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Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
ADAMS AUDREY A 40-Nurse 05/26/2005
ADAMS LAURIE 40-Nurse 11/30/2009
Agnew Donald Pharmacist 03/31/2015
AHUMADA CARLOS A 51-Physician 10/20/2008
ALBERT FERNAND R 11-Behavioral Health Clinician
04/11/2002
ALDEN TRACI E Bookkeeper 12/18/2007
Alfiero Nicholas Home Health Aide 07/31/2013
Ali Dafle A Owner/Operator 05/12/2015
Ali Mohdi Owner/Operator 12/04/2012
ALLEN GEORGE R 11-Behavioral Health Clinician
01/09/2002
Allen Mari J Owner/Operator 04/18/2014
Altman Myra 51-Physician 04/30/2013
A'MFILO BASIL 51-Physician 07/17/2003
ANDERSON DAVID 51-Physician 02/06/2002
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 1 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
ANDERSON WILLIAM J CNA 02/16/1999
Anderson Carline Lortie Christine 40-Nurse 05/20/2012
Anderton Jeremy 40-Nurse 05/20/2018
AROOSTOOK ENT CLINIC
51-Physician 04/16/2007
AROOSTOOK ENT CLINIC
51-Physician 04/19/2007
Arsenault Terri Business Manager
07/16/2013
ASTON ROBIN A 11-Behavioral Health Clinician
04/13/1998
BABINE SARAH 51-Physician 04/02/2008
Bachelder April CNA 01/04/2011
Backman Stacey Marzakis Stacey Backmann Stacey Backman Stacy PCA 07/20/2015
Bagley Sky CNA 05/21/2015
Bailey Susan Susan Morrison 40-Nurse 03/28/2017
Ballard Beverly 40-Nurse 04/17/2013
BARRETT MARILYN E 40-Nurse 06/23/1998
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 2 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Bartlett Jeffrey 40-Nurse 03/21/2014
BATTLES STACIE L MORRILL STACIE L.
40-Nurse 03/02/2006
BEAN DONNA CNA 03/23/2004
Bean Amanda CNA 01/13/2011
Bean Stevie CNA 09/25/2014
BEANE HEIDI A 40-Nurse 07/02/2004
Beardsley Danielle CNA 05/12/2014
Beaucage Lionel Other 12/27/2013
Beaulieu Kristy Pharmacy Technician
10/18/2013
Beaulieu Amy J Pharmacy Technician
01/03/2017
BECKER JON Owner/Operator 03/26/1997
BECKER MARLENE 70-Transportation 05/12/1997
BEGGS DANIEL M CNA 10/19/1993
BEGGS STEPHEN L 52-Physician Assistant
08/14/1990
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 3 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
BEICH MICHAEL N 11-Behavioral Health Clinician
11/20/1997
BELISLE LANA MANSIR LANA CNA 07/28/1991
BELONGA ELIZABETH Other 04/24/1989
Beninati Joleen 07/09/2019
BERETSOS ANGELA Other 01/10/2005
Berkley David CNA 07/17/2015
Berry Michelle Berry Michele Pharmacy Technician
03/20/2016
BERRYMAN ROBERT W 49-Physical Therapist
04/10/2003
Berube Jennifer MacLean Jennifer 40-Nurse 03/29/2013
BETTER HEALTH CARE
Home Health Agency Employee
07/18/1998
BEVERIDGE WILEY J N/A N/A N/A N/A N/A N/A N/A N/A 40-Nurse 10/14/2010
BIDDLE VIRGINIA 51-Physician 12/30/2005
BINA FARID 51-Physician 11/20/1998
BISHOP BARBARA 40-Nurse 07/15/2010
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 4 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Bisso Raymond Pharmacist 11/15/2013
BIXLER ANDREW T 11-Behavioral Health Clinician
10/27/1997
Black Gertrude Trudy Home Health Aide 07/05/2013
BLACKSTONE QUENTIN M 40-Nurse 06/27/2001
BLANCHARD MELISSA A Billing Staff 04/27/2007
Blank Anthony D 40-Nurse 05/27/2015
BLASTOW SANDRA Wallace Bookkeeper 04/21/1995
BOHURJAK MARK Other 10/19/2009
Bohurjak Christina Kling Christina Bohurjak Kling
Christina Hospoda Christina Hospodar Christine 40-Nurse 07/20/2016
BOISVERT CAROLEE 40-Nurse 06/14/2005
BOLDUC KEVIN Dental Technician 03/25/1994
BOOKER MICHELE L ROBERTSON
MICHELE
CNA 12/22/2008
BOONE MICHAEL 16-Chiropractor 03/10/1982
BORTZ SANDRA E Other 09/19/2002
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 5 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Bosquet Robert Robert B Bouquet
Bennett Robert Bosquet Robert PCA 06/19/2016
BOUCHER DANA 40-Nurse 04/10/1995
BOUFFARD ANNE B 40-Nurse 08/01/2002
Bourgoin Lori Brown LaChance Home Health Aide 06/20/2014
BOURNE ANDREW R 40-Nurse 10/14/1997
Boutaugh Jason 40-Nurse 06/05/2018
Boutot Shana Burke Shana 06/06/2017
BOYNTON MARILYN 11-Behavioral Health Clinician
11/17/1995
BRACKETT RICHARD P 52-Physician Assistant
11/03/2006
Brady Gerry Brody Gery Brady Geary 40-Nurse 08/03/2016
Brady Kristen Beady Kristen Brady Brady Kristin CRMA 06/18/2015
Braga Paulo Braga Paolo Braga Pulo Brago Palo Braga Baulo Counselor 02/25/2016
BRAYALL JACQUELINE
CNA 07/03/2004
Brecht Jolene 40-Nurse 05/20/2018
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 6 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
BRECKEN SIGRID E 40-Nurse 08/07/2006
BRISSETTE MICHELLE M INGALLS MICHELLE M.
Pharmacy Technician
12/13/2006
Brock Gwen Other 12/04/2012
BROCUGLIO STEVE Other 11/08/2001
Brooks Merissa Osgood Merissa Osgood-Brooks
Merissa 14-Case Management
Services Provider
04/03/2019
BROUSSARD NED E CNA 10/17/2001
Brown Jennifer L Coon Jennifer 12/11/2018
Brown Brittney 06/20/2018
BROWNELL-BERRY
ELAINE L 11-Behavioral Health Clinician
03/11/2009
Brummer Paula Gustins Paula 40-Nurse 12/01/2014
Bruns Kathleen Brums Kathleen Bruns Katie Bruns, Kaitlyn
CNA 05/26/2016
BUCKLEY DOREEN Nursing Home Employee
10/31/1989
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 7 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
BUCKLEY GAILENE J Nursing Home Administrator
10/31/1989
Bunker Jessica Lawley Jessica CNA 04/03/2019
BURKE KENNETH P 51-Physician 02/23/1994
BURNS MARSHA 11-Behavioral Health Clinician
01/06/2005
BURNS JOANNE K KLINA JOANNE DORIS
40-Nurse 12/01/2002
Burns Jaime Bodge Jaime 48-Pharmacy 02/20/2019
Burns Cheryl CRMA 07/09/2019
Burns Nancy CNA 02/24/2015
Bushwood Amanda Pharmacy Technician
09/24/2014
BUTLER LAURA MACARTHUR
LAURA A.
