Cross-source identity
National Provider Identifier 1104913540 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 1104913540 |
| Registry identity — psychiatrist, taxonomy 2084P0800X |
| Source:CMS NPPESSnapshot 2026-05-06 |
| CMS Medicare Part D | NPI 1104913540 | 19 drugs prescribed, 2024 | Source:CMS Part DSnapshot DY2024 |
| Fonteum entity graph | entity 5ddc9116… | Canonical resolved node · 1 identifier(s) · 0 edge(s) | Source:Entity graphSnapshot 2026-06-11 |
Prescribing
Prescriptions written under Medicare Part D, aggregated by drug across the program. Totals reflect claims paid, not patients treated.
| Drug | Claims | Drug cost |
|---|---|---|
| Auvelity(Dextromethorphan Hbr/Bupropion) | 25 | $33,032 |
| Aripiprazole | 52 | $13,165 |
| Bupropion Xl(Bupropion Hcl) | 130 | $2,647 |
| Doxepin Hcl | 13 | $2,525 |
| Venlafaxine Hcl Er(Venlafaxine Hcl) | 63 | $2,083 |
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.