Medicare/Medicaid List - By Name

Transcription

Physicians Who Agreed to Treat Medicare/Medicaid Patients
Physicians Licensed Between July 2011 - June 2016
Important: This list is updated after each board meeting, which is now five times per year. You should always refer to
the board's profile information for the most recent data and for more details about a physician. The link is below.
You will need the physician's license number for easiest access to profile information.
http://www.tmb.state.tx.us/page/look-up-a-license
This list is sorted alphabetically by name.
License
Number
Q0392
Physician Name
Medicare/Me Medicare/Me
dicaid
dicaid
Agreement
Agreement Primary Specialty (SelfStart Date
End Date
Designated)
6/2/2014
P2817
Q0393
ABADIE SOLE, MONTSERRAT, MD
ABANG-HAYES, SARAH NICOLE,
MD
ABATE, SIU HAN PAOLA, MD
H9291
ABATI, ANDREA D, MD
P1839
ABAWI, LAILAH MARIE, DO
1/17/2012
P6758
Q7307
ABBARA, SUHNY, MD
ABBAS, MALIHA , DO
6/3/2013
04-Mar-16
Q5311
ABBAS, UME LUBNA, MD
P5251
ABBAS, ZOHAIR, MD
1/15/2013
1/15/2018 RHEUMATOLOGY
INTERNAL MEDICINE
Q1546
ABBASI, BUSHRA, MD
8/29/2014
8/29/2019 INTERNAL MEDICINE
Q1066
P4536
ABBASI, DAVID BEN, MD
ABBASI, NADIA HAFEEZ, MD
8/1/2014
10/1/2012
Q3997
ABBEY, ASHKAN MICHAEL, MD
5/1/2015
8/1/2019 ORTHOPEDICS
OPHTHALMOLOGY 5/1/2020 VITREOUS SURGERY
HOSPITALIST
SPORTS MEDICINE ORTHOPEDICS
Q5133
ABBURI, TRIVENI, MD
7/15/2015
4/13/2012
6/2/2014
12/15/2011
8/3/2015
6/2/2019 FAMILY MEDICINE
Secondary Specialty
(Self-Designated)
OBSTETRICS
DERMATOPATHOLOG
12/15/2016 Y
CYTOPATHOLOGY
EMERGENCY
1/17/2017 MEDICINE
CARDIOTHORACIC
6/3/2018 RADIOLOGY
RADIOLOGY
04-Mar-21 INTERNAL MEDICINE
INFECTIOUS
8/3/2020 DISEASES
INTERNAL MEDICINE
Page 1 of 402
Practice City
TULSA
Registration
Status of
Practice
Texas
State
License
OK
SAN ANTONIO TX
ROCKVILLE
LOCUM
TENENS
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/4/2014 None
N/A
4/13/2012 None
6/5/2014 None
N/A
N/A
MD
ACTIVE
12/20/2011 None
N/A
OH
ACTIVE
1/30/2012 None
N/A
BOSTON
MA
FORT WORTH TX
ACTIVE
ACTIVE
6/7/2013 None
26-May-16 None
N/A
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/5/2015 None
N/A
1/15/2013 None
N/A
8/29/2014 None
N/A
HOUSTON
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
8/6/2014 None
10/25/2012 None
N/A
N/A
DALLAS
TX
JACKSONVILL
E
FL
ACTIVE
5/6/2015 None
N/A
ACTIVE
9/11/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q3998
ABD EL KADER, AKRAM ADEL, MD
5/1/2015
P9994
ABDELFATTAH, BASEM, MD
5/2/2014
ANESTHESIOLOGY 5/2/2019 PAIN MANAGEMENT
Q3625
4/1/2015
4/1/2020 NEUROLOGY
P1954
ABDELHAMID, NOURELDIN M, MD
ABDELMOULA, MOHAMED MAHDY,
MD
ABDELRAHIM, MAEN , MD
ABDEL-REHIM, MOHAMED SABER,
MD
ABDOU, MARWA , MD
ABDUL KARIM, RAGHAD MUHSIN,
MD
ABDUL, OLUMUYIWA ADEGBENGA,
MD
Q5743
ABDULLAH, FARHAN SALMAN, DO
P9996
ABDULLAH, SAIF, MD
Q5611
ABEBE, EYOEL, MD
Q4552
ABERCROMBIE, JOHN F, MD
P6119
ABID, HUMAIRA -, MD
P0328
Q1781
P7055
Q3469
P8435
Secondary Specialty
(Self-Designated)
ANESTHESIOLOGY
VASCULAR
NEUROLOGY
Practice City
WICHITA
FALLS
8/5/2011 None
9/22/2014 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
7/16/2013 None
4/13/2015 None
N/A
N/A
TX
ACTIVE
12/10/2013 None
N/A
CLEVELAND
OH
ACTIVE
2/3/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
9/1/2015 None
N/A
5/2/2014 None
N/A
8/14/2015 None
N/A
6/1/2015 None
N/A
4/12/2013 None
N/A
ACTIVE
1/7/2015 None
N/A
ACTIVE
4/13/2015 None
N/A
5/2/2019 HOSPITALIST
EMERGENCY
6/1/2020 MEDICINE
TX
Q2501
ABIDI, MATEEN FATIMA, MD
12/3/2014
Q3626
4/1/2015
4/1/2020 PLASTIC SURGERY
P9283
ABNER, MONIQUE LISA, MD
ABODUNDE, OLADAPO
AKINKUNMI, MD
3/17/2014
P9141
ABOU-CHEBL, ALEX, MD
Q1782
Q0853
ABOUJAOUDE, DORY ROBERT, MD
ABOUTALEBI, AMIR , MD
9/15/2014
7/15/2014
7/15/2019 DERMATOLOGY
Q6996
ABRAHAM, ALBIN, MD
01-Feb-16
GASTROENTEROLOG EAST
01-Feb-21 INTERNAL MEDICINE Y
MEADOW
Page 2 of 402
3/3/2014
12/3/2019 CARDIOLOGY
CARDIOVASCULAR
IMAGING
3/3/2019 NEUROLOGY
N/A
ACTIVE
ACTIVE
INTERNAL MEDICINE DALLAS
4/12/2013
5/12/2014 None
TX
TX
6/1/2015
ACTIVE
HOUSTON
HOUSTON
12/6/2013
8/14/2015
N/A
N/A
FAMILY MEDICINE
5/2/2014
5/11/2015 None
4/7/2015 None
3/16/2020 PEDIATRICS
ACTIVE
ACTIVE
7/1/2013
3/16/2015
8/28/2015
Disciplinary
Status Date
NY
2/1/2017 PSYCHIATRY
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
BUFFALO
7/15/2011
9/15/2014
2/1/2012
Registration
Status of
Practice
Texas
State
License
MARSHFIELD WI
HAGERSTWO
N
MD
BOSTON
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
PLANO
MA
ACTIVE
3/26/2014 None
N/A
TX
ACTIVE
3/14/2014 None
N/A
HOSPITALIST
KS
ACTIVE
ACTIVE
10/6/2014 None
7/21/2014 None
N/A
N/A
NY
ACTIVE
03-Feb-16 None
N/A
WICHITA
License
Number
Physician Name
Q7621
ABRAHAM, ASHLEY, MD
dicaid
dicaid
Agreement
End Date
Designated)
01-Apr-16
01-Apr-21 OPHTHALMOLOGY
P2819
ABRAHAM, GEORGE , MD
4/13/2012
Q1548
P6306
P4730
ABRAHAM, JEMINI, MD
ABRAHAM, JENSON, MD
ABRAHAM, SAM S, MD
8/29/2014
5/1/2013
11/1/2012
Q5315
ABRAMOWITZ, JESSICA, MD
8/3/2015
P8828
ABREU, MARCONI , MD
2/7/2014
ENDOCRINOLOGY,
DIABETES AND
8/3/2020 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
2/7/2019 METABOLISM
Q0718
Q7125
ABU ALNAAJ, HANAN, MD
ABU SULB, AHMAD, MD
6/27/2014
16-Feb-16
P7234
ABUELEM, TAREK , MD
7/15/2013
K7129
ABUJAMRA, LINA MAY, MD
01-Feb-16
P7235
ABUNASSER, JAFAR JAMIL, MD
7/15/2013
Q3999
5/1/2015
01-Apr-16
10-Jun-16
01-Apr-21 INTERNAL MEDICINE
10-Jun-21 INTERNAL MEDICINE
Q4001
ABURIME, EKINADESE, MD
ABU-SPEITAN, MOHANAD
HAMDAN, MD
ACEVEDO, ABNER JORGE, MD
ACHARYA, NIKHIL BHUPENDRA,
MD
5/1/2015
Q4354
ACHI, EUGENE, MD
5/15/2015
5/15/2020 NEUROLOGY
Q5316
ACHUFF, BARBARA-JO, MD
8/3/2015
8/3/2020 PEDIATRICS
P9497
ACKERMAN, BRANDEY LYNNE, MD
4/1/2014
4/1/2019 PEDIATRICS
P0691
ACKLIN, JOY DEANN, DO
Q7622
Q8688
8/15/2011
16-Feb-21 PEDIATRICS
NEUROLOGICAL
7/15/2018 SURGERY
PEDIATRIC
EMERGENCY
01-Feb-21 MEDICINE (PEDS)
PULMONARY
7/15/2018 MEDICINE
GASTROENTEROLOG
5/1/2020 Y
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
KANSAS CITY MO
ACTIVE
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/29/2014 None
5/8/2013 None
11/5/2012 None
N/A
N/A
N/A
8/5/2015 None
N/A
2/18/2014 None
N/A
6/27/2014 None
19-Feb-16 None
N/A
N/A
7/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
13-Apr-16 None
N/A
7/15/2013 None
N/A
ACTIVE
5/18/2015 None
N/A
TUSCALOOSA AL
SAN ANGELO TX
ACTIVE
ACTIVE
21-Apr-16 None
20-Jun-16 None
N/A
N/A
BROOKLYN
ACTIVE
5/12/2015 None
N/A
LICENSE
ISSUED
5/15/2015 None
N/A
ACTIVE
8/7/2015 None
N/A
ACTIVE
4/7/2014 None
N/A
ACTIVE
8/29/2011 None
N/A
DALLAS
BURLESON
EMERGENCY
MEDICINE
CRITICAL CARE
MEDICINE (IM)
NAPERVILLE
IL
INTERNAL MEDICINE
CLINICAL
NEUROPHYSIOLOGY
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
8/15/2016 GENERAL PRACTICE
GENERAL SURGERY
Page 3 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
20-Apr-16 None
N/A
UNDER
BOARD
4/13/2012 ORDER
4/13/2012
NY
TX
License
Number
Q8652
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
01-Jun-16
P2567
ACORD, STEPHANIE NOELLE, MD
ACOSTA LARA, MARIA DEL PILAR,
MD
ACOSTA, KRISTY ROCIO, MD
ACOSTA, VERONICA DEL
SOCORRO, MD
Q8404
ACOSTA-TORRES, STEFANY , MD
01-Jun-16
P3602
ACUN, CEYDA, MD
6/15/2012
Q2422
Q7822
ADACHI, MARI, MD
ADAMS, BARBARA JEANNE, MD
Q4879
ADAMS, BROOK ANDREW, MD
Q7519
ADAMS, CLAYTON , MD
15-Mar-16
Q2719
P4403
ADAMS, GARETH JOHN, MD
ADAMS, GRETCHEN MAY, MD
1/5/2015
9/17/2012
P1955
Q6386
ADAMS, TAJ CORDELL, MD
ADAMS-KRUEGER, ANDREA
JANENE, MD
11/2/2015
P9498
Q7309
P5916
ADAMU, MOHAMMED T, DO
ADAPA, PAVANI, MD
ADAPA, SREEDHAR REDDY, MD
4/1/2014
04-Mar-16
4/1/2013
Q3319
ADDASI, ALAA A, MD
3/3/2015
P5582
ADEBO, DILACHEW ACHIKO, MD
3/1/2013
3/3/2020 VASCULAR SURGERY
PEDIATRICS,
3/1/2018 CARDIOLOGY
P8829
2/7/2014
2/7/2019 PEDIATRICS
Q0719
P4404
ADEBO, SENAIT MENGISTEAB, MD
ADEDEJI, ADEBUKOLA ADEN
ALEXANDER, MD
ADEDIJI, FAUSAT ABIDEMI, MD
6/27/2014
9/17/2012
6/27/2019 GENERAL SURGERY
Q5745
ADEGBESAN, SUSAN, MD
8/28/2015
P2568
P8632
4/2/2012
1/3/2014
4/2/2012
11/17/2014
15-Apr-16
7/1/2015
2/1/2012
Secondary Specialty
(Self-Designated)
Practice City
01-Jun-21 CHILD NEUROLOGY
4/2/2017 PEDIATRICS
OBSTETRICS AND
01-Jun-21 GYNECOLOGY
6/15/2017 NEONATOLOGY
PULMONARY
CRITICAL CARE
11/17/2019 MEDICINE
15-Apr-21 GENERAL SURGERY
ORTHOPEDIC
7/1/2020 SURGERY
ANESTHESIOLOGY 15-Mar-21 PAIN MANAGEMENT
NEUROLOGICAL
1/5/2020 SURGERY
9/17/2017 FAMILY PRACTICE
EMERGENCY
2/1/2017 MEDICINE
EMERGENCY
4/1/2019 MEDICINE
04-Mar-21 RADIOLOGY
4/1/2018 NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
01-Jun-16 None
N/A
GALVESTON
TX
ACTIVE
ACTIVE
4/4/2012 None
1/10/2014 None
N/A
N/A
DALLAS
TX
ACTIVE
4/27/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
07-Jun-16 None
N/A
6/15/2012 None
N/A
PEDIATRICS
SLEEP MEDICINE
NORWICH
CT
ACTIVE
ACTIVE
11/18/2014 None
25-Apr-16 None
N/A
N/A
GRANBURY
TX
ACTIVE
7/13/2015 None
N/A
LUBBOCK
TX
ACTIVE
25-Mar-16 None
N/A
HOUSTON
PAMPA
TX
TX
ACTIVE
ACTIVE
1/22/2015 None
9/19/2012 None
N/A
N/A
ATLANTA
GA
ACTIVE
2/7/2012 None
N/A
AUSTIN
TX
ACTIVE
11/17/2015 None
N/A
MA
TX
ACTIVE
ACTIVE
ACTIVE
5/1/2014 None
01-Apr-16 None
4/5/2013 None
N/A
N/A
N/A
ACTIVE
3/17/2015 None
N/A
PHILADELPHIA PA
CORPUS
CHRISTI
TX
ACTIVE
3/5/2013 None
N/A
ACTIVE
2/11/2014 None
N/A
SAN ANTONIO TX
SHAWNEE
OK
BRECKENRID
GE
TX
ACTIVE
ACTIVE
6/30/2014 None
11/8/2012 None
N/A
N/A
ACTIVE
8/31/2015 None
N/A
FAMILY PRACTICE
NEURO-RADIOLOGY BOSTON
INTERNAL MEDICINE GAINESVILLE
Page 4 of 402
License
Number
Physician Name
Q2635
ADEJUMO, ENIOLA ADEOLA, MD
Q7624
P2939
Q6804
dicaid
dicaid
Agreement
End Date
Designated)
12/15/2014
ADENWALA, YUSUF EBRAHIM, MD
01-Apr-16
ADEOYE, MARTINS ADEMOLA, MD
5/1/2012
CHILD AND
ADOLESCENT
5/1/2017 PSYCHIATRY
ADEPOJU, OLUWAROTIMI , MD
06-Jan-16
ADESANYA, ISMAIL OLAYINKA, MD
12/17/2012
P5019
12/17/2012
P5019
12/17/2012
P8105
ADESINA, ORE-OFE OLUWASEUN,
MD
10/15/2013
Q2502
ADEWUMI, DARE ALABI, MD
12/3/2014
10/15/2018 OPHTHALMOLOGY
NEUROLOGICAL
12/3/2019 SURGERY
P5253
1/15/2013
3/17/2014
P5152
ADEYEFA, BABATUNDE , MD
ADEYEFA, MODUPE MORONKE,
MD
ADEYEFA, OLUDAYO ADEDOTUN,
MD
ADEYEKUN, OMOBOLANLE
OMOLAYO, MD
P5766
ADEYEMI, OLUYEMISI ADEDOYIN,
MD
P5583
P1956
3/1/2013
1/4/2013
3/15/2013
P4842
ADEYEMO, FOYEKE ADEYELU, MD
ADEYEMO, VIVIAN
OGHENEVWEDE, MD
2/1/2012
Q4355
ADHIKARI, EMILY HARRIS, MD
5/15/2015
Q0213
P8208
ADIB, NAZILA, MD
ADIMOOLAM, KIRANMAYI, MD
5/15/2014
11/1/2013
11/15/2012
Practice City
LICENSE
ISSUED
HOUSTON
TX
CEDAR
RAPIDS
IA
FAMILY PRACTICE EMERGENCY MED
OTHER SPECIALTY
ACTIVE
LICENSE
ISSUED
PSYCHIATRY
06-Jan-21 PEDIATRICS
P5019
P9284
Secondary Specialty
(Self-Designated)
GERIATRIC
MEDICINE (INTERNAL
MED)
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/15/2014 None
N/A
20-Apr-16 None
N/A
5/1/2012 None
N/A
03-Mar-16 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
HOUSTON
TX
ACTIVE
10/17/2013 None
N/A
ATLANTA
GA
12/10/2014 None
N/A
ACTIVE
LICENSE
ISSUED
1/15/2013 None
N/A
3/17/2019 RADIOLOGY
ACTIVE
4/3/2014 None
N/A
ACTIVE
3/12/2013 None
N/A
3/1/2018 ANESTHESIOLOGY
OBSTETRICS &
GYNECOLOGICAL
3/15/2018 SURGERY
EMERGENCY
2/1/2017 MEDICINE
GERIATRICS 11/15/2017 INTERNAL MEDICINE
OBSTETRICS AND
5/15/2020 GYNECOLOGY
HOSPITALIST
POPLAR
BLUFF
MO
ACTIVE
2/4/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
4/4/2013 None
N/A
2/1/2012 None
N/A
12/31/2012 None
N/A
5/21/2015 None
N/A
5/15/2014 None
11/19/2013 None
N/A
N/A
EMERGENCY
MEDICINE
GERIATRICS
5/15/2019 PSYCHIATRY
Page 5 of 402
NEW HYDE
PARK
NY
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Agreement Primary Specialty (Self- Secondary Specialty
Start Date
End Date
Designated)
(Self-Designated)
DIAGNOSTIC
4/1/2013
4/1/2018 RADIOLOGY
NEURO-RADIOLOGY
EMERGENCY
10/1/2013
10/1/2018 MEDICINE
P5917
ADKISON, JONATHAN SCOTT, MD
P8007
ADMASU, FEKADU, DO
Q3628
Q8195
ADNAN, MUHAMMAD KASHIF, MD
ADONIS, MICHEL JOHN, MD
4/1/2015
16-May-16
P2409
ADU-LARTEY, SAMUEL MAXWELL,
DO
3/15/2012
16-May-21 PEDIATRICS
ORTHOPEDIC
SURGERY OF THE
3/15/2017 SPINE
P0530
P9501
ADYANTHAYA, ROHIT, MD
AELLA, SANJEETHA, MD
8/1/2011
4/1/2014
Q1067
8/1/2014
P0330
AERTKER, ROBERT ALAN, MD
AFOLABI, FOLASHADE
CATHERINE, MD
7/15/2011
P0692
P0945
P9143
AFTAB, MUHAMMAD , MD
AFTAB, RAFIA, MD
AFZAL, AASIM M, MD
8/15/2011
9/15/2011
3/3/2014
THORACIC
CARDIOVASCULAR
8/15/2016 SURGERY
Q2968
AFZAL, ATIF, MD
2/2/2015
Q0602
P9783
P0890
Q4357
AFZAL, SYED MUJTIBA, MD
AFZAL, USMAN, MD
AGARWAL, ANSHUL , MD
AGARWAL, DEVESH, MD
6/16/2014
4/15/2014
9/1/2011
5/15/2015
6/16/2019
4/15/2019
9/1/2016
5/15/2020
P4405
AGARWAL, HEMANT SHYAM, MD
9/17/2012
Q1934
AGARWAL, NIDHI, MD
10/1/2014
Q3841
P8438
AGARWAL, SALONI, MD
AGARWAL, SANJAY, MD
4/10/2015
12/6/2013
Q8196
AGARWAL, SHIVUM K, MD
16-May-16
FAMILY PRACTICE
INTERNAL MEDICINE
NUCLEAR MEDICINE
FAMILY MEDICINE
16-May-21 FAMILY MEDICINE
Practice City
TEMPLE
Registration
Status of
Practice
Texas
State
License
TX
N/A
10/1/2013 None
N/A
4/1/2015 None
20-May-16 None
N/A
N/A
3/20/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/5/2011 None
4/7/2014 None
N/A
N/A
8/1/2014 None
N/A
TX
ACTIVE
8/5/2011 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
8/22/2011 None
11/11/2011 None
3/5/2014 None
N/A
N/A
N/A
2/2/2015 None
N/A
FORT WORTH TX
ORTHOPEDIC
SURGERY
ACTIVE
OPHTHALMOLOGY VITREOUS SURGERY MCALLEN
TX
CARDIOLOGY
DALLAS
GENERAL SURGERY HOUSTON
FAMILY PRACTICE
GARLAND
DALLAS
EMERGENCY
MEDICINE
NEPHROLOGY
FAMILY MEDICINE
HOSPITALIST
PEDIATRIC
INTENSIVE CARE
PEDIATRICS
NEONATALPERINATAL
MEDICINE
HOSPITALIST
Disciplinary
Status Date
4/23/2013 None
HOSPITALIST
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
AUGUSTA
TX
GA
LINCOLN
ME
NASHVILLE
TN
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/30/2014
5/7/2014
9/8/2011
5/26/2015
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/1/2012 None
N/A
10/1/2014 None
N/A
SAN ANTONIO TX
RAPID CITY
SD
ACTIVE
ACTIVE
4/14/2015 None
12/12/2013 None
N/A
N/A
GENERAL PRACTICE FORT WORTH TX
ACTIVE
06-Jun-16 None
N/A
Page 6 of 402
License
Number
Physician Name
Q2969
AGBASI, FUNKE F, MD
Q7996
AGBOOLA, SUNDAY ABIODUN, MD
dicaid
dicaid
Agreement
End Date
Designated)
2/2/2015
02-May-16
P6941
P8106
P9285
P6760
Q5318
AGBORO-IDAHOSA, EJIRO VIVIAN,
MD
AGGARWAL, GITIKA, MD
AGGARWAL, HIMANSHU, MD
AGGARWAL, MONIKA, MD
AGHAROKH, LADAN, MD
P6761
AGNONE, JOHN HENRY, MD
Q8690
AGOSTO SALGADO, SARIMAR
NAHOMIS, MD
10-Jun-16
P9286
Q5135
P1257
AGRAWAL, HITESH, MD
AGRAWAL, MEGHA , MD
AGRAWAL, MONICA , MD
3/17/2014
7/15/2015
11/4/2011
Q0721
Q6387
AGRAWAL, RITWICK , MD
AGUIAR, RUDXANDRA, MD
AGUILAR, VIVIAN DEL CARMEN,
MD
6/27/2014
11/2/2015
2/13/2015
Q2720
AGUILUZ, CESAR EMILIO, DO
AGUINAGA, MARIA DE LOURDES,
MD
AGUIRRE, HEATHER GUADALUPE,
DO
Q0856
Q0396
AGUIRRE, JAVIER , MD
AGUSALA, BETHANY ANNE, MD
7/15/2014
6/2/2014
Q0214
AHADI, JAVID, DO
5/15/2014
P8008
Q3137
P4922
6/14/2013
10/15/2013
3/17/2014
6/3/2013
8/3/2015
6/3/2013
10/1/2013
11/30/2012
1/5/2015
Secondary Specialty
(Self-Designated)
Practice City
02-May-21 INTERNAL MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
CYTOPATHOLOGY
UROLOGY
INTERNAL MEDICINE
PEDIATRICS
6/14/2018
10/15/2018
3/17/2019
6/3/2018
8/3/2020
PSYCHIATRY
PATHOLOGY
UROLOGY
NEPHROLOGY
HOSPITALIST
CARDIOVASCULAR
6/3/2018 SURGERY
ENDOCRINOLOGY,
DIABETES AND
10-Jun-21 METABOLISM
PULMONARY
CRITICAL CARE
6/27/2019 MEDICINE
OBSTETRICS AND
PLASTIC &
RECONSTRUCTIVE
2/13/2020 SURGERY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/2/2015 None
N/A
CRANBERRY
PA
ACTIVE
04-May-16 None
N/A
SIOUX CITY
AUGUSTA
DALLAS
IA
GA
TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/25/2013
10/25/2013
3/25/2014
6/7/2013
8/4/2015
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
6/3/2013 None
N/A
INTERNAL MEDICINE SAN ANTONIO TX
PEDIATRICS,
CARDIOLOGY
CHICAGO
IL
GARLAND
TX
FAMILY PRACTICE
ACTIVE
21-Jun-16 None
N/A
ACTIVE
ACTIVE
ACTIVE
3/25/2014 None
7/17/2015 None
11/8/2011 None
N/A
N/A
N/A
SLEEP MEDICINE
HOUSTON
AUSTIN
TX
TX
ACTIVE
ACTIVE
7/1/2014 None
11/10/2015 None
N/A
N/A
UROGYNECOLOGY
AUSTIN
TX
ACTIVE
10/4/2013 None
N/A
ACTIVE
LICENSE
ISSUED
2/16/2015 None
N/A
11/30/2012 None
N/A
ACTIVE
2/16/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/18/2014 None
6/17/2014 None
N/A
N/A
5/15/2014 None
N/A
SAN ANTONIO TX
HOSPITALIST
OBSTETRICS &
GYNECOLOGICAL
7/15/2019 SURGERY
EMERGENCY
5/15/2019 MEDICINE
Page 7 of 402
DALLAS
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
INFECTIOUS
9/15/2016 DISEASES
P0946
Q1068
AHLUWALIA, MANEESHA , MD
AHMAD, ABIR, MD
Q6596
Q6596
Q6596
Q2636
Q4359
P9784
P0947
P0331
AHMAD, JAZBEEN HENNA, MD
AHMAD, MOHAMMED , MD
AHMAD, MUHAMMAD IMRAN, MD
AHMAD, MUHAMMAD ISMAIL, MD
AHMAD, SALMAN, MD
AHMAD, TANVIR, MD
P1721
AHMADI, SARA , MD
P1258
11/4/2011
Q4882
AHMADIAN, VERONICA ARCE, MD
AHMED TAHA, RIHAB ELAMEEN ,
MD
Q5959
AHMED, ABDUL-AZIZ R, MD
9/15/2015
EMERGENCY
9/15/2020 MEDICINE
P6120
Q4880
AHMED, AGHA JAMIL, MD
AHMED, ALI, MD
4/12/2013
7/1/2015
P1509
AHMED, ASHRAF, MD
12/1/2011
Q5320
AHMED, FARHAN, MD
8/3/2015
PULMONARY
CRITICAL CARE
8/3/2020 MEDICINE
HOSPITALIST
P1841
AHMED, IRFAN, MD
1/17/2017 NEPHROLOGY
INTERNAL MEDICINE
Q1069
AHMED, MOHAMMED ARIF, MD
Q6725
AHMED, MOHAMMED IQBAL, MD
AHMED, MOHAMMED SAIFUDDIN,
MD
Q5321
9/15/2011
8/1/2014
Secondary Specialty
(Self-Designated)
12/4/2015
04-Dec-15
04-Dec-15
12/15/2014
5/15/2015
4/15/2014
9/15/2011
7/15/2011
1/2/2012
7/1/2015
1/17/2012
8/1/2014
12/4/2020
04-Dec-20
04-Dec-20
12/15/2019
5/15/2020
4/15/2019
9/15/2016
7/15/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
ENDOCRINOLOGY,
DIABETES AND
1/2/2017 METABOLISM
NEPHROLOGY
HOSPITALIST
HOSPITALIST
GALVESTON
15-Dec-15
15-Dec-20 ANESTHESIOLOGY
8/3/2015
Registration
Status of
Practice
Texas
Practice City
State
License
DELINQUEN
T-NON
PAYMENT
RICHARDSON TX
ACTIVE
LICENSE
ISSUED
WACO
TX
ACTIVE
WACO
TX
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
LOVELAND
OH
ACTIVE
YAKIMA
WA
ACTIVE
NEPHROLOGY
SPORTS MEDICINE EMERGENCY MED
INTERVENTIONAL
CARDIOLOGY
HOSPITALIST
Disciplinary
Status Date
12/14/2011 None
8/5/2014 None
N/A
N/A
12/4/2015
13-Jan-16
13-Jan-16
12/16/2014
5/18/2015
4/16/2014
10/3/2011
8/31/2011
None
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
TX
ACTIVE
1/4/2012 None
N/A
SAN ANTONIO TX
ACTIVE
11/17/2011 None
N/A
DALLAS
TX
ACTIVE
8/5/2015 None
N/A
EDINBURG
TX
ACTIVE
9/21/2015 None
N/A
WICHITA
LONDON
KS
KY
ACTIVE
ACTIVE
LICENSE
ISSUED
4/23/2013 None
7/9/2015 None
N/A
N/A
12/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
8/17/2015 None
N/A
1/17/2012 None
N/A
MO
ACTIVE
8/21/2014 None
N/A
TX
ACTIVE
16-Dec-15 None
N/A
TX
ACTIVE
8/4/2015 None
N/A
HOUSTON
JEFFERSON
INTERNAL MEDICINE CITY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
DALLAS
DALLAS
Page 8 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
3/17/2014
3/17/2019 MEDICINE
SLEEP MEDICINE
P9287
AHMED, MURTUZA MOHAMMED,
MD
P5319
P9504
Q4361
AHMED, SOHAIL, MD
AHMED, SUBHAN , MD
AHMED, SUMAIRA, MD
2/1/2013
4/1/2014
5/15/2015
4/1/2019 NEPHROLOGY
P5254
AHMED, SYED MASHOOD, MD
1/15/2013
P4406
Q1344
Q5746
AHMED, SYED NASIM, MD
AHMED, SYED TAHSIN, DO
AHMED, UMER, MD
9/17/2012
8/15/2014
8/28/2015
Q4881
AHMED, WAMDA OSMAN, MD
7/1/2015
P2412
Q6137
AHMED, YASIR, MD
AHMED, YASIR, MD
3/15/2012
10/1/2015
7/1/2020 NEUROLOGY
INFECTIOUS
3/15/2017 DISEASES
Q6805
AHN, JIYONG, MD
06-Jan-16
Q4004
Q5747
AHN, SUN MI, MD
AIBANA, OMOWUNMI, MD
5/1/2015
8/28/2015
06-Jan-21 RADIOLOGY
HEAD AND NECK
5/1/2020 SURGERY
AIGBIVBALU, LEMUEL OSE, MD
5/15/2012
Q2227
11/7/2014
EMERGENCY
7/1/2020 MEDICINE
P6942
AIRUEHIA, EFOSA, MD
AIYEJORUN, AYODEJI
OLUKAYODE, MD
AIZMAN, ALEXANDER, MD
AJIBADE, OLUWASEUN AKINWALE,
MD
6/14/2013
P1723
Q0604
AJIBADE, TOPE, MD
AJINE, FADI, MD
1/2/2012
6/16/2014
Q4884
AJMAL, MUHAMMAD , MD
Q4883
P5153
7/1/2015
1/4/2013
7/1/2015
HOUSTON
FAMILY MEDICINE
INTERVENTIONAL
RADIOLOGY
OTOLARYNGOLOGY
TX
Disciplinary
Status Date
4/4/2014 None
N/A
OK
MO
2/1/2013 None
5/6/2014 None
6/8/2015 None
N/A
N/A
N/A
IA
ACTIVE
2/7/2013 None
N/A
CA
TX
TX
9/24/2012 None
8/18/2014 None
9/11/2015 None
N/A
N/A
N/A
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/1/2015 None
N/A
ODESSA
VICTORIA
TX
TX
ACTIVE
ACTIVE
3/16/2012 None
10/14/2015 None
N/A
N/A
WILTON
CT
ACTIVE
28-Jan-16 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
5/5/2015 None
8/31/2015 None
N/A
N/A
GALVESTON
TX
ACTIVE
5/25/2012 None
N/A
COLUMBIA
MO
ACTIVE
11/13/2014 None
N/A
HOUSTON
BROOKLYN
TX
NY
ACTIVE
ACTIVE
7/3/2015 None
1/15/2013 None
N/A
N/A
7/1/2013 None
N/A
1/2/2012 None
6/23/2014 None
N/A
N/A
7/3/2015 None
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
NASHVILLE
Page 9 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
INTERNAL MEDICINE TULSA
LEES SUMMIT
INTERVENTIONAL
CARDIOLOGY
CARROLL
CARDIOVASCULAR
IMAGING
MODESTO
TEMPLE
HOSPITALIST
BRYAN
CRITICAL CARE NEUROSURGERY
HOUSTON
PEDIATRIC
INFECTIOUS
DISEASE
CHILD AND
ADOLESCENT
PSYCHIATRY
P3108
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
ACTIVE
TN
ACTIVE
License
Number
P6763
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1511
AJMAL, MUHAMMAD SULEMAN, MD
AJUFO, CHRISTOPHER ANIKWE,
MD
AJUMOBI, ADEWALE BABATUNDE,
MD
Q4885
AKAJAGBOR, EDESIRI, MD
P6564
Q1070
AKALONU, AMAKA , MD
AKBAR, KULSUM, MD
5/15/2013
8/1/2014
P8573
AKHAVAN, NAJMEH, MD
12/16/2013
Q1935
AKHONDI ASL, HOSSEIN, MD
10/1/2014
P6311
P6312
P7603
Q1936
AKHTAR, OMAR H, MD
AKHTER, JAWEED, MD
AKINKUOTU, ADESOLA CYNTHIA
OMOWONUOLA, MD
AKINMURELE, OLADOTUN, MD
ORTHOPEDIC
5/1/2018 SURGERY
Q5322
AKINSANYA, ADEKEMI O, MD
Q7997
AKINTOLA, MORAKINYO O, MD
Q1345
Q3320
AKINYEMI, FOLUKE ADEOLA, MD
AKKINAPALLY, SMITA, MD
P2569
AKLE, NASSIM , MD
4/2/2012
P7375
AKOTIA, VIMESH BALUBHAI, MD
8/1/2013
Q7311
P6565
P7376
AKPAN, IMO MURRAY, MD
AKSADE, ARTUN, MD
AKTUNC, ERDEM, MD
P5020
AKUNYILI, EDOZIE JOHN, MD
12/17/2012
P5020
12/17/2012
Q0398
6/3/2013
6/2/2014
12/1/2011
OBSTETRICS AND
7/1/2020 GYNECOLOGY
7/1/2015
5/1/2013
5/1/2013
8/15/2013
10/1/2014
8/3/2015
02-May-16
8/15/2014
3/3/2015
04-Mar-16
5/15/2013
8/1/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SAN ANGELO TX
GASTROENTEROLOG
Y
SAN ANTONIO TX
PEDIATRICS
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/3/2013 None
N/A
6/5/2014 None
N/A
2/23/2012 None
N/A
7/1/2015 None
N/A
5/15/2013 None
8/4/2014 None
N/A
N/A
12/16/2013 None
N/A
INTERNAL MED EMERGENCY MED
HEREFORD
TX
ACTIVE
10/7/2014 None
N/A
AUSTIN
KARACHI
TX
DIABETES
ACTIVE
ACTIVE
5/7/2013 None
7/3/2013 None
N/A
N/A
PORTALES
NM
ACTIVE
ACTIVE
8/23/2013 None
10/6/2014 None
N/A
N/A
LAREDO
TX
ACTIVE
8/10/2015 None
N/A
KATY
TX
06-May-16 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/15/2014 None
4/1/2015 None
N/A
N/A
4/2/2012 None
N/A
OBSTETRICS AND
8/3/2020 GYNECOLOGY
EMERGENCY
02-May-21 MEDICINE
PHYSICAL MED. &
8/15/2019 REHABILITATION
3/3/2020 PEDIATRICS
4/2/2017 RADIOLOGY
GASTROENTEROLOG
8/1/2018 Y
INTERNAL MEDICINE
GASTROENTEROLOG
04-Mar-21 Y
8/1/2018 INTERNAL MEDICINE HOSPITALIST
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
Page 10 of 402
PALESTINE
TX
ACTIVE
8/26/2013 None
N/A
ODESSA
TX
ACTIVE
ACTIVE
ACTIVE
14-Mar-16 None
5/17/2013 None
8/6/2013 None
N/A
N/A
N/A
WOODLANDS TX
ACTIVE
1/7/2013 None
N/A
WOODLANDS TX
ACTIVE
1/7/2013 None
N/A
License
Number
P5020
P8831
Physician Name
Registration
dicaid
dicaid
Status of
Agreement
Practice
Texas
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
License
EMERGENCY
12/17/2012
12/17/2017 MEDICINE
WOODLANDS TX
ACTIVE
2/7/2014
ACTIVE
Q3321
AL AMERI, ALI , MD
AL HALLAK, MOHAMMED NAJEEB,
MD
Q5323
Q3471
Q8198
AL HAMMOUD, ROUKAYA , MD
AL HANAYNEH, MUHANNAD, MD
AL ISLAM ASHRAF, MUFEED, MD
8/3/2015
3/16/2015
16-May-16
P1613
Q7521
12/15/2011
15-Mar-16
Q2229
AL KHASAWNEH, EIHAB, MD
AL RIFAI, ANAS, MD
AL SAEDI, MUHANED GATEA
ABDUL NABEE, MD
P8832
AL SHAMY, GEORGE , MD
P9289
3/17/2014
Q2970
AL TAMIMI, MAZIN , MD
AL-AFGHANI, AL-HASAN KHALED
MOHAMMED, MD
NEUROLOGICAL
2/7/2019 SURGERY
NEUROLOGICAL
3/17/2019 SURGERY
2/2/2015
Q1552
ALALAWI, ABBAS HUSSAIN, MD
8/29/2014
P0160
ALALAWI, RAED , MD
Q4712
ALAM, HILMI, MD
3/3/2015
11/7/2014
2/7/2014
7/1/2011
6/12/2015
HOSPITALIST
PEDIATRIC
8/3/2020 INFECTIOUS DISEASE PEDIATRICS
16-May-21 NEONATOLOGY
PEDIATRIC
NEPHROLOGY
15-Mar-21 NEPHROLOGY
HOUSTON
TX
GALVESTON
HOUSTON
TX
TX
DALLAS
TX
PAIN & SPINE
GALVESTON
GERIATRIC
MEDICINE (INTERNAL
MED)
PULMONARY
CRITICAL CARE
MEDICINE
LUBBOCK
TX
ALAM, MD MONJURUL, MD
ALAM, NIMAT , MD
7/15/2011
5/1/2013
P9787
Q1346
ALAM, SAIMA , MD
ALAM, TARIQ, MD
4/15/2014
8/15/2014
8/15/2019 RADIOLOGY
P9041
P5768
Q1937
ALAM, UZMA, MD
ALATTAR, MONA LISA , MD
ALATTAR, SHAKIR , MD
2/18/2014
3/15/2013
10/1/2014
2/18/2019 RADIOLOGY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
GERIATRICS
GERIATRIC
PSYCHIATRY
NEURO-RADIOLOGY
ODESSA
AUSTIN
TX
ONCOLOGY
DALLAS
TX
Page 11 of 402
TX
1/7/2013 None
2/12/2014 None
N/A
N/A
3/6/2015 None
N/A
9/1/2015 None
3/17/2015 None
13-Jun-16 None
N/A
N/A
N/A
12/15/2011 None
07-Apr-16 None
N/A
N/A
ACTIVE
11/10/2014 None
N/A
2/20/2014 None
N/A
3/17/2014 None
N/A
2/5/2015 None
N/A
8/29/2014 None
N/A
ACTIVE
LICENSE
ISSUED
TX
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
P0332
P6314
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
7/6/2011 None
N/A
6/12/2015 None
N/A
ACTIVE
ACTIVE
7/25/2011 None
5/9/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/16/2014 None
8/27/2014 None
N/A
N/A
2/18/2014 None
4/1/2013 None
10/3/2014 None
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0333
ALAUDDIN, KASHIF, MD
7/15/2011
P6122
4/12/2013
Q5138
Q1938
ALAVA, IBRAHIM III, MD
ALAWI-KAKOMANOLIS, NADIA
ANNE, MD
ALAWIN, ISSAM ABDELKARIM
HUSSEIN, MD
ALAYYAN, AMBER SUDQI, MD
7/15/2015
10/1/2014
7/15/2020 ONCOLOGY
P5769
ALBERTS, MARK J, MD
3/15/2013
3/15/2018 NEUROLOGY
Q7824
ALBINI, PAUL THOMAS, MD
15-Apr-16
Q7825
ALBINO, MIGUEL, MD
15-Apr-16
HEMATOLOGY/ONCOL
15-Apr-21 OGY
Q2723
P0694
ALBREKTSON, JOSHUA, MD
AL-BUOSHKOR, OMER SALIH
MAHDI, MD
ALBUQUERQUE, KEVIN VINCENT
DE PAUL, MD
P7377
ALBURKI, ABDUSSALAM M, MD
Q5325
P1512
P2570
Q2971
4/2/2012
1/5/2020 RADIOLOGY
2/2/2015
RADIATION
8/15/2016 ONCOLOGY
ALCALAN, PAULINA MARTINEZ, DO
AL-CHADERCHI, SILVANA Y, MD
8/3/2015
12/1/2011
Q2231
P3603
ALDABAG, SADDAM KHALEEL, MD
ALDEIRI, MOLHAM , MD
11/7/2014
6/15/2012
K7967
8/3/2015
Q7004
ALDER, LAWRENCE ALLEN, MD
ALDINGER, JARRETT DESMOND,
MD
01-Feb-16
P2088
ALDRICH, JOSEPH ALBERT III, DO
2/10/2012
P6315
ALEMU, BENYAM GIZACHEW, MD
ALETI, SUMITH CHANDER REDDY,
MD
ALEXANDER, AMITA, MD
5/1/2013
2/1/2013
9/15/2011
BROOKLYN
2/1/2018 CARDIOLOGY
ACTIVE
NY
ACTIVE
LICENSE
ISSUED
ACTIVE
INTERNAL MEDICINE GALVESTON
TX
VASCULAR
NEUROLOGY
TX
DALLAS
7/15/2011 None
N/A
4/16/2013 None
N/A
4/5/2012 None
N/A
7/15/2015 None
11/17/2014 None
N/A
N/A
N/A
15-Apr-16 None
N/A
ACTIVE
21-Apr-16 None
N/A
ACTIVE
LICENSE
ISSUED
1/22/2015 None
N/A
2/2/2015 None
N/A
TX
ACTIVE
8/25/2011 None
N/A
TX
ACTIVE
8/6/2013 None
N/A
MANSFIELD
TX
ACTIVE
ACTIVE
8/5/2015 None
12/6/2011 None
N/A
N/A
PERTH
AMBOY
NJ
ACTIVE
ACTIVE
SAN ANTONIO TX
ACTIVE
SAN ANGELO
FORT
BENNING
TX
ACTIVE
16-Mar-16 None
N/A
GA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
2/20/2012 None
N/A
5/1/2013 None
N/A
2/1/2013 None
9/23/2011 None
N/A
N/A
TX
PEDIATRICS
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
LEVELLAND
Page 12 of 402
Disciplinary
Status Date
3/21/2013 None
INTERNAL MEDICINE
BRACHYTHERAPY/HY
PERTHERMIA
DALLAS
INFECTIOUS
DISEASES
HOUSTON
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
EL PASO
01-Feb-21 ANESTHESIOLOGY
EMERGENCY
2/10/2017 MEDICINE
TX
LOS ANGELES CA
8/1/2013
P5321
P0948
Practice City
INTERNAL MEDICINE
OTORHINOLARYNGOL
4/12/2018 OGY
OTOLARYNGOLOGY HOUSTON
1/5/2015
8/15/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
11/11/2014 None
6/18/2012 None
UNDER
BOARD
8/10/2015 ORDER
N/A
N/A
7/20/2015
License
Number
Physician Name
P3277
ALEXANDER, IAN J, MD
Q7312
dicaid
dicaid
Agreement
End Date
Designated)
6/1/2012
6/1/2017 OTOLARYNGOLOGY
ORTHOPEDIC
04-Mar-16
04-Mar-21 SURGERY
Q8199
ALEXANDER, JAMIE JACOB , MD
ALEXANDER, JAMIE KADUKUNNEL,
MD
P5504
ALEXANDER, NEBU T, MD
2/8/2013
P5922
ALEXANDER, WARREN, MD
ALFARAWATI, MOHAMMAD
NABEEL, MD
4/1/2013
4/1/2018 ONCOLOGY
1/2/2012
P1724
16-May-16
Q4556
P8633
ALFONSO, JOHN DENNIS
CAYANAN, MD
ALFORD, ERIC NATHAN, MD
ALFORD, RAPHAEL ETARIO, MD
ALGENDY, ABDALRAHMAN AHMED,
MD
AL-HADER, AHMAD , MD
P6764
AL-HAFEZ, BARAA , MD
Q7523
Q4007
ALHALBOUNI, SAADI, MD
ALHARBI, EMAN, MD
Q4008
Q1072
ALHASSAN, FATIMAT, MD
ALHOMOSH, ALAAEDIN , MD
P0532
P5322
Q7127
P0334
ALI, ABDULFATAH MOHAMED, MD
ALI, ADIL RUKNUDDIN, MD
ALI, EMAD S, MD
ALI, FOZIA AKHTAR, MD
8/1/2011
2/1/2013
16-Feb-16
7/15/2011
8/1/2016
2/1/2018
16-Feb-21
7/15/2016
Q6138
ALI, IRFAN , MD
10/1/2015
PEDIATRIC
10/1/2020 NEUROLOGY
P4843
ALI, ISHAQ, MD
11/15/2012
11/15/2017 NEUROLOGY
Q6139
ALI, JAWAD TAHIR, MD
P4538
P2184
P7238
10/1/2012
3/1/2012
7/15/2013
6/1/2015
1/3/2014
PHYSICAL MED. &
7/15/2018 RADIOLOGY
6/3/2013
NEUROLOGICAL
6/3/2018 SURGERY
15-Mar-16
5/1/2015
15-Mar-21 GENERAL SURGERY
5/1/2020 PEDIATRICS
5/1/2015
8/1/2014
10/1/2015
Secondary Specialty
(Self-Designated)
HOUSTON
TX
ACTIVE
02-May-16 None
N/A
TX
ACTIVE
23-May-16 None
N/A
TX
ACTIVE
2/12/2013 None
N/A
TX
ACTIVE
4/4/2013 None
N/A
ACTIVE
1/9/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
10/8/2012 None
3/13/2012 None
7/17/2013 None
N/A
N/A
N/A
6/1/2015 None
1/27/2014 None
N/A
N/A
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
6/10/2013 None
N/A
13-Jun-16 None
6/8/2015 None
N/A
N/A
5/1/2015 None
8/6/2014 None
N/A
N/A
8/1/2011
2/6/2013
18-Feb-16
7/28/2011
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
10/5/2015 None
N/A
ACTIVE
12/31/2012 None
N/A
ACTIVE
11/4/2015 None
N/A
HOUSTON
INFECTIOUS
DISEASES
DESOTO
HEMATOLOGY/ONCO
LOGY
EL PASO
PULMONARY
DISEASES
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
SAN ANTONIO
WACO
DALLAS
ANESTHESIOLOGY PAIN MANAGEMENT
ONCOLOGY
DALLAS
TX
TX
TX
TX
VASCULAR
SURGERY
5/1/2020 PEDIATRICS
OPHTHALMOLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE
FAMILY MEDICINE
Practice City
LOS ALAMOS
Registration
Status of
Practice
Texas
State
License
NM
ACTIVE
HOUSTON
TX
ODESSA
TX
OPHTHALMOLOGY CORNEA
HOSPITALIST
LUBBOCK
TX
NEURO-PHYSIOLOGY
(NEUROLOGY)
HOUSTON
TX
NEURO-PHYSIOLOGY
(NEUROLOGY)
ABDOMINAL
10/1/2020 GENERAL SURGERY SURGERY
AUSTIN
Page 13 of 402
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
6/13/2012 None
N/A
License
Number
Physician Name
Q6929
ALI, MIR MAJID, MD
dicaid
dicaid
Agreement
End Date
Designated)
15-Jan-16
15-Jan-21 FAMILY MEDICINE
P9788
ALI, MUHAMMAD , MD
4/15/2014
Q5326
ALI, MUJTABA MOHAMMED, MD
Q0722
Q0859
ALI, NADIA, MD
ALI, RAFIQ QASAM, MD
6/27/2014
7/15/2014
Q6599
ALI, RAMI, MD
12/4/2015
8/3/2015
Q6599
ALI, RAMI, MD
04-Dec-15
Q6599
ALI, RAMI, MD
04-Dec-15
FAMILY PRACTICE 12/4/2020 EMERGENCY MED
FAMILY PRACTICE 04-Dec-20 EMERGENCY MED
P7379
Q7128
ALI, RIYAZ MOHAMMED, MD
ALI, SADIQ, MD
8/1/2013
16-Feb-16
16-Feb-21 RHEUMATOLOGY
Q0216
P7735
ALI, SAJID ASIM, MD
ALI, SARFRAZ, MD
5/15/2014
8/30/2013
8/30/2018 PATHOLOGY
P4923
ALI, SAYED KARAR, MD
P6568
Q6140
ALI, SHAHID, MD
ALI, SYED IRFAN QASIM, MD
5/15/2013
10/1/2015
P2822
ALI, SYED MUJTABA, MD
4/13/2012
P3111
Q6004
5/15/2012
9/15/2015
P7736
P2413
ALI, WAIL, MD
ALIAN, ALI, MD
ALIBHAI, MUSTAFA
HUSSAMUDDIN, MD
ALICK, SASHA , MD
Q4886
Q5750
ALIFONSO-AMADOR, YAMINÉS, MD
ALIKAH, MAUREEN, MD
7/1/2015
8/28/2015
Q4009
ALIM, SALMAN RAZA, MD
11/30/2012
8/30/2013
3/15/2012
5/1/2015
Secondary Specialty
(Self-Designated)
Practice City
WINDOM
GASTROENTEROLOG
Y
DALLAS
DALLAS
GERIATRICS INTERNAL MEDICINE TEMPLE
FAMILY MEDICINE
HOUSTON
QUEBEC H1L
2N9
QUEBEC H1L
2N9
LEONARDTOW
N
INTERNAL MEDICINE SAN ANTONIO
CYTOPATHOLOGY
PALLIATIVE
MEDICINE
GASTROENTEROLOG
5/15/2018 Y
FAMILY MEDICINE
CRANFORD
BROCKTON
Registration
Status of
Practice
Texas
State
License
MN
ACTIVE
TX
ACTIVE
5/14/2014 None
N/A
TX
ACTIVE
8/5/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
7/2/2014 None
7/29/2014 None
N/A
N/A
12/4/2015 None
N/A
CA
ACTIVE
09-Dec-15 None
N/A
CA
ACTIVE
09-Dec-15 None
N/A
MD
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/12/2013 None
29-Mar-16 None
N/A
N/A
5/15/2014 None
9/9/2013 None
N/A
N/A
11/30/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
5/29/2013 None
10/5/2015 None
N/A
N/A
4/13/2012 None
N/A
5/15/2012 None
9/17/2015 None
N/A
N/A
8/30/2013 None
3/20/2012 None
N/A
N/A
ACTIVE
ACTIVE
7/27/2015 None
9/2/2015 None
N/A
N/A
ACTIVE
5/4/2015 None
N/A
NJ
MA
4/13/2017 INTERNAL MEDICINE NEPHROLOGY
PEDIATRIC INTENSIVE
5/15/2017 CARE
PEDIATRICS
9/15/2020 RADIOLOGY
INTERNAL MEDICINE
3/15/2017 NEUROLOGY
OBSTETRICS AND
7/1/2020 GYNECOLOGY
PULMONARY
CRITICAL CARE
5/1/2020 MEDICINE
INTERNAL MEDICINE HUMBLE
Page 14 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
01-Feb-16 None
N/A
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P3500
P3501
Q2876
ALI-OSMAN, FRANCIS REGINALD,
MD
ALIOTTA, MICHELLE LYNN, MD
ALIU, PETER INEGBENOSE, MD
6/8/2012
6/8/2012
1/15/2015
P0949
ALKALAY, AVISHAI ALBERT, MD
9/15/2011
P0950
P1515
ALKALAY, MICHELE JACQUELINE,
MD
ALLAIRE, BO JONATHAN, MD
9/15/2011
12/1/2011
P2571
P1844
P8635
Q1074
ALLAM, ANAND M, MD
ALLANKU, SARAT, MD
ALLEN, CHARLA BETH, MD
ALLEN, DAVID EUGENE, MD
4/2/2012
1/17/2012
1/3/2014
8/1/2014
OBSTETRICS AND
PEDIATRIC
GASTROENTEROLOG
9/15/2016 Y
PHYSICAL MED. &
K9978
ALLEN, RICHARD CUTLER, MD
2/2/2015
OPHTHALMOLOGY 2/2/2020 RECONST SURGERY
Q4010
ALLEN, ROBERT CHARLES, MD
5/1/2015
Q5328
ALLEN, SHAWN MICHAEL, MD
8/3/2015
Q3138
ALLEN, TIMOTHY GRAHAM, MD
2/13/2015
Q6727
15-Dec-15
Q2423
ALLEN, ZOEL GLEN III, MD
ALLGAIER, BRIAN CHRISTOPHER,
MD
P7380
P7878
ALLISON, JERRY ALVIN, MD
ALLRED, JAMES TED, MD
8/1/2013
9/16/2013
Q3139
ALLURI, VINOD, MD
ALMEIDA-JONES, MYRIAM
EVELINE, MD
ALMESTADY, RAJAA MOHAMMED ,
MD
2/13/2015
P6125
Q1075
11/17/2014
4/12/2013
8/1/2014
Secondary Specialty
(Self-Designated)
MATERNAL AND
FETAL MEDICINE
PEDIATRICS,
INTERVENTIONAL
RADIOLOGY
Page 15 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
6/8/2012 ORDER
6/11/2012
6/15/2012 None
N/A
1/19/2015 None
N/A
HARLINGEN
LONDON
TX
KY
LICENSE
ISSUED
ACTIVE
ACTIVE
BRONX
NY
ACTIVE
9/20/2011 None
N/A
MOUNT KISCO NY
BAYTOWN
TX
ACTIVE
ACTIVE
9/26/2011 None
12/5/2011 None
N/A
N/A
4/4/2012
1/23/2012
1/10/2014
8/13/2014
None
None
None
None
N/A
N/A
N/A
N/A
ALBUQUERQU
E
NM
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
2/2/2015 None
N/A
DALLAS
TX
ACTIVE
5/8/2015 None
N/A
HOUSTON
TX
ACTIVE
8/4/2015 None
N/A
2/13/2015 None
N/A
22-Dec-15 None
N/A
11/17/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/6/2013 None
9/24/2013 None
N/A
N/A
2/13/2015 None
N/A
SPINAL CORD
INJURY MEDICINE
HOUSTON
INTERNAL MEDICINE
LUBBOCK
INTERNAL MEDICINE ARDMORE
5/1/2020 VASCULAR SURGERY GENERAL SURGERY
OTORHINOLARYNGOL
8/3/2020 OGY
RHINOLOGY
HAND SURGERY ORTHOPEDIC
2/13/2020 SURGERY
EMERGENCY
15-Dec-20 MEDICINE
EMERGENCY
11/17/2019 MEDICINE
EMERGENCY
MEDICINE
8/1/2019 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
TX
OK
LICENSE
ISSUED
SAN MARCOS TX
DALLAS
AUSTIN
TX
TX
ACTIVE
LICENSE
ISSUED
NEW YORK
NY
ACTIVE
4/25/2013 None
N/A
DALLAS
TX
ACTIVE
8/5/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q0858
AL-MOHTASEB, ZAINA , MD
7/15/2014
Q1785
ALMUBASLAT, MOHAMMAD , MD
9/15/2014
OPHTHALMOLOGY 7/15/2019 CORNEA
NEUROLOGICAL
9/15/2019 SURGERY
P9292
Q7522
3/17/2014
15-Mar-16
P6320
ALMUNA, PABLO MAURICIO, MD
AL-NUAIMI, AHMED, MD
ALOBAIDI, AHMED MOHAMMED
KHAIRI, MD
5/1/2013
P6767
Q7525
ALOOR, SIMMY , MD
ALOUD, ABDRAHIM, MD
6/3/2013
15-Mar-16
6/3/2018 PEDIATRICS
P8636
ALPHONSO, CARLO JOSEPH, MD
Q1786
ALQARA, FARES, MD
9/15/2014
Q1551
AL-RAHAWAN, MOHAMAD MAJED,
MD
8/29/2014
1/3/2014
Secondary Specialty
(Self-Designated)
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
OPHTHALMOLOGY ANTERIOR SURGERY HOUSTON
TX
ACTIVE
7/28/2014 None
N/A
NEURO-RADIOLOGY
MANDEVILLE
FORREST
CITY
JAMAICA
LA
ACTIVE
11/4/2014 None
N/A
AR
NY
ACTIVE
ACTIVE
3/24/2014 None
07-Apr-16 None
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
5/7/2013 None
N/A
6/3/2013 None
24-Mar-16 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
2/24/2014 None
N/A
ROCKFORD
ACTIVE
11/10/2014 None
N/A
8/29/2014 None
N/A
7/23/2013 None
N/A
6/27/2014 None
N/A
8/1/2011 None
3/18/2014 None
N/A
N/A
7/1/2013 None
10/24/2014 None
N/A
N/A
11/17/2014 None
N/A
ACTIVE
11/18/2014 None
N/A
ACTIVE
ACTIVE
01-Mar-16 None
8/5/2011 None
N/A
N/A
ACTIVE
5/12/2015 None
N/A
OBSTETRICS AND
PEDIATRIC
HEMATOLOGY/ONCOL
8/29/2019 OGY
IL
LICENSE
ISSUED
P7240
ALSAAB, SAAD , MD
7/15/2013
INTERVENTIONAL
CARDIOLOGY
Q0723
ALSAKA, MHD ADNAN, MD
6/27/2014
NEPHROLOGY
P0534
P9293
8/1/2011
3/17/2014
P7058
Q2094
ALSHAREEF, BASHAR NIMAN, MD
ALSHEIKH, BATOOL, MD
ALSOBROOKS, CURRISSA PRUITT,
MD
ALTAF, MISBAH WASEEM, MD
7/1/2013
10/15/2014
Q2424
ALTAF, WASEEM, MD
11/17/2014
Q2230
AL-TAHER, OSSAMA M Z, MD
11/7/2014
Q7133
P0535
ALTAKI, MUHAMMAD SOUBHI , MD
ALTAMIRANO, RAY , MD
16-Feb-16
8/1/2011
16-Feb-21 INTERNAL MEDICINE
Q4006
AL-TAWIL, SAID H, MD
5/1/2015
Practice City
Registration
Status of
Practice
Texas
State
License
TOMBALL
FARGO
NEONATOLOGY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
Page 16 of 402
RENO
TX
ND
NV
SAN ANTONIO TX
WICHITA
FALLS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Q5330
Q6303
Physician Name
ALTMAN, KENNETH WAYNE, MD
ALTMAN, KIRSTIN , MD
dicaid
dicaid
Agreement
End Date
Designated)
8/3/2015
10/15/2015
Q7526
ALTMAN, MATTHEW , MD
15-Mar-16
P7059
ALVA, MARIA DOLORES, MD
P7738
ALVARADO, SERGIO ANTONIO, MD
8/30/2013
Q5140
ALVAREZ, CRYSTAL ALEX, MD
7/15/2015
7/1/2013
OCCUPATIONAL
ENVIRONMENTAL
15-Mar-21 MEDICINE
7/1/2018 PEDIATRICS
OBSTETRICS AND
Q1076
Q5331
ALVAREZ, LISA CRISTINA, MD
ALVAREZ, NAIARA , MD
8/1/2014
8/3/2015
Q5332
ALVAREZ, YVETTE VALERIO, DO
8/3/2015
P1041
ALVAREZ-CARDONA, JULIO JOSE,
MD
10/3/2011
Q7828
ALVEY, HEIDI LYNN, MD
15-Apr-16
P2186
Q6487
ALVI, SAADIA , MD
ALWAZEER, MOUHAMMAD RATEB ,
MD
Q7829
ALY, MUSTAFA GHALEB M R, MD
Q6486
AL-ZUBIDI, NAGHAM , MD
11/16/2015
P6321
Q2095
Q2096
AMACHER, AARON GEORGE III, MD
AMADOR, ARACELI, MD
AMADOR, PABLO ENRIQUE, MD
5/1/2013
10/15/2014
10/15/2014
Q5334
AMAN, MUAZZUM, MD
EMERGENCY
8/3/2020 MEDICINE
3/1/2012
11/16/2015
15-Apr-16
8/3/2015
CRITICAL CARE
15-Apr-21 MEDICINE
ENDOCRINOLOGY,
DIABETES AND
3/1/2017 METABOLISM
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
TEMPLE
OCCUPATIONAL
ENVIRONMENTAL
MEDICINE
KILLEEN
PEDIATRIC CRITICAL
CARE MEDICINE
PENSACOLA
SPORTS MEDICINE
(FAMILY PRACTICE) EL PASO
GASTROENTEROLOG
Y
INTERNAL MEDICINE EDINBURG
CORPUS
CHRISTI
INTERNAL MEDICINE
EMERGENCY
MEDICINE
TEMPLE
Registration
Status of
Practice
Texas
State
License
TX
TX
LIC. ISSUED
DUE TO
ADMIN
ERROR
ACTIVE
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/3/2015 None
10/16/2015 None
N/A
N/A
ACTIVE
02-Jun-16 None
N/A
FL
ACTIVE
7/31/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/9/2013 None
N/A
7/15/2015 None
N/A
TX
ACTIVE
ACTIVE
8/5/2014 None
8/17/2015 None
N/A
N/A
TX
ACTIVE
ACTIVE
8/5/2015 None
UNDER
BOARD
10/21/2011 ORDER
N/A
9/13/2011
TX
ACTIVE
18-Apr-16 None
N/A
PEDIATRIC
ENDOCRINOLOGY
TX
ACTIVE
LICENSE
ISSUED
3/30/2012 None
N/A
11/16/2015 None
N/A
NEPHROLOGY
NEUROOPHTHALMOLOGY
TX
ACTIVE
09-May-16 None
N/A
SAN ANTONIO TX
ACTIVE
11/23/2015 None
N/A
ARLINGTON
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
5/7/2013 None
10/21/2014 None
10/22/2014 None
N/A
N/A
N/A
8/3/2015 None
N/A
FAMILY MEDICINE
Page 17 of 402
LUBBOCK
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
5/1/2012
5/1/2017 GYNECOLOGY
Secondary Specialty
(Self-Designated)
Practice City
P2943
AMAN, ZARMINA, MD
P9790
P9145
Q7313
P6569
AMANING, JUDITH KWARTENG, MD
AMARA, VENKAT, MD
AMARAM-DAVILA, JAYA SHEELA,
MD
AMARIA, RODABE NAVROZE, MD
P6322
AMARO, JUSTIN AARON, DO
5/1/2013
K9479
AMATO, MALENA MARIE, MD
12/17/2012
OPHTHALMOLOGY RECONST SURGERY AUSTIN
K9479
12/17/2012
K9479
12/17/2012
P6770
AMBARDEKAR, ADITEE PARAG, MD
6/3/2013
P6944
6/14/2013
P2944
AMBRUZS, JOSEPHINE MARIE, MD
AMECHI-OBIGWE, ADANNA JULIET,
MD
P9505
P9506
P5584
AMICO, JENNIFER, MD
AMIN, AMEE, MD
AMIN, NIRAV, DO
P3605
AMIN, TANIA , MD
Q6488
AMJAD, IBRAHIM H, MD
P3502
AMMAR, RICHARD FREDERICK JR,
MD
TM00457 AMOLI, SEAN REZA, MD
4/15/2014
3/3/2014
3/3/2019 NEPHROLOGY
04-Mar-16
5/15/2013
5/15/2018 ONCOLOGY
FP/OSTEO
MANIPULATION
5/1/2018 MEDICINE
ANATOMIC/CLINICAL
6/14/2018 PATHOLOGY
5/1/2012
4/1/2014
4/1/2014
3/1/2013
6/15/2012
11/16/2015
PLASTIC &
RECONSTRUCTIVE
11/16/2020 SURGERY
6/8/2012
INTERVENTIONAL
6/8/2017 CARDIOLOGY
8/1/2011
8/1/2016 RADIOLOGY
PLANO
Registration
Status of
Practice
Texas
State
License
TX
HOUSTON
HOUSTON
5/4/2012 None
N/A
4/15/2014 None
3/17/2014 None
N/A
N/A
ACTIVE
ACTIVE
08-Mar-16 None
7/9/2013 None
N/A
N/A
LICENSE
ISSUED
5/1/2013 None
N/A
TX
ACTIVE
1/1/2013 None
N/A
TX
ACTIVE
1/1/2013 None
N/A
ACTIVE
1/1/2013 None
N/A
ACTIVE
6/19/2013 None
N/A
ACTIVE
7/9/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
5/10/2012 None
N/A
4/1/2014 None
4/2/2014 None
4/3/2013 None
N/A
N/A
N/A
ACTIVE
6/19/2012 None
N/A
11/16/2015 None
N/A
6/12/2012 None
N/A
8/1/2011 None
N/A
TX
TX
TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PHILADELPHIA PA
LITTLE ROCK
HOSPITALIST
GERIATRIC
PSYCHIATRY
AR
LA JOLLA
CA
DALLAS
TX
LICENSE
ISSUED
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
Page 18 of 402
IOWA CITY
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
INTERNAL MEDICINE
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
IA
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P2574
AMOR, COURTNEY JOSEPH, MD
Q2638
Q8005
AMRO, MOATH , MD
AMUDIPE, OLUBUKOLA T, MD
Q1077
AMULRAJ, EMMANUEL ANTONY,
MD
Q8006
Q5964
AN, RUOSU, MD
ANABOR, OMEGIE LINDA, MD
P9791
ANANI, ASHRAF, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/2/2012
4/2/2017
12/15/2014
02-May-16
12/15/2019
02-May-21
8/1/2014
8/1/2019
02-May-21 VASCULAR SURGERY
4/15/2014
ANAYA, SAMUEL JR, MD
4/12/2013
P7739
ANDACHEH, IDEN DAVID, MD
8/30/2013
Q2236
ANDERS, KRISTA JEAN, MD
11/7/2014
Q8007
ANDERSON, BRYAN, DO
Q6142
ANDERSON, CHARMAINE, MD
P1157
P8212
Q5614
Q6806
ANDERSON, GINA KATHLEEN, DO
ANDERSON, JOHN WILLIAM, MD
ANDERSON, KATHRYN TINSLEY,
MD
ANDERSON, MARK ROBERT, MD
P9507
ANDERSON, MARQUITA, MD
P1159
ANDERSON, MELANIE RENEE, MD
ANDERSON, NICOLAAS
CORNELIUS, DO
ANDERSON, RACHEL MAY, MD
Q8201
Q7831
01-Feb-16
02-May-16
10/1/2015
10/17/2011
11/1/2013
8/14/2015
06-Jan-16
4/1/2014
10/17/2011
16-May-16
15-Apr-16
HOUSTON
06-Jan-21 UROLOGIC SURGERY
OBSTETRICS AND
4/1/2019 GYNECOLOGY
EMERGENCY
10/17/2016 MEDICINE
NEUROMUSCULAR
DISEASE
Page 19 of 402
Disciplinary
Status Date
ACTIVE
4/13/2012 None
N/A
HOUSTON
TX
FORT WORTH TX
ACTIVE
ACTIVE
12/22/2014 None
25-May-16 None
N/A
N/A
8/1/2014 None
N/A
09-May-16 None
11/2/2015 None
N/A
N/A
5/1/2014 None
N/A
4/12/2013 None
N/A
8/30/2013 None
N/A
LICENSE
ISSUED
ROWLETT
BAYTOWN
POMPTON
LAKES
OBSTETRICS AND
FAMILY PRACTICE
DIAGNOSTIC
RADIOLOGY
PULMONARY
CRITICAL CARE
02-May-21 MEDICINE
INTERNAL MEDICINE
OBSTETRICS AND
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
ACTIVE
ACTIVE
NJ
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
EMERGENCY
MEDICINE
16-May-21 NEUROLOGY
15-Apr-21 PEDIATRICS
Practice City
GENERAL SURGERY
02-May-16
9/15/2015
P6127
TM00620 ANDERSON, ANTHONY SHANE, MD
ORTHOPEDIC
SURGERY
EMERGENCY
MEDICINE
FAMILY MEDICINE
THORACIC
CARDIOVASCULAR
SURGERY
Secondary Specialty
(Self-Designated)
SURGERY
Registration
Status of
Practice
Texas
State
License
DRAPER
UT
ACTIVE
11/11/2014 None
N/A
GREENSBORO NC
ACTIVE
22-Feb-16 None
N/A
ACTIVE
LICENSE
ISSUED
09-May-16 None
N/A
10/1/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
11/7/2011 None
12/2/2013 None
N/A
N/A
8/14/2015 None
11-Feb-16 None
N/A
N/A
4/1/2014 None
N/A
CORPUS
CHRISTI
TX
COLLEGE
STATION
HOUSTON
TX
TX
FORT HOOD
TX
DALLAS
TX
ACTIVE
11/1/2011 None
N/A
HOUSTON
AMARILLO
TX
TX
ACTIVE
ACTIVE
23-May-16 None
21-Apr-16 None
N/A
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q5142
Physician Name
ANDERSON, ROBERT WESLEY III,
MD
ANDERSON, SEAN DANIEL, MD
ANDERSON, TERRENCE DAMON,
MD
ANDRADE, ALONSO , MD
ANDRADE, NICHOLAS STEPHEN,
MD
P2188
ANDREWS, NICHOLE RENEE, MD
3/1/2012
Q0726
Q1942
ANDREWS, REENA, MD
ANDRY, JAMES MICHAEL JR, MD
6/27/2014
10/1/2014
10/1/2019 NEUROLOGY
Q1558
ANGELI, DIMITRA, MD
8/29/2014
P1444
ANIAKUDO, MAUREEN , MD
ANIEMEKE, CHIDINMA OKWUCHI,
MD
11/15/2011
10/15/2013
L9071
Q8008
Q5965
Q4889
P8113
2/8/2013
02-May-16
9/15/2015
7/1/2015
7/15/2015
PEDIATRIC
NEUROLOGICAL
7/15/2020 SURGERY
EMERGENCY
3/1/2017 MEDICINE
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012
P5024
ANITUBE, MAXIMUS
NWAKALUNNA, MD
12/17/2012
Q1943
ANJUM, SEHER, MD
10/1/2014
Q0402
P0696
ANKUMAH, NANA AMA ESI , MD
ANNAPUREDDY, CHANDRA
SEKHAR REDDY, MD
6/2/2014
8/15/2011
P6572
P7242
ANNAPURNA, VEERAYYAGARI, MD
ANOSIKE, BRENDA IJ, MD
5/15/2013
7/15/2013
P3606
P9295
ANSARI, ASAD, MD
ANSARI, ASIF ALI KHAN, MD
6/15/2012
3/17/2014
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE DENTON
AMARILLO
BETHESDA
EL PASO
SLEEP MEDICINE
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
2/21/2013 None
24-May-16 None
N/A
N/A
MD
TX
ACTIVE
ACTIVE
10/5/2015 None
7/3/2015 None
N/A
N/A
TYLER
TX
ACTIVE
7/17/2015 None
N/A
EL PASO
TX
3/20/2012 None
N/A
NASHVILLE
TN
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/27/2014 None
10/15/2014 None
N/A
N/A
8/29/2014 None
N/A
11/15/2011 None
N/A
ACTIVE
10/22/2013 None
N/A
LICENSE
ISSUED
12/17/2012 None
N/A
SAN ANTONIO TX
OBSTETRICS AND
6/2/2019 GYNECOLOGY
OBSTETRICS AND
PEDIATRIC
6/15/2017 PULMONOLOGY
MATERNAL AND
FETAL MEDICINE
DALLAS
TX
ACTIVE
1/15/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
1/15/2013 None
N/A
10/1/2014 None
N/A
6/5/2014 None
N/A
8/25/2011 None
N/A
5/15/2013 None
7/22/2013 None
N/A
N/A
6/15/2012 None
3/26/2014 None
N/A
N/A
HOUSTON
TX
SAN ANTONIO TX
HOUSTON
SLEEP MEDICINE
INTERNAL MEDICINE
Page 20 of 402
Disciplinary
Status Date
TX
TX
FAMILY MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
Q0217
ANSARI, NADEEM EBAD, DO
P3278
ANSARI, SHAN NUR, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2014
6/1/2012
NEUROMUSCULAR
DISEASE
INTERVENTIONAL
CARDIOLOGY
Q2505
ANSARI, SHARIQUE ASLAM, MD
12/3/2014
12/3/2019 NEUROLOGY
Q8414
ANSINELLI, RICHARD ALLEN, MD
01-Jun-16
01-Jun-21 CARDIOLOGY
P3279
ANTOINE, JILL A, MD
P3280
Q0728
ANTONELLI, MICHAEL JAMES, DO
ANTONOFF, MARA B, MD
P5926
ANTUNES, MARCELO BARROS, MD
P6574
5/15/2013
P3281
ANUGWOM, CHINASA PAUL, MD
ANUKAM, UZOESHI IHEANACHO,
MD
Q7316
ANVAR, BARDIA AARON, MD
04-Mar-16
Q5143
ANWAR, FAISAL, MD
7/15/2015
Q3633
ANWAR, MUHAMMAD ALI, MD
P5770
6/1/2012
Secondary Specialty
(Self-Designated)
Practice City
SIOUX FALLS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SD
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
N/A
ACTIVE
5/15/2014 None
UNDER
BOARD
6/13/2012 ORDER
ACTIVE
12/4/2014 None
N/A
ACTIVE
LICENSE
ISSUED
03-Jun-16 None
N/A
6/1/2012 None
N/A
5/10/2012
SAINT
PETERSBURG FL
HOUSTON
TX
ACTIVE
ACTIVE
6/5/2012 None
7/1/2014 None
N/A
N/A
ROCHESTER
NY
ACTIVE
4/3/2013 None
N/A
ELK RIVER
MN
ACTIVE
5/20/2013 None
N/A
TN
ACTIVE
6/27/2012 None
N/A
ACTIVE
22-Mar-16 None
N/A
ACTIVE
8/3/2015 None
N/A
4/1/2015
INFECTIOUS
4/1/2020 DISEASES
LOS ANGELES CA
ALBUQUERQU
E
NM
INTERNAL MEDICINE FORT WORTH TX
ACTIVE
4/13/2015 None
N/A
ANWAR, MUHAMMAD SALEEM, MD
3/15/2013
HOSPITALIST
TX
ACTIVE
4/26/2013 None
N/A
P8639
Q2879
ANWAR, MUHAMMAD UMAIR, MD
ANWAR, NAVEED SHAHID, MD
1/3/2014
1/15/2015
IL
TX
N/A
N/A
ANWAR, SANOBER SAJJAD, MD
8/1/2011
8/1/2011 None
N/A
P4412
P9794
ANWAR, ZESHAN, MD
ANYADIOHA, IFECHI, MD
ANYAEGBU, ELIZABETH IJEOMA,
MD
ANZALDUA, ALEJANDRO, MD
9/17/2012
4/15/2014
MILWAUKEE
WI
12/16/2012 None
5/6/2014 None
N/A
N/A
4/2/2012
12/3/2014
4/2/2017 PEDIATRICS
PAIN MEDICINE
PEDIATRIC
NEPHROLOGY
ACTIVE
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
1/15/2014 None
1/26/2015 None
P0538
LOCKPORT
INTERNAL MEDICINE HOUSTON
VASCULAR
SURGERY
ST LOUIS
MO
4/9/2012 None
12/5/2014 None
N/A
N/A
P2577
Q2506
6/1/2012
6/27/2014
4/1/2013
6/1/2012
6/27/2019 THORACIC SURGERY
OTORHINOLARYNGOL FACIAL PLASTIC
4/1/2018 OGY
SURGERY
URGENT CARE 5/15/2018 FAMILY MEDICINE
FAMILY PRACTICE
8/1/2016 ALLERGY
INTERNAL MEDICINE DYERSBURG
Page 21 of 402
DALLAS
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P8841
AOKI, ETSUKO , MD
2/7/2014
Q6304
Q1787
AOUTHMANY, MOUSTAFA
MOUHAMAD, MD
APARICIO, KIMBERLY ANN, MD
10/15/2015
9/15/2014
P1617
APONTE, EMMALIND, MD
12/15/2011
P8335
P9509
11/15/2013
4/1/2014
Q6490
APPACHI, ELUMALAI, MD
APPACHI, MALA, MD
APPALANENI, SRI RAMA MURTHY,
MD
Q8692
Q8415
APPLEBURY, JAMES EDWARD, MD
APPLETON, JEWEL N, MD
10-Jun-16
01-Jun-16
Q7136
APRILE, LOUIS DANTON, MD
16-Feb-16
P2947
AQUINO, KAREN MARGHANITA, MD
P1160
ARABZADEH, PAYMAN, MD
P8214
ARAFEH, HAZEM, MD
11/16/2015
5/1/2012
10/17/2011
NEONATAL10/15/2020 PERINATAL MEDICINE
HEMATOLOGY/ONCOL
12/15/2016 OGY
PEDIATRIC CRITICAL
11/15/2018 CARE MEDICINE
4/1/2019 PEDIATRICS
PHYSICAL MED. &
10-Jun-21 REHABILITATION
01-Jun-21 RADIOLOGY
EMERGENCY
16-Feb-21 MEDICINE
TM00458 ARAIZA, BEATRIX , MD
P9795
ARAMADA, HARSHA, MD
8/1/2011
4/15/2014
Q7631
P5325
ARANKE, SIDDHARTH VIJAY, MD
ARAPOS, LEONIDAS, MD
01-Apr-16
2/1/2013
P1161
ARAS, OMER, MD
10/17/2011
P1618
ARASHVAND, MOJGAN, DO
12/15/2011
8/1/2016 RADIOLOGY
PHYSICAL MED. &
01-Apr-21 REHABILITATION
DIAGNOSTIC
10/17/2016 RADIOLOGY
CARDIOVASCULAR
12/15/2016 DISEASES
ARAUJO, MARCO, MD
Q1079
ARAWIRAN, JENDA MILLAN, MD
Q3140
ARBELAEZ, GILBERTO, MD
11/17/2014
8/1/2014
2/13/2015
Disciplinary
Status Date
ACTIVE
2/25/2014 None
N/A
IN
TX
ACTIVE
ACTIVE
10/21/2015 None
9/23/2014 None
N/A
N/A
TX
ACTIVE
1/6/2012 None
N/A
PEDIATRICS
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
12/2/2013 None
4/21/2014 None
N/A
N/A
HOSPITALIST
LITTLE ROCK
AR
ACTIVE
12/3/2015 None
N/A
BODY IMAGING
SAN LEANDRO CA
HOUSTON
TX
ACTIVE
ACTIVE
14-Jun-16 None
06-Jun-16 None
N/A
N/A
AUSTIN
TX
ACTIVE
29-Feb-16 None
N/A
AUSTIN
TX
LAKE
JACKSON
TX
BROWNSVILL
E
TX
ACTIVE
5/7/2012 None
N/A
ACTIVE
10/20/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
11/20/2013 None
N/A
8/1/2011 None
4/23/2014 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
07-Apr-16 None
2/15/2013 None
N/A
N/A
10/17/2011 None
N/A
12/15/2011 None
N/A
11/17/2014 None
N/A
PEDIATRICS
MISHAWAKA
GARLAND
HEMATOLOGY/ONCO CORPUS
LOGY
CHRISTI
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
5/1/2017 NEUROLOGY
11/1/2013
Q2426
Secondary Specialty
(Self-Designated)
Practice City
HEMATOLOGY/ONCO
LOGY
HOUSTON
Registration
Status of
Practice
Texas
State
License
WASHINGTON DC
HOSPITALIST
EMERGENCY
2/13/2020 MEDICINE
Page 22 of 402
AMARILLO
TX
ACTIVE
8/8/2014 None
N/A
SAN ANTONIO TX
ACTIVE
2/18/2015 None
N/A
License
Number
Physician Name
P6326
Q3634
ARBOLEDA, ANDRES, MD
ARCE, CRISTINA MARIA, MD
Q0863
ARCILA, ELIZABETH , MD
Q7138
ARCOS, GEORGE JOHN, DO
Q8009
Q7317
ARCURE, JESS JOSEPH, MD
ARENAS, CARLITO GAVIOLA, MD
P6327
ARENIVAR, LEROY , MD
AREVALO SOSA, RICARDO
ANTONIO, MD
P6129
P7061
ARGISHTI, NARINE, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
EMERGENCY
5/1/2013
5/1/2018 MEDICINE
NASSAU BAY
4/1/2015
4/1/2020 NEPHROLOGY
INTERNAL MEDICINE
7/15/2014
16-Feb-21 PAIN MANAGEMENT
02-May-16
04-Mar-16
PHYSICAL MED. &
02-May-21 REHABILITATION
4/12/2013
7/1/2013
5/1/2018 PSYCHIATRY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
8/1/2011
OBSTETRICS AND
8/1/2016 GYNECOLOGY
Q4558
ARGUELLO, VANESSA , MD
6/1/2015
P8574
P6773
ARIAS, CARLOS IVAN, MD
ARIAS, GABRIELA AGUAYO, MD
P1517
ARIAS, ROBERT RANET, MD
ARIENMUGHARE, MARYANNE
ONORIODE, MD
12/1/2011
3/15/2013
OBSTETRICS
ARIF, FARHAN AHMAD, MD
ARIF, SAHAR, MD
ARIKATI, CHYTHANYA KALYANI,
MD
ARISTEIGUIETA, CESAR
ALEJANDRO, MD
ARIYAMUTHU, VENKATESH
KUMAR, MD
4/2/2012
7/15/2015
HOSPITALIST
5/1/2015
1/3/2014
EMERGENCY
1/3/2019 MEDICINE
8/3/2015
8/3/2020 NEPHROLOGY
P2578
Q5144
Q4015
P8640
Q5340
N/A
N/A
7/15/2014 None
N/A
FL
ACTIVE
26-Feb-16 None
N/A
MD
ACTIVE
ACTIVE
19-May-16 None
14-Mar-16 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
6/3/2013 None
N/A
4/12/2013 None
N/A
SULPHUR
SPRINGS
TX
ACTIVE
8/6/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
8/9/2011 None
N/A
6/1/2015 None
N/A
12/16/2013 None
6/12/2013 None
N/A
N/A
12/2/2011 None
N/A
3/15/2013 None
N/A
4/2/2012 None
7/22/2015 None
N/A
N/A
PORT
ARTHUR
Page 23 of 402
Disciplinary
Status Date
5/8/2013 None
4/3/2015 None
NEPHROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
ARGOTI, PEDRO SALVADOR, MD
P5773
PENSACOLA
SPORTS MEDICINE PHYSICAL MEDICINE
& REHABILITATION
ANNAPOLIS
HOSPITALIST
CHILD AND
ADOLESCENT
PSYCHIATRY
AUSTIN
P0539
12/16/2013
6/3/2013
TX
16-Feb-16
5/1/2013
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
BAY CITY
MI
ACTIVE
5/4/2015 None
N/A
HOUSTON
TX
ACTIVE
2/10/2014 None
N/A
DALLAS
TX
ACTIVE
8/4/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q2726
ARLATA, TAMANTHA SUE, MD
P6575
ARMAGHANY, TANNAZ, MD
5/15/2013
Q8416
ARMS, RICHARD GRAVES III, MD
01-Jun-16
Q5145
ARMSTRONG, MIA, MD
7/15/2015
Q4559
P6774
ARNOLD, ALANA JACQUELINE , MD
ARORA, ALLURY, MD
P8444
ARORA, GARIMA , MD
ARORA, RANGOLEE SHRAWAN,
MD
ARRIETA, SOLEIL , MD
Q2097
Q5616
1/5/2015
6/1/2015
6/3/2013
12/6/2013
PEDIATRIC
EMERGENCY
6/1/2020 MEDICINE (EM)
6/3/2018 PEDIATRICS
10/1/2012
P9997
P6775
ARROYO-AVILA, MARIANGELI , MD
ARSENAULT, DANIEL MICHAEL JR,
MD
ARSLANOV, RENAT, MD
P9297
ARTINYAN, AVO, MD
3/17/2014
RADIATION
5/2/2019 ONCOLOGY
6/3/2018 PEDIATRICS
SURGICAL
3/17/2019 ONCOLOGY
P5154
ARUN, MATHAGONDAPALLY S, MD
1/4/2013
P9998
5/2/2014
5/2/2019 PEDIATRICS
P6130
ARUNACHALAM, ATHIS RAJH , MD
ARVAPALLI, BHAGYALAKSHMI V,
MD
4/12/2013
Q1788
Q8693
ARYA, RISHI , MD
ARYAIE, AMIR HOSSEIN, MD
9/15/2014
10-Jun-16
P9148
ARYAN, SAEID ESMAEILY, DO
P7740
ARZOUMAN, DAVID ALLEN, MD
5/2/2014
6/3/2013
3/3/2014
8/30/2013
Practice City
1/5/2020 PEDIATRICS
HEMATOLOGY/ONCOL
5/15/2018 OGY
OBSTETRICS AND
EL PASO
10/15/2014
8/14/2015
P4542
Secondary Specialty
(Self-Designated)
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
1/5/2015 None
N/A
TX
ACTIVE
7/15/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
13-Jun-16 None
N/A
7/15/2015 None
N/A
6/1/2015 None
6/12/2013 None
N/A
N/A
TX
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
12/11/2013 None
N/A
TX
ACTIVE
ACTIVE
10/28/2014 None
8/31/2015 None
N/A
N/A
DALLAS
TX
ACTIVE
10/4/2012 None
N/A
AMARILLO
NEW YORK
TX
NY
ACTIVE
ACTIVE
5/12/2014 None
6/24/2013 None
N/A
N/A
TX
ACTIVE
3/21/2014 None
N/A
AL
ACTIVE
2/28/2013 None
N/A
5/2/2014 None
N/A
4/12/2013 None
N/A
LUBBOCK
FORTH
WORTH
TX
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/15/2014 None
20-Jun-16 None
N/A
N/A
TX
ACTIVE
3/4/2014 None
N/A
TUCSON
AZ
ACTIVE
9/9/2013 None
N/A
DALLAS
NEURO-PSYCHIATRY HOUSTON
INFECTIOUS
DISEASES
DALLAS
COLON AND RECTAL
SURGERY
HOUSTON
PUBLIC
HEALTH/PREVENTIVE
MEDICINE
(GENERAL)
HUNTSVILLE
NEONATALPERINATAL
MEDICINE
DIAGNOSTIC
9/15/2019 RADIOLOGY
INTERNAL MEDICINE
10-Jun-21 GENERAL SURGERY
NEUROLOGICAL
3/3/2019 SURGERY
THORACIC
CARDIOVASCULAR
8/30/2018 SURGERY
Page 24 of 402
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIOVASCULAR
INTERVENTIONAL
12/15/2011
12/15/2016 DISEASES
CARDIOLOGY
Registration
Status of
Practice
Texas
State
License
Practice City
THE
WOODLANDS TX
P1622
ASAD, MUHAMMAD , MD
P9298
ASADI, SARA, MD
3/17/2014
Q3847
4/10/2015
4/10/2020 RADIOLOGY
12/4/2015
12/4/2020 OTHER SPECIALTY
04-Dec-15
04-Dec-20 INTERNAL MEDICINE
HOSPITALIST
URBANA
IL
04-Dec-15
02-May-16
7/1/2011
7/1/2011
04-Dec-20
02-May-21
7/1/2016
7/1/2016
HOSPITALIST
URBANA
SPRINGFIELD
WACO
BARTOW
IL
IL
TX
FL
Q4715
ASANDRA, AMY SUPORN, MD
ASAPU, ESWARA VENKATA
ANJANI PRATHAP, MD
ANJANI PRATHAP, MD
ANJANI PRATHAP, MD
ASARE, ANGELA, MD
ASEH, OMERINE YEMBE, MD
ASHARAF, ABDULRASHEED, MD
ASHE-LAMBERT, ELTON MELVILLE,
MD
Q8012
ASHFAQ, MUHAMMAD ZUBAIR, MD
02-May-16
Q5970
Q1081
P8641
ASHIMI BALOGUN, OLAIDE AZIZAT,
MD
ASHITEY, SARAH OGBEDEI, MD
ASHLEY, TIMOTHY DALE JR, MD
9/15/2015
8/1/2014
1/3/2014
Q6601
Q6601
Q6601
Q8011
P0164
P0165
6/12/2015
INTERNAL MEDICINE
HOSPITALIST
FAMILY PRACTICE
INTERNAL MEDICINE
PEDIATRIC
N/A
3/17/2014 None
N/A
4/10/2015 None
N/A
12/4/2015 None
N/A
ACTIVE
25-Jan-16 None
N/A
25-Jan-16
09-May-16
7/27/2011
7/6/2011
None
None
None
None
N/A
N/A
N/A
N/A
OTOLARYNGOLOGY
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/12/2015 None
N/A
INTERNAL MEDICINE
ACTIVE
23-May-16 None
N/A
10/14/2015 None
8/5/2014 None
1/15/2014 None
N/A
N/A
N/A
HOSPITALIST
11/7/2014
6/3/2013
7/15/2014
5/15/2013
P9999
ASHPOLE, DAVID KENNETH, MD
ASHRAF, ASMA , MD
ASHRAF, RIDA, MD
ASHRITH, GUHA , MD
ASIF SIDDIQUI, OMER MUHAMMAD,
MD
OBSTETRICS &
GYNECOLOGICAL
9/15/2020 SURGERY
INTERVENTIONAL
5/2/2014
Q6390
ASIF, SHAHIDA, MD
11/2/2015
MEMPHIS
OKLAHOMA
CITY
Q6807
Q6728
ASIKAIWE, CHIMA NATHANIEL, MD
ASIM, AMNA, MD
06-Jan-16
15-Dec-15
06-Jan-21 PSYCHIATRY
Q5146
ASIMI, NTESI ANASTASIOS, MD
7/15/2015
P6577
ASIROT, RECHELLE LOZANO, MD
5/15/2013
Q2239
P6776
Q0864
M8509
Disciplinary
Status Date
12/29/2011 None
INTERNAL MEDICINE
INTERVENTIONAL
RADIOLOGY
MATERNAL AND
FETAL MEDICINE
HOUSTON
TX
FORT WORTH TX
BRYAN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
HOSPITALIST
PLANO
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
NEPHROLOGY
TN
CARDIOVASCULAR
DISEASES
CRITICAL CARE
ANESTHESIOLOGY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Page 25 of 402
11/7/2014
6/10/2013
7/22/2014
7/12/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
5/12/2014 None
N/A
OK
ACTIVE
11/9/2015 None
N/A
BINGHAMTON NY
SUGAR LAND TX
ACTIVE
ACTIVE
18-Jan-16 None
07-Mar-16 None
N/A
N/A
DALLAS
TX
ACTIVE
7/16/2015 None
N/A
HOUSTON
TX
ACTIVE
6/14/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6492
ASKARI, NASSER DEAN, DO
11/16/2015
P2580
P1518
Q0729
ASKENASY, ERIK PAUL, MD
ASLAM, MURAD , MD
ASLAM, WAQAS, MD
4/2/2012
12/1/2011
6/27/2014
Q3638
P5326
ASLINIA, FLORENCE, MD
ASOPA, AMIT, MD
4/1/2015
2/1/2013
Q3848
ASSEMI, SHAHROKH, MD
4/10/2015
Q2728
ATAALLA, MOHAMED , MD
P7742
P1162
ATAEI, HOMAYOUN, MD
ATALLAH, GEORGE MICHEL, DO
P6132
ATALLAH, RABIH, MD
P6329
ATASHBAND, ARMITA , MD
Q3142
P8114
Q3478
ATHIS RAJH, SANGEETHA, MD
ATILADE, ADEOLA GRACE, MD
ATIQ, AIDA, MD
Q0730
ATKINSON, CAMERON THEODORE,
MD
Q4560
ATLA, RAMA MOHAN REDDY, MD
P4543
P2823
P2581
ATLURI, SAI, MD
ATOLAGBE, ADEBAYO OLUFEMI,
MD
ATREY, VARTIKA , MD
P1445
ATRI, ASHUTOSH , MD
P6945
ATTIA, MINAH F, MD
1/5/2015
8/30/2013
10/17/2011
4/12/2013
5/1/2013
2/13/2015
10/15/2013
3/16/2015
COLON AND RECTAL
HOUSTON
AUSTIN
TEMPLE
GASTROENTEROLOG
BLOOMINGTO
4/1/2020 Y
INTERNAL MEDICINE N
PAIN MANAGEMENT LEXINGTON
DIAGNOSTIC
4/10/2020 RADIOLOGY
CHILD AND
ADOLESCENT
1/5/2020 PSYCHIATRY
PSYCHIATRY
6/14/2013
GYNECOLOGY
CHILD AND
ADOLESCENT
IN
KY
ACTIVE
ACTIVE
LICENSE
ISSUED
4/9/2015 None
2/15/2013 None
N/A
N/A
4/10/2015 None
SEE
PREVIOUS
1/5/2015 ORDER
N/A
LICENSE
ISSUED
TX
VA
Page 26 of 402
10/4/2012
ACTIVE
ACTIVE
LICENSE
ISSUED
9/6/2013 None
10/18/2011 None
N/A
N/A
4/12/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
5/3/2013 None
N/A
2/13/2015 None
10/17/2013 None
3/17/2015 None
N/A
N/A
N/A
6/27/2014 None
N/A
6/1/2015 None
N/A
ACTIVE
10/30/2012 None
N/A
4/26/2012 None
4/23/2012 None
N/A
N/A
11/17/2011 None
N/A
6/14/2013 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
GERIATRICS INTERNAL MEDICINE
PSYCHIATRY
N/A
N/A
N/A
N/A
ORTHOPEDIC
SURGERY
11/16/2015 None
4/5/2012 None
12/7/2011 None
7/2/2014 None
SHREVEPORT LA
HOUSTON
TX
LIVINGSTON
HAMPTON
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
INTERVENTIONAL
CARDIOLOGY
5/1/2018 CARDIOLOGY
6/1/2015
11/15/2011
PAIN MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
6/27/2014
4/13/2012
4/2/2012
Practice City
11/16/2020 INTERNAL MED - PEDS
10/15/2018 OBSTETRICS
6/27/2019 SURGERY
10/1/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
PHOENIX
DALLAS
AZ
TX
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
GASTROENTEROLOG
10-Jun-16
10-Jun-21 Y
PEDIATRICS
PEDIATRIC
01-Apr-16
01-Apr-21 OTOLARYNGOLOGY
OTOLARYNGOLOGY
Q8694
ATTIA, SUZANNA LABIB, MD
Q7633
ATTRA, JAMES JOHNATHAN, MD
Q2508
Q7833
Q3323
ATWAL, PALDEEP SINGH, MD
AU, JASON , MD
AUBERT, GREGORY , MD
12/3/2014
15-Apr-16
3/3/2015
Q6603
AUBIN, DEAN JR, MD
12/4/2015
Q6603
AUBIN, DEAN JR, MD
04-Dec-15
Q6603
AUBIN, DEAN JR, MD
04-Dec-15
9/15/2014
2/10/2012
P7880
AUERBACH, JONATHAN S, MD
AUGENSTEIN, ADAM CHRISTIAN,
MD
AUGUSTIN, PHILIPPA MARGARET,
MD
12/3/2019 MEDICAL GENETICS
15-Apr-21 PEDIATRIC UROLOGY
EMERGENCY
12/4/2020 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
CRITICAL CARE
9/15/2019 MEDICINE
Q1564
Q1791
AUGUSTINE, MARTIN MV, MD
AUSTIN, MOLLY BURNS, MD
8/29/2014
9/15/2014
Q1352
AVERICK, RAUVAN MICAH, MD
8/15/2014
Q2729
AVERILL, FRANCIS CULLEN III, MD
1/5/2015
Q4892
AVERILL, KELLY ANNE, MD
7/1/2015
SURGICAL
8/29/2019 ONCOLOGY
EMERGENCY
8/15/2019 MEDICINE
EMERGENCY
1/5/2020 MEDICINE
PEDIATRIC
7/1/2020 NEUROLOGY
P5774
AVERY, RICHEL ZAYAS, MD
AVILA ACOSTA, ADRIANA JANETH,
MD
3/15/2013
8/1/2013
Q1790
P2093
P7383
Q7008
AVILA, JORGE N, MD
P4629
Q2730
AVILA, LYDIA, MD
AVUTU, HIMA BINDU REDDY, MD
Q1353
AWAD, MAHER, MD
9/16/2013
01-Feb-16
10/15/2012
1/5/2015
8/15/2014
01-Feb-21 PSYCHIATRY
BOGOTÁ
AUSTIN
TX
HOUSTON
DALLAS
TX
TX
HOSPITALIST
CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
16-Jun-16 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
14-Apr-16 None
N/A
12/3/2014 None
25-Apr-16 None
3/5/2015 None
N/A
N/A
N/A
12/4/2015 None
N/A
ALLEN
TX
ACTIVE
09-Dec-15 None
N/A
ALLEN
TX
ACTIVE
09-Dec-15 None
N/A
ACTIVE
9/22/2014 None
N/A
ACTIVE
2/14/2012 None
N/A
TX
ACTIVE
10/3/2013 None
N/A
GENERAL SURGERY DALLAS
TX
ACTIVE
ACTIVE
9/5/2014 None
9/19/2014 None
N/A
N/A
STATEN
INTERNAL MEDICINE ISLAND
NY
ACTIVE
8/21/2014 None
N/A
LAREDO
TX
ACTIVE
1/7/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/6/2015 None
N/A
3/15/2013 None
N/A
8/1/2013 None
N/A
21-Apr-16 None
N/A
10/15/2012 None
1/27/2015 None
N/A
N/A
8/26/2014 None
N/A
HEAD AND NECK
SURGERY
RANDOLPH
AFB
SAN ANTONIO TX
ADDICTION
MEDICINE
1/5/2020 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
ATLANTA
ADDICTION
MEDICINE
Page 27 of 402
GA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
CRITICAL CARE
8/15/2013
8/15/2018 MEDICINE (IM)
01-Feb-16
01-Feb-21 HOSPITALIST
PEDIATRICS,
5/15/2014
Secondary Specialty
(Self-Designated)
PULMONARY
DISEASES
INTERNAL MEDICINE
Practice City
P7607
Q7009
AWAN, RINA NAZIR, MD
AWE, OPEYEMI ABIODUN, MD
Q0219
AWERBACH, JORDAN DANIEL, MD
Q3324
AYALA, ABRAHAM GUERRERO, MD
P4845
AYALA, CARLOS, MD
Q0001
P4544
AYALA, SANTIAGO M, MD
AYALLOORE, SIBY GEORGE, MD
5/2/2014
10/1/2012
Q3143
AYDIN, HUSEYIN NAIL, MD
2/13/2015
P5329
AYENI, OLAYINKA MODUPE, MD
P6133
AYERS, GAYLE YVONNE, DO
Q8015
AYERS, GREGORY WAYNE, MD
P9510
P7063
Q2731
P8845
AYOADE, KATHERINE OMUETI, MD
AYOOLA, FOLAHAN KOLAWOLE,
MD
AYOUB, SURA , MD
AYOUB-RODRIGUEZ, LISA
MICHELLE, MD
AZAR, SUSAN ELIZABETH, MD
AZARCON, FERNANDO C, MD
Q7319
AZEEZ, FARHAN ABDUL, DO
P6330
AZHAR, AHSAN , MD
5/1/2013
P2949
AZIZ, BUSHRA, MD
5/1/2012
5/1/2018 PALLIATIVE MEDICINE INTERNAL MEDICINE HOUSTON
CHILD AND
ADOLESCENT
5/1/2017 PSYCHIATRY
PSYCHIATRY
P6331
AZIZ, NIVIN, MD
5/1/2013
5/1/2018 NEPHROLOGY
P2826
Q4893
3/3/2015
11/15/2012
OTORHINOLARYNGOL FACIAL PLASTIC
11/15/2017 OGY
SURGERY
SURGICAL
2/13/2020 ONCOLOGY
2/1/2013
2/1/2018 PSYCHIATRY
4/12/2013
02-May-16
4/1/2014
4/13/2012
7/1/2015
7/1/2013
1/5/2015
2/7/2014
04-Mar-16
INTERNAL MEDICINE
MCALLEN
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
INTERNAL MEDICINE
GENERAL SURGERY BALTIMORE
CHILD AND
ADOLESCENT
PSYCHIATRY
EL PASO
PALLIATIVE
MEDICINE
MD
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
8/15/2013 None
25-Apr-16 None
N/A
N/A
5/15/2014 None
N/A
3/5/2015 None
N/A
11/19/2012 None
N/A
5/2/2014 None
12/3/2012 None
N/A
N/A
2/17/2015 None
SEE
PREVIOUS
2/22/2013 ORDER
N/A
4/12/2013 None
N/A
10-May-16 None
N/A
3/1/2011
BIRMINGHAM
AL
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/7/2014 None
N/A
4/13/2012 None
7/28/2015 None
N/A
N/A
7/19/2013 None
2/9/2015 None
2/10/2014 None
N/A
N/A
N/A
7/1/2018 PEDIATRICS
2/7/2019 RADIOLOGY
EMERGENCY
04-Mar-21 MEDICINE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOSPITALIST
EL PASO
TX
BODY IMAGING
EL PASO
TX
ACTIVE
ACTIVE
ACTIVE
IRVING
TX
ACTIVE
10-Mar-16 None
N/A
TX
ACTIVE
6/19/2013 None
N/A
ACTIVE
LICENSE
ISSUED
5/10/2012 None
N/A
5/1/2013 None
N/A
INTERNAL MEDICINE
Page 28 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
ENDOCRINOLOGY,
DIABETES AND
3/1/2013
3/1/2018 METABOLISM
3/1/2012
6/1/2015
DIAGNOSTIC
3/3/2014
3/3/2019 RADIOLOGY
8/1/2014
EMERGENCY
7/1/2015
7/1/2020 MEDICINE
INTERVENTIONAL
1/15/2013
P5589
P2190
Q4562
AZIZ, SHAHID, MD
AZIZ, WESAM SABRI, MD
AZIZAD, OMAIRA , MD
P9151
Q1083
Q4894
AZIZAD, SHAMEEM, MD
AZMY, SHERIN, MD
AZNAUROVA-ANDERSON, LILIYA ,
MD
P5258
AZPURUA, FEDERICO EMILIO, MD
P4732
Q7634
AZUOGU, ONYEMEZE , MD
AZZAM, MOHAMAD ALI, MD
11/1/2012
01-Apr-16
01-Apr-21 ANESTHESIOLOGY
P4415
Q6391
BABADE, MOSUNMOLA , MD
BABAR, SAMIA, MD
9/17/2012
11/2/2015
9/17/2017 PAIN MANAGEMENT
Q2732
BABEL, NITIN , MD
1/5/2015
Q7528
BABOOLAL, BRENT, MD
15-Mar-16
Q4895
BABU, VIJAY GUTTI, MD
7/1/2015
Q8422
BACA, MARSHALL G JR, DO
P2950
BACKLUND, AMANDA JANINE, MD
Q5755
H4867
Q3145
01-Jun-16
15-Mar-21 HOSPITALIST
EMERGENCY
01-Jun-21 MEDICINE
5/1/2012
BACKOFEN, GREGORY SCOTT, MD
BADALAMENTI, JOHN, MD
8/28/2015
9/15/2015
BADAR, SHAHID, MD
2/13/2015
Q3849
BADER, DONALD LEROY JR, MD
4/10/2015
EMERGENCY
4/10/2020 MEDICINE
Q0731
BADER, RAZAN, MD
BADIDI, OGHENETEGA ABRAHAM,
MD
6/27/2014
P5591
3/1/2013
Secondary Specialty
(Self-Designated)
Practice City
HOSPITALIST
HARLINGEN
DALLAS
CARDIOTHORACIC
RADIOLOGY
SAN ANTONIO
HOUSTON
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
3/7/2013 None
3/6/2012 None
6/15/2015 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
3/6/2014 None
8/21/2014 None
N/A
N/A
INTERNAL MEDICINE
ACTIVE
7/24/2015 None
N/A
INTERNAL MEDICINE
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
EL PASO
PAIN MANAGEMENT
ANESTHESIOLOGY PAIN MANAGEMENT PLANO
ACTIVE
1/28/2013 None
N/A
TX
ACTIVE
ACTIVE
12/4/2012 None
21-Jun-16 None
N/A
N/A
TX
ACTIVE
ACTIVE
10/3/2012 None
11/6/2015 None
N/A
N/A
FL
ACTIVE
1/12/2015 None
N/A
MA
ACTIVE
17-Mar-16 None
N/A
ACTIVE
8/3/2015 None
N/A
TX
ACTIVE
03-Jun-16 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/14/2012 None
N/A
8/28/2015 None
9/17/2015 None
N/A
N/A
2/13/2015 None
N/A
4/10/2015 None
N/A
6/27/2014 None
N/A
4/3/2013 None
N/A
ABDOMINAL
SURGERY
SPRING HILL
SOUTH
INTERNAL MEDICINE WEYMOUTH
EL PASO
LUBBOCK
EMERGENCY
MEDICINE
PALLIATIVE
MEDICINE
PEDIATRIC
GASTROENTEROLOG
Y
DALLAS
Page 29 of 402
DALLAS
TX
TX
LICENSE
ISSUED
TX
ACTIVE
License
Number
P7608
Physician Name
BADIGER, MALLIKARJUN
PUNDLEEK, MD
BADIREDDY, MADHU SUDHAN
REDDY, MD
P3115
BADLISSI, MICHAEL, MD
P1845
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2013
INTERNAL MEDICINE
5/15/2012
PEDIATRICS,
PEDIATRIC CRITICAL
CARE MEDICINE
EL PASO
BADUGU, SRINIVASA RAO, MD
L2118
BAG, REMZI, MD
P9800
P4416
BAGGERMAN, ERIC WAYNE, MD
BAGGETT, LISA R, MD
4/15/2014
9/17/2012
Q0404
BAGHERPOUR, ARYA NAVID, DO
6/2/2014
Q5756
P2951
BAGLEY, CARLOS ANTONIO, MD
BAGRODIA, MONA AMBIKA, MD
8/28/2015
5/1/2012
Q4020
Q5971
BAHAA ALDEEN, MOHAMMED , MD
BAHAL, PAUL AMIT, MD
5/1/2015
9/15/2015
Q5972
BAHLING, JOHN, MD
9/15/2015
Q1354
P8010
BAIG, MIRZA SHAHRUKH, MD
BAIJNATH, NALINI S, MD
8/15/2014
10/1/2013
P2191
BAILEY, APRIL ALEXANDER, MD
P6135
BAILEY, ELIZABETH ANN, MD
BAILEY, KALA JORDAN, MD
BAILEY, LAUREN HAYES, MD
Q7835
BAILEY, STEVEN L, MD
Q1084
BAINS, IQNOOR , MD
Practice City
1/17/2012
P9300
P8848
Q8017
Secondary Specialty
(Self-Designated)
3/17/2014
2/1/2013
3/1/2012
4/12/2013
2/7/2014
02-May-16
15-Apr-16
8/1/2014
PULMONARY
2/1/2018 DISEASES
N/A
8/15/2013 None
N/A
5/15/2012 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/10/2014 None
N/A
2/1/2013 None
N/A
4/15/2014 None
9/20/2012 None
N/A
N/A
6/2/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
9/4/2015 None
6/28/2012 None
N/A
N/A
ROUND ROCK TX
ACTIVE
ACTIVE
5/8/2015 None
11/13/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
12/7/2015 None
N/A
8/15/2014 None
10/7/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
3/12/2012 None
N/A
4/12/2013 None
N/A
DALLAS
CEDAR HILL
PEDIATRIC
EMERGENCY
9/15/2020 MEDICINE (PEDS)
TX
TX
INTERNAL MEDICINE
AUSTIN
DIAGNOSTIC
3/1/2017 RADIOLOGY
OBSTETRICS AND
Disciplinary
Status Date
1/24/2012 None
TEMPLE
6/2/2019 RADIOLOGY
NEUROLOGICAL
8/28/2020 SURGERY
5/1/2017 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
CRITICAL CARE
MEDICINE
DALLAS
TX
TX
ONE BAYLOR
PLAZA
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
2/21/2014 None
09-May-16 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
11-May-16 None
N/A
PSYCHIATRY
BAYTOWN
ACTIVE
8/21/2014 None
N/A
2/7/2019 PSYCHIATRY
CHILD AND
ADOLESCENT
8/1/2019 PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
Page 30 of 402
TX
License
Number
Physician Name
Q6494
Q7140
P6332
P5157
BAINS, KARANPREET SINGH, MD
BAINS, PAVIT , MD
BAIRD, TIFFANY RENEE, MD
BAKAJ, GENTIANA, MD
Q6145
BAKALIS, CHRISTINA, MD
Q8243
BAKER, NOELLE AISSA, MD
Q1947
P7064
BAKER, THOMAS JOSHUA, MD
BAKSHI, PRATIMA RAMESH, MD
Q0405
Q2427
BALA, VANITHA, MD
BALAMUTHUSAMY, SARAVANAN,
MD
P5930
BALAPALA, KIRANMAYE , MD
Q6146
BALASUBRAMANIAN, DIVYA, DO
Q8207
BALDWIN, CHRISTINA LAUREN, MD
P2954
BALLA, JUSTIN DOMINIQUE, MD
P6582
BALLAPURAM, KALYANI, MD
P6779
P8215
P1446
Q4897
Q6392
Q2511
Q1793
BALLAS, JERASIMOS, MD
BALLESTER-FUENTES, LEOMAR Y,
MD
BALMER-SWAIN, MALLORY ANNE,
DO
BALOGH, RYAN PATRICK, MD
BALOGUN, OLUSOLA ELIZABETH,
MD
BALSON, ANAND J, MD
BAMGBELU, OLUKAYODE, MD
dicaid
dicaid
Agreement
End Date
Designated)
INFECTIOUS
11/16/2015
11/16/2020 DISEASES
16-Feb-16
16-Feb-21 RADIOLOGY
5/1/2013
5/1/2018 PEDIATRICS
1/4/2013
INTERVENTIONAL
10/1/2015
10/1/2020 RADIOLOGY
OBSTETRICS AND
16-May-16
16-May-21 GYNECOLOGY
URGENT CARE
10/1/2014
10/1/2019 MEDICINE
7/1/2013
GASTROENTEROLOG
6/2/2014
6/2/2019 Y
11/17/2014
4/1/2013
10/1/2015
16-May-16
5/1/2012
5/15/2013
6/3/2013
11/1/2013
11/15/2011
7/1/2015
11/2/2015
12/3/2014
9/15/2014
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE MARKS
DIAGNOSTIC
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
MS
Registration
Status Date
Disciplinary
Status Date
MANSFIELD
GREENVILLE
TX
NC
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DESOTO
TX
ACTIVE
10/5/2015 None
N/A
ACTIVE
17-May-16 None
N/A
ACTIVE
ACTIVE
10/6/2014 None
7/9/2013 None
N/A
N/A
ACTIVE
6/5/2014 None
N/A
GENERAL PRACTICE
THE
INTERNAL MEDICINE WOODLANDS TX
11/17/2015
23-Mar-16
5/17/2013
2/7/2013
Disciplinary
Status of
Texas
License
None
None
None
None
N/A
N/A
N/A
N/A
GERIATRIC MEDICINE
4/1/2018 (INTERNAL MED)
FAMILY MEDICINE
EMERGENCY
10/1/2020 MEDICINE
FORT WORTH TX
ACTIVE
11/21/2014 None
N/A
GALVESTON
TX
ACTIVE
4/8/2013 None
N/A
DALLAS
TX
ACTIVE
10/14/2015 None
N/A
TAMPA
FL
ACTIVE
24-May-16 None
N/A
HOUSTON
WICHITA
FALLS
TX
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
5/23/2013 None
N/A
HOUSTON
TX
ACTIVE
7/1/2013 None
N/A
11/1/2013 None
N/A
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
MATERNAL AND
6/3/2018 FETAL MEDICINE
11/1/2018 PATHOLOGY
EMERGENCY
11/2/2020 MEDICINE
OBSTETRICS AND
GYNECOLOGY
MOLECULAR
GENETIC
PATHOLOGY
LICENSE
ISSUED
INTERNAL MEDICINE PHILADELPHIA PA
FT WORTH
TX
ACTIVE
ACTIVE
11/22/2011 None
7/9/2015 None
N/A
N/A
CHICAGO
IL
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
11/25/2015 None
12/4/2014 None
10/3/2014 None
N/A
N/A
N/A
HOSPITALIST
Page 31 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIAC
ELECTROPHYSIOLOG
3/3/2014
3/3/2019 Y
CARDIOLOGY
P9154
BANCHS, JAVIER EDUARDO, MD
P5027
BANDA, PRAGATI, MD
12/17/2012
P5027
BANDA, PRAGATI, MD
12/17/2012
P5027
Q7141
P5028
P5028
P5028
BANDA, PRAGATI, MD
BANDEALI, BARKATALI , DO
BANGA, MADHUMITA, MD
12/17/2012
16-Feb-16
12/17/2012
12/17/2012
12/17/2012
12/17/2017
16-Feb-21
12/17/2017
12/17/2017
12/17/2017
P2586
4/2/2012
4/2/2017
Q0002
BANGALE, ANITA, MD
BANGALORE HARISH,
RAJASHEKHAR, MD
5/2/2014
5/2/2019
P9514
Q2735
BANH, DAVID , MD
BANH, JEANNIE , DO
4/1/2014
1/5/2015
4/1/2019
1/5/2020
Q5148
7/15/2015
P9155
Q1086
BANKS, GERALD, MD
BANKS, LAUREN KAY HASTINGS,
MD
BANNA, HADELE, MD
Q7638
P6333
BANNER, JENNA NICOLE, MD
BANSAL, ARVIN, MD
01-Apr-16
5/1/2013
P7066
BANSAL, MANISH, MD
Q7321
BANSAL, PARDEEP, MD
Q4563
BANSAL, RAHUL, MD
Q2641
P4735
Q1087
BANSAL, SUDHA, MD
BANTU, VISHWAROOP, MD
BAPAT, KAVITA VISHRAM, MD
Q0866
BAQAI, ATIF, MD
HOSPITALIST
INTERNAL MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
EMERGENCY
MEDICINE
PEDIATRIC CRITICAL
CARE MEDICINE
OBSTETRICS AND
GYNECOLOGY
FAMILY MEDICINE
7/1/2013
OBSTETRICS AND
3/3/2019 GYNECOLOGY
OBSTETRICS AND
01-Apr-21 GYNECOLOGY
PEDIATRICS,
7/1/2018 CARDIOLOGY
04-Mar-16
3/3/2014
8/1/2014
6/1/2015
12/15/2014
11/1/2012
8/1/2014
7/15/2014
6/1/2020 PSYCHIATRY
8/1/2019 PEDIATRICS
Practice City
TEMPLE
HOUSTON
SPRINGFIELD
SPRINGFIELD
SPRINGFIELD
FALLS
CHURCH
EMERGENCY
MEDICINE
Registration
Status of
Practice
Texas
State
License
TX
TX
IL
IL
IL
VA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
3/13/2014 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012
18-Feb-16
12/26/2012
12/26/2012
12/26/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/11/2012 None
N/A
5/2/2014 None
N/A
DALLAS
SUGAR LAND
TX
TX
ACTIVE
ACTIVE
4/4/2014 None
1/19/2015 None
N/A
N/A
KINGSVILLE
TX
ACTIVE
7/30/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/4/2014 None
8/26/2014 None
N/A
N/A
01-Apr-16 None
5/10/2013 None
N/A
N/A
7/1/2013 None
N/A
07-Mar-16 None
N/A
6/1/2015 None
N/A
12/15/2014 None
11/15/2012 None
8/5/2014 None
N/A
N/A
N/A
7/22/2014 None
N/A
HOUSTON
PEDIATRICS
GASTROENTEROLOG
Y
SCRANTON
CHILD AND
ADOLESCENT
PSYCHIATRY
KALAMAZOO
HOUSTON
7/15/2019 VASCULAR SURGERY GENERAL SURGERY GARLAND
Page 32 of 402
TX
PA
ACTIVE
MI
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
TX
ACTIVE
License
Number
Q4564
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
6/1/2015
Q7012
Q4565
BARAD, BHAVESH, MD
BARAJAS DE LA ROCHA,
FRANCISCO JAVIER, MD
BARAN AKCE, LEYLA , MD
01-Feb-16
6/1/2015
6/1/2020 PSYCHIATRY
P7385
Q8426
Q5149
BARBA, CARLOS ALBERTO, MD
BARBARA, MARY, MD
BARBER, LISA MARIE , MD
8/1/2013
01-Jun-16
7/15/2015
P6947
P0698
BARDWELL, STEVEN JOHN, DO
BARE, SUDHIR, MD
6/14/2013
8/15/2011
EMERGENCY
6/14/2018 MEDICINE
P2588
BARKER, JEFFREY RYAN, MD
Q2880
BARKER, MICHAEL J, MD
1/15/2015
DIAGNOSTIC
1/15/2020 RADIOLOGY
Q7836
P7386
BARKER, SAMUEL FOX, MD
BARKLEY, SHANNON, MD
15-Apr-16
8/1/2013
15-Apr-21 FAMILY PRACTICE
P9803
BARLAPUDI, SHALINI RAO, MD
4/15/2014
P7244
P2415
BARNES, ARTI, MD
BARNES, JAMMIE KAY, MD
7/15/2013
3/15/2012
P6948
BARNES, MAISHA NICHOLE, MD
6/14/2013
P3286
P3118
BARNIDGE, MICHAEL JR, MD
BARNING, KENNETH , MD
6/1/2012
5/15/2012
Q2428
BARRA, MICHAEL, MD
Q4363
BARRAGAN, MYRIAM SORAYA, MD
J9572
BARRETT, ANDREA J, MD
Q7639
BARRETT, LISA SHANEL, MD
4/2/2012
11/17/2014
5/15/2015
12/15/2014
01-Apr-16
Secondary Specialty
(Self-Designated)
Practice City
CARDIOLOGY
Disciplinary
Status Date
6/1/2015 None
N/A
ACTIVE
ACTIVE
05-Feb-16 None
6/16/2015 None
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
8/9/2013 None
07-Jun-16 None
8/26/2015 None
N/A
N/A
N/A
FORT WORTH TX
INTERNAL MEDICINE ODESSA
TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
HOUSTON
TX
ACTIVE
ACTIVE
7/9/2013 None
8/18/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/12/2012 None
N/A
1/15/2015 None
SEE
PREVIOUS
18-Apr-16 ORDER
8/13/2013 None
N/A
4/15/2014 None
N/A
ACTIVE
ACTIVE
7/23/2013 None
3/16/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
6/20/2013 None
N/A
6/1/2012 None
5/30/2012 None
N/A
N/A
11/17/2014 None
N/A
CORPUS
CHRISTI
HOUSTON
INFECTIOUS
7/15/2018 DISEASES
GASTROENTEROLOG
6/14/2018 Y
DIAGNOSTIC
6/1/2017 RADIOLOGY
EMERGENCY
11/17/2019 MEDICINE
PEDIATRIC
GASTROENTEROLOG
5/15/2020 Y
ORTHOPEDIC
12/15/2019 SURGERY
PHYSICAL MED. &
01-Apr-21 REHABILITATION
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TRAUMATIC
SURGERY
SAN ANTONIO
HOUSTON
BROWNSVILL
E
SAN ANTONIO
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
TX
NEPHROLOGY
TX
INTERNAL MEDICINE MINNEAPOLIS MN
INTERVENTIONAL
RADIOLOGY
PASADENA
TX
Page 33 of 402
ACTIVE
ACTIVE
LICENSE
ISSUED
3/4/2016
N/A
HOUSTON
TX
ACTIVE
5/19/2015 None
N/A
UVALDE
TX
ACTIVE
12/17/2014 None
N/A
EL PASO
TX
ACTIVE
04-Apr-16 None
N/A
License
Number
P5259
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
1/15/2013
Q1568
BARRETTO, JOHAN JUDE, MD
BARREZUETA, HECTOR ALFREDO,
MD
8/29/2014
Q1355
BARROW, ALISON , MD
8/15/2014
EMERGENCY
8/15/2019 MEDICINE
P8849
BARROW, ALVIN J, MD
2/7/2014
Q7142
BARROW, ANDREW JOSEPH, MD
BARSHIKAR, SURENDRA
SHRIKRISHNA, MD
Q8019
P7881
16-Feb-16
02-May-16
DIAGNOSTIC
16-Feb-21 RADIOLOGY
PHYSICAL MED. &
PEDIATRICS,
EMERGENCY
6/8/2017 MEDICINE
EMERGENCY
5/1/2020 MEDICINE
HOSPITALIST
INTERVENTIONAL
RADIOLOGY
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
MEDICINE
9/16/2013
P3507
BARTAKIAN, SERGIO, MD
BARTON, JAMES BRADLEY
GUSTAF, MD
Q4025
BARTON, MELISSA ANN, MD
5/1/2015
P6137
BASALDUA, KELLY MARIE, MD
4/12/2013
P5776
BASANI, SAMATA, MD
3/15/2013
6/8/2012
Q0408
BASELLE, HOLLY ELIZABETH, DO
6/2/2014
Q0220
BASELLE, ZACHARY JOHN, DO
Q0409
BASIT, ABDUL, MD
6/2/2014
P9516
Q2736
BASKARAN, ARTI , MD
BASKARARAJAN,
VENKATASUBRAMANIAN, MD
P1962
BASLER, JOSEPH THEODORE, MD
2/1/2012
5/15/2014
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
TX
Disciplinary
Status Date
1/15/2013 None
N/A
8/29/2014 None
N/A
8/15/2014 None
N/A
2/7/2014 None
N/A
ACTIVE
04-Mar-16 None
N/A
ACTIVE
09-May-16 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
9/25/2013 None
N/A
BEAUMONT
TX
ACTIVE
6/14/2012 None
N/A
DETROIT
MI
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/11/2015 None
N/A
4/12/2013 None
N/A
3/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/9/2014 None
N/A
5/15/2014 None
N/A
6/2/2014 None
N/A
HOSPITALIST
NORTH
RICHLAND
HILLS
EMERGENCY
6/2/2019 MEDICINE
EMERGENCY
5/15/2019 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
4/1/2014
6/2/2019 CARDIOLOGY
EMERGENCY
4/1/2019 MEDICINE
DALLAS
TX
ACTIVE
4/2/2014 None
N/A
1/5/2015
1/5/2020 PSYCHIATRY
HATTIESBURG MS
ACTIVE
1/9/2015 None
N/A
SPRINGFIELD IL
ACTIVE
2/7/2012 None
N/A
GRAPEVINE
TX
ACTIVE
7/28/2015 None
N/A
IRVING
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
5/2/2014 None
8/17/2015 None
N/A
N/A
Q5151
BASORA, JOSE F, MD
7/15/2015
P9517
L3240
BASRA, APRAM APAR, DO
BASSALI, JOANNE BOTROS, MD
4/1/2014
8/14/2015
2/1/2017 RADIOLOGY
PULMONARY
CRITICAL CARE
7/15/2020 MEDICINE
EMERGENCY
4/1/2019 MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
Page 34 of 402
License
Number
P0341
Physician Name
BASSETT, ROBERT, DO
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
7/15/2011
7/15/2016 MEDICINE
P8852
P5509
BASSEY, HAWKINS UWEH, MD
BASSEY, UKANA, DO
2/7/2014
2/8/2013
N3485
BASSHAM, BRIAN SCOTT, MD
5/1/2013
Q4026
BASSI, BYRON MICHAEL, MD
5/1/2015
PEDIATRIC
EMERGENCY
EMERGENCY
5/1/2020 MEDICINE
Q7143
BASSI, DEEP GAGAN, MD
16-Feb-16
Q8427
Q5758
01-Jun-16
8/28/2015
P9805
P9158
BASSO, MARK ANTHONY, MD
BASSUNER, JURI, MD
BASTIDAS PALACIOS,
ALEXANDER, MD
BASU, SUPARNA, MD
Q6605
BATEMAN, JOHN BRIAN, MD
12/4/2015
Q6605
04-Dec-15
Q6605
P8446
BATES, JEREMY RYAN, MD
04-Dec-15
12/6/2013
16-Feb-21 RADIOLOGY
EMERGENCY
01-Jun-21 MEDICINE
CRITICAL CARE
3/3/2019 PSYCHIATRY
EMERGENCY
12/4/2020 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
P9518
4/1/2014
P2589
Q8020
BATES, JOHN CHARLES III, MD
BATHALA, THARAKESWARA
KUMAR, MD
BATHINA, RAJYA SHILPA, MD
4/2/2012
02-May-16
P8576
Q5346
BATHLA, LOKESH, MD
BATHULA, SRIKANTH, MD
12/16/2013
8/3/2015
P6584
E8311
BATISTA, DALIA L, MD
BATJER, HENRY HUNTINGTON III,
MD
Q4566
BATMANIS, PAUL STRATO, MD
P6138
BATRA, KIRAN, MD
4/15/2014
3/3/2014
5/15/2013
11/15/2013
6/1/2015
4/12/2013
Secondary Specialty
(Self-Designated)
FT. BLISS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/12/2011 None
N/A
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/7/2014 None
2/18/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/24/2013 None
N/A
GAINESVILLE
FL
ACTIVE
5/4/2015 None
N/A
HOUSTON
TX
ACTIVE
02-Mar-16 None
N/A
TEMPLE
HOUSTON
TX
TX
ACTIVE
ACTIVE
20-Jun-16 None
9/11/2015 None
N/A
N/A
INTERNAL MEDICINE DANVILLE
HARRISON
PA
NY
ACTIVE
ACTIVE
LICENSE
ISSUED
4/21/2014 None
4/8/2014 None
N/A
N/A
12/4/2015 None
N/A
PEDIATRICS
ABDOMINAL
RADIOLOGY
4/2/2017 RADIOLOGY
TRANSPLANT
12/16/2018 SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
DIAGNOSTIC
RADIOLOGY
ATHENS
TX
ACTIVE
08-Jan-16 None
N/A
ATHENS
DALLAS
NEW
ORLEANS
TX
TX
ACTIVE
ACTIVE
08-Jan-16 None
12/9/2013 None
N/A
N/A
LA
ACTIVE
4/3/2014 None
N/A
HOUSTON
CLOVIS
TX
NM
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/9/2012 None
03-May-16 None
N/A
N/A
12/16/2013 None
8/31/2015 None
N/A
N/A
5/15/2013 None
N/A
11/22/2013 None
N/A
6/9/2015 None
N/A
4/12/2013 None
N/A
INTERNAL MEDICINE
NEUROLOGICAL
11/15/2018 SURGERY
EMERGENCY
6/1/2020 MEDICINE
4/12/2018 RADIOLOGY
Page 35 of 402
DALLAS
TX
ACTIVE
FORTUNA
CA
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P9159
BATRA, NEHA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
3/3/2014
3/3/2019 PEDIATRICS
PEDIATRIC
7/15/2015
SPORTS MEDICINE
EMERGENCY
5/15/2014
5/15/2019 MEDICINE
ANESTHESIOLOGY 7/1/2013
7/1/2018 ALLERGY
PAIN MANAGEMENT
DIAGNOSTIC
8/3/2015
8/3/2020 RADIOLOGY
BODY IMAGING
DIAGNOSTIC
INTERVENTIONAL
5/15/2013
5/15/2018 RADIOLOGY
RADIOLOGY
15-Dec-15
Q5152
BAUER, KATHRYN LEIGH, MD
Q0221
P7067
BAUM, ZACHARY , DO
BAUMGARTNER, EDWARD
WILLIAM JR, MD
Q5347
BAXI, AMEYA JAGDISH, MD
P6585
Q6730
BAXTER, AARON JAMES, MD
BAXTER, KHANNAH , MD
P1447
BAYASI, MOHAMMED , MD
11/15/2011
P1447
BAYASI, MOHAMMED , MD
02-May-16
COLON AND RECTAL
02-May-21 SURGERY
P4926
BAYAT, NEYSAN, MD
11/30/2012
Q3327
BAYONA, ANDRES , MD
Q5153
P0544
BEALL, RAKEL CHANDRA, MD
BEAN, GARY ERWIN, MD
BEARD, HEATHER LEANNE
NORRIS, DO
P1848
3/3/2015
7/15/2015
8/1/2011
1/17/2012
Q7530
BEATTIE, JEANNE LOUISE, MD
15-Mar-16
Q7144
BECERRA, ISRAEL, MD
16-Feb-16
P6336
Q8429
BECK, ERIC HENRY, DO
BECK, JENNIFER, MD
5/1/2013
01-Jun-16
P1048
BECKER, EMILY MARIE, MD
10/3/2011
P4419
BECKER, JUDITH ANNE, MD
9/17/2012
Q4901
BECKER, TYSON ERIK, MD
7/1/2015
EMERGENCY
3/3/2020 MEDICINE
PLANO
TX
CLINICAL AND
LABORATORY
IMMUNOLOGY
(PEDIATRICS)
FAMILY MEDICINE
EMERGENCY
MEDICAL SERVICES
HOSPITALIST
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/13/2014 None
N/A
ACTIVE
LICENSE
ISSUED
7/29/2015 None
N/A
5/15/2014 None
N/A
TX
ACTIVE
7/12/2013 None
N/A
SAN ANTONIO TX
ACTIVE
9/10/2015 None
N/A
HOUSTON
GALVESTON
5/17/2013 None
25-Jan-16 None
N/A
N/A
11/15/2011 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
02-May-16 None
N/A
TX
ACTIVE
12/7/2012 None
N/A
HOUSTON
TX
3/24/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
7/15/2015 None
8/5/2011 None
N/A
N/A
FORT WORTH TX
ACTIVE
2/24/2012 None
N/A
AUSTIN
TX
ACTIVE
17-Mar-16 None
N/A
MCALLEN
TX
ACTIVE
29-Mar-16 None
N/A
DALLAS
TX
FORT WORTH TX
ACTIVE
ACTIVE
6/26/2013 None
10-Jun-16 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
10/9/2011 None
N/A
TX
ACTIVE
10/24/2012 None
N/A
TX
ACTIVE
7/7/2015 None
N/A
HOUSTON
GENERAL SURGERY GALVESTON
PORT
HAND SURGERY
ARTHUR
8/1/2016 PEDIATRICS
EMERGENCY
1/17/2017 MEDICINE
15-Mar-21 NEUROLOGY
EMERGENCY
16-Feb-21 MEDICINE
EMERGENCY
5/1/2018 MEDICINE
01-Jun-21 PEDIATRICS
PEDIATRIC
PEDIATRICS,
CRITICAL CARE
7/1/2020 (TRAUMA)
Practice City
PLYMOUTH
Registration
Status of
Practice
Texas
State
License
IN
ACTIVE
HOUSTON
FORT SAM
Page 36 of 402
TX
TX
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
DERMATOPATHOLOG
Q0867
BECKUM, KATHLEEN MARTIN, MD
7/15/2014
7/15/2019 Y
DERMATOLOGY
BECKUM, ORLANDO KENDRICK,
EMERGENCY
P3121
MD
5/15/2012
5/15/2017 MEDICINE
Q1356
BEDDIES, JOHN WILLIAM, MD
8/15/2014
8/15/2019 UROLOGY
ORTHOPEDIC
SURGERY OF THE
Q4902
BEDERMAN, STACEY SAMUEL, MD
7/1/2015
7/1/2020 SPINE
BEDFORD, CHRISTOPHER AARON,
DIAGNOSTIC
INTERVENTIONAL
P8853
MD
2/7/2014
2/7/2019 RADIOLOGY
RADIOLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
Q6809
Q4722
BEDI, HARJANEET SINGH, MD
BEDNAR, GRACE , MD
SHENANDOAH TX
GALVESTON TX
P8577
BEDNARZ, NANCY MCBRYDE, MD
12/16/2013
P8578
BEDNARZ, PAUL ANTHONY, MD
12/16/2013
P5932
BEDRI, BADRELDIN, MD
Q8021
BEDWELL, JOSHUA ROBERT, MD
02-May-16
P5033
BEER, B NICH, MD
12/17/2012
P5033
BEER, B NICH, MD
12/17/2012
P5033
BEER, B NICH, MD
12/17/2012
P0546
P4848
BEERS, JEFFREY ROBERT, MD
BEG, HUMAYUN, MD
8/1/2011
11/15/2012
P5777
P5334
BEH, SHIN CHIEN, MD
BEHZADI, CHRISTEN FLACK, MD
P5335
BEHZADI, PEDRAM AMIN, MD
2/1/2013
P2096
BEICKER, CLINT ROYAL, MD
2/10/2012
P2194
BEIDLER, STEPHANIE KATHRYN,
MD
06-Jan-16
6/12/2015
4/1/2013
3/15/2013
2/1/2013
3/1/2012
RADIATION
12/16/2018 ONCOLOGY
ORTHOPEDIC
12/16/2018 SURGERY
PEDIATRIC
4/1/2018 NEPHROLOGY
PEDIATRIC
02-May-21 OTOLARYNGOLOGY
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
8/1/2016 MEDICINE
3/15/2018 NEUROLOGY
EMERGENCY
2/1/2018 MEDICINE
ORTHOPEDIC
2/10/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
3/1/2017 SURGERY
PLANO
TX
HOUSTON
TX
Disciplinary
Status Date
7/15/2014 None
N/A
5/15/2012 None
8/19/2014 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/7/2015 None
N/A
2/7/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
21-Jan-16 None
6/18/2015 None
N/A
N/A
12/16/2013 None
N/A
12/16/2013 None
N/A
4/1/2013 None
N/A
HOUSTON
TX
ACTIVE
08-Jun-16 None
N/A
TEMPLE
TX
ACTIVE
1/3/2013 None
N/A
TEMPLE
TX
ACTIVE
1/3/2013 None
N/A
TEMPLE
TX
1/3/2013 None
N/A
HOUSTON
TX
8/1/2011 None
11/20/2012 None
N/A
N/A
ROCHESTER
NY
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
3/15/2013 None
2/6/2013 None
N/A
N/A
GENEVA
NY
ACTIVE
2/5/2013 None
N/A
LUBBOCK
TX
ACTIVE
2/20/2012 None
N/A
CHAPEL HILL
NC
ACTIVE
3/13/2012 None
N/A
NEUROOPHTHALMOLOGY
Page 37 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6781
BEJJANI, CARLA, MD
P1850
BEKANICH, STEPHEN JAMES, MD
1/17/2012
P0344
7/15/2011
7/15/2016 CLINICAL GENETICS
Q2242
BEKHEIRNIA, MIR REZA , MD
BELAME, SURESH NANJE GOWDA,
MD
11/7/2014
Q3148
P9519
BELANGER, THOMAS LONG JR, MD
BELAY, TILAHUN WORKU, MD
2/13/2015
4/1/2014
EMERGENCY
2/13/2020 MEDICINE
P1165
P4632
BELCHER, MEGAN ELIZABETH, DO
BELL, JACQUELINE MARIE, DO
10/17/2011
10/15/2012
Q1088
BELL, JAYSON PATRICK, MD
8/1/2014
Q2737
BELL, KATHLEEN REILLY, MD
1/5/2015
P2590
Q4366
BELL, MEGAN E, MD
BELL, ROBERT CODEY, MD
Q3642
BELL, STEPHEN DOUGLAS, DO
4/1/2015
Q5348
BELLO, OSAGIE, MD
8/3/2015
Q4723
BELLOWS, PATRICIA HARRIS, MD
6/12/2015
P4420
BELO, ANGELICA CHIOMA, MD
9/17/2012
TM00630 BELTON, DOUGLAS JR, MD
6/3/2013
4/2/2012
5/15/2015
16-May-16
P2416
BELTRAMINI, ERIN WEUST, DO
3/15/2012
P5933
P2591
BELTRAN, MICHAEL JOHN, MD
BELZ, GLENN ROLAND, MD
4/1/2013
4/2/2012
Q3330
BEN OMRAN, MOHAMED A I, MD
3/3/2015
6/3/2018 PSYCHIATRY
Secondary Specialty
(Self-Designated)
GERIATRIC
PSYCHIATRY
PALLIATIVE
MEDICINE
CLINICAL
MOLECULAR
GENETICS
ORTHOPEDIC
8/1/2019 SURGERY
PHYSICAL MED. &
DIAGNOSTIC
4/2/2017 RADIOLOGY
Practice City
PAIN MANAGEMENT
Page 38 of 402
Disciplinary
Status Date
TX
ACTIVE
6/4/2013 None
N/A
MIAMI
FL
ACTIVE
1/20/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
7/25/2011 None
N/A
11/7/2014 None
N/A
2/16/2015 None
4/9/2014 None
N/A
N/A
MCKINNEY
TX
ACTIVE
ACTIVE
SUGAR LAND
BEDFORD
TX
TX
ACTIVE
ACTIVE
N/A
N/A
ACTIVE
10/26/2011 None
12/28/2012 None
UNDER
BOARD
8/12/2014 ORDER
TX
ACTIVE
1/8/2015 None
N/A
SAN ANTONIO TX
BEAUMONT
TX
ACTIVE
ACTIVE
ORTHOPEDIC
TRAUMA
UNSPECIFIED
INTERVENTIONAL
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
DALLAS
PALLIATIVE
MEDICINE
FT WORTH
HEMATOLOGY/ONCOL
8/3/2020 OGY
INTERNAL MEDICINE WATERTOWN
OBSTETRICS AND
GASTROENTEROLOG
9/17/2017 Y
INTERNAL MEDICINE MARSHALL
DIAGNOSTIC
16-May-21 RADIOLOGY
EDEN PRAIRIE
OBSTETRICS AND
ORTHOPEDIC
FORT SAM
4/1/2018 SURGERY
HOUSTON
4/2/2017 PSYCHIATRY
HOUSTON
Registration
Status of
Practice
Texas
State
License
4/26/2012 None
6/4/2015 None
SEE
PREVIOUS
4/2/2015 ORDER
6/27/2014
N/A
N/A
TX
ACTIVE
NY
ACTIVE
LICENSE
ISSUED
9/2/2015 None
N/A
6/12/2015 None
N/A
TX
ACTIVE
9/19/2012 None
N/A
MN
ACTIVE
02-Jun-16 None
N/A
ACTIVE
3/23/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/29/2013 None
4/27/2012 None
N/A
N/A
3/3/2015 None
N/A
TX
TX
1/6/2014
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6810
BENARDETE, ETHAN ALEXANDER,
MD
Q1089
BENAVIDES, MONICA MARIE, MD
8/1/2014
P8856
P2956
BENDANA, EMMA ESTER, MD
BENDER, NATHAN SCOTT, MD
2/7/2014
5/1/2012
2/7/2019
5/1/2017
P5336
2/1/2013
2/1/2018
Q0412
P4547
BENDURE, ERIN O'NEILL, MD
BENFIELD, JONATHAN
ALEXANDER, DO
BENFOLD, NICOLE , MD
6/2/2014
10/1/2012
6/2/2019
10/1/2017
P7246
BENGLIS, DAVID MICHAEL JR, MD
7/15/2013
7/15/2018
Q5617
BENHAM, MICHAEL DAVID, MD
8/14/2015
8/14/2020
Q8022
P7247
BENIGNO, DAISY MAY GAMOTIN,
MD
BENJAMIN, BIJAS , MD
02-May-16
7/15/2013
02-May-21
7/15/2018
Q0005
BENSON, ANASTASIA MARIE, DO
5/2/2014
5/2/2019
P8216
BENTLEY, GAIL, MD
11/1/2013
11/1/2018
P7392
BENTON, EDWARD GARRISON JR,
MD
8/1/2013
8/1/2018
2/8/2013
11/7/2014
2/8/2018
11/7/2019
P5512
Q2244
Q0868
P4930
P4421
Q7644
BENTON, MARIA FLORENCIA, MD
BENTOW, JASON JOSHUA, MD
BENVENISTE, ANA PAULA ATIHE,
MD
BENVENISTE, MARCELO
KUPERMAN, MD
BENZ, MICHAEL, MD
BERAS MATOS, JULIO MANUEL,
MD
06-Jan-16
7/15/2014
11/30/2012
9/17/2012
01-Apr-16
NEUROLOGICAL
06-Jan-21 SURGERY
CARDIOVASCULAR
8/1/2019 DISEASES
Secondary Specialty
(Self-Designated)
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
Practice City
TEMPLE
BREAST IMAGING
INTERVENTIONAL
CARDIOLOGY
01-Apr-21 INTERNAL MEDICINE RHEUMATOLOGY
Page 39 of 402
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
07-Jan-16 None
N/A
8/1/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
2/24/2014 None
5/3/2012 None
N/A
N/A
TX
ACTIVE
2/7/2013 None
N/A
TX
ACTIVE
ACTIVE
6/6/2014 None
10/22/2012 None
N/A
N/A
GA
ACTIVE
7/26/2013 None
N/A
TX
ACTIVE
8/21/2015 None
N/A
KY
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
13-Jun-16 None
7/17/2013 None
N/A
N/A
5/2/2014 None
N/A
TN
ACTIVE
11/6/2013 None
N/A
TX
ACTIVE
8/6/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
2/12/2013 None
11/12/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
7/21/2014 None
N/A
HOUSTON
TX
ACTIVE
12/13/2012 None
N/A
JERSEY CITY
NJ
ACTIVE
10/22/2012 None
N/A
SAN ANTONIO TX
ACTIVE
02-May-16 None
N/A
INTERNAL MEDICINE
PLASTIC &
RECONSTRUCTIVE
UROLOGIC SURGERY SURGERY
LONGVIEW
FAMILY MEDICINE
SUGAR LAND
PEDIATRIC
EMERGENCY
PEDIATRICS
MEDICINE (PEDS)
HOUSTON
PHYSICAL MED. &
REHABILITATION
SAN ANTONIO
INTERNAL MEDICINE
NEUROLOGICAL
SURGERY
ATLANTA
EMERGENCY
MEDICINE
TEMPLE
GERIATRIC
MEDICINE (FAMILY
FAMILY MEDICINE
PRACTICE)
HICKMAN
INTERNAL MEDICINE
DALLAS
FAMILY
PRACTICE/OMM
ANATOMIC/CLINICAL HEMATOLOGY
PATHOLOGY
(PATHOLOGY)
MEMPHIS
ADULT
ORTHOPEDIC
RECONSTRUCTIVE
SURGERY
ORTHOPEDICS
WACO
HEMATOLOGY/ONCO
INTERNAL MEDICINE LOGY
HOUSTON
DERMATOLOGY
DALLAS
7/15/2019 RADIOLOGY
DIAGNOSTIC
CARDIOVASCULAR
9/17/2017 DISEASES
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q2245
BERES, ALANA L, MD
P2593
BERG, ERIC E, MD
P6337
Q5155
BERG, KRISTIN MARIE, MD
BERGAL, LINDA MICHELLE, MD
Q6308
Q0869
BERGAL, MICHAEL, MD
BERGER, ERICKA LYNN, MD
Q0006
BERGERON, JENNIFER LYNN, MD
Q3482
Q5760
P5034
P5034
P5034
BERGNER, ERYNN MARIE, MD
BERHIL, ANIS, MD
BERJE, ALBERT, MD
BERJE, ALBERT, MD
BERJE, ALBERT, MD
3/16/2015
8/28/2015
12/17/2012
12/17/2012
12/17/2012
3/16/2020
8/28/2020
12/17/2017
12/17/2017
12/17/2017
J1876
BERKMAN, SCOTT A, MD
BERKVENS, BENNIE JOHANNES,
MD
BERLIN, ARNOLD IRWIN, MD
BERMUDEZ POUCHARD, ELSIE
YAMILE, MD
BERMUDEZ WAGNER, KARLA
MARBELIA, MD
BERMUDEZ, CHRISTOPHER
JOSEPH, MD
BERNAL, NATHAN JAMES, MD
11/15/2013
6/16/2014
10-Jun-16
Q0607
E9109
P5338
Q2102
P7071
Q5618
11/7/2014
4/2/2012
5/1/2013
7/15/2015
10/15/2015
7/15/2014
5/2/2014
2/1/2013
10/15/2014
7/1/2013
8/14/2015
TM00601 BERNAL, OSCAR GUILLEMO, MD
BERNARD, FOLASHADE MODUPE,
Q8025
MD
Q5761
BERNARD, NICOLE LOUISE, MD
02-May-16
8/28/2015
Q8695
Q5619
10-Jun-16
8/14/2015
BERNS, DAVID HERSCHEL, MD
BERRY, BREANNA R, DO
4/1/2015
Secondary Specialty
(Self-Designated)
Practice City
11/7/2019 PEDIATRIC SURGERY GENERAL SURGERY
OTORHINOLARYNGOL
4/2/2017 OGY
EMERGENCY
5/1/2018 MEDICINE
HUMBLE
BEAUMONT
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/7/2014 None
N/A
ACTIVE
4/9/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
5/8/2013 None
7/21/2015 None
N/A
N/A
PORT NECHES TX
MCKINNEY
TX
ACTIVE
ACTIVE
11/9/2015 None
7/18/2014 None
N/A
N/A
STANFORD
CA
5/5/2014 None
N/A
HOUSTON
ST LOUIS
TX
MO
11/15/2018 PEDIATRIC UROLOGY
PARADISE
VALLEY
AZ
BROOKLYN
NY
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
PEDIATRICS
INTERNAL MEDICINE
RADIOLOGY
RADIOLOGY
RADIOLOGY
2/1/2018 PSYCHIATRY
MATERNAL AND
HOSPITALIST
ACTIVE
MEDICAL GENETICS
4/1/2020 NEUROLOGY
DIAGNOSTIC
10-Jun-21 RADIOLOGY
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
CANTON
MA
ACTIVE
ATLANTA
AUSTIN
GA
TX
HEREFORD
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
NEURO-RADIOLOGY
Page 40 of 402
3/16/2015
9/3/2015
1/1/2013
1/1/2013
1/1/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
11/15/2013 None
N/A
6/16/2014 None
15-Jun-16 None
N/A
N/A
2/5/2013 None
N/A
10/27/2014 None
N/A
7/1/2013 None
8/20/2015 None
N/A
N/A
4/14/2015 None
N/A
03-May-16 None
8/31/2015 None
N/A
N/A
10-Jun-16 None
8/18/2015 None
N/A
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
SURGERY OF THE
PEDIATRIC
Q5620
BERRY, CHIRAG ASHOK, MD
8/14/2015
8/14/2020 SPINE
ORTHOPEDICS
EMERGENCY
Q2248
BERRY, JOHNATHON ALLEN, DO
11/7/2014
11/7/2019 MEDICINE
EMERGENCY
Q5349
BERRY, MIKE P JR, MD
8/3/2015
8/3/2020 MEDICINE
FAMILY PRACTICE P1727
BERRY, SHANNON GAYLE, MD
1/2/2012
EMERGENCY MED
TRAUMATIC
Q1090
BERRY, SHIREE A, MD
8/1/2014
P7072
BERRY, THOMAS JOEL, MD
7/1/2013
ANESTHESIOLOGY
OBSTETRICS AND
P9304
BERRY-ROBERTS, CRYSTAL S, MD
3/17/2014
EMERGENCY
Q1358
BERTRAND, SKIPPER JOEL, MD
8/15/2014
8/15/2019 MEDICINE
TM00463 BESSETTE, PETER RICHARD, MD
P1964
BEST, AARON PATRICK, MD
Q6151
BEST, ANNA MOORHEAD, MD
Q1091
8/15/2011
2/1/2012
10/1/2015
8/1/2014
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Q6152
BEST, DOUGLAS L, MD
BETANSKI, FRANK ANTHONY III,
MD
10/1/2015
Q7146
P3288
BETHI, KRISHNAVENI, MD
BETTY, IRMA ELENA, MD
16-Feb-16
6/1/2012
P6141
BEVAN, CATHERINE IRENE, MD
4/12/2013
6/1/2017 PEDIATRICS
OBSTETRICS AND
Q6732
BEVEVINO, ADAM JAMES, MD
15-Dec-15
ORTHOPEDIC
15-Dec-20 SURGERY
P2595
BEVINAL, MANZOOR AHAMED, MD
4/2/2012
P5035
BEYENE, TESFAYE KEBEDE, MD
12/17/2012
P5035
12/17/2012
OBSTETRICS AND
GYNECOLOGY
ORTHOPEDIC
SURGERY OF THE
SPINE
Page 41 of 402
8/14/2015 None
N/A
TX
ACTIVE
11/11/2014 None
N/A
AMARILLO
TX
ACTIVE
8/14/2015 None
N/A
FORT WORTH TX
ACTIVE
2/28/2012 None
N/A
PLANO
BELLAIRE
TX
TX
ACTIVE
ACTIVE
8/5/2014 None
7/3/2013 None
N/A
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/20/2014 None
N/A
8/15/2014 None
N/A
8/15/2011 None
N/A
2/1/2012 None
N/A
10/1/2015 None
N/A
8/27/2014 None
N/A
10/1/2015 None
N/A
INTERVENTIONAL
RADIOLOGY
Disciplinary
Status Date
MANSFIELD
8/15/2016 RADIOLOGY
10/1/2020 PATHOLOGY
DIAGNOSTIC
8/1/2019 RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
OVERLAND
PARK
KILLEEN
NEW
ORLEANS
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LA
TX
ACTIVE
ACTIVE
29-Feb-16 None
6/6/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
4/18/2013 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
26-Jan-16 None
N/A
4/2/2012 None
N/A
12/17/2012 None
N/A
1/14/2013 None
N/A
NEWPORT
KS
AR
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5035
12/17/2012
P4633
BEZWADA, VISHNU VINOD, MD
10/15/2012
Q6495
P6143
BGOYA, KANEZA WALTER, MD
BHADRIRAJU, SATISH, MD
11/16/2015
4/12/2013
Q1092
BHAGIA, SANJAY NANIK, MD
Q7840
BHALALA, REENA U, MD
15-Apr-16
Q6733
Q2882
BHALALA, UTPAL S, MD
BHALANI, VIRAJ VINAYAK, MD
15-Dec-15
1/15/2015
8/1/2014
P2417
BHANDARI, ANGELINA DEVI, MD
3/15/2012
Q0872
BHANDARI, ASEEM KUMAR, MD
7/15/2014
Q3333
BHAR, SALEH , MD
P8118
BHARDWAJ, ANISH, MD
BHARI JAYADEVAPPA, ABHISHEK,
MD
BHASIN, ARPITA KADAKIA, MD
Q7646
Q1094
3/3/2015
10/15/2013
01-Apr-16
8/1/2014
Q3851
P8645
BHASKARAN, SMITA, MD
BHAT, ANAND KRISHNA, MD
4/10/2015
1/3/2014
P1166
Q6153
BHAT, ASHWINI, MD
BHAT, MUSHTAQ AHMAD, MD
10/17/2011
10/1/2015
P7744
BHAT, PRADEEP KRISHNA, MD
8/30/2013
P1201
BHAT, UDAYA M, MD
10/17/2011
Secondary Specialty
(Self-Designated)
PULMONARY
CRITICAL CARE
10/15/2017 MEDICINE
EMERGENCY
8/1/2019 MEDICINE
OBSTETRICS AND
PEDIATRIC CRITICAL
15-Dec-20 CARE MEDICINE
INTERVENTIONAL
7/15/2019 RADIOLOGY
3/3/2020 PEDIATRICS
Practice City
NEWPORT
SLEEP MEDICINE
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
DIAGNOSTIC
RADIOLOGY
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
VASCULAR
NEUROLOGY
ANESTHESIOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
GA
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
NY
N/A
10/15/2012 None
N/A
11/16/2015 None
4/26/2013 None
N/A
N/A
ACTIVE
8/6/2014 None
N/A
SAN ANTONIO TX
ACTIVE
21-Apr-16 None
N/A
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
11-Jan-16 None
1/26/2015 None
N/A
N/A
CORPUS
CHRISTI
TX
ACTIVE
3/21/2012 None
N/A
DESOTO
TX
ACTIVE
7/31/2014 None
N/A
HOUSTON
TX
ACTIVE
3/10/2015 None
N/A
GALVESTON
TX
ACTIVE
11/11/2013 None
N/A
UPLAND
PA
ACTIVE
ACTIVE
05-Apr-16 None
8/4/2014 None
N/A
N/A
LICENSE
ISSUED
ACTIVE
4/10/2015 None
2/3/2014 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/25/2011 None
10/8/2015 None
N/A
N/A
8/30/2013 None
N/A
ACTIVE
10/26/2011 None
N/A
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HEMATOLOGY/ONCOL
10/17/2016 OGY
PULMONARY
CRITICAL CARE
10/17/2016 MEDICINE
CLEVELAND
OH
TEMPLE
TX
FORT WORTH TX
INTERNAL MEDICINE
SLEEP MEDICINE
Page 42 of 402
Disciplinary
Status Date
1/14/2013 None
NEWNAN
NEW YORK
CITY
AR
Registration
Status Date
Disciplinary
Status of
Texas
License
MOUNT
LAUREL
NJ
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
04-Mar-16
PEDIATRICS
OPHTHALMOLOGY 7/15/2011
GLAUCOMA
7/15/2014
Q7325
BHATNAGAR, SONAL , MD
P0347
Q0873
BHATT, ANAND BIPIN, MD
BHATT, NEIL RAJENDRA, MD
Q6609
Q6609
Q6609
Q3483
P0958
BHATTARAI, ALOK, MD
BHATTARAI, ALOK, MD
BHATTARAI, ALOK, MD
BHATTARAI, RAJIV, MD
BHATTARAI, SUMIT, MD
Q2973
BHATTARAI, YUBARAJA, MD
2/2/2015
P2196
BHATTI, MAQSOOD AHMED, MD
3/1/2012
P4422
BHAVSAR, JENNIFER, MD
P3509
BHAVSAR, ROBIN RASHMI, MD
P4548
BHAVSAR, SHRIPAL KANTILAL, MD
Q6496
BHENDE, KISHOR M, MD
P9162
BHESANIYA, KALPESH PRAGJI, MD
P9049
12/4/2015
04-Dec-15
04-Dec-15
3/16/2015
9/15/2011
9/17/2012
6/8/2012
12/4/2020
04-Dec-20
04-Dec-20
3/16/2020
9/15/2016
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
HOSPITALIST
INFECTIOUS
DISEASES
10/1/2012
6/8/2017 UROLOGY
RADIATION
10/1/2017 ONCOLOGY
11/16/2015
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
16-Mar-16 None
N/A
AUSTIN
JACKSONVILL
E
MIDLAND
MIDLAND
TYLER
DALLAS
TX
ACTIVE
ACTIVE
7/25/2011 None
7/21/2014 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
12/8/2015
08-Dec-15
08-Dec-15
4/14/2015
12/7/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
2/2/2015 None
N/A
WA
ACTIVE
3/12/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/19/2012 None
N/A
6/8/2012 None
N/A
ACTIVE
10/12/2012 None
N/A
ACTIVE
11/19/2015 None
N/A
3/5/2014 None
N/A
2/18/2014 None
N/A
7/25/2011 None
N/A
7/15/2015 None
8/16/2013 None
15-Mar-16 None
N/A
N/A
N/A
5/15/2013 None
9/1/2015 None
N/A
N/A
6/24/2013 None
4/23/2014 None
N/A
N/A
HOQUIAM
COLLEGE
STATION
NC
TX
TX
TX
TX
MCLEANSBOR
O
IL
2/18/2014
P0348
BHIDE, SUWARNA ASHOK, MD
BHUSARI, VAISHALI KAWADUJI,
MD
7/15/2011
Q5157
P7394
Q7148
BHUSHAN, ANUP, MD
BHUTTA, SIDRA M, MD
BIBINAGAR, DEEPTHI, MD
7/15/2015
8/1/2013
16-Feb-16
P6588
Q5762
BICKETT, MELISSA MAE, MD
BICKNELL, KENDALL , MD
5/15/2013
8/28/2015
P6951
P9807
BIDROS, DANI SIROP, MD
BIENVENU, JOHN NELKEN, MD
6/14/2013
4/15/2014
SPORTS MEDICINE
5/15/2018 (ORTH SURG)
NEUROLOGICAL
6/14/2018 SURGERY
HOSPITALIST
PALLIATIVE
MEDICINE
HOSPITALIST
