National Provider Identifier 1104921949 as it appears in every federal dataset Fonteum holds. Each row is a distinct public source; the chip carries the source and the snapshot date behind that field — the record-level form of the source-provenanced graph.
CMS Quality Payment Program Merit-based Incentive Payment System (MIPS) final score, where this clinician participated. Absence of a score is not a quality signal — many clinicians report through a group or are exempt.
Enrollment & sanctions
Standing
Medicare enrollmentNo PECOS enrollment record found for this NPISource:CMS PECOS·Snapshot 2026
OIG exclusion (federal)No active OIG exclusion on recordSource:OIG LEIE·Snapshot 2026
Ownership & affiliations
Graph relationships
One-hop relationships in the resolved entity graph — chain membership, ownership, and operation edges, each backed by a federal source row. Most individual clinicians carry none; edges populate for owners and organizations as the Lane D backfill runs.
Compromised-flag (federal monitoring/penalties)No monitored-compliance or CMS penalty flag on record (OIG CIA, CMS Civil Money Penalties checked)Source:OIG CIA · CMS CMP·Snapshot 2026
Screening aid — re-confirm any match against the issuing list before acting. A clean result means no record was found in the federal OIG LEIE or the state Medicaid lists Fonteum currently holds (NY, OH, GA), not a guarantee that none exists elsewhere. Not a legal or credentialing certification.