing for Platelet Count, White Blood Cell Count (WBC Ct), Hemoglobin, Hematocrit, Red Blood Cell Count (RBC Ct), White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: May 31, 2017
REASON: Unsuccessful PT
STATUS: On 10/27/2017 the laboratory voluntarily withdrew from COLA. Laboratory no longer accredited by COLA.
CHRISTOPHER VALLE, DIRECTOR
CHI ST LUKE'S HEALTH EMERGENCY CENTER LAKES AREA
MONTGOMERY
18057 HIGHWAY 105 WEST SUITE 220
MONTGOMERY, TX 77356
CLIA ID# 45D2057336 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: August 29, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
ASIT CHOKSI M.D., DIRECTOR
CHI ST. LUKE’S PINECROFT HOSPITAL
9201 PINECROFT
THE WOODLANDS, TX 77380
CLIA ID# 45D2068937 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: February 1, 2017
REASON: Unsuccessful PT
STATUS: On 02/16/2017 the laboratory voluntarily withdrew from COLA. Laboratory no longer accredited by COLA.
FOYEKE IKAAYTOR, DIRECTOR
LIFE SAVERS EMERGENCY ROOM
17685 TOMBALL PARKWAY
HOUSTON, TX 77479
CLIA ID# 45D2104034 COLA
SANCTION: Cease testing for White Blood Cell Differential (WBC Diff).
EFFECTIVE DATE: June 1, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cease testing for WBC Diff still in effect.
PRAGNA SHETH, DIRECTOR
SOLSTAS LAB - CARILION STONEWALL JACKSON HOSPITAL
1 HEALTH CIRCLE
LEXINGTON, VA 24450
CLIA ID# 49D0232782 CAP
SANCTION: Cease testing for Compatibility Testing.
EFFECTIVE DATE: October 20, 2017
REASON: Unsuccessful PT
STATUS: Permanently ceased testing for Compatibility Testing on 11/06/2017.
MARIGNY ROBERTS, DIRECTOR
LEWISGALE HOSPITAL ALLEGHANY
1 ARH LANE
LOW MOOR, VA 24457
CLIA ID# 49D0714826 CAP
SANCTION: Cease testing for Compatibility Testing.
EFFECTIVE DATE: July 28, 2017
REASON: Unsuccessful PT
STATUS: Allowed to resume Compatibility Testing on 02/12/2018.
DAVID BOSTWICK, DIRECTOR
GRANGER GENETICS, LLC
601 BIOTECH DRIVE - SUITE 301
RICHMOND, VA 23235
CLIA ID# 49D2106421 CAP
SANCTION: Denial of Accreditation
EFFECTIVE DATE: June 7, 2017
REASON: Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2018 Laboratory not accredited by CAP.
AMR BEHIRI, DIRECTOR
ADVANCED HEALTH LAB SERVICES
212 LINDEN DRIVE - SUITE 158
WINCHESTER, VA 22601
CLIA ID# 49D2112492 COLA
SANCTION: Cease testing for Digoxin, Cortisol, hCG Total Serum Quantitative, Thyroxine (T4), Thyroxine Free (FT4), Triiodothyronine (T3), Valproic Acid, Phenytoin, Thyroid Stimulating Hormone (TSH), Urea (BUN), Magnesium, HDL Cholesterol, Albumin.
EFFECTIVE DATE: November 30, 2017
REASON: Unsuccessful PT
STATUS: As of 12/31/2017 cesase testing for Digoxin, Cortisol, hCG, T4, FT4, T3, Valproic Acid, Phenytoin, TSH, BUN,Magnesium, HDL Cholesterol, Albumin still in effect.
PAM KOTYNSKI MT (ASCP), DIRECTOR
SRH - RESPIRATORY THERAPY
1400 E KINCAID ST
MOUNT VERNON, WA 98274
CLIA ID# 50D0882701 CAP
SANCTION: Revocation of CLIA Certificate
EFFECTIVE DATE: May 26, 2017
REASON: Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2017 Laboratory not accredited by CAP.
RANDALL RIGGS M.D., DIRECTOR
INKARE
611 2ND AVE STE B
SPOKANE, WA 99202
CLIA ID# 50D2103358 CAP
SANCTION: Denial of Accreditation
EFFECTIVE DATE: January 31, 2017
REASON: Laboratory performance does not meet CAP standards of accreditation.
STATUS: As of 02/13/2018 Laboratory not accredited by CAP.
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
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7. A LIST OF LABORATORIES AGAINST WHICH CMS HAS BROUGHT SUIT UNDER SECTION 493.1846 AND THE REASON FOR THOSE ACTIONS.
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8. A LIST OF LABORATORIES THAT HAVE BEEN EXCLUDED FROM PARTICIPATION IN MEDICARE OR MEDICAID AND THE REASON FOR EXCLUSION.
MAHMOOD AIJAZI M.D., DIRECTOR
CAPITAL DIAGNOSTIC LABORATORY, LLC
14 PIDGEON HILL DRIVE - SUITE 150
STERLING, VA 20165
CLIA ID# 49D1107549
REASON: Revocation of CLIA Certificate effective Nov 28, 2017. Suspension and cancellation of Medicare approval effective Oct 4, 2017. Lab Owner and Lab Director prohibited from owning, operating and directing a CLIA lab from Nov 28, 2017 through Nov 28, 2019.
9. CORRECTION OF ANY ERRONEOUS STATEMENTS OF INFORMATION THAT APPEARED IN THE 2016 REGISTRY.
The following Laboratory information was inadvertently omitted from 2016 Laboratory Registry.
DANIEL FERGUSON, DIRECTOR
MEDCOMP SCIENCES LLC
20203 MACHOST ROAD
ZACHARY, LA 70791
CLIA ID# 19D2050143
SANCTION: Directed Plan of Correction (DPOC)
Directed Portion Plan of Correction (DPPOC)
EFFECTIVE DATE: October 5, 2016
October 5, 2016
REASON: Condition Level Non-Compliance with IJ
STATUS: Compliance Achieved
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.
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