INTERNAL MEDICINE
ORTHOPEDIC
SURGERY
Page 43 of 402
Disciplinary
Status Date
HOUSTON
UROLOGIC SURGERY
THERAPEUTIC
RADIOLOGY
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
3/3/2014
Registration
Status Date
Disciplinary
Status of
Texas
License
WICHITA
FALLS
PRINCETON
TYLER
TX
NJ
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
License
Number
Physician Name
Q1360
BIEN-WILLNER, GABRIEL
ALEJANDRO, MD
P3290
BIETZ, GABRIEL JACKSON, MD
Q6734
Q7647
P2958
BIGGS, GRACE ANNE YANG, MD
BILGUTAY, AYLIN , MD
BILLATOS, EHAB , MD
P6338
BILLUE, DAVID CLAYTON, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2014
6/1/2012
15-Dec-15
01-Apr-16
5/1/2012
5/1/2013
Q8696
BINDEWALD, MATTHEW GABRIEL,
MD
BIRKENFELD, ELIZABETH MARY,
MD
P1728
BIRKHOLZ, CHRISTOPHER , MD
Q5353
P8012
P5260
BIRNBAUM, GLENN, MD
BIRNBAUM, ITAMAR , MD
BISEN, AJIT KUMAR, MD
8/3/2015
10/1/2013
1/15/2013
Q7841
BISHOP, ANDREW J, MD
15-Apr-16
P4549
Q3149
BISHOP, DENNIS MICHAEL, MD
BISTA, DIPESH RAJ, MD
10/1/2012
2/13/2015
Q1096
BLACHER, ERIC, MD
8/1/2014
P2198
BLACK, DALLIAH MASHON, MD
3/1/2012
Q1361
8/15/2014
10-Jun-16
1/2/2012
ANATOMIC
8/15/2019 PATHOLOGY
GENERAL VASCULAR
6/1/2017 SURGERY
15-Dec-20 UROLOGY
01-Apr-21 UROLOGY
OBSTETRICS AND
5/1/2018 GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
8/15/2019 SURGERY
DIAGNOSTIC
10-Jun-21 RADIOLOGY
OBSTETRICS AND
1/2/2017 GYNECOLOGY
EMERGENCY
8/3/2020 MEDICINE
RADIATION
15-Apr-21 ONCOLOGY
EMERGENCY
10/1/2017 MEDICINE
SURGICAL BREAST
3/1/2017 ONCOLOGY
P9306
BLACK, JAMES CALVIN III, MD
3/17/2014
P1523
BLACK, JAMES EDWARD JR, MD
12/1/2011
EMERGENCY
3/17/2019 MEDICINE
EMERGENCY
12/1/2016 MEDICINE
Q3336
BLACK, JORGE W, MD
3/3/2015
3/3/2020 PEDIATRICS
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
MOLECULAR
GENETIC
PATHOLOGY
THE
(MEDICAL GENETICS) WOODLANDS TX
ACTIVE
VASCULAR
SURGERY
LICENSE
ISSUED
UROLOGIC SURGERY
HOUSTON
TX
DALLAS
TX
GUNTERSVILL
E
AL
HOUSTON
HOSPITALIST
HOSPITALIST
AEROSPACE
MEDICINE
PEDIATRIC
EMERGENCY
MEDICINE (EM)
Page 44 of 402
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/22/2014 None
N/A
6/1/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
12-Jan-16 None
16-May-16 None
5/3/2012 None
N/A
N/A
N/A
ACTIVE
5/9/2013 None
N/A
ACTIVE
8/19/2014 None
N/A
ACTIVE
16-Jun-16 None
N/A
ACTIVE
1/6/2012 None
N/A
AUSTIN
HOUSTON
LEBANON
TX
TX
PA
ACTIVE
ACTIVE
ACTIVE
8/6/2015 None
10/10/2013 None
1/22/2013 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
25-Apr-16 None
N/A
ACTIVE
ACTIVE
10/15/2012 None
2/17/2015 None
N/A
N/A
GALVESTON
TX
ACTIVE
8/5/2014 None
N/A
HOUSTON
TX
ACTIVE
3/16/2012 None
N/A
SAN ANTONIO TX
ACTIVE
3/25/2014 None
N/A
HOUSTON
TX
SPOTSYLVANI
A
VA
ACTIVE
2/17/2012 None
N/A
ACTIVE
3/18/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q5621
BLACK, KELLY DAWN, MD
8/14/2015
Q7648
P5158
P3510
BLACKMON, JOSHUA MARION, MD
BLAIR, MICHAEL , MD
BLAKE, PATRICK WILLIAM, MD
01-Apr-16
1/4/2013
6/8/2012
Q2974
BLAKEWAY, BRETT ANDREW, MD
2/2/2015
P2596
BLAKKOLB, CHRISTI LYNN, MD
4/2/2012
Q2251
BLANCK, ZALMEN, MD
11/7/2014
P4424
9/17/2012
P0815
P9522
Q7149
BLANKENSHIP, ALAN LANE JR, MD
BLECHACZ, BORIS ROMAN
ALEXANDER, MD
BLEJAN, CRISTINA, MD
BLESSING, ADRIENNE LORD, MD
8/26/2011
4/1/2014
16-Feb-16
P2098
BLIEDEN, LAUREN SASHA, MD
2/10/2012
Q2883
BLITZ, ARIE, MD
1/15/2015
Q4038
BLOMKALNS, ANDRA LEAH, MD
Q1796
P6340
BLONDET, NIVIANN MARIE, MD
BLOOM, DANIEL GORDON, MD
BLOOMGARDEN, GARY MICHAEL,
MD
Q0224
P5934
Q3853
Q0009
BLOW, BENJAMIN JAMES, MD
BLOWER, JESSICA ASHLEY
JOHNSON, MD
BLUMENFELD, YAIR, MD
5/1/2015
9/15/2014
5/1/2013
5/15/2014
4/1/2013
4/10/2015
5/2/2014
DIAGNOSTIC
01-Apr-21 RADIOLOGY
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ARLINGTON
ARLINGTON
TX
TX
TX
PLASTIC &
RECONSTRUCTIVE
4/2/2017 SURGERY
ELECTROPHYSIOLO
GY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/14/2015 None
N/A
14-Apr-16 None
1/7/2013 None
6/14/2012 None
N/A
N/A
N/A
2/2/2015 None
N/A
ACTIVE
4/6/2012 None
N/A
11/11/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
EMERGENCY
9/17/2017 MEDICINE
GASTROENTEROLOG
8/26/2016 Y
HEPATOLOGY
16-Feb-21 FAMILY MEDICINE
FAMILY PRACTICE
OPHTHALMOLOGY 2/10/2017 OPHTHALMOLOGY
GLAUCOMA
THORACIC
CARDIOVASCULAR
CARDIOVASCULAR
1/15/2020 SURGERY
SURGERY
EMERGENCY
5/1/2020 MEDICINE
PEDIATRIC
GASTROENTEROLOG
9/15/2019 Y
PEDIATRICS
5/1/2018 RADIOLOGY
NEUROLOGICAL
5/15/2019 SURGERY
PULMONARY
CRITICAL CARE
4/1/2018 MEDICINE
INTERNAL MEDICINE
SAN ANTONIO TX
ACTIVE
DALLAS
TX
9/24/2012 None
N/A
DANBURY
SUGAR LAND
CT
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/26/2011 None
4/7/2014 None
08-Mar-16 None
N/A
N/A
N/A
ACTIVE
2/17/2012 None
N/A
HOUSTON
TX
ACTIVE
OBSTETRICS AND
5/2/2019 GYNECOLOGY
DALLAS
TX
ACTIVE
LICENSE
ISSUED
MATERNAL AND
FETAL MEDICINE
Page 45 of 402
MCALLEN
TX
ACTIVE
1/27/2015 None
N/A
DALLAS
TX
ACTIVE
5/4/2015 None
N/A
DALLAS
AUSTIN
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/17/2014 None
5/22/2013 None
N/A
N/A
5/15/2014 None
N/A
4/4/2013 None
N/A
4/13/2015 None
N/A
5/2/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
ORAL &
MAXILLOFACIAL
10/1/2013
10/1/2018 SURGERY
EMERGENCY
3/1/2013
3/1/2018 MEDICINE
P8013
BLUNDELL, GARRETT DOUGLAS,
MD
P5597
BLYSTRA, ADAM CALVIN, DO
Q0225
BLYTHE, DIANA KATE, MD
5/15/2014
P2831
BOCIRNEA, CRISTINA, MD
4/13/2012
F5838
BODE, JOHN NICHOLAS, DO
11/30/2012
4/13/2017 GERIATRICS
DIAGNOSTIC
8/1/2014
EMERGENCY
8/1/2019 MEDICINE
Q1097
BODIGE, PRADEEP, DO
Q8213
BODOKY, ANETTE, MD
M6054
Q7651
BOEHMLER, JAMES HERBERT IV,
MD
BOGACHENCHU, SREENIVASULU,
MD
16-May-16
8/15/2013
01-Apr-16
P5936
Q8432
P0552
P8120
BOGERT, JAMES NATHANIEL, MD
BOGUNIEWICZ, JURI , MD
BOHN, SARAH BETH, MD
BOILS, CHRISTIE LYNN, MD
4/1/2013
01-Jun-16
8/1/2011
10/15/2013
Q8433
01-Jun-16
Q3338
BOLANOS, ALEXANDER , MD
BOLANOS, FERNANDO ALFREDO,
MD
P1271
BOLD, JONATHAN WYATT, MD
11/4/2011
Q2643
BOLLAVARAM, NAGABHUSHANAM,
MD
Q0417
BOLLINGER, TIMOTHY LEE, DO
P0701
BOLLO, ROBERT JOHN, MD
3/3/2015
Practice City
COLLEGE
STATION
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
PHOENIX
PLASTIC &
RECONSTRUCTIVE
8/15/2018 SURGERY
PLASTIC SURGERY
COLUMBUS
AZ
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
OH
4/1/2018
01-Jun-21
8/1/2016
10/15/2018
GENERAL SURGERY
PEDIATRICS
FAMILY MEDICINE
PATHOLOGY
SURGICAL CRITICAL
CARE
HOUSTON
HOUSTON
SAN ANTONIO
LITTLE ROCK
TX
TX
TX
AR
6/2/2014
DIAGNOSTIC
11/4/2016 RADIOLOGY
PULMONARY
CRITICAL CARE
12/15/2019 MEDICINE
EMERGENCY
6/2/2019 MEDICINE
8/15/2011
NEUROLOGICAL
8/15/2016 SURGERY
12/15/2014
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TEMPLE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
10/22/2013 None
N/A
3/18/2013 None
N/A
5/15/2014 None
N/A
4/13/2012 None
N/A
12/11/2012 None
SEE
PREVIOUS
8/7/2014 ORDER
N/A
16-May-16 None
N/A
8/19/2013 None
N/A
01-Apr-16 None
N/A
4/8/2013
20-Jun-16
8/5/2011
10/23/2013
11/9/2009
None
None
None
None
N/A
N/A
N/A
N/A
01-Jun-16 None
N/A
TX
ACTIVE
3/5/2015 None
N/A
EDEN PRAIRIE MN
ACTIVE
11/17/2011 None
N/A
LICENSE
ISSUED
12/15/2014 None
N/A
INTERNAL MEDICINE
DALLAS
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
Page 46 of 402
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
6/4/2014 None
N/A
TX
ACTIVE
8/29/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
5/15/2012
5/15/2017 SURGERY
SURGERY
OBSTETRICS AND
5/1/2012
5/1/2017 GYNECOLOGY
16-Feb-16
P3124
BOLSON, RAJSHRI MAHESHWARI,
MD
P2959
Q7151
BOLT, KATHERINE , MD
BONAM, RAMI REDDY, MD
M1524
Q5764
BONVILLE, DANIEL JAMES, DO
BOOHER, ASHLEY JADE, MD
01-Jun-16
8/28/2015
P8338
BOONE, BRADLEY ALLEN, MD
11/15/2013
P6341
BOOSTROM, SARAH YORK, MD
P0350
Q6498
BOOTH, ADA LOUISE, MD
BOOTH, FRANK VICTOR MCLEAN,
MD
Q4040
P0170
BOOTH, KELEY JOHN II, MD
BOOTWALA, YASMIN I, MD
P8339
BORDELON, PAULA C, DO
Q5765
BOSE, KINSHUK, MD
Q2430
BOSE, NILANJANA, MD
Q2742
Q1797
BOSE, PRITHVIRAJ, MD
BOSLEY, MICAH RYAN, MD
1/5/2015
9/15/2014
P8450
BOSSOUS, PAUL-MOREAU , MD
12/6/2013
Q7326
Q8434
BOSTICK SMITH, CHEVELTA A, DO
BOSTWICK, BRET LEE, MD
04-Mar-16
01-Jun-16
Q3645
BOSWELL, IRA , DO
BOTTALICO, JOSEPH NICHOLAS,
DO
P1969
5/1/2013
7/15/2011
11/16/2015
5/1/2015
7/1/2011
11/15/2013
8/28/2015
11/17/2014
4/1/2015
2/1/2012
CRITICAL CARE
01-Jun-21 (SURGERY)
Practice City
RAPID CITY
SD
MANSFIELD
OH
FAMILY PRACTICE
LUBBOCK
COLON AND RECTAL
5/1/2018 SURGERY
TX
TX
AUSTIN
TX
DALLAS
TX
PEDIATRIC
CORPUS
FORENSIC MEDICINE CHRISTI
Registration
Status of
Practice
Texas
State
License
TX
7/1/2016 UROLOGY
HOUSTON
GERIATRICS
PEDIATRIC
PSYCHIATRY
AUSTIN
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
1/5/2020 OGY
CONROE
OBSTETRICS AND
04-Mar-21 GYNECOLOGY
01-Jun-21 MEDICAL GENETICS
PHYSICAL MED. &
MATERNAL AND
PEDIATRICS
OBSTETRICS
Page 47 of 402
TX
TX
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
5/21/2012 None
N/A
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
5/3/2012 None
14-Apr-16 None
N/A
N/A
01-Jun-16 None
9/2/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
11/19/2013 None
N/A
5/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
7/20/2011 None
N/A
11/16/2015 None
N/A
5/1/2015 None
7/6/2011 None
N/A
N/A
11/15/2013 None
N/A
9/10/2015 None
N/A
11/17/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/7/2015 None
10/6/2014 None
N/A
N/A
12/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ERIE
HOUSTON
PA
TX
ACTIVE
ACTIVE
04-Apr-16 None
06-Jun-16 None
N/A
N/A
DALLAS
TX
ACTIVE
4/3/2015 None
N/A
ODESSA
TX
ACTIVE
2/10/2012 None
N/A
License
Number
Q5357
P9165
P7252
Q7652
P9166
Physician Name
BOUCHRA HANNA, HANI KHAIRY
ELSAYED, MD
BOUKAS, KONSTANTINOS, MD
BOULANGER, KRISTINE SERENA,
MD
BOUNAMA, AIDA, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/3/2015
3/3/2014
3/3/2019 PEDIATRICS
7/15/2013
01-Apr-16
P3291
BOURELL, LAUREN, MD
BOUTON, LAUREN KATHARINE
EBE, MD
BOWCHER, CHARITY MUTHONI,
MD
BOWEN, CASEY DANIEL, MD
BOWEN, REBECCA CATHERINE,
MD
H7918
P8014
BOWERS, HAL GREGORY JR, MD
BOWMAN, AUDRA GALE, MD
1/2/2012
10/1/2013
P7885
BOWMAN, CONRAD BRYSON, MD
9/16/2013
Q7653
BOYACK, DANE , DO
01-Apr-16
Q2516
Q5624
Q2975
BOYAR, ALAN HOWARD, MD
BOYARS, MICHAEL EUGENE, MD
BOYCE, DANIEL, MD
12/3/2014
8/14/2015
2/2/2015
M8552
16-Feb-16
Q6395
BOYD, CHARLES EDWARD JR, MD
BOYELLA, RAVICHANDRA REDDY,
MD
P8646
Q2517
BOYER, ANTHONY FRANCIS, MD
BOYER, MICAH LYNN, MD
1/3/2014
12/3/2014
Q2431
BOYLAN, MATTHEW WILLIAM, MD
11/17/2014
P4931
BOZORGI, FARSHID, MD
11/30/2012
Q8435
Q1099
Q4729
3/3/2014
01-Jun-16
8/1/2014
6/12/2015
6/1/2012
11/2/2015
ORAL &
MAXILLOFACIAL
3/3/2019 SURGERY
Registration
Status of
Practice
Texas
State
License
Secondary Specialty
(Self-Designated)
Practice City
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PEDIATRIC CRITICAL
CARE MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
PLANO
TX
SAN ANTONIO TX
8/1/2019 PEDIATRICS
OTORHINOLARYNGOL
6/1/2017 OGY
INTERVENTIONAL
DIAGNOSTIC
1/2/2017 RADIOLOGY
RADIOLOGY
EMERGENCY
9/16/2018 MEDICINE
EMERGENCY
01-Apr-21 MEDICINE
ALLERGY AND
12/3/2019 IMMUNOLOGY
INTERNAL MEDICINE
2/2/2020 RADIOLOGY
DIAGNOSTIC
16-Feb-21 RADIOLOGY
INTERVENTIONAL
PULMONARY
CRITICAL CARE
1/3/2019 MEDICINE
INTERNAL MEDICINE
EMERGENCY
11/17/2019 MEDICINE
DIAGNOSTIC
Page 48 of 402
Disciplinary
Status Date
8/3/2015 None
N/A
3/3/2014 None
N/A
ACTIVE
ACTIVE
7/22/2013 None
02-May-16 None
N/A
N/A
ACTIVE
3/5/2014 None
N/A
TX
ACTIVE
10-Jun-16 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
9/1/2014 None
6/15/2015 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
6/7/2012 None
N/A
PRESCOTT
LUBBOCK
AZ
TX
ACTIVE
ACTIVE
1/4/2012 None
12/12/2013 None
N/A
N/A
LUBBOCK
TX
ACTIVE
12/11/2013 None
N/A
FORT WORTH TX
ACTIVE
05-Apr-16 None
N/A
SAN ANTONIO
HOUSTON
PLANO
VIRGINIA
BEACH
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
2/11/2015 None
8/17/2015 None
2/5/2015 None
N/A
N/A
N/A
VA
ACTIVE
LICENSE
ISSUED
15-Mar-16 None
N/A
11/2/2015 None
N/A
TX
ACTIVE
ACTIVE
1/8/2014 None
12/5/2014 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
11/21/2014 None
N/A
LOS ANGELES CA
ACTIVE
1/7/2013 None
N/A
CRANIOFACIAL
SURGERY
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
AMARILLO
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
SURGERY OF THE
ORTHOPEDIC
10-Jun-16
10-Jun-21 SPINE
TRAUMA
EMERGENCY
12/15/2014
12/15/2019 MEDICINE
EMERGENCY
3/3/2014
3/3/2019 MEDICINE
Q8697
BOZZIO, ANTHONY, MD
Q2644
BRACE, RONALD JOHN, MD
P9167
BRADEN, BEAU RUSSELL, DO
P7076
BRADWAY, JAMES ARTHUR II, MD
7/1/2013
P9526
BRADY, RACHEL ELIZABETH, MD
4/1/2014
Q3151
Q1100
BRAGA, BRUNO PEROCCO, MD
BRAHMA, SUCHANDRA, MD
BRAHMAMDAM, ANANTHA
LAKSHMI, MD
P8221
2/13/2015
8/1/2014
11/1/2013
Q2743
BRAHMBHATT, NAISHADH , MD
1/5/2015
Q0876
BRANCH, BYRON CHARLES, MD
7/15/2014
Q0877
BRANDA, SUMMER R, MD
Q5358
P6787
EMERGENCY
4/1/2019 MEDICINE
Practice City
14-Jun-16 None
N/A
ACTIVE
12/22/2014 None
N/A
DENVER
ACTIVE
3/4/2014 None
N/A
ACTIVE
7/8/2013 None
N/A
ACTIVE
4/7/2014 None
N/A
2/13/2015 None
8/5/2014 None
N/A
N/A
11/1/2013 None
N/A
ACTIVE
2/4/2015 None
N/A
SAN ANTONIO TX
ACTIVE
7/23/2014 None
N/A
HOUSTON
TX
ACTIVE
7/18/2014 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
8/5/2015 None
6/18/2013 None
N/A
N/A
ACTIVE
8/7/2013 None
N/A
OH
ACTIVE
11/28/2011 None
N/A
LUBBOCK
TX
WACO
TX
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
7/11/2011 None
17-Dec-15 None
7/4/2014 None
N/A
N/A
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
11/4/2013 None
N/A
4/10/2015 None
N/A
ACTIVE
18-Apr-16 None
N/A
CO
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
KOLKATA
7/15/2014
BRANDS, CHAD KELLY, MD
BRANT, SARAH MARGARET, MD
8/3/2015
6/3/2013
P7077
BRAR, ANUREET KAUR, DO
7/1/2013
P1274
BRAR, INDERJEET S, MD
11/4/2011
8/3/2020 PEDIATRICS
PHYSICAL MED. &
PULMONARY
CRITICAL CARE
11/4/2016 MEDICINE
P0171
Q6736
N4957
BRATVOLD, JARED MICHAEL, MD
BRAUN, ERIC LYLE, MD
BRAUTBAR, ARIEL , MD
7/1/2011
15-Dec-15
6/27/2014
15-Dec-20 FAMILY MEDICINE
6/27/2019 GENETICS
P8222
BRAXTON, CARLA CELESTE, MD
11/1/2013
Q3855
BRAY, AMANDA ELIZABETH, MD
4/10/2015
Q7654
BRAZEAL, HILARY A, MD
01-Apr-16
DIAGNOSTIC
01-Apr-21 RADIOLOGY
CRITICAL CARE
MEDICINE (IM)
PALLIATIVE
MEDICINE
INTERNAL MED PEDS
SYCAMORE
MASSILLON
CRITICAL CARE
(SURGERY)
DALLAS
Page 49 of 402
Disciplinary
Status Date
ACTIVE
PEDIATRIC SURGERY
(NEUROLOGY)
PULMONARY
1/5/2020 MEDICINE
NEUROLOGICAL
7/15/2019 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
PLANO
TX
JACKSONVILL
E
FL
HOUSTON
NEUROLOGICAL
2/13/2020 SURGERY
8/1/2019 PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
IL
TX
TX
License
Number
Physician Name
N9816
BREDY, BRUNEL, MD
Q1101
Q0878
dicaid
dicaid
Agreement
End Date
Designated)
10/15/2013
BREEN, DAY BURRUSS , MD
8/1/2014
BREEN, JOHN MICHAEL, MD
7/15/2014
8/1/2019 PEDIATRICS
OBSTETRICS &
GYNECOLOGICAL
7/15/2019 SURGERY
TM00470 BREGER, ROBERT KARL, MD
9/1/2011
Q2254
BREINHOLT, JOHN PHILIP III, MD
11/7/2014
G9264
BREITE, WARREN MARK, MD
2/2/2015
P1729
BRENDEL, WILLIAM BRIAN JR, MD
1/2/2012
P3511
P1525
BRENNAN, RACHEL MICHELLE, DO
BRENNER, JOHN RUSSELL, DO
6/8/2012
12/1/2011
Q3152
BRENNER, ROBERT ALAN, MD
2/13/2015
P0172
BREWER, BRYAN DANIEL, MD
7/1/2011
G4225
BRICKER, JOHN TIMOTHY, MD
11/15/2011
Q6933
BRIDGE, KEVIN ALAN, MD
Q2106
BRIDGES, CHRISTINE ASPY, MD
Q0418
BRIDWELL, RICHARD BRENT, MD
P8340
BRIESE, BEAU, MD
11/15/2013
Q4046
Q2107
BRILLHART, DANIEL BRIGGS, MD
BRINKMAN, INGRID , MD
5/1/2015
10/15/2014
P9527
BRISENO, MICHAEL RYAN, MD
15-Jan-16
10/15/2014
6/2/2014
4/1/2014
9/1/2016 RADIOLOGY
PEDIATRICS,
PULMONARY
CRITICAL CARE
2/2/2020 MEDICINE
PHYSICAL MED. &
Secondary Specialty
(Self-Designated)
Practice City
FT WORTH
CHILD NEUROLOGY
UROGYNECOLOGY
PEDIATRICS
PULMONARY
CRITICAL CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
TX
ISSUED
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
10/15/2013 ORDER
8/16/2011
8/1/2014 None
N/A
EDINBURG
TX
ACTIVE
7/22/2014 None
N/A
MILWAUKEE
WI
ACTIVE
10/11/2011 None
N/A
HOUSTON
TX
ACTIVE
11/14/2014 None
N/A
FESTUS
MO
ACTIVE
2/4/2015 None
N/A
ACTIVE
2/21/2012 None
N/A
6/15/2012 None
12/13/2011 None
N/A
N/A
2/13/2015 None
N/A
6/8/2017 PEDIATRICS
DALLAS
SAN ANTONIO
GASTROENTEROLOG
2/13/2020 Y
INTERNAL MEDICINE
FLOWER
MOUND
PEDIATRICS,
HOUSTON
PLASTIC &
RECONSTRUCTIVE
15-Jan-21 SURGERY
GENERAL SURGERY
MOUNT
VERNON
SPORTS MEDICINE
6/2/2019 (FAMILY PRACTICE)
EMERGENCY
EMERGENCY
11/15/2018 MEDICINE
MEDICAL SERVICES HOUSTON
EMERGENCY
5/1/2020 MEDICINE
FORT HOOD
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
4/1/2019 SURGERY
SPINE
GRAPEVINE
Page 50 of 402
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
7/7/2011 None
N/A
TX
ACTIVE
11/22/2011 None
N/A
ACTIVE
20-Jan-16 None
N/A
ACTIVE
LICENSE
ISSUED
10/16/2014 None
N/A
6/2/2014 None
N/A
TX
ACTIVE
11/25/2013 None
N/A
TX
ACTIVE
ACTIVE
5/4/2015 None
10/29/2014 None
N/A
N/A
TX
ACTIVE
4/4/2014 None
N/A
WA
License
Number
P8764
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q1103
BRISTOL, TYRONE GARY, MD
BRITO TELLES, MARCELO
ERNESTO, MD
1/15/2014
P2202
BRITO, VERONICA DE CASTRO
FRANCISCO ESTEVAM DE, MD
Q2255
BRITTAIN, ADAM KIRK, MD
11/7/2014
P5938
BRITZ, GAVIN WAYNE, MD
4/1/2013
8/1/2014
3/1/2012
PULMONARY
CRITICAL CARE
3/1/2017 MEDICINE
N/A
MINEOLA
NY
3/8/2012 None
N/A
NEUROLOGICAL
4/1/2018 SURGERY
ORAL &
MAXILLOFACIAL
01-Jun-21 SURGERY
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
11/7/2014 None
N/A
HOUSTON
TX
ACTIVE
4/4/2013 None
N/A
DALLAS
TX
LICENSE
ISSUED
ACTIVE
01-Jun-16 None
5/22/2015 None
N/A
N/A
PEDIATRIC CRITICAL
PEDIATRIC
DALLAS
TX
ACTIVE
08-Feb-16 None
N/A
HOUSTON
TX
ACTIVE
9/8/2011 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/21/2011 None
N/A
8/30/2013 None
N/A
4/10/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
08-Mar-16 None
N/A
4/15/2014 None
N/A
7/15/2014 None
N/A
P0960
BROOKS, DAVID BRADLEY, MD
9/15/2011
P7746
8/30/2013
Q3856
BROOKS, JOHN A, MD
BROOKS, MEREDITH
ROCKEYMOORE, MD
4/10/2015
Q7330
BROOKS, MICHAEL AUSTIN, MD
04-Mar-16
04-Mar-21 UROLOGY
P9814
4/15/2014
EMERGENCY
7/15/2019 MEDICINE
P6146
P6346
BROOKS, PATRICK ANTHONY, MD
BROSSEIT, MATTHEW WILLIAM,
MD
BROUSSARD, JOHNECA
ROCHELLE, DO
BROWN, AARON , DO
P4851
P6788
BROWN, BENJAMIN JOHN, DO
BROWN, BENTON LEE, MD
P1970
BROWN, BRIAN DOYLE, MD
P5039
BROWN, C CHRISTOPHER, MD
4/12/2013
5/1/2013
11/15/2012
6/3/2013
2/1/2012
12/17/2012
N/A
8/6/2014 None
9/1/2011
7/15/2014
1/15/2014 None
ACTIVE
BRONICKI, RONALD ALAN, MD
Q0880
Disciplinary
Status Date
TX
P0895
01-Feb-16
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
Q7017
01-Jun-16
5/15/2015
Practice City
BROCKHOFF, HANS CHRISTIAN II,
MD
BRODBAKER, ELLIOTT, MD
BRODRICK, BROOKS BARRETT,
MD
Q8438
Q4368
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
5/1/2018 PSYCHIATRY
EMERGENCY
11/15/2017 MEDICINE
SLEEP MEDICINE
PSYCHIATRY
ANESTHESIOLOGY
UROLOGIC
ONCOLOGY
HOUSTON
TX
HOUSTON
TX
FT. WORTH
TX
ACTIVE
ACTIVE
4/16/2013 None
5/7/2013 None
N/A
N/A
SAN ANGELO
TX
ACTIVE
ACTIVE
11/26/2012 None
6/5/2013 None
N/A
N/A
ACTIVE
2/3/2012 None
N/A
ACTIVE
12/20/2012 None
N/A
URGENT CARE
MEDICINE
EMERGENCY
MEDICINE
Page 51 of 402
SAN ANTONIO TX
License
Number
Physician Name
P5039
P5039
Q8439
BROWN, DANA MICHELLE, MD
P9052
BROWN, DANIELLE NICHOLE, MD
P1971
P3292
BROWN, ELIZABETH J, MD
BROWN, EMILY RENEE, MD
Q6310
BROWN, JESSICA LYNN, MD
Q2108
BROWN, JULIA MEYER, MD
P8341
BROWN, KEITH ASHLEY, MD
Q8440
Q1104
BROWN, KYLE ANTHONY, MD
BROWN, LATOYA ANTOINETTE,
MD
Q6499
BROWN, LOREN ELIZABETH, MD
J6356
BROWN, LYNN ALAN, MD
Q7018
BROWN, NICOLAS DMITRI, MD
P6347
BROWN, ROBERT ALLEN JR, DO
Q5767
P2961
BROWN, ROBERT JAMES DIX, MD
BROWN, SHANNA JEAN, MD
P8648
P1054
P1168
BROWN, SHAUN ROBERT, DO
BROWNE-BARNUM, MICHELLE L,
MD
BROWNING, CAROL ANN
TENNENT, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
12/17/2017 VITREOUS SURGERY
01-Jun-16
EMERGENCY
2/18/2014
2/18/2019 MEDICINE
PEDIATRIC
2/1/2012
2/1/2017 NEPHROLOGY
6/1/2012
6/1/2017 PEDIATRICS
OBSTETRICS AND
10/15/2015
EMERGENCY
10/15/2014
10/15/2019 MEDICINE
CHILD AND
ADOLESCENT
11/15/2013
PSYCHIATRY
PEDIATRIC CRITICAL INTERNAL MED 01-Jun-16
01-Jun-21 CARE MEDICINE
PEDS
8/1/2014
11/16/2015
5/15/2014
01-Feb-16
5/1/2013
8/28/2015
5/1/2012
1/3/2014
10/3/2011
10/17/2011
EMERGENCY
11/16/2020 MEDICINE
EMERGENCY
5/15/2019 MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
EMERGENCY
MEDICAL SERVICES
EMERGENCY
5/1/2018 MEDICINE
8/28/2020 NEUROLOGY
OTHER SPECIALTY
TRAUMATIC
SURGERY
DIAGNOSTIC
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
SAN ANTONIO TX
ACTIVE
12/20/2012 None
N/A
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
12/20/2012 None
03-Jun-16 None
N/A
N/A
HOUSTON
TX
ACTIVE
2/20/2014 None
N/A
DALLAS
SAINT LOUIS
TX
MO
ACTIVE
ACTIVE
2/7/2012 None
6/8/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
10/27/2015 None
N/A
ACTIVE
11/3/2014 None
N/A
11/19/2013 None
N/A
AUSTIN
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
13-Jun-16 None
N/A
8/1/2014 None
N/A
12/4/2015 None
N/A
5/15/2014 None
N/A
11-Feb-16 None
N/A
MUSKOGEE
OK
SHAWNEE
MISSION
KS
ACTIVE
TEXAS
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
FT. HOOD
TX
5/3/2013 None
N/A
HOUSTON
LUBBOCK
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/28/2015 None
5/3/2012 None
N/A
N/A
FORT HOOD
TX
ACTIVE
1/10/2014 None
N/A
ACTIVE
10/11/2011 None
N/A
ACTIVE
12/16/2011 None
N/A
EDEN PRAIRIE MN
Page 52 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q1364
BROWNING, CELIA MONCRIEF, MD
8/15/2014
P2203
Q8441
Q0610
BROZENA, KRISTIN , MD
BRUCE, KEELIE, DO
BRUDEY, CHEVELLE, MD
3/1/2012
01-Jun-16
6/16/2014
P5159
P2419
Q4051
BRUNNER, NOEMI , MD
BRUNO, KATIE ELIZABETH, MD
BRUNS, ASHLEY SUZANNE, DO
1/4/2013
3/15/2012
5/1/2015
Q1105
Q1798
BRYAN, DIANNA, MD
BRYAN, ISAAC G, DO
8/1/2014
9/15/2014
Q0015
Q3154
BRYANT, STEFANIE , MD
BUCHANAN, CLAY THOMAS, MD
5/2/2014
2/13/2015
P0896
BUCHANAN, EDWARD PATRICK,
MD
9/1/2011
P8863
BUCHANAN, IAN ANDREW, MD
2/7/2014
Q4370
Q0881
Q0882
Q6157
P7255
BUCHINGER, JAMES BRANT, MD
BUCK, CATHERINE O'NEILL, MD
BUCK, LARISA, DO
BUDHARAJU, SUBBARAJU, MD
BUENDIA, JORGE , MD
5/15/2015
7/15/2014
7/15/2014
10/1/2015
7/15/2013
P9815
BUESO, ANTONIO, MD
4/15/2014
Q1954
BUESSING, MELISSA A, DO
10/1/2014
P7613
BUI, CINDY-THANHHOA HUYNH,
MD
8/15/2013
Q4371
BUI, JIMMY , DO
5/15/2015
P8649
Q1106
Q2977
BUI, LEWIS , DO
BUI, PRIYA KAJI, DO
BUI, THAI HOANG, MD
1/3/2014
8/1/2014
2/2/2015
OBSTETRICS AND
3/1/2017 GYNECOLOGY
1/4/2018 RADIOLOGY
5/1/2020 PEDIATRICS
EMERGENCY
8/1/2019 MEDICINE
OBSTETRICS AND
5/2/2019 GYNECOLOGY
CRANIOFACIAL
9/1/2016 SURGERY
EMERGENCY
2/7/2019 MEDICINE
OBSTETRICS AND
GYNECOLOGY
PEDIATRICS
INTERNAL MEDICINE
FAMILY MEDICINE
FAMILY PRACTICE
EMERGENCY
4/15/2019 MEDICINE
EMERGENCY
10/1/2019 MEDICINE
5/15/2020
7/15/2019
7/15/2019
10/1/2020
7/15/2018
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
Practice City
DALLAS
EMERGENCY
1/3/2019 MEDICINE
8/1/2019 PEDIATRICS
Page 53 of 402
Disciplinary
Status Date
ACTIVE
8/20/2014 None
N/A
SAN ANTONIO TX
FORT WORTH TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
3/8/2012 None
02-Jun-16 None
6/17/2014 None
N/A
N/A
N/A
1/10/2013 None
3/29/2012 None
5/4/2015 None
N/A
N/A
N/A
8/1/2014 None
9/25/2014 None
N/A
N/A
TX
HOUSTON
TX
MCALLEN
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
LUBBOCK
TX
TX
ACTIVE
ACTIVE
5/14/2014 None
2/16/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
9/15/2011 None
N/A
AUSTIN
TX
ACTIVE
N/A
CUSHING
OK
DALLAS
TX
SAN ANTONIO TX
2/24/2014 None
UNDER
BOARD
5/28/2015 ORDER
7/17/2014 None
7/17/2014 None
10/6/2015 None
7/22/2013 None
ODESSA
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ABILENE
TX
ACTIVE
4/17/2014 None
N/A
ARLINGTON
TX
ACTIVE
10/9/2014 None
N/A
LUBBOCK
CORPUS
CHRISTI
TX
ACTIVE
8/20/2013 None
N/A
TX
ACTIVE
6/8/2015 None
N/A
HOUSTON
TX
FORT WORTH TX
LOMA LINDA
CA
ACTIVE
ACTIVE
ACTIVE
2/28/2014 None
8/4/2014 None
2/6/2015 None
N/A
N/A
N/A
HOSPITALIST
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
PSYCHIATRY
EMERGENCY/TRAUM
A RADIOLOGY
EL PASO
PLASTIC &
RECONSTRUCTIVE
SURGERY
Registration
Status of
Practice
Texas
State
License
4/28/2015
N/A
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6147
Q1107
BUI, THERESA DIEM-HANG, DO
BUI, TIEN, DO
4/12/2013
8/1/2014
Q3155
P9531
BUJAK, MARCIN , MD
BUJANDA, DANIEL ESTEBAN, MD
2/13/2015
4/1/2014
Q1575
P0817
P2963
BULKEN-HOOVER, JAMIE DIANNE,
MD
BUMP, JENNIFER MICHELE
MAGDALENE, MD
BUNCH, DARRELL ALAN, DO
BUNKER, SCOTT RYAN, DO
Q4569
BUNYAN, SAYL , MD
Q1365
BURAS, WENDE RUTH, MD
BURDICK, CHRISTOPHER JOSEPH,
MD
P8121
P7081
10/15/2013
8/29/2014
8/26/2011
5/1/2012
6/1/2015
8/15/2014
7/1/2013
Q4909
BURFORD, HOLLY NORTHAM, MD
P3609
Q8443
BURGBACHER, TODD EUGENE, DO
BURGE, LAUREN REAGAN , MD
6/15/2012
01-Jun-16
P0962
P5602
BURK, KATHRYN JEAN, MD
BURKART, RYAN DANIEL, MD
9/15/2011
3/1/2013
Q0885
BURKHOLDER, DAVID BRUCE, MD
7/15/2014
P7614
BURLINGAME, ONAME ORO, MD
8/15/2013
Q1955
BURLISON, CHARLES KEVIN, MD
10/1/2014
Q4730
BURNELL, CHARLES PAUL, MD
6/12/2015
P4935
P4634
BURNETT, BRETT ALLEN, MD
BURNEY, JOHN MARCEL JAMES,
MD
7/1/2015
11/30/2012
10/15/2012
INTERVENTIONAL
10/15/2018 SURGERY
OBSTETRICS AND
EMERGENCY
8/15/2019 MEDICINE
CRITICAL CARE
ANATOMIC/CLINICAL
7/1/2020 PATHOLOGY
EMERGENCY
6/15/2017 MEDICINE
EMERGENCY
9/15/2016 MEDICINE
7/15/2019 NEUROLOGY
ANATOMIC/CLINICAL
8/15/2018 PATHOLOGY
OBSTETRICS AND
EMERGENCY
6/12/2020 MEDICINE
EMERGENCY
11/30/2017 MEDICINE
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
CARDIOLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
HOUSTON
DALLAS
HOUSTON
TX
TX
TX
THE
WOODLANDS TX
DERMATOPATHOLO
GY
EMERGENCY
MEDICAL SERVICES
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
4/12/2013 None
8/5/2014 None
N/A
N/A
2/16/2015 None
4/3/2014 None
N/A
N/A
10/15/2013 None
N/A
8/29/2014 None
9/1/2011 None
5/3/2012 None
N/A
N/A
N/A
6/3/2015 None
N/A
8/15/2014 None
N/A
7/1/2013 None
N/A
7/3/2015 None
N/A
6/15/2012 None
10-Jun-16 None
N/A
N/A
AL
HOUSTON
TX
HOUSTON
TX
ACTIVE
ACTIVE
10/31/2011 None
3/4/2013 None
N/A
N/A
TX
ACTIVE
7/21/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/26/2013 None
N/A
10/1/2014 None
N/A
6/12/2015 None
N/A
BRENTWOOD TN
Page 54 of 402
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
Disciplinary
Status Date
BIRMINGHAM
NEURO-PHYSIOLOGY
(NEUROLOGY)
TEMPLE
EMERGENCY
MEDICINE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
TEMPLE
TX
ACTIVE
12/11/2012 None
N/A
LONGVIEW
TX
ACTIVE
10/19/2012 None
N/A
License
Number
Physician Name
Q7657
BURNS, DAVID, MD
L0910
BURNS, TANIA DENISE, MD
P3293
P0177
BURRIS, GARRETT C, MD
BURROW, TREY CULLEN, MD
Q3859
BURSHE, DAVID MICHAEL, MD
Q2110
BURT, BRYAN MICHAEL, MD
Q7155
Q5770
BURTON, ANNE WINSJANSEN, DO
BURTON, CHRISTIAN ANTHONY,
MD
Q1108
BURZINSKI, SHILOE SOUZA, MD
dicaid
dicaid
Agreement
End Date
Designated)
DIAGNOSTIC
01-Apr-16
01-Apr-21 RADIOLOGY
PEDIATRIC CRITICAL
11/15/2011
PEDIATRIC
6/1/2012
6/1/2017 NEUROLOGY
7/1/2011
4/10/2015
Disciplinary
Status Date
01-Apr-16 None
N/A
PEDIATRICS
EL PASO
TX
ACTIVE
12/6/2011 None
N/A
PEDIATRICS
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/15/2012 None
8/25/2011 None
N/A
N/A
4/10/2015 None
N/A
10/15/2014 None
N/A
4/10/2020 RADIOLOGY
16-Feb-16
TULSA
OK
ACTIVE
07-Apr-16 None
N/A
8/28/2015
OBSTETRICS AND
8/1/2019 GYNECOLOGY
FT WORTH
TX
ACTIVE
9/3/2015 None
N/A
GALVESTON
TX
ACTIVE
8/5/2014 None
N/A
2/7/2014 None
N/A
DALLAS
FORT SAM
HOUSTON
TX
LICENSE
ISSUED
LICENSE
ISSUED
1/4/2013 None
N/A
TX
ACTIVE
3/5/2013 None
N/A
DALLAS
TX
ACTIVE
05-Apr-16 None
N/A
AMARILLO
LUFKIN
CORPUS
CHRISTI
DALLAS
TX
TX
ACTIVE
ACTIVE
5/8/2012 None
20-May-16 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
8/5/2013 None
10/21/2014 None
N/A
N/A
LONGVIEW
DALLAS
TX
TX
ACTIVE
ACTIVE
12/17/2014 None
2/5/2013 None
N/A
N/A
WACO
TX
ACTIVE
6/20/2014 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
09-Mar-16 None
5/5/2015 None
N/A
N/A
8/1/2014
2/7/2014
P5160
BUSKEN, CHRISTOPHER JOHN, MD
1/4/2013
P5604
BUSKEN, MELISSA ROSA, MD
3/1/2013
Q7659
BUSTI, ANTHONY, MD
P2964
Q8215
BUSTOS MUNOZ, SERGIO , MD
BUSUEGO, ROBERT SOLIS, MD
5/1/2012
16-May-16
P7402
Q2111
BUTCHKO, GARY JON, MD
BUTLER, ERIN BRIDGET, MD
BUTLER, JACQUELINE FONTENOT
, MD
BUTLER, MICHELLE RENEE, MD
BUTLER, RENESHA CHRISTINE,
MD
BUTLER-WILLIAMS, SHANNON
ALAYNA, MD
BUTT, AHMAR MANNAN, MD
8/1/2013
10/15/2014
Q7333
Q4054
Registration
Status Date
BUSER, RAQUEL TANYA, MD
Q0612
Practice City
Disciplinary
Status of
Texas
License
10/15/2014
P8865
Q2519
P5342
Secondary Specialty
(Self-Designated)
CARDIOTHORACIC
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
01-Apr-16
12/3/2014
2/1/2013
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
EMERGENCY
3/1/2018 MEDICINE
EMERGENCY
01-Apr-21 MEDICINE
PEDIATRIC CRITICAL
5/1/2017 PEDIATRICS
CARE MEDICINE
16-May-21 INTERNAL MEDICINE INTERNAL MEDICINE
PEDIATRICS,
8/1/2018 CARDIOLOGY
PEDIATRICS
EMERGENCY
12/3/2019 MEDICINE
6/16/2014
04-Mar-16
5/1/2015
04-Mar-21 PATHOLOGY
5/1/2020 PSYCHIATRY
CYTOPATHOLOGY
Page 55 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P8225
BUTT, SHAMAIL , MD
11/1/2013
Q5627
BUTVILAS, KEITH JOHN, DO
8/14/2015
P0352
BYNON, JOHN STEVENSON JR, MD
7/15/2011
P4936
BYRD, TERESA T, MD
P6349
BYUN, YOUNG SUP, MD
P1056
P5605
P7403
CABANAS, JOSE GUILLERMO, MD
CABILING, DAVID SHANNON, MD
CACERES LARA, ALFREDO BORIS,
MD
CADDELL, HEATHER OTTMERS,
MD
CAGA-ANAN, MARIA CRISTINA
ESPERA, MD
Q2434
P2602
11/30/2012
5/1/2013
10/3/2011
3/1/2013
OBSTETRICS AND
4/15/2014
8/1/2013
CAI, LI, MD
11/17/2014
P8345
CAI, QIANGJUN , MD
11/15/2013
CARDIOVASCULAR
11/15/2018 DISEASES
Q0016
Q5981
CAI, XUAN, MD
CAIN, MATTHEW A, MD
P4635
CAIRE, SAMUEL RAHN, MD
P0178
P2422
CAIRO, MICHELINA MARIE, MD
CAJITA, CEZAR LAGO, MD
P5606
P6594
CAJITA, ELEONOR IGNACIO, MD
CALA MORALES, CLAUDIA LUCIA,
MD
5/15/2013
Q1957
P0354
CALARGE, CHADI ALBERT, MD
CALDERON, ANA MARIA, MD
10/1/2014
7/15/2011
5/2/2014
9/15/2015
10/15/2012
BEAUMONT
OBSTETRICS &
GYNECOLOGICAL
SURGERY
NEONATAL5/1/2018 PERINATAL MEDICINE PEDIATRICS
EMERGENCY
EMERGENCY
10/3/2016 MEDICINE
MEDICAL SERVICES
OBSTETRICS AND
P9817
4/2/2012
EMERGENCY
8/14/2020 MEDICINE
TRANSPLANT
7/15/2016 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
HEMATOLOGY/ONCO
LOGY
HOUSTON
EMERGENCY
10/15/2017 MEDICINE
7/1/2011
3/15/2012
7/1/2016 ONCOLOGY
3/1/2013
3/1/2018 PEDIATRICS
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
11/13/2013 None
N/A
TX
ACTIVE
8/24/2015 None
N/A
TX
ACTIVE
7/21/2011 None
N/A
11/30/2012 None
N/A
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
5/9/2013 None
N/A
AUSTIN
HOUSTON
ACTIVE
ACTIVE
10/12/2011 None
3/13/2013 None
N/A
N/A
ACTIVE
4/6/2012 None
N/A
SAN ANTONIO TX
ACTIVE
5/14/2014 None
N/A
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
8/12/2013 None
N/A
11/17/2014 None
N/A
11/22/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
5/2/2014 None
9/17/2015 None
N/A
N/A
OK
ACTIVE
10/19/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
7/7/2011 None
3/19/2012 None
N/A
N/A
3/1/2013 None
N/A
ACTIVE
6/18/2013 None
N/A
ACTIVE
ACTIVE
10/15/2014 None
8/24/2011 None
N/A
N/A
AMES
OKLAHOMA
CITY
HEMATOLOGY INTERNAL MEDICINE HOUSTON
HARLINGEN
CHILD AND
ADOLESCENT
PSYCHIATRY
Page 56 of 402
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
TX
IA
TX
License
Number
P8765
Physician Name
Q7661
CALDWELL, CARMELLA DAWN, MD
CALDWELL, JASON
CHRISTOPHER, MD
P8866
CALDWELL, KENNETH LEE, MD
Q0738
CALDWELL, SCOTT, MD
P0557
CALERO, SHANNA MICHELLE, MD
Q8216
CALLAHAN, BRYON SCOTT, MD
Q5771
dicaid
dicaid
Agreement
End Date
Designated)
1/15/2014
01-Apr-16
2/7/2014
6/27/2014
8/1/2011
16-May-16
DIAGNOSTIC
01-Apr-21 RADIOLOGY
ORTHOPEDIC
2/7/2019 SURGERY
BODY IMAGING
EMERGENCY
8/1/2016 MEDICINE
EMERGENCY
16-May-21 MEDICINE
8/28/2015
Q1958
CALLEJAS, LEYDA PENNYNA, MD
CALLEROS MACIAS, JESUS
EDMUNDO , MD
CALLOWAY, TRACIE SHENELLE,
DO
CAMACHO ACEVEDO, ROBERTO,
MD
10/1/2014
8/1/2018 PEDIATRICS
P3297
Q4373
CAMACHO, ALLAN CASTILLO, MD
CAMACHO, GRISELDA , MD
6/1/2012
5/15/2015
Q3485
3/16/2015
3/16/2020 RADIOLOGY
02-May-16
P2206
CAMARENA, JACINTO III, MD
CAMARENA, JULIEANNA ANGEL,
DO
CAMARILLO, RANDAL MATTHEW,
MD
P1169
Q6159
CAMP, STEVEN MARTIN, MD
CAMPBELL, CARMEN MARIE, MD
10/17/2011
10/1/2015
Q6400
11/2/2015
P6595
CAMPBELL, JAMIE RENEE, MD
CAMPBELL, MATTHEW THOMAS,
MD
P2833
CAMPBELL, NEVILLE FITZROY, MD
4/13/2012
P2423
P7404
Q8030
3/15/2012
8/1/2013
3/1/2012
5/15/2013
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
3/15/2017 RADIOLOGY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
INTERVENTIONAL
RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
FORT WORTH TX
ACTIVE
1/24/2014 None
N/A
ACTIVE
11-Apr-16 None
N/A
ACTIVE
LICENSE
ISSUED
2/28/2014 None
N/A
6/27/2014 None
N/A
TX
ACTIVE
8/15/2011 None
N/A
HOUSTON
TX
ACTIVE
06-Jun-16 None
N/A
LICENSE
ISSUED
8/28/2015 None
N/A
ACTIVE
LICENSE
ISSUED
3/23/2012 None
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
11/6/2014 None
N/A
6/1/2012 None
6/10/2015 None
N/A
N/A
3/16/2015 None
N/A
ACTIVE
04-May-16 None
N/A
ACTIVE
4/2/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/1/2011 None
10/23/2015 None
N/A
N/A
11/2/2015 None
N/A
ACTIVE
LICENSE
ISSUED
5/22/2013 None
N/A
4/13/2012 None
N/A
EL PASO
TX
TEXARKANA
TX
HOUSTON
TX
DALLAS
TX
GALVESTON
tx
PLASTIC SURGERY
FORT WORTH TX
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
5/15/2018 OGY
ANESTHESIOLOGY 4/13/2017 ANESTHESIOLOGY
PAIN MANAGEMENT
Page 57 of 402
Disciplinary
Status Date
EL PASO
INTERVENTIONAL
RADIOLOGY
ORTHOPEDIC
3/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
10/17/2016 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Q3860
P5940
Q5772
Physician Name
CAMPBELL, STEPHEN MICHAEL,
DO
CAMPO MALDONADO, JOSE
ERNESTO, MD
P3514
CAMPOY, ABRAHAM , MD
CAMP-ROGERS, TERESA
RANDELLE, MD
P1732
CANACCI, ANASTASIA MARIE, MD
Q6934
dicaid
dicaid
Agreement
End Date
Designated)
4/10/2015
4/1/2013
8/28/2015
6/8/2012
INFECTIOUS
4/1/2018 DISEASES
EMERGENCY
6/8/2017 MEDICINE
1/2/2017 PATHOLOGY
CANALES CHAVEZ, ROBERTO, MD
15-Jan-16
P9055
CANDANOSA, EDUARDO , MD
2/18/2014
P4739
11/1/2012
15-Mar-16
P0706
CANNON, BRETT H, MD
CANNONE, SEAN CHRISTOPHER,
DO
CANOVA CIPRIANO, EDUARDO
CARLOS, MD
EMERGENCY
11/1/2017 MEDICINE
GERIATRIC MEDICINE
15-Mar-21 (FAMILY PRACTICE)
P7886
CANSECO, ELVIA ISELA, MD
9/16/2013
P7083
P0707
CANTU, JAMES ARNOLD, MD
CANTU, SERGIO SAUL, MD
7/1/2013
8/15/2011
Q3342
Q3486
CAO, DAZHE, MD
CAO, JENNIFER HSULEEJEN, MD
3/3/2015
3/16/2015
Q2256
CAO, MAILAN MELISSA, MD
11/7/2014
Q0614
6/16/2014
Q6615
CAO, WEIWEI, MD
CAPERTON, KIMBERLY KRISTA,
MD
CAPPIELLO DZIEDZIC,
JACQUELINE MARIE, DO
Q6615
CAPPIELLO DZIEDZIC,
P3515
8/15/2011
OPHTHALMOLOGY
EMERGENCY
MEDICINE
HOSPITALIST
12/4/2015
EMERGENCY
3/3/2020 MEDICINE
TOXICOLOGY
DIAGNOSTIC
11/7/2019 RADIOLOGY
GASTROENTEROLOG
6/16/2019 Y
INTERNAL MEDICINE
OTORHINOLARYNGOL
6/8/2017 OGY
EMERGENCY
12/4/2020 MEDICINE
04-Dec-15
EMERGENCY
04-Dec-20 MEDICINE
6/8/2012
Practice City
INTERNAL MEDICINE
1/2/2012
Q7537
Secondary Specialty
(Self-Designated)
Page 58 of 402
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/10/2015 None
N/A
4/1/2013 None
N/A
8/28/2015 None
N/A
6/8/2012 None
N/A
CARROLLTON TX
ACTIVE
2/24/2012 None
N/A
EL PASO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
25-Feb-16 None
N/A
2/18/2014 None
N/A
11/1/2012 None
N/A
TX
DALLAS
TX
ACTIVE
13-Apr-16 None
N/A
LAREDO
TX
ACTIVE
8/18/2011 None
N/A
HOUSTON
TX
ACTIVE
9/26/2013 None
N/A
KINGSVILLE
TX
ACTIVE
ACTIVE
7/8/2013 None
8/19/2011 None
N/A
N/A
DENVER
CAMBRIDGE
CO
MA
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/30/2015 None
3/30/2015 None
N/A
N/A
11/7/2014 None
N/A
6/16/2014 None
N/A
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
6/27/2012 None
N/A
12/4/2015 None
N/A
03-Mar-16 None
N/A
LAFAYETTE
CO
License
Number
Q6615
P2604
N6190
P5250
P0559
P2834
Q3488
Q6160
Physician Name
CAPPIELLO DZIEDZIC,
CARABALLO, AIXA, MD
CARABALLO, MICHELLE JEAN
BROCK, MD
CARABELLO, BLASE ANTHONY, MD
CARBAJAL MENDOZA, ROGER
FRANCISCO, MD
CARBALLO, JUAN EDUARDO, MD
CARDENAS ROSALES, JUAN
CARLOS, MD
dicaid
dicaid
Agreement
End Date
Designated)
04-Dec-15
4/2/2012
3/3/2015
1/4/2013
AUSTIN
SLEEP MEDICINE
AURORA
CO
CARDIOLOGY
HOUSTON
TX
Secondary Specialty
(Self-Designated)
Practice City
8/1/2011
4/13/2012
8/1/2016 NEPHROLOGY
INTERNAL MEDICINE
3/16/2015
10/1/2015
6/27/2014
NEUROLOGICAL
7/1/2016 SURGERY
Q0739
CARDENAS, CARLOS PATRICK, MD
CARDENAS, MAGDALENO RAFAEL
JR, MD
P0179
CARDENAS, RAUL JOSE, MD
7/1/2011
P5161
1/4/2013
P8651
CARDON, CANDICE THERESA, MD
CARDONA ORELLANA, ILIANA
LISET, MD
1/3/2014
Q4056
CARDONA-HUERTA, BARBARA, MD
5/1/2015
Q0740
CARLSON, MATTHEW, MD
6/27/2014
Q7335
P7615
04-Mar-16
8/15/2013
Q2259
CARLTON, SHARREL MARIE, MD
CARMEL, MAUDE, MD
CARNELL, ANTHONY QUINTAIN,
DO
CARODISKEY, MARCUS ANDREW,
DO
Q1960
CAROZZA, DESI R, MD
10/1/2014
P1528
CARPENTER, SHAUN ROBERT, MD
12/1/2011
P8453
EMERGENCY
04-Dec-20 MEDICINE
PEDIATRIC
Registration
Status of
Practice
Texas
State
License
DELINQUEN
T-NON
PAYMENT
TX
ACTIVE
SAN ANTONIO TX
DALLAS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
03-Mar-16 None
4/9/2012 None
N/A
N/A
ACTIVE
3/18/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/16/2013 None
N/A
8/1/2011 None
4/16/2012 None
N/A
N/A
4/1/2015 None
N/A
10/6/2015 None
N/A
6/27/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
7/8/2011 None
N/A
EMERGENCY
1/4/2018 MEDICINE
SPINE MEDICINE
PEDIATRIC
EMERGENCY
MEDICINE (EM)
CORPUS
CHRISTI
TX
ACTIVE
1/24/2013 None
N/A
NEPHROLOGY
EAGLE PASS
WICHITA
FALLS
TX
ACTIVE
1/21/2014 None
N/A
TX
ACTIVE
5/18/2015 None
N/A
DALLAS
COLLEGE
STATION
DALLAS
TX
ACTIVE
7/4/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
08-Mar-16 None
8/20/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/9/2013 None
N/A
11/7/2014 None
N/A
12/6/2013
5/1/2020 PEDIATRICS
GYNECOLOGIC
6/27/2019 ONCOLOGY
OBSTETRICS AND
8/15/2018 UROLOGY
FAMILY
12/6/2018 PRACTICE/OMM
11/7/2014
SPORTS MEDICINE
PALLIATIVE
10/1/2019 INTERNAL MED - PEDS MEDICINE
UNDERSEA
HYPERBARIC MED
12/1/2016 (EMER MED)
Page 59 of 402
DALLAS
TX
ACTIVE
10/28/2014 None
N/A
COVINGTON
LA
ACTIVE
12/8/2011 None
N/A
License
Number
Q8031
Q0228
Q1368
P6953
P3127
Q8218
Q3157
Q0019
Physician Name
CARRASQUILLO, INES, MD
CARREON, JENNY LYNN
DEQUILLA, MD
CARRERA, VICTORIA MICHELLE,
MD
CARRERAS, YULY D, MD
CARRERO, ANGELA MARIA, MD
CARRETE, LOLA , MD
CARRION MONSALVE, ANDRES F,
MD
CARROLL, CHRISTIN ALEJNIKOV,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PLASTIC &
RECONSTRUCTIVE
HAND SURGERY 02-May-16
02-May-21 SURGERY
PLASTIC SURGERY
5/15/2014
8/15/2014
6/14/2013
5/15/2012
16-May-16
2/13/2015
5/2/2014
P9312
CARROLL, JOHN RAYMOND, MD
3/17/2014
Q1801
P9533
CARROLL, KRISTEN LEE, MD
CARROLL, MATTHEW, MD
9/15/2014
4/1/2014
P7887
P3516
P2606
P2103
CARROLL, TANNON DAJUAN, MD
CARROTHERS, IRENE A, MD
CARROUTH, DAVID AARON, MD
CARSON, WILLIAM KEITH, MD
9/16/2013
6/8/2012
4/2/2012
2/10/2012
Q4374
CARTAYA, JULIA, MD
5/15/2015
Q0229
CARTER, COURTNEY, DO
5/15/2014
Q0887
CARTER, JASON ANDREW, MD
7/15/2014
Q7158
CARTER, SCOTT ALLEN, MD
16-Feb-16
Q5630
P3298
CARTER, STACEY ANN , MD
CARUSO, ANDREW C, MD
8/14/2015
6/1/2012
K7258
CARUSO, JARED PAUL, MD
7/15/2014
Practice City
WAUSAU
Registration
Status of
Practice
Texas
State
License
WI
24-May-16 None
N/A
5/15/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/26/2014 None
6/24/2013 None
6/14/2012 None
N/A
N/A
N/A
16-May-16 None
N/A
2/13/2015 None
N/A
ACTIVE
5/12/2014 None
N/A
TX
ACTIVE
3/24/2014 None
N/A
UT
OH
ACTIVE
ACTIVE
9/23/2014 None
4/8/2014 None
N/A
N/A
ROUND ROCK
DALLAS
ADDISON
HOUSTON
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
GASTROENTEROLOG
Y
SAN ANTONIO TX
PEDIATRIC
4/1/2019 PEDIATRICS
INTERVENTIONAL
2/10/2017 RADIOLOGY
PEDIATRIC
5/15/2020 ENDOCRINOLOGY
EMERGENCY
7/15/2019 MEDICINE
EMERGENCY
16-Feb-21 MEDICINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
CARDIOLOGY
HOSPITALIST
EMERGENCY
MEDICAL SERVICES
PEDIATRIC
EMERGENCY
FAMILY PRACTICE
SURGICAL BREAST
ONCOLOGY
Page 60 of 402
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
FORT WORTH TX
BRONX
NY
5/2/2019 PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
CORPUS
CHRISTI
SALT LAKE
CITY
CINCINNATI
10/14/2013
6/19/2012
4/4/2012
2/28/2012
None
None
None
None
N/A
N/A
N/A
N/A
5/21/2015 None
N/A
5/15/2014 None
N/A
SPRINGFIELD MO
ACTIVE
9/2/2014 None
N/A
PARIS
TX
ACTIVE
19-Feb-16 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/20/2015 None
6/14/2012 None
N/A
N/A
SUGAR LAND
TX
ACTIVE
7/21/2014 None
N/A
License
Number
Q0615
Physician Name
CARVAJAL GUZMAN, SONIA
CAROLINA, MD
P0560
CARVER, ALISSA RENEE, MD
P0560
CARVER, ALISSA, MD
P2608
CASALE, ANTHONY JOSEPH, MD
P6954
P8227
P4636
Q5632
P7618
CASAL-FERNANDEZ, ALYN
CRISTINA, MD
CASARES, PABLO ALBERTO, MD
CASAS, CHEYANNE MARIE, MD
CASEY, CHRISTINA VU, DO
CASIANO, FELIX ANGEL JR, MD
dicaid
dicaid
Agreement
End Date
Designated)
6/16/2014
8/1/2011
15-Apr-16
4/2/2012
MATERNAL AND
OBSTETRICS AND
6/14/2018
11/1/2018
10/15/2017
8/14/2020
8/15/2018
12/6/2013
16-Feb-16
12/6/2018
16-Feb-21
Q7844
CASILLAS, ADRIAN, MD
CASOY, FLAVIO, MD
CASSELL, NATHANIEL CONLEY,
MD
15-Apr-16
Q2260
CASSIDY, LLOYD CHARLES IV, MD
11/7/2014
Q0020
CASTAGNINI, LUIS ANTONIO, MD
Q2261
CASTANEDA, ELIEZER , MD
Q4913
CASTANEDA, MELISSA MARIE, MD
CASTANEDA-VIDAURRE, MILAGRO
PATRICIA, MD
CASTANO DE ZAMACONA,
MARCELA LUCIA, MD
P8766
P1170
Q3648
Q0230
N2980
CASTANO, EKATERINA, MD
CASTELLON INESTROZA,
RICARDO ESTEBAN, MD
CASTILLO KONTAK, LETICIA, MD
5/2/2014
PUBLIC
HEALTH/PREVENTIVE
MEDICINE (GENERAL)
INTERNAL MEDICINE NEPHROLOGY
FAMILY MEDICINE
FAMILY MEDICINE
PSYCHIATRY
ALLERGY AND
IMMUNOLOGY
INTERNAL MEDICINE
PSYCHIATRY
6/24/2014 None
N/A
GALVESTON
TX
ACTIVE
8/10/2011 None
N/A
MACON
GA
ACTIVE
LICENSE
ISSUED
29-Apr-16 None
N/A
4/2/2012 None
N/A
DALLAS
TX
SAN ANTONIO TX
N/A
N/A
N/A
N/A
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
12/13/2013 None
18-Feb-16 None
N/A
N/A
HOUSTON
TX
ACTIVE
22-Apr-16 None
N/A
FORT WORTH TX
ACTIVE
11/10/2014 None
N/A
SAN ANTONIO TX
EL PASO
TX
5/2/2014 None
N/A
11/7/2014 None
N/A
PEDIATRIC
5/2/2019 INFECTIOUS DISEASE
5/15/2014
8/14/2015
ACTIVE
None
None
None
None
None
7/1/2015
4/1/2015
Disciplinary
Status Date
6/18/2013
12/5/2013
10/17/2012
8/31/2015
8/20/2013
10/17/2011
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
11/7/2014
1/15/2014
MATERNAL AND
FETAL MEDICINE
Practice City
4/2/2017 PEDIATRIC UROLOGY UROLOGY
6/14/2013
11/1/2013
10/15/2012
8/14/2015
8/15/2013
P8454
Q7159
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
OBSTETRICS
ANATOMIC/CLINICAL
4/1/2020 PATHOLOGY
LICENSE
ISSUED
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
9/1/2015 None
N/A
COLUMBUS
ACTIVE
1/23/2014 None
N/A
10/20/2011 None
N/A
4/1/2015 None
N/A
5/15/2014 None
8/18/2015 None
N/A
N/A
OH
SAN ANTONIO TX
INTERNAL MEDICINE BALLWIN
Page 61 of 402
MO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
P4852
P2836
CASTILLO, HEIDI, MD
CASTILLO, JUANITA, MD
P3612
CASTILLO, MANUEL, MD
Q3159
Q7022
P3517
Q8701
CASTRO GARCIA, JOSE ANTONIO,
MD
CASTRO PENA, NORYS
ALEXANDRA, MD
CASTRO-SILVA, FERNANDO
JAVIER, MD
Q2523
CASTRO-URGANUS, SANDRA, MD
CATAGUE, BELMUND RAY
YPULONG, MD
Q3343
CATIC, ANGELA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
DEVELOPMENTALBEHAVIORAL
11/15/2012
PEDIATRICS
4/13/2012
6/15/2012
2/13/2015
01-Feb-16
6/8/2012
PLASTIC &
RECONSTRUCTIVE
2/13/2020 SURGERY
HEMATOLOGY
6/8/2017 (PATHOLOGY)
10-Jun-16
10-Jun-21 FAMILY PRACTICE
12/3/2014
3/3/2015
P5046
CATTANO, DAVIDE , MD
12/17/2012
P5046
12/17/2012
P5046
12/17/2012
Q3160
CATUOGNO, SEAN MICHAEL, MD
2/13/2015
P7256
CAUTHEN, CLAY ADAMS, MD
7/15/2013
EMERGENCY
2/13/2020 MEDICINE
CARDIOVASCULAR
7/15/2018 DISEASES
Q8219
CAVAZOS, ALFONSO JOEL JR, MD
16-May-16
16-May-21 ANESTHESIOLOGY
Q5633
CAVAZOS, ELOY JR, MD
8/14/2015
P9535
P3130
CAVENDER, LORI HARKER, MD
CAYCE, RACHAEL LYNN, MD
4/1/2014
5/15/2012
P9818
CAYME, RODRIGO I, MD
4/15/2014
P5784
Q5363
CAYO, ASHLEY KAPPES, MD
CAZZANIGA, STEFANO, MD
3/15/2013
8/3/2015
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/21/2012 None
4/18/2012 None
N/A
N/A
6/15/2012 None
N/A
LICENSE
ISSUED
2/13/2015 None
N/A
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
INFECTIOUS
DISEASES
SAN ANTONIO TX
ACTIVE
08-Mar-16 None
N/A
PATHOLOGY
DALLAS
ACTIVE
LICENSE
ISSUED
6/18/2012 None
N/A
10-Jun-16 None
N/A
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
OTHER SPECIALTY
OBSTETRICS AND
4/1/2019 GYNECOLOGY
PHYSICAL MED. &
SPINE MEDICINE
SURGICAL
3/15/2018 GENERAL SURGERY ONCOLOGY
Page 62 of 402
TX
SCHERTZ
TX
ACTIVE
12/11/2014 None
N/A
HOUSTON
TX
ACTIVE
3/11/2015 None
N/A
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
TX
ACTIVE
12/20/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
12/20/2012 None
N/A
2/13/2015 None
N/A
AUSTIN
TX
ACTIVE
8/7/2013 None
N/A
TEMPLE
TX
ACTIVE
18-May-16 None
N/A
HOUSTON
TX
ACTIVE
8/19/2015 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
4/17/2014 None
6/12/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
5/1/2014 None
N/A
MILWAUKEE
ARLINGTON
WI
TX
ACTIVE
ACTIVE
3/29/2013 None
8/4/2015 None
N/A
N/A
License
Number
P0357
P8867
Q8221
Q5634
Q0232
P6794
P8579
P6955
Q4059
P0964
Physician Name
CEBALLOS, GILDARDO ANDRES,
MD
CEBE, JAMES JOSEPH, MD
CECIL, KATHRYN WIESMAN, MD
CEDARS, ARI MICHAEL, MD
CEDENO SANCHEZ, GIBEL
SORAYA, MD
CEDRONE, ANTHONY JOSEPH, MD
CELEBERTI, JULIE, MD
CEPEDA-IRUEGAS, NIRU , MD
CERDA, NATALIE, MD
CERNA, NORMA CAROLINA, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2011
2/7/2014
16-May-16
8/14/2015
PEDIATRIC
16-May-21 ORTHOPEDICS
5/15/2014
6/3/2013
12/16/2013
6/14/2013
5/1/2015
9/15/2011
Q2524
Q5773
Q4060
CERSONSKY, NANCY ANN, MD
CERVANTES, TESSA JENE, MD
CESPEDES, PAUL LUIS, MD
12/3/2014
8/28/2015
5/1/2015
CARDIOLOGY
PEDIATRICS
INTERNAL MEDICINE
PEDIATRICS
FAMILY MEDICINE
RADIATION
12/3/2019 ONCOLOGY
Q5774
Q2525
8/28/2015
12/3/2014
Q5985
CHA, DAVID JEANGUP, MD
CHACKO, ELIZABETH , DO
CHACKO, ELIZABETH MATHEWS,
MD
9/15/2015
Q3161
CHAHIL, MANDEEP SINGH, MD
2/13/2015
P3299
CHAI, CHRISTY YOON-HEE, MD
6/1/2012
P5049
CHAICHA-BROM, TIRA, MD
12/17/2012
P5049
12/17/2012
P5049
Q4915
CHAISSON, JORDAN , MD
12/17/2012
7/1/2015
P6956
CHAISSON-MCRAE, CLARISSA, MD
6/14/2013
6/3/2018
12/16/2018
6/14/2018
5/1/2020
9/15/2016
Secondary Specialty
(Self-Designated)
RICHMOND
HOUSTON
CORPUS
CHRISTI
DALLAS
INTERVENTIONAL
CARDIOLOGY
HOSPITALIST
PALLIATIVE
MEDICINE
NEPHROLOGY
PEDIATRIC
ENDOCRINOLOGY
2/13/2020 NEUROLOGY
SURGICAL
6/1/2017 ONCOLOGY
ENDOCRINOLOGY,
DIABETES AND
12/17/2017 METABOLISM
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
Practice City
Registration
Status of
Practice
Texas
State
License
TX
TX
ACTIVE
ACTIVE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
BAY CITY
TX
SAN ANGELO
TX
WAXAHACHIE TX
SAN ANTONIO TX
PLANO
TX
ALLENTOWN
PA
NEURO-PHYSIOLOGY
(NEUROLOGY)
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
GENERAL SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/20/2011 None
2/14/2014 None
N/A
N/A
20-May-16 None
8/17/2015 None
N/A
N/A
5/15/2014 None
N/A
6/3/2013
12/18/2013
6/26/2013
6/1/2015
9/19/2011
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
12/9/2014 None
8/31/2015 None
5/7/2015 None
N/A
N/A
N/A
8/28/2015 None
12/5/2014 None
N/A
N/A
10/26/2015 None
N/A
2/13/2015 None
N/A
6/1/2012 None
N/A
INTERNAL MEDICINE AUSTIN
TX
ACTIVE
12/18/2012 None
N/A
TX
ACTIVE
12/18/2012 None
N/A
CARDIOLOGY
HOUSTON
TX
TX
ACTIVE
ACTIVE
12/18/2012 None
7/2/2015 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
7/16/2013 None
N/A
Page 63 of 402
License
Number
P7409
Physician Name
Registration
dicaid
dicaid
Status of
Agreement
Practice
Texas
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
License
CARDIOVASCULAR
8/1/2013
8/1/2018 DISEASES
ACTIVE
P1171
CHAKILAM, SRUJANA, MD
CHAKKALAKAL, ANNETTE
ELIZABETH JAMES, MD
P1060
CHALASANI, RAMBABU , MD
10/3/2011
GASTROENTEROLOG
10/3/2016 Y
P5785
P5943
CHALLA, SOUJANYA, MD
CHALLA, TEJO RAMAM, MD
3/15/2013
4/1/2013
P9536
CHALLAGALI, KIRAN KUMAR, MD
10/17/2011
4/1/2014
11/21/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
10/17/2011 None
N/A
3/15/2013 None
4/15/2013 None
N/A
N/A
4/1/2014 None
N/A
COLLEGE
STATION
NORTH
RICHLAND
HILLS
Q0021
CHAMAKURA, SANJAYANTH
REDDY, MD
5/2/2014
TX
ACTIVE
13-Jun-16 None
N/A
TX
ACTIVE
5/12/2014 None
N/A
P3518
CHAMARTHI, PHANI PRABHAKARA
SRINIVASA SASTRY, MD
6/8/2012
Q4916
CHAMARTHY, MURTHY R, MD
7/1/2015
Q3491
02-May-16
P4429
CHAMBERLAIN, TIMOTHY , MD
CHAMBERS, CLAUDIA SUZETTE,
MD
CHAMBERS-KERSH, LAURA SINDA,
MD
6/8/2017 PEDIATRICS
INTERVENTIONAL
7/1/2020 RADIOLOGY
EMERGENCY
3/16/2020 MEDICINE
OBSTETRICS AND
TX
ACTIVE
6/11/2012 None
N/A
NUCLEAR MEDICINE DALLAS
TX
ACTIVE
7/7/2015 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
3/20/2015 None
N/A
02-May-16 None
N/A
9/17/2012
OBSTETRICS
FT HOOD
TX
ACTIVE
10/9/2012 None
N/A
Q7539
Q1369
CHAMSI-PASHA, MOHAMMED, MD
CHAN, ALEX CUA, MD
15-Mar-16
8/15/2014
8/15/2019 RADIOLOGY
OMAHA
HUNTSVILLE
NE
AL
Q0233
CHAN, AUDREY JACQUELINE, MD
5/15/2014
Q8449
CHAN, EDWARD SHEI AHU, MD
01-Jun-16
01-Jun-21 SURGERY
CARDIOLOGY
NEURO-RADIOLOGY
PEDIATRIC
DERMATOLOGY
ACTIVE
ACTIVE
LICENSE
ISSUED
18-Mar-16 None
8/18/2014 None
N/A
N/A
5/15/2014 None
N/A
ACTIVE
06-Jun-16 None
N/A
Q5986
CHAN, EDWARD Y H, MD
9/15/2015
Q7339
CHAN, GALANT AU, MD
04-Mar-16
CARDIOVASCULAR
DISEASES
EL PASO
SAN ANTONIO TX
INFECTIOUS
04-Mar-21 DISEASES
N/A
ACTIVE
CHALLAPALLI, VISHNU P, MD
3/16/2015
10-Jun-21 PSYCHIATRY
CARDIOINTERVENTIONAL
5/2/2019 RADIOLOGY
8/13/2013 None
CO
Q8702
Q8033
10-Jun-16
Disciplinary
Status Date
DENVER
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
9/16/2015 None
N/A
TX
ACTIVE
23-Mar-16 None
N/A
Page 64 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
4/1/2015
4/1/2020 MEDICINE
4/1/2014
4/1/2019 PEDIATRICS
GASTROENTEROLOG
8/14/2015
8/14/2020 Y
INTERNAL MEDICINE
OBSTETRICS AND
06-Jan-16
06-Jan-21 GYNECOLOGY
5/1/2012
5/1/2017 RADIOLOGY
PEDIATRICS,
10/15/2012
PEDIATRICS
PEDIATRICS,
11/17/2014
CARDIOLOGY
10/15/2014
Q3650
P9537
CHAN, ISAAC, MD
CHAN, JACKYLN , MD
Q5635
CHAN, JOHANNA LEIGH, MD
Q6814
P2967
CHAN, REXANNA , DO
CHAN, ROXANNE, MD
P4637
CHAN, SOI-YU, MD
Q2435
Q2113
CHANANA, NITIN, MD
CHANCEY, REBECCA J, MD
P9819
CHANDABHAI, HUZEFA YUSUF, MD
4/15/2014
Q4917
CHANDLER, JESSICA NICOLE, DO
7/1/2015
OBSTETRICS &
GYNECOLOGICAL
7/1/2020 SURGERY
5/15/2013
11/30/2012
PHYSICAL MED. &
GYNECOLOGIC
SURGERY
OSTEO
MANIPULATIVE
MEDICINE
P6596
P4939
CHANDLER, SETH DUNCAN, DO
CHANDLER, WEST, MD
Q7340
04-Mar-16
04-Mar-21 CARDIOLOGY
Q7024
Q2751
P7749
P3613
CHANDRAPRAKASAM, SATISH, MD
CHANDRASHEKHAR, RAVINDRA,
MD
CHANG SEN, LAUREN QING, MD
CHANG, ALEX CHIA, MD
CHANG, EDWARD, MD
01-Feb-16
1/5/2015
8/30/2013
6/15/2012
01-Feb-21
1/5/2020
8/30/2018
6/15/2017
Q7663
CHANG, I-YUAN JOSEPH, MD
01-Apr-16
01-Apr-21
Q4918
CHANG, JESSE LIMMON, MD
7/1/2015
7/1/2020
L1542
CHANG, JOE, MD
10/1/2014
10/1/2019
P3519
CHANG, MARY PEARL, MD
6/8/2012
6/8/2017
M3981
CHANG, MICHAEL LEE, MD
7/1/2015
PEDIATRIC
Page 65 of 402
INTERNAL MEDICINE
RADIOLOGY
ANESTHESIOLOGY
PEDIATRICS
DIAGNOSTIC
RADIOLOGY
CRITICAL CARE
MEDICINE (IM)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
EMERGENCY
MEDICINE
INTERVENTIONAL
CARDIOLOGY
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
HOUSTON
TX
PASADENA
ATLANTA
Practice City
Disciplinary
Status Date
4/1/2015 None
4/11/2014 None
N/A
N/A
ACTIVE
8/17/2015 None
N/A
TX
GA
ACTIVE
ACTIVE
04-Feb-16 None
5/3/2012 None
N/A
N/A
TEMPLE
TX
10/18/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/17/2014 None
10/17/2014 None
N/A
N/A
DAVENPORT
IA
ACTIVE
4/29/2014 None
N/A
EL PASO
TX
ACTIVE
7/9/2015 None
N/A
MARSHALL
TX
ACTIVE
ACTIVE
7/4/2013 None
12/24/2012 None
N/A
N/A
FORTWORTH
TX
ACTIVE
21-Apr-16 None
N/A
PITTSBURGH
HOUSTON
ANGLETON
PA
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10-Feb-16
1/12/2015
9/9/2013
6/20/2012
None
None
None
None
N/A
N/A
N/A
N/A
DALLAS
TX
ACTIVE
02-Jun-16 None
N/A
SAINT LOUIS
MO
ACTIVE
7/21/2015 None
N/A
DALLAS
TX
ACTIVE
10/7/2014 None
N/A
HOUSTON
TX
ACTIVE
6/25/2012 None
N/A
HOUSTON
TX
ACTIVE
7/16/2015 None
N/A
SLEEP MEDICINE
PULMONARY
DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q0888
CHANG, OLIVER, MD
7/15/2014
P5344
CHANG, RHODA YUEH, MD
2/1/2013
P6353
P7620
CHANG, RICHARD RAY, MD
CHANG, TIFFANY, MD
5/1/2013
8/15/2013
P4741
CHANG, VICTOR, MD
Q5775
CHANGELA, KINJAL, MD
Disciplinary
Status Date
ACTIVE
8/4/2014 None
N/A
ACTIVE
2/4/2013 None
N/A
6/12/2013 None
8/20/2013 None
N/A
N/A
ACTIVE
ACTIVE
11/1/2012
TX
12/13/2012 None
N/A
8/28/2015
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/28/2015 None
N/A
MCALLEN
TX
ACTIVE
LICENSE
ISSUED
12/9/2013 None
N/A
11/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/19/2015 None
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
3/11/2014 None
N/A
2/7/2014 None
N/A
ACTIVE
5/12/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
19-Apr-16 None
N/A
3/16/2015 None
7/7/2011 None
N/A
N/A
11/16/2015 None
N/A
5/5/2015 None
N/A
8/1/2011 None
N/A
1/16/2012 None
N/A
12/6/2013
P8229
CHANTORNSAENG, SIRINAN, MD
11/1/2013
Q2886
CHAO, BRENDA RU-LAN, MD
1/15/2015
OBSTETRICS AND
P0561
CHAO, STEPHEN KEN-WEI, MD
8/1/2011
P9173
CHAO, ZUBAIR, MD
3/3/2014
P8869
CHAPA, YESICA , MD
CHAPARRO-KRUEGER, CYNTHIA,
DO
2/7/2014
5/1/2015
Q7846
CHAPEL, ROSS JOSEPH, MD
15-Apr-16
Q3494
P0182
CHAPMAN, ERIC BRANDON, MD
CHAPMAN, JOHN CAYLOS, MD
CHAPPELL, JEANEEN
ANTOINETTE, MD
3/16/2015
7/1/2011
11/16/2015
Q4064
CHAPPELL, NEIL RYAN, MD
5/1/2015
P0562
CHAR, VANDANA, MD
CHARFEN, CHARLOTTE NEWMAN,
MD
8/1/2011
P1736
Registration
Status Date
TX
TX
CHANGLANI, MAHESH, MD
Q6501
Practice City
Disciplinary
Status of
Texas
License
EMERGENCY
5/1/2018 MEDICINE
FT. WORTH
8/15/2018 NEUROLOGY
PHYSICAL MED. &
HOUSTON
P8456
Q4063
Secondary Specialty
(Self-Designated)
PLASTIC &
RECONSTRUCTIVE
SURGERY
Registration
Status of
Practice
Texas
State
License
1/2/2012
CARDIOVASCULAR
DISEASES
NEONATOLOGY
DALLAS
TX
EMERGENCY
3/3/2019 MEDICINE
OBSTETRICS AND
5/1/2020 GYNECOLOGY
AUSTIN
ORTHOPEDIC
15-Apr-21 SURGERY
SPORTS MEDICINE 3/16/2020 ORTHOPEDICS
TX
SURGERY
ORTHOPEDIC
SURGERY
HOUSTON
TX
OBSTETRICS AND
5/1/2020 GYNECOLOGY
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
8/1/2016 PEDIATRICS
EMERGENCY
1/2/2017 MEDICINE
HOUSTON
KISSIMMEE
Page 66 of 402
TX
FL
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q2980
CHARITAKIS, KONSTANTINOS, MD
2/2/2015
Q7664
CHARLES, LORRAINE ALEXIS, MD
01-Apr-16
Q7847
CHARLES, MARVINIA, MD
15-Apr-16
P1281
CHATER, MICHAEL GEORGE, MD
11/4/2011
Q2264
CHATHA, SARTAJ SINGH, MD
11/7/2014
Q5162
Q3496
CHAU, ALEX, MD
CHAU, KIM TU, DO
7/15/2015
3/16/2015
Q4919
CHAU, NHAN PHUOC, MD
Q0023
P1529
CHAUDHARI, BHARTI R, DO
CHAUDHARY, AISHA LUBNA, MD
5/2/2014
12/1/2011
P1975
Q5776
CHAUDHARY, HUMERA M, MD
CHAUDHARY, JESSICA, MD
2/1/2012
8/28/2015
P5051
P5051
P5051
CHAUDHARY, VISHY, MD
Q6163
CHAUDHRY, AISHA BASHIR, MD
7/1/2015
12/17/2012
12/17/2012
12/17/2012
2/2/2020 CARDIOLOGY
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
CARDIOLOGY
01-Apr-21 FAMILY MEDICINE
EMERGENCY
15-Apr-21 MEDICINE
OTORHINOLARYNGOL
11/4/2016 OGY
RHINOLOGY
FAMILY PRACTICE 11/7/2019 FAMILY MEDICINE
EMERGENCY MED
INTERVENTIONAL
DIAGNOSTIC
7/15/2020 RADIOLOGY
RADIOLOGY
EMERGENCY
7/1/2020 MEDICINE
EMERGENCY
5/2/2019 MEDICINE
DIAGNOSTIC
ABDOMINAL
2/1/2017 RADIOLOGY
RADIOLOGY
PSYCHIATRY
10/1/2015
AM00023 CHAUDHRY, HAROON W, MD
CHAUDHRY, MUHAMMAD KASHIF,
P8230
MD
P3614
CHAUDHRY, PRIYANKA , MD
10/1/2012
11/1/2013
6/15/2012
P3132
CHAUDHRY, SARMAD MUNIR, MD
5/15/2012
P3133
Q6816
CHAUDHRY, SUFIYAN HAFEEZ, MD
CHAUDHRY, USMAN UL HAQ, MD
5/15/2012
06-Jan-16
6/15/2017 NEUROLOGY
PULMONARY
CRITICAL CARE
5/15/2017 MEDICINE
GASTROENTEROLOG
5/15/2017 Y
06-Jan-21 FAMILY PRACTICE
P1530
Q5778
CHAUDRY, KANWAL NISAR, MD
CHAUDRY, SALMANN IMTIAZ, DO
12/1/2011
8/28/2015
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
Disciplinary
Status Date
ACTIVE
2/6/2015 None
N/A
ACTIVE
06-Apr-16 None
N/A
18-Apr-16 None
N/A
11/15/2011 None
N/A
11/7/2014 None
N/A
IRVING
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LUBBOCK
BAY CITY
TX
TX
ACTIVE
ACTIVE
7/16/2015 None
3/20/2015 None
N/A
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
7/14/2015 None
N/A
5/2/2014 None
12/9/2011 None
N/A
N/A
2/3/2012 None
9/9/2015 None
N/A
N/A
12/17/2012 None
1/17/2013 None
1/17/2013 None
N/A
N/A
N/A
EL PASO
DANBURY
TX
CT
YORK
YORK
GRAND
FORKS
PA
PA
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ND
ACTIVE
10/6/2015 None
N/A
10/3/2012 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/1/2013 None
6/19/2012 None
N/A
N/A
DALLAS
TX
ACTIVE
6/15/2012 None
N/A
TN
PA
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
5/31/2012 None
19-Jan-16 None
N/A
N/A
12/1/2011 None
9/1/2015 None
N/A
N/A
INTERNAL MEDICINE
CRITICAL CARE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
INTERNAL MEDICINE MEMPHIS
HOSPITALIST
PITTSBURGH
INTERNAL MEDICINE TEMPLE
Page 67 of 402
TX
License
Number
Physician Name
Q0024
CHAUHAN, ASHIMA , MD
dicaid
dicaid
Agreement
End Date
Designated)
5/2/2014
Q1370
CHAUHAN, RAVI RONI, DO
8/15/2014
P9316
P5162
3/17/2014
1/4/2013
11/2/2015
2/1/2012
P2211
CHAUHAN, SUNEET, MD
CHAUM, EDWARD, MD
CHAVARRIA, HUMBERTO JOSE,
MD
CHAVDA, CHIRAG, MD
CHAVEZ MAC GREGOR, MARIANA ,
MD
OBSTETRICS AND
Q1111
CHAVEZ, ANTONIO BENJAMIN, DO
8/1/2014
Q4733
CHAVEZ-VELAZQUEZ, ALBERTO
OMAR, MD
Q6403
P1977
P4941
P7087
CHAWLA, DAVE, MD
CHECKA, CRISTINA MARGARITA,
MD
P9539
CHEEK, NADIA LAUREN, MD
Q8451
Q8452
CHEELA, SHILPA, MD
CHEEMA, BAKHT SULTAN, MD
Q0025
CHEEMA, FAREEHA HUSSAIN, MD
3/1/2012
6/12/2015
11/30/2012
7/1/2013
4/1/2014
01-Jun-16
01-Jun-16
5/2/2014
Q8704
CHEEMA, MUHAMMAD Q, MD
10-Jun-16
P1282
CHEEMA, SIDRA SHAFIQ, MD
11/4/2011
Q3344
Q0741
P1737
CHEEMA, YASER, MD
CHEERAN, DANIEL , MD
CHELIKANI KOTAGIRI, SUNANDA,
MD
Q1112
CHELLAPPA, PARKAVI, MD
3/3/2015
6/27/2014
1/2/2012
8/1/2014
3/1/2017 ONCOLOGY
OBSTETRICS AND
8/1/2019 GYNECOLOGY
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICAL SERVICES
MATERNAL AND
FETAL MEDICINE
PEDIATRICS
Practice City
BAYTOWN
NEW
ORLEANS
ACTIVE
9/5/2014 None
N/A
HOUSTON
MEMPHIS
TX
TN
ACTIVE
ACTIVE
4/30/2014 None
1/10/2013 None
N/A
N/A
MCALLEN
TX
ACTIVE
ACTIVE
11/4/2015 None
2/24/2012 None
N/A
N/A
TX
ACTIVE
3/28/2012 None
N/A
ACTIVE
8/4/2014 None
N/A
6/12/2015 None
N/A
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
LICENSE
ISSUED
MARBLE
FALLS
SURGICAL
7/1/2018 ONCOLOGY
BREAST ONCOLOGY NASSAU BAY
PEDIATRIC
HEMATOLOGY/ONCOL
4/1/2019 OGY
SAN ANTONIO
EMERGENCY
01-Jun-21 MEDICINE
AUSTIN
TX
ACTIVE
12/11/2012 None
N/A
TX
ACTIVE
7/2/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/17/2014 None
N/A
01-Jun-16 None
13-Jun-16 None
N/A
N/A
5/2/2014 None
N/A
MO
ACTIVE
16-Jun-16 None
N/A
11/10/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
3/3/2015 None
7/1/2014 None
N/A
N/A
ACTIVE
1/23/2012 None
N/A
ACTIVE
8/15/2014 None
N/A
TX
10-Jun-21 NEPHROLOGY
ANATOMIC/CLINICAL
11/4/2016 PATHOLOGY
CARDIOVASCULAR
3/3/2020 DISEASES
1/2/2017 PEDIATRICS
CHILD AND
ADOLESCENT
8/1/2019 PSYCHIATRY
OSAGE
INTERNAL MEDICINE BEACH
INTERVENTIONAL
CARDIOLOGY
DALLAS
PSYCHIATRY
Page 68 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/12/2014 None
N/A
LA
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
FAYETTEVILLE NC
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
2/8/2013
2/8/2018 MEDICINE
4/2/2017 VITREOUS SURGERY OPHTHALMOLOGY
GERIATRIC
MEDICINE (FAMILY
1/2/2012
PRACTICE)
EMERGENCY
8/1/2013
8/1/2018 MEDICINE
CRITICAL CARE
12/3/2014
ANESTHESIOLOGY
PLASTIC &
RECONSTRUCTIVE
3/1/2012
3/1/2017 SURGERY
6/16/2014
RADIATION
7/15/2014
7/15/2019 ONCOLOGY
INTERNAL MEDICINE
15-Mar-16
15-Mar-21 INTERNAL MEDICINE PSYCHIATRY
P5522
CHEN, AARON, MD
P2613
CHEN, CAROLYN , MD
P1738
CHEN, DONGNING, MD
P7412
CHEN, JERRY, DO
Q2528
CHEN, JOY LO, MD
P2213
Q0616
CHEN, JOYCE CHI-YI, MD
CHEN, JUSTIN RAY, MD
Q0889
Q7541
CHEN, LEECHUAN ANDY , MD
CHEN, LEON , DO
P1061
CHEN, MERRY, MD
10/3/2011
Q1371
CHEN, ORIANA IJUN, MD
8/15/2014
P6597
CHEN, PHILIP, MD
5/15/2013
P6354
P5607
P1739
5/1/2013
3/1/2013
1/2/2012
P2969
CHEN, TING-YI, MD
CHEN, XIANGBAI , MD
CHEN, YEN I GRACE, MD
CHENG, CHRISTOPHER HAIYUN,
MD
P6356
CHENG, PANG, MD
5/1/2013
P7892
Q3652
9/16/2013
4/1/2015
P2427
CHENG, RAYMOND YEN-TONG, MD
CHENG, WEI , MD
CHENNAREDDY, KIRAN KUMAR,
MD
Q1965
CHENNURU, SUDHATHI, MD
10/1/2014
5/1/2012
3/15/2012
10/3/2016 NEUROLOGY
EMERGENCY
8/15/2019 MEDICINE
INFECTIOUS
5/1/2018 DISEASES
3/1/2018 PATHOLOGY
5/1/2017 PEDIATRICS
EMERGENCY
5/1/2018 MEDICINE
EMERGENCY
9/16/2018 MEDICINE
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
2/18/2013 None
N/A
ACTIVE
4/9/2012 None
N/A
HOUSTON
TX
ACTIVE
1/6/2012 None
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
DALLAS
TX
ACTIVE
12/8/2014 None
N/A
LUBBOCK
DALLAS
TX
TX
ACTIVE
ACTIVE
3/13/2012 None
6/23/2014 None
N/A
N/A
BEAUMONT
TX
ACTIVE
ACTIVE
7/17/2014 None
23-Mar-16 None
N/A
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
HOUSTON
TX
ACTIVE
10/24/2011 None
N/A
HOUSTON
TX
8/18/2014 None
N/A
5/15/2013 None
N/A
RHINOLOGY
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
CYTOPATHOLOGY
DALLAS
TX
TEMPLE
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
5/7/2013 None
3/11/2013 None
1/5/2012 None
N/A
N/A
N/A
ACTIVE
6/5/2012 None
N/A
ACTIVE
5/3/2013 None
N/A
9/23/2013 None
4/2/2015 None
N/A
N/A
3/15/2012 None
N/A
10/10/2014 None
N/A
HOUSTON
TX
HOSPITALIST
HOSPITALIST
HEMATOLOGY/ONCOL
10/1/2019 OGY
Page 69 of 402
WESTERVILLE OH
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q1966
CHERRY, MATTHEW, DO
10/1/2014
10/1/2019 RADIOLOGY
Q2267
CHERRY, SANDEEP MATHEW, MD
11/7/2014
PEDIATRIC
Q4068
P4554
Q6616
Q6616
Q6616
CHESTER, MARC ANDREW, MD
CHEUNG, ERIC, MD
CHEUNG, MICHAEL SHAU-FUNG,
MD
MD
MD
5/1/2015
10/1/2012
12/4/2015
04-Dec-15
04-Dec-15
P2214
CHEUNG, MIN-YUEN CYNTHIA, MD
P6152
CHHABRA, SUMEET KUMAR, MD
4/12/2013
Q8706
CHHABRIA, ARUNA JYOTHI, MD
10-Jun-16
Q2115
CHHATRIWALA, HATIM F, MD
P1978
Q6404
CHHIPWADIA, AMISHA S, MD
CHI, JOSE ALBERTO, MD
Q2116
Q1373
Q7665
P4853
CHIANG, ERIC PING, MD
CHICHAKLI, RAMSEY NEAL, MD
CHIEJINA, MARIA EZIAFA, MD
CHIKE-OBI, CHUMA , MD
P5163
CHIKKALA, SUBHA , MD
Q5636
Q4377
CHILAKAPATI, RAJANI K, MD
CHILAKAPATI, VENKATA SAMBA
SIVA RAO, MD
P9174
CHILDRESS, DAVID, MD
3/1/2012
10/15/2014
2/1/2012
11/2/2015
10/15/2014
8/15/2014
01-Apr-16
11/15/2012
1/4/2013
8/14/2015
5/15/2015
3/3/2014
Secondary Specialty
(Self-Designated)
PEDIATRIC
NEPHROLOGY
EMERGENCY
12/4/2020 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
ELECTROPHYSIOLOG
4/12/2018 Y
CARDIOLOGY
EMERGENCY
10-Jun-21 FAMILY MEDICINE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
10/15/2019
8/15/2019
01-Apr-21
11/15/2017
INTERVENTIONAL
EMERGENCY
3/3/2019 MEDICINE
Page 70 of 402
11/7/2014 None
N/A
5/4/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
10/4/2012 None
N/A
12/4/2015 None
N/A
EL PASO
TX
ACTIVE
06-Jan-16 None
N/A
EL PASO
TX
ACTIVE
06-Jan-16 None
N/A
LOS ANGELES CA
ACTIVE
3/5/2012 None
N/A
PLANO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/25/2013 None
N/A
10-Jun-16 None
N/A
10/15/2014 None
N/A
2/1/2012 None
11/4/2015 None
N/A
N/A
TX
LUBBOCK
TX
TAMUNING
LONGVIEW
GQ
TX
RHEUMATOLOGY
CARDIOVASCULAR
DISEASES
N/A
ACTIVE
GENERAL
PREVENTIVE
MEDICINE
10/1/2014 None
TX
URGENT CARE FAMILY PRACTICE
INTERNAL MEDICINE
UROLOGY
INTERNAL MEDICINE
PLASTIC SURGERY
Disciplinary
Status Date
CORPUS
CHRISTI
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
10/15/2014
8/25/2014
16-May-16
11/28/2012
None
None
None
None
N/A
N/A
N/A
N/A
1/14/2013 None
N/A
8/14/2015 None
N/A
DESOTO
TX
ACTIVE
6/1/2015 None
N/A
NAPLES
FL
ACTIVE
3/10/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
1/5/2015
5/15/2013
OBSTETRICS AND
1/5/2020 GYNECOLOGY
2/13/2015
4/2/2012
12/15/2011
4/2/2017 CARDIOLOGY
Q2752
P6598
CHILDRESS, KRISTA JO, MD
CHILUVERI, MADHU, MD
Q3164
P2615
P1627
CHIMEGAWE, TANMAY MANEK, MD
CHIN, MARK MAW-CHANG, MD
CHING, LINA MIRIAM, MD
P8652
CHING, YIMING AVERY, MD
P8457
CHINITZ, NOAH BENJAMIN, MD
12/6/2013
Q1582
CHINN, IVAN KINGYUE, MD
8/29/2014
Q5369
P0564
CHINNAIYAN, PREMNATH, MD
CHINTALA, NARANATH, MD
1/3/2014
8/3/2015
8/1/2011
CHINTALAPUDI, UDAYA BHASKARA
TM00502 RAO, MD
P4555
CHIRACHANCHAI, MIKE GLA, MD
P7413
CHIRALA, KARTHIK , MD
2/1/2012
10/1/2012
8/1/2013
P7258
CHIRANAND, PAULPOJ, MD
7/15/2013
Q3653
P5787
CHIRUMAMILLA, DIVYA, MD
CHIRUMAMILLA, NEELIMA, MD
4/1/2015
3/15/2013
P7622
CHISHOLM, SIAN S, MD
8/15/2013
Q7343
CHISHTI, WAQAS AHMED, MD
04-Mar-16
Q3862
P1062
P5052
P5052
CHISTY, KHAJA, MD
CHITTURI, RADHA KUMARI, MD
CHITWOOD, DARCIE ANDERSON,
DO
DO
4/10/2015
10/3/2011
12/17/2012
12/17/2012
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
HOSPITALIST
Practice City
HOUSTON
LONGVIEW
Registration
Status of
Practice
Texas
State
License
TX
TX
GERIATRICS
INTERNAL MEDICINE FARMINGTON MO
RHEUMATOLOGY
HOUSTON
TX
JBSA FT. SAM
1/3/2019 VASCULAR SURGERY GENERAL SURGERY HOUSTON
TX
FOOT AND ANKLE,
ORTHOPEDICS
DALLAS, TX
TX
ALLERGY AND
IMMUNOLOGY
HOUSTON
TX
8/3/2020 PEDIATRICS
2/1/2017 RADIOLOGY
GASTROENTEROLOG
8/15/2018 Y
PULMONARY
CRITICAL CARE
04-Mar-21 MEDICINE
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
OPHTHALMOLOGY
FAMILY MEDICINE
FT. WORTH
TX
BIRMINGHAM
ALLEN
HOUSTON
AL
TX
TX
Disciplinary
Status Date
1/9/2015 None
5/17/2013 None
N/A
N/A
2/13/2015 None
4/11/2012 None
12/19/2011 None
N/A
N/A
N/A
ACTIVE
1/20/2014 None
N/A
ACTIVE
12/16/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
9/4/2014 None
N/A
8/3/2015 None
8/5/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
2/29/2012 None
10/4/2012 None
8/5/2013 None
N/A
N/A
N/A
7/15/2013 None
N/A
BROOKLINE
MA
ACTIVE
ACTIVE
4/8/2015 None
4/1/2013 None
N/A
N/A
HARKER
HEIGHTS
TX
ACTIVE
8/19/2013 None
N/A
DALLAS
TX
ACTIVE
17-Mar-16 None
N/A
LICENSE
ISSUED
ACTIVE
4/10/2015 None
10/28/2011 None
N/A
N/A
TX
ACTIVE
12/19/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/19/2012 None
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
GERIATRIC MEDICINE PALLIATIVE
MEDICINE
MEDICINE
Page 71 of 402
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANGELO
License
Number
P5052
Physician Name
DO
P9058
CHIU, LOUISA WHAI-EN, MD
P9822
CHIU, NORA, DO
P5608
CHO, DONG SIK, MD
Q5371
CHOCKALINGAM, VIJAYARATNA ,
MD
CHODKIEWICZ, HUBERT MARTIN,
MD
Q1114
CHOI, ANDREW, MD
P2838
CHOI, HUIMAHN ALEX, MD
P8870
CHOI, JOHN, MD
Q5780
CHOI, SE MYUNG, MD
P5946
CHOI, SUNG-HEE, MD
Q1804
CHOI, WARREN , MD
P3300
CHOKSHI, NITI YOGESH, MD
Q5372
Q0891
CHOKSHI, REENA VIJAY, MD
CHOKSI, ADRIENNE NICOLE, MD
Q1115
CHOKSI, NEEL SHARAD, MD
P6799
Q6405
P5347
P7623
Q1116
CHOLLET, HILLARY ANTHONY
ANDREW, MD
CHONG, EUMING, MD
CHONG, JAMES JAY, MD
CHONG, JONATHAN KALEIMOMI,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
12/17/2012
MEDICINE
SAN ANTONIO
SURGICAL CRITICAL
2/18/2014
2/18/2019 GENERAL SURGERY CARE
HOUSTON
OBSTETRICS AND
4/15/2014
PHYSICAL MED. &
ELECTRODIAGNOSTI
3/1/2013
C MEDICINE
MARSHALL
ENDOCRINOLOGY,
DIABETES AND
6/3/2013
6/3/2018 METABOLISM
INTERNAL MEDICINE
DERMATOLOGIC
8/3/2015
SURGERY
EMERGENCY
8/1/2014
8/1/2019 MEDICINE
CRITICAL CARE 4/13/2012
4/13/2017 NEUROLOGY
NEUROSURGERY
OKLAHOMA
2/7/2014
CITY
EMERGENCY
8/28/2015
8/28/2020 MEDICINE
HEMATOLOGY/ONCOL
4/1/2013
4/1/2018 OGY
PAIN MANAGEMENT
PEDIATRICS,
ALLERGY &
6/1/2012
6/1/2017 PEDIATRICS
IMMUNOLOGY
HOUSTON
GASTROENTEROLOG
8/3/2015
8/3/2020 Y
7/15/2014
HOUSTON
GASTROENTEROLOG
8/1/2014
8/1/2019 Y
11/2/2015
2/1/2013
8/15/2013
8/1/2014
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
N/A
2/24/2014 None
N/A
4/15/2014 None
N/A
ACTIVE
3/8/2013 None
N/A
LICENSE
ISSUED
6/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/14/2015 None
N/A
8/1/2014 None
N/A
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
2/11/2014 None
N/A
8/28/2015 None
N/A
ACTIVE
4/3/2013 None
N/A
ACTIVE
9/18/2014 None
N/A
TX
ACTIVE
6/27/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
8/12/2015 None
7/25/2014 None
N/A
N/A
8/1/2014 None
N/A
11/5/2015 None
2/6/2013 None
8/16/2013 None
N/A
N/A
N/A
8/4/2014 None
N/A
TX
OK
TX
TX
TX
CEDAR HILL
TX
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
Page 72 of 402
Disciplinary
Status Date
12/19/2012 None
GENERAL VASCULAR
SURGERY
HARLINGEN
TRAUMATIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
P3301
Physician Name
CHONG, MICHELLE , MD
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
6/1/2012
6/1/2017 GYNECOLOGY
Secondary Specialty
(Self-Designated)
PLASTIC &
RECONSTRUCTIVE
SURGERY
SURGICAL
ONCOLOGY
Practice City
P2616
CHOO, JOSHUA HYOSUNG, MD
4/2/2012
P9059
CHOTI, MICHAEL ANDREW, MD
2/18/2014
Q2268
CHOU, JONATHAN , MD
11/7/2014
P2107
CHOU, SHIH-CHIN, MD
2/10/2012
EMERGENCY
2/10/2017 MEDICINE
P9060
Q2753
2/18/2014
1/5/2015
Q4379
CHOU, YI-CHUN , MD
CHOUDHARY, CHANDNI , MD
CHOUDHRY, MUHAMMAD WAQAS ,
MD
5/15/2015
P0713
CHOUEIRI, NABIL ELIA, MD
8/15/2011
5/15/2020 INTERNAL MEDICINE CARDIOLOGY
GALVESTON
GASTROENTEROLOG
8/15/2016 Y
INTERNAL MEDICINE TYLER
P6599
CHOUFANI, JOE NAJI, MD
5/15/2013
Q0742
CHOUHAN, CHAROO, MD
6/27/2014
Q8227
CHOW, JEREMY YAN-SHUN, MD
INFECTIOUS
16-May-21 DISEASES
Q3345
P5349
CHOWDHARY, SAJEEL AKBAR, MD
CHOWDHURY, ASHWINI, MD
Q1374
CHOWDHURY, KHAZA, MD
P3521
CHOWNING, SCOTT, MD
16-May-16
FLUSHING
3/3/2015
2/1/2013
3/3/2020 NEUROLOGY
8/15/2014
6/8/2012
DALLAS
6/8/2017 PEDIATRICS
DIAGNOSTIC
5/1/2020 RADIOLOGY
CHRISTENSEN, JARED ALLEN, MD
5/1/2015
Q0235
5/15/2014
Q2754
CHRISTIAN, CECIL FRENKLIN, MD
CHRISTIANSON, BRANDON LEE,
MD
1/5/2015
Q5781
CHRISTNER, JENNIFER GOLD, MD
8/28/2015
TX
NY
RHEUMATOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
6/5/2012 None
N/A
ACTIVE
4/9/2012 None
N/A
ACTIVE
LICENSE
ISSUED
2/19/2014 None
N/A
11/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
2/20/2012 None
N/A
2/18/2014 None
1/26/2015 None
N/A
N/A
6/4/2015 None
N/A
8/22/2011 None
N/A
5/15/2013 None
N/A
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
HOUSTON
TX
ACTIVE
7/2/2014 None
N/A
TX
ACTIVE
19-May-16 None
N/A
NEURO-ONCOLOGY
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/4/2015 None
2/4/2013 None
N/A
N/A
8/15/2014 None
N/A
6/8/2012 None
N/A
5/19/2015 None
N/A
5/15/2014 None
N/A
HOUSTON
PALESTINE
HOSPITALIST
INTERVENTIONAL
RADIOLOGY
Q4070
Registration
Status of
Practice
Texas
State
License
Page 73 of 402
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
1/8/2015 None
N/A
HOUSTON
TX
ACTIVE
9/4/2015 None
N/A
License
Number
P1628
P0714
Physician Name
CHRISTODOULOU,
CHRISTODOULOS , MD
Q0893
CHRONISTER, JUSTIN DAVID, DO
CHRONISTER, JUSTIN EDWARD,
MD
P1629
CHRONISTER, STACY, DO
dicaid
dicaid
Agreement
End Date
Designated)
ALLERGY AND
12/15/2011
8/15/2011
7/15/2014
12/15/2011
Secondary Specialty
(Self-Designated)
HOSPITALIST
Q8453
Q5639
CHU, ANDREW, MD
CHU, DANIELLE DAIYUN, MD
01-Jun-16
8/14/2015
OBSTETRICS AND
4/2/2017 GYNECOLOGY
PLASTIC &
RECONSTRUCTIVE
3/16/2020 SURGERY
2/10/2017 UROLOGIC SURGERY
P2619
P4431
CHU, ETEM TABOGHO, MD
CHU, JEFFREY TING-YUAN, MD
4/2/2012
9/17/2012
Q3497
P2108
CHU, KAI CHENG CARRIE, MD
CHU, LEI, MD
3/16/2015
2/10/2012
P3302
CHU, RICHARD CHUN HSIEN, DO
6/1/2012
Q3346
CHUANG, ION S, MD
3/3/2015
Q4923
CHUA-TUAN, JOHN JAMES, MD
7/1/2015
Q2269
11/7/2014
Q8455
Q0618
P3304
CHUKWU, EMMANUEL E, MD
CHUKWUMAH, LETITIA DANIELLE,
MD
CHUKWUOGO, OLAYEMI, MD
CHUNDRU, VITTAL KUMAR, MD
01-Jun-16
6/16/2014
6/1/2012
Q0026
Q7163
Q1375
CHUNG, DAUN, DO
CHUNG, HANNAH LIM, MD
CHUNG, HUNG, MD
5/2/2014
16-Feb-16
8/15/2014
PHYSICAL MED. &
16-Feb-21 RADIOLOGY
Q7027
CHUNG, JANE S, MD
01-Feb-16
Q4380
CHUNG, PETER S, MD
5/15/2015
Disciplinary
Status Date
AL
ACTIVE
3/1/2012 None
N/A
TX
ACTIVE
8/22/2011 None
N/A
BELLAIRE
CORPUS
CHRISTI
TX
ACTIVE
7/22/2014 None
N/A
TX
ACTIVE
1/12/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
08-Jun-16 None
8/21/2015 None
N/A
N/A
TX
ACTIVE
ACTIVE
4/11/2012 None
9/18/2012 None
N/A
N/A
LICENSE
ISSUED
ACTIVE
3/16/2015 None
2/14/2012 None
N/A
N/A
FORT WORTH TX
ACTIVE
6/25/2012 None
N/A
VOORHEES
ACTIVE
3/10/2015 None
N/A
LONGVIEW
NJ
NEURO-RADIOLOGY
DALLAS
HOSPITALIST
SPINAL CORD
INJURY MEDICINE
DALLAS
NUCLEAR MEDICINE HOUSTON
ALEXANDRIA
SPORTS MEDICINE01-Feb-21 PEDIATRICS
PEDS
PLANO
INTERNAL MED 5/15/2020 INTERNAL MED - PEDS PEDS
HOUSTON
Page 74 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
NICOSIA
CORPUS
CHRISTI
PEDIATRIC
GASTROENTEROLOG
Y
HOUSTON
DALLAS
EMERGENCY
3/3/2020 MEDICINE
DIAGNOSTIC
7/1/2020 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
7/6/2015 None
N/A
11/7/2014 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
14-Jun-16 None
6/20/2014 None
6/27/2012 None
N/A
N/A
N/A
TX
TX
LA
ACTIVE
ACTIVE
ACTIVE
5/5/2014 None
29-Feb-16 None
8/20/2014 None
N/A
N/A
N/A
TX
ACTIVE
03-Feb-16 None
N/A
TX
ACTIVE
5/21/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P8124
CHUTKE, PRASHANT, MD
P5788
P9823
CIANCI, CHRISTOPHER BRIAN, DO
CIRES-DROUET, RAFAEL
SANTIAGO, MD
CISNEROS, YVET LINDA, MD
CIVITARESE, FRANCESCA ROSE,
DO
Q1118
Q5989
Q0619
CIVUNIGUNTA, NARENDRA, MD
CIZENSKI, JEFFREY DAVID, MD
CLAASSEN, DAVID ALAN, MD
8/1/2014
9/15/2015
6/16/2014
P5266
CLARK, BRADLY DOUGLAS, MD
1/15/2013
ANATOMIC
1/15/2018 PATHOLOGY
P1531
CLARK, CHERYL ANN, MD
12/1/2011
CRITICAL CARE
P1740
CLARK, JAMES ALLEN, MD
1/2/2012
P0565
P1630
P1979
CLARK, SHARONDA NICOLE, MD
Q2648
CLARK, STEVEN, MD
10/15/2013
3/15/2013
8/1/2011
12/15/2011
4/15/2014
2/1/2012
12/15/2014
P2971
CLARKE, CAROLINE ELIZABETH,
MD
CLARKE, JERMAINE GARNETTE,
DO
P1980
Q5782
CLARKE, JONATHAN ERIC, MD
CLARKE, NICHOLAS , MD
2/1/2012
8/28/2015
Q7668
CLAVER, HAROLD , DO
01-Apr-16
Q5375
P0185
Q7670
CLEARFIELD, DANIEL ADAM, DO
CLINE, MALLORIE TAYLOR, MD
8/3/2015
5/1/2012
7/1/2011
01-Apr-16
EMERGENCY
4/15/2019 MEDICINE
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
INTERVENTIONAL
CARDIOLOGY
FRISCO
TX
ACTIVE
DENTON
TX
CHILD AND
ADOLESCENT
PSYCHIATRY
MATERNAL AND
FETAL MEDICINE
Page 75 of 402
11/22/2013 None
N/A
3/20/2013 None
N/A
8/1/2011 None
12/29/2011 None
N/A
N/A
4/15/2014 None
N/A
8/1/2014 None
9/17/2015 None
7/1/2014 None
N/A
N/A
N/A
TX
TX
MEMPHIS
TN
ACTIVE
1/22/2013 None
N/A
HOLLYWOOD
FL
ACTIVE
N/A
WOODVILLE
TX
LICENSE
ISSUED
12/6/2011 None
UNDER
BOARD
1/2/2012 ORDER
HOUSTON
TX
LICENSE
ISSUED
HOUSTON
TX
CONROE
INTERNAL MEDICINE SHERMAN
EMERGENCY
MEDICAL SERVICES
DALLAS
SPORTS MEDICINE
(FAMILY PRACTICE)
Disciplinary
Status Date
DALLAS
DALLAS
HOSPITALIST
CYTOPATHOLOGY
PULMONARY
CRITICAL CARE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
VASCULAR MEDICINE
2/1/2017 PSYCHIATRY
OBSTETRICS AND
PLASTIC &
RECONSTRUCTIVE
8/3/2020 SURGERY
GASTROENTEROLOG
5/1/2017 Y
EMERGENCY
2/1/2017 MEDICINE
EMERGENCY
01-Apr-21 MEDICINE
FAMILY
Practice City
Registration
Status of
Practice
Texas
State
License
12/15/2011
2/1/2012 None
N/A
ACTIVE
12/30/2014 None
N/A
TX
ACTIVE
8/4/2015 None
N/A
TX
ACTIVE
5/3/2012 None
N/A
TX
ACTIVE
ACTIVE
2/8/2012 None
9/1/2015 None
N/A
N/A
ACTIVE
04-Apr-16 None
N/A
ACTIVE
ACTIVE
7/8/2011 None
11-Apr-16 None
N/A
N/A
FORT WORTH TX
DALLAS
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
TRAUMATIC
SURGERY
P9824
CLOONAN, MELISSA E, MD
4/15/2014
P0361
7/15/2011
7/15/2016 UNSPECIFIED
P2973
CLOS, AUDRA LEA, MD
CLOSE, CATHERINE COTTERMAN,
MD
P9176
CLOSE, CHARLES BRANDON, DO
3/3/2014
P4744
Q1806
CLOUD, ROSE JOSEPH, MD
CLOUD, WILLIAM GRAYDON, MD
CLOWER, MATTHEW SIMPSON,
MD
11/1/2012
9/15/2014
6/12/2015
6/15/2012
Q6166
CLULEY, JOHN DAVID, MD
COCIANNI, RANNIERI MATHEUS,
MD
6/12/2020 RADIOLOGY
GASTROENTEROLOG EMERGENCY
6/15/2017 Y
MEDICINE
P0362
COFFEE, ROBERT EARL III, MD
7/15/2011
P0363
P2621
COHEN, DAN CHAIM, MD
COKER, BRIDGETTE DENISE, MD
7/15/2011
4/2/2012
P0566
Q6406
COKER, KARAH LYNN, MD
COLAN, DAVID ROBERT, MD
8/1/2011
11/2/2015
P9061
COLATO, FERNANDO J, MD
2/18/2014
P1533
12/1/2011
Q7346
COLBERT, CHRISTLE DENISE, MD
COLBERT, WONDIFUL AUBRAYAI,
MD
04-Mar-16
P0968
COLE, ERIC LOWRY, MD
9/15/2011
P9062
COLE, PATRICK , MD
2/18/2014
04-Mar-21 FAMILY MEDICINE
PLASTIC &
RECONSTRUCTIVE
9/15/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
2/18/2019 SURGERY
P4558
COLEMAN, ALAN MICHAEL, MD
10/1/2012
Q4736
P3616
5/1/2012
10/1/2015
EMERGENCY
3/3/2019 MEDICINE
Practice City
ACTIVE
LICENSE
ISSUED
7/15/2011 None
N/A
5/8/2012 None
N/A
3/21/2014 None
N/A
11/1/2012 None
9/22/2014 None
N/A
N/A
6/12/2015 None
N/A
6/15/2012 None
N/A
ACTIVE
10/12/2015 None
N/A
TX
ACTIVE
8/15/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
8/1/2011 None
4/9/2012 None
N/A
N/A
8/1/2011 None
11/3/2015 None
N/A
N/A
TX
ACTIVE
2/24/2014 None
N/A
SAN ANTONIO TX
ACTIVE
12/5/2011 None
N/A
ANGLETON
TX
ACTIVE
15-Mar-16 None
N/A
TX
ACTIVE
9/28/2011 None
N/A
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
2/20/2014 None
N/A
12/30/2012 None
N/A
HOUSTON
GASTROENTEROLOG
7/15/2016 Y
GARLAND
TEMPLE
OTORHINOLARYNGO
LOGY
GALVESTON
HOUSTON
Page 76 of 402
Disciplinary
Status Date
N/A
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
WARRENTON VA
HOSPITALIST
INTERVENTIONAL
CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
4/28/2014 None
MIDLAND
CORPUS
CHRISTI
CARDIOVASCULAR
2/18/2019 DISEASES
PHYSICAL MED. &
Registration
Status of
Practice
Texas
State
License
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q1377
Q6167
Physician Name
COLEMAN, JESSIE DANIEL JUAN
SR, MD
COLEMAN, KIONA P, MD
Q8230
COLEMAN, WYCHE T III, MD
P5949
COLLADO, CARLA, MD
Q7544
COLLARD, MICHAEL DAVID, MD
15-Mar-16
P7416
COLLEN, JACOB FREDRICK, MD
8/1/2013
P3305
COLLINS, AISHA RENEE, MD
6/1/2012
P6361
COLLINS, CHRISTOPHER JOEL, MD
5/1/2013
Q0028
COLLINS, CLYDE , MD
5/2/2014
8/15/2014
10/1/2015
16-May-16
16-May-21 OPHTHALMOLOGY
4/1/2013
GASTROENTEROLOG
5/2/2019 Y
INTERNAL MEDICINE
OBSTETRICS AND
OBSTETRICS AND
8/15/2014
Q6819
COLLINS, LINDEN REID, MD
06-Jan-16
P8231
COLLINS, NNYEKAA , MD
11/1/2013
Q7671
01-Apr-16
Q2986
COLLINS, SABRINA LEE, MD
COLON PINEIRO, EDGARDO LUIS,
MD
OBSTETRICS AND
2/2/2015
P8874
COLON, OLGA MARINA, MD
2/7/2014
Q4382
COLON-RODRIGUEZ, LARISSA, MD
COLVIN, BRADLEY CHRISTOPHER,
MD
COMPTON-JOSEPH, BRANDI
ANTOINETTE, MD
OBSTETRICS AND
OBSTETRICS AND
6/3/2018 GYNECOLOGY
OBSTETRICS AND
6/8/2017 GYNECOLOGY
P3524
P5350
P8126
CONE, JEFFREY DONALD JR, MD
CONLEY, LAKEISHA MARIE, MD
6/3/2013
6/8/2012
2/1/2013
10/15/2013
CRANIOFACIAL
2/1/2018 SURGERY
Page 77 of 402
Disciplinary
Status Date
8/15/2014 None
10/6/2015 None
N/A
N/A
16-May-16 None
N/A
TX
ACTIVE
4/4/2013 None
N/A
DALLAS
TX
ACTIVE
17-Mar-16 None
N/A
ACTIVE
LICENSE
ISSUED
8/6/2013 None
N/A
6/1/2012 None
N/A
ACTIVE
LICENSE
ISSUED
5/7/2013 None
N/A
5/2/2014 None
N/A
SAN ANTONIO TX
LONGVIEW
WA
CROSS
ROADS
TX
ACTIVE
8/18/2014 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
20-Jan-16 None
N/A
11/1/2013 None
N/A
TX
ACTIVE
06-Apr-16 None
N/A
EL PASO
TX
SPARTANBUR
G
SC
ACTIVE
2/6/2015 None
N/A
ACTIVE
2/17/2014 None
N/A
LAREDO
TX
ACTIVE
6/17/2015 None
N/A
SHREVEPORT LA
ACTIVE
7/8/2013 None
N/A
HOUSTON
TX
ACTIVE
6/13/2012 None
N/A
TAMPA
GASTONIA
FL
NC
ACTIVE
ACTIVE
2/11/2013 None
12/12/2013 None
N/A
N/A
CEDAR PARK
PLASTIC &
RECONSTRUCTIVE
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
COLLINS, LEORA CAVAZOS, MD
P6802
Practice City
PAIN MANAGEMENT
DIAGNOSTIC
15-Mar-21 RADIOLOGY
PULMONARY
CRITICAL CARE
8/1/2018 DISEASES
MEDICINE (IM)
Q1378
5/15/2015
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Q1379
Physician Name
CONLEY, LAWRENCE LEE, DO
dicaid
dicaid
Agreement
End Date
Designated)
ORTHOPEDIC
8/15/2014
8/15/2019 SURGERY
P5789
CONNALLY, PATRICIA AILEEN, DO
3/15/2013
Q7672
CONNEELY, SHANNON ELISE, MD
01-Apr-16
P5950
CONNER, JAMES MICHAEL, MD
CONNOLLY, PATRICK
JOHNMICHAEL, DO
CONNOR, BRYNNA , MD
Q2891
P1064
P7090
Q5377
Q6168
Q1967
CONRAD, CLAUDIUS, MD
CONRAD, ELIZABETH, MD
CONSTANTINE, GREGORY M, MD
CONSTANTINE, MATTHEW
WAYNE, MD
CONTRERAS, JAIME HERIBERTO,
MD
P6362
CONTRERAS, JAMIE JAQUA, MD
P0365
4/1/2013
1/15/2015
10/3/2011
7/1/2013
8/3/2015
10/1/2015
7/15/2011
FP/OSTEO
MANIPULATION
MEDICINE
EMERGENCY
1/15/2020 MEDICINE
SURGICAL
7/1/2018 ONCOLOGY
8/3/2020 PEDIATRICS
EMERGENCY
7/15/2016 MEDICINE
2/7/2014
12/15/2014
10/1/2019 RADIOLOGY
PEDIATRIC
EMERGENCY
OTORHINOLARYNGOL
8/15/2018 OGY
OBSTETRICS &
GYNECOLOGICAL
2/7/2019 SURGERY
8/3/2015
11/15/2013
COOK, RACHEL BERRY, MD
2/13/2015
P4745
COOLE, SCOTT JOSEPH, DO
11/1/2012
P9320
COOLEY, ANDREA CORINNE, DO
3/17/2014
PULMONARY
CRITICAL CARE
11/1/2017 MEDICINE
PEDIATRIC
CARDIOTHORACIC
3/17/2019 SURGERY
P7624
CONTRERAS, JORGE IVAN, MD
P8875
Q2651
Q5379
P8348
CONYAC, THERESA, MD
COOK, AMBER NICOLE, MD
COOK, DIANA CAROLYN GOMEZ,
MD
COOK, JOEL BARRETT, DO
Q3167
10/1/2014
5/1/2013
8/15/2013
Secondary Specialty
(Self-Designated)
Practice City
GILLETTE
OBSTETRICS AND
GYNECOLOGY
CARDIOVASCULAR
SURGERY
Page 78 of 402
Disciplinary
Status Date
8/15/2014 None
N/A
ACTIVE
3/19/2013 None
N/A
TX
ACTIVE
05-Apr-16 None
N/A
TX
ACTIVE
4/19/2013 None
N/A
WHEELING
AUSTIN
WV
TX
ACTIVE
ACTIVE
2/18/2015 None
11/16/2011 None
N/A
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/31/2013 None
8/5/2015 None
10/6/2015 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/20/2011 None
N/A
10/1/2014 None
N/A
NEURO-RADIOLOGY
OTOLARYNGIC
ALLERGY
Registration
Status Date
Disciplinary
Status of
Texas
License
WY
HOUSTON
COLON AND RECTAL
SURGERY
TEMPLE
FAMILY PRACTICE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
PLANO
TX
ACTIVE
5/6/2013 None
N/A
EL PASO
TX
ACTIVE
8/16/2013 None
N/A
ROCKWALL
TYLER
TX
TX
ACTIVE
ACTIVE
2/13/2014 None
12/22/2014 None
N/A
N/A
HUTTO
BRYAN
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
8/10/2015 None
11/21/2013 None
N/A
N/A
2/13/2015 None
N/A
MESA
AZ
ACTIVE
12/10/2012 None
N/A
DALLAS
TX
ACTIVE
5/8/2014 None
N/A
License
Number
P0820
Physician Name
COOLEY, CRAIG, MD
TM00464 COOLEY, PETER ALEXANDER, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
MEDICAL SERVICES
8/15/2011
Q3656
COOMBES, STACEY LYNN, MD
4/1/2015
Q0236
COON, AMBER MARIE, MD
5/15/2014
P7894
9/16/2013
Q5380
COOPER, BENJAMIN , MD
COOPER, CHRISTOPHER JOHN,
MD
P2622
COOPER, DAVID M, MD
4/2/2012
4/2/2017
P1981
COOPER, JAMES KEITH, MD
2/1/2012
2/1/2017
Q1380
Q1381
COOPER, KATHY LYNN, DO
COOPER, ROBERT HENRY, MD
8/15/2014
8/15/2014
8/15/2019
8/15/2019
Q1382
COOPER, SARAH ELIZABETH, MD
8/15/2014
P5352
2/1/2013
Q0621
Q5381
COPELAND, DANIEL REID, MD
COPELAND, MARILYN ELIZABETH,
MD
CORBIN, JUSTIN MICHAEL, MD
P1174
CORDERO, BRUNILDA, MD
P7092
CORDOBA KISSEE, MICHELLE
LYNN, MD
ORTHOPEDIC
6/16/2019 SURGERY
PEDIATRIC
ENDOCRINOLOGY,
DIABETES AND
7/1/2018 METABOLISM
P1285
P9544
CORNELIUS, BEATRIZ , MD
CORNELIUS, BRANDON CHASE,
MD
P1983
CORNWELL, WILLIAM KENT III, MD
7/1/2013
11/4/2011
4/1/2014
2/1/2012
Disciplinary
Status Date
8/31/2011 None
N/A
8/15/2011 None
N/A
ACTIVE
LICENSE
ISSUED
4/7/2015 None
N/A
5/15/2014 None
N/A
TX
ACTIVE
9/19/2013 None
N/A
TX
ACTIVE
8/4/2015 None
N/A
TX
ACTIVE
4/5/2012 None
N/A
OK
ACTIVE
2/16/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
8/21/2014 None
8/19/2014 None
N/A
N/A
TX
ACTIVE
8/18/2014 None
N/A
GENERAL SURGERY
SPORTS MEDICINE
THE
(ORTH SURG)
WOODLANDS TX
FAMILY MEDICINE
DUMAS
TX
ACTIVE
2/6/2013 None
N/A
ACTIVE
ACTIVE
6/19/2014 None
8/5/2015 None
N/A
N/A
PEDIATRICS
ACTIVE
11/3/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/10/2013 None
N/A
11/4/2011 None
N/A
BRIDGETON
DALLAS
SURGICAL CRITICAL
TRAUMATIC SURGERY CARE
DALLAS
PAIN
MANAGEMENT/REHA
PAIN MANAGEMENT
B MED
ROCKWALL
DIAGNOSTIC
RADIOLOGY
EDMOND
MEDICAL
TOXICOLOGY
EMERGENCY
(EMERGENCY
MEDICINE
MEDICINE)
FORT WORTH
FAMILY MEDICINE
AMARILLO
8/3/2020
10/17/2011
SAN ANTONIO TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
8/15/2016 RADIOLOGY
OBSTETRICS &
GYNECOLOGICAL
4/1/2020 SURGERY
OBSTETRICS AND
EMERGENCY
9/16/2018 MEDICINE
8/3/2015
6/16/2014
8/3/2015
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
FAYETTEVILLE NC
INTERNAL MEDICINE EDINBURG
OBSTETRICS AND
4/1/2019 GYNECOLOGY
Page 79 of 402
MO
TX
DALLAS
TX
ACTIVE
4/9/2014 None
N/A
DALLAS
TX
ACTIVE
2/6/2012 None
N/A
License
Number
Q5164
Physician Name
CORONA, HILLE CHARMAINE
VISITACION, MD
P1536
CORONA, RITA ESMERALDA, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2015
12/1/2011
Q2755
CORRIGAN, DANIELLE ANNA, MD
1/5/2015
P7626
P1450
CORRIGAN, DEVLYN, DO
COSGROVE, AMY DANIELLE, MD
8/15/2013
11/15/2011
P1984
COSS, ELIZABETH , MD
P7627
COSSEY, LARRY NICHOLAS, MD
2/1/2012
8/15/2013
ANATOMIC
8/15/2018 PATHOLOGY
COSSEY, TIFFANY , MD
15-Apr-16
15-Apr-21 NEUROLOGY
P7895
COSTA, DANIEL NOBREGA DA, MD
9/16/2013
Q2756
COSTAS, LAURA, MD
1/5/2015
9/16/2018 RADIOLOGY
EMERGENCY
1/5/2020 MEDICINE
P6960
COTTRELL, RICHARD ALLEN, DO
6/14/2013
P8234
COUCH, MATTHEW HAROLD, MD
11/1/2013
PEDIATRIC
PULMONOLOGY
1/5/2020 PEDIATRICS
EMERGENCY
8/15/2018 MEDICINE
Q7853
Secondary Specialty
(Self-Designated)
VASCULAR
NEUROLOGY
N/A
8/23/2013 None
11/17/2011 None
N/A
N/A
2/1/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LITTLE ROCK
AR
ACTIVE
8/21/2013 None
N/A
HOUSTON
TX
ACTIVE
12-May-16 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/18/2013 None
N/A
1/5/2015 None
N/A
6/14/2013 None
N/A
17-Feb-16 None
N/A
WACO
TX
ACTIVE
10/6/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
11-Jan-16 None
1/20/2012 None
N/A
N/A
6/12/2015 None
N/A
TX
ACTIVE
5/10/2013 None
N/A
TX
ACTIVE
5/10/2013 None
N/A
ACTIVE
11/9/2011 None
N/A
SPORTS MEDICINE
Q6820
P1743
COURSEY, JOSHUA CHARLES , MD
COURTNEY, KEVIN DALE, MD
06-Jan-16
1/2/2012
Q4738
COVIN, YVONNE NICOLLE, MD
6/12/2015
HOSPITALIST
10/17/2011
1/13/2015 None
ACTIVE
COLON AND RECTAL
06-Jan-21 SURGERY
1/2/2017 ONCOLOGY
COWDEN, COURTNEY HOLT III, MD
ACTIVE
TX
9/15/2015
P1175
TX
DALLAS
COURSEAULT, JAESON KELLY, MD
DALLAS
11/21/2011
N/A
Q5992
5/1/2013
TX
11/12/2013 None
P6364
N/A
ACTIVE
7/16/2015 None
UNDER
BOARD
12/5/2011 ORDER
ACTIVE
16-Feb-16
LUBBOCK
Disciplinary
Status Date
CARDIOTHORACIC
ANESTHESIOLOGY
5/1/2013
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAINT
PETERSBURG FL
COUCH, MICHAEL CHRISTIAN, MD
COVINGTON, BILL RAY, MD
COVINGTON, JACQUELYN ROSE,
MD
SAN ANTONIO TX
GENERAL PRACTICE MIDLAND
TX
OBSTETRICS
FORT WORTH TX
GASTROENTEROLOG
Y
Q7170
P6363
Practice City
Registration
Status of
Practice
Texas
State
License
DALLAS
COLLEGE
STATION
COLLEGE
STATION
KANSAS CITY MO
Page 80 of 402
License
Number
Physician Name
P7262
COX, DERRICK DIONE, MD
P1286
COX, JOHN A, MD
Q5165
Q1968
COX, SHANNA MARIE, MD
COX, VERONICA LEIGH, MD
P0189
COYNER, KATHERINE JUNE, MD
P5952
P0898
Q1384
CRAIG, ELIZABETH STIRLING, MD
CRAIG, JOHN ANTHONY, MD
CRALL, NICHOLAS DANIEL, DO
P2842
Q7172
CRANE, ERIN KING, MD
CRANE, STEPHANIE MICHELLE,
MD
Q8235
CRAWFORD, CATHERINE CLAIRE,
MD
Q7173
CRAWFORD, COURTNEY
MAURICE, MD
P0568
P0821
CRAWFORD, HEATHER PAIGE, MD
CRAWFORD, LAKIESHA KITCHEN,
MD
CREIGHTON, CANEITA QUIARA,
MD
CREIGHTON, CHRISTOPHER
PRICE, MD
Q7349
CRENSHAW, GREGORY
DESHAURN, MD
Q8236
Q4074
N4364
Q7350
CRIM, CHAD DAVID, MD
CRISMON, CHRISTOPHER CHASE,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
SURGICAL
7/15/2013
7/15/2018 ONCOLOGY
GENERAL SURGERY EL PASO
RADIATION
11/4/2011
11/4/2016 ONCOLOGY
GALVESTON
BROWNSVILL
7/15/2015
E
10/1/2014
10/1/2019 RADIOLOGY
HOUSTON
ORTHOPEDIC
SPORTS MEDICINE 7/1/2011
7/1/2016 SURGERY
ORTHOPEDICS
DALLAS
PLASTIC &
RECONSTRUCTIVE
4/1/2013
4/1/2018 SURGERY
9/1/2011
SAN ANTONIO
8/15/2014
BIG SPRING
GYNECOLOGIC
4/13/2012
4/13/2017 ONCOLOGY
HOUSTON
EMERGENCY
16-Feb-16
16-Feb-21 MEDICINE
DALLAS
PEDIATRIC
HEMATOLOGY/ONCOL
16-May-16
16-May-21 OGY
PEDIATRICS
DALLAS
16-Feb-16
8/1/2011
16-May-16
5/1/2015
OPHTHALMOLOGY VITREOUS SURGERY ABILENE
16-Feb-21 OPHTHALMOLOGY
8/1/2016 PEDIATRICS
MEDICAL GENETICS
ADOLESCENT
MEDICINE - PD
5/1/2020 PEDIATRICS
HOUSTON
8/26/2011
PAIN MEDICINE
04-Mar-16
GENERAL VASCULAR
04-Mar-21 SURGERY
NEW
GENERAL SURGERY ORLEANS
8/15/2013
04-Mar-16
EMERGENCY
04-Mar-21 MEDICINE
Page 81 of 402
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
7/24/2013 None
N/A
TX
ACTIVE
11/11/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
7/24/2015 None
10/17/2014 None
N/A
N/A
TX
ACTIVE
7/7/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/3/2013 None
9/6/2011 None
8/22/2014 None
N/A
N/A
N/A
TX
ACTIVE
4/17/2012 None
N/A
TX
ACTIVE
14-Mar-16 None
N/A
TX
ACTIVE
20-May-16 None
N/A
TX
ACTIVE
LICENSE
ISSUED
29-Feb-16 None
N/A
8/1/2011 None
N/A
ACTIVE
13-Jun-16 None
N/A
5/7/2015 None
N/A
8/26/2011 None
N/A
09-Mar-16 None
N/A
8/15/2013 None
N/A
08-Mar-16 None
N/A
TX
LA
ACTIVE
LICENSE
ISSUED
WACO
TX
ACTIVE
TEXAS
LICENSE
ISSUED
CONROE
TX
ACTIVE
License
Number
P3137
P6600
Physician Name
CRISTOBAL, RONALD SALAMAT,
MD
CRITCHLOW, ALLISON LINDSEY,
DO
TM00607 CROCE, KEVIN JAMES, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2012
5/15/2013
DIAGNOSTIC
7/15/2020 RADIOLOGY
7/15/2015
Q3658
CROITORU, ANDREI MIHAI, MD
4/1/2015
P9828
Q7855
CROMWELL, DEAN, MD
CROOMS, JAMISE , MD
4/15/2014
15-Apr-16
P2109
CROSS, ALISA A, MD
2/10/2012
P2844
P4433
CROSS, MATTHEW WELDON, MD
CROTTY, KEVIN PATRICK, DO
4/13/2012
9/17/2012
EMERGENCY
4/13/2017 MEDICINE
Q3865
CROW, JENNIFER HELENE, MD
4/10/2015
4/10/2020 PATHOLOGY
Q1386
CROWDER, JEFFREY BLAKE, MD
8/15/2014
P0190
7/1/2011
P5953
CRUM, ALISON VOIGT, MD
CRUMBAKER, MARIAH LINDSEY,
MD
4/1/2013
Q6937
Q7856
CRUMBIE, DAVID ANTHONY JR, MD
CRUZ, RIZA ELAINE, MD
ORTHOPEDIC
15-Jan-21 SURGERY
Q0032
CRUZ, RODNI, MD
15-Jan-16
15-Apr-16
5/2/2014
EMERGENCY
4/15/2019 MEDICINE
CRUZ-DIAZ, MANUEL OMAR, MD
8/29/2014
8/29/2019 UROLOGY
P8459
CRUZ-FLORES, SALVADOR , MD
12/6/2013
Q0898
CRUZ-GOMEZ, GLOYDIAN , MD
CRUZ-HERNANDEZ, ROSA MARIA,
MD
7/15/2014
12/6/2018 NEUROLOGY
PHYSICAL MED. &
1/5/2015
Practice City
AUSTIN
TX
ACTIVE
COLUMBIA
MO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
HOSPITALIST
SAN ANTONIO TX
HOUSTON
TX
HEMATOLOGY
(PATHOLOGY)
Page 82 of 402
5/23/2012 None
N/A
7/4/2013 None
N/A
7/15/2015 None
N/A
4/1/2015 None
N/A
4/23/2014 None
18-May-16 None
N/A
N/A
2/10/2012 None
N/A
4/18/2012 None
9/25/2012 None
N/A
N/A
DURHAM
ACTIVE
LICENSE
ISSUED
4/14/2015 None
N/A
8/15/2014 None
N/A
NC
TX
ACTIVE
8/1/2011 None
N/A
FORT WORTH TX
ACTIVE
4/8/2013 None
N/A
HOUSTON
LUBBOCK
ACTIVE
ACTIVE
22-Mar-16 None
18-Apr-16 None
UNDER
BOARD
5/2/2014 ORDER
N/A
N/A
8/29/2014 None
N/A
12/6/2013 None
N/A
ACTIVE
7/21/2014 None
N/A
ACTIVE
1/30/2015 None
N/A
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
PEDIATRIC
UROLOGY
VASCULAR
NEUROLOGY
1/5/2020 PEDIATRICS
Disciplinary
Status Date
ACTIVE
ACTIVE
OPHTHALMOLOGY RECONST SURGERY DALLAS
PAIN MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
FORT HOOD
TX
OBSTETRICAL
5/2/2019 ANESTHESIA
Q1584
H4894
Secondary Specialty
(Self-Designated)
CHILD AND
ADOLESCENT
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
5/2/2014
License
Number
Physician Name
Q5166
CUBITT, BRADLEY , MD
P2845
CULLINAN, PATRICK COREY, DO
Q4739
CULNAN, DEREK MARTIN , MD
Q1122
Q5993
Q3660
CULP, BRITTNEY , MD
dicaid
dicaid
Agreement
End Date
Designated)
PHYSICAL MED. &
7/15/2015
INTERNAL MED 4/13/2012
4/13/2017 EMERGENCY MED
6/12/2015
8/1/2014
CUNG, TAM NHAT, DO
CUNG, TRANG , DO
9/15/2015
4/1/2015
TM00508 CUNNEELY, KEVIN PATRICK, MD
Q4740
CUNNINGHAM, LEIGH ERIN, MD
5/1/2012
6/12/2015
Q3352
Q1808
Q2655
CURE, LUZ MARINA, MD
CUSICK, MICHAEL CHRISTOPHER,
MD
DA CUNHA PINHO, MARCO , MD
P6153
DABIRI, TAJUDEEN O, MD
K6557
DACKIW, ALAN PAUL BORDEN, MD
P0969
DACUMOS, NANETTE REYES, MD
P1634
DAFTARY, AMEET SHIRISH, MD
P5168
DAGNEW, ELIAS, MD
Q2533
DAGROSA, RICHARD , MD
Q5785
3/3/2015
9/15/2014
12/15/2014
4/12/2013
8/1/2014
9/15/2011
12/15/2011
1/4/2013
12/3/2014
8/28/2015
P9829
DAHDEL, MAHER, MD
DAHLQUIST, ROBERT THOMAS,
MD
Q4078
Q4742
Q5167
DAHSE, MELANIE CHRISTINE, MD
DAHU, JIRIES SULEIMAN, MD
DAI, WEIWEI, DO
5/1/2015
6/12/2015
7/15/2015
4/15/2014
Secondary Specialty
(Self-Designated)
SPINE AND SPORTS
MEDICINE
CRITICAL CARE
MEDICINE
PEDIATRIC
NEUROLOGICAL
1/4/2018 SURGERY
EMERGENCY
12/3/2019 MEDICINE
PULMONARY
CRITICAL CARE
8/28/2020 MEDICINE
EMERGENCY
4/15/2019 MEDICINE
5/1/2020 RADIOLOGY
7/15/2020 NEUROLOGY
ADDISON
TX
WASHINGTON DC
GENERAL SURGERY
SALT LAKE
CITY
DIAGNOSTIC
5/1/2017 RADIOLOGY
DIAGNOSTIC
3/3/2020 RADIOLOGY
ORTHOPEDIC
9/15/2019 SURGERY
OBSTETRICS AND
SURGICAL
8/1/2019 ONCOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
7/22/2015 None
N/A
ACTIVE
LICENSE
ISSUED
4/23/2012 None
N/A
6/12/2015 None
N/A
UT
ACTIVE
8/5/2014 None
N/A
FORT WORTH
GARLAND
GOODLETTSVI
LLE
HOUSTON
TX
TX
ACTIVE
ACTIVE
9/16/2015 None
4/2/2015 None
N/A
N/A
TN
TX
ACTIVE
ACTIVE
5/10/2012 None
6/15/2015 None
N/A
N/A
AVENTURA
FL
ACTIVE
4/6/2015 None
N/A
HUMBLE
DALLAS
TX
TX
ACTIVE
ACTIVE
9/17/2014 None
12/18/2014 None
N/A
N/A
KILLEEN
TX
ACTIVE
4/19/2013 None
N/A
TX
URGENT CARE MADISONVILL
FAMILY PRACTICE
E
TX
SALT LAKE
SLEEP MEDICINE
CITY
UT
ACTIVE
8/12/2014 None
N/A
ACTIVE
9/21/2011 None
N/A
ACTIVE
12/29/2011 None
N/A
NEURO-RADIOLOGY
PULMONARY
CRITICAL CARE
MEDICINE
SUWANEE
FORT SAM
HOUSTON
GA
ACTIVE
2/13/2013 None
N/A
TX
ACTIVE
2/6/2015 None
N/A
WEBSTER
TX
ACTIVE
9/14/2015 None
N/A
DALLAS
TX
ACTIVE
4/21/2014 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
5/19/2015 None
6/18/2015 None
7/23/2015 None
N/A
N/A
N/A
NEURO-RADIOLOGY HOUSTON
TEMPLE
Page 83 of 402
License
Number
P4640
Physician Name
DAILEY GARNES, NATALIE JANINE
MIRIAM, MD
Q7352
DALIO, JESSICA PAIGE, MD
Q7353
DALIO, JUSTINO NOEL, DO
P8768
DALLAS, TORIJAUN, MD
P9063
DALLEY, ETHAN BERNELL, MD
P2625
Q4080
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INFECTIOUS
10/15/2017 DISEASES
PEDS
EMERGENCY
04-Mar-16
04-Mar-21 MEDICINE
EMERGENCY
04-Mar-16
04-Mar-21 MEDICINE
CARDIOTHORACIC
1/15/2014
ANESTHESIOLOGY
PHYSICAL MED. &
2/18/2014
PAIN MANAGEMENT
P9065
DALMACION-LAYNO, GRACE, MD
DALY, GEMMA FRANCES, MD
DAMANI, RAHUL HARESHKUMAR,
MD
DAMIAN, ALLAN MICHAEL
VERTUDEZ, MD
Q5786
DAMODARAN, SENTHILKUMAR, MD
P5955
Q5169
Q5640
DAMTEW, AHMED M, MD
DANAWALA, ZEESHAN ASHRAF,
MD
DANDA, DIVYA REDDY, MD
7/15/2015
8/14/2015
7/15/2020 UROLOGY
P9322
DANDAMUDI, VENKATA S, MD
3/17/2014
P0716
DANDAN, MELHEM, MD
8/15/2011
3/17/2019 NEUROLOGY
OBSTETRICS AND
M9947
P7630
DANDAPANTULA, HARI KUMAR, MD
DANESHFAR, BAHRAUM DANIEL,
MD
8/15/2013
Q4933
Q7354
DANFORD, JILL MCHENRY, MD
DANG, DANIEL NGOC, MD
7/1/2015
04-Mar-16
P5058
DANG, MATTHEW K, MD
Q3866
4/2/2012
5/1/2015
Practice City
ACTIVE
10/23/2012 None
N/A
BELLAIRE
TX
ACTIVE
10-Mar-16 None
N/A
BELLAIRE
TX
ACTIVE
10-Mar-16 None
N/A
DURHAM
NC
ACTIVE
1/22/2014 None
N/A
ACTIVE
2/28/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/18/2012 None
5/4/2015 None
N/A
N/A
4/10/2015 None
N/A
2/18/2014 None
N/A
TX
ACTIVE
8/31/2015 None
N/A
CA
ACTIVE
4/10/2013 None
N/A
UROLOGIC SURGERY SHENANDOAH TX
HOUSTON
TX
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
GALVESTON TX
ACTIVE
ACTIVE
9/9/2015 None
8/19/2015 None
N/A
N/A
ACTIVE
3/19/2014 None
N/A
FAMILY MEDICINE
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/22/2011 None
N/A
2/8/2013 None
N/A
8/15/2013 None
N/A
7/1/2015 None
07-Mar-16 None
N/A
N/A
12/17/2012 None
N/A
FAR
ROCKAWAY
NY
SAN ANTONIO TX
4/10/2020 NEUROLOGY
2/18/2014
HOSPITALIST
8/28/2015
8/28/2020 ONCOLOGY
ADDICTION
PSYCHIATRY
GILROY
2/8/2013
12/17/2012
CRITICAL CARE
MEDICINE
2/8/2018 CARDIOLOGY
7/1/2020 UROGYNECOLOGY
04-Mar-21 PATHOLOGY
DIAGNOSTIC
Disciplinary
Status Date
TX
5/1/2020 PEDIATRICS
4/1/2018 PSYCHIATRY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
4/10/2015
4/1/2013
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
DALLAS
TX
GYNECOLOGY
Page 84 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
DIAGNOSTIC
12/17/2012
DIAGNOSTIC
12/17/2012
8/1/2013
2/1/2012
EMERGENCY
3/17/2014
3/17/2019 MEDICINE
PLASTIC &
RECONSTRUCTIVE
5/2/2014
5/2/2019 SURGERY
P5058
DANG, MATTHEW K, MD
P5058
P7419
P1985
DANG, MATTHEW K, MD
DANG, NATALIE MYLAN, MD
DANG, TAM II, MD
P9323
DANG, VI, MD
Q0426
DANG, VU HUNG, MD
Q0033
DANIALI, LILY, MD
P0822
Q1971
DANIEL, HELEN CHARISSE, MD
DANIEL, IAN, MD
8/26/2011
10/1/2014
P7899
DANIEL, MARGARET, MD
9/16/2013
Q7175
DANIEL-JOHNSON, JENNIFER
ALISON, MD
P1856
Q8458
DANNA, JOSEPH RICHARD, MD
DAO CAMPI, HAISAR EDUARDO,
MD
P5526
P2626
Q5386
DAO, BAO DUY, MD
DAO, HARRY JR, MD
DAO, JASMINE QUYNH, MD
EMERGENCY
9/16/2018 MEDICINE
Secondary Specialty
(Self-Designated)
NEURO-RADIOLOGY
Practice City
THE
WOODLANDS
THE
WOODLANDS
HOUSTON
EL PASO
Registration
Status of
Practice
Texas
State
License
ACTIVE
1/22/2013 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
1/22/2013 None
8/8/2013 None
2/13/2012 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
3/26/2014 None
N/A
HOUSTON
TX
ACTIVE
6/3/2014 None
N/A
DALLAS
TX
5/6/2014 None
N/A
LONGVIEW
SOUTHLAKE
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/26/2011 None
11/19/2014 None
N/A
N/A
HOUSTON
TX
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
SAN ANTONIO TX
ACTIVE
10/11/2013 None
N/A
ACTIVE
13-May-16 None
N/A
TX
ACTIVE
2/6/2012 None
N/A
MA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
03-Jun-16 None
N/A
2/8/2013 None
4/10/2012 None
8/4/2015 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/22/2011 None
4/13/2015 None
12/3/2013 None
N/A
N/A
N/A
5/15/2014 None
N/A
TX
ACTIVE
ACTIVE
3/12/2014 None
7/15/2013 None
N/A
N/A
GA
ACTIVE
4/4/2012 None
N/A
NEURO-RADIOLOGY
OPHTHALMOLOGY
ANESTHESIOLOGY
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
1/17/2012
01-Jun-16
KILLEEN, TX
COLON AND RECTAL
SURGERY
BOSTON
2/8/2013
4/2/2012
8/3/2015
8/3/2020 PEDIATRICS
CLEVELAND
HOUSTON
OH
TX
HOUSTON
TX
P0366
Q3661
P8349
DAO, MINH DUY, MD
DAO, THUAN DUC, MD
DAO, TUAN, MD
7/15/2011
4/1/2015
11/15/2013
Q0238
DAR, ABDULLAH AFTAB, MD
P9180
P7095
DAR, IMRAN AHMED, MD
DAR, KHOLA HAMEED, MD
3/3/2014
7/1/2013
P2627
DAR, WASIM AKRAM, MD
4/2/2012
5/15/2014
OBSTETRICS AND
INTERVENTIONAL
3/3/2019 CARDIOLOGY
TRANSPLANT
4/2/2017 SURGERY
Disciplinary
Status Date
TX
LABORATORY
16-Feb-21 MEDICINE
EMERGENCY
1/17/2017 MEDICINE
16-Feb-16
Registration
Status Date
Disciplinary
Status of
Texas
License
OBSTETRICS &
GYNECOLOGICAL
SURGERY
CARDIOLOGY
FAMILY MEDICINE
AUSTIN,
GENERAL SURGERY ATLANTA
Page 85 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P2628
DARBY, JOHN BYRON, MD
4/2/2012
Q0624
DARIYA, VEDANTA SINGH, MD
6/16/2014
P7756
DARLING, MATTHEW JAMES, DO
8/30/2013
Q8042
DARWIN, ANDREW JORDAN, DO
02-May-16
P8879
DARWISH, AHMED , MD
2/7/2014
Q6174
DARWISH, TAREK, MD
10/1/2015
Q1809
DARYANANI, MICHELLE, DO
9/15/2014
P4560
DAS, BIDHAN, MD
10/1/2012
P2629
Q0745
DAS, DIPAN , MD
DAS, GOPIMOHAN, MD
4/2/2012
6/27/2014
COLON AND RECTAL
10/1/2017 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/2/2017 SURGERY
Q5387
DAS, JISHU KINGKAR, MD
8/3/2015
P8460
DASNADI, SHAEEQUA P, MD
12/6/2013
P2224
Q5995
DATLA, SIREESHA, MD
DATLA, SWATHI, MD
3/1/2012
9/15/2015
Q2119
DATTA, ANITA RANI, MD
10/15/2014
Q7673
DATTA, SOUMITRA, DO
01-Apr-16
P2225
DAUM, ALLISON NICOLE, MD
P3309
Q8044
DAVALOS, KARLA DIAZ, MD
DAVE, HINA , MD
P9830
DAVENPORT, BIANCA MARIE, MD
3/1/2012
6/1/2012
02-May-16
4/15/2014
Secondary Specialty
(Self-Designated)
Practice City
4/2/2017 PEDIATRICS
PEDIATRICS,
URGENT CARE
MEDICINE
DALLAS
FT SAM
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
WICHITA
FALLS
EMERGENCY
10/15/2019 MEDICINE
EMERGENCY
01-Apr-21 MEDICINE
EMERGENCY
3/1/2017 MEDICINE
PULMONARY
CRITICAL CARE
6/1/2017 MEDICINE
02-May-21 NEUROLOGY
HAND SURGERY PLASTIC SURGERY
INTERNAL MEDICINE SAN ANGELO
NEONATALPERINATAL
MEDICINE
EMERGENCY
MEDICINE
HOSPITALIST
URGENT CARE
MEDICINE
6/23/2014 None
N/A
9/9/2013 None
N/A
02-May-16 None
N/A
ACTIVE
LICENSE
ISSUED
2/24/2014 None
N/A
10/1/2015 None
N/A
ACTIVE
9/18/2014 None
N/A
ACTIVE
10/26/2012 None
N/A
4/9/2012 None
7/3/2014 None
N/A
N/A
8/3/2015 None
N/A
12/6/2013 None
N/A
3/1/2012 None
9/24/2015 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
NEPHROLOGY
CRITICAL CARE
ANESTHESIOLOGY
N/A
ACTIVE
TX
TX
TX
Disciplinary
Status Date
4/2/2012 None
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
SPRINGFILED OH
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
SUGAR LAND
TX
ACTIVE
10/23/2014 None
N/A
INTERNAL MEDICINE GARDEN CITY MI
URGENT CARE
MEDICINE
ACTIVE
20-May-16 None
N/A
ACTIVE
3/8/2012 None
N/A
6/1/2012 None
18-May-16 None
N/A
N/A
4/15/2014 None
N/A
INTERNAL MEDICINE EL PASO
Page 86 of 402
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
N1344
DAVES, MARLA HAWKINS, MD
P9182
DAVIDS, NEIL BRIAN, MD
DAVIDSON, DEEPAK
MANAPPALLIL, MD
Q8240
P6154
Q5788
Q6407
DAVIDSON, JOSEPH LELAND, MD
DAVIDSON, RUSSELL GORDON,
MD
DAVIES JONES, OLUBUKOLA
ADUKE, MD
Q0239
DAVIES, JONATHAN LYLE, MD
P5354
DAVIES, SUMMER DANIELLE, MD
DAVILA RODRIGUEZ, AMANDA
SOFIA, MD
P5957
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
HEMATOLOGY/ONCOL
7/1/2015
7/1/2020 OGY
PEDIATRICS
EMERGENCY
EMERGENCY
3/3/2014
3/3/2019 MEDICINE
MEDICAL SERVICES
7/7/2015 None
N/A
TX
ACTIVE
3/24/2014 None
N/A
ROUND ROCK TX
ACTIVE
06-Jun-16 None
N/A
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
4/15/2013 None
N/A
8/28/2015
EMERGENCY
8/28/2020 MEDICINE
8/28/2015 None
N/A
11/2/2015
DALLAS
ACTIVE
11/9/2015 None
N/A
LICENSE
ISSUED
5/15/2014 None
N/A
2/11/2013 None
N/A
4/1/2013 None
N/A
4/12/2013
2/1/2013
2/1/2018 PEDIATRICS
4/1/2013
4/1/2018 PEDIATRICS
8/1/2014
P0570
DAVIS, GLENA JUNE, DO
8/1/2011
P7421
P0367
DAVIS, LANCE LEE, MD
DAVIS, LESLEY JOY, MD
8/1/2013
7/15/2011
Q5641
P1857
DAVIS, LINDSAY TAYLOR, MD
DAVIS, MICHAEL ROBERT, MD
8/14/2015
1/17/2012
Q2270
DAVIS, RAVEN G, MD
11/7/2014
P2630
DAVIS, REINA DANICA, MD
Q1972
DAWSON, LAUREN ANN, MD
16-May-21 PSYCHIATRY
5/15/2014
DAVILA, SAMUEL ZACHARY, MD
DAVIS, RYAN WILLIAM, MD
Disciplinary
Status Date
ACTIVE
16-May-16
4/2/2012
8/1/2013
10/1/2014
CRITICAL CARE
OBSTETRICS AND
8/1/2016 GYNECOLOGY
UNDERSEA AND
HYPERBARIC MED
8/1/2018 (PREV MED)
EMERGENCY
11/7/2019 MEDICINE
4/2/2017 PEDIATRICS
DIAGNOSTIC
8/1/2018 RADIOLOGY
EMERGENCY
10/1/2019 MEDICINE
HOUSTON
FORT SAM
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
Q1127
P7422
Practice City
Registration
Status of
Practice
Texas
State
License
TX
NEONATALPERINATAL
MEDICINE
LUBBOCK
PEDIATRIC
INFECTIOUS
DISEASE
FAMILY MEDICINE
OPHTHALMOLOGY GLAUCOMA
EMERGENCY/TRAUM
A RADIOLOGY
Page 87 of 402
DALLAS
MINERAL
WELLS
TX
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
8/6/2014 None
N/A
TX
ACTIVE
8/5/2011 None
N/A
CHARLESTON SC
KATY
TX
ACTIVE
ACTIVE
8/5/2013 None
8/1/2011 None
N/A
N/A
GRAPEVINE
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/28/2015 None
1/23/2012 None
N/A
N/A
11/7/2014 None
N/A
4/2/2012 None
N/A
8/1/2013 None
N/A
10/1/2014 None
N/A
License
Number
Physician Name
P5527
DAY, ARTHUR LINWOOD, MD
P5792
DAY, CEDRIC TARRYL JR, MD
P7757
DAY, CYNTHIA MADISON, MD
Q0035
P5169
DAYA, WILLIAM BURGOS, MD
DAYANI, ARIA, MD
P6601
DAYE, SUHAIL SAMI, MD
P1451
D'COSTA, QUEENIE MOUSUMI, MD
P1858
J4072
P4641
Q2535
Q1973
P6155
DE GORORDO ARZAMENDI,
ANTONIO, MD
DE HOYOS, ALBERTO LEOPOLDO,
MD
DE JESUS, MARIA AUDRIE, MD
DE LA GARZA, JOSEPH ANDREW,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
NEUROLOGICAL
2/8/2013
2/8/2018 SURGERY
OBSTETRICS AND
3/15/2013
DIAGNOSTIC
8/30/2013
8/30/2018 RADIOLOGY
OTHER SPECIALTY
EMERGENCY
5/2/2014
5/2/2019 MEDICINE
1/4/2013
ABDOMINAL
5/15/2013
PEDIATRIC CRITICAL
11/15/2011
PULMONARY
CRITICAL CARE
1/17/2012
1/17/2017 MEDICINE
INTERNAL MEDICINE
8/3/2015
10/15/2012
12/3/2014
GYNECOLOGIC
12/3/2019 ONCOLOGY
EMERGENCY
10/1/2019 MEDICINE
10/1/2014
4/12/2013
P6370
DE LA MATA, MARIANO, MD
DE LA MORA, DIEGO , MD
DE LA ROSA PEREZ, DEENI LUZ,
MD
Q5789
DE LEON, ELAINE SAQUI, MD
8/28/2015
P1287
P0899
DE LEON, OSCAR , MD
DE LOS SANTOS, BILLY A, MD
11/4/2011
9/1/2011
P7758
DE LOS SANTOS, DANIEL , MD
8/30/2013
EMERGENCY
8/30/2018 MEDICINE
P6805
DE LOS SANTOS, MARCO
ANTONIO, MD
Q3171
DE LOTA, MICHAEL FORONDA, MD
5/1/2013
6/3/2013
2/13/2015
5/1/2018 PEDIATRICS
INTERNAL MED PEDS
ACTIVE
2/13/2013 None
N/A
TEMPLE
TX
ACTIVE
3/20/2013 None
N/A
SAN ANTONIO TX
ACTIVE
9/9/2013 None
N/A
CLARKSVILLE TX
ACTIVE
ACTIVE
5/6/2014 None
1/11/2013 None
N/A
N/A
MASSENA
NY
ACTIVE
5/23/2013 None
N/A
TEMPLE
TX
ACTIVE
11/23/2011 None
N/A
MA
ACTIVE
2/17/2012 None
N/A
LA
TX
ACTIVE
ACTIVE
8/10/2015 None
11/28/2012 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
12/8/2014 None
N/A
THE VILLAGES FL
DALLAS
TX
CORPUS
CHRISTI
TX
ACTIVE
ACTIVE
10/15/2014 None
4/26/2013 None
N/A
N/A
ACTIVE
5/17/2013 None
N/A
HOUSTON
TX
9/8/2015 None
N/A
MESQUITE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/4/2011 None
9/6/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
9/10/2013 None
N/A
6/3/2013 None
N/A
2/19/2015 None
N/A
LICENSE
ISSUED
WACO
Page 88 of 402
Disciplinary
Status Date
TX
PULMONARY
CRITICAL CARE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
BOSTON
NEW
GENERAL SURGERY ORLEANS
GREENVILLE
PEDIATRICS
PALLIATIVE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
License
Number
Physician Name
AM00024 DE MASI, LEON GREGORY, MD
P6602
P6371
dicaid
dicaid
Agreement
End Date
Designated)
Practice City
5/15/2013
5/1/2013
PUBLIC
HEALTH/PREVENTIVE
10/15/2017 MEDICINE (GENERAL)
SURGICAL
5/15/2018 ONCOLOGY
HOUSTON
TX
SAN ANTONIO TX
5/15/2014
9/15/2011
5/15/2019 PATHOLOGY
FORT WORTH TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
12/15/2014
UNION
10/15/2012
Q0241
P0970
DE ROSA, NICOLE, MD
DE SILVA, ANIL MOHAN, MD
DE SIMONE, NICOLE KANDALAFT,
MD
DEAN, MARC RICHARD, MD
Q2657
DEAN, SAMMY, MD
P7423
P0368
DEAN, THAD JAMES, DO
DEBELA, ZENEBE ASFAW, MD
8/1/2013
7/15/2011
ORTHOPEDIC
8/1/2018 SURGERY
Q4083
DEBOER, BETHANY MARIE, DO
5/1/2015
P3141
Q2536
Q4084
DECKARD, NATHAN ALLEN, MD
DEEN, ZAHRA , MD
DEGAZON, YVETTE JANINE, MD
5/15/2012
12/3/2014
5/1/2015
Q0036
DEGIRONEMO, LOUIS , MD
5/2/2014
P4563
DEIPARINE, JULIUS F, MD
10/1/2012
10/1/2017 NEUROLOGY
P0369
7/15/2011
1/15/2015
Q0900
DEL CRISTO, ROBERTO RAUL, MD
DELACERDA, ASHLEY BRANDON,
MD
DELASALAS, HAROLD CARIAGA,
MD
P2110
DELAUZ, CARIDAD MAYLIN, MD
2/10/2012
Q6744
15-Dec-15
Q1586
DELEON, ASHLEY NICOLE, MD
DELEON, RICHARD RICK
RODRIGO, DO
8/29/2014
15-Dec-20 GENERAL SURGERY
EMERGENCY
8/29/2019 MEDICINE
Q3172
DELESSIO, STEPHEN THOMAS, MD
2/13/2015
Q2892
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
7/15/2014
PEDIATRICS,
ACTIVE
ARTHRITIS & JOINT
IMPLANT SURGERY
Disciplinary
Status Date
10/23/2012 None
N/A
6/13/2013 None
5/6/2013 None
N/A
N/A
5/15/2014 None
12/8/2011 None
N/A
N/A
ACTIVE
12/29/2014 None
N/A
ACTIVE
ACTIVE
9/10/2013 None
7/22/2011 None
N/A
N/A
TX
ACTIVE
6/11/2015 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
5/16/2012 None
12/15/2014 None
5/18/2015 None
N/A
N/A
N/A
5/2/2014 None
N/A
IL
FORT WORTH TX
AUSTIN
TX
TROPICAL MEDICINE DALLAS
URGENT CARE
MEDICINE
DALLAS
KATY
Registration
Status Date
Disciplinary
Status of
Texas
License
NEURO-PHYSIOLOGY
(NEUROLOGY)
BEAUMONT
TX
ACTIVE
10/19/2012 None
N/A
HEREFORD
TX
ACTIVE
7/22/2011 None
N/A
TEMPLE
TX
ACTIVE
2/4/2015 None
N/A
ACTIVE
LICENSE
ISSUED
8/4/2014 None
N/A
2/10/2012 None
N/A
19-Jan-16 None
N/A
8/29/2014 None
N/A
2/13/2015 None
N/A
ALLERGY AND
IMMUNOLOGY
PEDIATRICS
TRAUMATIC
SURGERY
Page 89 of 402
DUNCANVILLE TX
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Q3173
DELGADO GONZALEZ, ABDIER, MD
2/13/2015
TYLER
TX
ACTIVE
P1289
Q1128
DELGADO, GUSTAVO ADOLFO, MD
DELGADO, KRISTIAN, MD
11/4/2011
8/1/2014
BRYAN
TX
Q0242
DELJOUI, KATY M, MD
5/15/2014
ACTIVE
ACTIVE
LICENSE
ISSUED
P1538
DELRIE, RONALD DWAYNE JR, MD
12/1/2011
P5960
DELUKIE, ALEIGHA ANN, DO
CRITICAL CARE
EMERGENCY
5/15/2019 MEDICINE
MEDICINE
HEMATOLOGY/ONCOL
12/1/2016 OGY
OBSTETRICS AND
4/1/2018 GYNECOLOGY
P9547
P5059
P5059
P5059
P9548
DELUMPA, ALFRED EUGENE, MD
DELYRIA, PAUL , MD
DELYRIA, PAUL , MD
DELYRIA, PAUL , MD
DEMANDANTE, CARLO GREG
NIEPES, MD
P9833
DEMBLA, VIKAS, MD
P1464
DEMOLA, SARA MICHELLE, MD
DEMOSS, DUSTIN STONEWALL,
DO
P9834
4/1/2013
4/1/2014
12/17/2012
12/17/2012
12/17/2012
4/1/2014
4/15/2014
11/15/2011
4/15/2014
Q1969
D'EMPAIRE, INNA, MD
10/1/2014
P9549
DENG, YI , MD
Q0901
DENKER, ADAM JOSHUA, MD
7/15/2014
Q8460
DENNARD, AUSTIN, DO
01-Jun-16
F6568
DENNEY, TERESA SUSAN, MD
8/26/2011
P8654
DENNIS, LARA LEIGH, MD
P0370
DENNIS, ROBYN MONET, MD
4/1/2014
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/16/2015 None
N/A
11/10/2011 None
8/25/2014 None
N/A
N/A
5/15/2014 None
N/A
DALLAS
TX
ACTIVE
1/23/2012 None
N/A
TEMPLE
TX
ACTIVE
4/10/2013 None
N/A
RADIOLOGY
NEURO-RADIOLOGY HOUSTON
TX
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
RADIATION
4/1/2019 ONCOLOGY
FAIRFIELD
CA
HEMATOLOGY/ONCOL
4/15/2019 OGY
INTERNAL MEDICINE SHREVEPORT LA
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/1/2019
12/17/2017
12/17/2017
12/17/2017
INTERNAL MED 4/15/2019 PSYCHIATRY
1/3/2019 RADIOLOGY
7/15/2011
ACTIVE
LICENSE
ISSUED
None
None
None
None
N/A
N/A
N/A
N/A
4/3/2014 None
N/A
4/24/2014 None
N/A
11/15/2011 None
N/A
FORT WORTH TX
ACTIVE
4/29/2014 None
N/A
WICHITA
KS
ACTIVE
10/2/2014 None
N/A
HOUSTON
TX
ACTIVE
4/3/2014 None
N/A
SAN ANTONIO TX
ACTIVE
7/18/2014 None
N/A
DALLAS
TX
ACTIVE
06-Jun-16 None
N/A
MISSOULA
MT
ACTIVE
N/A
IRVING
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
Page 90 of 402
TX
ACTIVE
9/6/2011 None
UNDER
BOARD
2/14/2014 ORDER
TX
ACTIVE
7/21/2011 None
N/A
PSYCHOSOMATIC
MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
CARDIAC
ELECTROPHYSIOLOG
7/15/2019 Y
CARDIOLOGY
OBSTETRICS AND
EMERGENCY
8/26/2016 MEDICINE
1/3/2014
ACTIVE
4/8/2014
12/24/2012
12/24/2012
12/24/2012
12/19/2013
License
Number
P0194
P7900
Q1129
P0572
Physician Name
DENNISON, MATTHEW STEPHEN,
MD
DENNISTON, SARAH FALL, MD
DENNY, MARY CARTER , MD
DEO, SHEETAL RAMACHANDRA,
MD
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2011
9/16/2013
8/1/2014
8/1/2019 NEUROLOGY
8/1/2011
P8461
DEOSKAR, DHANANJAY SHRIPAD,
MD
12/6/2013
Q5996
DERAMO, JENNIFER SHULER, MD
9/15/2015
P0371
DERESKA, NINA HOLTZAPPLE, MD
7/15/2011
P7267
Q2988
DERMISH, AMNA IBRAHIM, MD
DESAI, ANU GUPTA, MD
7/15/2013
2/2/2015
OBSTETRICS AND
P8020
DESAI, CHIRAG KIRIT, MD
10/1/2013
P8655
DESAI, KEVIN ASWIN, MD
1/3/2014
Q4574
P2431
DESAI, KUNJ KISHORE, MD
DESAI, MIT NAVANIT, MD
6/1/2015
3/15/2012
Q4086
Q5997
P2432
Q3504
DESAI, NEIL BIPINCHANDRA, MD
DESAI, NINA, MD
DESAI, RONAK KIRTI, MD
DESAI, SHIVANI NIRANJAN, MD
5/1/2015
9/15/2015
3/15/2012
3/16/2015
Q3663
DESAI, SHIVANI, MD
4/1/2015
Q3664
DESAI, SHUCHI GITESH, MD
4/1/2015
P4435
DESAI, SONAL SUBODH, MD
9/17/2012
P9183
DESAI, SVETANG VIJAY, MD
3/3/2014
PHYSICAL MED. &
PLASTIC &
RECONSTRUCTIVE
6/1/2020 SURGERY
RADIATION
5/1/2020 ONCOLOGY
Secondary Specialty
(Self-Designated)
HOSPITALIST
VASCULAR
NEUROLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
HOUSTON
TX
NEONATALPERINATAL
MEDICINE
UROGYNECOLOGY
HAND SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/1/2011 None
11/11/2013 None
N/A
N/A
9/3/2014 None
N/A
8/1/2011 None
N/A
LICENSE
ISSUED
12/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
9/17/2015 None
N/A
WEBSTER
TX
ACTIVE
7/25/2011 None
N/A
AUSTIN
CHICAGO
TX
IL
ACTIVE
ACTIVE
N/A
N/A
HOUSTON
TX
ACTIVE
7/26/2013 None
2/11/2015 None
SEE
PREVIOUS
10/7/2013 ORDER
ACTIVE
1/15/2014 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
6/8/2015 None
3/21/2012 None
N/A
N/A
DALLAS
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/26/2015
9/17/2015
3/26/2012
3/30/2015
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
4/9/2015 None
N/A
ACTIVE
4/3/2015 None
N/A
ACTIVE
9/25/2012 None
N/A
ACTIVE
3/13/2014 None
N/A
TX
AUSTIN
TX
OBSTETRICS AND
4/1/2020 GYNECOLOGY
PEDIATRIC
GASTROENTEROLOG
9/17/2017 Y
SAN ANTONIO TX
GASTROENTEROLOG
3/3/2019 Y
TX
Page 91 of 402
9/12/2013
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P8883
DESAI, TARINA R, MD
2/7/2014
Q4938
7/1/2015
Q4087
DESALVO, DANIEL JOSEPH, MD
DESANTIS, ANGELA CHRISTINE,
DO
P1452
DESANTIS, JAMES MICHAEL, MD
11/15/2011
P5794
5/1/2015
HOUSTON
INTERVENTIONAL
CARDIOLOGY
Q5171
P6604
P0195
DESHPANDE, AVINASH SHRINIVAS,
MD
P0719
P2635
DESOUZA, ROWENA ANNE, MD
DESTA, DEREJE, MD
8/15/2011
4/2/2012
Q7355
DETTLING, JAMES RICHARD, MD
04-Mar-16
8/15/2016 UROLOGIC SURGERY UROLOGY
SPORTS MEDICINE 04-Mar-21 ORTHOPEDICS
ORTHOPEDICS
Q2537
P6375
DEUEL, CHRISTOPHER JAMES, MD
DEVAGIRI, MADHAVI, MD
DEVANEY, RACHEL LEA ISRAEL,
MD
DEVATHI, SUDHAKAR VENKATA
LAKSHMI, MD
12/3/2014
5/1/2013
6/14/2013
9/15/2014
11/1/2013
Q5389
P5617
DEVDHAR, MADHURI RAO, MD
DEVESH, VARALAKSHMI
JHINGADE, MD
DEVIDOSS, SHARMILA , MD
ENDOCRINOLOGY,
DIABETES AND
Q8046
DEVINE, BRENDAN PATRICK, MD
02-May-16
Q6823
P9550
DEVNANI, AVINASH NANIKRAM, MD
DEVULAPALLY, PAVAN, MD
06-Jan-16
4/1/2014
P4944
DEW, LAUREN ASHLEY, MD
Q1813
P8237
7/15/2015
5/15/2013
7/1/2011
8/3/2015
3/1/2013
11/30/2012
EMERGENCY
7/15/2020 MEDICINE
7/1/2016 PEDIATRICS
3/1/2018 NEPHROLOGY
EMERGENCY
02-May-21 MEDICINE
Practice City
FAMILY PRACTICE
DESHMUKH, ANAND RAMESH, MD
DESHMUKH, SATYAJIT
HANUMANT, MD
DESHPANDE, ALOK , MD
P6964
3/15/2013
PEDIATRIC
OBSTETRICS AND
5/1/2020 GYNECOLOGY
EMERGENCY
11/15/2016 MEDICINE
Secondary Specialty
(Self-Designated)
OMAHA
NEW
INTERNAL MEDICINE BRAUNFELS
HOUSTON
PUNE,
MAHARASHTR
A
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
Disciplinary
Status Date
2/7/2014 None
N/A
ACTIVE
7/15/2015 None
N/A
ACTIVE
LICENSE
ISSUED
5/18/2015 None
N/A
11/15/2011 None
N/A
NE
ACTIVE
3/20/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
7/20/2015 None
5/27/2013 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
7/8/2011 None
N/A
8/15/2011 None
4/13/2012 None
N/A
N/A
ACTIVE
15-Mar-16 None
N/A
12/10/2014 None
5/3/2013 None
N/A
N/A
6/14/2013 None
N/A
9/15/2014 None
N/A
LICENSE
ISSUED
11/1/2013 None
N/A
TX
ACTIVE
ACTIVE
8/19/2015 None
4/22/2013 None
N/A
N/A
TX
ACTIVE
04-May-16 None
N/A
TUCSON
AZ
SAN ANTONIO TX
ACTIVE
ACTIVE
15-Feb-16 None
5/5/2014 None
N/A
N/A
DALLAS
ACTIVE
12/14/2012 None
N/A
KANSAS
KS
FORT WORTH TX
INTERVENTIONAL
CARDIOLOGY
TYLER
TX
INFECTIOUS
DISEASES
EMERGENCY
MEDICAL SERVICES GAINESVILLE
INTERNAL MEDICINE
06-Jan-21 RADIOLOGY
OBSTETRICS AND
Page 92 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
Physician Name
Q5643
DEWAN, ASHVIN KUMAR, MD
Q4939
Q5173
DEWAN, VINAY NEIL, MD
DEWATERS, AMI L, MD
P9835
DEWEY, KELLY JEAN, DO
P4642
DEWITT, ROBERT MICHAEL, MD
Q1130
DEZZUTTI, BRIAN PETER, MD
Q2122
DHADE, AMANBIR, MD
Q0427
DHALIWAL, AMANDEEP SINGH, MD
Q5174
P4749
Q7859
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
SPORTS MEDICINE
8/14/2015
8/14/2020 SURGERY
(ORTH SURG)
GLAUCOMA
7/15/2015
EMERGENCY
4/15/2014
4/15/2019 MEDICINE
DIAGNOSTIC
INTERVENTIONAL
10/15/2012
RADIOLOGY
ANESTHESIOLOGY
10/15/2014
ACTIVE
8/25/2015 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/7/2015 None
7/17/2015 None
N/A
N/A
4/15/2014 None
N/A
10/15/2012 None
N/A
8/14/2014 None
N/A
10/15/2014 None
N/A
ACTIVE
6/9/2014 None
N/A
ACTIVE
7/21/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
11/28/2012 None
19-Apr-16 None
N/A
N/A
TX
FL
ACTIVE
ACTIVE
3/8/2012 None
4/2/2014 None
N/A
N/A
INTERNAL MEDICINE SHREVEPORT LA
ACTIVE
4/3/2013 None
N/A
9/17/2017 RADIOLOGY
RHEUMATOLOGY
RADIOLOGY
8/1/2011 None
9/24/2012 None
N/A
N/A
7/1/2018 UROLOGY
PULMONARY
CRITICAL CARE
1/4/2018 MEDICINE
INTERVENTIONAL
10/1/2019 RADIOLOGY
PEDIATRIC
FAMILY PRACTICE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
2/1/2012 None
7/3/2013 None
N/A
N/A
1/4/2013 None
N/A
7/15/2015
7/15/2020
11/1/2012
15-Apr-16
11/1/2017
15-Apr-21
P2228
P9325
DHANANI, NADEEM NIZAR, MD
DHAR, MRINAL, MD
DHARAMSI, JENNIFER WARNER,
MD
DHATT, GURJIT SINGH, MD
3/1/2012
3/17/2014
3/1/2017
3/17/2019
P5963
DHAWAN, MANISH, MD
P0373
P4436
DHAWAN, RICHA, MD
DHEER, SACHIN, MD
P1986
P7096
DHILLON, RENNEE NAGRA, MD
DHIR, ROHIT ROBERT, MD
2/1/2012
7/1/2013
P5171
DHOTRE, DHEERAJ, MD
1/4/2013
Q1975
DI IORIO, MICHAEL MARIO, MD
10/1/2014
Q0747
DIAB, MICHEL GERGES, MD
6/27/2014
DIAGNE, THIENDELLA, MD
7/1/2011
KILLEEN
TX
DHAMNE, SAGAR ANIL, MD
P0196
Disciplinary
Status Date
TX
6/2/2019
7/15/2011
9/17/2012
Registration
Status Date
Disciplinary
Status of
Texas
License
SUGAR LAND
6/2/2014
4/1/2013
Practice City
Registration
Status of
Practice
Texas
State
License
INTERVENTIONAL
CARDIOLOGY
CARDIOLOGY
IOWA CITY
ANATOMIC/CLINICAL
PATHOLOGY
PATHOLOGY
UROLOGIC
UROLOGIC SURGERY ONCOLOGY
HOUSTON
UROLOGY
HOUSTON
DERMATOLOGIC
DERMATOLOGY
SURGERY
DALLAS
INTERNAL MEDICINE NEPHROLOGY
GAINESVILLE
4/1/2018 ONCOLOGY
IA
SHREVEPORT LA
CHERRY HILL NJ
HOUSTON
TX
LICENSE
ISSUED
INTERNAL MEDICINE
RADIOLOGY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
7/1/2016 GYNECOLOGY
SURGERY
Page 93 of 402
ACTIVE
LICENSE
ISSUED
PHOENIX
AZ
ACTIVE
10/13/2014 None
N/A
LUBBOCK
TX
ACTIVE
7/3/2014 None
N/A
EDINBURG
TX
ACTIVE
8/3/2011 None
N/A
License
Number
P4565
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
10/1/2012
P9184
DIAMOND, MICHAEL JEREMY, MD
DIAZ PARDO, JENNY ELIZABETH,
MD
3/3/2014
P5355
P4750
DIAZ, JESUS RAFAEL, MD
DIAZ, KYLE IBANEZ, MD
2/1/2013
11/1/2012
DIAGNOSTIC
2/1/2018 RADIOLOGY
P1290
DIAZ, LINA BOLANOS, MD
11/4/2011
P5172
DIAZ, LUCIA ZORAIDA, MD
1/4/2013
P0823
P4860
DICE, DAVID LOUIS JR, MD
DICKERSON, JEREMY LEE, MD
Q0625
DICKHUTE, ANDREW , MD
8/26/2011
11/15/2012
6/16/2014
RADIOLOGY
ORTHOPEDIC
8/26/2016 SURGERY
EMERGENCY
6/16/2019 MEDICINE
DICKSON, DOUGLAS DARKO, MD
1/2/2012
ORTHOPEDIC
1/2/2017 SURGERY
P8885
DIDWANIYA, NEHA, MD
2/7/2014
Q7177
DIDYUK, OKSANA, MD
16-Feb-16
Q1394
DIERCKS, DEBORAH BAKER, MD
8/15/2014
P5173
DIESTEL, ECKHART, MD
EMERGENCY
8/15/2019 MEDICINE
CARDIOVASCULAR
1/4/2018 DISEASES
ORTHOPEDIC
5/15/2019 SURGERY
ORTHOPEDIC
SURGERY OF THE
SPINE
PALLIATIVE
MEDICINE
CRITICAL CARE
ANESTHESIOLOGY
ACTIVE
10/3/2012 None
N/A
HOUSTON
TX
ACTIVE
3/5/2014 None
N/A
EL PASO
EL DORADO
TX
AR
ACTIVE
ACTIVE
2/28/2013 None
11/6/2012 None
N/A
N/A
ACTIVE
11/23/2011 None
N/A
ACTIVE
1/14/2013 None
N/A
TYLER
TX
ACTIVE
ACTIVE
9/2/2011 None
11/27/2012 None
N/A
N/A
TEMPLE
TX
ACTIVE
6/24/2014 None
N/A
1/2/2012 None
N/A
ACTIVE
2/10/2014 None
N/A
ACTIVE
29-Feb-16 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/18/2014 None
N/A
1/4/2013 None
N/A
5/15/2014 None
N/A
LICENSE
ISSUED
PASADENA
TX
TX
DIETRICH, LINDSEY NICOLE, MD
5/15/2014
Q5176
Q4088
DIKE, NNAMDI CHIMA, DO
DIKE, OGECHI N, MD
7/15/2015
5/1/2015
Q5790
DILLE, RENEE , MD
8/28/2015
P9836
DILLON, SHENA JO, MD
4/15/2014
7/15/2020 NEUROLOGY
EMERGENCY
8/28/2020 MEDICINE
OBSTETRICS AND
P1539
DILMAGHANIAN, OMID GILLANI, MD
12/1/2011
Disciplinary
Status Date
TX
DALLSA
Q0243
Registration
Status Date
Disciplinary
Status of
Texas
License
Practice City
CARRIZO
SPRINGS
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PEDIATRIC
DERMATOLOGY
P1746
1/4/2013
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
CRITICAL CARE
ANESTHESIOLOGY
Registration
Status of
Practice
Texas
State
License
NEURO-PHYSIOLOGY
(NEUROLOGY)
FRISCO
HOSPITALIST
DALLAS
TX
TX
ACTIVE
ACTIVE
7/16/2015 None
5/8/2015 None
N/A
N/A
AUSTIN
TX
ACTIVE
9/3/2015 None
N/A
ACTIVE
4/28/2014 None
N/A
ACTIVE
1/4/2012 None
N/A
FAMILY MEDICINE
Page 94 of 402
CHEYENNE
WY
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P0720
DIM, UZODINMA RAPHAEL, MD
Q5391
Q6409
P6605
DINARDO, ANDREW R, MD
DINARDO, COURTNEY DENTON,
MD
DINASARAPU, CHANDRASEKHAR
REDDY, MD
DING, KAN , MD
P2229
DING, LIN, DO
3/1/2012
Q3665
4/1/2015
Q1395
DINGLE, ARDEN D, MD
DINSFRIEND, WILLIAM MICHAEL,
MD
8/15/2014
Q4387
P8887
DIPASQUALE, ALLISON, MD
DISCHERT, KEVIN MICHAEL, MD
5/15/2015
2/7/2014
P6606
P9327
Q8048
DITOMMASO, CRAIG , MD
DIVANJI, PUNAG HARESH, MD
DIVINSKY, IANIR , MD
5/15/2013
3/17/2014
02-May-16
P3144
DIXIT, SANTOSH KUMAR, DO
5/15/2012
Q3505
DIXON, ALEXIS ELISE, MD
3/16/2015
P2851
Q3871
P9552
DIXON, CHRISTOPHER LUKE, MD
DIXON, MICHAEL KEVIN, DO
P7099
DIXON, TANYA STOYANOVA, DO
Q5392
P8773
8/15/2011
8/3/2015
4/13/2012
11/2/2015
5/15/2013
4/10/2015
4/1/2014
Secondary Specialty
(Self-Designated)
CARDIAC
ELECTROPHYSIOLO
GY
INTERVENTIONAL
INFECTIOUS
8/3/2020 DISEASES
HEMATOLOGY/ONCOL
4/13/2017 OGY
ONCOLOGY
5/15/2018 NEUROLOGY
EMERGENCY
3/1/2017 MEDICINE
CHILD AND
ADOLESCENT
4/1/2020 PSYCHIATRY
SURGICAL BREAST
5/15/2020 ONCOLOGY
PHYSICAL MED. &
EMERGENCY
5/15/2017 MEDICINE
ORTHOPEDIC
3/16/2020 SURGERY
MATERNAL AND
7/1/2013
7/1/2018
DIXON-SHAMBLEY, KAMILAH , MD
DJURDJULOV, ADAM VOJIN, MD
8/3/2015
1/15/2014
8/3/2020
1/15/2019
P9328
DO, LIEN THI, MD
3/17/2014
3/17/2019
Q4388
DO, NGUYEN TRONG, DO
5/15/2015
5/15/2020
NEUROLOGICAL
SURGERY
OBSTETRICS AND
GYNECOLOGY
ANESTHESIOLOGY
OBSTETRICS AND
GYNECOLOGY
NEUROLOGICAL
SURGERY
HOSPITALIST
PSYCHIATRY
Practice City
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
8/15/2011 None
N/A
8/3/2015 None
N/A
4/13/2012 None
N/A
PA
TX
ACTIVE
ACTIVE
11/9/2015 None
5/23/2013 None
N/A
N/A
FLUSHING
NY
ACTIVE
3/23/2012 None
N/A
HARLINGEN
TX
ACTIVE
4/6/2015 None
N/A
DALLAS
TX
ACTIVE
8/19/2014 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
5/19/2015 None
2/21/2014 None
N/A
N/A
HOUSTON
DALLAS
SEQUIM
TX
TX
WA
ACTIVE
ACTIVE
ACTIVE
6/3/2013 None
3/26/2014 None
03-May-16 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
5/21/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
3/31/2015 None
N/A
4/10/2015 None
4/8/2014 None
N/A
N/A
FORT WORTH TX
ACTIVE
8/23/2013 None
N/A
RICHMOND
STANFORD
COLLEGE
STATION
TX
CA
ACTIVE
ACTIVE
9/9/2015 None
1/17/2014 None
N/A
N/A
TX
ACTIVE
3/21/2014 None
N/A
SAN RAMON
CA
ACTIVE
5/20/2015 None
N/A
LOS ANGELES CA
LUFKIN
SPINE MEDICINE
Page 95 of 402
Disciplinary
Status Date
CAMP HILL
DALLAS
OBSTETRICS AND
GYNECOLOGY
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
License
Number
Physician Name
P2433
DO, NHU QUYNH, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
3/15/2012
PEDIATRIC
VASCULAR
10/1/2013
10/1/2018 NEUROLOGY
NEUROLOGY
12/1/2011
P8021
P1541
DOAN, DAVID THUY, MD
DOAN, JANIE THAO, MD
P8462
12/6/2013
Q0748
DOAN, PHUONGDOAN LAM, DO
DOBARIYA, MANOJKUMAR
AVACHARBHAI, MD
6/27/2014
P7268
DOBKIN, DEAN, MD
7/15/2013
Q0626
P4753
DOBYNE, AMBER PATRICE, MD
DODD, JAMES RUSSELL, MD
6/16/2014
11/1/2012
Q5177
DODWAD, SHAH-NAWAZ, MD
7/15/2015
P2230
P2980
DOE, ANDREW LAWRENCE, MD
DOE, JENNIFER WEN, MD
P9840
DOHADWALA, MUSTAFA, MD
4/15/2014
Q2272
DOLLINS, DAVID LORIS, DO
11/7/2014
P4437
DOLZ, MARK STEPHEN, DO
9/17/2012
Q3358
P5269
DOMBROSKI, RICHARD TODD, DO
DOMINGUEZ VALLEJOS, LUIS
AUGUSTO, MD
EMERGENCY
7/15/2018 MEDICINE
OBSTETRICS AND
ORTHOPEDIC
SURGERY OF THE
7/15/2020 SPINE
ANGIOGRAPHY &
INTERVENTIONAL
3/1/2017 RADIOLOGY
5/1/2017 RADIOLOGY
CARDIAC
ELECTROPHYSIOLOG
4/15/2019 Y
EMERGENCY
11/7/2019 MEDICINE
ANATOMIC/CLINICAL
9/17/2017 PATHOLOGY
SPORTS MEDICINE
P5968
DOMINGUEZ, AURORA, MD
4/1/2013
Q7678
DOMINGUEZ, MARLENE, MD
01-Apr-16
3/1/2012
5/1/2012
3/3/2015
1/15/2013
P8463
DOMINGUEZ, WILFRIDO OMAR, MD
12/6/2013
Q7549
DOMINICI, PAUL GIOVANNI, MD
15-Mar-16
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/19/2012 None
N/A
10/23/2013 None
12/6/2011 None
N/A
N/A
12/6/2013 None
N/A
FORT WORTH TX
ACTIVE
6/30/2014 None
N/A
PHILADELPHIA PA
ACTIVE
LICENSE
ISSUED
ACTIVE
7/18/2013 None
N/A
6/16/2014 None
11/16/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
7/17/2015 None
N/A
DIAGNOSTIC
RADIOLOGY
BREAST IMAGING
UNION
MONTCLAIR
NJ
NJ
ACTIVE
ACTIVE
3/26/2012 None
5/18/2012 None
N/A
N/A
CARDIOLOGY
DALLAS
TX
ACTIVE
5/2/2014 None
N/A
GENERAL PRACTICE CENTERVILLE IA
ACTIVE
11/11/2014 None
N/A
CYTOPATHOLOGY
MEMPHIS
ACTIVE
9/27/2012 None
N/A
FAMILY MEDICINE
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/20/2015 None
N/A
1/15/2013 None
N/A
4/1/2013 None
N/A
OBSTETRICS AND
4/1/2018 GYNECOLOGY
DIAGNOSTIC
01-Apr-21 RADIOLOGY
EMERGENCY
15-Mar-21 MEDICINE
Practice City
SPRING
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
CHILD AND
ADOLESCENT
PSYCHIATRY
Page 96 of 402
TN
HOUSTON
TX
ACTIVE
02-May-16 None
N/A
GALVESTON
TX
ACTIVE
12/11/2013 None
N/A
EDINBURG
TX
ACTIVE
31-Mar-16 None
N/A
License
Number
Q4940
Physician Name
DOMMARAJU, SUBHA RAJITHA ,
MD
DONALDSON, JANA ELIZABETH,
MD
P5969
DONELSON, JULIA ANNE, MD
P9330
DONEPUDI, INDIRA, MD
DONEPUDI, SREEKRISHNA KANTH,
MD
DONHAM, BENJAMIN POWELSON,
MD
DONKOR, FAUSTINA NANA YAA,
DO
P0375
Q1134
Q5998
Q4576
Q3506
Q6179
DONNELLY, LANE FRANCIS, MD
DONTHI REDDY, SRINIVASA
REDDY, MD
P4438
DORTILUS, JEAN NERVA, MD
Q6316
DOSSUL, AMENA, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2011
7/1/2015
4/1/2013
3/17/2014
8/1/2014
9/15/2015
6/1/2015
GASTROENTEROLOG
3/17/2019 Y
HEPATOLOGY
OTORHINOLARYNGOL
8/1/2019 OGY
EMERGENCY
9/15/2020 MEDICINE
3/16/2015
10/1/2015
10/15/2015
Q5393
DOSUMU, REMILEKUN SHARIZA,
MD
8/3/2015
P5796
P9331
DOUGHERTY, ALEXIS LEAH, MD
DOUGHERTY, DANE H, MD
3/15/2013
3/17/2014
Q8465
H7553
01-Jun-16
12/3/2014
P6607
DOUGHTIE, CATHRYN ANNE, MD
DOUGLAS, SUSAN MARIE, MD
DOWDELL-SMITH, CICELY
PATRICE, MD
Q7180
DOZIER, JAMES HARLEY, MD
16-Feb-16
Q4747
DRAGANN, BRENDAN, DO
DRAKSHARAM, PADMA LAKSHMI,
MD
DREISS, WILLIAM , MD
6/12/2015
Q7181
P7269
EMERGENCY
7/1/2020 MEDICINE
PEDIATRIC
3/16/2020 RADIOLOGY
9/17/2012
5/15/2013
16-Feb-16
7/15/2013
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
8/8/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
7/8/2015 None
N/A
4/1/2013 None
N/A
ACTIVE
4/16/2014 None
N/A
ACTIVE
8/4/2014 None
N/A
MIDLAND
TX
FORT HOOD
TX
ACTIVE
9/22/2015 None
N/A
TYLER
TX
ACTIVE
6/3/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
3/23/2015 None
N/A
10/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
10/18/2012 None
N/A
10/15/2015 None
N/A
ACTIVE
8/7/2015 None
N/A
ACTIVE
ACTIVE
3/21/2013 None
3/28/2014 None
N/A
N/A
SURGICAL
01-Jun-21 ONCOLOGY
GENERAL SURGERY
PEDIATRIC
5/15/2018 NEUROLOGY
OBSTETRICS AND
16-Feb-21 GYNECOLOGY
EMERGENCY
6/12/2020 MEDICINE
HEMATOLOGY/ONCOL
16-Feb-21 OGY
INTERNAL MEDICINE
Page 97 of 402
Disciplinary
Status Date
SUGAR LAND
CHILD AND
ADOLESCENT
PSYCHIATRY
GERIATRIC
MEDICINE (INTERNAL
MED)
DERMATOLOGIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
FORT
WASHINGTON MD
SANTA
BARBARA
CA
HOUSTON
TX
AMARILLO
TX
ACTIVE
ACTIVE
02-Jun-16 None
12/5/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/17/2013 None
N/A
LONGVIEW
TX
ACTIVE
16-Mar-16 None
N/A
AUSTIN
TX
ACTIVE
6/17/2015 None
N/A
BROOKLYN
TYLER
NY
TX
ACTIVE
ACTIVE
01-Mar-16 None
7/19/2013 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
11/7/2014
11/7/2019 SURGERY
INTERVENTIONAL
DIAGNOSTIC
5/1/2015
5/1/2020 RADIOLOGY
RADIOLOGY
7/15/2013
CARDIAC
ELECTROPHYSIOLOG
1/5/2015
1/5/2020 Y
INTERNAL MEDICINE
TRANSPLANT
8/15/2014
8/15/2019 THORACIC SURGERY SURGERY
7/1/2015
7/1/2020 CARDIOLOGY
9/16/2013
6/3/2013
6/3/2018 PSYCHIATRY
SURGICAL CRITICAL
8/1/2014
8/1/2019 TRAUMATIC SURGERY CARE
Q2273
DREXLER, KATHLYN JOAN, MD
Q4090
P7270
DREYER, STEPHEN EDWARD , MD
DRIMER-KAGAN, TALY , MD
Q2760
DRIS, LAMIA , MD
Q1388
N0833
P7897
P6808
D'SOUZA, DESMOND MARIO, MD
D'SOUZA, PENNY LYNN , DO
D'SOUZA, VEEMAL M, MD
DU, YE BEVERLY, MD
Q1135
DUANE, THERESE MARIE, MD
P5356
DUBOIS, JEFFERY COLEMAN, MD
2/1/2013
Q3359
DUDAIE, RONEN SHEM, MD
3/3/2015
Q5791
DUDLEY, LEE ANTHONY, DO
8/28/2015
P1292
DUFFY, THARREN CHARLES, DO
11/4/2011
P5618
P7902
DUFRESNE, GARY WILLIAM, DO
DUGAR, JYOTI RANI, MD
3/1/2013
9/16/2013
EMERGENCY
8/28/2020 MEDICINE
EMERGENCY
11/4/2016 MEDICINE
EMERGENCY
3/1/2018 MEDICINE
P2111
2/10/2012
L7362
DUGGIRALA, RAVI KUMAR, MD
DUMITRASCU, GEORGE
ALEXANDRU, MD
Q4941
DUMITRU, CRISTINA IOANA, MD
P0377
DUMLAO, DONATO GAERLAN, MD
7/15/2011
M0397
DUNCAN, ANDREA FREEMAN, MD
8/29/2014
Q0627
DUNCAN, COLEY BRYANT, MD
6/16/2014
11/30/2012
7/1/2015
ENDOCRINOLOGY,
DIABETES AND
7/1/2020 METABOLISM
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
N/A
ACTIVE
ACTIVE
5/11/2015 None
7/26/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
1/7/2015 None
N/A
DALLAS
TOMBALL
BEDFORD
HOUSTON
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
FORT WORTH TX
BIRMINGHAM
AL
8/19/2014
7/2/2015
9/26/2013
6/5/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
8/8/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/7/2013 None
N/A
3/3/2015 None
N/A
8/28/2015 None
N/A
GRAND BLANC MI
ACTIVE
12/13/2011 None
N/A
SAN ANTONIO TX
BEAUMONT
TX
CLEARWATER
,
FL
OTTAWA,
ONTARIO
ACTIVE
ACTIVE
3/4/2013 None
9/20/2013 None
N/A
N/A
ACTIVE
2/20/2012 None
N/A
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
8/25/2015 None
N/A
TX
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
7/21/2011 None
N/A
8/29/2014 None
N/A
6/16/2014 None
N/A
7/15/2016 PALLIATIVE MEDICINE INTERNAL MEDICINE KINGWOOD
Page 98 of 402
11/7/2014 None
TX
TX
INFECTIOUS
6/16/2019 INTERNAL MEDICINE DISEASES
Disciplinary
Status Date
HOUSTON
DALLAS
INTERNAL MEDICINE
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
License
Number
Physician Name
Q2991
DUNCAN, JEFFREY AARON, DO
Q5793
DUNCAN, JONATHAN SCOTT, MD
Q8049
DUNCAN, JOSHUA KYLE, DO
Q2438
DUNGOG, PAULA, MD
P6156
Q7679
DUNHAM, JEAN ANDERSON, MD
DUNHAM, STEVEN RICHARD JR,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ORTHOPEDIC
2/2/2015
2/2/2020 SURGERY
ORTHOPEDIC
SURGERY OF THE
ORTHOPEDIC
8/28/2015
8/28/2020 SPINE
SURGERY
OPHTHALMOLOGY 02-May-16
CORNEA
11/17/2014
01-Apr-16
01-Apr-21 NEUROLOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
Q1815
DUNN, CARY LEO, MD
9/15/2014
Q1816
DUNN, HOLLY ELSBETH, MD
9/15/2014
G9735
DUNPHY, CHERIE HILBORN, MD
10/1/2012
Q6623
DUNSON, TEDDRICK LOVELL, MD
12/4/2015
OBSTETRICS AND
ANATOMIC/CLINICAL
10/1/2017 PATHOLOGY
Q6623
04-Dec-15
ANESTHESIOLOGY 04-Dec-20 PAIN MANAGEMENT
Q6623
P0721
DUONG, HUYEN VU, MD
04-Dec-15
8/15/2011
J4094
K7012
DUONG, PAUL LIEM, MD
DUONG, ROBERT TRIEU, MD
Q1591
DUONG, THAO , MD
8/29/2014
ANESTHESIOLOGY 04-Dec-20 PAIN MANAGEMENT
RADIATION
3/1/2017 ONCOLOGY
7/1/2016 RADIOLOGY
Q1136
DUPONT, NEFERTITI CHIANTI, MD
P6609
DURAINI, MAZEN , MD
5/15/2013
OBSTETRICS AND
8/1/2019 GYNECOLOGY
ORAL &
MAXILLOFACIAL
5/15/2018 SURGERY
Q2539
DURAIRAJ, SONIA SHARON, MD
12/3/2014
8/1/2014
LICENSE
ISSUED
HOUSTON
TX
4/12/2013
3/1/2012
7/1/2011
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
DERMATOLOGIC
SURGERY
MATERNAL AND
FETAL MEDICINE
HEMATOLOGY
(PATHOLOGY)
Disciplinary
Status Date
2/2/2015 None
N/A
8/28/2015 None
N/A
ACTIVE
LICENSE
ISSUED
03-May-16 None
N/A
11/17/2014 None
N/A
AUSTIN
tx
LICENSE
ISSUED
4/12/2013 None
N/A
HOUSTON
TX
ACTIVE
25-Apr-16 None
N/A
WACO
TX
ACTIVE
10/31/2014 None
N/A
GALVESTON
TX
ACTIVE
9/16/2014 None
N/A
DURHAM
NC
ACTIVE
LICENSE
ISSUED
10/3/2012 None
N/A
12/4/2015 None
SEE
PREVIOUS
14-Dec-15 ORDER
SEE
PREVIOUS
14-Dec-15 ORDER
8/19/2011 None
N/A
3/12/2012 None
7/7/2011 None
N/A
N/A
8/29/2014 None
N/A
8/6/2014 None
N/A
5/31/2013 None
N/A
12/3/2014 None
N/A
ANESTHESIOLOGY
ANESTHESIOLOGY
FORT WORTH TX
ACTIVE
ANESTHESIOLOGY
FORT WORTH TX
ACTIVE
ACTIVE
NEURO-RADIOLOGY
LOS
ALAMITOS
TAMPA
GYNECOLOGIC
ONCOLOGY
THE
WOODLANDS TX
INTERNAL MEDICINE
Page 99 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
IRVING
CA
FL
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
12/7/2015
12/7/2015
N/A
License
Number
P8128
Physician Name
Q7036
DURAIRAJ, VIKRAM DAVID, MD
DURAN SIERRA, PAULA ANDREA,
MD
Q7359
Q6180
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OPHTHALMOLOGY FACIAL PLASTIC
10/15/2013
10/15/2018 RECONST SURGERY SURGERY
01-Feb-16
DURAN, CIHAN , MD
DURAN, HILCIAS, MD
04-Mar-16
10/1/2015
04-Mar-21 RADIOLOGY
Q8466
DURAN, SILVESTRE ROBERTO, MD
01-Jun-16
P1177
DURAND SANCHEZ, ANA V, MD
10/17/2011
Q2992
Q2894
DURANI, OMAR ARIF, MD
DURANT, KACEY , MD
Q5395
11/7/2014
7/15/2014
P5970
DURGAM, PREETHI , DO
DURHAM, CHRISTOPHER ALAN,
MD
DURLING, LAURA, MD
DURRANT, AUDREY CARMELITA,
MD
Q7360
DURSO, PETER JOHN, MD
04-Mar-16
P7103
Q6181
DUTTA, ERYN HART, DO
DUTTER, TAMARA LYNN, MD
7/1/2013
10/1/2015
P3526
DUVALL, DAVID BURL, MD
Q2274
Q0905
2/2/2015
1/15/2015
8/3/2015
4/1/2013
6/8/2012
P6157
P0900
DUVALL, LUCAS MAIER, MD
DUVIC, MARGARET DENISE, DO
4/12/2013
9/1/2011
P3527
DVORAK, DERRICK WILLIAM, MD
6/8/2012
P7429
8/1/2013
P1294
DWYER, PAUL RICHARD, MD
DYER, CHRISTOPHER ANTHONY,
MD
11/4/2011
P8239
DYER, HAROLD LEE, DO
11/1/2013
NEPHROLOGY
CARDIOTHORACIC
RADIOLOGY
PEDIATRICS,
CARDIOLOGY
PHYSICAL MED. &
FAMILY MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
CO
ACTIVE
10/30/2013 None
N/A
TEMPLE
TX
ACTIVE
12-Feb-16 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
11-Mar-16 None
10/20/2015 None
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
07-Jun-16 None
N/A
10/17/2011 None
N/A
2/2/2015 None
1/26/2015 None
N/A
N/A
ACTIVE
8/5/2015 None
N/A
ACTIVE
ACTIVE
11/11/2014 None
7/17/2014 None
N/A
N/A
ACTIVE
4/11/2013 None
N/A
ACTIVE
10-Mar-16 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/9/2013 None
11/17/2015 None
N/A
N/A
6/8/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/24/2013 None
11/3/2011 None
N/A
N/A
6/8/2012 None
N/A
ACTIVE
8/12/2013 None
N/A
12/20/2011 None
N/A
11/1/2013 None
N/A
AUSTIN
HOUSTON
TX
TX
4/1/2018 PEDIATRIC SURGERY GENERAL SURGERY SAN ANTONIO TX
EMERGENCY
04-Mar-21 MEDICINE
OBSTETRICS AND
MATERNAL AND
7/1/2018 GYNECOLOGY
FETAL MEDICINE
GALVEVSTON TX
9/1/2016 PEDIATRICS
EMERGENCY
8/1/2018 MEDICINE
PULMONARY
11/1/2018 MEDICINE
CARDIOVASCULAR
SURGERY
SHREVEPORT LA
SAN ANTONIO TX
EMERGENCY
MEDICINE
WYOMING
MI
INTERNAL MEDICINE
Page 100 of 402
Disciplinary
Status Date
DENVER
NEURO-PHYSIOLOGY
(NEUROLOGY)
8/3/2020 NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
EMERGENCY
11/16/2015
11/16/2020 MEDICINE
HOUSTON
SURGICAL CRITICAL
15-Apr-16
15-Apr-21 CARE
GENERAL SURGERY
Q6504
EADEH, HANNA, MD
Q7862
EAGLETON, AUSTIN , MD
P4754
P8353
EAGLETON, KWAME , MD
EAPEN, JENNY MARY, MD
11/1/2012
11/15/2013
Q2439
EARL, CAMERON LEE, DO
11/17/2014
Q3175
EARLE, KIMBERLY ANN, DO
2/13/2015
Q6624
EARLY, MARSHALL DON, DO
12/4/2015
Q6624
04-Dec-15
Q6624
04-Dec-15
Q4749
Q0430
EBADAT, AILEEN , MD
EBANGIT, RUTH LAVONE, MD
6/12/2015
6/2/2014
Q1593
Q6000
EBERT, MARK OREN, MD
EBOH, NGOZI IHUOMA, MD
8/29/2014
9/15/2015
OBSTETRICS AND
P1988
EBRAHEEM, MOHAMMAD, MD
2/1/2012
P1989
2/1/2012
P9185
P9186
ECHARTEA GONZALEZ, JAIME, MD
ECHAVARRIA, JUAN FERNANDO,
MD
ECHENDU, CHIDIEBERE , MD
Q1137
ECKSTEIN, OLIVE SIMONE, MD
8/1/2014
P5174
EDGELL, RANDALL CLIVE, MD
EDIONWE, SUSAN OMWANGHE,
MD
1/4/2013
Q4943
3/3/2014
3/3/2014
7/1/2015
EMERGENCY
11/17/2019 MEDICINE
Registration
Status of
Practice
Texas
State
License
TX
FORT WORTH TX
VASCULAR
SURGERY
CHESTER
VASCULAR
SURGERY
CHESTER
SURGICAL CRITICAL
CARE
AUSTIN
LUBBOCK
Page 101 of 402
Disciplinary
Status Date
ACTIVE
12/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
26-Apr-16 None
N/A
11/1/2012 None
11/19/2013 None
N/A
N/A
11/20/2014 None
N/A
2/13/2015 None
N/A
12/4/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
PA
ACTIVE
18-Jan-16 None
N/A
PA
ACTIVE
18-Jan-16 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
6/17/2015 None
6/3/2014 None
N/A
N/A
8/29/2014 None
9/25/2015 None
N/A
N/A
2/1/2012 None
N/A
TX
PEDIATRIC CRITICAL
CARE MEDICINE
2/1/2017 PEDIATRICS
PEDIATRIC
GASTROENTEROLOG
2/1/2017 Y
PEDIATRICS
GASTROENTEROLOG
3/3/2019 INTERNAL MEDICINE Y
PEDIATRIC
HEMATOLOGY/ONCOL
8/1/2019 OGY
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
1/4/2018 NEUROLOGY
GY
OTORHINOLARYNGOL
7/1/2020 OGY
RHINOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
CINCINNATI
OH
ACTIVE
2/3/2012 None
N/A
SAN ATONIO
AMARILLO
TX
TX
ACTIVE
ACTIVE
3/21/2014 None
3/14/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/11/2014 None
N/A
HOUSTON
TX
ACTIVE
2/21/2013 None
N/A
RICHMOND
TX
ACTIVE
7/17/2015 None
N/A
License
Number
P5357
Physician Name
EDSON, EMMANUEL, MD
dicaid
dicaid
Agreement
End Date
Designated)
2/1/2013
Q7863
Q7864
P5971
EDWARDS, FRANK DAMON, MD
EDWARDS, JASON TRAVIS, MD
EDWARDS, JEFFERY D, MD
15-Apr-16
15-Apr-16
4/1/2013
FAMILY PRACTICE 15-Apr-21 EMERGENCY MED
Q8713
10-Jun-16
Q0248
EDWARDS, JORDAN WILLIAM, MD
EDWARDS, LINDSAY ATHERTON,
MD
5/15/2014
Q2541
EDWARDS, MONTESSA, MD
12/3/2014
EMERGENCY
12/3/2019 MEDICINE
P7761
8/30/2013
8/30/2018 NEUROLOGY
Q2441
EDWARDS, NANCY JEAN, MD
EDWARDS, SAMUEL BRANDON,
MD
Q3507
EFTEKHARI, SIAVASH, MD
11/17/2014
3/16/2015
Q5397
EFURIBE, CHINWE OYERONKE, MD
8/3/2015
P1637
EGBORGE, ESEOVHE ALALIBO, MD
12/15/2011
P3315
P9336
EGELAND, BRENT M, MD
EGESI, ADAEZE, MD
P6381
Q2125
EGGLESTON, JOHN MORTON III,
MD
EGGLESTON, MAURICE KEITH JR,
MD
6/1/2012
3/17/2014
5/1/2013
10/15/2014
P8240
Q7680
EGLY, JONATHAN ANDREW, MD
EHASZ, MONA, DO
11/1/2013
01-Apr-16
P6610
EHLERS, KARA A, MD
5/15/2013
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
SPORTS MEDICINE IM
PEDIATRICS,
CARDIOLOGY
ORAL &
MAXILLOFACIAL
3/16/2020 SURGERY
ADOLESCENT
MEDICINE - PD
8/3/2020 PEDIATRICS
PLASTIC &
RECONSTRUCTIVE
6/1/2017 SURGERY
5/1/2018 MICROSURGERY
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Page 102 of 402
Disciplinary
Status Date
2/1/2013 None
N/A
LONGVIEW
DALLAS
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
19-Apr-16 None
25-Apr-16 None
4/9/2013 None
N/A
N/A
N/A
HENRIETTA
TX
ACTIVE
LICENSE
ISSUED
20-Jun-16 None
N/A
5/15/2014 None
N/A
12/8/2014 None
N/A
9/5/2013 None
N/A
11/17/2014 None
N/A
DENTON
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
PORTLAND
OR
ACTIVE
3/31/2015 None
N/A
WOOBURY
MN
ACTIVE
8/5/2015 None
N/A
ACTIVE
12/20/2011 None
N/A
6/1/2012 None
3/18/2014 None
N/A
N/A
HAND SURGERY PLASTIC SURGERY
PLASTIC &
RECONSTRUCTIVE
SURGERY
MATERNAL AND
FETAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
HUMBLE
TX
LICENSE
ISSUED
ACTIVE
AUSTIN
CORPUS
CHRISTI
TX
ACTIVE
5/7/2013 None
N/A
TX
ACTIVE
10/28/2014 None
N/A
KERRVILLE
HARLINGEN
TX
TX
ACTIVE
ACTIVE
11/7/2013 None
04-Apr-16 None
N/A
N/A
DALLAS
TX
ACTIVE
5/27/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q7183
EHSANZADEH CHEEMEH,
PARVANEH , MD
16-Feb-16
Q7681
EILERS, MARK AARON, MD
01-Apr-16
Q1138
EISEN, MICHAEL, MD
Q7184
EISSA, KHALED ELSAYED AHMED,
MD
P5176
EITTER, PATRICK THOMAS, MD
Q6182
8/1/2014
16-Feb-16
OCCUPATIONAL
16-Feb-21 MEDICINE
ORTHOPEDIC
01-Apr-21 SURGERY
1/4/2013
EMERGENCY
1/4/2018 MEDICINE
EKPENIKE, ANTHONIA, MD
10/1/2015
P2982
P3146
EKPENYONG, UDEME ISIDORE, MD
EL AHDAB, SAMIH , MD
5/1/2012
5/15/2012
P2435
EL ANNAN, JAAFAR FADL, MD
3/15/2012
Q2762
EL BAAGE, THAR, MD
5/1/2017 PEDIATRICS
CRITICAL CARE
1/5/2020 MEDICINE
1/5/2015
Q4577
EL FEKI, AMRO, MD
6/1/2015
Q4092
EL GHAMRY, MOATAZ NIER, MD
5/1/2015
Q1139
EL MALLAH, WAEL, MD
8/1/2014
P1178
EL TAL, ABDEL KADER , MD
Q0750
ELAHI, SHAHID, MD
6/27/2014
P2639
Q2543
Q0431
ELAMIR, HANNAH SAFIA, DO
ELANGWE, PATRICK MOTE, MD
ELAPROLU, KISHORE, MD
4/2/2012
12/3/2014
6/2/2014
DIAGNOSTIC
4/2/2017 RADIOLOGY
P0578
EL-BAGHDADI, MARIAM MAHDI, MD
8/1/2011
10/17/2011
6/1/2020 NEUROLOGY
RADIATION
5/1/2020 ONCOLOGY
8/1/2019 RADIOLOGY
DERMATOLOGIC
10/17/2016 SURGERY
Secondary Specialty
(Self-Designated)
PREVENTIVE OCCUPATIONAL ENVIRONMENTAL
MED
SPORTS MEDICINE
(ORTH SURG)
SPORTS MEDICINE
(FAMILY PRACTICE)
PULMONARY
CRITICAL CARE
MEDICINE
AEROSPACE
MEDICINE
Practice City
HOUSTON
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
TX
SAN ANTONIO TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
29-Feb-16 None
N/A
ACTIVE
11-Apr-16 None
N/A
ACTIVE
8/7/2014 None
N/A
ACTIVE
08-Apr-16 None
N/A
ACTIVE
LICENSE
ISSUED
1/15/2013 None
N/A
10/1/2015 None
N/A
MOBILE
AL
ACTIVE
ACTIVE
5/7/2012 None
5/17/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
3/19/2012 None
N/A
INTERNAL MEDICINE BOCA RATON FL
ACTIVE
2/17/2015 None
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
LICENSE
ISSUED
6/1/2015 None
N/A
OPHTHALMOLOGY
LOUISVILLE
KY
ACTIVE
5/26/2015 None
N/A
CARDIOLOGY
EL PASO
TX
ACTIVE
8/4/2014 None
N/A
DERMATOLOGY
DEARBORN
MI
ACTIVE
LICENSE
ISSUED
10/18/2011 None
N/A
6/27/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
4/4/2012 None
12/9/2014 None
6/4/2014 None
N/A
N/A
N/A
ACTIVE
8/11/2011 None
N/A
HOSPITALIST
HOSPITALIST
Page 103 of 402
HOUSTON
DAYTON
BROOKINGS
TX
OH
SD
License
Number
Physician Name
Q2544
P9557
ELBASH, AHMAD FERAS, MD
ELBHLOUL, HAITHAM, MD
Q3668
Q3177
ELDER, LANA ANDREA, MD
ELDOKLA, AHMED MOHAMED
ATTIA, MD
ELEGBE, OLUGBEMI
OLUMAYOKUN, MD
Q8714
ELHOFF, JUSTIN JEFFREY, MD
Q8052
ELIAS, GEORG , MD
Q3178
ELIAS, MARY ELIAS, DO
Q0432
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
INTERVENTIONAL
12/3/2014
CARDIOLOGY
4/1/2014
EMERGENCY
4/1/2015
4/1/2020 MEDICINE
NEUROMUSCULAR
6/2/2014
6/2/2019 NEUROLOGY
DISEASE
LUBBOCK
EMERGENCY
2/13/2015
MEDICAL SERVICES
PEDIATRICS,
PEDIATRIC CRITICAL
10-Jun-16
CARE MEDICINE
HOUSTON
GASTROENTEROLOG
02-May-16
02-May-21 INTERNAL MEDICINE Y
HERRIN
2/13/2015
12/6/2013
5/2/2014
12/6/2018 RADIOLOGY
5/2/2019 ONCOLOGY
P7430
ELIZARRARAS, HERIBERTO , MD
Q6183
ELIZONDO, CARLOS , MD
P5620
ELJAMMAL, SAM, MD
P5271
EL-KASS, GABRIEL, MD
1/15/2013
P9843
Q7682
EL-KHATIB, NORA, MD
ELKHATIB, RANIA , MD
4/15/2014
01-Apr-16
01-Apr-21 PSYCHIATRY
P1069
P6612
P8025
ELLENBECKER, BEAU JAMES, DO
ELLENT, LIBBY, MD
ELLIS, CHRISTIAN EDWARD, MD
10/3/2011
5/15/2013
10/1/2013
Q2126
ELLIS, MATTHEW JAMES, MD
P7431
ELLIS, STEVEN LEE, DO
Q1595
ELLISON HODGES, CHANTE, MD
8/1/2013
10/1/2015
PULMONARY
CRITICAL CARE
3/1/2018 MEDICINE
10/15/2014
8/1/2013
8/29/2014
N/A
N/A
4/1/2015 None
N/A
ACTIVE
6/11/2014 None
N/A
ACTIVE
2/18/2015 None
N/A
TX
ACTIVE
15-Jun-16 None
N/A
IL
ACTIVE
LICENSE
ISSUED
09-May-16 None
N/A
2/13/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
12/17/2013 None
5/6/2014 None
N/A
N/A
8/1/2013 None
N/A
ACTIVE
10/8/2015 None
N/A
ACTIVE
3/7/2013 None
N/A
ACTIVE
1/23/2013 None
N/A
4/23/2014 None
04-Apr-16 None
N/A
N/A
TX
INTERNAL MEDICINE LOS ANGELES CA
GERIATRIC
MEDICINE (INTERNAL
MED)
BROOKLYN
NY
10/15/2019 ONCOLOGY
EMERGENCY
8/1/2018 MEDICINE
BALTIMORE
MD
ACTIVE
ACTIVE
APO
AE
HARLINGEN
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/31/2011 None
5/29/2013 None
10/23/2013 None
N/A
N/A
N/A
10/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
8/6/2013 None
N/A
8/29/2014 None
N/A
EL PASO
Page 104 of 402
Disciplinary
Status Date
12/9/2014 None
5/8/2014 None
MUSCULOSKELETAL ALBUQUERQU
RADIOLOGY
E
NM
TX
EMERGENCY
MEDICINE
CORPUS
CHRISTI
TX
ELIFRITZ, JAMIE MARIE, MD
ELIMOVA, ELENA, MD
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
P8465
Q0040
3/1/2013
Registration
Status of
Practice
Texas
State
License
TX
License
Number
Physician Name
P7105
P5800
ELLISON, JEFFREY COWAN, MD
ELLISON, KEITH TAYLOR, MD
J1985
ELLSTROM, STEVEN JORDAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2013
3/15/2013
6/3/2013
P4568
ELMAZI, FUNDIME , DO
10/1/2012
OBSTETRICS AND
P1297
P6160
P7104
P9844
ELMHISHI, OSAMA MOHAMED, MD
ELNEMR, MINA , MD
EL-QADDOUMI, HIBA F, MD
ELSAHARTY, SALAH AHMED, MD
11/4/2011
4/12/2013
7/1/2013
4/15/2014
11/4/2016
4/12/2018
7/1/2018
4/15/2019
P8893
ELSAKKA, MOSTAFA SOLIMAN, MD
EL-SAYED, MAHMOUD MOHAMAD
ALI, MD
2/7/2014
2/18/2014
Q6828
ELSBECKER, STEVEN, DO
ELSHATORY, KAREEM MOHAMED,
MD
06-Jan-16
06-Jan-21 INTERNAL MEDICINE
Q8468
ELWIR, SALEH, MD
01-Jun-16
Q0041
EMANUEL, MATTHEW EZRA, MD
EMBREY, EVERETT CLAYTON III,
MD
EMECHEBE-KENNEDY, OBINNA C,
MD
EMORY, RONYA LASHELLE, MD
ENAKPENE, CHRISTOPHER
ATSABOGHENA, MD
ENEKEBE, KENECHUKWU
OBIAJULU, MD
7/15/2014
OPHTHALMOLOGY 5/2/2019 GLAUCOMA
EMERGENCY
10/1/2019 MEDICINE
OBSTETRICS AND
4/1/2014
P9067
Q1979
Q5398
P1639
Q0908
P9558
P1748
3/17/2014
5/2/2014
10/1/2014
8/3/2015
12/15/2011
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
N/A
N/A
6/11/2013 None
N/A
AUSTIN
TX
ACTIVE
10/8/2012 None
N/A
IA
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/8/2011
4/22/2013
7/3/2013
5/1/2014
None
None
None
None
N/A
N/A
N/A
N/A
2/7/2014 None
N/A
ACTIVE
3/20/2014 None
N/A
ACTIVE
2/24/2014 None
N/A
ACTIVE
11-Jan-16 None
N/A
TX
ACTIVE
13-Jun-16 None
N/A
TX
ACTIVE
LICENSE
ISSUED
5/9/2014 None
N/A
10/1/2014 None
N/A
DALLAS
CARDIOTHORACIC
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
7/1/2013 None
4/11/2013 None
ACTIVE
LAKEWAY
EMERGENCY
MEDICINE
GASTROENTEROLOG
Y
DALLAS
MATERNAL AND
FETAL MEDICINE
Disciplinary
Status Date
NY
INTERNAL MEDICINE
ANESTHESIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
BROOKLYN
INTERNAL MEDICINE INTERNAL MEDICINE IOWA CITY
INTERNAL MEDICINE HOSPITALIST
HOUSTON
INTERNAL MEDICINE
MIDLAND
UROLOGIC SURGERY UROGYNECOLOGY
CRITICAL CARE
EMERGENCY
2/18/2019 MEDICINE
P9337
Secondary Specialty
(Self-Designated)
GASTROENTEROLOG
Y
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
TX
TEXARKANA
GARLAND
TX
TX
ACTIVE
ACTIVE
8/24/2015 None
1/5/2012 None
N/A
N/A
BROOKLYN
NY
ACTIVE
7/21/2014 None
N/A
ACTIVE
4/30/2014 None
N/A
ACTIVE
LICENSE
ISSUED
1/9/2012 None
N/A
2/1/2012 None
N/A
ACTIVE
ACTIVE
8/9/2011 None
6/9/2014 None
N/A
N/A
1/2/2012
P1992
ENG, DAVID ROBERT, MD
ENG, KRISTINA MARIE-MARTEL,
MD
SAN ANTONIO TX
2/1/2012
P0202
Q0434
ENG, MARVIN HO-KEUNG, MD
ENG, MATTHEW, MD
7/1/2011
6/2/2014
CARDIOVASCULAR
7/1/2016 DISEASES
DALLAS
TX
Page 105 of 402
License
Number
Physician Name
P6613
ENGELHARDT, CANDACE, MD
ENGELHARDT, KEVIN PATRICK,
P5622
MD
ENGELMANN, LAUREN
Q3179
ANNELIESE, MD
ENGLAND, CHRISTOPHER RAY,
Q6184
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
5/15/2013
PEDIATRICS,
3/1/2013
3/1/2018 CARDIOLOGY
PEDIATRICS
2/13/2015
10/1/2015
OBSTETRICS AND
15-Dec-20 GYNECOLOGY
EMERGENCY
3/1/2017 MEDICINE
Q6746
P4947
ENGLAND, JOEY ANN, MD
ENWEMNWA, NNEAMAKA, MD
15-Dec-15
11/30/2012
P2232
EPPEL, KONRAD JOSEPH, MD
3/1/2012
P0203
Q6829
EPPS, WILLIAM JAMES, MD
ERICKSON, KEVIN FURMAN, MD
7/1/2011
06-Jan-16
06-Jan-21 NEPHROLOGY
Q0252
ERICSON, STEPHANIE ANNE, MD
5/15/2014
Q2443
ERKONEN, GWEN ELAINE, MD
11/17/2014
P1455
ERWIN, JAMIE LIN WALKER, MD
11/15/2011
Q7038
ESANGBEDO, IVIE DORIS, MD
01-Feb-16
PEDIATRIC CRITICAL
OBSTETRICS AND
PEDIATRIC CRITICAL
01-Feb-21 CARE MEDICINE
P2233
ESCALANTE, THERESA JEAN, MD
3/1/2012
P1994
ESCANDON, JOSE AMBROSIO, MD
P1749
ESCHBERGER, ANNE MARIE , MD
ESCOBAR CAMARGO, JORGE
MARIO, MD
P4863
P7106
P6161
P6811
Q4750
Q2659
Q1597
P6966
Q4946
ESCORCIA, EDUARDO , MD
ESCOVAR, EKTA SAHEBA, MD
ESCOVAR, RAPHAEL, MD
ESFAHANI, FATEMEH
BAGHERIANNEJAD, MD
ESHO, ADENIKE, MD
ESIN, ESHAMU , MD
ESPARZA, LUIS MIGUEL, MD
ESPINOZA, DAVID ROBERTO, MD
Registration
Status of
Practice
Texas
Practice City
State
License
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
OTORHINOLARYNGO
LOGY
EL PASO
MATERNAL AND
FETAL MEDICINE
EMERGENCY
KLAMATH
MEDICINE
FALLS
TX
OR
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/22/2013 None
N/A
3/1/2013 None
N/A
2/13/2015 None
N/A
ACTIVE
10/14/2015 None
N/A
ACTIVE
ACTIVE
25-Mar-16 None
12/11/2012 None
N/A
N/A
3/28/2012 None
N/A
7/1/2011 None
11-Jan-16 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/15/2014 None
N/A
11/17/2014 None
N/A
ACTIVE
11/18/2011 None
N/A
DALLAS
TX
ACTIVE
19-Feb-16 None
N/A
KERRVILLE
TX
ACTIVE
4/10/2012 None
N/A
2/1/2012
HARLINGEN
TX
ACTIVE
2/3/2012 None
N/A
1/2/2012
BRYAN
TX
ACTIVE
1/17/2012 None
N/A
CARDIOLOGY
HOUSTON
TX
ACTIVE
12/24/2012 None
N/A
ANESTHESIOLOGY
AUSTELL
GA
ALPINE
TX
8/19/2013 None
4/17/2013 None
6/5/2013 None
N/A
N/A
N/A
MIDLAND
EL PASO
LUBBOCK
SAN ANTONIO
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/12/2015
2/13/2015
9/1/2014
6/18/2013
7/20/2015
N/A
N/A
N/A
N/A
N/A
11/15/2012
7/1/2013
4/12/2013
6/3/2013
6/12/2015
12/15/2014
8/29/2014
6/14/2013
7/1/2015
6/12/2020
12/15/2019
8/29/2019
6/14/2018
7/1/2020
INTERNAL MEDICINE
INTERNAL MEDICINE PUBLIC HEALTH
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
Page 106 of 402
None
None
None
None
None
License
Number
P2983
P0206
Physician Name
ESPINOZA-ERVIN, CHRISTOPHER,
MD
P1860
ESQUILIN, JOSE MANUEL, MD
ESQUIVEL, HEATHER MICHELE,
MD
ESQUIVEL-VANEGAS, GERMAN
ROMAN, MD
P4864
ESSANI, RAHILA, MD
Q2994
ESTEVEZ, ROSA MARLENY, MD
ESTRADA VELEZ, CARLOS
ANDRES, MD
ESTRADA, KRYSTAL A, MD
ESUZOR, LINDA CHIBUZOR, MD
ETEMADI, ALIREZA, MD
ETOKHANA, KENNETH
OSHIOKHAYAMHE, MD
ETTINGER, NICHOLAS ANDREAS,
MD
Q7362
P9559
Q6185
P5623
P5973
P2438
Q6186
dicaid
dicaid
Agreement
End Date
Designated)
ORTHOPEDIC
5/1/2012
5/1/2017 SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
7/1/2011
7/1/2016 OGY
04-Mar-16
1/17/2012
11/15/2012
2/2/2015
4/1/2019
10/1/2020
3/1/2018
4/1/2018
3/15/2012
10/1/2015
EVANS, AMANDA SUAREZ, MD
10/3/2011
P9338
Q0042
EVANS, ERICA L, MD
EVANS, JOSHUA MARK, DO
3/17/2014
5/2/2014
Q2545
EVANS, LAUREN DEEANN, MD
12/3/2014
Q3872
4/10/2015
P5625
EVANS, RICKY LEE, MD
EVERETT, CHRISTOPHER JAVIER,
MD
EVERETT, JENNIFER MICHELLE,
DO
P7107
EVERETT, JEREMY CHAD, DO
Q0253
EVERSGERD, JAYSON LEE, DO
Q4095
COLON AND RECTAL
11/15/2017 SURGERY
EMERGENCY
2/2/2020 MEDICINE
INTERNAL MEDICINE
FAMILY MEDICINE
HOSPITALIST
FAMILY MEDICINE
3/1/2013
7/1/2013
5/15/2014
Registration
Status Date
Disciplinary
Status Date
5/1/2012 None
N/A
TX
ACTIVE
7/11/2011 None
N/A
DALLAS
TX
ACTIVE
04-Apr-16 None
N/A
MCALLEN
TX
ACTIVE
1/23/2012 None
N/A
GENERAL SURGERY TEMPLE
TX
ACTIVE
12/3/2012 None
N/A
HOUSTON
CRITICAL CARE
CHRISTIANSB
MEDICINE
URG
FAMILY MEDICINE
WACO
ALISO VIEJO
TX
ACTIVE
2/4/2015 None
N/A
VA
TX
TX
CA
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/8/2014
10/7/2015
3/25/2013
4/12/2013
None
None
None
None
N/A
N/A
N/A
N/A
BRONX
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
NY
ACTIVE
3/21/2012 None
N/A
TX
ACTIVE
10/5/2015 None
N/A
DALLAS
TX
ACTIVE
11/15/2011 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
5/7/2014 None
5/12/2014 None
N/A
N/A
TEMPLE
TX
ACTIVE
12/5/2014 None
N/A
BEAUMONT
TX
ACTIVE
LICENSE
ISSUED
4/13/2015 None
N/A
5/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2013 None
N/A
7/1/2013 None
N/A
5/15/2014 None
N/A
PEDIATRIC
EMERGENCY
3/17/2019 MEDICINE
INTERVENTIONAL
12/3/2019 RADIOLOGY
RADIOLOGY
OBSTETRICS AND
5/1/2015
Practice City
Disciplinary
Status of
Texas
License
CORPUS
CHRISTI
4/1/2014
10/1/2015
3/1/2013
4/1/2013
P1070
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
EMERGENCY
5/15/2019 MEDICINE
Page 107 of 402
WOODLANDS TX
dicaid
dicaid
License
Agreement
Agreement Primary Specialty (SelfNumber
Physician Name
Start Date
End Date
Designated)
NEUROLOGICAL
Q7685
EVERSON, RICHARD GEORGE, MD
01-Apr-16
01-Apr-21 SURGERY
P2641
EVERT, LISA MARIE, MD
P5062
EWING, JAMES I, MD
12/17/2012
P5062
EWING, JAMES I, MD
12/17/2012
P5062
EWING, JAMES I, MD
12/17/2012
Q0909
Q1399
P7432
EWING, MANUELA, MD
EWOH, CHARLES EGBO, MD
EXUM, KELVIN, MD
P1995
P5178
4/2/2012
7/15/2014
8/15/2014
8/1/2013
Q0043
EZZATI, MOHAMMAD, MD
FABELA, PAUL ANDREW, MD
FAGBAMI, OLUWAKEMI YETUNDE,
MD
Q6187
P5063
P5063
P5063
FAHOUM, SAMER HANNA, MD
FAHOURY, ALEX IBRAHIM, MD
P8026
FAIRBROTHER, HILARY EVE, MD
10/1/2013
Q1819
FAIRLEY, ROMEO , MD
9/15/2014
P9562
FAKHOURI, TAREK M, MD
P1299
FAKIR, SAMI M, MD
Q4947
Q5648
FALCON, JACOB , MD
FALEBITA, OLUWATOYIN TOLANI,
MD
Q2444
FALEBITA, OPEYEMI, MD
2/1/2012
1/4/2013
5/2/2014
10/1/2015
12/17/2012
12/17/2012
12/17/2012
4/1/2014
11/4/2011
7/1/2015
HEMATOLOGY/ONCOL
12/17/2017 OGY
HEMATOLOGY/ONCOL
12/17/2017 OGY
HEMATOLOGY/ONCOL
12/17/2017 OGY
EMERGENCY
7/15/2019 MEDICINE
8/1/2018 PSYCHIATRY
OBSTETRICS AND
2/1/2017 GYNECOLOGY
PULMONARY
CRITICAL CARE
10/1/2020 MEDICINE
EMERGENCY
10/1/2018 MEDICINE
EMERGENCY
9/15/2019 MEDICINE
DIAGNOSTIC
11/4/2016 RADIOLOGY
EMERGENCY
7/1/2020 MEDICINE
8/14/2015
11/17/2014
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
CRITICAL CARE
ANESTHESIOLOGY
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
13-Apr-16 None
N/A
4/2/2012 None
N/A
12/17/2012 None
N/A
TX
ACTIVE
1/14/2013 None
N/A
TX
ACTIVE
1/14/2013 None
N/A
AUSTIN
TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
8/5/2014 None
8/18/2014 None
8/7/2013 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
2/17/2012 None
1/7/2013 None
N/A
N/A
HOSPITALIST
DALLAS
DENTON
WEST
READING
PA
ACTIVE
5/6/2014 None
N/A
INTERNAL MEDICINE
HOSPITALIST
HOSPITALIST
HOSPITALIST
FORTWORTH
BROCKPORT
BROCKPORT
BROCKPORT
TX
NY
NY
NY
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/5/2015
1/7/2013
1/7/2013
1/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
BROOKLYN
NY
ACTIVE
10/3/2013 None
N/A
AUSTIN
TX
ACTIVE
9/30/2014 None
N/A
DEARBORN
MI
ACTIVE
4/2/2014 None
N/A
NUCLEAR MEDICINE DETROIT
MI
ACTIVE
11/15/2011 None
N/A
KYLE
CARRIZO
SPRING
TX
ACTIVE
7/2/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/24/2015 None
N/A
11/17/2014 None
N/A
INTERNAL MEDICINE
REPRODUCTIVE
ENDOCRINOLOGY
AND INFERTILITY
DERMATOLOGIC
SURGERY
Page 108 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q0044
FALLON, SARA CHILDRESS, MD
5/2/2014
P0207
FANG, XIANG , MD
7/1/2011
7/1/2016 NEUROLOGY
Q1600
FANKHAUSER, GRANT THOMAS,
MD
8/29/2014
P8468
Q1980
Q4578
P3149
FANNELL, MATTHEW WALKER, MD
FANNING, JOHN PAUL, DO
FARACH, LAURA SCHOCH, MD
FARAHAT, ALAA, MD
12/6/2013
10/1/2014
6/1/2015
5/15/2012
P8896
FARAHMAND, FOAD, MD
P8664
Q5649
FARBER, GERALD LAVON, MD
FARDAL, JOHN PATRICK, DO
Q3670
FARES, SALAH, MD
Q5650
FARHAT, DAVID WILLIAM, MD
8/14/2015
Q2278
FARINETTI, FABIANA ZIEGLER, MD
11/7/2014
P6614
FARKAS, JORDAN PHILLIP, MD
5/15/2013
2/7/2014
1/3/2014
8/14/2015
4/1/2015
EMERGENCY
12/6/2018 MEDICINE
PEDIATRICS
ORTHOPEDIC
1/3/2019 SURGERY
SURGERY
PULMONARY
CRITICAL CARE
4/1/2020 MEDICINE
INTERNAL MEDICINE
EMERGENCY
8/14/2020 MEDICINE
PLASTIC &
RECONSTRUCTIVE
5/15/2018 SURGERY
Q1400
Q4096
FAROOQ, UZMA, MD
FAROOQI, SAMINA SIYAR, MD
8/15/2014
5/1/2015
Q1144
FAROOQI, SOFIA AHMED, DO
8/1/2014
8/15/2019 PATHOLOGY
5/1/2020 PEDIATRICS
EMERGENCY
8/1/2019 MEDICINE
Q3873
P1640
FAROOQUI, ASIM ASHRAF, MD
FAROUSSI, SAWSAN, MD
4/10/2015
12/15/2011
12/15/2016 PATHOLOGY
Q6412
FARR, DEBORAH ELAINE, MD
P2237
FARR, MICHAEL BENJAMIN, DO
11/2/2015
3/1/2012
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
Page 109 of 402
N/A
N/A
LICENSE
ISSUED
7/1/2011 None
UNDER
BOARD
8/29/2014 ORDER
8/29/2014
TX
TX
TX
IA
ACTIVE
ACTIVE
ACTIVE
ACTIVE
12/9/2013
10/6/2014
6/3/2015
5/16/2012
None
None
None
None
N/A
N/A
N/A
N/A
YUKON
OK
ACTIVE
2/19/2014 None
N/A
ODESSA
AUSTIN
TX
TX
ACTIVE
ACTIVE
1/7/2014 None
8/27/2015 None
N/A
N/A
THE
WOODLANDS TX
ACTIVE
4/2/2015 None
N/A
TEXARKANA
TX
ACTIVE
8/24/2015 None
N/A
HOUSTON
TX
ACTIVE
11/10/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/20/2013 None
N/A
8/15/2014 None
5/21/2015 None
N/A
N/A
8/4/2014 None
N/A
4/10/2015 None
12/20/2011 None
N/A
N/A
HOUSTON
11/2/2020 BREAST ONCOLOGY
ORTHOPEDIC
3/1/2017 SURGERY
5/2/2014 None
Disciplinary
Status Date
TEMPLE
FT BLISS
HOUSTON
FORT DODGE
DERMATOPATHOLO
GY
CYTOPATHOLOGY
SURGICAL
ONCOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
JACKSON
MS
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
11/3/2015 None
N/A
ACTIVE
3/13/2012 None
N/A
License
Number
Q4948
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1457
P7109
FARR, NORMAN MILES, MD
FARRACH, HUSSEM ALEJANDRO,
MD
FARRAG, SAFA ELSEBAI, MD
11/15/2011
7/1/2013
Q0630
FARRIS, TIMOTHY RAYMOND, MD
6/16/2014
Q0254
FARZAD, ALI, MD
5/15/2014
EMERGENCY
5/15/2019 MEDICINE
GYNECOLOGIC
6/8/2017 ONCOLOGY
P3528
Q8473
FARZAN, THAHIR , MD
FATIMA, ANEES, MD
P8582
FATIMA, AZIM, MD
7/1/2015
6/8/2012
01-Jun-16
12/16/2013
P7763
FAUSETT, MERLIN BARDETT, MD
8/30/2013
P8665
FAUST, JOHN ROBERT, MD
FAWEYA, AYOTUNDE GREGORY,
MD
1/3/2014
P4646
Secondary Specialty
(Self-Designated)
MATERNAL AND
PEDIATRIC
EMERGENCY
MEDICINE
GYNECOLOGIC
SURGERY
OBSTETRICS AND
GYNECOLOGY
ORTHOPEDIC
SURGERY
FAYAD, ZIAD YOUSSEF, MD
FEDARAU, MAKSIM
ALEKSANDROVICH, MD
FEDERICO, MASSIMO DOMENICO,
MD
11/15/2012
9/17/2012
EMERGENCY
9/17/2017 MEDICINE
8/15/2014
7/15/2015
11/16/2015
Q5183
FEDOR, DAVID MATTHEW, DO
FEDSON, SAVITRI, MD
FEETHAM, HATTIE JILL, MD
FEHLIS, KIMBERLY CATHERINE,
MD
7/15/2015
P1751
Q0631
Q7364
FEIGENBAUM, FRANK, MD
FEIN, MINDY HARRIS, MD
FEINGOLD, WILLIAM ISAAC, DO
1/2/2012
6/16/2014
04-Mar-16
Q7687
FEINSTEIN, STEVEN J, MD
01-Apr-16
P5974
FELDMAN, LILIYA, MD
NEUROLOGICAL
1/2/2017 SURGERY
OBSTETRICS AND
HEMATOLOGY
4/1/2018 (PATHOLOGY)
P6813
P4441
Q1401
Q5181
Q6506
6/3/2013
4/1/2013
Disciplinary
Status Date
TX
ACTIVE
7/3/2015 None
N/A
ARDMORE
EL PASO
OK
TX
ACTIVE
ACTIVE
11/25/2011 None
7/4/2013 None
N/A
N/A
7/1/2014 None
N/A
5/15/2014 None
N/A
6/11/2012 None
06-Jun-16 None
N/A
N/A
12/16/2013 None
N/A
8/30/2013 None
N/A
1/10/2014 None
N/A
11/30/2012 None
N/A
11/15/2012 None
N/A
6/3/2013 None
N/A
AMARILLO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
STARKE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
FORT HOOD
CRITICAL CARE
MEDICINE
OGDEN
INTERNAL MEDICINE
DERMATOLOGY
DALLAS
MARBLE
FALLS
FL
TX
ACTIVE
9/19/2012 None
N/A
UT
TX
ACTIVE
ACTIVE
ACTIVE
8/19/2014 None
7/22/2015 None
11/17/2015 None
N/A
N/A
N/A
TX
ACTIVE
7/27/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
1/9/2012 None
6/25/2014 None
16-Mar-16 None
N/A
N/A
N/A
TX
ACTIVE
06-Apr-16 None
N/A
NJ
ACTIVE
4/12/2013 None
N/A
KANSAS CITY MO
HOUSTON
TX
DALLAS
TX
MATERNAL AND
FETAL MEDICINE
EL PASO
ANATOMIC/CLINICAL ELMWOOD
PATHOLOGY
PARK
Page 110 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
TEXAS CITY
SAN ANTONIO TX
10/15/2012
P4865
Practice City
Registration
Status of
Practice
Texas
State
License
License
Number
P0975
P0208
P2238
P7436
Q7365
Physician Name
FELIZ RODRIGUEZ, NILSON DAVID,
MD
FELTON, JASON ANDREW, MD
FENG, ZICHUN , MD
FERGUSON, ANGELA GREMILLION,
DO
FERGUSON, CHRIS-GERALD, MD
FERGUSON, JAMES EDWARD III,
MD
dicaid
dicaid
Agreement
End Date
Designated)
9/15/2011
7/1/2011
3/1/2012
ACTIVE
9/21/2011 None
N/A
LUBBOCK
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/28/2011 None
3/9/2012 None
N/A
N/A
LUBBOCK
SAN ANGELO
TX
TX
ACTIVE
ACTIVE
8/5/2013 None
07-Mar-16 None
N/A
N/A
HOUSTON
TX
ACTIVE
04-Apr-16 None
N/A
LUBBOCK
TX
ACTIVE
8/23/2013 None
N/A
DALLAS
TX
ACTIVE
7/28/2015 None
N/A
HOUSTON
TX
ACTIVE
4/13/2015 None
N/A
FORT WORT
TX
ACTIVE
LICENSE
ISSUED
10/7/2013 None
N/A
3/16/2015 None
N/A
7/1/2015
Q3672
P7909
FERNANDEZ, DAVID ALVARO, DO
9/16/2013
Q3511
4/1/2015
3/16/2015
Q0045
FERNANDEZ, DIANE ROXANNE, MD
FERNANDEZ, EDGAR EDUARDO,
MD
P1301
FERNANDEZ, JIMMY DANIEL, MD
11/4/2011
P6815
FERNANDEZ, JUAN FELIPE, MD
Q5400
P2439
FERNANDEZ, WILLIAM, MD
FERNANDO, SANTHI, MD
8/3/2015
3/15/2012
P2440
FERONTI, CHARLES JAMES, DO
3/15/2012
Q0436
5/2/2014
6/3/2013
Disciplinary
Status Date
TX
7/15/2013
Q4949
Registration
Status Date
ABILENE
FERGUSON, MATTHEW PAUL, MD
FERNANDEZ PALMER, MANUEL
AGUSTIN, MD
FERNANDEZ, CRISTINA
MARGARITA, MD
P7271
01-Feb-16
Practice City
Disciplinary
Status of
Texas
License
NEUROLOGICAL
7/1/2016 SURGERY
UROLOGIC
01-Feb-21 ONCOLOGY
ORTHOPEDIC
7/15/2018 SURGERY
Q7040
8/1/2013
04-Mar-16
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
UROLOGY
EMERGENCY
9/16/2018 MEDICINE
3/16/2020 PATHOLOGY
ORTHOPEDIC
5/2/2019 SURGERY
PULMONARY
CRITICAL CARE
6/3/2018 MEDICINE
EMERGENCY
8/3/2020 MEDICINE
EMERGENCY
3/15/2017 MEDICINE
HEMATOLOGY
(PATHOLOGY)
ACTIVE
HOSPITALIST
PSYCHIATRY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
CARDIOTHORACIC
ANESTHESIOLOGY
HOSPITALIST
6/2/2014
Q0751
P1996
FERRARI, ANNABELLA , MD
FERREIRA MARACAJA NETO, LUIZ,
MD
FERRUFINO, LUIS EDGARDO, MD
6/27/2014
2/1/2012
Q4398
FETZKO, STEPHANIE LYNNE, MD
5/15/2015
Page 111 of 402
5/5/2014 None
SEE
PREVIOUS
12/15/2011 ORDER
N/A
SAN ANTONIO TX
ACTIVE
EL PASO
TX
ACTIVE
6/14/2013 None
N/A
HOUSTON
SAN ANGELO
TX
TX
ACTIVE
ACTIVE
8/20/2015 None
4/17/2012 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
4/19/2012 None
N/A
HOUSTON
TX
ACTIVE
6/4/2014 None
N/A
SAN ANTONIO TX
MCALLEN
TX
ACTIVE
ACTIVE
7/2/2014 None
2/6/2012 None
N/A
N/A
HOUSTON
ACTIVE
5/20/2015 None
N/A
TX
11/16/2011
License
Number
Physician Name
P0209
FEY, VICTOR, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2011
Q2279
P3529
FEYGIN, POLINA T, MD
FIELDS, JOANNA RENEE, MD
11/7/2014
6/8/2012
P1072
Q4950
FIERKE, SHELBY RYAN, MD
FIKE, FRANKIE BETH, MD
10/3/2011
7/1/2015
10/3/2016 RADIOLOGY
7/1/2020 PEDIATRIC SURGERY
P3321
FILETTI, LUSIA CRISTINA, MD
6/1/2012
P0582
FILIPETTO, FRANK ANTHONY, DO
FILLINGANE, CHARLES SAMUEL II,
DO
FINCH, ROBERT E JR, MD
FINNERTY, KATIE NICOLE, MD
8/1/2011
8/1/2013
8/1/2014
3/1/2013
Q5185
7/15/2015
P0583
FIRAN, MIHAIL , MD
FIROUZTALE, PEJMAN AVRAHAM,
MD
Q3182
FIROZ, NAJAM MUHAMMAD, MD
2/13/2015
P6386
FIRZLI, ELIE SALIM, MD
5/1/2013
Q5401
FISHER, BETH ANN, MD
8/3/2015
P6387
FISHER, CHRISTINE, MD
5/1/2013
Q4099
FISHER, DAVID RAY, DO
5/1/2015
8/1/2011
Q0632
FISHER, KEVIN EDWARD, MD
6/16/2014
P7273
FITZGERALD, TAMARA N, MD
FITZPATRICK, THOMAS MICHAEL,
MD
FITZWATER, JOHN WELTON, MD
7/15/2013
P2987
P1753
5/1/2012
1/2/2012
FAMILY PRACTICE
PEDIATRIC
RADIOLOGY
Practice City
CLINTON
RANCHO
PALOS
VERDES
LAREDO
ACTIVE
ACTIVE
11/12/2014 None
6/18/2012 None
N/A
N/A
OH
TX
ACTIVE
ACTIVE
10/12/2011 None
7/9/2015 None
N/A
N/A
LICENSE
ISSUED
6/1/2012 None
N/A
TX
ACTIVE
8/5/2011 None
N/A
PORT LAVACA TX
8/13/2013 None
8/11/2014 None
3/7/2013 None
N/A
N/A
N/A
CINCINNATI
DALLAS
SAGINAW
OBSTETRICS
HEMATOLOGY
(PATHOLOGY)
7/15/2020 PATHOLOGY
DIAGNOSTIC
8/1/2016 RADIOLOGY
PEDIATRIC
5/1/2018 NEPHROLOGY
CRITICAL CARE
PLASTIC &
RECONSTRUCTIVE
5/1/2018 SURGERY
EMERGENCY
5/1/2020 MEDICINE
ANATOMIC/CLINICAL
6/16/2019 PATHOLOGY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
7/12/2011 None
N/A
CA
TN
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
P7438
Q1146
P5627
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
OK
ACTIVE
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
7/28/2015 None
N/A
ATLANTA
GA
ACTIVE
LICENSE
ISSUED
8/22/2011 None
N/A
2/13/2015 None
N/A
ACTIVE
5/13/2013 None
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE ST. LOUIS
MO
ACTIVE
8/6/2015 None
N/A
COSMETIC SURGERY AUSTIN
TX
ACTIVE
6/3/2013 None
N/A
ACTIVE
5/12/2015 None
N/A
TX
ACTIVE
6/25/2014 None
N/A
EL PASO
TX
JACKSONVILL
E
TX
LUBBOCK
TX
ACTIVE
8/21/2013 None
N/A
ACTIVE
ACTIVE
6/5/2012 None
1/5/2012 None
N/A
N/A
MOLECULAR
GENETIC
PATHOLOGY
ORTHOPEDIC
5/1/2017 SURGERY
Page 112 of 402
HOUSTON
License
Number
Q2129
Physician Name
FIVECOAT, PHILLIP TRENT, DO
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
10/15/2014
10/15/2019 MEDICINE
FORT WORTH TX
FLAHERTY, STEPHEN, MD
P5975
FLANAGAN, MARK NICHOLAS, DO
Q7191
FLEMING, MICHAEL JAMES, MD
16-Feb-16
EMERGENCY
4/1/2018 MEDICINE
EMERGENCY
16-Feb-21 MEDICINE
Q8054
FLETCHER, JAMES, MD
02-May-16
02-May-21 PALLIATIVE MEDICINE NEPHROLOGY
P6816
Q2765
FLETCHER, JEFFREY CLAY JR, DO
FLETCHER, THOMAS PAUL, MD
Q8717
FLOM, JUDITH, MD
10-Jun-16
P8775
FLOREK, RODNEY SEVERIN, MD
1/15/2014
Q8475
P2441
FLORES AGUAYO, ANDRES A, MD
FLORES, AMY WALLACE, MD
01-Jun-16
3/15/2012
Q4101
FLORES, JESUS , MD
5/1/2015
P1754
P1755
FLORES, JOSE, MD
FLORES, RENEE J, MD
1/2/2012
1/2/2012
Q6831
FLORES, ROBERTO III, MD
Q2766
FLORES, ROBERTO JESUS, MD
P9342
FLOYD, BRIAN R, MD
1/15/2019 RADIOLOGY
OBSTETRICS AND
COLON AND RECTAL
5/1/2020 SURGERY
INFECTIOUS
1/2/2017 DISEASES
EMERGENCY
06-Jan-21 MEDICINE
EMERGENCY
1/5/2020 MEDICINE
EMERGENCY
3/17/2019 MEDICINE
FLOYD, CARALYN JEAN, DO
P0211
FLOYED, REBECCA LYNN, MD
P9567
Q7366
FLURRY, MITCHELL DUNCAN, MD
FLYNN, ADAM NEILL, MD
4/1/2013
6/3/2013
1/5/2015
06-Jan-16
1/5/2015
3/17/2014
8/28/2015
7/1/2011
4/1/2014
04-Mar-16
Practice City
TRAUMATIC
SURGERY
Q0257
Q5797
5/15/2014
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
1/5/2020 PSYCHIATRY
INFECTIOUS
DISEASES
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
GYNECOLOGIC
SURGERY
BEAUMONT
CAMP
LEJEUNE
Disciplinary
Status Date
10/23/2014 None
N/A
5/15/2014 None
N/A
4/1/2013 None
N/A
TX
ACTIVE
14-Mar-16 None
N/A
NC
ACTIVE
11-May-16 None
N/A
SAN ANTONIO TX
GALVESTON TX
ACTIVE
ACTIVE
7/3/2013 None
1/9/2015 None
N/A
N/A
ACTIVE
15-Jun-16 None
N/A
ACTIVE
1/27/2014 None
N/A
ACTIVE
ACTIVE
03-Jun-16 None
3/26/2012 None
N/A
N/A
TX
ACTIVE
6/11/2015 None
N/A
DERBY
CT
ACTIVE
ACTIVE
1/10/2012 None
2/14/2012 None
N/A
N/A
WACO
TX
ACTIVE
07-Jan-16 None
N/A
ACTIVE
1/9/2015 None
N/A
ACTIVE
3/25/2014 None
N/A
ACTIVE
9/1/2015 None
N/A
EL PASO
TX
SAN ANTONIO TX
GENERAL SURGERY LUBBOCK
INTERNAL MEDICINE
RIVERTON
WY
GERIATRIC
PSYCHIATRY
PEDIATRIC
EMERGENCY
PLASTIC &
RECONSTRUCTIVE
4/1/2019 SURGERY
PLASTIC SURGERY
HOSPITALIST
Page 113 of 402
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
AUSTIN
TX
ACTIVE
7/11/2011 None
N/A
DALLAS
WICHITA
TX
KS
ACTIVE
ACTIVE
4/8/2014 None
21-Mar-16 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q4103
FOGARTY, JAMES PATRICK JR, MD
5/1/2015
P8667
1/3/2014
P9068
FOLB, LEAH CLAIRE, MD
FOLKERSON, LINDLEY ELIZABETH,
MD
FOLORUNSHO, ADENIKE OYINKAN,
MD
2/18/2014
ENDOCRINOLOGY,
DIABETES AND
1/3/2019 METABOLISM
EMERGENCY
4/1/2020 MEDICINE
EMERGENCY
2/18/2019 MEDICINE
Q3184
FOMUNUNG, EDMOND NKETTI, MD
2/13/2015
Q3673
4/1/2015
P5804
FONG, ALEXANDER ERIC, MD
3/15/2013
3/15/2018 NEUROLOGY
Q8476
P3623
FONG, AMELIA ANN, MD
FONKEM, EKOKOBE, DO
01-Jun-16
6/15/2012
Q4105
P6389
FONSECA, ANNABELLE LEAH, MD
FONTENOT, BENNETT BOUSTANY,
MD
01-Jun-21 OPHTHALMOLOGY
6/15/2017 NEUROLOGY
SURGICAL
5/1/2020 ONCOLOGY
P3322
Q5186
FOO, WAI CHIN , MD
FORAGE, JOHN WILLIAM, MD
6/1/2012
7/15/2015
P6164
FORBES, JOANNA , MD
4/12/2013
Q8244
FORD, JONATHAN ROSS, MD
P7910
5/1/2015
5/1/2013
16-May-16
Q8056
FORD, MICHAEL CARTER, MD
FORDHAM, MORGAN TAYLOR JR,
MD
FORERO, JULIE FREDERICKSON,
DO
02-May-16
P1545
FORNARI, GIANLUIGI ALOISIO, MD
12/1/2011
Q4106
FORZANI, BRIAN RICHARD, MD
P9851
9/16/2013
4/15/2014
5/1/2015
Secondary Specialty
(Self-Designated)
Practice City
GALVESTON
5/11/2015 None
N/A
TX
ACTIVE
1/24/2014 None
N/A
HOUSTON
TX
ACTIVE
4/3/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
2/28/2014 None
N/A
2/13/2015 None
N/A
TX
ACTIVE
4/23/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
06-Jun-16 None
6/18/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/4/2015 None
N/A
HOUSTON
TX
ACTIVE
5/6/2013 None
N/A
HOUSTON
AMARILLO
TX
TX
ACTIVE
ACTIVE
6/7/2012 None
7/23/2015 None
N/A
N/A
DALLAS
TX
ACTIVE
4/18/2013 None
N/A
FORT WORTH TX
ACTIVE
20-May-16 None
N/A
ACTIVE
9/19/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/24/2014 None
N/A
02-May-16 None
N/A
HOUSTON
PLASTIC SURGERY
SELECTIVE
PATHOLOGY
OPHTHALMOLOGY ANTERIOR SURGERY TYLER
TX
SAN ANTONIO TX
02-May-21 DERMATOLOGY
12/1/2016 RADIOLOGY
PHYSICAL MED. &
Disciplinary
Status Date
ACTIVE
OPHTHALMOLOGY RECONST SURGERY DALLAS
NEURO-ONCOLOGY TEMPLE
PEDIATRIC
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
VASCULAR
NEUROLOGY
ANATOMIC
6/1/2017 PATHOLOGY
OBSTETRICS AND
EMERGENCY
16-May-21 MEDICINE
Registration
Status of
Practice
Texas
State
License
BREAST IMAGING
LUBBOCK
TX
ACTIVE
12/30/2011 None
N/A
PAIN MEDICINE
AUSTIN
TX
ACTIVE
5/5/2015 None
N/A
Page 114 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
HEMATOLOGY/ONCOL
9/16/2013
9/16/2018 OGY
PEDIATRICS
4/1/2015
4/1/2020 RADIOLOGY
BODY IMAGING
PULMONARY
CRITICAL CARE
5/1/2015
5/1/2020 INTERNAL MEDICINE MEDICINE
DIAGNOSTIC
ABDOMINAL
5/15/2015
5/15/2020 RADIOLOGY
RADIOLOGY
2/1/2013
8/29/2014
P7912
Q3674
FOSTER, JENNIFER HAUNANI, MD
FOSTER, MICHAEL A, MD
Q4107
FOSTER, MICHAEL LAWRENCE,
MD
Q4399
P5362
Q1601
FOSTER, TANJA MINOVA, MD
FOSTER, TROY , DO
FOULADI RAD, SHERVIN , MD
P1863
FOWLER, AJA JENELLE, MD
1/17/2012
P2443
3/15/2012
Q4751
FOWLER, MICHELE MARIE, DO
FOX, CHRISTINA ARETI
GOUGOUTAS, MD
J9035
FOX, JOHN ALAN, MD
2/13/2015
P4950
FOX, LINDSAY ARNOULT, MD
P2988
FOX, MATTHEW C, MD
P8131
FOX, NIKKI SHANDELL, DO
10/15/2013
P4951
FOX, WILLIAM CORY, MD
11/30/2012
P2239
Q5798
FRACHTMAN, STEVEN JAY, MD
FRANCE, ADRIAN KAY, MD
FRANCESCONI, JAMES EDWARD,
MD
FRANCISCO, ANNA MARIE
TUNGOL, MD
TUNGOL, MD
TUNGOL, MD
P3624
P5065
P5065
P5065
6/12/2015
11/30/2012
5/1/2012
3/1/2012
8/28/2015
6/15/2012
EMERGENCY
3/15/2017 MEDICINE
DIAGNOSTIC
6/12/2020 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
HOUSTON
GROVE
TX
OK
ACTIVE
ACTIVE
9/19/2013 None
4/3/2015 None
N/A
N/A
DALLAS
TX
ACTIVE
5/4/2015 None
N/A
DALLAS
TX
BAYTOWN
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
5/18/2015 None
2/6/2013 None
9/1/2014 None
N/A
N/A
N/A
1/17/2012 None
N/A
4/6/2012 None
N/A
6/12/2015 None
N/A
2/13/2015 None
N/A
HOUSTON
TX
DALLAS
TX
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
ANESTHESIOLOGY
HOUSTON
TX
ACTIVE
12/5/2012 None
N/A
DERMATOLOGY
AUSTIN
TX
ACTIVE
5/18/2012 None
N/A
ACTIVE
11/27/2013 None
N/A
BREAST IMAGING
PEDIATRIC
CARDIOTHORACIC
DERMATOLOGIC
5/1/2017 SURGERY
PAIN
MANAGEMENT/REHAB
10/15/2018 MED
INTERVENTIONAL
GASTROENTEROLOG
3/1/2017 Y
Registration
Status Date
Disciplinary
Status of
Texas
License
PAIN MANAGEMENT
DIAGNOSTIC
RADIOLOGY
6/15/2017 NEUROLOGY
SUGARLAND
TX
ACTIVE
12/5/2012 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
3/15/2012 None
9/3/2015 None
N/A
N/A
SHERMAN
TX
ACTIVE
6/20/2012 None
N/A
12/17/2012
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
12/17/2012
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
12/17/2012
ODESSA
TX
ACTIVE
1/7/2013 None
N/A
Page 115 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
16-Feb-16
ORTHOPEDIC
16-Feb-21 SURGERY
Secondary Specialty
(Self-Designated)
SURGERY
Q7192
FRANCISCO, BEN SCOTT, MD
P2643
FRANKFURT, JOSHUA AARON, MD
Q1404
FRANKLIN, GREGORY ARTHUR,
MD
8/15/2014
P9343
FRANKLIN, JAMES DAVID, MD
3/17/2014
Q2896
FRANKLIN, WILLIAM ELLIS, DO
1/15/2015
EMERGENCY
3/17/2019 MEDICINE
EMERGENCY
1/15/2020 MEDICINE
P4569
FRATTARELLI, TEASHA-LEE A, DO
10/1/2012
4/2/2012
Q4108
FRAUSTO, EDGGAR EMMANUEL,
MD
5/1/2015
P5364
FREDIEU, ANDRE, MD
2/1/2013
P0826
Q2662
P8243
8/26/2011
12/15/2014
11/1/2013
Q7371
FREEDHAND, ADAM M, MD
FREEMAN, LEAH , DO
FREEMAN, MARLA ANN, MD
FREEMAN, RICHARD BENTON JR,
MD
P8355
P3150
FRERKING, TYRUS RAYBURN, DO
FRIDAY, DWAYNE, MD
11/15/2013
5/15/2012
P4952
FRIEBEN, RYAN WILLIAM, MD
11/30/2012
P1302
FRIEDLAND, JOHN T, MD
11/4/2011
P1864
FRIEDMAN, DEBORAH ISA, MD
1/17/2012
P5275
FRIEDMAN, DUNCAN AESCTUN,
MD
1/15/2013
P8901
FRIEDMAN, JEFFREY ERIC, MD
2/7/2014
04-Mar-16
NEONATAL4/2/2017 PERINATAL MEDICINE NEONATOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
SAN ANTONIO TX
ACTIVE
17-Feb-16 None
N/A
DALLAS
TX
ACTIVE
4/9/2012 None
N/A
HOUSTON
TX
ACTIVE
8/19/2014 None
N/A
TYLER
TX
ACTIVE
3/24/2014 None
N/A
VISALIA
CA
ACTIVE
1/26/2015 None
N/A
AKRON
OH
ACTIVE
10/4/2012 None
N/A
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
SAN ANTONIO TX
ACTIVE
5/4/2015 None
N/A
NEUROLOGY
PLANO
TX
2/21/2013 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/26/2011 None
12/17/2014 None
11/7/2013 None
N/A
N/A
N/A
TX
ACTIVE
19-Apr-16 None
N/A
TX
TX
ACTIVE
ACTIVE
11/19/2013 None
5/16/2012 None
N/A
N/A
11/30/2017 UROLOGIC SURGERY UROLOGIC SURGERY HOUSTON
TX
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
11/4/2016 SURGERY
SPINE
SAN ANTONIO TX
NEURO1/17/2017 NEUROLOGY
OPHTHALMOLOGY
DALLAS
TX
ACTIVE
12/31/2012 None
N/A
ACTIVE
11/16/2011 None
N/A
ACTIVE
1/23/2012 None
N/A
ACTIVE
LICENSE
ISSUED
1/17/2013 None
N/A
2/7/2014 None
N/A
INTERVENTIONAL
2/1/2018 RADIOLOGY
ORTHOPEDIC
8/26/2016 SURGERY
TRANSPLANT
04-Mar-21 SURGERY
CARDIOVASCULAR
11/15/2018 DISEASES
GENERAL SURGERY AUSTIN
INTERVENTIONAL
CARDIOLOGY
GRANBURY
EL PASO
OPHTHALMOLOGY VITREOUS SURGERY BIRMINGHAM
Page 116 of 402
AL
dicaid
dicaid
License
Agreement
Physician Name
Start Date
End Date
Designated)
INTERVENTIONAL
Q3185
FRIEND, CHRISTOPHER JOHN, MD
2/13/2015
2/13/2020 RADIOLOGY
Q4752
6/12/2015
PEDIATRIC
EMERGENCY
MEDICINE (EM)
EMERGENCY
6/12/2020 MEDICINE
P4648
FRIESEN, PHILLIP AUSTEN, DO
FRISCHHERTZ, BENJAMIN PAUL,
MD
P5531
Q5802
FRITTS, AARON HASKELL, MD
FRONTZ, REBECCA LEAH, DO
2/8/2013
8/28/2015
Q3363
FROST, DENZIL KENNETH, DO
3/3/2015
P1303
Q8057
FRYBARGER, JAMES ROBERT, MD
FU, QIUYU , MD
11/4/2011
02-May-16
Q8058
P9570
FUCHS, DANIEL JOSEPH, MD
FUCHS, JENNIFER LAUREN, MD
02-May-16
4/1/2014
N3036
FUCHS, JULIE ROBIN, MD
1/15/2015
P8668
Q6939
FUHRMAN, BRADLEY PHILLIP, MD
FULLER, AUDRA JANE, MD
1/3/2014
15-Jan-16
P0977
FULLER, CLIFTON DAVID, MD
9/15/2011
Q6011
Q0438
FULLER, NICHOLAS S, MD
FULLER, TIMOTHY SMITH, MD
9/15/2015
6/2/2014
Q5803
FUSI, STEFANO, MD
8/28/2015
Q0439
GABAEFF, DINA ROBIN, MD
Q1603
P0384
GABRIELLE, CLAUDIA G, MD
GADAM, MOHAN RAVINDRA, MD
8/29/2014
7/15/2011
P3152
Q6012
P6167
GADDIS, TODD DONAVON, MD
GADGIL, MEGHANA, MD
GADHIA, HETAL TALSI, DO
5/15/2012
9/15/2015
4/12/2013
10/15/2012
6/2/2014
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
2/8/2018 RADIOLOGY
EMERGENCY
3/3/2020 MEDICINE
EMERGENCY
11/4/2016 MEDICINE
ORTHOPEDIC
02-May-21 SURGERY
4/1/2019 PEDIATRICS
Practice City
AUSTIN
INTERVENTIONAL
RADIOLOGY
PLANO
KATY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/13/2015 None
N/A
TX
ACTIVE
6/15/2015 None
N/A
TX
ACTIVE
10/18/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
2/20/2013 None
9/1/2015 None
N/A
N/A
ACTIVE
4/8/2015 None
N/A
HOUSTON
TEXARKANA
TX
TX
ACTIVE
ACTIVE
11/10/2011 None
03-May-16 None
N/A
N/A
DALLAS
TX
04-May-16 None
4/7/2014 None
N/A
N/A
STANFORD
CA
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
1/15/2015 None
N/A
EL PASO
LUBBOCK
TX
TX
ACTIVE
ACTIVE
1/7/2014 None
28-Jan-16 None
N/A
N/A
HOUSTON
BEVERLY
HILLS
DALLAS
TX
ACTIVE
11/2/2011 None
N/A
CA
TX
ACTIVE
ACTIVE
9/21/2015 None
6/16/2014 None
N/A
N/A
GENERAL SURGERY GUILFORD
CT
ACTIVE
9/2/2015 None
N/A
NEURO-RADIOLOGY
NV
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/9/2014 None
N/A
8/29/2014 None
7/21/2011 None
N/A
N/A
5/15/2012 None
9/16/2015 None
4/23/2013 None
N/A
N/A
N/A
HOSPITALIST
FOOT AND ANKLE,
ORTHOPEDICS
HOSPITALIST
PEDIATRIC INTENSIVE
1/3/2019 CARE
PEDIATRICS
RADIATION
9/15/2016 ONCOLOGY
ANESTHESIOLOGY
DIAGNOSTIC
6/2/2019 RADIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LAS VEGAS
FAMILY PRACTICE
AUSTIN
HOSPITALIST
AUSTIN
TX
SAN ANTONIO TX
Page 117 of 402
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
N1638
GADHIA, MONIKA, MD
11/16/2015
P8244
Q1405
Q4110
P5179
GADIRAJU, SILPA BHARATHI, MD
GADOEH, MOHAMED, MD
GADWALA, SWETHA , MD
GAFFNEY, KRISTIN ALEXANDRIA,
DO
P6818
GAFFORD, PHILIP SCOTT, MD
6/3/2013
P6391
GAINES, ROBERT J, MD
5/1/2013
Q5804
GAINOR, ROBERT EDWARD, MD
8/28/2015
Q3186
Q4580
GAITAN RUEDA, JUAN ISRAEL, MD
GAJANAYAKA, RANIL, MD
2/13/2015
6/1/2015
Q2663
P0585
GAJULA, RAMARAO SUNDARA, MD
GAJWANI, PRASHANT, MD
12/15/2014
8/1/2011
Q4753
GALANTE, NICHOLAS JOSEPH, MD
6/12/2015
P7441
P9346
Q0635
GALINANES, EDGAR LUIS, MD
GALINDO, GINA PAOLA, MD
GALKE, CURTIS LLOYD, DO
8/1/2013
3/17/2014
6/16/2014
P4445
GALL, JOHN ANTHONY, MD
9/17/2012
P7442
GALLAGHER, KATHLEEN KELLY,
MD
8/1/2013
P1757
GALLAGHER, SEAN MICHAEL, MD
1/2/2012
Q8479
GALLEGOS, ANALYSA, MD
01-Jun-16
Q5405
GALLEGOS, CINTHIA , MD
8/3/2015
11/1/2013
8/15/2014
5/1/2015
1/4/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
TX
ISSUED
EMERGENCY
11/1/2018 MEDICINE
GASTROENTEROLOG
1/4/2018 Y
INTERNAL MEDICINE
SURGICAL
ORTHOPEDIC
TRAUMATIC
5/1/2018 SURGERY
SURGERY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PULMONARY
CRITICAL CARE
DALLAS
1504TAUBLOO
P,HOUSTON
TX
WEBSTER
TX
8/1/2016 PSYCHIATRY
MUSCULOSKELETAL
6/12/2020 IMAGING
11/16/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
11/20/2013 None
8/21/2014 None
5/5/2015 None
N/A
N/A
N/A
ACTIVE
1/18/2013 None
N/A
TX
ACTIVE
7/1/2013 None
N/A
LUBBOCK
TX
ACTIVE
5/3/2013 None
N/A
FRESNO
CA
ACTIVE
9/14/2015 None
N/A
MOUNT
VERNON
IL
LICENSE
ISSUED
ACTIVE
2/13/2015 None
6/12/2015 None
N/A
N/A
OLD BRIDGE
HOUSTON
NJ
TX
1/14/2015 None
8/11/2011 None
N/A
N/A
6/12/2015 None
N/A
8/1/2013 None
4/2/2014 None
6/25/2014 None
N/A
N/A
N/A
ABDOMINAL
RADIOLOGY
OTOLARYN & FACIAL
PLASTIC SURGERY
HOUSTON
ADULT
RECONSTRUCTION AUSTIN
Page 118 of 402
Disciplinary
Status Date
MIDLAND
GENERAL VASCULAR
8/1/2018 VASCULAR SURGERY SURGERY
WATERLOO
EDINBURG
EMERGENCY
9/17/2017 MEDICINE
COLUMBUS
HEAD AND NECK
8/1/2018 SURGERY
ORTHOPEDIC
1/2/2017 SURGERY
EMERGENCY
01-Jun-21 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
NASSAU BAY
ACTIVE
ACTIVE
LICENSE
ISSUED
IA
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
IN
ACTIVE
11/21/2012 None
N/A
TX
ACTIVE
8/9/2013 None
N/A
TX
ACTIVE
1/4/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
16-Jun-16 None
N/A
8/3/2015 None
N/A
License
Number
P7766
Physician Name
GAMBAROTA, MARCI CATHERINE,
MD
Q3676
GAMBLE, CANDACE , MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
PALLIATIVE
8/30/2013
8/30/2018 MEDICINE
MEDICINE
4/1/2015
Q0047
GAMBLE, LISA LYNELLE, MD
P8776
GAMEZ-GODOY, JOSE DAVID, MD
1/15/2014
CRITICAL CARE
PEDIATRIC
Q1606
Q6627
Q6627
Q6627
GAN, SAMUEL , MD
GANDHI, AVANTI LATTHE, MD
8/29/2014
12/4/2015
04-Dec-15
04-Dec-15
8/29/2019
12/4/2020
04-Dec-20
04-Dec-20
Q5654
GANDHI, BHERU BHARAT, MD
8/14/2015
Q3364
P7915
GANDHI, PRITESH HARISH, MD
GANDRA, RAGHA DIVYA, MD
3/3/2015
9/16/2013
P8474
12/6/2013
Q4111
Q0440
GANESAN, SRINIVASAN, MD
GANESHAN,
DHAKSHINAMOORTHY , MD
GANGAR, PAMELA , MD
N2081
GANGASANI, ASHISH , MD
01-Apr-16
Q1607
GANGIREDDY, SREEDEVI, MD
8/29/2014
P9347
Q8059
P1642
GANGOPADHYAY, NOOPUR , MD
GANIM, NIDAL MAZEN, MD
GANO, HEATHER MARIE, MD
5/2/2014
5/1/2015
6/2/2014
PULMONARY
MEDICINE
PEDIATRICS
FAMILY MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
HOUSTON
GASTROENTEROLOG
12/6/2018 Y
INTERNAL MEDICINE
DIAGNOSTIC
ABDOMINAL
5/1/2020 RADIOLOGY
RADIOLOGY
HOUSTON
HOUSTON
CARDIAC
ELECTROPHYSIOLO
01-Apr-21 CARDIOLOGY
GY
TYLER
Q3365
Q4112
GANTI, LATHA, MD
GANTI, RAMAPRIYA , MD
3/3/2015
5/1/2015
PLASTIC &
RECONSTRUCTIVE
3/17/2019 SURGERY
EMERGENCY
3/3/2020 MEDICINE
5/1/2020 RADIOLOGY
Q4113
Q5406
GANTWERKER, ERIC ALAN, MD
GARAGHTY, ANNIE TOUNG, DO
5/1/2015
8/3/2015
3/17/2014
02-May-16
12/15/2011
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
PEDIATRIC
OTOLARYNGOLOGY
Page 119 of 402
Disciplinary
Status Date
8/30/2013 None
N/A
4/1/2015 None
N/A
5/13/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
1/15/2014 None
N/A
8/29/2014
12/8/2015
08-Dec-15
08-Dec-15
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
8/25/2015 None
N/A
3/18/2015 None
11/14/2013 None
N/A
N/A
12/6/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
TX
ACTIVE
ACTIVE
5/19/2015 None
6/17/2014 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
22-Apr-16 None
N/A
8/29/2014 None
N/A
4/1/2014 None
06-May-16 None
12/29/2011 None
N/A
N/A
N/A
HOSPITALIST
VASCULAR
NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
EL PASO
DALLAS
TX
TX
ACTIVE
ACTIVE
3/13/2015 None
5/13/2015 None
N/A
N/A
DALLAS
TX
ACTIVE
ACTIVE
5/18/2015 None
8/17/2015 None
N/A
N/A
License
Number
Physician Name
Q4581
GARBETT, DONALD LEE, MD
Q3677
GARCHA, PUNEET SINGH, MD
GARCIA FAJARDO, CARLOS
ERNESTO, MD
GARCIA MAYORGA, JESUS
GUILLERMO, MD
Q6014
Q1983
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
VASCULAR AND
INTERVENTIONAL
6/1/2015
6/1/2020 RADIOLOGY
RADIOLOGY
PULMONARY
CRITICAL CARE
4/1/2015
9/15/2015
10/1/2014
Q7372
GARCIA SOTO, ARLENE ESTHER,
MD
04-Mar-16
Q0913
GARCIA, ALYSON DANELLE, MD
7/15/2014
P3328
GARCIA, CESAR JOSE, MD
P9852
GARCIA, EDIBERTO DEJESUS, MD
6/1/2012
4/15/2014
OBSTETRICS &
GYNECOLOGICAL
SURGERY
GYNECOLOGIC
04-Mar-21 ONCOLOGY
OBSTETRICS AND
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
6/2/2015 None
N/A
CLEVELAND
OH
ACTIVE
4/2/2015 None
N/A
SAN ANTONIO TX
ACTIVE
9/17/2015 None
N/A
AMARILLO
TX
ACTIVE
10/3/2014 None
N/A
DALLAS
TX
ACTIVE
21-Mar-16 None
N/A
8/5/2014 None
N/A
6/1/2012 None
N/A
4/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
27-Jan-16 None
N/A
6/12/2015 None
N/A
TX
ACTIVE
12/1/2011 None
N/A
TX
ACTIVE
7/1/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
9/19/2011 None
N/A
6/12/2015
10/19/2015
5/17/2013
11/10/2014
ACTIVE
ACTIVE
OCCUPATIONAL
4/15/2019 MEDICINE
Q6940
GARCIA, GERALD MATTHEW, DO
15-Jan-16
15-Jan-21 ANESTHESIOLOGY
Q4754
GARCIA, JAYNE MARIN, MD
6/12/2015
HOSPITALIST
P1180
GARCIA, JESSICA , DO
Q0636
10/17/2011
GARCIA, JULIAN CORDOBES, DO
6/16/2014
P0978
GARCIA, LUIS EDMUNDO, MD
9/15/2011
Q4755
Q6190
P6618
Q2282
GARCIA, OMAR , MD
GARCIA, RICARDO JR, DO
GARCIA, STEVEN GARZA, MD
GARCIA-BEACH, SYLVIA, MD
6/12/2015
10/1/2015
5/15/2013
11/7/2014
PHYSICAL MED. &
P9069
GARD, ANNE LAJEAN, MD
2/18/2014
P1307
Q7875
GARDA, JACQUELINE LABOE, DO
GARDINER, LESLEY , MD
11/4/2011
15-Apr-16
OBSTETRICS AND
PLANO
CORPUS
CHRISTI
CORPUS
CHRISTI
RIO GRANDE
CITY.
BRYAN
DALLAS
FT. WORTH
TEMPLE
Page 120 of 402
Disciplinary
Status Date
CYPRESS
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
TX
TX
None
None
None
None
N/A
N/A
N/A
N/A
2/18/2014 None
N/A
11/15/2011 None
26-Apr-16 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
3/1/2012
3/1/2017 MEDICINE
5/2/2014
EMERGENCY
15-Apr-16
15-Apr-21 MEDICINE
8/1/2011
P2242
Q0048
GARDNER, KIMBERLY RENEE, MD
GARDNER, SARAH V, DO
Q7876
P0587
GARFF, ANDREW STEWART, MD
GARG, MURARI, MD
P0588
P9349
GARG, NADISH, MD
GARG, PARUL , MD
8/1/2011
3/17/2014
P6168
Q4114
GARNER, ERIN PAIGE, DO
GARNER, KRISTIN , MD
4/12/2013
5/1/2015
Q3515
GARRELS, RICKY LEE, MD
3/16/2015
Q6413
Q7553
11/2/2015
15-Mar-16
Q3187
GARREN, JOSHUA DAVID, MD
GARREPALLI, SWAPNA, MD
GARRETT, DONALD RAYMOND JR,
DO
P4650
GARRETT, JAMES BRYAN, MD
P0213
GARRETT, LAURA MEADOWS, MD
7/1/2011
Q3678
4/1/2015
Q6015
P4446
GARRIGUES, DAVID GERARD, MD
GARZA BERLANGA, ANDRES
EUGENIO, MD
GARZA ROMERO, AARON CALEV,
MD
GARZA, AMANDA , MD
9/15/2015
9/17/2012
Q8482
GARZA, ERICA CELINA, MD
01-Jun-16
OBSTETRICS AND
Q8247
P4571
P1308
GARZA, ERIK , MD
GARZA, HOMERO , MD
GARZA, JOSE E., MD
16-May-16
10/1/2012
11/4/2011
P6169
GARZA, RALPH ZACHARY, MD
P2648
2/13/2015
10/15/2012
4/2/2012
4/12/2013
OBSTETRICS &
GYNECOLOGICAL
4/12/2018 SURGERY
OCCUPATIONAL
3/16/2020 MEDICINE
RADIATION
11/2/2020 ONCOLOGY
EMERGENCY
2/13/2020 MEDICINE
ORAL &
MAXILLOFACIAL
10/15/2017 SURGERY
PHYSICAL MED. &
INTERVENTIONAL
4/2/2017 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
25-Apr-16 None
8/9/2011 None
N/A
N/A
8/1/2011 None
4/14/2014 None
N/A
N/A
ABILENE
TX
FORT WORTH TX
ACTIVE
ACTIVE
4/17/2013 None
5/13/2015 None
N/A
N/A
DAVENPORT
IA
ACTIVE
4/10/2015 None
N/A
DALLAS
BRONX
TX
NY
ACTIVE
ACTIVE
LICENSE
ISSUED
11/3/2015 None
21-Mar-16 None
N/A
N/A
2/13/2015 None
N/A
GA
CARDIOLOGY
PAIN MEDICINE
COLLEGE
STATION
TX
ACTIVE
10/19/2012 None
N/A
HOUSTON
TX
ACTIVE
8/8/2011 None
N/A
TEXAS
TX
ACTIVE
4/3/2015 None
N/A
SAN ANTONIO TX
ACTIVE
4/12/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/8/2015 None
9/24/2012 None
N/A
N/A
01-Jun-16 None
N/A
24-May-16 None
10/23/2012 None
11/9/2011 None
N/A
N/A
N/A
4/12/2013 None
N/A
INTERNAL MEDICINE NEW YORK
HOUSTON
GYNECOLOGIC
SURGERY
CORPUS
CHRISTI
PEDIATRICS
HOSPITALIST
SEGUIN
Page 121 of 402
Disciplinary
Status Date
3/1/2012 None
5/6/2014 None
WAYCROSS
EMERGENCY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
NY
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
P0724
Physician Name
GARZA, TRINI JON, MD
P9192
GARZA-MIRANDA, VANESSA R, MD
GASCOIGNE, RICHARD HOLT JR,
AM00071 MD
P0589
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2011
3/3/2014
01-Jun-16
P6392
GASCO-TAMARIT, JAIME , MD
GASKIN, FREDERICK SPENCER,
MD
P2117
GASSEN, JOSEPH ARISTIDE III, MD
Q4115
GASSMAN, ANDREW, MD
5/1/2015
P6393
GATLIN, SCOTT, MD
5/1/2013
P7767
GAUTAM, ABHINAV, MD
8/30/2013
Q4406
GAUVAIN, TAGGART TAYLOR, MD
5/15/2015
Q4956
GAVALDA, JUAN CARLOS, MD
8/1/2011
5/1/2013
2/10/2012
7/1/2015
Q4116
Q6192
GAVINI, SRAVANYA, MD
GAVINO, CHRISTINE KAY, DO
5/1/2015
10/1/2015
Q0443
GAVIRIA AGUDELO, CLAUDIA
LORENA, MD
6/2/2014
Q7373
Q7194
GAVVALA, JAY R, MD
GAVVALA, SHEELA LAXMI, DO
Q0049
GAY, ANDRE NICOLAS, MD
P6969
GAZZANEO, MARIA CAROLINA, MD
6/14/2013
P9351
GBADEBO, TOKUNBO DAVID, MD
3/17/2014
Q1984
GE, LIANG, MD
10/1/2014
04-Mar-16
16-Feb-16
5/2/2014
Secondary Specialty
(Self-Designated)
EMERGENCY
3/3/2019 MEDICINE
NEUROLOGICAL
8/1/2016 SURGERY
PLASTIC &
RECONSTRUCTIVE
5/1/2020 SURGERY
PEDIATRICS,
5/1/2018 CARDIOLOGY
Practice City
RIO GRANDE
CITY
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
TX
ACTIVE
8/19/2011 None
N/A
HOUSTON
SALT LAKE
CITY
TX
ACTIVE
3/7/2014 None
N/A
UT
ACTIVE
14-Jun-16 None
N/A
GALVESTON
TX
ACTIVE
9/6/2011 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
5/7/2013 None
N/A
2/10/2012 None
N/A
MICROSURGERY
DALLAS
TX
ACTIVE
5/6/2015 None
N/A
PEDIATRICS
DALLAS
TX
ACTIVE
LICENSE
ISSUED
5/6/2013 None
N/A
8/30/2013 None
N/A
ACTIVE
5/19/2015 None
N/A
TX
ACTIVE
7/6/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
5/7/2015 None
10/8/2015 None
N/A
N/A
6/2/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
14-Mar-16 None
02-Mar-16 None
N/A
N/A
5/2/2014 None
N/A
ACTIVE
6/20/2013 None
N/A
ACTIVE
4/17/2014 None
N/A
ACTIVE
10/8/2014 None
N/A
ORTHOPEDIC
5/15/2020 SURGERY
GRAND
PRAIRIE
Registration
Status Date
Disciplinary
Status of
Texas
License
GASTROENTEROLOG
Y
DALLAS
BAYTOWN
PEDIATRIC
INFECTIOUS
DISEASE
6/2/2019 PEDIATRICS
CLINICAL
04-Mar-21 NEUROPHYSIOLOGY NEUROLOGY
ORTHOPEDIC
5/2/2019 SURGERY
PEDIATRIC INTENSIVE
6/14/2018 CARE
CARDIAC
ELECTROPHYSIOLOG
3/17/2019 Y
CARDIOLOGY
EMERGENCY
10/1/2019 MEDICINE
Page 122 of 402
HOUSTON
AUSTIN
HOUSTON
NEW YORK
LICENSE
ISSUED
TX
TX
TX
NY
License
Number
Physician Name
Q2131
P2446
GEARY, KATE E, DO
GEBARA, NATHALIE, MD
Q8483
GEISLER, DANIEL PHILLIP, MD
Q2132
dicaid
dicaid
Agreement
End Date
Designated)
10/15/2014
3/15/2012
01-Jun-16
Q0637
GEIST, DERIK JOSEF, MD
GELABERT, CHRISTOPHER JAMES,
MD
Q2897
GELFIUS, CARL DANE, MD
Q5407
11/2/2015
11/2/2020 UROLOGY
P9352
GELONECK, MEGAN MCREE, MD
GELPI-HAMMERSCHMIDT,
FRANCISCO JOSE, MD
GENITEMPO, ANDREW GREGORY,
DO
3/17/2014
Q1821
GENOVA, RONALD THOMAS, MD
9/15/2014
P3154
P4447
GENTILE, MARK PATRICK, MD
GENTRY, JAMES DUSTIN, MD
5/15/2012
9/17/2012
P0591
GEORGE, ALEX, MD
8/1/2011
EMERGENCY
9/15/2019 MEDICINE
EMERGENCY
5/15/2017 MEDICINE
PEDIATRIC
HEMATOLOGY/ONCOL
8/1/2016 OGY
P0214
Q4583
GEORGE, BRANNON EDWARD, MD
GEORGE, CHRISTINA M, MD
7/1/2011
6/1/2015
Q6415
10/15/2014
3/15/2017 RADIOLOGY
COLON AND RECTAL
01-Jun-21 SURGERY
ORTHOPEDIC
10/15/2019 SURGERY
EMERGENCY
6/16/2019 MEDICINE
PEDIATRIC
REHABILITATION
1/15/2020 MEDICINE
PEDIATRIC
6/16/2014
1/15/2015
8/3/2015
Secondary Specialty
(Self-Designated)
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
NEURO-RADIOLOGY
GEORGE, ELIAS RODRIGUEZ, MD
7/15/2013
7/15/2018 PATHOLOGY
P7636
GEORGE, JOHN MICHAEL, MD
8/15/2013
P4759
P0592
Q0638
GEORGE, MICHAEL ROBERT, MD
GEORGE, ROSHNY A, MD
GEORGE, ROXANNE, MD
11/1/2012
8/1/2011
6/16/2014
M4086
GEORGE, SAIRA JACOB, MD
8/29/2014
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
10/23/2014 None
4/4/2012 None
N/A
N/A
01-Jun-16 None
N/A
TX
ACTIVE
10/22/2014 None
N/A
SAN ANTONIO TX
ACTIVE
7/3/2014 None
N/A
NEW YORK
HOUSTON
NY
ELECTRODIAGNOSTI
C MEDICINE
HOUSTON
TX
ACTIVE
1/30/2015 None
N/A
HOUSTON
TX
ACTIVE
8/5/2015 None
N/A
HOUSTON
TX
ACTIVE
11/4/2015 None
N/A
ACTIVE
3/21/2014 None
N/A
ACTIVE
9/29/2014 None
N/A
SAN ANTONIO TX
TYLER
TX
ACTIVE
ACTIVE
5/22/2012 None
10/26/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/17/2011 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/8/2011 None
6/10/2015 None
N/A
N/A
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
7/25/2013 None
N/A
8/15/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
11/8/2012 None
8/8/2011 None
6/18/2014 None
N/A
N/A
N/A
8/29/2014 None
N/A
UROLOGIC
ONCOLOGY
P7274
Practice City
Registration
Status of
Practice
Texas
State
License
HEMATOLOGY
(PATHOLOGY)
INTERVENTIONAL
CARDIOLOGY
GENERAL PRACTICE IRVING
Page 123 of 402
TX
SPRING
TX
GLENDALE
AZ
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q7879
Q6834
GEORGE, TIMOTHY JACOB, MD
GEORGE, VERGHESE , MD
15-Apr-16
06-Jan-16
P3627
GEORGIADIS, PARASKEVI, MD
6/15/2012
Q0261
GEPHART, LAURA FAYE, MD
5/15/2014
P1999
GERARD, JODY, MD
P8027
GERARDO OCHOA, FABRICIO , MD
P9855
Q2284
CARDIOVASCULAR
15-Apr-21 SURGERY
06-Jan-21 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
THORACIC
CARDIOVASCULAR
SURGERY
PLANO
NUCLEAR MEDICINE HOUSTON
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
OBSTETRICS &
GYNECOLOGICAL
5/15/2019 SURGERY
EMERGENCY
2/1/2017 MEDICINE
NEONATOLOGY
ACTIVE
ACTIVE
LICENSE
ISSUED
UROGYNECOLOGY
LICENSE
ISSUED
10/1/2013
PEDIATRICS
ACTIVE
LICENSE
ISSUED
GERAYMOVYCH, ELENA, MD
GERLA, ANDREA MICHELLE, MD
4/15/2014
11/7/2014
OPHTHALMOLOGY VITREOUS SURGERY SAN ANTONIO TX
TYLER
TX
ACTIVE
ACTIVE
4/23/2014 None
11/11/2014 None
N/A
N/A
P7919
Q7374
GERLACH, KAREN ELISSA, MD
GERTSCH, MATTHEW C, MD
9/16/2013
04-Mar-16
DIAGNOSTIC
9/16/2018 RADIOLOGY
04-Mar-21 ANESTHESIOLOGY
10/18/2013 None
21-Mar-16 None
N/A
N/A
P2857
Q5655
GESLANI, GIOVANNI A, DO
GESLANI, JOANNA LEUNG, DO
4/13/2012
8/14/2015
4/13/2012 None
8/24/2015 None
N/A
N/A
Q1609
GHABACH, BASSAM, MD
8/29/2014
8/29/2014 None
N/A
Q4407
GHADIALI, MOHSIN YUNUS, MD
5/15/2015
8/29/2019 ONCOLOGY
DIAGNOSTIC
5/15/2020 RADIOLOGY
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/15/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/4/2014 None
8/25/2011 None
N/A
N/A
11/15/2012 None
09-Feb-16 None
11/5/2014 None
N/A
N/A
N/A
4/15/2014 None
N/A
01-May-16 None
N/A
2/1/2012
Q1152
P0388
GHADIALI, MURTAZA TAHER, MD
GHADIMI-MAHANI, MOHSEN , MD
8/1/2014
7/15/2011
P4868
Q7044
Q2133
GHAFOORI, AHMAD FAWAD, MD
GHALAMBOR, OMID, MD
GHANTA, DEEPA, MD
11/15/2012
01-Feb-16
10/15/2014
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
MAMMOGRAPHY
HOUSTON
LUBBOCK
TX
TX
DALLAS
TX
INTERNAL MEDICINE
P9856
GHANTA, MAHENDRA, MD
4/15/2014
Q7045
GHARFEH, MAYA , MD
01-Feb-16
OTORHINOLARYNGO
LOGY
HOUSTON
ONCOLOGY
GALVESTON
PAIN MANAGEMENT
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
PEDIATRICS,
ALLERGY &
IMMUNOLOGY
Page 124 of 402
EFFINGHAM
EVANSVILLE
TX
TX
IL
IN
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
25-Apr-16 None
18-Jan-16 None
N/A
N/A
6/15/2012 None
N/A
5/15/2014 None
N/A
2/13/2012 None
N/A
10/1/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q5408
GHATAK, ABHIJIT, MD
8/3/2015
Q3875
Q7375
Q1407
GHATTAS, PAUL JOHN, DO
GHAWI, HANI, MD
GHAZY, KHALID AZIZ, MD
4/10/2015
04-Mar-16
8/15/2014
P2650
GHIA, AMOL JITENDRA, MD
4/2/2012
P3531
GHOBADI, ARMIN , MD
6/8/2012
P5066
GHOSH, LINA, MD
12/17/2012
P5066
GHOSH, LINA, MD
12/17/2012
P5066
GHOSH, LINA, MD
12/17/2012
Q0640
Q8485
GHOSH, SUBHA, MD
GHOTRA, AMANINDERAPAL , MD
CARDIOTHORACIC
6/16/2019 RADIOLOGY
P2000
GHUMMAN, UMAR, MD
2/1/2012
P2993
GIACOMETTI, JOSEPH, MD
5/1/2012
Q5409
GIAMPAOLO, JENNIFER RETH, MD
8/3/2015
8/3/2020 PSYCHIATRY
6/16/2014
01-Jun-16
P3532
GIANATASIO, RYAN MARTIN, MD
P8778
GIANELLA, DANIEL LEON, MD
1/15/2014
Q7880
GIANG, ERIC LE, DO
GIANOPOULOS, JOHN GEORGE,
MD
GIBBONS, JANICE LYNN, MD
GIBBY, CONRAD CURTIS, MD
15-Apr-16
P5807
P1866
Q1408
P2448
P8586
GIBBY, MARK HYRUM, MD
GIBSON, GEORGE RAYMOND III,
DO
6/8/2012
3/15/2013
1/17/2012
8/15/2014
3/15/2012
12/16/2013
8/3/2020 CARDIOLOGY
ORTHOPEDIC
4/10/2020 SURGERY
RADIATION
4/2/2017 ONCOLOGY
6/8/2017 NEUROLOGY
1/15/2019 RADIOLOGY
ORTHOPEDIC
15-Apr-21 SURGERY
MATERNAL AND
8/15/2019 RADIOLOGY
EMERGENCY
12/16/2018 MEDICINE
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
CARDIOLOGY
Practice City
Disciplinary
Status Date
9/7/2015 None
N/A
TX
4/10/2015 None
11-Mar-16 None
8/20/2014 None
N/A
N/A
N/A
HOUSTON
HEMATOLOGY/ONCO
LOGY
HOUSTON
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
PALLIATIVE
MEDICINE
TX
ACTIVE
4/13/2012 None
N/A
TX
ACTIVE
6/26/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
ACTIVE
12/19/2012 None
N/A
INTERNAL MEDICINE COLUMBUS
INTERNAL MEDICINE
OH
6/17/2014 None
17-Jun-16 None
N/A
N/A
2/1/2012 None
N/A
DOHA
ODESSA
OPHTHALMOLOGY RECONST SURGERY HOUSTON
VASCULAR
NEUROLOGY
NM
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
FAMILY MEDICINE
LAS CRUCES
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
5/7/2012 None
N/A
DALLAS
TX
ACTIVE
8/5/2015 None
N/A
PLANO
TX
ACTIVE
LICENSE
ISSUED
6/13/2012 None
N/A
1/15/2014 None
N/A
NEURO-RADIOLOGY
OBSTETRICS AND
GYNECOLOGY
AEROSPACE
MEDICINE
Page 125 of 402
ACTIVE
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
21-Apr-16 None
N/A
AUSTIN
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
3/19/2013 None
1/30/2012 None
8/18/2014 None
N/A
N/A
N/A
GATESVILLE
TX
ACTIVE
LICENSE
ISSUED
3/19/2012 None
N/A
12/16/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
PULMONARY
CRITICAL CARE
8/28/2015
8/28/2020 MEDICINE
ORTHOPEDIC
5/2/2014
5/2/2019 SURGERY
HURST
RADIATION
5/2/2014
5/2/2019 ONCOLOGY
9/15/2015
HOUSTON
N8296
GIBSON, RACHELE ANN, MD
Q0051
GIBSON, SCOTT HOWARD, DO
Q0052
Q6017
GIESLER, JOHN HAROLD, MD
GILBERT, LOUIS , DO
Q0053
GILL, AVNEET, MD
P1867
GILLALA, VARSHA REDDY, DO
1/17/2012
P0827
GILLEN, ARIC CHRISTOPHER, MD
8/26/2011
P3156
GILLETTE, STEPHANIE, MD
5/15/2012
P3332
Q7555
GILLIAM, BRADLEY DALE, MD
GILLIS, HOLLY CATHERINE, MD
6/1/2012
15-Mar-16
Q4957
GILLMAN, BRAD M, MD
Q2551
Q4958
GILLMAN, MONIQUE, MD
GILLORY, LAUREN ANN, MD
12/3/2014
7/1/2015
Q0444
P1868
GILROY, JEFFREY SCOTT, MD
GINGRICH, KEVIN, MD
6/2/2014
1/17/2012
PHYSICAL MED. &
OBSTETRICS &
GYNECOLOGICAL
8/26/2016 SURGERY
ORTHOPEDIC
6/1/2017 SURGERY
15-Mar-21 PEDIATRICS
ORTHOPEDIC
7/1/2020 SURGERY
OBSTETRICS AND
RADIATION
6/2/2019 ONCOLOGY
Q0755
GINJUPALLI, MADHURI, MD
6/27/2014
Q7046
P9857
Q3519
01-Feb-16
4/15/2014
3/16/2015
P4652
GINNE, PURSHOTHAM REDDY, MD
GIOMI, ANDREA, MD
GIRALDO, SANTIAGO, MD
GIRGIS, GEORGE WAGIH
YOUSSEF, MD
GIRONELLA, ANNA CARMELA
SAGCAL, MD
Q2898
GIST, TAYLOR LEE, MD
P2244
5/2/2014
7/1/2015
3/1/2012
10/15/2012
1/15/2015
PEDIATRIC
NEUROLOGICAL
1/15/2020 SURGERY
Registration
Status of
Practice
Texas
State
License
ACTIVE
9/2/2015 None
N/A
TX
ACTIVE
5/12/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/7/2014 None
9/22/2015 None
N/A
N/A
5/2/2014 None
N/A
ACTIVE
1/27/2012 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
5/24/2012 None
N/A
6/1/2012 None
29-Mar-16 None
N/A
N/A
TX
WACO
TX
MANGUM
OK
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
SAN ANTONIO TX
ACTIVE
7/2/2015 None
N/A
NORFOLK
HOUSTON
VA
TX
ACTIVE
ACTIVE
12/16/2014 None
9/4/2015 None
N/A
N/A
CODY
WY
ACTIVE
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
ACTIVE
ACTIVE
6/6/2014 None
1/26/2012 None
N/A
N/A
6/27/2014 None
N/A
01-May-16 None
4/23/2014 None
3/18/2015 None
N/A
N/A
N/A
ODESSA
Page 126 of 402
Disciplinary
Status Date
TX
HOSPITALIST
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
SAN ANTONIO TX
ACTIVE
3/13/2012 None
N/A
HOUSTON
TX
ACTIVE
10/18/2012 None
N/A
HOUSTON
TX
ACTIVE
1/19/2015 None
N/A
License
Number
Physician Name
P4956
GIVENS, KELLY , MD
Q0918
GIZERSKY, YAKOV JOSHUA, DO
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
11/30/2012
7/15/2014
PEDIATRICS,
5/15/2013
PEDIATRICS
6/1/2012
URGENT CARE
04-Mar-16
04-Mar-21 GENERAL PRACTICE MEDICINE
9/15/2015
P6619
P3333
GLASOW, CHRISTINE ANNE, MD
GLASS, DANIEL ADAM, MD
Q7376
Q6018
GLASS, ERIC EDWARD, MD
GLASS, KRISTINE MUNOZ, MD
Q1611
GLASS, SHANNON BARRY, MD
Q4960
GLASSER, SCOTT ANDREW, MD
P4957
Q6835
GLASSMAN, THEODORE, MD
GLEASON, ADAM KESLING, MD
Q0445
Q6836
GLEASON, MICHAEL WILLIAM, MD
GLEASON, MIRANDA KIMBERLY,
MD
06-Jan-16
P6620
GLICK, JONATHAN MICHAEL, MD
5/15/2013
06-Jan-21 RADIOLOGY
EMERGENCY
5/15/2018 MEDICINE
Q3190
GLORI, MARIA F, MD
2/13/2015
Q0262
GLOVER, MARK ANDREW, MD
GLOVER, PORTER HUDSON SR,
MD
GLOYD, TIMOTHY, MD
5/15/2014
01-Jun-16
16-May-16
12/15/2011
3/17/2014
EMERGENCY
8/29/2019 MEDICINE
EMERGENCY
8/1/2018 MEDICINE
Q8486
Q8251
P1643
P9354
GO, JON AVERY TAN, MD
GOCHNOUR, DAVID CHRISTEN II,
MD
Q1612
Q8487
Q2552
GODALE, HEATHER R, MD
GODARA, POOJA, MD
GODFRED-CATO, SHANA , DO
P7445
GODFREY, BENJAMIN ROBERT, DO
GODINEZ, CARLOS DRAEGER JR,
MD
P6622
8/29/2014
7/1/2015
11/30/2012
06-Jan-16
6/2/2014
8/29/2014
01-Jun-16
12/3/2014
8/1/2013
5/15/2013
8/29/2019 RADIOLOGY
DIAGNOSTIC
7/1/2020 RADIOLOGY
EMERGENCY
11/30/2017 MEDICINE
06-Jan-21 RADIOLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
6/2/2019 OGY
PEDIATRICS
Page 127 of 402
Practice City
WACO
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/10/2012 None
N/A
7/25/2014 None
N/A
ALTANTA
TYLER
GA
TX
ACTIVE
ACTIVE
5/23/2013 None
6/8/2012 None
N/A
N/A
EL PASO
EL PASO
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
14-Mar-16 None
9/17/2015 None
N/A
N/A
8/29/2014 None
N/A
LAKEWOOD
CO
ACTIVE
7/8/2015 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
12/10/2012 None
15-Jan-16 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/18/2014 None
N/A
DALLAS
TX
ACTIVE
15-Jan-16 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
5/21/2013 None
N/A
2/13/2015 None
N/A
5/15/2014 None
N/A
01-Jun-16 None
02-Jun-16 None
N/A
N/A
12/15/2011 None
N/A
3/20/2014 None
N/A
8/29/2014 None
06-Jun-16 None
12/5/2014 None
N/A
N/A
N/A
ACTIVE
8/6/2013 None
N/A
ACTIVE
5/17/2013 None
N/A
MIDDLETOWN CT
CEDAR PARK
TEMPLE
TX
TX
HOUSTON
TX
JACKSONVILL
E
FL
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
Physician Name
P3628
GODLEY, STACEY ALECE, MD
P4448
P5068
GODOY, GUILHERME , MD
GODOY, MYRNA COBOS BARCO,
MD
MD
MD
Q2667
GOEBEL, ROBERT HOWARD, MD
P5068
P5068
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
6/15/2012
UROLOGIC
9/17/2012
9/17/2017 ONCOLOGY
DIAGNOSTIC
12/17/2012
DIAGNOSTIC
12/17/2012
DIAGNOSTIC
12/17/2012
RADIATION
12/15/2014
12/15/2019 ONCOLOGY
Q1613
GOEL, AMITABH, MD
8/29/2014
Q0919
GOEL, SARA , DO
7/15/2014
Q6196
P5069
P5069
P5069
Q5412
GOEL, SUMINA, MD
GOENTZEL, BRIAN JOHN, MD
GOFFI, ADRIANO ENRICO, MD
P2246
GOGIA, SUDHANSHU, MD
Q4585
Q8252
P1076
P8781
GOGINENI, JYOTHI, MD
GOHAR, SALMAN , MD
GOKAPAI, MADHUMATHI, MD
GOKHALE, SANKALP, MD
P3158
Secondary Specialty
(Self-Designated)
UROLOGY
CARDIOTHORACIC
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
CARDIOTHORACIC
RADIOLOGY
PHYSICAL MED. &
PHYSICAL MED. &
NUCLEAR MEDICINE
ANESTHESIOLOGY
ANESTHESIOLOGY
ANESTHESIOLOGY
FAMILY MEDICINE
GASTROENTEROLOG
Y
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
CARDIOLOGY
FAMILY PRACTICE
NEUROLOGY
EMERGENCY
MEDICINE
DIAGNOSTIC
RADIOLOGY
3/1/2012
3/1/2017
6/1/2015
16-May-16
10/3/2011
1/15/2014
6/1/2020
16-May-21
10/3/2016
1/15/2019
GOLDBERG, SCOTT, MD
5/15/2012
5/15/2017
Q0756
GOLDEN, MICHAEL JAMES, MD
6/27/2014
6/27/2019
Q4586
GOLDEN, OTASHE NYOKU, MD
6/1/2015
FAMILY MEDICINE
P9577
GOLDENSTEIN, LEONARD, MD
4/1/2014
NEPHROLOGY
P4958
GOLDFARB, DAVID WOLFF, MD
11/30/2017 UROLOGY
HOSPITALIST
Disciplinary
Status Date
TX
ACTIVE
6/27/2012 None
N/A
HOUSTON
TX
ACTIVE
9/28/2012 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
HOUSTON
TX
ACTIVE
12/31/2012 None
N/A
ACTIVE
12/24/2014 None
N/A
8/29/2014 None
N/A
7/15/2014 None
N/A
10/1/2015
1/2/2013
1/2/2013
1/2/2013
8/5/2015
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
3/1/2012 None
N/A
PAIN MANAGEMENT
10/1/2020
12/17/2017
12/17/2017
12/17/2017
8/3/2020
Registration
Status Date
Disciplinary
Status of
Texas
License
SPRING
PAIN
MANAGEMENT/REHA
B MED
10/1/2015
12/17/2012
12/17/2012
12/17/2012
8/3/2015
11/30/2012
Practice City
Registration
Status of
Practice
Texas
State
License
TEMPLE
TEMPLE
TEMPLE
HEREFORD
TX
TX
TX
TX
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE ROANOKE
HOSPITALIST
DALLAS
EMERGENCY
MEDICAL SERVICES DALLAS
NUCLEAR MEDICINE HARLINGEN
UROLOGIC SURGERY HOUSTON
Page 128 of 402
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
VA
TX
ACTIVE
6/1/2015
23-May-16
10/9/2011
2/5/2014
None
None
None
None
N/A
N/A
N/A
N/A
6/22/2012 None
N/A
7/7/2014 None
N/A
6/1/2015 None
N/A
4/1/2014 None
N/A
12/6/2012 None
N/A
License
Number
Physician Name
Q2135
GOLDSHMID, FRANCIS M, MD
Q5806
GOLDSMITH, SHAINA JILL, MD
Q6838
GOLDSON, TOVE MARTINE, MD
dicaid
dicaid
Agreement
End Date
Designated)
10/15/2014
8/28/2015
06-Jan-16
Q8488
P6623
Q8489
GOLI, KIRAN, MD
GOLI, KRISHNA, MD
GOLI, NEETA MUDLAGIRI, MD
01-Jun-16
5/15/2013
01-Jun-16
Q1822
GOLI, SUJATHA ANIL, MD
9/15/2014
P1644
Q5413
GOLLA, PRADEEP, DO
GOLOVAC, STANLEY , MD
12/15/2011
8/3/2015
P6399
Q4118
GOLUB, VITALY, MD
GOMBERA, MUFADDAL MUSTAFA,
MD
Q8253
GOMES, NATHAN, MD
16-May-16
Q8490
Q5656
01-Jun-16
8/14/2015
P0725
GOMEZ, JESSICA, MD
GOMEZ, LAURA , MD
GOMEZ-MEADE, CARLEY ANNE,
DO
P0829
GOMEZ-MEADE, CARLOS, DO
8/26/2011
P6625
GONZALEZ MONTOYA, VICTOR
HUGO, MD
5/15/2013
5/15/2018 NEUROLOGY
P0979
GONZALEZ, CARLOS, MD
9/15/2011
P7113
GONZALEZ, DELIA , MD
P2860
GONZALEZ, ENRIQUE , MD
GONZALEZ, ESTEBAN
ALEJANDRO, MD
P8669
5/1/2013
5/1/2015
8/15/2011
7/1/2013
4/13/2012
1/3/2014
5/15/2018 NEUROLOGY
PULMONARY
9/15/2019 MEDICINE
EMERGENCY
12/15/2016 MEDICINE
8/3/2020 PAIN MEDICINE
INFECTIOUS
5/1/2018 DISEASES
ORTHOPEDIC
5/1/2020 SURGERY
DIAGNOSTIC
16-May-21 RADIOLOGY
OPHTHALMOLOGY 01-Jun-21 VITREOUS SURGERY
PEDIATRIC
Secondary Specialty
(Self-Designated)
NEPHROLOGY
NEURO-ONCOLOGY
CRITICAL CARE
MEDICINE
Practice City
FT. WORTH
HOUSTON
GALVESTON
VICKSBURG
GARLAND
PORT
ARTHUR
OLYMPIA
FIELDS
MERRITT ISL.