Other 06/05/2002
Butler-Porter Michelle Butler Michelle Dinsmore Michelle Bartlett Michelle Spinney Michelle 79-PCA Agency 01/19/2016
Buzzell Robin 40-Nurse 04/23/2013
CALDER ELIZABETH B 40-Nurse 07/07/2002
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 8 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
CAMPBELL ROSE Volunteer Driver 03/11/1995
CAMPBELL TIFFANY CNA 01/11/2010
CANNING JOYCE 70-Transportation 12/13/2004
Capponi Kayla Chiasson Kayla 11-Behavioral Health Clinician
04/03/2019
Carney Ashley Risinger Home Health Aide 01/08/2015
Caron Sarah CRMA 04/23/2014
Caron Tina Ehlenbach Tina Henthrone Tina CNA 08/12/2015
CARPENTER DARRELL CNA 03/28/1996
CARR DALE A 40-Nurse 12/21/2010
Carson Lisa Carson Lisa M Willey Lisa M CNA 02/07/2017
CASSIDY BRIAN M CNA 01/07/2009
CENTER FOR BEING
FOUNDATION
38-Mental Health Clinic
04/26/1984
Chadwick Ashley Chadwick Ashley Pharmacy Technician
05/29/2016
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 9 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
CHAMBERLAIN
WENDY E 40-Nurse 09/04/2012
CHAMBERLAIN
MARC P 40-Nurse 07/20/2009
CHAMBERS JOHN V Business Manager
02/12/2007
Chaousis Elizabeth Harrigan Elizabeth Schoonmaker
Elizabeth 40-Nurse 06/20/2019
CHAPLOW BARBARA A 40-Nurse 06/23/2006
Chapman Lacey CRMA 01/03/2017
CHASE JOANNE E 02-Advanced Practice
Registered Nurse
09/20/2009
Chase-Colby Katelyn Colby Kathelyn Colby Katelyn Cobey Kacelyn chasecolby Katelyn PCA 05/19/2016
CHASSE JOHN Other 12/17/2001
CHINETTI STEPHEN E 49-Physical Therapist
06/20/2003
Christensen Marc Christianson Marc Christianson
Mark 51-Physician 10/27/2015
Christian Rebecca PCA 05/21/2019
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 10 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Christie Scott 11-Behavioral Health Clinician
08/23/2012
CLARK TAMARA L BACON TAMARA L.
CNA 01/11/2007
Clark Kayla Pharmacy Technician
09/19/2011
CLAYTON JANE M 40-Nurse 03/07/2009
Clifton Anna 40-Nurse 12/30/2014
CLOUTIER GEORGE 51-Physician 03/03/1983
CLUKEY HAROLD F Pharmacist 06/19/1984
COCHRAN R. 51-Physician 02/23/1995
COCKS JAMES R 16-Chiropractor 09/06/1996
COFFEY PETER N Paramedic 09/11/2000
COFFIN LISA Other 01/21/2009
COLBOURNE CAROLYN GAMAL-ELDIN
CAROLYN
40-Nurse 11/29/2006
COLE ROSEMARY A 40-Nurse 02/16/1993
COLE SUSAN L 40-Nurse 03/13/2006
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 11 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
COLEMAN JESSICA L SMITH JESSICA L.
Pharmacy Technician
02/20/2006
COLLIGAN JAMES E 11-Behavioral Health Clinician
01/07/2003
COLLINS BEVERLY R 40-Nurse 08/19/2002
Colon Melanie Pharmacy Technician
12/16/2011
COMFORT CHRISTOPHER
Pharmacist 09/20/2001
Comtois Sara CNA 09/15/2014
Condon Ricky Counselor 06/20/2014
Condon Julie Pharmacy Technician
04/29/2014
COOK THOMAS Pharmacy Technician
08/20/2008
COOK CYNTHIA M 11-Behavioral Health Clinician
12/23/1998
Cook Cassandra 40-Nurse 06/10/2013
COOKSON MICHELLE R Pharmacy Technician
01/12/2008
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 12 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
COOKSON LINDA J 40-Nurse 06/07/2002
Coombs Chad Counselor 12/11/2018
COPP JERRY A 40-Nurse 06/17/1999
CORRIN DENNIS D 11-Behavioral Health Clinician
11/08/2004
Corson Heather 20-Dental Hygienist
10/29/2012
COSTIGAN KEVIN 11-Behavioral Health Clinician
08/09/1999
Cotton Laura 40-Nurse 04/08/2013
COUBERT BETTY S Other 02/12/1987
COUTURE NANCY E CNA 11/09/1995
Cox Marshall Cox Michael PCA 09/24/2015
CRANE SUSAN 11-Behavioral Health Clinician
09/20/2002
Crawford Nikkita CNA 03/31/2017
Creighton Robert J 40-Nurse 03/06/2013
Crommie Erin N 40-Nurse 03/29/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 13 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
CROSSMAN MERLE N 40-Nurse 11/25/2006
Cross-Snell Robin 40-Nurse 10/23/2018
Crowe Jennifer South Jennifer Christine
40-Nurse 12/20/2016
CUCCO LUIGI 51-Physician 06/26/1997
Culver Rebecca 40-Nurse 09/17/2018
CURRAN EDWARD J 11-Behavioral Health Clinician
11/01/1996
CURRAN WILLIAM J 63-Speech Language Pathologist
10/06/1984
Currier Maria 40-Nurse 11/27/2012
CURTIS ROBERT T 40-Nurse 02/21/2008
Curtis Jane R 40-Nurse 06/30/2011
Curtis Nastassja Nicholas Nastassja
12/20/2018
CUSACK PAMELA J Pearson Pamela Other 04/05/2004
Cushing Rebecca Other 06/13/2013
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 14 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Cutliffe Jessica Hall Jessica 16-Chiropractor 02/26/2016
CYR JOSEPH C 51-Physician 08/22/2000
Daigle Rena Michaud Tardif 40-Nurse 04/03/2014
DALEY REBECCA S CNA 04/05/2003
DALEY SUSAN L SHAFT SUSAN L.
40-Nurse 11/06/2005
DALTON ROBERTA R 40-Nurse 07/04/1991
Damron Elizabeth Pharmacy Technician
09/12/2011
Daniels Kathleen 06/20/2018
Daniels Katharine Home Health Aide 01/20/2019
DARLING BLANCHE M Other 01/02/1986
Dauphinee Nicolle Nicolle Haney Smith Nicole Dauphinnee
Nicole Haney Nicolle 40-Nurse 01/23/2015
DAVIS RACHEL A WILLIAMS RACHEL A.
40-Nurse 05/25/2006
DAVIS CYNTHIA G 40-Nurse 06/23/1997
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 15 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Davis Amber Pharmacy Technician
04/23/2013
Davis Elizabeth Taylor Elizabeth Taylor Lisa Davis Eliabeth 40-Nurse 10/22/2015
Day Theresa 40-Nurse 06/19/2014
De Los Heros Reinaldo H Delos Heros Reinaldo Delosheros
Reinaldo 51-Physician 12/15/2017
DEAN NANCY C 40-Nurse 01/03/2001
DEARBORN JAMES Radiology Technician
02/16/2005
DEERING WILLIAM 11-Behavioral Health Clinician
05/10/1993
DELANO CAROLYN 11-Behavioral Health Clinician
04/10/1985
DellaRipa Susan 22-Dentist 04/18/2017
DELLARMA BRENT 49-Physical Therapist
08/11/2009
Demerchant Teriann PCA 05/20/2018
Demerchant Clayton Demarchant Clayton PCA 04/19/2018
Dempsey Marie 40-Nurse 10/20/2014
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 16 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
DENNETT ROBIN A Bookkeeper 12/19/2005
Depugh Dana CNA 10/11/2018
DERBOVEN PAUL H 51-Physician 07/16/1998
Desai Robert Robert Desai Robert K 51-Physician 07/17/2015
Deshane Lori A 40-Nurse 04/24/2012
Despres Claire CNA 04/03/2014
DESROCHERS PAULINE L 40-Nurse 10/02/2000
Desrosiers Henri Desrosiers Henri Paul
40-Nurse 01/03/2017
Dickinson Jared M 40-Nurse 11/28/2011
Didominicus Catherine Catherine Cram Catherine Bois 40-Nurse 07/10/2017
DIESSNER ARDELL W 51-Physician 10/10/2006
DISHONG DENNIS Nursing Home Administrator
07/09/1985
Disy Jenna Disy Jenn Disy Jena CNA 05/06/2015
DIXON RICHARD G Paramedic 02/07/1995
DOAK BONNIE CNA 12/26/2008
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 17 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
DOBSON CHRISTOPHER
D 11-Behavioral Health Clinician
05/27/2004
DONEGAL TOWN INC.
73-Waiver Services Provider
10/27/2003
Donnell Heather Truman Heather Pharmacy Technician
05/14/2018
Dorn John M Ochiltree James 51-Physician 07/26/2011
DORR ANGELA M CNA 08/23/2004
Dorvee John Doruee John Dorver John John Dorvee 48-Pharmacy 12/03/2015
Doucette Destiny CNA 06/04/2013
DOW MELLETTE A PEPIN MELLETTE A.
