Cross-source identity
National Provider Identifier 1104035617 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.
| Federal source | Key | What it provides | Provenance |
|---|
| CMS NPPES | NPI 1104035617 | Registry identity — psychiatrist, taxonomy 2084P0800X | Source:CMS NPPESSnapshot 2026-05-06 |
| CMS Open Payments | NPI 1104035617 | 2 industry-payment records, 2024 | Source:CMS Open PaymentsSnapshot PY2024 |
| CMS Medicare Part D | NPI 1104035617 | 11 drugs prescribed, 2024 | Source:CMS Part DSnapshot DY2024 |
| Fonteum entity graph | entity 48ce74d6… | Canonical resolved node · 2 identifier(s) · 0 edge(s) | Source:Entity graphSnapshot 2026-06-11 |
Industry payments
Payments and transfers of value this clinician received from drug and device manufacturers, disclosed under the Physician Payments Sunshine Act. A payment is a disclosure, not a judgment.
| Nature of payment | Amount | Records |
|---|---|---|
| Food and Beverage | $49 | 2 |
| Manufacturer | Amount | Records |
|---|---|---|
| 180 Medical, Inc. | $28 | 1 |
| Idorsia Pharmaceuticals Us Inc | $21 | 1 |
Prescribing
Prescriptions written under Medicare Part D, aggregated by drug across the program. Totals reflect claims paid, not patients treated.
| Drug | Claims | Drug cost |
|---|---|---|
| Duloxetine Hcl | 24 | $693 |
| Escitalopram Oxalate | 30 | $452 |
| Venlafaxine Hcl Er(Venlafaxine Hcl) | 28 | $409 |
| Gabapentin | 31 | $361 |
| Quetiapine Fumarate | 28 | $338 |
Beneficiary counts below 11 are suppressed by CMS — the total shown is a lower bound.
Quality
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
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.
Ownership & affiliations
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.