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/22/2014 None
N/A
9/2/2015 None
N/A
15-Jan-16 None
N/A
01-Jun-16 None
7/12/2013 None
08-Jun-16 None
N/A
N/A
N/A
TX
ACTIVE
9/16/2014 None
N/A
IL
FL
ACTIVE
ACTIVE
12/19/2011 None
8/5/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/28/2013 None
N/A
ACTIVE
5/4/2015 None
N/A
PEDIATRICS
MOHS
MICROGRAPHIC
SURGERY
SAYRE
PA
ACTIVE
23-May-16 None
N/A
HOUSTON
AMARILLO
TX
TX
ACTIVE
ACTIVE
13-Jun-16 None
8/25/2015 None
N/A
N/A
MIAMI
FL
ACTIVE
8/22/2011 None
N/A
HOLLYWOOD
FL
ACTIVE
9/2/2011 None
N/A
LICENSE
ISSUED
5/15/2013 None
N/A
TX
ACTIVE
9/21/2011 None
N/A
TX
ACTIVE
7/4/2013 None
SEE
PREVIOUS
4/13/2012 ORDER
N/A
CLINICAL
NEUROPHYSIOLOGY
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
EL PASO
ORTHOPEDIC
9/15/2016 SURGERY
OBSTETRICS &
GYNECOLOGICAL
7/1/2018 SURGERY
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
MS
ACTIVE
TX
ACTIVE
AUSTIN
Page 129 of 402
LICENSE
ISSUED
LICENSE
ISSUED
1/3/2014 None
4/16/2012
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Q3192
GONZALEZ, JAIME , MD
2/13/2015
Q3520
GONZALEZ, KYMBERLY MARIE, MD
3/16/2015
P5182
P4959
GONZALEZ, LORENA , MD
GONZALEZ, MARIO G, MD
GONZALEZ, VANESSA CASANOVA,
MD
1/4/2013
11/30/2012
FAMILY PRACTICE
EL PASO
10/15/2014
12/16/2013
P2654
GONZALEZ, WILLIAM, MD
GONZALEZ-AMMATUNA, ELENA,
MD
GONZALEZ-AYALA, RAFAEL , MD
GONZALEZ-BERRIOS, NEREIDA,
MD
MD
MD
GONZALEZ-FRAGA, JULIAN DAX,
DO
GONZALEZ-SCARANO,
FRANCISCO ANTONIO, MD
GONZALEZ-STAWINSKI, GONZALO
VICENTE, MD
Q0642
GOODELL, CARA , MD
Q2136
P8587
P8782
P2249
P5071
P5071
P5071
Q3369
P1253
DALLAS
EL PASO
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/13/2015 None
N/A
TX
ACTIVE
3/18/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
1/28/2013 None
12/6/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/27/2014 None
N/A
12/16/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
2/5/2014 None
3/9/2012 None
N/A
N/A
12/17/2012 None
N/A
TX
TX
12/17/2012
12/17/2012
MCALLEN
TX
ACTIVE
2/8/2013 None
N/A
12/17/2012
MCALLEN
TX
ACTIVE
2/8/2013 None
N/A
GALVESTON
TX
ACTIVE
3/11/2015 None
N/A
SAN ANTONIO TX
ACTIVE
10/25/2011 None
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/9/2012 None
N/A
6/16/2014 None
N/A
1/5/2015 None
1/7/2014 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/21/2013 None
N/A
6/15/2012 None
N/A
3/3/2015
10/17/2011
4/2/2012
6/16/2014
CARDIOVASCULAR
4/2/2017 SURGERY
GOODMAN, OLGA, MD
GOODMAN, SAMANTHA HIRSCH,
MD
8/15/2013
6/15/2012
GOODSETT, JAMES ROBERT, MD
GOODWIN, ANNIE GAO, MD
GOODWIN, BRANDON PATRICK,
MD
8/1/2013
01-Jun-16
P7638
Q0447
1/5/2015
1/3/2014
GOODMAN, GENS PIERCE, DO
GOODMAN, LESLIE ALAN, MD
P7449
Q8480
DALLAS
ORTHOPEDIC
1/5/2020 SURGERY
Q2772
P8670
P3629
1/15/2014
3/1/2012
NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
6/2/2014
TRANSPLANT
SURGERY
ORTHOPEDIC
TRAUMA
RHEUMATOLOGY
INTERNAL MED PEDS
Page 130 of 402
TX
BEAUMONT
TX
HOUSTON
TX
WACO
HOUSTON
TX
TX
ACTIVE
ACTIVE
8/5/2013 None
03-Jun-16 None
N/A
N/A
GALVESTON
TX
ACTIVE
6/6/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
7/1/2013
7/1/2018 SURGERY
Secondary Specialty
(Self-Designated)
P7114
GOODWIN, JULIA, MD
Q6508
GOPAL, ARUN, MD
11/16/2015
INTERNAL MEDICINE
Q6509
11/16/2015
OTHER SPECIALTY
P5978
GOPAL, JEGAN, MD
GOPALAKRISHNAN, RAJALAKSHMI
THIRUNELLAI, MD
Q4119
GOPURALA, BALAGANESH, MD
P7639
GORADIA, VIPOOL KIRIT, MD
Q4963
GORDON, CARLA RASHELLE, MD
Q0921
P5367
Q8066
GORDON, ERIN EILEEN, DO
GORDON, JENNIFER ROSE
SHULTZ, MD
GORDON, STEVEN LARS, MD
P8245
GORDY, STEPHANIE DAWN, MD
11/1/2013
P6170
GORE, MARIA ODETTE, MD
4/12/2013
P9579
P5632
GORE, MARINA VASILEVA, MD
GORE, MEGHANA SANDEEP, MD
P7920
GOROUHI, FARIBORZ, MD
9/16/2013
P1314
GORREPATI, NAVAKANTH, MD
11/4/2011
P2657
GOSPIN, TAL ALON, MD
4/2/2012
P6400
Q0055
GOSWAMI, AARTI, MD
GOTARDO, ANNA , MD
5/1/2013
5/2/2014
Q4587
GOTHA, HEATHER ELIZABETH, MD
6/1/2015
Q3877
GOTTIMUKKALA, SRI BALA RANGA
SUNDARA VIJAYA LAKSHMI, MD
4/10/2015
4/1/2013
5/1/2015
8/15/2013
7/1/2015
7/15/2014
2/1/2013
02-May-16
4/1/2014
3/1/2013
4/1/2018 NEPHROLOGY
5/1/2020 ONCOLOGY
ORTHOPEDIC
8/15/2018 SURGERY
7/1/2020 PEDIATRICS
PEDIATRIC CRITICAL
02-May-21 PLASTIC SURGERY
11/1/2018 TRAUMATIC SURGERY
CARDIOVASCULAR
4/12/2018 DISEASES
EMERGENCY
4/1/2019 MEDICINE
Practice City
DALLAS
INTERNAL MEDICINE SAINT LOUIS
HEMATOLOGY INTERNAL MEDICINE ALABASTER
HUMBLE
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
7/9/2013 None
N/A
11/16/2015 None
N/A
11/16/2015 None
N/A
MO
ACTIVE
4/10/2013 None
N/A
AL
ACTIVE
5/18/2015 None
N/A
TX
ACTIVE
9/2/2013 None
N/A
HOUSTON
TX
ACTIVE
7/10/2015 None
N/A
DALLAS
TX
ACTIVE
8/6/2014 None
N/A
AUSTIN
HOUSTON
TX
TX
ACTIVE
ACTIVE
2/11/2013 None
10-May-16 None
N/A
N/A
SURGICAL CRITICAL
CARE
HOUSTON
TX
ACTIVE
11/6/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/17/2013 None
N/A
4/1/2014 None
3/6/2013 None
N/A
N/A
ACTIVE
9/30/2013 None
N/A
ACTIVE
11/28/2011 None
N/A
TX
ACTIVE
4/9/2012 None
N/A
NY
ACTIVE
ACTIVE
LICENSE
ISSUED
5/2/2013 None
5/5/2014 None
N/A
N/A
6/1/2015 None
N/A
4/10/2015 None
N/A
CRITICAL CARE
MEDICINE (IM)
HEMATOLOGY 9/16/2018 ONCOLOGY
INTERNAL MEDICINE VICTORIA
GASTROENTEROLOG
11/4/2016 Y
INTERNAL MEDICINE
PEDIATRICS,
4/2/2017 CARDIOLOGY
HOUSTON
HEMATOLOGY
5/1/2018 PATHOLOGY
(PATHOLOGY)
NEW YORK
ORTHOPEDIC
6/1/2020 SURGERY
OBSTETRICS &
GYNECOLOGICAL
4/10/2020 SURGERY
Page 131 of 402
TX
LICENSE
ISSUED
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
8/28/2015
8/28/2020 RADIOLOGY
NEURO-RADIOLOGY
15-Jan-16
6/14/2013
7/15/2011
FAMILY PRACTICE
6/27/2014
4/15/2014
HOSPITALIST
License
Number
Q5807
Q6941
P6970
P0391
Q0757
P9859
Physician Name
GOULD, ROBERT JOHN, MD
GOUNDEN, RENEE , MD
GOUX, VINCENT PAUL, MD
GOVATHOTI, DEEPTI A, MD
GOVERDHANA, SHYAM, MD
GOVINDAN, ARCHANA , MD
P2250
GOWANI, JEHANGIR WAZIRALI, MD
3/1/2012
Q2773
GOWDA, SHAILA, MD
1/5/2015
Q2447
GOWDA, SRINATH THIMMAIAH, MD
P2862
GOWRIGARI, NEELIMA , MD
J8252
GOYAL, LALIT, MD
Q8491
GOYAL, MITALI, MD
01-Jun-16
Q0758
GOYAL, VINITA , MD
6/27/2014
P0726
P5810
P7450
8/15/2011
3/15/2013
8/1/2013
Q7049
GRAHAM, BELINDA, MD
GRAHAM, GARY PETER, MD
GRAHAM, PAUL HARDIN, MD
GRAHAM, REBECCA BECKY GAIL,
DO
P5979
GRAHAM, TIMUR TAFARI, MD
Q7882
GRAMMATICO, ROBERT JOHN, MD
15-Apr-16
P7640
GRANADOS, HECTOR MANUEL, MD
8/15/2013
P1316
11/4/2011
Q2137
P5634
GRANDE, KATHRYN BURNS, MD
GRANDHI, BALA KOTESWARARAO,
MD
GRANDHI, JAYASREE, MD
Q5808
GRANDHI, RAMESH, MD
11/17/2014
4/13/2012
6/1/2012
01-Feb-16
4/1/2013
10/15/2014
3/1/2013
8/28/2015
3/1/2017 INTERNAL MED - PEDS SLEEP MEDICINE
1/5/2020 NEUROLOGY
PEDIATRICS,
DUNCAN
OK
Practice City
MEQUON
CLINICAL
NEUROPHYSIOLOGY
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
6/1/2017 MEDICINE
OBSTETRICS AND
ALLERGY AND
OBSTETRICS AND
PULMONARY
CRITICAL CARE
4/1/2018 MEDICINE
EMERGENCY
15-Apr-21 MEDICINE
PEDIATRIC
OBSTETRICS AND
KINGSLAND
CARTHAGE
DUMAS
DALLAS
Registration
Status of
Practice
Texas
State
License
WI
ACTIVE
ACTIVE
TX
ACTIVE
TX
ACTIVE
TX
ACTIVE
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
DAYTON
OH
Registration
Status Date
9/4/2015
02-Feb-16
7/8/2013
7/21/2011
6/30/2014
4/23/2014
Disciplinary
Status of
Texas
License
None
None
None
None
None
None
Disciplinary
Status Date
N/A
N/A
N/A
N/A
N/A
N/A
3/5/2012 None
N/A
1/5/2015 None
N/A
11/17/2014 None
N/A
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/11/2012 None
N/A
01-Jun-16 None
N/A
6/27/2014 None
N/A
PLANO
WICHITA
HOUSTON
TX
KS
TX
ACTIVE
ACTIVE
ACTIVE
8/18/2011 None
4/5/2013 None
8/5/2013 None
N/A
N/A
N/A
TYLER
TX
ACTIVE
09-Feb-16 None
N/A
ACTIVE
4/3/2013 None
N/A
INTERNAL MEDICINE
BEAUMONT
TX
ACTIVE
19-Apr-16 None
N/A
EL PASO
TX
ACTIVE
8/20/2013 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
12/15/2011 None
N/A
10/15/2014 None
3/29/2013 None
N/A
N/A
8/31/2015 None
N/A
3/1/2018 NEPHROLOGY
INTERNAL MEDICINE IRVING
TX
NEUROLOGICAL
8/28/2020 SURGERY
SAN ANTONIO TX
Page 132 of 402
ACTIVE
dicaid
dicaid
License
Agreement
Physician Name
Start Date
End Date
Designated)
GRANDSTAFF, PHILLIP MATTHEW,
EMERGENCY
P2252
MD
3/1/2012
3/1/2017 MEDICINE
Q0056
GRANNIS, CHARITY HALPHEN, MD
5/2/2014
Q0265
P7451
Q0643
P8134
GRANT, SHEENA MARY, MD
GRANT, WILLIAM NELSON III, MD
GRANVILLE TEAMER, CHANEL N,
MD
GRAVEL, PAUL BARRINGER, MD
5/15/2014
8/1/2013
6/16/2014
10/15/2013
DERMATOLOGIC
2/2/2020 SURGERY
12/15/2019 PHLEBOLOGY
Q3000
Q2669
P8671
GRAVES, MICHAEL STEPHEN, MD
GRAY, CAPTAIN KING, MD
GRAY, CHRISTOPHER, MD
2/2/2015
12/15/2014
1/3/2014
TM00479 GRAY, DANA ANN, MD
10/17/2011
H5448
Q5657
P2003
GRAY, LAURA ANN, MD
GRAY, MEGAN JANE, MD
GRAY, VON PRESTON, MD
11/30/2012
8/14/2015
2/1/2012
P2004
P0980
GREAR, BENJAMIN JOPLIN, MD
GRECO, PAUL THOMAS, MD
2/1/2012
9/15/2011
P1079
GREEN, AVAL-NA'REE SIAN, MD
10/3/2011
Q3879
P9357
GREEN, JOHN CHRISTOPHER, MD
GREEN, LINDSAY, MD
4/10/2015
3/17/2014
P9862
GREENBLATT, ADAM B, DO
GREENBLATT, JENNIFER
CZAPLICKI, DO
GREENE, NOAH HIMES, MD
4/15/2014
EMERGENCY
4/15/2019 MEDICINE
8/1/2014
7/1/2011
7/1/2016 CARDIOLOGY
Q1154
P0220
P4572
GREENE, SPENCER COREY, MD
10/1/2012
Q6199
GREENFIELD, BRAD JOSEPH, MD
GREENWOOD, NATHANIEL
VROMAN, DO
10/1/2015
P2863
4/13/2012
PHYSICAL MED. &
FOOT AND ANKLE,
EMERGENCY
10/1/2017 MEDICINE
RADIATION
10/1/2020 ONCOLOGY
EMERGENCY
4/13/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
TAHOKA
TX
HOSPITALIST
PHLEBOLOGY
INTERNAL MEDICINE LAWRENCE
KS
FORT WORTH TX
TUPELO
MS
WASHINGTON DC
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
3/9/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
5/5/2014 None
N/A
5/15/2014 None
8/7/2013 None
N/A
N/A
6/16/2014 None
10/25/2013 None
N/A
N/A
2/2/2015 None
12/18/2014 None
2/3/2014 None
N/A
N/A
N/A
10/17/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
12/3/2012 None
8/31/2015 None
2/14/2012 None
N/A
N/A
N/A
2/7/2012 None
10/11/2011 None
N/A
N/A
ORTHOPEDIC
SURGERY
DALLAS
TX
TX
ACTIVE
ACTIVE
TEMPLE
TX
10/5/2011 None
N/A
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/10/2015 None
3/24/2014 None
N/A
N/A
TOMBALL
TX
ACTIVE
4/30/2014 None
N/A
SPRING
NELLIS AFB
TX
NV
ACTIVE
ACTIVE
8/13/2014 None
7/8/2011 None
N/A
N/A
HOSPITALIST
MEDICAL
TOXICOLOGY
(EMERGENCY
MEDICINE)
EMERGENCY
MEDICAL SERVICES
Page 133 of 402
HOUSTON
ABILENE
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
SEE
PREVIOUS
10/18/2012 ORDER
11/16/2012
10/1/2015 None
N/A
4/25/2012 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/3/2015
8/3/2020 MEDICINE
Q4964
Physician Name
GREGERSON, BRYCE GUSTAVE,
MD
GREGG, COURTNEY ELIZABETH,
MD
Q0922
GREGORY, JAMES M, MD
P1759
P8357
GREGORY, JANET, DO
GREGORY, WILLIAM BEDINGER,
MD
Q0760
GREIVES, MATTHEW ROBERT, MD
6/27/2014
7/1/2020 PEDIATRICS
ORTHOPEDIC
7/15/2019 SURGERY
EMERGENCY
1/2/2017 MEDICINE
EMERGENCY
11/15/2018 MEDICINE
PLASTIC &
RECONSTRUCTIVE
6/27/2019 SURGERY
Q4965
7/1/2015
Q1825
P6626
GREWAL, GAGANPREET KAUR, MD
GREWAL, HERMANJEET SINGH,
MD
GREWAL, KUSHMIT SINGH, MD
9/15/2014
5/15/2013
Q5658
GREWAL, NAVNEET KAUR, MD
8/14/2015
Q8067
GREWAL, PRABHDEEP KAUR, MD
02-May-16
Q0644
GRIFFIN, JOHN RANDALL, MD
6/16/2014
Q4410
GRIFFIN, MATTHEW PATRICK, MD
5/15/2015
P3160
GRIFFIN, STEPHEN JOHN, MD
5/15/2012
H9337
GRIFFIN, TIMOTHY CAMERON, MD
OBSTETRICS AND
PEDIATRIC
HEMATOLOGY/ONCOL
4/1/2019 OGY
OCCUPATIONAL
ENVIRONMENTAL
01-Feb-21 MEDICINE
GASTROENTEROLOG
01-Feb-21 Y
Q5415
7/1/2015
7/15/2014
1/2/2012
11/15/2013
4/1/2014
Q7051
GRIFFITH, MARGARET IRENE, MD
01-Feb-16
Q7052
GRIGG-GUTIERREZ, NICOLE M, MD
01-Feb-16
Q4411
GRIGGS, FELICIA SEATON, MD
5/15/2015
Q3002
GRIGGS, MOREKO ALTOINE, MD
2/2/2015
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
CRITICAL CARE
MEDICINE
DERMATOPATHOLO
GY
GENERAL
PREVENTIVE
MEDICINE
TX
ACTIVE
8/12/2015 None
N/A
HOUSTON
TX
ACTIVE
7/8/2015 None
N/A
HOUSTON
TX
ACTIVE
8/26/2014 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
2/2/2012 None
N/A
11/15/2013 None
N/A
HOUSTON
TX
ACTIVE
7/2/2014 None
N/A
DALLAS
TX
ACTIVE
7/3/2015 None
N/A
HOUSTON
YUMA
TX
AZ
ACTIVE
ACTIVE
9/23/2014 None
5/21/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/18/2015 None
N/A
02-May-16 None
N/A
DALLAS
TX
ACTIVE
6/20/2014 None
N/A
BLUE ISLAND
IL
ACTIVE
6/3/2015 None
N/A
AMARILLO
TX
ACTIVE
5/17/2012 None
N/A
SAN ANTONIO TX
ACTIVE
4/3/2014 None
N/A
JERSEY CITY
NJ
ACTIVE
21-Apr-16 None
N/A
NC
ACTIVE
LICENSE
ISSUED
02-Feb-16 None
N/A
5/15/2015 None
N/A
2/4/2015 None
N/A
INTERNAL MEDICINE CHARLOTTE
DIAGNOSTIC
2/2/2020 RADIOLOGY
Page 134 of 402
Disciplinary
Status Date
TEMPLE
EMERGENCY
MEDICAL SERVICES
CRANIOFACIAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE
PULMONARY
8/28/2015
MEDICINE
Q5809
GRIGORIYAN, ARTUR , MD
P9359
GRIGSBY, DANIELLE NICOLE, MD
3/17/2014
Q6840
GRIGSBY, EMILY WYATT, MD
06-Jan-16
P2120
GRIMM, LEANDER MOREL JR, MD
2/10/2012
Q3881
GRINBLATAS, IORAM, MD
4/10/2015
EMERGENCY
06-Jan-21 MEDICINE
P9360
Q2902
GROGAN, BRIAN FOLEY, MD
1/15/2015
CRANIOFACIAL
6/27/2019 SURGERY
EMERGENCY
3/17/2019 MEDICINE
ORTHOPEDIC
1/15/2020 SURGERY
Q5659
GROISBERG, ROMAN , MD
8/14/2015
P3335
Q4967
GRONSTEDT, GARY, DO
GROOTERS, CHARLES EMERSON,
MD
6/1/2012
7/1/2015
8/29/2014
6/1/2017 PSYCHIATRY
ORTHOPEDIC
7/1/2020 SURGERY
ORTHOPEDIC
8/29/2019 SURGERY
Q1618
GROSS, DOMINIC LINUS, MD
Q1156
GROSS, NEIL D, MD
8/1/2014
P2994
GROSSMAN, JULIA, MD
5/1/2012
P8028
Q2138
GROSU, HORIANA B, MD
GROTH, SHAWN SPENCER, MD
P5636
GRUBBS, CHRISTINA DANIEL, MD
3/1/2013
DIAGNOSTIC
5/1/2017 RADIOLOGY
PULMONARY
CRITICAL CARE
10/1/2018 MEDICINE
OBSTETRICS AND
3/1/2018 GYNECOLOGY
Q4412
GRUENEBAUM, DANE DAVID, DO
5/15/2015
10/1/2013
10/15/2014
9/4/2015 None
N/A
LA
ACTIVE
3/19/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
05-Feb-16 None
N/A
2/10/2012 None
N/A
4/10/2015 None
N/A
6/27/2014 None
N/A
4/9/2014 None
N/A
1/27/2015 None
N/A
8/14/2015 None
N/A
ACTIVE
CHILD AND
ADOLESCENT
PSYCHIATRY
SURGERY
HEAD AND NECK
SURGERY
CARDIOLOGY
Page 135 of 402
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
FT. HOOD
Registration
Status Date
Disciplinary
Status of
Texas
License
KY
PLASTIC &
RECONSTRUCTIVE
SURGERY
6/27/2014
3/17/2014
PIKEVILLE
NEW
ORLEANS
EMERGENCY
4/10/2020 MEDICINE
GRINER, DEVAN, MD
GROETSEMA, GREGORY ALLEN,
MD
Q0761
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
AUSTIN
TX
ACTIVE
6/8/2012 None
N/A
LONGVIEW
TX
ACTIVE
8/26/2015 None
N/A
EL PASO
TX
9/3/2014 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/1/2014 None
N/A
DALLAS
TX
ACTIVE
5/7/2012 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
10/4/2013 None
10/21/2014 None
N/A
N/A
TEMPLE
CORPUS
CHRISTI
TX
ACTIVE
3/5/2013 None
N/A
TX
ACTIVE
5/25/2015 None
N/A
License
Number
Q0450
P1761
P2253
P9361
Physician Name
GRZYBOWSKI, RICHARD FRANCIS,
DO
GU, MELINDA MIN, MD
P1646
P4450
Q4968
Q6943
GU, YING, MD
GUDUR, SUMA, MD
GUERRA VALENCIA, EDUARDO
MIGUEL, MD
GUERRA, CRISTINA, MD
GUERRA, MEGAN CASKEY, MD
GUERRERO, KAREN TARM, MD
P6172
GUESS, AARON ALAN, DO
Q8255
GUILLEN, PHILLIP TOMAS, MD
P6403
GUIROLA, RICARDO , MD
P6972
P5184
GUJJA, KARTHIK REDDY, MD
GULBIS, ANDREW JOHN, MD
Q8497
GULERIA, SAURABH, MD
P9362
P9196
P4653
GULLETT, JEFFEEA , MD
GUMMADAPU, RAGINI, MD
GUMMELT, KYLE LAMAR, DO
Q5660
GUNAWAN, JONAS , MD
dicaid
dicaid
Agreement
End Date
Designated)
6/2/2014
1/2/2012
3/1/2012
3/17/2014
12/15/2011
9/17/2012
7/1/2015
15-Jan-16
4/12/2013
16-May-16
5/1/2013
6/14/2013
1/4/2013
01-Jun-16
3/17/2014
3/3/2014
10/15/2012
8/14/2015
6/2/2019 RADIOLOGY
12/15/2016
9/17/2017
7/1/2020
15-Jan-21
FAMILY MEDICINE
GENERAL SURGERY
PEDIATRICS
DERMATOLOGY
EMERGENCY
4/12/2018 MEDICINE
16-May-21 SURGERY
PEDIATRIC
Secondary Specialty
(Self-Designated)
ANGIOGRAPHY &
INTERVENTIONAL
RADIOLOGY
Q5193
GUNDERT, EMILY E, MD
7/15/2015
P1549
12/1/2011
P3336
GUNN, ELAINE E, MD
GUNTIPALLI, PRAVEEN KUMAR,
MD
6/1/2012
P3161
Q1986
GUO, MEIHUA , MD
GUPTA, ARCHANA, MD
5/15/2012
10/1/2014
Disciplinary
Status Date
TX
TX
ACTIVE
ACTIVE
6/16/2014 None
2/10/2012 None
N/A
N/A
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOSPITALIST
HINES
DALLAS
IL
TX
ACTIVE
ACTIVE
3/2/2012 None
3/24/2014 None
N/A
N/A
GERIATRICS
GALVESTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
1/19/2012
10/8/2012
7/3/2015
22-Jan-16
None
None
None
None
N/A
N/A
N/A
N/A
4/12/2013 None
N/A
23-May-16 None
N/A
5/3/2013 None
N/A
6/14/2013 None
1/7/2013 None
N/A
N/A
02-Jun-16 None
N/A
3/17/2014 None
4/16/2014 None
10/18/2012 None
N/A
N/A
N/A
8/14/2015 None
N/A
SAN ANTONIO TX
ORTHOPEDIC
SURGERY
SPORTS MEDICINEPEDS
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
7/15/2020 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
HOUSTON
PEDIATRIC
RADIOLOGY
01-Jun-21 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
CRITICAL CARE
MEDICINE
5/15/2017 PATHOLOGY
MIDLAND
TX
ACTIVE
HOUSTON
TX
HEMPHILL
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
AUSTIN
TX
LONG BEACH
DALLAS
CA
TX
DALLAS
TX
ACTIVE
8/13/2015 None
N/A
BRYAN
TX
ACTIVE
12/5/2011 None
N/A
6/12/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
5/15/2012 None
10/9/2014 None
N/A
N/A
CYPRESS
Page 136 of 402
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q1619
GUPTA, ATUL K, MD
8/29/2014
Q4590
P5638
P5983
Q8256
P6173
GUPTA, DIVYA, MD
GUPTA, ISHA, MD
GUPTA, MOHIT, MD
GUPTA, MONALI, MD
GUPTA, NISHANT, MD
6/1/2015
3/1/2013
4/1/2013
16-May-16
4/12/2013
Q4758
P0393
GUPTA, ROHAN , DO
GUPTA, SACHIN, MD
6/12/2015
7/15/2011
P6824
GUPTA, SACHIN, MD
6/3/2013
P7115
P4761
GUPTA, SUNITA NARENDRA, MD
GUPTA, SURESH C, MD
7/1/2013
11/1/2012
P0221
P7771
Q4122
GUPTA, UMANG, MD
GUPTE, MANJUSHA ARUN, MD
GURJI, HUNAID ADAM, DO
7/1/2011
8/30/2013
5/1/2015
Q3683
Q7556
GURRAM, BHASKAR, MD
GURRAM, SRINIVASA R, MD
4/1/2015
15-Mar-16
P3163
GUST, SHANNON KATHLEEN, MD
5/15/2012
6/1/2020
3/1/2018
4/1/2018
16-May-21
4/12/2018
INTERNAL MEDICINE
INTERNAL MEDICINE
HOSPITALIST
RADIOLOGY
INTERNAL MEDICINE
OTOLARYNGOLOGY
6/3/2018 (NEUROTOLOGY)
INFECTIOUS
7/1/2018 DISEASES
PEDIATRICS,
7/1/2016 CARDIOLOGY
5/1/2020 PEDIATRICS
PEDIATRIC
GASTROENTEROLOG
4/1/2020 Y
EMERGENCY
5/15/2017 MEDICINE
GUTHEIL, LAUREN K, DO
Q2671
GUTHRIE, TRAVIS JAMES, MD
12/15/2014
EMERGENCY
12/15/2019 MEDICINE
Q6320
GUTIERREZ, ARMANDO I, MD
GUTIERREZ, BERNARDO ALVARO,
MD
GUTIERREZ, GENARO JESUS JR,
MD
10/15/2015
GUTIERREZ, JAMES JOSEPH, MD
GUTIERREZ, JONATHAN MARIO,
MD
9/15/2015
Q0924
Q6021
Q3371
10/17/2011
7/15/2014
3/3/2015
Practice City
8/29/2019 RADIOLOGY
P8029
J5778
10/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
NJ
ACTIVE
PA
ACTIVE
TX
ACTIVE
NJ
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
6/12/2015 None
7/21/2011 None
N/A
N/A
ACTIVE
6/5/2013 None
N/A
ACTIVE
ACTIVE
7/2/2013 None
11/7/2012 None
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/6/2011 None
9/9/2013 None
5/11/2015 None
N/A
N/A
N/A
LUFKIN
TX
LICENSE
ISSUED
ACTIVE
4/1/2015 None
17-Mar-16 None
N/A
N/A
ROWLETT
TX
ACTIVE
LICENSE
ISSUED
5/29/2012 None
N/A
10/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
12/30/2014 None
N/A
10/15/2015 None
N/A
DALLAS
OTOLOGY/NEUTOTO
LOGY
DALLAS
TX
INTERNAL MEDICINE
CORPUS
CHRISTI
AUSTIN
HOUSTON
PEDIATRICS
HOUSTON
TX
6/1/2015
4/29/2013
4/8/2013
25-May-16
4/29/2013
N/A
N/A
N/A
N/A
N/A
N/A
PALLIATIVE
MEDICINE
8/29/2014 None
Disciplinary
Status Date
None
None
None
None
None
HOSPITALIST
PATERSON
INTERNAL MEDICINE UPLAND
HOUSTON
CARDIOLOGY
PATERSON
PEDIATRICS
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
GERIATRICS INTERNAL MEDICINE TEMPLE
TX
ACTIVE
10/18/2011 None
N/A
ANESTHESIOLOGY
AUSTIN
TX
ACTIVE
8/4/2014 None
N/A
LAREDO
TX
ACTIVE
9/16/2015 None
N/A
EL PASO
TX
ACTIVE
3/23/2015 None
N/A
9/15/2020 NEUROLOGY
EMERGENCY
3/3/2020 MEDICINE
Page 137 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
3/15/2012
3/15/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
P2452
GUTIERREZ, JOSE ARMANDO, MD
Q0925
GUTIERREZ, JULIO ANACLETO, MD
7/15/2014
7/15/2019 HEPATOLOGY
P0395
GUTIERREZ, MARIO A, MD
GUTIERREZ, MICHAEL JOSEPH,
MD
GUTIERREZ, NORA , MD
7/15/2011
7/15/2013
01-Jun-16
01-Jun-21 ANESTHESIOLOGY
11/17/2014
P6174
P6404
GUTIERREZ-CAMPOS, GARY, MD
GUTIERREZ-MACIAS, RODOLFO
GABRIEL, MD
GUTMAN, JUSTIN, MD
4/12/2013
5/1/2013
Q0645
GUTTA, VEERENDRA KUMAR, MD
6/16/2014
Q7883
P6627
GUTTENBERG, KATIE BATES, MD
GUZMAN, ALFONSO JR, MD
15-Apr-16
5/15/2013
ENDOCRINOLOGY,
DIABETES AND
15-Apr-21 METABOLISM
P3533
Q4417
GUZMAN-ABLOG, MYLEEN, MD
GUZZETTA, ANGELA ANNE, MD
6/8/2012
5/15/2015
P7278
GWIN, KATJA, MD
7/15/2013
Q4591
GWIN, TAYLOR S, MD
P1871
HA, THOA KIM, MD
1/17/2012
Q3883
Q6201
4/10/2015
10/1/2015
P9866
HA, TRUNG VAN, MD
HABIB, FAROOQ, MD
HABTGIORGIS, DRESSLGN AYLE,
MD
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
SURGERY
DALLAS
PHYSICAL MED. &
PEDIATRICS
4/15/2014
P2662
HACKL, THEODORE E, MD
4/2/2012
Q4593
HACKNER, DANI, MD
6/1/2015
P7277
Q8498
Q2448
6/1/2015
TX
GASTROENTEROLOG
Y
SAN ANTONIO TX
NEUROLOGICAL
SURGERY
6/8/2017 PEDIATRICS
ANATOMIC
7/15/2018 PATHOLOGY
CRITICAL CARE
6/1/2020 MEDICINE
DALLAS
Registration
Status of
Practice
Texas
State
License
LAREDO
HOUSTON
OTHER SPECIALTY
TX
TX
HOUSTON
TX
DALLAS
TX
DALLAS
TX
TX
HUGHESVILLE MD
OPHTHALMOLOGY ANTERIOR SURGERY
PULMONARY
DISEASES
HOUSTON
Page 138 of 402
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
3/23/2012 None
N/A
ACTIVE
8/1/2014 None
N/A
ACTIVE
7/20/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/10/2013 None
13-Jun-16 None
N/A
N/A
11/17/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/26/2013 None
5/21/2013 None
N/A
N/A
6/16/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
25-Apr-16 None
5/20/2013 None
N/A
N/A
6/8/2012 None
5/18/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/19/2013 None
N/A
6/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
2/23/2012 None
N/A
4/10/2015 None
10/22/2015 None
N/A
N/A
ACTIVE
5/1/2014 None
N/A
LICENSE
ISSUED
4/2/2012 None
N/A
ACTIVE
6/9/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
CARDIOVASCULAR
11/1/2012
11/1/2017 DISEASES
EMERGENCY
8/29/2014
8/29/2019 MEDICINE
PLASTIC &
RECONSTRUCTIVE
4/13/2012
4/13/2017 SURGERY
4/1/2014
MATERNAL AND
8/1/2011
CARDIOVASCULAR
11/4/2011
11/4/2016 DISEASES
ORTHOPEDIC
9/15/2015
9/15/2020 SURGERY
ALLERGY AND
10/15/2013
7/15/2015
16-Feb-16
11/15/2012
11/15/2017 ONCOLOGY
GERIATRIC MEDICINE
8/1/2013
CARDIOTHORACIC
01-Apr-16
2/1/2013
2/1/2018 RADIOLOGY
P4762
HADDADIAN, BABAK, MD
Q1620
HADDOCK, ALISON, MD
P2866
P9583
HADDOCK, NICHOLAS TILL, MD
HADIDI, OMAR FAYEZ, MD
P0595
HAERI, SINA , MD
P1317
HAEUSSLEIN, ERNEST A, MD
Q6022
HAGAG, AHMED THABET, MD
P8136
Q5194
Q7200
P4871
HAGAMAN, DAVID DANIEL, MD
HAGEN, MICHAEL PETER JR, MD
HAGER, JONATHAN LEE, MD
HAGIN, GERALD DOUGLAS, MD
P7453
Q7727
P5371
HAGIWARA, YUYA , MD
HAGLER, ANNA K KOWALCZYK,
MD
HAGOPIAN, TARA , DO
P7454
HAGOS, ELILTA M, MD
P0398
HAHN, GIORA, MD
7/15/2011
Q4418
HAHN, STEPHEN MICHAEL, MD
5/15/2015
Q4419
HAI, NABILA, MD
5/15/2015
RADIATION
5/15/2020 ONCOLOGY
DIAGNOSTIC
5/15/2020 RADIOLOGY
Q0061
HAIDAR, GEORGES MOUNIR, MD
5/2/2014
Q6752
HAIDER, ADNAN , MD
15-Dec-15
GERIATRICS 15-Dec-20 INTERNAL MEDICINE
Q4420
HAIDER, ALI, MD
5/15/2015
Q7884
HAIDER, ALIYA, MD
15-Apr-16
8/1/2013
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE LACROSSE
HAND SURGERY
CARDIOLOGY
OBSTETRICS AND
GYNECOLOGY
Registration
Status of
Practice
Texas
State
License
WI
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
11/8/2012 None
N/A
8/29/2014 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
4/23/2012 None
4/3/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/5/2011 None
N/A
ACTIVE
11/7/2011 None
N/A
TX
ACTIVE
10/19/2015 None
N/A
TX
IA
ACTIVE
ACTIVE
ACTIVE
ACTIVE
11/6/2013
7/27/2015
18-Feb-16
12/21/2012
None
None
None
None
N/A
N/A
N/A
N/A
SD
ACTIVE
8/7/2013 None
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
05-Apr-16 None
2/18/2013 None
N/A
N/A
8/1/2013 None
N/A
INTERNAL MEDICINE
PEDIATRIC
ORTHOPEDICS
EL PASO
PULMONARY
MEDICINE
SEGUIN
INTERNAL MEDICINE SIOUX CITY
PALLIATIVE
MEDICINE
SIOUX FALLS
IRVING
NEURO-RADIOLOGY
ASPEN
CO
ACTIVE
8/10/2011 None
N/A
ONCOLOGY
HOUSTON
TX
ACTIVE
5/26/2015 None
N/A
BREAST IMAGING
VASCULAR
SURGERY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
PALLIATIVE
MEDICINE
HOUSTON
TX
ACTIVE
5/20/2015 None
N/A
ACTIVE
5/9/2014 None
N/A
TX
ACTIVE
16-Dec-15 None
N/A
TX
ACTIVE
5/18/2015 None
N/A
ACTIVE
26-Apr-16 None
N/A
ODESSA
HOUSTON
INFECTIOUS
15-Apr-21 DISEASES
INTERNAL MEDICINE
Page 139 of 402
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
8/15/2011
7/15/2011
INTERNAL MEDICINE
12/15/2011
8/30/2013
INTERNAL MEDICINE
License
Number
P0728
P0399
P1648
P7772
Physician Name
HAIDER, AMAN , MD
HAIDER, HUMA, MD
HAIDER, NADEEM, MD
HAILE, ISRAEL, MD
P3631
P2005
HAIN, PAUL DOUGLAS, MD
HAIRR, JOHN, MD
P3534
HAJIRAWALA, MITABEN, MD
Q1987
HAKEEM, IMTIYAZ HUSSAIN, MD
P6407
HAKIM, HANA, MD
5/1/2013
P0597
HAKIM, VICTOR NABEEL, MD
8/1/2011
6/15/2012
2/1/2012
10/1/2014
HALEY, LINDSEY , MD
2/18/2014
Q1988
Q6023
HALL, AMANDA BROOKE, DO
HALL, CHAD MAXWELL, MD
10/1/2014
9/15/2015
Q5420
Q5421
HALL, DAVID RYAN, MD
HALL, ELIZABETH ANNE, MD
Q4761
HAMES, CHRISTAL CRAMER, MD
ACTIVE
LICENSE
ISSUED
PLANO
N/A
N/A
6/8/2012 None
N/A
10/9/2014 None
N/A
5/1/2013 None
N/A
TX
ACTIVE
8/31/2011 None
N/A
2/19/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
10/1/2014 None
9/17/2015 None
N/A
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
TX
TX
ACTIVE
ACTIVE
9/10/2015 None
8/4/2015 None
N/A
N/A
6/12/2015
TX
ACTIVE
6/17/2015 None
N/A
WI
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/30/2011 None
9/17/2015 None
12/17/2014 None
N/A
N/A
N/A
HOUSTON
TX
GRAFTON
WI
ACTIVE
ACTIVE
ACTIVE
05-May-16 None
8/20/2013 None
6/12/2012 None
N/A
N/A
N/A
DALLAS
WICHITA
FALLS
TX
ACTIVE
6/18/2014 None
N/A
TX
ACTIVE
8/20/2015 None
N/A
02-May-16
8/1/2013
5/15/2012
Q4970
MO
6/15/2012 None
2/7/2012 None
HOUSTON
Q8070
P7455
P3166
HAMDI, TAMIM, MD
OBSTETRICS AND
POPLAR
BLUFF
Disciplinary
Status Date
N/A
N/A
N/A
N/A
8/3/2015
8/3/2015
12/15/2011
9/15/2015
12/15/2014
Q0646
5/1/2018 PEDIATRICS
ORTHOPEDIC
8/1/2016 SURGERY
HOSPITALIST
PEDIATRIC
INFECTIOUS
DISEASE
Registration
Status Date
8/24/2011
8/8/2011
1/3/2012
9/9/2013
Disciplinary
Status of
Texas
License
None
None
None
None
TRANSPLANT
8/3/2020 SURGERY
8/3/2020 PEDIATRICS
HALLAHAN, KATIE MARIE , MD
HALLENBECK, KATHERINE ANN,
TM00493 MD
Q6024
HALLMARK, CHRISTOPHER, MD
Q2672
HALPERIN, DANIEL M, MD
HAMAD, ALIA I, DO
HAMBY, RICKEY WHITE JR, MD
HAMDARD, FARAH, MD
6/8/2012
P9071
Practice City
HOUSTON
HOUSTON
FARGO
LIBERTY
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
ND
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
6/16/2014
7/1/2015
9/15/2020 RADIOLOGY
12/15/2019 ONCOLOGY
PEDIATRIC
EMERGENCY
02-May-21 MEDICINE (PEDS)
TEMPLE
BREAST IMAGING
MILWAUKEE
CYPRESS
FAMILY MEDICINE
CRITICAL CARE
MEDICINE
Page 140 of 402
License
Number
Physician Name
J9080
Q7382
HAMID, FARRUKH, MD
HAMILL, ANDREW, DO
P3633
HAMILTON, ALAN SCOTT, MD
P0401
HAMILTON, CARLTON
CARMICHAEL II, MD
HAMILTON, FRANCHELL RICHARD,
MD
HAMILTON, TANISHA JAMARRIA,
MD
Q4123
Q7886
HAMM, APRIL M, MD
HAMMAD, TAREK, MD
L3675
P3167
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PHYSICAL MED. &
4/1/2015
PAIN MEDICINE
04-Mar-16
PHYSICAL MED. &
SPINE AND SPORTS
6/15/2012
MEDICINE
4/13/2012
EMERGENCY
4/13/2017 MEDICINE
5/15/2012
7/15/2011
ORTHOPEDIC
5/1/2020 SURGERY
5/1/2015
15-Apr-16
TM00532 HAMMER, RICHARD A, MD
12/17/2012
12/17/2012
12/17/2012
P1320
HAMMOND, GAINES JR, MD
11/4/2011
Q8499
01-Jun-16
Q7201
HAMMOUDEH, FADI , MD
HAMPOLE, HEMANTH NAGARAJA,
MD
16-Feb-16
Q4421
HAMSTRA, DANIEL ALLAN, MD
5/15/2015
P1762
HAMZEH, IHAB, MD
1/2/2012
11/4/2016 UROLOGY
PULMONARY
CRITICAL CARE
01-Jun-21 MEDICINE
TX
TX
HAN, ANTHONY TAE HYUNG, MD
10/17/2011
Q8071
P3337
HAN, SHAOJIE, MD
HANCOCK, HEATHER MAY, MD
02-May-16
6/1/2012
H5450
HANCOCK, MARK, MD
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
4/6/2015 None
15-Mar-16 None
N/A
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
6/20/2012 None
N/A
4/13/2012 None
N/A
ACTIVE
5/29/2012 None
N/A
TX
ACTIVE
7/20/2011 None
N/A
TX
ACTIVE
ACTIVE
6/4/2015 None
19-Apr-16 None
N/A
N/A
NM
ACTIVE
12/21/2012 None
N/A
NM
ACTIVE
12/21/2012 None
N/A
NM
12/21/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
11/4/2011 None
N/A
INTERNAL MEDICINE SUGAR LAND
TX
ACTIVE
08-Jun-16 None
N/A
NEPHROLOGY
HOUSTON
TX
ACTIVE
17-Feb-16 None
N/A
IRVING
TX
ACTIVE
6/5/2015 None
N/A
HOUSTON
TX
ACTIVE
1/16/2012 None
N/A
EL PASO
TX
ACTIVE
11/2/2011 None
N/A
03-May-16 None
6/7/2012 None
N/A
N/A
12/4/2015 None
N/A
AUSTIN
ORTHOPEDIC
SURGERY
ALBUQUERQU
E
ALBUQUERQU
E
ALBUQUERQU
E
WACO
RADIATION
5/15/2020 ONCOLOGY
CARDIOVASCULAR
1/2/2017 DISEASES
12/4/2020 ONCOLOGY
PLANO
MCKINNEY
CLEARWATER FL
P1182
12/4/2015
Practice City
Registration
Status of
Practice
Texas
State
License
ADDICTION
PSYCHIATRY
HOUSTON
TX
SAN ANTONIO TX
HEMATOLOGY/ONCO
LOGY
MISSOULA
Page 141 of 402
MT
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
H5450
HANCOCK, MARK, MD
04-Dec-15
04-Dec-20 ONCOLOGY
H5450
HANCOCK, MARK, MD
04-Dec-15
Q2292
HANFLAND, ROBERT ANTHONY,
MD
11/7/2014
L4420
HANIF, BASHIR, MD
6/8/2012
04-Dec-20 ONCOLOGY
PEDIATRIC
CARDIOTHORACIC
11/7/2019 SURGERY
CARDIOVASCULAR
6/8/2017 DISEASES
P0403
HANIF, SYRA, MD
7/15/2011
P0598
P9868
Q4596
P1321
HANNA, ANGELA MARIE, MD
HANNA, LOUAY, MD
HANNA, MINA FAWZI FAHIM, MD
HANNON, PAUL JOSEPH III, MD
8/1/2011
4/15/2014
6/1/2015
11/4/2011
8/1/2016
4/15/2019
6/1/2020
11/4/2016
P5373
HANRAHAN, ROBERT, MD
NEUROLOGICAL
3/3/2020 SURGERY
3/3/2015
Q0062
HANSEN, NATHAN JOHN, MD
5/2/2014
Q7887
HANUDEL, MATTHEW WAYNE, MD
15-Apr-16
P6177
HAPP, ERIN MARIE, DO
4/12/2013
P2995
HAPPE, SARAH KATHLEEN, MD
P6629
HAQ, OMAR ANWAR, MD
5/15/2013
Q2904
HAQUE, SAIMA, MD
1/15/2015
P3340
P7117
HAQUE, WAQAR MOHAMMAD, MD
HARCOURT, KAREN AIKO, DO
TM00466 HARDIE, ROBERT CHARLES, MD
PARIS
2/1/2013
HANSEN, DANIEL ROBERT, MD
HARDEN, JEANNIE K, MD
CARDIOVASCULAR
SURGERY
INTERVENTIONAL
CARDIOLOGY
PEDIATRIC SURGERY GENERAL SURGERY
ONCOLOGY
RADIOLOGY
DALLAS
RADIOLOGY
EMERGENCY
2/1/2018 MEDICINE
KALAMAZOO
Q3374
Q8500
Secondary Specialty
(Self-Designated)
Practice City
HEMATOLOGY/ONCO
LOGY
AURORA
HEMATOLOGY/ONCO
LOGY
AURORA
5/1/2012
6/1/2012
7/1/2013
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
EMERGENCY
15-Apr-21 MEDICINE
MARSHALL
4/12/2018 RADIOLOGY
OBSTETRICS AND
5/1/2017 GYNECOLOGY
DALLAS
GASTROENTEROLOG
5/15/2018 Y
INTERNAL MEDICINE ATLANTA
RADIATION
6/1/2017 ONCOLOGY
01-Jun-16
PHYSICAL MED. &
01-Jun-21 REHABILITATION
8/15/2011
8/15/2016 RADIOLOGY
Registration
Status of
Practice
Texas
State
License
PEDIATRIC
REHABILITATION
MEDICINE
Page 142 of 402
Disciplinary
Status Date
CO
ACTIVE
03-Feb-16 None
N/A
CO
ACTIVE
03-Feb-16 None
N/A
LICENSE
ISSUED
11/7/2014 None
N/A
6/12/2012 None
N/A
7/15/2011 None
N/A
TX
TX
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
8/1/2011
4/17/2014
6/10/2015
11/11/2011
None
None
None
None
N/A
N/A
N/A
N/A
MI
ACTIVE
2/15/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
3/25/2015 None
N/A
5/2/2014 None
N/A
ACTIVE
LICENSE
ISSUED
02-May-16 None
N/A
4/12/2013 None
N/A
6/22/2012 None
N/A
6/5/2013 None
N/A
1/15/2015 None
N/A
6/7/2012 None
7/9/2013 None
N/A
N/A
03-Jun-16 None
N/A
8/15/2011 None
N/A
TX
TX
ACTIVE
GA
ACTIVE
LICENSE
ISSUED
HOSPITALIST
GALVESTON
TOMBALL
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
Q1411
HARDIN, RONALD DAVID JR, MD
Q6202
HAREL, TAMAR , MD
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2014
10/1/2015
Secondary Specialty
(Self-Designated)
PEDIATRICS
WINSTON
SALEM
NC
ACTIVE
NEURO-RADIOLOGY
TEMPLE
COVINGTON
TX
LA
TREMONT
WICHITA
FALLS
NE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
TX
ACTIVE
Q2673
HARHARA, HALEEMA FAZAL, MD
12/15/2014
P0405
P8031
HARIRI, HOUSSAM YOUSSEF, MD
HARLIN, DANIEL C, MD
7/15/2011
10/1/2013
10/1/2018 RADIOLOGY
L2302
HAROON, MUHAMMAD SALMAN,
MD
15-Apr-16
15-Apr-21
Q8502
HARPER, HOWARD DALE, MD
01-Jun-16
01-Jun-21
P6178
P7118
Q2674
HARRINGTON, KATHERINE
BROOKS, MD
HARRIS, ANDREA DENISE, MD
HARRIS, BRIAN ADAM, MD
4/12/2013
7/1/2013
12/15/2014
4/12/2018
7/1/2018
12/15/2019
Q3376
HARRIS, DOROTHY YOLANDA, MD
3/3/2015
3/3/2020
P8361
HARRIS, ELIZABETH IRENE, MD
11/15/2013
11/15/2018
P2006
HARRIS, JEFFREY THEODORE, MD
P8138
HARRIS, JOSHUA DAVID, MD
P3341
Q5663
HARRIS, MARCUS LAVELLE, MD
HARRIS, REX LEE JR, MD
6/1/2012
8/14/2015
Q7699
HARRIS, RICHARD EDWARD II, MD
01-Apr-16
P3634
HARRIS, RYAN JED, MD
6/15/2012
P9072
HARRIS, SAMAR , MD
2/18/2014
Q5664
HARRIS, TARA JACQUELINE, MD
8/14/2015
Q5423
HARRISON, MARY ELIZABETH, MD
P0729
Q0929
HARRISON, MATTHEW LEE, DO
HARRISON, PAUL, MD
EMERGENCY
6/15/2017 MEDICINE
GASTROENTEROLOG
2/18/2019 Y
OBSTETRICS AND
OBSTETRICS AND
8/3/2020 GYNECOLOGY
EMERGENCY
8/15/2016 MEDICINE
GENERAL PRACTICE
Page 143 of 402
2/1/2012
10/15/2013
8/3/2015
8/15/2011
7/15/2014
HEMATOLOGY/ONCOL
OGY
DIAGNOSTIC
RADIOLOGY
RADIOLOGY
THORACIC
CARDIOVASCULAR
SURGERY
PEDIATRICS
INTERNAL MEDICINE
PEDIATRIC
OTHER SPECIALTY
ORTHOPEDICS
ANATOMIC/CLINICAL
PATHOLOGY
2/1/2017 NEUROLOGY
ORTHOPEDIC
10/15/2018 SURGERY
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ACTIVE
SPORTS MEDICINE
LAS CRUCES
GALVESTON
NM
TX
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/19/2014 None
N/A
10/7/2015 None
N/A
2/5/2015 None
N/A
7/20/2011 None
10/15/2013 None
N/A
N/A
15-Apr-16 None
N/A
08-Jun-16 None
N/A
4/12/2013 None
7/8/2013 None
1/5/2015 None
N/A
N/A
N/A
3/3/2015 None
N/A
11/15/2013 None
N/A
2/1/2012 None
N/A
10/28/2013 None
N/A
6/1/2012 None
8/21/2015 None
N/A
N/A
HOUSTON
TX
WACO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
RICHMOND
CAMP
LEJEUNE
TX
ACTIVE
05-Apr-16 None
N/A
NC
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/21/2012 None
N/A
2/18/2014 None
N/A
8/14/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/4/2015 None
N/A
8/15/2011 None
8/18/2014 None
N/A
N/A
ROUND ROCK TX
GREENVILLE
AL
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
P7119
HARROW, JEFFREY ALAN, MD
Q3195
HART, JEFFREY BLAKE, MD
Q5812
P1460
HART, RODERICK, MD
HART, SUZANNE BARBARA, MD
8/28/2015
11/15/2011
Q6323
HARTFELDER, BRIAN SCOTT, MD
10/15/2015
P5987
HARTING, MANDY S, MD
4/1/2013
P5988
HARTING, MATTHEW TIHEN, MD
4/1/2013
4/1/2018
Q0270
HARTMAN, CYNTHIA LYNN, DO
5/15/2014
5/15/2019
P3342
Q7700
HARVEY, ADRIAN TIMOTHY, DO
HARVEY, RYAN JOSEPH, MD
6/1/2012
01-Apr-16
6/1/2017
01-Apr-21
Q5813
Q2295
HASAN, ASMA, MD
HASAN, SHAHZAD , MD
8/28/2015
11/7/2014
P1649
P0730
P2996
HASAN, SYED NAVED, MD
HASAN, SYED SAMIH, MD
HASHAM, SARAH , MD
12/15/2011
8/15/2011
5/1/2012
P9197
HASHMI, SYED SAFIUDDIN, MD
5/1/2017 PEDIATRICS
DIAGNOSTIC
3/3/2019 RADIOLOGY
2/13/2015
3/3/2014
Secondary Specialty
(Self-Designated)
Practice City
MCKINNEY
Registration
Status of
Practice
Texas
State
License
TX
EMERGENCY
8/28/2020 MEDICINE
EMERGENCY
10/15/2020 MEDICINE
MOHS
MICROGRAPHIC
4/1/2018 SURGERY
LICENSE
ISSUED
ACTIVE
FAMILY MEDICINE
ADMINISTRATIVE
MEDICINE
DERMATOLOGY
CRITICAL CARE
PEDIATRIC SURGERY (SURGERY)
OBSTETRICS AND
GYNECOLOGY
NEUROLOGICAL
SURGERY
ANESTHESIOLOGY
HASKOVEC, LAURA , MD
6/2/2014
ORTHOPEDIC
9/1/2016 SURGERY
P0903
HASLAM, SEAN GREGORY, MD
9/1/2011
Q8504
HASNAIN, FARHEEN JAMIL, MD
01-Jun-16
P0831
HASSAN, AIMAN AMIN, MD
8/26/2011
P2455
HASSAN, AMEER ELSAYED, DO
3/15/2012
3/15/2017 NEUROLOGY
Disciplinary
Status Date
8/14/2013 None
N/A
2/13/2015 None
UNDER
BOARD
8/28/2015 ORDER
12/5/2011 None
N/A
8/28/2015
N/A
SAN ANTONIO TX
ACTIVE
10/16/2015 None
N/A
THE
WOODLANDS TX
ACTIVE
4/8/2013 None
N/A
ACTIVE
LICENSE
ISSUED
4/8/2013 None
N/A
5/15/2014 None
N/A
HOUSTON
TX
6/5/2012 None
07-Apr-16 None
N/A
N/A
AZ
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
8/28/2015 None
11/19/2014 None
N/A
N/A
MADISON
TEMPLE
AMARILLO
AL
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/19/2011 None
8/29/2011 None
5/9/2012 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
3/6/2014 None
N/A
SUGAR LAND
TX
ACTIVE
6/4/2014 None
N/A
PLANO
TX
JEFFERSONVI
GENERAL PRACTICE LLE
IN
EMERGENCY
MEDICINE
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY HARLINGEN
TX
ACTIVE
9/13/2011 None
N/A
ACTIVE
LICENSE
ISSUED
17-Jun-16 None
N/A
8/26/2011 None
N/A
ACTIVE
3/28/2012 None
N/A
HOSPITALIST
HOSPITALIST
SPORTS MEDICINE
(FAMILY PRACTICE)
PALLIATIVE
MEDICINE
Q0451
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Page 144 of 402
HOUSTON
GALVESTON
TX
TX
PEORIA
License
Number
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dicaid
dicaid
Agreement
End Date
Designated)
Q4975
HASSAN, SOHAIB, MD
7/1/2015
P7457
HASSAN, SYED FAHIM, MD
8/1/2013
Q8258
HASSANPOUR, ALI, MD
P2664
HASSID, VICTOR JOSEPH, MD
PEDIATRIC
ANESTHESIOLOGY
16-May-21 (PEDS)
PLASTIC &
RECONSTRUCTIVE
4/2/2017 SURGERY
Q8072
HASTIE, DAVID GEORGE, MD
P9870
Q4125
HASTINGS, SCOTT ELDON, DO
HASTINGS, STEPHEN MICHAEL,
MD
Q0063
16-May-16
4/2/2012
02-May-16
4/15/2014
FAMILY
5/1/2015
5/1/2020 PATHOLOGY
HASTINGS, WILLIAM CHARLES, DO
5/2/2014
5/2/2019 PEDIATRICS
P0224
P5278
HATAHET, MOHAMAD HAZEM, MD
HATCHER, JEANNE LEIGH, MD
7/1/2011
1/15/2013
P9871
HATHCOCK, AMBER MARIE, MD
4/15/2014
P3343
HATTER, ALYN DALE, DO
P8479
PEDIATRIC
EMERGENCY
6/1/2012
HATTI, KALPITA MAHESH, MD
HATZENBUEHLER, LINDSAY ANN,
MD
12/6/2013
9/16/2013
2/1/2013
Q2450
HAUBERT, LISA MARIE, MD
HAUCK, MICHELLE MARIE, MD
HAUGER, GEOFFREY BENJAMIN,
MD
Q7702
HAUGHTON, NICOLE, MD
P7458
HAUPTMEIER, CHERIE LINAE, DO
8/1/2013
P6826
HAWASLY, KINAN, MD
6/3/2013
P5375
P7927
P5376
2/1/2013
2/1/2018 PEDIATRICS
COLON AND RECTAL
9/16/2018 SURGERY
11/17/2014
01-Apr-16
Secondary Specialty
(Self-Designated)
Practice City
GASTROENTEROLOG
Y
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
NEPHROLOGY
ANESTHESIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
7/27/2015 None
N/A
8/1/2013 None
N/A
HOUSTON
TX
ACTIVE
20-Jun-16 None
N/A
CARDIOTHORACIC
ANESTHESIOLOGY
DALLAS
TX
ACTIVE
4/9/2012 None
N/A
TX
ACTIVE
09-May-16 None
N/A
ALLERGY
FORENSIC
PATHOLOGY
SHOW LOW
AZ
ACTIVE
5/5/2014 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
5/6/2015 None
N/A
5/2/2014 None
N/A
NEPHROLOGY
TEMPLE
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
7/11/2011 None
1/31/2013 None
N/A
N/A
PEDIATRICS
DERMATOLOGIC
SURGERY
HOUSTON
TX
ACTIVE
4/28/2014 None
N/A
LONGVIEW
TX
ACTIVE
LICENSE
ISSUED
6/12/2012 None
N/A
12/6/2013 None
N/A
INFECTIOUS
DISEASES
HOUSTON
TX
ACTIVE
2/7/2013 None
N/A
HOUSTON
TX
INTERNAL MEDICINE ROUND ROCK TX
ACTIVE
ACTIVE
10/2/2013 None
2/5/2013 None
N/A
N/A
11/18/2014 None
N/A
01-Apr-16 None
N/A
8/1/2013 None
N/A
6/3/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
OBSTETRICS AND
6/3/2018 GYNECOLOGY
Page 145 of 402
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
Q5424
HAWS, BLAIR , MD
8/3/2015
8/3/2020 GYNECOLOGY
HAWTHORNE, KRISTEN MICHELLE,
OPHTHALMOLOGY P0832
MD
8/26/2011
8/26/2016 CORNEA
OPHTHALMOLOGY
ORTHOPEDIC
Q6843
HAY, DAVID CLARK, MD
06-Jan-16
06-Jan-21 SURGERY
SURGERY
P7776
HAYANGA, JEREMIAH WILLIAM, MD
N4463
HAYDEN, DAISHA AYANA, MD
8/30/2013
5/1/2015
Q0452
HAYDEN, KYLE BRANCH, DO
6/2/2014
5/1/2020 RADIOLOGY
INTERVENTIONAL
6/2/2019 RADIOLOGY
Q3687
4/1/2015
P4574
P0600
HAYEK, ADAM JOHN, DO
HAYES, CHRISTOPHER BARTON,
MD
HAYES, ERIEL WALLACE, MD
10/1/2012
8/1/2011
P4455
HAYES, JODY COLEMAN, MD
9/17/2012
Q3378
P6632
HAYES, KEVIN RANDALL, MD
HAYES, MATTHEW , MD
3/3/2015
5/15/2013
P5814
Q1989
P4960
HAYGOOD-KANE, T LYNNE, DO
HAYLEY, LAUREN POWELL, MD
HAYS, AUGUSTA ELLICE, MD
3/15/2013
10/1/2014
11/30/2012
8/1/2016 PEDIATRICS
DIAGNOSTIC
9/17/2017 RADIOLOGY
CARDIAC
ELECTROPHYSIOLOG
3/3/2020 Y
OBSTETRICS AND
FAMILY PRACTICE
DIAGNOSTIC
RADIOLOGY
PULMONARY
CRITICAL CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
Practice City
FREDERICKSB
URG
TX
OBSTETRICS AND
GYNECOLOGY
HAZANY, SALAR , MD
10/15/2014
Q3885
HAZIN, HESHAM, MD
4/10/2015
P2997
P3535
HE, GUOCHENG DAVID, MD
HE, ZENING, MD
5/1/2012
6/8/2012
5/1/2017 NUCLEAR MEDICINE
6/8/2017 ONCOLOGY
P8911
HEAD, RACHEL BAUBLET, MD
2/7/2014
2/7/2019 UROLOGY
Q3007
HEAD, RYAN, MD
2/2/2015
2/2/2020 PEDIATRICS
8/4/2015 None
N/A
8/26/2011 None
N/A
ACTIVE
05-Feb-16 None
N/A
9/4/2013 None
N/A
5/1/2015 None
N/A
MEXIA
TX
ACTIVE
TEXAS
LICENSE
ISSUED
DALLAS
TX
ACTIVE
6/26/2014 None
N/A
TEMPLE
TX
ACTIVE
4/6/2015 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
10/8/2012 None
8/9/2011 None
N/A
N/A
ACTIVE
9/24/2012 None
N/A
TEXARKANA
DALLAS
TX
TX
ACTIVE
ACTIVE
3/16/2015 None
5/17/2013 None
N/A
N/A
HENDERSON
NASHVILLE
TX
TN
ACTIVE
ACTIVE
ACTIVE
3/21/2013 None
10/14/2014 None
12/4/2012 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
10/20/2014 None
N/A
4/10/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/3/2012 None
6/13/2012 None
N/A
N/A
2/7/2014 None
N/A
2/2/2015 None
N/A
HOUSTON
HEMATOLOGY/ONCOL
4/10/2020 OGY
INTERNAL MEDICINE
GENERAL PRACTICE HOUSTON
INTERNAL MEDICINE WAUSAU
Page 146 of 402
ACTIVE
LICENSE
ISSUED
TX
DERMATOLOGIC
SURGERY
Q2139
Disciplinary
Status Date
ANDREWS
BREAST IMAGING
CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
WI
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
Q6844
HEALY, MCKENNA BALDINI, MD
06-Jan-16
06-Jan-21 MEDICINE
EMERGENCY
P6414
HEARD, DENNIS J II, DO
5/1/2013
5/1/2018 MEDICINE
EMERGENCY
Q1414
HEATON, DAVID LEE, DO
8/15/2014
8/15/2019 MEDICINE
P8912
HEBERT, KENNETH J, MD
2/7/2014
2/7/2019 RADIOLOGY
NEURO-RADIOLOGY
HECHANOVA, MARTIN LORENZO,
OBSTETRICS AND
P8589
MD
12/16/2013
P2257
HEGDE, JAY NARAYAN, MD
3/1/2012
EMERGENCY
P9588
HEHMAN, MICHAEL GERARD, MD
4/1/2014
4/1/2019 MEDICINE
EMERGENCY
URGENT CARE
P7279
HEIBERGER, BRANDON JOE, MD
7/15/2013
7/15/2018 MEDICINE
MEDICINE
ANESTHESIOLOGY Q0453
HEIL, THOMAS LUKE, MD
6/2/2014
PAIN MANAGEMENT
P3344
HEINEN, ALLISON PAIGE, DO
6/1/2012
OCCUPATIONAL
FAMILY PRACTICE ENVIRONMENTAL
P4575
HEKEREM, KEMKA ONUZEM, MD
10/1/2012
MEDICINE
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
Q1623
HELLIWELL, JASON PAUL, MD
8/29/2014
SURGERY
PAIN
MANAGEMENT/REHAB PHYSICAL MED. &
Q0065
HELMI, HANY MEDHAT, MD
5/2/2014
5/2/2019 MED
REHABILITATION
CARDIOVASCULAR
P7777
HELSEL, BRYAN SCOTT, MD
8/30/2013
8/30/2018 THORACIC SURGERY SURGERY
EMERGENCY
Q8722
HEMERKA, JOSEPH NICKOLAS, MD
10-Jun-16
10-Jun-21 MEDICINE
P5377
HEMMERICH, JASON, MD
2/1/2013
DIAGNOSTIC
INTERVENTIONAL
P7121
HENDERSON, BENJAMIN REID, MD
7/1/2013
7/1/2018 RADIOLOGY
RADIOLOGY
HENDERSON, CHRISTOPHER EAN,
ORTHOPEDIC
ORTHOPEDIC
P0833
MD
8/26/2011
8/26/2016 SURGERY
TRAUMA
HENDERSON, MICHELLE REINA
PEDIATRIC CRITICAL
Q5425
BOSLEY, MD
8/3/2015
PEDIATRICS
GERIATRIC
HENDERSON, RASHIDA
MEDICINE (FAMILY
Q1162
CHAMPION, MD
8/1/2014
PRACTICE)
Page 147 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
07-Mar-16 None
N/A
FORT WORTH TX
ACTIVE
5/8/2013 None
N/A
HONOLULU
HI
9/3/2014 None
2/19/2014 None
N/A
N/A
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
12/16/2013 None
3/6/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/8/2014 None
N/A
NASSAU BAY
TX
ACTIVE
7/17/2013 None
N/A
CHARLOTTE
HOUSTON
NC
TX
ACTIVE
ACTIVE
6/23/2014 None
6/18/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
10/4/2012 None
UNDER
BOARD
8/29/2014 ORDER
N/A
LICENSE
ISSUED
8/29/2014
ACTIVE
LICENSE
ISSUED
5/6/2014 None
N/A
8/30/2013 None
N/A
AUSTIN
SAN DIEGO
TX
CA
ACTIVE
ACTIVE
14-Jun-16 None
2/21/2013 None
N/A
N/A
TEXARKANA
TX
ACTIVE
LICENSE
ISSUED
7/10/2013 None
N/A
8/26/2011 None
N/A
ACTIVE
8/25/2015 None
N/A
8/1/2014 None
N/A
DALLAS
TX
LICENSE
ISSUED
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
P1550
Physician Name
HENDRIX, CHRISTOPHER KYLE,
DO
HENDRIX, JENNIFER ANN
KOVARIC, DO
Q1415
HENDRIX, KRISTEN RENATA, MD
Q0066
HENDRY, RONAK DANA, MD
5/2/2014
P2670
HENKE, JEFFREY W, MD
4/2/2012
Q3523
HENNER, JARYN THIP, MD
HENNESSY, SARA
ABDOLLAHZADEH, MD
HENRICHS, KIMBERLY LYNETTE,
MD
3/16/2015
P1461
Q4976
Q1163
P7461
P1184
Q3199
P7462
HENRY, MICHAEL DANIEL, MD
HENRY-DACOSTA, NICOLE
DANEEL, DO
11/15/2011
12/1/2011
8/15/2014
PEDIATRIC
EMERGENCY
5/2/2019 MEDICINE
8/1/2014
8/1/2019 PEDIATRICS
10/17/2011
8/1/2018 PEDIATRICS
OBSTETRICS AND
OBSTETRICS &
GYNECOLOGICAL
2/13/2020 SURGERY
2/13/2015
8/1/2013
P0602
HENSLEY, AUTUMN LYNN, MD
HERALD, KAITLIN JEAN, DO
HERATH, PRIYANTHA PUSHPA
KUMARA, MD
Q6425
HERBERT, GARTH, MD
11/2/2015
P7646
HEREDIA, JACQUELINE , MD
8/15/2013
P6415
HERLAND, JONATHAN SETH, MD
Q8074
HERMAN, BRIAN ARTHUR, MD
02-May-16
Q2906
HERMAN, MICHAEL PAUL, MD
1/15/2015
DIAGNOSTIC
02-May-21 RADIOLOGY
RADIATION
1/15/2020 ONCOLOGY
INTERVENTIONAL
7/1/2020 CARDIOLOGY
OBSTETRICS AND
6/2/2019 GYNECOLOGY
8/1/2011
5/1/2013
Q4977
HERMANN, DANIEL GENE, MD
7/1/2015
Q0454
HERMANN, LAUREN ANNALISE, DO
6/2/2014
Practice City
ACTIVE
12/7/2011 None
N/A
PEKIN
IL
ACTIVE
12/7/2011 None
N/A
ACTIVE
8/19/2014 None
N/A
5/6/2014 None
N/A
4/2/2012 None
N/A
3/16/2015 None
N/A
ACTIVE
7/9/2015 None
N/A
ACTIVE
8/15/2014 None
N/A
ACTIVE
8/7/2013 None
N/A
TX
ACTIVE
11/10/2011 None
N/A
TX
LICENSE
ISSUED
ACTIVE
2/13/2015 None
9/9/2013 None
N/A
N/A
9/6/2011 None
N/A
11/2/2015 None
N/A
8/15/2013 None
N/A
5/7/2013 None
N/A
LAREDO
HOUSTON
ROUND ROCK TX
BANGOR
MORTON
GROVE
CARDIOVASCULAR
DISEASES
Page 148 of 402
Disciplinary
Status Date
IL
SURGICAL CRITICAL
CARE
DALLAS
TX
PEDIATRIC
ENDOCRINOLOGY
SAN ANTONIO TX
MOUNT
PLEASANT
TX
MOVEMENT
DISORDERS
8/1/2016 NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
PEORIA
HOUSTON
TX
THE
WOODLANDS TX
7/1/2015
8/1/2013
Secondary Specialty
(Self-Designated)
INTERVENTIONAL
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ME
ACTIVE
IL
ACTIVE
LICENSE
ISSUED
06-Jun-16 None
N/A
1/15/2015 None
N/A
TX
ACTIVE
7/13/2015 None
N/A
SAN MARCOS TX
ACTIVE
6/9/2014 None
N/A
HOUSTON
License
Number
Q3690
Q1165
Q1166
Q1164
P6181
P7280
P6416
Physician Name
HERNANDEZ CARDONA,
ELIZABETH , MD
HERNANDEZ GARCIA, JUAN
CARLOS ISRAEL, MD
HERNANDEZ RIVERA, HELDER
OSCAR, MD
HERNANDEZ, DAVID , MD
HERNANDEZ, ENRIQUE, MD
HERNANDEZ, JENNIFER LORETTE,
MD
HERNANDEZ, LILIA HORTENCIA,
MD
P4655
HERNANDEZ, MAURILIO, MD
Q0273
Q5667
Q0764
Q5668
8/1/2014
8/1/2014
8/1/2014
4/12/2013
7/15/2013
5/1/2013
8/1/2019 CARDIOLOGY
INTERVENTIONAL
PEDIATRIC
ANESTHESIOLOGY
7/15/2018 (PEDS)
HERNANDEZ, NADIA, MD
5/15/2014
HERNANDEZ, OSCAR, MD
HERNANDEZ, RAMIRO , MD
HERNANDEZ, RICARDO JAVIER,
MD
8/14/2015
6/27/2014
OBSTETRICS AND
6/27/2019 NEUROLOGY
8/14/2015
Q2556
HERNANDEZ, SARAH LUREE, MD
HERNANDEZ-ZHANG, MARY
CARMEN, MD
12/3/2014
DIAGNOSTIC
6/1/2017 RADIOLOGY
FAMILY
PRACTICE/PSYCHIATR
12/3/2019 Y
7/15/2011
6/1/2012
Q4978
P4456
HERRERA, HENRY ROBERT JR, MD
HERRERA, SEBASTIAN RAMON,
MD
HERRERA, ULYSSES , MD
6/1/2012
7/1/2015
9/17/2012
Q1993
HERSHMAN, JOHN ERIC, MD
10/1/2014
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
DALLAS
TX
ACTIVE
4/3/2015 None
N/A
EL PASO
TX
ACTIVE
8/5/2014 None
N/A
EL PASO
TX
LICENSE
ISSUED
ACTIVE
8/1/2014 None
8/26/2014 None
N/A
N/A
CARDIOVASCULAR
DISEASES
NEW YORK
NY
ACTIVE
4/30/2013 None
N/A
ANESTHESIOLOGY
DALLAS
TX
ACTIVE
7/23/2013 None
N/A
ACTIVE
5/28/2013 None
N/A
10/22/2012 None
N/A
5/15/2014 None
N/A
8/14/2015 None
7/2/2014 None
N/A
N/A
ACTIVE
8/20/2015 None
N/A
ACTIVE
6/4/2012 None
N/A
12/3/2014 None
N/A
7/15/2011 None
N/A
CARDIAC
ELECTROPHYSIOLO
GY
HERNANDEZ, RYAN JAMES, MD
P3347
4/1/2015
10/15/2012
P3346
P0406
dicaid
dicaid
Agreement
End Date
Designated)
PAW PAW
HOUSTON
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
PLANO
MI
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
DALLAS
NEUROLOGICAL
7/1/2020 SURGERY
TUCSON
PLASTIC &
RECONSTRUCTIVE
10/1/2019 SURGERY
GENERAL SURGERY AUGUSTA
Page 149 of 402
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
6/11/2012 None
N/A
AZ
ACTIVE
ACTIVE
7/30/2015 None
10/23/2012 None
N/A
N/A
GA
ACTIVE
10/7/2014 None
N/A
License
Number
Physician Name
Q6846
HERTEL, ADAM , MD
dicaid
dicaid
Agreement
End Date
Designated)
06-Jan-16
Q4599
Q6028
HESSLER, PAUL C, MD
HESSLER, RONALD JASON, MD
6/1/2015
9/15/2015
P2672
4/2/2012
P5379
HESTER, CHRISTIAN CARDELL, MD
HEVA-PATHTHINIGE, INDIKA
THARANGANIE, MD
P2999
HEXSEL FOLK, CAMILE LUIZA, MD
5/1/2012
Q8075
HEYDEMANN, JOHN ALBERT, MD
02-May-16
Q8505
HEYNE, NICHOLAS GREGORY, MD
01-Jun-16
Q4426
HIBBERD, PETER HUNT, MD
5/15/2015
DERMATOLOGIC
5/1/2017 SURGERY
ORTHOPEDIC
02-May-21 SURGERY
ADDICTION
EMERGENCY
5/15/2020 MEDICINE
P6634
HICE-GARZA, JARMARA
LAURETTE, MD
5/15/2013
OBSTETRICS AND
Q3200
Q7557
HICKEY, WESTON CHEARIS, MD
HICKS, ALBERT JAMES III, MD
2/13/2015
15-Mar-16
Q4128
HICKS, MASON GAGE, MD
Q0648
HICKS, MICHELLE, DO
Q3380
P0226
2/1/2013
6/1/2020 PEDIATRICS
6/16/2014
DIAGNOSTIC
5/1/2020 RADIOLOGY
EMERGENCY
6/16/2019 MEDICINE
HICKS, PATRICE, DO
3/3/2015
3/3/2020 PEDIATRICS
HICKS, WILLIAM JAMES II, MD
7/1/2011
7/1/2016 NEUROLOGY
5/1/2015
Q2451
HIDALGO, JESUS ENRIQUE, MD
11/17/2014
P8480
Q2141
HIGGINS, JOEL, MD
HIGO, OMOKHAYE MOGOKEOLA,
MD
10/15/2014
Q6325
Q0932
HIJAZI, BILAL , MD
HILAL, AMR A, MD
10/15/2015
7/15/2014
P6182
HILL, AUSTIN D, MD
ORTHOPEDIC
4/12/2018 TRAUMA
12/6/2013
4/12/2013
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
OPHTHALMOLOGY
Practice City
TYLER
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
22-Jan-16 None
N/A
FORT WORTH, TX
WACO
TX
ACTIVE
ACTIVE
6/4/2015 None
9/17/2015 None
N/A
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
4/11/2012 None
N/A
2/1/2013 None
N/A
TX
DERMATOLOGY
PEDIATRIC
ORTHOPEDICS
HOUSTON
TX
ACTIVE
5/14/2012 None
N/A
HOUSTON
TX
ACTIVE
03-May-16 None
N/A
PSYCHIATRY
EMERGENCY
MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
DALLAS
TX
ACTIVE
08-Jun-16 None
N/A
PALM BEACH
FL
ACTIVE
5/25/2015 None
N/A
LUBBOCK
TX
6/12/2013 None
N/A
2/13/2015 None
25-Apr-16 None
N/A
N/A
6/1/2015 None
N/A
6/20/2014 None
N/A
3/3/2015 None
N/A
7/1/2011 None
N/A
11/17/2014 None
N/A
12/13/2013 None
N/A
10/15/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
TEMPLE
TX
ACTIVE
MESQUITE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
CRITICAL CARE
(SURGERY)
MARSHALL
CRITICAL CARE
ANESTHESIOLOGY
EMERGENCY
MEDICINE
ORTHOPEDIC
SURGERY
Page 150 of 402
TX
ACTIVE
LICENSE
ISSUED
MEMPHIS
TN
ACTIVE
ACTIVE
11/5/2015 None
8/1/2014 None
N/A
N/A
AUSTIN
TX
ACTIVE
4/26/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6975
HILL, BRANDON ROBERT, MD
6/14/2013
P5816
HILL, CHARLES ARTHUR III, MD
3/15/2013
Q0649
HILL, GEOFFREY MAURICE, MD
6/16/2014
P4961
Q7388
HILL, GUYON JAMES, MD
HILL, RONALD CLAIR, MD
P0904
K6467
HILL, SAMANTHA E, MD
HILLBRICK, TIMOTHY JOE, DO
9/1/2011
12/3/2014
P6635
HILLIER, SHANNON LYNNE, DO
5/15/2013
P0982
HILTON, LEVI JEFFERSON, MD
9/15/2011
11/30/2012
04-Mar-16
EMERGENCY
11/30/2017 MEDICINE
PEDIATRIC
HILTS, MICHAEL JOHN, MD
9/15/2014
Q7205
P9590
P0604
HINCKS, KERRY LIN, DO
HINES, AISHA, DO
HINH, PETER , MD
16-Feb-16
4/1/2014
8/1/2011
4/1/2019 PSYCHIATRY
8/1/2011
P5817
HINKLE, CHELSEA ELIZABETH, MD
3/15/2013
Q1624
HINMAN, BRENDA DAWN, DO
8/29/2014
P0407
Q4428
Q8507
HINOJOSA, ELIAS , MD
HINOJOSA, MARCO ADRIAN, MD
HINOJOSA, STEPHANIE RENEE,
MD
HINSHAW, SHIRLEY JEANETTE,
MD
01-Jun-16
Q4129
P4459
HIRANRATTANA, ANUNYA, MD
HIREMATH, ADARSH, MD
5/1/2015
9/17/2012
P7123
HIRSCH, BENJAMIN AARON, MD
Q1829
SPORTS MEDICINE
(FAMILY PRACTICE)
Practice City
SALT LAKE
CITY
UT
9/15/2014
OBSTETRICS AND
PEDIATRIC
HOSPITALIST
INTERNAL MEDICINE
CARDIOVASCULAR
Page 151 of 402
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
6/25/2013 None
N/A
3/15/2013 None
N/A
TX
ACTIVE
6/27/2014 None
N/A
TX
FL
ACTIVE
ACTIVE
12/4/2012 None
16-Mar-16 None
N/A
N/A
AUSTIN
TX
ACTIVE
ACTIVE
9/6/2011 None
12/8/2014 None
N/A
N/A
CORPUS
CHRISTI
TX
ACTIVE
5/20/2013 None
N/A
DALLAS
TX
ACTIVE
9/26/2011 None
N/A
LAGO VISTA
MISSOURI
CITY
TAMPA
HOUSTON
TX
ACTIVE
10/3/2014 None
N/A
TX
FL
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
18-Feb-16 None
4/2/2014 None
8/8/2011 None
N/A
N/A
N/A
8/1/2011 None
N/A
ACTIVE
3/20/2013 None
N/A
LICENSE
ISSUED
8/29/2014 None
N/A
ACTIVE
ACTIVE
7/20/2011 None
5/20/2015 None
N/A
N/A
ACTIVE
9/23/2014 None
N/A
ACTIVE
09-Jun-16 None
N/A
ACTIVE
ACTIVE
5/4/2015 None
9/19/2012 None
N/A
N/A
ACTIVE
7/23/2013 None
N/A
OBSTETRICS &
GYNECOLOGICAL
8/29/2019 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
FORT SAM
HOUSTON
SEBRING
8/1/2016 RADIOLOGY
7/15/2011
5/15/2015
7/1/2013
DERMATOLOGY
EMERGENCY
9/15/2016 MEDICINE
Q1828
TM00459 HINKE, DAVID HENRY, MD
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
CORPUS
CHRISTI
TX
SAN ANTONIO TX
DAVENPORT
IA
FORT WORTH TX
License
Number
Physician Name
P9874
HIRSH, SHARON MARGARET, MD
P4657
HITCHCOCK, ROBERT JOHN, MD
Q5815
Q5816
HITE, PAMELA RENE, MD
HLAING, CRYSTAL , MD
Q6029
Q8508
HO, JEFFREY C, MD
HOAK, DAVID ARNOLD, DO
P6637
HOANG, AMANDA PHAM, MD
P6638
Q0934
Q6847
P7778
HOANG, AN NGOC, MD
HOANG, CHAU BAO, MD
HOANG, CHRISTINE , MD
HOANG, VU LINH, MD
Q4601
HOBBS, JANICE ELIZABETH, MD
P1082
HODGE, SCOTT DAVID, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ANATOMIC/CLINICAL
4/15/2014
4/15/2019 PATHOLOGY
CYTOPATHOLOGY
EMERGENCY
10/15/2012
10/15/2017 MEDICINE
EMERGENCY
8/28/2015
8/28/2020 MEDICINE
8/28/2015
DIAGNOSTIC
9/15/2015
9/15/2020 RADIOLOGY
NEURO-RADIOLOGY
01-Jun-16
01-Jun-21 NEUROLOGY
DIAGNOSTIC
5/15/2013
5/15/2018 RADIOLOGY
UROLOGIC
5/15/2013
5/15/2018 UROLOGY
ONCOLOGY
7/15/2014
06-Jan-16
8/30/2013
NEONATALPERINATAL
6/1/2015
6/1/2020 PEDIATRICS
MEDICINE
EMERGENCY
10/3/2011
10/3/2016 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
8/26/2011
8/26/2016 SURGERY
P0834
HODGES, KELLY R, MD
P2261
HODGES, MICHAEL CAMERON, MD
Q6204
HODGES, TIFFANY RENEE, MD
10/1/2015
Q3888
HOEFNER, ERNEST JOSEPH, DO
4/10/2015
P2673
HOENE, ANDREW JOHN, MD
4/2/2012
Q1169
HOFF, LISA ANN, MD
8/1/2014
P3000
P8675
HOFFARTH, KEVIN, MD
HOFFMAN, CHRISTOPHER
DONALD, MD
3/1/2012
NEUROLOGICAL
10/1/2020 SURGERY
EMERGENCY
4/2/2017 MEDICINE
EMERGENCY
8/1/2019 MEDICINE
5/1/2012
1/3/2014
GENERAL
PREVENTIVE
MEDICINE
Page 152 of 402
Practice City
AUSTIN
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
MCKINNEY
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
PLANO
AUSTIN
TX
TX
MANASSAS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/24/2014 None
N/A
10/22/2012 None
N/A
8/28/2015 None
9/1/2015 None
N/A
N/A
ACTIVE
ACTIVE
9/23/2015 None
16-Jun-16 None
N/A
N/A
VA
ACTIVE
5/17/2013 None
N/A
SUGAR LAND
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/6/2013
7/21/2014
15-Feb-16
9/2/2013
None
None
None
None
N/A
N/A
N/A
N/A
6/1/2015 None
N/A
10/24/2011 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
4/11/2012 None
N/A
10/27/2015 None
N/A
4/10/2015 None
N/A
LICENSE
ISSUED
ACTIVE
AMARILLO
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
AUSTIN
TX
ACTIVE
4/11/2012 None
N/A
KERRVILLE
TX
ACTIVE
8/15/2014 None
N/A
LAKEWAY
TX
ACTIVE
5/3/2012 None
N/A
TYLER
TX
ACTIVE
1/17/2014 None
N/A
License
Number
P1764
Q8723
Q8077
Physician Name
HOFFMAN, KEVIN LEE, MD
HOFFMAN, MALLORY MICHELLE ,
MD
HOGUE, MICHAEL ANDREW, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
1/2/2012
1/2/2017 MEDICINE
OBSTETRICS AND
10-Jun-16
02-May-16
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
P9200
HOHMAN, DONALD WAYNE JR, MD
Q3889
HOLBROOK, NATHAN BLAIR, DO
4/10/2015
ORTHOPEDIC
3/3/2019 SURGERY
EMERGENCY
4/10/2020 MEDICINE
P5534
Q6754
HOLDER, JIMMY LLOYD JR, MD
HOLINEJ, SHARISSE, MD
2/8/2013
15-Dec-15
2/8/2018 CHILD NEUROLOGY
Q0070
HOLLAND, MARIAN, MD
Q6513
HOLLAND, SOEMIWATI WEIDRIS,
MD
P5380
HOLLER-MANAGAN, YOLANDA, MD
Q8078
P6419
HOLLIDAY, EMMA BREY, MD
HOLLINGWORTH, DANIELLE
MARIE, MD
Q2298
HOLLOWAY, JEFFREY LYNN, DO
P5535
HOLLSTEN, JORDAN ENID, MD
2/8/2013
P3002
HOLMES, AMIE ELIZABETH, MD
5/1/2012
Q0277
HOLMES, CHAD TIMOTHY, DO
5/15/2014
Q0765
Q0071
HOLMES, KATHERINE ANN, DO
HOLSTER, SEAN ERIC, MD
6/27/2014
5/2/2014
P1765
HOLT, OLAYINKA OMOWUNMI, MD
Q4431
HOM, EMILY KAR QUEEN, MD
3/3/2014
5/2/2014
11/16/2015
2/1/2013
02-May-16
5/1/2013
11/7/2014
1/2/2012
5/15/2015
Secondary Specialty
(Self-Designated)
5/2/2019 CARDIOLOGY
ELECTROPHYSIOLO
GY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
OBSTETRICS AND
5/1/2017 GYNECOLOGY
EMERGENCY
5/15/2019 MEDICINE
EMERGENCY
6/27/2019 MEDICINE
ACTIVE
1/4/2012 None
N/A
HOUSTON
EDMOND
TX
OK
ACTIVE
ACTIVE
21-Jun-16 None
12-May-16 None
N/A
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
4/1/2014 None
N/A
4/10/2015 None
N/A
2/8/2013 None
24-Dec-15 None
N/A
N/A
5/2/2014 None
N/A
ACTIVE
11/24/2015 None
N/A
ACTIVE
2/5/2013 None
N/A
ACTIVE
16-May-16 None
N/A
ACTIVE
LICENSE
ISSUED
5/24/2013 None
N/A
11/7/2014 None
N/A
ACTIVE
2/27/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
5/11/2012 None
N/A
5/15/2014 None
N/A
6/27/2014 None
5/12/2014 None
N/A
N/A
ACTIVE
1/9/2012 None
N/A
ACTIVE
5/20/2015 None
N/A
TEMPLE
TX
TX
TX
SAN ANTONIO TX
GENERAL PRACTICE FORT WORTH TX
BRYAN
NEPHROLOGY
OBSTETRICS AND
GYNECOLOGY
Page 153 of 402
Disciplinary
Status Date
TX
HOUSTON
TRAUMATIC
SURGERY
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
CORSICANA
RADIATION
02-May-21 ONCOLOGY
EMERGENCY
5/1/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
TEMPLE
TX
TX
License
Number
Physician Name
P7465
HONG, ROBERT, MD
P0228
HONTZ, BLAIR, DO
P6977
HOOD, BRIAN JAMES, MD
P5993
P6641
HOODA, BARKAT SADRUDDIN, MD
HOOVER, JASON MARSHALL
THOMAS, MD
Q1831
HOPE, LISEL M, MD
Q3693
Q6848
P1875
Q2301
P2459
HOPKINS, STEVEN M, DO
HOQUE, RUMANA , MD
HOREISH, ADAM, MD
HORMOZDI, BAHRAM, MD
HORNER, JOHN GASTON, MD
G4232
HOROWITZ, SUSAN AMY, MD
P0835
HORRALL, SHAWN DANIEL, MD
P8790
HORTON, AMANDA LAUREN, MD
P5994
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
URGENT CARE
8/1/2013
8/1/2018 MEDICINE
MEDICINE
EMERGENCY
7/1/2011
7/1/2016 MEDICINE
NEUROLOGICAL
6/14/2013
6/14/2018 SURGERY
PEDIATRIC
HEMATOLOGY/ONCO
4/1/2013
4/1/2018 PEDIATRICS
LOGY
NEUROLOGICAL
5/15/2013
5/15/2018 SURGERY
ENDOCRINOLOGY,
DIABETES AND
9/15/2014
INTERNAL MEDICINE
EMERGENCY
4/1/2015
4/1/2020 MEDICINE
06-Jan-16
1/17/2012
11/7/2014
NEUROLOGY
3/15/2012
ANATOMIC/CLINICAL
1/17/2012
1/17/2017 PATHOLOGY
CYTOPATHOLOGY
EMERGENCY
8/26/2011
8/26/2016 MEDICINE
MATERNAL AND
1/15/2014
OBSTETRICS
ORTHOPEDIC
SPORTS MEDICINE 4/1/2013
4/1/2018 SURGERY
ORTHOPEDICS
Q1172
HORTON, JOSEPH, MD
HORTON, MICHELLE KREISBERG,
DO
Q7390
HORTON, RYAN , MD
04-Mar-16
P9368
HOSAKOPPAL SATHYANARAYANA,
NIRIKSHA , MD
3/17/2014
H0465
Q3526
Q4602
HOSFORD, SARAH LYNN, MD
HOSSAIN, JAHANGIR MOHAMMAD,
MD
HOSSAIN, SHABBIR MAJID, MD
8/1/2014
8/1/2019 PATHOLOGY
EMERGENCY
04-Mar-21 MEDICINE
CYTOPATHOLOGY
11/1/2013
OBSTETRICS AND
3/16/2015
6/1/2015
GYNECOLOGIC
ONCOLOGY
UNSPECIFIED
Page 154 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/5/2013 None
N/A
7/27/2011 None
N/A
6/14/2013 None
N/A
4/1/2013 None
N/A
BRYAN
TX
ACTIVE
5/23/2013 None
N/A
BROOKLYN
BULLHEAD
CITY
LUBBOCK
GILBERT
BRAINERD
COLEMAN
POMPANO
BEACH
NY
ACTIVE
9/24/2014 None
N/A
AZ
TX
AZ
MN
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
FL
TEMPLE
TX
4/6/2015
18-Jan-16
1/31/2012
11/17/2014
3/20/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
ACTIVE
1/25/2012 None
N/A
ACTIVE
LICENSE
ISSUED
8/31/2011 None
N/A
1/15/2014 None
N/A
ALAMOGORD
O
NM
ACTIVE
4/3/2013 None
N/A
AUSTIN
TX
ACTIVE
8/18/2014 None
N/A
AUSTIN
TX
ACTIVE
04-Apr-16 None
N/A
ODESSA
TX
ACTIVE
3/20/2014 None
N/A
LUBBOCK
TX
ACTIVE
11/6/2013 None
N/A
BINGHAMTON, NY
DALLAS
TX
ACTIVE
ACTIVE
4/2/2015 None
6/2/2015 None
N/A
N/A
License
Number
Q4130
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
5/1/2015
5/1/2020 MEDICINE
ORTHOPEDIC
5/15/2013
5/15/2018 SURGERY
5/1/2012
5/1/2017 UROLOGIC SURGERY UROGYNECOLOGY
P6642
P3004
HOTCHKISS, NICOLE MAREE, DO
HOTCHKISS, WILLIAM RICHARD,
MD
HOU, JACK CHENG-TSUNG, MD
Q8509
HOUCK, KIMBERLY , MD
P3350
HOUGH, SCOTT MATTHEW, MD
6/1/2012
Q0457
HOULTON, CRYSTAL JOY, MD
6/2/2014
01-Jun-16
Q0458
HOULTON, JEFFREY JOHN, MD
6/2/2014
P7466
HOUSER, JOSHUA L, MD
8/1/2013
P9876
HOUSER, KOURTNEY
HENDERSON, MD
HOUSHMAND, ELIZABETH BAHAR,
MD
HOUSTON, CHRISTOPHER
WILLIAM, MD
HOUSTON, CHRISTOPHER, MD
HOUSTON, LAURA PARESO, MD
HOVERMAN, CLAIRE ELIZABETH,
MD
Q2675
HOWARD, PAUL E, MD
Q5817
HOWE, JARETT KENT, MD
8/28/2015
P5645
Q6944
HOWELL, AMBER , MD
HOWZE, SHERI LAKEITHA, MD
3/1/2013
15-Jan-16
Q3201
HOYT, CHRISTOPHER HAYES, MD
2/13/2015
Q7558
P8364
Q2452
P8676
P9201
01-Jun-21 CHILD NEUROLOGY
EMERGENCY
6/1/2017 MEDICINE
OBSTETRICS AND
6/2/2019 GYNECOLOGY
EMERGENCY
8/1/2018 MEDICINE
15-Mar-21 OPHTHALMOLOGY
11/15/2013
EMERGENCY
11/17/2019 MEDICINE
OBSTETRICS AND
11/17/2014
1/3/2014
3/3/2014
4/15/2014
12/15/2014
SEGUIN
TX
ACTIVE
DALLAS
DALLAS
TX
TX
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HEAD AND NECK
SURGERY
CORNEA
REFRACTIVE
SURGERY
15-Mar-16
Practice City
Registration
Status of
Practice
Texas
State
License
P6643
HRANJEC, TJASA, MD
5/15/2013
Q0935
HROMAS, ALAN RICHARD, MD
7/15/2014
N/A
5/17/2013 None
5/3/2012 None
N/A
N/A
01-Jun-16 None
N/A
6/1/2012 None
N/A
6/2/2014 None
N/A
6/2/2014 None
N/A
ACTIVE
8/5/2013 None
N/A
HOUSTON
TX
ACTIVE
31-Mar-16 None
N/A
PA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
11/29/2013 None
N/A
11/17/2014 None
1/14/2014 None
3/14/2014 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/28/2014 None
N/A
SAN ANTONIO TX
AUSTIN
TRAUMATIC
SURGERY
5/5/2015 None
TX
TX
SURGICAL CRITICAL
5/15/2018 CARE
Disciplinary
Status Date
TEMPLE
INTERNAL MEDICINE ALLENTOWN
CRITICAL CARE
8/28/2020 PEDIATRIC SURGERY (SURGERY)
EMERGENCY
3/1/2018 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
12/15/2014 None
SEE
PREVIOUS
9/9/2015 ORDER
N/A
EL PASO
TX
ACTIVE
TEMPLE
EL PASO
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
4/10/2013 None
01-Apr-16 None
N/A
N/A
2/13/2015 None
N/A
TX
ACTIVE
5/17/2013 None
N/A
TX
ACTIVE
7/30/2014 None
N/A
DALLAS
OPHTHALMOLOGY VITREOUS SURGERY HOUSTON
Page 155 of 402
8/31/2015
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q0936
P9202
HROMAS, CARRIE ANNA, MD
HSIEH, JOHN , MD
7/15/2014
3/3/2014
P4965
HSIEH, JOSEPH CHIA-YU, MD
11/30/2012
Q3010
HSU, PAUL THOMAS, MD
Q6427
HU, BEI , MD
P7468
HU, MELISSA, MD
Q0937
HU, MICHAEL YI, MD
7/15/2014
P6979
HU, SHIMIN, MD
6/14/2013
P7783
Q6945
P6423
HUANG, CHRISTINE, MD
HUANG, ERYONG, MD
HUANG, HAOJIANG, MD
8/30/2013
15-Jan-16
5/1/2013
P8365
HUANG, JASON HAITAO, MD
K9303
HUANG, JONIE HSIENG-CHUN, MD
P0230
HUANG, STEVEN, MD
7/1/2011
Q1173
HUBBELL, GWENDOLYN, MD
HUDDLESTON, ASHLEY MALCOM,
MD
8/1/2014
Q4603
Q7560
Q7561
Q4133
Q4432
P8677
HUDSON, FRANK PARKER III, MD
HUDSON, KATHRYN ELIZABETH,
MD
HUDSPETH, TESSA NICOLE, DO
HUERTA, CHRISTOPHER
LAWRENCE, MD
HUFF, JAMIE BETH, DO
2/2/2015
11/2/2015
8/1/2013
11/15/2013
5/15/2014
6/1/2015
15-Mar-16
15-Mar-16
5/1/2015
5/15/2015
1/3/2014
3/3/2019 PSYCHIATRY
NEUROLOGICAL
11/30/2017 SURGERY
EMERGENCY
2/2/2020 MEDICINE
HEMATOLOGY/ONCOL
11/2/2020 OGY
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Practice City
HOUSTON
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
TX
OTORHINOLARYNGOL OTOLARYN & FACIAL
8/1/2018 OGY
PLASTIC SURGERY
INTERVENTIONAL
7/1/2016 RADIOLOGY
RADIOLOGY
MUSCULOSKELETAL DIAGNOSTIC
8/1/2019 RADIOLOGY
RADIOLOGY
EMERGENCY
6/1/2020 MEDICINE
INFECTIOUS
INTERNAL MED 15-Mar-21 DISEASES
PEDS
HEMATOLOGY/ONCOL
15-Mar-21 OGY
DIAGNOSTIC
5/1/2020 RADIOLOGY
EMERGENCY
5/15/2020 MEDICINE
1/3/2019 PSYCHIATRY
Page 156 of 402
Disciplinary
Status Date
7/15/2014 None
3/18/2014 None
N/A
N/A
11/30/2012 None
N/A
2/2/2015 None
N/A
11/3/2015 None
N/A
8/1/2013 None
N/A
ACTIVE
8/14/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/21/2013 None
N/A
8/30/2013 None
28-Jan-16 None
7/5/2013 None
N/A
N/A
N/A
11/18/2013 None
N/A
5/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
7/15/2019 INTERNAL MED - PEDS INTERNAL MEDICINE FORT WORTH TX
HEMATOLOGY
6/14/2018 PATHOLOGY
(PATHOLOGY)
HOUSTON
TX
5/1/2018 PSYCHIATRY
NEUROLOGICAL
11/15/2018 SURGERY
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
LOUISVILLE
KY
TEMPLE
TX
CORPUS
CHRISTI
TX
ACTIVE
TEXAS
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
7/18/2011 None
N/A
HOUSTON
TX
ACTIVE
8/20/2014 None
N/A
FORT WORTH TX
ACTIVE
6/4/2015 None
N/A
ACTIVE
17-Mar-16 None
N/A
AUSTIN
TX
ACTIVE
21-Mar-16 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
5/28/2015 None
N/A
5/15/2015 None
1/7/2014 None
N/A
N/A
FORT WORTH TX
License
Number
Q5432
Physician Name
P8366
HUFF, MATTHEW RAY, DO
HUFFMAN, JOSEPHINE
KATHERINE, MD
Q1626
P6424
HUFFMAN, LYNN C, MD
HUH, BILLY KEON, MD
P7470
HUIZAR, ISHAM ALEJANDRO, MD
Q3384
HULL, MICHAEL EDWARD, MD
Q0651
HULTS, CHRISTOPHER MARK, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/3/2015
8/3/2020 MEDICINE
OBSTETRICS AND
11/15/2013
CARDIOVASCULAR
8/29/2014
8/29/2019 SURGERY
5/1/2013
PULMONARY
CRITICAL CARE
8/1/2013
8/1/2018 MEDICINE
ANATOMIC/CLINICAL
3/3/2015
3/3/2020 PATHOLOGY
6/16/2014
Q4984
HUME, JOHN WESTMORELAND,
MD
HUMMEL, CHRISTOPHER
JONATHAN, DO
P8916
HUMMEL, JOSEPH JACOB, MD
2/7/2014
Q3011
HUMPHREY, ALYSSA NICOLE, MD
2/2/2015
Q4769
HUMPHREY, JENNA, MD
Q0459
P0231
HUMPHREYS, AARON G, MD
HUNT, CHRISTINE M, MD
Q2302
HUNT, LAURA TRYPHENA, MD
11/7/2014
P0735
HUNT, LISA MARGUERITE, MD
8/15/2011
P4872
P6980
HUNT, THOMAS R III, MD
HUNTER, GRANT, DO
11/15/2012
6/14/2013
Q8264
HUNTER, JACOB, MD
16-May-16
P8139
Q4985
HUNTER, MEGHAN ELIZABETH, DO
HUNTER, NOTA, MD
10/15/2013
7/1/2015
P0733
8/15/2011
7/1/2015
6/12/2015
6/2/2014
7/1/2011
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
WACO
TX
ACTIVE
TYLER
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/5/2015 None
N/A
11/20/2013 None
N/A
8/29/2014 None
5/8/2013 None
N/A
N/A
THORACIC SURGERY
PAIN MANAGEMENT HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
INTERNAL MEDICINE LUBBOCK
TX
ACTIVE
8/12/2013 None
N/A
CYTOPATHOLOGY
CO
ACTIVE
LICENSE
ISSUED
3/10/2015 None
N/A
6/16/2014 None
N/A
ACTIVE
8/23/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/8/2015 None
N/A
2/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
2/4/2015 None
N/A
6/12/2015 None
N/A
6/4/2014 None
7/6/2011 None
N/A
N/A
11/7/2014 None
N/A
8/15/2011 None
N/A
PAIN
MANAGEMENT/REHAB
8/15/2016 MED
EMERGENCY
7/1/2020 MEDICINE
DENVER
DALLAS
TX
EMERGENCY
2/2/2020 MEDICINE
ORTHOPEDIC
6/2/2019 SURGERY
GATESVILLE
HOUSTON
TX
TX
ORTHOPEDIC
11/15/2017 SURGERY
SURGERY
OTORHINOLARYNGOL OTOLOGY/NEUROTO
16-May-21 OGY
LOGY
FAMILY
Page 157 of 402
HOUSTON
NORWICH
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
CT
ACTIVE
ACTIVE
11/20/2012 None
6/17/2013 None
N/A
N/A
DALLAS
TX
THE
WOODLANDS TX
CONROE
TX
ACTIVE
18-May-16 None
N/A
ACTIVE
ACTIVE
10/18/2013 None
7/3/2015 None
N/A
N/A
License
Number
Physician Name
P5818
HURLBURT, BRIAN SCOTT, MD
P8917
P6187
P9369
HURLBURT, JAMES BRANDON, DO
HURT, MYERS ROBINSON III, MD
HUSAIN, ABIHA SYEDA, DO
dicaid
dicaid
Agreement
End Date
Designated)
3/15/2013
2/7/2014
4/12/2013
3/17/2014
Secondary Specialty
(Self-Designated)
Practice City
BEAUMONT
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
BRYAN
GALVESTON
DALLAS
TX
TX
TX
2/10/2014 None
4/22/2013 None
4/11/2014 None
N/A
N/A
N/A
01-Jun-16 None
N/A
5/15/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
8/22/2014 None
2/6/2015 None
3/19/2015 None
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
1/16/2013 None
14-Jun-16 None
13-Jun-16 None
N/A
N/A
N/A
TX
TN
ACTIVE
ACTIVE
4/18/2012 None
9/18/2014 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
2/6/2015 None
N/A
11/15/2013 None
N/A
Q8512
HUSAIN, KAMRAN, MD
01-Jun-16
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Q0280
5/15/2014
INTERNAL MEDICINE
Q1419
Q3013
Q3527
HUSAIN, MARIA QAYYUM, MD
HUSBAND, MEAGAN ORENE
JARBOE, MD
HUSSAIN KHAN, SHAHRUKH, MD
HUSSAIN, MUZZAFFAR, MD
8/15/2014
2/2/2015
3/16/2015
P5189
Q7562
Q7710
HUSSAIN, SHABBIR, MD
HUSSAIN, SHAHID, MD
HUSSAIN, SYED SHOIB, DO
1/4/2013
15-Mar-16
01-Apr-16
15-Mar-21 PSYCHIATRY
LUBBOCK
TX
FORT WORTH TX
TX
P2678
Q1832
HUSSAIN, YESSAR M, MD
HUSSAINI, SYED MANSOOR, MD
4/2/2012
9/15/2014
4/2/2017 NEUROLOGY
9/15/2019 NEUROLOGY
Q3014
HUSSEIN, HUSSEIN ALAA , MD
2/2/2015
P8367
HUSSEIN, QAALI ABDALLA, MD
11/15/2013
P1768
P9370
HUSTAK, ERIK CHRISTOPHER, MD
HUSTED, HONGMEI, MD
Q3015
HUTCHINS, LESLIE MARIAN, MD
1/2/2012
3/17/2014
2/2/2015
P9371
HUTCHISON, STEPHANIE, MD
3/17/2014
Q1833
Q4137
Q7208
Q0460
HUTTING, HALEY GALLUP, MD
HUYNH, BAO QUYNH NGOC, MD
HUYNH, MYLIEN , MD
HUYNH, NGUYEN PHONG, DO
9/15/2014
5/1/2015
16-Feb-16
6/2/2014
P3352
HUYNH, PHUONG NAM-THUY, MD
6/1/2012
NEUROMUSCULAR
DISEASE
LICENSE
ISSUED
LICENSE
ISSUED
AUSTIN
MEMPHIS
EMERGENCY
2/2/2020 VASCULAR SURGERY MEDICINE
HOUSTON
SURGICAL CRITICAL
HOUSTON
NEUROLOGICAL
2/2/2020 SURGERY
OBSTETRICS AND
PEDIATRIC
ANESTHESIOLOGY
9/15/2019 (PEDS)
ACTIVE
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/27/2013 None
N/A
TX
GALVESTON
TX
ACTIVE
ACTIVE
2/24/2012 None
4/17/2014 None
N/A
N/A
RICHMOND
VA
ACTIVE
2/9/2015 None
N/A
KERRVILLE
TX
ACTIVE
5/6/2014 None
N/A
SAN ANTONIO TX
INTERNAL MEDICINE IRVINE
CA
9/24/2014
5/18/2015
10-Mar-16
6/12/2014
None
None
None
None
N/A
N/A
N/A
N/A
6/13/2012 None
N/A
OBSTETRICS &
GYNECOLOGICAL
SURGERY
HOSPITALIST
6/1/2017 SPORTS MEDICINE
FAMILY MEDICINE
Page 158 of 402
DIBERVILLE
MS
ACTIVE
ACTIVE
ACTIVE
ACTIVE
CLEVELAND
OH
ACTIVE
License
Number
Physician Name
Q5820
P5646
P3353
HUYNH, QUYEN , MD
HUYNH, SUSAN LYNN, DO
HUYNH, TAI T, MD
P5537
HWANG, BECKY JUNGSUN, DO
Q5672
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/28/2015
8/28/2020 MEDICINE
3/1/2013
6/1/2012
2/8/2013
2/8/2018 RADIOLOGY
HWANG, WILLY, MD
8/14/2015
P6189
HWANG, YOO JOO, DO
4/12/2013
8/14/2020 RADIOLOGY
EMERGENCY
4/12/2018 MEDICINE
P3354
HYDE, KELLY VAUGHAN, MD
P7284
HYLTON, ALECIA ROSEMARIE, MD
N0116
P2009
IACOBAS, IONELA , MD
IBARRA, JOHN ISIDRO, MD
P7650
8/15/2013
P0905
IBARRA, RAFAEL ANDRES, MD
IBE, CHIMKAMA NGOZI CYNTHIA,
MD
P7786
IBIDAPO-OBE, OYETOKUNBO, MD
8/30/2013
6/1/2012
7/15/2013
5/2/2014
2/1/2012
9/1/2011
Secondary Specialty
(Self-Designated)
PEDIATRIC
RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
TX
ACTIVE
ACTIVE
ACTIVE
9/7/2015 None
3/6/2013 None
6/25/2012 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
2/18/2013 None
N/A
8/14/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2013 None
N/A
6/1/2012 None
N/A
7/15/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
5/9/2014 None
2/3/2012 None
N/A
N/A
8/15/2013 None
N/A
TX
ACTIVE
9/29/2011 None
N/A
SAN ANTONIO TX
ACTIVE
9/4/2013 None
N/A
11/4/2011 None
N/A
4/9/2012 None
N/A
PEDIATRIC
HEMATOLOGY/ONCOL
5/2/2019 OGY
PEDIATRICS
HOUSTON
URGENT CARE 8/15/2018 FAMILY PRACTICE
FAMILY PRACTICE
HOUSTON
Disciplinary
Status Date
HOUSTON
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
CHILD AND
ADOLESCENT
PSYCHIATRY
P1330
IBRAHIM, AALAMGEER KHAKAN,
MD
P2680
IBRAHIM, ALI DHIA, MD
4/2/2012
INDIANAPOLIS IN
ACTIVE
P2681
IBRAHIM, PARISA, MD
4/2/2012
INDIANAPOLIS IN
4/10/2012 None
N/A
Q7711
IBRAHIM, SYED TARIQ, MD
ACTIVE
LICENSE
ISSUED
01-Apr-16 None
N/A
P6000
IDAHOSA, VICTOR OMAMODE, MD
4/1/2013
Q3701
IDELL, RICHARD DAVID, MD
4/1/2015
P9372
P9879
P4873
IDEM, EMEM, MD
IDEM, IFIOK, MD
IDOWU, OLAKUNLE, MD
11/4/2011
01-Apr-16
3/17/2014
4/15/2014
11/15/2012
PEDIATRIC
4/1/2020 PSYCHIATRY
LICENSE
ISSUED
INTERNAL MEDICINE
INTERNAL MEDICINE SIOUX CITY
IA
ACTIVE
4/22/2013 None
N/A
PSYCHIATRY
FL
ACTIVE
4/7/2015 None
N/A
MARTINSVILLE VA
DANVILLE
KY
BROOKLYN
NY
ACTIVE
ACTIVE
ACTIVE
3/24/2014 None
4/17/2014 None
11/20/2012 None
N/A
N/A
N/A
Page 159 of 402
MIAMI
License
Number
Physician Name
P4874
IDOWU, TECHECIA TAMARA, MD
P1085
IDRIZI, HANEME , MD
IFAFORE, ADEBOLA TEMITOPE,
P4966
MD
IGBINIGIE, VERA
Q1420
OSAGBAROGHEMWEN, MD
IGBOKWE, EBERENNE FRANCINE,
P6428
DO
dicaid
dicaid
Agreement
End Date
Designated)
11/15/2012
10/3/2011
EMERGENCY
11/30/2012
11/30/2017 MEDICINE
8/15/2014
5/1/2013
Q1421
IGNATIUS, RENJITHA TOM, MD
P3006
P3355
IHEKWEAZU, FAITH DORSEY, MD
IHEUKWUMERE, ESTHER
ORIEAKU, MD
Q7058
Q5821
IJAZ, MOHSIN, MD
IKEKPEAZU, NKEMAKONAM, MD
01-Feb-16
8/28/2015
Q4433
IKERD, ROBERT PAUL, MD
5/15/2015
P1462
IKHISEMOJIE, AUGUSTA UAYE, MD
Q3385
Q7712
P8680
IKOMA, NARUHIKO , MD
IKUGBAGBE, OLAOLUWAPO, MD
ILIESIU, MIHAI , MD
P1654
ILIEV, DESSISLAVA DIMITROVA,
MD
12/15/2011
P8035
ILLANGO, RAMANATHAN K, MD
10/1/2013
Q4604
ILLURI, VIDHYA DEVI SRINIVASAN,
MD
Q2776
P3356
P7285
P3172
ILOANYA, NKOLI OBIOMA, MD
ILOCHONWU, IKECHUKWU
CHRISTIAN, MD
ILYAS, MUZNA ATIF, MD
IM, JIN SEON , MD
8/15/2014
FAMILY PRACTICE
HEMATOLOGY/ONCOL
8/15/2019 OGY
INTERNAL MEDICINE
5/1/2017 PEDIATRICS
6/1/2012
6/1/2017 NEPHROLOGY
3/3/2015
01-Apr-16
1/3/2014
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/1/2012
11/15/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
Practice City
State
License
ACTIVE
SAN ANTONIO TX
ACTIVE
HOUSTON
EMERGENCY
5/15/2020 MEDICINE
SURGICAL
3/3/2020 ONCOLOGY
6/1/2015
ENDOCRINOLOGY,
DIABETES AND
6/1/2020 METABOLISM
1/5/2015
6/1/2012
7/15/2013
5/15/2012
INTERNAL MEDICINE PARIS
PULMONARY
CRITICAL CARE
MEDICINE
EMERGENCY
MEDICINE
FAMILY MEDICINE
8/15/2014 None
N/A
5/1/2013 None
N/A
8/15/2014 None
N/A
5/11/2012 None
N/A
TX
ACTIVE
6/20/2012 None
N/A
ACTIVE
ACTIVE
12-Feb-16 None
9/14/2015 None
N/A
N/A
ACTIVE
5/25/2015 None
N/A
ACTIVE
12/5/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
3/10/2015 None
02-May-16 None
1/10/2014 None
N/A
N/A
N/A
ACTIVE
1/23/2012 None
N/A
ACTIVE
11/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/10/2015 None
N/A
1/5/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
6/18/2012 None
8/27/2013 None
5/21/2012 None
N/A
N/A
N/A
TX
TX
Page 160 of 402
N/A
ACTIVE
PEDIATRIC
ANESTHESIOLOGY
SLEEPY
(PEDS)
HOLLOW
NY
HEMATOLOGY INTERNAL MEDICINE FARMINGTON NM
KINGWOOD
12/12/2012 None
TX
SAN ANTONIO TX
GRAND
PRAIRIE
TX
HOUSTON
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
11/19/2012 None
N/A
10/11/2011 None
N/A
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
HEMATOLOGY/ONCO
LOGY
P9373
IMAM, MUHAMMAD HASSAAN, MD
3/17/2014
L2338
L4005
Q0461
IMAM, SYED NASRAT, MD
IMAM, TABASSUM ZAFFAR, MD
IMANGULI, MATIN, MD
9/15/2014
8/28/2015
6/2/2014
P0906
IMAS, FRANK, MD
9/1/2011
P6832
P6429
Q0768
IMGRUND, KATHRYN HAWKINS,
MD
IMIERE, EDWIN OLATUNJI, MD
INAM, FAHAD, MD
P8591
Q3386
INAMDAR, VATSAL, MD
INAMPUDI, SUJAY, MD
Q7059
INANO, STEVEN, MD
01-Feb-16
Q0462
Q6947
INCORVATI, DENNIS LOUIS, DO
INDIRA, PRIYA PILLAI, MD
6/2/2014
15-Jan-16
Q0940
INDRESANO, ANDREW, MD
7/15/2014
P2873
Q7564
INGRAM, JELANI D, MD
INGRIM, JOEL ANDREW, MD
4/13/2012
15-Mar-16
Q4987
7/15/2013
Q4773
INTSIFUL, HARRY HUBERTUS, MD
IOSELEVICH, VADIM BORISOVICH,
MD
IOVETTZ-TERESHCHENKO, NADIA
SKY, MD
6/12/2015
EMERGENCY
6/12/2020 MEDICINE
Q2304
IPE, GEORGE VINU, MD
11/7/2014
10-Jun-16
PULMONARY
CRITICAL CARE
10-Jun-21 INTERNAL MEDICINE MEDICINE
Page 161 of 402
P7286
Q8728
IQBAL, ABID SHEIKH, MD
6/3/2013
5/1/2013
6/27/2014
12/16/2013
3/3/2015
7/1/2015
OBSTETRICS AND
6/3/2018 GYNECOLOGY
CARDIAC
ELECTROPHYSIOLOG
12/16/2018 Y
PHYSICAL MED. &
01-Feb-21 REHABILITATION
INTERVENTIONAL
6/2/2019 CARDIOLOGY
ORTHOPEDIC
SURGERY OF THE
7/15/2019 SPINE
PLASTIC &
RECONSTRUCTIVE
7/1/2020 SURGERY
GERIATRICS
OBSTETRICS &
GYNECOLOGICAL
SURGERY
DANVILLE
KATY
DALLAS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TEXAS
LICENSE
IL
ISSUED
TX
ACTIVE
TX
ACTIVE
MARYSVILLE
OH
ACTIVE
9/8/2011 None
N/A
TYLER
LUBBOCK
HOBBS
TX
TX
NM
ACTIVE
ACTIVE
ACTIVE
6/21/2013 None
5/6/2013 None
7/7/2014 None
N/A
N/A
N/A
12/16/2013 None
3/24/2015 None
N/A
N/A
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
3/17/2014 None
N/A
9/15/2014 None
9/4/2015 None
6/9/2014 None
N/A
N/A
N/A
WINCHESTER VA
LICENSE
ISSUED
ACTIVE
SACRAMENTO CA
ACTIVE
22-Feb-16 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
6/16/2014 None
08-Feb-16 None
N/A
N/A
ORTHOPEDIC
SURGERY
CORPUS
CHRISTI
TX
ACTIVE
7/22/2014 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
4/17/2012 None
31-Mar-16 None
N/A
N/A
HAND SURGERY
GREAT NECK
NY
ACTIVE
7/31/2015 None
N/A
HOUSTON
TX
ACTIVE
7/24/2013 None
N/A
KNOXVILLE
TN
ACTIVE
LICENSE
ISSUED
6/17/2015 None
N/A
11/7/2014 None
N/A
10-Jun-16 None
N/A
CARDIOLOGY
CARDIOVASCULAR
DISEASES
FAMILY MEDICINE
LICENSE
ISSUED
License
Number
Physician Name
Q4138
IQBAL, FAHAD, MD
P3007
P7128
Q6033
IQBAL, MOHAMMED S, MD
IQBAL, NADIA WASI, MD
IQBAL, NAYYER, MD
Q7713
P5648
IQBAL, SAAD, MD
IQBAL, ZOHA , MD
P7129
Q2564
IRELAND, RHIANA, MD
IRONSIDE, ABIGAIL , MD
Q3203
ISAACSON, JARED SCOTT, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIOVASCULAR
5/1/2015
5/1/2020 DISEASES
INTERNAL MEDICINE
PEDS
7/1/2013
7/1/2018 NEPHROLOGY
INTERNAL MEDICINE
9/15/2015
NEUROLOGY
INTERVENTIONAL
01-Apr-16
01-Apr-21 RADIOLOGY
3/1/2013
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
12/3/2014
2/13/2015
ISAACSON, TERAH C, MD
10/1/2012
Q5436
P2683
ISKANDAR, SANDIA , MD
ISLAM, MAHMUDA, MD
8/3/2015
4/2/2012
P7287
ISLAM, MAHMUDA, MD
7/15/2013
Q1627
ISLAM, SHAHEDUL , MD
ISMAAEL, THAYER GELIL KHALIL,
MD
8/29/2014
3/1/2013
P9596
ISMAEL, HISHAAM, MD
P8140
Q2142
P9374
ISMAIL, ABRAR IBRAHIM, MD
ISON, DAVID PHILIP, MD
ITTAMAN, SUNITHA, MD
Q8514
ITWARU, SANDY ANN, MD
Q5437
IVANOV, GENNADIY, MD
Q6948
IVANOVA, NATALIA, DO
Q5438
IVANUKOFF, VICTORIA , DO
P7787
IYANAGA, MASAYUKI, MD
4/1/2014
10/15/2013
10/15/2014
3/17/2014
01-Jun-16
8/3/2015
15-Jan-16
8/3/2015
8/30/2013
OAK PARK
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
IL
ACTIVE
5/4/2015 None
N/A
PENSACOLA
FL
ACTIVE
ACTIVE
ACTIVE
6/18/2012 None
7/15/2013 None
10/26/2015 None
N/A
N/A
N/A
KINGWOOD
TEXARKANA
TX
AR
ACTIVE
ACTIVE
05-May-16 None
3/11/2013 None
N/A
N/A
LONGVIEW
TEMPLE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
7/17/2013 None
12/22/2014 None
N/A
N/A
2/13/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
11/5/2012 None
N/A
8/3/2015 None
4/13/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/17/2013 None
N/A
8/29/2014 None
N/A
3/5/2013 None
N/A
5/12/2014 None
N/A
10/15/2013 None
10/31/2014 None
4/14/2014 None
N/A
N/A
N/A
01-Jun-16 None
N/A
8/3/2015 None
N/A
13-Apr-16 None
N/A
9/7/2015 None
N/A
8/30/2013 None
N/A
2/13/2020 RADIOLOGY
P4580
P5649
Practice City
Registration
Status of
Practice
Texas
State
License
COLON AND RECTAL
SURGERY
FAMILY PRACTICE
WICHITA
FALLS
TX
ACTIVE
SURGICAL
ONCOLOGY
HARVEY
MARSHFIELD
HEMATOLOGY/ONCO
01-Jun-21 INTERNAL MEDICINE LOGY
OBSTETRICS AND
8/3/2020 GYNECOLOGY
FAMILY
15-Jan-21 PRACTICE/OMM
FAMILY MEDICINE
LUMBERTON
CRITICAL CARE
VASCULAR
8/3/2020 (TRAUMA)
SURGERY
EMERGENCY
8/30/2018 MEDICINE
EL PASO
Page 162 of 402
IL
WI
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
License
Number
Q0076
Q3017
Physician Name
IZAGUIRRE, MARISA RODRIGUEZ,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
GASTROENTEROLOG
5/2/2014
5/2/2019 Y
PEDIATRICS
P1770
IZEDIUNO, IFEANYI, MD
IZQUIERDO, MIGUEL ARMANDO,
MD
2/2/2015
P8368
JABBOUR, ELIAS, MD
11/15/2013
Q2305
JABEEN, JAVARIA, DO
11/7/2014
Q3204
JABEEN, SAMEERA, MD
2/13/2015
Q6518
P3008
Q0653
Q6329
Q0769
JABER, NOOR MAHMOUD, MD
JABSHETTY, SANGMESH, MD
JACINTO, ROCHELLE , MD
JACKMAN, KYLE CHRISTIAN, DO
JACKSON, ALOYSIUS FRANCIS
JOE, MD
P9882
1/2/2012
11/16/2015
5/1/2012
6/16/2014
10/15/2015
Practice City
AUSTIN
Registration
Status of
Practice
Texas
State
License
TX
2/2/2020 PSYCHIATRY
HEMATOLOGY/ONCOL
11/15/2018 OGY
HOSPITALIST
OBSTETRICS
ACTIVE
LICENSE
ISSUED
5/6/2014 None
N/A
2/2/2015 None
N/A
1/3/2012 None
N/A
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/25/2013 None
N/A
11/7/2014 None
N/A
2/13/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/17/2015
6/6/2012
6/23/2014
10/22/2015
HUMBLE
TX
LEVELLAND
BRYAN
TX
TX
6/27/2014
JACKSON, CHELSI MARIELLE, MD
4/15/2014
OVERTON
TX
ACTIVE
P2125
Q7714
JACKSON, DANIELLE, MD
JACKSON, MAISIE LEE, MD
2/10/2012
01-Apr-16
EMERGENCY
2/10/2017 MEDICINE
AUSTIN
HOUSTON
TX
TX
ACTIVE
ACTIVE
P4461
JACKSON, MASHEIKA SHONTAE,
DO
9/17/2012
FT. WORTH
TX
P5383
Q6852
JACKSON, PAUL MCLEAN, MD
JACKSON, RUTH ELAINE, MD
2/1/2013
06-Jan-16
2/1/2018 RADIOLOGY
Q4434
P0411
JACKSON, SHARI ALEENE, MD
JACKSON, SIMONA, MD
5/15/2015
7/15/2011
P5385
JACKSON, TIFFANY RHEA, MD
2/1/2013
Q7211
JACO, JOHN WILLIAM, MD
16-Feb-16
OBSTETRICS AND
2/1/2018 GYNECOLOGY
DIAGNOSTIC
16-Feb-21 RADIOLOGY
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
Q3893
JACOB, CELINE, DO
4/10/2015
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOSPITALIST
GYNECOLOGIC
SURGERY
Page 163 of 402
Disciplinary
Status Date
HOUSTON
EMERGENCY
11/16/2020 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
LONGVIEW
TX
CELEBRATION FL
LANDSTUHL,
GERMANY
AE
ACTIVE
ACTIVE
LICENSE
ISSUED
None
None
None
None
N/A
N/A
N/A
N/A
6/27/2014 None
N/A
4/22/2014 None
SEE
PREVIOUS
2/14/2012 ORDER
04-Apr-16 None
N/A
2/13/2012
N/A
11/16/2012 None
N/A
2/1/2013 None
16-Feb-16 None
N/A
N/A
5/15/2015 None
8/22/2011 None
N/A
N/A
2/5/2013 None
N/A
18-Feb-16 None
N/A
4/10/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Practice City
P7288
P3357
P6649
JACOB, ROY GEORGE, MD
JACOB, SURAJ, MD
JADAV, DIP SURESHKUMAR, MD
7/15/2013
6/1/2012
5/15/2013
Q7715
P0412
JAFFE, DAVID ERIC, MD
JAFFER, SALIMA , MD
01-Apr-16
7/15/2011
Q3018
JAFFERJEE, NASIMA A, MD
P5086
JAFFRANI, WASEEM MUHAMMAD,
MD
12/17/2012
P5086
MD
12/17/2012
P5086
MD
12/17/2012
2/2/2020 RADIOLOGY
P8369
JAFFRI, SAYYED FARHAN ALI, MD
11/15/2013
P2127
JAFRI, SYED FARRUKH HASAN, MD
2/10/2012
P7931
JAFRI, SYED H, MD
9/16/2013
P3542
JAFRI, SYED RAZA ABBAS, MD
P5087
JAGARLAMUDI, ANNAPURNA, MD
12/17/2012
P5087
12/17/2012
P5087
12/17/2012
P0413
JAGLOWSKI, JEFFREY ROBERT,
MD
JAGRAM-PAYER, NALINI RAVIDAI,
MD
7/15/2011
ORTHOPEDIC
7/15/2018 SURGERY
Q1176
JAHAN, IFFAT, MD
8/1/2014
P7289
P7290
Q7892
JAHAN-TIGH, RICHARD REZA, MD
JAHOOR, ANIL FAROOK, DO
2/2/2015
6/8/2012
7/15/2013
7/15/2013
15-Apr-16
7/15/2018 NEURO-RADIOLOGY
FOOT AND ANKLE,
01-Apr-21 ORTHOPEDICS
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
DALLAS
DALLAS
SUGAR LAND
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/17/2013 None
6/11/2012 None
5/20/2013 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
08-Apr-16 None
9/6/2011 None
N/A
N/A
2/2/2015 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
12/17/2012 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
12/17/2012 None
N/A
INTERNAL MEDICINE
LICENSE
ISSUED
12/17/2012 None
N/A
HOSPITALIST
EVANSVILLE
IN
ACTIVE
12/17/2013 None
N/A
HEMATOLOGY/ONCOL
9/16/2018 OGY
HARLINGEN
TX
ACTIVE
2/16/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
9/25/2013 None
N/A
6/8/2012 None
N/A
ACTIVE
12/26/2012 None
N/A
ACTIVE
12/26/2012 None
N/A
INTERNAL MEDICINE GALLIPOLIS
OH
ACTIVE
12/26/2012 None
N/A
HOUSTON
TX
ACTIVE
7/22/2013 None
N/A
SPIRIT LAKE
SULPHUR
SPRINGS
IA
ACTIVE
8/18/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/11/2014 None
N/A
7/15/2013 None
20-Apr-16 None
N/A
N/A
DERMATOPATHOLO
GY
Page 164 of 402
License
Number
Physician Name
P1463
JAIJAKUL, SIRAYA , MD
Q5440
JAIN, KUNAL SUDHIR, MD
JAIN, LOUIE ANTHONY GARCIA,
MD
JAIN, NISHANK, MD
JAIN, RUBY, MD
Q3019
P2874
Q6034
Q1628
Q5441
Q3530
JAIN, SHILPA, MD
JAIN, SIDHARTH, MD
JAJI-DREW, ZENAB OLAJUMOKE,
MD
Q4989
Q3021
JALAL, REZA THULKARNAI, MD
JALAL, UZMA, MD
Q5198
JALAL, ZULEKHA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
INFECTIOUS
11/15/2011
11/15/2016 DISEASES
OTORHINOLARYNGOL HEAD AND NECK
8/3/2015
8/3/2020 OGY
SURGERY
HOUSTON
2/2/2015
4/13/2012
9/15/2015
8/29/2014
8/3/2015
8/29/2019 PATHOLOGY
3/16/2015
7/1/2015
2/2/2015
7/15/2015
JAMAL, NAIOMI, MD
JAMAL, OMER MOHAMMED, DO
JAMALI, MEHRNAZ NICOLE, MD
16-Feb-16
4/1/2014
3/1/2013
Q7716
JAMEEL, NASEER IBRAHEEM, MD
01-Apr-16
Q5199
JAMERSON, SANA, MD
7/15/2015
OBSTETRICS AND
Q4990
P3358
JAMES, ARTHUR, MD
JAMES, CLEVE ORIAN, MD
7/1/2015
6/1/2012
Q1178
JAMES, ELIZABETH, MD
8/1/2014
JAMES, FRANK PAUL, MD
1/5/2015
P8038
JAMES, JANINE A, MD
10/1/2013
P1552
JAMES, MICHAEL EUGENE, MD
12/1/2011
11/17/2011 None
N/A
TX
ACTIVE
8/6/2015 None
N/A
2/4/2015 None
4/24/2012 None
9/24/2015 None
N/A
N/A
N/A
8/29/2014 None
8/7/2015 None
N/A
N/A
MARSHALL
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
3/17/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/17/2015 None
2/18/2015 None
N/A
N/A
7/15/2015 None
N/A
PALLIATIVE
MEDICINE
EMERGENCY
8/1/2019 MEDICINE
1/5/2020 PSYCHIATRY
MATERNAL AND
PHYSICAL MED. &
GALVESTON
DALLAS
ALISO VIEJO
TX
TX
CA
ACTIVE
ACTIVE
ACTIVE
23-Feb-16 None
4/4/2014 None
4/3/2013 None
N/A
N/A
N/A
SANTA ROSA
CA
ACTIVE
21-Apr-16 None
N/A
KERRVILLE
TX
ACTIVE
7/17/2015 None
N/A
STAFFORD
TX
ACTIVE
ACTIVE
7/14/2015 None
6/15/2012 None
N/A
N/A
ACTIVE
9/1/2014 None
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
WALTHAM
MA
ACTIVE
GYNECOLOGY
EL PASO
TX
ACTIVE
LICENSE
ISSUED
Page 165 of 402
Disciplinary
Status Date
ACTIVE
SAN ANTONIO TX
TX
PREVENTIVE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
Q7212
P9597
J7797
Q2777
Registration
Status of
Practice
Texas
State
License
1/13/2015 None
SEE
PREVIOUS
11/19/2013 ORDER
12/1/2011 None
N/A
9/13/2013
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P8370
JAMES, ROBERT FRANKLIN IV, MD
11/15/2013
11/15/2018
Q8081
JAMESON, STEPHEN JOHN, MD
02-May-16
02-May-21
Q1629
P8371
JAMMA, SHAILAJA, MD
JANG, SHAUN EUGENE, MD
8/29/2014
11/15/2013
8/29/2019
11/15/2018
Q4992
Q4993
P4967
JANI, TAPAN , DO
JANJUA, EJAZ A, DO
JANSEN, RICHARD KEITH, MD
JANSSEN, CHRISTOPHER JAMES,
MD
7/1/2015
7/1/2015
11/30/2012
7/1/2020
7/1/2020
11/30/2017
4/1/2014
4/1/2019
3/3/2014
5/15/2012
8/3/2015
M0445
JAQUISH, BENJAMIN PAUL, MD
JARAMILLO, ELIZABETH , MD
JARIDO, VERONICA TAISHA, MD
JAROSZEWSKI, DAWN ELIZABETH,
MD
P8372
JASANI, ROJINA HABIB, MD
Q1179
JASTI, RAHUL, MD
8/1/2014
Q3023
2/2/2015
P6650
P7472
JASTY, PRASANTHI, MD
JATAVALLABHULA, NARASIMHA
SASTRY, MD
JATSKIV, ANDREW , MD
5/15/2013
8/1/2013
Q8519
JAUNG, MICHAEL SENYU, MD
01-Jun-16
P9599
P9206
P3175
Q5442
01-Jun-16
11/15/2013
Q3205
JAVAID, SADAF , MD
2/13/2015
Q6208
JAVAID, SIMRA, DO
10/1/2015
P8257
JAVED, QAZI U, MD
11/1/2013
Secondary Specialty
(Self-Designated)
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
NEUROLOGICAL
SURGERY
EMERGENCY
MEDICINE
GASTROENTEROLOG
Y
INTERNAL MEDICINE
INTERVENTIONAL
CARDIOLOGY
CARDIOLOGY
INTERNAL MEDICINE
ANESTHESIOLOGY
PHYSICAL MED. &
REHABILITATION
PAIN MEDICINE
GENERAL VASCULAR
3/3/2019 SURGERY
01-Jun-21 THORACIC SURGERY
OBSTETRICS AND
8/1/2019 RADIOLOGY
INFECTIOUS
2/2/2020 DISEASES
NEUROLOGICAL
5/15/2018 SURGERY
EMERGENCY
01-Jun-21 MEDICINE
URGENT CARE
10/1/2020 MEDICINE
Practice City
GREENVILLE
Registration
Status of
Practice
Texas
State
License
NC
SAINT CLOUD MN
N/A
TX
DALLAS
HOUSTON
FRISCO
TX
TX
CO
ACTIVE
ACTIVE
ACTIVE
7/3/2015 None
9/10/2015 None
12/13/2012 None
N/A
N/A
N/A
SIOUX FALLS
SD
ACTIVE
4/9/2014 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
3/12/2014 None
6/5/2012 None
8/11/2015 None
N/A
N/A
N/A
AZ
ACTIVE
13-Jun-16 None
N/A
LA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/26/2013 None
N/A
8/1/2014 None
N/A
2/2/2015 None
N/A
GENERAL SURGERY PHOENIX
LAKE
CHARLES
INTERNAL MEDICINE
INTERNAL MEDICINE
Page 166 of 402
12/5/2013 None
EDINBURG
TEMPLE
CHILD AND
ADOLESCENT
PSYCHIATRY
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
TRAUMATIC
SURGERY
GERIATRICS
CHILD AND
ADOLESCENT
PSYCHIATRY
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
10-May-16 None
N/A
8/29/2014 None
11/18/2013 None
N/A
N/A
LONGVIEW
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
5/17/2013 None
8/9/2013 None
N/A
N/A
HOUSTON
ACTIVE
02-Jun-16 None
N/A
LICENSE
ISSUED
2/13/2015 None
N/A
ACTIVE
10/19/2015 None
N/A
ACTIVE
11/12/2013 None
N/A
TX
License
Number
P4462
Physician Name
P0609
JAVERI, HETA , MD
JAVIER, EDUARDO PASMAN JR,
MD
P2686
dicaid
dicaid
Agreement
End Date
Designated)
9/17/2012
8/1/2011
JAWAID, FARRUKH, MD
4/2/2012
P7132
JAWED, IRFAN, MD
7/1/2013
7/1/2018 ONCOLOGY
P5653
JAWED, SAMIHA, MD
3/1/2013
Q2307
JAY, COLLEEN LOUISE, MD
L3696
P2268
JAZAERI, AMIR ANTHONY, MD
JEANETTE, JOSEPH PATRICK II,
DO
M7306
JEAN-PIERRE, CLAUDEL DUCLOS,
MD
Q6519
JEEVAN, DHRUVE SATISH, MD
P6836
JEMELKA, BROOKE ELAINE, MD
6/3/2013
P2876
JEN, HOWARD CHUNG-HAO, MD
4/13/2012
Q3897
JENEVIZIAN, ARA, MD
4/10/2015
Q1994
JENIS, ANDREW, MD
10/1/2014
P5388
Q8729
JENKINS, JOSEPH RAY, MD
JENKINS, RICHARD BEAUREGARD,
MD
EMERGENCY
10/1/2019 MEDICINE
EMERGENCY
2/1/2018 MEDICINE
10-Jun-16
Q7565
JENKS, CAROLYN GERHARDT, DO
15-Mar-16
Q4146
Q6209
JENNINGS, AISHA CHANTAL, MD
JENNINGS, AMY KIRSTEN, DO
5/1/2015
10/1/2015
3/3/2014
3/1/2012
11/7/2014
11/16/2015
2/1/2013
Practice City
SAN ANTONIO TX
INTERNAL MEDICINE
TRANSPLANT
11/7/2019 SURGERY
OBSTETRICS &
GYNECOLOGICAL
3/3/2019 SURGERY
11/7/2014
Secondary Specialty
(Self-Designated)
INFECTIOUS
DISEASES
Registration
Status of
Practice
Texas
State
License
MATERNAL AND
SAN ANTONIO TX
GYNECOLOGIC
ONCOLOGY
ACTIVE
HUMBLE
TX
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
PEDIATRIC SURGERY
(NEUROLOGY)
TEMPLE
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
OBSTETRICS AND
GYNECOLOGY
NEUROLOGICAL
11/16/2020 SURGERY
OBSTETRICS AND
6/3/2018 GYNECOLOGY
CHARLOTTES
VILLE
VA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
PEDIATRIC SURGERY
ABILENE
HOUSTON
HEMATOLOGY/ONCOL
15-Mar-21 OGY
INTERNAL MEDICINE
EMERGENCY
5/1/2020 MEDICINE
DALLAS
Page 167 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/8/2012 None
N/A
8/1/2011 None
N/A
4/2/2012 None
N/A
7/1/2013 None
N/A
3/1/2013 None
N/A
11/14/2014 None
N/A
3/4/2014 None
N/A
3/1/2012 None
N/A
11/7/2014 None
N/A
12/7/2015 None
N/A
6/6/2013 None
N/A
4/13/2012 None
N/A
4/10/2015 None
N/A
10/1/2014 None
N/A
TX
ACTIVE
2/4/2013 None
N/A
TX
ACTIVE
14-Jun-16 None
N/A
ACTIVE
17-Mar-16 None
N/A
ACTIVE
ACTIVE
6/1/2015 None
10/12/2015 None
N/A
N/A
TX
License
Number
Physician Name
P6002
Q5200
P0236
JENNINGS, ANDREW WAYNE, MD
JENNINGS, MARISA LEIGH, MD
JENSEN, BURKITT WILLIAM, MD
P7133
JENSEN, CLAIRE STEWART, MD
Q6430
JENSEN, JAMES II, MD
Q4994
JENSEN, SHANE, MD
P9883
JEONG, WOONDONG, MD
Q1836
P5089
P5089
P5089
JEPPSON, CORINNE NICOLE, DO
JEPPSON, JOSEPH JEPPA, DO
AM00045 JEREMIAH, SARAH ELIZABETH, MD
P6837
JERNIGAN, SARAH, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/1/2013
7/15/2015
7/1/2011
4/1/2018
7/15/2020
7/1/2016
7/1/2013
7/1/2018
11/2/2015
11/2/2020
7/1/2015
4/15/2014
9/15/2014
12/17/2012
12/17/2012
12/17/2012
12/6/2013
6/3/2013
P5822
P7932
JEROUDI, AHMAD MOHAMED, MD
JETER, ASHLEY ABIDE, MD
3/15/2013
9/16/2013
P6192
JETPURI, ZAIBA IQBAL, DO
4/12/2013
Q1995
P1655
Q4435
JEZARI, ANNA MARGARET, MD
JHA, MANIKA , MD
JIANG, BRYAN CHARLES, MD
P1333
JILANI, MASOOD, MD
10/1/2014
12/15/2011
5/15/2015
11/4/2011
Secondary Specialty
(Self-Designated)
Practice City
SURGICAL CRITICAL
GENERAL SURGERY CARE
DALLAS
PSYCHIATRY
SAN ANTONIO
UROLOGIC SURGERY UROLOGY
HUMBLE
EMERGENCY
PALLIATIVE
MEDICINE
MEDICINE
DALLAS
EMERGENCY
MEDICINE
PEDIATRICS
HEMATOLOGY/ONCOL
4/15/2019 OGY
OBSTETRICS AND
ADMINISTRATIVE
12/6/2018 MEDICINE
NEUROLOGICAL
6/3/2018 SURGERY
CARDIOVASCULAR
3/15/2018 DISEASES
9/16/2018 ONCOLOGY
OBSTETRICS AND
FAMILY MEDICINE
JILANI, SHAIQUEL AREFIN, MD
1/15/2015
Q5825
JIMENEZ RAMOS, FARRAH, MD
8/28/2015
JIMENEZ, CHRISTOPHER LOUIS,
MD
P7134
JIMENEZ, HAROLD ESTEBAN, MD
16-May-16
7/1/2013
ORTHOPEDIC
16-May-21 SURGERY
EMERGENCY
7/1/2018 MEDICINE
SAN ANTONIO
WAILUKU
WAILUKU
WAILUKU
4/22/2013 None
7/28/2015 None
7/6/2011 None
N/A
N/A
N/A
TX
ACTIVE
7/8/2013 None
N/A
ACTIVE
12/1/2015 None
N/A
ACTIVE
7/8/2015 None
N/A
ACTIVE
4/28/2014 None
N/A
TX
TX
HI
HI
HI
INTERVENTIONAL
CARDIOLOGY
ATLANTA
GA
INTERNAL MEDICINE SAN MARCOS TX
HOSPITALIST
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
Page 168 of 402
PALM
SPRINGS
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
FAMILY MEDICINE
EL PASO
EDCOUCH
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
TX
TX
TX
INTERNAL MEDICINE
Q2909
Q8267
GYNECOLOGIC
ONCOLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
Registration
Status of
Practice
Texas
State
License
CA
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/24/2014
12/21/2012
12/21/2012
12/21/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/10/2013 None
N/A
6/3/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
3/22/2013 None
9/27/2013 None
N/A
N/A
4/12/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/2/2014 None
12/20/2011 None
6/5/2015 None
N/A
N/A
N/A
11/4/2011 None
N/A
ACTIVE
LICENSE
ISSUED
1/16/2015 None
N/A
8/28/2015 None
N/A
ACTIVE
LICENSE
ISSUED
20-May-16 None
N/A
7/1/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q2566
JINDAL, MEENU MITTAL, DO
12/3/2014
Q2308
JINDAL, VIKAS, MD
11/7/2014
Q3024
JOBE, JEFFREY TAYLOR, MD
2/2/2015
P2691
JOE, TIFFANY DAISY, MD
4/2/2012
Q6211
P1657
P7933
JOH, JAE WON , MD
JOHN, ABRAHAM, MD
JOHN, LIJO , MD
P2692
P1334
JOHN, REVERLY, MD
JOHN, RUBY SAMUEL, MD
4/2/2012
11/4/2011
Q0281
JOHN, SAMUEL , MD
5/15/2014
10/1/2015
12/15/2011
9/16/2013
P6838
JOHN, SUNITHA SARA, MD
6/3/2013
P9208
3/3/2014
Q7396
JOHN, VINEETH PHILIP, MD
JOHNS, MONTGOMERY NEWMAN,
MD
04-Mar-16
Q6330
JOHNSON, ANDREW KESSLER, MD
10/15/2015
CLINICAL AND
LABORATORY
IMMUNOLOGY
11/7/2019 (PEDIATRICS)
2/2/2020 SURGERY
EMERGENCY
4/2/2017 MEDICINE
EMERGENCY
10/1/2020 MEDICINE
PULMONARY
CRITICAL CARE
4/2/2017 MEDICINE
Secondary Specialty
(Self-Designated)
HOSPITALIST
ONCOLOGY
3/3/2019 PSYCHIATRY
OBSTETRICS AND
JOHNSON, ARTHUR III, MD
7/15/2014
P2128
JOHNSON, BOBBY SUDHIR, MD
2/10/2012
HOSPITALIST
Q0771
JOHNSON, BRANDON JAROD, MD
6/27/2014
5/1/2015
EMERGENCY
5/1/2020 MEDICINE
PALLIATIVE
MEDICINE
06-Jan-16
Q6854
JOHNSON, DOUGLAS ROBERT, DO
ORAL &
MAXILLOFACIAL
SURGERY
Page 169 of 402
12/15/2014 None
N/A
LICENSE
ISSUED
11/7/2014 None
N/A
LICENSE
ISSUED
2/2/2015 None
N/A
4/25/2012 None
N/A
HOUSTON
TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
10/7/2015 None
1/13/2012 None
9/30/2013 None
N/A
N/A
N/A
4/2/2012 None
11/16/2011 None
N/A
N/A
5/15/2014 None
N/A
ACTIVE
6/10/2013 None
N/A
ACTIVE
3/4/2014 None
N/A
ACTIVE
14-Mar-16 None
N/A
TX
Disciplinary
Status Date
ACTIVE
PLANO
PALLIATIVE
MEDICINE
GERIATRIC
PSYCHIATRY
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN MARCOS TX
INTERNAL MEDICINE
Q0943
JOHNSON, CANDACE NICOLE, MD
NY
INTERVENTIONAL
RADIOLOGY
ORAL &
MAXILLOFACIAL
7/15/2019 SURGERY
Q4147
Practice City
HOPEWELL
JUNCTION
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
10/19/2015 None
N/A
HOUSTON
EVERGREEN
PARK
TX
ACTIVE
7/29/2014 None
N/A
IL
2/17/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/27/2014 None
N/A
5/1/2015 None
N/A
ACTIVE
08-Jan-16 None
N/A
FORT WORTH TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P6003
JOHNSON, JAMEEL RASHEED, MD
Q6035
JOHNSON, JENNA LYNN, MD
9/15/2015
EMERGENCY
9/15/2020 MEDICINE
Q1632
8/29/2014
P2693
Q4996
JOHNSON, KASSIE SOEFJE, MD
JOHNSON, KATHARINE MORTON,
MD
JOHNSON, KATHRYN ANN, MD
4/2/2012
7/1/2015
7/1/2020 PEDIATRICS
P3360
JOHNSON, KATIE , DO
6/1/2012
P5389
JOHNSON, KELLY ANNE, MD
2/1/2013
Q3026
JOHNSON, KIMBERLY SUSAN, MD
2/2/2015
DIAGNOSTIC
2/1/2018 RADIOLOGY
ALLERGY AND
2/2/2020 IMMUNOLOGY
Q1633
JOHNSON, NATALIE INGE, MD
8/29/2014
Q4777
JOHNSON, PAUL, MD
JOHNSON, RAPHNY ALEXANDRE,
MD
6/12/2015
OBSTETRICS AND
ORTHOPEDIC
2/1/2018 SURGERY
Q8520
4/1/2013
01-Jun-16
Q1545
JOHNSON, TATUM SIMON, MD
P1465
JOHNSON, VAN ALLAN JR, MD
JOHNSON, VERNON NATHANIEL,
MD
11/15/2011
9/15/2015
8/1/2014
15-Dec-15
15-Dec-20 PSYCHIATRY
Q2310
JOHNSTON, CLARISSA MARY, MD
JOHNSTON, NATHAN SCOTT, DO
JOHNSTON, STERLING
CLAIBORNE, MD
11/7/2014
P6839
JOLLY, AARON FRANCIS, MD
Q5826
JONES, ANGELA, DO
11/7/2019 NEUROLOGY
CARDIOVASCULAR
6/3/2018 IMAGING
OBSTETRICS AND
Q1181
Q6755
6/3/2013
8/28/2015
HOUSTON
TX
ACTIVE
BIRMINGHAM
AL
8/15/2019 RADIOLOGY
BREAST IMAGING
WEBSTER
ACTIVE
LICENSE
ISSUED
9/29/2015 None
N/A
8/29/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/4/2012 None
7/3/2015 None
N/A
N/A
6/1/2012 None
N/A
ACTIVE
2/6/2013 None
N/A
TX
ACTIVE
2/18/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
9/3/2014 None
N/A
6/12/2015 None
N/A
ACTIVE
08-Jun-16 None
N/A
ACTIVE
2/21/2013 None
N/A
9/1/2014 None
N/A
11/15/2011 None
N/A
9/18/2015 None
N/A
8/1/2014 None
16-Dec-15 None
N/A
N/A
TX
PEDIATRIC
RADIOLOGY
ACTIVE
LICENSE
ISSUED
BIG SPRING
Disciplinary
Status Date
N/A
FAYETTEVILLE AR
PEDIATRICS
ABILENE
GERIATRIC
MEDICINE (INTERNAL
MED)
TYLER
Registration
Status Date
Disciplinary
Status of
Texas
License
4/3/2013 None
SAN ANTONIO TX
DALLAS
TX
JOHNSON, STEVEN MICHAEL, DO
8/15/2014
Practice City
SPORTS MEDICINE
P5390
Q6036
2/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
VASCULAR
NEUROLOGY
AUSTIN
TX
ACTIVE
11/13/2014 None
N/A
CARDIOLOGY
HOUSTON
TX
ACTIVE
6/18/2013 None
N/A
ACTIVE
9/9/2015 None
N/A
PALLIATIVE
MEDICINE
Page 170 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P2129
JONES, CARL RAY, DO
P3903
JONES, CHRISTINA , MD
Q2312
P0238
JONES, CHRISTOPHER L, MD
JONES, CORTNEY VANDERBILT,
MD
P9601
JONES, JAIME, MD
Q1998
JONES, JEREMY C, MD
10/1/2014
Q7397
JONES, JEREMY RYAN, MD
04-Mar-16
Q3531
P7652
JONES, KEVIN CHRISTOPHER, DO
JONES, KRISTIE ELIZABETH, MD
3/16/2015
8/15/2013
Q0468
JONES, KRISTINA, MD
Q3207
JONES, MARGARET MING, MD
2/13/2015
Q2144
JONES, PATRICK WILLIAM, MD
10/15/2014
Q0469
JONES, PEARL KURIAN, MD
Q2568
JONES, RHODA, MD
12/3/2014
Q5827
Q2910
JONES, ROGER STARNER JR, MD
JONES, WHAY HAN, MD
8/28/2015
1/15/2015
P2878
JORGENSEN, TYLER SCOTT, MD
4/13/2012
Q1426
JOSEPH, ABU ABRAHAM, DO
8/15/2014
P1337
JOSEPH, ALLEN, MD
2/10/2012
11/16/2015
11/7/2014
7/1/2011
4/1/2014
6/2/2014
6/2/2014
11/4/2011
Secondary Specialty
(Self-Designated)
GASTROENTEROLOG
2/10/2017 Y
NACOGDOCH
ES
TX
DALLAS
HEMATOLOGY/ONCOL
7/1/2016 OGY
EMERGENCY
4/1/2019 MEDICINE
ANESTHESIOLOGY
PHYSICAL MED. &
04-Mar-21 REHABILITATION
PAIN MANAGEMENT
CARDIOVASCULAR
3/16/2020 DISEASES
INTERNAL MEDICINE
OBSTETRICS &
GYNECOLOGICAL
2/13/2020 SURGERY
EMERGENCY
10/15/2019 MEDICINE
6/2/2019 NEUROLOGY
URGENT CARE
12/3/2019 MEDICINE
EMERGENCY
8/28/2020 MEDICINE
EMERGENCY
4/13/2017 MEDICINE
EMERGENCY
8/15/2019 MEDICINE
INTERVENTIONAL
11/4/2016 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
11/16/2015 None
N/A
11/7/2014 None
N/A
SAN ANGELO
TX
ACTIVE
7/8/2011 None
N/A
KERRVILLE
TX
ACTIVE
LICENSE
ISSUED
5/8/2014 None
N/A
10/1/2014 None
N/A
ACTIVE
16-Mar-16 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
3/18/2015 None
8/16/2013 None
N/A
N/A
6/2/2014 None
N/A
2/13/2015 None
N/A
10/21/2014 None
N/A
6/10/2014 None
N/A
N/A
LUBBOCK
TX
LUBBOCK
TX
LICENSE
ISSUED
TEMPLE
TX
CLINICAL
NEUROPHYSIOLOGY SAN ANTONIO TX
OCCUPATIONAL
MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
MD
ACTIVE
ACTIVE
12/3/2014 None
UNDER
BOARD
9/1/2015 ORDER
2/2/2015 None
ROUND ROCK TX
ACTIVE
4/17/2012 None
N/A
FORT WORTH TX
ACTIVE
8/18/2014 None
N/A
SAN JOSE
ACTIVE
11/15/2011 None
N/A
EDGEWATER
DIAGNOSTIC
RADIOLOGY
Page 171 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
2/16/2012 ORDER
2/13/2012
CA
8/28/2015
N/A
License
Number
Q0282
Physician Name
JOSEPH, DANNY MATHEW, MD
P0239
JOSEPH, DAVID OOMMEN, MD
Q7214
P6431
Q6950
JOSEPH, GEORGE MALIAKKAL, MD
JOSEPH, JAMES , MD
JOSEPH, JEAN MANASSE, MD
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2014
7/1/2011
16-Feb-16
5/1/2013
15-Jan-16
JOSEPH, JUBY A, MD
JOSEPH, KRISTA ANN, MD
8/1/2014
10/15/2013
Q4151
JOSEPH, LINDA MARY, MD
5/1/2015
Q6331
JOSEPH, ROMEO JEAN, MD
Q6212
JOSEPH, SANTHOSH PAUL, MD
10/1/2015
Q5828
JOSEPH, SUSAN M, MD
8/28/2015
P8483
JOSHI, AMAR HEMANT, MD
12/6/2013
TM00467 JOSHI, JAIDEEP SHRINIVAS, MD
Q2569
JOSHI, KUMUD, MD
8/15/2011
12/3/2014
P7653
JOSHI, RAJEEV , MD
8/15/2013
P5193
JOSHI, RAVI VIVEKANAND, MD
1/4/2013
Q3899
JOSON, JOSEPH VARGAS, DO
4/10/2015
8/15/2016 RADIOLOGY
ELECTROPHYSIOLOG
8/15/2018 Y
CARDIOTHORACIC
DIAGNOSTIC
4/10/2020 RADIOLOGY
P2270
JOTWANI, VIJAY M, MD
3/1/2012
P6983
JOUMA, BASHAR N, MD
6/14/2013
P2694
JOURNIGAN, JOANN G, MD
Q8268
JU, KEVIN LEE, MD
16-May-16
CARDIOVASCULAR
4/2/2017 DISEASES
ORTHOPEDIC
SURGERY OF THE
16-May-21 SPINE
Q7398
JUAN-RAMIREZ, JUAN PABLO, MD
04-Mar-16
04-Mar-21 RADIOLOGY
4/2/2012
Practice City
Q1182
P8142
10/15/2015
Secondary Specialty
(Self-Designated)
EMERGENCY
5/1/2020 MEDICINE
EMERGENCY
10/15/2020 MEDICINE
DIAGNOSTIC
10/1/2020 RADIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Disciplinary
Status Date
5/15/2014 None
N/A
TEMPLE
TX
ACTIVE
7/6/2011 None
N/A
BIG SPRING
EL PASO
TX
TX
ACTIVE
ACTIVE
ACTIVE
08-Mar-16 None
5/10/2013 None
18-Jan-16 None
N/A
N/A
N/A
SULPHUR
SPRINGS
TX
ACTIVE
ACTIVE
8/11/2014 None
10/28/2013 None
N/A
N/A
FORT WORTH TX
ACTIVE
5/4/2015 None
N/A
TX
ACTIVE
11/5/2015 None
N/A
TX
ACTIVE
10/21/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/11/2015 None
N/A
12/6/2013 None
N/A
8/15/2011 None
12/5/2014 None
N/A
N/A
TX
ACTIVE
8/19/2013 None
N/A
CA
ACTIVE
1/8/2013 None
N/A
OH
ACTIVE
4/13/2015 None
N/A
IN
ACTIVE
3/23/2012 None
N/A
OH
ACTIVE
6/21/2013 None
N/A
MCKINNEY
TX
ACTIVE
4/6/2012 None
N/A
ROCKWALL
TX
ACTIVE
18-May-16 None
N/A
ACTIVE
14-Mar-16 None
N/A
FAMILY PRACTICE
HOUSTON
MUSCULOSKELETAL
RADIOLOGY
HOUSTON
CARDIOVASCULAR
DISEASES
DALLAS
CARDIOLOGY
DALLAS
SAN
ANESTHESIOLOGY
FRANCISCO
MUSCULOSKELETAL CORPUS
RADIOLOGY
CHRISTI, TX
SPORTS MEDICINE
(FAMILY PRACTICE) INDIANAPOLIS
CRITICAL CARE
ANESTHESIOLOGY
MAUMEE
Page 172 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
Q0773
JULIAN, SCOTT EARL, MD
P7654
JULURI, RAVI, MD
P7655
P0417
JUNG, YEWAH, DO
JURDEN, LUCINDA ANN, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
6/27/2014
GASTROENTEROLOG
8/15/2013
8/15/2018 Y
INTERNAL MEDICINE
P1089
JUSTO, ANALIZA TENIDO, MD
10/3/2011
OBSTETRICS &
GYNECOLOGICAL
10/3/2016 SURGERY
Q4780
6/12/2015
Q2456
JYOTHINAGARAM, PRAVEENA, MD
JYOTHINAGARAM, SRIKANTH T,
MD
Q4608
JYOTHINDRAN, REVATHI, MD
Q4781
P0611
KABBUR, PRAKASH MUTTANNA,
MD
KABIR, JAHANGIR , MD
Q6037
Q2677
KABIR, MOHAMMAD HUMAYUN, MD
KADAKIA, KEVIN DIXIT, MD
Q1428
KADEN, ANDREAS, MD
8/15/2013
7/15/2011
11/17/2014
6/1/2015
6/12/2015
8/1/2011
EMERGENCY
6/1/2020 MEDICINE
KINGWOOD
8/15/2014
NEPHROLOGY
ARLINGTON
HOUSTON
TX
TX
FORT WORTH tx
DALLAS
TX
JACKSONVILL
E
FL
KADIYALA, ARAVIND BABU, MD
9/15/2014
Q0283
KADRI, SYED REHAN, MD
5/15/2014
P2271
P2014
KAFERLY, JAMES GABEL III, MD
KAHN, BEN JARONG, MD
3/1/2012
2/1/2012
Q0947
KAILA, DIVYA, MD
3/1/2017 PEDIATRICS
PULMONARY
CRITICAL CARE
7/15/2019 MEDICINE
P0241
KAISER, JACOB BRIAN, DO
7/1/2011
7/1/2016 PEDIATRICS
P5539
KAISER, SHAUN, MD
2/8/2013
Q5445
KAISER, TIMOTHY N, MD
8/3/2015
2/8/2018 NEPHROLOGY
OTORHINOLARYNGOL
8/3/2020 OGY
SLEEP MEDICINE
Page 173 of 402
NEPHROLOGY
INTERNAL MEDICINE RAPID CITY
WICHITA
FALLS
LAWTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/27/2014 None
N/A
8/19/2013 None
N/A
8/15/2013 None
8/1/2011 None
N/A
N/A
10/3/2011 None
N/A
6/12/2015 None
N/A
11/17/2014 None
N/A
ACTIVE
6/5/2015 None
N/A
ACTIVE
ACTIVE
6/17/2015 None
8/19/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
9/30/2015 None
1/29/2015 None
N/A
N/A
8/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/27/2014 None
N/A
5/15/2014 None
N/A
3/1/2012 None
2/3/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
Q1838
7/15/2014
TX
NEPHROLOGY
NEONATALNEONATALPERINATAL
6/12/2020 PERINATAL MEDICINE MEDICINE
9/15/2015
12/15/2014
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SD
ACTIVE
7/28/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
7/11/2011 None
N/A
2/8/2013 None
N/A
8/4/2015 None
N/A
OK
ACTIVE
License
Number
Q7215
Q4153
Q3208
Q1839
Physician Name
KAITHA, SINDHU REDDY, MD
KAJESE, TANYARADZWA MIRIAM,
MD
KAKARALA, BHARAT , MD
KAKLAMANI, VIRGINIA GEORGIA,
MD
P9375
KALB, THOMAS HELLER, MD
P2272
KALCICH, MICHAEL, MD
Q0285
Q2146
KALE, NEELIMA JAYAVANT, MD
KALE, SANTOSH SUDHIR, MD
Q2780
P5825
KALEEM, HASSAN , MD
KALIDINDI, RAVI, MD
Q3707
KALIRAO, SONIA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
GASTROENTEROLOG
OKLAHOMA
16-Feb-16
16-Feb-21 Y
INTERNAL MEDICINE CITY
5/1/2015
2/13/2020 RADIOLOGY
9/15/2014
9/15/2019 ONCOLOGY
3/1/2012
5/15/2014
10/15/2014
1/5/2015
3/15/2013
KALKWARF, KYLE JEFFREY, MD
KALLADA, SAHLA, MD
15-Apr-16
1/17/2012
Q6432
KALLAM, AJAY SHUBHADEEP, MD
11/2/2015
P8259
Q7216
KALMER, JENNIFER LYNN, MD
KALRA, NEERAJ KUMAR, MD
11/1/2013
16-Feb-16
Q7720
KALRA, RICKY RAJ SINGH, MD
01-Apr-16
Q4782
KALSTED, CHARLES L, MD
6/12/2015
Q6433
KALVA, SANJEEVA PRASAD, MD
11/2/2015
PHYSICAL MED. &
NEUROLOGICAL
01-Apr-21 SURGERY
EMERGENCY
6/12/2020 MEDICINE
VASCULAR AND
INTERVENTIONAL
11/2/2020 RADIOLOGY
P4876
KALYANASWAMY, NARMADHA, MD
Q7399
KAMALI, ARASH, MD
04-Mar-16
N/A
ACTIVE
5/5/2015 None
N/A
LICENSE
ISSUED
2/13/2015 None
N/A
SAN ANTONIO TX
ACTIVE
9/24/2014 None
N/A
ST. LOUIS
MO
ACTIVE
3/20/2014 None
N/A
4/2/2012 None
N/A
HORN LAKE
MS
ACTIVE
LICENSE
ISSUED
ACTIVE
5/15/2014 None
10/20/2014 None
N/A
N/A
ROSEBURG
OR
ACTIVE
ACTIVE
LICENSE
ISSUED
1/14/2015 None
4/18/2013 None
N/A
N/A
4/1/2015 None
N/A
HOUSTON
TX
TAYLORVILLE IL
ACTIVE
ACTIVE
18-Apr-16 None
1/23/2012 None
N/A
N/A
EL PASO
TX
ACTIVE
11/11/2015 None
N/A
LUFKIN
DALLAS
SALT LAKE
CITY
TX
TX
ACTIVE
ACTIVE
11/5/2013 None
26-Feb-16 None
N/A
N/A
UT
ACTIVE
LICENSE
ISSUED
05-Apr-16 None
N/A
6/12/2015 None
N/A
ACTIVE
LICENSE
ISSUED
11/3/2015 None
N/A
11/15/2012 None
N/A
01-Apr-16 None
N/A
HEMATOLOGY/ONCO
LOGY
DIAGNOSTIC
04-Mar-21 RADIOLOGY
CRITICAL CARE
(SURGERY)
NEPHROLOGY
RADIOLOGY
DALLAS
NEURO-RADIOLOGY
RADIOLOGY
DEPARTMENT TX
Page 174 of 402
Disciplinary
Status Date
16-May-16 None
4/1/2020 NEUROLOGY
Q7900
P1881
11/15/2012
CRITICAL CARE
MEDICINE (IM)
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
EMERGENCY
3/1/2017 MEDICINE
4/1/2015
OK
2/13/2015
3/17/2014
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
EMERGENCY
5/1/2012
PEDIATRICS
PULMONARY
CRITICAL CARE
04-Mar-16
04-Mar-21 MEDICINE
SLEEP MEDICINE
8/1/2013
8/1/2018 PEDIATRICS
ALLERGY AND
11/1/2012
11/1/2017 INTERNAL MEDICINE IMMUNOLOGY
04-Mar-16
NEUROLOGICAL
INTERVENTIONAL
12/3/2014
12/3/2019 SURGERY
RADIOLOGY
P3012
KAMAT, SHYAMA, MD
Q7400
P7477
KAMATHAM, MADHURI, MD
KAMDAR, ADITI BHARAT, MD
P4769
Q7401
KAMILI, QURAT-UL-AIN , MD
KAMPE, DORIS, MD
Q2570
KAN, PETER TZE MAN, MD
P2273
Q4611
P8260
KANCHERLA, DAYAKAR, MD
KANDATHIL, ASHA, MD
KANDIL, ENAS, MD
Q4998
KANE, EVAN DANIEL, MD
7/1/2015
Q3027
KANE, JUSTIN, MD
2/2/2015
P8484
KANG, DAVID R, MD
12/6/2013
Q8269
KANG, GHANA , MD
16-May-16
3/1/2012
6/1/2015
11/1/2013
Q5829
P6653
KANG, LISA, MD
KANIN, ELENITA , MD
8/28/2015
5/15/2013
Q4612
KANJIA, MAYUR BHAGVANJI, MD
Q4783
KANJIA, MEGHA KARKERA, MD
6/12/2015
P9606
Q5674
P9209
KANNEGANTI, SWARNALATHA, MD
KANSAL, RISHAV, MD
KANTAMNENI, SYLAZA, MD
4/1/2014
8/14/2015
3/3/2014
Q6522
KANURI, NAVYA DEEPTHI, MD
P2274
KANURI, RAVI, MD
6/1/2015
11/16/2015
3/1/2012
6/1/2020 RADIOLOGY
EMERGENCY
7/1/2020 MEDICINE
ORTHOPEDIC
2/2/2020 SURGERY
ORAL &
MAXILLOFACIAL
12/6/2018 SURGERY
HEMATOLOGY/ONCOL
16-May-21 OGY
PEDIATRIC
8/28/2020 RADIOLOGY
Practice City
HOUSTON
INTERVENTIONAL
RADIOLOGY
PAIN MEDICINE
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
TX
Disciplinary
Status Date
ACTIVE
5/9/2012 None
N/A
ACTIVE
ACTIVE
09-Mar-16 None
9/9/2013 None
N/A
N/A
TX
NC
ACTIVE
ACTIVE
12/10/2012 None
20-Apr-16 None
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
12/11/2014 None
N/A
3/1/2012 None
6/5/2015 None
11/7/2013 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/6/2015 None
N/A
2/2/2015 None
N/A
12/18/2013 None
N/A
RICHARDSON TX
ACTIVE
LICENSE
ISSUED
16-May-16 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
8/31/2015 None
5/27/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/11/2015 None
N/A
LICENSE
ISSUED
6/12/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
4/7/2014 None
8/31/2015 None
3/10/2014 None
N/A
N/A
N/A
11/17/2015 None
N/A
3/1/2012 None
N/A
DALLAS
TX
TX
TX
TX
RICHARDSON TX
GASTROENTEROLOG
11/16/2020 Y
TX
Page 175 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
BOLIVIA
PAIN MANAGEMENT DALLAS
CORPUS
CHRISTI
FOOT AND ANKLE,
ORTHOPEDICS
HEAD AND NECK
SURGERY
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Registration
Status of
Secondary Specialty
Practice
Texas
(Self-Designated)
Practice City
State
License
LICENSE
INTERNAL MEDICINE
ISSUED
SAN ANTONIO TX
ACTIVE
Q2313
Q5830
KANWAL, AYESHA, DO
KAOUS, SHAHID MEHMOOD, MD
11/7/2014
8/28/2015
Q8525
KAPLAN, KEVIN ALAN, MD
01-Jun-16
P2133
KAPOOR, ASHWANI, MD
2/10/2012
Q4437
KAPOOR, MEGHA MADHUKAR, MD
5/15/2015
Q3708
P8921
P0242
KAPOOR, SUMIT, MD
KAPRAL, JANE LOUISE, MD
KARAK, PRASANTA KUMAR, MD
4/1/2015
2/7/2014
7/1/2011
Q3028
KARAM, JOSEPH R, MD
2/2/2015
Q8526
KARANJA, JASON M, MD
P5092
KARIA, VIJAY, MD
12/17/2012
INTERNAL MEDICINE
P5092
KARIA, VIJAY, MD
12/17/2012
INTERNAL MEDICINE
P5092
KARIA, VIJAY, MD
12/17/2012
INTERNAL MEDICINE
P8486
Q2911
KARIM, ADNANUL , MD
KARIM, AZIM AMIN, MD
12/6/2013
1/15/2015
Q0474
KARIM, SHAHEEN, MD
6/2/2014
Q2783
KARIM, SHAKIL ABDUL, DO
KARIM-UD-DIN, SHEIKH RIZWAN,
MD
1/5/2015
Q6333
01-Jun-16
10/15/2015
PEDIATRIC
01-Jun-21 PULMONOLOGY
SLEEP MEDICINE
GASTROENTEROLOG
2/10/2017 Y
5/15/2020 RADIOLOGY
CRITICAL CARE
2/7/2019 PEDIATRICS
7/1/2016 RADIOLOGY
EMERGENCY
01-Jun-21 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/7/2014 None
9/2/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
03-Jun-16 None
N/A
RICHMOND
VA
ACTIVE
2/27/2012 None
N/A
HOUSTON
TX
ACTIVE
5/29/2015 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
4/8/2015 None
2/21/2014 None
7/12/2011 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
2/11/2015 None
N/A
WEBSTER
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10-Jun-16 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/6/2013 None
1/19/2015 None
N/A
N/A
BREAST IMAGING
RADIOLOGY
CRITICAL CARE
(SURGERY)
1/15/2020 UNSPECIFIED
GASTROENTEROLOG
1/5/2020 Y
HEPATOLOGY
TX
CORPUS
CHRISTI
TX
ACTIVE
6/9/2014 None
N/A
NEWARK
OH
ACTIVE
1/7/2015 None
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/20/2015 None
N/A
8/29/2014 None
N/A
4/1/2015 None
6/12/2015 None
N/A
N/A
ACTIVE
11/12/2014 None
N/A
ACTIVE
10/5/2015 None
N/A
HEMATOLOGY/ONCO
LOGY
Q1635
KARIPPOT, ASHA, MD
8/29/2014
Q3709
Q4438
KARIUKI, JOHN M NJUGUNA, MD
KARIYAWASAM, CHARMY, MD
4/1/2015
5/15/2015
Q2314
KARKHANIS, LUKENA, MD
11/7/2014
Q6215
KARNATI, DEEPTI, MD
10/1/2015
4/1/2020 PEDIATRICS
INTERNAL MEDICINE
ALLERGY AND
SAN ANTONIO TX
GASTROENTEROLOG
10/1/2020 Y
RICHLANDS
VA
Page 176 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CARDIOVASCULAR
INTERVENTIONAL
9/15/2015
9/15/2020 DISEASES
CARDIOLOGY
CARDIOTHORACIC
9/17/2012
ANESTHESIOLOGY
Q6041
KARNATI, PAVAN KUMAR, MD
P4467
KARRI, SARASWATHI V, MD
P1882
P1466
KARTHIK, LAKSHMI, MD
KARTOUMAH, ALMUTAZ BILLAH,
MD
P0910
KARTVELISHVILI, ALEX, MD
P8144
KARUR, VINIT GOPAL, MD
P2697
KARUTURI, MEGHAN SRI, MD
P0741
KASHANI, NASSER , MD
8/15/2011
Q2315
KASHYAP, POOJA, MD
11/7/2014
Q3710
KASIM, KASIM M, MD
Q2571
KASMAI, HANIYEH , MD
1/17/2012
11/15/2011
9/1/2011
10/15/2013
4/2/2012
4/1/2015
12/3/2014
P8922
Q4999
KASSAR, DARINE, MD
KASSEM, HANIA , MD
2/7/2014
7/1/2015
Q6855
P8374
KASS-HOUT, OMAR, MD
KASSIR, RENEE LYNN, DO
P2016
KASTURI, KRISHNA SAGAR, MD
Q8731
KASUGA, DANIEL TAKEO, MD
10-Jun-16
Q1999
Q8527
Q5450
P5540
KATARI, VIJAY SEKHAR, MD
KATARIA, JASMEET KAUR, MD
KATARIA, RAHUL , MD
KATCHER, KELLY RENEE, MD
10/1/2014
01-Jun-16
8/3/2015
2/8/2013
P5282
KATHURIA, AMITA, MD
1/15/2013
06-Jan-16
11/15/2013
2/1/2012
HOSPITALIST
NEUROMUSCULAR
DISEASE
NEPHROLOGY
VASCULAR
NEUROLOGY
FAMILY MEDICINE
INTERNAL MEDICINE
PEDIATRICS
PEDIATRICS
ANESTHESIOLOGY
ENDOCRINOLOGY,
DIABETES AND
INTERNAL MEDICINE
Page 177 of 402
Disciplinary
Status Date
ACTIVE
9/17/2015 None
N/A
CLEVELAND
OH
HUNTINGDON
VALLEY
PA
ACTIVE
9/18/2012 None
N/A
ACTIVE
LICENSE
ISSUED
1/24/2012 None
N/A
11/15/2011 None
N/A
MCALLEN
TX
ACTIVE
10/12/2011 None
N/A
TEMPLE
TX
ACTIVE
10/24/2013 None
N/A
HOUSTON
TX
ACTIVE
4/26/2012 None
N/A
SAN ANTONIO TX
ACTIVE
8/18/2011 None
N/A
ACTIVE
LICENSE
ISSUED
11/11/2014 None
N/A
4/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
1/8/2015 None
N/A
2/7/2014 None
9/4/2015 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
22-Feb-16 None
11/18/2013 None
N/A
N/A
2/1/2012 None
N/A
16-Jun-16 None
N/A
10/1/2014
03-Jun-16
8/5/2015
2/18/2013
None
None
None
None
N/A
N/A
N/A
N/A
1/28/2013 None
N/A
WICHITA
FALLS
TX
GALVESTON
TX
06-Jan-21 NEUROLOGY
AMHERST
SPRINGDALE
GASTROENTEROLOG
2/1/2017 Y
INTERNAL MEDICINE
EL PASO
10/1/2019
01-Jun-21
8/3/2020
2/8/2018
Registration
Status Date
Disciplinary
Status of
Texas
License
VA
HOSPITALIST
2/7/2019 NEUROLOGY
RICHLANDS
INTERNAL MEDICINE
VITREOUS SURGERY
HEMATOLOGY/ONCOL
10/15/2018 OGY
INTERNAL MEDICINE
HEMATOLOGY/ONCO
4/2/2017 INTERNAL MEDICINE LOGY
EMERGENCY
MEDICINE
PEDIATRICS,
Practice City
Registration
Status of
Practice
Texas
State
License
NY
AR
TX
HOUSTON
EL PASO
ELMHURST
TX
TX
IL
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
License
Number
Q8082
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
02-May-16
02-May-21 MEDICINE
Q6756
P8796
KATHURIA, NEIL, MD
KATIKANENI, RAO
MURALIKRISHNA, MD
KATIKIREDDY, NETHRA, MD
Q5675
KATKAR, AMOL SURYAKANT, MD
P0612
KATRE, RASHMI SURESH, MD
Q2912
KATTA, PRATHIBA, MD
1/15/2015
Q2913
KATTA, SHRAVAN KUMAR, MD
1/15/2015
P1555
KATUNA, BRUCE ALAN, MD
12/1/2011
P6986
Q5000
KATZ, KERRY, MD
KATZ, ROBERT MICHAEL, MD
6/14/2013
7/1/2015
P2134
KAUFFMAN, JULIA ANNE, MD
2/10/2012
Q8528
KAUFMAN, BRIAN EDWARD, MD
01-Jun-16
15-Dec-15
1/15/2014
15-Dec-20 PEDIATRICS
8/14/2015
8/14/2020 RADIOLOGY
8/1/2011
8/1/2016 RADIOLOGY
MEDICAL
TOXICOLOGY
(EMERGENCY
1/15/2020 MEDICINE)
CLINICAL
12/1/2016 NEUROPHYSIOLOGY
OBSTETRICS &
GYNECOLOGICAL
6/14/2018 SURGERY
PEDIATRIC
01-Jun-21 ORTHOPEDICS
P6006
KAUFMAN, CAROLINE , MD
Q2000
Q6216
KAUK, JUSTIN RYAN, MD
KAUL, BHAVIKA , MD
P8924
KAUNG, GEOFFREY WAI CHUNG,
MD
2/7/2014
P6843
KAUR, MANREET, MD
6/3/2013
OBSTETRICS AND
4/1/2018 GYNECOLOGY
ORTHOPEDIC
10/1/2019 TRAUMA
ORTHOPEDIC
SURGERY OF THE
2/7/2019 SPINE
GASTROENTEROLOG
6/3/2018 Y
Q0475
KAUR, NAVJEET, MD
6/2/2014
Q5833
Q5453
KAURA, ABHIMANYU, MD
KAUSER, RICKY, MD
4/1/2013
10/1/2014
10/1/2015
8/28/2015
8/3/2015
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
WHITE PLAINS NY
ABDOMINAL
RADIOLOGY
OBSTETRICS
DERMATOPATHOLO
GY
SAN ANTONIO TX
Disciplinary
Status Date
ACTIVE
09-May-16 None
N/A
ACTIVE
ACTIVE
28-Dec-15 None
1/24/2014 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/20/2015 None
N/A
8/1/2011 None
N/A
1/15/2015 None
N/A
LICENSE
ISSUED
1/15/2015 None
N/A
LONGMONT
CO
ACTIVE
12/6/2011 None
N/A
LUBBOCK
COLUMBUS
TX
TX
ACTIVE
ACTIVE
7/2/2013 None
7/3/2015 None
N/A
N/A
ACTIVE
2/14/2012 None
N/A
ACTIVE
03-Jun-16 None
N/A
ACTIVE
4/11/2013 None
N/A
ACTIVE
ACTIVE
10/6/2014 None
10/26/2015 None
N/A
N/A
ACTIVE
2/14/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/28/2013 None
N/A
6/2/2014 None
N/A
8/28/2015 None
8/7/2015 None
N/A
N/A
AUSTIN
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
PLANO
HOUSTON
TX
TX
ORTHOPEDIC
THE
SURGERY
WOODLANDS TX
GASTROENTEROLOG
Y
HOUSTON
TX
Page 178 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
FORT WORTH TX
License
Number
Physician Name
P9377
KAUSHIK, DHARAM, MD
Q8529
KAUSHIK, PRAFUL, MD
dicaid
dicaid
Agreement
End Date
Designated)
3/17/2014
3/17/2019 UROLOGY
01-Jun-16
Q0287
KAUSHIK, RUCHI, MD
5/15/2014
Q4439
KAVOUSSI, SHAHEEN , MD
5/15/2015
Q0476
6/2/2014
9/15/2014
6/16/2014
P0419
KAWAGUCHI, AKEMI LORAINE, MD
KAYANICKUPURAM, ANNIE
JOLEEN, DO
KAYYAL, SIMON YOUSEF, MD
KAZAN TANNUS, JOAO FERNANDO
, MD
7/15/2011
Q6042
KAZEMI, SHOELEH, MD
9/15/2015
P0420
Q4613
Q5454
P7478
KAZI, BEENA , MD
KAZI, HASEEB A, MD
KAZI, RUCHIKA, MD
KAZI, SEEMA, MD
7/15/2011
6/1/2015
8/3/2015
8/1/2013
Q3900
P4771
KAZIANIS, JOHN ATHANASIOS, MD
KAZIE, NELSON, MD
4/10/2015
11/1/2012
7/15/2016 RADIOLOGY
DIAGNOSTIC
9/15/2020 RADIOLOGY
PEDIATRIC
EMERGENCY
8/1/2018 PSYCHIATRY
CRITICAL CARE
Q1637
KAZIGO, NAKIZITO, MD
8/29/2014
P7479
Q2678
KAZIMI, FARZANEH SARAH, MD
KEATING, ELIZABETH M, MD
P1775
KEBEDE, TEWABE GIRMA, MD
1/2/2012
Q1184
KEC, ROBERT MATTHEW, MD
8/1/2014
Q1430
KEDIA, PRASHANT S, MD
8/15/2014
Q1431
KEDIA, RAASHEE SOOD, MD
8/15/2014
P9611
KEDIKA, RAMALINGA , MD
Q1842
Q0657
Q6337
KEEFE, KRISTIN ANN, MD
8/1/2013
12/15/2014
4/1/2014
10/15/2015
8/1/2018 RADIOLOGY
1/2/2017 NEPHROLOGY
EMERGENCY
8/1/2019 MEDICINE
GASTROENTEROLOG
8/15/2019 Y
EMERGENCY
8/15/2019 MEDICINE
GASTROENTEROLOG
4/1/2019 Y
Secondary Specialty
(Self-Designated)
Practice City
HUMBLE
OPHTHALMOLOGY
ABDOMINAL
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
5/15/2014 None
N/A
HOUSTON
TX
ACTIVE
6/17/2015 None
N/A
HOUSTON
TX
ACTIVE
6/5/2014 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
9/24/2014 None
6/26/2014 None
N/A
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
8/19/2011 None
N/A
9/15/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/22/2011
6/2/2015
8/4/2015
8/5/2013
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/14/2015 None
11/5/2012 None
N/A
N/A
8/29/2014 None
N/A
ACTIVE
ACTIVE
8/12/2013 None
1/2/2015 None
N/A
N/A
ACTIVE
1/16/2012 None
N/A
ACTIVE
8/4/2014 None
N/A
BREAST IMAGING
PEDIATRICS
FRISCO
TX
TX
MO
FORT PIERCE FL
PORT LAVACA TX
HOUSTON
TX
STOCKBRIDG
INTERNAL MEDICINE E
GA
OBSTETRICS AND
10/15/2020 PALLIATIVE MEDICINE GYNECOLOGY
Page 179 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/7/2014 None
N/A
10-Jun-16 None
N/A
DALLAS
TX
ACTIVE
9/4/2014 None
N/A
DALLAS
TX
ACTIVE
9/4/2014 None
N/A
ODESSA
TX
ACTIVE
4/7/2014 None
N/A
AUSTIN
TX
ACTIVE
10/22/2015 None
N/A
License
Number
P9612
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P2469
KEEFE, RACHAEL, MD
KEELING-JOHNSON, KONYA
KAVITA, MD
4/1/2014
3/15/2012
Q3901
KEENAN, PETER, MD
4/10/2015
4/1/2019 PEDIATRICS
COLON AND RECTAL
3/15/2017 SURGERY
EMERGENCY
4/10/2020 MEDICINE
Practice City
NEW
ORLEANS
GENERAL SURGERY MESA
GERIATRIC
PSYCHIATRY
EMERGENCY
MEDICAL SERVICES
P7480
KEENMON, CORINNA MARIA, MD
8/1/2013
P3367
KEEPERMAN, JACOB BRIAN, MD
6/1/2012
Q5835
KEHRES, DOUGLAS LUKE, MD
8/28/2015
Q3212
KELASH, FNU, MD
2/13/2015
P8925
Q6436
Q5002
KELEMEN, JOHN JOSEPH III, MD
KELLER, BRADLY J, MD
KELLER, DEBORAH SUSAN, MD
2/7/2014
11/2/2015
7/1/2015
H6334
KELLER, KEVIN RAY, MD
12/3/2014
CARDIOVASCULAR
2/7/2019 SURGERY
ALLERGY AND
Q0080
KELLER, MICHAEL PAUL, MD
P9615
Q1843
KELLEY, JAMES MICHAEL, MD
KELLEY, WILLIAM HEATH, MD
4/1/2014
9/15/2014
4/1/2019
9/15/2019
P1884
KELLY, DOUGLAS A, MD
1/17/2012
1/17/2017
P3014
KELLY, JOHN MATTHEW, MD
5/1/2012
5/1/2017
P2470
KELLY, KEVIN ROBERT, MD
3/15/2012
3/15/2017
P5093
KELLY, MICHAEL JAMES, MD
12/17/2012
12/17/2017
P5093
12/17/2012
12/17/2017
P5093
12/17/2012
12/17/2017
Q8083
KELLY, SARAH VAN EPP, MD
02-May-16
02-May-21 INTERNAL MEDICINE PATHOLOGY
Page 180 of 402
5/2/2014
8/1/2018 PSYCHIATRY
EMERGENCY
6/1/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LA
ACTIVE
AZ
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/3/2014 None
N/A
ACTIVE
LICENSE
ISSUED
3/26/2012 None
N/A
4/10/2015 None
N/A
8/27/2013 None
N/A
HOUSTON
TX
ACTIVE
SAINT LOUIS
MO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/4/2012 None
N/A
8/28/2015 None
N/A
2/13/2015 None
N/A
2/14/2014 None
11/4/2015 None
7/2/2015 None
N/A
N/A
N/A
DENTON
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
SAN ANTONIO TX
ACTIVE
12/11/2014 None
N/A
NM
ACTIVE
5/12/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
4/2/2014 None
9/24/2014 None
N/A
N/A
OK
ACTIVE
1/20/2012 None
N/A
NM
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
3/22/2012 None
N/A
12/17/2012 None
N/A
1/28/2013 None
N/A
LAS CRUCES
BLOOD
BANKING/TRANSFUSI
CLINICAL PATHOLOGY ON MEDICINE
HOUSTON
FAMILY MEDICINE
TEXARKANA
RADIATION
ONCOLOGY
TULSA
ALBUQUERQU
INTERNAL MEDICINE
E
HEMATOLOGY/ONCOL
OGY
SAN ANTONIO
DIAGNOSTIC
RADIOLOGY
DIAGNOSTIC
RADIOLOGY
EVANS
DIAGNOSTIC
RADIOLOGY
EVANS
GA
ACTIVE
GA
ACTIVE
ACTIVE
1/28/2013 None
UNDER
BOARD
09-May-16 ORDER
N/A
4/4/2016
License
Number
Physician Name
Q5003
KEMAL, NEJMUDIN RESHAD, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
7/1/2015
Q3030
KENAA, BLAINE F, MD
2/2/2015
P4660
KENNEDY, CHAD MATTHEW, MD
Q7722
KENNEDY, CHRISTOPHER, MD
01-Apr-16
Q4786
KENNEDY, RYAN OLIVER , MD
6/12/2015
6/12/2020
Q5004
Q6338
KENNY, COLIN MATTHEW, DO
KENNY, JOHN MICHAEL, MD
7/1/2015
10/15/2015
7/1/2020
10/15/2020
Q0081
KERGOSIEN, MATTHEW COLE, MD
5/2/2014
5/2/2019
P0243
KERIWALA, RAJ DILIP, MD
5/1/2015
5/1/2020
P3015
KERNAN, LEAH KATHYANN, DO
5/1/2012
5/1/2017
P7135
KERNS, JOHNATHON SCOTT, DO
7/1/2013
7/1/2018
P1658
KERR, CHRISTY LYNN, MD
12/15/2011
12/15/2016
Q2914
P2277
KERR, EDWARD EMMANUEL, MD
KERR, TREVOR , MD
1/15/2015
3/1/2012
1/15/2020
3/1/2017
P5658
KERWIN, DIANA ROSE, MD
3/1/2013
3/1/2018
Q3031
KESANI, ANIL KUMAR, MD
2/2/2015
2/2/2020
P8376
KESZLER, JASON, DO
11/15/2013
11/15/2018
F1094
KEUER, EDWARD JOHN III, MD
2/1/2013
2/1/2018
Q7065
KEUNG, EMILY ZHI-YUN, MD
01-Feb-16
01-Feb-21
Q5201
KEY, RICHARD GARRETT, MD
7/15/2015
7/15/2020
P6007
KEYLANI, ABDUL, MD
4/1/2013
4/1/2018
10/15/2012
ORTHOPEDIC
10/15/2017 SURGERY
EMERGENCY
01-Apr-21 MEDICINE
ORTHOPEDICS
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
DALLAS
SURGICAL CRITICAL
EMERGENCY
EMERGENCY
MEDICINE
MEDICINE
ALICE
PSYCHIATRY
SCARSDALE
ORTHOPEDIC
SURGERY
BEAUMONT
CRITICAL CARE
PULMONARY
MEDICINE (IM)
DISEASES
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
STEPHENVILL
FAMILY MEDICINE
E
NEUROLOGICAL
SURGERY
DALLAS
OPHTHALMOLOGY
DALLAS
GERIATRIC
MEDICINE (INTERNAL
INTERNAL MEDICINE MED)
ORTHOPEDIC
ORTHOPEDIC
SURGERY OF THE
SURGERY
SPINE
DIAGNOSTIC
RADIOLOGY
FORT MEADE
PEDIATRIC
OAKBROOK
DERMATOLOGY
DERMATOLOGY
TERRACE
SURGICAL
GENERAL SURGERY ONCOLOGY
PSYCHOSOMATIC
PSYCHIATRY
MEDICINE
AUSTIN
CARDIOVASCULAR
INTERVENTIONAL
DISEASES
CARDIOLOGY
FORT WORTH
Page 181 of 402
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
9/7/2015 None
N/A
2/2/2015 None
N/A
11/13/2012 None
N/A
11-Apr-16 None
N/A
6/12/2015 None
N/A
TX
NY
ACTIVE
ACTIVE
7/3/2015 None
10/20/2015 None
N/A
N/A
TX
ACTIVE
5/7/2014 None
N/A
5/12/2015 None
N/A
5/1/2012 None
N/A
7/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
12/19/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
1/20/2015 None
3/5/2012 None
N/A
N/A
LICENSE
ISSUED
3/1/2013 None
N/A
LICENSE
ISSUED
2/2/2015 None
N/A
SD
ACTIVE
11/26/2013 None
N/A
IL
ACTIVE
2/13/2013 None
N/A
ACTIVE
04-Feb-16 None
N/A
TX
ACTIVE
7/17/2015 None
N/A
TX
ACTIVE
4/17/2013 None
N/A
License
Number
Q0288
Q6043
Physician Name
KEYSER, ALLISON CHRISTINE, MD
Q3712
KHADBAI, ADAM , MD
KHADER, TALAL TAHER
MOHAMMAD, MD
P5541
dicaid
dicaid
Agreement
End Date
Designated)
5/15/2014
9/15/2015
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
Practice City
LICENSE
ISSUED
WEATHERFOR
D
TX
4/1/2015
HOSPITALIST
KHADIMALLY, KHAWER PASHA, DO
2/8/2013
Q3032
P0244
Q0477
KHADKA, BHUPESH, MD
KHAIR, TARIF HISHAM, MD
KHAIRA, SHARMEEL KAUR, MD
2/2/2015
7/1/2011
6/2/2014
2/2/2020 NEPHROLOGY
6/2/2019 PEDIATRICS
INTERNAL MEDICINE
Q0950
KHAJA, MASI, MD
7/15/2014
Q7402
KHALAF, HAMZAH, MD
04-Mar-16
OPHTHALMOLOGY 04-Mar-21 VITREOUS SURGERY
Q0658
P0743
P0987
KHALID, ADNAN, MD
KHALID, BAZGHA, MD
KHALID, HAROON, MD
6/16/2014
8/15/2011
9/15/2011
Q4159
P8041
KHALID, HUMAIRA, MD
KHALID, MIRZA UMAIR, MD
5/1/2015
10/1/2013
5/1/2020 PSYCHIATRY
Q5837
Q7901
P2472
KHALID, MONA, MD
KHALIL, ANDREW, DO
KHALIL, BUSHRA , MD
8/28/2015
15-Apr-16
3/15/2012
P5827
KHALIL, MOUNIR FAWZI, MD
3/15/2013
PHYSICAL MED. &
P7656
KHALIL, QASIM, MD
8/15/2013
Q3214
P1339
KHALIL, YASSER KHALID, MD
KHALILI, HOUMAN , MD
2/13/2015
11/4/2011
Q1640
Q2003
KHALINA, SVETLANA, MD
KHAMBATY, MALEKA , MD
8/29/2014
10/1/2014
P2701
KHAN, AAYESHA MUMTAZ, MD
OTORHINOLARYNGOL
4/2/2017 OGY
OTOLARYNGOLOGY
4/2/2012
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
TX
NEONATOLOGY
OPHTHALMOLOGY
INTERVENTIONAL
CARDIOLOGY
HOSPITALIST
5/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
9/22/2015 None
N/A
4/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
2/13/2013 None
N/A
2/2/2015 None
7/20/2011 None
6/4/2014 None
N/A
N/A
N/A
7/15/2014 None
N/A
TX
ACTIVE
10-Mar-16 None
N/A
DALLAS
LIVINGSTON
KANSAS CITY
MONMOUTH
JUNCTION
TX
TX
KS
ACTIVE
ACTIVE
ACTIVE
6/19/2014 None
9/2/2011 None
12/13/2011 None
N/A
N/A
N/A
NJ
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
5/18/2015 None
10/7/2013 None
N/A
N/A
8/28/2015 None
04-May-16 None
4/12/2012 None
N/A
N/A
N/A
3/15/2013 None
N/A
8/15/2013 None
N/A
2/13/2015 None
11/8/2011 None
N/A
N/A
8/29/2014 None
10/22/2014 None
N/A
N/A
4/16/2012 None
N/A
HOSPITALIST
ANESTHESIOLOGY
SPINE MEDICINE
Page 182 of 402
Disciplinary
Status Date
MCALLEN
CARDIOLOGY
HOSPITALIST
CARDIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
TX
SAN ANTONIO TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PH00004 KHAN, ADNAN , MD
04-Mar-16
P7936
Q0479
KHAN, AHMER MATEEN, DO
KHAN, AMBER, MD
9/16/2013
6/2/2014
EMERGENCY
9/16/2018 MEDICINE
Q0480
KHAN, AMIR A, MD
6/2/2014
Q0082
KHAN, ANGABEEN, MD
5/2/2014
P6655
KHAN, ASJAD MASOOD, MD
5/15/2013
P0615
Q7066
KHAN, AZHAR ULLAH, MD
KHAN, FAHAD, MD
8/1/2011
01-Feb-16
SPORTS MEDICINE 5/2/2019 REHAB MED
CRITICAL CARE
5/15/2018 MEDICINE
PULMONARY
8/1/2016 MEDICINE
01-Feb-21 NEPHROLOGY
Q6339
KHAN, FAISAL RASHID, MD
10/15/2015
P5393
KHAN, FARHAN ANWAR, MD
2/1/2013
Q0481
KHAN, GOUHAR YUSUOF, MD
6/2/2014
OBSTETRICS AND
6/2/2019 GYNECOLOGY
CARDIOVASCULAR
7/15/2020 DISEASES
Q5203
P2278
KHAN, HASHIM ALI, MD
KHAN, HENA ZAFAR, MD
7/15/2015
3/1/2012
Q6857
P1885
KHAN, HUMA, MD
KHAN, IMRAN ANWAR, MD
06-Jan-16
1/17/2012
P8926
Q5005
KHAN, IRFAN A, MD
KHAN, MADIHA AHMED, MD
2/7/2014
7/1/2015
P8042
Q4160
P9212
Q4614
KHAN, MADIHA IQBAL, MD
KHAN, MAHBOOB ALI, MD
KHAN, MAJAZ ALI, DO
KHAN, MAZHAR AHMED, MD
10/1/2013
5/1/2015
3/3/2014
6/1/2015
P9619
KHAN, MEAGHAN L, MD
4/1/2014
P5394
KHAN, MEHWISH AMIR, MD
2/1/2013
CARDIOVASCULAR
2/7/2019 DISEASES
ENDOCRINOLOGY,
DIABETES AND
5/1/2020 NEPHROLOGY
HEMATOLOGY/ONCOL
4/1/2019 OGY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
DALLAS
TX
INTERNAL MEDICINE
INFECTIOUS
DISEASES
SHREVEPORT LA
INTERNAL MEDICINE JOPLIN
OKLAHOMA
SLEEP MEDICINE
CITY
INTERNAL MEDICINE CLOVIS
INTERVENTIONAL
CARDIOLOGY
PALLIATIVE
MEDICINE
N/A
1/20/2012
N/A
6/9/2014 None
N/A
5/2/2014 None
N/A
MO
ACTIVE
6/3/2013 None
N/A
OK
CA
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/9/2011 None
19-Apr-16 None
N/A
N/A
10/15/2015 None
N/A
2/1/2013 None
N/A
MEQUON
WI
ACTIVE
6/4/2014 None
N/A
AUSTIN
GROTON
TX
CT
ACTIVE
ACTIVE
7/16/2015 None
3/6/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
07-Jan-16 None
1/24/2012 None
N/A
N/A
2/7/2014 None
7/3/2015 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
12/5/2013
5/6/2015
3/4/2014
6/2/2015
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/24/2014 None
N/A
2/1/2013 None
N/A
SAN ANTONIO TX
EL PASO
TX
GALVESTON
INTERNAL MEDICINE PITTSBURGH
HOSPITALIST
GLENDALE
FAMILY PRACTICE
TX
TX
PA
AZ
ROUND ROCK TX
Page 183 of 402
14-Mar-16 None
SEE
PREVIOUS
9/19/2013 ORDER
6/12/2014 None
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ELECTROPHYSIOLO
GY
INTERNAL MEDICINE
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Q1641
Physician Name
KHAN, MOHAMMAD SHAHBAZ, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/29/2014
CAMPBELLSVI
LLE
KY
KHAN, MUHAMMAD A, MD
Q6524
P8377
P1092
KHAN, MUHAMMAD ALI NIAZ, MD
KHAN, MUHAMMAD AZEEM, MD
KHAN, MUHAMMAD FUAD, MD
Q5204
KHAN, NABEELA, DO
P3640
Q6045
Q2149
KHAN, OWAIS AHMED, MD
KHAN, RAO ALI HASHIM, MD
KHAN, RAZA LATIF, MD
P8043
10/1/2013
Q2915
P8262
KHAN, REHAN AHMAD, MD
KHAN, REHAN JAWAID SULTAN,
MD
KHAN, ROOHI MAJEED, MD
1/15/2015
11/1/2013
Q5840
Q8530
KHAN, SADAF SANA, MD
KHAN, SAFIA SAMEEM, MD
8/28/2015
01-Jun-16
Q1432
KHAN, SAIMA, MD
8/15/2014
Q2005
Q6046
Q8085
KHAN, SAIRA KHALID, MD
KHAN, SAMAD HASSAN, MD
KHAN, SANA IMTIAZ, DO
KHAN, SHAHER WAHEED, MD
11/16/2015
11/15/2013
10/3/2011
7/15/2015
6/15/2012
9/15/2015
10/15/2014
10/1/2014
9/15/2015
02-May-16
4/10/2015
Q0951
Q3532
KHAN, SHARIQ, MD
KHAN, SHEHPAR ASHRAF, MD
7/15/2014
3/16/2015
P2703
KHAN, SOBIA, MD
P6660
KHAN, TARIQ NAWAZ, MD
5/15/2013
P9381
KHAN, TARIQ RAHMAN, MD
3/17/2014
4/2/2012
Practice City
Q6757
Q3903
15-Dec-15
Secondary Specialty
(Self-Designated)
INFECTIOUS
7/15/2020 DISEASES
PLASTIC &
RECONSTRUCTIVE
4/10/2020 SURGERY
EMERGENCY
7/15/2019 MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
INTERNAL MEDICINE
NEONATALPERINATAL
MEDICINE
INTERNAL MEDICINE
SLEEP MEDICINE
GASTROENTEROLOG
Y
8/29/2014 None
N/A
21-Dec-15 None
N/A
11/16/2015 None
11/25/2013 None
11/4/2011 None
N/A
N/A
N/A
HOBBS
DALLAS
NM
TX
HOUSTON
TX
ACTIVE
7/22/2015 None
N/A
CHICAGO
BLUEFIELD
HARLINGEN
IL
WV
TX
ACTIVE
ACTIVE
ACTIVE
6/27/2012 None
11/16/2015 None
10/24/2014 None
N/A
N/A
N/A
11/14/2013 None
N/A
1/15/2015 None
12/9/2013 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
8/28/2015 None
07-Jun-16 None
N/A
N/A
8/15/2014 None
N/A
10/1/2014 None
9/16/2015 None
23-May-16 None
N/A
N/A
N/A
4/10/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/21/2014 None
4/13/2015 None
N/A
N/A
4/2/2012 None
N/A
FORT WORTH TX
ACTIVE
5/20/2013 None
N/A
FORT WORTH TX
ACTIVE
3/19/2014 None
N/A
HOUSTON
TX
LICENSE
ISSUED
4/2/2017 INTERNAL MEDICINE GYNECOLOGY
TRANSPLANT
ABDOMINAL
5/15/2018 SURGERY
SURGERY
EMERGENCY
3/17/2019 MEDICINE
Page 184 of 402
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
INTERNAL MEDICINE
SLEEP MEDICINE
PLANO
EMERGENCY
MEDICINE
NEPHROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
DETROIT
TX
MI
License
Number
Physician Name
Q8086
Q2006
KHAN, UMAR, MD
KHAN, WAJAHAT ULLAH, MD
Q0776
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
SPORTS MEDICINE IM
02-May-16
10/1/2014
KHAN, ZAHOOR , MD
6/27/2014
P6661
KHAN, ZARTASH ZAFAR, MD
5/15/2013
Q6639
KHAN, ZEESHAN MOHAMMAD, MD
12/4/2015
INFECTIOUS
5/15/2018 DISEASES
MEDICAL
TOXICOLOGY
(EMERGENCY
12/4/2020 MEDICINE)
Q6639
04-Dec-15
FAMILY MEDICINE
Q6639
P6988
04-Dec-15
6/14/2013
FAMILY MEDICINE
L8761
KHANDELWAL, SUMITRA, MD
KHANDELWAL, SUSAN KURUVILLA,
MD
5/15/2012
Q2007
P2136
KHANDKER, SAMIUR RAHMAN, MD
KHANIJOW, VIKESH , MD
10/1/2014
2/10/2012
Q5006
KHARBANDA, BRYAN SINGH, MD
EMERGENCY
10/1/2019 MEDICINE
EMERGENCY
7/1/2020 MEDICINE
Q0659
KHATEEB, FAHAD NISAR, MD
Q2679
KHATIB, MAAN, MD
Q1643
KHATRI, ISHRAT, MD
Q0291
P4661
KHEIR, RIHAB ZAIN, MD
KHERADPOUR, RABIN, MD
P2474
7/1/2015
6/16/2014
12/15/2014
8/29/2014
INTERNAL MEDICINE WICHITA
RESTON
PEDIATRIC
GASTROENTEROLOG
12/15/2019 Y
PEDIATRICS
EMERGENCY
8/29/2019 MEDICINE
KHETPAL, VIJAY, MD
3/15/2012
Q3215
P0842
KHICHI, MAHMOOD H, MD
KHIN, YU YU, MD
2/13/2015
8/26/2011
P4662
KHIRI, EMAN, MD
SAN ANTONIO TX
BAYTOWN
TX
HOUSTON
5/15/2014
10/15/2012
10/15/2012
Practice City
Registration
Status of
Practice
Texas
State
License
KS
TX
VA
SAN ANTONIO TX
SAN ANTONIO TX
INTERNAL MEDICINE
OPHTHALMOLOGY VITREOUS SURGERY
PEDIATRIC CRITICAL
CARE MEDICINE
URGENT CARE
MEDICINE
Page 185 of 402
HOBBS
NM
ACTIVE
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
09-May-16 None
10/3/2014 None
N/A
N/A
6/27/2014 None
N/A
ACTIVE
6/20/2013 None
N/A
LICENSE
ISSUED
12/4/2015 None
N/A
ACTIVE
14-Dec-15 None
N/A
ACTIVE
ACTIVE
14-Dec-15 None
6/20/2013 None
N/A
N/A
ACTIVE
6/11/2012 None
N/A
ACTIVE
ACTIVE
10/7/2014 None
2/14/2012 None
N/A
N/A
7/2/2015 None
N/A
6/16/2014 None
N/A
1/29/2015 None
N/A
8/29/2014 None
N/A
5/15/2014 None
10/25/2012 None
N/A
N/A
3/26/2012 None
N/A
2/13/2015 None
8/31/2011 None
N/A
N/A
10/23/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
Physician Name
P1189
KHOURY, CHAOUKI K, MD
KHOURY, GHASSAN HANI NICOLA,
Q6858
MD
Q7220
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
10/17/2011
NEUROLOGY
06-Jan-16
P8264
Q6525
KHOURY, SPIRO ADEL, MD
KHROMACHOU, TAMIM ROGERS,
MD
KHURRAM, SOBIA K, MD
16-Feb-16
11/1/2013
11/16/2015
Q8087
KHWAJA, SHARIQ , MD
02-May-16
Q0660
KIBBEY, CAITLIN MARSH, MD
P8928
P4663
P0617
KIBRIA, RIZWAN E, MD
KIDAMBI, SHANTANU SRINIVASAN,
MD
KIDANE, ALISHA KITHCART, MD
P8929
P5396
Q1433
P7136
KIDD, JOSEPH AINSLEE, DO
KIDD, MATTHEW CHARLES, DO
KIDWAI, SHAHROZ , MD
KIDWELL, DAVID THOMAS, MD
6/16/2014
2/7/2014
10/15/2012
8/1/2011
2/7/2014
2/1/2013
8/15/2014
7/1/2013
4/13/2012
PHYSICAL MED. &
PEDIATRICS,
GYNECOLOGIC
5/2/2019 ONCOLOGY
P2880
KIEU, PHONG, MD
Q6341
KILGORE, ADRIENNE LATRICE, MD
Q0083
P7294
Q1645
KILGORE, JOSHUA EDSON, MD
KILGORE, JULIE KARNES, MD
KILPATRICK, JOSHUA CHARLES,
MD
Q2151
KILPATRICK, LAUREL BROWN, MD
Q3033
KIM, BRYANT JUNGKUN, MD
2/2/2015
Q4162
KIM, CATHERINE LISA, MD
5/1/2015
10/15/2015
5/2/2014
7/15/2013
8/29/2014
10/15/2014
AMARILLO
TX
ACTIVE
18-Jan-16 None
N/A
29-Feb-16 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/1/2013 None
11/18/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
09-May-16 None
N/A
DALLAS
TX
ACTIVE
6/18/2014 None
N/A
KETTERING
OH
ACTIVE
2/26/2014 None
N/A
PUTNAM
HOUSTON
CT
TX
10/24/2012 None
8/5/2011 None
N/A
N/A
EL PASO
CORSICANA
TEMPLE
TX
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
RADIATION
02-May-21 ONCOLOGY
EMERGENCY
6/16/2019 MEDICINE
GASTROENTEROLOG
2/7/2019 Y
INTERNAL MEDICINE
EMERGENCY
2/7/2019 MEDICINE
2/1/2018 NEUROLOGY
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
OBSTETRICS
SPORTS MEDICINE PHYSICAL MEDICINE
& REHABILITATION
TX
ROCKWALL
TX
SPORTS MEDICINE
(FAMILY PRACTICE)
GERIATRIC
MEDICINE (INTERNAL
10/15/2019 PALLIATIVE MEDICINE MED)
TEMPLE
Page 186 of 402
None
None
None
None
N/A
N/A
N/A
N/A
4/13/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
11/2/2015 None
N/A
5/2/2014 None
8/13/2013 None
N/A
N/A
8/29/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/17/2014 None
N/A
2/2/2015 None
N/A
5/1/2015 None
N/A
LICENSE
ISSUED
HOUSTON
TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/28/2011 None
N/A
2/7/2014
2/5/2013
8/18/2014
7/5/2013
License
Number
Physician Name
Q8088
KIM, CLAIRE HYAEKYONG, DO
Q6220
KIM, DANIEL DAEUN, MD
dicaid
dicaid
Agreement
End Date
Designated)
02-May-16
10/1/2015
P1887
P2021
KIM, DO HEE, MD
KIM, EDWARD , MD
1/17/2012
2/1/2012
Q8090
Q4163
P4469
P6848
KIM, EDWARD HYONGCHOL, MD
KIM, EDWIN HYUN-JIN, MD
KIM, GRACE WEN, MD
KIM, JAMES, MD
P6197
KIM, JONGOH , MD
4/12/2013
P4585
KIM, JONGYEOL , MD
10/1/2012
Q3713
KIM, JOYCE HEJIN, MD
P8488
KIM, JULIA JIEUN, MD
12/6/2013
P3019
KIM, JUNG-HOON, MD
5/1/2012
P7791
KIM, MICHELLE MIRAN, MD
8/30/2013
Q3534
P5398
Q4444
KIM, RICHARD EARL, MD
KIM, SOO HYUN, MD
KIM, THOMAS OUYJUUNG, MD
3/16/2015
2/1/2013
5/15/2015
P6198
KIMYAI-ASADI, MITHRA, MD
4/12/2013
Q5680
KINDRED, ROBIN, MD
8/14/2015
Q6048
KING, AARON MATTHEW, MD
9/15/2015
Q1844
KING, HEATHER MERCEIR, MD
9/15/2014
P7485
KING, JAMES DONAVON II, MD
8/1/2013
Q8272
KING, STACI DENISE, MD
02-May-16
5/1/2015
9/17/2012
6/3/2013
4/1/2015
16-May-16
EMERGENCY
10/1/2020 MEDICINE
EMERGENCY
02-May-21 MEDICINE
5/1/2020 RADIOLOGY
6/3/2018 ONCOLOGY
ENDOCRINOLOGY,
DIABETES AND
10/1/2017 NEUROLOGY
Secondary Specialty
(Self-Designated)
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
NUCLEAR IMAGING
AND THERAPY
CARDIOLOGY
CEDAR PARK
HOUSTON
HOUSTON
DALLAS
VASCULAR
NEUROLOGY
LUBBOCK
ANESTHESIOLOGY PAIN MANAGEMENT HOUSTON
GERIATRICS
GERIATRIC MEDICINE
RADIATION
8/30/2018 ONCOLOGY
CRITICAL CARE
ANESTHESIOLOGY
GALVESTON
LYNN
MORGANTOW
4/12/2018 RADIOLOGY
N
OBSTETRICS AND
PHYSICAL MED. &
VICTORIA
SURGICAL BREAST
9/15/2019 ONCOLOGY
PARIS
SPORTS MEDICINE
(FAMILY PRACTICE) BRYAN
THE
16-May-21 CHILD NEUROLOGY
WOODLANDS
Page 187 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
03-May-16 None
N/A
ACTIVE
10/5/2015 None
N/A
ACTIVE
ACTIVE
2/3/2012 None
2/9/2012 None
N/A
N/A
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
TX
09-May-16
5/5/2015
9/20/2012
6/5/2013
None
None
None
None
N/A
N/A
N/A
N/A
LICENSE
ISSUED
4/12/2013 None
N/A
TX
ACTIVE
10/3/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
4/6/2015 None
N/A
12/6/2013 None
N/A
TX
ACTIVE
5/3/2012 None
N/A
9/9/2013 None
N/A
TX
MA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/16/2015 None
2/5/2013 None
5/18/2015 None
N/A
N/A
N/A
4/25/2013 None
N/A
8/14/2015 None
N/A
ACTIVE
11/16/2015 None
N/A
ACTIVE
10/14/2014 None
N/A
TX
ACTIVE
8/22/2013 None
N/A
TX
ACTIVE
24-May-16 None
N/A
WV
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q8531
KING, VAN LEWIS JR, MD
01-Jun-16
P9622
KINGAH, PASCAL LEMNYUY, MD
4/1/2014
P0245
KINGMA, DOUGLAS WILLIAM, MD
7/1/2011
7/1/2016 PATHOLOGY
Q2916
KINLOCH, RAMON LAROD, MD
1/15/2015
P8930
P0246
KINNE, SANDFORD HALSEY III, DO
KINNEY, BRANDON SCOTT, MD
2/7/2014
7/1/2011
Q2573
KINNEY, MELISSA HESTER, MD
12/3/2014
P4472
KINSLER, ALISON , MD
9/17/2012
Q8532
KIOKO, MARILYN MUTHEU, MD
P0247
KIRANE, HARSHAL DEVIDAS, MD
P3179
KIRBY, JAMIE ELLEN, MD
5/15/2012
Q3535
KIRKLAND, PATRICK JAMES, MD
3/16/2015
P6201
KIRKPATRICK, IAN SHANE, DO
4/12/2013
Q3216
KIRMANI, BATOOL FUAD, MD
2/13/2015
P3021
P6663
KIRUMAKI, ASHOK SATYAMURTHY,
MD
KISSEL, ABIGAIL MARION, MD
5/1/2012
5/15/2013
Q1648
KISSINGER, WENDY, DO
8/29/2014
P3180
KISTLER, ANNALIESE ELAINE, MD
KITTINGER, BENJAMIN JOSEPH,
MD
5/15/2012
P4473
01-Jun-16
7/1/2011
9/17/2012
SURGICAL BREAST
12/3/2019 ONCOLOGY
ORTHOPEDIC
9/17/2017 SURGERY
Secondary Specialty
(Self-Designated)
ADDICTION
PSYCHIATRY
PULMONARY
CRITICAL CARE
MEDICINE
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
ORMOND
BEACH
AUSTIN
EL PASO
7/1/2016 PSYCHIATRY
EMERGENCY
3/16/2020 MEDICINE
FAMILY
02-Jun-16 None
N/A
4/7/2014 None
N/A
7/1/2011 None
N/A
1/15/2015 None
N/A
FL
TX
ACTIVE
ACTIVE
2/19/2014 None
8/3/2011 None
N/A
N/A
TX
ACTIVE
12/4/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/21/2012 None
N/A
01-Jun-16 None
N/A
7/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/23/2012 None
N/A
3/16/2015 None
N/A
4/12/2013 None
N/A
DALLAS
TX
TYLER
TX
GERIATRICS
2/13/2020 NEUROLOGY
PULMONARY
CRITICAL CARE
5/1/2017 MEDICINE
EMERGENCY
8/29/2019 MEDICINE
OBSTETRICS AND
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
PEDIATRIC CRITICAL
CARE MEDICINE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
NEURO-PHYSIOLOGY
(NEUROLOGY)
TEMPLE
TX
ACTIVE
2/16/2015 None
N/A
DALLAS
MO
TX
ACTIVE
ACTIVE
5/3/2012 None
5/23/2013 None
N/A
N/A
CANTON
OH
ACTIVE
9/5/2014 None
N/A
AUSTIN
TX
ACTIVE
5/23/2012 None
N/A
TEMPLE
TX
ACTIVE
9/19/2012 None
N/A
EMERGENCY
MEDICINE
Page 188 of 402
License
Number
Q6527
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE
PULMONARY
11/16/2015
DISEASES
INFECTIOUS
9/17/2012
9/17/2017 DISEASES
INTERNAL MEDICINE
NEUROLOGY/DIAGNO
STIC
RAD/NEURORADIOLO
5/15/2013
5/15/2018 GY
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
2/1/2013
P4474
KITZIS, VANESSA, MD
KIZILBASH, QURATULAIN FATIMA,
MD
P6664
KLAR, NITASHA GREWAL, MD
P2705
P5400
KLECKNER, KENNETH, MD
KLEIN, JEFFREY ADAM, MD
Q0485
KLEM, THEODORE CARROLL, MD
6/2/2014
Q4164
KLING, EMMANUEL RE, MD
5/1/2015
P6435
KLINGLESMITH, ROBERT E JR, MD
5/1/2013
5/1/2020 PEDIATRICS
DIAGNOSTIC
5/1/2018 RADIOLOGY
P8631
P7137
KLOTMAN, PAUL EVAN, MD
KLOVENSKI, VICTORIA
SCHNEIDER, MD
KLUCSARITS, SHANNON
ELIZABETH, MD
P8045
Q6049
Q4791
KLUK, AUGUSTA WHITNEY, MD
KNAPP, ERIC FARQUIS, MD
KNIGHT, CHERYL LOGSDON, MD
Q3391
KNIGHT, JASON, MD
Q5842
12/16/2013
8/28/2015
7/1/2013
10/1/2013
9/15/2015
6/12/2015
3/3/2015
10/1/2018 SURGERY
EMERGENCY
3/3/2020 MEDICINE
ACTIVE
11/24/2015 None
N/A
HOUSTON
TX
ACTIVE
10/8/2012 None
N/A
AUSTIN
TX
ACTIVE
5/30/2013 None
N/A
PHILADELPHIA PA
DALLAS
TX
ACTIVE
ACTIVE
4/17/2012 None
2/6/2013 None
N/A
N/A
AUSTIN
ACTIVE
LICENSE
ISSUED
6/9/2014 None
N/A
5/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
6/19/2013 None
N/A
12/16/2013 None
N/A
TX
SURGERY
KNIGHT, JOHN THOMAS, MD
KNOLL, KATHERINE ANN, MD
3/16/2015
7/15/2014
ORTHOPEDIC
3/16/2020 SURGERY
Q6640
Q6640
Q6640
KNOTT, EROL MARTIN JR, DO
12/4/2015
04-Dec-15
04-Dec-15
04-Dec-20 PEDIATRIC SURGERY
04-Dec-20 PEDIATRIC SURGERY
P3368
KNOWLES, MARTYN , MD
TX
NEPHROLOGY
ORTHOPEDIC
SURGERY
TEMPLE
TX
ACTIVE
9/14/2015 None
N/A
DALLAS
TX
ACTIVE
7/17/2013 None
N/A
PROVIDENCE RI
BRYAN
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
10/21/2013 None
9/17/2015 None
6/18/2015 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
3/5/2015 None
N/A
DALLAS
BISMARCK
TX
ND
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/6/2015 None
8/28/2014 None
N/A
N/A
12/4/2015 None
29-Feb-16 None
29-Feb-16 None
N/A
N/A
N/A
6/7/2012 None
N/A
FORT WORTH TX
FORT WORTH TX
6/1/2017 VASCULAR SURGERY GENERAL SURGERY DALLAS
Page 189 of 402
Disciplinary
Status Date
MO
HOUSTON
EMERGENCY
8/28/2020 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
SAINT LOUIS
NEONATOLOGY
Q3536
Q0952
6/1/2012
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q7222
KNOX, CHARLES G, MD
16-Feb-16
Q8093
Q2787
KNUDTSON, JOHN DAVID , MD
KO, ETHAN S, DO
02-May-16
1/5/2015
P8489
KO, MI KYUNG, MD
Q0087
KOAY, EUGENE JON, MD
P9889
KOBOBEL, JASEN SCOTT, MD
Q8274
KOBRIN, JONATHAN ALLEN, MD
P4772
P5198
KOCH, CHRISTOPHER, MD
KOCH, ERIC B, MD
Q5457
P5096
P5096
P5096
KOCIK, JUREK FRANCISCO, MD
KOCUREK, EMILY GADDIS, MD
12/6/2013
5/2/2014
4/15/2014
16-May-16
11/1/2012
1/4/2013
8/3/2015
12/17/2012
12/17/2012
12/17/2012
TM00451 KODE SAMMARCO, LAKSHMI, MD
Q5681
KOEHLER, BRUCE ERIC II, MD
7/1/2011
8/14/2015
P7937
9/16/2013
KOEHLER, MICHAEL BRUCE, MD
DIAGNOSTIC
02-May-21 RADIOLOGY
RADIATION
12/6/2018 ONCOLOGY
RADIATION
5/2/2019 ONCOLOGY
Practice City
8/3/2020
12/17/2017
12/17/2017
12/17/2017
GENERAL SURGERY
INTERNAL MEDICINE
INTERNAL MEDICINE
INTERNAL MEDICINE
7/1/2016 RADIOLOGY
EMERGENCY
9/16/2018 MEDICINE
KOENIG, KARL MARC, MD
15-Jan-16
Q0294
KOENIG, KELLY LEE, DO
5/15/2014
ORTHOPEDIC
15-Jan-21 SURGERY
EMERGENCY
5/15/2019 MEDICINE
P0843
KOERNER, KATHLEEN MARY, DO
8/26/2011
P0248
KOGANTI, MADHURI LATHA, MD
7/1/2011
P7138
KOH, CHESTER, MD
7/1/2013
Q6642
KOH, HEAJEOUNG ELIZABETH, MD
7/1/2016 NEUROLOGY
CRITICAL CARE
(SURGERY)
NEURO-RADIOLOGY
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
URGENT CARE
MEDICINE
Disciplinary
Status Date
TX
ACTIVE
07-Mar-16 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
04-May-16 None
1/7/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
12/10/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/8/2014 None
N/A
4/15/2014 None
N/A
16-May-16 None
N/A
EDEN PRAIRIE MN
BIG SPRING
TX
ACTIVE
ACTIVE
11/27/2012 None
1/9/2013 None
N/A
N/A
TYLER
DALLAS
DALLAS
DALLAS
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
8/20/2015
1/7/2013
1/7/2013
1/7/2013
None
None
None
None
N/A
N/A
N/A
N/A
CINCINNATI
OH
ACTIVE
ACTIVE
7/11/2011 None
8/18/2015 None
N/A
N/A
SAVANNAH
GA
ACTIVE
9/25/2013 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
20-Jan-16 None
N/A
5/15/2014 None
N/A
NEPHROLOGY
DIAGNOSTIC
11/1/2017 RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
Q6953
12/4/2015
Secondary Specialty
(Self-Designated)
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Registration
Status of
Practice
Texas
State
License
GONZALES
NEURO-PHYSIOLOGY ALAMOGORD
(NEUROLOGY)
O
7/1/2018 PEDIATRIC UROLOGY UROLOGIC SURGERY HOUSTON
EMERGENCY
12/4/2020 MEDICINE
Page 190 of 402
TX
ACTIVE
9/1/2011 None
N/A
NM
ACTIVE
7/6/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
7/9/2013 None
N/A
12/4/2015 None
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
Q6642
04-Dec-15
04-Dec-20 MEDICINE
EMERGENCY
Q6642
04-Dec-15
04-Dec-20 MEDICINE
PULMONARY
P2883
KOHAN, JAMES MICHAEL, MD
4/13/2012
4/13/2017 MEDICINE
SLEEP MEDICINE
KOHATSU, JORGE AUGUSTO, MD
11/1/2012
EMERGENCY MED
Q1651
Q1187
KOHLI, PARMISH LALIT, MD
KOHLI, SHARAD KUMAR, MD
P6436
KOLLI, SARITHA, DO
Q7067
KOLTZ, MICHAEL THOMAS, MD
01-Feb-16
P6666
KOMMINENI, VIJAYA, MD
5/15/2013
P3022
Q0090
Q3219
5/1/2012
5/2/2014
2/13/2015
P6438
KONDA, SUBBAREDDY, MD
KONERU, PRAVEEN, MD
KONERU, SREEKANTH , MD
KONOPACKI, MICHAEL STUART,
MD
KONZELMANN, HENRY JOSEPH,
MD
Q6439
KOO, MICHAEL HOSUNG, MD
11/2/2015
INTERVENTIONAL
Q1846
KOO, SONYA JANET, MD
9/15/2014
9/15/2019 RADIOLOGY
Q0661
KOONER, GAGANDEEP KAUR, MD
6/16/2014
Q1189
KOPARI, NICOLE MARIE , MD
Q5683
P5200
Q3220
P6850
P5663
KOPP, FABIOLLA SIQUEIRA, MD
KORNEGAY, CHASE RYAN, MD
KORNIYENKO, ALEKSANDR, MD
KORNSAWAD, KANAPA , MD
KORTEWEG, JEREMY , MD
Q4166
KORUPOLU, RADHA , MD
SURGICAL CRITICAL
TRAUMATIC
8/1/2019 CARE
SURGERY
PHYSICAL MED. &
INTERNAL MEDICINE
PHYSICAL MED. &
SPINAL CORD
INJURY MEDICINE
Page 191 of 402
P1341
8/29/2014
8/1/2014
5/1/2013
11/4/2011
5/1/2013
8/1/2014
8/14/2015
1/4/2013
2/13/2015
6/3/2013
3/1/2013
5/1/2015
NEPHROLOGY
NEUROLOGICAL
01-Feb-21 SURGERY
INTERNAL MEDICINE
CARDIOVASCULAR
5/1/2017 SURGERY
2/13/2020 NEUROLOGY
INTERNAL MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
SALEM
OR
ACTIVE
16-Dec-15 None
N/A
SALEM
OR
ACTIVE
16-Dec-15 None
N/A
DEL MAR
CA
ACTIVE
4/18/2012 None
N/A
IOWA
LA
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
11/7/2012 None
N/A
8/29/2014 None
8/21/2014 None
N/A
N/A
5/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
10-Feb-16 None
N/A
5/15/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/4/2012 None
5/15/2014 None
2/19/2015 None
N/A
N/A
N/A
11/4/2011 None
N/A
ROUND ROCK TX
THORACIC SURGERY ROUND ROCK TX
AUSTIN
TX
FAMILY MEDICINE
SANANTONIO TX
CARDIOVASCULAR
DISEASES
INTERVENTIONAL
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
PILOT KNOB
MO
ACTIVE
5/7/2013 None
N/A
SUGAR LAND
TX
ACTIVE
11/24/2015 None
N/A
DALLAS
CORPUS
CHRISTI
TX
ACTIVE
9/16/2014 None
N/A
TX
ACTIVE
6/18/2014 None
N/A
HOUSTON
TX
ACTIVE
8/11/2014 None
N/A
HOUSTON
TULSA
TX
OK
SAN ANTONIO TX
WACO
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
8/18/2015
1/9/2013
2/16/2015
7/16/2013
3/4/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
HOUSTON
ACTIVE
6/3/2015 None
N/A
TX
License
Number
Physician Name
P1342
KOSARAC, BRANKA , MD
KOSHY, DANIEL
Q1190
PLAVILAKANDATHIL, MD
dicaid
dicaid
Agreement
End Date
Designated)
11/4/2011
8/1/2014
P6203
P4878
KOSHY, JANICE JOHN, MD
KOSHY, THOMAS PHILIP, MD
4/12/2013
11/15/2012
Q3392
Q0091
KOTA, SAI SOUMYA, MD
KOTEY, ANTOINETTE ADOWAA,
MD
3/3/2015
EMERGENCY
5/2/2019 MEDICINE
Q4792
KOTHANDARAMAN, SRILATHA, MD
6/12/2015
Q3714
Q7904
KOTNIS, GREGORY RAPHAEL, MD
KOTRA, HARIKRISHNA, MD
4/1/2015
15-Apr-16
ANATOMIC/CLINICAL
4/1/2020 PATHOLOGY
Q1191
KOTTARATHIL, JOHN, MD
8/1/2014
P0250
KOTTO-KOME GARCIA-SALAS,
ANNE CATHERINE ALBERTINE, MD
7/1/2011
5/2/2014
Secondary Specialty
(Self-Designated)
DALLAS
TX
DENVER
CO
SPRINGFIELD MA
16-Feb-16
Q3539
Q1192
3/16/2015
8/1/2014
8/1/2019 PSYCHIATRY
Q0779
KOVACEV, TED ARMSTRONG, MD
6/27/2014
Q3905
P1557
KOVACS, MICHELE SARA, MD
KOVOOR, JOHNNY GEORGE, MD
4/10/2015
12/1/2011
Q0092
KOWALCHUK, DEBORAH ANN, MD
5/2/2014
FOOT AND ANKLE,
P2708
KOWALCZYK, COURTNEY ANNE,
MD
4/2/2012
P0746
KOYA, LAXMI DEEPIKA, MD
Q8275
KOZANEK, MICHAL, MD
16-May-16
TX
RHEUMATOLOGY
KOUL, ASHOK KUMAR, MD
KOURKOUMPETIS, THEMISTOKLIS,
MD
KOUSA, SAHAR, MD
8/15/2011
DALLAS
INFECTIOUS
DISEASES
7/1/2016 PEDIATRICS
NEONATOLOGY
CARDIAC
ELECTROPHYSIOLOG CARDIOVASCULAR
16-Feb-21 Y
DISEASES
Q7223
Practice City
GALVESTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ORTHOPEDIC
SURGERY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
SAN ANGELO
8/5/2014 None
N/A
4/12/2013 None
11/19/2012 None
N/A
N/A
3/3/2015 None
N/A
5/2/2014 None
N/A
6/12/2015 None
N/A
4/15/2015 None
19-Apr-16 None
N/A
N/A
8/1/2014 None
N/A
7/1/2011 None
N/A
TX
ACTIVE
17-Feb-16 None
N/A
3/23/2015 None
8/12/2014 None
N/A
N/A
6/27/2014 None
N/A
YONKERS
NY
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/10/2015 None
12/5/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
5/14/2014 None
N/A
TX
ACTIVE
4/9/2012 None
N/A
FL
ACTIVE
8/29/2011 None
N/A
ACTIVE
23-May-16 None
N/A
DALLAS
GASTROENTEROLOG
8/15/2016 Y
INTERNAL MEDICINE TAMPA
ORTHOPEDIC
FOOT AND ANKLE,
16-May-21 SURGERY
ORTHOPEDICS
Page 192 of 402
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
11/10/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
NEUROLOGY &
11/15/2011
Secondary Specialty
(Self-Designated)
P1467
KOZMINSKI, MATTHEW, DO
Q0662
P3370
KOZMINSKI, TONYA NICOLE, DO
KRAMADHATI, ROHITHA, MD
6/16/2014
6/1/2012
P5283
KRAMER, BREE CYRENE, DO
1/15/2013
P4586
KRATZ, KURT GREGORY, MD
10/1/2012
PEDIATRIC CRITICAL
ANATOMIC/CLINICAL
10/1/2017 PATHOLOGY
Q5844
P3371
KRAUSE, ROBERT WILLIAM, MD
KRAVITZ, DANIEL JAY, MD
8/28/2015
6/1/2012
8/28/2020 RADIOLOGY
Q7906
KREIN, STUART, MD
15-Apr-16
P2024
P0747
KRESS, MELISSA GALE, DO
KRESSIN, MARGARITA ROSENDO,
MD
OTORHINOLARYNGOL PEDIATRIC
2/1/2017 OGY
OTOLARYNGOLOGY
8/15/2011
Q5686
KRIG, MARIE, MD
8/14/2015
P1777
1/2/2012
P6440
KRISHNA, VIVEK RAJ, MD
KRISHNAMURTHY, GURUPRASAD ,
MD
Q0093
P2709
KRISHNAN, KUMAR , MD
KRISHNAN, NIVEDITA, MD
5/2/2014
4/2/2012
Q6759
KROES, JEREMY SCOTT, MD
15-Dec-15
Q5845
KRONFOL, ZIAD NABIL, MD
8/28/2015
M1189
KRUCKNER, DOUGLAS LEE, MD
K9827
KRUITBOSCH, SHANE HENRY, MD
Q5687
KRUSE, KEVIN KARL II, MD
P5201
P0620
KUBAL, AMIT ANANT, MD
KUDAKKASSERIL, ANUP S, MD
2/1/2012
5/1/2013
10/15/2015
4/1/2014
8/14/2015
1/4/2013
8/1/2011
8/15/2016 UROLOGY
OBSTETRICS AND
CYTOPATHOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
FORT HOOD
TX
LITTLE ROCK
AR
ACTIVE
LICENSE
ISSUED
ACTIVE
EL PASO
TX
DENISON
TX
LUFKIN
TX
UROLOGIC SURGERY
NEUROMUSCULAR
DISEASE
1/2/2017 NEUROLOGY
NEUROLOGY &
5/1/2018 PSYCHIATRY
4/2/2017 PEDIATRICS
EMERGENCY
15-Dec-20 MEDICINE
COLON AND RECTAL
8/28/2020 SURGERY
6/16/2014 None
6/7/2012 None
N/A
N/A
ACTIVE
1/25/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
11/1/2012 None
N/A
8/28/2015 None
6/4/2012 None
N/A
N/A
15-Apr-16 None
N/A
2/1/2012 None
N/A
8/15/2011 None
N/A
8/28/2015 None
N/A
GALVESTON
TX
ACTIVE
1/31/2012 None
N/A
TX
ACTIVE
5/10/2013 None
N/A
TX
ACTIVE
ACTIVE
5/13/2014 None
4/9/2012 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
17-Dec-15 None
N/A
8/28/2015 None
N/A
ACTIVE
10/29/2015 None
N/A
ACTIVE
4/9/2014 None
N/A
8/17/2015 None
N/A
1/4/2013 None
8/8/2011 None
N/A
N/A
GENERAL SURGERY
STAMFORD
TX
DALLAS
TX
HARRISBURG PA
Page 193 of 402
N/A
ACTIVE
MIDLAND
1/4/2018 RADIOLOGY
8/1/2016 PEDIATRICS
11/28/2011 None
MD
Disciplinary
Status Date
CLINTON
PEDIATRICS
EL PASO
GASTROENTEROLOG
Y
HOUSTON
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
P6667
KUDRATH, ABDULLA , MD
Q7907
KUECK, ANGELA, MD
Q7729
KUECK, KATHLEEN DEAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
5/15/2013
5/15/2018 MEDICINE
GYNECOLOGIC
15-Apr-16
15-Apr-21 ONCOLOGY
OBSTETRICS &
GYNECOLOGICAL
01-Apr-16
01-Apr-21 SURGERY
P7139
KUHLMAN-WOOD, KATE ASHLI, MD
P6668
Q8277
KUHNS, CRAIG ALLEN, MD
KUHRT, MAUREEN PONS, MD
Q7908
15-Apr-16
P7793
KUKKAR, NITIN, MD
KUKREJA, JANET ELYSE BAACK,
MD
KUKREJA, KAMLESH
UTTAMCHAND, MD
Q6760
Q4169
KUKREJA, MARCIA KOMLOS, MD
KULIK, CYNTHIA MARIE, DO
15-Dec-15
5/1/2015
Q6862
KULKARNI, ANUBHI , MD
06-Jan-16
P8492
KULKARNI, RISHIKESH, MD
12/6/2013
Q5010
Q3035
P6205
KULP, KARI ANN, MD
KULSHRESTHA, SATYARTH, MD
KUMAR, AMITA, MD
7/1/2015
2/2/2015
4/12/2013
Q2575
Q3716
Q2321
Q2576
Q6052
Q5846
P8046
P4587
KUMAR, ASHOK, MD
KUMAR, ASHWINI, MD
KUMAR, BHAVIK , MD
KUMAR, BIJENDER, MD
KUMAR, DAVID VIJAY, MD
KUMAR, DEEPAK, MD
KUMAR, HARESH, MD
KUMAR, NEIL MITHILESH, MD
12/3/2014
4/1/2015
11/7/2014
12/3/2014
9/15/2015
8/28/2015
10/1/2013
10/1/2012
Q7909
7/1/2013
5/15/2013
16-May-16
15-Apr-16
8/30/2013
HAND SURGERY 7/1/2018 PLASTIC SURGERY
16-May-21 GENERAL SURGERY
ORTHOPEDIC
15-Apr-21 SURGERY
15-Apr-21 UROLOGIC SURGERY
INTERVENTIONAL
8/30/2018 RADIOLOGY
PEDIATRIC
15-Dec-20 RADIOLOGY
OBSTETRICS AND
OBSTETRICS AND
EMERGENCY
7/1/2020 MEDICINE
2/2/2020 NEPHROLOGY
HEMATOLOGY/ONCOL
12/3/2019 OGY
10/1/2017 RADIOLOGY
Secondary Specialty
(Self-Designated)
SURGERY
OTHER SPECIALTY
ORTHOPEDIC
SURGERY OF THE
SPINE
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
5/22/2013 None
N/A
AUSTIN
TX
ACTIVE
19-Apr-16 None
N/A
AUSTIN
TX
ACTIVE
05-Apr-16 None
N/A
HOUSTON
TX
7/11/2013 None
N/A
EVANSVILLE
IN
ACTIVE
LICENSE
ISSUED
ACTIVE
5/15/2013 None
23-May-16 None
N/A
N/A
QUINCY
IL
ACTIVE
18-Apr-16 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
20-Apr-16 None
N/A
8/30/2013 None
N/A
HOUSTON
TX
FORT WORTH TX
ACTIVE
ACTIVE
11-Jan-16 None
5/11/2015 None
N/A
N/A
LUBBOCK
TX
ACTIVE
04-Feb-16 None
N/A
LUBBOCK
TX
ACTIVE
12/13/2013 None
N/A
TX
IA
KY
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/6/2015 None
2/10/2015 None
4/22/2013 None
N/A
N/A
N/A
AUSTIN
INTERNAL MEDICINE IOWA CITY
LEXINGTON
INTERNAL MEDICINE
BRONX
NY
NEWMARKET
COALINGA
CA
DALLAS
TX
INTERNAL MEDICINE
Page 194 of 402
Disciplinary
Status Date
FORT WORTH TX
PEDIATRIC
RADIOLOGY
NEURO-RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
12/3/2014
4/13/2015
11/13/2014
2/16/2015
11/9/2015
9/1/2015
10/3/2013
11/5/2012
None
None
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
1/3/2014
Practice City
P8686
KUMAR, PARAAG, MD
Q2458
KUMAR, RAJENDER, MD
P6011
KUMAR, RAJIV, MD
4/1/2013
4/1/2018 RADIOLOGY
Q5011
Q3394
KUMAR, SACHIN, MD
KUMAR, SURACHIT, MD
7/1/2015
3/3/2015
7/1/2020 CARDIOLOGY
P7939
P4588
KUMAR, SURESH, MD
KUMAR, UMESH, MD
9/16/2013
10/1/2012
Q1847
KUMAR, VIBHASH, MD
9/15/2014
Q3717
KUMARAVEL, ARTHI, MD
Q7571
P2711
KUMARAVEL, VEENA, MD
KUMAR-FLORES, JESSICA, MD
Q0094
P7659
P6441
KUMBUM, KAVITHA, MD
KUMMERFELD, DAVID ANDREW,
MD
KUNDLER, MARC WILLIS, MD
P2712
KUNG, AMY , MD
Q0954
KUNG, DAVID HANS, MD
7/15/2014
P1095
KUNIYIL, JESHEEJA, MD
10/3/2011
P8687
KUO, EDWARD , MD
P6989
KUO, JEFF, MD
6/14/2013
Q0955
KUPERAN, ARJUNA BRYAN, MD
7/15/2014
PEDIATRIC
FORENSIC MEDICINE PAMPA
OTORHINOLARYNGOL
7/15/2019 OGY
RHINOLOGY
HOUSTON
P1558
Q0489
KUREPA, DALIBOR, MD
KURIACHAN, VIPIN PRABHU, MD
12/1/2011
6/2/2014
11/17/2014
4/1/2015
15-Mar-16
4/2/2012
5/2/2014
8/15/2013
5/1/2013
4/2/2012
1/3/2014
Secondary Specialty
(Self-Designated)
AUSTIN
Registration
Status of
Practice
Texas
State
License
TX
HOSPITALIST
GENERAL PRACTICE SAN ANTONIO TX
INTERVENTIONAL
CARDIOLOGY
NEPHROLOGY
DALLAS
TX
SHREVEPORT
L
LA
HOSPITALIST
9/16/2018 NEUROLOGY
PEDIATRICS,
PEDIATRICS
GASTROENTEROLOG
4/1/2020 Y
GASTROENTEROLOG
15-Mar-21 Y
GASTROENTEROLOG
5/2/2019 Y
INTERNAL MEDICINE
ORTHOPEDIC
8/15/2018 SURGERY
5/1/2018 PSYCHIATRY
OBSTETRICS &
OBSTETRICS AND
GYNECOLOGICAL
4/2/2017 GYNECOLOGY
SURGERY
CRITICAL CARE
INTERNAL MEDICINE
EMERGENCY
1/3/2019 MEDICINE
PEDIATRICS
OPHTHALMOLOGY
Page 195 of 402
OAK LAWN
IL
RICHARDSON TX
SARTELL
MN
TAYLOR
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/28/2014 None
N/A
11/17/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
4/4/2013 None
N/A
7/1/2015 None
3/12/2015 None
N/A
N/A
ACTIVE
ACTIVE
9/25/2013 None
10/5/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
9/29/2014 None
N/A
4/1/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11-Apr-16 None
4/16/2012 None
N/A
N/A
5/2/2014 None
N/A
8/15/2013 None
5/3/2013 None
N/A
N/A
4/2/2012 None
N/A
LICENSE
ISSUED
ST. LOUIS
STATEN
ISLAND
MO
ACTIVE
7/24/2014 None
N/A
NY
ACTIVE
10/26/2011 None
N/A
HOUSTON
TX
ACTIVE
1/13/2014 None
N/A
TX
ACTIVE
6/18/2013 None
N/A
TX
ACTIVE
8/8/2014 None
N/A
SHREVEPORT LA
IRVING
TX
ACTIVE
ACTIVE
12/12/2011 None
6/4/2014 None
N/A
N/A
License
Number
P3374
Physician Name
KURKJIAN, THEODORUS
JONATHAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
6/1/2012
6/1/2017 SURGERY
SPORTS MEDICINE
11/2/2015
10/15/2012
PEDIATRIC
04-Mar-16
04-Mar-21 ORTHOPEDICS
GERIATRICS 4/13/2012
2/18/2014
4/15/2014
11/15/2012
Q6440
P4667
KURUP, SUNIL , MD
KUSEMIJU, OLADIPO AJOSE, MD
Q7407
P2886
P9081
P9893
P4879
KUSHARE, INDRANIL, MD
KUTAGULA, VINAY
VENGAREDDIGARI, MD
KUTEN, DAVID, MD
KUY, SREYRAM , MD
KUYE, TAIWO ADEYINKA, MD
P0424
P9894
KWAN, CHRISTINE, MD
KWAN, MELISSA HOR-YEE, MD
7/15/2011
4/15/2014
Q7732
KWON, JOE YOSUP, MD
KYATHANAHALLI PUTTALINGAPPA,
LOKESH, MD
01-Apr-16
Q5014
P9083
KYTHAPARAMPIL JOHN, BIJO, MD
7/1/2015
2/18/2014
Q1850
LABATIA, IHAB YOUSSEF, MD
9/15/2014
P3375
LABAULT-SANTIAGO, JOSE
RAFAEL, MD
Q3540
LABI, MARLON AMOS, MD
3/16/2015
P7660
LABORDE, CATHERINE, MD
8/15/2013
Q2577
LACAZE, MARY ELIZABETH, MD
12/3/2014
Q7572
15-Mar-16
P6669
LACEFIELD, EVAN, MD
LACHMANSINGH, JINESH
STEPHAN, MD
Q8278
LACOSS, JENNIFER JOY, MD
16-May-16
6/1/2012
5/15/2013
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
ORTHOPEDIC
SURGERY
PALLIATIVE
MEDICINE
ADDICTION
PSYCHIATRY
Practice City
Registration
Status of
Practice
Texas
State
License
6/1/2017 NEUROLOGY
3/16/2020 SLEEP MEDICINE
EMERGENCY
8/15/2018 MEDICINE
PEDIATRIC
HEMATOLOGY/ONCOL
12/3/2019 OGY
15-Mar-21 UROLOGY
CRITICAL CARE
N/A
11/4/2015 None
12/21/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
30-Mar-16 None
N/A
ADDISON
HOUSTON
TX
TX
HARLINGEN
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
JOHNSON
CITY
EL PASO
COLLEGE
UROLOGIC SURGERY STATION
Page 196 of 402
6/25/2012 None
ACTIVE
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
7/15/2011 None
5/5/2014 None
N/A
N/A
ACTIVE
11-Apr-16 None
N/A
ACTIVE
LICENSE
ISSUED
8/18/2015 None
N/A
2/18/2014 None
N/A
ACTIVE
9/26/2014 None
N/A
ACTIVE
6/6/2012 None
N/A
ACTIVE
4/1/2015 None
N/A
ACTIVE
8/19/2013 None
N/A
TX
ACTIVE
1/23/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
17-Mar-16 None
N/A
5/15/2013 None
N/A
ACTIVE
25-May-16 None
N/A
TX
TN
NEURO-PHYSIOLOGY
(NEUROLOGY)
SAN ANTONIO TX
PULMONARY
CORAL
MEDICINE
SPRINGS
FL
URGENT CARE
MEDICINE
ANESTHESIOLOGY
PALLIATIVE
MEDICINE
ACTIVE
TX
MS
GASTROENTEROLOG
Y
PAIN & SPINE
Disciplinary
Status Date
GRAPEVINE
PICAYUNE
PHYSICAL MED. &
Registration
Status Date
Disciplinary
Status of
Texas
License
SAN ANTONIO TX
4/24/2012
2/27/2014
4/16/2014
11/21/2012
License
Number
Q3720
P9385
P0251
Physician Name
LACSINA, PATRICIA MAY
BUMAGAT, MD
LADAK, HADI KASSIMALI, MD
LADHA, MALIK MOLEDINA, MD
P6853
LAETSCH, THEODORE WILLIS JR,
MD
dicaid
dicaid
Agreement
End Date
Designated)
4/1/2015
3/17/2014
7/1/2011
6/3/2013
Secondary Specialty
(Self-Designated)
3/17/2019 INTERNAL MEDICINE GERIATRICS
PEDIATRIC
HEMATOLOGY/ONCOL
6/3/2018 OGY
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
SAN ANTONIO TX
GREENVILLE NC
BRYAN
TX
ACTIVE
ACTIVE
ACTIVE
4/7/2015 None
4/1/2014 None
7/6/2011 None
N/A
N/A
N/A
DALLAS
TX
6/4/2013 None
N/A
TEMPLE
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
14-Apr-16 None
4/17/2014 None
N/A
N/A
12/6/2013 None
N/A
12/4/2015 None
N/A
Q6956
P9895
LAFREE, ANDREW THOMAS, MD
LAGAN, CASEY LEE, MD
15-Jan-16
4/15/2014
P8495
LAHMANN, BRIAN, MD
12/6/2013
EMERGENCY
15-Jan-21 MEDICINE
EMERGENCY
12/6/2018 MEDICINE
Q6644
LAHOURCADE, JOHN AUSTIN, MD
12/4/2015
Q6644
04-Dec-15
SAN ANTONIO TX
ACTIVE
10-Dec-15 None
N/A
Q6644
04-Dec-15
SAN ANTONIO TX
10-Dec-15 None
N/A
Q1197
LAHUD, LUIS A, MD
ACTIVE
LICENSE
ISSUED
8/1/2014 None
N/A
P3185
LAI, ERIC CHRISTIAN, MD
5/15/2012 None
N/A
P4881
Q0490
LAI, VICTOR TINFUNG, MD
LAI, WENDY CHING YUAT, MD
11/15/2012 None
6/3/2014 None
N/A
N/A
Q5015
LAINE, AARON MICHAEL, MD
P1559
LAIRD, AMANDA MICHELLE, MD
P6854
P1661
LAIRD, JOSHUA CODY, MD
LAKHANI, ASIF WAHID, MD
Q1198
LAKHDHIR, AMIN, MD
P7794
Q2788
LAKKO, ROBERT JORDAN, DO
LAKOMA, ANNA , MD
LAKSHMANAN, BALAMURUGAN,
MD
Q2789
8/1/2014
5/15/2012
11/15/2012
6/2/2014
7/1/2015
12/1/2011
6/3/2013
12/15/2011
8/1/2014
8/30/2013
1/5/2015
1/5/2015
PLASTIC &
RECONSTRUCTIVE
5/15/2017 SURGERY
6/2/2019 PEDIATRICS
RADIATION
7/1/2020 ONCOLOGY
EMERGENCY
6/3/2018 MEDICINE
FAMILY
SURGICAL
ONCOLOGY
MESQUITE
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
7/3/2015 None
N/A
TEMPLE
TX
ACTIVE
12/20/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
6/6/2013 None
2/9/2012 None
N/A
N/A
8/1/2014 None
N/A
HOUSTON
INTERNAL MEDICINE BRYAN
OBSTETRICS
Page 197 of 402
HEREFORD
HOUSTON
TX
TX
ACTIVE
ACTIVE
9/4/2013 None
1/7/2015 None
N/A
N/A
AUSTIN
TX
ACTIVE
1/28/2015 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P8689
Q1199
Q8095
LAL, YASIR , MD
LALANI, HUSHEN HABIBBHAI, MD
LALANI, TANIA, MD
P8934
LAM, SANDI, MD
2/7/2014
Q5016
LAM, VIEN CAM, MD
7/1/2015
Q8538
LAMB, GABRIELLA SOPHIA, MD
01-Jun-16
P6990
LAMBERT, EDDIE L, MD
6/14/2013
P0991
LAMBERT, JERRY V JR, MD
9/15/2011
Q0780
LAMONT, LAUREN ELIZABETH, MD
6/27/2014
Q2919
1/3/2014
8/1/2014
02-May-16
1/15/2015
Q0299
LAMUS, DANIEL , MD
LANDGREBE, MARGUERITE
CATHERINE, DO
P6206
LANDHERR, KATHRYN M, MD
4/12/2013
Q8736
LANDI, DANIEL BRYCE, MD
10-Jun-16
P1344
11/4/2011
Q7068
LANDRUM, MICHAEL L, MD
LANDRY, DANA MARIE CHANEY,
MD
01-Feb-16
P7940
P8935
LANE, GABRIEL NICHOLAS, MD
LANE, NATALIE BRITTAN, MD
9/16/2013
2/7/2014
Q5847
LANE, NATHANIEL GRAHAM, MD
8/28/2015
Q6530
LANERIE, JESSICA ANN, MD
Q3908
LANGENBERG, MATTHEW
THOMAS, MD
5/15/2014
11/16/2015
4/10/2015
8/1/2019 PEDIATRICS
NEUROLOGICAL
2/7/2019 SURGERY
OBSTETRICS AND
7/1/2020 GYNECOLOGY
Secondary Specialty
(Self-Designated)
INFECTIOUS
DISEASES
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
CONYERS
GA
ACTIVE
PANAMA CITY FL
ACTIVE
LICENSE
HOUSTON
TX
ISSUED
ANGLETON
INFECTIOUS
DISEASES
HOUSTON
COLON AND RECTAL
SURGERY
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
1/3/2014 None
8/14/2014 None
13-May-16 None
N/A
N/A
N/A
2/7/2014 None
N/A
TX
ACTIVE
7/3/2015 None
N/A
TX
ACTIVE
03-Jun-16 None
N/A
TX
ACTIVE
DELINQUEN
T-NON
PAYMENT
LICENSE
ISSUED
7/12/2013 None
N/A
12/14/2011 None
N/A
6/27/2014 None
N/A
EMERGENCY
9/15/2016 MEDICINE
ORTHOPEDIC
6/27/2019 SURGERY
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
1/15/2020 RADIOLOGY
SAN ANTONIO TX
EMERGENCY
5/15/2019 MEDICINE
OBSTETRICS AND
PEDIATRIC
HEMATOLOGY/ONCOL
10-Jun-21 OGY
INFECTIOUS
11/4/2016 DISEASES
EMERGENCY
01-Feb-21 MEDICINE
ACTIVE
LICENSE
ISSUED
1/21/2015 None
N/A
5/15/2014 None
N/A
ACTIVE
4/23/2013 None
N/A
LICENSE
ISSUED
10-Jun-16 None
N/A
ACTIVE
11/10/2011 None
N/A
ACTIVE
08-Feb-16 None
N/A
EMERGENCY
8/28/2020 MEDICINE
ACTIVE
ACTIVE
9/23/2013 None
2/18/2014 None
N/A
N/A
GENERAL PRACTICE
GENERAL VASCULAR
Page 198 of 402
TEMPLE
TX
FORT WORTH TX
ACTIVE
LICENSE
ISSUED
9/4/2015 None
N/A
11/16/2015 None
N/A
LICENSE
ISSUED
4/10/2015 None
N/A
License
Number
Q1654
Q6057
Physician Name
LANGHORN, CARLYLE GEORGE
JR, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/29/2014
8/29/2019 MEDICINE
Q2152
LANGMADE, LAURA LAWSON, MD
LANGSTON, JENNIFER MICHELLE,
MD
9/15/2015
10/15/2014
P8381
LANIEWICZ, NATALIE LORRAINE,
DO
11/15/2013
P9627
LANKERANI, LELA, DO
4/1/2014
P0844
LANSKI, STEVEN L, MD
8/26/2011
Q2010
LANTRY, JAMES HENRY III, MD
10/1/2014
P8691
LANZI, JOSEPH THOMAS JR, MD
Q6865
LANZILLO, CHARLES F III, MD
Q2791
LAPLANTE, MARIA, MD
1/3/2014
06-Jan-16
1/5/2015
Q8737
LAPOSATA, MICHAEL , MD
10-Jun-16
P8150
LAPPORTE, ROBERT, MD
10/15/2013
Q8096
Q2324
P3186
LAPSIA, MUNISH HARISH, MD
LARA DEL RIO, JOSE AGUSTIN ,
MD
LARA, ANNA KOPIECZEK, MD
02-May-16
Q6223
Q5208
P2715
LARAWAY, JOHN DAVID, MD
LARGE, RANDY SIMPSON, DO
LARIOS, PATRICIA , MD
10/1/2015
7/15/2015
4/2/2012
P2138
LAROCHE, LAUREN ASHLEIGH, MD
2/10/2012
Q5209
Q0491
LARRAZALETA, MARIA ELENA, MD
LARRIEU, RENE ALFREDO, MD
7/15/2015
6/2/2014
11/7/2014
5/15/2012
PEDIATRIC
FP/OSTEO
MANIPULATION
11/15/2018 MEDICINE
Secondary Specialty
(Self-Designated)
PEDIATRICS
FORT WORTH TX
MARBLE
FALLS
PEDIATRIC
EMERGENCY
EMERGENCY
10/1/2019 MEDICINE
ORTHOPEDIC
1/3/2019 SURGERY
EMERGENCY
06-Jan-21 MEDICINE
Practice City
CRITICAL CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
10-Jun-21 PATHOLOGY
EMERGENCY
10/15/2018 MEDICINE
ACTIVE
9/1/2014 None
N/A
ACTIVE
12/7/2015 None
N/A
ACTIVE
10/17/2014 None
N/A
LICENSE
ISSUED
11/15/2013 None
N/A
ACTIVE
4/3/2014 None
N/A
EL PASO
JBSA FORT
SAM
HOUSTON
TX
ACTIVE
9/6/2011 None
N/A
TX
ACTIVE
11/20/2014 None
N/A
EL PASO
TX
ACTIVE
1/13/2014 None
N/A
VICTORIA
TX
ACTIVE
LICENSE
ISSUED
23-Mar-16 None
N/A
1/5/2015 None
N/A
ACTIVE
21-Jun-16 None
N/A
ACTIVE
10/23/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10-May-16 None
N/A
11/7/2014 None
6/15/2012 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/6/2015 None
7/29/2015 None
4/4/2012 None
N/A
N/A
N/A
2/10/2012 None
N/A
ACTIVE
ACTIVE
7/27/2015 None
6/4/2014 None
N/A
N/A
GALVESTON
TX
CRITICAL CARE
MEDICINE (IM)
DIAGNOSTIC
11/7/2019 RADIOLOGY
BODY IMAGING
OBSTETRICS AND
FAMILY MEDICINE
EMERGENCY
2/10/2017 MEDICINE
OBSTETRICS AND
Page 199 of 402
Disciplinary
Status Date
TX
LABORATORY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
BRENHAM
TX
SCOTTSDALE AZ
DALLAS
TX
EL PASO
TX
SAN ANTONIO TX
License
Number
Physician Name
P0751
LARSEN, DOUGLAS ALAN, MD
Q1200
P0752
Q7573
LARSEN, JAIVA B, MD
LARSON, ADAM, MD
LARSON, CHRISTOPHER DAVID
DAVIS, DO
P6670
LARSON, TIMOTHY BRAD, MD
Q2011
LARTEY, KINGSLEY ASAMOAH, DO
LASAKI, ABIOSE OLUFUNMILAYO,
MD
P4668
Q1655
P9389
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
8/15/2011
8/15/2016 PATHOLOGY
CYTOPATHOLOGY
EMERGENCY
8/1/2014
8/1/2019 MEDICINE
8/15/2011
CARDIOTHORACIC
15-Mar-16
ANESTHESIOLOGY
5/15/2013
5/15/2018 SURGERY
ORTHOPEDICS
10/1/2014
Practice City
TEMPLE
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LOS ANGELES CA
SLC
UT
ACTIVE
ACTIVE
9/1/2014 None
8/29/2011 None
N/A
N/A
TEMPLE
TX
ACTIVE
21-Mar-16 None
N/A
CINCINNATI
OH
ACTIVE
LICENSE
ISSUED
5/23/2013 None
N/A
10/1/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
10/24/2012 None
N/A
8/29/2014 None
4/8/2014 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
22-Mar-16 None
11/22/2013 None
N/A
N/A
5/15/2012 None
N/A
TX
ACTIVE
ACTIVE
7/23/2015 None
12/13/2013 None
N/A
N/A
LANTANA
TX
ACTIVE
11/25/2013 None
N/A
ST. LOUIS
MO
ACTIVE
5/6/2015 None
N/A
NE
ACTIVE
LICENSE
ISSUED
4/5/2013 None
N/A
5/15/2014 None
N/A
10/15/2012
8/29/2014
3/17/2014
06-Jan-16
11/15/2013
PUBLIC HEALTH
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/18/2011 None
N/A
SALT LAKE
CITY
UT
DALLAS
TX
HOUSTON
TX
P3188
LASCHOBER, RYAN DAVID, MD
LASH, AUSTIN THOMAS, MD
LASHER, STEPHEN ANDREW JR,
MD
LATIF, PERNIA, MD
LATTA, TAMIKA DANIELLE
SHAUNTA, MD
Q5210
P8496
LAU, ABBY, MD
LAU, LISA TAK-HING, MD
L2977
LAUGHREY, MICHAEL SCOTT, MD
Q4171
LAURIE, DANIEL EDWARD, MD
LAVEDAN, ANNA LIZA CAMUNGOL,
MD
5/1/2015
4/1/2013
OMAHA
5/15/2014
Q3223
LAVENS, MEGAN MCGREEVY, DO
LAVERTY BALLESTEROS, CYNTHIA
KAY, MD
EMERGENCY
5/15/2019 MEDICINE
2/13/2015
DENTON
TX
ACTIVE
2/18/2015 None
N/A
P5667
LAVIOLETTE, JUDY DERRICK, MD
SHREVEPORT LA
ACTIVE
3/8/2013 None
N/A
Q6763
LAW, HUAY-ZONG , MD
15-Dec-15
PLASTIC &
RECONSTRUCTIVE
15-Dec-20 SURGERY
DALLAS
17-Dec-15 None
N/A
Q5849
LAWAL, NURUDEEN AKANBI, MD
8/28/2015
ACTIVE
LICENSE
ISSUED
8/28/2015 None
N/A
Q6866
P8382
P6014
Q0300
5/15/2012
7/15/2015
12/6/2013
11/15/2013
3/1/2013
INFECTIOUS
7/15/2020 DISEASES
AEROSPACE
11/15/2018 MEDICINE
PALLIATIVE
MEDICINE
FAMILY PRACTICE
EMERGENCY
MEDICINE
CRITICAL CARE
MEDICINE (IM)
Page 200 of 402
TX
License
Number
Physician Name
P9390
LAWENDY, EMAD , MD
LAWRENCE, ANGELENE
P2025
MICHAELE, MD
dicaid
dicaid
Agreement
End Date
Designated)
3/17/2014
2/1/2012
P0753
LAWRENCE, EMILY JEAN, DO
Q4172
LAWRENCE, LINDSEY, MD
5/1/2015
Q1656
LAWSON, SHARON D, MD
LAYEEQUR RAHMAN,
RAKHSHANDA , MD
8/29/2014
LAYMAN, RACHEL MICHELLE, MD
LAYNO, MELISSA ANNE ABESAMIS,
MD
15-Apr-16
11/30/2012
P6209
LAZARIDIS, CHRISTOS , MD
LAZARINI, JONATHAN ALEXANDER,
MD
K5140
LAZARO, LARRY RIVERA, MD
Q1657
LE, ANDY TUAN, DO
Q4173
LE, CHRISTINA PHUONG, MD
P9897
P2283
Q7912
Q3396
P4973
8/15/2011
3/1/2012
3/3/2015
4/12/2013
2/1/2017 PSYCHIATRY
PEDIATRICS,
EMERGENCY
5/1/2020 MEDICINE
Secondary Specialty
(Self-Designated)
PSYCHIATRY
CARDIOVASCULAR
DISEASES
SURGICAL BREAST
3/1/2017 ONCOLOGY
15-Apr-21 ONCOLOGY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/19/2014 None
N/A
NV
ACTIVE
2/10/2012 None
N/A
HOUSTON
TX
ACTIVE
8/30/2011 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
6/4/2015 None
N/A
8/29/2014 None
N/A
TX
ACTIVE
3/5/2012 None
N/A
INTERNAL MEDICINE
EMERGENCY
MEDICINE
VASCULAR
NEUROLOGY
CHARLESTON SC
ACTIVE
30-May-16 None
N/A
ACTIVE
3/11/2015 None
N/A
ACTIVE
1/8/2013 None
N/A
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
4/29/2013 None
N/A
7/1/2011 None
N/A
8/29/2014 None
N/A
ACTIVE
LICENSE
ISSUED
5/22/2015 None
N/A
4/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
8/8/2013 None
N/A
8/3/2015 None
3/30/2012 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
4/16/2012 None
7/8/2015 None
10/6/2011 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
14-Mar-16 None
N/A
6/1/2012 None
N/A
FORT WORTH TX
8/29/2014
5/1/2015
LE, HANG ALINE, DO
4/15/2014
P7300
LE, LIET NGOC, MD
7/15/2013
Q5465
P2284
LE, LINDA , MD
LE, MICHAEL, MD
P2887
Q5017
P1096
LE, MINH MAN, MD
LE, MY DUYEN, MD
LE, PHUC NHAT, MD
4/13/2012
7/1/2015
10/3/2011
FAMILY MEDICINE
EMERGENCY
4/13/2017 MEDICINE
FAMILY PRACTICE
Q7408
LE, THANH-THAO T, MD
04-Mar-16
P3376
LE, Y THANH, DO
6/1/2012
RENO
GENERAL SURGERY AMARILLO
7/1/2011
8/3/2015
3/1/2012
Practice City
LAS CRUCES
Registration
Status of
Practice
Texas
State
License
NM
ACTIVE
HOSPITALIST
ANESTHESIOLOGY
REMUS
HOUSTON
MI
TX
HOSPITALIST
DERMATOLOGIC
SURGERY
6/1/2017 PEDIATRICS
Page 201 of 402
HOUSTON
TX
WINTER
HAVEN
FL
BEAUMONT
HANSCOM
AFB
TX
MA
License
Number
Physician Name
P1779
LEAK, MORGAN GRANT, MD
dicaid
dicaid
Agreement
End Date
Designated)
1/2/2012
Secondary Specialty
(Self-Designated)
ADDICTION
PSYCHIATRY
H8993
LEAL, DANIEL HECTOR, MD
6/15/2012
P7795
LEATHAM, AUNA OTTS, MD
8/30/2013
Q2580
12/3/2014
P8497
LEBLANC, LOUIS J, MD
LECHEMINANT, CHRISTOPHER D,
MD
EMERGENCY
8/30/2018 MEDICINE
EMERGENCY
12/3/2019 MEDICINE
12/6/2013
ANESTHESIOLOGY
Q7224
LEDESMA, RUDRICK VILLOSO, MD
16-Feb-16
NEPHROLOGY
Q6531
LEDFORD, JAMIE R, MD
11/16/2015
Q7913
LEE, AMY ELIZABETH, MD
15-Apr-16
Q8098
LEE, ANDY YEN-TANG, MD
02-May-16
P3026
LEE, ANHTUYET THI BUI, MD
5/1/2012
PEDIATRIC CRITICAL
15-Apr-21 CARE MEDICINE
CARDIOVASCULAR
02-May-21 DISEASES
PLASTIC &
RECONSTRUCTIVE
5/1/2017 SURGERY
P5668
LEE, BENJAMIN SWEE LENG, MD
3/1/2013
P2477
Q6224
Q8541
LEE, BOWLVA MICHAEL, DO
LEE, CHIAO, MD
LEE, CHRISTOPHER , MD
3/15/2012
10/1/2015
01-Jun-16
Q4174
LEE, CHRISTOPHER THOMAS, MD
Q6765
P1560
Q5688
Q7574
LEE, DANIEL C, MD
LEE, DANIEL WONIL, MD
LEE, DAVID , MD
LEE, DAVID WEE, DO
15-Dec-15
12/1/2011
8/14/2015
15-Mar-16
Q3037
LEE, EDWARD WON, MD
2/2/2015
Q0098
LEE, ELIZABETH T, DO
5/2/2014
Q7226
LEE, EUNICE, MD
5/1/2015
16-Feb-16
Practice City
AMARILLO
SAN ANTONIO TX
CANTON
THORACIC
CARDIOVASCULAR
15-Dec-20 SURGERY
12/1/2016 RADIOLOGY
ORTHOPEDIC
2/2/2020 SURGERY
VALHALLA
OH
NY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/23/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/18/2012 None
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
2/11/2015 None
N/A
12/6/2013 None
N/A
ACTIVE
LICENSE
ISSUED
07-Mar-16 None
N/A
11/16/2015 None
N/A
DALLAS
TX
ACTIVE
29-Apr-16 None
N/A
TX
ACTIVE
03-May-16 None
N/A
LA
ACTIVE
5/7/2012 None
N/A
TX
ACTIVE
3/20/2013 None
N/A
NEW YORK
NY
FORT WORTH TX
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
3/23/2012 None
10/12/2015 None
13-Jun-16 None
N/A
N/A
N/A
ARLINGTON
TX
ACTIVE
5/11/2015 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
NEW
ORLEANS
CORPUS
CHRISTI
3/1/2018 NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
PSYCHIATRY
GENERAL SURGERY TEMPLE
NEURO-RADIOLOGY
PLANO
FAMILY PRACTICE
TALIHINA
OBSTETRICS AND
HANFORD
ALLENTOWN
Page 202 of 402
TX
OK
CA
PA
ACTIVE
LICENSE
ISSUED
ACTIVE
06-Jan-16
12/30/2011
8/17/2015
31-Mar-16
None
None
None
None
N/A
N/A
N/A
N/A
2/4/2015 None
N/A
5/2/2014 None
N/A
07-Apr-16 None
N/A
License
Number
Physician Name
P5832
LEE, FAYE, MD
P0846
LEE, FRANCESCA M, MD
Q4796
P2888
LEE, HELEN HEEYOUNG, MD
LEE, HUN JU, MD
Q0099
LEE, HUNG-WEI, MD
P5202
P7662
LEE, JANA, MD
LEE, JANE EVELYN, DO
Q0100
LEE, JI-YANG SOPHIE, MD
P7301
LEE, KATIE AMY, MD
P0622
LEE, KEAGAN HYUN-CHUL, MD
P4976
LEE, KENNETH THOMAS, MD
Q0492
LEE, KEVIN WEI I, MD
Q7575
LEE, KIE YUNG, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
3/15/2013
3/15/2018 MEDICINE
INFECTIOUS
8/26/2011
8/26/2016 DISEASES
PATHOLOGY
6/12/2015
4/13/2012
5/2/2014
1/4/2013
8/15/2013
5/2/2014
7/15/2013
8/1/2011
11/30/2012
6/2/2014
15-Mar-16
P2717
LEE, KIWON, MD
4/2/2012
Q7576
Q1438
P9629
LEE, MARIA NIEN-FENG, MD
LEE, MICHAEL ALEXANDER, MD
LEE, MICHELLE , MD
P7143
LEE, SABINA MIKYONG, MD
Q0959
LEE, SANDRA MAUREEN, DO
7/15/2014
P0847
LEE, SANG HYUN, MD
8/26/2011
P3190
LEE, SEUNG TAE , MD
5/15/2012
15-Mar-16
8/15/2014
4/1/2014
7/1/2013
4/13/2017 ONCOLOGY
ANATOMIC/CLINICAL
5/2/2019 PATHOLOGY
EMERGENCY
1/4/2018 MEDICINE
ANATOMIC/CLINICAL
8/1/2016 PATHOLOGY
THORACIC
CARDIOVASCULAR
11/30/2017 SURGERY
EMERGENCY
6/2/2019 MEDICINE
EMERGENCY
15-Mar-21 MEDICINE
DIAGNOSTIC
7/15/2019 RADIOLOGY
EMERGENCY
8/26/2016 MEDICINE
HEMATOLOGY/ONCOL
5/15/2017 OGY
ACTIVE
DALLAS
GLENDALE
TX
TX
AZ
NEPHROLOGY
DALLAS
TX
DERMATOPATHOLO
GY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/24/2013 None
N/A
9/2/2011 None
N/A
6/12/2015 None
4/26/2012 None
N/A
N/A
5/2/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/9/2013 None
8/19/2013 None
N/A
N/A
5/2/2014 None
N/A
ACTIVE
LICENSE
ISSUED
7/23/2013 None
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
GENERAL SURGERY TEXARKANA
DALLAS
TX
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
6/25/2014 None
N/A
ARLINGTON
TX
ACTIVE
01-Apr-16 None
N/A
HOUSTON
TX
ACTIVE
4/16/2012 None
N/A
WEBSTER
TX
14-Apr-16 None
8/19/2014 None
4/3/2014 None
N/A
N/A
N/A
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/1/2013 None
N/A
NV
ACTIVE
7/25/2014 None
N/A
TX
ACTIVE
9/2/2011 None
N/A
TX
ACTIVE
5/30/2012 None
N/A
4/2/2017 NEUROLOGY
ENDOCRINOLOGY,
DIABETES AND
15-Mar-21 METABOLISM
4/1/2019 PEDIATRICS
Practice City
Registration
Status of
Practice
Texas
State
License
INFECTIOUS
DISEASES
HOUSTON
MUSCULOSKELETAL
RADIOLOGY
LAS VEGAS
EMERGENCY
MEDICAL SERVICES HOUSTON
Page 203 of 402
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
10-Jun-16
Q8739
Physician Name
LEE-OSTERMAYER, KATHY
KAISEE, MD
Q0493
LEFAVE, JEAN PAUL JOSEPH, MD
6/2/2014
Q0494
LEFEBVRE, ERIC MITCHELL, MD
6/2/2014
P9898
P4477
LEGA, BRADLEY CHARLES, MD
LEGARDA, EUGENIA , MD
4/15/2014
9/17/2012
Q1851
LEGAULT, GARY LAURENT, MD
9/15/2014
P7144
LEGER, KASEY JOANNE, MD
Q0302
P6015
LEHMAN, DOUGLAS ROSS, MD
LEHMAN, WESTON MARK, MD
5/15/2014
4/1/2013
P6993
LEHMANN, ANA ROSA, MD
6/14/2013
7/1/2013
P2479
LEI, JUNYI , MD
3/15/2012
Q6059
Q1203
LELEUX, TODD M, MD
LELLA, LEELA KUMAR, MD
9/15/2015
8/1/2014
Q3724
LEMERT, JAMES REX JR, MD
Q0961
LEMMA, YONATAN SOLOMON, MD
P1097
LEMO, PRETEI EBIKEME, MD
J1293
LENDER, DAN, MD
P2480
LENERT-WILLIAMS, CARMELL, MD
TM00608 LENG, THEODORE, MD
Q8283
LEON, PHILLIP JOSEPH, MD
4/1/2015
7/15/2014
10/3/2011
Practice City
COLON AND RECTAL
6/2/2019 ABDOMINAL SURGERY SURGERY
HOUSTON
EMERGENCY
6/2/2019 MEDICINE
HOUSTON
NEUROLOGICAL
4/15/2019 SURGERY
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10-Jun-16 None
N/A
TX
ACTIVE
6/12/2014 None
N/A
TX
ACTIVE
6/10/2014 None
N/A
TX
ACTIVE
ACTIVE
5/6/2014 None
9/19/2012 None
N/A
N/A
TX
ACTIVE
9/17/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
7/24/2013 None
N/A
5/15/2014 None
4/15/2013 None
N/A
N/A
6/14/2013 None
N/A
COLLEGEVILL
E
PA
ACTIVE
3/22/2012 None
N/A
CROWLEY
MIDLAND
LA
TX
ACTIVE
ACTIVE
9/22/2015 None
8/5/2014 None
N/A
N/A
CORNEA REFRACTIVE
9/15/2019 SURGERY
OPHTHALMOLOGY
EL PASO
PEDIATRIC
HEMATOLOGY/ONCO
7/1/2018 PEDIATRICS
LOGY
DALLAS
FAMILY PRACTICE
TEMPLE
TX
3/15/2017 PATHOLOGY
ANATOMIC/CLINICAL
9/15/2020 PATHOLOGY
8/1/2019 CARDIOLOGY
PATHOLOGY
DERMATOPATHOLO
GY
4/1/2020 UROLOGY
EMERGENCY
7/15/2019 MEDICINE
UROLOGIC SURGERY TEMPLE
TX
ACTIVE
4/7/2015 None
N/A
DALLAS
TX
ACTIVE
8/7/2014 None
N/A
GREENVILLE
TX
ACTIVE
10/13/2011 None
N/A
TX
ACTIVE
7/7/2011 None
N/A
SHREVEPORT LA
ACTIVE
4/2/2012 None
N/A
KILLEEN
LICENSE
ISSUED
ACTIVE
7/15/2015 None
03-Jun-16 None
N/A
N/A
3/15/2012
ENDOCRINOLOGY,
DIABETES AND
7/1/2016 METABOLISM
EMERGENCY
3/15/2017 MEDICINE
7/15/2015
16-May-16
7/1/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
OPHTHALMOLOGY VITREOUS SURGERY
Page 204 of 402
TX
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q6532
Physician Name
LEONG, AMELIA WIKE FREEMAN,
MD
Q4448
LEREW, MELANIE RUYLE, MD
5/15/2015
Q6868
LESAGE, FRANCOIS DANIEL, MD
06-Jan-16
P8797
LESNICK, JOSEPH SCOTT, MD
1/15/2014
Q2012
Q2325
LESSER, STEVEN HARRY, MD
LESTER, SARAH ELIZABETH, MD
10/1/2014
11/7/2014
Q8284
LESTER, SHAYLA, MD
16-May-16
P9632
LESTON, ALISON, MD
4/1/2014
P8798
Q7577
LEUCK, JO ANNA, MD
LEUNG, SAMSON, MD
1/15/2014
15-Mar-16
P3028
LEVAR, JOSHUA , MD
5/1/2012
11/16/2015
TM00452 LEVEY, MICHAEL STEVEN, MD
Q8544
LEVEY, RICHARD MICHAEL, MD
7/1/2011
01-Jun-16
Q7409
LEVIN, DANA REED, MD
04-Mar-16
Q8740
Q5214
LEVINE, MARLA CASEY, MD
LEVINE, MICHAEL HOWARD, MD
10-Jun-16
7/15/2015
Q5215
LEWIS, JONATHAN DANIEL, MD
7/15/2015
P4671
LEWIS, RYAN LEIGHTON, MD
Q5471
LEWIS, SPENCER RYAN, MD
8/3/2015
Q4623
LEWIS, WHITNEY KRISTINA, DO
6/1/2015
10/15/2012
Secondary Specialty
(Self-Designated)
OTORHINOLARYNGOL
5/15/2020 OGY
EMERGENCY
06-Jan-21 MEDICINE
FAMILY MEDICINE
EMERGENCY
1/15/2019 MEDICINE
PEDIATRIC
EMERGENCY
EMERGENCY
10/1/2019 MEDICINE
MEDICINE (EM)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
DIAGNOSTIC
7/1/2016 RADIOLOGY
01-Jun-21 RADIOLOGY
EMERGENCY
04-Mar-21 MEDICINE
PEDIATRIC
EMERGENCY
10-Jun-21 MEDICINE (PEDS)
7/15/2020 NEUROLOGY
N/A
ACTIVE
6/2/2015 None
N/A
ACTIVE
25-Jan-16 None
N/A
TX
ACTIVE
1/20/2014 None
N/A
HAMMOND
LA
FORT WORTH TX
ACTIVE
ACTIVE
10/10/2014 None
11/17/2014 None
N/A
N/A
ACTIVE
07-Jun-16 None
N/A
ACTIVE
5/9/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
2/5/2014 None
21-Mar-16 None
N/A
N/A
5/1/2012 None
N/A
WICHITA
FALLS
TX
PLATTSBURG
H
NY
HOUSTON
EMERGENCY
10/15/2017 MEDICINE
CLINICAL
NEUROPHYSIOLOGY DALLAS
TX
FORT WORTH TX
CLAREMONT CA
SLEEP MEDICINE
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
EMERGENCY
MEDICAL SERVICES
EMERGENCY
6/1/2020 MEDICINE
Page 205 of 402
Disciplinary
Status Date
11/16/2015 None
16-May-21 INTERNAL MED - PEDS
4/1/2019 NEUROLOGY
EMERGENCY
1/15/2019 MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
COLUMBUS
OROVILLE
OH
CA
ACTIVE
ACTIVE
7/6/2011 None
15-Jun-16 None
N/A
N/A
WEBSTER
TX
ACTIVE
16-Mar-16 None
N/A
LICENSE
ISSUED
ACTIVE
10-Jun-16 None
7/21/2015 None
N/A
N/A
8/4/2015 None
N/A
10/19/2012 None
N/A
8/3/2015 None
N/A
6/1/2015 None
N/A
HOUSTON
TX
ACTIVE
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
SURGICAL
2/13/2015
2/13/2020 ONCOLOGY
GENERAL SURGERY PASADENA
OBSTETRICS AND
MATERNAL AND
CORPUS
16-May-16
FETAL MEDICINE
CHRISTI
Q3226
Physician Name
LEWIS-TRAYLOR, ANGELA
MICHELLE, MD
Q8285
LI, CHAO, MD
P6858
Q6869
P0428
Q2154
LI, HUAIGUANG, MD
LI, JINGYI, MD
LI, LINDA , MD
LI, WANG , MD
Q1204
LI, WENPING , MD
8/1/2014
P8692
Q2581
LI, ZHAOHUI, MD
LIANG, DAVID , MD
1/3/2014
12/3/2014
1/3/2019 CARDIOLOGY
P7799
P7800
LIANG, MIKE KUO, MD
LIANG, MIN , MD
8/30/2013
8/30/2013
P7302
LIANG, QINGHUA, MD
7/15/2013
7/15/2018 NEUROLOGY
Q7410
P2890
LIAO, BING , MD
LIAO, GEORGE PAUL, MD
04-Mar-16
4/13/2012
04-Mar-21 NEUROLOGY
6/3/2013
06-Jan-16
7/15/2011
10/15/2014
6/3/2018
06-Jan-21
7/15/2016
10/15/2019
INTERNAL MEDICINE
ANESTHESIOLOGY
GENERAL SURGERY
FAMILY MEDICINE
ANATOMIC/CLINICAL
8/1/2019 PATHOLOGY
P2719
LIBERMAN, SHARI RACHEL, MD
4/2/2012
4/2/2017
P0429
LIBREROS, JAIRO ANDRES, MD
7/15/2011
7/15/2016
Q8099
LICHLITER, ANDREW H, MD
02-May-16
02-May-21
Q4177
LIEBERMAN, ROBERT ISAAC, MD
5/1/2015
5/1/2020
Q0305
LIEN, VIVIAN , MD
5/15/2014
P3030
LIEPPMAN, KYLE, MD
5/1/2012
Q3726
LIESER, GREGORY CHARLES, MD
4/1/2015
Q4178
LIESER, SOFIA ANA, MD
5/1/2015
PEDIATRIC CRITICAL
4/1/2020 UROLOGY
OBSTETRICS AND
5/1/2020 GYNECOLOGY
TX
ACTIVE
TX
HOUSTON
ODESSA
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
AUGUSTA
NEW
ORLEANS
HOUSTON
GA
ACTIVE
LA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
HOSPITALIST
CYTOPATHOLOGY
CARDIOLOGY
ORTHOPEDIC
SURGERY
INTERNAL MED - PREV
MED
DIAGNOSTIC
RADIOLOGY
INTERVENTIONAL
RADIOLOGY
Registration
Status of
Practice
Texas
State
License
MOVEMENT
DISORDERS
NEUROMUSCULAR
DISEASE
SURGERY
ADMINISTRATIVE
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
2/19/2015 None
N/A
17-May-16 None
N/A
6/3/2013
09-Mar-16
7/22/2011
10/24/2014
None
None
None
None
N/A
N/A
N/A
N/A
9/3/2014 None
N/A
2/24/2014 None
12/18/2014 None
N/A
N/A
8/30/2013 None
9/6/2013 None
N/A
N/A
7/15/2013 None
N/A
ROCHESTER
HOUSTON
MN
TX
ACTIVE
ACTIVE
07-Apr-16 None
4/16/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/9/2012 None
N/A
ACTIVE
7/20/2011 None
N/A
04-May-16 None
N/A
5/1/2015 None
N/A
5/15/2014 None
N/A
DALLAS
TX
ACTIVE
LICENSE
ISSUED
CORNEA
REFRACTIVE
SURGERY
LICENSE
ISSUED
PEDIATRICS
ACTIVE
5/3/2012 None
N/A
UROLOGIC SURGERY
ACTIVE
4/8/2015 None
N/A
ACTIVE
5/4/2015 None
N/A
Page 206 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
11/15/2011
MEDICINE
P1469
LIETO, JANET, DO
P9634
LIEW, CARISA SIN HUI, DO
4/1/2014
P5836
LILES, JOE SPENCER, MD
3/15/2013
P7148
LIM, DAVID TAO-WAY, DO
7/1/2013
P0624
Q1439
Q1205
LIM, HAJIN, MD
LIM, JANET M, MD
LIM, MEVELLINE KUON, MD
P3549
LIMA, BRIAN, MD
Q6060
LIMA, SHIRLEY, MD
P6448
LIMAS, FLOR AURORA, MD
Q6647
LIN, CAROL, MD
8/1/2011
8/15/2014
8/1/2014
6/8/2012
9/15/2015
5/1/2013
12/4/2015
Q6647
LIN, CAROL, MD
04-Dec-15
Q6647
LIN, CAROL, MD
04-Dec-15
P3191
LIN, CHUN HUIE, MD
5/15/2012
P6018
LIN, FRANK Y, MD
Q6648
Q6648
Q6648
LIN, PETER CHARLIE, MD
Q2796
LIN, SUSIE I CHING, MD
P2891
LIN, TED TAI KU, MD
4/1/2013
12/4/2015
04-Dec-15
04-Dec-15
1/5/2015
4/13/2012
NEURO-PHYSIOLOGY
4/1/2019 NEUROLOGY
(NEUROLOGY)
SURGICAL
3/15/2018 ONCOLOGY
EMERGENCY
7/1/2018 MEDICINE
CARDIOVASCULAR
8/1/2016 DISEASES
8/1/2019 PEDIATRICS
THORACIC
CARDIOVASCULAR
6/8/2017 SURGERY
OBSTETRICS &
GYNECOLOGICAL
9/15/2020 SURGERY
OBSTETRICS AND
5/1/2018 GYNECOLOGY
DIAGNOSTIC
12/4/2020 RADIOLOGY
DIAGNOSTIC
04-Dec-20 RADIOLOGY
DIAGNOSTIC
04-Dec-20 RADIOLOGY
INTERVENTIONAL
CARDIOLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
4/1/2018 OGY
PEDIATRICS
ORAL &
MAXILLOFACIAL
1/5/2020 SURGERY
Page 207 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
FORT WORTH TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
11/30/2011 None
N/A
ACTIVE
4/8/2014 None
N/A
HOUSTON
TX
ACTIVE
4/12/2013 None
N/A
BURNET
TX
ACTIVE
7/4/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
8/9/2011 None
8/25/2014 None
8/5/2014 None
N/A
N/A
N/A
AUSTIN
TX
ACTIVE
6/19/2012 None
N/A
LAKE
JACKSON
TX
ACTIVE
9/28/2015 None
N/A
ACTIVE
LICENSE
ISSUED
5/3/2013 None
N/A
12/4/2015 None
N/A
IL
ACTIVE
09-Dec-15 None
N/A
IL
ACTIVE
09-Dec-15 None
N/A
HOUSTON
TX
ACTIVE
5/17/2012 None
N/A
HOUSTON
TX
4/5/2013 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
12/4/2015 None
03-Feb-16 None
03-Feb-16 None
N/A
N/A
N/A
LICENSE
ISSUED
1/5/2015 None
N/A
4/20/2012 None
N/A
MORTON
GROVE
MORTON
GROVE
GALVESTON
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
PULMONARY
CRITICAL CARE
4/13/2012
4/13/2017 MEDICINE
COLON AND RECTAL
CORPUS
4/1/2014
4/1/2019 SURGERY
GENERAL SURGERY CHRISTI
1/2/2012
1/2/2017 RADIOLOGY
NEURO-RADIOLOGY
P2892
LIN, YANN-BOR, MD
P9636
P1780
LIN, YU HSIN, MD
LINCOLN, CHRISTIE MARY, MD
P0756
Q3227
Q6957
LINCOLN, JEWEL CATHERINE, DO
LINDBERG, MATTHEW ROBERT,
MD
LINDEMAN, TRACEY EINEM, MD
P8596
LINDEN, BENJAMIN JOSEPH, MD
12/16/2013
P7149
LINDLE, KATHERINE ALEXIS, MD
7/1/2013
Q2327
LINDLEY, KATARINA, DO
11/7/2014
Q4452
LINDLEY, SARAH WINTER, MD
5/15/2015
Q7411
LINDSEY, JAMES YORK, MD
04-Mar-16
5/15/2020 PATHOLOGY
EMERGENCY
04-Mar-21 MEDICINE
8/15/2011
2/13/2015
15-Jan-16
2/13/2020 PATHOLOGY
P9217
LINDSEY, JULIANNA, MD
3/3/2014
Q6533
Q4454
P6859
LING, CARL H, MD
LING, JINYI, DO
LINGAM, PRANATHI , MD
11/16/2015
5/15/2015
6/3/2013
P3378
P3379
LINGAN, CHRISTOPHER C, MD
LINGAPPAN, KRITHIKA , MD
Q8743
LINK, MARK STEVEN, MD
P9218
LIONG, URSULA AURORA PO, MD
3/3/2014
P5410
LIOU, ROBERT DAR TEH, MD
2/1/2013
P0625
LIPPMANN, MELANIE JILL, MD
8/1/2011
6/1/2012
6/1/2012
10-Jun-16
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
FORT WORTH TX
PEDIATRICS,
CARDIOLOGY
7/1/2018 CARDIOLOGY
HOUSTON
MINERAL
WELLS
EMERGENCY
6/1/2017 MEDICINE
CARDIAC
ELECTROPHYSIOLOG
10-Jun-21 Y
CARDIOLOGY
PULMONARY
CRITICAL CARE
2/1/2018 MEDICINE
EMERGENCY
8/1/2016 MEDICINE
4/4/2014 None
1/10/2012 None
N/A
N/A
8/15/2011 None
N/A
2/13/2015 None
22-Jan-16 None
N/A
N/A
12/16/2013 None
N/A
7/12/2013 None
N/A
11/12/2014 None
N/A
5/15/2015 None
N/A
ACTIVE
25-Mar-16 None
N/A
3/11/2014 None
N/A
11/16/2015 None
5/19/2015 None
6/28/2013 None
N/A
N/A
N/A
6/1/2012 None
6/4/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
LAS CRUCES
NM
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
21-Jun-16 None
N/A
ACTIVE
3/24/2014 None
N/A
CA
ACTIVE
2/5/2013 None
N/A
TX
ACTIVE
8/9/2011 None
N/A
INTERNAL MEDICINE ORANGE
Page 208 of 402
N/A
ACTIVE
CARROLLTON TX
Disciplinary
Status Date
4/13/2012 None
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q2797
Physician Name
LIQUETE, EGBERT JOSEPH
CADENA, MD
Q0497
LISS, MICHAEL ANDRE, MD
P1781
P6672
LITTLE, KATHRYN ELIZABETH, MD
LITTRELL, LAUREL A, MD
P5670
P0626
LITVAK, STANLEY JAMES, MD
LIU, CHRISTINE Y, MD
3/1/2013
8/1/2011
Q3728
LIU, CICI SIJUAN, MD
4/1/2015
P0627
LIU, DONGXIN, MD
8/1/2011
Q3399
LIU, ENCHUN MIKE, MD
3/3/2015
P1782
LIU, HENRY, MD
1/2/2012
P5102
LIU, HONGBO, MD
12/17/2012
P5102
LIU, HONGBO, MD
12/17/2012
P5102
LIU, HONGBO, MD
12/17/2012
P2141
LIU, LI-HERNG, MD
2/10/2012
P6211
Q3400
LIU, LINA, MD
LIU, MUGEN , MD
4/12/2013
3/3/2015
Q2798
LIU, NA, MD
Q6534
LIU, YAN , MD
P2029
LIVINGSTON, ANDREW DALE, MD
2/1/2012
Q7914
P6860
LIVINGSTON, COLE JOSEPH, MD
LIWAG, NOAH ABILLE, MD
LIZARDO SANCHEZ, LUIS SAUL,
MD
15-Apr-16
6/3/2013
NEUROLOGICAL
2/1/2017 SURGERY
EMERGENCY
15-Apr-21 MEDICINE
5/15/2014
Q0307
1/5/2015
6/2/2014
1/2/2012
5/15/2013
1/5/2015
11/16/2015
1/5/2020 NEPHROLOGY
UROLOGIC
6/2/2019 ONCOLOGY
Secondary Specialty
(Self-Designated)
Practice City
INTERNAL MEDICINE
UROLOGY
BREAST IMAGING
5/15/2018 RADIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SAN ANTONIO TX
ROCHESTER MN
POUGHKEEPS
IE
NY
AUSTIN
TX
3/1/2018 RADIOLOGY
OBSTETRICS AND
GYNECOLOGIC
4/1/2020 GYNECOLOGY
ONCOLOGY
DALLAS
TX
HEMATOLOGY/ONCOL
8/1/2016 OGY
INTERNAL MEDICINE
SAN ANTONIO TX
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
ORTHOPEDIC
12/17/2017 SURGERY
ANESTHESIOLOGY
ANATOMIC
4/12/2018 PATHOLOGY
CYTOPATHOLOGY
HEMATOLOGY/ONCOL
1/5/2020 OGY
INTERNAL MEDICINE
Page 209 of 402
Disciplinary
Status Date
1/5/2015 None
N/A
ACTIVE
6/10/2014 None
N/A
ACTIVE
ACTIVE
1/12/2012 None
5/28/2013 None
N/A
N/A
ACTIVE
ACTIVE
3/6/2013 None
8/29/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/3/2015 None
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
3/23/2015 None
N/A
1/2/2012 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
FULTON
KY
ACTIVE
12/27/2012 None
N/A
ACTIVE
2/21/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/19/2013 None
3/6/2015 None
N/A
N/A
1/5/2015 None
N/A
11/16/2015 None
N/A
2/1/2012 None
N/A
04-May-16 None
6/12/2013 None
N/A
N/A
5/15/2014 None
N/A
TEMPLE
DALLAS
TX
TX
INTERNAL MEDICINE
GASTROENTEROLOG
Y
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
EL PASO
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
P9900
P8383
P2287
P3380
P8050
P1348
Physician Name
LLANOS-VAZQUEZ, ROXANNA
MARIA, MD
LLINAS CEPEDA, JOSE
ALEJANDRO, MD
LLOREN, CHARISSE CASTELLANO,
MD
dicaid
dicaid
Agreement
End Date
Designated)
4/15/2014
11/15/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
3/1/2017 PEDIATRICS
HOUSTON
TX
6/1/2012
10/1/2013
11/4/2011
6/1/2017 PSYCHIATRY
11/4/2016 RADIOLOGY
KATY
HOUSTON
TX
TX
Q2683
LLUBERES, NUBIA GEYSSELL, MD
LOBANOVA, JYLIA, MD
LOCKER, MATTHEW JAMES, MD
LOCKMAN, ANNE ELIZABETH
JULIANA, MD
12/15/2014
STANFORD
CA
Q3911
LODESPOTO, MARK JOSEPH, MD
4/10/2015
TM00494 LOEFFLER, PAUL MARK, MD
LOESCHER, STEVEN RANDOLPH,
P8269
DO
12/15/2011
DIAGNOSTIC
4/10/2020 RADIOLOGY
DIAGNOSTIC
EMERGENCY
11/1/2018 MEDICINE
EMERGENCY
8/29/2019 MEDICINE
Q1659
LOGUE, RICHARD THOMAS, MD
8/29/2014
NEURO-RADIOLOGY
VISALIA
CA
P6212
Q3401
LOH, JOHN CHUCH SHENG, MD
LOHREY, JOHN HOWARD, MD
4/12/2013
3/3/2015
4/12/2018 RADIOLOGY
3/3/2020 ONCOLOGY
MUSCULOSKELETAL
IMAGING
MANCHESTER NH
FT WORTH
TX
Q0782
LONG, CHRISTINA MARIEKE, DO
6/27/2014
NEONATOLOGY
Q0107
LONG, DANXUAN, MD
Q7228
Q4457
P6861
Q7734
P9637
P8270
LONG, RACHEL ANNA, DO
LONGANECKER, JOHN MICHAEL,
DO
LONGHOFER, LISA KAY, MD
LOOCHTAN, MICHAEL, MD
LOOMIS, BRANDI , MD
LOPEZ FINKENKELLER, ROBIN
ERIN, MD
5/2/2014
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
16-Feb-16
5/15/2015
6/3/2013
01-Apr-16
4/1/2014
6/3/2018 SURGERY
4/1/2019 PEDIATRICS
11/1/2013
ORTHOPEDIC
SURGERY
OTHER SPECIALTY
CARDIOTHORACIC
ANESTHESIOLOGY
Page 210 of 402
Disciplinary
Status Date
4/17/2014 None
N/A
11/15/2013 None
N/A
3/14/2012 None
N/A
6/1/2012 None
10/2/2013 None
11/17/2011 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
1/14/2015 None
N/A
4/10/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
12/23/2011 None
N/A
11/1/2013 None
N/A
8/29/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/23/2013 None
3/17/2015 None
N/A
N/A
6/27/2014 None
N/A
5/2/2014 None
N/A
LICENSE
ISSUED
3/1/2012
11/1/2013
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
18-Feb-16 None
N/A
LUBBOCK
TX
ACTIVE
5/19/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/11/2013 None
04-Apr-16 None
4/24/2014 None
N/A
N/A
N/A
11/1/2013 None
N/A
SAN ANTONIO TX
SAN ANTONIO TX
License
Number
Q5217
Physician Name
LOPEZ PAYARES, GISELA MARIA,
MD
Q5020
LOPEZ SEPULVEDA, JAXEL, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/15/2015
7/1/2015
GERIATRICS 04-Mar-21 INTERNAL MEDICINE
Q7412
Q6767
LOPEZ VAZQUEZ, MANUEL , MD
LOPEZ, ANDREA DEL PILAR, MD
04-Mar-16
15-Dec-15
Q2328
LOPEZ, HUMBERTO JR, DO
11/7/2014
Q4183
Q4184
LOPEZ, JESSICA ANNE, MD
LOPEZ, KENDRICK, MD
5/1/2015
5/1/2015
P0849
LOPEZ, MARCO ANTONIO, MD
Q8289
LOPEZ, MICHAEL ANTHONY, MD
P7303
LOPEZ, RAUL JOSE, MD
7/15/2013
Q1206
Q8290
LOPEZ, REMBERTO , MD
LOPEZ, ROSALIND , MD
8/1/2014
16-May-16
P6449
P4591
P4778
Q2329
LOPEZ, SANDRA , MD
LOPEZ, SEBASTIAN , MD
LOPEZ-LLADO, SARA M, MD
LOPEZ-MENA, GERARDO, MD
5/1/2013
10/1/2012
11/1/2012
11/7/2014
Q5689
LOREE, ROBERT THOMAS, MD
8/14/2015
8/14/2020 RADIOLOGY
P8499
LOSEY, ERIN SUSAN, DO
12/6/2013
OBSTETRICS AND
Q7736
LOTT, BRITTON BENNETT, MD
01-Apr-16
01-Apr-21 RADIOLOGY
P7664
LOTT, FEYISETAN , DO
8/15/2013
8/15/2018
P3032
LOU, YANYAN , MD
5/1/2012
5/1/2017
K3313
LOUBE, DANIEL, MD
11/4/2011
11/4/2016
P6021
LOUGH, ERIK GREG, MD
4/1/2013
4/1/2018
8/26/2011
16-May-16
Secondary Specialty
(Self-Designated)
RICHMOND
INFECTIOUS
DISEASES
EMERGENCY
5/1/2020 MEDICINE
PEDIATRIC
Practice City
ANESTHESIOLOGY
OBSTETRICS AND
5/1/2018 GYNECOLOGY
BREAST IMAGING
FAMILY PRACTICE
HEMATOLOGY/ONCO
INTERNAL MEDICINE LOGY
CRITICAL CARE
PULMONARY
MEDICINE (IM)
MEDICINE
ABDOMINAL
GENERAL SURGERY SURGERY
Page 211 of 402
VA
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/28/2015 None
N/A
7/1/2015 None
N/A
SAN ANTONIO TX
KYLE
TX
CORPUS
CHRISTI
TX
ACTIVE
ACTIVE
30-May-16 None
08-Feb-16 None
N/A
N/A
ACTIVE
11/13/2014 None
N/A
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
LICENSE
ISSUED
5/6/2015 None
5/6/2015 None
N/A
N/A
8/26/2011 None
N/A
17-May-16 None
N/A
HOUSTON
TX
ACTIVE
EL PASO
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/7/2013 None
N/A
8/1/2014 None
24-May-16 None
N/A
N/A
EL PASO
TX
ROSWELL
NM
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
5/8/2013
11/12/2012
12/3/2012
11/11/2014
None
None
None
None
N/A
N/A
N/A
N/A
EL PASO
ACTIVE
8/21/2015 None
N/A
LICENSE
ISSUED
12/6/2013 None
N/A
11-Apr-16 None
N/A
8/15/2013 None
N/A
MESQUITE
INTERVENTIONAL
RADIOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Registration
Status of
Practice
Texas
State
License
TX
TX
FAYETTEVILLE AR
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
5/8/2012 None
N/A
SANTA ROSA
CA
ACTIVE
11/17/2011 None
N/A
AUSTIN
TX
ACTIVE
4/17/2013 None
N/A
License
Number
P9088
Q4458
Physician Name
Q2583
LOUIS, MARTHA, MD
LOVE, SAMUEL HAMMOND, MD
LOVELACE, SPENCER CHARLES,
MD
Q0108
P2031
LOVELESS, ALITA, MD
LOVOI, JOSEPH JASPER JR, MD
Q0308
Q2156
LOWRY, MICHAEL STERLING, DO
LOZANO, JOSE JAVIER, DO
P5287
Q0109
P0992
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
2/18/2014
OBSTETRICS
5/15/2015
5/15/2014
10/15/2014
OBSTETRICS &
GYNECOLOGICAL
5/2/2019 SURGERY
EMERGENCY
5/15/2019 MEDICINE
LOZANO, KRISTINA MARIE, MD
LU, GARY, MD
LU, LINH M, DO
1/15/2013
5/2/2014
9/15/2011
5/2/2019 ONCOLOGY
P9901
LU, YUXIN, MD
4/15/2014
P3033
P8800
LUBBE, WILHELM , MD
LUCAS, MARY GRACE, MD
5/1/2012
1/15/2014
P6022
LUCAS, MIKAEL, MD
4/15/2019 PATHOLOGY
RADIATION
5/1/2017 ONCOLOGY
EMERGENCY
4/1/2018 MEDICINE
P5546
LUCCHESE, CHRISTOPHER
FRANK, DO
LUCERO-UGALINO, LULITA
TAGUBA, MD
Q5476
LUCK, JOHN BENJAMIN, MD
P1784
12/3/2014
5/2/2014
2/1/2012
4/1/2013
1/2/2012
2/8/2013
8/3/2015
Q2157
LUDWIG, NICHOLAS SCOTT, MD
P7152
Q1446
P4779
LUE, JEFFREY , MD
LUEDKE, COLTEN CHRISTOPHER,
DO
LUGO, ESMERALDA , MD
8/15/2014
11/1/2012
Q1854
LUIKENS, DEDRICK SPENCER, DO
9/15/2014
Q1207
LUISI, ANDREW JOHN JR, MD
10/15/2014
7/1/2013
8/1/2014
Practice City
BRYAN
ONCOLOGY
FP/OSTEO
MANIPULATION
MEDICINE
EMERGENCY
8/3/2020 MEDICINE
DIAGNOSTIC
ORTHOPEDIC
SPORTS MEDICINE 7/1/2018 SURGERY
ORTHOPEDICS
ORTHOPEDIC
SPORTS MEDICINE
8/15/2019 SURGERY
(ORTH SURG)
EMERGENCY
9/15/2019 MEDICINE
CARDIOVASCULAR
CARDIOVASCULAR
8/1/2019 DISEASES
IMAGING
Page 212 of 402
FORT WORTH
LACKLAND
AFB
TEMPLE
FORT WORTH
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
Disciplinary
Status Date
2/18/2014 None
5/22/2015 None
N/A
N/A
12/5/2014 None
N/A
5/2/2014 None
2/20/2012 None
N/A
N/A
5/15/2014 None
11/6/2014 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
2/4/2013 None
5/16/2014 None
9/19/2011 None
N/A
N/A
N/A
4/15/2014 None
N/A
TX
ACTIVE
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
TX
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
SPRING
TX
ACTIVE
ACTIVE
6/22/2012 None
2/26/2014 None
N/A
N/A
KATY
TX
ACTIVE
4/3/2013 None
N/A
SHERMAN
TX
ACTIVE
2/2/2012 None
N/A
MISHAWAKA
IN
ACTIVE
2/18/2013 None
N/A
ACTIVE
8/28/2015 None
N/A
LACKLAND
AFB
TX
ACTIVE
10/21/2014 None
N/A
PLANO
TX
ACTIVE
7/29/2013 None
N/A
FORT WORTH TX
ACTIVE
ACTIVE
8/25/2014 None
11/5/2012 None
N/A
N/A
ACTIVE
10/9/2014 None
N/A
ACTIVE
8/5/2014 None
N/A
WILLIAMSVILL
E
NY
License
Number
Physician Name
P5547
LUKE, MANJU, DO
P3383
P5103
P5103
P5103
LUM, ALBERT WAI-MING, MD
LUNA, JEFFREY LEE, MD
P7153
LUNA, RENE IMMANUEL, MD
LUNDY, JONATHAN BERGENDAHL,
MD
Q8101
dicaid
dicaid
Agreement
End Date
Designated)
2/8/2013
6/1/2012
12/17/2012
12/17/2012
12/17/2012
7/1/2013
02-May-16
P7802
LUNG, JOHN, MD
8/30/2013
P6213
LUNSFORD, ALISON JOAN, MD
4/12/2013
P5548
LUNSFORD, JEROD, MD
Q6958
Q4186
LUNSFORD, KERI ELIZABETH, MD
LUONG, THO MINH, DO
15-Jan-16
5/1/2015
P3384
P7803
P9640
LUPO, PAMELA , MD
LUPTON, DREW TAYLOR, DO
LURAGUIZ, NATALIA , MD
6/1/2012
8/30/2013
4/1/2014
P6863
Q5022
LUSINS, JOHN O III, MD
LUSK, KATHERINE M, MD
Q2336
LUTHAR, ANSHU, MD
11/7/2014
Q7916
LUU, DAI CHU NGUYEN, MD
15-Apr-16
Q0965
LUU, HOA NGOC, MD
7/15/2014
2/8/2013
6/3/2013
7/1/2015
TM00542 LY, JUSTIN, MD
5/15/2013
Q0966
7/15/2014
LYBBERT, MONTY REX, MD
Secondary Specialty
(Self-Designated)
INTERNAL MEDICINE
GERIATRIC MEDICINE
FAMILY MEDICINE
OBSTETRICS AND
7/1/2018 GYNECOLOGY
02-May-21 TRAUMATIC SURGERY GENERAL SURGERY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
PEDIATRIC
PEDIATRICS
EMERGENCY
2/8/2018 MEDICINE
TRANSPLANT
15-Jan-21 GENERAL SURGERY SURGERY
NEURODEVELOPMEN
TAL DISABILITIES
6/1/2017 (PEDIATRICS)
CHILD NEUROLOGY
FORENSIC
6/3/2018 PSYCHIATRY
PSYCHIATRY
7/1/2020 PEDIATRICS
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
FORT WORTH TX
FORT WORTH TX
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
FORT HOOD
TX
2/8/2013 None
6/11/2012
12/20/2012
12/20/2012
12/20/2012
Disciplinary
Status Date
N/A
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
7/11/2013 None
N/A
ACTIVE
16-May-16 None
N/A
LICENSE
ISSUED
8/30/2013 None
N/A
AMARILLO
TX
ACTIVE
4/29/2013 None
N/A
AMARILLO
TX
ACTIVE
2/18/2013 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
19-Jan-16 None
5/5/2015 None
N/A
N/A
HOUSTON
TX
MAGNOLIA
CORPUS
CHRISTI
HOUSTON
AR
ACTIVE
ACTIVE
ACTIVE
6/11/2012 None
9/4/2013 None
4/4/2014 None
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/10/2013 None
7/13/2015 None
N/A
N/A
11/7/2014 None
N/A
ACTIVE
19-Apr-16 None
N/A
ACTIVE
7/17/2014 None
N/A
7/3/2013 None
N/A
7/15/2014 None
N/A
TX
TX
HEMATOLOGY/ONCOL
15-Apr-21 OGY
TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
SHREVEPORT LA
DIAGNOSTIC
5/15/2018 RADIOLOGY
POWAY
CA
EMERGENCY
7/15/2019 MEDICINE
Page 213 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
Q5023
LYNCH, BERNARD ANDREW, MD
Q4799
LYNDS, ROSS TUCKER, MD
Q7917
LYON, STEPHEN MICHAEL, DO
Q8292
LYONS, CARLY ELIZABETH, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
7/1/2015
7/1/2020 GYNECOLOGY
EMERGENCY
EMERGENCY
15-Apr-16
15-Apr-21 MEDICINE
MEDICINE
16-May-16
PEDIATRIC
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
7/10/2015 None
N/A
6/12/2015 None
N/A
ABILENE
COLLEGE
STATION
TX
ACTIVE
26-Apr-16 None
N/A
TX
ACTIVE
18-May-16 None
N/A
LITTLE ROCK
AR
ACTIVE
8/31/2015 None
N/A
LICENSE
ISSUED
6/1/2015 None
N/A
TX
ACTIVE
7/4/2014 None
N/A
Q5858
LYONS, KAREN , MD
Q4628
Q0785
LYTLE, BRUCE WHITNEY, MD
LYTLE, HEATHER MARY SPONSEL,
MD
6/27/2014
8/28/2020 RADIOLOGY
THORACIC
CARDIOVASCULAR
6/1/2020 SURGERY
OBSTETRICS AND
P1350
MA, SHING-LU, MD
11/4/2011
INTERNAL MEDICINE BAKERSFIELD CA
ACTIVE
11/18/2011 None
N/A
Q1208
MAANI, NATALIA R, MD
8/1/2014
ACTIVE
8/15/2014 None
N/A
8/1/2014
GALVESTON
TX
ACTIVE
9/4/2014 None
N/A
DECATUR
TX
ACTIVE
6/19/2013 None
N/A
TX
ACTIVE
7/16/2014 None
N/A
CARDIOLOGY
MIAMI
FL
ACTIVE
4/15/2013 None
N/A
DALLAS
DALLAS
LUBBOCK
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
11/18/2013 None
12/8/2014 None
2/4/2015 None
N/A
N/A
N/A
P3192
MAASSEN, NICHOLAS H, MD
MABANTA, SHEILAINE RODRIGO,
MD
MACCONMARA, MALCOLM POL,
MD
MACEDO, FRANCISCO YURI
BULCAO, MD
MACHANNAFORD, JUAN CARLOS,
MD
MACHI, ANTHONY THOMAS, MD
MACHIN, AMBER, MD
MACIAS CEDENO, FRANZ WILLIAM,
MD
OBSTETRICS
SANTA PAULA CA
Q1209
ORTHOPEDIC
8/1/2019 SURGERY
RADIATION
6/14/2018 ONCOLOGY
TRANSPLANT
7/15/2019 SURGERY
BROOKLYN
NY
5/18/2012 None
N/A
P8271
P4592
Q0666
MACIAS, LAURA, MD
MACK, TOREY L, MD
MADADI, PRAVEEN REDDY, MD
TX
SC
11/1/2013 None
10/3/2012 None
6/18/2014 None
N/A
N/A
N/A
P0629
MADAIN, SAFI B, DO
HOUSTON
ANDERSON
BATON
ROUGE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LA
ACTIVE
8/3/2011 None
N/A
Q3912
MADAN, NITIN, MD
SAN ANTONIO TX
ACTIVE
4/14/2015 None
N/A
P6999
Q0967
P6214
P8154
Q2585
Q3042
8/28/2015
Practice City
Registration
Status of
Practice
Texas
State
License
6/1/2015
6/14/2013
7/15/2014
4/12/2013
10/15/2013
12/3/2014
2/2/2015
CARDIOVASCULAR
10/15/2018 SURGERY
2/2/2020 PEDIATRICS
CARDIOVASCULAR
SURGERY
DALLAS
5/15/2012
11/1/2013
10/1/2012
6/16/2014
NEONATOLOGY
EMERGENCY
8/1/2016 MEDICINE
PEDIATRICS,
Page 214 of 402
8/1/2011
4/10/2015
License
Number
Physician Name
Q6873
MADAN, PANKAJ, MD
Q3403
MADAN, ROHIT, MD
dicaid
dicaid
Agreement
End Date
Designated)
06-Jan-16
3/3/2015
P3385
MADAPPA, TARUN, MD
6/1/2012
Q3729
MADAR, MERCI, MD
4/1/2015
P9394
MADDEN, BRYAN PATRICK, MD
3/17/2014
Q1662
Q0968
MADDEN, KEVIN, MD
MADERO, GUILLERMO , MD
8/29/2014
7/15/2014
P5411
Q5219
MADHANI, NEAL BHAGWANJI, MD
MADHAVAN, RANGANATHAN
GURU, MD
MADHRIRA, MACHAIAH
MUTHANNA, MD
Q3730
MADILL, JUSTIN JEFFREY, DO
Q7413
P6023
MADISON, ADRIENNE NICOLE, MD
MADNI, SYED A, MD
04-Mar-16
4/1/2013
Q2587
MADUPUR, MUKESH KUMAR, MD
12/3/2014
Q1855
9/15/2014
P2896
MAENZA, RICHARD, MD
MAGADAN, ALEJANDRO ALFONSO,
MD
P1667
MAGEE, JEFFREY A, MD
L0391
MAGEE, MICHAEL ALLEN, MD
8/15/2014
Q6959
MAGUCHI ALDRETE, MEGUMI , MD
15-Jan-16
Q0112
MAHAJAN, NITIN, MD
P0757
2/1/2013
EMERGENCY
4/1/2020 MEDICINE
EMERGENCY
3/17/2019 MEDICINE
7/15/2015
EMERGENCY
4/1/2020 MEDICINE
EMERGENCY
04-Mar-21 MEDICINE
12/15/2011
5/2/2014
PULMONARY
CRITICAL CARE
MEDICINE
SAN ANTONIO TX
15-Jan-21 GERIATRICS
INTERVENTIONAL
5/2/2019 CARDIOLOGY
TX
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
13-Jan-16 None
N/A
3/3/2015 None
N/A
ACTIVE
LICENSE
ISSUED
6/26/2012 None
N/A
4/1/2015 None
N/A
ACTIVE
4/2/2014 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
9/3/2014 None
8/19/2014 None
N/A
N/A
PITTSBURGH
ACTIVE
LICENSE
ISSUED
2/5/2013 None
N/A
8/15/2011 None
N/A
ACTIVE
8/26/2015 None
N/A
ACTIVE
4/13/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
08-Mar-16 None
4/5/2013 None
N/A
N/A
12/3/2014 None
N/A
PA
FORT WORTH TX
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
HOSPITALIST
12/3/2019 RADIOLOGY
EMERGENCY
9/15/2019 MEDICINE
4/13/2017 NEUROLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
12/15/2016 OGY
CORPUS
CHRISTI
HUMBLE
8/29/2019 PALLIATIVE MEDICINE PEDIATRICS
7/15/2019 INTERNAL MEDICINE GERIATRICS
EMERGENCY
2/1/2018 MEDICINE
4/13/2012
Practice City
3/3/2020 PSYCHIATRY
8/15/2011
4/1/2015
Secondary Specialty
(Self-Designated)
CARDIOVASCULAR
DISEASES
Registration
Status of
Practice
Texas
State
License
KINGWOOD
DANBURY
TX
CT
SHARON
PA
ACTIVE
9/26/2014 None
N/A
BETHESDA
MD
ACTIVE
4/20/2012 None
N/A
DALLAS
TX
ACTIVE
12/22/2011 None
N/A
TEMPLE
TX
ACTIVE
8/26/2014 None
N/A
HOSPITALIST
PENSACOLA
FL
ACTIVE
18-Jan-16 None
N/A
CARDIOLOGY
EL PASO
TX
ACTIVE
5/14/2014 None
N/A
VASCULAR
NEUROLOGY
Page 215 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1668
P4593
MAHALINGAM, DEVALINGAM , MD
MAHAND, JENNIFFIER M, MD
12/15/2011
10/1/2012
12/15/2016 ONCOLOGY
Q2159
10/15/2014
Q6537
MAHARAJ, NIRMALA NANDINI, MD
MAHASNEH, OMAR ALI
MOHAMMAD, MD
11/16/2015
Q7071
Q5691
MAHER, STEVEN MICHAEL, DO
MAHESHWARI, SURBHI, MD
01-Feb-16
8/14/2015
EMERGENCY
01-Feb-21 MEDICINE
P5104
MAHLMANN, MICHAEL RAY, MD
12/17/2012
P5104
12/17/2012
P5104
12/17/2012
P3035
MAHMOOD, USAMA , MD
Q8294
Q5026
Q3229
P8272
MAHMOUD, AHMED, MD
MAHMOUD, ROLA ABDELRAHMAN
MOSTAFA , MD
MAHMOUDI, MAHYAR, MD
MAHNOOR, REESHA , MD
P1352
MAI, FLOWER HOANG, DO
11/4/2011
Q4189
P7947
MAI, KIM-BINH THI, MD
MAI, VINH TUAN, MD
5/1/2015
9/16/2013
Q3547
5/1/2012
16-May-16
7/1/2015
2/13/2015
11/1/2013
3/16/2015
Secondary Specialty
(Self-Designated)
Practice City
HEMATOLOGY/ONCO
LOGY
SAN ANTONIO TX
BAYTOWN
TX
HARPERS
FERRY
WV
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
ACTIVE
1/12/2012 None
10/17/2012 None
N/A
N/A
ACTIVE
11/6/2014 None
N/A
AMARILLLO
TX
ACTIVE
11/20/2015 None
N/A
AUSTIN
TX
ACTIVE
ACTIVE
03-Mar-16 None
8/19/2015 None
N/A
N/A
TX
ACTIVE
1/1/2013 None
N/A
TX
ACTIVE
1/1/2013 None
N/A
RADIATION
5/1/2017 ONCOLOGY
PHYSICAL MED. &
TX
ACTIVE
LICENSE
ISSUED
1/1/2013 None
N/A
5/1/2012 None
N/A
7/1/2020 NEUROLOGY
ENDOCRINOLOGY,
DIABETES AND
Q8744
Q1780
P0431
MAINALI, SHRADDHA , MD
MAIRURA, EDWARD MASENGO,
MD
MAITRA, ANIRBAN, MD
MAJUMDAR, AYANAVA, MD
10-Jun-16
8/29/2014
7/15/2011
3/16/2020 NEUROLOGY
ORTHOPEDIC
10-Jun-21 SURGERY
8/29/2019 PATHOLOGY
Q8102
P2033
MAKABALI, REYNALDO LIMPIN, MD
MAKADIA, PARIN M, MD
02-May-16
2/1/2012
2/1/2017 NEPHROLOGY
Q0668
MAKAM, ALOK , MD
6/16/2014
Registration
Status of
Practice
Texas
State
License
PAIN & SPINE
BRIDGEPORT WV
ACTIVE
10-Jun-16 None
N/A
HOUSTON
TX
INTERNAL MEDICINE AMARILLO
TX
ACTIVE
ACTIVE
ACTIVE
7/20/2015 None
2/17/2015 None
11/12/2013 None
N/A
N/A
N/A
SULPHUR
INTERNAL MEDICINE SPRINGS
TX
ACTIVE
11/10/2011 None
N/A
OPHTHALMOLOGY
HOUSTON
TX
ACTIVE
ACTIVE
6/1/2015 None
11/12/2013 None
N/A
N/A
VASCULAR
NEUROLOGY
DALLAS
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/23/2015 None
N/A
10-Jun-16 None
9/3/2014 None
7/22/2011 None
N/A
N/A
N/A
ACTIVE
ACTIVE
04-May-16 None
2/10/2012 None
N/A
N/A
ACTIVE
6/17/2014 None
N/A
ORTHOPEDICS
DALLAS
HOUSTON
INTERNAL MEDICINE PALESTINE
TX
TX
TX
GENERAL PRACTICE LOS ANGELES CA
INTERNAL MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
HOUSTON
TX
Page 216 of 402
License
Number
P1099
Physician Name
MAKAM, RAGHAVENDRA CHARAN
PARTHASARATHI, MD
P7497
P4480
dicaid
dicaid
Agreement
End Date
Designated)
10/3/2011
MAKEY, IAN ANDREW, MD
MAKHLOUF, TONY , MD
8/1/2013
9/17/2012
P7154
MAKINDE, EDILEOLA, MD
7/1/2013
P2292
MAKKAR, AKASH, MD
3/1/2012
Q8745
MAKNOJIA, ASIF , MD
MAKOHONIUK, LESLIE WILLIAM,
MD
OBSTETRICS AND
7/1/2018 GYNECOLOGY
CARDIAC
ELECTROPHYSIOLOG
3/1/2017 Y
NEUROLOGICAL
10-Jun-21 SURGERY
P0758
10-Jun-16
Q7415
P3195
MAKWANA, HEMRAJ R, MD
MALARCHER, ANGELA, MD
MALAS, AMER, MD
MALATESTA MUNCHER, ROSSANA,
MD
MALAVE, SAMANTHA D, MD
04-Mar-16
5/15/2012
INTERVENTIONAL
PEDIATRIC
P0432
MALBAS, ANTONIO CABRERA, MD
7/15/2011
P8695
MALBAS, MARJORIE ANN , MD
Q8550
Q2015
P7948
P6455
MALDONADO CORCHADO,
ENRIQUE R, MD
MALDONADO, CESAR ALFREDO,
MD
MALDONADO, PEDRO ANTONIO,
MD
Q3548
Q8103
Q1664
8/15/2011
01-Jun-16
10/1/2014
9/16/2013
1/3/2014
02-May-16
8/29/2014
Secondary Specialty
(Self-Designated)
Practice City
HENDERSON
Registration
Status of
Practice
Texas
State
License
5/1/2013
OBSTETRICS AND
5/1/2018 GYNECOLOGY
MALHOTRA, DEEPAK, MD
3/16/2015
CARDIOVASCULAR
3/16/2020 SURGERY
Q6649
MALI, RAJESH, MD
12/4/2015
Q6649
MALI, RAJESH, MD
04-Dec-15
Disciplinary
Status Date
TX
ACTIVE
10/13/2011 None
N/A
GENERAL SURGERY SAN ANTONIO TX
HOSPITALIST
RIO RANCHO NM
ACTIVE
ACTIVE
8/6/2013 None
12/5/2012 None
N/A
N/A
CARDIOVASCULAR
DISEASES
BALTIMORE
MD
ACTIVE
8/7/2013 None
N/A
ANN ARBOR
MI
ACTIVE
3/6/2012 None
N/A
SAN ANTONIO TX
ACTIVE
20-Jun-16 None
N/A
LINCOLN
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/18/2011 None
N/A
01-Jun-16 None
10/3/2014 None
9/20/2013 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
07-Mar-16 None
5/22/2012 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
8/11/2011 None
N/A
1/3/2014 None
N/A
ACTIVE
09-May-16 None
N/A
ACTIVE
9/5/2014 None
N/A
5/8/2013 None
N/A
NE
CRITICAL CARE
MEDICINE (IM)
SAN ANTONIO TX
EDINBURG
TX
HOUSTON
DICKINSON
CORPUS
CHRISTI
Registration
Status Date
Disciplinary
Status of
Texas
License
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
UROGYNECOLOGY
THORACIC
CARDIOVASCULAR
SURGERY
Page 217 of 402
SAN ANTONIO TX
DALLAS
TX
ACTIVE
ABILENE
TX
ACTIVE
LICENSE
ISSUED
3/23/2015 None
N/A
12/4/2015 None
N/A
ACTIVE
11-Feb-16 None
N/A
NEW SMYRNA
BEACH
FL
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6649
MALI, RAJESH, MD
04-Dec-15
Q7416
MALIE, PATRICK MICHAEL, DO
04-Mar-16
01-Apr-16
4/1/2015
MALIGI, COURTNEY B , MD
Q3731
MALIK, AMBER, MD
P8598
P7307
Q0502
MALIK, AMINA, MD
MALIK, AMYN, MD
MALIK, ANIQA SAAFAN, MD
P5675
Q7739
MALIK, ATIF BABAR, MD
MALIK, FAHAD MUBARIK, MD
3/1/2013
01-Apr-16
6/2/2019 PEDIATRICS
PHYSICAL MED. &
P0994
MALIK, MOHAMMAD IBRAHIM, MD
9/15/2011
Q3913
MALIK, MOHAMMAD TARIQ, DO
4/10/2015
P6024
MALIK, OSMAN , MD
4/1/2013
Q6960
P7000
P0995
P1100
MALIK, TAMER AYAD, MD
MALIREDDY, KISHORE KUMAR
REDDY , MD
MALIYIL, JEPSIN ANAT, MD
MALL, SANJEEV KUMAR, MD
15-Jan-16
15-Jan-21 GENERAL SURGERY
6/14/2013
9/15/2011
10/3/2011
Q2462
MALLICK, DEOBRAT CHANDRA, MD
P9220
MALLIKARJUN, CHAITHANYA, MD
P6674
MALONE, LOREN, MD
5/15/2013
Q1665
MALOUF, NICOLE ELAINE, MD
8/29/2014
11/17/2014
3/3/2014
Practice City
NEW SMYRNA
BEACH
FL
CORPUS
CHRISTI
TX
PALLIATIVE
MEDICINE
Q7738
12/16/2013
7/15/2013
6/2/2014
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
HOUSTON
OPHTHALMOLOGY RECONST SURGERY
CARDIOLOGY
GRAPEVINE
EL PASO
11-Feb-16 None
N/A
ACTIVE
23-Mar-16 None
N/A
ACTIVE
LICENSE
ISSUED
05-Apr-16 None
N/A
4/1/2015 None
N/A
12/16/2013 None
8/14/2013 None
6/17/2014 None
N/A
N/A
N/A
4/3/2013 None
06-Apr-16 None
N/A
N/A
10/17/2011 None
N/A
4/10/2015 None
N/A
4/8/2013 None
N/A
14-Apr-16 None
N/A
7/3/2013 None
10/28/2011 None
10/14/2011 None
N/A
N/A
N/A
11/17/2014 None
N/A
ACTIVE
5/16/2014 None
N/A
TX
ACTIVE
5/20/2013 None
N/A
TX
ACTIVE
9/4/2014 None
N/A
TX
TX
TX
PULMONARY
CRITICAL CARE
MEDICINE
FALLS
CHURCH
TX
VA
TRANSPLANT
SURGERY
GASTROENTEROLOG
3/3/2019 Y
HEPATOLOGY
PEDIATRIC CRITICAL
CARE MEDICINE
DALLAS
EMERGENCY
NEW
8/29/2019 MEDICINE
BRAUNFELS
Page 218 of 402
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
WACO
Disciplinary
Status Date
ACTIVE
PAIN MANAGEMENT
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
GASTROENTEROLOG
5/1/2015
5/1/2020 Y
PEDIATRICS
8/15/2014
Q4190
Q1447
MALOWITZ, STANTON MICHAEL,
MD
MALOY, MICHAEL JAMES JR, MD
P9091
MALYALA, RAJASEKHAR , MD
P3037
MAMILLAPALLI, PADMAJA DEVI, MD
Q2338
P0252
MAMINDLA, KAVITHA, MD
MAMMEN, TONY, MD
P3386
MANASA, POONAM MEHTA, MD
Q7920
Q6062
MANCEAU-KHA, AMANDA RAE, DO
MANCIA, EDUARDO , MD
15-Apr-16
9/15/2015
Q3914
MANCZKO, THADDEUS JOHN, MD
4/10/2015
2/18/2014
11/7/2014
7/1/2011
PHYSICAL MED. &
OBSTETRICS AND
EMERGENCY
4/10/2020 MEDICINE
16-May-16
Q8296
MANDA, YUGANDHAR REDDY, MD
Q4191
MANDAL, SMITA DINESH, MD
Q1857
MANDAPALLI, SRINIVASA RAO, MD
P0632
MANDAVA, ANEEL, MD
8/1/2011
INTERVENTIONAL
8/1/2016 RADIOLOGY
Q3549
MANDELL, JOANNA, MD
3/16/2015
5/1/2015
9/15/2014
Q5481
MANDELL, RYAN SCOTT, DO
8/3/2015
Q8104
P6864
MANDOLA, VINCENT JOSEPH, MD
MANDYAM, SRINAND ANANDAM,
MD
Q4801
MANE, SHIKHA KAUSHIK, MD
P3387
MANEK, NEIL RAMESH, MD
6/1/2012
Q5482
MANGALAT, NEAL, MD
8/3/2015
02-May-16
6/3/2013
6/12/2015
HOUSTON
HARLINGEN
TX
TX
5/1/2012
6/1/2012
Practice City
Registration
Status of
Practice
Texas
State
License
PA
ARLINGTON
TX
AUTIN
LUFKIN
TX
TX
ELECTROPHYSIOLO
GY
EMERGENCY
8/3/2020 MEDICINE
N/A
N/A
2/18/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
6/1/2012 None
N/A
11/7/2014 None
7/12/2011 None
N/A
N/A
6/8/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
18-Apr-16 None
9/17/2015 None
N/A
N/A
4/10/2015 None
N/A
19-May-16 None
N/A
5/1/2015 None
N/A
9/15/2014 None
N/A
8/1/2011 None
N/A
3/16/2015 None
N/A
8/3/2015 None
N/A
06-May-16 None
N/A
6/6/2013 None
N/A
6/12/2015 None
N/A
6/1/2012 None
N/A
8/4/2015 None
N/A
PLANO
TX
HOUSTON
TX
ACTIVE
KILLEEN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
DIAGNOSTIC
RADIOLOGY
8/3/2020 CARDIOLOGY
5/8/2015 None
8/25/2014 None
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ALLERGY AND
IMMUNOLOGY
NEPHROLOGY
EMERGENCY
MEDICAL SERVICES
Page 219 of 402
HOUSTON
TX
Disciplinary
Status Date
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
INTERVENTIONAL
CARDIOLOGY
16-May-21 CARDIOLOGY
BRYN MAWR
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
License
Number
Q8297
Q4192
Q5028
Q8299
Q5029
Physician Name
MANGEL, RYAN SEAN, MD
MANGONA, KATE LOUISE
MORENG, MD
MANGONA, VICTOR SUVA-VIOLA,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
16-May-16
16-May-21 MEDICINE
FAMILY MEDICINE
PEDIATRIC
DIAGNOSTIC
5/1/2015
5/1/2020 RADIOLOGY
RADIOLOGY
RADIATION
7/1/2015
7/1/2020 ONCOLOGY
16-May-16
7/1/2015
P3197
MANI, JULIE MARY, MD
MANI, PREETHI , MD
MANJAPPA, NAGARATHNA
GOWDA, MD
P2726
MANKAN, NAGENDER, MD
4/2/2012
P2727
MANKIDY, BABITH JOSEPH, MD
4/2/2012
P3647
MANKIN, SARAH ASHLEY, DO
Q4193
MANN, BARBARA, MD
P9092
MANN, DARVY, MD
5/15/2012
6/15/2012
5/1/2015
2/18/2014
7/15/2015
01-Feb-16
Q6228
MANN, MONICA JOY SUZANNE, MD
10/1/2015
P5415
P4481
MANN, SHANNON ELIZABETH, DO
MANNE, HARI KRISHNA, MD
2/1/2013
9/17/2012
2/1/2018 PATHOLOGY
Q0312
5/15/2014
11/4/2011
P0434
Q5692
MANOHARAN, UMAVATHY, MD
MANONGAS, MARIA AURORA
RAYPON, MD
MANOUKIAN, GEORGE EDWARD,
MD
MANSON, PAUL VINCENT, MD
P8599
P0760
MANSON, WILLIAM CLARK, MD
MANSOOR, SABA, MD
12/16/2013
8/15/2011
IRVING
AL
HOSPITALIST
Disciplinary
Status Date
19-May-16 None
N/A
ACTIVE
5/8/2015 None
N/A
ACTIVE
7/3/2015 None
N/A
30-May-16 None
7/6/2015 None
N/A
N/A
5/15/2012 None
N/A
ACTIVE
4/6/2012 None
N/A
ACTIVE
4/5/2012 None
N/A
TX
ACTIVE
6/18/2012 None
N/A
MO
ACTIVE
LICENSE
ISSUED
5/6/2015 None
N/A
2/18/2014 None
N/A
TX
PHILADELPHIA PA
CRITICAL CARE
ANESTHESIOLOGY
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
TX
MANN, DEEPINDER , DO
MANN, MICAH DAVID, MD
7/15/2011
8/14/2015
BIRMINGHAM
INTERNAL MEDICINE
HEMATOLOGY/ONCOL
4/2/2017 OGY
EL PASO
PULMONARY
CRITICAL CARE
OSTEO
MANIPULATIVE
MEDICINE
LUBBOCK
CRITICAL CARE
Q5220
Q7072
P1354
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
LICENSE
ISSUED
GALVESTON
AUSTIN
TX
TX
ACTIVE
ACTIVE
7/17/2015 None
26-Feb-16 None
N/A
N/A
MIDLAND
TX
ACTIVE
10/2/2015 None
N/A
FARGO
ND
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/14/2013 None
10/8/2012 None
N/A
N/A
5/15/2014 None
N/A
11/4/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
7/20/2011 None
8/19/2015 None
N/A
N/A
12/16/2013 None
8/23/2011 None
N/A
N/A
LUBBOCK
EMERGENCY
12/16/2018 MEDICINE
ANESTHESIOLOGY
Page 220 of 402
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5550
MANSOOR, TARIQ , MD
2/8/2013
Q5860
MANSOOR, UROOJ, MD
8/28/2015
Secondary Specialty
(Self-Designated)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
P1565
MANSOUR, ALFRED AMEEN III, MD
12/1/2011
PEDIATRIC
Q0970
MANSOUR, IBRAHIM, MD
7/15/2014
HOSPITALIST
Q6063
MANSOUR, RANA, MD
9/15/2015
HOSPITALIST
P5417
MANSOURKHANI, SHIVA , MD
Q6651
MANTENA, YOGITA, DO
12/4/2015
Q6651
MANTENA, YOGITA, DO
04-Dec-15
Q6651
MANTENA, YOGITA, DO
04-Dec-15
CHILD AND
ADOLESCENT
2/1/2018 PSYCHIATRY
EMERGENCY
12/4/2020 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
P2487
MANTHENA, SWAPNA, MD
MANUKYAN, MARIUXI CHERRIE ,
MD
3/15/2012
Q0115
P8943
2/1/2013
5/2/2014
P6216
P5678
Q7230
P6865
MAPES, KENNETH LEROY, MD
6/3/2013
4/12/2018 RADIOLOGY
EMERGENCY
6/3/2018 MEDICINE
P7665
P0633
MARAKATHAM, SREEDEVI, MD
MARANCENBAUM, ARIE , MD
8/15/2013
8/1/2011
P6026
GALVESTON
TX
GREEENWOO
D VILLAGE
CO
COLLEGE
STATION
TX
PSYCHIATRY
INTERNAL MEDICINE
8/1/2014
EMERGENCY
8/1/2019 MEDICINE
4/1/2013
4/12/2013
3/1/2013
16-Feb-16
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
2/21/2013 None
N/A
8/28/2015 None
N/A
ACTIVE
12/6/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/21/2014 None
N/A
9/15/2015 None
N/A
ACTIVE
LICENSE
ISSUED
2/25/2013 None
N/A
12/4/2015 None
N/A
INTERNAL MEDICINE SUGARLAND
TX
ACTIVE
26-Jan-16 None
N/A
INTERNAL MEDICINE SUGARLAND
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
26-Jan-16 None
N/A
3/15/2012 None
N/A
5/2/2014 None
UNDER
BOARD
2/24/2014 ORDER
N/A
CRITICAL CARE
5/2/2019 TRAUMATIC SURGERY (TRAUMA)
MANUSOV, ERON GRANT, MD
MANZANARES, MARIAH NICHOL,
MD
MANZANO, JOANNA GRACE MAYO,
MD
MANZOUL, SAAD MAHMOUDADAM, MD
MAPAKSHI, NANDANA, MD
MAPAKSHI, SRIKAR REDDY, MD
Q1213
2/7/2014
Practice City
Registration
Status of
Practice
Texas
State
License
EDINBURG
TX
ACTIVE
DALLAS
TX
ACTIVE
8/4/2014 None
N/A
TX
ACTIVE
4/18/2013 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
4/19/2013 None
4/11/2013 None
21-Apr-16 None
N/A
N/A
N/A
GENOA
OH
6/19/2013 None
N/A
BAYTOWN
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/15/2013 None
8/19/2011 None
N/A
N/A
HOUSTON
MUSCULOSKELETAL
RADIOLOGY
PLANO
NEPHROLOGY
Page 221 of 402
2/18/2014
License
Number
Physician Name
Q5861
Q2923
MARANTO, LISMAIDA, DO
MARARAC, CELESTINE ANN, MD
P2728
MARCUM, BENJAMIN AUSTIN, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/28/2015
8/28/2020 MEDICINE
1/15/2015
4/2/2012
Secondary Specialty
(Self-Designated)
Practice City
DALLAS
NICEVILLE
Registration
Status of
Practice
Texas
State
License
TX
FL
Disciplinary
Status Date
9/1/2015 None
1/21/2015 None
N/A
N/A
4/2/2012 None
N/A
7/15/2015 None
N/A
ACTIVE
LICENSE
ISSUED
DELINQUEN
T-NON
PAYMENT
10/12/2015 None
N/A
1/15/2015 None
N/A
14-Apr-16 None
N/A
TX
ACTIVE
11/12/2013 None
N/A
SAN ANTONIO TX
THE
WOODLANDS TX
ACTIVE
7/20/2011 None
N/A
ACTIVE
17-Dec-15 None
N/A
ACTIVE
11/15/2011 None
N/A
CRITICAL CARE
MEDICINE (IM)
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Q5221
MARCUS, JONATHAN EVAN, MD
7/15/2015
Q6229
MARCUS, MONICA LAUREN, DO
10/1/2015
Q2924
MARCUS, PETER SEBASTIAN, MD
1/15/2015
PEDIATRIC
OBSTETRICS AND
Q6963
15-Jan-16
15-Jan-21 ANESTHESIOLOGY
P8274
MARDAKH, SIMON, MD
MARDONES, MABEL ALEJANDRA,
MD
11/1/2013
P0436
MAREN, CHRISTINE , DO
7/15/2011
Q6769
MARES, JON WILLIAM, DO
15-Dec-15
P1101
MARFATIA, RINA SUDHIR, MD
MARGOLIS, MICHAEL JONATHAN,
MD
MARIANO, MARIA RIZZA DELIZO,
MD
10/3/2011
INFECTIOUS
10/3/2016 DISEASES
1/3/2014
ACTIVE
2/10/2014 None
N/A
3/15/2013
PLASTIC &
RECONSTRUCTIVE
01-Feb-21 SURGERY
ACTIVE
3/20/2013 None
N/A
ACTIVE
16-Feb-16 None
N/A
ACTIVE
ACTIVE
ACTIVE
04-Apr-16 None
4/3/2015 None
4/9/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
6/15/2015 None
11/13/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/14/2011 None
N/A
8/29/2014 None
N/A
P8697
P5840
Q7073
Q7740
Q3405
P2729
Q4802
Q6445
P1102
Q1667
MARICEVICH, MARCO ANDRE
BORGES RODRIGUES, MD
MARIGOWDA, LOKESH
KEBBEHUNDI, MD
MARIN, JOSE ALBERTO, MD
MARINA, SHADI, MD
MARINES COPADO, DIEGO
CARLOS, MD
MARIONI, NOE , MD
MARKAN, SANDEEP, MD
MARKETTO, DON LAWRENCE III,
DO
01-Feb-16
01-Apr-16
3/3/2015
4/2/2012
HOUSTON
ONCOLOGY
FP/OSTEO
MANIPULATION
MEDICINE
DALLAS
TX
TX
GENERAL SURGERY
PALLIATIVE
MEDICINE
FAYETTEVILLE NC
EL PASO
TX
HOSPITALIST
ROCKFORD
IL
6/12/2015
11/2/2015
COLON AND RECTAL
6/12/2020 SURGERY
10/3/2011
8/29/2014
Page 222 of 402
CARDIOTHORACIC
ANESTHESIOLOGY
MILWAUKEE
WI
License
Number
Physician Name
Q6230
MARKMAN, BRUCE SCOTT, MD
P3038
MARKO, NICHOLAS FRANK, MD
P3648
MARKS, LATOIA MONNEQUE, MD
P5206
MARKS, SONYA DENISE, MD
dicaid
dicaid
Agreement
End Date
Designated)
ORTHOPEDIC
10/1/2015
10/1/2020 SURGERY
NEUROLOGICAL
5/1/2012
5/1/2017 SURGERY
OBSTETRICS AND
6/15/2012
OBSTETRICS AND
1/4/2013
1/4/2018 GYNECOLOGY
Q8301
MARKUS, RICHARD WILLIAM, MD
16-May-16
Q7921
P3039
MARNENI, SHASHIDHAR RAO, MD
MARQUEZ, AMES TADEO, MD
15-Apr-16
5/1/2012
M3011
MARR, JONATHAN K, MD
P0437
MARSH, DAVID GEORGE JR, MD
5/1/2013
7/15/2011
Q1449
Q2016
MARSH, JILL WATERS, MD
MARSHALL, AMANDA LEA, MD
8/15/2014
10/1/2014
P7806
MARSHALL, LINDSAY ANNE, DO
8/30/2013
P8944
MARSO, STEVEN PATRICK, MD
2/7/2014
P7499
MARTE, MICHAEL, MD
8/1/2013
Q3916
MARTIKYAN, TIGRAN , MD
P2296
MARTIN, AMY RUTH, MD
Q3230
MARTIN, ANDREA ZIDD, MD
P7309
P8052
MARTIN, DONALD JOSEPH, MD
MARTIN, ELIZABETH MARIE, DO
P7500
MARTIN, ERIC BRANDON, MD
4/10/2015
3/1/2012
2/13/2015
7/15/2013
10/1/2013
8/1/2013
5/1/2017 PSYCHIATRY
PEDIATRIC
EMERGENCY
ORTHOPEDIC
7/15/2016 SURGERY
EMERGENCY
8/30/2018 MEDICINE
Secondary Specialty
(Self-Designated)
SPORTS MEDICINE
(ORTH SURG)
OBSTETRICS AND
GYNECOLOGY
PEDIATRICS,
CARDIOLOGY
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Practice City
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
RADIOLOGY
GASTROENTEROLOG
Y
Page 223 of 402
10/6/2015 None
N/A
5/3/2012 None
N/A
6/15/2012 None
N/A
TX
ACTIVE
2/11/2013 None
N/A
DALLAS
TX
ACTIVE
18-May-16 None
N/A
DALLAS
TX
ACTIVE
ACTIVE
02-May-16 None
5/23/2012 None
N/A
N/A
5/9/2013 None
N/A
7/15/2011 None
N/A
8/15/2014 None
10/7/2014 None
N/A
N/A
8/30/2013 None
N/A
2/7/2014 None
N/A
9/2/2013 None
N/A
4/10/2015 None
N/A
3/15/2012 None
N/A
2/13/2015 None
N/A
7/15/2013 None
10/16/2013 None
N/A
N/A
8/1/2013 None
N/A
DALLAS
TX
CARDIOVASCULAR
2/7/2019 DISEASES
HEMATOLOGY/ONCOL
8/1/2018 OGY
EMERGENCY
3/1/2017 MEDICINE
EMERGENCY
2/13/2020 MEDICINE
Disciplinary
Status Date
HOUSTON
FORT WORTH TX