Nursing Home Administrator
04/02/2004
DOYLE ROBERT 51-Physician 07/01/1988
DOYON RAEANN M 40-Nurse 08/21/2006
DRISCOLL JOHN P 51-Physician 03/19/2007
DROWN LISA V PCA 06/07/2002
Dubay Karen CRMA 11/20/2018
DUBE CALVIN E 40-Nurse 06/24/1997
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 18 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Dubois Matthew Radiology Technician
06/20/2014
DUCHARME DENIS M Paramedic 04/07/2004
DUMONT KAREN B Bookkeeper 09/07/1999
DURLAND-MCDERMOTT
MARY 40-Nurse 12/22/2009
Duymazlar Hasan 51-Physician 12/22/2014
Dwyer Jennifer 40-Nurse 03/20/2012
Dyroff Michael Pharmacist 04/17/2013
EDELSTON A. K 11-Behavioral Health Clinician
08/02/2002
EGGLESTON CLARK O 51-Physician 11/15/1983
Ehler Pamela 40-Nurse 10/20/2013
ELAM RICHARD 11-Behavioral Health Clinician
07/29/1988
Elie Catherine Cathy M Elie Leo Catherine Elie Kathy Elie Chelsy CRMA 03/31/2015
ELLIOTT CHRISTIAN B Other 09/19/2002
Ellis Line G 40-Nurse 12/07/2010
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 19 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Emerson Kelsey CNA 06/18/2015
Emery Casey Emery Kasey Pharmacy Technician
09/20/2018
Enman Catherine Frongilo Catherine Frongillo Cathy Frongillo Catherine Enman Cathy Pharmacy Technician
08/21/2015
Enzinger Peter Shays Owner/Operator 04/19/2012
ESPOSITO MICHELINA F Medical Technician
11/06/2004
Estes Stephanie Brotherton Stephanie D
Brotherton Stephannie D
Estes Stephannie
CNA 06/19/2016
EVANS LORENE M CRMA 04/12/2010
FALDMAN CLIFFORD 16-Chiropractor 04/06/2010
Farnsworth Suzanne 40-Nurse 09/06/2016
Farrell Jason CNA 08/09/2012
FERRY JENNETTE M Pharmacy Technician
04/20/2010
Field Sara L Counselor 04/17/2012
Fields Jacqueline Libby Jackie CNA 06/27/2011
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 20 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
FISH TRACEY L 40-Nurse 11/27/2002
Fisher Brenda 03/28/2017
Fisk Scott 69-Substance Abuse Provider
04/16/2009
FITZPATRICK PATRICIA A PARMENTER
PATRICIA ANN
PARMENTER
PATRICK 40-Nurse 01/26/2002
FLEISCHMAN A. M 51-Physician 02/16/1988
Flowers Janice M Flowers Jan R. Strong Janice M. 40-Nurse 08/20/2017
FOLEY CANDACE Bookkeeper 09/26/1996
Folkemer Carl Folkemer C. Thomas
Folkmer C T Folkemar Carl Thomas
Folkmer C. Thomas
51-Physician 05/20/2015
FORAKER ROBERT CNA 03/29/1994
Ford Gregory 11-Behavioral Health Clinician
05/10/2017
FORSMAN JAMIE CNA 01/05/2009
FORTIN KAREN M Other 06/07/2002
FORTIN JEFFREY A Other 09/28/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 21 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
FOSTER STEPHEN 11-Behavioral Health Clinician
05/22/1998
Fournier Dawn M 01/04/2019
FOX ROBYN L CNA 05/07/1997
FOX JANICE A 11-Behavioral Health Clinician
12/26/1995
FOX BARBARA A 40-Nurse 08/11/2004
FRASIER SHIRLEY A 40-Nurse 11/07/2000
FRYE SUSAN M 40-Nurse 11/19/2002
Fuller-McMahan
Angel Owner/Operator 09/04/2012
GADDIS THOMAS D Nursing Home Administrator
04/14/2002
Gagnon Jade 40-Nurse 02/13/2012
Galatis Micheel Galatis Mike Jalatis Mike 02-Advanced Practice
Registered Nurse
07/20/2015
Gallagher Brittany CNA 02/24/2015
Gallagher Jon Counselor 04/03/2019
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 22 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
GALLANT MARY E 40-Nurse 01/28/2002
GALLANT ROBERT Other 09/13/2002
Garbarino Robert Garbarino Robert 07-Assisted Living Service Provider
07/19/2018
Garceau Lori CNA 09/10/2014
GARRETT HOLLY A CHIRAMBO HOLLY CNA 05/14/1997
Garrison James D 40-Nurse 10/20/2014
GAY LINE G Ellis Line G. 40-Nurse 09/24/1998
Gayer Robert 49-Physical Therapist
10/17/2013
Gendreau Tracy CNA 09/09/2013
George Elaina Gaudet 40-Nurse 05/02/2014
Gerfin Judith 06/20/2018
Getchell Rena 73-Waiver Services Provider
06/10/2019
Giberti Angela 40-Nurse 11/25/2014
Gibson Lori Medical Technician
11/20/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 23 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
GILBERTI ROCCO C Paramedic 04/06/2004
GILES JOAN A 40-Nurse 11/26/2004
Giles Kevin Other 01/04/2013
GILL CHARLES 11-Behavioral Health Clinician
04/11/1996
GILLESPIE TAMMY J Other 09/19/2002
GILLESPIE JON B 16-Chiropractor 07/30/2001
GILLEY MARGARET L COLBY MARGARET L.
Consumer/Member
03/09/2005
Gilman Bobbi J Francis Bobbie Jo
CNA 10/11/2018
GINTY PATRICIA 40-Nurse 01/20/2010
GIOBBI RENEE M 40-Nurse 08/15/2005
Girard John Giard John 51-Physician 05/19/2016
Giroux Mark Giroux Mark Counselor 05/26/2016
GOFF WENDY M 40-Nurse 07/20/2004
GOLDENBERG JACOB E 22-Dentist 11/01/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 24 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Golliday Gregory 16-Chiropractor 07/06/2012
Goodman Kathleen 40-Nurse 08/14/2013
Goodwin Timothy R Goodwin Timothy Beth
40-Nurse 08/20/2017
Goodwin Brandy Fillion Brandy Pharmacy Technician
02/07/2017
Goodwin-Moore
Carl Counselor 03/13/2012
Goth Cordelia 40-Nurse 06/02/2011
Goulet Gloria 40-Nurse 08/14/2013
Gower Amber CNA 03/04/2011
Gracie Reginald S Pharmacist 07/06/2012
GRANT ALICE R Other 06/20/2002
GREENFIELD JEFFREY B 16-Chiropractor 05/08/2002
GREGORY SUSAN HANDS SUSAN L.
40-Nurse 02/22/1994
GRIFFIN BRIAN Other 10/26/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 25 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
GRIFFIN JAMES E GRIFFIN, JR.
JAMES E.
40-Nurse 10/06/2005
GROVER SHERRY L GROWER SHERRY L.
