Table Of ContentCLIA ANNUAL LABORATORY REGISTRY
2007
Once year the Center for Medicare and Medicaid Services makes available to physicians
and to the general public specific information (including information provided to CMS by
the Office of the Inspector General) that is useful in evaluating the performance of
laboratories. The Clinical Laboratory Improvement Amendments of 1988 (CLIA) and
implementing regulations at 42 CFR 493.1850 require that this include the following:
(1) A list of laboratories that have been convicted, under Federal or State laws
relating to fraud and abuse, false billing, or kickbacks.
(2) A list of laboratories that have had their CLIA certificate suspended,
limited, or revoked, and the reason for the adverse actions.
(3) A list of persons who have been convicted of violating CLIA requirements,
as specified in section 353(1) of the PHS Act, together with circumstances of
each case and the penalties imposed.
(4) A list of laboratories on which alternative sanctions have been imposed,
showing--
(i) the effective date of the sanctions;
(ii) the reason for imposing them;
(iii) any corrective action taken by the laboratory;
(iv) if the laboratory has achieved compliance, the verified date of
compliance
(5) A list of laboratories whose accreditation has been withdrawn or revoked
and the reason for withdrawal or revocation.
(6) All appeals and hearing decisions.
(7) A list of laboratories against which CMS has brought suit under Section
493.1846 and the reason for those actions.
(8) A list of laboratories that have been excluded from participation in
Medicare or Medicaid and the reason for exclusion.
Civil settlements reached with clinical laboratories are also noted.
The Laboratory Registry is complied for the calendar year preceding the date the
information is made available and also contains corrections of any erroneous
statements of information that appeared in the previous registry. A final section
includes other specific information that may be useful in evaluating the
performance of laboratories, as specified in 42 CFR 493.1850(a). It also includes
information provided by CLIA exempt states.
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2007 CLIA LAB REGISTRY
(As Required By Section 353(N) of The Public Health Act)
Activity 01/01/2007 – 12/31/2007
1. LABORATORIES SUBJECT TO CLIA THAT HAVE BEEN CONVICTED,
UNDER FEDERAL OR STATE LAW RELATING TO FRAUD AND
ABUSE, FALSE BILLING, OR KICKBACKS.
NONE
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2. LABORTORIES THAT HAVE HAD THEIR CLIA CERTIFICATE SUSPENDED,
LIMITED, OR REVOKED, AND THE REASON FOR THE ADVERSE ACTION.
(MEDICARE CANCELLATION, A PRINCIPAL SANCTION, HAS BEEN
INCLUDED IN THIS CATEGORY.)
KHALID MATIN MD, DIRECTOR
CANCER CARE CENTER OF MONTGOMERY SOUTH
2055 E SOUTH BLVD STE 202 MORROW BLDG
MONTGOMERY, AL 36116
CLIA ID# 01D1002049
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 08, 2007
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: LAB VOLUNTARILY CEASED TESTING
CERTIFICATE REINSTATED
JOE DAUGHERTY MD, DIRECTOR
DAUGHERTY & DAUGHERTY MEDICAL CLINIC
1409 WEST BRADEN STREET
JACKSONVILLE, AR 72076
CLIA ID# 04D0466369
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: DECEMBER 05, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
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PHILLIP LEVINE MD, DIRECTOR
G & L LABORATORY
631 WEST 3RD STREET, SUITE #815 E
LOS ANGELES, CA 90048
CLIA ID# 05D0544727
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: JANUARY 23, 2007
REASON: UNSUCCESSFUL PT CONDITION LEVEL
NONCOMPLIANCE
NORMAN LAVIN MD, DIRECTOR
TARZANA PEDIATRIC GROUP
18370 BURBANK BOULEVARD SUITE 204
TARZANA, CA 91356
CLIA ID# 05D0559321
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: JANUARY 02, 2007
REASON: UNSUCCESSFUL PROFICIENCEY TESTING
CONDITION LEVEL NONCOMPLIANCE
CALVIN MARANTZ MD, DIRECTOR
COLWELL CLINICAL LABORATORIES INC
1125 EAST 17TH STREET, SUITE N-156
SANTA ANA, CA 92701
CLIA ID# 05D0580755
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: FEBRUARY 16, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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TOMASZ PAWLOWSKI MD, DIRECTOR
VICTOR VALLEY COMM HOSP/CLINICAL LAB
15248 11 TH ST
VICTORVILLE, CA 92392
CLIA ID# 05D0663016
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 11, 2007
REASON: IMPROPER PROFICIENCY TESTING REFERRAL
ACTIVITIES
STATUS: HEARING REQUESTED
ADRIAN JAFFER MD, DIRECTOR
ALLERGY & RHEUMATOLOGY MEDICAL CLINIC
9850 GENESEE AVENUE SUITE 810
LA JOLLA, CA 92037
CLIA ID# 05D0687526
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: MAY 11, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