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
Q6964
MARTIN, ERIK CHARLES, DO
P9646
P6217
MARTIN, JARED, DO
MARTIN, JOHN MATTHEW IV, MD
Q0504
MARTIN, JUAN JOSE, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
15-Jan-16
15-Jan-21 MEDICINE
EMERGENCY
4/1/2014
4/1/2019 MEDICINE
4/12/2013
NEUROLOGICAL
6/2/2014
6/2/2019 SURGERY
MARTIN, KIMBERLY CLAIRE, DO
MARTIN, LANCE STEVEN, MD
11/7/2014
2/8/2013
11/7/2019
2/8/2018
Q1668
MARTIN, NATHAN SCOTT, MD
8/29/2014
8/29/2019
P1566
MARTIN, PATRICIA, MD
12/1/2011
12/1/2016
Q4196
Q5693
MARTIN, ROBERT BENJAMIN, MD
MARTIN, ROBERT LEE, MD
5/1/2015
8/14/2015
5/1/2020
8/14/2020
Q8553
01-Jun-16
01-Jun-21
P6458
MARTIN, THOMAS GEORGE, MD
MARTINEZ GAMBA, GERMAN
NICOLAS, MD
MARTINEZ RUMAYOR, ABELARDO
ALFONSO, MD
MARTINEZ TORRES, CARLO OBET,
MD
P6219
MARTINEZ, ADRIANA , MD
4/12/2013
P7501
MARTINEZ, BRENDA NOEMI, MD
8/1/2013
8/1/2018 PEDIATRICS
Q1669
Q7418
MARTINEZ, ENRIQUE, MD
MARTINEZ, HIRAM ALBERTO, MD
P5418
MARTINEZ, JOSE LUIS JR, MD
Q7232
MARTINEZ, LAUREN CARTER, MD
Q6065
P9396
MARTINEZ, MARCOS MANUEL, MD
3/1/2013
9/15/2015
5/1/2013
8/29/2014
04-Mar-16
2/1/2013
16-Feb-16
3/17/2014
INTERVENTIONAL
TX
Disciplinary
Status Date
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
6/9/2014 None
N/A
SILVER
SPRING
LUBBOCK
MD
TX
ACTIVE
ACTIVE
11/13/2014 None
2/14/2013 None
N/A
N/A
MARSHALL
TX
ACTIVE
9/3/2014 None
N/A
FOGELSVILLE PA
ACTIVE
12/6/2011 None
N/A
DALLAS
TEMPLE
TX
TX
ACTIVE
ACTIVE
5/11/2015 None
8/20/2015 None
N/A
N/A
AMARILLO
TX
ACTIVE
03-Jun-16 None
N/A
ACTIVE
3/6/2013 None
N/A
21-Jan-16 None
N/A
4/1/2014 None
4/16/2013 None
N/A
N/A
9/22/2015 None
N/A
5/1/2013 None
N/A
4/12/2013 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
HUMBLE
TX
ACTIVE
2/15/2013 None
N/A
DALLAS
NEW
BRUNSWICK
TX
ACTIVE
29-Feb-16 None
N/A
NJ
ACTIVE
3/18/2014 None
N/A
FAMILY MEDICINE
ORTHOPEDIC
SURGERY
Page 224 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
CARDIOVASCULAR
SURGERY
EMERGENCY
2/1/2018 MEDICINE
16-Feb-21 RADIOLOGY
ORTHOPEDIC
3/17/2019 SURGERY
Practice City
IRVING
PEDIATRIC
INFECTIOUS DISEASE
FAMILY MEDICINE
FAMILY MEDICINE
EMERGENCY
MEDICINE
FAMILY MEDICINE
DIAGNOSTIC
RADIOLOGY
NEURO-RADIOLOGY
OBSTETRICS AND
GYNECOLOGY
ANESTHESIOLOGY
MEDICAL
TOXICOLOGY
EMERGENCY
(EMERGENCY
MEDICINE
MEDICINE)
Q2339
P5551
P5680
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
8/1/2013 None
N/A
8/29/2014 None
08-Apr-16 None
N/A
N/A
License
Number
Physician Name
P5679
MARTINEZ, MICHAEL JOEL, MD
Q7579
MARTINEZ, MONICA ANNE, MD
P7502
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
3/1/2013
3/1/2018 GENERAL SURGERY OTHER SPECIALTY
15-Mar-16
P1895
MARTINEZ, OSCAR JR, MD
MARTINEZ-MADRIGAL, EZEQUIEL,
MD
Q2463
MARTIROSYAN, ZARA, MD
11/17/2014
Q5695
Q2684
P6676
P0996
MARTUS, WESLEY DANIEL, MD
MARVIN, JOY D, MD
MARX, JULIE ERICA, MD
MASAND, RAMYA PRAKASH, MD
8/14/2015
12/15/2014
5/15/2013
9/15/2011
Q7419
MASCARENHAS, RANDHIR , MD
04-Mar-16
Q4804
Q6066
MASDEU, JOSE CRUZ, MD
MASHA, LUKE IVAN , MD
6/12/2015
9/15/2015
P8600
MASON, JOHN D, MD
P2488
P1567
MASON, SHAUNNA TORRANCE,
MD
MASOOD, FARAH , MD
P2145
P4675
MASOODI, NASSEER A, MD
MASRUR, FATIMA, MD
Q4806
P7503
MASSOUD, MONA , MD
MASSUMI, MAHSA ABOLFATHIAN,
MD
Q0118
MASSUMI, MEHRAN , MD
P2146
MASTERS, KEN , MD
Q5696
MASUD, ALI, MD
P9904
P1197
P4887
MATA, JOEL EDUARDO, MD
MATADEEN-ALI, CHANDRA, MD
MATAOUI, NOHA, MD
8/1/2013
1/17/2012
EMERGENCY
8/14/2020 MEDICINE
9/15/2016 PATHOLOGY
SPORTS MEDICINE 04-Mar-21 ORTHOPEDICS
12/16/2013
6/12/2020 NEUROLOGY
EMERGENCY
12/16/2018 MEDICINE
3/15/2012
12/1/2011
OBSTETRICS AND
2/10/2012
10/15/2012
6/12/2015
5/2/2014
8/14/2015
4/15/2014
10/17/2011
11/15/2012
WARREN
ST. FRANCIS
DALLAS
HOUSTON
MI
WI
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
HOUSTON
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
HOSPITALIST
SPORTS MEDICINE
(ORTH SURG)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
HOSPITALIST
ROCHESTER
NY
8/1/2013
2/10/2012
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
CARDIOVASCULAR
DISEASES
N/A
1/17/2012 None
N/A
11/17/2014 None
N/A
8/20/2015
12/24/2014
6/12/2013
9/20/2011
None
None
None
None
N/A
N/A
N/A
N/A
11-Mar-16 None
N/A
6/12/2015 None
10/26/2015 None
N/A
N/A
12/16/2013 None
N/A
3/15/2012 None
12/9/2011 None
N/A
N/A
2/10/2012 None
11/12/2012 None
N/A
N/A
6/12/2015 None
N/A
8/5/2013 None
N/A
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/16/2014 None
N/A
2/10/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
9/1/2015 None
N/A
4/15/2014 None
10/21/2011 None
11/29/2012 None
N/A
N/A
N/A
CARDIOVASCULAR
DISEASES
PAIN MANAGEMENT
10/17/2016 INTERNAL MEDICINE SLEEP MEDICINE
Page 225 of 402
8/1/2013 None
HOUSTON
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/25/2013 None
N/A
22-Mar-16 None
N/A
GLEN MILLS
PA
License
Number
P9398
P7668
Physician Name
MATHEN, TAHIRA , MD
MATHERS, RACHEL ELIZABETH,
MD
DIAGNOSTIC
7/1/2020 RADIOLOGY
12/6/2013
P7669
P1568
MATHEW, ASHA , MD
MATHEW, NEETHU MUPPADHYIL,
MD
MATHEW, PAUL, MD
8/15/2013
12/1/2011
Q7744
MATHEW, STEPHEN THOMAS, MD
01-Apr-16
ORTHOPEDIC
01-Apr-21 SURGERY
Q5865
MATHEW, TEENA, MD
8/28/2015
N3873
Q1215
MATHEWKUTTY, SHINY , MD
MATHEWS, EDWIN, MD
7/15/2015
8/1/2014
Q1216
P9647
Q8106
P3199
MATHEWS, JOHN , MD
MATHIS, HENRIETTE MERCEDES,
MD
MATHIS, SAMUEL ELI, MD
MATHUR, MONIKA, MD
Q1217
MATHUR, VINITA, MD
8/1/2014
ANATOMIC/CLINICAL
8/1/2019 PATHOLOGY
Q4198
MATIN, ABUSALEH, MD
5/1/2015
P8504
8/1/2014
4/1/2014
02-May-16
5/15/2012
10/1/2014
Practice City
MATINPOUR, KEYAN , MD
Q3045
MATTA, ANIL SRINIVAS, MD
2/2/2015
Q3046
2/2/2015
Q2340
MATTA, MANDEEP SINGH, MD
MATTHEWS, CHARLES HARRISON,
MD
Q1218
MATTHEWS, RYAN LAMBERT, MD
8/1/2014
INFECTIOUS
2/2/2020 DISEASES
RADIATION
11/7/2019 ONCOLOGY
PHYSICAL MED. &
Q3232
MATTHIESEN, RYAN ANDREW, DO
2/13/2015
INTERNAL MEDICINE
Page 226 of 402
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Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
3/21/2014 None
N/A
TEXAS CITY
TX
ACTIVE
8/21/2013 None
N/A
PARKER
CO
ACTIVE
LICENSE
ISSUED
7/9/2015 None
N/A
12/6/2013 None
N/A
ACTIVE
ACTIVE
8/22/2013 None
12/6/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
15-Jun-16 None
N/A
8/28/2015 None
N/A
NY
WI
ACTIVE
ACTIVE
7/31/2015 None
8/8/2014 None
N/A
N/A
TX
ACTIVE
9/3/2014 None
N/A
ID
TX
MA
ACTIVE
ACTIVE
ACTIVE
4/8/2014 None
04-May-16 None
6/4/2012 None
N/A
N/A
N/A
NASHVILLE
TN
CANANDAIGU
A
NY
ACTIVE
8/4/2014 None
N/A
ACTIVE
5/25/2015 None
N/A
HOUSTON
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
10/8/2014 None
N/A
2/2/2015 None
N/A
2/2/2015 None
N/A
11/7/2014 None
N/A
8/1/2014 None
N/A
2/13/2015 None
N/A
LAS CRUCES
NM
DALLAS
TX
BOISE
SUGAR LAND
HOLDEN
DERMATOLOGIC
SURGERY
Registration
Status of
Practice
Texas
State
License
DALLAS
INTERVENTIONAL
CARDIOLOGY
NEW YORK
WAUKESHA
HEMATOLOGY/ONCOL
8/1/2019 OGY
Q2017
11/7/2014
Secondary Specialty
(Self-Designated)
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
7/1/2015
G9036
MATHESON, MICHAEL ROBERT,
MD
dicaid
dicaid
Agreement
End Date
Designated)
INTERNAL MED - PREV
8/15/2013
8/15/2018 MED
TX
License
Number
Physician Name
P3041
MATUS, HEIDI L, MD
Q0119
MAUCH, BRIAN GERALD, MD
P8505
Q4199
MAUPIN, RACHEL CARTIER, DO
Q3560
P1198
Q5032
MAURITZ, AMY , MD
MAUSKAR, MELISSA MUSZYNSKI,
MD
MAVANI, GAURANG P, MD
MAXWELL, DANIEL , MD
Q4461
MAY, JASON ROSS, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
5/1/2012
5/2/2014
5/2/2019 PEDIATRICS
HOSPITALIST
12/6/2013
5/1/2015
3/16/2015
10/17/2011
7/1/2015
5/15/2015
DIAGNOSTIC
5/15/2020 RADIOLOGY
PEDIATRIC
P0634
MAY, MEGAN MICHELLE, MD
8/1/2011
Q0974
MAYA, TAHIR MOHMMAD, MD
7/15/2014
Q1672
MAYER, BRIAN, DO
8/29/2014
P8158
MAYNARD, LATOYA, MD
P7504
P5419
MAYOR, JOEY DAVID OSCAR, MD
MAYORGA, CHRISTIAN ANTONIO
JR, MD
Q6539
MAYS, ASHLEY C, MD
P0441
MAYS, RANA MAJD, MD
7/15/2011
Q8559
Q2018
MAZO CANOLA, MARCELA , MD
MAZZELLA, WILLIAM, MD
01-Jun-16
10/1/2014
P2492
MBADUGHA, IFEANYI M, MD
3/15/2012
Q2341
11/7/2014
P8506
Q3233
MBI, PRYSCA NGALAME, MD
MCALHANY, STEPHANIE JONES,
MD
MCALVANY, KELLY LYNNE, DO
12/6/2013
2/13/2015
Q7233
MCATEE, ROBERT GORHAM, MD
16-Feb-16
12/6/2018 CYTOPATHOLOGY
2/13/2020 UROLOGY
EMERGENCY
16-Feb-21 MEDICINE
10/15/2013
8/1/2013
2/1/2013
11/16/2015
Practice City
HOUSTON
EL PASO
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
12/6/2013 None
N/A
ACTIVE
5/21/2015 None
N/A
CHEVY CHASE MD
ALEXANDRIA LA
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
3/26/2015 None
10/24/2011 None
7/6/2015 None
N/A
N/A
N/A
LUFKIN
TX
ACTIVE
5/19/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/12/2011 None
N/A
7/15/2014 None
N/A
8/29/2014 None
N/A
ACTIVE
LICENSE
ISSUED
11/5/2013 None
N/A
8/1/2013 None
N/A
OBSTETRICAL
ANESTHESIA
SPORTS MEDICINE
(ORTH SURG)
EMERGENCY
8/29/2019 MEDICINE
EMERGENCY
10/15/2018 MEDICINE
HUMBLE
EMERGENCY
8/1/2018 MEDICINE
GASTROENTEROLOG
2/1/2018 Y
WINSTON
SALEM
451 N. TEXAS
7/15/2016 INTERNAL MEDICINE DERMATOLOGY
AVE
HEMATOLOGY/ONCOL
01-Jun-21 OGY
SAN ANTONIO
DECATUR
CORPUS
PEDIATRICS
CHRISTI
Page 227 of 402
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Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/3/2012 None
N/A
5/13/2014 None
N/A
TX
TX
ACTIVE
2/4/2013 None
N/A
NC
ACTIVE
11/23/2015 None
N/A
TX
ACTIVE
7/20/2011 None
N/A
TX
AL
ACTIVE
ACTIVE
02-Jun-16 None
11/17/2014 None
N/A
N/A
TX
3/20/2012 None
N/A
11/7/2014 None
N/A
12/6/2013 None
2/16/2015 None
N/A
N/A
18-Feb-16 None
N/A
LONGVIEW
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
SEGUIN
TX
ACTIVE
License
Number
Physician Name
P6030
MCBETH, KATRINA ELIZABETH, MD
P1896
MCCAIN, FRANCINE FRASER, MD
Q2019
dicaid
dicaid
Agreement
End Date
Designated)
4/1/2013
1/17/2012
4/1/2018 PEDIATRICS
OBSTETRICS AND
MCCALLUM, RICHARD W, MD
MCCANN-CROSBY, BONNIE MARIE,
MD
10/1/2014
1/17/2012
4/1/2014
Q8107
MCCARTY, MORGAN JANELLE, DO
MCCARUS, STEVEN DOUGLAS SR,
MD
Q1452
Q7925
MCCLOUD, MICHON A, MD
MCCLUNG, MEGAN, MD
8/15/2014
15-Apr-16
Q5033
MCCORMICK, FRANK, MD
MCCORMICK, SARAH
MARGUERITE, DO
7/1/2015
P1897
P9648
P7505
P6032
Q4463
MCCORMICK, TIMOTHY CHAD, DO
MCCORVEY, FARAH EBONI, MD
02-May-16
8/1/2013
4/1/2013
5/15/2015
P8508
MCCOY, DANIEL WYATT, MD
12/6/2013
Q3917
4/10/2015
P9222
MCCREIGHT, JEFFREY NOEL, MD
MCCULLOUGH, LOUISE DEBORAH,
MD
MCCULLOUGH, PETER ANDREW,
MD
Q4201
MCCULLOUGH, WILLIAM T, MD
Q3235
Q4631
MCCURDY, MATTHEW RIEGEL, MD
MCDANIEL, RENNY, MD
MCDEAVITT, JAMES THOMAS II,
MD
MCDONAGH, DAVID LAWRENCE,
MD
Q6233
P8601
Q1673
10/1/2015
3/3/2014
5/1/2015
2/13/2015
6/1/2015
12/16/2013
8/29/2014
GYNECOLOGIC
02-May-21 SURGERY
OBSTETRICS AND
ORTHOPEDIC
7/1/2020 SURGERY
Secondary Specialty
(Self-Designated)
PEDIATRIC
PULMONOLOGY
3/3/2019 CARDIOLOGY
NEUROLOGICAL
5/1/2020 SURGERY
RADIATION
2/13/2020 ONCOLOGY
PHYSICAL MED. &
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/3/2013 None
N/A
1/17/2012 None
N/A
TX
ACTIVE
10/13/2014 None
N/A
HOUSTON
TX
ACTIVE
1/23/2012 None
N/A
TEMPLE
TX
ACTIVE
4/18/2014 None
N/A
ACTIVE
09-May-16 None
N/A
ARLINGTON
AUSTIN
TX
TX
ACTIVE
ACTIVE
8/21/2014 None
25-Apr-16 None
N/A
N/A
BEDFORD
TX
ACTIVE
7/14/2015 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/6/2013 None
N/A
4/1/2013 None
6/1/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
12/10/2013 None
N/A
4/10/2015 None
N/A
TX
ACTIVE
10/12/2015 None
N/A
TX
ACTIVE
3/5/2014 None
N/A
FRISCO
TX
ACTIVE
5/18/2015 None
N/A
KYLE
CUERO
TX
TX
2/17/2015 None
6/15/2015 None
N/A
N/A
ELECTRODIAGNOSTI
C MEDICINE
ACTIVE
ACTIVE
LICENSE
ISSUED
12/16/2013 None
N/A
NEUROLOGY
ACTIVE
9/1/2014 None
N/A
GYNECOLOGIC
SURGERY
VASCULAR
SURGERY
VASCULAR
NEUROLOGY
10/1/2020 NEUROLOGY
HOUSTON
GASTROENTEROLOG
Y
EL PASO
8/1/2018 PEDIATRICS
GYNECOLOGIC
4/1/2018 ONCOLOGY
THORACIC
CARDIOVASCULAR
12/6/2018 SURGERY
EMERGENCY
4/10/2020 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
Page 228 of 402
DENTON
HOUSTON
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Q8751
MCDONALD, ANTHONY ROSS, MD
10-Jun-16
SAN ANGELO
TX
ACTIVE
Q1674
MCDONALD, KELLY COLLEEN, MD
8/29/2014
BRENHAM
TX
P8509
MCDONALD, MARK WESLEY, MD
12/6/2013
Q8561
MCDONALD, SAMUEL ARTHUR, MD
01-Jun-16
EMERGENCY
01-Jun-21 MEDICINE
Q0121
MCDONNELL, KENNON MARC, MD
5/2/2014
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
Q4632
MCDONOUGH, RYAN , DO
6/1/2015
P6033
MCDOWELL, AMANDA , MD
4/1/2013
Q0791
MCFARLAND, WILLIAM JOHN, MD
6/27/2014
04-Mar-16
6/1/2020 RADIOLOGY
CARDIOTHORACIC
HOUSTON
Q7422
MCFARLANE, NADIA ANNE, MD
P8387
MCFATE, JOHN ALLEN, MD
Q4203
MCGEHEE, MICHAEL LEE, MD
5/1/2015
P2731
4/2/2012
Q0313
MCGHIE, TRAVEA ALEE, MD
MCGINNIS, ROBERT SAMUEL III,
MD
5/15/2014
Q8562
MCGREW, ALLEN DAVID, DO
01-Jun-16
Q5223
MCHUGH, THOMAS MICHAEL, MD
7/15/2015
11/15/2013
LICENSE
ISSUED
PLASTIC &
RECONSTRUCTIVE
11/15/2018 SURGERY
PHYSICAL MED. &
INFECTIOUS
4/2/2017 DISEASES
DIAGNOSTIC
5/15/2019 RADIOLOGY
Q5035
MCINTIRE, HOLLY LEIGH, MD
7/1/2015
ANATOMIC/CLINICAL
7/1/2020 PATHOLOGY
Q0507
Q5487
Q2160
MCINTOSH, ADEKA D, MD
MCINTOSH, G ANDREW, MD
MCKAY, JOSHUA LAMAR, MD
6/2/2014
8/3/2015
10/15/2014
6/2/2019 RADIOLOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
Page 229 of 402
Disciplinary
Status Date
14-Jun-16 None
N/A
9/1/2014 None
N/A
12/6/2013 None
N/A
01-Jun-16 None
N/A
5/2/2014 None
N/A
6/1/2015 None
N/A
TX
ACTIVE
4/12/2013 None
N/A
PORT LAVACA TX
ACTIVE
7/1/2014 None
N/A
ROCKVILLE
ACTIVE
08-Mar-16 None
N/A
ACTIVE
11/22/2013 None
N/A
ACTIVE
5/7/2015 None
N/A
4/17/2012 None
N/A
MD
INTERNAL MEDICINE
MUSCULOSKELETAL
RADIOLOGY
INTERVENTIONAL
CARDIOLOGY
DERMATOPATHOLO
GY
PEDIATRIC
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/15/2014 None
N/A
01-Jun-16 None
N/A
HOUSTON
TX
ACTIVE
9/14/2015 None
N/A
BIRMINGHAM
AL
ACTIVE
7/3/2015 None
N/A
FORT WORTH TX
BOERNE
TX
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
6/5/2014 None
8/4/2015 None
10/22/2014 None
N/A
N/A
N/A
License
Number
Physician Name
Q4808
MCKEE, DANIEL, MD
Q0792
G5359
MCKEITH, JAMES JOHN, MD
MCKELLAR, DUNCAN LAWRENCE
JR, MD
P7506
MCKENZIE, KRISTI HAMILTON, MD
Q1453
MCKENZIE, PAULA ALISON, MD
Q3048
MCKINNEY, CYNTHIA DENISE, MD
P0997
dicaid
dicaid
Agreement
End Date
Designated)
PLASTIC &
RECONSTRUCTIVE
6/12/2015
6/12/2020 SURGERY
EMERGENCY
6/27/2014
6/27/2019 MEDICINE
ORTHOPEDIC
8/28/2015
8/28/2020 SURGERY
OBSTETRICS AND
8/1/2013
8/1/2018 GYNECOLOGY
8/15/2014
2/2/2015
9/15/2011
Q8303
MCKISSACK, MELANIE LENISE, MD
MCLAUGHLIN, HSIANG CHI CATHY,
MD
16-May-16
P6463
P6678
MCLAUGHLIN, MICHAEL PAUL, DO
MCLAURIN, LATISHA , MD
5/1/2013
5/15/2013
P7159
MCLEOD, MICHAEL PAUL, MD
7/1/2013
P8947
MCLOUGHLIN, LUCILLE, MD
2/7/2014
Q3049
MCMAHON, KEVIN CORNELIUS, MD
2/2/2015
Q5224
MCMILLAN, SAM, MD
7/15/2015
P5291
MCMILLEN, THURSTON DRU, MD
MCNAMARA, WILLIAM FRANCIS,
MD
1/15/2013
MCNIEL, MELINDA , MD
MCNIERNEY-MOORE, AFTON
ROSE, DO
MCNUTT, GRACE MARIE, MD
5/15/2015
Q3737
Q4464
P8801
Q7745
4/1/2015
1/15/2014
01-Apr-16
Secondary Specialty
(Self-Designated)
LICENSE
ISSUED
LICENSE
ISSUED
INFECTIOUS
DISEASES
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
16-May-21 UROLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
ANESTHESIOLOGY
PHYSICAL MED. &
REHABILITATION
PEDIATRIC
GASTROENTEROLOG
2/7/2019 Y
NEURO-PHYSIOLOGY
2/2/2020 (NEUROLOGY)
EMERGENCY
7/15/2020 MEDICINE
PAIN
MANAGEMENT/REHAB SPORTS MEDICINE 1/15/2018 MED
REHAB MED
HEAD AND NECK
OBSTETRICS AND
EMERGENCY
1/15/2019 MEDICINE
01-Apr-21 NEPHROLOGY
INTERNAL MEDICINE
Page 230 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
6/12/2015 None
N/A
6/27/2014 None
N/A
CLARKSVILLE TN
ACTIVE
9/10/2015 None
N/A
AUSTIN
TX
ACTIVE
8/2/2013 None
N/A
LUBBOCK
GRAND
PRAIRIE
TX
ACTIVE
8/25/2014 None
N/A
TX
ACTIVE
2/11/2015 None
N/A
GALVESTON
TX
ACTIVE
12/6/2011 None
N/A
FORT HOOD
OKLAHOMA
CITY
LUBBOCK
CORPUS
CHRISTI
TX
ACTIVE
24-May-16 None
N/A
OK
TX
ACTIVE
ACTIVE
5/30/2013 None
5/17/2013 None
N/A
N/A
TX
ACTIVE
7/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
2/11/2014 None
N/A
2/2/2015 None
N/A
ACTIVE
7/20/2015 None
N/A
LICENSE
ISSUED
1/15/2013 None
N/A
ACTIVE
4/3/2015 None
N/A
ACTIVE
6/1/2015 None
N/A
ACTIVE
ACTIVE
1/24/2014 None
05-May-16 None
N/A
N/A
SAN ANTONIO TX
HOUSTON
DALLAS
CORPUS
CHRISTI
LAREDO
MO
TX
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q7580
MCNUTT, STEPHEN ANDREW, MD
15-Mar-16
M7420
MCUNU, ARTHUR NTANDO
SIBUSISO JR, MD
2/13/2015
P9649
15-Mar-21 OPHTHALMOLOGY
CARDIOVASCULAR
2/13/2020 SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
4/1/2019 OGY
OBSTETRICS AND
ORTHOPEDIC
7/15/2018 SURGERY
OBSTETRICS AND
CRITICAL CARE
9/15/2019 MEDICINE
HEMATOLOGY/ONCOL
2/13/2020 OGY
HEMATOLOGY/ONCOL
6/16/2019 OGY
Q6448
11/2/2015
P7311
MEARS, SIMON CAVENDISH, MD
7/15/2013
Q6234
Q6235
P6869
MEDEL, MICHELLE PHI, MD
MEDINA, ALFREDO , MD
MEDINA, DIANA , MD
10/1/2015
10/1/2015
6/3/2013
Q1859
MEEKS, LLOYD CALHOUN, MD
MEENEGHAN, MATHEW ROBERT,
MD
9/15/2014
6/16/2014
P5292
MEERASAHIB, ANISH, MD
MEGHAPARA, BHAVINKUMAR K,
MD
P4786
MEHTA, AMIT MAYUR, MD
11/1/2012
P9906
P9093
4/15/2014
2/18/2014
P5209
MEHTA, ASHWINI PRAMOD, DO
MEHTA, BHAVI DEEPAK, MD
MEHTA, CHIRAG
VIRENDRAKUMAR, MD
1/4/2013
P7508
MEHTA, MANISHA SHIVANG, DO
8/1/2013
Q8304
P9401
MEHTA, MEGHA SATISH, MD
MEHTA, MUNIRA , DO
16-May-16
3/17/2014
Q6658
MEHTA, NIKHIL K, MD
12/4/2015
Q0673
2/13/2015
1/15/2013
Practice City
OPHTHALMOLOGY ANTERIOR SURGERY LAREDO
MEADE, JULIA CAROLINE, MD
MEANS, JACQUELYN MICHELLE,
MD
Q3236
4/1/2014
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
THORACIC SURGERY
DALLAS
TX
ACTIVE
TEXAS
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
01-Apr-16 None
N/A
2/13/2015 None
N/A
ACTIVE
5/2/2014 None
N/A
ACTIVE
11/9/2015 None
N/A
ACTIVE
8/13/2013 None
N/A
FAMILY MEDICINE
DALLAS
ODESSA
HOSUTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
10/13/2015 None
11/9/2015 None
6/27/2013 None
N/A
N/A
N/A
ANESTHESIOLOGY
ST. LOUIS
MO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/10/2014 None
N/A
2/13/2015 None
N/A
6/16/2014 None
N/A
1/22/2013 None
N/A
INTERNAL MEDICINE
INTERNAL MEDICINE
EMERGENCY
11/1/2017 MEDICINE
GASTROENTEROLOG
4/15/2019 Y
BAKERSFIELD CA
ACTIVE
HOUSTON
TX
11/27/2012 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/15/2014 None
2/24/2014 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
2/14/2013 None
N/A
8/1/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
03-Jun-16 None
4/3/2014 None
N/A
N/A
NM
ACTIVE
12/7/2015 None
N/A
NEPHROLOGY
PEDIATRIC
GASTROENTEROLOG
Y
DALLAS
GALVESTON
EMERGENCY
ALAMOGORD
MEDICINE
O
Page 231 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6658
MEHTA, NIKHIL K, MD
04-Dec-15
Q6658
P4678
MEHTA, NIKHIL K, MD
MEHTA, PANKAJ, MD
04-Dec-15
10/15/2012
Q8564
MEINDL HOLMAN, JUDI D, MD
01-Jun-16
EMERGENCY
01-Jun-21 MEDICINE
Q7236
16-Feb-16
Q5038
MEISSNER, MARISSA NICOLE, MD
MEISSNER, MATTHEW ARTHUR,
MD
MEJIA GARCIA, ALEX VLADIMIR,
MD
P1106
MEKA, MADHAVI, MD
10/3/2011
P4890
MEKETE, BAHIRU BELACHEW, MD
Q7746
P6221
MELAMED, ESTHER, MD
MELEK, JOHN, MD
01-Apr-16
4/12/2013
NEUROLOGY &
Q1454
MELHEM, AYYASH YOUSEF, MD
8/15/2014
Q7423
04-Mar-16
7/1/2015
11/15/2012
P7160
MELLA, CESAR FRANCISCO, MD
7/1/2013
Q4635
MELLO, LEAH , MD
6/1/2015
ACTIVE
ACTIVE
07-Dec-15 None
10/31/2012 None
N/A
N/A
ACTIVE
03-Jun-16 None
N/A
INTERNAL MEDICINE
UROLOGIC
04-Mar-21 UROLOGIC SURGERY ONCOLOGY
HEMATOLOGY/ONCO
7/1/2020 INTERNAL MEDICINE LOGY
SAN ANTONIO TX
ACTIVE
08-Mar-16 None
N/A
ACTIVE
08-Mar-16 None
N/A
ACTIVE
7/31/2015 None
N/A
10/3/2016 VASCULAR SURGERY GENERAL SURGERY BEDFORD
TX
ACTIVE
11/2/2011 None
N/A
OK
ACTIVE
11/20/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
04-May-16 None
4/24/2013 None
N/A
N/A
8/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
7/3/2013 None
N/A
6/1/2015 None
N/A
ACTIVE
ACTIVE
5/21/2013 None
8/15/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2013 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
12/17/2012 None
N/A
2/28/2014 None
N/A
6/27/2014 None
N/A
7/1/2018 PEDIATRICS
OBSTETRICS AND
6/1/2020 GYNECOLOGY
P6222
MELTON, COLT LESLEY, MD
4/12/2013
EMERGENCY
4/12/2018 MEDICINE
P5106
MELTON, JENNIFER LEIGH, MD
12/17/2012
P5106
12/17/2012
P5106
12/17/2012
P8949
MELVILLE SANTOS, MELANIE, MD
6/27/2014
Disciplinary
Status Date
N/A
5/15/2013
8/1/2013
MEMON, ABDUL MAJEED, MD
Registration
Status Date
07-Dec-15 None
MELLOTT, JUSTIN, DO
MELNITSKY, HANNAH , MD
Q0793
Practice City
ALAMOGORD
O
NM
ALAMOGORD
O
NM
SPRINGFIELD MA
Disciplinary
Status of
Texas
License
ACTIVE
P6679
P7509
2/7/2014
Secondary Specialty
(Self-Designated)
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
ANESTHESIOLOGY
Registration
Status of
Practice
Texas
State
License
LAWTON
NEUROLOGY
AUSTIN
TX
SAN ANTONIO TX
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
2/7/2019 PSYCHIATRY
PULMONARY
Page 232 of 402
TX
DIMMITT
TX
FORT WORTH TX
STEPHENVILL
E
TX
GALVESTON
TX
GALVESTON
TX
GALVESTON
TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P7671
MEMON, NAIM A, MD
P6037
Q2023
MEMON, REHAN, MD
MENDEZ LEON, CARLOS
ALBERTO, MD
P0442
MENDEZ SOTO, DAVID B, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/15/2013
4/1/2013
TX
ACTIVE
LICENSE
ISSUED
Disciplinary
Status Date
8/16/2013 None
N/A
4/1/2013 None
N/A
10/1/2014
WOODSTOCK IL
ACTIVE
11/21/2014 None
N/A
7/15/2011
CORAL
GABLES
FL
ACTIVE
8/1/2011 None
N/A
EL PASO
TX
18-Apr-16 None
4/4/2013 None
10/5/2015 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
1/15/2015 None
8/9/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/5/2013 None
N/A
EL PASO
TX
ACTIVE
11/11/2011 None
N/A
MCALLEN
TX
ACTIVE
5/8/2015 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
1/26/2015 None
11/6/2014 None
N/A
N/A
DALLAS
NEW YORK
TX
NY
ACTIVE
ACTIVE
5/5/2014 None
02-Mar-16 None
N/A
N/A
ACTIVE
5/25/2015 None
N/A
ACTIVE
LICENSE
ISSUED
5/21/2013 None
N/A
8/1/2014 None
N/A
ACTIVE
7/21/2011 None
N/A
ACTIVE
11/19/2013 None
N/A
15-Apr-16
4/1/2013
10/1/2015
15-Apr-21 NEUROLOGY
Q2926
P7510
MENDEZ, MAGDA DESIREE, MD
MENDEZ, RUBEN , MD
1/15/2015
8/1/2013
P5842
3/15/2013
Q4207
MENDEZ-FIGUEROA, HECTOR, MD
MENDIOLA, ANNA MARIE TEENA
CAPULONG, MD
MENDOZA PAREDES, ALBERTO,
MD
8/1/2018 PSYCHIATRY
OBSTETRICS AND
Q2927
Q2024
MENDOZA REQUENA, DANIEL, MD
MENDOZA, WALTER D, MD
1/15/2015
10/1/2014
Q0122
Q7237
MENEGHINI, LUIGI FERNANDO, MD
MENG, HSIANG-CHI, DO
5/2/2014
16-Feb-16
11/4/2011
5/1/2015
Q4466
MENGA, EMMANUEL NGANKU, MD
5/15/2015
P6680
MENNITE, BRIDGIT, MD
5/15/2013
Q1223
MENSAH, APRYL SCOTT, MD
MERCADO, CLAUDIA GETZABETH,
MD
MERCADO-MARMAROSH, DIANA
MARIA, MD
P8390
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
OBSTETRICS AND
MENDEZ VARGAS, KARINA, MD
MENDEZ, ANGELICA DURAN, MD
MENDEZ, ILEANA ELITA, MD
P0443
Practice City
4/1/2018
Q7929
P6038
Q6236
P1361
Secondary Specialty
(Self-Designated)
GERIATRIC
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
8/1/2014
NEUROMUSCULAR
DISEASE
MATERNAL AND
FETAL MEDICINE
PEDIATRICS,
5/1/2020 CARDIOLOGY
ENDOCRINOLOGY,
DIABETES AND
5/2/2019 METABOLISM
ORTHOPEDIC
5/15/2020 SURGERY
EMERGENCY
5/15/2018 MEDICINE
RADIATION
8/1/2019 ONCOLOGY
7/15/2011
11/15/2013
PEDIATRICS
INFECTIOUS
DISEASES
ORTHOPEDIC
SURGERY OF THE
SPINE
MIDDLETOWN CT
LAREDO
Page 233 of 402
TX
License
Number
Q8752
Physician Name
Q7747
Q2802
MERCER, YOLANDA JANE, MD
MERCHANT, DELWIN SHELDON,
MD
MERCHANT, ZABEENA , MD
Q1455
Q7078
MERCHANT, ZAHRA MEHBOOB,
MD
MERJANEH, ZAHI, MD
Q1225
MERRIAM, MARGARET ANNE, DO
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
GERIATRICS SPORTS MEDICINE 10-Jun-16
10-Jun-21 INTERNAL MEDICINE IM
EMERGENCY
01-Apr-16
01-Apr-21 MEDICINE
1/5/2015
PAIN
MANAGEMENT/REHAB
8/15/2014
8/15/2019 MED
PAIN & SPINE
01-Feb-16
8/1/2014
Q2803
MERRICK, MICHAEL THOMAS, MD
Q5868
MERRITT, CURTIS JAMES, DO
8/28/2015
Q4636
P6464
MERRITT, JUDSON, MD
MERRITT, NATHAN HENRY, MD
6/1/2015
5/1/2013
P2732
MESHRAM, SHEETAL , MD
4/2/2012
Q5869
Q6966
MESHRI, GITA DAYAL, DO
MESKI, ALEXANDER, MD
8/28/2015
15-Jan-16
P7811
P5685
MESSICK, CRAIG ALAN, MD
MESSING, ROBERT OWEN, MD
8/30/2013
3/1/2013
Q6877
METWALLI, OMAR AHMED, MD
06-Jan-16
P1362
1/5/2015
11/4/2011
P0855
METZ, RACHEL LYNN, MD
MEWADA, NISHITH
MAHENDRABHAI, MD
MEYER, ANDREW DUNCAN
JOSEPH, MD
Q7079
MEYER, DAVID EVAN, MD
01-Feb-16
H9239
MEYER, YVES JEAN, MD
5/15/2013
Q5490
8/3/2015
8/26/2011
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ORTHOPEDIC
1/5/2020 SURGERY
EMERGENCY
6/1/2020 MEDICINE
OBSTETRICS &
GYNECOLOGICAL
8/28/2020 SURGERY
15-Jan-21 PSYCHIATRY
3/1/2018 NEUROLOGY
EMERGENCY
06-Jan-21 MEDICINE
EMERGENCY
11/4/2016 MEDICINE
PEDIATRIC CRITICAL
01-Feb-21 GENERAL SURGERY
NEUROLOGICAL
5/15/2018 SURGERY
N/A
13-Apr-16 None
1/12/2015 None
N/A
N/A
CLEVELAND
ACTIVE
ACTIVE
8/18/2014 None
17-Mar-16 None
N/A
N/A
ACTIVE
8/4/2014 None
N/A
ACTIVE
LICENSE
ISSUED
1/8/2015 None
N/A
8/28/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/15/2015 None
5/6/2013 None
N/A
N/A
4/2/2012 None
N/A
9/10/2015 None
18-Jan-16 None
N/A
N/A
8/30/2013 None
3/14/2013 None
N/A
N/A
13-Jan-16 None
N/A
11/10/2011 None
N/A
8/3/2015 None
N/A
OH
LOUISVILLE
KY
SOUTHLAKE
TX
FORT WORTH TX
SAN ANTONIO TX
AUSTIN
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
COLON AND RECTAL
SURGERY
URGENT CARE
MEDICINE
10-Jun-16 None
ACTIVE
ACTIVE
INTERNAL MEDICINE
PAIN MANAGEMENT
Disciplinary
Status Date
BELLEVILLE
IL
FORT WORTH TX
ORTHOPEDIC
SURGERY OF THE
SPINE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOSPITALIST
PEDIATRICS
SAN ANTONIO TX
SURGICAL CRITICAL
CARE
HOUSTON
TX
ACTIVE
9/7/2011 None
N/A
ACTIVE
02-Feb-16 None
N/A
FORT WORTH TX
ACTIVE
5/16/2013 None
N/A
Page 234 of 402
License
Number
Physician Name
P8804
MEYERS, KEVIN PATRICK, MD
Q2162
MEYN, JOSEPH WILLIAM, MD
Q2930
MICHAEL, LAURA ELLEN, DO
MICHAEL, MEGHAN MCDONALD,
MD
P9910
P6467
dicaid
dicaid
Agreement
End Date
Designated)
GASTROENTEROLOG
1/15/2014
1/15/2019 Y
OBSTETRICS AND
10/15/2014
ANATOMIC/CLINICAL
1/15/2015
1/15/2020 PATHOLOGY
4/15/2014
Q5228
MICHAEL, WAYNE ALAN, MD
MICHAELS, BROOKS CARLTON,
MD
5/1/2013
P7512
MICHAUD, ROBERT JEROME, MD
8/1/2013
Q4637
MICIC, VESNA MILOJE, MD
6/1/2015
Q8566
MIDDLETON, BLAKE, DO
P1672
MIDGLEY, PHILIP GLENN, DO
P2301
P5686
7/15/2015
01-Jun-16
Secondary Specialty
(Self-Designated)
SPORTS MEDICINE
01-Jun-21 (FAMILY PRACTICE)
12/15/2011
MIER Y TERAN, JOSE LUIS, MD
MIHU, RAMONA , MD
3/1/2012
3/1/2013
Q5493
MIKHAEL, MARCO NAGY, MD
8/3/2015
Q2805
MIKHAIL, LYREE NOUR, MD
1/5/2015
P4594
Q0509
MIKHAIL, PETER, MD
MIKKILINENI, ARCHANA, MD
10/1/2012
6/2/2014
OBSTETRICS AND
1/5/2020 GYNECOLOGY
CARDIOVASCULAR
10/1/2017 SURGERY
N5245
P7312
MIKKILINENI, HARITHA, MD
MILAN, STACEY ANNE, MD
6/27/2014
7/15/2013
Q7080
Q2163
MILES, JANET MARY, MD
MILIAN, RICHARD KYLE, MD
01-Feb-16
10/15/2014
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ROUND ROCK TX
ACTIVE
2/20/2014 None
N/A
GROVE CITY
PA
ACTIVE
10/23/2014 None
N/A
ALPHARETTA
GA
ACTIVE
1/27/2015 None
N/A
DALLAS
TX
ACTIVE
4/25/2014 None
N/A
DALLAS
PORTER
RANCH
TX
ACTIVE
5/8/2013 None
N/A
PALLIATIVE
MEDICINE
CA
ACTIVE
7/20/2015 None
N/A
FAMILY MEDICINE
SAN ANTONIO TX
ACTIVE
8/6/2013 None
N/A
CLINICAL
NEUROPHYSIOLOGY HUNT VALLEY MD
ACTIVE
6/9/2015 None
N/A
FAMILY MEDICINE
BRYAN
ACTIVE
N/A
FAMILY MEDICINE
FORT WORTH TX
03-Jun-16 None
UNDER
BOARD
12/19/2011 ORDER
3/1/2012 None
3/8/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/10/2015 None
N/A
1/5/2015 None
N/A
10/3/2012 None
7/2/2014 None
N/A
N/A
KY
TX
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
6/27/2014 None
7/25/2013 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
06-Apr-16 None
10/21/2014 None
N/A
N/A
ORAL &
MAXILLOFACIAL
5/1/2018 SURGERY
EMERGENCY
8/1/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
MAYWOOD
TX
TX
IL
WICHITA
THORACIC SURGERY FALLS
TX
SAN ANTONIO TN
ANATOMIC/CLINICAL
01-Feb-21 PATHOLOGY
NEURO-PATHOLOGY
Page 235 of 402
ASHLAND
EL PASO
FORTH
WORTH
CONROE
ACTIVE
LICENSE
ISSUED
ACTIVE
12/1/2011
License
Number
Physician Name
P5557
MILLENDER, KAREN LOUISE, MD
P5422
MILLER, ADAM RICHARD, MD
Q2164
Q2344
MILLER, BRIAN DOUGLAS, MD
MILLER, CHRISTOPHER EDWARD,
DO
P9227
MILLER, CHRISTOPHER TODD, MD
Q7748
P0444
Q4638
Q8753
MILLER, DOUGLAS MICHAEL, DO
MILLER, JOSHUA PAUL SR, MD
MILLER, KYLE SCOTT, DO
MILLER, MICHAEL STEPHEN, MD
dicaid
dicaid
Agreement
End Date
Designated)
2/8/2013
2/1/2013
EMERGENCY
10/15/2014
10/15/2019 MEDICINE
11/7/2014
3/3/2014
01-Apr-16
7/15/2011
6/1/2015
10-Jun-16
Secondary Specialty
(Self-Designated)
Practice City
ORTHOPEDIC
01-Apr-21 SURGERY
EMERGENCY
7/15/2016 MEDICINE
6/1/2020 PEDIATRICS
MATERNAL AND
OBSTETRICS AND
HOUSTON
FORT SAM
HOUSTON
SAN ANTONIO TX
5/15/2014
Q7930
MILLER, PATRICIA ANN, DO
15-Apr-16
P4983
MILLER, RYAN BRYCE, MD
11/30/2012
Q3054
MILLER, SARAH BYESEDA, MD
2/2/2015
Q4810
MILLER, SPENCER OWEN, MD
6/12/2015
6/12/2020 NEUROLOGY
HOSPITALIST
Q7081
MILLER, SUZANNE KILCOYNE, MD
01-Feb-16
P5423
H3915
P7513
MILLER, TYRONE JOSEPH, DO
MILLER, WILFRED DEAN, DO
MILLIN, JOHN ANDREW, MD
2/1/2013
7/15/2011
8/1/2013
Q7082
Q7749
MILLS, KYLE CHARLES, MD
MILLS, SHERYL, MD
P0639
MILNER, JENNIFER NICOLE, MD
Q5697
MILOH, TAMIR, MD
01-Feb-16
01-Apr-16
8/1/2011
8/14/2015
TX
OBSTETRICS AND
GYNECOLOGY
MILLER, NATHANIEL R, MD
11/1/2012
11/15/2012
TX
ADULT
RECONSTRUCTION
Q0316
TM00529 MILLMOND, STEVEN HARRIS, MD
P4893
MILLS, ALICIA E, MD
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
DALLAS
TX
SAHUARITA
LAS CRUCES
DIAGNOSTIC
11/1/2017 RADIOLOGY
NUCLEAR MEDICINE LYNDHURST
MANSFIELD
ANATOMIC/CLINICAL
01-Feb-21 PATHOLOGY
DERMOPATHOLOGY ALPHARETTA
CUERO
8/1/2016 PEDIATRICS
PEDIATRIC
GASTROENTEROLOG
8/14/2020 Y
HEPATOLOGY
Page 236 of 402
HOUSTON
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
2/12/2013 None
N/A
2/5/2013 None
N/A
ACTIVE
LICENSE
ISSUED
11/20/2014 None
N/A
11/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
3/10/2014 None
N/A
01-Apr-16 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/20/2011 None
6/17/2015 None
15-Jun-16 None
N/A
N/A
N/A
5/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
18-Apr-16 None
N/A
11/30/2012 None
N/A
ACTIVE
LICENSE
ISSUED
2/4/2015 None
N/A
6/12/2015 None
N/A
TX
ACTIVE
15-Feb-16 None
N/A
AZ
NM
ACTIVE
ACTIVE
ACTIVE
2/22/2013 None
7/21/2011 None
8/7/2013 None
N/A
N/A
N/A
OH
TX
ACTIVE
ACTIVE
11/6/2012 None
11/26/2012 None
N/A
N/A
GA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
24-Feb-16 None
10-May-16 None
N/A
N/A
8/1/2011 None
N/A
8/27/2015 None
N/A
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
3/1/2013
3/1/2018 GYNECOLOGY
P5687
MILOV, SEVA, MD
Q5494
Q2346
MILTON, ROBERT MICHAEL, MD
MIMS, TIMOTHY THOMAS, MD
8/3/2015
11/7/2014
8/3/2020 PSYCHIATRY
Q4811
MINAIE, ARASH, DO
6/12/2015
Secondary Specialty
(Self-Designated)
PAIN MEDICINE
NJ
AUSTIN
CORPUS
CHRISTI
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
Disciplinary
Status Date
3/12/2013 None
N/A
8/3/2015 None
11/12/2014 None
N/A
N/A
TX
ACTIVE
6/16/2015 None
N/A
MD
18-Mar-16 None
N/A
TX
ACTIVE
LICENSE
ISSUED
12/6/2013 None
N/A
MINDIKOGLU, AYSE LEYLA, MD
04-Mar-16
P8510
MINDRU, CEZARINA, MD
12/6/2013
P8054
Q2347
MING, BRYAN WOEI, MD
MINHAS, SHAHEENA , MD
10/1/2013
11/7/2014
INFECTIOUS
12/6/2018 DISEASES
ORTHOPEDIC
10/1/2018 TRAUMA
Q1677
P7514
Q6449
MINIDIS, NATASCHA MAREN, DO
MINN, CHARLES KEE JOON, MD
MINNA, DAVID GIOVANNI, MD
8/29/2014
8/1/2013
11/2/2015
Q0977
MINNEY, ALEXANDER JAMES, MD
7/15/2014
Q6068
MINTER, REBECCA MANGET, MD
9/15/2015
P5109
MIOCINOVIC, SVJETLANA, MD
12/17/2012
P5109
12/17/2012
P5109
Q4212
P4484
MIR, IMRAN NAZIR, MD
MIR, TASADUQ HUSSAIN, MD
12/17/2012
5/1/2015
9/17/2012
Q2348
Q1456
MIRAMONTES, DAVID ALAN, MD
MIRANDA, MICHAEL , MD
P1476
P8161
MIRASOL, ALAN P, MD
MIRELES, GLORIA , MD
P0640
Q7582
MIRELES, PATRICIA SALAZAR, MD
MIRO, VIKTOR, MD
8/1/2011
15-Mar-16
P4595
MIROSHNICHENKO, GENNADY, MD
10/1/2012
5/1/2020 PEDIATRICS
EMERGENCY
EMERGENCY
11/7/2019 MEDICINE
MEDICAL SERVICES
PHYSICAL MED. &
PEDIATRIC
8/1/2016 NEUROLOGY
15-Mar-21 HOSPITALIST
INTERNAL MEDICINE
GYNECOLOGIC
10/1/2017 ONCOLOGY
Page 237 of 402
11/15/2011
10/15/2013
EHT
Registration
Status Date
Disciplinary
Status of
Texas
License
GASTROENTEROLOG
Y
BALTIMORE
Q7427
11/7/2014
8/15/2014
Practice City
Registration
Status of
Practice
Texas
State
License
OTHER SPECIALTY
INFECTIOUS
DISEASES
NEPHROLOGY
SURGICAL
ONCOLOGY
MOVEMENT
DISORDERS
MOVEMENT
DISORDERS
MOVEMENT
DISORDERS
NEONATOLOGY
FORT WORTH TX
DALLAS
TX
ACTIVE
ACTIVE
10/4/2013 None
11/10/2014 None
N/A
N/A
SAN ANTONIO TX
HOUSTON
TX
MANSFIELD
TX
ACTIVE
ACTIVE
ACTIVE
9/4/2014 None
8/16/2013 None
11/4/2015 None
N/A
N/A
N/A
SAN ANGELO
TX
ACTIVE
7/22/2014 None
N/A
DALLAS
TX
ACTIVE
9/16/2015 None
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
DALLAS
TX
ACTIVE
12/24/2012 None
N/A
DALLAS
DALLAS
DALLAS
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/24/2012 None
5/6/2015 None
10/1/2012 None
N/A
N/A
N/A
SAN ANTONIO
HOUSTON
BEVERLY
HILLS
MCALLEN
TX
TX
ACTIVE
ACTIVE
11/11/2014 None
8/18/2014 None
N/A
N/A
CA
TX
ACTIVE
ACTIVE
11/17/2011 None
10/16/2013 None
N/A
N/A
PLANO
TX
ACTIVE
ACTIVE
8/5/2011 None
22-Mar-16 None
N/A
N/A
FORT WORTH TX
ACTIVE
10/4/2012 None
N/A
License
Number
Physician Name
P4596
MIRYALA, SHYAMALA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
10/1/2012
EMERGENCY
4/2/2012
4/2/2017 MEDICINE
BRONX
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
P2735
MIRZA, UMARFAROOK JAVED, DO
Q3556
MIRZA, ZUBAIR BAIG, MD
3/16/2015
Q6069
9/15/2015
P2303
MISELIS, KRISTIN ANN, MD
MISHRA, MICHAEL DONALD VIJAY,
MD
3/1/2012
3/1/2017 RADIOLOGY
P9653
MISHRA, RAHUL , DO
4/1/2014
P8056
MISHRA, VINEET, MD
10/1/2013
DERMATOLOGIC
10/1/2018 SURGERY
P5843
P9911
MISRA, NEETI V, MD
MISRA, SUNITA N, MD
3/15/2013
4/15/2014
OBSTETRICS AND
P1108
P8162
MITCHELL, BAKER ADAMS III, MD
MITCHELL, DEREK LLOYD, MD
MITCHELL, IAN CRICHTON SLIGHT,
MD
MITCHELL, JAMES ROBERT, MD
10/3/2011
10/15/2013
MITCHELL, JUSTIN S, DO
MITCHELL, KATRINA BLACKBURN,
MD
11/1/2013
6/1/2017 PEDIATRIC SURGERY GENERAL SURGERY SAN ANTONIO TX
HOUSTON
TX
11/1/2018 SURGERY
EL PASO
TX
2/13/2015
P3391
Q6450
P8276
Q3240
P8604
MITCHELL, LEX ALLEN, MD
6/1/2012
11/2/2015
12/16/2013
Q5229
MITCHELL, ROBERT BYRON, DO
7/15/2015
P8277
MITCHELL, RON B, MD
11/1/2013
Q3055
MITCHELL, SCOTT ANDREW, MD
2/2/2015
HOSPITALIST
CHILD AND
ADOLESCENT
PSYCHIATRY
NY
PEDIATRIC
2/2/2020 SURGERY
ACTIVE
LICENSE
ISSUED
4/3/2012 None
N/A
3/16/2015 None
N/A
AUSTIN
TX
ACTIVE
9/22/2015 None
N/A
PLANO
TX
3/12/2012 None
N/A
PAIN MANAGEMENT
PLANO
TX
ACTIVE
LICENSE
ISSUED
4/1/2014 None
N/A
DERMATOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
SAN ANTONIO TX
ACTIVE
11/7/2013 None
N/A
FREEHOLD
HOUSTON
NJ
TX
3/21/2013 None
4/24/2014 None
N/A
N/A
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
10/3/2011 None
12/11/2013 None
N/A
N/A
6/5/2012 None
11/3/2015 None
N/A
N/A
11/11/2013 None
N/A
2/13/2015 None
N/A
12/16/2013 None
N/A
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
DIAGNOSTIC
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
11/20/2012 None
N/A
OTOLARYNGOLOGY
Page 238 of 402
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
CORPUS
CHRISTI
TX
ACTIVE
7/20/2015 None
N/A
DALLAS
TX
ACTIVE
11/6/2013 None
N/A
2/2/2015 None
N/A
LICENSE
ISSUED
License
Number
Physician Name
Q4470
MITHAIWALA, MARIAH, DO
P5425
MITRO, JOSEPH CALEB, MD
Q1679
Q7750
MITROPOULOS, PANAGIOTIS, DO
MITTAL, ANGELA, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
5/15/2015
5/15/2020 MEDICINE
OBSTETRICS AND
2/1/2013
2/1/2018 GYNECOLOGY
P1901
MITTAN, DANIELLA MARIANA, MD
1/17/2012
P7673
MIYAKE, CHRISTINA, MD
8/15/2013
Q0674
MMEJE, CHINEDU , MD
6/16/2014
P6682
MOBAYED, MOHAMMAD, MD
5/15/2013
P9403
MOBLEY, CONSTANCE MARIE, MD
3/17/2014
Q2806
Q8570
MOBLEY, ELIZABETH MARIE, MD
MOCHERLA, BHAVANA , MD
MODI, DHRUVANGKUMAR
ARUNCHANDRA, MD
1/5/2015
01-Jun-16
1/5/2020 UROLOGY
4/10/2015
P4485
MODI, HRISHIKESH , MD
9/17/2012
P8278
MODRYKAMIEN, ARIEL, MD
MOEMEKA, ANGELA NNEBUCHI,
MD
11/1/2013
Q5495
Q2349
MOGRI, IDREES, MD
11/7/2014
8/3/2020 PEDIATRICS
PULMONARY
11/7/2019 DISEASES
P9229
Q7083
MOHAMED, AHMED SHEHATA, MD
MOHAMED, ASHREF , MD
3/3/2014
01-Feb-16
Q4641
MOHAMED, OSAMA , MD
MOHAMED, SHARIF SAMY FAHMY,
MD
MOHAMMAD, NASER RAMADAN
ABDELRAHMAN, MD
6/1/2015
Q7239
Q0317
8/3/2015
PULMONARY
CRITICAL CARE
11/1/2018 MEDICINE
Practice City
ARLINGTON
01-Apr-21 PEDIATRIC UROLOGY
ENDOCRINOLOGY,
DIABETES AND
INTERNAL MEDICINE
PEDIATRICS,
ELECTROPHYSIOLO
GY
UROLOGIC
6/16/2019 UROLOGY
ONCOLOGY
HEMATOLOGY/ONCOL
5/15/2018 OGY
INTERNAL MEDICINE
TRANSPLANT
SURGICAL CRITICAL
3/17/2019 SURGERY
CARE
Q3920
8/29/2014
01-Apr-16
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
MIAMI
FL
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
5/28/2015 None
N/A
2/1/2013 None
N/A
8/29/2014 None
05-Apr-16 None
N/A
N/A
COLLEGE
STATION
TX
ACTIVE
1/19/2012 None
N/A
HOUSTON
TX
ACTIVE
8/23/2013 None
N/A
ACTIVE
6/23/2014 None
N/A
FINDLEY
OH
ACTIVE
5/17/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/20/2014 None
N/A
1/5/2015 None
03-Jun-16 None
N/A
N/A
4/10/2015 None
N/A
TX
ACTIVE
9/21/2012 None
N/A
INTERNAL MEDICINE OMAHA
NE
ACTIVE
11/5/2013 None
N/A
DALLAS
TX
ACTIVE
8/7/2015 None
N/A
HOT SPRINGS AR
ACTIVE
11/11/2014 None
N/A
SUGAR LAND
LUBBOCK
ACTIVE
ACTIVE
LICENSE
ISSUED
4/3/2014 None
10-Feb-16 None
N/A
N/A
6/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
09-May-16 None
N/A
5/15/2014 None
N/A
UROLOGIC SURGERY
URGENT CARE
MEDICINE
CRITICAL CARE
MEDICINE
FLEXIBLE
HOUSTON
TX
TX
16-Feb-16
5/15/2014
INTERVENTIONAL
Page 239 of 402
GALVESTON
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P9654
MOHAMMED, ABRAR ALVI, MD
4/1/2014
Q6070
MOHAMMED, ANDREW ALIEEL, MD
9/15/2015
OPHTHALMOLOGY 9/15/2020 ANTERIOR SURGERY
P7674
MOHAMMED, ANWARULLAH , MD
8/15/2013
Q1680
MOHAMMED, ILYAS KHAN, MD
8/29/2014
Q1681
P4788
MOHAMMED, SOMALA , MD
MOHAN, KRISHN , MD
MOHIDAT, HASAN MOSA
ABDULLAH, MD
8/29/2014
11/1/2012
Q3056
2/2/2015
MOHIUDDIN, ZAHUR, MD
1/15/2014
Q3557
Q3409
MOHMAND, ASAD KHAN, MD
MOHR, THOMAS JAMES, DO
3/16/2015
3/3/2015
P6871
MOISI, MARC DANIEL, MD
6/3/2013
6/3/2018 FLEXIBLE
P5427
MOIZ, ABDUL, MD
2/1/2013
2/1/2018 NEPHROLOGY
P6042
MOJTAHEDI, ALIREZA, MD
4/1/2013
P5110
MOKHASHI, MOINUDDIN HABIB, MD
P5110
12/17/2012
P5110
12/17/2012
PEDIATRIC
PEDIATRIC
PEDIATRIC
Q2466
Q8572
MOKKALA, VIDU BALA, MD
MOLCHEN, WALLIS ANNE, DO
MOLINA ROJO, JOANNA ESTHER,
MD
11/17/2014
01-Jun-16
01-Jun-21 OTHER SPECIALTY
P2305
3/1/2012
Practice City
4/7/2014 None
N/A
LAS CRUCES
WICHITA
FALLS
NM
ACTIVE
12/2/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/16/2013 None
N/A
8/29/2014 None
N/A
8/29/2014 None
11/15/2012 None
N/A
N/A
2/2/2015 None
N/A
1/15/2014 None
N/A
3/16/2015 None
3/5/2015 None
SEE
PREVIOUS
6/6/2013 ORDER
N/A
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
CARDIOLOGY
SAN ANTONIO TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
CORPUS
CHRISTI
CORPUS
CHRISTI
HOUSTON
Q6662
MOLNAR, ARTHUR FRANCIS, MD
12/4/2015
Page 240 of 402
DALLAS
N/A
4/1/2013 None
N/A
12/17/2012 None
N/A
2/6/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
2/6/2013 None
N/A
11/17/2014 None
09-Jun-16 None
N/A
N/A
3/13/2012 None
N/A
4/8/2014 None
N/A
12/4/2015 None
N/A
TX
ACTIVE
3/17/2014
2/1/2013 None
ACTIVE
MOLLET, TODD WAYNE, MD
5/15/2013
TX
INTERNAL MEDICINE
P9404
Disciplinary
Status Date
ACTIVE
CARDIOVASCULAR
DISEASES
SURGICAL
ONCOLOGY
DERMATOLOGIC
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
MINNEAPOLIS MN
2/2/2020 VASCULAR MEDICINE
P8806
12/17/2012
Secondary Specialty
(Self-Designated)
MEDICAL
INFORMATICS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
Q6662
Q6662
P8511
P3651
P8807
MONAGAS, JAVIER JOSE, MD
dicaid
dicaid
Agreement
End Date
Designated)
04-Dec-15
04-Dec-15
12/6/2013
Q6239
P0767
MONAGHAN, MICAH, MD
MONDAL, UTPAL, MD
MONDRAGON, DONALD GENE II,
MD
MONFORD, DIANE KAY, MD
P6469
MONGE, MARIA CLAIRE, MD
P4486
MONGKOLRATTANOTHAI,
KANOKPORN, MD
9/17/2012
Q0978
MONICO, EVELYN CAROLINA, MD
7/15/2014
P7956
Q2932
MONREAL, FERNANDO , MD
MONROE, ALICIA DENISE, MD
9/16/2013
1/15/2015
P7957
9/16/2013
4/1/2015
01-Feb-16
P9656
P9657
MONROE, ROBERT JON, MD
MONROY ALBA, SCARLETT
YVONNE, MD
MONTALVO, TIMOTHY RAY, MD
MONTANA DE LA CADENA, PAULA
ANDREA, MD
MONTEMAYOR, EDGARDO
LOZANO JR, MD
MONTES, GUILLERMO, MD
PEDIATRIC
PEDIATRIC
ANESTHESIOLOGY
7/15/2019 (PEDS)
EMERGENCY
9/16/2018 MEDICINE
ANATOMIC/CLINICAL
9/16/2018 PATHOLOGY
P4985
Q5496
MONTES, JORGE ANTONIO, MD
MONTOYA, JUAN PABLO, MD
Q6771
Q0511
MOODLEY, ENASH, DO
MOODLEY, JAYAVANI, MD
15-Dec-15
6/2/2014
Q7752
MOOK, JASON SCOTT, MD
01-Apr-16
Q3740
Q7085
P0445
6/15/2012
1/15/2014
RADIATION
6/15/2017 ONCOLOGY
10/1/2015
8/15/2011
Practice City
LUBBOCK
LUBBOCK
PEDIATRIC
GASTROENTEROLOG
Y
HOSPITALIST
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
09-Dec-15 None
N/A
09-Dec-15 None
N/A
LICENSE
ISSUED
12/6/2013 None
N/A
PORT
ARTHUR, TX
SALEM
TX
OR
ACTIVE
ACTIVE
6/18/2012 None
1/27/2014 None
N/A
N/A
PHOENIX
AZ
CYTOPATHOLOGY
INTERNAL MED PEDS
ACTIVE
ACTIVE
11/24/2015 None
8/22/2011 None
N/A
N/A
BOSTON
MA
ACTIVE
6/4/2013 None
N/A
PEDIATRICS
LUBBOCK
TX
ACTIVE
10/9/2012 None
N/A
7/15/2014 None
N/A
EL PASO
HOUSTON
SOUTH SAN
FRANCISCO
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/16/2013 None
1/26/2015 None
N/A
N/A
CA
ACTIVE
9/26/2013 None
N/A
OCALA
TEMPLE
FL
TX
ACTIVE
ACTIVE
4/2/2015 None
15-Feb-16 None
N/A
N/A
7/15/2011
SAN ANTONIO TX
ACTIVE
7/21/2011 None
N/A
4/1/2014
4/1/2014
OPHTHALMOLOGY 11/30/2017 ANTERIOR SURGERY
CRITICAL CARE
15-Dec-20 MEDICINE
EMERGENCY
01-Apr-21 MEDICINE
CADIZ
KY
ACTIVE
ACTIVE
4/14/2014 None
4/7/2014 None
N/A
N/A
OPHTHALMOLOGY
SAN ANTONIO TX
ACTIVE
ACTIVE
12/17/2012 None
8/6/2015 None
N/A
N/A
EMERGENCY
MEDICINE
MYRTLE
BEACH
HOUSTON
SC
TX
ACTIVE
ACTIVE
08-Jan-16 None
6/10/2014 None
N/A
N/A
LONGVIEW
TX
ACTIVE
21-Apr-16 None
N/A
5/1/2013
11/30/2012
8/3/2015
8/15/2016 PATHOLOGY
ADOLESCENT
5/1/2018 MEDICINE - IM
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
CYTOPATHOLOGY
Page 241 of 402
License
Number
Physician Name
Q7431
Q0512
MOOKEN, GRACE MARIE , MD
MOOLJI, BEEZER, MD
Q8574
MOON, LISA MICHELLE, MD
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
04-Mar-16
6/2/2014
6/2/2019 PEDIATRICS
OBSTETRICS AND
01-Jun-16
P5690
P2306
MOON, MIA KWUN, MD
MOON, TIFFANY SUN, MD
3/1/2013
3/1/2012
P2307
MOORE, DAVID FRANCIS, MD
3/1/2012
Q1682
MOORE, DEAN II, MD
8/29/2014
P2147
2/10/2012
Q1861
MOORE, GRADIE ELIZABETH, MD
MOORE, GRAYSON ARMSTRONG,
MD
P2039
MOORE, JULENE RAE, MD
3/1/2017 NEUROLOGY
EMERGENCY
8/29/2019 MEDICINE
OBSTETRICS AND
ORTHOPEDIC
9/15/2019 SURGERY
ANATOMIC/CLINICAL
2/1/2017 PATHOLOGY
9/15/2014
2/1/2012
Q3921
MOORE, LOUIS THOMAS III, MD
4/10/2015
P5691
MOORE, MILTON RAHMON, MD
3/1/2013
P1365
Q7241
MOORE, NAKITA M, MD
MOORE, SHAMIER E'LAN, DO
11/4/2011
16-Feb-16
P9405
MOORJANI, BHAGWAN INDUR, MD
3/17/2014
P4487
MOOSA, YUNUS, MD
9/17/2012
3/17/2019 NEUROLOGY
INTERVENTIONAL
Q2591
MOOSAVI, SYED SHADAAB, MD
12/3/2014
Q1457
MOOSSAVI, NAZANIN , MD
Q8307
MORADI, MEHRAN , DO
MORALES DEMORI, RAYSA
CRISTINA, MD
MORALES GARCIA, CARLOS
SAMUEL, MD
P8808
Q5498
8/15/2014
16-May-16
1/15/2014
8/3/2015
4/10/2020 RADIOLOGY
PEDIATRIC
Secondary Specialty
(Self-Designated)
PHARMACEUTICAL
MEDICINE
VASCULAR
NEUROLOGY
Practice City
Disciplinary
Status Date
TX
ACTIVE
ACTIVE
10-Mar-16 None
6/16/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
15-Jun-16 None
N/A
FORT WORTH TX
DALLAS
TX
ACTIVE
ACTIVE
3/4/2013 None
3/6/2012 None
N/A
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
3/28/2012 None
N/A
8/29/2014 None
N/A
ACTIVE
2/14/2012 None
N/A
9/22/2014 None
N/A
TX
GALVESTON
TX
ACTIVE
RATON
NM
ACTIVE
LICENSE
ISSUED
2/6/2012 None
N/A
4/10/2015 None
N/A
INTERVENTIONAL
RADIOLOGY
URGENT CARE
MEDICINE
HOUSTON
TX
ACTIVE
3/26/2013 None
N/A
PSYCHIATRY
TEMPLE
TX
ACTIVE
ACTIVE
11/29/2011 None
01-Mar-16 None
N/A
N/A
CA
ACTIVE
3/24/2014 None
N/A
LA
ACTIVE
LICENSE
ISSUED
9/21/2012 None
N/A
12/3/2014 None
N/A
8/20/2014 None
N/A
24-May-16 None
N/A
1/15/2014 None
N/A
9/10/2015 None
N/A
HOSPITALIST
COLON AND RECTAL
8/3/2020 SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
NEURO-PHYSIOLOGY
(NEUROLOGY)
LA QUINTA
CARDIOVASCULAR
DISEASES
ZACHARY
EMERGENCY
16-May-21 MEDICINE
Registration
Status of
Practice
Texas
State
License
WICHITA
FALLS
TX
ACTIVE
HILLSBORO
TX
ACTIVE
LICENSE
ISSUED
GENERAL SURGERY BEAUMONT
Page 242 of 402
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1477
MORALES MENDEZ, JACOBO S,
MD
P0446
MORALES, FRANCISCO J, MD
7/15/2011
Q5872
8/28/2015
P4894
MORALES-RALAT, ASTRID, MD
MORANI, AJAYKUMAR
CHANDRALAL, MD
P7675
MORCOS, HANAN, MD
P8950
Q4215
P8605
MORE, SNEHAL RAMKRISHNA, MD
MOREHEAD, CHARLIE ANN, MD
MORELAND, AMBER MICHELLE,
MD
MORELAND, JESSICA GERMOND,
MD
P9913
MORENO, WILMER , MD
P9095
11/15/2011
11/15/2012
8/15/2013
2/7/2014
5/1/2015
2/18/2014
12/16/2013
4/15/2014
P8809
MORGAN, ANDREW RICHARD, MD
1/15/2014
Q6665
MORGAN, JEFFREY ADAM, MD
12/4/2015
Q6665
04-Dec-15
Q6665
P7816
MORGAN, RUTH, MD
04-Dec-15
8/30/2013
P1366
MORGAN, SHERRI LYNN, MD
P0641
MORGAN, TIMOTHY GENE, DO
Q1685
MORI, SHAHRAM, MD
MORIATES, CHRISTOPHER PAUL,
MD
MORILLA HOLGUIN, MIGUEL
EMILIO, MD
MORILLA, DANIEL BYRNES, MD
Q8308
P1790
P8164
11/4/2011
8/1/2011
8/29/2014
16-May-16
1/2/2012
10/15/2013
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
DIAGNOSTIC
7/15/2016 RADIOLOGY
INTERVENTIONAL
RADIOLOGY
ABDOMINAL
CARDIAC
ELECTROPHYSIOLOG
8/15/2018 Y
2/7/2019 RADIOLOGY
5/1/2020 PEDIATRICS
TX
ACTIVE
LICENSE
ISSUED
7/22/2011 None
N/A
8/28/2015 None
N/A
PEDIATRIC
RADIOLOGY
HOUSTON
TX
ACTIVE
12/3/2012 None
N/A
CARDIOVASCULAR
DISEASES
SAN ANGELO
TX
ACTIVE
8/19/2013 None
N/A
GALVESTON TX
FLORESVILLE TX
ACTIVE
ACTIVE
2/25/2014 None
5/7/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
2/25/2014 None
N/A
12/16/2013 None
N/A
ACTIVE
4/16/2014 None
N/A
ACTIVE
1/20/2014 None
N/A
BODY IMAGING
PEDIATRIC CRITICAL
OBSTETRICS AND
EMERGENCY
1/15/2019 MEDICINE
CARDIOVASCULAR
12/4/2020 SURGERY
CARDIOVASCULAR
04-Dec-20 SURGERY
CARDIOVASCULAR
04-Dec-20 SURGERY
LAREDO
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
11/15/2011 ORDER
7/5/2011
GASTROENTEROLOG
Y
DALLAS
DALLAS
TRANSPLANT
SURGERY
TRANSPLANT
SURGERY
TRANSPLANT
SURGERY
TX
ACTIVE
12/8/2015 None
N/A
HOUSTON
TX
ACTIVE
08-Dec-15 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
08-Dec-15 None
9/2/2013 None
N/A
N/A
TX
ACTIVE
11/28/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
8/29/2014 None
N/A
DALLAS
DIAGNOSTIC
8/1/2016 RADIOLOGY
NEURO-RADIOLOGY DALLAS
HEMATOLOGY/ONCOL
8/29/2019 OGY
INTERNAL MEDICINE
Page 243 of 402
TX
HOUSTON
OBSTETRICS AND
GYNECOLOGY
16-May-21 HOSPITALIST
INFECTIOUS
1/2/2017 DISEASES
10/15/2018 UROLOGY
TX
AUSTIN
TX
ACTIVE
19-May-16 None
N/A
PALMVIEW
EL PASO
TX
TX
ACTIVE
ACTIVE
1/9/2012 None
11/8/2013 None
N/A
N/A
License
Number
Q2027
Physician Name
MORLEND, ROBERT MATHEW, MD
Q4472
MORO-SUTHERLAND, DONNA
MARIE, MD
MORPER, JACK GREGORY, MD
MORRELL, MIRIAM BELEN GARCIA,
DO
P9914
MORRICAL, STEPHEN O, MD
J9225
Q6240
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
CARDIOVASCULAR
10/1/2014
10/1/2019 DISEASES
PEDIATRIC
EMERGENCY
8/1/2011
PEDIATRICS
HOUSTON
10/1/2015
KERRVILLE
5/15/2015
4/15/2014
Q4216
P4488
MORRIS, CARRIE LYNN, MD
MORRIS, EVELYN LETHITIA, MD
5/1/2015
9/17/2012
Q2687
MORRIS, PETER DAVID, MD
Q7931
MORRISON, CHRISTOPHER, MD
15-Apr-16
Q5874
MORRISON, MATTHEW ELLIS, MD
8/28/2015
12/15/2014
EMERGENCY
4/15/2019 MEDICINE
EMERGENCY
12/15/2019 MEDICINE
GASTROENTEROLOG
15-Apr-21 Y
EMERGENCY
8/28/2020 MEDICINE
MORRISON, ROBERT STANLEY III,
MD
MORSE, JESSICA HARTSON, MD
MORSE, MEROE BERGMAN, MD
6/3/2013
8/1/2014
8/1/2014
Q5500
MORSE, ROGER, MD
8/3/2015
Q5698
Q4219
MORSHEDI, BRANDON , MD
MOSA, ABO BAKER AHMD, MD
8/14/2015
5/1/2015
DIAGNOSTIC
6/3/2018 RADIOLOGY
8/1/2019 PEDIATRICS
EMERGENCY
8/3/2020 MEDICINE
EMERGENCY
8/14/2020 MEDICINE
Q0319
5/15/2014
P1368
MOSCOL, GIANCARLO, MD
MOSCOSO AGOSTO, ALEJANDRA,
MD
11/4/2011
P2500
MOSCOSO, WALTER ENRIQUE, MD
3/15/2012
MOSELEY, MICAH SETH, MD
4/10/2015
P1791
MOSER, DAVID WALTER, DO
1/2/2012
PEDIATRIC
PLASTIC &
RECONSTRUCTIVE
SURGERY
GERIATRICS
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
Disciplinary
Status Date
ACTIVE
10/2/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
8/8/2011 None
10/5/2015 None
N/A
N/A
6/3/2015 None
N/A
4/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
FORT WORTH TX
WORCESTER MA
ACTIVE
ACTIVE
5/4/2015 None
10/11/2012 None
N/A
N/A
DALLAS
WICHITA
FALLS
TX
ACTIVE
2/5/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
18-Apr-16 None
N/A
8/28/2015 None
N/A
BEAUMONT
AUSTIN
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/6/2013 None
8/18/2014 None
8/21/2014 None
N/A
N/A
N/A
SUGAR LAND
TX
ACTIVE
8/6/2015 None
N/A
DALLAS
TYLER
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
8/31/2015 None
5/4/2015 None
N/A
N/A
5/15/2014 None
N/A
TX
ACTIVE
11/7/2011 None
N/A
TX
ACTIVE
LICENSE
ISSUED
3/19/2012 None
N/A
4/10/2015 None
N/A
1/4/2012 None
N/A
DALLAS
CORPUS
CHRISTI
Page 244 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
PEDIATRICS
P6874
Q1233
Q1234
Q3922
Registration
Status of
Practice
Texas
State
License
AUSTIN
TX
ACTIVE
License
Number
Q2592
P6044
Physician Name
MOSES, DEBRA JEAN SMOUSE,
DO
MOSES, ELI, MD
Q4473
dicaid
dicaid
Agreement
End Date
Designated)
12/3/2014
4/1/2013
Secondary Specialty
(Self-Designated)
Practice City
ACTIVE
12/10/2014 None
N/A
DALLAS
TX
ACTIVE
4/8/2013 None
N/A
GRAPEVINE
TX
ACTIVE
5/19/2015 None
N/A
PALO ALTO
CA
ACTIVE
LICENSE
ISSUED
8/25/2014 None
N/A
6/12/2015 None
N/A
P3208
MOSS, HART BEAMAN, MD
5/15/2012
P0256
P8512
MOSU, NICOLAE, MD
MOTA, ESTELA , MD
7/1/2011
12/6/2013
P1111
MOTAMARRY, SILUS, MD
D8040
MOTES, JOSEPH L JR, MD
P2309
MOTTL, STEVEN DAVID JR, DO
Q6242
MOUALLA, HAYAN, MD
10/1/2015
Q6243
MOUHAFFEL, ASSAD H, MD
10/1/2015
Q6666
MOURAD, MOUSTAFA WALID, MD
12/4/2015
Q6666
04-Dec-15
Q6666
Q4474
P5212
04-Dec-15
5/15/2015
1/4/2013
Q0676
Q1862
MOUSA, ELMOUTAZ, MD
MOVVA, SUDHIR BABU, MD
MOWLA, MOHAMMED RASHEDUL,
MD
MOYE, BRANNON, MD
3/1/2017 CARDIOLOGY
HEMATOLOGY/ONCOL
10/1/2020 OGY
INTERNAL MEDICINE HARLINGEN
WEST
MONROE
OTOLARYN & FACIAL
OTOLARYN & FACIAL HEAD AND NECK
04-Dec-20 PLASTIC SURGERY
SURGERY
FORT WORTH
OTOLARYN & FACIAL HEAD AND NECK
SURGERY
FORT WORTH
LUBBOCK
RUTLAND
6/16/2014
9/15/2014
9/15/2019 RADIOLOGY
Q8577
MOZA, ROMA , MD
01-Jun-16
Q6969
MU, XIAO CHUN, MD
15-Jan-16
01-Jun-21 INTERNAL MED - PEDS
ANATOMIC/CLINICAL DERMATOPATHOLO
15-Jan-21 PATHOLOGY
GY
Page 245 of 402
6/12/2015
10/3/2011
OBSTETRICS AND
7/1/2016 GYNECOLOGY
10/3/2011
3/1/2012
UNSPECIFIED
Disciplinary
Status Date
TX
5/15/2015
8/15/2014
Registration
Status Date
Disciplinary
Status of
Texas
License
KINGWOOD
MOSES, GEOFFREY FRANKLIN, MD
MOSHFEGHI, DARIUS MOHAMMAD,
TM00586 MD
MOSHIREE THOMAS, BANAFSHEH,
Q4814
MD
PEDIATRIC
OPHTHALMOLOGY
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
ACTIVE
5/21/2012 None
N/A
JAMAICA
NY
ACTIVE
ACTIVE
7/25/2011 None
12/11/2013 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
GENERAL SURGERY
CARDIOVASCULAR
IMAGING
LEWISVILLE
N/A
ACTIVE
10/5/2011 None
UNDER
BOARD
10/9/2011 ORDER
TX
ACTIVE
3/12/2012 None
N/A
TX
ACTIVE
10/5/2015 None
N/A
LA
ACTIVE
LICENSE
ISSUED
10/28/2015 None
N/A
12/4/2015 None
N/A
TX
ACTIVE
16-Dec-15 None
N/A
TX
TX
VT
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
16-Dec-15 None
5/25/2015 None
1/9/2013 None
N/A
N/A
N/A
6/16/2014 None
9/16/2014 None
N/A
N/A
ACTIVE
08-Jun-16 None
N/A
ACTIVE
19-Jan-16 None
N/A
HOSPITALIST
OCALA
9/14/2011
FL
DALLAS
TX
CHATTANOOG
A
TN
License
Number
P8513
Physician Name
MUDASIRU-DAWODU, ENIOLA
FATIMA, MD
Q3924
Q4475
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
12/6/2013
12/6/2018 RADIOLOGY
MUDIMBI, KRISHNA RAMA, MD
4/10/2015
5/15/2015
SAN ANTONIO TX
Q4220
MUDRICK, JESSICA BRITTAIN, MD
MUDRICK, TUCKER RANDOLPH,
MD
5/1/2015
Q8578
Q5700
MUECK, KRISLYNN MICHELLE, MD
MUELLER, LYNDA LEA, MD
01-Jun-16
8/14/2015
Q3411
MUENCH, RICHARD J, MD
3/3/2015
K0143
MUENS, GUENTHER, MD
3/15/2013
Q1235
MUESSE, JASON LEONARD, MD
P0449
Q6667
Q6667
Q6667
MUGHAL, MOHAMMAD ANSAR, MD
MUGHAL, TANVEER HAIDER, MD
7/15/2011
12/4/2015
04-Dec-15
04-Dec-15
P1112
MUGHRABI, LINDA BASSAM, MD
10/3/2011
8/1/2014
Q7086
P2310
P0257
MUHAMMAD, AHMAD TALIB, MD
MUJURUKI, CEPHAS , MD
MUKALEL, JESSEN JAMES, MD
01-Feb-16
3/1/2012
7/1/2011
P0258
Q7087
7/1/2011
01-Feb-16
P2311
MUKALEL, NINON JAMES, MD
MUKE, MAUREEN, MD
MUKERJI, SHRADDHA SIDDHARTH,
MD
Q0983
P9916
MUKERJI, SIDDHARTH , MD
MUKHERJEE, BIJOY, DO
7/15/2014
4/15/2014
Q7933
MUKKAMALLA, UMAMAHESWARI,
MD
15-Apr-16
3/1/2012
NUCLEAR MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
PAIN MEDICINE
URGENT CARE
MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
OBSTETRICS AND
01-Feb-21 GENERAL PRACTICE
PEDIATRIC
7/1/2016 NEUROLOGY
GENERAL
PREVENTIVE
MEDICINE
SLEEP MEDICINE
PEDIATRIC
OTOLARYNGOLOGY
CARDIAC
ELECTROPHYSIOLOG
7/15/2019 Y
CARDIOLOGY
VASCULAR AND
INTERVENTIONAL
15-Apr-21 RADIOLOGY
RADIOLOGY
Page 246 of 402
Disciplinary
Status Date
12/6/2013 None
N/A
4/10/2015 None
N/A
ACTIVE
5/19/2015 None
N/A
SAN ANTONIO TX
ACTIVE
5/4/2015 None
N/A
HOUSTON
ACTIVE
ACTIVE
LICENSE
ISSUED
21-Jun-16 None
9/11/2015 None
N/A
N/A
3/3/2015 None
N/A
SILVERDALE
TX
WA
ACTIVE
4/1/2013 None
N/A
GA
ACTIVE
8/18/2014 None
N/A
SAN ANTONIO TX
8/11/2011
12/8/2015
08-Dec-15
08-Dec-15
None
None
None
None
N/A
N/A
N/A
N/A
GENERAL SURGERY ATLANTA
7/15/2016
12/4/2020
04-Dec-20
04-Dec-20
Registration
Status Date
Disciplinary
Status of
Texas
License
LIVINGSTON
LIVINGSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HENDERSON
TX
ACTIVE
10/5/2011 None
N/A
HOUSTON
AMARILLO
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
04-Feb-16 None
3/19/2012 None
7/7/2011 None
N/A
N/A
N/A
HOUSTON
TACOMA
TX
WA
ACTIVE
ACTIVE
7/7/2011 None
23-Feb-16 None
N/A
N/A
GALVESTON
TX
ACTIVE
3/12/2012 None
N/A
ACTIVE
ACTIVE
7/31/2014 None
4/18/2014 None
N/A
N/A
ACTIVE
25-Apr-16 None
N/A
THE
WOODLANDS TX
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Q3741
Physician Name
MUKKAVILLI, VENKATA
MARTHANDA SASTRY, MD
Q5045
P0916
MULLEN, CASEY KYLEE, MD
MULLICAN, DAVID RYAN, MD
7/1/2015
9/1/2011
4/1/2020 PSYCHIATRY
EMERGENCY
7/1/2020 MEDICINE
P8952
MULLINS, JANICE NHAN, DO
2/7/2014
Q8110
P8514
H2632
MULTANI, KIRANPREET KAUR, DO
MULUKUTLA, RAMA , MD
MULVEHILL, SHARON ANN, MD
02-May-16
12/6/2013
5/15/2013
Q7242
Q6350
MUMFORD, LINDA ALICE, MD
MUMME, JESSICA MARIE, MD
16-Feb-16
10/15/2015
P8165
P0770
MUMTAZ, MUHAMMAD ALI, MD
MUNDRA, VISHAL, MD
10/15/2013
8/15/2011
Q7243
Q5046
P5849
MUNGARA, CHARAN, MD
MUNIZ, BRENNA MICHELL, MD
MUNIZ, MANUEL R, MD
16-Feb-16
7/1/2015
3/15/2013
P1369
MUNOZ, JAVIER LUIS, MD
11/4/2011
P9659
MUNSHI, OMER , MD
P2900
Q4476
MUNSHI, SATVIK BHARGAV, MD
MUPPARAPU, SANTOSH KUMAR,
MD
16-Feb-21 OTHER SPECIALTY
THORACIC
CARDIOVASCULAR
10/15/2018 SURGERY
THORACIC
CARDIOVASCULAR
16-Feb-21 SURGERY
GENERAL SURGERY
HEMATOLOGY/ONCOL
11/4/2016 OGY
INTERNAL MEDICINE
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
PAIN MEDICINE
Q2167
MUPPURI, SWAPNA, MD
Q5047
MURADOV, PAVEL, MD
J3166
MURAKAMI, CAROL SUMI, MD
MURALIDHARA, KESTURKOPPAL ,
MD
P0857
4/1/2015
4/1/2014
4/13/2012
ACTIVE
ACTIVE
LICENSE
ISSUED
DECATUR
CONROE
BILLINGS
10/15/2014
ORTHOPEDIC
7/1/2020 SURGERY
GASTROENTEROLOG
4/10/2020 Y
INTERNAL MEDICINE
8/26/2011
8/26/2016
Page 247 of 402
Disciplinary
Status Date
4/1/2015 None
N/A
7/3/2015 None
9/7/2011 None
N/A
N/A
2/7/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
09-May-16 None
12/13/2013 None
7/8/2013 None
N/A
N/A
N/A
MO
TX
ACTIVE
ACTIVE
29-Feb-16 None
10/19/2015 None
N/A
N/A
TX
OK
ACTIVE
ACTIVE
10/25/2013 None
8/19/2011 None
N/A
N/A
HOUSTON
DENISON
TX
TX
ACTIVE
ACTIVE
ACTIVE
03-Mar-16 None
7/6/2015 None
4/1/2013 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
11/10/2011 None
N/A
SAN ANTONIO TX
NEW
ORLEANS
LA
ACTIVE
4/29/2014 None
N/A
ACTIVE
4/23/2012 None
N/A
ACTIVE
6/16/2015 None
N/A
10/15/2014 None
N/A
7/3/2015 None
N/A
4/10/2015 None
N/A
8/26/2011 None
N/A
HOSPITALIST
PULMONARY
CRITICAL CARE
MEDICINE
4/10/2015
Registration
Status Date
Disciplinary
Status of
Texas
License
IL
TX
MT
OBSTETRICS
OTORHINOLARYNGO
LOGY
ST LOUIS
HOUSTON
PEDIATRIC
CARDIOTHORACIC
SURGERY
SAN ANTONIO
TULSA
5/15/2015
7/1/2015
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
P3654
MURPHY, ANDREW CHARLES, MD
6/15/2012
6/15/2017 MEDICINE
Q5502
MURPHY, DANIEL , MD
8/3/2015
SPORTS MEDICINE
P6876
MURPHY, LORI MAE, MD
6/3/2013
OPHTHALMOLOGY
EMERGENCY
Q7434
MURPHY, SEAN MICHAEL, MD
04-Mar-16
04-Mar-21 MEDICINE
EMERGENCY
Q3742
MURRAY, KELLY L, MD
4/1/2015
4/1/2020 MEDICINE
EMERGENCY
Q3558
MURRAY, KYLE JOSEPH, DO
3/16/2015
3/16/2020 MEDICINE
Q7754
MURRELL, MATTHEW , MD
01-Apr-16
Q5048
MURTHY, KENTON KUMAR, DO
7/1/2015
THORACIC
CARDIOVASCULAR
Q3245
MURTHY, RAGHAV ALAMPALLI, MD
2/13/2015
2/13/2020 SURGERY
GENERAL SURGERY
P6685
MURTHY, SANTOSH BHASKAR, MD
P2312
MURTY, RAMANA M, MD
P5850
5/15/2013
5/15/2018 NEUROLOGY
INTERVENTIONAL
CARDIOLOGY
3/1/2012
3/1/2017 CARDIOLOGY
MUSGRAVE, WILLIAM LARKIN, DO
3/15/2013
Q3927
MUSHAM, CHAITANYA KUMAR, MD
4/10/2015
P8954
MUSHTAQ, ALIYA NAAZ, MD
2/7/2014
P0259
MUSSO, MARYFRANCES , DO
7/1/2011
2/7/2019 CARDIOLOGY
PEDIATRIC
Q0320
P4987
Q6773
MUSSOMELI, JUSTIN XAVIER, MD
MUSTAFA, ARSHAD , MD
MUSTAFA, NADA FURQAAN, MD
5/15/2014
11/30/2012
15-Dec-15
5/15/2019 NEUROLOGY
Q0321
MUSTAFA, NADIA MUHAMMAD, MD
5/15/2014
P8955
2/7/2014
Q2688
P5692
MUSTAFA, SADAF, MD
MUSUNURU, JAGADEESWARA
RAO, MD
MUTHAPPA, DIVYA, MD
12/15/2014
3/1/2013
Q2472
P4895
MUTTAL, SARASWATI, MD
MUZAFFAR, SUMERA, MD
11/17/2014
11/15/2012
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
SAN ANTONIO TX
ADDICTION
MEDICINE - AN
FAMILY MEDICINE
Page 248 of 402
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
6/21/2012 None
8/5/2015 None
6/7/2013 None
N/A
N/A
N/A
ACTIVE
09-Mar-16 None
N/A
ACTIVE
4/10/2015 None
N/A
3/27/2015 None
06-Apr-16 None
7/7/2015 None
N/A
N/A
N/A
CORPUS
CHRISTI
TX
BURLESON
TX
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
2/19/2015 None
N/A
BALTIMORE
MD
STEUBENVILL
E
OH
ACTIVE
6/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
3/15/2012 None
N/A
3/15/2013 None
N/A
4/10/2015 None
N/A
2/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/6/2011 None
N/A
5/15/2014 None
12/10/2012 None
17-Dec-15 None
N/A
N/A
N/A
5/15/2014 None
N/A
2/7/2014 None
N/A
12/29/2014 None
3/8/2013 None
N/A
N/A
11/17/2014 None
11/20/2012 None
N/A
N/A
HOSPITALIST
INTERVENTIONAL
CARDIOLOGY
OTOLARYNGOLOGY
NEUROMUSCULAR
DISEASE
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
DALLAS
SUGAR LAND
TX
TX
FOND DU LAC WI
BANDERA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
L4074
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
10/1/2014
P8515
MYCHASKIW, GEORGE II, DO
MYDLARZ, WOJCIECH
KRZYSZTOF, MD
12/6/2013
G6576
MYERS, STUART IRA, MD
6/14/2013
Q0677
MYINT, ALEX HORST, MD
6/16/2014
Q0322
MYINT, THU ZAR, MD
5/15/2014
Q8579
MYNATT, IRENE ANN, DO
01-Jun-16
EMERGENCY
01-Jun-21 MEDICINE
Q2029
MYSER, KRYSTEN ELIZABETH, MD
10/1/2014
Q5506
Q6451
P1370
NABI, NEELOFAR , MD
NACHIMUTHU, NAGAKRISHNAL ,
MD
NAGA, OSAMA IBRAHIM, MD
11/2/2015
11/4/2011
Q1687
P4790
Q6246
NAGALLA, BHANU PRAKASH, MD
NAGALLA, SUBHASH K S, MD
NAGARAJ, ALAKANANDA, MD
8/29/2014
11/1/2012
10/1/2015
P3556
P6474
NAGARAJ, SUDHA, MD
NAGARAJ, SUMA, MD
6/8/2012
5/1/2013
5/1/2018 PEDIATRICS
Q0678
NAGARAJAN, PRIYADHARSINI, MD
6/16/2014
Q5507
NAGARKAR, PURUSHOTTAM , MD
8/3/2015
Q6247
P9235
NAGEL, THEODORE WILLIAM, MD
NAGI, RAVNEET K, MD
10/1/2015
3/3/2014
6/16/2019 PATHOLOGY
PLASTIC &
RECONSTRUCTIVE
8/3/2020 SURGERY
PLASTIC &
RECONSTRUCTIVE
10/1/2020 SURGERY
P3209
Q3063
Q5875
NAGPAL, AMEET SINGH, MD
NAGPAL, STUTI, MD
NAGRA, AMRITA, DO
5/15/2012
2/2/2015
8/28/2015
8/3/2015
Secondary Specialty
(Self-Designated)
HEAD AND NECK
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
10/8/2014 None
N/A
HOUSTON
TX
ACTIVE
12/13/2013 None
N/A
NE
ACTIVE
6/20/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/17/2014 None
N/A
5/15/2014 None
N/A
01-Jun-16 None
N/A
10/14/2014 None
N/A
8/3/2015 None
N/A
11/2/2015 None
12/1/2011 None
N/A
N/A
8/29/2014 None
11/7/2012 None
10/9/2015 None
N/A
N/A
N/A
6/8/2012 None
5/3/2013 None
N/A
N/A
ACTIVE
6/23/2014 None
N/A
TX
ACTIVE
8/5/2015 None
N/A
FORT WORTH TX
BELLAIRE
TX
ACTIVE
ACTIVE
10/5/2015 None
3/31/2014 None
N/A
N/A
HOUSTON
AMARILLO
DALLAS
ACTIVE
ACTIVE
ACTIVE
5/22/2012 None
2/9/2015 None
9/1/2015 None
N/A
N/A
N/A
INTERNAL MEDICINE
TEMPLE
TX
8/3/2020 PEDIATRICS
INFECTIOUS
DISEASES
BEAUMONT
TX
PEORIA
IL
DERMATOPATHOLO
GY
DALLAS
MICROSURGERY
PHYSICAL MED. &
REHABILITATION
Page 249 of 402
Disciplinary
Status Date
PHILADELPHIA PA
GENERAL VASCULAR
LINCOLN
GASTROENTEROLOG
6/16/2019 Y
HOSPITALIST
OTHER SPECIALTY
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
Q2030
NAGUBANDI, RAVI, MD
P4684
NAHAR, RIADUN , MD
Q0129
NAHAR, TAMANNA, MD
P9098
Q7088
NAIDITCH, JESSICA ANN, MD
NAIDS, STEVEN, MD
P6046
P0917
NAIDU, KARTHIK, MD
NAIK, JAEE, MD
P7679
NAIK, SEEMA GIRISH, MD
P7165
NAIK, SWATI , MD
Q0324
NAIR, ANIL GOVINDAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
10/1/2014
10/15/2012
5/2/2014
2/18/2014
01-Feb-16
4/1/2013
9/1/2011
8/15/2013
7/1/2013
5/15/2014
Secondary Specialty
(Self-Designated)
Practice City
CARDIOVASCULAR
5/2/2019 DISEASES
ORAL &
MAXILLOFACIAL
4/1/2018 SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
7/1/2018 OGY
Q6072
NAIR, JAYAN, MD
9/15/2015
P7680
NAIR, RINSY, MD
8/15/2013
P6223
NAIR, SAJAY, MD
4/12/2013
Q7246
NAIR, SREEJIT, MD
16-Feb-16
HEMATOLOGY/ONCOL
9/15/2020 OGY
PEDIATRIC
EMERGENCY
INTERVENTIONAL
16-Feb-21 RADIOLOGY
P8703
NAIR, SRIKUMAR , MD
1/3/2014
P4600
NAJAM, FERHANA, MD
10/1/2012
Q6669
NAJARA, JULIA ELVIRA, MD
12/4/2015
Q6669
04-Dec-15
CHILD AND
ADOLESCENT
CHILD AND
ADOLESCENT
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/1/2014 None
N/A
12/10/2012 None
N/A
5/2/2014 None
N/A
2/18/2014 None
28-Mar-16 None
N/A
N/A
4/1/2013 None
9/9/2011 None
N/A
N/A
ACTIVE
8/20/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/25/2013 None
N/A
5/15/2014 None
N/A
ACTIVE
9/22/2015 None
N/A
FAMILY PRACTICE
ACTIVE
8/26/2013 None
N/A
PEDIATRICS
LICENSE
ISSUED
4/12/2013 None
N/A
WICHITA
FALLS
TX
INTERVENTIONAL
CARDIOLOGY
PEDIATRIC SURGERY
GERIATRICS
HEMATOLOGY INTERNAL MEDICINE SAN ANTONIO TX
HOUSTON
HEMATOLOGY/ONCO
LOGY
BEMIDJI
TX
MN
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
VASCULAR MEDICINE NEW YORK
NY
ACTIVE
01-Mar-16 None
N/A
HOUSTON
WICHITA
INTERNAL MEDICINE FALLS
TX
ACTIVE
1/7/2014 None
N/A
TX
ACTIVE
10/2/2012 None
N/A
PSYCHIATRY
LYTLE
TX
ACTIVE
12/8/2015 None
N/A
PSYCHIATRY
LYTLE
TX
ACTIVE
08-Dec-15 None
N/A
Page 250 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CHILD AND
ADOLESCENT
04-Dec-15
PSYCHIATRY
11/4/2011
11/4/2016 RADIOLOGY
4/2/2012
Q6669
P1372
P2741
NAKAMURA, LEE MAYUMI, MD
NAKIB, EVAN ZEB, MD
Q0796
NALLAMOTHU, GEETHA, MD
P1478
NALLU, SAGARIKA, MD
11/15/2011
P9409
NALLURI, SUMAN, MD
3/17/2014
3/17/2019 NEUROLOGY
Q3247
NALUBOTULA, ANIL KUMAR, MD
2/13/2015
Q1688
6/27/2014
PEDIATRIC
Q1459
NAMBIAR, SUDHEER, MD
NAMBUDIRI, DRAUPATHI
EASWARAN, MD
8/29/2014
8/15/2014
Q5049
NAMUDURI, ANURADHA , DO
7/1/2015
Q0325
P2042
NANEZ, LILIANA , MD
NANGIA, SAMIR KUMAR, MD
5/15/2014
2/1/2012
Q2169
Q2351
NANGIA, SHARAD, MD
NANGRANI, MEHAK D, DO
Q4478
P1113
P1904
Q1239
NANNAPANENI, SRIKANT, MD
NAQVI, ALI HASNAIN, MD
NAQVI, ERUM, MD
NAQVI, HUMERA, MD
5/15/2015
10/3/2011
1/17/2012
8/1/2014
Q4817
NARASIMHAN, KULUMANI
MUTHUSWAMIARYA, MD
6/12/2015
Q8758
NARAYAN, MAYUR, MD
10-Jun-16
Q1241
NARENDRA, DHARANI KUMARI, MD
Q7247
NARMALA, SHRAVAN KUMAR, MD
10/15/2014
11/7/2014
8/1/2014
16-Feb-16
Practice City
LYTLE
GALVESTON
MONROE
Registration
Status of
Practice
Texas
State
License
TX
TX
LA
SLEEP MEDICINE
PULMONARY
CRITICAL CARE
MEDICINE
GERIATRIC
PSYCHIATRY
2/1/2017 NEPHROLOGY
INTERNAL MEDICINE
GASTROENTEROLOG
10/15/2019 Y
CRITICAL CARE
5/15/2020 INTERNAL MEDICINE MEDICINE (IM)
HOSPITALIST
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
DESOTO
DALLAS
AMARILLO
SAN ANTONIO
HOUSTON
GENERAL VASCULAR
SURGERY
SURGICAL CRITICAL
CARE
DALLAS
PULMONARY
CRITICAL CARE
MEDICINE
HOUSTON
HEMATOLOGY/ONCOL
16-Feb-21 OGY
INTERNAL MEDICINE BILOXI
Page 251 of 402
Disciplinary
Status Date
08-Dec-15 None
11/10/2011 None
4/12/2012 None
N/A
N/A
N/A
6/27/2014 None
N/A
ACTIVE
12/6/2011 None
N/A
ACTIVE
LICENSE
ISSUED
3/18/2014 None
N/A
2/13/2015 None
N/A
8/29/2014 None
N/A
8/15/2014 None
N/A
7/2/2015 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
FORT WORTH TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
5/15/2014 None
2/10/2012 None
N/A
N/A
10/15/2014 None
11/11/2014 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/3/2015
10/13/2011
1/31/2012
8/18/2014
None
None
None
None
N/A
N/A
N/A
N/A
LICENSE
ISSUED
6/12/2015 None
N/A
TX
ACTIVE
17-Jun-16 None
N/A
TX
ACTIVE
8/5/2014 None
N/A
MS
ACTIVE
01-Mar-16 None
N/A
TX
TX
TX
TX
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P1114
NARULA, ARUN, MD
10/3/2011
Q1864
Q0517
P1374
NASH, ZACK , MD
NASIR, MAHWISH , MD
NASIR, SOBIA , MD
9/15/2014
6/2/2014
11/4/2011
P6224
P7961
NASON, ROBERT, MD
NASR, RABIH, MD
4/12/2013
9/16/2013
Q2810
NASR, TALA RAMZI, MD
Q6248
P0451
Q6884
NASRALLAH, FADI VICTOR, MD
NASREEN, JOHRA, MD
NASSAR, TAREQ ISSA MICHAEL,
MD
Q0130
P8704
NASSER EDDIN, AMMAR, MD
NASSER, YASSER A, MD
5/2/2014
1/3/2014
P6877
NASTOUPIL, LORETTA JO, MD
6/3/2013
Secondary Specialty
(Self-Designated)
NEONATALNEONATALPERINATAL
10/3/2016 PERINATAL MEDICINE MEDICINE
10/1/2015
7/15/2011
6/2/2019 PEDIATRICS
PEDIATRIC
OTOLARYNGOLOGY
NEONATALPERINATAL
1/5/2020 PEDIATRICS
MEDICINE
CARDIOTHORACIC
ANESTHESIOLOGY
HOSPITALIST
06-Jan-16
1/5/2015
P4685
NASUR, ALI MOHAMED, MD
P3394
NATARAJAN, BALAKRISHNAN, MD
Q1460
NATESAN, RAJNI, MD
8/15/2014
DIAGNOSTIC
8/15/2019 RADIOLOGY
P8283
Q7757
NATH, BIPASHA, MD
NATHAN, NIRAJ RAMA, MD
11/1/2013
01-Apr-16
Q0518
NATION-HOWARD, BRIEANNA, DO
TM00495 NATTELL, DANIEL F, MD
10/15/2012
1/3/2019 NEPHROLOGY
HEMATOLOGY/ONCOL
6/3/2018 OGY
INTERVENTIONAL
6/1/2012
6/2/2014
12/15/2011
Q6075
P7166
NAVAEI, AMIR HASSAN , MD
NAVALKELE, DIGVIJAYA D, MD
9/15/2015
7/1/2013
Q0797
NAVEED, AMMARA, MD
6/27/2014
Practice City
ALGONQUIN
Registration
Status of
Practice
Texas
State
License
IL
SAN ANTONIO TX
N/A
ACTIVE
ACTIVE
ACTIVE
9/23/2014 None
6/11/2014 None
11/8/2011 None
N/A
N/A
N/A
TX
ACTIVE
ACTIVE
4/23/2013 None
12/9/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
2/4/2015 None
N/A
TYLER
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
10/7/2015 None
8/8/2011 None
N/A
N/A
19-Jan-16 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
5/2/2014 None
1/13/2014 None
N/A
N/A
TX
ACTIVE
6/7/2013 None
N/A
10/25/2012 None
N/A
6/1/2012 None
N/A
HOUSTON
Page 252 of 402
10/10/2011 None
AUSTIN
ELECTROPHYSIOLO
GY
PALLIATIVE
MEDICINE
6/2/2019 PALLIATIVE MEDICINE FAMILY MEDICINE
DIAGNOSTIC
PEDIATRIC CRITICAL
CARE MEDICINE
7/1/2018 NEUROLOGY
ACTIVE
TX
HEPATOLOGY
HOSPITALIST
Disciplinary
Status Date
MCALLEN
NEPHROLOGY
BREAST IMAGING
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
HOUSTON
CORPUS
CHRISTI
HOUSTON
TX
ACTIVE
8/19/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
12/13/2013 None
25-Apr-16 None
N/A
N/A
CARROLLTON TX
ACTIVE
6/13/2014 None
N/A
BIRMINGHAM
AL
ACTIVE
12/22/2011 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/24/2015 None
7/8/2013 None
N/A
N/A
6/27/2014 None
N/A
License
Number
Physician Name
Q2033
NAVIA, RAMIRO OSVALDO, MD
Q1689
NAWAZ, ASAD, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
10/1/2014
GERIATRICS
8/29/2014
ANESTHESIOLOGY
Q1243
NAYAK, SUJIR PRITHA SURESH,
MD
NAYAR, ANJU THANKAMONIAMMA,
MD
P7320
P4896
NAYAR, TUSHAR, MD
NAZ, TABASSUM, MD
P7962
NAZARIAN, MICHAEL, MD
P6475
NAZARIO, MICHELLE O, MD
5/1/2013
Q1244
NAZDRYN, ANDREI, MD
8/1/2014
Q6885
P0919
NAZEER, OMER, MD
NAZHA, AZIZ , MD
06-Jan-16
9/1/2011
5/1/2018 PSYCHIATRY
EMERGENCY
8/1/2019 MEDICINE
EMERGENCY
06-Jan-21 MEDICINE
P0859
Q7758
NAZIM, MUHAMMAD HARIS, MD
NAZIR, FIZA , MD
8/26/2011
01-Apr-16
Q3065
NAZIR, TABASUM, MD
Q7089
NAZLI, YASMEEN Z, MD
01-Feb-16
Q5233
NDI, JULIUS SAMA, MD
7/15/2015
Q8759
NDUKU, VALENTINE T, DO
NDUKWE, STELLA ADA-IHUOMA,
MD
10-Jun-16
OBSTETRICS AND
EMERGENCY
7/15/2020 MEDICINE
NEUROLOGICAL
10-Jun-21 SURGERY
8/1/2013
4/2/2012
4/2/2017 HAND SURGERY
Q2034
P7520
P2743
10/1/2014
8/1/2014
7/15/2013
11/15/2012
9/16/2013
2/2/2015
OBSTETRICS AND
8/1/2019 GYNECOLOGY
CARDIOVASCULAR
9/16/2018 SURGERY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
NEW YORK
NY
THORACIC SURGERY FORT WORTH TX
PEDIATRIC
PSYCHIATRY
HOUSTON
TX
SAN ANTONIO TX
DALLAS
TRAUMATIC
SURGERY
GERIATRICS
DALLAS
EAST
MEADOW
N/A
8/1/2014 None
N/A
7/15/2013 None
12/17/2012 None
N/A
N/A
ACTIVE
10/10/2013 None
N/A
ACTIVE
5/14/2013 None
N/A
ACTIVE
8/12/2014 None
N/A
07-Jan-16 None
9/13/2011 None
N/A
N/A
8/26/2011 None
06-Jun-16 None
N/A
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/2/2015 None
N/A
NY
ACTIVE
08-Feb-16 None
N/A
ACTIVE
LICENSE
ISSUED
7/16/2015 None
N/A
10-Jun-16 None
N/A
TX
TX
FAMILY MEDICINE
Q6076
9/15/2015
P0771
NEDELCU, ELENA , MD
8/15/2011
P7521
NEDELKA, MICHELE, MD
8/15/2016 PATHOLOGY
RADIATION
8/1/2018 ONCOLOGY
FAMILY MEDICINE
PLASTIC &
RECONSTRUCTIVE
SURGERY
HEMATOLOGY
(PATHOLOGY)
Page 253 of 402
PASADENA
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/8/2014 None
N/A
9/3/2014 None
N/A
10/2/2014 None
HOSPITALIST
FAMILY PRACTICE
NEAMAN, KEITH C, MD
NEBAB, EMMANUEL GUILLERMO,
MD
8/1/2013
Registration
Status of
Practice
Texas
Practice City
State
License
SAN ANTONIO TX
ACTIVE
ROUND ROCK TX
ACTIVE
TX
ACTIVE
8/8/2013 None
N/A
SAN ANTONIO TX
ACTIVE
4/3/2012 None
N/A
ACTIVE
9/24/2015 None
N/A
HOUSTON
TX
ACTIVE
8/23/2011 None
N/A
KERRVILLE
TX
ACTIVE
8/5/2013 None
N/A
License
Number
P6225
Physician Name
NEELAND, IAN JASON, MD
TM00531 NEELY, PHILIP E, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/12/2013
11/15/2012
7/1/2011
ORTHOPEDIC
7/1/2016 SURGERY
ALLERGY AND
P0264
NEFF, ROBERT SWANSON II, MD
Q5877
8/28/2015
P3395
NEGRICH, RONALD JAMES, MD
NEGRON RODRIGUEZ, BRENDALI ,
MD
6/1/2012
P7820
NEIL, ERIN ELIZABETH, DO
8/30/2013
Q1690
NEIMAN, ELI SAMUEL, DO
8/29/2014
Q0132
Q6249
Q1867
P8058
NEIMAN, VANESSA RENEE, MD
NEJAT, MARTIN JAMES, MD
NEKKANTI, NARESH, MD
NELKIN, CORY STEPHEN, DO
5/2/2014
10/1/2015
9/15/2014
10/1/2013
8/29/2019 NEUROLOGY
OBSTETRICS AND
5/2/2019 GYNECOLOGY
Q1868
NELL, MARINA MICHAELOVNA, MD
9/15/2014
Q5050
NELSON, CHRISTOPHER JOHN, DO
7/1/2015
P9411
NELSON, JESSICA LYNELLE, MD
P8957
Q0520
NELSON, JESSICA MARIE, MD
NELSON, KELLY CARTER, MD
Q6670
Q6670
Q6670
NELSON, KIMBERLY C, MD
12/4/2015
04-Dec-15
04-Dec-15
P9412
Q0134
P3213
P8705
NELSON, SEAN, MD
NEMARUGOMMULA, VISHAL, MD
NEMATI, PROSHAD, MD
NEPAL, MANOJ KUMAR, MD
3/17/2014
5/2/2014
5/15/2012
1/3/2014
Q5511
NESBITT, SHAYLA, MD
3/17/2014
2/7/2014
6/2/2014
8/3/2015
Secondary Specialty
(Self-Designated)
CARDIOVASCULAR
DISEASES
NEUROMUSCULAR
DISEASE
HOSPITALIST
Disciplinary
Status Date
TX
ACTIVE
4/16/2013 None
N/A
MADISON
AL
ACTIVE
11/29/2012 None
N/A
HOUSTON
TX
ACTIVE
7/6/2011 None
N/A
TOLEDO
OH
ACTIVE
8/31/2015 None
N/A
SPRING
TX
ACTIVE
6/4/2012 None
N/A
DALLAS
TX
ACTIVE
9/2/2013 None
N/A
8/29/2014 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
9/19/2014 None
N/A
ACTIVE
7/8/2015 None
N/A
ACTIVE
4/25/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
2/17/2014 None
6/18/2014 None
N/A
N/A
12/4/2015 None
14-Dec-15 None
14-Dec-15 None
N/A
N/A
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
3/20/2014
5/6/2014
5/17/2012
1/6/2014
None
None
None
None
N/A
N/A
N/A
N/A
BEAUMONT
ACTIVE
8/14/2015 None
N/A
SAN ANTONIO TX
MATTOON
IL
FORT WORTH TX
WACO
TX
DALLAS
TX
LUBBOCK
LUBBOCK
TX
TX
HOUSTON
DETROIT
TX
MI
ANESTHESIOLOGY
Page 254 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
CLINICAL
NEUROPHYSIOLOGY
EMERGENCY
7/1/2020 MEDICINE
EMERGENCY
3/17/2019 MEDICINE
EMERGENCY
2/7/2019 MEDICINE
EMERGENCY
3/17/2019 MEDICINE
1/3/2019 PEDIATRICS
OBSTETRICS AND
8/3/2020 GYNECOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
5/2/2014
10/27/2015
10/31/2014
10/14/2013
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
GASTROENTEROLOG
6/1/2015
6/1/2020 Y
Q4648
NESHATIAN, LEILA, MD
P9413
NESS, PETER JOSEPH, MD
Q3412
NEUMANN, ALICE AMACHER, MD
Q7090
NEVELS, RICHARD ALLEN, MD
01-Feb-16
P6226
NEW, AARON ROBERT, MD
4/12/2013
P9099
Q2690
NEWBY, TRAVIS AARON, DO
NEWGENE, KENNY, MD
Q0135
3/17/2014
3/3/2015
2/18/2014
12/15/2014
NEWMAN, ADAM TODD, MD
NEWMAN, ERRIN MARIE
Q1246
GAJKOWSKI, MD
NEWMAN, JACK NATHANIEL JR,
TM00546 MD
5/2/2014
Q1247
NEWMAN, JASON RICHARD, MD
8/1/2014
Q3563
NEWTON, TIMOTHY CLARK, DO
3/16/2015
8/1/2014
7/1/2013
P3396
NEYMAN, EDWARD, MD
6/1/2012
Q1463
NEYRA, JAVIER A, MD
8/15/2014
P6227
P8060
NG, KENNETH , DO
NG, WEIQING ALAN, MD
4/12/2013
10/1/2013
Q0679
NG, YU-TZE , MD
6/16/2014
Q7936
NGO, CHINH, DO
15-Apr-16
Q4479
Q7760
NGO, HUAN T, MD
NGO, MICHAEL, DO
5/15/2015
01-Apr-16
Q2473
P5694
NGO, THEMY TRONG, DO
NGO, THUY-TRANG THI, MD
11/17/2014
3/1/2013
ANATOMIC/CLINICAL
3/3/2020 PATHOLOGY
EMERGENCY
01-Feb-21 MEDICINE
4/12/2018 UROLOGY
EMERGENCY
2/18/2019 MEDICINE
OBSTETRICS AND
5/2/2019 GYNECOLOGY
PEDIATRIC
CARDIOVASCULAR
7/1/2018 IMAGING
Secondary Specialty
(Self-Designated)
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
6/10/2015 None
N/A
OPHTHALMOLOGY
BROWNWOOD TX
ACTIVE
3/24/2014 None
N/A
CYTOPATHOLOGY
AUBURN
AL
ACTIVE
3/12/2015 None
N/A
RICHMOND
IN
ACTIVE
04-Feb-16 None
N/A
UROLOGIC SURGERY
ACTIVE
4/29/2013 None
N/A
HOSPITALIST
ACTIVE
ACTIVE
2/28/2014 None
1/22/2015 None
N/A
N/A
5/6/2014 None
N/A
8/1/2014 None
N/A
ACTIVE
7/11/2013 None
N/A
JACKSONVILL
E
TX
PEDIATRICS
EMERGENCY
3/16/2020 MEDICINE
6/1/2017 RADIOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
DIAGNOSTIC
RADIOLOGY
PEDIATRIC
GASTROENTEROLOG
4/12/2018 Y
PAIN MANAGEMENT
PEDIATRIC
6/16/2019 NEUROLOGY
15-Apr-21 INTERNAL MEDICINE HOSPITALIST
EMERGENCY
5/15/2020 MEDICINE
01-Apr-21 HOSPITALIST
EMERGENCY
11/17/2019 MEDICINE
Page 255 of 402
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
8/6/2014 None
N/A
AUSTIN
TX
ACTIVE
3/23/2015 None
N/A
WILMETTE
IL
ACTIVE
LICENSE
ISSUED
6/5/2012 None
N/A
8/15/2014 None
N/A
4/12/2013 None
12/9/2013 None
N/A
N/A
6/16/2014 None
N/A
ACTIVE
26-Apr-16 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
6/2/2015 None
04-Apr-16 None
N/A
N/A
11/17/2014 None
3/6/2013 None
N/A
N/A
SEATTLE
WA
WEST
COLUMBIA
SC
HOUSTON
TX
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
P6228
NGO, TIN CHAN, MD
NGONGANG, CHELSEA
Q4819
KECHONSON, MD
P6687
NGUYEN, ANDY HUY, DO
P8958
Q1248
NGUYEN, ANH HUNG, MD
NGUYEN, ANH TUAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/12/2013
4/12/2018 UROLOGY
6/12/2015
5/15/2013
2/7/2014
8/1/2014
PLASTIC &
RECONSTRUCTIVE
2/7/2019 SURGERY
8/1/2019 NEUROLOGY
Q2474
P7167
Q8580
Q8581
NGUYEN, ANN , MD
NGUYEN, BAOCHAN, MD
NGUYEN, CAROLINE TRINH, MD
NGUYEN, CUONG HUY, DO
11/17/2014
7/1/2013
01-Jun-16
01-Jun-16
11/17/2019
7/1/2018
01-Jun-21
01-Jun-21
Q8582
P4897
NGUYEN, DAI HO, MD
NGUYEN, DAT, DO
01-Jun-16
11/15/2012
01-Jun-21
11/15/2017
P1793
NGUYEN, DOANH, MD
1/2/2012
1/2/2017
P6478
Q5052
NGUYEN, DOMINIC DUNG, MD
NGUYEN, DUNG DUC-TIEN, MD
5/1/2013
7/1/2015
5/1/2018
7/1/2020
Q4820
P9667
P1116
Q6077
NGUYEN, DUSTIN DUY, DO
NGUYEN, HAI THUY, MD
NGUYEN, HANH NGOC, DO
NGUYEN, HUY DUC, MD
6/12/2015
4/1/2014
10/3/2011
9/15/2015
6/12/2020
4/1/2019
10/3/2016
9/15/2020
P1794
NGUYEN, JENNIFER LIEN, DO
1/2/2012
Q4650
NGUYEN, JULIE M, MD
6/1/2015
Q3930
NGUYEN, KEN DUONG, MD
4/10/2015
Q8583
P4493
Q1869
Q8584
NGUYEN, KHUONG, DO
NGUYEN, KIM YEN THI, MD
NGUYEN, LAURA, MD
NGUYEN, LOAN THANH, MD
01-Jun-16
9/17/2012
9/15/2014
01-Jun-16
Q0327
NGUYEN, LONG VAN, MD
5/15/2014
Q8112
NGUYEN, MARY CECILIA, DO
02-May-16
FAMILY MEDICINE
OPHTHALMOLOGY
FAMILY MEDICINE
RADIOLOGY
EMERGENCY
MEDICINE
INTERNAL MEDICINE
ALLERGY AND
IMMUNOLOGY
RADIATION
ONCOLOGY
INTERNAL MEDICINE
RADIOLOGY
RADIOLOGY
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY
EMERGENCY
6/1/2020 MEDICINE
Secondary Specialty
(Self-Designated)
MICROSURGERY
Practice City
HOUSTON
6/15/2015 None
5/20/2013 None
N/A
N/A
2/18/2014 None
8/5/2014 None
N/A
N/A
DALLAS
TX
FORT WORTH TX
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
SAN ANTONIO TX
FORT WORTH TX
ACTIVE
ACTIVE
HOUSTON
TX
PALLIATIVE
MEDICINE
INTERNAL MEDICINE
RADIATION
ONCOLOGY
FAMILY PRACTICE
FAMILY MEDICINE
AUSTIN
TX
HOUSTON
WACO
GARLAND
TX
TX
TX
01-Jun-21
9/17/2017
9/15/2019
01-Jun-21
THE
INTERNAL MEDICINE WOODLANDS
PEARLAND
ARLINGTON
HOUSTON
02-May-21 INTERNAL MEDICINE UNSPECIFIED
Page 256 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/22/2013 None
N/A
ACTIVE
ACTIVE
GASTROENTEROLOG
Y
HOSPITALIST
INTERNAL MEDICINE
FAMILY MEDICINE
PEDIATRICS
EMERGENCY
5/15/2019 MEDICINE
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
11/17/2014
7/5/2013
07-Jun-16
06-Jun-16
None
None
None
None
N/A
N/A
N/A
N/A
06-Jun-16 None
12/3/2012 None
N/A
N/A
2/1/2012 None
N/A
5/1/2013 None
7/2/2015 None
N/A
N/A
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
2/8/2012 None
N/A
ACTIVE
LICENSE
ISSUED
6/2/2015 None
N/A
4/10/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
6/12/2015
4/7/2014
10/19/2011
9/17/2015
09-Jun-16
10/10/2012
11/17/2014
07-Jun-16
None
None
None
None
N/A
N/A
N/A
N/A
5/15/2014 None
N/A
02-May-16 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P5855
NGUYEN, MICHAEL LY, MD
3/15/2013
P7821
NGUYEN, MICHAEL VAN, MD
8/30/2013
P9668
NGUYEN, MICHELLE KIM, MD
4/1/2014
P2320
NGUYEN, MINH DUC, MD
3/1/2012
P9100
P1796
Q5516
NGUYEN, MINH XUAN, MD
NGUYEN, NAM H, DO
NGUYEN, NAM HOANG, MD
2/18/2014
1/2/2012
8/3/2015
P9415
NGUYEN, NGOC ANH ANH, MD
3/17/2014
P2043
NGUYEN, NHAT QUANG, MD
Q2812
Q2035
Q3748
Q0799
NGUYEN, NORMAN KHOA, MD
NGUYEN, PHUC, MD
NGUYEN, PHUONG NGOC, MD
NGUYEN, QUAN DANG, MD
1/5/2015
10/1/2014
4/1/2015
6/27/2014
P9101
NGUYEN, RICHARD, DO
NGUYEN, ROSELYNN HONGLAM,
MD
2/18/2014
EMERGENCY
8/30/2018 MEDICINE
3/1/2017 SURGERY
CARDIOTHORACIC
2/18/2019 RADIOLOGY
1/2/2017 PSYCHIATRY
8/3/2020 PEDIATRICS
EMERGENCY
3/17/2019 MEDICINE
GASTROENTEROLOG
2/1/2017 Y
EMERGENCY
1/5/2020 MEDICINE
4/1/2020 PEDIATRICS
6/27/2019 RADIOLOGY
EMERGENCY
2/18/2019 MEDICINE
8/28/2015
Q5879
2/1/2012
P7822
Q2353
Q5235
NGUYEN, STEVEN XUAN, MD
NGUYEN, STEVEN, MD
NGUYEN, TAM, MD
8/30/2013
11/7/2014
7/15/2015
P9923
NGUYEN, THAI VIET, DO
4/15/2014
P8284
NGUYEN, THANH GIAO THI, MD
11/1/2013
P7823
Q7764
NGUYEN, THI THANH, DO
NGUYEN, TONY T, MD
8/30/2013
01-Apr-16
01-Apr-21 DERMATOLOGY
P8285
NGUYEN, TRUNG, MD
11/1/2013
P4794
NGUYEN, TUAN ANH NGOC, MD
11/1/2012
EMERGENCY
11/1/2017 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
4/15/2013 None
N/A
SUGAR LAND
TX
ACTIVE
9/9/2013 None
N/A
ACTIVE
4/7/2014 None
N/A
LICENSE
ISSUED
3/1/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
2/25/2014 None
1/9/2012 None
8/5/2015 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
3/24/2014 None
N/A
2/1/2012 None
N/A
NUCLEAR MEDICINE
GALVESTON
DALLAS
TX
TX
WEBSTER
TX
INTERNAL MEDICINE
TEMPLE
TX
GALVESTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
2/27/2014 None
N/A
DALLAS
TX
ACTIVE
9/8/2015 None
N/A
LA
WI
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/2/2013 None
11/10/2014 None
7/21/2015 None
N/A
N/A
N/A
4/15/2014 None
N/A
11/1/2013 None
N/A
8/30/2013 None
21-Apr-16 None
N/A
N/A
ACTIVE
11/21/2013 None
N/A
ACTIVE
11/5/2012 None
N/A
INTERNAL MEDICINE
LAFAYETTE
MARINETTE
FAMILY
PRACTICE/OMM
KANSAS CITY KS
SULPHUR
SPRINGS
TX
FAMILY MEDICINE
Page 257 of 402
Disciplinary
Status Date
BEDFORD
ORTHOPEDICS
BREAST IMAGING
Registration
Status Date
Disciplinary
Status of
Texas
License
RICHMOND
TX
1/6/2015
10/23/2014
4/10/2015
7/7/2014
dicaid
dicaid
License
Agreement
Physician Name
Start Date
End Date
Designated)
P9416
NGUYEN, VINH Q, MD
3/17/2014
P1117
NGUYEN, VINH QUANG, MD
10/3/2011
PEDIATRIC
EMERGENCY
P0455
NGUYEN, VU ANH, MD
7/15/2011
7/15/2016 MEDICINE (EM)
P5856
NIAZI, NADIA, MD
3/15/2013
PEDIATRIC
HEMATOLOGY/ONCOL
P7522
NICHOLLS, LAUREN ANNE, MD
8/1/2013
8/1/2018 OGY
PEDIATRIC CRITICAL
Q4480
NICHOLS, BLAKE E, MD
5/15/2015
EMERGENCY
P2044
NICHOLS, PATRICK MARSHALL, DO
2/1/2012
2/1/2017 MEDICINE
NICHOLSON, BRYSON ANDREW,
Q3749
MD
4/1/2015
OBSTETRICS AND
Q2036
NICHOLSON, FIONA CLAIRE, MD
10/1/2014
EMERGENCY
G3647
NICHOLSON, HEIDI THERESA, MD
15-Jan-16
15-Jan-21 MEDICINE
Q7438
NICLAS, JOSHUA, MD
04-Mar-16
Q3252
NIEDBALEC, ERICA, MD
P1675
P0860
NIEGOS, FREDERICK BOADO, MD
NIELAND, MELISSA JANE, MD
P2904
NIEMAND, NOELLE ROSE, MD
Q4228
Q0986
NIEMEYER, CHAD ROBERT, MD
NIETO FONSECA, CARLOS
ANDRES, MD
7/15/2014
P3656
Q8585
P0643
NIETO, ROMAN JR, MD
NIETO, ZEINA , MD
NIGAM, RUPESH , MD
6/15/2012
01-Jun-16
8/1/2011
Q6886
P1375
NIGO, MASAYUKI , MD
NIJHAWAN, DEEPAK, MD
NIMA ZEGARRA, HARRY MARTIN,
MD
06-Jan-16
11/4/2011
Q3253
2/13/2015
12/15/2011
8/26/2011
4/13/2012
5/1/2015
2/13/2015
ENDOCRINOLOGY,
DIABETES AND
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
Practice City
SUGAR LAND
PEDIATRICS
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
3/26/2014 None
N/A
10/25/2011 None
N/A
SUGAR LAND
TX
ACTIVE
ACTIVE
7/21/2011 None
3/20/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/23/2013 None
N/A
DALLAS
TX
ACTIVE
5/20/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
2/7/2012 None
N/A
4/1/2015 None
N/A
NEPHROLOGY
GENERAL PRACTICE EL PASO
DALLAS
TX
ACTIVE
10/2/2014 None
N/A
GA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
21-Jan-16 None
24-Mar-16 None
N/A
N/A
2/13/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/3/2012 None
8/31/2011 None
N/A
N/A
4/13/2012 None
N/A
TX
ACTIVE
5/11/2015 None
N/A
SAN ANTONIO TX
ACTIVE
7/17/2014 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
6/21/2012 None
07-Jun-16 None
8/8/2011 None
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
19-Jan-16 None
11/9/2011 None
N/A
N/A
2/13/2015 None
N/A
INTERNAL MEDICINE GAINESVILLE
HOUSTON
INTERNAL MEDICINE VICTORIA
BELTON
EMERGENCY
6/15/2017 MEDICINE
INFECTIOUS
06-Jan-21 DISEASES
11/4/2016 ONCOLOGY
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
HOUSTON
Page 258 of 402
TX
TX
License
Number
Q0802
P2322
Physician Name
NIMMAKAYALA, KAMESWARA RAO,
MD
Q4229
P1676
P6689
NINAN, RONY , MD
NINGEGOWDA, LOKESH
BASAVANAHALLI, MD
NISAN, ABIGAIL, MD
NISHAT, ARIFA, MD
P0266
NIU, MARY C, MD
P8397
Q4653
Q5703
NIZAMI, MAIMOONA QAYYUM, MD
NJI NVUH MBAIMOUN,
JEANNETTE, MD
NJOKU, ANGELA IFEOMA, DO
Q3254
NJOKU, VICTOR OBIJURU, MD
Q1695
dicaid
dicaid
Agreement
End Date
Designated)
6/27/2014
3/1/2012
5/1/2015
12/15/2011
5/15/2013
7/1/2011
11/15/2013
7/1/2016 PEDIATRICS
Q1465
NODLER, JAMES LEONARD, MD
8/15/2014
P8287
NOEL, JAMES MEREDITH, MD
11/1/2013
P7322
NOEL, TAMEKA LACHELLE, MD
7/15/2013
P0774
NOFZIGER, ADAM VON, MD
8/15/2011
8/1/2014
2/7/2014
6/1/2015
Q0987
NONAKA, DAISUKE FRANCIS, MD
7/15/2014
Q1872
NOOR, MUHAMMAD FARRUKH, MD
9/15/2014
P5112
NOORDA, SCOTT J, DO
12/17/2012
Practice City
FORT WORTH TX
NEUROMUSCULAR
DISEASE
HOUSTON
INTERNAL MEDICINE ABILENE
CALHOUN
PEDIATRICS,
CARDIOLOGY
HOUSTON
TX
8/1/2019 PEDIATRICS
REPRODUCTIVE
ENDOCRINOLOGY
8/15/2019 AND INFERTILITY
PEDIATRIC
GASTROENTEROLOG
11/1/2018 Y
EMERGENCY
8/15/2016 MEDICINE
CARDIOLOGY
PEDIATRICS
HOUSTON
FAMILY
Page 259 of 402
N/A
3/8/2012 None
N/A
5/1/2015 None
1/9/2012 None
6/4/2013 None
N/A
N/A
N/A
ACTIVE
7/27/2011 None
N/A
ACTIVE
12/3/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/3/2015 None
8/31/2015 None
N/A
N/A
2/13/2015 None
N/A
ACTIVE
LICENSE
ISSUED
9/5/2014 None
N/A
8/1/2014 None
N/A
TX
TX
ACTIVE
8/18/2014 None
N/A
SAN ANTONIO TX
ACTIVE
11/4/2013 None
N/A
DALLAS
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/9/2013 None
N/A
8/15/2011 None
N/A
2/7/2014 None
6/4/2015 None
N/A
N/A
TX
CRITICAL CARE
ANESTHESIOLOGY
CARDIOTHORACIC
ANESTHESIOLOGY
6/30/2014 None
TX
NEONATOLOGY
GYNECOLOGIC
SURGERY
Disciplinary
Status Date
TX
LA
TULSA
OK
FORT WORTH TX
DALLAS
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
2/13/2015
Q1249
NOGHREHKAR, DENA, MD
NOLEN, PATRICK RYAN, DO
3/1/2017 NEUROLOGY
8/29/2014
P8960
Q4655
6/1/2015
8/14/2015
NNAMANI, NWAMAKA PAMELA, MD
NNOROM, CHUKWUMA CHINEDU,
MD
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
DALLAS
TX
ACTIVE
7/21/2014 None
N/A
CAMBRIDGE
OH
ACTIVE
10/20/2014 None
N/A
CONROE
TX
ACTIVE
1/7/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
FAMILY
12/17/2012
FAMILY
12/17/2012
4/1/2015
ANATOMIC/CLINICAL HEMATOLOGY
10/1/2012
10/1/2017 PATHOLOGY
(PATHOLOGY)
P5112
NOORDA, SCOTT J, DO
P5112
Q3750
NOORDA, SCOTT J, DO
NOORMOHAMMADI, OMID , MD
P4603
NORA, FREDERICK, MD
Q7937
NORMAN, ROY EDWARD JR, DO
15-Apr-16
P0861
8/26/2011
Q7091
NORSWORTHY, TWYLA NASH, MD
NORTHCUTT, BENJAMIN GORDON,
MD
01-Feb-16
P9418
NORTHROP, MICHAEL, MD
3/17/2014
P7323
7/15/2013
P9925
NORTHROP, SARA CHRISTINE, DO
NORTHROP, SARAH ALLISON
WILLIAMS, MD
Q4231
NORTON, DENISE, MD
Q8763
10-Jun-16
Q5882
NORVELL, CARA BRIANNE, DO
NOTTAGE-MURPHY, LATOYA
CHRISTAL, MD
P8606
NOURANI, CAMERON NIMA, MD
12/16/2013
4/15/2014
5/1/2015
8/28/2015
OBSTETRICS AND
01-Feb-21 RADIOLOGY
PEDIATRIC CRITICAL
OBSTETRICS AND
PEDIATRIC FORENSIC
4/15/2019 MEDICINE
PHYSICAL MED. &
EMERGENCY
10-Jun-21 MEDICINE
EMERGENCY
12/16/2018 MEDICINE
INTERVENTIONAL
6/15/2017 RADIOLOGY
NEURO-RADIOLOGY
PEDIATRICS
SPINE AND SPORTS
MEDICINE
DIAGNOSTIC
RADIOLOGY
FACIAL PLASTIC
SURGERY
PEDIATRICS
6/15/2012
Q7938
NOVIS, SARAH, MD
15-Apr-16
P9419
NOVOA URIARTE, MARIA
VICTORIA, MD
3/17/2014
COLON AND RECTAL
4/2/2017 SURGERY
GENERAL SURGERY
EMERGENCY
11/1/2017 MEDICINE
FAMILY MEDICINE
INFECTIOUS
INTERNAL MED 8/1/2019 DISEASES
PEDS
8/1/2016 NEPHROLOGY
INTERNAL MEDICINE
Page 260 of 402
4/2/2012
P4795
11/1/2012
Q1250
P0645
NSEIR, BACEL, MD
NTENDE, HENRY WAKIKU, MD
8/1/2014
8/1/2011
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
1/7/2013 None
N/A
CONROE
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
1/7/2013 None
4/3/2015 None
N/A
N/A
TX
ACTIVE
10/30/2012 None
N/A
TX
ACTIVE
26-Apr-16 None
N/A
AR
ACTIVE
9/6/2011 None
N/A
SAN ANTONIO TX
ACTIVE
10-Feb-16 None
N/A
NASHVILLE
TN
ACTIVE
3/19/2014 None
N/A
MANSFIELD
TX
ACTIVE
7/18/2013 None
N/A
SAN ANTONIO TX
ACTIVE
4/21/2014 None
N/A
ACTIVE
LICENSE
ISSUED
5/11/2015 None
N/A
10-Jun-16 None
N/A
9/7/2015 None
N/A
12/16/2013 None
N/A
6/15/2012 None
N/A
ACTIVE
27-Apr-16 None
N/A
ACTIVE
3/24/2014 None
N/A
MAGNOLIA
NOURANIFAR, RABIN, MD
NOVOSAD, LAURIE SUSAN, MD
NOYA, ANTHONY ARMANDO
DENIS, MD
CONROE
DENISON
CORPUS
INTERNAL MEDICINE CHRISTI
P3657
P2746
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
TX
DALLAS
TX
ACTIVE
4/4/2012 None
N/A
FORT HOOD
TX
ACTIVE
11/6/2012 None
N/A
SAN ANTONIO TX
ODESSA
TX
ACTIVE
ACTIVE
8/5/2014 None
8/25/2011 None
N/A
N/A
License
Number
P2501
Q6078
Q6251
Q4656
P9670
P1571
P1005
Physician Name
NUCKOLS, MATTHEW CHARLES,
MD
NUESA, WILSON ORTEGA IV, MD
NULU, SHANTI, MD
NUNEZ BURGOS, MIGUEL TOMAS,
MD
NUNEZ GERMOSEN, YANILDA M,
MD
NUNEZ, RIGOBERTO NICHOLAS,
MD
dicaid
dicaid
Agreement
End Date
Designated)
3/15/2012
9/15/2015
10/1/2015
6/1/2015
4/1/2014
PHYSICAL MED. &
12/1/2011
4/5/2012 None
9/17/2015 None
10/7/2015 None
N/A
N/A
N/A
LEAGUE CITY TX
ACTIVE
6/9/2015 None
N/A
NEPHROLOGY
SAN ANTONIO TX
ACTIVE
5/7/2014 None
N/A
SAN ANTONIO TX
FORT SAM
HOUSTON
TX
ACTIVE
1/16/2012 None
N/A
CRITICAL CARE
(SURGERY)
ACTIVE
9/30/2011 None
N/A
ACTIVE
9/5/2013 None
N/A
CARDIOVASCULAR
SURGERY
ACTIVE
4/15/2013 None
N/A
OBSTETRICS AND
GYNECOLOGY
LICENSE
ISSUED
6/14/2013 None
N/A
12/16/2011 None
11/5/2013 None
5/11/2015 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/6/2012 None
N/A
2/18/2014 None
N/A
12/4/2015 None
N/A
BRIDGEPORT CT
ACTIVE
17-Dec-15 None
N/A
BRIDGEPORT CT
ACTIVE
17-Dec-15 None
N/A
MILWAUKEE
ACTIVE
LICENSE
ISSUED
11/19/2012 None
N/A
11/7/2014 None
N/A
3/4/2015 None
N/A
P6230
NURI, MUHAMMAD ATAUNUR
KHALID, MD
4/12/2013
P7010
NURUDEEN, SAHADAT KEMI, MD
6/14/2013
P1572
P8288
Q4232
NUSBAUM, DEREK MATTHEW, MD
NUTHAKKI, SUSHMA, MD
NUTI, RATHNA RAO, MD
12/1/2011
11/1/2013
5/1/2015
P4686
NWACHUKWU, CHISOM DAISY, MD
NWADIKE, EMMANUEL
OBUMNEME, MD
NWADIKE, VINCENTIA CHINEME,
MD
MD
MD
10/15/2012
HOSPITALIST
2/18/2014
NEPHROLOGY
12/4/2015
04-Dec-15
04-Dec-15
SPORTS MEDICINE
Q6673
P4898
NWAEZE, IJEOMA O, MD
Q2355
NWAFO, GOLIBE ADAOBI, MD
Q3413
NWAGWU, FLORENCE, MD
11/15/2012
11/7/2014
3/3/2015
Disciplinary
Status Date
ACTIVE
ACTIVE
ACTIVE
8/30/2018 NEUROLOGY
PEDIATRIC
CARDIOTHORACIC
4/12/2018 SURGERY
REPRODUCTIVE
ENDOCRINOLOGY
Q6673
8/30/2013
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
NJ
CT
P7824
Q6673
Practice City
EL PASO
PATERSON
INTERNAL MEDICINE NEW HAVEN
NUNEZ, TIMOTHY CHARLES, MD
NUNEZ-WALLACE, KAREN ROSA,
MD
P9102
9/15/2011
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
NEONATOLOGY
SPORTS MEDICINE
(FAMILY PRACTICE)
Page 261 of 402
HOUSTON
HOUSTON
DALLAS
TX
TX
TX
WI
ACTIVE
ACTIVE
ACTIVE
ACTIVE
License
Number
P0456
P2906
Q6674
Q6674
Q6674
Physician Name
NWAKUCHE, UZOMA , MD
NWANEGBO, EDWARD CHIEKE,
MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
HEMATOLOGY/ONCOL
7/15/2011
7/15/2016 OGY
INTERNAL MEDICINE BAYTOWN
EAST
4/13/2012
LANSING
12/4/2015
04-Dec-15
04-Dec-15
4/13/2012
P7963
NWANERI, MICHAEL OSITA, MD
NWANKWO, CHRISTIAN CHIDUBE,
MD
NWANKWO, CORDELIA
AFOMACHUKWU, MD
Q2356
NWANKWO, FRANK AZUBUIKE, MD
11/7/2014
OBSTETRICS AND
OBSTETRICS AND
Q5236
NWAOGWUGWU, UCHEOMA, MD
7/15/2015
Q6352
NWIZU, TOBENNA IGWEONU, MD
10/15/2015
Q6353
NWOJO, RAPHAEL EZERA, MD
10/15/2015
P1573
NWOKOLO, FELIX
CHUKWUEMEKA, MD
12/1/2011
Q2357
Q5883
NWOSU, ADAEZE CHIMEOGO, MD
NWOSU, JENIFER CHIOMA, MD
11/7/2014
8/28/2015
Q1873
NWOSU, MICHELLE ERUMU, MD
9/15/2014
Q3069
NWOYE, CHRISTOPHER KENE, MD
Q2358
P2907
9/16/2013
2/2/2015
NYALAKONDA, HARITA , MD
11/7/2014
P5437
NYATSANZA, IGNATIUS, MD
2/1/2013
P8962
NYLAND, CHAD , DO
OBAYAN, OLUBUSAYO KEHINDE,
MD
OBERDICK, WENDY TIPTON, MD
2/7/2014
7/1/2015
3/17/2014
FP/OSTEO
MANIPULATION
2/7/2019 MEDICINE
Page 262 of 402
Disciplinary
Status Date
ACTIVE
8/18/2011 None
N/A
MI
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
4/24/2012 None
N/A
12/4/2015 None
31-Dec-15 None
31-Dec-15 None
N/A
N/A
N/A
ST. LOUIS
MO
ACTIVE
4/23/2012 None
N/A
DALLAS
TX
ACTIVE
9/19/2013 None
N/A
ADA
OK
ACTIVE
LICENSE
ISSUED
11/14/2014 None
N/A
7/15/2015 None
N/A
ACTIVE
10/19/2015 None
N/A
ACTIVE
10/16/2015 None
N/A
12/1/2011 None
N/A
ACTIVE
ACTIVE
11/11/2014 None
9/1/2015 None
N/A
N/A
ACTIVE
9/22/2014 None
N/A
2/4/2015 None
N/A
11/17/2014 None
N/A
2/1/2013 None
N/A
CLINICAL
NEUROPHYSIOLOGY
INFECTIOUS
DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
HEMATOLOGY/ONCOL
10/15/2020 OGY
INTERNAL MEDICINE CLEVELAND
OH
OTORHINOLARYNGOL
10/15/2020 OGY
CHILD AND
ADOLESCENT
PSYCHIATRY
CORPUS
CHRISTI
TX
SAN ANTONIO TX
EMERGENCY
2/2/2020 MEDICINE
Q5053
P9422
NEPHROLOGY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
WEBSTER
TX
ACTIVE
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
2/10/2014 None
N/A
AUSTIN
TX
ACTIVE
ACTIVE
7/13/2015 None
5/8/2014 None
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
3/15/2012
3/15/2017 MEDICINE
P2502
OBERG, ERIK DONALD, MD
P6481
5/1/2013
5/1/2018 CARDIOLOGY
Q0523
OBERTON, SELBY BRENT, MD
OBI, CHRISTIANA-ROSE KELECHI,
DO
6/2/2014
P2747
OBIE, OGADINMA IJEOMA, MD
4/2/2012
EMERGENCY
4/2/2017 MEDICINE
P8963
2/7/2014
2/7/2019 NEUROLOGY
P7524
OBIH, IKECHUKWU JOHN, MD
OBI-OFODILE, DANIEL
CHINWEUBA, MD
8/1/2013
P1799
OBOKHARE, IZI DANIEL, MD
1/2/2012
P0457
P5696
OCHANI, POONAM, MD
OCHOA, JOSE MARIA IV, MD
7/15/2011
3/1/2013
PHYSICAL MED. &
Q6675
O'CONNELL, ETHAN, MD
12/4/2015
Q6675
04-Dec-15
Q6675
04-Dec-15
Q0524
ODAFE, JACINTA OGECHUKWUKA,
MD
6/2/2014
P5295
O'DEA, COLIN MAGNUSON, MD
1/15/2013
P5113
ODEDRA, RANDHIRJI P, MD
12/17/2012
P5113
12/17/2012
P5113
P0646
ODELL, ROBERT H JR, MD
ODEYEMI, EMMANUEL OLUSEGUN,
MD
ODIGBOEGWU, JOYCE CYNTHIA,
MD
ODIONU, ANDREW KENECHUKWU,
MD
12/17/2012
8/1/2011
EMERGENCY
1/15/2018 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
EMERGENCY
12/17/2017 MEDICINE
Q2037
Q7586
Q2038
Secondary Specialty
(Self-Designated)
Practice City
FORT SAM
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
4/13/2012 None
N/A
5/1/2013 None
N/A
6/2/2014 None
N/A
ACTIVE
4/16/2012 None
N/A
ACTIVE
2/20/2014 None
N/A
ACTIVE
8/5/2013 None
N/A
ACTIVE
1/6/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/26/2011 None
3/6/2013 None
N/A
N/A
12/4/2015 None
N/A
TX
ACTIVE
21-Dec-15 None
N/A
TX
ACTIVE
21-Dec-15 None
N/A
TX
ACTIVE
6/3/2014 None
N/A
1/22/2013 None
N/A
12/17/2012 None
N/A
ACTIVE
1/29/2013 None
N/A
MCHENRY
IL
FORT WORTH TX
ACTIVE
ACTIVE
1/29/2013 None
8/8/2011 None
N/A
N/A
CLINICAL
NEUROPHYSIOLOGY ROCKDALE
TX
FAMILY PRACTICE
COLON AND RECTAL
SURGERY
TEMPLE
CORPUS
CHRISTI
CORPUS
CHRISTI
BAYTOWN
TX
SAN ANTONIO TX
MCHENRY
ANESTHESIOLOGY
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
IL
ACTIVE
LICENSE
ISSUED
10/1/2014
WESTON
WI
ACTIVE
10/7/2014 None
N/A
15-Mar-16
IRVINGTON
NJ
ACTIVE
24-Mar-16 None
N/A
10/1/2014
ODESSA
TX
ACTIVE
10/10/2014 None
N/A
Page 263 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
DIAGNOSTIC
INTERVENTIONAL
2/7/2014
2/7/2019 RADIOLOGY
RADIOLOGY
EMERGENCY
1/5/2015
1/5/2020 MEDICINE
EMERGENCY
8/15/2013
8/15/2018 MEDICINE
FAMILY PRACTICE 5/1/2013
EMERGENCY MED
P8964
ODISIO, BRUNO CALAZANS, MD
Q2814
ODOM, BRANDON WALLACE, MD
P7683
ODOM, GEOFFREY LYLE, MD
P6482
ODOM, LYNDA GAYLE, MD
P7525
ODUMOSU, OLUTONI , MD
Q5518
Q4821
ODUMUSI, KOLAWOLE, MD
OETGEN, WILLIAM JOHN, MD
P8607
OFOLE, OBIORA JUDE, MD
12/16/2013
P8168
OGBODO, EMMANUEL OBINNA, MD
10/15/2013
P7526
OGBOGU, KENE, MD
OGBORN, ARTHUR CHESTER JR,
MD
Q0527
8/1/2013
8/3/2015
6/12/2015
8/1/2013
6/2/2014
8/3/2020 PEDIATRICS
P7826
OGBU, CHIJIOKE EJIOFOR, MD
8/30/2013
Q6677
OGBURN, JOSEPH ANTHONY, MD
12/4/2015
Q6677
04-Dec-15
Q6677
04-Dec-15
Q6452
OGHOGHO, EYITEMI , MD
11/2/2015
OBSTETRICS AND
OBSTETRICS AND
OBSTETRICS AND
EMERGENCY
11/2/2020 MEDICINE
P9927
P1203
OGIDAN, PATRICK T, MD
OGUNDIPE, OLUKEMI , MD
4/15/2014
10/17/2011
Q0140
OGUNGBAMIGBE, THEOPHILUS T,
MD
5/2/2014
ACTIVE
2/17/2014 None
N/A
TEMPLE
TX
ACTIVE
1/23/2015 None
N/A
ACTIVE
8/19/2013 None
N/A
5/7/2013 None
N/A
8/1/2013 None
N/A
8/3/2015 None
6/17/2015 None
N/A
N/A
12/16/2013 None
N/A
11/4/2013 None
N/A
8/8/2013 None
N/A
6/2/2014 None
N/A
6/2/2014 None
N/A
8/30/2013 None
N/A
12/4/2015 None
N/A
DENVER CITY TX
TX
HOSPITALIST
MEDFORD
ST LOUIS
PARK
6/2/2019 PEDIATRICS
ACTIVE
MN
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
NEPHROLOGY
PULMONARY
CRITICAL CARE
MEDICINE
Page 264 of 402
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
OR
NEONATALPERINATAL
MEDICINE
OGBOZOR, UCHENNA DIDACTUS,
LAZARUS, MD
Disciplinary
Status Date
TX
KERRVILLE
PEDIATRIC
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
Q0528
6/2/2014
Practice City
Registration
Status of
Practice
Texas
State
License
EDINBURG
TX
ACTIVE
06-Jan-16 None
N/A
EDINBURG
TX
ACTIVE
06-Jan-16 None
N/A
HOUSTON
TX
11/3/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/15/2014 None
10/26/2011 None
N/A
N/A
TOPEKA
KS
ACTIVE
5/5/2014 None
N/A
License
Number
P1204
Q6888
Physician Name
OGUNTUGA, OLUSESAN ABIODUN,
MD
OGWUDU, UGOCHUKWU C, MD
P6231
OH, MICHAEL CHIHONG, MD
Q4658
OHENE-ADJEI, RITA, MD
dicaid
dicaid
Agreement
End Date
Designated)
10/17/2011
06-Jan-16
4/12/2013
6/1/2015
06-Jan-21 THORACIC SURGERY
NEUROLOGICAL
4/12/2018 SURGERY
Secondary Specialty
(Self-Designated)
OBSTETRICS AND
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OHUOBA, ESOHE FAITH, MD
9/16/2013
P2152
OI, SEIJO, MD
2/10/2012
Q6549
OJEDA, WILLIBALDO, MD
11/16/2015
PULMONARY
CARDIAC
ELECTROPHYSIOLOG
11/16/2020 Y
CARDIOLOGY
Q2476
OJIAKU, ALAMEZIE, MD
11/17/2014
Q0329
OJO, ADEWUNI SEYI, MD
5/15/2014
Q1698
P2327
Q5520
OJODU, MOHAMMED ADEOLA, MD
OK, JOHN YOUNG, MD
OKAFOR, KANAYO KEVIN, MD
8/29/2014
3/1/2012
8/3/2015
Q2360
P7965
OKAFOR, NWANDO O, MD
OKAFOR, OBIORA, MD
11/7/2014
9/16/2013
EMERGENCY
11/7/2019 MEDICINE
Q2815
OKEH, VICTOR EZINNA, MD
1/5/2015
Q6776
OKEREKE, IKENNA CHIDUME, MD
15-Dec-15
15-Dec-20 THORACIC SURGERY
P4604
P8965
OKIN, ABIODUN ADEJUMOKE, MD
OKOLI, KELECHI CHIMA, MD
10/1/2012
2/7/2014
Q5521
OKOLO, EMMANUEL OBIORA, MD
8/3/2015
OKONKWO, CHINWE, DO
8/1/2014
P2045
Q5054
OKONKWO, FRANCIS ARINZE, MD
OKORAFOR, NNAJA , MD
2/1/2012
7/1/2015
PAWHUSKA
TEMPL
SAN
FRANCISCO
OK
TX
ACTIVE
ACTIVE
CA
P7964
Q1252
Practice City
Registration
Status of
Practice
Texas
State
License
OBSTETRICS AND
8/1/2019 GYNECOLOGY
OBSTETRICS AND
GYNECOLOGY
Page 265 of 402
ACTIVE
LICENSE
ISSUED
4/26/2013 None
N/A
6/1/2015 None
N/A
9/18/2013 None
SEE
PREVIOUS
2/21/2012 ORDER
ACTIVE
KERRVILLE
TX
ACTIVE
MD
TX
DAYTON
OH
HOSPITALIST
FAMILY PRACTICE
N/A
N/A
TX
BALTIMORE
CYPRESS
Disciplinary
Status Date
10/25/2011 None
16-Feb-16 None
HOUSTON
BREAST ONCOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
N/A
2/13/2012
11/18/2015 None
N/A
11/17/2014 None
N/A
5/15/2014 None
N/A
8/29/2014 None
3/13/2012 None
8/4/2015 None
N/A
N/A
N/A
11/7/2014 None
9/24/2013 None
N/A
N/A
1/5/2015 None
N/A
GALVESTON
TX
ACTIVE
25-Feb-16 None
N/A
ODESSA
FAIRFIELD
TX
OH
ACTIVE
ACTIVE
10/16/2012 None
2/13/2014 None
N/A
N/A
JACKSON
MS
ACTIVE
8/10/2015 None
N/A
NEW ORLEAN LA
ACTIVE
8/4/2014 None
N/A
FORT SMITH
HOUSTON
ACTIVE
ACTIVE
2/20/2012 None
7/3/2015 None
N/A
N/A
AR
TX
License
Number
J4947
Physician Name
OKORIE, BERTRAM
IHEANYICHUKWU, MD
Q3751
OKORO, EJIKE NICHOLAS, MD
P7324
OKORO, NOSAKHARE , MD
P7173
P5697
OKORODUDU, JANAI MARLIS, MD
OKOYE, EKENE IFEYINWA, MD
Q4822
P6483
P1006
P5441
P7014
P5858
P2908
Q5704
P8709
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
8/15/2011
8/15/2016 MEDICINE
4/1/2015
Secondary Specialty
(Self-Designated)
Practice City
MESA
Registration
Status of
Practice
Texas
State
License
AZ
7/15/2013
7/1/2013
3/1/2013
3/1/2018 PATHOLOGY
OKPUKPARA, ONYINYE, MD
OKUDA, DARIN T, MD
6/12/2015
5/1/2013
5/1/2018 NEUROLOGY
OKUNDAYE, EBIMA CLIFFORD, MD
OKUSAGA, OLAOLUWA OLOLADE,
MD
OLABODE, IRENE SEYI, DO
9/15/2011
2/1/2013
6/14/2013
2/1/2018 PSYCHIATRY
OLAECHEA, JASOR, MD
OLALOWO, OLOYEDE OLABODE,
MD
OLANREWAJU, IFEDOLAPO , MD
3/15/2013
INTERNAL MEDICINE
4/13/2012
8/14/2015
INTERNAL MEDICINE
HOSPITALIST
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
8/19/2011 None
N/A
4/1/2015 None
N/A
WICHITA
FALLS
TX
ACTIVE
7/22/2013 None
N/A
DALLAS
HOUSTON
TX
TX
8/14/2013 None
3/11/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DELINQUEN
T-NON
PAYMENT
6/12/2015 None
5/7/2013 None
N/A
N/A
12/14/2011 None
N/A
2/26/2013 None
6/18/2013 None
N/A
N/A
3/15/2013 None
N/A
4/13/2012 None
8/18/2015 None
N/A
N/A
INTERNAL MEDICINE
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
1/3/2014
METAIRIE
LA
ACTIVE
2/3/2014 None
N/A
2/1/2013
DETROIT
MI
ACTIVE
2/7/2013 None
N/A
P2328
OLAOSUN, ADENRELE ABIOLA, MD
OLARTE MERIDA, KAREN EVELIN,
MD
OLATUNBOSUN, SADIAT KRISTINA,
MD
3/1/2012
3/1/2017 PSYCHIATRY
ACTIVE
3/12/2012 None
N/A
P7523
O'LEARY, MANDY FLANNERY, MD
8/1/2013
8/1/2018 PATHOLOGY
ACTIVE
8/19/2013 None
N/A
Q3070
2/2/2015
2/2/2015 None
N/A
Q8765
Q8315
OLEKA, CHIMSOM T, MD
OLINDE, ALLISON ELISABETH
TATUM, MD
OLINDE, JUSTIN BRANDT, MD
GALVESTONT TX
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
HOUSTON
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Q6079
OLINO, KELLY , MD
HOSPITALIST
HOSPITALIST
SURGICAL
ONCOLOGY
P5442
10-Jun-16
16-May-16
9/15/2015
Page 266 of 402
LICENSE
ISSUED
BURLESON
BURLESON
TX
TX
ACTIVE
ACTIVE
13-Jun-16 None
18-May-16 None
N/A
N/A
GALVESTON
TX
ACTIVE
9/16/2015 None
N/A
License
Number
Physician Name
P5216
OLIPHANT, NEKESHA, MD
Q5238
P9676
P3401
OLISA, CHARLES ONWUMERE, MD
OLIVAS, LUIS, DO
OLIVIER, HOLLY , DO
Q5056
OLMSTED, TAYLOR E, MD
P7827
OLMSTED, THOMAS JAMES, DO
Q5057
dicaid
dicaid
Agreement
End Date
Designated)
FAMILY
PRACTICE/PSYCHIATR
1/4/2013
1/4/2018 Y
7/15/2015
4/1/2014
6/1/2012
6/1/2017 PSYCHIATRY
7/1/2015
7/1/2020 PEDIATRICS
EMERGENCY
8/30/2018 MEDICINE
PLASTIC &
RECONSTRUCTIVE
7/1/2020 SURGERY
8/30/2013
Q0330
OLORUNNIPA, SHOLA, MD
OLOSUNDE, AYOTOKUNBO
OLAITAN, MD
OLOTU, ADETOKUNBO
OLUWAYEMISI, MD
OLSEN, JOHN JAMES, MD
OLSON, KELLY ANN, MD
OLSTEIN, RICHARD LAWRENCE,
MD
P9425
OLUBUYIDE, TEMITOPE, MD
3/17/2014
Q8766
Q1874
Q0522
OLUSANYA, YETUNDE , MD
OMAR, SABRY A, MD
O'MEILIA, JACOB RAYMOND, MD
10-Jun-16
9/15/2014
6/2/2014
P4991
OMER, SHUAB , MD
P6486
P9237
G9175
OMMANI, SOPHIA JOSEFINA, MD
ONAWUNMI, GBONJUBOLA
OLUWATOYIN, MD
ONEILL, THOMAS KEVIN, MD
N1811
ONETO, JULIETA MARIANA, MD
P3214
ONG, JINFON , MD
P1121
P1007
Q2039
P5699
7/1/2015
9/15/2011
10/1/2014
3/1/2013
3/1/2018 PEDIATRICS
INTERVENTIONAL
OBSTETRICS AND
11/30/2012
5/1/2013
6/2/2019 PSYCHIATRY
THORACIC
CARDIOVASCULAR
11/30/2017 SURGERY
OBSTETRICS AND
5/1/2018 GYNECOLOGY
3/3/2014
5/15/2015
5/15/2020 UROLOGY
12/15/2014
PEDIATRIC
5/15/2017 NEUROLOGY
5/15/2012
Practice City
10/3/2011
5/15/2014
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
FORT WORTH TX
HEMATOLOGY/ONCO
LOGY
HOUSTON
TX
PLASTIC SURGERY
WITHIN THE HEAD
AND NECK
HOUSTON
GASTROENTEROLOG
Y
TX
EL PASO
TX
SAN ANTONIO TX
CARDIOVASCULAR
DISEASES
FORT WORTH TX
CORPUS
CHRISTI
PEDIATRIC
RADIOLOGY
Page 267 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
2/4/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
7/17/2015 None
4/4/2014 None
6/6/2012 None
N/A
N/A
N/A
7/9/2015 None
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/20/2015 None
N/A
10/3/2011 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
10/14/2011 None
10/13/2014 None
3/8/2013 None
N/A
N/A
N/A
5/15/2014 None
N/A
3/17/2014 None
N/A
10-Jun-16 None
9/16/2014 None
6/3/2014 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
12/7/2012 None
N/A
TX
ACTIVE
7/9/2013 None
N/A
BRIDGEPORT CT
SAN ANTONIO TX
ACTIVE
ACTIVE
3/11/2014 None
5/26/2015 None
N/A
N/A
ACTIVE
2/19/2015 None
N/A
ACTIVE
5/18/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P9678
ONG, PHILIP GREGORY, MD
4/1/2014
P6487
ONI, MARGARET BOSEDE, MD
5/1/2013
P7685
ONISKO, NANCY SUZANNE, DO
8/15/2013
PHYSICAL MED. &
EMERGENCY
8/15/2018 MEDICINE
Q1466
ONOFRIO, ANTHONY ROBERT, MD
ONOVIRAN, OLUSOLA FRANCISCA,
MD
8/15/2014
8/15/2019 RADIOLOGY
01-Jun-16
OBSTETRICS AND
Q8589
Q3936
ONSTAD, MICHAELA , MD
ONUOHA, ADAEZE
ANYANWUTUTU, MD
ONUORAH EZENEKWE, IFEOMA
OBIAGELI, MD
4/10/2015
15-Mar-16
P3403
Q2816
ONYEACHOLEM, IFEANYI C, MD
ONYENEKWE, CHINEDU TRACY,
MD
ONYENEKWU, NKEIRUKA NGOZI,
MD
ONYIA, BARBARA, MD
P4495
Q7440
ONYIKE, AHAM ELEMUWA, MD
OO, SHWE YEE , MD
9/17/2012
04-Mar-16
Q4660
Q3259
OOMMEN, BINDHU, MD
OPERE, CAXTON ADEREMI, MD
6/1/2015
2/13/2015
Q5522
OPHORI, EMUEJE, MD
P9106
P7016
2/18/2014
6/14/2013
Q8590
OPONDO, MILDRED A, MD
OPPELTZ, RICHARD, MD
OQUENDO RINCON, MARCIAL
ANDRES, MD
01-Jun-16
P1122
ORAN, BETUL , MD
10/3/2011
HEMATOLOGY/ONCOL
10/3/2016 OGY
Q1700
Q1875
Q7587
P9679
8/29/2014
8/29/2019 NEUROLOGY
9/15/2014
DIAGNOSTIC
15-Mar-21 RADIOLOGY
4/1/2014
6/1/2012
1/5/2015
8/3/2015
Secondary Specialty
(Self-Designated)
PULMONARY
DISEASES
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
N/A
ACTIVE
LICENSE
ISSUED
5/13/2013 None
N/A
8/15/2013 None
N/A
ACTIVE
8/19/2014 None
N/A
TX
ACTIVE
16-Jun-16 None
N/A
TX
ACTIVE
LICENSE
ISSUED
4/14/2015 None
N/A
8/29/2014 None
N/A
ACTIVE
9/24/2014 None
N/A
TX
ACTIVE
17-Mar-16 None
N/A
AUSTIN
TX
EMERGENCY
MEDICINE
SAN ANTONIO TX
INTERNAL MEDICINE
ACTIVE
4/7/2014 None
N/A
6/11/2012 None
1/22/2015 None
N/A
N/A
12/16/2012 None
29-Apr-16 None
N/A
N/A
6/1/2015 None
2/19/2015 None
N/A
N/A
8/3/2015 None
N/A
2/18/2014 None
6/27/2013 None
N/A
N/A
01-Jun-16 None
N/A
10/20/2011 None
N/A
GERIATRICS INTERNAL MEDICINE GALVESTON
HOUSTON
ACTIVE
TX
BREAST IMAGING
INTERNAL MED 6/1/2017 EMERGENCY MED
AUSTIN
SAN ANTONIO TX
Disciplinary
Status Date
4/7/2014 None
DALLAS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
HOSPITALIST
SPORTS MEDICINE
Page 268 of 402
MINNEAPOLIS MN
ACTIVE
ACTIVE
DELINQUEN
T-NON
PAYMENT
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
P5116
ORANGE, JORDAN SCOTT, MD
P5116
P5116
P0460
ORDONEZ, ADOLFO JOSE, MD
Q6551
P8966
ORDONEZ, ALEX, MD
ORDONEZ, CONRADO JOSE, MD
P7175
ORDONEZ, EDGARDO, MD
ORDONEZ-SANCHEZ, SANDRA
IRIS, MD
O'REILLY FLORES, DAPHNE
STEPHANIE, MD
P8608
P9671
Q1467
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRICS,
ALLERGY &
12/17/2012
PEDIATRICS,
ALLERGY &
12/17/2012
PEDIATRICS,
ALLERGY &
12/17/2012
7/15/2011
11/16/2015
2/7/2014
7/1/2013
EMERGENCY
7/1/2018 MEDICINE
12/16/2013
4/1/2014
8/15/2014
8/15/2019 NEUROLOGY
P7527
Q7095
ORENGO, JAMES PETER, MD
ORILLOSA, SUSAN JEDA
DOLLOSA, MD
ORNELAS LOZANO, ABBY, MD
8/1/2013
01-Feb-16
P1379
ORNELAS, JACOB D, MD
11/4/2011
OBSTETRICS AND
Q1701
OROZCO, LYNNE ANNE, MD
8/29/2014
P8710
ORR, JUSTIN D, MD
Q8591
P5117
ORSINI, DAVID RAPHAEL, MD
ORTEGA BARNETT, JUAN RAMON,
MD
MD
MD
P8609
ORTEGA, MARTIN , MD
P5117
P5117
1/3/2014
01-Jun-16
ORTHOPEDIC
1/3/2019 SURGERY
12/17/2012
01-Jun-21 ORTHOPEDICS
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
12/16/2013
12/17/2012
12/17/2012
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
ALLERGY AND
IMMUNOLOGY
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/17/2012 None
N/A
ALLERGY AND
IMMUNOLOGY
HOUSTON
TX
ACTIVE
1/22/2013 None
N/A
ALLERGY AND
IMMUNOLOGY
HOUSTON
TX
ACTIVE
1/22/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
7/20/2011 None
N/A
11/16/2015 None
2/24/2014 None
N/A
N/A
7/16/2013 None
N/A
12/16/2013 None
N/A
ACTIVE
5/5/2014 None
N/A
ACTIVE
8/25/2014 None
N/A
WEBSTER
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
8/2/2013 None
07-Mar-16 None
N/A
N/A
LUBBOCK
ACTIVE
LICENSE
ISSUED
12/8/2011 None
N/A
8/29/2014 None
N/A
OTHER SPECIALTY
TX
NEUROMUSCULAR
DISEASE
ORTHOPEDIC
TRAUMA
FOOT AND ANKLE,
ORTHOPEDICS
FAMILY PRACTICE
Page 269 of 402
TX
ACTIVE
LICENSE
ISSUED
EL PASO
TX
ACTIVE
1/7/2014 None
N/A
HOUSTON
TX
ACTIVE
08-Jun-16 None
N/A
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
GALVESTON
TX
ACTIVE
12/18/2012 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
12/18/2012 None
N/A
12/16/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q3753
P6232
ORTIGOZA, ERIC BRUM, MD
ORTIZ, CHRISTIAN , MD
4/1/2015
4/12/2013
4/1/2020
4/12/2018
P9426
ORTIZ, GLORIA , MD
3/17/2014
3/17/2019
NEONATALPERINATAL MEDICINE PEDIATRICS
PSYCHIATRY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
GERIATRIC
PSYCHIATRY
PSYCHIATRY
H8781
ORTIZ, IRENE ELIZABETH, MD
7/1/2011
7/1/2016
Q1253
8/1/2014
P7686
ORTIZ, LUCY, MD
ORUE QUINTANA, VALERIA
ALEJANDRA, MD
Q4661
OSADEBE, SHIRLEY, MD
P0461
OSAMA, FAUZIA KHALIDA, MD
OSAYOMORE, AMADIN ONOME,
MD
Q8592
8/15/2013
6/1/2015
7/15/2011
01-Jun-16
Secondary Specialty
(Self-Designated)
LICENSE
ISSUED
ACTIVE
4/1/2015 None
4/18/2013 None
N/A
N/A
LICENSE
ISSUED
3/17/2014 None
N/A
8/1/2011 None
N/A
8/1/2014 None
N/A
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
8/19/2013 None
N/A
MEDICAL
TOXICOLOGY
(EMERGENCY
7/15/2016 MEDICINE)
KINGWOOD
TX
ACTIVE
6/9/2015 None
N/A
7/15/2011 None
N/A
01-Jun-16 None
N/A
9/6/2013 None
N/A
01-Jun-21 FAMILY PRACTICE
8/30/2013
Q7441
OSBORN, LESLEY ANNE, MD
04-Mar-16
Q5887
OSHINOWO, ADEOTI E, MD
8/28/2015
Q3566
OSIECKI, KRISTEN LYNNE, DO
3/16/2015
P7829
8/30/2013
P3404
OSLUND, SCOTT ALLEN, MD
OSMAN, HOUSSAM GALAL ELDIN,
MD
OSMAN, KWABENA AGYAPONG,
MD
Q6454
OSMAN, MOHAMMAD HUSSEIN
ABBAS MOHAMMAD, MD
11/2/2015
6/1/2017 PEDIATRICS
PEDIATRIC
GASTROENTEROLOG
11/2/2020 Y
PEDIATRICS
P1380
OST, LOREN BARRETT, MD
11/4/2011
11/4/2016 UROLOGIC SURGERY UROLOGY
6/1/2012
Disciplinary
Status Date
HOUSTON
OSBORN, CLINTON ROGER, MD
3/15/2013
ALBUQUERQU
E
NM
Registration
Status Date
Disciplinary
Status of
Texas
License
P7828
P5859
Practice City
Registration
Status of
Practice
Texas
State
License
EMERGENCY
04-Mar-21 MEDICINE
GYNECOLOGIC
8/28/2020 SURGERY
EMERGENCY
3/16/2020 MEDICINE
EMERGENCY
8/30/2018 MEDICINE
LICENSE
ISSUED
LICENSE
ISSUED
WEST LAKE
HILLS, TX
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
10-Mar-16 None
N/A
8/28/2015 None
N/A
GYNECOLOGY
ABDOMINAL
SURGERY
Page 270 of 402
ODESSA
TX
ACTIVE
3/24/2015 None
N/A
WACO
TX
ACTIVE
9/6/2013 None
N/A
DALLAS
TX
ACTIVE
3/29/2013 None
N/A
ACTIVE
6/15/2012 None
N/A
MI
ACTIVE
11/4/2015 None
N/A
TX
ACTIVE
11/17/2011 None
N/A
ROYAL OAK
SULPHUR
SPRINGS
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
P9680
OSTERMAYER, DANIEL, MD
4/1/2014
4/1/2019 MEDICINE
ORTHOPEDIC
OTERO LOPEZ, ERNESTO RAFAEL,
SURGERY OF THE
P8399
MD
11/15/2013
11/15/2018 SPINE
P7176
OTERO LUGO, ARLYN , MD
7/1/2013
PHYSICAL MED. &
P3560
OTHEE, MANDEEP SINGH, MD
6/8/2012
PAIN MEDICINE
EMERGENCY
OTTO, CHRISTIAN, MD
4/13/2012
4/13/2017 MEDICINE
EMERGENCY MED
P1381
OTULANA, OLAKUMBI B, DO
11/4/2011
Q6254
OUELLETTE, HEATHER L, MD
10/1/2015
EMERGENCY
P6691
OUYANG, DA , MD
5/15/2013
5/15/2018 MEDICINE
P8400
P5700
OVERSTREET, HALEY CLARK, MD
OVERTURF, STEVEN , MD
11/15/2013
3/1/2013
Q8318
Q8115
OVIEDO, RODOLFO JOSE, MD
OVILLE, JELANI KEHINDE, MD
16-May-16
02-May-16
Q0804
Q1254
OWEN, LOUISE MAE, MD
OWEN, PHILIP GORDON, MD
Q0143
OWENS, CHARLES TAYLOR II, MD
P1911
OWENS, ERIN MACDONALD, MD
P5218
OWENS, JEANNIE, DO