Home Health Agency Employee
10/28/2005
Guild Ashleigh 11-Behavioral Health Clinician
04/03/2019
GUIOU MARCI A Business Manager
09/20/2004
GULED AHMED Y N/A N/A N/A N/A N/A N/A N/A N/A Consumer/Member
06/20/2011
GULESIAN A. J 51-Physician 12/12/1991
GUSTAFSON WENDI S 40-Nurse 03/23/2009
Hackett Suzanne Snowman 40-Nurse 07/06/2012
Hackett Danielle Counselor 10/25/2014
Haggett Heather CNA 09/12/2014
HAGOPIAN LAURIE 56-Podiatrist 12/02/1993
HALL LUCILLE R 40-Nurse 11/27/1992
Hall Andrew J 40-Nurse 01/23/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 26 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Hall Samuel 12/20/2013
Hall Kathryn 40-Nurse 03/27/2015
HALPERIN DAVID 51-Physician 01/13/1986
Halvachs Paul 40-Nurse 09/20/2015
Hamilton-Butts Morgan 06/20/2018
Hamlin Rebecca Pharmacy Technician
12/22/2014
HAMRICK-BURWELL
LIANE 11-Behavioral Health Clinician
10/01/2001
Hands Susan L Gregory CNA 02/22/1994
HANSCOM F. E Other 11/17/1985
Harding Leslie 51-Physician 10/22/2015
HARRIS WILLIAM R CNA 12/03/2002
HARRIS JOANNE CNA 11/12/2003
HARRIS VERNE D 51-Physician 12/01/2003
Harris Rudolph J Home Health Aide 10/28/2014
Harrison Jill R 05/20/2018
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 27 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
HART THOMAS J 51-Physician 08/02/1997
HARTIGAN SHARON CNA 02/19/1994
HART-LECLERC
JANET N 40-Nurse 11/13/2007
Hartley Ashley 08/30/2011
HARTZELL SAMUEL CNA 01/25/2002
Harvin Devine Other 06/13/2013
HASKELL DOREEN SALISBURY DOREEN 40-Nurse 11/07/1992
Hawkes Derek CNA 02/03/2011
HEATH DEBORAH A 40-Nurse 11/26/1991
Heggeman Janet M Heggeman Janet A. 40-Nurse 09/20/2018
Heikkinen Raymond CNA 01/04/2011
Heinzman Timothy C 40-Nurse 03/20/2012
Hendry Michael W 02-Advanced Practice
Registered Nurse
04/11/2011
Herrell Emily 40-Nurse 03/31/2015
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 28 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
HERSEY DEBORAH A CNA 01/14/2009
HESSELTINE CHRISTINA E Bookkeeper 02/24/2009
HEY RICHARD 11-Behavioral Health Clinician
01/10/1991
Hichborn Terri L Nivison-Hichborn
Terri L. Home Health Aide 07/11/2017
HICKMAN CARRIE S 40-Nurse 04/23/1999
HIGGINS JENNIFER L 40-Nurse 09/19/2003
HIGGINS LORNA M Other 10/28/2002
Higgins Anna-Lee 40-Nurse 10/20/2013
Hill Bethany CRMA 06/18/2015
Hoak Lindsay Office Assistant 07/07/2015
HODGKISS NANCY Reynolds Nancy 40-Nurse 09/02/1998
HOFFMAN GREGORY 40-Nurse 12/02/1998
Hoffman Dianne 40-Nurse 01/14/2014
HOLBROOK LINDA A RICHARDSON
LINDA POLLEY LINDA A. POLLEY LINDA ANN
PUNTOLILLO
LINDA 40-Nurse 02/06/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 29 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Holbrook Herman Holbrook Herman Oscar
Holbrook Oscar 40-Nurse 02/10/2016
HOLCOMB ROBERT M Pharmacist 02/20/2006
Hold Trevor Radiology Technician
05/20/2014
Holman Heather Pharmacy Technician
04/17/2013
Holzman Diane H Holzman Diane Hope
40-Nurse 09/06/2016
HOOKS JAMES M 40-Nurse 10/05/2004
HOPE PETER B 51-Physician 04/18/2003
Horner David J 40-Nurse 09/30/2011
HOULE CHERYL T TIMBERLAKE
CHERYL A.
Other 07/24/2002
HOWES BONNIE S 40-Nurse 04/02/2010
Hubbard Sue E Hubbard Sue CNA 06/18/2015
Hughes Kimberly Sacco Heather Pugh Heather Smith Heather 48-Pharmacy 12/30/2015
HUNTER JAMES E 11-Behavioral Health Clinician
08/01/1999
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 30 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
HUNTINGTON WILLIAM N 40-Nurse 07/02/2005
HUNTON CLARA M SMITH CLARA MARIE
MESERVE CLARA MARIE
40-Nurse 01/25/2002
Hurd John I Hurd John II 40-Nurse 10/22/2015
HUTCHINSON SANDRA A GULCHINSON
SANDRA CNA 01/10/2007
HYNES GEORGE Other 09/20/2000
INDEPENDENT HOMECARE
INC
Home Health Agency Employee
09/21/2002
Inman Denise 06/27/2018
Issa Abdullahi Abdullah Issa PCA 10/22/2015
Jack Deanna Bolduc Deanna D
CNA 02/07/2017
JACKSON SCOTT R Other 09/19/2002
Jackson Joseph 51-Physician 07/08/2015
Jacobs Allen 22-Dentist 08/14/2017
Janosco Kristen Manton Kristen Pfusch Kristen Pepin Kristen Ober Kristen CNA 05/26/2016
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 31 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
JARBOE KATHRYN R 40-Nurse 01/09/2003
Jarry Lisa CRMA 07/01/2014
JEALOUS JAMES S 51-Physician 08/30/2005
Jedju Linda 40-Nurse 06/05/2018
JEFFERS LINDA A 40-Nurse 03/16/2006
Jehn Cheryl Noble Cheryl Paiva Cheryl 40-Nurse 01/24/2017
JELLISON KRISTINA CNA 12/11/2008
JENDRASKO ANN Pharmacy Technician
02/01/2005
Jensen Jennifer Smith Jennifer 03/28/2017
JEWELL SHERRI L Medical Technician
04/08/2005
JEWETT PAMELA 40-Nurse 09/24/1998
Joachim Dan W 51-Physician 01/17/2012
JOHNSON RANDY L 40-Nurse 02/08/2000
Johnson Trudy A Camp Gagnon 40-Nurse 04/03/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 32 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Johnson Tchernavia McKinnis Tchernavia
McKinnis Johnson
Tchernavia
40-Nurse 05/11/2018
JOHNSTON HUGH H 51-Physician 01/02/1991
Johnston Courtney Pharmacy Technician
03/28/2017
Jordan Carey 40-Nurse 06/05/2018
Jordan John 08/23/2018
JOYCE JAMES L Other 08/23/2004
Judd Mark 08/14/2013
JUNKINS MICHELLE Home Health Agency Employee
01/25/2005
KAHL RUSSELL A COOPER RUSSELL ALAN
SMITH RUSSELL ALAN
40-Nurse 10/09/2001
KAMM PATRICK W 51-Physician 07/18/1987
KAMMERMAN ROBERT 51-Physician 09/15/1986
Karl-Wellman Alison Pharmacy Technician
04/19/2012
Kary Daniel J 51-Physician 11/18/2014
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 33 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Kay Alan Kay Alan Michael
Kay Allen Kay Allan 48-Pharmacy 07/17/2015
Keating Lorraine Office Assistant 01/30/2012
Keefe John 11-Behavioral Health Clinician
12/06/2012
Kellermann Thomas F Kellerman Thomas 48-Pharmacy 06/20/2019
KELLEY EDWARD M 11-Behavioral Health Clinician
06/30/2000
Kerwin Leah Herwin Leah 40-Nurse 02/26/2018
KESSLER RONALD W 52-Physician Assistant
04/02/2009
KESTENBAUM RICHARD 11-Behavioral Health Clinician
08/10/1992
Khan Waleed 51-Physician 08/15/2014
KIMBALL BRENDA 11-Behavioral Health Clinician
05/14/2004
KIMBALL JODY L 11-Behavioral Health Clinician
11/17/2001
KIMBALL PATRICIA L 40-Nurse 11/17/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 34 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
KLENTZMAN MARC F 22-Dentist 02/18/2004
Klimaytis Gregory 40-Nurse 03/28/2017
KNOLL MARJORIE A Other 04/20/1999
Knowles Jennifer Knowls Jennifer 40-Nurse 06/06/2017
KOENIG-HENRY
JANET 70-Transportation 03/01/1990
KOONTZ JENNIFER Other 03/13/1995
