Form 5 Peer Review Organization

the

DataBank

DCN: 5950000090960755
Process Date: 11/25/2014
Page: 1
of
2
MANN, ANITTA
For authorized use by:
REPORT DISCLOSURE TESTING

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov

MANN, ANITTA
REPORT DISCLOSURE TESTING
PEER REVIEW ORGANIZATION ACTION

Date of Action: 11/25/2014

Initial Action
- RECOMMENDATION TO SANCTION
- OTHER, SEE SECTION C. OF THE REPORT FOR
DETAILS
A. REPORTING
ENTITY

Entity Name:
Address:
City, State, Zip:
Country:
Name or Office:
Title or Department:
Telephone:
Entity Internal Report Reference:
Type of Report:

Subject Name:
Other Name(s) Used:
Gender:
Date of Birth:
Organization Name:
Work Address:
City, State, ZIP:
Organization Type:
Home Address:
City, State, ZIP:
Deceased:
Federal Employer Identification Numbers (FEIN):
Social Security Numbers (SSN):
National Provider Identifiers (NPI):
Professional School(s) & Year(s) of Graduation:
Occupation/Field of Licensure (Code):
State License Number, State of Licensure:
Drug Enforcement Administration (DEA) Numbers:
Unique Physician Identification Numbers (UPIN):
Name(s) of Health Care Entity (Entities) With Which Subject Is
Affiliated or Associated (Inclusion Does Not Imply Complicity in
the Reported Action.):
Business Address of Affiliate:
City, State, ZIP:
Nature of Relationship(s):

B. SUBJECT
IDENTIFICATION
INFORMATION
(INDIVIDUAL)

Basis for Initial Action
- IMPROPER OR ABUSIVE BILLING PRACTICES

REPORT DISCLOSURE TESTING
123 FAKE ST.
FAIRFAX, VA 22030
DEVELOPER
DEVELOPER
(703) 555-1212
INITIAL
MANN, ANITTA
FEMALE
01/01/1982
REPORT DISCLOSURE TESTING
123 FAKE ST.
FAIRFAX, VA 22030
CHIROPRACTIC GROUP/PRACTICE (361)
5600 FISHERS LN
ROCKVILLE, MD 20852-1750
NO
***-**-1111
UNIVERSITY OF THE FOOT (2006)
PODIATRIST
MD56, MD

FOOTCAREINC
5600 FISHERS LN
ROCKVILLE, MD 20852-1750
SUBJECT IS OWNER/PARTNER OF AFFILIATE OR ASSOCIATE (100)

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY

the

DataBank

DCN: 5950000090960755
Process Date: 11/25/2014
Page: 2
of
2
MANN, ANITTA
For authorized use by:
REPORT DISCLOSURE TESTING

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov

C. INFORMATION
REPORTED

Type of Adverse Action: PEER REVIEW ORGANIZATION
Basis for Finding: IMPROPER OR ABUSIVE BILLING PRACTICES (55)
Type of Negative Finding: RECOMMENDATION TO SANCTION (1830)
OTHER FINDING - NOT CLASSIFIED, SPECIFY (1889)
Other, as Specified: ABUSIVE STUFF
Date of Finding: 11/25/2014
Description of Finding: SHE HAD ABUSIVE BILLING PRACTICES.

D. SUBJECT
STATEMENT

If the subject identified in Section B of this report has submitted a statement, it appears in this section.

E. REPORT STATUS

Unless a box below is checked, the subject of this report identified in Section B has not contested this report.
This report has been disputed by the subject identified in Section B.
At the request of the subject identified in Section B, this report is being reviewed by the Secretary of the
U.S. Department of Health and Human Services to determine its accuracy and/or whether it complies with
reporting requirements. No decision has been reached.
At the request of the subject identified in Section B, this report was reviewed by the Secretary of the U.S.
Department of Health and Human Services and a decision was reached. The subject has requested that
the Secretary reconsider the original decision.
At the request of the subject identified in Section B, this report was reviewed by
the Secretary of the U.S. Department of Health and Human Services. The Secretary’s decision
is shown below:
Date of Original Submission:

11/25/2014

Date of Most Recent Change:

11/25/2014

This report is maintained under the provisions of: Section 1921
The information contained in this report is maintained by the National Practitioner Data Bank for restricted use under the
provisions of Section 1921 of the Social Security Act, and 45 CFR Part 60. All information is confidential and may be used only for
the purpose for which it was disclosed. Disclosure or use of confidential information for other purposes is a violation of federal law.
For additional information or clarification, contact the reporting entity identified in Section A.
END OF REPORT

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY