{ "state": "VA", "state_name": "Virginia", "medicaid_program": "Cardinal Care", "agency": "Department of Medical Assistance Services (DMAS)", "release_date": "2026-05-08", "generated_at": "2026-05-14T22:26:21+00:00", "methodology_version": "0.2.0", "denominators": { "practitioner": 130127, "organization": 67291, "location": 34157 }, "findings": { "npi-taxonomy-correctness": { "headline": "129,470 of 130,127 VA practitioner NPIs (99.4951%) match NPPES; 4,090 are flagged deactivated in NPPES while still active in the federal NDH.", "state_pct": 99.4951, "state_numerator": 129470, "state_denominator": 130127 }, "duplicate-detection": { "headline": "VA has 67,291 Organization resources covering 39,833 unique NPIs \u2014 27,458 excess resources (40.8049%) appear duplicated.", "state_pct": 40.8049, "state_numerator": 27458, "state_denominator": 67291 }, "temporal-staleness": { "headline": "0 of 231,575 VA-resident resources carry a meta.lastUpdated on the 2026-05-08 release day. As at the national level, meta.lastUpdated is a release-time stamp; state-scoping does not change this finding.", "state_pct": 0.0, "state_numerator": 0, "state_denominator": 231575 } }, "federally_excluded_cohort": { "total_critical": 125, "reason_breakdown": [ { "reasons": [ "oig_excluded", "sam_excluded" ], "count": 59, "pct_of_critical": 47.2 }, { "reasons": [ "oig_excluded" ], "count": 49, "pct_of_critical": 39.2 }, { "reasons": [ "nppes_deactivated", "oig_excluded", "sam_excluded" ], "count": 14, "pct_of_critical": 11.2 }, { "reasons": [ "nppes_deactivated", "oig_excluded" ], "count": 1, "pct_of_critical": 0.8 }, { "reasons": [ "nppes_deactivated", "sam_excluded" ], "count": 1, "pct_of_critical": 0.8 }, { "reasons": [ "sam_excluded" ], "count": 1, "pct_of_critical": 0.8 } ], "top_samples": [ { "npi": "1013125830", "name": "ARONSOHN, MICHAEL", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1013125830" }, { "npi": "1013136605", "name": "VELURI, RAVI", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1013136605" }, { "npi": "1083627376", "name": "COWLING, LAWRENCE", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1083627376" }, { "npi": "1184683120", "name": "MADDEN, WILLIS", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1184683120" }, { "npi": "1265531388", "name": "PUJOL, JACKIE", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1265531388" }, { "npi": "1487766077", "name": "PARKES, ALVIN", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1487766077" }, { "npi": "1548272495", "name": "FASANO, ANTHONY", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1548272495" }, { "npi": "1558315341", "name": "ELLISON, WALDO", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1558315341" }, { "npi": "1558356907", "name": "RODRIGUEZ CAYRO, N", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1558356907" }, { "npi": "1619056124", "name": "MORGAN, DAVID", "score": 3.8, "reason_codes": [ "oig_excluded", "sam_excluded", "nppes_deactivated" ], "leie_lookup_url": "https://exclusions.oig.hhs.gov/", "sam_lookup_url": "https://sam.gov/search/?index=ex", "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1619056124" } ], "all_npis_csv": "/api/v1/states/va-cohort-critical.csv" }, "h26_payer_directory_exposure": { "headline": "2 of 131 federally excluded VA-resident providers (LEIE or SAM, score >= 1.5) appear in at least one of 4 wired payer provider directories. Per-payer: Humana 0, Cigna 2, UnitedHealthcare 0, Molina 0.", "numerator": 2, "denominator": 131, "per_payer": [ { "name": "Humana", "matched": 0, "queried": 131, "errors": 0 }, { "name": "Cigna", "matched": 2, "queried": 131, "errors": 0 }, { "name": "UnitedHealthcare", "matched": 0, "queried": 131, "errors": 0 }, { "name": "Molina", "matched": 0, "queried": 131, "errors": 0 } ], "matched_npis": [ { "npi": "1710496161", "name": "BURKHEAD, JASON", "matched_in": [ "Cigna" ], "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1710496161" }, { "npi": "1801070313", "name": "BREWER, STEVEN", "matched_in": [ "Cigna" ], "nppes_lookup_url": "https://npiregistry.cms.hhs.gov/provider-view/1801070313" } ] }, "stage_b_roadmap": [ "Anthem HealthKeepers Plus (Anthem Medicaid in VA) \u2014 Elevance TotalView, OAuth registration required", "Aetna Better Health of Virginia (CVS/Aetna Medicaid) \u2014 developerportal.aetna.com OAuth", "UHC Community Plan (UHC Medicaid) \u2014 confirm public PDex base URL", "Sentara Community Plan \u2014 API delayed per parent payer notice", "Molina Complete Care \u2014 discovery needed", "Virginia Premier \u2014 discovery needed" ] }