KOPET RONALD 51-Physician 10/08/1986
Korpaczewski Angelica Pharmacy Technician
01/12/2012
KORZENIEWSKI
SUSAN L 11-Behavioral Health Clinician
01/17/1997
KRAUS TREVOR J 40-Nurse 12/22/2008
Kristiansen Michelle Pharmacy Technician
12/24/2012
LABBE MAURICE Nursing Home Administrator
02/03/1997
Labbe Amy Labbe Amy Elizabeth
Labbe A 40-Nurse 06/01/2015
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 35 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
LACASE MARION 11-Behavioral Health Clinician
04/10/1985
LACHIOMA LORI M 40-Nurse 09/10/1990
LAGASSE JOY A 40-Nurse 11/08/2001
Lambert Darlene Joy Darlene 40-Nurse 03/31/2015
LAMSON LAVONNE M Bookkeeper 10/03/1993
LANDOLT ETHEL M Paul-Landolt Ethel M. 40-Nurse 10/29/2004
LANDRY LEE R CNA 12/01/1986
Landsman Ann Sacker Ann Landsaman
Ann Landsman Ann Marsha
Landsam Ann 52-Physician Assistant
05/20/2015
LANE JOHN W Nursing Home Administrator
06/18/1986
LANE AMANDA E 40-Nurse 04/28/2004
LANNING PATRICIA E 40-Nurse 12/07/2000
LAPRELL RENEE 40-Nurse 08/20/1998
LARBY DAVID A Other 12/02/2009
LARSON JEANNINE C Other 11/09/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 36 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
LaVallee Amanda Yenco Amanda Pharmacy Technician
02/16/2012
LAVIGNE ROXANNE E 40-Nurse 06/15/2011
LAVINE DEBORAH S N/A N/A N/A N/A N/A N/A N/A N/A 40-Nurse 10/05/2010
LAWLER JAMES O 11-Behavioral Health Clinician
06/01/2000
LAZARO JUAN C LAZARO-PAULINA
JAY C. 51-Physician 11/28/2004
Lea Karen J 40-Nurse 01/01/2011
LEACH DEBRA Other 10/26/2001
LEASK LOIS CNA 08/06/2009
LEBLANC VALERIE L 40-Nurse 04/19/2006
LeBlanc Michael I PCA 03/20/2017
LEBOEUF JEANNE M 40-Nurse 06/24/2006
LeClair Crissy Shorette Crissy Marie
Michaud Crissy 40-Nurse 09/06/2016
LECOMTE SUSAN A 40-Nurse 10/26/1999
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 37 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
LEE DAVID 11-Behavioral Health Clinician
03/16/1996
Legassey Betty Tharp Betty Phillips Bety Philips Betty CNA 08/21/2015
LEIGHTON HUGH J CNA 03/20/1996
Lemay Robert Pharmacist 01/19/2012
LeMoine Jeffrey D 40-Nurse 03/21/2012
Lennon Meranda 11/20/2018
Lenz Emily 40-Nurse 06/13/2013
LEONARD DANIEL CRMA 11/04/2002
Leong Keng C Miao K C Leong Barbara Liping Keng Keng Leong 51-Physician 06/01/2015
Levensaler Michael J 07/11/2017
Levensaler Sharon L Home Health Aide 07/11/2017
LEVESQUE RICHARD M 51-Physician 01/20/1998
Lewis Wayne Wayne F MHRT 10/02/2015
Libby Jody Pharmacy Technician
12/06/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 38 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
LIBERATO DORIA F DORIA LIBERATO
CNA 02/18/2009
Liberty Brooke Liberty Brooke CNA 11/28/2018
LICHT JEFFREY A Pharmacist 10/22/2002
LINSCOTT TERRY Other 10/18/2001
LITCHFIELD JEAN Counselor 08/24/2010
Little Justin CNA 07/16/2014
LITTLEFIELD KATHLEEN B 40-Nurse 10/08/1998
Littlefield Trina Littlefield Trina Marie
40-Nurse 09/06/2016
LIZOTTE JOY CNA 02/20/2003
LIZOTTE BETHANY S CRMA 05/05/2009
LIZZOTTE LUE A CNA 12/02/1993
LOBACZ LINDA M 40-Nurse 07/31/2007
LOCKE HOPE M ROGERS, HOPE M. CNA 03/15/2006
Locke Robin E 51-Physician 09/14/2017
LOGAN HAROLD F Other 12/13/1981
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 39 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Long Julia Pharmacy Technician
11/02/2016
LORD SALLY Other 03/14/1984
LOVELL DEAN R Pharmacist 10/06/2000
LUCK GREGORY C 51-Physician 08/01/1999
LUCK DIANNE M 40-Nurse 02/03/2005
LUNDEN LISA E CNA 05/30/1997
LYMNEOS MICHAEL 11-Behavioral Health Clinician
06/06/2009
LYSAGHT GWYNETH N/A N/A N/A N/A N/A N/A N/A N/A 40-Nurse 07/20/2010
MacArthur Laura 03/28/2017
MACMURRAY PETER S 51-Physician 07/10/1990
MADISON KIMBERLY J Jeffries Kimberly 40-Nurse 09/08/1999
Malcomson Karen L 40-Nurse 06/20/2019
MANNING MARCOS B 51-Physician 04/03/2004
MANZO SUZANNE M ROBSHAW SUZANNE M.
40-Nurse 06/06/2000
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 40 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
MARCHETTI ANGELA M PHILLIPS ANGELA M.
CNA 12/18/2007
MAREK CASSANDRA
L 40-Nurse 02/27/2006
Marquis Tanya M Maquis Tanya 40-Nurse 06/06/2017
Marsh Carla Shiplett Carla CNA 11/20/2015
MARSTON CARROLL Nursing Home Administrator
10/01/1998
Martin Bonnie 40-Nurse 10/28/2011
Martin Heather CNA 05/26/2016
Martin Audrey L 40-Nurse 09/14/2017
Martin Kasandra Pharmacy Technician
12/27/2013
MASON RITA J Other 06/15/1990
MASON MORNINGSTAR
Pharmacy Technician
02/16/2007
MASOOD RAJ 51-Physician 12/02/2000
MATOS MANUEL W 40-Nurse 03/18/2009
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 41 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
MATTHIAS WEEZA 51-Physician 08/18/2008
MATTSON LINDA M 49-Physical Therapist
06/02/1997
MATUSKO TIMOTHY A N/A N/A N/A N/A N/A N/A N/A N/A Other 10/01/2010
Maxwell Yvonne Brown Yvonne Maxwell Yvonne M
40-Nurse 10/11/2016
Mazur Lawrence A 51-Physician 04/20/2011
MCALLISTER FELICIA P CNA 09/21/2000
McClellan Katherine PCA 02/24/2015
McCoy Jody Home Health Aide 09/09/2013
MCCRILLIS LISA M CNA 02/27/1996
McCullom Douglas 51-Physician 01/17/2014
McEldoon Wesley 51-Physician 09/06/2016
MCFARLAND MARY 11-Behavioral Health Clinician
05/31/1996
MCFARLAND DAVID 11-Behavioral Health Clinician
04/01/2004
MCFARLAND DAWN 40-Nurse 12/20/2000
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 42 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
McFarland Peter J Pharmacist 12/27/2016
MCGEE IDA M 40-Nurse 05/24/2008
MCGOVERN DANA E Business Manager
04/16/2002
MCGOVERN AMBULANCE
05-Ambulance 04/16/2002
MCGUIRE JANE T 40-Nurse 04/08/1996
McKean Adrienne Pharmacy Technician
08/19/2014
MCMAINS LISA A 40-Nurse 01/11/2008
MCNALLY MARILYN R 40-Nurse 05/20/1998
McQuinn Jean PCA 01/08/2015
McRae Angela Pharmacist 08/29/2014
Melevsky Walter 22-Dentist 07/23/2014
MELLAND DANIEL D 40-Nurse 09/10/2007
MEMEL STEPANIE D BRETON STEPHANIE
40-Nurse 05/19/2004
MERCINKO JANICE 40-Nurse 01/20/1996
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 43 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
MERRILL SANDRA J 40-Nurse 04/29/2004
Merrill Michael PCA 05/21/2019
MESERVEY PAMELA Nursing Home Administrator
12/26/1986
MEYER THOMAS L 51-Physician 01/11/2000
Michalowski Ellen E 51-Physician 12/22/2010
Michalski Marybeth 40-Nurse 01/18/2018
MICHAUD DEBORAH L CORNISH DEBORAH
CNA 03/25/1993
Miller Donna McKinnis Tchernavia
McKinnis Johnson
Tchernavia
40-Nurse 06/05/2018
MILLETT DEBORAH L BURNS DEBORAH L.
GAMMON DEBORAH L.