CYRUS PARSA DO, DIRECTOR
DUZ MOR DIAGNOSTIC LABORATORY
DBA PACIFIC MEDICAL LABORATORY
2700 WEST MANCHESTER BOULEVARD
INGLEWOOD, CA 90305
CLIA ID# 05D0698644
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: MARCH 08, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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MARIO KOHAN MD., DIRECTOR
CCL LABORATORIES, INC
333 NORTH SANTA ANITA AVENUE UNIT 10
ARCADIA, CA 91007
CLIA ID# 05D0873183
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: OCTOBER 16, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
IRAJ NAZARIAN MD, DIRECTOR
PHYSICIAN LABORATORY TECHNOLOGY INC
200 NORTH ROBERTSON BOULEVARD STE 207
BEVERLY HILLS, CA 90211
CLIA ID# 05D0916240
SANCTION: REVOCATION OF CLIA CERTIFICATE
CANCELL ATION OF MEDICARE APPROVAL
EFFECTIVE DATE: JUNE 13, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
MUSTAFA MAHDAVY MD, DIRECTOR
PASADENA LABORATORY SERVICES INC
1250 E WALNUT STREET # 136
PASADENA, CA 91106
CLIA ID# 05D1006436
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: JANUARY 22, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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MUSTAFA MAHDAVY MD, DIRECTOR
PASADENA LABORATORY SERVICES INC
1250 E WALNUT STREET # 136
PASADENA, CA 91106
CLIA ID# 05D1006436
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 15, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
BARBARA BIELA MD, DIRECTOR
PRIME DIAGNOSTICS LABORATORIES
22777 LYONS AVE STE 100
SANTA CLARITA, CA 91321
CLIA ID# 05D1019911
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: OCTOBER 15, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
EVA WASEF MD, DIRECTOR
FOOTHILL CLINICAL LABORATORIES
2500 E FOOTHILL BL# 110
PASADENA, CA 91107
CLIA ID# 05D1030317
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: JANUARY 24, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
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EVA WASEF MD, DIRECTOR
FOOTHILL CLINICAL LABORATORIES
2500 E FOOTHILL BL# 110
PASADENA, CA 91107
CLIA ID# 05D1030317
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: OCTOBER 11, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
WITH IMMEDIATE JEOPARDY
FAILURE TO CORRECT DEFICIENCIES
MANOUCHEHR ADELI-SARDO MD, DIRECTOR
MANOUCHEHR ADELI-SARDO MD INC
2080 CENTURY PARK EAST #603
LOS ANGELES, CA 90067
CLIA ID# 05D1031057
SANCTION: LIMITATION OF CLIA CERTIFICATE
MEDICAR E CANCELLATION/SUSPENSION
EFFECTIVE DATE: JUNE 17, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
UNSUCCESSFUL PROFICIENCY TESTING
GEORGE GINDI MD, DIRECTOR
FAMILY PRACTICE
302 N MAIN STREET
GEORGETOWN, IL 61846
CLIA ID# 14D0976937
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 26, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STATUS: CERTIFICATE REINSTATED 10/07/2007
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MARILYN EVRARD MD, DIRECTOR
HEMATOLOGY ONCOLOGY ASSOC OF ILLINOIS
1200 S YORK RD-SUITE 3280
ELMHURST, IL 60126
CLIA ID# 14D0979186
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 21, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
LUIS FLORES, DIRECTOR
BIO-MEDICAL LAB INC
6116 W ROOSEVELT ROAD
OAK PARK, IL 60304
CLIA ID# 14D1039162
SANCTION: CANCEL MEDICARE/MEDICAID APPROVAL
REVOCATION OF CLIA CERTIFICATE
SUSPENSION OF CLIA CERTIFICATE
EFFECTIVE DATE: SEPTEMBER 28, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE WITH
IMMEDIATE JEOPARDY
STEPHEN BONSIB MD, DIRECTOR
BEST QUALITY LAB
503 E SUMMIT STREET #5
CROWN POINT, IN 46307
CLIA ID# 15D1071923
SANCTION: REVOCATION OF CLIA CERTIFICATE
EFFECTIVE DATE: NOVEMBER 16, 2007
REASON: CONDITION LEVEL NONCOMPLIANCE
STATUS: SURVEYORS WERE UNABLE TO VERIFY
LOCATION OF LAB
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JENNIFER BURSTAIN, MD, DIRECTOR
BUCHANAN COUNTY HEALTH CENTER
1600 FIRST STREET EAST
INDEPENDENCE, IA 50644
CLIA ID# 16D0384646
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: APRIL 18, 2007
REASON: UNSUCCESSFUL PT
STATUS: SUSPENSION AND LIMITATION LIFTED
A WRIGHT, DIRECTOR
A C WRIGHT MD LABOTATORY
430 E PLEASANT STREET PO BOX 278
CYNTHIANA, KY 41031
CLIA ID# 18D0324281
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: MAY 30, 2007
REASON: UNSUCCESSFUL PROFICIENCY TESTING
LEONOR SO, DIRECTOR
GENERAL MEDICAL LABORATORY
156 ISLAND CREEK ROAD
PIKEVILLE, KY 41501
CLIA ID# 18D0325041
SANCTION: LIMITATION OF CLIA CERTIFICATE
EFFECTIVE DATE: FEBRUARY 26, 2007
REASON: UNSUCCESSFUL PROFICIENCY TESTING
STATUS: CERTIFICATE REINSTATED
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Description:STEPHEN BONSIB MD, DIRECTOR. BEST QUALITY LAB . AHMED ARIF, DIRECTOR. AHMED A ARIF STEVE AYANRUOH, DIRECTOR. TRINITY
