Screening result
NPI 1104809755Screened 6/3/2026, 1:49:50 PM against OIG LEIE (snapshot 2026-05-08) + state board sanctions + SAM.gov + OFAC SDN + FDA Debarment.
WATCH
Historical or low-severity record.
This NPI has a historical record — typically a reinstated exclusion or a less-severe state board action. Surface to compliance review.
Reasons (5)
- • IL medical board probation (2021-01-11)
- • IL medical board fine (2020-12-28)
- • IL medical board suspension (2019-11-04)
- • IL medical board probation (2019-01-09)
- • IL medical board suspension (2018-11-09)
State board sanctions
| State / Board | Action | Date | Reinstated |
|---|---|---|---|
| IL medical | Probation | 2021-01-11 | — |
| IL medical | Fine | 2020-12-28 | — |
| IL medical | Suspension | 2019-11-04 | 2020-12-28 |
| IL medical | Probation | 2019-01-09 | 2019-11-04 |
| IL medical | Suspension | 2018-11-09 | 2019-01-08 |
Financial transparency (Open Payments)
CMS Open Payments (Sunshine Act) data for 2023. Shows payments from pharmaceutical and device companies to this provider.
Total received
$314
Total records
14
Payment categories
1
| Nature of payment | Amount | Records |
|---|---|---|
| Food and Beverage | $314 | 14 |
Monitor this provider
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Source + audit trail
- NPI screened
- 1104809755
- Screen timestamp
- 6/3/2026, 1:49:50 PM
- OIG LEIE snapshot
- 2026-05-08
- State boards consulted
- (none with active adapters)
- Risk band
- WATCH
- Risk score
- 90
- Matches found
- 5
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ProviderScore — Sanctions Screening Record
Record generated 6/3/2026, 1:49:50 PM
NPI 1104809755
WATCH Historical or low-severity record.
Screened 6/3/2026, 1:49:50 PM
Lists checked
| Source list | Result | Detail |
|---|---|---|
| OIG LEIE (federal exclusions) | Clear | snapshot 2026-05-08 |
| State board sanctions | FLAGGED (5) | 40 states live: AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, IL, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NV, NY, OH, OR, PA, SC, TN, TX, WA, WV, WY |
| State Medicaid exclusions | Clear | — |
| SAM.gov / GSA exclusions | Clear | — |
| OFAC SDN (Treasury) | Clear | — |
| FDA debarment | Clear | — |
Findings (5)
- IL medical board probation (2021-01-11)
- IL medical board fine (2020-12-28)
- IL medical board suspension (2019-11-04)
- IL medical board probation (2019-01-09)
- IL medical board suspension (2018-11-09)
Source + audit trail
| NPI screened | 1104809755 |
| Screen timestamp | 6/3/2026, 1:49:50 PM |
| OIG LEIE snapshot | 2026-05-08 |
| State boards covered | AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, IL, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NV, NY, OH, OR, PA, SC, TN, TX, WA, WV, WY |
| Risk band | WATCH |
| Risk score | 90 |
| Total matches | 5 |
This record reflects the sources and snapshot dates listed above at the time of generation. Not legal advice. ProviderScore screens exclusion/sanction lists, not primary-source license verification.
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