40-Nurse 02/25/2006
MINGO CHRISTOPHER
CNA 11/16/1993
MITCHELL CATHERINE
L 40-Nurse 09/15/1998
MITCHELL ROBERT G Business Manager
06/02/1992
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 44 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
MITCHELL KENNETH A 11-Behavioral Health Clinician
11/18/2006
MITCHELL JOSHUA BROWN MIKE SMITH DAN WILLIAMS JOHN Pharmacy Technician
11/06/2006
MITCHELL SYLENDA 40-Nurse 01/13/2009
Mitchell Drew Mansir 40-Nurse 03/23/2011
MOHAMED ABDIRAHMAN
CNA 01/22/2009
Mohler-Avery Jay T 40-Nurse 07/20/2014
Moon Keith Nursing Home Administrator
01/04/2013
MOORE D. W Owner/Operator 10/22/2001
Moore MaryAnne W 51-Physician 07/15/2011
MOORES BETTY CNA 01/15/2009
Moran Tammy M Lebon Moran Tammy Thompson Moran
Tammy 40-Nurse 06/06/2017
MORGAN JESSICA S N/A N/A N/A N/A N/A N/A N/A N/A Other 11/08/2010
Morgan Penny 40-Nurse 07/07/2015
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 45 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
MORIN SHARON 40-Nurse 10/17/1992
MORIN MARK D 11-Behavioral Health Clinician
05/26/2006
Morin Diane Roberts Diane Dore Dianne 40-Nurse 06/09/2016
Morin Kelly I 40-Nurse 08/20/2017
Morin Samantha A Leavitt Samantha
Pharmacy Technician
07/11/2019
MORIN-SMITH PETER Other 09/19/2002
Morris Stacylee Counselor 10/29/2014
Morrison Michael Morrison Michael L.
Morrison Michael R.
Office Manager 07/18/2019
Morse Rachel 11-Behavioral Health Clinician
09/19/2013
MOTLEY EDWARD J 11-Behavioral Health Clinician
11/20/2000
MOTT HEIDI M PCA 01/23/2001
Mouland Sioux Sioux M Roderick Sioux CNA 09/18/2015
Munger Andrew CRMA 04/14/2015
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 46 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Murchie Sheila Muchie Sheila Murchie Shiela 11-Behavioral Health Clinician
09/06/2016
MURCHISON RICKY G 11-Behavioral Health Clinician
02/24/2009
MURRAY APRIL B 40-Nurse 11/09/1994
MYERS JOHN L 51-Physician 01/14/2009
NADEAU DONALD M Other 09/19/2002
NAGY CAROLYN C 40-Nurse 02/11/1991
Naughton Michelle CRMA 10/24/2013
Neault Alesha CNA 06/15/2011
Nesbit Alexandria Chall Alexandria
Alexandria Nesbit Nesbit A Ch Alexandria
52-Physician Assistant
12/30/2014
NEWMAN JUDITH L 40-Nurse 01/28/2002
NICHOLS RONDA BURKE RONDA CNA 02/15/1997
NICHOLS MARGARET T 40-Nurse 04/24/2001
NIGRO CAROL 40-Nurse 08/13/2009
NOLETTE RICHARD E Other 02/20/2003
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 47 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
NORRIS LISA 40-Nurse 03/09/2009
North Jody North Jody A 40-Nurse 11/02/2016
NORTON WAYNE 40-Nurse 12/20/2000
NUESSE WILLIAM E 51-Physician 11/23/1998
O'Brien Kate Cross Kate Nursing Home Administrator
06/18/2015
OCERETKO ARKADY 51-Physician 07/23/1989
O'DONNELL KEN Owner/Operator 10/27/2003
O'DONNELL LORRAINE E 40-Nurse 09/09/1994
O'Farrell Carol Pharmacy Technician
09/24/2018
OLIVER IRENE H CNA 08/19/1996
Oliver Desarey CNA 04/19/2019
Orem-Hough Carole 12/20/2013
ORLANDO JOSEPH CNA 07/24/1995
ORLOWSKI JOHN V 16-Chiropractor 10/15/1997
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 48 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
O'Rourke Kelly O'Rourke Kelly F 11-Behavioral Health Clinician
05/08/2017
Ortiz William Ortiz William B William Ortiz Ortiz Willi Burgos William 51-Physician 12/30/2014
Ortiz-Escobar Gemma Ortiz Gemma Escobar-Ortiz
Gemma Jimenez Gemma 40-Nurse 04/15/2014
Orvald Thomas Thomas O Orbald Thomas Owen
Owen Orvald Orvald Tucker 51-Physician 04/14/2015
OSMAN DAHABO A N/A N/A N/A N/A N/A N/A N/A N/A Consumer/Member
05/14/2012
PADDOCK LISA A 40-Nurse 07/13/1998
PAHILAN ABE N 51-Physician 06/19/2006
PALMER SHANNON M CRMA 05/28/2008
PALMER JOEL W CNA 07/27/2008
Papineau Lynn Papineav Fisher 40-Nurse 01/08/2015
PARISI JAMES J 06/17/2010
PARRY JANE Other 12/11/1990
PARSONS SHARRON L 40-Nurse 02/07/2005
Pascal Sarah Other 09/09/2011
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 49 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
PATEL REBECCA M 40-Nurse 05/15/1998
Patel Bharat 51-Physician 10/01/2019
Payne Heather York Heather CNA 11/28/2018
PEARSON LISA M 40-Nurse 10/24/2005
PEAVEY MARYANN E CNA 03/31/2008
PEDROSO SHIRLEY A CNA 06/13/1997
PEEK RICHARD G 11-Behavioral Health Clinician
09/17/2003
PELLETIER STEPHEN J Pharmacist 06/19/2008
PELOTTE CANDY CNA 03/08/2010
PENNEY-SMITH
DONNA I 40-Nurse 09/18/2002
PEPIN LAURIER A 40-Nurse 12/28/1999
Perkins Kara Pharmacy Technician
11/16/2011
Perkins Linda Belanger CNA 02/24/2015
PERRY SHERRY A 40-Nurse 07/27/2005
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 50 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Perry John B 56-Podiatrist 09/04/2012
PERRYMAN BRET A 11-Behavioral Health Clinician
06/25/2002
Pete Jasmine Pete Jasmine Long Jasmine Long Jasmin PCA 02/18/2016
Petersen Ronald Owner/Operator 07/26/2012
Phillips Christopher Phillips Marc Phillips Mark Phillips Chris 40-Nurse 10/02/2015
PIERCE DAVID T Pharmacist 03/08/2010
PINKHAM JENNIFER L LABONTE JENNIFER L.
MAGUE JENNIFER L.
STEWART JENNIFER L.
40-Nurse 10/12/2006
Pinkham Joseph C 40-Nurse 05/23/2011
PLEASANT HILL HCF
41-Nursing Home 10/17/1985
POIRIER JACQUELINE
16-Chiropractor 07/09/1993
Poitras Emily Medical Technician
04/30/2013
Pollis Logan Polis Logam CRMA 03/31/2015
POMBRIANT JAMES W Business Manager
06/08/1992
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 51 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
POOLER DEBRA A 40-Nurse 03/08/2005
PORTER JENNA M Home Health Agency Employee
02/20/2007
PORTER CHRISTINE M PRESTON CHRISTINE
Pharmacy Technician
02/14/2006
POTTER MARK C Other 11/09/2001
POTTLE KIMBERLY A BOUCHARD KIMBERLY A.