Q7766
OWENS, LISA , DO
OWENS, RICHARD ALEXANDER,
MD
P6234
P0648
6/27/2014
8/1/2014
5/2/2014
1/17/2012
1/4/2013
01-Apr-16
4/12/2013
5/2/2019 NEPHROLOGY
EMERGENCY
1/17/2017 MEDICINE
ABDOMINAL
SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
4/7/2014 None
N/A
HARLINGEN
TX
ACTIVE
ACTIVE
12/13/2013 None
8/27/2013 None
N/A
N/A
ODESSA
TX
ACTIVE
6/18/2012 None
N/A
HOUSTON
TX
LOS LUNAS
NM
ACTIVE
ACTIVE
ACTIVE
4/27/2012 None
11/11/2011 None
10/9/2015 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
5/20/2013 None
N/A
CEDAR PARK
TX
ACTIVE
ACTIVE
12/3/2013 None
4/2/2013 None
N/A
N/A
TALLAHASSEE FL
HOUSTON
TX
ACTIVE
ACTIVE
18-May-16 None
09-May-16 None
N/A
N/A
LAS CRUCES
NM
LICENSE
ISSUED
ACTIVE
6/27/2014 None
8/7/2014 None
N/A
N/A
TX
ACTIVE
5/5/2014 None
N/A
ARLINGTON
SULPHUR
SPRINGS
TX
ACTIVE
2/29/2012 None
N/A
TX
ACTIVE
1/8/2013 None
N/A
HOUSTON
TX
ACTIVE
06-Apr-16 None
N/A
ANN ARBOR
MI
4/19/2013 None
N/A
HARLINGEN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
8/1/2011 None
N/A
4/1/2014 None
N/A
4/1/2014 None
N/A
NEONATAL01-Apr-21 PERINATAL MEDICINE NEONATOLOGY
EMERGENCY
4/12/2018 MEDICINE
OBSTETRICS AND
8/1/2016 GYNECOLOGY
8/1/2011
P9681
OWENSBY, TRACEY LYNN, MD
OWUSU-NYAMEKYE, NANA
ADOMA, MD
4/1/2014
P9682
OYEBOLA, OLUBUKUNMI, MD
4/1/2014
PAIN MANAGEMENT
Page 271 of 402
Disciplinary
Status Date
HOUSTON
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
EMERGENCY
MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
EULESS
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Q7443
OYEDIRAN, BABATUNDE O, MD
04-Mar-16
Q5888
8/28/2015
Q6081
OYENUGA, OLUSEGUN A, MD
OYENUGA, TAIWO IBUKUNOLUWA,
MD
ANESTHESIOLOGY 04-Mar-21 ANESTHESIOLOGY
PAIN MANAGEMENT
CARDIAC
ELECTROPHYSIOLOG
8/28/2020 Y
CARDIOLOGY
9/15/2015
P8712
OZBEK, YAKUP, MD
Q3568
P1576
3/16/2015
12/1/2011
Q7444
PABLICO, PAMELA CATE, MD
PACHA, OMAR , MD
PACHNANDA, ALEXANDER ALOK,
MD
04-Mar-16
P5862
PACKER, ALLAN DEAN, MD
3/15/2013
P7177
P9429
7/1/2013
3/17/2014
Q6256
PADI, ABHILASH, MD
PAEZ FERNANDEZ, DAVID A, MD
PAGADALA, MANGESH RAJARAM,
MD
04-Mar-21 RADIOLOGY
EMERGENCY
3/15/2018 MEDICINE
EMERGENCY
7/1/2018 MEDICINE
Q4234
PAGAN CABRERA, ANA MARIA, MD
5/1/2015
P2751
P3215
PAGAN FERRER, JUAN , MD
PAGAN, SHARON JAELL, MD
PAGE-RAMSEY, SARAH MICHELE,
MD
4/2/2012
5/15/2012
11/2/2015
Q1703
P1802
PAHLAJANI, NIRAJ HIRO, MD
PAI, CHANDRASHEKHAR
LAXMINARAYAN, MD
PAING, SOE, MD
OBSTETRICS AND
1/5/2020 GYNECOLOGY
RADIATION
11/2/2020 ONCOLOGY
8/29/2014
1/2/2012
HOSPITALIST
HOSPITALIST
Q0332
PAISLEY, ELIZABETH, MD
5/15/2014
Q1704
P3050
PAL, ANANDITA , DO
PAL, SUNITA , MD
8/29/2014
5/1/2012
INTERNAL MEDICINE
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
Page 272 of 402
Q2817
Q6455
1/3/2014
10/1/2015
1/5/2015
Practice City
Registration
Status of
Practice
Texas
State
License
ST. LOUIS
MO
ACTIVE
LUBBOCK
TX
ACTIVE
LUBBOCK
TX
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
PLANO
TX
ACTIVE
ROWLETT
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
OBSTETRICS AND
5/1/2020 GYNECOLOGY
DERMATOLOGY
INTERVENTIONAL
RADIOLOGY
GASTROENTEROLOG
Y
DALLAS
TX
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
07-Mar-16 ORDER
3/7/2016
9/4/2015 None
N/A
11/4/2015 None
N/A
1/3/2014 None
N/A
3/16/2015 None
12/14/2011 None
N/A
N/A
08-Mar-16 None
N/A
4/1/2013 None
N/A
7/1/2013 None
4/2/2014 None
N/A
N/A
10/20/2015 None
N/A
SAN ANTONIO TX
ABILENE
TX
ACTIVE
ACTIVE
5/13/2015 None
UNDER
BOARD
4/3/2012 ORDER
5/17/2012 None
SAN ANTONIO TX
ACTIVE
1/13/2015 None
N/A
TEMPLE
TX
11/3/2015 None
N/A
LACONIA
NH
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/29/2014 None
1/9/2012 None
N/A
N/A
5/15/2014 None
N/A
8/29/2014 None
5/22/2012 None
N/A
N/A
LICENSE
ISSUED
ACTIVE
N/A
3/19/2012
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
Q6679
PALAC, SUSAN MARY, MD
12/4/2015
12/4/2020 NEUROLOGY
CLINICAL
NEUROPHYSIOLOGY
Q6679
04-Dec-15
04-Dec-20 NEUROLOGY
CLINICAL
NEUROPHYSIOLOGY BATH
MI
ACTIVE
03-Mar-16 None
N/A
Q6679
04-Dec-15
04-Dec-20 NEUROLOGY
CLINICAL
NEUROPHYSIOLOGY BATH
MI
03-Mar-16 None
N/A
P1803
P8521
PALACIO, CARLOS ANDRES, MD
PALACIO, LILIANA, MD
1/2/2012
12/6/2013
1/2/2012 None
12/16/2013 None
N/A
N/A
Q8593
PALADINO, PAIGE ELIZABETH, DO
01-Jun-16
OBSTETRICS AND
Q2479
PALADUGU, ANUBHA, MD
Q2040
PALADUGU, NEELIMA, MD
PALAKURTHI, LAKSHMI
CHARUSEELA, MD
PALEY, CHARLES WILLIAM, MD
Q8319
Q5241
P6883
11/17/2014
10/1/2014
16-May-16
7/15/2015
P8291
PALISCH, CATHERINE , MD
PALLEKONDA, VIJAY ANAND RAJ,
MD
11/1/2013
Q8116
PALLISTER, MEGAN GERMAN, MD
02-May-16
P6236
PALM, DANIEL BRIAN, MD
P9238
PALMER, RYAN M, DO
P5864
PALOMBARO, GEREMIE, DO
PAMERLA, MOHAN RAMKUMAR,
MD
PAN, EDWARD, MD
Q6355
P5219
6/3/2013
12/4/2015 None
N/A
BRADENTON
FL
ACTIVE
LICENSE
ISSUED
ACTIVE
WARREN
MI
ACTIVE
09-Jun-16 None
N/A
DALLAS
TX
ACTIVE
11/21/2014 None
N/A
10/1/2014 None
N/A
16-May-16 None
7/17/2015 None
N/A
N/A
6/6/2013 None
N/A
11/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
09-Jun-16 None
N/A
4/12/2013 None
N/A
OH
ACTIVE
3/13/2014 None
N/A
OPHTHALMOLOGY RECONST SURGERY EL PASO
TX
3/19/2013 None
N/A
NEUROLOGY
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
10/15/2015 None
1/31/2013 None
N/A
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
CARDIAC
ELECTROPHYSIOLO
GY
ORTHOPEDIC
6/3/2018 SURGERY
FORT WORTH TX
HOUSTON
OBSTETRICS &
GYNECOLOGICAL
02-May-21 SURGERY
ANESTHESIOLOGY
FAMILY MEDICINE
3/3/2014
ORTHOPEDIC
3/3/2019 SURGERY
3/15/2013
10/15/2015
1/4/2013
1/4/2018 NEURO-ONCOLOGY
4/12/2013
LICENSE
ISSUED
HOUSTON
COLUMBUS
Page 273 of 402
DALLAS
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2013
Practice City
P7178
PAN, RUTH, MD
P9930
PAN, WENTONG , MD
P5220
P0649
PANDEY, MANJU KHATIWADA, MD
PANDIAN, ANBU VALAVAN, MD
P3405
Q2598
PANDIT, SINDHU, MD
PANDYA, SAPNA S, DO
6/1/2012
12/3/2014
PHYSICAL MED. &
P1382
PANDYA, SUNIL RAMESH, MD
11/4/2011
Q4664
P8062
PANG, KAM FUN, MD
PANGARKAR, SANDEEP, DO
6/1/2015
10/1/2013
Q0147
PANGULURI, RAJEEV LOCHAN, MD
5/2/2014
5/2/2019 PSYCHIATRY
JACKSON
P5444
Q4236
PANITHI, RANJANI, MD
PANIZA, LAUREN MICHELLE, MD
2/1/2013
5/1/2015
2/1/2018 PEDIATRICS
5/1/2020 PEDIATRICS
4/15/2014
1/4/2013
8/1/2011
ENDOCRINOLOGY,
DIABETES AND
Secondary Specialty
(Self-Designated)
INTERNAL MED PREV MED
Disciplinary
Status Date
ACTIVE
7/12/2013 None
N/A
TX
ACTIVE
5/14/2014 None
N/A
LEWISVILLE
TEMPLE
TX
TX
ACTIVE
ACTIVE
2/28/2013 None
8/5/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
6/13/2012 None
2/19/2015 None
N/A
N/A
11/4/2011 None
N/A
ACTIVE
ACTIVE
6/16/2015 None
10/10/2013 None
N/A
N/A
MS
ACTIVE
5/14/2014 None
N/A
BAKERSFIELD CA
SAN ANTONIO TX
ACTIVE
ACTIVE
2/8/2013 None
5/7/2015 None
N/A
N/A
CHICAGO
IL
ACTIVE
09-Feb-16 None
N/A
10/1/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
11/16/2015 None
6/29/2012 None
N/A
N/A
5/11/2012 None
11/20/2012 None
N/A
N/A
2/2/2015 None
N/A
ACTIVE
8/31/2015 None
N/A
ACTIVE
3/26/2015 None
N/A
ACTIVE
11/8/2013 None
N/A
SIERRA VISTA AZ
INTERNAL MEDICINE ROUND ROCK TX
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PEDIATRIC
INTENSIVE CARE
PANJWANI, ANJANA SAHANI, MD
01-Feb-16
Q1877
PANT, KRISHNAWARI , MD
9/15/2014
Q6553
P3407
PANUGANTI, KIRAN KUMAR, MD
PAPAILA, ELIZABETH M, MD
11/16/2015
6/1/2012
P3051
P4900
PAPAVASILIOU, PAVLOS , MD
PARACHA, FARRAH TASNIM, MD
5/1/2012
11/15/2012
Q3073
Q5891
PARASHAR, SUNIL DUTT, MD
PARASURAMAN, RAVIPRASENNA
KUMAR, MD
8/28/2015
Q3569
PARAT, SUMESH, MD
3/16/2015
P7967
PARCELLS, JEREMY PATRICK, MD
9/16/2013
Page 274 of 402
2/2/2015
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
Q7096
SURGICAL
5/1/2017 ONCOLOGY
HOUSTON
Registration
Status of
Practice
Texas
State
License
HOSPITALIST
PLANO
TX
TX
2/2/2020 PSYCHIATRY
NEPHROLOGY
NEONATALPERINATAL
MEDICINE
MAYWOOD
ARLINGTON
IL
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q6554
Q4485
Physician Name
PARCHEM, JACQUELINE GILMORE,
MD
PARDE, ANDREA KZ, MD
Q8594
P6885
PARDINI, RICCI STEFAN, MD
PAREDES, JOHN ENRIQUE, DO
01-Jun-16
6/3/2013
Q4486
5/15/2015
P0650
PAREKH, JUSTIN, MD
PAREKH, NINAD DHANVANTRAY,
MD
11/16/2020 OBSTETRICS
EMERGENCY
01-Jun-21 MEDICINE
TRANSPLANT
5/15/2020 SURGERY
8/1/2011
Q0333
PAREPALLY, MAYUR, MD
5/15/2014
P0463
PARETS-RODRIGUEZ, LISSET , MD
7/15/2011
11/16/2015
5/15/2015
Q3758
P1804
PARIKH, AMAY, MD
PARIKH, ARCHANA ARPIT, MD
4/1/2015
1/2/2012
4/1/2020 NEPHROLOGY
P5221
P1913
PARIKH, GAURAV, MD
PARIKH, MAMTA HARISH, MD
1/4/2013
1/17/2012
Q8118
PARIKH, RUSHI RUTESH, DO
02-May-16
PEDIATRIC
EMERGENCY
02-May-21 MEDICINE (PEDS)
P9433
PARIKH, TEJAS DINESH, MD
3/17/2014
P9434
PARIMI, PRABHU SATYA, MD
3/17/2014
Q6082
PARIS, GABRIEL, MD
9/15/2015
P2504
Q6083
PARISH, DAVID, MD
PARK, BORAM KIM, MD
3/15/2012
9/15/2015
Q2177
PARK, ELIZABETH , MD
10/15/2014
P8401
PARK, EUNICE YOUNG, MD
11/15/2013
P8714
PARK, HYEIN, MD
P8522
PARK, JAY SUNG, DO
1/3/2014
12/6/2013
Secondary Specialty
(Self-Designated)
CRITICAL CARE
MEDICINE
HOSPITALIST
PEDIATRICS
NEONATALPERINATAL
MEDICINE
PEDIATRICS,
PEDIATRICS
3/15/2017 RADIOLOGY
EMERGENCY
10/15/2019 MEDICINE
EMERGENCY
11/15/2018 MEDICINE
OBSTETRICS AND
1/3/2019 GYNECOLOGY
12/6/2018 RADIOLOGY
Page 275 of 402
LINCOLN
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
NE
ACTIVE
HERMISTON
LONGVIEW
OR
TX
DALLAS
WICHITA
FALLS
Practice City
NEPTUNE
PLANO
DALLAS
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/16/2015 None
5/29/2015 None
N/A
N/A
ACTIVE
ACTIVE
06-Jun-16 None
6/5/2013 None
N/A
N/A
TX
ACTIVE
5/21/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
5/15/2014 None
N/A
ACTIVE
8/24/2011 None
N/A
4/3/2015 None
1/9/2012 None
N/A
N/A
1/4/2013 None
1/23/2012 None
N/A
N/A
NJ
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
09-May-16 None
N/A
PHILADELPHIA PA
ACTIVE
3/19/2014 None
N/A
KANSAS CITY KS
CORPUS
CHRISTI
TX
ACTIVE
3/25/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
9/17/2015 None
N/A
3/15/2012 None
9/17/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/23/2014 None
N/A
11/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
1/27/2014 None
N/A
12/6/2013 None
N/A
DALLAS
MINEOLA
TX
NY
License
Number
Physician Name
P9435
PARK, JU UN , MD
P3562
PARK, JUNG HYUN, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
3/17/2014
6/8/2012
CARDIOVASCULAR
5/1/2015
5/1/2020 DISEASES
4/1/2013
1/5/2015
1/5/2020 PEDIATRICS
EMERGENCY
8/1/2011
8/1/2016 MEDICINE
10/15/2015
INTERNAL MEDICINE
6/2/2014
11/17/2014
Q4238
P6056
Q2820
PARK, MYUNG H, MD
PARK, NAM HOON , MD
PARK, OLGA, MD
P0652
Q6356
Q0530
Q2480
PARKER, DAINA WYATT, MD
PARKER, JEFFREY RYAN, MD
PARKER, MARY KENDALL, MD
PARKER, MICHELLE BELL, MD
P0776
Q5706
PARKER-ACTLIS, TOMASINA Q, MD
PARKS, GREGORY MARTIN, MD
8/15/2011
8/14/2015
Q5894
PARKS, SARAH, MD
8/28/2015
P7017
Q6556
Q0806
Q8323
PARKS, THOMAS JOSEPH, MD
PARMAR, AMIT, MD
PARMAR, HARVEER SINGH, MD
PARMAR, KARAN PRATAPSINGH,
DO
P5702
PARMET, PHILLIP NOAH, MD
6/14/2013
11/16/2015
6/27/2014
16-May-16
3/1/2013
8/14/2020 NEUROLOGY
UNDERSEA AND
HYPERBARIC MED
8/28/2020 (PREV MED)
PHYSICAL MED. &
EMERGENCY
16-May-21 MEDICINE
DIAGNOSTIC
3/1/2018 RADIOLOGY
Q0335
PARNES, MERED , MD
5/15/2014
Q1256
PARRA, ALBERTO , MD
8/1/2014
P2753
PARROTT, JUSTIN JAMES, MD
4/2/2012
CHILD AND
ADOLESCENT
4/2/2017 PSYCHIATRY
Q4239
5/1/2015
5/1/2020
P8293
PARUCHURI, POONAM, MD
PARUCHURI, VIJAYAPRAVEENA ,
MD
11/1/2013
11/1/2018
P0464
PARVATANENI, SIRISHA, MD
7/15/2011
7/15/2016
P8294
PARVUS, DIRK FRANCIS, MD
11/1/2013
11/1/2018
Practice City
HOUSTON
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
HOUSTON
LACONIA
BROOKLYN
TX
NH
NY
ACTIVE
ACTIVE
ACTIVE
HOUSTON
HOUSTON
HOUSTON
TYLER
TX
TX
TX
TX
PARIS
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
HARVEY
ELECTRODIAGNOSTI
C MEDICINE
ADDISON
FAMILY MEDICINE
CLARKSVILLE
CLEBURNE
LA
MOVEMENT
DISORDERS
PSYCHIATRY
GERIATRIC
MEDICINE (FAMILY
FAMILY MEDICINE
PRACTICE)
CARDIOVASCULAR
INTERNAL MEDICINE DISEASES
FAMILY PRACTICE
EMERGENCY
FAMILY MEDICINE
MEDICINE
Page 276 of 402
HOUSTON
ABILENE
5/5/2015 None
4/8/2013 None
1/8/2015 None
N/A
N/A
N/A
N/A
8/15/2011 None
8/19/2015 None
N/A
N/A
ACTIVE
9/7/2015 None
N/A
TX
TN
TX
ACTIVE
ACTIVE
ACTIVE
6/20/2013 None
11/18/2015 None
7/7/2014 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
23-May-16 None
N/A
3/1/2013 None
N/A
5/15/2014 None
N/A
8/1/2014 None
N/A
4/10/2012 None
N/A
5/1/2015 None
N/A
ACTIVE
11/26/2013 None
N/A
ACTIVE
8/1/2011 None
N/A
ACTIVE
11/18/2013 None
N/A
TX
TX
ACTIVE
FL
8/5/2011
10/16/2015
6/9/2014
11/19/2014
N/A
N/A
N/A
None
None
None
None
LICENSE
ISSUED
VERO BEACH
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
5/13/2014 None
N/A
6/28/2012 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q5059
Q8597
P7687
Physician Name
PASDAR-SHIRAZI, CO-MAY DANG,
MD
PASHA, TAYYAB RASOOL, DO
PASHAEI, HAMED, MD
P4689
PASOL, ELIAS KIREL, MD
P6239
PASSANANTE, JOSEPH A, MD
PASTUSZAK, ALEXANDER
WOJCIECH, MD
4/12/2013
3/17/2014
P9685
PATCH, MICHAEL RYAN, MD
PATEL, ABHILASHA JAYANTILAL,
MD
Q7942
PATEL, ADESH, MD
15-Apr-16
P7180
P4496
PATEL, AFSHEEN ABDULLAH, MD
PATEL, AKASH MAHENDRA, MD
7/1/2013
9/17/2012
Q0807
PATEL, AMEEBEN ANILKUMAR, DO
6/27/2014
Q2821
PATEL, AMIT MANILAL, MD
Q7448
P0465
PATEL, AMIT, MD
PATEL, AMITKUMAR NATVARLAL,
MD
Q5707
Registration
Status Date
Disciplinary
Status Date
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
7/2/2015 None
02-Jun-16 None
8/29/2013 None
N/A
N/A
N/A
HARLINGEN
TX
ACTIVE
10/24/2012 None
N/A
AUSTIN
TX
ACTIVE
4/23/2013 None
N/A
9/15/2019 UROLOGY
URGENT CARE
3/17/2019 MEDICINE
RADIATION
4/1/2019 ONCOLOGY
ALLERGY AND
15-Apr-21 IMMUNOLOGY
STE 1700
TX
ACTIVE
LICENSE
ISSUED
9/23/2014 None
N/A
3/17/2014 None
N/A
ACTIVE
LICENSE
ISSUED
5/13/2014 None
N/A
15-Apr-16 None
N/A
COLUMBIA
MO
ACTIVE
ACTIVE
7/15/2013 None
9/19/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
7/2/2014 None
N/A
IL
ACTIVE
2/9/2015 None
N/A
04-Mar-16
PEDIATRIC
PLASTIC &
RECONSTRUCTIVE
1/5/2020 SURGERY
EMERGENCY
04-Mar-21 MEDICINE
TX
08-Mar-16 None
N/A
7/15/2011
ACTIVE
LICENSE
ISSUED
7/15/2011 None
N/A
PATEL, ANAY RAJENDRA, MD
8/14/2015
ORTHOPEDIC
8/14/2020 SURGERY
TX
ACTIVE
N/A
Q5895
Q1470
PATEL, ARVIND CHUNIBHAI, MD
PATEL, BHAVESH M, MD
8/28/2015
8/15/2014
FORT WORTH TX
HENRICO
VA
ACTIVE
ACTIVE
8/19/2015 None
SEE
PREVIOUS
9/14/2015 ORDER
8/25/2014 None
P7181
PATEL, BIMAL RAMAN, DO
PATEL, CHETANBABU MANUBHAI,
MD
PATEL, DARPAN VINOD, DO
PATEL, DERIN, MD
FORT WORTH TX
ACTIVE
7/15/2013 None
N/A
EL PASO
DALLAS
ACTIVE
ACTIVE
ACTIVE
2/20/2014 None
5/18/2015 None
3/16/2015 None
N/A
N/A
N/A
P9436
P8971
Q4487
Q3416
10/15/2012
9/15/2014
4/1/2014
1/5/2015
7/1/2013
2/7/2014
5/15/2015
3/3/2015
Practice City
Disciplinary
Status of
Texas
License
WHARTON
WHARTON
DALLAS
Q1878
7/1/2015
01-Jun-16
8/15/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
EMERGENCY
4/12/2018 MEDICINE
PSYCHOSOMATIC
MEDICINE
SAN ANTONIO TX
SLEEP MEDICINE
GENERAL SURGERY CHICAGO
HOUSTON
INTERNAL MEDICINE
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
HOUSTON
INTERNAL MEDICINE
OBSTETRICS AND
7/1/2018 GYNECOLOGY
PEDIATRIC
Page 277 of 402
TX
TX
8/31/2015
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
4/1/2013
4/1/2018 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
P6057
PATEL, DEVANG JITENDRA, MD
Q2822
Q6892
PATEL, DHRUTI BHARATBHAI, MD
PATEL, DIPABEN, MD
1/5/2015
06-Jan-16
Q2042
PATEL, GEETA KRISHNAKANT, DO
10/1/2014
P5298
PATEL, HENNA, DO
1/15/2013
Q0336
PATEL, JANKI N, DO
5/15/2014
P9933
PATEL, JAY ARVIND, DO
4/15/2014
PEDIATRIC
GASTROENTEROLOG
1/15/2018 Y
PEDIATRICS
ARLINGTON
INFECTIOUS
5/15/2019 DISEASES
INTERNAL MEDICINE
SURGICAL
Q6456
PATEL, JIGNESH, MD
11/2/2015
P1009
PATEL, KALPESH KANU, MD
9/15/2011
Q3940
P7182
Q3417
PATEL, KAMAKSHI, MD
PATEL, KAUSHAL , MD
PATEL, KEVIN, MD
4/10/2015
7/1/2013
3/3/2015
P7968
P5703
P7327
PATEL, KHUSHBU RAHUL, DO
PATEL, KIRTAN S, MD
PATEL, LAJJA JITENDRA, MD
9/16/2013
3/1/2013
7/15/2013
Q5530
PATEL, MANISH LALJIBHAI, MD
8/3/2015
4/10/2020 NEUROLOGY
FAMILY
PULMONARY
CRITICAL CARE
8/3/2020 MEDICINE
P5869
PATEL, MANISHA NILESH, MD
3/15/2013
P8064
PATEL, MEHUL BABUBHAI, MD
P0268
PATEL, MEHUL DILIP, MD
7/1/2011
PATEL, MEHUL KIRIT, MD
3/1/2012
7/1/2016 PEDIATRICS
RADIATION
3/1/2017 ONCOLOGY
P2330
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
DALLAS
TX
ACTIVE
4/4/2013 None
N/A
MADISON
WI
ACTIVE
ACTIVE
1/12/2015 None
07-Jan-16 None
N/A
N/A
ACTIVE
11/20/2014 None
N/A
1/23/2013 None
N/A
5/15/2014 None
N/A
4/15/2014 None
N/A
LICENSE
ISSUED
11/2/2015 None
N/A
TX
ACTIVE
9/22/2011 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/14/2015 None
7/2/2013 None
3/4/2015 None
N/A
N/A
N/A
CONROE
HOSPITALIST
INTERNAL MEDICINE FRANKFORT
TX
ACTIVE
ACTIVE
ACTIVE
9/23/2013 None
3/11/2013 None
7/16/2013 None
N/A
N/A
N/A
SLEEP MEDICINE
TX
HOSPITALIST
GASTROENTEROLOG
9/15/2016 Y
10/1/2013
Registration
Status of
Practice
Texas
State
License
NEURO-PHYSIOLOGY
(NEUROLOGY)
GALVESTON
HOUSTON
CARDIAC
ELECTROPHYSIOLO
GY
PEDIATRICS,
CARDIOLOGY
Page 278 of 402
AMARILLO
TX
KY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
8/5/2015 None
N/A
3/15/2013 None
N/A
HOUSTON
TX
ACTIVE
10/2/2013 None
N/A
DALLAS
TX
ACTIVE
7/11/2011 None
N/A
TEMPLE
TX
ACTIVE
3/7/2012 None
N/A
License
Number
Physician Name
Q2178
PATEL, MIHIR, MD
Q5896
Q1259
dicaid
dicaid
Agreement
End Date
Designated)
10/15/2014
PATEL, MITESH MAHESH, DO
PATEL, MOHITA A, MD
8/28/2015
8/1/2014
Q6458
Q8325
Q8326
PATEL, MONIKA YOGESH , MD
PATEL, NAPOLEON, MD
PATEL, NAYAN M, MD
11/2/2015
16-May-16
16-May-16
PHYSICAL MED. &
P5299
Q7767
PATEL, NAYANKUMAR, MD
PATEL, NEERAJ M, MD
1/15/2013
01-Apr-16
Q1705
PATEL, NEHA VIJAY, MD
8/29/2014
Q1260
PATEL, NIKHIL KANTI, MD
Q0990
PATEL, NILANG J, MD
P5559
PATEL, NILESH ARVINDBHAI, MD
NEUROLOGICAL
8/1/2019 SURGERY
EMERGENCY
7/15/2019 MEDICINE
HEMATOLOGY/ONCOL
2/8/2018 OGY
Q4488
PATEL, NIMESH, MD
5/15/2015
Q8769
Q7589
PATEL, NIMESH, MD
PATEL, NIRAV DILIPBHAI, MD
10-Jun-16
15-Mar-16
Q2600
PATEL, NISHANT JAYANTI, MD
12/3/2014
10-Jun-21 RADIOLOGY
GASTROENTEROLOG
12/3/2019 Y
8/1/2014
7/15/2014
2/8/2013
Q5897
PATEL, NISHIT HARISHBHAI, MD
8/28/2015
Q6357
10/15/2015
P0466
PATEL, NIYATI MITAL, MD
PATEL, PARISHRAM
BIPINCHANDRA, MD
7/15/2011
P2506
PATEL, PAYAL VINOD, DO
3/15/2012
P6496
PATEL, PIKUL, MD
P1577
PATEL, POOJA RANI, MD
EMERGENCY
5/1/2018 MEDICINE
OBSTETRICS AND
5/1/2013
12/1/2011
Registration
Status of
Secondary Specialty
Practice
Texas
(Self-Designated)
Practice City
State
License
GASTROENTEROLOG
LICENSE
Y
ISSUED
LICENSE
ISSUED
RICHARDSON TX
ACTIVE
JACKSONVILL
PAIN MANAGEMENT E
FL
ACTIVE
ACTIVE
ACTIVE
LICENSE
INTERNAL MEDICINE
ISSUED
ACTIVE
GASTROENTEROLOG
LICENSE
Y
ISSUED
CARDIOLOGY
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
Disciplinary
Status Date
10/15/2014 None
N/A
8/28/2015 None
8/4/2014 None
N/A
N/A
11/12/2015 None
23-May-16 None
17-May-16 None
N/A
N/A
N/A
1/15/2013 None
21-Apr-16 None
N/A
N/A
8/29/2014 None
N/A
ARLINGTON
TX
ACTIVE
8/4/2014 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
9/1/2014 None
N/A
2/8/2013 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
5/18/2015 None
N/A
10-Jun-16 None
17-Mar-16 None
N/A
N/A
12/11/2014 None
N/A
9/14/2015 None
N/A
10/15/2015 None
N/A
7/15/2011 None
N/A
ACTIVE
3/19/2012 None
N/A
ACTIVE
5/3/2013 None
N/A
ACTIVE
1/2/2012 None
N/A
LOS ANGELES CA
DALLAS
TX
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
MOHS
MICROGRAPHIC
SURGERY
MORRISTOWN NJ
OAK LAWN
Page 279 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
IL
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Q4242
Physician Name
PATEL, PRAGNESH
JITENDRABHAI, MD
Q5245
PATEL, PRASHANT SHANTILAL, MD
7/15/2015
Q0808
PATEL, PRITI GUPTA, MD
6/27/2014
5/1/2015
INTERVENTIONAL
PEDIATRIC
Q5246
PATEL, PURVESH RAJENDRABHAI,
MD
P8972
PATEL, RAJAN P, MD
2/7/2014
P9239
PATEL, RAJESH, MD
3/3/2014
DIAGNOSTIC
2/7/2019 RADIOLOGY
EMERGENCY
3/3/2019 MEDICINE
P2754
PATEL, RAKHI MAGANLAL, MD
PATEL, RAXITKUMAR
BHUPENDRAKUMAR, MD
4/2/2012
P9934
Q4665
7/15/2015
4/15/2014
Q3262
Q1472
PATEL, REEVA YOGESH, MD
PATEL, RITESHKUMAR
RAMESHBHAI, MD
PATEL, RONAK JAYANT, DO
2/13/2015
8/15/2014
P8973
Q7097
PATEL, ROSHANKUMAR B, MD
PATEL, RUPERL, MD
2/7/2014
01-Feb-16
Q0685
P4497
P0468
PATEL, SAMEER, MD
PATEL, SAMIR KAUSHIK, MD
PATEL, SANJAY H, DO
6/16/2014
9/17/2012
7/15/2011
Q3074
P2333
Q3760
PATEL, SANJAY SHASHIKANT, MD
PATEL, SEEMA VINOD, MD
PATEL, SHALIN SHAILESH, MD
P7688
P2050
P9437
PATEL, SHALU SHARAD, MD
PATEL, SHEETAL B, MD
PATEL, SHITAL, MD
P7832
PATEL, SHITEL DINESHBHAI, MD
6/1/2015
2/2/2015
3/1/2012
4/1/2015
8/15/2013
2/1/2012
3/17/2014
8/30/2013
EMERGENCY
6/1/2020 MEDICINE
Secondary Specialty
(Self-Designated)
CARDIOVASCULAR
DISEASES
Practice City
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
5/4/2015 None
N/A
HOUSTON
TX
ACTIVE
7/29/2015 None
N/A
EL PASO
TX
ACTIVE
7/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
7/21/2015 None
N/A
2/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
3/24/2014 None
N/A
4/2/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
4/21/2014 None
N/A
6/1/2015 None
N/A
2/13/2015 None
8/21/2014 None
N/A
N/A
PULMONARY
CRITICAL CARE
MEDICINE
PEDIATRIC
RADIOLOGY
IRVING
EMERGENCY
8/15/2018 MEDICINE
2/1/2017 NEPHROLOGY
INTERVENTIONAL
CARDIOLOGY
Disciplinary
Status Date
HOUSTON
TX
INTERNAL MEDICINE WYNNEWOOD PA
CARDIOVASCULAR
2/7/2019 DISEASES
SURGICAL
6/16/2019 ONCOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
JOHNSTOWN
LINDALE
PA
TX
ACTIVE
ACTIVE
2/20/2014 None
03-Feb-16 None
N/A
N/A
HOUSTON
GALVESTON
MIDLAND
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
6/18/2014 None
9/26/2012 None
7/21/2011 None
N/A
N/A
N/A
MARIETTA
OH
CARDIOLOGY
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
2/9/2015 None
3/15/2012 None
4/3/2015 None
N/A
N/A
N/A
9/4/2013 None
2/6/2012 None
3/26/2014 None
N/A
N/A
N/A
9/3/2013 None
N/A
INTERNAL MEDICINE CHICAGO
IL
ACTIVE
ACTIVE
ACTIVE
PLASTIC &
RECONSTRUCTIVE
SURGERY
TX
ACTIVE
Page 280 of 402
HOUSTON
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
OBSTETRICS AND
MATERNAL AND
4/1/2014
4/1/2019 GYNECOLOGY
FETAL MEDICINE
P9687
PATEL, SHIVANI R, MD
P7689
PATEL, SHRESTHA DILIPBHAI, DO
P1207
Q0992
Q4489
PATEL, SIMA BALUBHAI, MD
PATEL, SITAL, DO
PATEL, SNEHALKUMAR
ARJUNBHAI, MD
Q0339
PATEL, SONALI , MD
5/15/2014
Q0149
PATEL, TANAY M, MD
5/2/2014
Q6259
PATEL, UMANG HASMUKH, MD
10/1/2015
EMERGENCY
5/15/2019 MEDICINE
OBSTETRICS AND
5/2/2019 GYNECOLOGY
RADIATION
10/1/2020 ONCOLOGY
Q8770
PATEL, UMANGI , MD
10-Jun-16
Q3265
PATEL, VIKASH UMESH, MD
2/13/2015
Q1473
PATEL, VIPUL NAVIN, DO
8/15/2014
EMERGENCY
8/15/2019 MEDICINE
Q0534
P5705
PATEL, VIRESH YOGESH, MD
PATEL, VISHAL CHANDRAKANT,
MD
Q7945
PATEL, VIVEK-SAGAR, MD
P6497
PATEL, ZUHAIB, DO
PATERICK, TIMOTHY EDWARD SR,
MD
PATERNINA, JESUS DAVID, MD
PATHAK, INDU S, MD
Q8327
P2334
P1011
J4425
P7328
P0270
PATHAN, ASAD Z, MD
PATIL, PUNAM MAHENDRA, MD
PATIL, SACHIN MALLANAGOUDA,
MD
8/15/2013
10/17/2011
7/15/2014
5/15/2015
6/2/2014
3/1/2013
15-Apr-16
5/1/2013
16-May-16
3/1/2012
9/15/2011
4/1/2013
7/15/2013
7/1/2011
OTOLARYN & FACIAL
15-Apr-21 PLASTIC SURGERY
EMERGENCY
5/1/2018 MEDICINE
CARDIOVASCULAR
IMAGING
CARDIOVASCULAR
4/1/2018 DISEASES
DALLAS
GENERAL PRACTICE GALVESTON
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
HOUSTON
HOUSTON
INTERVENTIONAL
CARDIOLOGY
FAMILY MEDICINE
Practice City
INTERVENTIONAL
CARDIOLOGY
Page 281 of 402
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
4/3/2014 None
N/A
TX
ACTIVE
8/23/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
11/3/2011 None
8/4/2014 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/22/2015 None
N/A
5/15/2014 None
N/A
5/2/2014 None
N/A
10/5/2015 None
N/A
10-Jun-16 None
N/A
2/13/2015 None
N/A
8/15/2014 None
N/A
KILLEEN
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
6/3/2014 None
N/A
ACTIVE
3/4/2013 None
N/A
HOUSTON
TX
ACTIVE
27-Apr-16 None
N/A
DALLAS
TX
ACTIVE
5/10/2013 None
N/A
DALLAS
MCALLEN
EL PASO
TX
TX
TX
13-Jun-16 None
3/28/2012 None
9/21/2011 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
4/1/2013 None
7/23/2013 None
N/A
N/A
7/8/2011 None
N/A
ACTIVE
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
RADIATION
P7183
PATIL, SACHIN SHYAM, MD
7/1/2013
7/1/2018 ONCOLOGY
NEUROLOGICAL
P1127
PATIL, SHASHIKANT, MD
10/3/2011
10/3/2016 SURGERY
ORTHOPEDIC
ORTHOPEDIC
Q4490
PATIL, VISHWAS BAPURAO, MD
5/15/2015
5/15/2020 SURGERY
SURGERY
PEDIATRIC
P5870
PATNI, NIVEDITA , MD
3/15/2013
ENDOCRINOLOGY
Q0535
PATRI, JYOTHI, MD
6/2/2014
INTERVENTIONAL
P8975
PATRI, RAHUL, MD
2/7/2014
2/7/2019 CARDIOLOGY
CARDIOLOGY
FAMILY
Q7257
PATRIC, KENNETH W JR, MD
16-Feb-16
16-Feb-21 PRACTICE/OMM
EMERGENCY
Q2044
PATRITO, GINA MARIE, MD
10/1/2014
10/1/2019 MEDICINE
ALLERGY AND
P5447
PATTANAIK, DEBENDRA NATH, MD
2/1/2013
2/1/2018 IMMUNOLOGY
RHEUMATOLOGY
AEROSPACE
P6887
PATTARINI, JAMES MARTIN, MD
6/3/2013
FAMILY PRACTICE Q6682
PATTON, HEATHER TILL, MD
12/4/2015
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
7/15/2013 None
N/A
SHREVEPORT LA
ACTIVE
10/17/2011 None
N/A
SAN ANTONIO TX
ACTIVE
5/21/2015 None
N/A
MIAMI
ACTIVE
ACTIVE
4/23/2013 None
6/18/2014 None
N/A
N/A
ACTIVE
2/11/2014 None
N/A
FL
ROCKWALL
TX
ACTIVE
29-Feb-16 None
N/A
KINGSTON
NY
ACTIVE
LICENSE
ISSUED
10/9/2014 None
N/A
2/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
6/11/2013 None
N/A
12/4/2015 None
SEE
PREVIOUS
07-Jan-16 ORDER
SEE
PREVIOUS
07-Jan-16 ORDER
2/4/2015 None
10/7/2014 None
N/A
GALVESTON
TX
Q6682
04-Dec-15
COLLEGE
STATION
TX
ACTIVE
Q6682
Q2937
Q2045
PATTON, SAMUEL ROSS, MD
PAUDEL, KESHAB, MD
04-Dec-15
1/15/2015
10/1/2014
COLLEGE
STATION
GALVESTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
P8612
Q5064
PAUDYAL-NEPAL, BANDANA, MD
PAUL, DUSTIN JACOB, DO
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
12/17/2013 None
7/14/2015 None
N/A
N/A
Q4243
PAUL, MARY K, MD
ACTIVE
6/10/2015 None
N/A
Q1262
P9108
Q8600
PAULOSE, TARA LIZBETH, MD
PAULSON, ANDREW SCOTT, MD
PAULSON, QIWEI , MD
ACTIVE
ACTIVE
ACTIVE
8/12/2014 None
2/24/2014 None
13-Jun-16 None
N/A
N/A
N/A
12/16/2013
7/1/2015
5/1/2015
8/1/2014
2/18/2014
01-Jun-16
ALLERGY AND
5/1/2020 IMMUNOLOGY
2/18/2019 ONCOLOGY
HOSPITALIST
PEDIATRIC
NEPHROLOGY
PEDIATRICS
PEDIATRICS,
ALLERGY &
IMMUNOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
INTERNAL MEDICINE
HOSPITALIST
Page 282 of 402
HOUSTON
DALLAS
AUSTIN
TX
TX
TX
12/4/2015
12/4/2015
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q4244
PAVASIA, NIRAV RAJENDRA, MD
5/1/2015
Q6893
PAYAN SCHOBER, FERNANDA, MD
P5448
PAYAN, HECTOR A, MD
Q7450
Q7592
Q6260
PAYNE, BRIAN, MD
PAYNE, BRYAN KEITH, MD
PAYNE, JOHN ANDREW, DO
04-Mar-16
15-Mar-16
10/1/2015
P3219
Q1882
PAYNE, THOMAS, MD
PEAN, JULES, MD
5/15/2012
9/15/2014
Q2180
PEARCE, MEGAN, MD
10/15/2014
P0922
P1579
PEARCE, STEVEN GABRIEL, MD
PEARLMAN, MICHAEL L, MD
9/1/2011
12/1/2011
P7533
PEARSON, BRADLEY VANN, MD
8/1/2013
P0271
PEARSON, MATTHEW DEAN, MD
7/1/2011
P2336
PEARSON, NADIA MARY, DO
3/1/2012
Q6085
9/15/2015
Q4245
PEARSON, STEPHANIE , MD
PECCORA, CHRISTIAN DAVID
ALBERT, MD
7/1/2016 UROLOGY
EMERGENCY
3/1/2017 MEDICINE
PHYSICAL MED. &
5/1/2015
N2724
PECHITTY, SMITA SAGAR, MD
10/15/2013
Q2046
PECK, DEVIN BENNETT, MD
10/1/2014
P5706
PECK, MARIANNE BERGQUIST, MD
3/1/2013
OBSTETRICS AND
3/1/2018 GYNECOLOGY
P5120
P5120
PECKHAM, RUSSELL , DO
06-Jan-16
2/1/2013
12/17/2012
12/17/2012
5/1/2020 NEUROLOGY
06-Jan-21 NEPHROLOGY
PULMONARY
CRITICAL CARE
2/1/2018 MEDICINE
04-Mar-21 PEDIATRICS
OBSTETRICS &
GYNECOLOGICAL
5/15/2017 SURGERY
EMERGENCY
10/15/2019 MEDICINE
EMERGENCY
8/1/2018 MEDICINE
Secondary Specialty
(Self-Designated)
MOVEMENT
DISORDERS
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
DALLAS
TX
ACTIVE
5/11/2015 None
N/A
EL PASO
TX
ACTIVE
07-Jan-16 None
N/A
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
ST LOUIS
PEDIATRICS
SAN ANTONIO
LUBBOCK
TX
ACTIVE
2/22/2013 None
N/A
MO
TX
TX
ACTIVE
ACTIVE
ACTIVE
16-Mar-16 None
17-Mar-16 None
10/6/2015 None
N/A
N/A
N/A
AUSTIN
INTERNAL MEDICINE VICTORVILLE
TX
CA
ACTIVE
ACTIVE
5/17/2012 None
9/19/2014 None
N/A
N/A
ALLEN
GASTROENTEROLOG
Y
HOUSTON
NEURO-ONCOLOGY HOUSTON
TX
ACTIVE
11/12/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/23/2011 None
12/7/2011 None
N/A
N/A
8/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/12/2011 None
N/A
3/1/2012 None
N/A
ACTIVE
9/17/2015 None
N/A
ACTIVE
5/18/2015 None
N/A
LA
ACTIVE
10/22/2013 None
N/A
TX
ACTIVE
10/8/2014 None
N/A
3/1/2013 None
N/A
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
12/17/2012 None
1/17/2013 None
N/A
N/A
UROLOGIC SURGERY AUSTIN
TX
SAN ANTONIO TX
ANESTHESIOLOGY
BATON
INTERNAL MEDICINE ROUGE
ANESTHESIOLOGY PAIN MANAGEMENT AUSTIN
OBSTETRICS &
GYNECOLOGICAL
SURGERY
FT. HOOD
Page 283 of 402
License
Number
Physician Name
P5120
Q0686
PECKINS, CHRISTOPHER S, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
12/17/2012
6/16/2014
FP/OSTEO
MANIPULATION
15-Mar-16
15-Mar-21 MEDICINE
12/1/2011
12/1/2016 RADIOLOGY
BODY IMAGING
6/12/2015
Q7593
P1580
Q4824
PEDERSON, KATHERINE
ADELAIDE, DO
PEDROSA, IVAN, MD
PEERA, FATEHALI GECOBE, MD
Q2824
PEGRAM, KATIE GREENE, MD
Q2364
PEGRAM, TREY AMERSON, MD
11/7/2014
P5223
Q5709
PEKAREV, MAXIM, MD
PELAEZ-VELEZ, CRISTINA , MD
1/4/2013
8/14/2015
Q3764
PELLECCHIA, CRESCENS
MICHAEL, DO
4/1/2015
Q2825
PELLI, JOSEPH RICHARD JR, MD
AM00051 PENA, HERIBERTO, MD
P8976
PENA, JAVIER JR, MD
P7969
M0860
PENA-HERNANDEZ, LUIS JAVIER,
MD
PENAMANTE-LUM, ESLYNN ROSE
ANN, MD
PENDARVIS, RAINE W, MD
P9243
Q2826
PENDLETON, CLAY MICHAEL, MD
PENG, MONICA, MD
Q2048
PENICK, CIMBERLY L, DO
P7534
Q3765
Q7258
P8296
1/5/2015
18-Mar-16 None
12/22/2011 None
6/17/2015 None
N/A
N/A
N/A
ACTIVE
1/8/2015 None
N/A
ACTIVE
11/17/2014 None
N/A
TX
ACTIVE
ACTIVE
1/9/2013 None
8/18/2015 None
N/A
N/A
TX
ACTIVE
4/3/2015 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/29/2015 None
N/A
8/29/2014 None
N/A
2/7/2014 None
N/A
FL
ACTIVE
11/6/2013 None
N/A
PA
GA
ACTIVE
ACTIVE
9/23/2013 None
3/9/2015 None
N/A
N/A
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
3/13/2014 None
2/3/2015 None
N/A
N/A
10/1/2014 None
UNDER
BOARD
8/7/2013 ORDER
N/A
4/1/2015 None
25-Feb-16 None
N/A
N/A
GENERAL SURGERY
1/5/2015
8/29/2014
GERIATRICS
2/7/2014
PULMONARY
CRITICAL CARE
11/1/2018 MEDICINE
URGENT CARE
9/16/2018 MEDICINE
3/3/2020 RADIOLOGY
9/16/2013
3/3/2015
3/3/2014
1/5/2015
FORT WORTH TX
DALLAS
TX
LUBBOCK
TX
10/1/2014
3/3/2019 UROLOGY
1/5/2020 PEDIATRICS
OBSTETRICS AND
PENNINGTON, BRENT LEE, MD
8/1/2013
PERALTA, MATHEW , MD
PEREIRA, DANIEL RAFAEL, MD
4/1/2015
16-Feb-16
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
1/17/2013 None
N/A
6/26/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
PULMONARY
CRITICAL CARE
4/1/2020 MEDICINE
EMERGENCY
1/5/2020 MEDICINE
11/1/2013
Practice City
FT. HOOD
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
TX
ACTIVE
HOUSTON
INTERNAL MEDICINE ATLANTIS
URGENT CARE SLIPPERY
FAMILY PRACTICE
ROCK
ALPHARETTA
HOUSTON
HOSPITALIST
4/1/2020 PEDIATRICS
Page 284 of 402
REFUGIO
TX
RICHARDSON TX
ACTIVE
LICENSE
ISSUED
ACTIVE
7/1/2013
License
Number
P7184
Physician Name
PERES, NATANA NAVARRO, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
7/1/2013
7/1/2018 MEDICINE
Q5066
PEREZ GARAY, ESTELA MARIA, MD
7/1/2015
P7535
PEREZ RODRIGUEZ, OMAR, MD
8/1/2013
OBSTETRICS AND
8/1/2018 GYNECOLOGY
P6888
PEREZ, ANGEL S, MD
6/3/2013
6/3/2018 NEUROLOGY
Q3573
PEREZ, JORGE ERNESTO, MD
P6500
PEREZ, KARLA ALEJANDRA, MD
Q0687
PEREZ, LEONEL JR, MD
Q5899
PEREZ, NICHOLAS JAMES, MD
3/16/2015
5/1/2013
6/16/2014
8/28/2015
MUSCULOSKELETAL
6/16/2019 ONCOLOGY
OBSTETRICS AND
ORTHOPEDIC
4/1/2020 SURGERY
Secondary Specialty
(Self-Designated)
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
ACTIVE
7/9/2013 None
N/A
EL PASO
TX
ACTIVE
7/2/2015 None
N/A
LAREDO
TX
ACTIVE
8/5/2013 None
N/A
FAYETTEVILLE AR
ACTIVE
6/21/2013 None
N/A
ACTIVE
3/23/2015 None
N/A
ACTIVE
LICENSE
ISSUED
5/13/2013 None
N/A
6/16/2014 None
N/A
ACTIVE
LICENSE
ISSUED
8/31/2015 None
N/A
4/1/2015 None
N/A
ACTIVE
11/14/2014 None
N/A
ACTIVE
ACTIVE
3/27/2014 None
11/22/2011 None
N/A
N/A
ACTIVE
9/3/2014 None
N/A
ACTIVE
1/6/2015 None
N/A
CORPUS
CHRISTI
GRAND
JUNCTION
Q3766
PEREZ-CARRILLO, OMAR M, MD
Q2365
PEREZ-SCHWARTZ, LUZ, MD
11/7/2014
P9440
P1385
PEREZ-STOKES, SARA MARIE, MD
PERIANAYAGAM, ANJANA, MD
PERISETTI, NAGA MARUTHI
KUMAR, MD
PERKINS, CHRISTOPHER HEATH,
MD
3/17/2014
11/4/2011
8/29/2014
ORTHOPEDIC
1/5/2020 TRAUMA
HOSPITALIST
ORTHOPEDIC
TRAUMA
PEDIATRIC
5/1/2017 NEUROLOGY
CLINICAL
NEUROPHYSIOLOGY AUSTIN
Q1707
Q2827
P3058
Q8772
Q1883
Q7259
P0272
Q4492
PERKINS, FREEDOM FREDERICK
JR, MD
PERKINS, JONATHAN MORGAN,
MD
PERLA, RAMANI PADMAJA, MD
PERRO, CHRISTOPHER
ALEXANDER, MD
PERROTTE, NICOLE TAHIRA, MD
PERRY, BENJAMIN FRANKLIN II,
MD
1/5/2015
5/1/2012
10-Jun-16
9/15/2014
16-Feb-16
7/1/2011
5/15/2015
TX
CO
PHILADELPHIA PA
TX
FORT WORTH TX
JACKSONVILL
E
FL
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/18/2012 None
N/A
10-Jun-16 None
N/A
9/15/2014 None
N/A
SAN ANTONIO TX
ATLANTA
GA
ACTIVE
ACTIVE
29-Feb-16 None
8/1/2011 None
N/A
N/A
WACO
ACTIVE
5/19/2015 None
N/A
OPHTHALMOLOGY
FACIAL PLASTIC
16-Feb-21 SURGERY
OTOLARYNGOLOGY
GERIATRIC MEDICINE
FAMILY MEDICINE
Page 285 of 402
Disciplinary
Status Date
TX
PREVENTIVE
MEDICINE
OBSTETRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
4/1/2015
Registration
Status of
Practice
Texas
State
License
TX
Registration
dicaid
dicaid
Status of
License
Agreement
Practice
Texas
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
State
License
Q1263
PERRY, BRANDON MICHAEL, MD
8/1/2014
ACTIVE
EMERGENCY
LICENSE
Q4825
PERRY, MICHAEL CHARLES JR, MD
6/12/2015
6/12/2020 MEDICINE
ISSUED
LICENSE
P4901
PERSON, MARJORIE , MD
11/15/2012
ISSUED
Q6557
PERWEZ, FARIHAH BADAR, MD
11/16/2015
DALLAS
TX
ACTIVE
LICENSE
P8524
PESCO, JONATHAN PHILIP, MD
12/6/2013
ISSUED
G3685
PESICKA, GARY ALLEN, MD
PETALCORIN, JOAN SYBELL
REMOLLO, MD
4/12/2013
8/28/2015
Q6358
PETERS, CRAIG ANDREW, MD
PETERS, WALTER RUSSELL JR,
MD
Q0536
PETERSEN, JOHN L, MD
Q2367
Q6262
PETERSON, DARREN LOUIS, MD
PETERSON, JAMES ALLEN KRAFT,
DO
Q0151
PETERSON, WYLAN CORNELIUS,
MD
Q5067
Q5901
Q4493
PETRICH, CHRISTINE, MD
P5449
PETTIGREW, CANDACE DIANE, MD
7/1/2015
10/15/2015
6/2/2014
11/7/2014
PHYSICAL MED. &
8/28/2020 UROLOGY
COLON AND RECTAL
10/15/2020 SURGERY
EMERGENCY
6/2/2019 MEDICINE
10/1/2015
DIAGNOSTIC
10/1/2020 RADIOLOGY
5/2/2014
5/15/2015
2/1/2013
EMERGENCY
2/1/2018 MEDICINE
P6242
PETTY, LEONORA KATHLEEN, MD
4/12/2013
P3222
PEZZULLO, ROSEMARIE ANNE, MD
5/15/2012
OTOLARYNGOLOGY
6/14/2018 (NEUROTOLOGY)
P7018
PFANNENSTIEL, TRAVIS JOHN, MD
6/14/2013
P8525
P6243
P0924
PHAM, AMY QUYNH TRANG, MD
PHAM, ANTOINE NGUYEN, DO
PHAM, MARY ELIZABETH , MD
12/6/2013
4/12/2013
9/1/2011
OPHTHALMOLOGY VITREOUS SURGERY DALLAS
VIRGINIA
PAIN & SPINE
BEACH
PEDIATRIC
UROLOGY
INTERNAL MEDICINE MIDLAND
COLON AND RECTAL
SURGERY
AMARILLO
LAS VEGAS
OTOLARYNGOLOGY
FORT SAM
HOUSTON
12/6/2018 INTERNAL MEDICINE FAMILY MEDICINE
FAMILY MEDICINE
AMARILLO
Page 286 of 402
N/A
11/15/2012 None
11/20/2015 None
N/A
N/A
12/6/2013 None
N/A
ACTIVE
4/18/2013 None
N/A
VA
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/21/2015 None
N/A
8/28/2015 None
N/A
10/15/2015 None
N/A
TX
ACTIVE
6/23/2014 None
N/A
TX
ACTIVE
11/19/2014 None
N/A
NV
ACTIVE
10/9/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/15/2014 None
N/A
5/15/2015 None
N/A
2/1/2013 None
N/A
ACTIVE
4/23/2013 None
N/A
ACTIVE
5/21/2012 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/24/2013 None
N/A
12/6/2013 None
4/25/2013 None
12/9/2011 None
N/A
N/A
N/A
FORENSIC
PSYCHIATRY
EL PASO
6/12/2015 None
TX
JBSA FT. SAM
HOUSTON
TX
CHILD AND
ADOLESCENT
PSYCHIATRY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/8/2014 None
N/A
TX
TX
TX
TX
License
Number
Physician Name
Q8603
PHAM, NHAT-LONG LAM, MD
P2756
PHAM, NIKKI HOA THI, MD
P6245
P1128
PHAM, QUOC VAN, MD
PHAM, RYAN KHANHHOANG, DO
P8980
PHAM, SAPA THI, MD
5/1/2012
EMERGENCY
4/12/2018 MEDICINE
INTERVENTIONAL
5/1/2017 CARDIOLOGY
PHAM, THANH NGOC, MD
12/3/2014
PHAM, TRUC THI THU, MD
4/2/2012
P3060
PHAM, SON VAN, MD
Q2605
P2757
P5560
PHAM, VIET HOAI, MD
P7834
PHAN, AN T, MD
P8065
P2340
P4995
PHAN, DAN CONG, MD
PHAN, DUC HONG, MD
PHAN, NGOC KHANH THI, DO
Q3942
PHAN, ROBERT D, MD
Q2606
P1208
PHARISS, ROBERT CHASE, DO
PHATAK, UMA R, MD
Q3268
P3565
PHILIP, JISSY RACHEL, DO
PHILIP, LEENA, MD
Q4248
PHILIP, SHIBU, MD
P1129
Q3574
Q7594
P9936
P5876
dicaid
dicaid
Agreement
End Date
Designated)
RADIATION
01-Jun-16
01-Jun-21 ONCOLOGY
PHILIPS, SHAILE, MD
PHILIPS, STEVEN THOMAS, MD
PHILLIPS, ALEXIS MICHELE, DO
PHILLIPS, CHRIS, MD
PHILLIPS, CHRISTOPHER WEST,
MD
4/2/2012
4/12/2013
10/3/2011
2/7/2014
2/8/2013
8/30/2013
ANATOMIC/CLINICAL
10/1/2018 PATHOLOGY
10/1/2013
3/1/2012
11/30/2012
4/10/2015
12/3/2014
10/17/2011
EMERGENCY
12/3/2019 MEDICINE
2/13/2015
6/8/2012
5/1/2015
10/3/2011
3/16/2015
15-Mar-16
4/15/2014
3/15/2013
Secondary Specialty
(Self-Designated)
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
FORT WORTH TX
CARDIOVASCULAR
DISEASES
SAN ANTONIO TX
OTORHINOLARYNGO
LOGY
GALVESTON
HOSPITALIST
NASHVILLE
HOUSTON
HOUSTON
TX
TN
TX
TX
FORT WORTH TX
HOUSTON
TX
5/1/2020 CARDIOLOGY
10/3/2016
3/16/2020
15-Mar-21
4/15/2019
RADIOLOGY
INTERNAL MEDICINE
PEDIATRICS
INTERNAL MEDICINE
EMERGENCY
3/15/2018 MEDICINE
ABDOMINAL
RADIOLOGY
URGENT CARE
MEDICINE
Page 287 of 402
SAN ANTONIO
DALLAS
ATASCOCITA
BIRMINGHAM
TX
TX
TX
AL
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
07-Jun-16 None
N/A
4/2/2012 None
N/A
4/12/2013 None
10/4/2011 None
N/A
N/A
2/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/3/2012 None
N/A
12/3/2014 None
N/A
4/2/2012 None
N/A
ACTIVE
LICENSE
ISSUED
2/20/2013 None
N/A
8/30/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/4/2013 None
3/15/2012 None
12/4/2012 None
N/A
N/A
N/A
4/10/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
12/15/2014 None
10/19/2011 None
N/A
N/A
2/13/2015 None
6/12/2012 None
N/A
N/A
5/1/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/11/2011
3/19/2015
28-Apr-16
5/12/2014
ACTIVE
None
None
None
None
N/A
N/A
N/A
N/A
3/29/2013 None
N/A
License
Number
P6061
Physician Name
PHILLIPS, JUSTIN DANIEL, MD
P8402
PHILLIPS, LARON EDWARD, MD
Q2368
PHILLIPS, LEE GARRIT, MD
P5707
P9692
P8171
Q5535
PHILLIPS, MARGARET ELIZABETH,
MD
PHILLIPS, MATTHEW DAVID, MD
PHILLIPS, RICHARD ROSS, MD
PHILLIPS, ROBERT A, MD
Q3269
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
4/1/2013
4/1/2018 MEDICINE
11/15/2013
11/7/2014
Secondary Specialty
(Self-Designated)
Disciplinary
Status Date
4/5/2013 None
N/A
IL
ACTIVE
12/9/2013 None
N/A
TX
ACTIVE
11/12/2014 None
N/A
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
3/18/2013
4/2/2014
10/21/2013
8/4/2015
None
None
None
None
N/A
N/A
N/A
N/A
LICENSE
ISSUED
2/13/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
22-Jan-16
11/8/2011
5/5/2014
5/11/2015
None
None
None
None
N/A
N/A
N/A
N/A
OPHTHALMOLOGY VITREOUS SURGERY GALVESTON
TX
ACTIVE
7/17/2014 None
N/A
BREAST IMAGING
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/12/2015 None
18-Mar-16 None
N/A
N/A
4/10/2015 None
N/A
11/15/2011 None
N/A
8/13/2013 None
N/A
16-May-16 None
N/A
3/26/2012 None
N/A
5/15/2012 None
N/A
7/21/2011 None
10/13/2015 None
N/A
N/A
ARLINGTON
HEIGHTS
DALLAS
VICTORIA
AUSTIN
3/1/2013
4/1/2014
10/15/2013
8/3/2015
3/1/2018
4/1/2019
10/15/2018
8/3/2020
PHILLIPS, ROBERT AMOS JR, MD
2/13/2015
2/13/2020
Q6976
P1387
P9693
Q4249
PHILLIPS, SCOTT BRIAN, MD
PHUAH, ELAINE IE LIN, DO
PHUOC, VICTOR HOTAN, MD
PHYO, NYAN WAI, MD
15-Jan-16
11/4/2011
4/1/2014
5/1/2015
15-Jan-21
11/4/2016
4/1/2019
5/1/2020
Q0993
7/15/2014
Q3422
Q7595
PICCIANI, RENATA, MD
PICHARDO-LAFONTAINE,
GABRIELA, MD
PICKERING, MELANIE RAE, DO
3/3/2015
15-Mar-16
Q3943
PICKERT, CURTIS BLAINE, MD
4/10/2015
15-Mar-21 RADIOLOGY
PEDIATRIC CRITICAL
P1482
11/15/2011
P7538
PICKNEY, LUCILLE MARY, MD
PIDLAOAN, VICTORIO PARAYNO,
MD
Q8330
PIERCE, CALEB ANDREW, MD
16-May-16
P2341
PIERI, RICHARD EMEKA, MD
3/1/2012
EMERGENCY
16-May-21 MEDICINE
INFECTIOUS
3/1/2017 DISEASES
P3223
PIERRE, HAROLD LUCO, MD
5/15/2012
P0469
Q6264
PIERRE, JAMES ANTHONY JR, MD
PIERRE, PATRICK, MD
7/15/2011
10/1/2015
Page 288 of 402
8/1/2013
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
PEDIATRIC
OPHTHALMOLOGY
ANESTHESIOLOGY
HOSPITALIST
CARDIOLOGY
THORACIC
CARDIOVASCULAR
SURGERY
NEUROLOGICAL
SURGERY
INTERNAL MEDICINE
GENERAL SURGERY
INTERNAL MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
VASCULAR
SURGERY
PAIN & SPINE
SAN ANTONIO TX
NEPHROLOGY
HOUSTON
EDINBURG
CYPRESS
PEDIATRICS
DALLAS
TX
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
SAN ANTONIO TX
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS AND
3/1/2012
3/1/2017 GYNECOLOGY
P2342
PIERSON, SERENA MICHELLE, MD
Q5248
PILGRIM, PETRA MARIE ANNE, MD
7/15/2015
P8526
Q8776
Q4250
PILGRIM, SCOTT MATTHEW, MD
PILIE, PATRICK GLEN, MD
PILKINTON, DAVID THOMAS, MD
12/6/2013
10-Jun-16
5/1/2015
Q0538
PILLAI, ANIL KUMAR, MD
Q7260
PILLAI, CHANTHU , MD
PILLAI, MADHAVAN VELAYUDHAN,
MD
Q1476
P2343
6/2/2014
16-Feb-16
8/15/2014
6/2/2019 RADIOLOGY
P3566
P0470
P5709
PILLUS, DAVID, MD
Q3270
P1915
PIMENTEL, JESUS JAVIER, MD
PIMENTEL, SACRAMENTO, MD
2/13/2015
1/17/2012
P9444
P7691
P9694
P4799
PINERO, JAIME, MD
PINNAMANENI, PAVAN , MD
PINNAMANENI, PRAMOD , MD
PINTO, MAURICIO , MD
3/17/2014
8/15/2013
4/1/2014
11/1/2012
3/17/2019
8/15/2018
4/1/2019
11/1/2017
P7539
PIPARIA, MAANSI, MD
Q5068
Q2184
PIRACHA, AMIR RASHID, MD
PIRACHA, FYZA, MD
7/1/2015
10/15/2014
Q2185
PIRC, GEANINE, MD
10/15/2014
11/16/2015
6/8/2012
7/15/2011
3/1/2013
8/1/2013
PSYCHOANALYSIS
Practice City
EMERGENCY
3/1/2018 MEDICINE
FAMILY PRACTICE
FAMILY PRACTICE
INTERNAL MEDICINE
FAMILY MEDICINE
OBSTETRICS AND
8/1/2018 GYNECOLOGY
INTERVENTIONAL
7/1/2020 CARDIOLOGY
ACTIVE
4/16/2012 None
N/A
HOUSTON
TX
7/22/2015 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
12/6/2013 None
20-Jun-16 None
5/14/2015 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
6/4/2014 None
N/A
TX
ACTIVE
29-Feb-16 None
N/A
TX
ACTIVE
8/21/2014 None
N/A
TX
ACTIVE
3/8/2012 None
N/A
TX
ACTIVE
12/7/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
6/11/2012 None
7/20/2011 None
N/A
N/A
3/7/2013 None
N/A
CO
ACTIVE
LICENSE
ISSUED
ACTIVE
2/13/2015 None
1/26/2012 None
N/A
N/A
HARLINGEN
HARLINGEN
BURLINGTON
EMERGENCY
MEDICINE
LAREDO
TX
HUNTINGTON TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
AUSTIN
TX
ACTIVE
KY
ACTIVE
ACTIVE
LICENSE
ISSUED
HOSPITALIST
INTERNAL MEDICINE LOUISVILLE
PEDIATRICS
Page 289 of 402
Disciplinary
Status Date
TX
INTERNAL MEDICINE
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
AUSTIN
HEMATOLOGY/ONCOL
8/15/2019 OGY
PULMONARY
CRITICAL CARE
3/1/2017 MEDICINE
OBSTETRICS AND
ODESSA
PILLAI, REGINA , MD
PILLARISETTY, LEELA SHARATH,
MD
PILLI, PRASAD JOHNSON RAJU,
MD
PILLI, SUJA PERAKATHU, MD
Q6559
3/1/2012
PEDIATRICS,
5/1/2020 RADIOLOGY
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
3/24/2014
8/20/2013
4/9/2014
11/12/2012
None
None
None
None
N/A
N/A
N/A
N/A
8/2/2013 None
N/A
8/3/2015 None
10/22/2014 None
N/A
N/A
10/15/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
PEDIATRIC
CARDIOTHORACIC
8/14/2015
8/14/2020 SURGERY
THORACIC SURGERY DALLAS
5/15/2015
AUSTIN
Q5711
Q4494
PIROLLI, TIMOTHY JOHN, MD
PISANO, ELINOR ELIZABETH, MD
Q5250
PISIMISIS, GEORGE, MD
7/15/2015
P2508
PITOTTI, CHRISTOPHER , MD
3/15/2012
P6890
P0653
Q5070
Q7946
PIWONKA, KYLE THOMAS, DO
PIZZOLA, STEPHAN G, MD
PLATTNER, COURTNEY ANN, MD
PLEITZ, JORDAN LEE, MD
6/3/2013
8/1/2011
7/1/2015
15-Apr-16
P7540
PLOSKANYCH, TARAS , MD
P2758
Q6086
Q4667
Q1266
PLOTKIN, FREDRIC ROBERT, MD
POAGE, FREDERICK DEAN, DO
POCHE, CLAIRE MICHELLE, MD
POGOSIAN, ELENA GRIGOREVNA,
MD
POKHAREL, YASHASHWI, MD
POLA, BHARATH , DO
POLANCO, PATRICIO MARCELO,
MD
Q2607
POLAR, GREGORY ANDREW, DO
12/3/2014
P7330
POLES, JOSH , DO
7/15/2013
P1680
P6248
Q8608
8/1/2013
4/2/2012
9/15/2015
6/1/2015
12/15/2011
4/12/2013
01-Jun-16
8/1/2014
P0654
POLEY, RAINER NIKOLAUS, MD
Q1477
8/15/2014
P8066
POLIQUIT, DONNA MAE DIVINA, MD
POLKAMPALLY, CHUDAMANI RAO,
MD
10/1/2013
P6700
P1131
POLKAMPALLY, PRITAM RAO, MD
POLLARD, KATHLEEN ROSE, MD
5/15/2013
10/3/2011
INTERVENTIONAL
01-Apr-16
NEUROLOGICAL
01-Apr-21 SURGERY
Q7769
POLLOCK, GLEN AARON, MD
8/1/2011
DIAGNOSTIC
RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
TX
ACTIVE
ACTIVE
8/27/2015 None
5/19/2015 None
N/A
N/A
TX
ACTIVE
8/3/2015 None
N/A
TX
ACTIVE
3/21/2012 None
N/A
TX
TX
TX
KY
ACTIVE
ACTIVE
ACTIVE
ACTIVE
6/17/2013
8/5/2011
8/21/2015
26-Apr-16
None
None
None
None
N/A
N/A
N/A
N/A
TX
ACTIVE
8/5/2013 None
N/A
FL
TX
TX
ACTIVE
ACTIVE
ACTIVE
4/18/2012 None
9/17/2015 None
6/8/2015 None
N/A
N/A
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/22/2011 None
4/22/2013 None
03-Jun-16 None
N/A
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
8/4/2014 None
N/A
12/3/2014 None
N/A
FORT WORTH TX
ACTIVE
8/26/2013 None
N/A
AUSTIN
TX
ACTIVE
8/15/2011 None
N/A
CEDAR HILL
TX
ACTIVE
LICENSE
ISSUED
8/19/2014 None
N/A
10/1/2013 None
N/A
EMERGENCY
FT SAM
3/15/2017 MEDICINE
HOUSTON
OPHTHALMOLOGY 6/3/2018 VITREOUS SURGERY OPHTHALMOLOGY
MCALLEN
SAN ANGELO
7/1/2020 UROLOGY
HOUSTON
LEXINGTON
PHYSICAL MED. &
TEMPLE
EMERGENCY
4/2/2017 MEDICINE
GENERAL PRACTICE MIAMI
AMARILLO
6/1/2020 PEDIATRICS
HOUSTON
PALLIATIVE
MEDICINE
SAN ANTONIO
HOUSTON
SAN ANTONIO
SURGICAL
DALLAS
EMERGENCY
7/15/2018 MEDICINE
INTERVENTIONAL
8/1/2016 RADIOLOGY
Registration
Status of
Practice
Texas
State
License
INTERNAL MEDICINE
CARDIOLOGY
LAKEWAY
TX
ACTIVE
ACTIVE
6/11/2013 None
10/31/2011 None
N/A
N/A
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
Page 290 of 402
RALEIGH
NC
ACTIVE
11-Apr-16 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
P1682
Physician Name
POLNASZEK, NATHANIEL
MICHAEL, MD
Q6897
POLOUSKY, JOHN D, MD
06-Jan-16
Q8123
P3061
02-May-16
5/1/2012
P4498
POLYNICE, PAMELA, DO
POMEROY, BRIAN JAMES, MD
POMMERENING, MATTHEW
JAMES, MD
Q6560
POOL, GARRET STEVEN, MD
11/16/2015
P3416
POOLE, KIMBERLY MELISSA, DO
6/1/2012
Q1267
Q0539
POOLE, REBECCA L, MD
POON, MAGDALA , MD
8/1/2014
6/2/2014
6/1/2017 PSYCHIATRY
OBSTETRICS AND
8/1/2019 GYNECOLOGY
6/2/2019 NEUROLOGY
Q2187
POONAWALLA, TASNEEM AZIZ, MD
Q0997
POREMBKA, JESSICA HUANG, MD
7/15/2014
Q0998
POREMBKA, MATTHEW RYAN, MD
7/15/2014
P1918
PORR, JENNIFER REHM, MD
1/17/2012
12/15/2011
9/17/2012
10/15/2014
P4694
P1211
PORTEN, SIMA PRABODH, MD
PORTER, CHAD THOMAS, MD
10/15/2012
10/17/2011
Q2938
PORTER, DOUGLAS RYAN, MD
1/15/2015
P8298
PORTER, JASON, MD
11/1/2013
Q2608
PORTER, JONATHAN CASTILLO,
MD
PORTILLO RAMILA, GUILLERMO,
MD
Q4668
PORTO, MARIANO JR, MD
P4902
11/15/2012
12/3/2014
6/1/2015
12/15/2016 UROLOGY
ORTHOPEDIC
06-Jan-21 SURGERY
EMERGENCY
02-May-21 MEDICINE
5/1/2017 PEDIATRICS
Secondary Specialty
(Self-Designated)
1/2/2012 None
N/A
SPORTS MEDICINE
PLANO
TX
ACTIVE
08-Jan-16 None
N/A
LUBBOCK
TX
ACTIVE
ACTIVE
17-May-16 None
5/15/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
9/24/2012 None
N/A
SMITHTOWN
NY
11/23/2015 None
N/A
TEMPLE
COLLEGE
STATION
TX
ACTIVE
LICENSE
ISSUED
6/1/2012 None
N/A
TX
ACTIVE
ACTIVE
9/3/2014 None
6/13/2014 None
N/A
N/A
MADISON
WI
ACTIVE
10/24/2014 None
N/A
DALLAS
TX
ACTIVE
7/22/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
7/16/2014 None
N/A
1/17/2012 None
N/A
10/24/2012 None
10/31/2011 None
N/A
N/A
BREAST IMAGING
UROLOGIC
ONCOLOGY
PEDIATRICS
6/1/2020 NEUROLOGY
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
TN
ACTIVE
COLDWATER
OH
ACTIVE
HOUSTON
TX
ACTIVE
11/21/2012 None
N/A
SAN ANTONIO TX
ACTIVE
12/12/2014 None
N/A
6/1/2015 None
N/A
CLINICAL
NEUROPHYSIOLOGY NASHVILLE
1/15/2020 NEUROLOGY
Disciplinary
Status Date
ACTIVE
URGENT CARE
MEDICINE
FORENSIC
PSYCHIATRY
10/15/2017 UROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
UROLOGIC SURGERY ROUND ROCK TX
DIAGNOSTIC
7/15/2019 RADIOLOGY
SURGICAL
7/15/2019 ONCOLOGY
Practice City
Registration
Status of
Practice
Texas
State
License
NEURO-PHYSIOLOGY
(NEUROLOGY)
Page 291 of 402
LICENSE
ISSUED
2/4/2015 None
SEE
PREVIOUS
11/7/2013 ORDER
N/A
10/3/2013
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PORTOUW, STEVEN, MD
P0655
POSS, JAMES MATTHEW, MD
Q3575
POSSLEY, DANIEL R, DO
3/16/2015
ORTHOPEDIC
3/16/2020 SURGERY
Q0342
POSTACCHINI, IZABELA, MD
5/15/2014
Q0343
POSTACCHINI, MARK, MD
5/15/2014
Q7453
04-Mar-16
P9695
POSTALIAN, ALEXANDER , MD
POTEPALOV, SERGEY
SERGEYEVICH, MD
CARDIOVASCULAR
04-Mar-21 DISEASES
EMERGENCY
4/1/2019 MEDICINE
Q1478
POTHULA, NAGESWARRAO, MD
8/15/2014
P3225
POTTER, ANDREW , DO
5/15/2012
P7331
POTTER, ELISABETH HOUSE, MD
POTTY, ANISH GOVIND
RADHAKRISHNAN, MD
POURALIFAZEL, POOYA PATRICK,
MD
7/15/2013
Q3076
P4607
P7970
Q6898
02-May-16
EMERGENCY
02-May-21 MEDICINE
Q8125
8/1/2011
4/1/2014
2/2/2015
10/1/2012
POWELL, KENNETH PATRICK, MD
POWELL, MELANIE ANN, MD
POWELLSON, MATTHEW DANIEL,
MD
9/16/2013
06-Jan-16
8/26/2011
P5710
POWERS, KAREN LYNNE, MD
POWITZKY, ROSSER KENNEDY,
MD
Q1709
PRABHALA, ANU RADHA, MD
8/29/2014
Q1887
P0863
9/15/2014
3/1/2013
EMERGENCY
5/15/2017 MEDICINE
PLASTIC &
RECONSTRUCTIVE
7/15/2018 SURGERY
ORTHOPEDIC
2/2/2020 SURGERY
ORTHOPEDIC
9/16/2018 SURGERY
Secondary Specialty
(Self-Designated)
UNDERSEA
HYPERBARIC MED
(EMER MED)
FORT HOOD
TX
TX
SHREVEPORT LA
HOSPITALIST
PLASTIC SURGERY
PEDIATRIC
ORTHOPEDICS
PEDIATRIC
ORTHOPEDICS
PLASTIC &
RECONSTRUCTIVE
8/26/2016 SURGERY
ENDOCRINOLOGY,
DIABETES AND
Practice City
Registration
Status of
Practice
Texas
State
License
PEDIATRIC
OTOLARYNGOLOGY
INTERNAL MEDICINE
Page 292 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
03-May-16 None
N/A
8/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
3/17/2015 None
N/A
5/15/2014 None
N/A
5/15/2014 None
N/A
ACTIVE
07-Mar-16 None
N/A
4/4/2014 None
N/A
8/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
6/4/2012 None
N/A
AUSTIN
TX
ACTIVE
7/24/2013 None
N/A
LAREDO
OKLAHOMA
CITY
TX
ACTIVE
2/4/2015 None
N/A
OK
ACTIVE
10/15/2012 None
N/A
FORT WORTH TX
DALLAS
TX
THE
WOODLANDS TX
ACTIVE
ACTIVE
9/23/2013 None
25-Jan-16 None
N/A
N/A
ACTIVE
9/23/2014 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
3/8/2013 None
N/A
8/29/2014 None
N/A
MINNEAPOLIS MN
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
15-Apr-16
15-Apr-21 (PEDS)
PEDIATRICS
PSYCHOSOMATIC
8/28/2015
MEDICINE
GERIATRIC
MEDICINE (FAMILY
11/17/2014
PRACTICE)
Q7947
PRADA RICO, MIGUEL ANGEL, MD
Q5904
PRADHAN, AMIT PRAKASH, MD
Q2485
PRADO, MONICA AIDA , MD
Q3576
PRASAD, VINOD, MD
3/16/2015
P1389
Q3423
PRASARN, MARK LAWRENCE, MD
PRASLA, ZOHRA , MD
11/4/2011
3/3/2015
ORTHOPEDIC
SURGERY OF THE
11/4/2016 SPINE
Q5905
8/28/2015
Q5072
PRATT, ADRIANA AZAR, MD
PRATT, BABAFEMI BABAWANDE ,
MD
Q5073
PRATT, KIMBALL NELSON, MD
Q2370
PRAVEEN, SHAMA, MD
11/7/2014
PEDIATRICS
P8299
Q4253
PRAVEEN, VIJAYAKUMAR, MD
PREJEAN, ASHLEY JOSEPH, MD
11/1/2013
5/1/2015
HOSPITALIST
Q3772
PRESCOTT, LAUREN SHORE, MD
4/1/2015
P9446
3/17/2014
P9447
PRESCOTT, NATHAN EDMAN, DO
PRETORIUS, CHRISTOPHER CARL,
MD
5/1/2020 RADIOLOGY
GYNECOLOGIC
4/1/2020 ONCOLOGY
EMERGENCY
3/17/2019 MEDICINE
P0864
PREVENTZA, OURANIA , MD
8/26/2011
Q7770
PRICE, BRANDON MICHAEL, MD
P3660
PRICE, STEPHEN BRYAN, MD
Q0154
PRIETO, PETER ANTHONY, MD
7/1/2015
7/1/2015
3/17/2014
01-Apr-16
6/15/2012
5/2/2014
6/15/2017 RADIOLOGY
SURGICAL
5/2/2019 ONCOLOGY
HOUSTON
COOPERSTO
WN
TX
NY
ORTHOPEDIC
TRAUMA
HOUSTON
DALLAS
TX
TX
AUSTIN
TX
NORMAN
GYNECOLOGY
OK
Disciplinary
Status Date
02-May-16 None
N/A
8/28/2015 None
N/A
11/17/2014 None
N/A
3/16/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/16/2011 None
4/15/2015 None
N/A
N/A
8/28/2015 None
N/A
7/1/2015 None
N/A
9/1/2015 None
N/A
11/7/2014 None
N/A
11/1/2013 None
5/5/2015 None
N/A
N/A
HOUMA
LA
HOUSTON
TX
ACTIVE
4/6/2015 None
N/A
FORT WORTH TX
ACTIVE
3/24/2014 None
N/A
HOUSTON
ACTIVE
4/7/2014 None
N/A
LICENSE
ISSUED
8/26/2011 None
N/A
TX
ACTIVE
21-Apr-16 None
N/A
SAN ANTONIO TX
ACTIVE
6/19/2012 None
N/A
HOUSTON
ACTIVE
5/14/2014 None
N/A
CORPUS
CHRISTI
Page 293 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
TX
CRITICAL CARE
(SURGERY)
INTERVENTIONAL
RADIOLOGY
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
NEUROLOGICAL
7/1/2020 SURGERY
THORACIC
CARDIOVASCULAR
8/26/2016 SURGERY
EMERGENCY
01-Apr-21 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRIC
HEMATOLOGY/ONCOL
6/2/2014
6/2/2019 OGY
Q0540
PRIOLA, GINNA MARIE, MD
P5225
PROBST, JOSEPH JOHN, MD
1/4/2013
1/4/2018 RADIOLOGY
Q4254
PROPPER, BRANDON WILLIAM, MD
5/1/2015
P1809
PROVENCIO, MAURO JR, MD
Q0811
PROVENZA, LOUIS JOSEPH, MD
Q1710
P1484
PRUITT, SPENCER , MD
PUDHOTA, SUNITHA GUDAPATI,
MD
P0276
PUENTE CUELLAR, NAPOLEON
ANTONIO, MD
Q3944
PUENTE, ERWIN CALVO, MD
1/2/2012
6/27/2014
8/29/2014
11/15/2011
7/1/2011
4/10/2015
SPORTS MEDICINE
(FAMILY PRACTICE)
NEUROLOGICAL
6/27/2019 SURGERY
Practice City
P7692
PUGAO, REO, MD
8/15/2013
Q3273
PULIDO SIERRA, LUIS FELIPE, MD
2/13/2015
ORTHOPEDIC
2/13/2020 SURGERY
Q1269
PULIDO, ANGEL ALEJANDRO, MD
8/1/2014
8/1/2019 NEUROLOGY
P3227
PULLALAREVU, RAGHAVESH, MD
5/15/2012
P7835
P0277
P9697
P3228
PULLANO, JAMES GEORGE, MD
PUNATAR, ANKIT D, MD
PUNDLA, KALYAN KUMAR, MD
PUNJABI BAJPAI, ANITA , DO
8/30/2013
7/1/2011
4/1/2014
5/15/2012
OBSTETRICS AND
Q3077
PURAM, AJITH KUMAR, MD
2/2/2015
ACTIVE
7/3/2014 None
N/A
TX
ACTIVE
1/15/2013 None
N/A
TX
ACTIVE
5/4/2015 None
N/A
EL PASO
TX
ACTIVE
1/4/2012 None
N/A
ACTIVE
LICENSE
ISSUED
7/2/2014 None
N/A
8/29/2014 None
N/A
11/24/2011 None
N/A
ACTIVE
LICENSE
ISSUED
7/14/2011 None
N/A
4/10/2015 None
N/A
P2510
PURAYIDOM, ANNILYN S, MD
3/15/2017 PATHOLOGY
Page 294 of 402
ACTIVE
EL PASO
TX
ACTIVE
8/21/2013 None
N/A
HOUSTON
TX
ACTIVE
2/18/2015 None
N/A
AUSTIN
TX
ACTIVE
8/4/2014 None
N/A
PA
ACTIVE
6/4/2012 None
N/A
TX
TX
NM
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
9/5/2013
7/12/2011
4/7/2014
5/21/2012
ACTIVE
INTERNAL MEDICINE PITTSBURGH
MATERNAL AND
FETAL MEDICINE
SUGAR LAND
SOCORRO
DALLAS
NEPHROLOGY
BLOOD
BANKING/TRANSFUSI
ON MEDICINE
Disciplinary
Status Date
TX
GASTROENTEROLOG
11/15/2016 Y
MANSFIELD
TX
PULMONARY
CRITICAL CARE
7/1/2016 MEDICINE
ORAL &
MAXILLOFACIAL
SURGERY
ADULT
RECONSTRUCTIVE
ORTHOPEDICS
VASCULAR
NEUROLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
FORT SAM
HOUSTON
FORT SAM
HOUSTON
PEDIATRIC CRITICAL
CARE MEDICINE
ORAL &
MAXILLOFACIAL
8/15/2018 SURGERY
3/15/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
None
None
None
None
N/A
N/A
N/A
N/A
2/2/2015 None
N/A
3/23/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q2487
PURI, KRITI, MD
Q3578
PURI, PUJA KUMARI, MD
3/16/2015
Q6978
P5878
PUROHIT, MAULIK PRAFULL, MD
PURYEAR, ANGEL SUN, MD
15-Jan-16
3/15/2013
Q7261
16-Feb-16
P2346
PUSCA, SORIN VLADIMIR, MD
PUTMAN, CHRISTOPHER MARK,
MD
3/1/2012
3/1/2017 NEURO-RADIOLOGY
Q1000
PUTTY, BRADLEY SCOTT, MD
7/15/2014
Q4827
QADIR, RABAH, MD
6/12/2015
ORTHOPEDIC
6/12/2020 SURGERY
P9938
QADRI, GHAZIUDDIN AHMED, MD
4/15/2014
Q7771
11/17/2014
Secondary Specialty
(Self-Designated)
Practice City
PEDIATRICS,
CARDIOLOGY
DERMATOPATHOLOG ANATOMIC/CLINICAL
3/16/2020 Y
PATHOLOGY
RALEIGH
PHYSICAL MED. &
15-Jan-21 REHABILITATION
PUBLIC HEALTH
PLANO
THORACIC
CARDIOVASCULAR
VASCULAR
CORPUS
16-Feb-21 SURGERY
SURGERY
CHRISTI
QAMRUDDIN, SALIMA, MD
QASEM, AMANI MESBAH AHMAD,
MD
01-Apr-16
4/1/2014
4/1/2019 PEDIATRICS
4/2/2012
15-Mar-16
P7020
QIU, CUIE , MD
QUADRI, SYEDA A, DO
QUAINE, PATRICIA ANN REYES,
MD
P0656
QUALLS, JAMES ROBERT, DO
Q4828
QUALLS, TED RICHARD, MD
Q1270
Q1271
P1390
Q2052
QUANSAH, RAPHAEL KOBINA, MD
QUARTEY, NANA AMA A KWAKOR,
MD
QUBTY, ROBIN , DO
QUELIZA, KAREN ALEXIS, MD
8/1/2014
11/4/2011
10/1/2014
P5711
QUIGG, TROY CHRISTOPHER, DO
3/1/2013
P9698
P2760
Q7596
6/14/2013
8/1/2011
6/12/2015
8/1/2014
RADIOLOGY
SURGICAL CRITICAL
CARE
ORTHOPEDIC
TRAUMA
PALLIATIVE
MEDICINE
CARDIOVASCULAR
IMAGING
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
11/17/2014 None
N/A
ACTIVE
3/26/2015 None
N/A
TX
ACTIVE
ACTIVE
07-Apr-16 None
3/20/2013 None
N/A
N/A
TX
ACTIVE
18-Feb-16 None
N/A
TX
ACTIVE
4/16/2012 None
N/A
FORT WORTH TX
THE
WOODLANDS TX
ACTIVE
8/4/2014 None
N/A
6/16/2015 None
N/A
4/15/2014 None
N/A
03-May-16 None
N/A
DALLAS
NEW
ORLEANS
DALLAS
ACTIVE
LICENSE
ISSUED
LA
ACTIVE
4/21/2014 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
4/2/2012 None
21-Mar-16 None
N/A
N/A
TX
ACTIVE
6/20/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/26/2011 None
N/A
6/12/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/28/2014 None
N/A
8/1/2014 None
11/11/2011 None
10/7/2014 None
N/A
N/A
N/A
3/11/2013 None
N/A
Page 295 of 402
Disciplinary
Status Date
NC
4/2/2017 NEUROLOGY
15-Mar-21 FAMILY PRACTICE
MESQUITE
GASTROENTEROLOG
6/14/2018 Y
INTERNAL MEDICINE TOMBALL
FAMILY
WACO
EMERGENCY
6/12/2020 MEDICINE
8/1/2019 INTERNAL MEDICINE PUBLIC HEALTH
PEDIATRIC
HEMATOLOGY/ONCOL
3/1/2018 OGY
PEDIATRICS
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
SAN ANTONIO TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6687
QUIGLEY, LAJOHN BRADFORD, MD
12/4/2015
Q6687
04-Dec-15
Q6687
04-Dec-15
P7545
P2761
QUINN, BRENDON MICHAEL, MD
QUINN, COURTNEY ELIZABETH,
MD
8/1/2013
4/2/2012
PEDIATRIC
EMERGENCY
01-Jun-21 MEDICINE (PEDS)
Q8609
QUINN, KELLIE, DO
01-Jun-16
Q4829
QUINONES, MARLON P, MD
6/12/2015
Q3424
QUINTANA, DAVID JONATHAN, MD
3/3/2015
P5712
QUIROZ, RENE, MD
3/1/2013
P8174
QURESHI, ATHAR MAHMOOD, MD
P0865
P9248
QURESHI, ATIF SALEEM, MD
QURESHI, HAMMAD AHMAD, MD
8/26/2011
3/3/2014
Q0812
P3567
QURESHI, IMRAAN AHMER, MD
QURESHI, IRFAN RASHID, MD
QURESHI, MUHAMMAD RAZA
KARIM, MD
QURESHI, NASEEM AKHTAR, MD
6/27/2014
6/8/2012
QURESHI, YASMEEN, MD
RAAYASA, SRIKANTH
KRISHNAMURTHY, MD
RABADI, SAHER , MD
RABDIYA, VIMAL, MD
P9699
Q5074
Q2053
P0278
Q1481
P7188
10/15/2013
DIAGNOSTIC
3/3/2020 RADIOLOGY
CARDIOVASCULAR
3/1/2018 DISEASES
PEDIATRICS,
PULMONARY
CRITICAL CARE
8/26/2016 MEDICINE
PEDIATRIC
Secondary Specialty
(Self-Designated)
UNDERSEA AND
HYPERBARIC MED
(PREV MED)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
AMARILLO
TX
ACTIVE
AMARILLO
TX
ACTIVE
PARIS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
PEDIATRICS
INTERVENTIONAL
RADIOLOGY
AUSTIN
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/4/2015 None
SEE
PREVIOUS
31-Dec-15 ORDER
SEE
PREVIOUS
31-Dec-15 ORDER
N/A
8/15/2013 None
N/A
4/2/2012 None
N/A
01-Jun-16 None
N/A
6/12/2015 None
N/A
12/7/2015
12/7/2015
TX
ACTIVE
3/12/2015 None
N/A
VASCULAR MEDICINE BOSTON
MA
ACTIVE
3/15/2013 None
N/A
PEDIATRICS
TX
ACTIVE
10/18/2013 None
N/A
LICENSE
ISSUED
ACTIVE
8/26/2011 None
3/11/2014 None
N/A
N/A
HOUSTON
SLEEP MEDICINE
ADDISON
VICTORIA
TX
TX
ACTIVE
ACTIVE
7/4/2014 None
6/12/2012 None
N/A
N/A
INTERNAL MEDICINE
NEPHROLOGY
JACKSON
MS
ACTIVE
ACTIVE
4/9/2014 None
7/9/2015 None
N/A
N/A
10/1/2014
4/1/2019 NEPHROLOGY
DIAGNOSTIC
10/1/2019 RADIOLOGY
VICTORIA
TX
ACTIVE
11/21/2014 None
N/A
7/1/2011
8/15/2014
7/1/2013
7/1/2016 NEPHROLOGY
7/1/2018 CARDIOLOGY
INTERNAL MEDICINE KINGWOOD
HOUSTON
INTERNAL MEDICINE URBABA
TX
TX
IL
ACTIVE
ACTIVE
ACTIVE
8/16/2011 None
8/18/2014 None
9/2/2013 None
N/A
N/A
N/A
4/1/2014
7/1/2015
PSYCHIATRY
Page 296 of 402
License
Number
Physician Name
Q6088
RABINE, JOHN CARLTON, MD
P4696
RABSATT, LATASHA ALEXIS, MD
RACELA, RAYMUNDO CAVOSORA,
MD
Q4670
P6504
Q1714
Q7773
Q0542
P7546
P1683
RACEY, JEREMY CLYDE, MD
RADHAKRISHNAN, GEETHA
LAKSHMI, MD
RADHI, SABA , MD
RADTKE, STEVEN JOSE, MD
RADWANSKI, SYLVIA VICTORIA,
MD
Q4671
RAFIE, SHERVIN, MD
RAGAB, SHERIF ALY MOHAMED
ALY, MD
Q7100
RAGESH PANIKKATH, DEEPA , MD
dicaid
dicaid
Agreement
End Date
Designated)
GASTROENTEROLOG
9/15/2015
9/15/2020 Y
OBSTETRICS AND
10/15/2012
6/1/2015
5/1/2013
8/29/2014
01-Apr-16
EMERGENCY
5/1/2018 MEDICINE
6/2/2014
OBSTETRICS AND
6/2/2019 GYNECOLOGY
8/1/2013
12/15/2011
6/1/2015
01-Feb-16
ONCOLOGY
7/15/2011
P4998
RAGHUWANSHI, ANITA P, MD
11/30/2012
ENDOCRINOLOGY,
DIABETES AND
Q7597
RAGIREDDY, KRANTHI, MD
15-Mar-16
Q5539
Q7950
RAGLAND, JEREMY THOMAS, MD
RAGSDALE, LEE MICHAEL, DO
8/3/2015
15-Apr-16
P7336
RAHHAL, RYAN FOUAD, MD
7/15/2013
8/3/2020 NEUROLOGY
NEUROLOGICAL
7/15/2018 SURGERY
Q5909
RAHIM, ROBBY, MD
8/28/2015
8/28/2020 RADIOLOGY
Q3425
RAHIM-GILANI, SANIA, MD
3/3/2015
3/3/2020 RADIOLOGY
Q8611
RAHIMI NAINI, SOHRAB, MD
Q3774
RAHIMY, EHSAN , MD
ACTIVE
9/22/2015 None
N/A
ACTIVE
10/22/2012 None
N/A
ACTIVE
6/9/2015 None
N/A
AUSTIN
TX
ACTIVE
5/13/2013 None
N/A
GALVESTON
LUBBOCK
TX
TX
ACTIVE
ACTIVE
9/3/2014 None
04-Apr-16 None
N/A
N/A
LONGVIEW
TX
ACTIVE
6/12/2014 None
N/A
SAN ANTONIO TX
ACTIVE
8/9/2013 None
N/A
ACTIVE
12/23/2011 None
N/A
ACTIVE
6/2/2015 None
N/A
ACTIVE
25-Feb-16 None
N/A
ACTIVE
7/21/2011 None
N/A
TX
ACTIVE
12/4/2012 None
N/A
TX
ACTIVE
06-Apr-16 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
8/25/2015 None
21-Apr-16 None
N/A
N/A
7/15/2013 None
N/A
ACTIVE
LICENSE
ISSUED
9/14/2015 None
N/A
3/3/2015 None
N/A
ACTIVE
06-Jun-16 None
N/A
ACTIVE
4/7/2015 None
N/A
LUBBOCK
TX
DALLAS
GUN BARREL
CITY
HOUSTON
TX
SAN ANTONIO TX
SHREVEPORT LA
NUCLEAR MEDICINE
GASTROENTEROLOG
Y
Page 297 of 402
Disciplinary
Status Date
CA
PEDIATRIC
NEUROLOGY
FAMILY MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
MODESTO
ABDOMINAL
RADIOLOGY
RAGHUTHAMAN, THARA, MD
4/1/2015
TRAUMATIC
SURGERY
Practice City
WESTMINSTE
R
MD
6/1/2020 PSYCHIATRY
P0472
01-Jun-16
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
License
Number
Physician Name
Q5540
RAHIMZADEH, MARYAM, DO
Q6561
RAHMAN, ALYSHA, MD
dicaid
dicaid
Agreement
End Date
Designated)
8/3/2015
11/16/2015
P7837
RAHMAN, ARIF, MD
8/30/2013
P1583
RAHMAN, HASSAN TOUFIQUR, MD
12/1/2011
P9700
RAHMAN, SABEENA , DO
4/1/2014
DIAGNOSTIC
8/30/2018 RADIOLOGY
OBSTETRICS AND
4/1/2019 GYNECOLOGY
ANATOMIC/CLINICAL
CARDIOVASCULAR
5/2/2019 DISEASES
8/1/2019 RADIOLOGY
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
RAINS, MICHAEL LEROY, MD
8/15/2013
Q3274
RAINVILLE, HARVEY CHARLES, MD
RAINWATER, YEVGENIYA
BYEKOVA, MD
2/13/2015
01-Jun-16
01-Jun-21 DERMATOLOGY
PEDIATRICS,
8/1/2019 CARDIOLOGY
PEDIATRIC
PEDIATRIC
GASTROENTEROLOG GASTROENTEROLOG
6/1/2020 Y
Y
CARDIOTHORACIC
ANESTHESIOLOGY
CARDIOVASCULAR
5/1/2020 SURGERY
THORACIC SURGERY
6/1/2015
Q7776
Q3078
RAJA, ASIM-NAZIR, MD
RAJA, WASIF, MD
Q4257
RAJAGOPAL, KESHAVA, MD
Q8613
RAJAGOPAL, SELVI , MD
Q4673
RAJAGOPAL, SHILPA, MD
Q5912
RAJAGOPAL, SURESH KUMAR, MD
Q7777
RAJAMANICKAM, ANITHA, MD
01-Apr-16
2/2/2015
5/1/2015
01-Jun-16
6/1/2015
8/28/2015
01-Apr-16
12/7/2011 None
N/A
4/1/2014 None
N/A
ACTIVE
10/19/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
5/6/2014 None
11/18/2013 None
8/7/2014 None
N/A
N/A
N/A
8/15/2013 None
N/A
2/13/2015 None
N/A
01-Jun-16 None
N/A
ACTIVE
LICENSE
ISSUED
P7693
RAJ, PRIYA, MD
N/A
TX
5/2/2014
11/15/2013
8/1/2014
Q4672
9/9/2013 None
HOUSTON
RAHMAN, SHAHID, MD
RAHMAN, SOPHIA, MD
RAHMAN, SYED AZIZ-UR, MD
8/1/2014
N/A
OPHTHALMOLOGY
Q0156
P8404
Q1273
RAISHER, BRADLEY DEAN, MD
11/16/2015 None
ACTIVE
10/15/2015
01-Jun-21 INTERNAL MED - PEDS
6/1/2020 PEDIATRICS
CARDIOVASCULAR
8/28/2020 DISEASES
INTERVENTIONAL
CARDIOLOGY
Page 298 of 402
NJ
TX
Disciplinary
Status Date
N/A
TX
HEMATOLOGY
(PATHOLOGY)
ORADELL
INTERVENTIONAL
CARDIOLOGY
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
8/3/2015 None
HOUSTON
RAHMAN, SAUD SAQIB, MD
Q1274
LICENSE
ISSUED
LICENSE
ISSUED
INTERVENTIONAL
RADIOLOGY
Q6361
Q8612
Practice City
Registration
Status of
Practice
Texas
State
License
CORPUS
CHRISTI
TX
ACTIVE
8/6/2014 None
N/A
BRONX
NY
ACTIVE
6/4/2015 None
N/A
ALBANY
NY
ACTIVE
ACTIVE
05-Apr-16 None
2/6/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/16/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
02-Jun-16 None
N/A
6/1/2015 None
N/A
8/28/2015 None
N/A
ACTIVE
09-May-16 None
N/A
RANCHO
CUCAMONGA CA
License
Number
Physician Name
P4698
RAJAN, JESSEN ANN, MD
P3661
RAJAN, NIRAJA, MD
Q1482
P4500
RAJAN, SUBRAMANIYAM, MD
RAJAN, THOMAS, MD
RAJAPREYAR, INDRANEE
P7337
NAMASIVAYAM, MD
RAJKOWSKI, SAMUEL THOMAS,
TM00478 DO
Q1275
RAJLAKSHMI, FNU , MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
10/15/2012
FAMILY PRACTICE
PEDIATRIC
ANESTHESIOLOGY
6/15/2012
(PEDS)
PULMONARY
CRITICAL CARE
8/15/2014
9/17/2012
INTERNAL MEDICINE
CARDIOVASCULAR
7/15/2013
7/15/2018 DISEASES
10/3/2011
8/1/2014
P6893
RAJU, ROMAN , MD
6/3/2013
P5451
RAJURKAR, SWAPNIL, MD
2/1/2013
P6249
RALSTON, MELISSA FAITH, MD
Q8779
Q2191
RAM, AARTHI , MD
RAM, JONATHAN , MD
Q4675
P6250
10/3/2016 RADIOLOGY
DIAGNOSTIC
6/3/2018 RADIOLOGY
Practice City
CONROE
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
11/19/2012 None
N/A
LICENSE
ISSUED
6/15/2012 None
N/A
DALLAS
TX
FORT WORTH TX
ACTIVE
ACTIVE
8/18/2014 None
12/7/2012 None
N/A
N/A
HOUSTON
TX
ACTIVE
8/15/2013 None
N/A
MILWAUKEE
WI
PLEASANTON TX
FRIENDSWOO
D
TX
ACTIVE
ACTIVE
10/18/2011 None
8/4/2014 None
N/A
N/A
ACTIVE
6/7/2013 None
N/A
CA
ACTIVE
2/28/2013 None
N/A
NY
ACTIVE
LICENSE
ISSUED
ACTIVE
4/22/2013 None
N/A
10-Jun-16 None
10/24/2014 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/2/2015 None
4/16/2013 None
N/A
N/A
6/15/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
5/29/2013 None
8/4/2014 None
N/A
N/A
MO
ACTIVE
LICENSE
ISSUED
2/18/2015 None
N/A
12/4/2015 None
N/A
NEURO-RADIOLOGY
HEMATOLOGY/ONCO
LOGY
POMONA
EAST
PATCHOGUE
4/12/2013
EMERGENCY
4/12/2018 MEDICINE
10-Jun-16
10/15/2014
10-Jun-21 NEUROLOGY
RAM, RADHA, MD
RAMACHANDRAN, SHALINI, MD
6/1/2015
4/12/2013
P3662
RAMACHANDRUNI, SRIKANTH, MD
6/15/2012
P6703
Q1001
RAMAKRISHNA, ROHAN, MD
RAMAKRISHNAN, ARAVIND , MD
5/15/2013
7/15/2014
Q2698
RAMAKRISHNAN, NAGARAJAN, MD
12/15/2014
NEUROLOGICAL
5/15/2018 SURGERY
CRITICAL CARE
Q6688
RAMAKRISHNAN, SREEMDEVI, MD
12/4/2015
Q6688
04-Dec-15
LOVES PARK
IL
ACTIVE
22-Dec-15 None
N/A
Q6688
04-Dec-15
LOVES PARK
IL
22-Dec-15 None
N/A
Q3079
RAMAMURTHY, SURESH, MD
ACTIVE
LICENSE
ISSUED
2/2/2015 None
N/A
2/2/2015
2/2/2020 CARDIOLOGY
SLEEP MEDICINE
HOUSTON
PEDIATRIC
OPHTHALMOLOGY
DALLAS
ONCOLOGY
HOUSTON
AUSTIN
INTERNAL MEDICINE ST LOUIS
INTERNAL MEDICINE
Page 299 of 402
TX
TX
TX
License
Number
Physician Name
P0658
RAMAN, SIVAKUMAR, MD
P2763
RAMANATH, VIJAY SITHARAM, MD
RAMANUJAM, SATHYAVANI
MUTHU, MD
Q8127
P9111
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INFECTIOUS
8/1/2011
8/1/2016 DISEASES
INTERNAL MEDICINE
CARDIOVASCULAR
INTERVENTIONAL
4/2/2012
4/2/2017 DISEASES
CARDIOLOGY
02-May-16
RAMARAJ, RADHAKRISHNAN, MD
RAMHARACK, JONATHAN BISRAM,
MD
RAMINENI, RAJESH , MD
2/18/2014
6/8/2012
Q1889
RAMIREDDY, SWEEYA REDDY , MD
RAMIREZ - CHAPMAN, ANA LISA ,
MD
9/15/2014
Q8128
RAMIREZ GOMEZ, FERNANDO, MD
02-May-16
P5562
RAMIREZ, ANDREA ANNE, MD
2/8/2013
P7547
RAMIREZ, CARMEN TERESA, MD
8/1/2013
P7338
RAMIREZ, ELIZABETH ANN, MD
Q5075
P9702
P3569
P8175
Q5076
RAMIREZ, JORGE AARON, DO
RAMIREZ, JORGE ALFREDO, MD
7/1/2015
4/1/2014
7/15/2013
4/1/2019 CARDIOLOGY
INFECTIOUS
6/8/2017 DISEASES
Q3275
RAMIREZ, PHILIP URESTI, MD
2/13/2015
P7972
RAMIREZ, RUBEN , MD
9/16/2013
Q1715
RAMM, JASON DEAN, MD
8/29/2014
Q8614
RAMMEL, JENNIFER LEIGH , MD
01-Jun-16
Q0813
P1685
RAMNATH, VENKTESH
RUDRAPATNA, MD
RAMOLIA, PARAS BATUK, MD
6/27/2014
12/15/2011
SAINT LOUIS
HOUSTON
8/1/2018 NEUROLOGY
OBSTETRICS AND
TX
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Disciplinary
Status Date
8/12/2011 None
N/A
4/2/2012 None
N/A
02-May-16 None
N/A
2/18/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
7/21/2015 None
4/3/2014 None
N/A
N/A
6/8/2012 None
N/A
ACTIVE
9/25/2014 None
N/A
ACTIVE
06-May-16 None
N/A
2/21/2013 None
N/A
8/1/2013 None
N/A
TX
IRVING
TX
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
7/30/2013 None
N/A
LAREDO
TX
ACTIVE
ACTIVE
10/18/2013 None
7/3/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/31/2011 None
N/A
2/13/2015 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
9/18/2013 None
N/A
8/29/2014 None
N/A
01-Jun-16 None
N/A
LICENSE
ISSUED
ACTIVE
6/27/2014 None
12/26/2011 None
N/A
N/A
BROWNSVILL
E
TX
DALLAS
TX
INTERNAL MEDICINE
LUBBOCK
Page 300 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
GASTROENTEROLOG
9/16/2018 Y
HEPATOLOGY
PEDIATRIC
01-Jun-21 RHEUMATOLOGY
PULMONARY
CRITICAL CARE
6/27/2019 MEDICINE
MO
TX
INTERNAL MEDICINE
OBSTETRICS AND
PEDIATRIC
OBSTETRICS AND
8/26/2011
INTERVENTIONAL
CARDIOLOGY
7/1/2020 UROLOGY
RAMIREZ, ORLANDO MANUEL, MD
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
10/15/2013
7/1/2015
P0866
Practice City
Registration
Status of
Practice
Texas
State
License
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
GASTROENTEROLOG
02-May-16
02-May-21 Y
INTERNAL MEDICINE SOUTHLAKE
PHYSICAL MED. &
8/30/2013
AUSTIN
Q8129
RAMOS, CHRISTOPHER, MD
P7839
RAMOS, JESUS MIGUEL, MD
P9940
RAMOS, JOSE LAZARO, MD
P6505
RAMOS-DURAN, LUIS RAUL, MD
M5407
RAMSEY, LOAN, MD
P4608
RAMSEY, PAMELA MCVEY, MD
Q8331
RAMSEYER, ABIGAIL MARIE, DO
P9941
RANA, ABBAS A, MD
4/15/2014
P1394
P1014
11/4/2011
9/15/2011
Q0545
RANA, BILAL A, DO
RANA, SHAUNAK, MD
RANBHISE, PRIYADARSHINI
SURENDRA, MD
P8300
RANDHAWA, MOHINDER PAUL
SINGH JR, MD
11/1/2013
P3570
P8069
P2054
RANDLE, KELLEE LORRAINE, DO
RANE, MIHIR NITIN, DO
RANE, POONAM N, MD
6/8/2012
10/1/2013
2/1/2012
P7549
RANGANATH, RAMAKRISHNAN, MD
P8529
RANGASWAMY, NANDEESH, MD
Q3080
P7550
Q0689
P4501
RANGINENI, SIDDHARTHA, MD
RANNULU, SUDATH GUNADEERA,
MD
RAO, APARNA, MD
RAO, BHASKAR, MD
4/15/2014
5/1/2013
12/15/2014
10/1/2012
16-May-16
6/2/2014
8/1/2013
12/6/2013
2/2/2015
8/1/2013
6/16/2014
9/17/2012
THORACIC
CARDIOVASCULAR
11/1/2018 SURGERY
CARDIOVASCULAR
8/1/2018 DISEASES
8/1/2018 PEDIATRICS
Disciplinary
Status Date
ACTIVE
16-May-16 None
N/A
TX
ACTIVE
9/4/2013 None
N/A
HOUSTON
TX
ACTIVE
5/16/2014 None
N/A
EL PASO
TX
ACTIVE
5/8/2013 None
N/A
IRVING
TX
ACTIVE
12/17/2014 None
N/A
SAN ANGELO
TX
ACTIVE
10/3/2012 None
N/A
LUBBOCK
TX
ACTIVE
16-Jun-16 None
N/A
HOUSTON
TX
ACTIVE
CRITICAL CARE
ANESTHESIOLOGY
HOUSTON
INTERNAL MEDICINE
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
GENERAL SURGERY DENISON
HOUSTON
INTERVENTIONAL
CARDIOLOGY
4/17/2014 None
UNDER
BOARD
12/19/2011 ORDER
11/4/2011 None
N/A
6/2/2014 None
N/A
11/19/2013 None
N/A
6/8/2012 None
10/3/2013 None
2/6/2012 None
N/A
N/A
N/A
8/7/2013 None
N/A
LICENSE
ISSUED
12/6/2013 None
N/A
OK
ACTIVE
2/11/2015 None
N/A
TX
ACTIVE
ACTIVE
ACTIVE
8/16/2013 None
6/17/2014 None
10/8/2012 None
N/A
N/A
N/A
TX
TX
SPRINGFIELD MA
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
4/15/2019 PALLIATIVE MEDICINE INTERNAL MEDICINE
DIAGNOSTIC
5/1/2018 RADIOLOGY
NEURO-RADIOLOGY
GLAUCOMA
URGENT CARE
EMERGENCY
10/1/2017 MEDICINE
MEDICINE
OBSTETRICS AND
16-May-21 PALLIATIVE MEDICINE GYNECOLOGY
TRANSPLANT
SURGICAL
4/15/2019 SURGERY
ONCOLOGY
Registration
Status of
Practice
Texas
State
License
OKLAHOMA
CITY
HOSPITALIST
ADOLESCENT
MEDICINE - PD
CEDAR HILL
INTERNAL MEDICINE
Page 301 of 402
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
11/4/2011
N/A
License
Number
P8301
Physician Name
P7840
RAO, HARSHIT S, MD
RAO, KRISHNASREE KASUGANTI,
MD
RAO, KRISHNASWAMY JYOTSNA,
MD
Q6267
P0474
P7694
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE
PULMONARY
11/1/2013
11/1/2018 MEDICINE
MEDICINE
8/15/2013
8/30/2013
PEDIATRIC
RAO, SEEMA LAXMINARAYANA, MD
RAO, SILPA, MD
10/1/2015
7/15/2011
P9705
G2004
P3232
RAO, SUCHITRA, MD
RAO, SWARAJYALAXMI B, MD
RAO, TARA ANANTHA, MD
4/1/2014
01-Feb-16
5/15/2012
P9942
RAOSHAN, ASEEMA, MD
4/15/2014
ORTHOPEDIC
11/1/2018 SURGERY
8/1/2019 PSYCHIATRY
PEDIATRICS
EL PASO
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
HOUSTON
RICHMOND
DALLAS
ORTHOPEDIC
TRAUMA
RAPOSO, JUAN MIGUEL, MD
RAQIB, FARAHNAZ , MD
RASHEED, NIDA, MD
11/1/2013
8/1/2014
5/15/2013
P9112
P5302
M8938
RASHID, ASHRAF OMAR, MD
RASHID, SAMIYA, DO
RASHID, SUMIA , MD
2/18/2014
1/15/2013
10/1/2012
Q8615
RASKIN, JEFFREY STEVEN, MD
01-Jun-16
1/15/2018 NEUROLOGY
NEUROLOGICAL
01-Jun-21 SURGERY
Q2942
RASKIND, CRAIG HOWARD, MD
1/15/2015
Q8616
RASTOGI, KOMAL , MD
01-Jun-16
01-Jun-21 NEUROLOGY
ST. LOUIS
AUSTIN
INTERNAL MEDICINE ST LOUIS
P8530
RATH, SIDDHARTHA, MD
12/6/2013
Q3582
RATHI, BANSHI MOHAN, MD
RATLIFF, JEANINE LOUISE DAVIS,
MD
RATNAYAKE, MAHESHIKA
KALPANA, MD
3/16/2015
NEPHROLOGY
5/15/2013
PEDIATRICS
4/2/2012
HOUSTON
PORTLAND
FAMILY PRACTICE
CRITICAL CARE
MEDICINE
TRAUMATIC
SURGERY
P2766
DALLAS
TX
INTERNAL MEDICINE
P8302
Q1277
P6704
P6706
Practice City
Registration
Status of
Practice
Texas
State
License
Page 302 of 402
TX
ACTIVE
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
TX
Disciplinary
Status Date
11/11/2013 None
N/A
8/15/2013 None
N/A
9/4/2013 None
N/A
10/8/2015 None
7/25/2011 None
N/A
N/A
4/1/2014 None
09-Feb-16 None
5/22/2012 None
N/A
N/A
N/A
4/15/2014 None
N/A
TX
OR
ACTIVE
ACTIVE
ACTIVE
11/5/2013 None
8/27/2014 None
5/20/2013 None
N/A
N/A
N/A
MO
TX
MO
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
2/24/2014 None
1/18/2013 None
10/8/2012 None
N/A
N/A
N/A
01-Jun-16 None
N/A
2/11/2015 None
N/A
01-Jun-16 None
N/A
12/13/2013 None
N/A
3/16/2015 None
N/A
TEL AVIV
DALLAS
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
TX
ACTIVE
LICENSE
ISSUED
GALVESTON
TX
ACTIVE
5/31/2013 None
N/A
GARLAND
TX
ACTIVE
4/16/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7551
RATSIU, JOANA MARIA, MD
8/1/2013
Q4677
RAU, BRYAN C, MD
6/1/2015
P4502
Q5077
Q1002
RAU, RACHEL ELIZABETH, MD
RAUF, KHALIQ ABDUL, MD
RAUT, AARTI JAGDISH, MD
Q5542
RAVI, ANANTH KUMAR, MD
P8531
P8177
RAVINDRAN, ROHINI, MD
RAWAL, ISH, MD
P6066
RAWAT, ANISH , MD
Q4831
RAWLS, STACEY LAWRENCE, MD
6/12/2015
Q6268
P6896
RAY, DANIEL BUTLER, MD
RAY, JOHN KINDLEY, MD
10/1/2015
6/3/2013
Q0345
P7022
RAY, JOSEPH WILLIAM, MD
RAY, KATIE LAEL KUCERA, MD
5/15/2014
6/14/2013
Q3427
RAY, VALERIE ANN YANTSOS, MD
Q0346
Q1717
P2511
Q4497
RAYABHARI, ANANTH, MD
RAYTHATHA, SURENDRA
HARIDAS, MD
RAZA, ALI, MD
RAZA, FAYEZ S, MD
P2767
RAZA, SHAKEEL, MD
P6508
Q2943
RAZA, SYED ARMAN, MD
RAZA, SYED ASAD, MD
5/1/2013
1/15/2015
Q1003
RAZA, SYED SADI, MD
7/15/2014
9/17/2012
7/1/2015
7/15/2014
8/3/2015
12/6/2013
10/15/2013
4/1/2013
3/3/2015
Secondary Specialty
(Self-Designated)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
DIAGNOSTIC
6/1/2020 RADIOLOGY
PEDIATRIC
HEMATOLOGY/ONCOL
9/17/2017 OGY
PEDIATRICS
EMERGENCY
4/1/2018 MEDICINE
EMERGENCY
10/1/2020 MEDICINE
ANATOMIC/CLINICAL
3/3/2020 PATHOLOGY
ACTIVE
9/9/2013 None
N/A
HOUMA
LA
ACTIVE
6/12/2015 None
N/A
HOUSTON
GRAPEVINE
URBANA
TX
TX
IL
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
9/24/2012 None
7/7/2015 None
7/21/2014 None
N/A
N/A
N/A
8/3/2015 None
N/A
12/6/2013 None
10/28/2013 None
N/A
N/A
4/3/2013 None
N/A
6/12/2015 None
N/A
10/6/2015 None
6/7/2013 None
N/A
N/A
5/15/2014 None
6/20/2013 None
N/A
N/A
3/5/2015 None
N/A
5/15/2014 None
N/A
8/29/2014 None
4/26/2012 None
5/19/2015 None
N/A
N/A
N/A
TX
OH
ACTIVE
LICENSE
ISSUED
INTERNAL MEDICINE
ALPINE
TX
MARFA
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
MOBILE
AL
ACTIVE
4/6/2012 None
N/A
KINGWOOD
HINSDALE
TX
IL
ACTIVE
ACTIVE
5/29/2013 None
1/22/2015 None
N/A
N/A
DALLAS
TX
ACTIVE
7/17/2014 None
N/A
PEDIATRICS
DERMATOPATHOLO
GY
8/29/2014
3/15/2012
5/15/2015
CHILD AND
ADOLESCENT
4/2/2017 PSYCHIATRY
PSYCHIATRY
CARDIOVASCULAR
INTERVENTIONAL
5/1/2018 DISEASES
CARDIOLOGY
SLEEP MEDICINE
CARDIOVASCULAR
7/15/2019 DISEASES
INTERNAL MEDICINE
Page 303 of 402
Disciplinary
Status Date
TX
DALLAS
CANTON
Registration
Status Date
Disciplinary
Status of
Texas
License
GRAPEVINE
8/3/2020 RADIOLOGY
5/15/2014
4/2/2012
Practice City
Registration
Status of
Practice
Texas
State
License
License
Number
Q1718
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q8332
RAZAQ, SAQIB, MD
RAZOOK, JOHN MICHAEL BRYAN,
MD
8/29/2014
P7695
RAZVI, SHEHLA SYED, MD
8/15/2013
Q5914
RAZZAQ, KANWAL, MD
8/28/2015
Q8618
REA, FRANCO R, MD
01-Jun-16
16-May-16
WICHITA
FALLS
16-May-21 RADIOLOGY
P6707
READER, SARA DWYER, MD
5/15/2013
Q6689
REAVES, JASON SCOTT, MD
12/4/2015
Q6689
04-Dec-15
Q6689
Q6463
04-Dec-15
11/2/2015
Q5253
REBAL, BRETT ALLEN, MD
RECAVARREN ABARCA, MARCIA
VANESSA, MD
7/15/2015
P0280
RECIO-RESTREPO, MARIA
VICTORIA, MD
Q5712
RECTENWALD, JOHN E, MD
8/14/2015
P4699
REDCROSS, JOSEPH II, DO
10/15/2012
Q1719
Q6092
REDD, TAM NGUYEN, MD
REDDICK, JACOB WILLARD, MD
REDDING, COLTON REISINGER,
DO
Q7778
Q3776
Q5255
REDDY, ARHAANTH DHARAM, MD
REDDY, DEREDDI RAJA SHEKAR,
MD
Practice City
INFECTIOUS
8/28/2020 DISEASES
THORACIC
CARDIOVASCULAR
01-Jun-21 SURGERY
EMERGENCY
5/15/2018 MEDICINE
EMERGENCY
12/4/2020 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
7/1/2011
Secondary Specialty
(Self-Designated)
7/1/2016 NEUROLOGY
NEURO-RADIOLOGY
PEDIATRIC CRITICAL
CARE MEDICINE
HOUSTON
8/29/2014
9/15/2015
01-Apr-16
4/1/2015
7/15/2015
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/29/2014 None
N/A
17-May-16 None
N/A
TX
ACTIVE
TX
9/9/2013 None
N/A
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
8/28/2015 None
N/A
SURGICAL CRITICAL
CARE
LICENSE
ISSUED
01-Jun-16 None
N/A
ACTIVE
LICENSE
ISSUED
5/27/2013 None
N/A
12/4/2015 None
N/A
JACKSONVILL
E
FL
ATHENS
TX
ACTIVE
28-Jan-16 None
N/A
ATHENS
DALLAS
TX
TX
ACTIVE
ACTIVE
28-Jan-16 None
11/6/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
7/16/2015 None
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
DALLAS
TX
ACTIVE
7/12/2011 None
N/A
DALLAS
TX
ACTIVE
8/17/2015 None
N/A
10/18/2012 None
N/A
8/29/2014 None
9/22/2015 None
N/A
N/A
04-Apr-16 None
N/A
4/3/2015 None
N/A
7/15/2015 None
N/A
PEDIATRIC
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ORANGEBURG SC
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
GARLAND
TX
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
PSYCHIATRY
PULMONARY
CRITICAL CARE
MEDICINE
CRITICAL CARE
MEDICINE
Page 304 of 402
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
REDDY, JAGADESHWAR GUMMI,
CRITICAL CARE
P3233
MD
5/15/2012
5/15/2017 MEDICINE
ORAL &
ORAL &
MAXILLOFACIAL
MAXILLOFACIAL
Q0158
REDDY, LIKITH VOOTUKURU, MD
5/2/2014
5/2/2019 SURGERY
SURGERY
REDDY, NAVEEN, MD
6/2/2014
PAIN MANAGEMENT
EMERGENCY
Q5543
REDDY, NAVEEN, MD
8/3/2015
8/3/2020 MEDICINE
P2160
REDDY, PRASHANT , DO
2/10/2012
OBSTETRICS &
REDDY, SIREESHA YERRADHODDI,
OBSTETRICS AND
GYNECOLOGICAL
P1810
MD
1/2/2012
1/2/2017 GYNECOLOGY
SURGERY
Q0816
6/27/2014
P9114
REDDY, SWARUPA T, MD
REDFERN, FREDERICK CHARLES,
MD
Q5256
REDING, KATIE BETH, MD
7/15/2015
Q5257
REDMAN, CHRISTOPHER N, MD
7/15/2015
Q1720
REECK, AMANDA , MD
8/29/2014
P4503
P1133
Q1890
9/17/2012
10/3/2011
9/15/2014
P6897
REED, JANELLE LOUISE, MD
REEDER, KRISTEN NICOLE, MD
REES, CHRISTOPHER ADAM, MD
REESE-HOLLEY, MELODI NICHOLE,
MD
P8179
REEVE, CHARLES DUSTEN, DO
10/15/2013
P1686
REEVES, DONNY LUPRICE, MD
12/15/2011
K2108
REEVES, JOHN JOSEPH, MD
Q3777
REEVES, STEVEN CHARLES , MD
2/18/2014
6/3/2013
15-Apr-16
4/1/2015
ORTHOPEDIC
2/18/2019 SURGERY
ORTHOPEDIC
7/15/2020 SURGERY
EMERGENCY
9/17/2017 MEDICINE
6/3/2018 OBSTETRICS
EMERGENCY
10/15/2018 MEDICINE
SPORTS MEDICINE
(ORTH SURG)
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
PEDIATRIC
ORTHOPEDICS
OTHER SPECIALTY
EMERGENCY
MEDICINE
RECONST SURGERY
PEDIATRIC
EMERGENCY
15-Apr-21 MEDICINE (PEDS)
PEDIATRICS
ANATOMIC/CLINICAL
4/1/2020 PATHOLOGY
Page 305 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
FORT WORTH TX
ACTIVE
5/17/2012 None
N/A
DALLAS
ACTIVE
5/5/2014 None
N/A
ACTIVE
6/17/2014 None
N/A
TX
PALMDALE
CA
ACTIVE
ACTIVE
8/10/2015 None
2/15/2012 None
N/A
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/12/2012 None
N/A
6/27/2014 None
N/A
2/18/2014 None
N/A
TEMPLE
TX
ACTIVE
7/17/2015 None
N/A
PLANO
TX
ACTIVE
LICENSE
ISSUED
7/17/2015 None
N/A
8/29/2014 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
11/22/2012 None
12/5/2011 None
9/19/2014 None
N/A
N/A
N/A
6/3/2013 None
N/A
ATHENS
DALLAS
HOUSTON
TX
TX
TX
SPRINGFIELD IL
ACTIVE
11/4/2013 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
12/26/2011 None
N/A
AUSTIN
TX
ACTIVE
18-Apr-16 None
N/A
SAN ANTONIO TX
ACTIVE
4/9/2015 None
N/A
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
11/15/2013
PEDIATRICS
P8406
Physician Name
REGUNATHA SARMA, RANJANA,
MD
Q4259
REHMAN, AZIZ UR, MD
5/1/2015
Q0548
P6510
P7553
REHRER, SETH , DO
REICHERT, SARAH IRENE, DO
REID, NICOLE L, MD
6/2/2014
5/1/2013
8/1/2013
EMERGENCY
6/2/2019 MEDICINE
Q3277
REIERSEN, DAVID ARNOLD, MD
2/13/2015
H1260
REIMER, MARK BRENNAN, MD
11/16/2015
P8072
REINCKE, TONIE KRISTINE, MD
10/1/2013
P7841
Q5916
REINHART, LARS , MD
REINKE, TESSA , MD
REINSVOLD, THOMAS MICHAEL,
MD
8/30/2013
8/28/2015
P4999
11/30/2012
P7192
P6898
REKHI, JASWINDER, DO
RELPH, ANDREW JAMES, DO
7/1/2013
6/3/2013
Q0549
REMEDIOS, ALEXANDER, MD
6/2/2014
OBSTETRICS AND
INTERVENTIONAL
10/1/2018 RADIOLOGY
EMERGENCY
8/30/2018 MEDICINE
INTERVENTIONAL
OBSTETRICS AND
7/1/2018 GYNECOLOGY
6/3/2018 PEDIATRICS
EMERGENCY
6/2/2019 MEDICINE
P6511
REMICK, KATHERINE ELIZABETH,
MD
5/1/2013
5/1/2018 PEDIATRICS
Q0550
REMIGIO, CHERYL CORNEJO, MD
6/2/2014
Q3583
Q5545
REMME, LINDSEY C, DO
REMSBURG, IRINA, MD
3/16/2015
8/3/2015
6/2/2019 PEDIATRICS
EMERGENCY
3/16/2020 MEDICINE
8/3/2020 PEDIATRICS
Q2374
P7554
P7973
REMSING, JUSTIN LYNN, MD
REMSTER, ERIC MICHAEL, MD
REN, QING, MD
11/7/2014
8/1/2013
9/16/2013
P6899
RENCHER, LOGAN , DO
6/3/2013
Registration
Status of
Practice
Texas
State
License
Practice City
JACKSONVILL
E
FL
HOSPITALIST
HOSPITALIST
HOUSTON
HOUSTON
HILLSBORO
TX
TX
TX
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
8/1/2018 PEDIATRICS
PEDIATRIC
EMERGENCY
NEUROLOGY
NEPHROLOGY
Page 306 of 402
Disciplinary
Status Date
ACTIVE
LICENSE
ISSUED
12/17/2013 None
N/A
5/1/2015 None
N/A
6/4/2014 None
5/20/2013 None
8/19/2013 None
N/A
N/A
N/A
2/13/2015 None
N/A
11/16/2015 None
N/A
10/21/2013 None
N/A
9/9/2013 None
9/2/2015 None
N/A
N/A
11/30/2012 None
N/A
OWATONNA
MN
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
TEXAS
LICENSE
ISSUED
SUGAR LAND
TX
ACTIVE
BRYAN
TX
CARDIOVASCULAR
DISEASES
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
LICENSE
ISSUED
LAKE
JACKSON
AMARILLO
TX
TX
ACTIVE
ACTIVE
8/7/2013 None
6/7/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
6/12/2014 None
N/A
AUSTIN
TX
ACTIVE
5/17/2013 None
N/A
TYLER
TX
6/4/2014 None
N/A
MIDLAND
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/16/2015 None
8/5/2015 None
N/A
N/A
11/7/2014 None
8/20/2013 None
11/18/2013 None
N/A
N/A
N/A
LICENSE
ISSUED
6/3/2013 None
N/A
DALLAS
TX
License
Number
P3423
Physician Name
RENDON GARCIA, JUAN JESUS,
MD
P3065
RENGO, RENA BURLINGAME, MD
P6900
Q2375
dicaid
dicaid
Agreement
End Date
Designated)
6/1/2012
5/1/2012
ANATOMIC/CLINICAL
5/1/2017 PATHOLOGY
REQUENEZ, EDWARD, MD
RESMAN, MASHA, MD
6/3/2013
11/7/2014
Q7102
REYBOLD, BEVERLY, DO
01-Feb-16
Q0348
REYES, ANDRES , MD
5/15/2014
AEROSPACE
MEDICINE
FOOT AND ANKLE,
ORTHOPEDICS
P5453
REYES, DAVID , MD
Q1891
REYES, GUY EDMUND JR, MD
9/15/2014
P4804
REYES, LUIS, MD
11/1/2012
P2349
REYES, MANUEL MUNOZ, MD
3/1/2012
Q3949
REYES, MICHAEL JAVIER, MD
4/10/2015
Q5917
8/28/2015
Q4500
REYES, RAUL JR, MD
REYNA MALDONADO, EDGAR
DAVID, MD
5/15/2015
Q5079
REYNA, ISABEL , MD
7/1/2015
P2351
REYNOLDS, MARION ARLEEN, MD
3/1/2012
Q3584
REYNOSO, DAVID , MD
OBSTETRICS AND
3/1/2017 GYNECOLOGY
INFECTIOUS
3/16/2020 DISEASES
Q3428
REZVANI, KATAYOUN , MD
Q7455
REZVANKHOO, KABIR, MD
RHINEHART VENTURA, JESSICA
LEIGH, MD
P9710
2/1/2013
3/16/2015
3/3/2015
04-Mar-16
4/1/2014
Secondary Specialty
(Self-Designated)
CRITICAL CARE
(SURGERY)
DERMATOPATHOLO
GY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
ORTHOPEDIC
9/15/2019 SURGERY
EMERGENCY
11/1/2017 MEDICINE
INTERVENTIONAL
3/1/2017 CARDIOLOGY
CARDIOLOGY
Practice City
MCALLEN
MCALLEN
HOUSTON
VIRGINIA
BEACH
GALVESTON
HOUSTON
HARLINGEN
Registration
Status of
Practice
Texas
State
License
TX
EMERGENCY
04-Mar-21 MEDICINE
OBSTETRICS AND
4/1/2019 GYNECOLOGY
INTERNAL MEDICINE
HEMATOLOGY/ONCO
LOGY
HOUSTON
CRITICAL CARE
MEDICINE (IM)
Page 307 of 402
Disciplinary
Status Date
ACTIVE
6/8/2012 None
N/A
ACTIVE
5/7/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
6/10/2013 None
11/12/2014 None
N/A
N/A
VA
ACTIVE
LICENSE
ISSUED
08-Feb-16 None
N/A
5/15/2014 None
N/A
ACTIVE
2/6/2013 None
N/A
ACTIVE
11/20/2014 None
N/A
ACTIVE
11/5/2012 None
N/A
3/5/2012 None
N/A
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
WESLACO
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
TX
ACTIVE
4/10/2015 None
SEE
PREVIOUS
9/1/2015 ORDER
N/A
5/19/2015 None
SEE
PREVIOUS
8/6/2015 ORDER
N/A
9/3/2013
9/4/2012
ACTIVE
3/5/2012 None
N/A
ACTIVE
3/25/2015 None
N/A
ACTIVE
3/5/2015 None
N/A
21-Mar-16 None
N/A
4/1/2014 None
N/A
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q0163
RHO, JASON, MD
P6709
Q1280
RHOADES, COURTNEY PAIGE, DO
RIAD, SAMY MAGDY, MD
5/15/2013
8/1/2014
P6710
RIAZ, JAWAD, MD
5/15/2013
P8303
RIAZ, NAJEEB, MD
11/1/2013
CHILD AND
ADOLESCENT
Q5546
RIAZ, SABEEN J, MD
8/3/2015
8/3/2020 PSYCHIATRY
P6255
RIBEIRO, ANNELISE NATASHA, MD
P1811
RICARD, BRANDY C, MD
H1194
RICAURTE, EDUARDO LUIS, MD
10/1/2013
P0784
P7696
RICE, CHRISTION GREGORY, MD
RICE, LYNN ANN, DO
8/15/2011
8/15/2013
P7023
P2056
6/14/2013
2/1/2012
L6157
RICHANI, KARINA, MD
RICHARDS, JOHN CALEB, MD
RICHARDSON, ALVIE CLIFFORD,
MD
MD
MD
P0785
RICHARDSON, KEVIN DEWAYNE,
DO
J7157
RICHART, CHARLES M, MD
1/3/2014
P2352
RICHEY, JONATHAN D, DO
3/1/2012
L6157
L6157
5/2/2014
4/12/2013
1/2/2012
12/17/2012
12/17/2012
12/17/2012
8/15/2011
OBSTETRICS AND
8/1/2019 NEPHROLOGY
Secondary Specialty
(Self-Designated)
PULMONARY
CRITICAL CARE
MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
SLEEP MEDICINE
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
PEDIATRIC
NEPHROLOGY
OBSTETRICS AND
EMERGENCY
URGENT CARE
8/15/2016 MEDICINE
MEDICINE
2/1/2017 RADIOLOGY
MATERNAL AND
MATERNAL AND
MATERNAL AND
ORTHOPEDIC
8/15/2016 SURGERY
Disciplinary
Status Date
5/2/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
6/4/2013 None
8/6/2014 None
N/A
N/A
5/15/2013 None
N/A
NEWARK
NJ
ACTIVE
11/6/2013 None
N/A
MCKINNEY
TX
ACTIVE
8/19/2015 None
N/A
QUITMAN
TX
ACTIVE
4/16/2013 None
N/A
PALESTINE
TX
ACTIVE
1/4/2012 None
N/A
BETTENDORF IA
CORPUS
CHRISTI
TX
MESA
AZ
ACTIVE
10/14/2013 None
N/A
ACTIVE
ACTIVE
8/26/2011 None
8/20/2013 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
7/10/2013 None
2/9/2012 None
N/A
N/A
TX
ACTIVE
12/26/2012 None
N/A
TX
ACTIVE
12/26/2012 None
N/A
TX
ACTIVE
12/26/2012 None
N/A
8/15/2011 None
N/A
ACTIVE
1/8/2014 None
N/A
ACTIVE
3/5/2012 None
N/A
HOUSTON
OBSTETRICS AND
GYNECOLOGY
AUSTIN
OBSTETRICS AND
GYNECOLOGY
AUSTIN
OBSTETRICS AND
GYNECOLOGY
AUSTIN
ORTHOPEDIC
SURGERY OF THE
SPINE
CRITICAL CARE
(SURGERY)
EDINBURG
DERMATOLOGIC
SURGERY
Page 308 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
LICENSE
ISSUED
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
P9449
RICHIE, WILLIAM DONALD, MD
3/17/2014
Q4679
Q8335
6/1/2015
16-May-16
Q0551
RICHMOND, NEAL J, MD
RICKERT, PAUL J, MD
RICKNER-SCHMIDT, SHANNON
SEANA, MD
Q5262
RICKS-CORD, ANILA RONDELL, MD
7/15/2015
Q3585
RIDER, NICHOLAS L, DO
3/16/2015
EMERGENCY
6/1/2020 MEDICINE
EMERGENCY
6/2/2019 MEDICINE
OBSTETRICS AND
ALLERGY AND
P3424
P4903
P7341
6/1/2012
11/15/2012
7/15/2013
H1526
P3234
RIDLEY, RYAN WINTRELL, MD
RIEBEL, HEATHER ROSE, MD
RIGGS, JENNIFER LYNN, MD
RIGNEY, CHARLES EDWARD III,
MD
RIHANI, JORDAN JOSEPH, MD
11/1/2012
5/15/2012
P7842
P7697
RILEY, CYNTHIA R, MD
RILEY, MARISTELLA, MD
PHYSICAL MED. &
P5123
RINARD, KATHERINE LEIGH, MD
12/17/2012
12/17/2017 UROLOGY
UROLOGIC SURGERY LUBBOCK
TX
P5123
12/17/2012
12/17/2017 UROLOGY
P5123
12/17/2012
12/17/2017 UROLOGY
P1397
RINCON, ENRIQUE JOSE
ANTONIO, MD
FORT SAM
HOUSTON
P6256
RINGLER, ROBERT LLOYD JR, MD
P1812
RIOS PEREZ, JIMMI, MD
P8812
Q2700
RIOS ROJAS, LILIANA E, MD
RIOS, TOMAS GABRIEL, MD
Q1004
RIPP, ZACHARY THOMAS, MD
RIPPERDA, CHRISTOPHER MARK,
MD
Q1005
6/2/2014
8/30/2013
8/15/2013
11/4/2011
4/12/2013
OBSTETRICS AND
1/2/2017 GYNECOLOGY
1/2/2012
1/15/2014
12/15/2014
7/15/2014
7/15/2014
EMERGENCY
MEDICAL SERVICES
PEDIATRICS
N/A
6/9/2015 None
23-May-16 None
N/A
N/A
DALLAS
WICHITA
FALLS
1102 BATES
AVENUE
TX
ACTIVE
6/9/2014 None
N/A
TX
ACTIVE
9/2/2015 None
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
3/23/2015 None
N/A
6/1/2012 None
11/26/2012 None
7/18/2013 None
N/A
N/A
N/A
11/9/2012 None
5/22/2012 None
N/A
N/A
8/30/2013 None
8/19/2013 None
N/A
N/A
ACTIVE
12/20/2012 None
N/A
TX
ACTIVE
12/20/2012 None
N/A
TX
ACTIVE
12/20/2012 None
N/A
TX
ACTIVE
11/14/2011 None
N/A
TX
4/17/2013 None
N/A
1/2/2012 None
N/A
1/15/2014 None
1/15/2015 None
N/A
N/A
GENERAL PRACTICE DEL RIO
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
7/23/2014 None
N/A
DALLAS
TX
ACTIVE
7/16/2014 None
N/A
Page 309 of 402
3/17/2014 None
ACTIVE
ACTIVE
SAN ANTONIO TX
ODESSA
TX
OBSTETRICS AND
GYNECOLOGY
Disciplinary
Status Date
FORT WORTH TX
BIRMINGHAM AL
CEDAR PARK
OBSTETRICS AND
Registration
Status Date
Disciplinary
Status of
Texas
License
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
10/17/2011
10/17/2016 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
P1216
RISCH, ROBERT MARTIN, MD
Q5919
RISEN, SARAH RUNDELL, MD
8/28/2015
GRAPEVINE
NEURODEVELOPMEN
TAL DISABILITIES
(PEDIATRICS)
HOUSTON
P6257
RISNER, DAVID SCHULLER JR, MD
4/12/2013
OPHTHALMOLOGY ANTERIOR SURGERY TYLER
P8407
Q3429
RITCHIE, SIMON ALEXANDER, MD
RITTER, CORY DIANE, MD
11/15/2013
3/3/2015
Q8620
RITTER, SAMUEL ISAAC, MD
K2270
RITTER, STEVEN EKBERG, MD
Q5081
P9711
RITTIMANN, JAMES ALBERT, MD
RIVAS, ELIZABETH RAE, MD
7/1/2015
4/1/2014
P3426
6/1/2012
P6902
RIVERA JIMENEZ, JOEL R, MD
RIVERA PABON, FRANCISCO
RAFAEL, MD
EMERGENCY
01-Jun-21 MEDICINE
DERMATOLOGIC
12/15/2016 SURGERY
VASCULAR AND
INTERVENTIONAL
7/1/2020 RADIOLOGY
OBSTETRICS AND
6/1/2017 GYNECOLOGY
6/3/2013
P6903
RIVERA VAZQUEZ, MARIMER , MD
6/3/2013
Q5263
RIVERA, ENRIQUE JAVIER , MD
7/15/2015
Q3281
RIVERA, JAVIER, MD
2/13/2015
2/13/2020 RADIOLOGY
Q2488
RIVERA, LEONOR BUGARIN, MD
Q5264
Q6093
P7698
01-Jun-16
12/15/2011
DERMATOLOGY
RIVERA-CRESPO, LUIS RAUL, MD
7/15/2015
RIVERA-LEVY, ALMA E, MD
RIVERA-SOTO, ANGEL MANUEL,
MD
9/15/2015
8/15/2013
8/15/2018 GENERAL PRACTICE INTERNAL MEDICINE
Page 310 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
11/8/2011 None
N/A
TX
ACTIVE
9/1/2015 None
N/A
TX
4/22/2013 None
N/A
11/15/2013 None
3/5/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
DALLAS
TX
ACTIVE
02-Jun-16 None
N/A
SAN ANTONIO TX
ACTIVE
12/22/2011 None
N/A
TULSA
OK
ACTIVE
ACTIVE
8/20/2015 None
4/15/2014 None
N/A
N/A
MCALLEN
TX
ACTIVE
LICENSE
ISSUED
6/8/2012 None
N/A
6/3/2013 None
N/A
ACTIVE
7/1/2013 None
N/A
ACTIVE
7/17/2015 None
N/A
2/13/2015 None
N/A
11/17/2014 None
N/A
FAMILY MEDICINE
NEUROOPHTHALMOLOGY
DALLAS
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
11/17/2014
Registration
Status of
Practice
Texas
State
License
GERIATRICS
GERIATRIC
MEDICINE (INTERNAL
MED)
LAS CRUCES
NEONATALPERINATAL
MEDICINE
FT. WORTH,
TX
LICENSE
ISSUED
LICENSE
ISSUED
NM
ACTIVE
7/22/2015 None
N/A
TX
ACTIVE
10/12/2015 None
N/A
ACTIVE
8/26/2013 None
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
HEMATOLOGY/ONCOL
P3066
RIVERO, GUSTAVO , MD
5/1/2012
5/1/2017 OGY
HOUSTON
RIVERS, AEISHA KEKHIA STIMAGE,
SURGICAL BREAST
P7193
MD
7/1/2013
7/1/2018 ONCOLOGY
ANESTHESIOLOGY P7843
RIXTER, DAVIDA DENISE, MD
8/30/2013
PAIN MANAGEMENT
RIZVI, FAWAD, DO
8/3/2015
PAIN MANAGEMENT
Q8781
RIZVI, RABA, MD
10-Jun-16
P5000
RIZVI, SHAFQAT NA, MD
P0667
RIZVI, SYED ZULFIQAR HYDER, MD
Q2836
Q5716
RIZVI, SYED, MD
RIZWAN, ATIF, MD
P5563
RIZZO, ANNE GRACE, MD
Q7264
Q2837
RIZZO, JULIE ANN, MD
ROB, FARHANA, DO
P8988
2/7/2014
P5564
ROBBINS, ROBERT CLAYTON, MD
ROBERSON, RUSSELL STUART,
MD
Q8782
ROBERTS, COURTNEY ROME, MD
10-Jun-16
11/30/2012
8/1/2011
1/5/2015
8/14/2015
2/8/2013
16-Feb-16
1/5/2015
2/8/2013
Q4503
Q3780
ROBERTS, ERIC C, MD
ROBERTS, JAY WAYNE, DO
5/15/2015
4/1/2015
Q2055
Q6095
Q3952
ROBERTS, KYLE JOSEPH, MD
ROBERTS, ROBYN LIANE, MD
ROBERTS, RUSSELL , DO
10/1/2014
9/15/2015
4/10/2015
Q5548
ROBERTSON, BROWN JR, MD
8/3/2015
Q1006
ROBERTSON, DANIEL, MD
7/15/2014
Registration
Status of
Practice
Texas
State
License
ACTIVE
6/28/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
7/15/2013 None
N/A
8/30/2013 None
N/A
8/3/2015 None
N/A
10-Jun-16 None
UNDER
BOARD
11/30/2012 ORDER
N/A
8/1/2011 None
N/A
1/5/2015 None
8/17/2015 None
N/A
N/A
ADDICTION
PSYCHIATRY
INTERVENTIONAL
1/5/2020 CARDIOLOGY
INTERNAL MEDICINE
INTERNAL MEDICINE
TRAUMATIC
CRITICAL CARE
16-Feb-21 GENERAL SURGERY (TRAUMA)
CARDIOVASCULAR
2/7/2019 SURGERY
CRITICAL CARE
ANESTHESIOLOGY
PHYSICAL MED. &
DALLAS
WICHITA
FALLS
FORT SAM
HOUSTON
SUGAR LAND
TX
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
TX
ACTIVE
2/18/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
01-Mar-16 None
1/8/2015 None
N/A
N/A
HOUSTON
TX
ACTIVE
2/24/2014 None
N/A
CHAPEL HILL
NC
ACTIVE
2/12/2013 None
N/A
ARDMORE
OK
ACTIVE
20-Jun-16 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
5/19/2015 None
4/3/2015 None
N/A
N/A
10/1/2014 None
9/23/2015 None
4/14/2015 None
N/A
N/A
N/A
PAIN
MANAGEMENT/REHA
B MED
9/15/2020 UROLOGY
EMERGENCY
8/3/2020 MEDICINE
ORTHOPEDIC
7/15/2019 SURGERY
Page 311 of 402
Disciplinary
Status Date
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
FORT WORTH TX
11/30/2012
GALVESTON
TX
MEMPHIS
TN
ACTIVE
8/24/2015 None
N/A
SAN ANTONIO TX
ACTIVE
7/17/2014 None
N/A
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Q2194
P0480
Physician Name
ROBINSON HAWKINS, YVONNE ,
MD
ROBINSON, CHRISTINA, MD
P7027
ROBINSON, SHAUN B, MD
6/14/2013
Q6695
ROBISON, DENNIS J, MD
12/4/2015
Q6695
04-Dec-15
FARMINGTON NM
ACTIVE
Q6695
04-Dec-15
FARMINGTON NM
Q0164
ROBLES, JULIANA LORRAINE, MD
5/2/2014
Q3782
ROBLES-SUAREZ, JEANETTE, MD
4/1/2015
Q3588
Q6364
Q2195
ROCA, FERNANDO JOSE, MD
ROCHELIN, FLEURGIN, MD
ROCHELIN, JEAN ROCHEL FILS,
MD
Q1008
ROCKE, BRENT AARON, MD
7/15/2014
Q5265
P0481
RODDY, DANTIN JERAMY, MD
RODE, RASHMI, MD
7/15/2015
7/15/2011
P9713
RODGERS, JOSHUA JOSEPH, MD
4/1/2014
P6258
RODGERS, KATHERINE ANNA, MD
4/12/2013
Q8784
RODGERS, NATHAN JOSEPH, MD
10-Jun-16
Q6365
RODRIGO, GILBERTO, MD
P2059
P1017
P6259
RODRIGO, JUAN JOSE, MD
RODRIGUEZ ACOSTA, MANUEL
EDUARDO, MD
RODRIGUEZ CASTRO, CARLOS E,
MD
10/15/2014
7/15/2011
3/16/2015
10/15/2015
10/15/2014
10/15/2015
2/1/2012
9/15/2011
4/12/2013
5/2/2019 PEDIATRICS
OBSTETRICS AND
PEDIATRIC CRITICAL
GERIATRICS
FAMILY PRACTICE
OBSTETRICS AND
ORTHOPEDIC
2/1/2017 SURGERY
EMERGENCY
9/15/2016 MEDICINE
HOSPITALIST
PEDIATRICS,
CARDIOLOGY
ARTHRITIS & JOINT
IMPLANT SURGERY
Disciplinary
Status Date
N/A
N/A
6/24/2013 None
N/A
N/A
ACTIVE
12/4/2015 None
SEE
PREVIOUS
14-Dec-15 ORDER
SEE
PREVIOUS
14-Dec-15 ORDER
SAN ANTONIO TX
ACTIVE
5/13/2014 None
N/A
HOUSTON
TX
4/3/2015 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
3/16/2015 None
12/2/2015 None
N/A
N/A
10/15/2014 None
N/A
TX
HOUSTON
TX
ACTIVE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
10/17/2014 None
7/21/2011 None
SAN ANGELO
INTERNAL MEDICINE
4/1/2019 PSYCHIATRY
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
12/4/2015
12/4/2015
TEMPLE
TX
ACTIVE
7/17/2014 None
N/A
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/22/2015 None
7/21/2011 None
N/A
N/A
HOUSTON
TX
ACTIVE
4/4/2014 None
N/A
DALLAS
TX
ACTIVE
4/24/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
21-Jun-16 None
N/A
10/15/2015 None
N/A
WACO
TX
ACTIVE
2/29/2012 None
N/A
AMARILLO
TX
ACTIVE
9/19/2011 None
N/A
TX
ACTIVE
4/24/2013 None
N/A
4/12/2018 INTERNAL MEDICINE INTERNAL MEDICINE EL PASO
Page 312 of 402
License
Number
P5231
Physician Name
RODRIGUEZ LIEN, ELIZABETH
ANN, MD
RODRIGUEZ MUNOZ, MARIA
VICTORIA, MD
P1134
RODRIGUEZ, ANA VERONICA, MD
P1219
RODRIGUEZ, AXEL , MD
P3429
RODRIGUEZ, CARMEN , MD
Q4265
Q4504
Q7600
Q0165
Q7103
RODRIGUEZ, DAVID ANTHONY, MD
RODRIGUEZ, DAVID FRANCISCO,
MD
RODRIGUEZ, EMMA ISABEL, MD
RODRIGUEZ, GILBERT SAENZ JR,
MD
dicaid
dicaid
Agreement
End Date
Designated)
5/1/2015
5/1/2020 PEDIATRICS
1/4/2013
1/4/2018 PEDIATRICS
10/3/2011
10/17/2011
6/1/2012
5/15/2015
15-Mar-16
OBSTETRICS AND
5/2/2019 GYNECOLOGY
MATERNAL AND
FETAL MEDICINE
5/2/2014
01-Feb-16
RODRIGUEZ, GUSTAVO JOSE, MD
RODRIGUEZ, JESUS , MD
2/8/2013
11/16/2015
P0870
RODRIGUEZ, JOSE ANTONIO, MD
8/26/2011
Q8135
P1016
RODRIGUEZ, JOSE LUIS, MD
RODRIGUEZ, JOSE RUBEN, MD
P8724
RODRIGUEZ, JOSHUA DAVID, MD
RODRIGUEZ, LIMAEL ESTEBAN,
MD
P0284
P0871
P7343
Q4505
RODRIGUEZ, LORNA, MD
RODRIGUEZ, MARISOL LOREDO,
MD
RODRIGUEZ, RONALD , MD
RODRIGUEZ, THOMAS ANDREW,
MD
02-May-16
9/15/2011
1/3/2014
5/1/2013
7/1/2011
Practice City
VASCULAR
2/8/2018 NEUROLOGY
OBSTETRICS AND
EMERGENCY
1/3/2019 MEDICINE
OBSTETRICS AND
7/1/2016 GYNECOLOGY
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
FAMILY PRACTICE
SPORTS MEDICINE
(FAMILY PRACTICE)
MATERNAL AND
FETAL MEDICINE
8/26/2011
7/15/2013
UROLOGIC
7/15/2018 UROLOGIC SURGERY ONCOLOGY
5/15/2015
HOSPITALIST
Page 313 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
GALVESTON
CORPUS
CHRISTI
TX
ACTIVE
5/4/2015 None
N/A
TX
ACTIVE
2/28/2013 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/6/2011 None
N/A
10/17/2011 None
N/A
6/1/2012 None
N/A
6/2/2015 None
N/A
ACTIVE
LICENSE
ISSUED
21-Mar-16 None
N/A
5/2/2014 None
N/A
03-Feb-16 None
N/A
CHILD AND
ADOLESCENT
PSYCHIATRY
P5565
Q6564
P6512
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
ACTIVE
TEMPLE
TX
ACTIVE
EL PASO
HARLINGEN
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
2/12/2013 None
11/17/2015 None
N/A
N/A
8/26/2011 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
04-May-16 None
9/19/2011 None
N/A
N/A
TEMPLE
TX
ACTIVE
1/17/2014 None
N/A
ACTIVE
5/7/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/29/2011 None
N/A
8/26/2011 None
N/A
ACTIVE
7/22/2013 None
N/A
ACTIVE
6/8/2015 None
N/A
ARLINGTON
TX
SAN ANTONIO TX
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
8/15/2011
8/15/2016 MEDICINE
ORTHOPEDIC
4/1/2015
4/1/2020 SURGERY
PLASTIC &
RECONSTRUCTIVE
4/15/2014
4/15/2019 SURGERY
BREAST ONCOLOGY
EMERGENCY
5/1/2015
5/1/2020 MEDICINE
01-Jun-16
8/1/2014
8/1/2019 PEDIATRICS
PEDIATRIC
OTORHINOLARYNGO
2/1/2013
LOGY
Q3783
Physician Name
RODRIGUEZ-QUINONES, JULIO
JOSE, MD
RODRIGUEZ-QUINTANA, DAVID,
MD
N8844
ROE, ELISE MARIE, MD
Q4266
Q8621
Q1285
ROE, JADA LANE, MD
ROE, TYLER CHARLES, DO
ROEDER, KRISTEN RENEE, MD
P5458
ROEHM, CORRIE ELIZABETH, MD
M5909
ROETHLE, SCOTT T, MD
01-Jun-16
P1688
ROFAIEL, GEORGE, MD
12/15/2011
P1952
ROFSKY, NEIL M, MD
1/17/2012
P7974
ROGE, DESIREE L, MD
9/16/2013
Q0167
ROGERS, MARK WAYNE, MD
P0786
Q6096
5/2/2014
Q6466
ROGERS, RYAN TRAVIS, MD
ROGERS, SELWYN OLWESTON JR,
MD
G0023
ROGERS, WILLIAM BRETT, MD
P4505
ROHM, TREVOR , MD
9/17/2012
P6260
Q7265
ROHRA, ANITA, MD
ROHRER, DAVID A, MD
4/12/2013
16-Feb-16
P8989
ROIFE, DAVID JOHN, MD
2/7/2014
P3574
ROIG ROJAS, INGRID LIDIA, MD
6/8/2012
TRANSPLANT
12/15/2016 SURGERY
DIAGNOSTIC
1/17/2017 RADIOLOGY
PHYSICAL MED. &
EMERGENCY
5/2/2019 MEDICINE
9/15/2015
11/2/2015
7/1/2013
EMERGENCY
4/12/2018 MEDICINE
16-Feb-21 GENERAL SURGERY
INFECTIOUS
6/8/2017 DISEASES
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/15/2011 None
N/A
4/1/2015 None
N/A
ACTIVE
4/25/2014 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
5/8/2015 None
02-Jun-16 None
8/18/2014 None
N/A
N/A
N/A
HOUSTON
OVERLAND
PARK
TX
ACTIVE
2/11/2013 None
N/A
KS
ACTIVE
13-Jun-16 None
N/A
GENERAL SURGERY SEATTLE
WA
ACTIVE
3/2/2012 None
N/A
PEDIATRIC
REHABILITATION
MEDICINE
HOUSTON
TX
ACTIVE
2/16/2012 None
N/A
TX
ACTIVE
11/12/2013 None
N/A
HOUSTON
TX
ACTIVE
5/6/2014 None
N/A
GA
ACTIVE
LICENSE
ISSUED
9/17/2015 None
N/A
11/2/2015 None
N/A
SAINT LOUIS
MOHS
MICROGRAPHIC
SURGERY
MACON
SURGICAL CRITICAL
CARE
FAMILY MEDICINE
DOWAGIAC
MI
ACTIVE
7/12/2013 None
N/A
QUANAH
TX
ACTIVE
9/24/2012 None
N/A
FLUSHING
NY
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/30/2013 None
18-Feb-16 None
N/A
N/A
2/7/2014 None
N/A
6/8/2012 None
N/A
INTERNAL MEDICINE HUNTSVILLE
Page 314 of 402
MO
AL
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q8622
ROITSCH, CHARLES MCCLAIN, DO
01-Jun-16
Q7105
Q5550
ROJAS RUIZ, SANDRA LILIANA, MD
ROJAS, ANA MARIA, MD
01-Feb-16
8/3/2015
Q3953
ROKADIA, HAALA, MD
4/10/2015
P1689
P6069
ROLAND, CYNTHIA RENEE, MD
ROLDAN, GUADALUPE , MD
12/15/2011
4/1/2013
Q4506
ROLLER, EVAN WARD, MD
5/15/2015
Q6271
ROMAN, MARIA CARMEN, MD
10/1/2015
P3430
ROMAN, NICHOLAS ORDUNO, MD
P1399
ROMEO, BRUNO A, MD
Q0352
Q3784
ROMERO, ANTONIO NAVARRO JR,
MD
ROMERO, CHRISTOPHER-DAVID
MICHAEL, MD
6/1/2012
11/4/2011
5/15/2014
EMERGENCY
10/1/2020 MEDICINE
RADIATION
6/1/2017 ONCOLOGY
OBSTETRICS &
GYNECOLOGICAL
11/4/2016 SURGERY
ORTHOPEDIC
5/15/2019 SURGERY
4/15/2014
5/15/2015
Q6696
Q7781
ROMEZI, MONA , MD
RONCAL, OSCAR ADOLFO, MD
RONCALLO, JENNIFER
MARGARITA, MD
RONDEAU, BRYAN JOSEPH, MD
12/4/2015
01-Apr-16
Q1011
RONNEBERG, KEVIN ROBERT, MD
7/15/2014
P1922
P1136
ROOSTAEIAN, JASON, MD
ROOT, JOHN CHINNICK, MD
1/17/2012
10/3/2011
P0668
ROOT, TIMOTHY DANFORTH, MD
PLASTIC &
RECONSTRUCTIVE
1/17/2017 SURGERY
EMERGENCY
8/1/2016 MEDICINE
8/1/2011
CRITICAL CARE
ANESTHESIOLOGY
Practice City
Page 315 of 402
Disciplinary
Status Date
TX
ACTIVE
13-Jun-16 None
N/A
MIAMI
BEDFORD
FL
TX
ACTIVE
ACTIVE
15-Feb-16 None
8/5/2015 None
N/A
N/A
LICENSE
ISSUED
4/10/2015 None
N/A
ACTIVE
ACTIVE
12/19/2011 None
4/15/2013 None
N/A
N/A
ACTIVE
5/19/2015 None
N/A
ACTIVE
10/8/2015 None
N/A
ACTIVE
N/A
LICENSE
ISSUED
6/11/2012 None
SEE
PREVIOUS
11/4/2011 ORDER
LICENSE
ISSUED
5/15/2014 None
N/A
ACTIVE
4/3/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
5/9/2014 None
6/3/2015 None
N/A
N/A
12/4/2015 None
08-Apr-16 None
N/A
N/A
MINNEAPOLIS MN
ACTIVE
7/22/2014 None
N/A
ALTUS
LICENSE
ISSUED
ACTIVE
1/17/2012 None
10/25/2011 None
N/A
N/A
8/25/2011 None
N/A
HOUSTON
TX
SAN ANTONIO TX
EMERGENCY
MEDICAL SERVICES
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
ORTHOPEDIC
SURGERY OF THE
SPINE
OBSTETRICS AND
5/15/2020 PATHOLOGY
P9945
Q4508
4/1/2015
ANESTHESIOLOGY 01-Feb-21 PAIN MANAGEMENT
8/3/2020 ONCOLOGY
PULMONARY
CRITICAL CARE
4/10/2020 MEDICINE
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
NEONATALPERINATAL
MEDICINE
Registration
Status of
Practice
Texas
State
License
LA JOLLA
CA
HOUSTON
TX
TEMPLE
TX
OK
NOBLESVILLE IN
ACTIVE
12/13/2011
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
NEUROLOGICAL
6/12/2015
6/12/2020 SURGERY
GERIATRIC MEDICINE
6/3/2013
FAMILY PRACTICE
OTORHINOLARYNGOL
4/12/2013
4/12/2018 OGY
EMERGENCY
10/15/2015
10/15/2020 MEDICINE
Q4838
ROPPER, ALEXANDER E, MD
P6905
ROSALEZ, MISSY NEDA, MD
H5202
P5460
Q6367
ROSANE, BRET, MD
ROSANOVA, CHRISTOPHER
ROBIN, DO
ROSARIO FELICIANO, RALPHIE
ALBERTO, MD
ROSARIO, ZAHIRA, MD
P3067
ROSAS, LUIS ALBERTO, MD
P7558
P9946
ROSE, CARY, MD
ROSE, RYAN , MD
8/1/2013
4/15/2014
P2773
P7344
ROSEBROCK, RICHARD ERIC, MD
ROSEMAN, JOHN TYLER II, MD
4/2/2012
7/15/2013
Q8138
ROSENBAUM, LARA, MD
Q5552
ROSENBERG, TARA L, MD
8/3/2015
Q4683
ROSENBLAT, ELAN AARON, MD
6/1/2015
P5461
ROSENGART, TODD KENNETH, MD
2/1/2013
Q6366
2/1/2013
10/15/2015
5/1/2012
02-May-16
TM00597 ROSENTHAL, KIM, MD
12/3/2014
Q2056
Q6785
ROSERO MORA, ERIC BRIAN, MD
ROSINIA, FRANCIS, MD
10/1/2014
15-Dec-15
P1487
ROSLUND, GREGORY LANE, MD
11/15/2011
Q2378
ROSMAN, ILANA, MD
11/7/2014
CARDIOVASCULAR
8/1/2018 DISEASES
INFECTIOUS
DISEASES
CARDIAC
ELECTROPHYSIOLO
GY
4/2/2017 RADIOLOGY
NEURO-RADIOLOGY
MOHS
MICROGRAPHIC
02-May-21 DERMATOLOGY
SURGERY
PEDIATRIC
OTOLARYNGOLOGY
CORNEA
REFRACTIVE
SURGERY
CARDIOVASCULAR
2/1/2018 SURGERY
ANESTHESIOLOGY
EMERGENCY
11/15/2016 MEDICINE
DERMATOPATHOLOG
11/7/2019 Y
DERMATOLOGY
Page 316 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
TX
ACTIVE
6/16/2015 None
N/A
LUBBOCK
TX
ACTIVE
6/12/2013 None
N/A
ANCHORAGE
AK
ACTIVE
4/15/2013 None
N/A
JASPER
TX
ACTIVE
10/27/2015 None
N/A
ABILENE
JOPLIN
TX
MO
ACTIVE
ACTIVE
2/7/2013 None
11/17/2015 None
N/A
N/A
MCALLEN
TX
ACTIVE
6/8/2012 None
N/A
LONGVIEW
DALLAS
TX
TX
8/5/2013 None
4/21/2014 None
N/A
N/A
4/2/2012 None
8/5/2013 None
N/A
N/A
LONGVIEW
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
11-May-16 None
N/A
HOUSTON
TX
ACTIVE
8/4/2015 None
N/A
LICENSE
ISSUED
6/1/2015 None
N/A
HOUSTON
TX
ACTIVE
2/11/2013 None
N/A
EUREKA
CA
ACTIVE
12/11/2014 None
N/A
DALLAS
TX
FORT WORTH TX
ACTIVE
ACTIVE
10/7/2014 None
21-Dec-15 None
N/A
N/A
MISHAWAKA
IN
ACTIVE
11/28/2011 None
N/A
SAINT LOUIS
MO
ACTIVE
11/13/2014 None
N/A
License
Number
Physician Name
Q3590
Q1012
ROSS, CAROLYN KENIA, MD
ROSS, CURTIS PAUL, DO
P4703
ROSS, DAVID JAMES, DO
ROSS, DAVID WILLIAM MALCOLM,
DO
ROSS, THEODORA S, MD
Q6273
P2161
Q7458
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
3/16/2015
3/16/2020 SURGERY
7/15/2014
7/15/2019 UROLOGY
EMERGENCY
10/15/2012
10/15/2017 MEDICINE
EMERGENCY
10/1/2015
10/1/2020 MEDICINE
2/10/2012
2/10/2017 ONCOLOGY
EMERGENCY
04-Mar-16
04-Mar-21 MEDICINE
DIAGNOSTIC
5/15/2013
5/15/2018 RADIOLOGY
P6714
ROSSETTIE, ANTHONY S, MD
ROSSMANN, MICHELLE DEBRA,
MD
P8184
ROSSO, RITCHIE JR, MD
P5232
ROTHSTEIN, ROBERT JOSEPH, MD
P5304
ROUNTREE, ANGELA RUTH, MD
1/15/2013
P6513
P9117
ROWE, ADAM EDWARD, MD
ROWE, REGINA KAY, MD
5/1/2013
2/18/2014
P5233
L9462
ROY, ANUKUL RANJAN, MD
ROY, JAMES WILLIAM, MD
1/4/2013
7/1/2013
Q8624
ROY, SANI ANN MATHEW, MD
01-Jun-16
Q6902
ROY, SHRUTI, DO
06-Jan-16
Q6786
ROY, SUDEEP, MD
15-Dec-15
P8726
ROZIER, ANTONIO, MD
P7198
P5884
P2919
RUALES, STEPHANIE RODIS, MD
RUAN, CHENG-HUAI, MD
RUAS, VIRGINIA LAURA, MD
7/1/2013
3/15/2013
4/13/2012
Q5270
RUBIN, LEWIS PHILLIP, MD
7/15/2015
10/15/2013
1/4/2013
1/3/2014
EMERGENCY
1/4/2018 MEDICINE
EMERGENCY
1/15/2018 MEDICINE
EMERGENCY
5/1/2018 MEDICINE
Secondary Specialty
(Self-Designated)
Practice City
PHOENIX
AZ
SAN ANTONIO TX
10/15/2012 None
N/A
10/1/2015 None
2/17/2012 None
N/A
N/A
ACTIVE
14-Mar-16 None
N/A
ACTIVE
5/22/2013 None
N/A
ACTIVE
10/22/2013 None
N/A
ACTIVE
1/8/2013 None
N/A
ACTIVE
1/31/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
5/8/2013 None
2/27/2014 None
N/A
N/A
1/4/2013 None
7/3/2013 None
N/A
N/A
01-Jun-16 None
N/A
PHILADELPHIA PA
ACTIVE
29-Jan-16 None
N/A
AUSTIN
NORTH
RICHLAND
HILLS
TX
ACTIVE
17-Dec-15 None
N/A
TX
1/17/2014 None
N/A
MUNCIE
IN
ARLINGTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
7/1/2013 None
3/22/2013 None
4/20/2012 None
N/A
N/A
N/A
7/15/2015 None
N/A
TX
ABILENE
TX
EMERGENCY/TRAUM FARMINGTON
A RADIOLOGY
HILLS
MI
DERMATOLOGIC
SURGERY
ODESSA
TX
DALLAS
7/1/2018 SLEEP MEDICINE
PEDIATRIC
01-Jun-21 ENDOCRINOLOGY
HUNTSVILLE
OTOLARYN & FACIAL
SPINE AND SPORTS
MEDICINE
PEDIATRICS
Page 317 of 402
Disciplinary
Status Date
N/A
N/A
EMERGENCY
MEDICAL SERVICES
MD
TX
AL
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
4/6/2015 None
7/17/2014 None
BETHESDA
PHYSICAL MED. &
Registration
Status of
Practice
Texas
State
License
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
CRITICAL CARE 11/15/2013
11/15/2018 NEUROSURGERY
NEUROLOGY
P8408
RUBIN, MICHAEL ADAM, MD
Q2379
Q2840
RUBINATE, LAURA , DO
RUBLE, MATTHEW WILLIAM, MD
Q5084
RUCINSKI, MARIA C, MD
Q0693
RUDA, FRANK JOSEPH, MD
Q1288
RUDA, VAN MICHELLE TRAN , MD
Q5718
RUDERFER, DANIEL , MD
8/14/2015
Q1728
RUDIS, STEVEN, MD
RUIZ HURTARTE, JUAN MANUEL,
MD
8/29/2014
P8409
11/7/2014
1/5/2015
7/1/2015
6/16/2014
8/1/2014
1/5/2020 PSYCHIATRY
EMERGENCY
7/1/2020 MEDICINE
8/1/2019 PEDIATRICS
11/15/2013
EMERGENCY
8/29/2019 MEDICINE
DIAGNOSTIC
15-Dec-20 RADIOLOGY
Q6787
Q8787
RULNICK, ADAM DAVID, MD
RUSHI, SWATI, MD
15-Dec-15
10-Jun-16
Q5271
RUSS, EDMOND VINCENT III, MD
7/15/2015
Q8140
RUSS, ISI J, MD
Q0354
P5568
RUSSELL, MARY ELIZABETH, DO
RUSSELL, MICHAEL ADAM, DO
5/15/2014
2/8/2013
P7975
RUSSELL, SARAH BETH, MD
9/16/2013
Q5553
Q1013
RUSSO, MELISSA LAUREN, MD
RUSSO, MICHAEL, MD
8/3/2015
7/15/2014
Q1289
Q4269
RUSSO, RUSSELL RUBEN, MD
RUST, STEFANIE NICOLE, DO
8/1/2014
5/1/2015
P7976
RUTH, GREGORY D, MD
9/16/2013
Q6903
RUTLEDGE, WHIT , MD
06-Jan-16
02-May-16
OPHTHALMOLOGY
DALLAS
TX
CAMBRIDGE
MA
DALLAS
TX
MORGANTOW
N
WV
OTHER SPECIALTY
ANESTHESIOLOGY
NEUROLOGY/DIAGN
OSTIC
RAD/NEURORADIOLO
GY
EDEN PRAIRIE MN
HOSPITALIST
DALLAS
TX
7/15/2020 RADIOLOGY
EMERGENCY
02-May-21 MEDICINE
PHYSICAL MED. &
MATERNAL AND
ORTHOPEDIC
8/1/2019 SURGERY
Practice City
Registration
Status of
Practice
Texas
State
License
LOS ANGELES CA
CRITICAL CARE
ANESTHESIOLOGY
GENETICS
SPORTS MEDICINE
(ORTH SURG)
EMERGENCY
06-Jan-21 MEDICINE
Page 318 of 402
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
11/27/2013 None
N/A
11/7/2014 None
1/14/2015 None
N/A
N/A
7/13/2015 None
N/A
7/2/2014 None
N/A
8/1/2014 None
N/A
8/14/2015 None
N/A
8/29/2014 None
N/A
11/15/2013 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
16-Dec-15 None
13-Jun-16 None
N/A
N/A
7/15/2015 None
N/A
06-May-16 None
N/A
5/15/2014 None
2/21/2013 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
HOUSTON
AUSTIN
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
COLUMBUS
OH
ACTIVE
9/23/2013 None
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
8/10/2015 None
7/16/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
8/25/2014 None
5/15/2015 None
N/A
N/A
9/16/2013 None
N/A
ACTIVE
22-Jan-16 None
N/A
FORT WORTH TX
License
Number
P1813
P2355
Physician Name
RUTZ, JOSEPH ALEXANDER JR,
MD
RYALI, NEELIMA DEVI R A, MD
P8185
RYAN, CAITRIONA , MD
Q0553
RYAN, PAULA DENISE, MD
P1586
RZEPKA, ROBERT , MD
Q1730
SA, DANIEL SIMOES DE, MD
P6070
SAAD, ANTONIO , MD
P1400
SAAP, LILIANA J, MD
Q5272
SAATEE, SIAVOSH, MD
Q5555
SAAVEDRA, TERESA GAIL, DO
P6908
SABA, SALIM CHARLES, MD