CNA 05/09/2005
Poulin Donna 20-Dental Hygienist
06/20/2014
Prather Michelle Peveler Michelle Prayther Michelle 40-Nurse 05/10/2019
PRATT JAY 11-Behavioral Health Clinician
07/26/2004
PREBLE ALDEN A Owner/Operator 12/13/1988
PREBLE DONNA I Owner/Operator 12/13/1988
Preston Paul Pharmacist 02/18/2016
PROSKAUER STEPHEN 51-Physician 03/31/1986
PROSSER BOBBI J Other 09/04/2007
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 52 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Prosser Katrina Home Health Agency Employee
08/13/2013
PROULX DENEEN T Billing Staff 10/11/2005
Proulx Michael CNA 08/16/2011
Provencher Jeannie M 40-Nurse 08/16/2011
Pulley Matthew W 16-Chiropractor 08/11/2009
PURCELL ANNE P 40-Nurse 08/01/2002
QUINN ELIZABETH 11-Behavioral Health Clinician
01/23/2009
RABON JUDY D 40-Nurse 10/18/2004
RADFORD JODIE R MUNROE JODIE R. BRAYLEY JODIE 40-Nurse 03/14/2006
Ramos Patricia 40-Nurse 10/20/2013
RAMSEY NANCY B 11-Behavioral Health Clinician
06/17/1999
RANDALL BETHANY L Pharmacy Technician
07/15/2005
Randall Leigh M Pharmacy Technician
09/19/2011
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 53 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
RANSIER KHELA R 51-Physician 08/11/2009
RAUCH STEVEN M 51-Physician 06/25/1999
Rawley Alicia Jones alicia Neild Alicia Home Health Aide 07/20/2015
REEVES PRUDENCE J Office Assistant 05/17/2007
REILLY ALAN D 40-Nurse 05/16/2001
RESTHAVEN NURSING
HOME
41-Nursing Home 01/06/1993
RETAMAR RONNIE CNA 03/25/1996
REYNOLDS SHANNON CNA 10/20/2008
Reynolds Warren Renolds Warren Reynolds Kirk Reynolds Werren CNA 10/02/2015
Reynolds Mary Reynolds Mary Anne
Michaud Mary A Reynolds Marilyn Stewart Mary 40-Nurse 03/20/2016
RICHARDS JANE E Pharmacy Technician
04/04/1994
RICHARDSON ERIC 11-Behavioral Health Clinician
01/07/2010
Rickards Amanda Richards Amanda Pharmacy Technician
02/18/2016
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 54 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
RICKER KYLIE M Pharmacy Technician
02/20/2006
RIDLEY MARY 40-Nurse 06/17/1994
Riley Joseph Riley Joe Riley Joseph Charles
11-Behavioral Health Clinician
10/11/2016
RING ROBIN R VAN NESS ROBIN CRMA 10/20/2008
Rios Michelle CNA 11/20/2012
RITTALL LAURA 40-Nurse 06/20/2003
Roark Christopher Pharmacy Technician
06/13/2012
ROBBINS DEBORAH R Bookkeeper 02/09/2007
ROBERTS JAMES M N/A N/A N/A N/A N/A N/A N/A N/A CNA 10/07/2010
Roberts Sandra CNA 03/09/2015
ROBINSON GLENN 11-Behavioral Health Clinician
08/31/1988
Robinson-Henry
Marjorie Robinson Marjorie A
40-Nurse 10/05/2016
Rodriguez Melanie Rodriquez Melanie 40-Nurse 06/20/2019
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 55 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Rodson Oscar Rodson Jr. Oscar Odson Oscar 40-Nurse 11/20/2018
Rohan Megan 40-Nurse 03/12/2013
Ronco Mollie Ronco A Beavlieu Mollie Beaulieu Mollie Beauliell Mollie 40-Nurse 10/02/2015
Rondeau Amber L 40-Nurse 03/20/2018
Rose Lauren 10/18/2017
ROSSIGNOL RONALD J 40-Nurse 04/06/2004
ROULEAU BARBARA N 40-Nurse 11/23/1992
Rowe-Akerley Deborah B 40-Nurse 07/19/2011
ROY ROBERT Other 11/06/1986
Roy Brenda Daggett Rpy CNA 02/24/2015
Roy Roland 40-Nurse 12/22/2014
Royal John Royal John Sr 22-Dentist 08/03/2016
ROYER RITA CNA 10/30/2005
RUCKER SUSAN B 40-Nurse 11/01/1999
RUMSEY FRED L CNA 08/11/2009
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 56 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Sabean Joel A Sabean IV Joel Joel Sabean
Jr
51-Physician 07/11/2017
SANBORN KAREN M CNA 07/03/1996
Sanborn Suzanne 40-Nurse 07/20/2014
SANDERSON YOLANDA D CNA 03/22/1996
Sanford-Johnson
Kris Johnson Kris Kris Sanford Sandford Kris Sauford Kris 40-Nurse 07/07/2015
SAPP LORI DENIKE LORI EVANS
DENIKE LORI L. SAPP LORI L. Office Manager 09/23/2006
Sapp Nicole Pharmacy Technician
08/15/2014
Sarkisian Michele 05/20/2018
Saunders Carolyn J Saunders Carol Beede Carolyn Office Manager 12/07/2017
SAVADOVE ROBERT F 51-Physician 04/19/2006
SAVAGE LORI DURRELL LORI Office Manager 03/30/2017
Savitz Andrea 40-Nurse 12/20/2013
SAWICKI JOHN Paramedic 08/17/2001
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 57 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
SAWTELLE PAULA J JONES PAULA 40-Nurse 09/01/2004
Sawyer Benjamin 40-Nurse 04/10/2014
Sawyer Ashly CRMA 06/26/2014
Schecter Daniel 22-Dentist 11/05/2014
SCHENCK RUTH M 11-Behavioral Health Clinician
06/02/1998
Schickle Judith H Bookkeeper 09/09/2011
SCHMEHL ROLAND M 51-Physician 10/04/1998
Schucker Jason Schuckner Jason Schucker Jas Pharmacist 10/20/2016
SCHWABE/LEAVITT
CHRISTINE M LEAVITT CHRISTINE
SCHWABE
CHRISTINE M.
CRMA 04/09/2004
SCHWARTZ DUANE E Other 11/23/2000
Scott Laura 42-Occupational Therapist
11/29/2016
Scott Mary Mellick Marie Marrick Gellick Scottlmsw Counselor 02/24/2015
SCRIBNER LAURIE A Other 08/20/1998
Seacoast Sleep Solutions
Enzinger Peter Shays Peter 27-DMESupplier 07/19/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 58 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Searles Marie Pharmacy Technician
03/19/2015
SEEKINGS JENNIFER 40-Nurse 08/19/2009
Segerson Nicole 40-Nurse 05/13/2014
Semple Jaime Harnett Counselor 03/21/2012
SEVIGNY WILLIAM J 40-Nurse 04/30/2004
Shanklin Rodger CNA 10/29/2012
SHAW GLENWOOD
E Pharmacist 04/23/2005
SHAW GABRIEL D Pharmacy Technician
02/07/2008
Sheehan Karen Billing Staff 09/04/2013
Sheen April 40-Nurse 04/15/2014
Shelton Kathy Grice Kathy Brice Kathy 40-Nurse 08/17/2012
SHERMAN FORREST A 11-Behavioral Health Clinician
04/30/2004
SHINDERMAN MARK S SHINDERMAN
MARC S. 51-Physician 09/13/2007
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 59 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
SHOEMAKER JILL I COTE JILL I. 40-Nurse 01/06/2001
SHOREY MELONY M 40-Nurse 01/30/2001
SHROUT WILLIAM J Other 10/05/2001
SIEPMANN LAURA M 40-Nurse 06/25/2001
SIMONDS SHARON 11-Behavioral Health Clinician
07/06/2001
Simpson Ezra 40-Nurse 08/31/2018
SIROIS JAMES R 40-Nurse 09/29/2003
SIROIS JEFFREY S Business Manager
07/02/2007
SITTINGER RICHARD 51-Physician 11/05/1980
Skeffington Robert 40-Nurse 04/29/2014
SMALL OLIAN CNA 08/15/1990
Small Rachael Pharmacy Technician
04/17/2012
SMITH ANN E 40-Nurse 08/27/1997
SMITH THANIEL C CNA 03/11/1996
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 60 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
SMITH ROBIN E MCCARTHY ROBIN E.
Nursing Home Administrator
01/15/2005
Smith Tonia Pharmacy Technician
08/19/2014
SNOW SHARI A 40-Nurse 12/10/2009
SOLLNERSAWYER
LISA SAYLOR LISA 40-Nurse 08/04/2004
Solomon Dawn L 04-Alternative Residential
Facility
08/10/2011
SOREFF STEPHEN M 51-Physician 04/24/1990
SORG RONALD A 11-Behavioral Health Clinician
03/15/2002
SOULE SHEILA M 40-Nurse 07/03/1996
SOUTHARD PATRICIA A Other 07/17/2002
SPRINGER R. S Other 04/06/1989
Sprys Thomas 40-Nurse 06/19/2018
Stanasek Nicole M Stamasek Nicole Stonasek Nicole 01/18/2018
STANFIELD ELLEN 40-Nurse 12/18/1998
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 61 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Steele Annette Home Health Aide 08/20/2019
STEINBERG IRA 22-Dentist 08/18/1998
STOKES TED T N/A N/A N/A N/A N/A N/A N/A N/A 16-Chiropractor 09/10/2010
STORMANN LORRAINE F 40-Nurse 01/26/2001
Strauss Leslie 40-Nurse 09/25/2012
STROUSE DAVID W Strauss David N/A N/A N/A N/A N/A N/A 40-Nurse 10/05/2010
STULC JAROSLAV P 51-Physician 10/28/2009
Sullivan Caitlin Pharmacy Technician
07/03/2012
Sundaram Malathy 04/19/2019
Swain Linda 40-Nurse 07/08/2014
TABLEMAN BETH C Bookkeeper 12/03/2000
Talarico Louis C Counselor 12/17/2018
TANJUAY KATHRYN J TANGUAY KATHRYN B.
SARGENT KATHRYN B.
KATTS CATHERINE
CATTS KATHERINE
CNA 06/05/2007
Tao Nathan 40-Nurse 08/01/2012
Termini Ray Owner/Operator 06/26/2012
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 62 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
TETREAULT MICHAEL 40-Nurse 12/06/2009
THACHER FREDERICK
J Company Officer 07/14/2003
THERIAULT ALEX J CNA 02/12/2009
THIBODEAU PATRICK THIBS PATRICK Other 11/08/2001
THIBODEAU ANNE F Other 04/02/2004
THIBODEAU RICHARD 40-Nurse 09/08/2001
THOMPSON DONALD J Other 01/18/1984
Thorne Paula A 40-Nurse 06/08/2011
THURSTON MICHAEL Company Officer 11/23/2000
TIBBETTS CORRINA M CRMA 04/21/2007
TICE ELLEN R 06/18/2010
Tice Jodi Byers Jodi L. Carpenter Jodi L. Home Health Aide 09/20/2018
TIDD CHRISTINE CNA 01/29/2009
Timms Rebecca Stevens Rebecca Lee
40-Nurse 08/20/2017
Tirado Heidy Valley Heidi Iriado Heidy Tiravo Heicly Balley Heidy Office Assistant 03/20/2016
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 63 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
TITO JAMES Pharmacist 03/22/1982
TITO STEPHEN Pharmacist 03/22/1982
TOMARCHIO JANET T 40-Nurse 09/12/2001
Tommasino Sharon Thommasino Sharon 40-Nurse 10/22/2015
Torres Brittany Torres Brittany R
CNA 07/21/2016
TOWLE KIMBERLY H 40-Nurse 10/18/2004
Towle Annette 40-Nurse 09/26/2014
Towns Christine CRMA 04/23/2014
TOWNSEND TIFFANY R CNA 04/04/2003
TREMO GREGORY S Pharmacist 11/20/2006
TRIPP LESLIE N 51-Physician 10/19/2009
TROTT CHARLES A CNA 05/22/2007
TROTTIER MARIANNE HAMMER MARRIANNE K.
11-Behavioral Health Clinician
08/03/2004
TRUE ROBERT A 11-Behavioral Health Clinician
12/29/2004
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 64 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
True Courtney A Files Courtney 40-Nurse 06/06/2017
TRUNCK WILLIAM A 40-Nurse 01/19/2004
TUKEY JAMES H 40-Nurse 11/24/1997
Turgeon Normand F Pharmacist 03/29/2012
Tutt Steven 40-Nurse 05/11/2018
TUTTLE LISA PORTER LISA J. 40-Nurse 07/15/2004
Twadelle Jon R Pharmacy Technician
08/15/2014
TYLER JOHN W Other 11/08/2001
Underwood John 48-Pharmacy 08/15/2012
URQUHART DENNIS R Bookkeeper 01/05/1998
VAILLANCOURT
DANIELLE M Clement Danielle 40-Nurse 01/20/2008
VAN PELT JOHN J 51-Physician 02/18/2006
Varley Tyece CNA 09/10/2014
Vickery Elaine Chasse Elaine Burby Elaine Burbee Elaine CNA 10/22/2015
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 65 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Vigue Kimberly A Gentile Kimberly A.
Lewis Kimberly A.
40-Nurse 08/20/2017
Viles Rebecca Other 10/29/2012
VINCZE MARGARET 22-Dentist 07/24/2001
VIOLETTE JEFFREY 11-Behavioral Health Clinician
05/22/2000
Virgin Deborah J Business Manager
08/28/2014
Voisine Andrea Home Health Aide 08/11/2014
VOYE ROBERTA Pharmacist 08/19/1999
WAINWRIGHT ALLISON T Pharmacist 04/25/2005
WALDEN BARRY M 11-Behavioral Health Clinician
12/01/2008
WALLACE DARLENE CNA 01/08/2009
Warren Donna Leen Donna PCA 03/31/2015
Washburn Michael 11/20/2018
WATSON JACOB 11-Behavioral Health Clinician
01/01/1996
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 66 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
WATSON SARA Moore Sara 40-Nurse 12/14/1996
WEBSTER ANTHONY F Other 10/26/2001
Webster Lloyd Other 04/08/2013
WEED MERTON CNA 05/07/1997
Wells Jessica 06/05/2018
WELSH EDDIE T Other 01/19/2004
Wentzell Amanda CNA 03/20/2014
WERNER DONALD R 51-Physician 09/14/1999
WESTON DON N 51-Physician 01/14/1997
Wharton-Goodman
Victoria Goodman Wharton
Victoria Goodman Victoria 40-Nurse 09/20/2018
WHEELER AUDREY P CNA 01/19/2005
Whippo Amanda Caron Amanda Counselor 01/04/2019
White Tiffney 07/19/2018
White Stephanie Pharmacy Technician
12/07/2011
White Anne CNA 01/01/2011
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 67 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
Whitney Anna CNA 07/07/2014
Whittington Jessica 40-Nurse 12/12/2012
Wilkinson John Counselor 12/30/2014
WILLIAMS JANELLE L Pharmacy Technician
08/24/2009
WILSON JAMES E Pharmacist 02/08/2002
WINE RICHARD A 40-Nurse 02/18/2010
WING DARLENE Other 05/27/2010
WINKLER STEPHEN D 16-Chiropractor 10/31/1994
Withers Elizabeth Wither Elizabeth Witjers Elizabeth PCA 09/22/2015
WITT LINDA 40-Nurse 07/30/1997
Woldt Eve A 07/13/2011
Wood Rebecca Richards Rebecca Woo Rebecca 40-Nurse 08/09/2017
Wood Melissa Marandola 40-Nurse 05/15/2013
Woodard Melissa Woodward Melissa 07/18/2019
Woodbury Linda Hersey Linda Hamnergoulding
Linda Hamner Linda CNA 05/26/2016
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 68 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
Provider Last Name Provider First Name
Provider MI
Alias Last Name 1
Alias First Name 1
Alias Last Name 2
Alias First Name 2
Alias Last Name 3
Alias First Name 3
Alias Last Name 4
Alias First Name 4
Provider Type State Exclusion Start Date
WOODRUFF ALAN F 51-Physician 03/16/2005
Woods Jessie PCA 04/19/2018
WOODSOME ROBERT J 40-Nurse 05/02/2007
Wooten Matthew Home Health Aide 04/17/2014
Worrick-Soule Michael 40-Nurse 06/20/2014
Worthen Cindy L Home Health Aide 11/13/2014
WRIGHT KAREN CNA 08/13/1996
WYMAN NOREEN CNA 01/14/2009
Wynn Laura 40-Nurse 03/09/2015
YORK DAVID A N/A N/A N/A N/A N/A N/A N/A N/A 51-Physician 09/24/2010
YOUNG LORENDA CNA 02/12/2009
YOUNG ELIZABETH Y 40-Nurse 04/17/2010
Zehrung Dawn Hull Grover 12/08/2011
Zuschlag Kristen M Zoschlac Kristen Zuschlog Kristen Owner/Operator 06/20/2019
Zuschlag Robert Zuschiag Robert Zosehlag Robert Owner/Operator 07/18/2019
End of Report
* * * * * Contains HIPAA PHI Sensitive Data * * * * *Page 69 of 69
Monthly Exclusion Report
Report Number: PI0008-PM
AS of 11/01/2019
Report Description:
This report will contain a list of all excluded providers. The data retrieved in this report is generated on a monthly basis and may not include providers excluded within the last thirty days. Please run the “Provider Exclusion Check” on the portal to check for more recent exclusions.
Run Date: 11/01/2019
MaineCare ServicesAn Office of the
Department of Health and Human Services