Q4511
SABATES, REBECCA ANGELICA,
MD
P5463
SABIR, SHARJEEL , MD
K9894
P6071
P1814
Q2702
SABO, TONIA MARIE, MD
SABRI, NADIA A, MD
SABRI, SAMMY , MD
SADAT, KAMEL , MD
P2776
P0669
SADEGHI, MOHAMMADREZA, MD
SADIGHI, ZSILA SOUSAN, MD
Q0355
SADIQ, SYED BAQER, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
OBSTETRICS AND
1/2/2012
1/2/2017 GYNECOLOGY
BASTROP
3/1/2012
3/1/2017 INTERNAL MEDICINE INTERNAL MEDICINE ABILENE
PROCEDURAL
10/15/2013
DERMATOLOGY
DALLAS
THE
6/2/2014
WOODLANDS
INFECTIOUS
12/1/2011
12/1/2016 INTERNAL MEDICINE DISEASES
CONCORD
MOVEMENT
8/29/2014
8/29/2019 NEUROLOGY
DISORDERS
OBSTETRICS AND
MATERNAL AND
4/1/2013
4/1/2018 GYNECOLOGY
FETAL MEDICINE
GALVESTON
DERMATOLOGIC
11/4/2011
SURGERY
PROVIDENCE
CRITICAL CARE
7/15/2015
ANESTHESIOLOGY
HOUSTON
NEUROMUSCULOSK
FAMILY
ELETAL
BROWNSVILL
8/3/2015
MEDICINE/OMT
E
PLASTIC &
RECONSTRUCTIVE
6/3/2013
6/3/2018 SURGERY
NEONATALPERINATAL
5/15/2015
MEDICINE
HOUSTON
INTERVENTIONAL
DIAGNOSTIC
2/1/2013
2/1/2018 RADIOLOGY
RADIOLOGY
HOUSTON
8/29/2014
4/1/2013
1/2/2012
12/15/2014
4/2/2012
8/1/2011
5/15/2014
8/29/2019
4/1/2018
1/2/2017
12/15/2019
CHILD NEUROLOGY
PEDIATRICS
ANESTHESIOLOGY
INTERNAL MEDICINE
4/2/2017 NEUROLOGY
8/1/2016 NEURO-ONCOLOGY
5/15/2019 NEUROLOGY
Registration
Status of
Practice
Texas
State
License
ACTIVE
ACTIVE
1/12/2012 None
3/9/2012 None
N/A
N/A
TX
ACTIVE
11/13/2013 None
N/A
TX
ACTIVE
6/12/2014 None
N/A
NH
ACTIVE
LICENSE
ISSUED
1/30/2012 None
N/A
8/29/2014 None
N/A
TX
ACTIVE
4/12/2013 None
N/A
RI
ACTIVE
11/28/2011 None
N/A
TX
ACTIVE
7/28/2015 None
N/A
TX
ACTIVE
8/6/2015 None
N/A
TX
ACTIVE
6/4/2013 None
N/A
TX
ACTIVE
5/21/2015 None
N/A
TX
ACTIVE
TEXAS
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
2/4/2013 None
N/A
CARDIOLOGY
BIRMINGHAM
GALVESTON
AL
TX
CHILD NEUROLOGY
HOUSTON
TX
Page 319 of 402
Disciplinary
Status Date
LA
TX
SAN ANTONIO TX
PAIN MANAGEMENT
Registration
Status Date
Disciplinary
Status of
Texas
License
8/29/2014
4/10/2013
1/9/2012
12/16/2014
None
None
None
None
N/A
N/A
N/A
N/A
4/2/2012 None
8/5/2011 None
N/A
N/A
5/15/2014 None
N/A
License
Number
P2163
Q7955
Physician Name
SADOUN, ELISE YASMEEN, MD
SAEED, UROOJ , MD
P4506
SAEED, YAHYA, MD
Q8141
SAENZ, JENNIFER ELISABETH, MD
Q1731
SAENZ, REBECCA L, MD
dicaid
dicaid
Agreement
End Date
Designated)
2/10/2012
15-Apr-16
9/17/2012
02-May-16
EMERGENCY
8/29/2019 MEDICINE
8/29/2014
ADDICTION
PSYCHIATRY
Q2703
SAFDAR, KAMRAN, MD
12/15/2014
Q3085
P0287
SAFFER, TRACY HOPE, MD
SAGALLA, REX B, DO
2/2/2015
7/1/2011
Q8142
SAGAR, YESHODRA, MD
Q3086
SAGASLLI, AHMED ALI, MD
2/2/2015
P0288
P3575
SAGER, DERICK ALAN, MD
SAGHIER, SADAF, MD
7/1/2011
6/8/2012
6/8/2017 PEDIATRICS
Q4685
P6909
SAHA, ARNOLD, MD
SAHEBJAM, FARHAD, MD
6/1/2015
6/3/2013
6/1/2020 RADIOLOGY
L7871
SAHETA, SANJAYA NARAYAN, MD
1/4/2013
1/4/2018 CARDIOLOGY
P2514
SAHLOUL, ELSAYED AHMED, MD
3/15/2012
P8411
SAHNI, ADARSH, MD
11/15/2013
Q1290
SAHNI, DESHDEEPAK , MD
8/1/2014
NEUROLOGICAL
8/1/2019 SURGERY
Q0554
SAIED, NAHEL , MD
6/2/2014
Q8626
SAIFULLAH, MONA SIDDIQI, MD
01-Jun-16
Q2613
SAINI, VIRENDER SINGH, MD
12/3/2014
02-May-16
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
LICENSE
ISSUED
ACTIVE
NEW HAVEN
CT
ACTIVE
12/12/2012 None
N/A
EDINBURG
TX
ACTIVE
LICENSE
ISSUED
05-May-16 None
N/A
8/29/2014 None
N/A
ACTIVE
12/23/2014 None
N/A
2/9/2015 None
7/18/2011 None
N/A
N/A
02-May-16 None
N/A
2/2/2015 None
N/A
7/1/2011 None
6/26/2012 None
N/A
N/A
6/2/2015 None
6/5/2013 None
N/A
N/A
1/4/2013 None
N/A
GASTROENTEROLOG
Y
MINNEAPOLIS MN
WHEAT RIDGE CO
INTERVENTIONAL
RADIOLOGY
INTERVENTIONAL
CARDIOLOGY
FAMILY PRACTICE 01-Jun-21 EMERGENCY MED
CRITICAL CARE
12/3/2019 MEDICINE
HEPATOLOGY
CRITICAL CARE
MEDICINE (IM)
SPINAL CORD
INJURY MEDICINE
CRITICAL CARE
MEDICINE
INTERNAL MEDICINE
Page 320 of 402
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
SEE
PREVIOUS
2/10/2012 ORDER
2/13/2012
03-May-16 None
N/A
ANN ARBOR
HOUSTON
MI
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
WASHINGTON PA
ACTIVE
ACTIVE
TEXAS
LICENSE
ISSUED
DALLAS
TX
ACTIVE
4/12/2012 None
N/A
ST. LOUIS
MO
ACTIVE
11/20/2013 None
N/A
HOUSTON
TX
ACTIVE
8/12/2014 None
N/A
NASHVILLE
TN
ACTIVE
LICENSE
ISSUED
6/3/2014 None
N/A
01-Jun-16 None
N/A
12/12/2014 None
N/A
ACTIVE
License
Number
Physician Name
Q2614
SAINTE-THOMAS, NAGELA, MD
P4705
P6072
P1402
SAIYAD, SALEEM, MD
SAJJA, NAVEEN, MD
SAJJAN, RAJENDRA N, MD
SALAKO, OLUBUNMI NKEM
ADEKUMBI, MD
SALAMEH, HABEEB MUNIR, MD
P5234
P8992
P0928
10/15/2012
4/1/2013
11/4/2011
1/4/2013
2/7/2014
1/4/2018 PEDIATRICS
9/1/2016 PEDIATRICS
8/1/2014
9/15/2014
Q1292
SALAS, MONICA JACQUELINE, MD
SALAU-OKELEJI, ADERONKE
OLUTOPE, MD
Q5921
Q2843
P3666
SALAZAR, HUGO PASTOR JR, MD
SALCEDO, VICTOR MANUEL, MD
SALCIDO, ARMANDO JR, MD
8/28/2015
1/5/2015
6/15/2012
Q1486
P1924
Q5922
SALCIDO, PEDRO JR, MD
SALDANA, DAVID ABRAM, MD
SALDANHA, USHA, MD
8/15/2014
1/17/2012
8/28/2015
Q7462
04-Mar-16
Q1487
K0183
Q1293
P4808
P2515
SALDANHA, VILAS, MD
SALDIVAR, CHRISTINA LORRAINE,
MD
SALEEM, ASMA, MD
SALEEM, AZRA FATIMA, MD
SALEEM, KASHIF , MD
SALEEM, SADAF, MD
EMERGENCY
8/15/2019 MEDICINE
1/17/2017 RADIOLOGY
ORTHOPEDIC
04-Mar-21 TRAUMA
8/15/2014
2/1/2013
8/1/2014
11/1/2012
3/15/2012
8/15/2019
2/1/2018
8/1/2019
11/1/2017
3/15/2017
P2516
P1589
Q6904
SALEEM, SADIA , MD
SALEEM, USMAN, MD
SALEH, ANAS W, MD
3/15/2012
12/1/2011
06-Jan-16
Q1897
Q3432
SALEH, BILAL AHMAD M, MD
8/1/2014
3/3/2015
NEUROLOGY
PEDIATRICS
INTERNAL MEDICINE
FAMILY PRACTICE
FAMILY MEDICINE
3/3/2020 RADIOLOGY
Secondary Specialty
(Self-Designated)
Practice City
EL PASO
DALLAS
GALVESTON
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
9/1/2011
Q1291
SALAMI, OLUFUNMILAYO I, MD
SALARZON, ROSARIO BLANCA
NIEVES, MD
dicaid
dicaid
Agreement
End Date
Designated)
PEDIATRIC
EMERGENCY
12/3/2014
Registration
Status of
Practice
Texas
State
License
TX
TX
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/31/2014 None
N/A
10/15/2012 None
4/8/2013 None
11/18/2011 None
N/A
N/A
N/A
1/4/2013 None
2/24/2014 None
N/A
N/A
MINNEAPOLIS MN
ACTIVE
9/28/2011 None
N/A
ODESSA
TX
ACTIVE
8/6/2014 None
N/A
SAN ANTONIO TX
ACTIVE
9/18/2014 None
N/A
HOSPITALIST
DALLAS
TX
8/4/2014 None
N/A
HOSPITALIST
ODESSA
AMARILLO
TX
TX
8/28/2015 None
1/8/2015 None
6/27/2012 None
N/A
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
8/15/2014 None
1/20/2012 None
9/14/2015 None
N/A
N/A
N/A
AUSTIN
NV
07-Mar-16 None
N/A
ORTHOPEDIC
SURGERY
NEUROMUSCULAR
DISEASE
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
TOLEDO
OH
ACTIVE
LUBBOCK
TX
PAIN MEDICINE
INTERVENTIONAL
RADIOLOGY
Page 321 of 402
ACTIVE
8/18/2014
2/25/2013
8/6/2014
11/21/2012
3/29/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
3/15/2012 None
2/20/2012 None
27-Jan-16 None
N/A
N/A
N/A
3/11/2015 None
N/A
License
Number
Q1488
Q6098
Physician Name
SALEHI, ADEL , MD
SALEJEE, ISMAIL, MD
dicaid
dicaid
Agreement
End Date
Designated)
DIAGNOSTIC
8/15/2014
8/15/2019 RADIOLOGY
9/15/2015
Q7268
Q2704
SALEM, ANDREW KAMIL, MD
SALEM, SALEM A, MD
16-Feb-16
12/15/2014
Q7108
SALEM, USAMA , MD
01-Feb-16
Q2490
SALEM, YASSER, MD
11/17/2014
P3069
Q4270
SALGADO GONZALEZ, GONZALO
ALEJANDRO, MD
SALGADO, BENJAMIN C, MD
5/1/2012
5/1/2015
Q4271
SALGADO, BRANDON, MD
5/1/2015
P4507
P4809
Q3955
SALHAB, SAMER, MD
SALIFU, ZAKARE, DO
SALIGRAM, UMA, MD
9/17/2012
11/1/2012
4/10/2015
Q2945
Q5274
SALIHU, HAMISU MOHAMMED, MD
SALINAS, ALAN , MD
1/15/2015
7/15/2015
P3576
SALINAS, CRYSTAL MICHELLE, MD
6/8/2012
6/8/2017 PEDIATRICS
P6910
P3434
SALINAS, CYNTHIA MAE, MD
SALINAS, MARIELA , MD
6/3/2013
6/1/2012
6/3/2018
6/1/2017
Q2844
Q3433
SALINSKY, DANIEL ERIC, MD
SALLEE, CALEB , MD
1/5/2015
3/3/2015
1/5/2020
3/3/2020
Q5087
SALMAN, TAYYABA, MD
7/1/2015
P9453
P4706
SALUJA, PARAMVEER SINGH, MD
SALVI, SAMBHITAB SUNIL, MD
3/17/2014
10/15/2012
Secondary Specialty
(Self-Designated)
DIAGNOSTIC
RADIOLOGY
01-Feb-21 RADIOLOGY
PULMONARY
CRITICAL CARE
5/1/2017 MEDICINE
5/1/2020 PEDIATRICS
DIAGNOSTIC
9/17/2017 RADIOLOGY
4/10/2020 NEUROLOGY
OCCUPATIONAL
1/15/2020 MEDICINE
TEMPLE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
HOUSTON
HOUSTON
TX
TX
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
Practice City
SLEEP MEDICINE
12/4/2015
Q6699
SALVINO, CHRISTOPHER K, MD
04-Dec-15
N/A
N/A
07-Mar-16 None
12/22/2014 None
N/A
N/A
04-Feb-16 None
N/A
11/17/2014 None
N/A
5/3/2012 None
5/25/2015 None
N/A
N/A
TX
TX
ACTIVE
5/13/2015 None
N/A
ATLANTA
GLASGOW
BRYAN
GA
KY
TX
ACTIVE
ACTIVE
ACTIVE
10/4/2012 None
11/7/2012 None
4/13/2015 None
N/A
N/A
N/A
PREVENTIVE
MEDICINE
HOUSTON
TX
ACTIVE
ACTIVE
1/23/2015 None
7/16/2015 None
N/A
N/A
TX
ACTIVE
6/14/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
7/8/2013 None
6/29/2012 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
1/13/2015 None
3/6/2015 None
N/A
N/A
7/1/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
3/31/2014 None
10/19/2012 None
N/A
N/A
12/4/2015 None
N/A
26-Feb-16 None
N/A
ABILENE
8/15/2014 None
9/30/2015 None
AUSTIN
MOUNT
PLEASANT
TX
INTERNAL MEDICINE
Q6699
Disciplinary
Status Date
ACTIVE
ACTIVE
AUSTIN
SURGICAL CRITICAL
MCALLEN
FAMILY MEDICINE
FAMILY MEDICINE
SAN ANTONIO
EMERGENCY
MEDICINE
GENERAL SURGERY
LUBBOCK
Registration
Status Date
Disciplinary
Status of
Texas
License
TRAUMATIC
SURGERY
TRAUMATIC
SURGERY
Page 322 of 402
MCALLEN
TX
TX
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6699
04-Dec-15
P3435
P0670
Q5557
P6911
P4905
SALYER, RENA, DO
SALZMAN, CHRISTOPHER
WILLARD VINCENT, MD
SAM, JERMALE, MD
SAM, KENNY , DO
SAM, SIBY , MD
8/1/2011
8/3/2015
6/3/2013
11/15/2012
8/1/2016
8/3/2020
6/3/2018
11/15/2017
P8728
P7345
P5128
P5128
P5128
SAMAROPOULOS, XANTHIA, MD
SAMBALINGAM, DEVARAJ, MD
SAMBANDAM, BALAGURU , MD
1/3/2014
7/15/2013
12/17/2012
12/17/2012
12/17/2012
1/3/2019
7/15/2018
12/17/2017
12/17/2017
12/17/2017
P6717
SAMBASIVAN, AJAI , MD
5/15/2013
5/15/2018
P5466
P8993
M1331
SAMEERUDDIN, SYED RAHEEL, MD
SAMINENI, SANKAR ANAND, MD
SAMMARELLI, PATRICIA, MD
Q1734
SAMPATH, KARTHIK , MD
Q2845
SAMPATH, PRAVEEN KUMAR, MD
1/5/2015
Q2846
1/5/2015
P9949
SAMUEL, GEORGE , MD
SAMUEL, PAULRAJ ANAND
RUPKUMAR, MD
4/15/2014
P7977
SAMUELIAN, JASON , DO
9/16/2013
Q0169
SAMUELSON, MICAL MARIE, MD
5/2/2014
P3436
6/1/2012
J2302
SAN MARTIN, JOSE EDUARDO, MD
SAN MIGUEL, VIRGINIA VILLEGAS,
MD
Q6566
SANA, SAID SHOIB, DO
6/1/2012
2/1/2013
2/7/2014
8/3/2015
8/29/2014
5/1/2015
11/16/2015
EMERGENCY
6/1/2017 MEDICINE
GENERAL SURGERY
ANESTHESIOLOGY
RADIOLOGY
FAMILY MEDICINE
ENDOCRINOLOGY,
DIABETES AND
METABOLISM
NEONATOLOGY
GENERAL SURGERY
GENERAL SURGERY
GENERAL SURGERY
PHYSICAL MED. &
REHABILITATION
PHYSICAL MED. &
INFECTIOUS
1/5/2020 DISEASES
RADIATION
9/16/2018 ONCOLOGY
Secondary Specialty
(Self-Designated)
TRAUMATIC
SURGERY
Practice City
MCALLEN
TX
SAN ANTONIO TX
HOUSTON
TX
HOUSTON
TX
HOSPITALIST
PEDIATRICS
EL PASO
DALLAS
DALLAS
DALLAS
TX
TX
TX
TX
HOUSTON
TX
HOSPITALIST
GASTROENTEROLOG
Y
FORT MEYERS FL
PULMONARY
DISEASES
INTERVENTIONAL
CARDIOLOGY
KINGWOOD
TX
HOUSTON
OBSTETRICS AND
6/1/2017 GYNECOLOGY
OBSTETRICS AND
5/1/2020 GYNECOLOGY
OTORHINOLARYNGOL
11/16/2020 OGY
Registration
Status of
Practice
Texas
State
License
ANESTHESIOLOGY
SHREVEPORT LA
FAMILY PRACTICE
ADMINISTRATIVE
MEDICINE
PORTLAND
OTOLOGY/NEUTOTO
LOGY
Page 323 of 402
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
Disciplinary
Status Date
26-Feb-16 None
N/A
6/1/2012 None
N/A
8/25/2011
8/12/2015
6/25/2013
11/27/2012
None
None
None
None
N/A
N/A
N/A
N/A
1/15/2014
7/18/2013
1/7/2013
1/7/2013
1/7/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
5/15/2013 None
N/A
2/1/2013 None
2/11/2014 None
8/6/2015 None
N/A
N/A
N/A
8/29/2014 None
N/A
ACTIVE
1/7/2015 None
N/A
ACTIVE
1/6/2015 None
N/A
ACTIVE
4/25/2014 None
N/A
ACTIVE
LICENSE
ISSUED
9/23/2013 None
N/A
5/2/2014 None
N/A
6/5/2012 None
N/A
5/11/2015 None
N/A
11/16/2015 None
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
OR
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
License
Number
dicaid
dicaid
Agreement
End Date
Designated)
Registration
Status of
Practice
Texas
State
License
Q5923
SANCHEZ, DIMARYS , MD
8/28/2015
Secondary Specialty
(Self-Designated)
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
Q1014
SANCHEZ, HECTOR, MD
7/15/2014
INFECTIOUS
6/1/2017 DISEASES
JEFFFERSONV
INTERNAL MEDICINE ILLE
IN
P3437
Physician Name
6/1/2012
Practice City
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/28/2015 None
N/A
7/15/2014 None
N/A
ACTIVE
6/8/2012 None
N/A
P9455
SANCHEZ, KATHRYN TINIO, MD
SANCHEZ, KRISTINA NAHASBAH,
MD
3/17/2014
3/17/2019 PHLEBOLOGY
PUEBLO
CO
ACTIVE
4/7/2014 None
N/A
Q7109
SANCHEZ, RACQUEL A, MD
01-Feb-16
ACTIVE
04-Apr-16 None
N/A
Q8629
SANCHEZ, RICHARD, DO
01-Jun-16
MACOMB TWP MI
CORPUS
CHRISTI
TX
ACTIVE
02-Jun-16 None
N/A
P0289
SANCHEZ-VELEZ, CATALINA , MD
P3236
SANDBERG, DAVID ILAN, MD
5/15/2012
P7846
SANDERS, BRIDGET MARIE, MD
8/30/2013
Q5558
SANDERS, DREW THOMAS, MD
8/3/2015
P9717
SANDERS, JOHN PAUL, MD
4/1/2014
P8729
SANDERS, OPHELIA ROSE, MD
1/3/2014
7/1/2011
7/1/2016 NEPHROLOGY
NEUROLOGICAL
5/15/2017 SURGERY
COLON AND RECTAL
8/30/2018 SURGERY
ORTHOPEDIC
8/3/2020 TRAUMA
CARDIOLOGY
TX
ACTIVE
8/15/2011 None
N/A
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
5/16/2012 None
N/A
8/30/2013 None
N/A
ACTIVE
LICENSE
ISSUED
8/4/2015 None
N/A
4/1/2014 None
N/A
ACTIVE
1/8/2014 None
N/A
LICENSE
ISSUED
8/29/2014 None
N/A
GENERAL SURGERY
ORTHOPEDIC
SURGERY
DALLAS
EMERGENCY
1/3/2019 MEDICINE
TEXAS CITY
TX
UNDERSEA
HYPERBARIC MED
(EMER MED)
Q1735
SANDERS, ROBERT W, MD
8/29/2014
P2164
SANDERSON, DREW , MD
2/10/2012
Q8345
Q1015
16-May-16
7/15/2014
Q2705
SANDHIR, AMBICA, DO
SANDOVAL, JOSE LUIS, MD
SANDULACHE, VLAD CONSTANTIN,
MD
EMERGENCY
8/29/2019 MEDICINE
PLASTIC &
RECONSTRUCTIVE
2/10/2017 SURGERY
EMERGENCY
16-May-21 MEDICINE
12/15/2014
Q2706
SANGHA, BHUPINDER SINGH, MD
12/15/2014
P0488
SANGHA, NAVDEEP SINGH, MD
VASCULAR
7/15/2016 NEUROLOGY
Page 324 of 402
7/15/2011
TX
OTOLARYNGOLOGY
OMAHA
NE
ACTIVE
2/14/2012 None
N/A
PEARLAND
TX
ACTIVE
ACTIVE
23-May-16 None
7/21/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
1/23/2015 None
N/A
12/15/2014 None
N/A
7/15/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7701
SANGHADIA, MUKESH, MD
8/15/2013
Q3089
P0290
SANGHANI, RACHANA VIJAY, MD
SANGHAVI, MONIKA, MD
Q5275
P6074
SANGHVI, REEMA INDUKUMAR, MD
SANI, SHAHRAM NOROUZI, MD
Q5559
8/3/2015
P3577
SANKAR, ANILA PILLAI, MD
SANKARA, ISHWARA RAGHU
PRASHANTH, MD
Q0356
SANKARI, SAMAR RYIAD, MD
5/15/2014
ENDOCRINOLOGY,
DIABETES AND
Q2381
SANNER, COLIN CLANCY, MD
11/7/2014
11/7/2019 NEUROLOGY
2/2/2015
7/1/2011
7/15/2015
4/1/2013
6/8/2012
16-May-16
7/1/2016 CARDIOLOGY
8/3/2020 NEPHROLOGY
SANTANA, JONATHAN ANGEL, DO
P2062
Q8789
SANTAROSA, JULIANNE , MD
SANTIAGO-MATOS, CHRISTIAN
JAVIER, MD
10-Jun-16
L7160
SANTMAN, MARK, MD
9/17/2012
P0872
SANTORA, STEPHEN D, MD
8/26/2011
OBSTETRICS AND
ORTHOPEDIC
SURGERY OF THE
9/17/2017 SPINE
ORTHOPEDIC
8/26/2016 SURGERY
Q3957
P1018
SANTOS, ALAN CHRISTOPHER, MD
SANTOS, ALBERTO MOURA, MD
4/10/2015
9/15/2011
9/15/2016 NEUROLOGY
Q6277
Q1899
J8364
SANTOS, ARIEL PABLO, MD
SANTOS, DAVID ANTHONY, MD
SANTOS, JOSE SALVADOR, MD
10/1/2015
9/15/2014
4/2/2012
P6075
SANTOS, SUSANA, DO
EMERGENCY
4/1/2018 MEDICINE
Q6700
SANUSI, MONISOLA MODUPE, MD
4/1/2013
12/4/2015
Practice City
DALLAS
INTERNAL MEDICINE WASHINGTON DC
GERIATRIC
MEDICINE (INTERNAL
MED)
HOUSTON
TX
CRITICAL CARE
MEDICINE
DALLAS
TX
HOUSTON
COSMETIC SURGERY DALLAS
ORTHOPEDIC
SURGERY
SLEEP MEDICINE
CRITICAL CARE
(TRAUMA)
Page 325 of 402
Disciplinary
Status Date
N/A
2/2/2015 None
7/18/2011 None
N/A
N/A
ACTIVE
ACTIVE
8/17/2015 None
4/9/2013 None
N/A
N/A
ACTIVE
8/4/2015 None
N/A
ACTIVE
6/11/2012 None
N/A
5/15/2014 None
N/A
11/7/2014 None
N/A
TX
ACTIVE
24-May-16 None
N/A
TX
ACTIVE
2/3/2012 None
N/A
ACTIVE
13-Jun-16 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
10/5/2012 None
N/A
8/26/2011 None
N/A
4/10/2015 None
12/8/2011 None
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
10/5/2015 None
9/17/2014 None
4/5/2012 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
4/30/2013 None
N/A
12/4/2015 None
N/A
ROUND ROCK TX
AMARILLO
HOUSTON
SUNRISE
Registration
Status Date
Disciplinary
Status of
Texas
License
8/15/2013 None
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE
SPORTS MEDICINEPEDS
Q8346
2/1/2012
Secondary Specialty
(Self-Designated)
PSYCHOSOMATIC
MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
TX
TX
FL
SAN ANTONIO TX
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6700
04-Dec-15
Q6700
04-Dec-15
K4229
P8306
SAPERSTEIN, DAVID SCOTT, MD
SAPKOTA, BISHNU HARI, MD
10/17/2011
11/1/2013
P3439
SAQIB, NAVEED USMAN, MD
6/1/2012
Q2847
P7200
SARAH, KHALED, MD
SARAO, RAVJOT SINGH, MD
1/5/2015
7/1/2013
P1138
SARASWAT, SHANTANU, MD
10/3/2011
P0490
SARATA, JEFFREY D, DO
7/15/2011
P2165
2/10/2012
Q3284
SARDANA, JASMINE SAMUEL, MD
SARDAR, ZEESHAN MOHAMMAD,
MD
Q2382
SAREYYUPOGLU, BASAR , MD
11/7/2014
Q0817
SARFRAZ, MOHAMMAD, MD
6/27/2014
CARDIOVASCULAR
11/7/2019 SURGERY
OBSTETRICS AND
P8187
Q0558
Q7956
SARGENT, JAMES WIRTH IV, MD
SARGSYAN, ZAVEN, MD
SARKAR, ANAYAH, MD
10/15/2013
6/2/2014
15-Apr-16
2/13/2015
11/1/2018 NEUROLOGY
SARKAR, KUNAL, MD
5/15/2013
P9952
Q1900
SARKAR, RAKHI, MD
SARKAR, RINA, MD
4/15/2014
9/15/2014
Q6370
P5467
P1403
P7201
SARMA, REKHA REGHUNATHA, MD
SARMIENTO, JORGE LUIS, MD
SAROLIA, SEJAL PRAVIN, MD
SARRAFF, MICHELLE ANN, MD
P4811
SARTIN, MELISSA DAWN, MD
11/1/2012
NEUROMUSCULAR
DISEASE
ANATOMIC/CLINICAL
1/5/2020 PATHOLOGY
PATHOLOGY
HOSPITALIST
PULMONARY
CRITICAL CARE
10/3/2016 MEDICINE
EMERGENCY
7/15/2016 MEDICINE
OCCUPATIONAL
2/10/2017 MEDICINE
GENERAL PRACTICE
P6718
10/15/2015
2/1/2013
11/4/2011
7/1/2013
Secondary Specialty
(Self-Designated)
10/15/2020
2/1/2018
11/4/2016
7/1/2018
Practice City
Registration
Status of
Practice
Texas
State
License
Disciplinary
Status Date
ALBANY
GA
ACTIVE
11-Feb-16 None
N/A
ALBANY
GA
ACTIVE
11-Feb-16 None
N/A
BENBROOK
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
10/27/2011 None
11/20/2013 None
N/A
N/A
6/1/2012 None
N/A
ALBUQUERQU
E
NM
SAN ANTONIO TX
ACTIVE
ACTIVE
2/5/2015 None
8/23/2013 None
N/A
N/A
SUNCITY
WEST
AZ
ACTIVE
10/20/2011 None
N/A
SAN ANTONIO TX
ACTIVE
8/16/2011 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
2/13/2012 None
N/A
2/13/2015 None
N/A
11/7/2014 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
7/4/2014 None
N/A
10/15/2013 None
6/23/2014 None
18-Apr-16 None
N/A
N/A
N/A
5/16/2013 None
N/A
4/15/2014 None
9/30/2014 None
N/A
N/A
HOUSTON
PLANO
TX
TX
INTERVENTIONAL
CARDIOLOGY
INTERNAL MEDICINE
RADIOLOGY
NEPHROLOGY
INTERNAL MEDICINE
PEDIATRICS
EMERGENCY
11/1/2017 MEDICINE
Page 326 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
DENTON
EL PASO
HOUSTON
SAN ANGELO
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
10/21/2015
2/7/2013
11/8/2011
7/9/2013
None
None
None
None
N/A
N/A
N/A
N/A
11/6/2012 None
N/A
License
Number
P7978
Q7784
Physician Name
SASS, BRANDON , MD
SASSER, DAVID CHARLES
HEMINGWAY, MD
dicaid
dicaid
Agreement
End Date
Designated)
OBSTETRICS &
GYNECOLOGICAL
9/16/2013
9/16/2018 SURGERY
EMERGENCY
01-Apr-16
01-Apr-21 MEDICINE
Q6568
P4707
SASTRY, ASHWANI, MD
SATANI, DHAVAL D, MD
11/16/2015
10/15/2012
P0929
SATCHO, HONORE, MD
9/1/2011
P4906
SATTAR, AMBREEN, MD
Q0818
SATTAR, ARIF ABDUL, MD
11/15/2012
6/27/2014
OBSTETRICS AND
9/1/2016 GYNECOLOGY
INTERVENTIONAL
SATTAR, BEENA, MD
5/1/2015
Q4840
SATTAR, SHARIQ, MD
6/12/2015
HAND SURGERY 7/15/2019 SURGERY
EMERGENCY
7/15/2019 MEDICINE
SURGICAL BREAST
7/15/2019 ONCOLOGY
EMERGENCY
6/1/2017 MEDICINE
06-Jan-21 CHILD NEUROLOGY
SAUCEDO, JAMES MATTHEW, MD
SAUCIER, JESSICA MARIE, MD
7/15/2014
4/13/2012
Q1017
SAUDER, ADRIAN, MD
7/15/2014
Q1018
SAUDER, CANDICE , MD
7/15/2014
P3441
P4813
Q6905
SAUTNER, JEREMY SCOTT, MD
SAVAGE, ADAM MICHAEL, MD
SAVATIC, MIRJANA M, MD
6/1/2012
11/1/2012
06-Jan-16
Q5276
P7031
SAWEY, KATHRYN ANN , DO
SAWICKI, ANGELINE KATHARINE,
MD
SAWYERR, THOMAS NEMAHUN,
MD
Q4276
P5468
SAXON, SARAH, MD
SAYANI, JAIRAJ, MD
P1489
SAYEGH, GILBERT GEORGE, MD
P4509
Practice City
HOUSTON
TX
RADIOLOGY
INTERNAL MEDICINE BINGHAMTON NY
DIAGNOSTIC
RADIOLOGY
DETROIT
MI
Q4274
Q1016
P2921
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
PRESQUE
ISLE
ME
ORTHOPEDIC
SURGERY
SAN ANTONIO TX
TX
ACTIVE
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
12/3/2013 None
N/A
01-Apr-16 None
N/A
11/16/2015 None
1/9/2013 None
N/A
N/A
9/1/2011 None
N/A
ACTIVE
LICENSE
ISSUED
11/26/2012 None
N/A
6/27/2014 None
N/A
ACTIVE
LICENSE
ISSUED
5/19/2015 None
N/A
6/12/2015 None
N/A
ACTIVE
ACTIVE
7/28/2014 None
4/24/2012 None
N/A
N/A
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
HOUSTON
TX
ACTIVE
7/30/2014 None
N/A
TX
ACTIVE
8/1/2014 None
N/A
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
6/8/2012 None
11/6/2012 None
26-Jan-16 None
N/A
N/A
N/A
7/15/2015
WICHITA
FALLS
PAIN MANAGEMENT TEMPLE
HOUSTON
GERIATRICS 7/15/2020 PALLIATIVE MEDICINE INTERNAL MEDICINE
7/15/2015 None
N/A
9/17/2012
TEMPLE
TX
ACTIVE
9/19/2012 None
N/A
CORSICANA
TX
ACTIVE
7/16/2013 None
N/A
DALLAS
FREMONT
TX
OH
ACTIVE
ACTIVE
5/29/2015 None
2/15/2013 None
N/A
N/A
WHARTON
TX
ACTIVE
11/21/2011 None
N/A
6/14/2013
5/1/2015
2/1/2013
11/15/2011
OTOLARYN & FACIAL
OBSTETRICS AND
Page 327 of 402
License
Number
Physician Name
Q4513
SAYFO, SAMEH, MD
P7032
K3641
SAYIED, TAUSIF, MD
SBAR, ALAN DANIEL, MD
L1210
SBAR, EVELYN STANLEY, MD
Q1736
Q1294
N1131
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
INTERVENTIONAL
5/15/2015
CARDIOLOGY
PULMONARY
CRITICAL CARE
6/14/2013
6/14/2018 MEDICINE
SLEEP MEDICINE
6/2/2014
5/2/2014
SCERBO, MICHELLE , MD
SCHAEFER, DAVID , MD
8/29/2014
8/1/2014
SCHAEFER, JASON, MD
16-Feb-16
Q0358
SCHALLERT, ERICA KINARD, MD
5/15/2014
EMERGENCY
16-Feb-21 MEDICINE
DIAGNOSTIC
5/15/2019 RADIOLOGY
Q3591
SCHAUB, LAUREN MICHELLE, MD
SCHEBLER POULOS, ALLISON
KEELER, DO
3/16/2015
OBSTETRICS AND
9/15/2015
4/2/2012
Q4278
SCHEFLER, AMY CLAIRE, MD
SCHERER, ELIZABETH PADGETT,
MD
Q3791
SCHERRER, PATRICIA DIANE, MD
4/1/2015
Q5561
SCHERRER, PHILIP EDWARD, MD
8/3/2015
P8995
SCHIMIZZI, AIMEE LYNN, MD
2/7/2014
Q4514
SCHINDLER, ADAM MICHAEL, MD
5/15/2015
P6262
SCHLEGEL, CHELSEA ROSE, MD
4/12/2013
Q6702
SCHLIEVE, THOMAS, MD
12/4/2015
ORAL &
MAXILLOFACIAL
12/4/2020 SURGERY
Q6102
P2782
5/1/2015
PEDIATRIC CRITICAL
2/7/2019 SURGERY
PEDIATRIC
RADIOLOGY
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Practice City
ORTHOPEDIC
SURGERY
Page 328 of 402
Disciplinary
Status Date
N/A
6/14/2013 None
6/4/2014 None
N/A
N/A
5/2/2014 None
N/A
8/29/2014 None
8/6/2014 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
25-Feb-16 None
N/A
5/15/2014 None
N/A
TX
ACTIVE
3/20/2015 None
N/A
TX
ACTIVE
9/25/2015 None
N/A
TX
ACTIVE
4/3/2012 None
N/A
ACTIVE
5/11/2015 None
N/A
SAN ANTONIO TX
ACTIVE
4/10/2015 None
N/A
MIDLAND
TX
ACTIVE
8/5/2015 None
N/A
CORPUS
CHRISTI
TX
2/21/2014 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
5/15/2015 None
N/A
4/12/2013 None
N/A
ACTIVE
12/8/2015 None
N/A
AMARILLO
TX
WURZBURG
AE
WACO
TX
LAKEWAY
TX
DUMAS, TX
CORPUS
CHRISTI
ALLERGY AND
IMMUNOLOGY
HEAD AND NECK
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
5/15/2015 None
PEDIATRICS
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
DALLAS
TX
LICENSE
ISSUED
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
ORAL &
MAXILLOFACIAL
04-Dec-15
04-Dec-20 SURGERY
ORAL &
MAXILLOFACIAL
04-Dec-15
04-Dec-20 SURGERY
Secondary Specialty
(Self-Designated)
HEAD AND NECK
SURGERY
Q6702
Q6702
P4817
SCHLOMER, BRUCE JEREMY, MD
H3519
SCHMER, VERONICA R E, MD
3/1/2012
P3442
P9720
SCHMID, KRISTIN LEA, MD
SCHMIDT, AUBREY NICOLE, MD
6/1/2012
4/1/2014
Q4688
SCHMIDT, CAROLINE MARIE, MD
6/1/2015
Q2198
SCHMITT, ROBERT ELI, MD
Q3958
SCHNEBELEN, ALICIA MARIE, MD
4/10/2015
Q0694
SCHNEIDER, BRIAN WAYNE, DO
SCHNEIDER, SANDRA MCEWEN,
MD
6/16/2014
7/15/2014
Q1295
SCHOPP, JENNIFER , MD
SCHOTTEL, HELEN ELIZABETH,
MD
Q3436
SCHRAYER, AARON , MD
Q6372
SCHRODER, STEVEN JEFFREY,
MD
10/15/2015
8/1/2019 PEDIATRICS
ORTHOPEDIC
3/3/2020 SURGERY
ADULT
RECONSTRUCTIVE
P1223
SCHROEDER, ROBERT EUGENE,
MD
10/17/2011
Q6703
Q6703
Q6703
SCHUERGER, JOSEPH B, MD
12/4/2015
04-Dec-15
04-Dec-15
Q2059
SCHULTE, ADAM PHILLIP, DO
10/1/2014
Q3792
Q1019
11/1/2012
10/15/2014
4/1/2015
8/1/2014
3/3/2015
HEAD AND NECK
SURGERY
11/1/2017 PEDIATRIC UROLOGY UROLOGY
PEDIATRICS,
3/1/2017 CARDIOLOGY
GLAUCOMA
GLAUCOMA
EMERGENCY
10/15/2019 MEDICINE
DERMATOPATHOLO
4/10/2020 PATHOLOGY
GY
FAMILY
EMERGENCY
4/1/2020 MEDICINE
INTERNAL MEDICINE
DIAGNOSTIC
7/15/2019 RADIOLOGY
BREAST IMAGING
ORTHOPEDIC
SURGERY
SPORTS MEDICINE
Page 329 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
DALLAS
TX
ACTIVE
08-Dec-15 None
N/A
DALLAS
SAN
FRANCISCO
TX
ACTIVE
08-Dec-15 None
N/A
CA
ACTIVE
1/9/2013 None
N/A
ACTIVE
4/9/2012 None
N/A
HOUSTON
TEXARKANA
TX
TX
ACTIVE
ACTIVE
6/4/2012 None
4/17/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/10/2015 None
N/A
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
10/24/2014 None
N/A
4/10/2015 None
N/A
6/16/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/3/2015 None
N/A
7/15/2014 None
N/A
8/1/2014 None
N/A
ACTIVE
3/18/2015 None
N/A
TX
ACTIVE
11/17/2015 None
N/A
10/17/2011 None
N/A
TX
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
12/4/2015 None
15-Dec-15 None
15-Dec-15 None
N/A
N/A
N/A
10/13/2014 None
N/A
HOUSTON
SEGUIN
SEGUIN
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q3960
SCHULTE, CARLYE KAMARIA, MD
4/10/2015
P8535
SCHULTZ, ERIC MICHAEL, MD
12/6/2013
Q8143
SCHULTZ, JOSEPH, MD
Q4279
SCHULTZEL, MATTHEW, DO
SCHUMAN MCCOY, JEANNINE
MICHELLE, MD
P7563
P0672
Q5925
02-May-16
5/1/2015
8/1/2013
8/1/2011
8/28/2015
Q2617
SCHURMANN, PAUL ANTONIO, MD
SCHWAB, SHANNON JORY, DO
SCHWARTZ, BRADFORD EDWARD,
MD
P6263
SCHWARTZ, JOANNA DENISE, MD
4/12/2013
P1591
SCHWECHTEN, KEVIN J, MD
SCHWEGLER, ERIKA HERNANDEZ,
MD
SCHWEINSBERG, BJORN
STEPHEN, MD
SCHWIEGER, JENNIFER
MICHELLE, MD
12/1/2011
5/15/2015
P2359
Q8144
Q5926
SCHWIND, VALARIE MICHELLE, MD
SCIALDONE, ANTHONY MICHAEL,
MD
SCOGGINS, MARION ELIZABETH,
MD
SCORZA, ANDA TUNCAY, DO
SCOTT, BRIAN ANDREW, MD
Q1737
SCOTT, DAVID L, MD
8/29/2014
Q6104
SCOTT, JACK DOUGLAS, MD
9/15/2015
P4510
SCRIBNER, JAMES THOMAS, MD
9/17/2012
P2358
Q0359
P0874
Q4517
P2063
12/3/2014
3/1/2012
5/15/2014
8/26/2011
2/1/2012
3/1/2012
02-May-16
8/28/2015
Secondary Specialty
(Self-Designated)
Practice City
EMERGENCY
12/6/2018 MEDICINE
DIAGNOSTIC
MUSCULOSKELETAL
02-May-21 RADIOLOGY
RADIOLOGY
COLON AND RECTAL
HOUSTON
PEDIATRICS,
8/1/2018 CARDIOLOGY
PEDIATRICS
AUSTIN
EMERGENCY
12/3/2019 MEDICINE
PEDIATRIC
EMERGENCY
EMERGENCY
5/15/2019 MEDICINE
EMERGENCY
8/26/2016 MEDICINE
EMERGENCY
5/15/2020 MEDICINE
EMERGENCY
2/1/2017 MEDICINE
DIAGNOSTIC
3/1/2017 RADIOLOGY
EMERGENCY
8/29/2019 MEDICINE
EMERGENCY
9/15/2020 MEDICINE
EMERGENCY
9/17/2017 MEDICINE
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/10/2015 None
N/A
12/6/2013 None
N/A
ACTIVE
04-May-16 None
N/A
TX
ACTIVE
5/5/2015 None
N/A
TX
ACTIVE
8/12/2013 None
N/A
TYLER
TX
ACTIVE
ACTIVE
8/15/2011 None
9/3/2015 None
N/A
N/A
CHEVERLY
MD
ACTIVE
12/16/2014 None
N/A
PEDIATRICS
AUSTIN
TX
ACTIVE
4/25/2013 None
N/A
FAMILY MEDICINE
CORINTH
MS
ACTIVE
1/4/2012 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/10/2012 None
N/A
5/15/2014 None
N/A
8/26/2011 None
N/A
ACTIVE
LICENSE
ISSUED
5/25/2015 None
N/A
2/1/2012 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
3/5/2012 None
05-May-16 None
9/2/2015 None
N/A
N/A
N/A
8/29/2014 None
N/A
LONGVIEW
HOUSTON
PEDIATRICS
SEGUIN
Page 330 of 402
LUBBOCK
TX
TX
TX
TX
TX
ACTIVE
9/16/2015 None
N/A
FORT WORTH TX
ACTIVE
9/21/2012 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P3578
SCRUGGS, JESSICA M, MD
6/8/2012
P7981
SEABOLT, WESLEY, MD
9/16/2013
Q6696
SEALE, JENNIFER MARGARITA, MD
04-Dec-15
Q6696
SEALE, JENNIFER MARGARITA, MD
04-Dec-15
Q1902
Q7466
SEAWARD, JAMES RICHARD, MD
SEAY, MICHAEL BRUCE, MD
9/15/2014
04-Mar-16
Q8632
SEBASIGARI, DENISE , DO
01-Jun-16
Q4842
SEBASTIAN, TEENA, MD
6/12/2015
P1020
SECH, CANDICE KAY, MD
9/15/2011
Q3094
SEDAGHAT, DAVID, MD
P3581
Q2492
P8188
Q2618
P2361
SEERY, THOMAS J, MD
SEFEROVIC, ADMIR, MD
SEGAL, GRAHAM VICTOR, MD
SEGAN, SHIVANI, MD
SEGARS, DOUGLAS , DO
2/2/2015
6/8/2012
11/17/2014
10/15/2013
12/3/2014
3/1/2012
Disciplinary
Status Date
6/8/2012 None
N/A
ACTIVE
9/26/2013 None
N/A
WACO
TX
ACTIVE
10-Dec-15 None
N/A
PLASTIC &
RECONSTRUCTIVE
9/15/2019 SURGERY
WACO
TX
ACTIVE
10-Dec-15 None
N/A
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/29/2014 None
13-Apr-16 None
N/A
N/A
01-Jun-16 None
N/A
LICENSE
ISSUED
6/12/2015 None
N/A
9/21/2011 None
N/A
2/2/2015 None
N/A
CRANIOFACIAL
SURGERY
01-Jun-21 NEUROLOGY
PEDIATRIC
GASTROENTEROLOG
6/12/2020 Y
PEDIATRICS
INTERVENTIONAL
CARDIOLOGY
2/2/2020 CARDIOLOGY
PEDIATRICS,
6/8/2017 CARDIOLOGY
3/1/2017 PSYCHIATRY
5/1/2012
Q3794
SEIB, MICHAEL BERNARD II, MD
4/1/2015
P3582
SEIDEN, JASON ANDREW, MD
6/8/2012
OBSTETRICS AND
5/1/2017 GYNECOLOGY
EMERGENCY
4/1/2020 MEDICINE
PULMONARY
CRITICAL CARE
6/8/2017 MEDICINE
P8997
SEIDEN, MICHAEL V, MD
2/7/2014
2/7/2019 ONCOLOGY
12/15/2011
Registration
Status Date
TX
SEHGAL, MONICA, MD
SEIVWRIGHT, TRUDY LECEIN, MD
Practice City
Disciplinary
Status of
Texas
License
BAYTOWN
P3072
P1693
Secondary Specialty
(Self-Designated)
DERMATOLOGIC
SURGERY
PEDIATRIC
PSYCHIATRY
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
OBSTETRICS AND
PLANO
TX
INTERNAL MEDICINE
HOUSTON
TYLER
HOUSTON
OBSTETRICS &
GYNECOLOGICAL
SURGERY
SLEEP MEDICINE
OBSTETRICS &
GYNECOLOGICAL
SURGERY
Page 331 of 402
TX
TX
TX
ACTIVE
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
MARSHALL
ACTIVE
5/3/2012 None
N/A
BUCKHANNON WV
ACTIVE
4/10/2015 None
N/A
FORT WORTH TX
THE
WOODLANDS TX
ACTIVE
6/13/2012 None
N/A
ACTIVE
2/20/2014 None
N/A
ROSWELL
ACTIVE
12/22/2011 None
N/A
TX
NM
6/25/2012
11/18/2014
10/21/2013
12/10/2014
3/5/2012
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
SELBY, ROBERT RICK, MD
10/1/2014
Q1738
Q1491
SEMER, NADINE B, MD
SEMILLA, VLADIMIR , MD
8/29/2014
8/15/2014
8/29/2019
8/15/2019
P7982
Q3795
Q1903
P3241
SEN, AJANTA, DO
SEN, SHIRAJ , MD
SENGUPTA, PAPIYA, MD
SENGUPTA, PIYALI DAS, MD
9/16/2013
4/1/2015
9/15/2014
5/15/2012
9/16/2018
4/1/2020
9/15/2019
5/15/2017
P4819
SERIBURI, VIMON, MD
11/1/2012
11/1/2017
P8412
P1404
Q7468
SERIO, SARA SIBLEY, MD
SERLIN, SCOTT BENJAMIN, MD
SERRATO, JORGE RAFAEL, MD
P2362
SERRETTE, JUSTIN MICHAEL, MD
Q0560
SERUYA, MITCHEL, MD
P4709
SESHADRI, SHESHASHREE, MD
Q3961
Q2619
SETABUTR, DHAVE, MD
SETHI, AMI, MD
P1695
SETIAWAN, CHRISTOPHER TAN,
MD
P5571
P9954
3/1/2012
6/2/2014
10/15/2012
4/10/2015
12/3/2014
12/15/2011
Q7271
Q7959
SEUNGDAMRONG, JASON, MD
SEVAL, DIVYA , MD
SEWELL, AINEL BOONPRAKONG,
MD
SEWELL, JEFFREY THOMAS, MD
2/8/2013
4/15/2014
16-Feb-16
15-Apr-16
Q7787
P0493
SEWELL, MATTHEW JAMES, MD
SEWELL, STEVEN KENNETH, MD
01-Apr-16
7/15/2011
Practice City
SURGICAL CRITICAL
CARE
PLASTIC &
RECONSTRUCTIVE
PALLIATIVE MEDICINE SURGERY
DALLAS
FAMILY MEDICINE
INFECTIOUS
DISEASES
DALLAS
INTERNAL MEDICINE
DALLAS
ANESTHESIOLOGY
WATERBURY
PEDIATRICS
DICKINSON
INFECTIOUS
DISEASES
INTERNAL MEDICINE
H8825
11/15/2013
11/4/2011
04-Mar-16
Secondary Specialty
(Self-Designated)
11/4/2016 RADIOLOGY
RADIOLOGY
3/1/2017 PEDIATRICS
PLASTIC &
RECONSTRUCTIVE
SURGERY
OTORHINOLARYNGOL PEDIATRIC
4/10/2020 OGY
OTOLARYNGOLOGY
12/3/2019 RADIOLOGY
PEDIATRIC
ANESTHESIOLOGY
(PEDS)
EMERGENCY
2/8/2018 MEDICINE
DIAGNOSTIC
16-Feb-21 RADIOLOGY
BREAST IMAGING
15-Apr-21 NEPHROLOGY
INTERNAL MEDICINE
PEDIATRIC
01-Apr-21 DERMATOLOGY
DERMATOLOGY
SLEEP MEDICINE
Page 332 of 402
Registration
Status of
Practice
Texas
State
License
TEXAS
LICENSE
ISSUED
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/1/2014 None
N/A
9/3/2014 None
8/19/2014 None
N/A
N/A
TX
ACTIVE
ACTIVE
TX
TX
CT
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/17/2013
4/8/2015
9/23/2014
5/24/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
12/28/2012 None
N/A
SHREVEPORT LA
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
11/21/2013 None
12/8/2011 None
23-Mar-16 None
N/A
N/A
N/A
GALVESTON
TX
ACTIVE
3/9/2012 None
N/A
HOUSTON
CORPUS
CHRISTI
TX
ACTIVE
6/3/2014 None
N/A
TX
10/18/2012 None
N/A
GLEN ALLEN
VA
ACTIVE
LICENSE
ISSUED
ACTIVE
4/10/2015 None
2/3/2015 None
N/A
N/A
ACTIVE
1/6/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
2/18/2013 None
4/24/2014 None
N/A
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
23-Feb-16 None
25-Apr-16 None
N/A
N/A
LEESVILLE
ACTIVE
ACTIVE
04-Apr-16 None
8/1/2011 None
N/A
N/A
DALLAS
HOUSTON
LA
License
Number
Q4518
Physician Name
SEWRATHAN-GHOSH, SHERRY,
DO
dicaid
dicaid
Agreement
End Date
Designated)
PHYSICAL MED. &
5/15/2015
P1021
SEZGINIS, ARAL , MD
9/15/2011
P3073
SHADDIX, KYLE KIT, MD
Q1904
P5722
SHAEFFER, ZANE AARON, MD
SHAFIE, EL SHERIF OMAR, MD
9/15/2014
3/1/2013
P3074
SHAFII, ALEXIS EDWARD, MD
5/1/2012
P7205
SHAH, AJITA RAJANIKANT, MD
7/1/2013
Q8633
SHAH, AMITA , MD
01-Jun-16
Q1739
SHAH, ANKIT HARISH, MD
8/29/2014
Q3797
P0494
Q6906
P7704
SHAH, ANKOOR RAJNIKANT, MD
SHAH, ARATHI APURVA, MD
SHAH, ARPITA, MD
SHAH, AVNI ASHOK, DO
4/1/2015
7/15/2011
06-Jan-16
8/15/2013
Q5564
SHAH, BAIJU , MD
8/3/2015
Q4691
SHAH, BHUMIK, MD
6/1/2015
P8814
P5131
P5131
P5131
Q6373
SHAH, DISHANT GIRISH, MD
SHAH, GOPI BIPIN, MD
SHAH, HAIDER RAZA, MD
1/15/2014
12/17/2012
12/17/2012
12/17/2012
10/15/2015
P1696
SHAH, HEMALI , MD
12/15/2011
TM00474 SHAH, HEMANT BHARAT, MD
P3242
SHAH, JAY NARESH, DO
9/15/2011
5/15/2012
5/1/2012
Secondary Specialty
(Self-Designated)
Practice City
BRYAN
Registration
Status of
Practice
Texas
State
License
TX
PAIN
MANAGEMENT/REHA
B MED
PHYSICAL MED. &
EMERGENCY
9/15/2019 MEDICINE
CARDIOVASCULAR
5/1/2017 SURGERY
EMERGENCY
7/1/2018 MEDICINE
PLASTIC &
RECONSTRUCTIVE
01-Jun-21 SURGERY
DIAGNOSTIC LAB
IMMUNOLOGY8/29/2019 INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
AUSTIN
SUGAR LAND
Disciplinary
Status Date
5/19/2015 None
N/A
11/30/2011 None
N/A
5/1/2012 None
N/A
TX
TX
ACTIVE
ACTIVE
9/19/2014 None
3/21/2013 None
N/A
N/A
TX
ACTIVE
5/25/2012 None
N/A
AUSTIN
TX
ACTIVE
7/10/2013 None
N/A
GENERAL SURGERY SAN ANTONIO TX
ACTIVE
15-Jun-16 None
N/A
8/29/2014 None
N/A
4/1/2015
7/20/2011
07-Jan-16
8/29/2013
None
None
None
None
N/A
N/A
N/A
N/A
8/3/2015 None
N/A
6/1/2015 None
N/A
PEDIATRICS
NASHVILLE
NASHVILLE
NASHVILLE
GREENWOOD
TN
TN
TN
IN
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
12/26/2011 None
N/A
MILWAUKEE
WI
ACTIVE
ACTIVE
10/11/2011 None
6/19/2012 None
N/A
N/A
SAN ANTONIO TX
BAYTOWN
TX
AUSTIN
TX
8/3/2020 RADIOLOGY
DIAGNOSTIC
1/15/2019 RADIOLOGY
EMERGENCY
12/15/2016 MEDICINE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
EMERGENCY
MEDICINE
9/15/2016 RADIOLOGY
Page 333 of 402
1/15/2014
12/21/2012
12/21/2012
12/21/2012
10/27/2015
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q1493
SHAH, KESHA DESAI, MD
8/15/2014
P6519
SHAH, MANAN SHIRISHKUMAR, MD
P9955
Q0824
Q5565
P3447
SHAH, MANISH NARENDRA, MD
SHAH, MAULIN , MD
SHAH, MINAL ATUL, MD
SHAH, NAYNA VISHAL, MD
4/15/2014
6/27/2014
8/3/2015
6/1/2012
4/15/2019
6/27/2019
8/3/2020
6/1/2017
Q7470
Q5094
SHAH, NEEL NITIN, MD
SHAH, NEIL NAYAN, MD
04-Mar-16
7/1/2015
Q6984
SHAH, NILAY RAJNIKANT, MD
15-Jan-16
04-Mar-21 NEUROLOGY
PLASTIC &
RECONSTRUCTIVE
15-Jan-21 SURGERY
Q3097
Q3437
SHAH, NIRAV CHANDRAKANT, MD
SHAH, NISH LALIT, MD
Q7961
SHAH, RAJNIL G, MD
15-Apr-16
J6239
SHAH, SAQIB MIAN, MD
3/15/2012
Q5566
SHAH, SHENIL SHRENIK, MD
P4820
P5724
SHAH, SHILPAN SATISH, MD
SHAH, SHREYANSH DINESH, MD
Q5096
SHAH, SHWETA SHILPAN, MD
P9121
SHAH, SOHAIL RASHMI, MD
2/18/2014
Q8634
SHAH, TRUSHIL GAURAV, MD
01-Jun-16
P0791
SHAH, UMANG HASMUKHLAL, MD
8/15/2011
P8537
SHAH, VANDANA MRUGESH, MD
12/6/2013
Q1494
SHAH, VEERAL SHAILESH, MD
8/15/2014
5/1/2013
2/2/2015
3/3/2015
8/15/2019 RADIOLOGY
NEUROLOGICAL
SURGERY
INTERNAL MEDICINE
INTERNAL MEDICINE
FAMILY MEDICINE
2/2/2020 NEUROLOGY
EMERGENCY
15-Apr-21 MEDICINE
EMERGENCY
3/15/2017 MEDICINE
8/3/2015
11/1/2012
3/1/2013
3/1/2018 NEUROLOGY
PEDIATRIC
7/1/2020 NEPHROLOGY
7/1/2015
Secondary Specialty
(Self-Designated)
Practice City
MUSCULOSKELETAL
RADIOLOGY
CHAPEL HILL
ODESSA
PEDIATRIC SURGERY
(NEUROLOGY)
HOUSTON
HOUSTON
HOUSTON
HOSPITALIST
URBANA
VASCULAR
NEUROLOGY
HOUSTON
HOSPITALIST
AUSTIN
BAYTOWN
Registration
Status of
Practice
Texas
State
License
ACTIVE
8/20/2014 None
N/A
TX
ACTIVE
5/17/2013 None
N/A
TX
TX
TX
IL
ACTIVE
ACTIVE
ACTIVE
ACTIVE
4/16/2014
7/4/2014
8/12/2015
6/11/2012
None
None
None
None
N/A
N/A
N/A
N/A
TX
TX
ACTIVE
ACTIVE
07-Mar-16 None
7/15/2015 None
N/A
N/A
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
14-Mar-16 None
N/A
2/2/2015 None
3/13/2015 None
N/A
N/A
ACTIVE
10-May-16 None
N/A
TX
ACTIVE
3/20/2012 None
N/A
8/3/2015 None
N/A
TX
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
11/1/2012 None
3/5/2013 None
N/A
N/A
TX
PEDIATRICS
PULMONARY
01-Jun-21 INTERNAL MEDICINE MEDICINE
DALLAS
TX
INTERVENTIONAL
CARDIOLOGY
SAN ANTONIO TX
PEDIATRIC
NEURO8/15/2019 OPHTHALMOLOGY
OPHTHALMOLOGY
Page 334 of 402
Disciplinary
Status Date
NC
PEDIATRICS
INTERNAL MEDICINE MESQUITE
PULMONARY
CRITICAL CARE
MEDICINE
HEMATOLOGY/ONCO
LOGY
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
7/7/2015 None
N/A
2/18/2014 None
N/A
ACTIVE
06-Jun-16 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/22/2011 None
N/A
12/6/2013 None
N/A
8/15/2014 None
N/A
License
Number
Physician Name
P5132
SHAH, ZAINAB ZAHRA, MD
P5132
P5132
dicaid
dicaid
Agreement
End Date
Designated)
12/17/2012
12/17/2012
12/17/2012
EMERGENCY
6/1/2015
6/1/2020 MEDICINE
Q3593
SHAHANI, LOKESH RAMESH, MD
Q4694
SHAHANI, SAMIR NARESH, MD
Q3962
SHAHDAD, NOVREEN, MD
Q6374
Q0697
10/15/2015
6/16/2014
Q0825
SHAHEEN, EDWARD, MD
SHAHID, HASSAN, MD
SHAHID, MUHAMMAD WASEEM,
MD
Q7273
Q1495
SHAHID, NASAR MAHMOOD, MD
SHAHZAD, REEHAN, MD
16-Feb-16
8/15/2014
P9726
SHAIKH, ADEEL HAFEEZ, MD
P7853
SHAIKH, AISHA , MD
8/30/2013
Q6985
SHAIKH, HARRIS, MD
15-Jan-16
Q6907
SHAIKH, SANA, MD
06-Jan-16
P1022
SHAKER, ADEL, MD
9/15/2011
P5134
SHAKIR, AHMED RAZA, MD
12/17/2012
P5134
12/17/2012
P5134
12/17/2012
ANESTHESIOLOGY 15-Jan-21 PAIN MANAGEMENT
ANESTHESIOLOGY 06-Jan-21 PAIN MANAGEMENT
ANATOMIC
PATHOLOGY & LAB
9/15/2016 MEDICINE
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
NEUROLOGICAL
12/17/2017 SURGERY
P5891
SHAKIR, HUZAIFA ABBAS, MD
3/15/2013
CARDIOVASCULAR
3/15/2018 SURGERY
P3448
SHALHUB, SHERENE, MD
4/10/2015
6/27/2014
4/1/2014
6/1/2012
Secondary Specialty
(Self-Designated)
FAMILY MEDICINE
FAMILY MEDICINE
FAMILY MEDICINE
INFECTIOUS
DISEASES
Practice City
WICHITA
WICHITA
WICHITA
Registration
Status of
Practice
Texas
State
License
KS
ACTIVE
KS
ACTIVE
KS
ACTIVE
HOUSTON
TX
ACTIVE
3/25/2015 None
N/A
PLANO
TX
ACTIVE
6/5/2015 None
N/A
LICENSE
ISSUED
4/10/2015 None
N/A
ACTIVE
ACTIVE
11/3/2015 None
6/19/2014 None
N/A
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
4/10/2020 NEUROLOGY
EMERGENCY
10/15/2020 MEDICINE
6/16/2019 RADIOLOGY
MAMMOGRAPHY
PHYSICAL MED. &
16-Feb-21 REHABILITATION
MONROE
LA
SAN ANTONIO TX
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
12/24/2012 None
N/A
12/24/2012 None
N/A
12/24/2012 None
N/A
INTERNAL MEDICINE FORT MYERS
FL
ACTIVE
7/4/2014 None
N/A
PAIN MEDICINE
TEANECK
NJ
ACTIVE
ACTIVE
23-Feb-16 None
8/25/2014 None
N/A
N/A
OPHTHALMOLOGY
CINCINNATI
OH
ACTIVE
LICENSE
ISSUED
4/11/2014 None
N/A
8/30/2013 None
N/A
INTERNAL MEDICINE FREDERICK
MD
ACTIVE
28-Jan-16 None
N/A
FREDERICK
MD
ACTIVE
04-Feb-16 None
N/A
JACKSON
MS
ACTIVE
9/20/2011 None
N/A
ACTIVE
1/4/2013 None
N/A
ACTIVE
1/4/2013 None
N/A
ACTIVE
1/4/2013 None
N/A
NJ
ACTIVE
3/21/2013 None
N/A
TX
ACTIVE
6/12/2012 None
N/A
FORENSIC
PATHOLOGY
GENERAL VASCULAR
SURGERY
PASSAIC
Page 335 of 402
HOUSTON
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
FAMILY
8/15/2013
8/1/2014
8/1/2019 PEDIATRICS
P7707
Q1300
SHAMA, LEAH KATHERINE, DO
SHAMBAYATI, MARYAM , DO
Q2852
SHAMS, TANZILA, MD
1/5/2015
Q4282
SHAMSA-GRAY, TALA SHILA, DO
5/1/2015
P2786
SHANI, RAJ HARRY, MD
4/2/2012
Q2708
SHANK, JACOB DANIEL, MD
P1406
SHANKER, JASON ANDREW, DO
P8732
P7206
SHANKER, PRADHEEP JOTHI, MD
SHANKER, SHRUTI, DO
12/15/2014
11/4/2011
1/3/2014
7/1/2013
1/5/2020 NEUROLOGY
SHANMUGANATHAN, SUSILA, MD
04-Mar-16
Q0561
SHAPIRO, JORDAN MICHAEL, MD
6/2/2014
G1542
SHAPLEIGH, MARGARET LEIGH,
MD
4/10/2015
P0876
SHAQRA, HUSSEIN ABDO, MD
8/26/2011
4/1/2015
7/15/2013
Q8148
Q1496
Q7963
P2521
SHARARAH, ABDUL-WAHAB
HUSSEIN, MD
SHARDA, ROHIT, MD
SHAREEF, MOHAMMED RASHED,
MD
SHARIF, ZAIN, MD
SHARMA, ADITY, MD
SHARMA, AMIT, MD
P6915
SHARMA, KAMAL PRASAD, MD
Q1905
SHARMA, KAVITA, MD
9/15/2014
Q0698
SHARMA, KUNAL MADHAV, MD
6/16/2014
02-May-16
8/15/2014
15-Apr-16
3/15/2012
6/3/2013
VASCULAR
NEUROLOGY
ORTHOPEDIC
4/2/2017 SURGERY
EMERGENCY
12/15/2019 MEDICINE
EMERGENCY
11/4/2016 MEDICINE
DIAGNOSTIC
1/3/2019 RADIOLOGY
7/1/2018 PEDIATRICS
Q7472
Q3798
P7350
Secondary Specialty
(Self-Designated)
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
02-May-21
8/15/2019
15-Apr-21
3/15/2017
HOSPITALIST
INTERVENTIONAL
CARDIOLOGY
PLASTIC &
RECONSTRUCTIVE
SURGERY
HOSPITALIST
PEDIATRICS
NEONATOLOGY
INTERNAL MEDICINE PAIN MANAGEMENT
NEPHROLOGY
INTERNAL MEDICINE
PEDIATRIC CRITICAL
PEDIATRICS,
PEDIATRICS
EMERGENCY
6/16/2019 MEDICINE
Page 336 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
SAN ANTONIO TX
HOUSTON
TX
ACTIVE
ACTIVE
PLANO
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
8/28/2013 None
8/7/2014 None
N/A
N/A
1/8/2015 None
N/A
5/1/2015 None
N/A
4/2/2012 None
N/A
SAN ANTONIO TX
CORPUS
CHRISTI
TX
ACTIVE
12/18/2014 None
N/A
ACTIVE
11/10/2011 None
N/A
DUBLIN
OH
SAN ANTONIO TX
ACTIVE
ACTIVE
1/15/2014 None
7/12/2013 None
N/A
N/A
LAFAYETTE
LA
ACTIVE
26-Apr-16 None
N/A
HOUSTON
TX
6/25/2014 None
N/A
COLORADO
SPRINGS
CO
ACTIVE
TEXAS
LICENSE
ISSUED
LICENSE
ISSUED
4/10/2015 None
N/A
8/26/2011 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
4/13/2015 None
7/16/2013 None
N/A
N/A
DALLAS
DALLAS
TX
TX
FORT SMITH
HOUSTON
MERIDIAN
AR
TX
ID
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
02-May-16
8/25/2014
03-May-16
3/26/2012
None
None
None
None
N/A
N/A
N/A
N/A
6/7/2013 None
N/A
9/30/2014 None
N/A
6/16/2014 None
N/A
License
Number
Physician Name
Q2199
G7337
Q1497
SHARMA, MANEESH, MD
SHARMA, MANJOO, MD
SHARMA, NEHA, DO
Q3290
Q5568
SHARMA, RAJESH KUMAR, MD
SHARMA, RAM HARI, MD
Q2947
SHARMA, SAMEER, MD
Q0172
SHARMA, SANJAY KUMAR, MD
Q1906
P2522
SHARMA, SHARAD , MD
SHARMA, SUJATA, MD
Q5569
SHARMA, SURESH, MD
P7207
SHARP, LYDIA JANE, MD
P9727
P7854
Q1907
P1593
Q0699
SHARPE, LESLIE MARIE, MD
SHARRIEF, ANJAIL ZARINAH, MD
SHARRON, JENNIFER ANNE, MD
SHASTRI, SHANI, MD
SHAW, ANDREW , MD
P4711
SHAW, CATHRYN JOHNSON, MD
Q3438
SHAW, LISA , MD
P8539
SHAW, THOMAS , MD
Q0363
SHAWI, JOSEPH IBRAHIM, MD
Q7276
SHAY, ANDREW THOMAS, MD
Q7601
SHEAR, WILLIAM SCOVELL, MD
G1543
SHEETS, RANDALL ERNEST, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
6/1/2015
6/1/2020 INTERNAL MEDICINE INTERNAL MEDICINE
8/15/2014
PAIN MANAGEMENT
8/3/2015
8/3/2020 PEDIATRICS
PHYSICAL MED. &
1/15/2015
PAIN MANAGEMENT
EMERGENCY
5/2/2014
5/2/2019 MEDICINE
TRANSPLANT
9/15/2014
3/15/2012
CARDIOVASCULAR
INTERVENTIONAL
8/3/2015
8/3/2020 DISEASES
CARDIOLOGY
NEUROMUSCULAR
7/1/2013
7/1/2018 DISEASE
NEUROLOGY
EMERGENCY
4/1/2014
4/1/2019 MEDICINE
8/30/2013
8/30/2018 NEUROLOGY
9/15/2014
9/15/2019 NEUROLOGY
12/1/2011
INTERNAL MEDICINE
6/16/2014
VASCULAR AND
INTERVENTIONAL
DIAGNOSTIC
10/15/2012
RADIOLOGY
CARDIOTHORACIC
3/3/2015
ANESTHESIOLOGY
PHYSICAL MED. &
12/6/2013
OBSTETRICS &
GYNECOLOGICAL
5/15/2014
5/15/2019 SURGERY
SURGICAL CRITICAL
16-Feb-16
16-Feb-21 GENERAL SURGERY CARE
GASTROENTEROLOG
15-Mar-16
15-Mar-21 Y
INTERNAL MEDICINE
12/6/2013
Page 337 of 402
Practice City
HEMPSTEAD
EL PASO
LAS CRUCES
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
NY
ACTIVE
TX
ACTIVE
LICENSE
ISSUED
NM
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/15/2014 None
6/3/2015 None
8/18/2014 None
N/A
N/A
N/A
2/13/2015 None
8/7/2015 None
N/A
N/A
ACTIVE
1/26/2015 None
N/A
DALLAS
TX
ACTIVE
5/13/2014 None
N/A
GALVESTON
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
9/23/2014 None
3/23/2012 None
N/A
N/A
8/3/2015 None
N/A
7/8/2013 None
N/A
DALLAS
TX
ACTIVE
ABILENE
HOUSTON
TX
TX
DALLAS
HOUSTON
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
DALLAS
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
4/9/2014
9/4/2013
9/30/2014
12/7/2011
6/18/2014
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
10/26/2012 None
N/A
3/6/2015 None
N/A
12/6/2013 None
N/A
LICENSE
ISSUED
5/15/2014 None
N/A
EL PASO
TX
ACTIVE
04-Mar-16 None
N/A
AMARILLO
TX
30-Mar-16 None
N/A
ALTUS
OK
ACTIVE
TEXAS
LICENSE
ISSUED
12/6/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q6282
SHEIKH, EMRAN SALAHUDDIN, MD
10/1/2015
Q7277
SHEIKH, IMRAN, MD
16-Feb-16
Q6705
Q6705
Q6705
P2064
SHEIKH, SAMIA SAJID, MD
SHEIKH, SUFYAN AHMAD, MD
12/4/2015
04-Dec-15
04-Dec-15
2/1/2012
P3583
P7984
SHELLENBERGER, JEFFRY, MD
SHELTON, GEORGE JR, MD
6/8/2012
9/16/2013
TRANSPLANT
12/4/2020 SURGERY
04-Dec-20 NEPHROLOGY
04-Dec-20 NEPHROLOGY
EMERGENCY
6/8/2017 MEDICINE
Q5098
SHELTON, PAULA ANGELICA, MD
7/1/2015
Q1741
SHEMISA, KAMAL O, MD
8/29/2014
Q4519
SHEN, ALFRED CHIEH JEN, MD
5/15/2015
Q4696
SHEN, JEANNE, MD
6/1/2015
P9123
SHEN, JOHNNY , MD
2/18/2014
Q4844
SHEN, MIN, MD
6/12/2015
P9728
SHEN, WEI, MD
4/1/2014
P0496
SHEPARD, DANIEL PAUL, MD
P9729
SHEPHERD, RACHEL, MD
7/15/2011
4/1/2014
NEUROLOGICAL
5/15/2020 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
PLASTIC SURGERY
RUTHERFORD NJ
GASTROENTEROLOG
Y
GARLAND
TX
PAIN MANAGEMENT LOWELL
HOUSTON
RANCHO
MIRAGE
DALLAS
12/4/2015
25-Feb-16
25-Feb-16
2/7/2012
None
None
None
None
N/A
N/A
N/A
N/A
TX
ACTIVE
ACTIVE
6/12/2012 None
12/11/2013 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
7/14/2015 None
N/A
8/29/2014 None
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
6/3/2015 None
N/A
6/1/2015 None
N/A
2/18/2014 None
N/A
6/12/2015 None
N/A
ACTIVE
5/5/2014 None
N/A
ACTIVE
LICENSE
ISSUED
8/2/2011 None
N/A
4/1/2014 None
N/A
CA
TX
SANTA MARIA CA
Q0700
Q2948
SHER, DAVID JONATHAN, MD
1/15/2015
Q5929
SHERIF, ALI M, MD
8/28/2015
Q3964
Q3594
SHERIF, KHALED ALI B, MD
SHERMAN, MARK PHILIP, MD
4/10/2015
3/16/2015
4/10/2020 PALLIATIVE MEDICINE INTERNAL MEDICINE
LUBBOCK
Page 338 of 402
6/16/2014
N/A
SHEPHERD, SUZANNE MARIE, MD
SHEPPARD, FOREST RAYMOND,
MD
11/30/2012
03-May-16 None
IN
IN
MA
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
6/1/2020 PATHOLOGY
ORTHOPEDIC
4/1/2019 SURGERY
OBSTETRICS AND
4/1/2019 GYNECOLOGY
DIAGNOSTIC
Disciplinary
Status Date
N/A
INTERNAL MEDICINE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
10/8/2015 None
SAN ANTONIO TX
MUSCULOSKELETAL
RADIOLOGY
BIRMINGHAM
SURGICAL CRITICAL FORT SAM
HOUSTON
RADIATION
1/15/2020 ONCOLOGY
P5002
Registration
Status of
Practice
Texas
State
License
AL
ACTIVE
12/6/2012 None
N/A
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
6/20/2014 None
N/A
1/15/2015 None
N/A
8/28/2015 None
N/A
4/10/2015 None
3/18/2015 None
N/A
N/A
TX
License
Number
Q5570
Physician Name
SHERMAN, STEPHANIE VIDEKA,
MD
P0673
P1817
dicaid
dicaid
Agreement
End Date
Designated)
8/3/2015
HOSPITALIST
SHERPA, TSERING, MD
8/1/2011
HOSPITALIST
SHERWOOD, SCOT HAMILTON, MD
1/2/2012
1/2/2017 RADIOLOGY
P9730
SHETH, ANJALI BIPIN, MD
Q5930
P9731
SHETH, ARPITA ASHWINBHAI, MD
SHETH, MONISH APURVA, MD
Q4283
SHETH, RAHUL ANIL, MD
Q1302
SHETH, SAMAR SANTOSH, MD
Q7474
Q0174
SHETTY, SHALINI, MD
SHETTY, SHOHAN, MD
4/1/2014
8/28/2015
4/1/2014
INTERVENTIONAL
5/1/2020 RADIOLOGY
5/1/2015
8/1/2014
7/1/2013
8/3/2015
CHILD AND
ADOLESCENT
ORTHOPEDIC
1/5/2020 SURGERY
DIAGNOSTIC
01-Jun-21 RADIOLOGY
RADIATION
7/1/2018 ONCOLOGY
11/15/2011
04-Mar-16
5/2/2014
Q2854
SHEU, CHRISTOPHER , MD
Q8638
SHI, XIAO , MD
P7208
Q5571
SHI, ZHENG, MD
SHIE, MICHAEL M, MD
P1493
SHIFFLETTE, VANESSA KIANA, MD
P9001
SHIH, KAOSWI KARINA, MD
2/7/2014
P0932
SHINDE, ANITA BHAGWAN, MD
9/1/2011
1/5/2015
01-Jun-16
Q2064
SHINER, ERIN KATE, MD
10/1/2014
Q6986
SHINNEMAN, DREW WAYNE, MD
15-Jan-16
Q0175
Q8639
Q1744
P5726
Secondary Specialty
(Self-Designated)
SHIPES, SHERRYL DENISE, DO
SHIRAH, WILLIAM BRADLEY, MD
SHIRAZ, AARON YAMBOR, MD
SHIRLEY, YOUNG SHIL, MD
5/2/2014
01-Jun-16
8/29/2014
3/1/2013
EMERGENCY
15-Jan-21 MEDICINE
5/2/2019
01-Jun-21
8/29/2019
3/1/2018
Practice City
HOUSTON
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
OPHTHALMOLOGY GLAUCOMA
INFECTIOUS
DISEASES
HOSPITALIST
CARDIOVASCULAR
DISEASES
8/4/2015 None
N/A
8/1/2011 None
N/A
1/13/2012 None
N/A
4/8/2014 None
N/A
8/28/2015 None
4/14/2014 None
N/A
N/A
TX
TEMPLE
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
HOUSTON
TX
ACTIVE
5/4/2015 None
N/A
HOUSTON
TX
ACTIVE
8/6/2014 None
N/A
ACTIVE
ACTIVE
11-Mar-16 None
5/12/2014 None
N/A
N/A
ACTIVE
1/28/2015 None
N/A
ACTIVE
13-Jun-16 None
N/A
ACTIVE
ACTIVE
7/2/2013 None
8/4/2015 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
11/24/2011 None
N/A
2/7/2014 None
N/A
9/1/2011 None
N/A
TX
ACTIVE
10/24/2014 None
N/A
DALLAS
TX
26-Jan-16 None
N/A
BIRMINGHAM
DALLAS
EL PASO
AL
TX
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
5/2/2014
10-Jun-16
9/1/2014
3/4/2013
N/A
N/A
N/A
N/A
GALVESTON
PLANO
TX
TX
TRAUMATIC
SURGERY
WICHITA
INTERNAL MEDICINE FALLS
FAMILY PRACTICE
INTERNAL MEDICINE
ANESTHESIOLOGY
Page 339 of 402
Disciplinary
Status Date
HOUSTON
PSYCHIATRY
SPORTS MEDICINE
(ORTH SURG)
Registration
Status Date
Disciplinary
Status of
Texas
License
None
None
None
None
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P2924
SHITTA-BEY, ABIOLA LATIFAT, MD
4/13/2012
P0878
Q2388
Q3802
SHLAMOVITZ, GIL ZVI, MD
SHOIB, BUSHRA, MD
SHOKR, AIMAN, MD
8/26/2011
11/7/2014
4/1/2015
Q4520
P2527
SHOOK, JANICE R, MD
SHORE, BRAD LEON, MD
5/15/2015
3/15/2012
EMERGENCY
8/26/2016 MEDICINE
EMERGENCY
5/15/2020 MEDICINE
Q8350
SHORE, RICHARD WARREN, MD
16-May-16
Q1745
SHORT, NICHOLAS JAMES , MD
8/29/2014
P5237
SHORT, TRACEE C, MD
1/4/2013
Q5572
Q7964
SHOUKAT, SANA, MD
SHOUKIER, MAHRAN, MD
8/3/2015
15-Apr-16
Q1746
Q2389
P7855
SHOUKIH, TAMEEM AHMAD, MD
SHOUKRY, EMAD ESSAM, MD
SHPARAGO, NEAL IRA, DO
8/29/2014
11/7/2014
8/30/2013
H8837
SHREEVE, DANIEL FREDERICK,
MD
8/15/2013
P4712
SHRESTHA, SHREE OM, MD
P0294
SHRIVASTAVA, ANJU , MD
10/15/2012
7/1/2011
Q1304
SHROFF, JENNIFER , MD
8/1/2014
Q1908
SHROFF, SHEETAL , MD
9/15/2014
Q3439
SHROLL, JOSHUA TIMOTHY, MD
Q1747
SHTERN, MARINA, MD
3/3/2015
8/29/2014
CHILD AND
ADOLESCENT
Secondary Specialty
(Self-Designated)
HOSPITALIST
Registration
Status of
Practice
Texas
Practice City
State
License
LICENSE
ISSUED
LICENSE
ISSUED
FORT WORTH TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
SAN MARCOS TX
HEMATOLOGY/ONCO
LOGY
COSMETIC SURGERY
PALLIATIVE
MEDICINE
GALAX
VA
PEDIATRIC
EMERGENCY
MEDICINE (PEDS)
GERIATRICS
FORT WORTH TX
TX
PSYCHIATRY
CHILD AND
ADOLESCENT
PSYCHIATRY
GEORGETOW
N
TX
WINDSOR
MO
NEUROMUSCULAR
9/15/2019 DISEASE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
GASTROENTEROLOG
Y
HOUSTON
TX
ACTIVE
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ANESTHESIOLOGY
Page 340 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/13/2012 None
N/A
8/26/2011 None
11/11/2014 None
4/7/2015 None
N/A
N/A
N/A
5/20/2015 None
4/11/2012 None
N/A
N/A
17-May-16 None
N/A
8/29/2014 None
N/A
1/4/2013 None
N/A
8/5/2015 None
26-Apr-16 None
N/A
N/A
8/29/2014 None
11/10/2014 None
9/4/2013 None
N/A
N/A
N/A
8/19/2013 None
N/A
10/22/2012 None
N/A
7/1/2011 None
N/A
8/7/2014 None
N/A
10/10/2014 None
N/A
3/3/2015 None
N/A
8/29/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P4713
P4714
SHUHATOVICH, YEVGENY, DO
SHULMAN, JOSHUA M, MD
10/15/2012
10/15/2012
P7351
SHUM, JONATHAN, MD
7/15/2013
P1407
SHUMWAY, PRESTON WAYNE, DO
11/4/2011
Q3966
SHUPE, PAUL GREGORY, MD
4/10/2015
ORAL &
MAXILLOFACIAL
7/15/2018 SURGERY
Secondary Specialty
(Self-Designated)
Practice City
GENERAL SURGERY
NEUROLOGY
HOUSTON
HEAD AND NECK
SURGERY
OSTEO
MANIPULATIVE
MEDICINE
EMERGENCY
11/4/2016 MEDICINE
ORTHOPEDIC
4/10/2020 SURGERY
CARDIOVASCULAR
DISEASES
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
ACTIVE
10/29/2012 None
10/31/2012 None
N/A
N/A
TX
ACTIVE
8/6/2013 None
N/A
KALAMAZOO MI
JACKSONVILL
E
FL
ACTIVE
11/30/2011 None
N/A
ACTIVE
4/13/2015 None
N/A
LUBBOCK
ACTIVE
LICENSE
ISSUED
6/18/2014 None
N/A
12/17/2012 None
N/A
HOUSTON
Q0702
SHURMUR, SCOTT WEBSTER, MD
6/16/2014
P5135
SIA, JOHN PATRICK AGUILAR, MD
12/17/2012
INTERNAL MEDICINE
P5135
12/17/2012
NE
ACTIVE
1/31/2013 None
N/A
P5135
12/17/2012
NE
ACTIVE
1/31/2013 None
N/A
P9256
SICILIANO, GENINE , MD
EMERGENCY
3/3/2019 MEDICINE
ACTIVE
3/21/2014 None
N/A
ACTIVE
ACTIVE
10/9/2014 None
10/3/2013 None
N/A
N/A
FORT WORTH TX
POPLAR
BLUFF
MO
ACTIVE
11/18/2015 None
N/A
ACTIVE
3/17/2015 None
N/A
IRVING
ACTIVE
5/4/2012 None
N/A
12/15/2014 None
N/A
Q2065
P8079
SIDANI, MOHAMAD ANIS, MD
SIDDIG, SOUZAN, MD
3/3/2014
10/1/2014
10/1/2013
NEUROLOGICAL
11/2/2020 SURGERY
Q6468
SIDDIQ, FARHAN, MD
11/2/2015
Q3596
SIDDIQI, ASMAT QAYOOM, MD
3/16/2015
P3076
SIDDIQI, NAUMAN, MD
Q2709
SIDDIQUE, AWAIS HUSSAIN, MD
P6084
SIDDIQUE, KHURRUM , MD
P1594
SIDDIQUE, MUHAMMAD ASIM, MD
5/1/2012
12/15/2014
4/1/2013
12/1/2011
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
ENDOVASCULAR
SURGICAL
NEURORADIOLOGY
CARDIOVASCULAR
5/1/2017 DISEASES
DIAGNOSTIC
PEDIATRIC
4/1/2018 NEPHROLOGY
PULMONARY
CRITICAL CARE
12/1/2016 MEDICINE
INTERVENTIONAL
CARDIOLOGY
VASCULAR AND
INTERVENTIONAL
RADIOLOGY
HOUSTON
AMARILLO
TX
TX
TX
TX
LICENSE
ISSUED
PEDIATRICS
DALLAS
TX
ACTIVE
4/5/2013 None
N/A
SLEEP MEDICINE
HOUSTON
TX
ACTIVE
12/20/2011 None
N/A
Page 341 of 402
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
P7035
P6723
SIDDIQUE, MUHAMMAD TALAL, MD
SIDDIQUE, QAZI ASIF, MD
6/14/2013
5/15/2013
P8540
SIDDIQUI, ATIF SALEEM, MD
12/6/2013
Q6572
Q7476
SIDDIQUI, BAZGHA, MD
SIDDIQUI, BEENISH , MD
11/16/2015
04-Mar-16
P6273
SIDDIQUI, KIRAN F, MD
4/12/2013
CHILD AND
ADOLESCENT
P9960
SIDDIQUI, SAMINA, MD
4/15/2014
P6523
P8080
P2366
SIDDIQUI, UMAIR MAHMOOD, MD
SIDDIQUIE, AMBREEN S, MD
SIDHU, NAVNEET, MD
5/1/2013
10/1/2013
3/1/2012
P8541
SIDRANSKY, ARTURO, MD
12/6/2013
Q8352
SIDRANSKY, MOISES ADRIAN, MD
16-May-16
P5136
SIDWANI-CHAWLA, SEEMA LAKHO,
DO
12/17/2012
P5136
DO
12/17/2012
P5136
P9736
DO
SIEGEL, AMY BETH, MD
12/17/2012
4/1/2014
Q3291
Q7793
SIELING, JESSICA L, DO
SIEM, HENRY IGNATIUS, MD
2/13/2015
01-Apr-16
Q0364
SIEW, ISAAC, MD
5/15/2014
P4613
SIFUENTES-DOMINGUEZ, LUIS
FERNANDO, MD
10/1/2012
E6917
SIGMAN, ROBERT KARL, MD
10/17/2011
Secondary Specialty
(Self-Designated)
Practice City
LUBBOCK
INTERNAL MEDICINE HARLINGEN
PALLIATIVE
MEDICINE
CARLSBAD
INFECTIOUS
DISEASES
Registration
Status of
Practice
Texas
State
License
TX
TX
ACTIVE
ACTIVE
NM
ACTIVE
LICENSE
ISSUED
ACTIVE
Disciplinary
Status Date
7/10/2013 None
5/23/2013 None
N/A
N/A
12/16/2013 None
N/A
11/16/2015 None
14-Mar-16 None
N/A
N/A
4/12/2013 None
N/A
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
ACTIVE
4/15/2014 None
N/A
5/1/2013 None
10/23/2013 None
3/5/2012 None
N/A
N/A
N/A
ACTIVE
12/12/2013 None
N/A
TX
ACTIVE
23-May-16 None
N/A
ROUND ROCK TX
ACTIVE
12/28/2012 None
N/A
ROUND ROCK TX
ACTIVE
12/28/2012 None
N/A
ROUND ROCK TX
ACTIVE
ACTIVE
12/28/2012 None
4/7/2014 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
2/19/2015 None
05-Apr-16 None
N/A
N/A
5/15/2014 None
N/A
TX
ACTIVE
10/2/2012 None
N/A
FORT WORTH TX
ACTIVE
10/28/2011 None
N/A
PSYCHIATRY
GASTROENTEROLOG
5/1/2018 Y
INTERNAL MEDICINE
EMERGENCY
12/6/2018 MEDICINE
ANESTHESIOLOGY 16-May-21 PAIN MANAGEMENT
ANESTHESIOLOGY
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
ENDOCRINOLOGY,
DIABETES AND
EMERGENCY
2/13/2020 MEDICINE
EMERGENCY
5/15/2019 MEDICINE
PEDIATRIC
GASTROENTEROLOG
Y
OBSTETRICS AND
MATERNAL AND
FETAL MEDICINE
Page 342 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
TYLER
TYLER
UPLAND
DALLAS
TX
PA
License
Number
P8733
P6525
Q5574
Q6469
Physician Name
SIKES, AMY RICHELLE, MD
SIKKA, SEEMA, MD
SILVA, DHIEKSON MELQUISEDEK,
MD
SILVA, ERICA CLAUDETTE, MD
TM00577 SILVA, KATRINA SHEA, DO
dicaid
dicaid
Agreement
End Date
Designated)
1/3/2014
5/1/2013
8/3/2015
11/2/2015
4/15/2014
PHYSICAL MED. &
SPINAL CORD
INJURY MEDICINE
DIAGNOSTIC
4/15/2019 RADIOLOGY
SILVA, NAOMI NICOLE, MD
8/15/2014
8/15/2019 RADIOLOGY
Q3968
SILVER, NATALIE , MD
4/10/2015
SIM, BICH THUY THI, MD
4/1/2015
P8621
SIMAS, GILBERT MANUEL, MD
Q2066
P5728
SIMHADRI, PRATHAP KUMAR, MD
SIMHAN, JAY, MD
10/1/2014
3/1/2013
Q2621
P2529
P2367
SIMIEN, MELVIN PAUL, MD
SIMON, CYRIL MAKIL, DO
SIMON, GEORGE RAJAN, MD
12/3/2014
3/15/2012
3/1/2012
P1227
SIMON, PATRICK MICHAEL, MD
Q3103
SIMON, SILVI MARY, MD
12/16/2013
10/17/2011
2/2/2015
Q7602
SIMONE, VALERIA, MD
15-Mar-16
Q1305
Q6376
Q0564
SIMPSON, ANDREW KYLE, MD
SIMPSON, ERIC, DO
SIMPSON, ISAC PHIL, DO
8/1/2014
10/15/2015
6/2/2014
P8191
SIMPSON, MICHAEL PATRICK, MD
10/15/2013
P7708
SIMS, AMY ELIZABETH, MD
8/15/2013
Practice City
INFECTIOUS
DISEASES
ADDICTION
MEDICINE
3/1/2018 UROLOGY
GASTROENTEROLOG
12/3/2019 Y
INTERNAL MEDICINE
3/1/2017 ONCOLOGY
INTERNAL MEDICINE
ORTHOPEDIC
10/17/2016 SURGERY
ORTHOPEDIC
SURGERY OF THE
8/1/2019 SPINE
DERMATOLOGY
EMERGENCY
10/15/2018 MEDICINE
PEDIATRICS,
Page 343 of 402
Disciplinary
Status Date
1/3/2014 None
N/A
OH
ACTIVE
5/8/2013 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/4/2015 None
11/10/2015 None
N/A
N/A
PHOENIX
AZ
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
4/22/2014 None
N/A
8/15/2014 None
N/A
4/10/2015 None
N/A
4/3/2015 None
N/A
12/16/2013 None
N/A
10/1/2014 None
3/11/2013 None
N/A
N/A
PROVIDENCE RI
DALLAS
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
ACTIVE
GALVESTON
ODESSA
HOUSTON
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
12/22/2014 None
3/22/2012 None
3/7/2012 None
N/A
N/A
N/A
ACTIVE
LICENSE
ISSUED
10/24/2011 None
N/A
2/2/2015 None
N/A
SAN ANTONIO TX
2/2/2020 NEPHROLOGY
ABDOMINAL
SURGERY
Registration
Status Date
Disciplinary
Status of
Texas
License
CLEVELAND
PEDIATRIC
RADIOLOGY
Q1499
Q3804
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
NEW YORK
NY
ACTIVE
17-Mar-16 None
N/A
PLANO
TX
SAN ANTONIO TX
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
8/12/2014 None
10/27/2015 None
6/11/2014 None
N/A
N/A
N/A
FORT HOOD
TX
ACTIVE
10/31/2013 None
N/A
HOUSTON
TX
ACTIVE
8/16/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
K2593
SIMS, JOSEPH ANTHONY, DO
12/6/2013
Q8353
P7352
SING, ALAN CHIN-PAO, MD
SINGEETHAM, SARITA D, MD
16-May-16
7/15/2013
L7189
SINGH, ANURAG, MD
02-May-16
Q0365
SINGH, GURPREET , MD
P1228
SINGH, HARBIR , MD
Q3442
SINGH, HARINDER RAJINDER, MD
P0296
Q0565
P0498
Q3104
SINGH, KRISHNA ANJALI, MD
SINGH, MANDEEP , MD
SINGH, MANISH, MD
SINGH, MANU P, MD
7/1/2011
6/2/2014
7/15/2011
2/2/2015
PEDIATRICS,
CARDIAC
ELECTROPHYSIOLOG
02-May-21 Y
ORTHOPEDIC
5/15/2019 SURGERY
EMERGENCY
10/17/2016 MEDICINE
PEDIATRICS,
3/3/2020 CARDIOLOGY
ORTHOPEDIC
7/1/2016 SURGERY
Q8641
SINGH, PRABHAT, MD
01-Jun-16
Q6108
SINGH, RAHULKUMAR GULAB, MD
9/15/2015
P9002
SINGH, RAJ PAL, MD
2/7/2014
Q5575
SINGH, STEVE KELVIN, MD
8/3/2015
5/15/2014
10/17/2011
3/3/2015
Q2493
K7481
SINGH, SUKHJINDER PAL, MD
SINGH, SVETA, DO
11/17/2014
9/1/2011
Q6284
Q4697
SINGH, VISHNU SHRIDATH, MD
SINGHAL, MANISH, MD
10/1/2015
6/1/2015
Q0366
SINGHAL, SHASHIDEEP, MD
5/15/2014
P7353
SINGLETON, TERRELL ANN, MD
7/15/2013
Q1023
SINHA, NEHA , MD
7/15/2014
Secondary Specialty
(Self-Designated)
CARDIOLOGY
Registration
Status of
Practice
Texas
Practice City
State
License
TEXAS
LICENSE
MURRYSVILLE PA
ISSUED
Disciplinary
Status Date
12/6/2013 None
N/A
DALLAS
DALLAS
TX
TX
ACTIVE
ACTIVE
18-May-16 None
7/17/2013 None
N/A
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
16-May-16 None
N/A
5/15/2014 None
N/A
TX
ACTIVE
10/24/2011 None
N/A
SAN ANTONIO TX
ACTIVE
3/9/2015 None
N/A
DALLAS
ELECTROPHYSIOLO
GY
Registration
Status Date
Disciplinary
Status of
Texas
License
DALLAS
MCALLEN
AMARILLO
CORPUS
CHRISTI
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
7/11/2011
6/4/2014
8/16/2011
2/4/2015
None
None
None
None
N/A
N/A
N/A
N/A
TX
ACTIVE
21-Jun-16 None
N/A
CLEBURNE
TX
9/22/2015 None
N/A
CARDIOVASCULAR
8/3/2020 SURGERY
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
2/7/2014 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
8/12/2015 None
N/A
11/17/2014 None
11/30/2011 None
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
10/26/2015 None
6/3/2015 None
N/A
N/A
5/15/2014 None
N/A
ACTIVE
LICENSE
ISSUED
7/17/2013 None
N/A
7/15/2014 None
N/A
NEPHROLOGY
NEPHROLOGY
PEDIATRIC
RADIOLOGY
GASTROENTEROLOG
5/15/2019 Y
INTERNAL MEDICINE
DIAGNOSTIC
7/15/2019 BREAST IMAGING
RADIOLOGY
Page 344 of 402
SAN ANTONIO TX
SPOKANE
VALLEY
WA
MANOR
TX
License
Number
Physician Name
P8192
SINHA, SUMAN KUMAR, MD
Q3105
SIO, TERENCE TAI WENG, MD
Q7966
Q8642
SIROPAIDES, CAITLIN HOLT, DO
SIRUCEK, JOSH KENNETH, DO
Q3106
SISAY, EMNET, MD
Q2950
SISNEROS, SILVER CREE, DO
Q1749
P4716
Q6288
P1818
SISON, EDWARD ALLAN RACELA,
MD
SISTA, SATHYADEVI
RAJYALAKSHMI, MD
SIVARAMAN, PADMAPRIYA, MD
SIVASANKAR, CHITRA, MD
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PULMONARY
CRITICAL CARE
10/15/2013
10/15/2018 MEDICINE
MEDICINE
RADIATION
2/2/2015
2/2/2020 ONCOLOGY
15-Apr-16
01-Jun-16
2/2/2015
1/15/2015
8/29/2014
10/15/2012
10/1/2015
1/2/2012
Q1909
SKABELUND, ANDREW J, MD
9/15/2014
P1142
SKAPEK, STEPHEN XAVIER, MD
10/3/2011
P3669
SKEENS, JOSEPH LESLIE, MD
6/15/2012
P6088
P9964
SKEFOS, CHRYSTAN MARIA, MD
SKELTON, FELICIA MICHELLE
LYNN, MD
P1698
SKINNER, HEATH DEVIN, MD
Q3107
SKULPOONKITTI, BRYAN , DO
Q5279
SLATER, ROBERT THOMAS III, MD
7/15/2015
Q4521
SLOANE, PETER JEFFREY, MD
5/15/2015
TM00454 SLOVES, JAMES HOWARD, MD
7/1/2011
4/1/2013
4/15/2014
12/15/2011
2/2/2015
TEXARKANA
Registration
Status of
Practice
Texas
State
License
LICENSE
TX
ISSUED
ROCHESTER
MN
TX
TX
Practice City
15-Apr-21 PALLIATIVE MEDICINE INTERNAL MEDICINE DALLAS
BRYAN
INFECTIOUS
2/2/2020 DISEASES
INTERNAL MEDICINE
PEDIATRIC
PEDIATRIC
HEMATOLOGY/ONCOL
8/29/2019 OGY
10/1/2020 INTERNAL MEDICINE RHEUMATOLOGY
PULMONARY
CRITICAL CARE
9/15/2019 MEDICINE
INTERNAL MEDICINE
PEDIATRIC
HEMATOLOGY/ONCOL
10/3/2016 OGY
INTERVENTIONAL
6/15/2017 RADIOLOGY
RADIOLOGY
EMERGENCY
4/1/2018 MEDICINE
SPINAL CORD INJURY
4/15/2019 MEDICINE
RADIATION
12/15/2016 ONCOLOGY
PULMONARY
CRITICAL CARE
5/15/2020 MEDICINE
DIAGNOSTIC
7/1/2016 RADIOLOGY
Page 345 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
10/15/2013 None
N/A
ACTIVE
2/11/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
18-Apr-16 None
07-Jun-16 None
N/A
N/A
2/2/2015 None
N/A
1/15/2015 None
N/A
8/29/2014 None
N/A
1/9/2013 None
10/16/2015 None
1/9/2012 None
N/A
N/A
N/A
9/29/2014 None
N/A
10/11/2011 None
N/A
6/15/2012 None
N/A
LICENSE
ISSUED
SUGARLAND
TX
SAYRE
PA
ACTIVE
ACTIVE
ACTIVE
FT SAM
HOUSTON
TX
ACTIVE
DALLAS
TX
ACTIVE
LICENSE
ISSUED
KATY
TX
ACTIVE
4/17/2013 None
N/A
HOUSTON
TX
ACTIVE
5/7/2014 None
N/A
HOUSTON
TX
ACTIVE
12/22/2011 None
N/A
ACTIVE
2/9/2015 None
N/A
SUGAR LAND
TX
ACTIVE
7/22/2015 None
N/A
RESTON
VA
ACTIVE
5/28/2015 None
N/A
EDEN PRAIRIE MN
ACTIVE
8/11/2011 None
N/A
License
Number
Q2391
Physician Name
SMALLWOOD, SHARON CUTLER,
MD
P5004
dicaid
dicaid
Agreement
End Date
Designated)
11/7/2014
SMELTER, PAUL JOHN, MD
11/30/2012
P8542
P9004
P7709
SMITH, ADRIAN MZEE, MD
SMITH, BRETT EVAN, DO
SMITH, CAMERON , MD
12/6/2013
2/7/2014
8/15/2013
NEUROLOGICAL
12/6/2018 SURGERY
2/7/2019 PSYCHIATRY
8/15/2018 RADIOLOGY
Q8355
P7710
SMITH, CHRISTINA BEATRICE, MD
SMITH, CODY WILLIAM DUNBAR,
MD
Q1501
SMITH, DANIEL TIMOTHY, MD
Q8356
SMITH, DOUGLAS ALEXANDER, DO
16-May-16
P1229
SMITH, DUSTIN RICKY, MD
10/17/2011
16-May-16
8/15/2013
8/15/2014
Practice City
TULSA
OK
SPRINGFIELD IL
8/15/2013 None
N/A
ACTIVE
9/1/2014 None
N/A
TX
ACTIVE
18-May-16 None
N/A
DALLAS
TX
ACTIVE
11/16/2011 None
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
1/26/2012 None
N/A
8/15/2014 None
N/A
5/15/2014 None
N/A
4/15/2014 None
N/A
TX
ORTHOPEDIC
16-May-21 TRAUMA
EMERGENCY
10/17/2016 MEDICINE
HOUSTON
TX
GRAPEVINE
Q1502
SMITH, GEORGE DRENNAN II, MD
8/15/2014
Q0367
SMITH, GRACE , MD
5/15/2014
8/15/2019 PATHOLOGY
RADIATION
5/15/2019 ONCOLOGY
P9965
SMITH, JAMES CHRISTOPHER, MD
4/15/2014
Q7967
SMITH, JASON GREGORY, MD
15-Apr-16
4/15/2019 RADIOLOGY
DIAGNOSTIC
15-Apr-21 RADIOLOGY
P8082
SMITH, JEANENE GABRIEL, MD
10/1/2013
Q8794
SMITH, JODY LEEANN, MD
10-Jun-16
Q3805
SMITH, JORDAN SHELBY, MD
4/1/2015
P5731
SMITH, JOY MONICA, MD
3/1/2013
P2532
SMITH, LAUREN QUIRK, MD
NEURO-RADIOLOGY
TRAUMATIC
10-Jun-21 GENERAL SURGERY SURGERY
EMERGENCY
EMERGENCY
4/1/2020 MEDICINE
MEDICINE
OBSTETRICS AND
3/1/2018 GYNECOLOGY
OBSTETRICS AND
Page 346 of 402
12/3/2012
N/A
HOUSTON
1/17/2012
N/A
18-May-16 None
EMERGENCY
8/15/2018 MEDICINE
PEDIATRICS
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
11/14/2014 None
SEE
PREVIOUS
12/10/2012 ORDER
Disciplinary
Status Date
N/A
N/A
N/A
TX
TX
SMITH, EBONI MIKELLE, MD
SLEEP MEDICINE
ACTIVE
Registration
Status Date
Disciplinary
Status of
Texas
License
12/6/2013 None
2/26/2014 None
8/19/2013 None
EL PASO
TEMPLE
P1927
3/15/2012
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
ACTIVE
LICENSE
ISSUED
DALLAS
TX
ACTIVE
20-Jun-16 None
N/A
HOUSTON
TX
ACTIVE
N/A
EL PASO
TX
LICENSE
ISSUED
10/4/2013 None
SEE
PREVIOUS
10-Jun-16 ORDER
AUSTIN
TX
ACTIVE
4/3/2015 None
N/A
DALLAS
TX
ACTIVE
3/20/2013 None
N/A
TEMPLE
TX
ACTIVE
3/20/2012 None
N/A
8/24/2015
License
Number
Q5281
Physician Name
SMITH, MATTHEW KEITH, MD
dicaid
dicaid
Agreement
End Date
Designated)
EMERGENCY
7/15/2015
7/15/2020 MEDICINE
DALLAS
DALLAS
ALPHARETTA
TYLER
AUSTIN
IRVING
GA
TX
TX
TX
HEMATOLOGY/ONCO
LOGY
SMITH, MELODY , MD
SMITH, NATALIE MARIE, MD
SMITH, PAUL JOSEPH, MD
P4718
Q2710
P4615
P7572
SMITH, ROBERT STEPHEN, MD
SMITH, STEVEN SCOTT, MD
SMITH, TODD BENEDICT, MD
SMITH, WILLIAM ALFRED JR, MD
P3454
SMYTH, MICHAEL HENRY, MD
P1410
SNIEGOWSKI, MATTHEW
CONRAD, MD
Q4699
SNOW, JENNIFER ANNA LEE, DO
P8311
SNOWISE, SAUL , MD
Q4289
SO, CONNIE CARMEN, MD
Q2204
P0500
SO, RAYMOND LIM, MD
SOBAMOWO, HEZEKIAH
OLUWAROTIMI, MD
SOBANDE, PATRICK OLAMIDOTUN,
MD
P2066
SOBREVILLA, JOSE RICARDO, MD
2/1/2012
HOSPITALIST
P9738
SOBTI, DEEPAK, MD
4/1/2014
OPHTHALMOLOGY RECONST SURGERY
J5485
SOFINSKI, SANDRA JEAN, MD
3/1/2012
Q7795
SOHAIL, UMAIR, MD
01-Apr-16
ANTERIOR SURGERY MONTCLAIR
GASTROENTEROLOG
01-Apr-21 Y
INTERNAL MEDICINE
Q4846
SOHN, JEONG-HYEON, MD
6/12/2015
10/15/2012
12/15/2014
10/1/2012
8/1/2013
ANATOMIC/CLINICAL
Practice City
P3244
P7571
P6526
P1595
5/15/2012
8/1/2013
5/1/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
LICENSE
ISSUED
TX
ACTIVE
TX
ACTIVE
6/1/2012
11/4/2011
6/1/2015
11/1/2013
5/1/2015
10/15/2014
12/1/2011
7/15/2011
Disciplinary
Status Date
7/15/2015 None
N/A
5/15/2012 None
8/5/2013 None
5/6/2013 None
N/A
N/A
N/A
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
10/19/2012
12/16/2014
10/15/2012
8/27/2013
6/1/2012 None
N/A
TX
ACTIVE
11/15/2011 None
N/A
GENERAL SURGERY FORT WORTH TX
ACTIVE
6/3/2015 None
N/A
OBSTETRICS
HOUSTON
MUSCULOSKELETAL
RADIOLOGY
TEMPLE
TX
ACTIVE
11/6/2013 None
N/A
TX
ACTIVE
5/11/2015 None
N/A
MANCHESTER NH
NEW
ORLEANS
LA
ACTIVE
10/21/2014 None
N/A
2/6/2012 None
N/A
7/15/2011 None
N/A
ACTIVE
2/6/2012 None
N/A
ACTIVE
4/7/2014 None
N/A
ACTIVE
3/7/2012 None
N/A
ACTIVE
29-Apr-16 None
N/A
ACTIVE
6/15/2015 None
N/A
OBSTETRICS AND
GYNECOLOGY
MATERNAL AND
DIAGNOSTIC
5/1/2020 RADIOLOGY
Registration
Status Date
Disciplinary
Status of
Texas
License
PEDIATRIC
MCALLEN
TX
CA
OPHTHALMOLOGY VITREOUS SURGERY SAN ANTONIO TX
Page 347 of 402
ACTIVE
LICENSE
ISSUED
License
Number
P2369
Physician Name
SOKUNBI, ABIMBOLA OLAYINKA,
MD
dicaid
dicaid
Agreement
End Date
Designated)
3/1/2012
Q3110
SOLA, PATRICK GEORGE, MD
2/2/2015
P7210
7/1/2013
Q0178
Q5723
SOLANO, ROY, MD
SOLER ALFONSO, CLAUDIA
ROCIO, MD
SOLER, CARLA LANETTE, MD
5/2/2014
8/14/2015
P8544
SOLIMAN, MOHAMED, MD
12/6/2013
Q3806
Q8154
P7988
Q7112
Q3807
SOLIMAN, SAMEER, MD
SOLIZ, PATRICIA ELENA, MD
SOLOMON, BRETT DAVID, MD
SOLOMON, ERIC STEPHEN, MD
SOLOMON, KRISSEDA SHANTAI,
MD
P3587
SOLOMON, MATTHIAS, MD
P1231
SOMA, VIKAS REDDY, MD
P3078
P9462
SOMAIAH, NEETA, MD
SOMAN, JANICE GEORGE, DO
P9260
SOMANI, RAHUL, MD
P1023
SOMAYAZULA, RAVI KIRAN, DO
9/15/2011
P1411
SOMMERS, ROSS, MD
11/4/2011
Q6988
Q5931
SOMOGYI, MARIE BRENNER, MD
SOMURI, SASIDHAR, MD
15-Jan-16
8/28/2015
P2370
SON, COLIN TOWNES, MD
3/1/2012
Q4293
SONAIKE, EMMANUEL O, MD
5/1/2015
4/1/2015
02-May-16
9/16/2013
01-Feb-16
4/1/2015
6/8/2012
10/17/2011
5/1/2012
3/17/2014
3/3/2014
Secondary Specialty
(Self-Designated)
Disciplinary
Status Date
TX
ACTIVE
3/6/2012 None
N/A
TUCSON
AZ
ACTIVE
2/5/2015 None
N/A
DALLAS
TX
7/25/2013 None
N/A
LUBBOCK
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
5/2/2014 None
8/17/2015 None
N/A
N/A
OPHTHALMOLOGY
GALVESTON
TX
ACTIVE
12/12/2013 None
N/A
ANESTHESIOLOGY
SAN ANTONIO TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
4/13/2015
09-May-16
10/30/2013
08-Feb-16
None
None
None
None
N/A
N/A
N/A
N/A
4/1/2015 None
N/A
5/2/2019 PEDIATRICS
PEDIATRIC
EMERGENCY
4/1/2020 MEDICINE
GENETICS
CARDIOVASCULAR
10/17/2016 DISEASES
HEMATOLOGY/ONCOL
5/1/2017 OGY
DIAGNOSTIC
3/3/2019 RADIOLOGY
GENERAL SURGERY DULUTH
INTERVENTIONAL
CARDIOLOGY
URBANAI
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
CHILD AND
ADOLESCENT
PSYCHIATRY
2/2/2020 PSYCHIATRY
EMERGENCY
7/1/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
HOUSTON
TX
MN
ACTIVE
6/20/2012 None
N/A
IL
ACTIVE
11/16/2011 None
N/A
INTERNAL MEDICINE CHARLESTON SC
TULSA
OK
INTERVENTIONAL
RADIOLOGY
HOUSTON
TX
ACTIVE
ACTIVE
5/10/2012 None
4/17/2014 None
N/A
N/A
ACTIVE
3/24/2014 None
N/A
GENERAL SURGERY SUGARLAND
ACTIVE
9/22/2011 None
N/A
LICENSE
ISSUED
11/4/2011 None
N/A
TX
IL
ACTIVE
ACTIVE
18-Jan-16 None
8/31/2015 None
N/A
N/A
SAN ANTONIO TX
ACTIVE
3/20/2012 None
N/A
WASHINGTON DC
ACTIVE
5/4/2015 None
N/A
OPHTHALMOLOGY 15-Jan-21 RECONST SURGERY
NEUROLOGICAL
3/1/2017 SURGERY
CRITICAL CARE
5/1/2020 GENERAL SURGERY (SURGERY)
Page 348 of 402
AUSTIN
SILVIS
TX
License
Number
Physician Name
P9261
Q2207
SONG, CHERRY , DO
SONG, KIM-ANH NGUYEN, MD
Q4527
P9967
dicaid
dicaid
Agreement
End Date
Designated)
Secondary Specialty
(Self-Designated)
Practice City
SURGICAL CRITICAL
CARE
GALVESTON
NUTRITION
CLINICAL
PATHOLOGY
DALLAS
LAWTON
FARMINGTON
3/3/2014
10/15/2014
SONG, LIPING , MD
SONG, YEON, MD
5/15/2015
4/15/2014
5/15/2020 PATHOLOGY
Q5101
P9968
SONI, SACHIN JYOTISH, MD
SONI, SACHIN, MD
7/1/2015
4/15/2014
Q0179
P9740
SONI, SAMIT DILIP, MD
SOOD, AJAY , MD
P2927
SORAJJA, DAN, MD
P2790
SORENSEN, BRIAN SHAW, MD
K6339
Q4294
Q7797
8/26/2011
5/1/2015
01-Apr-16
Q7481
SORIA, DAVID MICHAEL, MD
SORIANO, JASON, MD
SOROKIN, IGOR, MD
SORRA, ENDEL ALEKSANDER II,
MD
5/2/2019 UROLOGY
4/1/2019 NEUROLOGY
CARDIAC
ELECTROPHYSIOLOG
4/13/2017 Y
CARDIOLOGY
EMERGENCY
4/2/2017 MEDICINE
EMERGENCY
8/26/2016 MEDICINE
5/1/2020 NEUROLOGY
01-Apr-21 UROLOGY
04-Mar-16
04-Mar-21 RADIOLOGY
Q2068
SORRELL, APRIL DEON, MD
10/1/2014
P3079
SORRENTINO, DAVID ALAN, DO
EMERGENCY
5/1/2017 MEDICINE
5/2/2014
4/1/2014
4/13/2012
4/2/2012
5/1/2012
Q1753
P0675
P3670
SOS, MELISSA ANN , MD
SOSA PEREZ, SUALY , MD
SOSA, JACQUELINE QUINN, MD
8/29/2014
8/1/2011
6/15/2012
P7355
Q4295
SOTO, ELEAZAR EDUARDO, MD
SOTO, JULIE LINDEN, MD
7/15/2013
5/1/2015
P8545
SOUMAKIEH, MOHAMED F, MD
12/6/2013
Q6709
SOURIAL, SOURIAL MORRIS, DO
12/4/2015
Q6709
04-Dec-15
OBSTETRICS AND
Registration
Status of
Practice
Texas
State
License
TX
TX
OK
NM
Disciplinary
Status Date
ACTIVE
ACTIVE
3/4/2014 None
10/21/2014 None
N/A
N/A
ACTIVE
ACTIVE
5/25/2015 None
4/28/2014 None
N/A
N/A
7/2/2015 None
5/2/2014 None
N/A
N/A
5/2/2014 None
4/3/2014 None
N/A
N/A
4/13/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
ABILENE
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
ACTIVE
4/3/2012 None
N/A
DENISON
TX
BRENTWOOD TN
DALLAS
TX
ACTIVE
ACTIVE
ACTIVE
9/6/2011 None
5/12/2015 None
04-Apr-16 None
N/A
N/A
N/A
DALLAS
TX
PEDIATRIC
HEMATOLOGY/ONCO
LOGY
SAN ANTONIO TX
ACTIVE
07-Mar-16 None
N/A
ACTIVE
10/14/2014 None
N/A
5/3/2012 None
N/A
8/29/2014 None
9/6/2011 None
6/19/2012 None
N/A
N/A
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
8/15/2013 None
6/1/2015 None
N/A
N/A
12/6/2013 None
N/A
12/4/2015 None
N/A
ACTIVE
18-Jan-16 None
N/A
TYLER
TX
HOUSTON
TX
HOUSTON
TX
CRITICAL CARE
ANESTHESIOLOGY
PEDIATRICS
MATERNAL AND
FETAL MEDICINE
FAMILY
PAIN MEDICINE
FAMILY
04-Dec-20 PRACTICE/OMM
PAIN MEDICINE
Page 349 of 402
WEBSTER
TX
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
FAMILY
04-Dec-15
04-Dec-20 PRACTICE/OMM
PAIN MEDICINE
WEBSTER
DERMATOLOGIC
6/3/2013
SURGERY
SUGAR LAND
SURGICAL CRITICAL
8/14/2015
HOUSTON
EMERGENCY
12/16/2013
12/16/2018 MEDICINE
Q6709
P6922
SOUSA, TATIANA SILVA, MD
Q5725
SOUTHARD, ROBERT ELLIS, MD
P8622
P2372
SOWARDS, JAMES GREGORY, MD
SPACEK-LLANAS, SHERRY
CELETE, MD
SPAGNUOLO, MICHAEL WILLIAM,
DO
SPALDING, MARSHALL CHANCE,
DO
SPANN, BRYAN MICHAEL-PAUL,
DO
Q7482
SPARKMAN, DARLENE, MD
04-Mar-16
P1597
P6527
SPARKS, CHARISSE YVETTE, MD
SPATH, FUAD ANTONIO, MD
12/1/2011
5/1/2013
P6092
SPEARS, BRIAN THOMAS, MD
4/1/2013
P3588
SPEARS, GREGORY LYNN, MD
6/8/2012
Q5282
P5305
Q5283
7/15/2015
1/15/2013
ORTHOPEDIC
1/15/2018 SURGERY
7/15/2015
3/1/2012
3/1/2017 NEUROLOGY
PLASTIC &
RECONSTRUCTIVE
04-Mar-21 SURGERY
ORTHOPEDIC
12/1/2016 TRAUMA
EMERGENCY
4/1/2018 MEDICINE
EMERGENCY
6/8/2017 MEDICINE
P5006
SPEARS, MICHAEL DON, MD
11/30/2012
P9463
P2534
SPEIGHT, CRAIG WILLIAM, MD
SPENCE, TIMOTHY AARON, MD
3/17/2014
3/15/2012
Q8796
SPERO, ELIZABETH MIRDZA, MD
10-Jun-16
Q6792
SPIEGEL, GARY RICHARD, MD
15-Dec-15
Q1754
Q4296
SPIGENER, SHANNON DAWN, MD
SPILLER, LORA RUTH, MD
8/29/2014
5/1/2015
Q0182
SPINKS, MATTHEW, MD
5/2/2014
EMERGENCY
3/17/2019 MEDICINE
ENDOVASCULAR
SURGICAL
15-Dec-20 NEURORADIOLOGY
5/1/2020 PEDIATRICS
WACO
TRAUMATIC
SURGERY
PLASTIC SURGERY
ORTHOPEDIC
SURGERY
Registration
Status of
Practice
Texas
State
License
ACTIVE
18-Jan-16 None
N/A
TX
ACTIVE
6/4/2013 None
N/A
TX
ACTIVE
LICENSE
ISSUED
8/18/2015 None
N/A
12/16/2013 None
N/A
ACTIVE
8/4/2015 None
N/A
ACTIVE
1/17/2013 None
N/A
TX
DALLAS
TX
ACTIVE
7/16/2015 None
N/A
HOUSTON
TX
ACTIVE
3/5/2012 None
N/A
HOUSTON
TX
ACTIVE
07-Mar-16 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
12/6/2011 None
7/2/2013 None
N/A
N/A
4/8/2013 None
N/A
6/8/2012 None
N/A
ACTIVE
12/4/2012 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
3/20/2014 None
3/27/2012 None
N/A
N/A
10-Jun-16 None
N/A
17-Dec-15 None
N/A
8/29/2014 None
5/4/2015 None
N/A
N/A
5/2/2014 None
N/A
MINNEAPOLIS MN
BROWNSVILL
E
TX
TACOMA
WA
SPORTS MEDICINE
(FAMILY PRACTICE)
INTERVENTIONAL
RADIOLOGY
Page 350 of 402
Disciplinary
Status Date
TX
ACTIVE
LICENSE
ISSUED
HEMATOLOGY
(PATHOLOGY)
Registration
Status Date
Disciplinary
Status of
Texas
License
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
ANESTHESIOLOGY
12/15/2014
3/15/2012
11/15/2011
P0796
Q2711
P2535
P1494
SPRINTZ, MICHAEL PHILLIP, DO
SPROCKEL, DENNIS, MD
SQUYRES, JUSTIN DAYLE, MD
SRESHTA, ERIN GEORDI, MD
P5733
P1232
Q7606
P4616
P7857
SRESHTA, JOSEPH NICHOLAS, MD
SRIDHAR, SRIKANTH , MD
SRIKISHEN, NEEL , MD
SRINIVAS, GOWRI SHASHI, MD
SRINIVASAN, ASHMITHA, MD
Q5102
Q1507
SRINIVASAN, SRIRAMAN RAM, MD
SRIVASTAVA, VERSHA KUMARI,
DO
8/15/2014
Q3973
SROUR, SAMER , MD
4/10/2015
Q2392
Q6290
ST HILL, RONALD GARVIN, MD
ST JOHN, JAY , MD
11/7/2014
10/1/2015
P2537
3/15/2012
9/15/2011
P7211
Q8358
STAFFORD, AMY , MD
STAFFORD, REBECCA ELIZABETH,
MD
STAGGS, BRENT CHRISTOPHER,
MD
STAMBOLIYSKA, MAYA, MD
Q1756
P5479
STAMPAS, ARGYRIOS, MD
STAN, ANA DESPINA, MD
8/29/2014
2/1/2013
P5892
Q1509
STANDIFER, JESSE ARTHUR II, MD
STANTON, RA NAE MARIE, MD
3/15/2013
8/15/2014
L6654
STARK, JAMES MATTHEW, MD
STARKS, GIOVANNA ELIZABETH,
MD
P1025
Q0185
Q5286
P5736
STATLER, ROBERT DOUGLAS, DO
STAUB, LAURA LEY, MD
3/1/2013
10/17/2011
15-Mar-16
10/1/2012
8/30/2013
7/1/2015
7/1/2013
16-May-16
3/1/2018
10/17/2016
15-Mar-21
10/1/2017
8/30/2018
UROLOGY
ANESTHESIOLOGY
UROLOGY
PEDIATRICS
RADIOLOGY
CRITICAL CARE
8/1/2011
7/1/2018 PATHOLOGY
16-May-21 NEUROLOGY
PHYSICAL MED. &
2/1/2018 PSYCHIATRY
EMERGENCY
3/15/2018 MEDICINE
PEDIATRIC
5/2/2014
7/15/2015
3/1/2013
Practice City
Disciplinary
Status Date
FORT WORTH TX
GALVESTON TX
8/22/2011
1/23/2015
3/19/2012
11/22/2011
None
None
None
None
N/A
N/A
N/A
N/A
GALVESTON
HOUSTON
HOUSTON
DALLAS
HOUSTON
TX
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
3/6/2013
10/24/2011
06-Jun-16
10/5/2012
9/4/2013
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
MO
ACTIVE
7/21/2015 None
N/A
HOUSTON
HEMATOLOGY/ONCO
LOGY
CHILD AND
ADOLESCENT
PSYCHIATRY
QUINCY
GERIATRICS
DALLAS
TX
ACTIVE
LICENSE
ISSUED
8/19/2014 None
N/A
4/10/2015 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
11/13/2014 None
10/12/2015 None
N/A
N/A
3/15/2012 None
N/A
HOSPITALIST
HEMATOLOGY
(PATHOLOGY)
SPINAL CORD
INJURY MEDICINE
PEDIATRICS
SPORTS MEDICINE
(FAMILY PRACTICE)
Page 351 of 402
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
ACTIVE
ACTIVE
ACTIVE
BREAST IMAGING
HOUSTON
Registration
Status of
Practice
Texas
State
License
IL
TX
EL PASO
TX
ACTIVE
10/24/2011 None
N/A
LITTLE ROCK
MELBOURNE
AR
FL
ACTIVE
ACTIVE
7/3/2013 None
23-May-16 None
N/A
N/A
HOUSTON
DALLAS
TX
TX
ACTIVE
ACTIVE
9/3/2014 None
2/5/2013 None
N/A
N/A
ORLANDO
CONROE
FL
TX
ACTIVE
ACTIVE
3/19/2013 None
8/19/2014 None
N/A
N/A
HOUSTON
TX
ACTIVE
LICENSE
ISSUED
8/5/2011 None
N/A
5/2/2014 None
N/A
7/27/2015 None
3/5/2013 None
N/A
N/A
BRYAN
HOUSTON
TX
TX
ACTIVE
ACTIVE
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
PHYSICAL MED. &
11/7/2014
Q2393
STAVRAKOS, JOHN E, MD
Q2069
STAVROS, ANTHONY THOMAS, MD
10/1/2014
P8816
STEADMAN, JONATHAN BLAIR, MD
1/15/2014
10/1/2019 RADIOLOGY
EMERGENCY
1/15/2019 MEDICINE
P3672
STEANS, MARIA CECILIA, MD
6/15/2012
P8547
STEED, SCOTT FRANKLIN, MD
12/6/2013
Q5287
P1932
P7713
STEFFEN, LAUREN, MD
STEFFER, KAREN JUNE, MD
STEFFY, DANIEL ANTHONY, MD
7/15/2015
1/17/2012
8/15/2013
P1414
STELL, CASEY NICOLE, DO
STEPHENS, CHARLES CLINTON,
MD
11/4/2011
EMERGENCY
10-Jun-21 MEDICINE
Q8797
P8735
Q7114
P0301
STEPHENS, KATHRYN BISHOP, MD
STEPHENS, MARK THOMAS, MD
STEPHENS, NATHANIEL
BRANDON, DO
P9006
STEPHENS, NICHOLAS ADAM, MD
P8313
STEPHENS, TRISH NGUYEN, MD
STEPHENSON, AMANDA MARIE,
MD
P8195
Q0370
10-Jun-16
1/3/2014
01-Feb-16
7/1/2011
2/7/2014
11/1/2013
10/15/2013
P3456
STEPHENSON, JOHN E, MD
STERENCHOCK, TRENT DOUGLAS,
MD
5/15/2014
Q8157
STERLACCI, SUSAN LOUISE, MD
Q5288
P7576
STERNARD, BRITNI TEAL, MD
STEVENER, DAVID SCOTT, MD
7/15/2015
8/1/2013
P6727
STEVENS, ALEXANDRA MCLEAN,
MD
5/15/2013
6/1/2012
02-May-16
Secondary Specialty
(Self-Designated)
PALLIATIVE
MEDICINE
Disciplinary
Status Date
11/7/2014 None
N/A
ACTIVE
10/15/2014 None
N/A
MS
ACTIVE
1/17/2014 None
N/A
EL PASO
TX
ACTIVE
LICENSE
ISSUED
6/19/2012 None
N/A
12/6/2013 None
N/A
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
7/22/2015 None
1/25/2012 None
8/21/2013 None
N/A
N/A
N/A
11/4/2011 None
N/A
SAN ANTONIO TX
ACTIVE
13-Jun-16 None
N/A
SAN ANTONIO TX
DALLAS
TX
ACTIVE
ACTIVE
1/20/2014 None
03-Feb-16 None
N/A
N/A
BURNET
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
7/6/2011 None
N/A
2/7/2014 None
N/A
11/1/2013 None
N/A
10/28/2013 None
N/A
5/15/2014 None
N/A
TX
TX
TX
TX
THORACIC SURGERY
LAKE
JACKSON
TX
EMERGENCY
MEDICINE
6/1/2017 UROLOGY
OBSTETRICS AND
EMERGENCY
7/15/2020 MEDICINE
PEDIATRIC
HEMATOLOGY/ONCOL
5/15/2018 OGY
PEDIATRICS
Page 352 of 402
Registration
Status Date
Disciplinary
Status of
Texas
License
JACKSON
COLLEGE
STATION
DALLAS
AUSTIN
1/3/2019 PEDIATRICS
EMERGENCY
7/1/2016 MEDICINE
EMERGENCY
11/1/2018 MEDICINE
EMERGENCY
10/15/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
BEAUMONT
TX
ACTIVE
6/5/2012 None
N/A
HOUSTON
TX
ACTIVE
16-May-16 None
N/A
LONGVIEW
CORSICANA
TX
TX
ACTIVE
ACTIVE
7/20/2015 None
8/2/2013 None
N/A
N/A
HOUSTON
TX
ACTIVE
6/4/2013 None
N/A
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
PEDIATRIC
01-Feb-16
PSYCHIATRY
Q7115
Physician Name
STEVENS, JONATHAN ROBERT,
MD
Q3974
STEVENS, SAMUEL HOUSTON, MD
P2374
STEVENSON, MATTHEW
TERRENCE, MD
3/1/2012
P9744
STEWARD, RYAN GOODSON, MD
4/1/2014
Q4850
STEWART, DANIEL THOMAS, MD
6/12/2015
Q3444
STEWART, EILEEN MERKLE, MD
3/3/2015
P7356
P3248
STEWART, JESSICA DANIELLE, MD
STEWART, JULIE NICOLE, MD
7/15/2013
5/15/2012
P7990
STEWART, PAUL J, MD
9/16/2013
Q2622
STEWART, ROBERT WILLIAM , MD
12/3/2014
Q8159
STEWART, ZACHARY ISAAC, MD
02-May-16
P9466
STILLER, GREGORY HUGH, MD
3/17/2014
4/10/2015
STOCKMAN, GAIL DIANE, MD
STOKES, RYAN GABRIEL , MD
11/15/2012
9/15/2014
Q4528
P6282
STONE, BRITT A, MD
STONE, JAMILLA CHRISTINE, MD
5/15/2015
4/12/2013
5/15/2020 NEUROLOGY
P4515
STONE, KENNETH ERIC, MD
9/17/2012
Q4851
STONE, SHANE , MD
6/12/2015
H5207
STONER, RICHARD SWOPE, MD
10/15/2015
P5572
STOUFFER, MARK HAROLD, MD
2/8/2013
Disciplinary
Status Date
ACTIVE
09-Feb-16 None
N/A
SAN ANTONIO TX
ACTIVE
4/13/2015 None
N/A
NEURO-PHYSIOLOGY
(NEUROLOGY)
FORT WORTH TX
ACTIVE
3/12/2012 None
N/A
GYNECOLOGY
ACTIVE
5/8/2014 None
N/A
LICENSE
ISSUED
6/12/2015 None
N/A
ACTIVE
4/10/2015 None
N/A
TOMBALL
TX
ORTHOPEDIC
SURGERY
PASADENA
HOUSTON
TX
TX
ACTIVE
ACTIVE
7/16/2013 None
6/18/2012 None
N/A
N/A
BELLAIRE
TX
ACTIVE
10/7/2013 None
N/A
TEMPLE
TX
ACTIVE
12/9/2014 None
N/A
SAN ANTONIO TX
ACTIVE
03-Jun-16 None
N/A
SAN ANTONIO TX
ACTIVE
3/21/2014 None
N/A
CORSICANA
HOUSTON
TX
TX
ACTIVE
ACTIVE
11/20/2012 None
9/17/2014 None
N/A
N/A
ROUND ROCK TX
LULING
TX
FORT SAM
TX
ACTIVE
ACTIVE
6/4/2015 None
4/22/2013 None
N/A
N/A
9/24/2012 None
N/A
6/12/2015 None
N/A
11/24/2015 None
N/A
2/8/2013 None
N/A
EMERGENCY
02-May-21 MEDICINE
EMERGENCY
3/17/2019 MEDICINE
E6635
Q1911
HOUSTON
Registration
Status Date
Disciplinary
Status of
Texas
License
TX
3/1/2017 NEUROLOGY
REPRODUCTIVE
ENDOCRINOLOGY
6/12/2020 SURGERY
PEDIATRICS,
3/3/2020 CARDIOLOGY
EMERGENCY
7/15/2018 MEDICINE
Practice City
Registration
Status of
Practice
Texas
State
License
PULMONARY
MEDICINE
PEDIATRICS
MOVEMENT
DISORDERS
EMERGENCY
10/15/2020 MEDICINE
ORTHOPEDIC
SURGERY OF THE
2/8/2018 SPINE
CONROE
TX
ACTIVE
LICENSE
ISSUED
ATHENS
TX
ACTIVE
LICENSE
ISSUED
Page 353 of 402
License
Number
Physician Name
P8623
STOUT, JOHN TIMOTHY, MD
P4618
STOWELL, JEFFREY RANDAL, MD
P5738
STREET, MEGAN HICKMAN, MD
dicaid
dicaid
Agreement
End Date
Designated)
12/16/2013
10/1/2012
3/1/2013
Q6472
STREFLING, JASON ANDREW, DO
11/2/2015
P3081
STRICKLAND, KIMBERLY LYNN, DO
5/1/2012
P6924
STRODER, RYAN ANDREW, DO
6/3/2013
Q7287
STROM, TOBIN JOEL, MD
Q6576
STRONG, MICHELLE LYNNE, MD
11/16/2015
Q1027
STROUPE, AMBER NICOLE, DO
7/15/2014
P5739
STRYKER, LOUIS SAMUEL, MD
3/1/2013
P5180
STUBBS, JENEE' GIBSON, MD
1/4/2013
P3673
STUBBS, WILL III, DO
6/15/2012
Q2953
STUTZ, CHRISTOPHER MICHAEL,
MD
1/15/2015
Q1028
STYPEREK, ANDREW, MD
7/15/2014
Q8359
SU, JINGDONG , MD
16-May-16
Q2209
SU, SHIRLEY Y, MD
10/15/2014
Q8361
P6531
SUBBIAH, ISHWARIA MOHAN, MD
SUBNANI, KISHORE RAJ, MD
16-May-16
5/1/2013
P6094
SUBRAMANIAM, HAMSA, MD
16-Feb-16
4/1/2013
EMERGENCY
10/1/2017 MEDICINE
PEDIATRIC
EMERGENCY
Secondary Specialty
(Self-Designated)
Practice City
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
12/18/2013 None
N/A
HOUSTON
TX
ACTIVE
10/3/2012 None
N/A
3/1/2013 None
N/A
ACTIVE
11/10/2015 None
N/A
ACTIVE
5/10/2012 None
N/A
ACTIVE
6/5/2013 None
N/A
TX
ACTIVE
04-Apr-16 None
N/A
TX
ACTIVE
11/19/2015 None
N/A
FORT WORTH TX
ACTIVE
7/21/2014 None
N/A
CHARLOTTE
ACTIVE
3/11/2013 None
N/A
ACTIVE
1/11/2013 None
N/A
ACTIVE
6/20/2012 None
N/A
LICENSE
ISSUED
INTERVENTIONAL
CARDIOLOGY
EMERGENCY
6/3/2018 MEDICINE
RADIATION
16-Feb-21 ONCOLOGY
LUBBOCK
TX
FORT WORTH TX
DALLAS
SURGICAL CRITICAL
AUSTIN
ORTHOPEDIC
3/1/2018 SURGERY
PEDIATRIC
1/4/2018 PSYCHIATRY
PSYCHIATRY
EMERGENCY
6/15/2017 MEDICINE
PEDIATRIC
1/15/2020 SURGERY
ORTHOPEDICS
DERMATOLOGIC
SURGERY
HEMATOLOGY/ONCOL
16-May-21 OGY
HEAD AND NECK
OTORHINOLARYNGO
10/15/2019 SURGERY
LOGY
PALLIATIVE
16-May-21 ONCOLOGY
MEDICINE
Registration
Status of
Practice
Texas
State
License
FAMILY MEDICINE
Page 354 of 402
NC
DALLAS
TX
ACTIVE
2/6/2015 None
N/A
HOUSTON
TX
ACTIVE
7/29/2014 None
N/A
ACTIVE
18-May-16 None
N/A
HOUSTON
TX
ACTIVE
11/10/2014 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
20-May-16 None
5/15/2013 None
N/A
N/A
REDWOOD
VALLEY
CA
ACTIVE
4/8/2013 None
N/A
License
Number
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
DIAGNOSTIC
15-Jan-16
15-Jan-21 RADIOLOGY
Q6990
Physician Name
SUBRAMANIAM, RATHAN
MARKANDAN, MD
Q3812
SUBRAMANIAN, SAKTHIRAJ, MD
Q4852
SUBRAMANIAN, SARADHA, MD
6/12/2015
PEDIATRICS,
Q8650
SUBRAYAPPA, NAVIN KUMAR, MD
01-Jun-16
Q4306
SUDARSANAM, HARDHIPRIYA, MD
5/1/2015
Q3112
SUE, PAUL KYUNGWON, MD
2/2/2015
PEDIATRIC
P3249
SUFFIELD, JILL J, MD
5/15/2012
Q1029
SUFFRIDGE, CANDIDA DAWN, MD
7/15/2014
Q0832
Q8362
SUGARBAKER, DAVID JOHN, MD
SUHAIL, MOHAMMED , DO
Q1030
SUIRE, KYLE MATTHEW, DO
SULEIMAN, EHAB SAID ABDEL
AZIZ, MD
SULEIMAN, YOUSEF NABIL, MD
P2376
P0302
4/1/2015
6/27/2014
16-May-16
7/15/2014
3/1/2012
7/1/2011
Q2495
K6350
SULLER, MARIA RENELA GAMBITO,
MD
SULLIVAN, BRIAN MICHAEL, MD
SULLIVAN, ZACHARY , DO
SULTAN, GHAYYATH , MD
SULTAN, MAHMOD HABIBULAH I,
MD
SUMMERS, JOHN HOWARD, MD
P0677
SUN, JACHI GEORGE, MD
8/1/2011
P8419
SUN, JACK JEN-KUEI, DO
11/15/2013
Q6112
SUNCIN TREJO, HECTOR
MAURICIO, MD
9/15/2015
Q8651
Q5103
Q6577
Q3296
01-Jun-16
7/1/2015
11/16/2015
2/13/2015
11/17/2014
12/15/2011
ENDOCRINOLOGY,
DIABETES AND
01-Jun-21 METABOLISM
Registration
Status of
Practice
Texas
State
License
TX
INTERNAL MEDICINE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
N/A
4/1/2015 None
N/A
6/12/2015 None
N/A
01-Jun-16 None
N/A
5/1/2015 None
N/A
2/2/2015 None
N/A
5/15/2012 None
N/A
7/22/2014 None
N/A
6/27/2014 None
18-May-16 None
N/A
N/A
ACTIVE
9/3/2014 None
N/A
3/12/2012 None
7/11/2011 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
VASCULAR MEDICINE MCALESTER
WACO
OK
TX
ACTIVE
ACTIVE
INTERNAL MEDICINE ARLINGTON
LIVINGSTON
HOUSTON
NEPHROLOGY
SAN ANTONIO
TX
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
MUSKOGEE
OK
GASTROENTEROLOG
8/1/2016 Y
EMERGENCY
11/15/2018 MEDICINE
CHILD AND
ADOLESCENT
PSYCHIATRY
HOUSTON
TX
Page 355 of 402
Disciplinary
Status Date
18-Jan-16 None
LICENSE
ISSUED
LICENSE
ISSUED
INTERNAL MEDICINE MESQUITE
TX
URGENT CARE
MEDICINE
ROUND ROCK TX
Registration
Status Date
Disciplinary
Status of
Texas
License
03-Jun-16
7/3/2015
11/17/2015
2/16/2015
None
None
None
None
N/A
N/A
N/A
N/A
11/17/2014 None
1/4/2012 None
N/A
N/A
ACTIVE
LICENSE
ISSUED
8/22/2011 None
N/A
11/15/2013 None
N/A
ACTIVE
11/25/2015 None
N/A
License
Number
Physician Name
P0678
SUNDERAJAN, KIRTANA , MD
dicaid
dicaid
Agreement
End Date
Designated)
8/1/2011
Secondary Specialty
(Self-Designated)
UROLOGIC
ONCOLOGY
Q5104
SUNDI, DEBASISH , MD
7/1/2015
7/1/2020 UROLOGY
P3458
SUNG, ANGIE C, MD
6/1/2012
Q0186
SUNG, SHANG, MD
5/2/2014
EMERGENCY
5/2/2019 MEDICINE
Q1514
SUNKARI, AMAR, MD
8/15/2014
P6731
SUNKERSETT, GAURI
BHUPENDRA, DO
5/15/2013
P2792
P9971
SUNNAPWAR, ABHIJIT , MD
SURAPANENI, SHIRI TEJA, MD
4/2/2012
4/15/2014
Q2855
SURESH, GAUTHAM KANEKAL, MD
P3250
SURI, MUHAMMAD FAREED KHAN,
MD
5/15/2012
P9972
SURVE, SAJID ALI, DO
4/15/2014
8/15/2019 INTERNAL MED - PEDS HOSPITALIST
PEDIATRIC
HEMATOLOGY/ONCOL
5/15/2018 OGY
ABDOMINAL
4/2/2017 RADIOLOGY
NEONATALPERINATAL
1/5/2020 PEDIATRICS
MEDICINE
ENDOVASCULAR
SURGICAL
5/15/2017 NEUROLOGY
NEURORADIOLOGY
OSTEO
PHYSICAL MED. &
MANIPULATIVE
MEDICINE
16-Feb-16
TM00622 SUSANO, MICHAEL VITTORIO, MD
1/5/2015
P3459
SUTHERLUN, LYDIA ANN, MD
6/1/2012
Q4308
SUTTON, ERNEST HENRY JR, MD
5/1/2015
Q2211
SVENSSON, TRAVIS KNIGHT, MD
Q1515
SVOBODA, MELISSA DZIUK, MD
P4719
SWALDEK, GNIEWOMIRA, MD
Q4853
SWANN, MATTHEW CHARLES, MD
P0305
SWANSON, TODD A, MD
10/15/2014
8/15/2014
10/15/2012
6/12/2015
7/1/2011
EMERGENCY
5/1/2020 MEDICINE
Practice City
DALLAS
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
HOUSTON
TX
7/24/2015 None
N/A
6/1/2012 None
N/A
LANSING
CORPUS
CHRISTI
MI
ACTIVE
5/5/2014 None
N/A
TX
ACTIVE
8/18/2014 None
N/A
DALLAS
TX
ACTIVE
5/16/2013 None
N/A
SAN ANTONIO TX
ACTIVE
ACTIVE
4/4/2012 None
4/16/2014 None
N/A
N/A
HOUSTON
ACTIVE
1/6/2015 None
N/A
LICENSE
ISSUED
5/15/2012 None
N/A
ACTIVE
4/16/2014 None
N/A
ACTIVE
LICENSE
ISSUED
01-Mar-16 None
N/A
6/1/2012 None
N/A
ACTIVE
5/6/2015 None
N/A
ACTIVE
11/5/2014 None
N/A
ACTIVE
9/1/2014 None
N/A
PHILADELPHIA PA
ACTIVE
11/5/2012 None
N/A
DALLAS
TX
ACTIVE
6/15/2015 None
N/A
GALVESTON
TX
ACTIVE
7/8/2011 None
N/A
FT. WORTH
TX
TX
SHREVEPORT LA
HOSPITALIST
PAIN MEDICINE
(PSYCHIATRY)
HOUSTON
TX
NEURODEVELOPMEN
TAL DISABILITIES
(PEDIATRICS)
SAN ANTONIO TX
ORTHOPEDIC
ORTHOPEDIC
6/12/2020 SURGERY
SURGERY
RADIATION
7/1/2016 ONCOLOGY
Page 356 of 402
ACTIVE
LICENSE
ISSUED
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
8/22/2011 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q3976
Q2856
SWEENEY, ALEX DANIEL, MD
SWEENEY, SARAH ANN, MD
4/10/2015
1/5/2015
Q4529
SWENSON, OREL YEHUDA, MD
5/15/2015
P1145
SWORDS, RONAN THOMAS, MD
10/3/2011
P5740
SYAMALA, SHIRMILA, MD
Q5291
SYED, ALMAS, MD
7/15/2015
Q2070
SYED, FAHAD MOHAMMAD, DO
10/1/2014
Q4309
SYED, ISHAQ Y, MD
Q6579
SYED, SABEEN ASLAM, MD
11/16/2015
P3254
P4517
SYED, WAQAR, MD
SYED, ZUBAIR AHMED, MD
5/15/2012
9/17/2012
P2540
SYEDA, UZMA AHMAD, MD
3/15/2012
Q4854
SYLVESTER, FRANCIS CRAIG, MD
6/12/2015
Q1308
P5482
SZABO, GRETA, MD
SZERLIP, HAROLD MICHAEL, MD
P4911
SZERLIP, MOLLY, MD
11/15/2012
Q6580
SZOLLAS, LASZLO, MD
11/16/2015
Q6713
TABE, CYRIL ETTA, MD
12/4/2015
Q6713
04-Dec-15
3/1/2013
5/1/2015
8/1/2014
2/1/2013
Secondary Specialty
(Self-Designated)
EMERGENCY
5/15/2020 MEDICINE
HEMATOLOGY/ONCOL
10/3/2016 OGY
DIAGNOSTIC
7/15/2020 RADIOLOGY
EMERGENCY
10/1/2019 MEDICINE
ORTHOPEDIC
SURGERY OF THE
5/1/2020 SPINE
LUMBERTON
TX
Practice City
SAN ANTONIO TX
DALALS
DALLAS
PEDIATRIC
GASTROENTEROLOG CORPUS
Y
CHRISTI
EMERGENCY
MEDICINE
RULEVILLE
DALLAS
TX
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
4/10/2015 None
1/7/2015 None
N/A
N/A
ACTIVE
5/22/2015 None
N/A
ACTIVE
LICENSE
ISSUED
10/4/2011 None
N/A
3/1/2013 None
N/A
ACTIVE
LICENSE
ISSUED
7/24/2015 None
N/A
10/1/2014 None
N/A
TX
ACTIVE
5/4/2015 None
N/A
TX
ACTIVE
11/18/2015 None
N/A
MS
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
6/4/2012 None
10/4/2012 None
N/A
N/A
3/15/2012 None
N/A
TX
ACTIVE
6/15/2015 None
N/A
DALLAS
TX
FORT WORTH TX
ACTIVE
ACTIVE
8/21/2014 None
2/13/2013 None
N/A
N/A
TUCSON
11/19/2012 None
N/A
PAIN MANAGEMENT
ACTIVE
LICENSE
ISSUED
11/16/2015 None
N/A
GENERAL SURGERY
LICENSE
ISSUED
12/4/2015 None
N/A
ACTIVE
04-Jan-16 None
N/A
INTERNAL MEDICINE
EMERGENCY
6/12/2020 MEDICINE
GASTROENTEROLOG
8/1/2019 Y
INTERVENTIONAL
CARDIOLOGY
THORACIC
CARDIOVASCULAR
12/4/2020 SURGERY
THORACIC
CARDIOVASCULAR
04-Dec-20 SURGERY
HOUSTON
Registration
Status of
Practice
Texas
State
License
LICENSE
ISSUED
TX
ACTIVE
HOUSTON
Page 357 of 402
AZ
TX
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
THORACIC
CARDIOVASCULAR
04-Dec-15
04-Dec-20 SURGERY
5/15/2013
HOSPITALIST
Q6713
P6732
TABE, JULIUS, MD
Q6794
Q8653
TABET, RANIA , MD
TABIBIAN, BENJAMIN, DO
15-Dec-15
01-Jun-16
15-Dec-20 OPHTHALMOLOGY
P8196
TADA, LAUREN TAMI, DO
10/15/2013
Q6114
TAFOYA, LAWRENCE CECILIO, MD
9/15/2015
Q2072
TAHA, FAROOK W, DO
10/1/2014
Q5106
Q0187
TAHERI, KEVIN, MD
TAHILRAMANI, REENA, MD
7/1/2015
5/2/2014
Q3978
TAJANI, AZEEM, MD
4/10/2015
Q2073
TAKAHASHI, KOICHI , MD
10/1/2014
Q2212
Q0188
P1236
Q3813
Q2398
TAKESUYE, ROBERT KENT, DO
TAKI, JAMES ALAN, MD
TAKKALLAPALLI, SRINU, MD
TALATI, KOMAL JYOTINDRA, MD
TALATI, KRUNAL KRISHNAKANT,
MD
Q2074
P2378
K1693
10/15/2014
5/2/2014
10/17/2011
4/1/2015
EMERGENCY
10/1/2019 MEDICINE
OTOLARYNGIC
ALLERGY
EMERGENCY
4/10/2020 MEDICINE
HEMATOLOGY/ONCOL
10/1/2019 OGY
INTERNAL MEDICINE
RADIATION
10/15/2019 ONCOLOGY
11/7/2014
TALEI, BENJAMIN AZIZ, MD
TAMEEZ, IFFAT, MD
10/1/2014
3/1/2012
7/15/2015
1/15/2014
1/15/2019 RADIOLOGY
P9011
TAMESIS, GRACE PATRICIA, MD
TAMMISETTI, VARAHA SATYA
SAIRAM, MD
TAMPI, RAJESH RAJAGOPALAN,
MD
ALLERGY AND
P6925
P3255
Q3814
TAN, ALVIN RAYMOND CO, MD
TAN, JENS, MD
TAN, VENESSA CHUA, MD
6/3/2013
5/15/2012
4/1/2015
P8817
2/7/2014
HOUSTON
2/7/2019 PSYCHIATRY
HOSPITALIST
FACIAL PLASTIC
SURGERY
FAMILY MEDICINE
PEDIATRICS
BODY IMAGING
GERIATRIC
PSYCHIATRY
Page 358 of 402
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
ACTIVE
ACTIVE
04-Jan-16 None
6/4/2013 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
29-Dec-15 None
06-Jun-16 None
N/A
N/A
10/15/2013 None
N/A
CORPUS
CHRISTI
TX
ACTIVE
10/9/2015 None
N/A
ARLINGTON
TX
ACTIVE
10/14/2014 None
N/A
AUSTIN
HOUSTON
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
7/3/2015 None
5/9/2014 None
N/A
N/A
4/10/2015 None
N/A
HOUSTON
TX
ACTIVE
11/20/2014 None
N/A
SAN DIEGO
KELLER
PARIS
SUGAR LAND
CA
TX
IL
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
10/20/2014
5/12/2014
11/14/2011
4/13/2015
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
11/20/2014 None
N/A
ACTIVE
ACTIVE
11/13/2014 None
3/12/2012 None
N/A
N/A
SAN ANTONIO TX
MCALLEN
TEXAS
TX
ACTIVE
8/6/2015 None
N/A
HOUSTON
TX
ACTIVE
1/22/2014 None
N/A
HARLINGEN
TX
2/26/2014 None
N/A
ST. LOUIS
MO
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
6/3/2013 None
5/17/2012 None
4/10/2015 None
N/A
N/A
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
EMERGENCY
EMERGENCY
01-Jun-16
01-Jun-21 MEDICINE
MEDICAL SERVICES
PEDIATRIC
HEMATOLOGY/ONCO
6/27/2014
LOGY
PEDIATRICS,
7/1/2015
7/1/2020 CARDIOLOGY
1/5/2015
11/7/2014
6/12/2015
Q8654
TANAKA, KAORI PATRICIA, DO
Q0834
TANAKA, RYUMA , MD
Q5107
Q2857
Q2399
Q4857
TANDON, ANIMESH, MD
TANDON, GAURAV, MD
TANG, DAMING, MD
TANG, VICTORIA KRYSTAL, MD
P3461
TANG, ZHOUWEN , MD
6/1/2012
P6532
TANIGUCHI, CULLEN MITSUO, MD
5/1/2013
Q0576
6/2/2014
Q3980
Q3599
TANK, VIVEK HASMUKH, MD
TANKSLEY, JOHN ANTHONY JR,
MD
TANNU, NILESH SURESH, MD
4/10/2015
3/16/2015
Q8655
TANSEL, AYLIN , MD
01-Jun-16
Q4858
TANTCHOU, IRLNA INGRID, MD
6/12/2015
Q4701
TANTOUSH, MANAL YOUSEF, MD
Q6294
P7861
P0307
P0308
TANVEER, UZMA, MD
TANWAR-AHUJA, MEENA, MD
TAO, JOSHUA DZKUAN, MD
TAPIA, NICOLE MARIE, MD
Q5579
TAPIA, SHANNON MURPHY, MD
Q8365
Q8656
P5897
TARAKAD, ARJUN , MD
TARAPASADE, SANDRA, MD
TARASEVICIUTE, AGNE , MD
P7578
TARBOX, MICHELLE BABB, MD
6/1/2015
Practice City
Registration
Status of
Practice
Texas
State
License
ACTIVE
06-Jun-16 None
N/A
HOUSTON
TX
ACTIVE
7/3/2014 None
N/A
DALLAS
WYNCOTE
TX
PA
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
LICENSE
ISSUED
TX
TX
6/1/2020 PEDIATRICS
10/1/2020
8/30/2018
7/1/2016
7/1/2016
8/3/2015
8/3/2020
16-May-16
01-Jun-16
3/15/2013
16-May-21
01-Jun-21
3/15/2018
8/1/2013
8/1/2018
FAMILY MEDICINE
PEDIATRICS
NEONATOLOGY
GENERAL SURGERY
GERIATRIC MEDICINE
(FAMILY PRACTICE)
FAMILY MEDICINE
MOVEMENT
DISORDERS
NEUROLOGY
INTERNAL MEDICINE
PEDIATRICS
DERMATOPATHOLO
DERMATOLOGY
GY
Page 359 of 402
Disciplinary
Status Date
SAN ANTONIO TX
RADIATION
5/1/2018 ONCOLOGY
ENDOVASCULAR
SURGICAL
6/2/2019 NEURORADIOLOGY
ORTHOPEDIC
SPORTS MEDICINE
4/10/2020 SURGERY
(ORTH SURG)
HUNTSVILLE
HOUSTON
GASTROENTEROLOG
01-Jun-21 Y
INTERNAL MEDICINE
COLON AND RECTAL
10/1/2015
8/30/2013
7/1/2011
7/1/2011
Registration
Status Date
Disciplinary
Status of
Texas
License
FORT WORTH TX
AUSTIN
TX
7/3/2015
1/6/2015
11/11/2014
6/16/2015
None
None
None
None
N/A
N/A
N/A
N/A
6/1/2012 None
N/A
5/20/2013 None
N/A
6/2/2014 None
N/A
ACTIVE
ACTIVE
LICENSE
ISSUED
4/13/2015 None
3/20/2015 None
N/A
N/A
01-Jun-16 None
N/A
ACTIVE
6/16/2015 None
N/A
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
6/17/2015 None
N/A
10/1/2015
9/10/2013
7/13/2011
7/12/2011
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
8/17/2015 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
18-May-16 None
02-Jun-16 None
3/19/2013 None
N/A
N/A
N/A
LUBBOCK
TX
ACTIVE
8/13/2013 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q0706
P7714
TARIQ, MUDASSAR, MD
TARIQ, ZARLISH, MD
6/16/2014
8/15/2013
Q7289
TARLOV, NICHOLAS EDWARD, MD
TARNAL, VIJAYKUMAR
CHANDRASHEKAR, MD
16-Feb-16
16-Feb-21 NEUROLOGY
5/15/2012
P3256
Q6715
TAROKH, SAEED, MD
12/4/2015
Q6715
TAROKH, SAEED, MD
04-Dec-15
Q6715
TAROKH, SAEED, MD
04-Dec-15
P7041
TASSONE, SHAWN ANTHONY, MD
6/14/2013
P3592
TATAH, ANDREW BAMNJO, MD
P0504
TATE, SHERI L, DO
P2381
P8197
TATSUI, CLAUDIO ESTEVES, MD
TATUM, RYAN HAMMOND, MD
P6733
TAUB, JASON SCOTT, MD
Q2859
P6533
TAUBE, RYAN , DO
TAUSCH, TIMOTHY JAMES, MD
1/5/2015
5/1/2013
P6926
TAUSEEF, MUHAMMAD ASIF, MD
6/3/2013
Q2625
Q6795
Q8161
TAVEAU, JON WILLIAM, DO
TAWBI, HUSSEIN A, MD
TAWBI, URSULA, MD
Q3447
TAWFIK, BERNARD, MD
3/3/2015
P7579
TAYAG, EMILIO CARREON, MD
TAYLOR, ADRIANA DE LA ROSA,
MD
TAYLOR, BEATRICE , DO
8/1/2013
Q2954
Q2075
6/8/2012
7/15/2011
3/1/2012
10/15/2013
5/15/2013
12/3/2014
15-Dec-15
02-May-16
1/15/2015
10/1/2014
EMERGENCY
04-Dec-20 MEDICINE
EMERGENCY
04-Dec-20 MEDICINE
OBSTETRICS AND
Secondary Specialty
(Self-Designated)
CHILD AND
ADOLESCENT
PSYCHIATRY
VASCULAR
NEUROLOGY
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
MEDICINE
EMERGENCY
7/15/2016 MEDICINE
INTERNAL MEDICINE
NEUROLOGICAL
3/1/2017 SURGERY
NEUROLOGICAL
5/15/2018 SURGERY
EMERGENCY
1/5/2020 MEDICINE
5/1/2018 UROLOGIC SURGERY UNSPECIFIED
6/3/2018 PEDIATRICS
NEUROLOGICAL
TRAUMATIC
12/3/2019 SURGERY
SURGERY
15-Dec-20 INTERNAL MEDICINE ONCOLOGY
HEMATOLOGY/ONCOL
3/3/2020 OGY
INTERNAL MEDICINE
NEUROLOGICAL
8/1/2018 SURGERY
NEUROLOGY
EMERGENCY
1/15/2020 MEDICINE
Page 360 of 402
Practice City
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
HOUSTON
WAVERLY
TX
IA
ACTIVE
ACTIVE
6/23/2014 None
8/26/2013 None
N/A
N/A
COLUMBIA
MO
ACTIVE
15-Mar-16 None
N/A
GALVESTON
TX
ACTIVE
LICENSE
ISSUED
5/18/2012 None
N/A
12/4/2015 None
N/A
ALBANY
NY
ACTIVE
14-Dec-15 None
N/A
ALBANY
NY
ACTIVE
14-Dec-15 None
N/A
AUSTIN
TX
ACTIVE
LICENSE
ISSUED
6/18/2013 None
N/A
6/8/2012 None
N/A
BURNET
TX
ACTIVE
7/20/2011 None
N/A
HOUSTON
TYLER
TX
TX
ACTIVE
ACTIVE
3/19/2012 None
10/17/2013 None
N/A
N/A
DALLAS
TX
ACTIVE
5/17/2013 None
N/A
FORT WORTH TX
DALLAS
TX
ACTIVE
ACTIVE
1/13/2015 None
5/2/2013 None
N/A
N/A
SHREVEPORT LA
ACTIVE
6/13/2013 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
ACTIVE
12/10/2014 None
18-Jan-16 None
10-May-16 None
N/A
N/A
N/A
DALLAS
TX
ACTIVE
3/13/2015 None
N/A
ACTIVE
8/20/2013 None
N/A
ACTIVE
ACTIVE
2/2/2015 None
10/6/2014 None
N/A
N/A
PHILADELPHIA PA
LA GRANGE
TX
License
Number
Physician Name
P9973
TAYLOR, CARMELITA MARIE, MD
P9012
TAYLOR, EDWIN EDGARDO, MD
Q3297
P8314
TAYLOR, JAMES PATRICK, MD
TAYLOR, JUNIOR AUTHER LEE,
MD
P3593
TAYLOR, KRISTAL , MD
P1026
TAYLOR, LAURA ANN, MD
P5574
TAYLOR, MATTHEW TODD, MD
dicaid
dicaid
Agreement
End Date
Designated)
4/15/2014
2/7/2014
EMERGENCY
2/13/2015
2/13/2020 MEDICINE
11/1/2013
6/8/2012
9/15/2011
OBSTETRICS &
GYNECOLOGICAL
SURGERY
OBSTETRICS AND
6/8/2017 GYNECOLOGY
DIAGNOSTIC
9/15/2016 RADIOLOGY
10-Jun-16
5/2/2014
Q2955
P1826
Q4311
TAYLOR, RYAN METRI, MD
TAYLOR, ZACHARY , MD
TAYYEM, ALA'A EDDIN HISHAM
SA'EED, MD
TE, TAM THI DUC, MD
TE, TRI, DO
1/15/2015
1/2/2012
5/1/2015
Q0707
TEAMER, JELANI ARNES, MD
6/16/2014
Q3448
TEAMES, RICHARD SPENCER, MD
3/3/2015
Q3816
TEBEJE, LEGESSE FULLA, MD
4/1/2015
Q4312
TEIXEIRA, PEDRO G R, MD
5/1/2015
CRITICAL CARE
5/1/2020 (TRAUMA)
Q2402
TEK, ROTANA STEVEN, DO
TEKLE, WONDWOSSEN
GEBREAMANUEL, MD
11/7/2014
P7216
P6927
7/1/2013
7/1/2018 NEUROLOGY
6/3/2013
P8198
TELLA, SWATHI NALLURI, MD
TELLEZ FLORES, ISRAEL JUAN
ENRIQUE, MD
P2382
P7042
TEMPLE, BRIAN A W, MD
TEN PAS, SHERRI L, DO
3/1/2012
6/14/2013
INFECTIOUS
3/1/2017 DISEASES
6/14/2018 NEUROLOGY
P0506
TENG, EDWARD CHAO HUNG, MD
7/15/2011
10/15/2013
Practice City
HOUSTON
ORTHOPEDIC
10-Jun-21 TRAUMA
Q8798
Q0189
2/8/2013
Secondary Specialty
(Self-Designated)
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ORTHOPEDIC
SURGERY
FAMILY MEDICINE
INTERVENTIONAL
RADIOLOGY
CRITICAL CARE
ANESTHESIOLOGY
EMERGENCY
MEDICINE
N/A
ACTIVE
12/16/2013 None
N/A
TX
ACTIVE
6/19/2012 None
N/A
ATLANTA
GA
ACTIVE
LICENSE
ISSUED
10/4/2011 None
N/A
2/8/2013 None
N/A
HOUSTON
TX
SAN ANTONIO TX
ACTIVE
ACTIVE
14-Jun-16 None
5/12/2014 None
N/A
N/A
GALVESTON
AUSTIN
ACTIVE
ACTIVE
ACTIVE
LICENSE
ISSUED
LICENSE
ISSUED
LICENSE
ISSUED
1/21/2015 None
2/13/2012 None
5/4/2015 None
N/A
N/A
N/A
6/16/2014 None
N/A
3/3/2015 None
N/A
4/1/2015 None
N/A
ACTIVE
LICENSE
ISSUED
5/18/2015 None
N/A
11/7/2014 None
N/A
AUSTIN
TX
TX
TX
HARLINGEN
TX
ACTIVE
7/25/2013 None
N/A
DALLAS
TX
ACTIVE
6/5/2013 None
N/A
LIMA
OH
ACTIVE
10/16/2013 None
N/A
TX
TX
ACTIVE
ACTIVE
3/28/2012 None
6/19/2013 None
N/A
N/A
AR
ACTIVE
8/1/2011 None
N/A
INTERNAL MEDICINE LUBBOCK
SLEEP MEDICINE
TYLER
TEXARKANA
Page 361 of 402
2/13/2015 None
HOUSTON
INTERNAL MEDICINE
VASCULAR
SURGERY
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
4/21/2014 None
N/A
2/20/2014 None
N/A
License
Number
Physician Name
dicaid
dicaid
Agreement
Start Date
End Date
Designated)
(Self-Designated)
Practice City
DIAGNOSTIC
MUSCULOSKELETAL
06-Jan-16
06-Jan-21 RADIOLOGY
RADIOLOGY
HOUSTON
6/3/2013
AUSTIN
PEDIATRIC
INFECTIOUS
8/1/2013
8/1/2018 PEDIATRICS
DISEASE
MCALLEN
6/2/2014
6/2/2019 ONCOLOGY
SAN ANTONIO
Q6912
P6928
TENG, MATTHEW W, MD
TENG, STEFANIE AMY, MD
P7581
Q0578
TENGSUPAKUL, SUPATIDA, MD
TENNER, LAURA, MD
P8089
TERAN SOTO, BETZI NARETH, MD
10/1/2013
P3258
TERASAKI, ORELIA RAMIREZ, MD
5/15/2012
Q8799
TERRAZAS, FRANCISCO, MD
P1827
Q1309
Registration
Status of
Practice
Texas
State
License
Registration
Status Date
Disciplinary
Status of
Texas
License
Disciplinary
Status Date
TX
TX
ACTIVE
ACTIVE
12-Jan-16 None
6/20/2013 None
N/A
N/A
TX
TX
ACTIVE
ACTIVE
8/2/2013 None
6/5/2014 None
N/A
N/A
MESQUITE
TX
ACTIVE
10/10/2013 None
N/A
TEXAS CITY
TX
ACTIVE
10-Jun-16
TERRY, AARON WADE, MD
1/2/2012
TESSIER, JEFFREY MICHAEL, MD
8/1/2014
INFECTIOUS
8/1/2019 DISEASES
SAN ANTONIO TX
RANDOLPH
AFB
TX
P9470
TEWARI, MEGHA, MD
3/17/2014
P4520
TEWARI, PRITI, MD
9/17/2012
P1700
P7218
TEWARI, SHALINI, MD
THACKER, ANMONA S, MD
12/15/2011
7/1/2013
Q1035
Q1311
THAKRAR, KUNAL DHIREN, MD
THAKRAR, SHIMONA BHATIA, DO
J9385
Q8368
THAKUR, NAVIN S, MD
THALER, KLAUS, MD
Q1312
THAMPI, SHEILA, MD
8/1/2014
Q3449
THANASAWAT, CHALERMKIAT, MD
3/3/2015
7/15/2014
8/1/2014
5/15/2015
16-May-16
PEDIATRIC
HEMATOLOGY/ONCOL
9/17/2017 OGY
GERIATRIC
MEDICINE (FAMILY
PRACTICE)
N/A
ACTIVE
5/17/2012 None
UNDER
BOARD
22-Jun-16 ORDER
ACTIVE
1/26/2012 None
N/A
FORT WORTH TX
ACTIVE
8/8/2014 None
N/A
LANSING
MI
ACTIVE
3/21/2014 None
N/A
HOUSTON
TX
ACTIVE
9/19/2012 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
1/2/2012 None
7/16/2013 None
N/A
N/A
AUSTIN
TX
ACTIVE
ACTIVE
7/16/2014 None
8/4/2014 None
N/A
N/A
VICTORIA
BAYTOWN
TX
TX
ACTIVE
ACTIVE
5/19/2015 None
25-May-16 None
N/A
N/A
8/5/2014 None
N/A
3/3/2015 None
N/A
GERIATRIC
MEDICINE (INTERNAL
MED)
7/1/2018 PEDIATRICS
EMERGENCY
7/15/2019 MEDICINE
8/1/2019 PEDIATRICS
HOSPITALIST
THORACIC
CARDIOVASCULAR
CARDIOVASCULAR
5/15/2020 SURGERY
SURGERY
PEDIATRIC
HEMATOLOGY/ONCOL
8/1/2019 OGY
EMERGENCY
3/3/2020 MEDICINE
Page 362 of 402
SAN ANTONIO TX
ACTIVE
LICENSE
ISSUED
6/10/2016
License
Number
Physician Name
dicaid
dicaid
Agreement
End Date
Designated)
Q5936
THANDRA, VIJAYA RAO, MD
8/28/2015
Q4531
P9265
P7716
P1238
THANGEDA, SRAVAN KUMAR, MD
THAPA, SHAILESH BIKRAM, MD
THARIAN, DIMPLE THARA, MD
THAROO, ANAM REHMAN, MD
5/15/2015
3/3/2014
8/15/2013
10/17/2011
Q8163
P0679
P8199
THARP, LAUREN JANE, MD
THATIKONDA, CHANDANA, MD
THEILKEN, LUKE STEVEN, MD
02-May-16
8/1/2011
10/15/2013
INTERNAL MEDICINE
INTERNAL MEDICINE
FAMILY PRACTICE
FAMILY MEDICINE
OBSTETRICS AND
M3764
THEIVAGT, CHARLES PATRICK, MD
9/15/2015
5/15/2020
3/3/2019
8/15/2018
10/17/2016
MOVEMENT
DISORDERS
Practice City
5/15/2015
4/11/2014
8/22/2013
10/27/2011
None
None
None
None
N/A
N/A
N/A
N/A
HOUSTON
KILLEEN
CHICAGO
TX
TX
IL
ACTIVE
ACTIVE
ACTIVE
06-Jun-16 None
8/5/2011 None
10/22/2013 None
N/A
N/A
N/A
MCALLEN
TX
ACTIVE
11/12/2015 None
N/A
NY
NY
ACTIVE
2/15/2012 None
N/A
NY
9/7/2011 None
9/17/2015 None
N/A
N/A
2/13/2015 None
8/4/2014 None
21-Jun-16 None
N/A
N/A
N/A
3/31/2014
9/18/2014
07-Jan-16
6/27/2012
None
None
None
None
N/A
N/A
N/A
N/A
ACTIVE
12/12/2011 None
N/A
7/8/2013
5/17/2012
11/14/2012
10/13/2014
22-Apr-16
8/5/2015
None
None
None
None
None
None
N/A
N/A
N/A
N/A
N/A
N/A
P0934
Q6116
THET, ZEYAR , MD
THI, VU HOANG, MD
9/1/2011
9/15/2015
Q3299
Q1313
Q8657
THIRUVASAHAR, THAMILVANI, MD
THODESON, DREW , MD
THODIMA, PRADEEP REDDY, MD
2/13/2015
8/1/2014
01-Jun-16
01-Jun-21 NEPHROLOGY
INTERNAL MEDICINE
DALLAS
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
P9471
Q1917
Q6913
P3464
THOGARUCHEETI, ANIL BABU, MD
THOLPADY, ASHOK , MD
THOM, WILLIAM H, MD
THOMAS MOHAN, REENA , MD
3/17/2014
9/15/2014
06-Jan-16
6/1/2012
3/17/2019
9/15/2019
06-Jan-21
6/1/2017
INTERNAL MEDICINE WESTON
HOUSTON
ANESTHESIOLOGY
SAN ANGELO
HOUSTON
WI
TX
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
P1601
12/1/2011
7/1/2013
5/1/2012
10/1/2012
9/15/2014
15-Apr-16
8/3/2015
7/1/2018
5/1/2017
10/1/2017
9/15/2019
15-Apr-21
8/3/2020
Q4315
THOMAS, ABEY KOZHIMANNIL, MD
THOMAS, ABRAHAM PALAMOOTIL,
MD
THOMAS, ANSA MARIN, MD
THOMAS, ASHA J, MD
THOMAS, DIVYA, MD
THOMAS, JEROME MATHEW, MD
THOMAS, JOANNA DEFEE, MD
THOMAS, JONATHAN GEORGE ,
MD
P0799
Q8369
THOMAS, KATHERINE ANNE, MD
THOMAS, LIA MARIAM, MD
5/1/2015
8/15/2011
16-May-16
INTERNAL MEDICINE BROOKLYN
NEUROLOGY
PEDIATRICS
RHEUMATOLOGY
INTERNAL MEDICINE
CARDIOLOGY
INTERNAL MEDICINE
ANESTHESIOLOGY
NEUROLOGICAL
5/1/2020 SURGERY
Page 363 of 402
N/A
SD
TX
2/1/2017 NEUROLOGY
INFECTIOUS
9/1/2016 DISEASES
NEPHROLOGY
VASCULAR
NEUROLOGY
9/3/2015 None
Disciplinary
Status Date
RAPID CITY
AMARILLO
THENGANATT, MARY ANN, MD
HOSPITALIST
PATHOLOGY
PAIN MANAGEMENT
INTERNAL MEDICINE
Registration
Status Date
Disciplinary
Status of
Texas
License
ACTIVE
LICENSE
ISSUED
ACTIVE
ACTIVE
ACTIVE
P2070
P7219
P3084
P4619
Q1918
Q7972
Q5580
2/1/2012
Secondary Specialty
(Self-Designated)
URGENT CARE
MEDICINE
Registration
Status of
Practice
Texas
State
License
HOUSTON
DALLAS
FORT WORTH
WINCHESTER
AUSTIN
KINGWOOD
TX
TX
TX
MA
TX
TX
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
ACTIVE
HOUSTON
TX
ACTIVE
5/18/2015 None
N/A
HOUSTON
TX
ACTIVE
ACTIVE
8/19/2011 None
23-May-16 None
N/A
N/A
dicaid
dicaid
License
Agreement
Number
Physician Name
Start Date
End Date
Designated)
(Self-Designated)
Practice City
P1146
THOMAS, MARTHA DIANNA, MD
10/3/2011
GAINESVILLE
P6736
THOMAS, NAJA MARI, MD
5/15/2013
HEMATOLOGY/ONCOL
P9259
THOMAS, PARIJATHAM S, MD
3/3/2014
3/3/2019 OGY
INTERNAL MEDICINE NEW YORK
CAPE
Q6584
THOMAS, REENA, MD
11/16/2015
GIRARDEAU
OBSTETRICS AND
P4912
THOMAS, SALY, MD
11/15/2012
DALLAS
P3259
THOMAS, SIBI PHILIPOSE, DO
5/15/2012
FORT WORTH
P2795
THOMAS, STEPHANIE, MD
4/2/2012
EMERGENCY
Q6118
THOMAS, TREVOR KARL, DO
9/15/2015
9/15/2020 MEDICINE
FORT WORTH
THOMASSON, BENJAMIN GOLDEN,
ORTHOPEDIC
P9266
DO
3/3/2014
3/3/2019 SURGERY
SAN ANTONIO
URGENT CARE
P3675
THOMPSON, BOBBYE JO, MD
6/15/2012
6/15/2017 MEDICINE
DERMATOLOGY
GALVESTON
THOMPSON, CHRISTOPHER ROSS,
OTORHINOLARYNGOL HEAD AND NECK
Q1919
MD
9/15/2014
9/15/2019 OGY
SURGERY
SAN ANTONIO
EMERGENCY
Q2713
THOMPSON, DONOVAN, MD
12/15/2014
12/15/2019 MEDICINE
CANTON
OBSTETRICS AND
Q2079
THOMPSON, FREDA DENISE, MD
10/1/2014
OBSTETRICS AND
Q8165
THOMSON, BROOK ALLEN, MD
02-May-16
OBSTETRICS
SAN ANTONIO
THORESON, GREGORY ROBERT,
UROLOGIC
Q4316
MD
5/1/2015
5/1/2020 UROLOGIC SURGERY ONCOLOGY
DALLAS
ADMINISTRATIVE
Q8166
THORNSBERRY, MICHAEL D, MD
02-May-16
MEDICINE
FORT WORTH
EMERGENCY
P9013
THORNTON, KEVIN MICHAEL, MD
2/7/2014
2/7/2019 MEDICINE
FAMILY MEDICINE
MURPHY
GERIATRIC
THOSANI, NIRAV CHANDRAKANT,
GASTROENTEROLOG MEDICINE (INTERNAL
P9472
MD
3/17/2014
3/17/2019 Y
MED)
HOUSTON
Q7290
THOTA, SARITHA, MD
16-Feb-16
FORT WORTH
Q5581
THUET, CHRISTINA, MD
P7362
P6098
THUNG, ELAINE GIOKLAN, MD
THURMAN, JERRY LEE JR, MD
Q4318
TIAN, CHENLU , MD
8/3/2015
7/15/2013
4/1/2013
5/1/2015
8/3/2020 PEDIATRICS
OPHTHALMOLOGY 7/15/2018 GLAUCOMA
OPHTHALMOLOGY
HOUSTON
HOUSTON
GASTROENTEROLOG
5/1/2020 Y
Page 364 of 402
Registration
Status of
Practice
Texas
State
License
TX
ACTIVE
ACTIVE
Disciplinary
Status of
Registration
Texas
Disciplinary
Status Date
License
Status Date
10/18/2011 None
N/A
5/21/2013 None
N/A
NY
ACTIVE
5/8/2014 None
N/A
MO
ACTIVE
11/17/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
ACTIVE
11/23/2012 None
5/25/2012 None
4/19/2012 None
N/A
N/A
N/A
TX
ACTIVE
9/18/2015 None
N/A
TX
ACTIVE
4/14/2014 None
N/A
TX
ACTIVE
6/19/2012 None
N/A
TX
ACTIVE
9/26/2014 None
N/A
OH
ACTIVE
12/24/2014 None
N/A
ACTIVE
10/27/2014 None
N/A
TX
ACTIVE
05-May-16 None
N/A
TX
ACTIVE
5/8/2015 None
N/A
TX
ACTIVE
05-May-16 None
N/A
TX
ACTIVE
2/21/2014 None
N/A
TX
TX
ACTIVE
ACTIVE
LICENSE
ISSUED
3/26/2014 None
30-Mar-16 None
N/A
N/A
8/3/2015 None
N/A
TX
TX
ACTIVE
ACTIVE
7/19/2013 None
4/29/2013 None
N/A
N/A
TX
ACTIVE
5/13/2015 None
N/A
License
Number
Physician Name
Q5110
TIAN, QI, MD
dicaid
dicaid
Agreement
End Date
Designated)
7/1/2015
Q6585
P9473
TIAN, SHIQIANG, MD
TIAN, WEI, MD
11/16/2015
3/17/2014
P9474
TIBBS, BRIAN MATTHEW, MD
Q8371
P0309
TICE, MATTHEW, MD
TIDROSKI, JENNIFER E

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