Total Suspect Records
15
All flagged records (run agent to narrow)
Suspected Claims Count
0
Across all 15 records (run agent to narrow to true positives)
Suspected Claims Amount
$0
Sum of Claims Paid across all records
rule-128-sop-v1.pdf· uploaded Jun 8, 2026
1.Validate NPI is active in NPPES registry
2.Identify the provider's specialty cluster (peer group)
3.Pull network IDs from at least 3 peer providers in the same ZIP3 + specialty
4.Compare suspect provider's network list to peer median
5.Flag as TRUE POSITIVE if missing ≥1 network present in ≥60% of peers
6.Cross-check recent claims (90-day) for activity under the missing network
7.If recent claims found under missing network → escalate as FALSE POSITIVE (data lag)
8.Confirm provider is not in an exclusion list (terminated / opted-out)
9.Claims evidence check — CLAIMS_CHECK_S = 'Claims Found - PAR' AND confidence ≥ 90% → TRUE_POSITIVE
10.Assign confidence score and write recommended action
| Verdict | NPI | Org | Provider | Taxonomy | Specialty | Address | Ntwk Owner | Networks | Dir Display | PARG | Claims Check | Claims # | Claims Paid | Conf. | Suggested Value | Suggested Type | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pending | 1184921785 | REHAB SPECIALISTS | James,J,Scherer | — | Physical Therapy | 415 N Crescent Dr Ste 200, Beverly Hills, CA | — | CANWTKSNP001|CANWTKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1386757094 | OLYMPIC ANESTHESIOLOGY | Thomas,C,Wohlstadter | — | Anesthesiology | 120 S Spalding Dr Ste 300, Beverly Hills, CA | — | CANTWKISNP01|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1295154359 | LOMA LINDA UNIVERSITY HEALTH | Emily,C,Barrett | — | Emergency Medicine | 11234 Anderson St, Loma Linda, CA | — | BPPOSL01|CAHDH20|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1235366782 | ACUITY EYE GROUP | Joshua,A,Morrison Reyes | — | Ophthalmology | 100 E California Blvd, Pasadena, CA | — | CAPBNSOO|CADHECO|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1053197616 | ADVANCED PSYCHIATRIC SOLUTIONS | Chidinma,Linda,Uzounwa | — | Psychiatric/Mental Health | 510 Plaza Dr Ste 170, Glendale, CA | — | CAHMCLMS|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1528249430 | ST. JOSEPH HERITAGE MEDICAL GROUP | Arlene,Susabda,Ing | — | Family Medicine | 2501 E Chapman Ave, Fullerton, CA | — | CANWTKSNP001|CANTWKPPOGRS | — | — | — | — | — | — | CAHMCLNP | — | |
Pending | 1003312901 | LUCILE SALTER PACKARD CHILDRENS | Shalini,Mittal | — | Pediatrics | 725 Welch Rd, Palo Alto, CA | — | CAPBNSOO|CAHMCLLA|CANTWKPPOGRS | — | — | — | — | — | — | CANTWKPPOGRS | — | |
Pending | 1639707557 | UNITED MEDICAL IMAGING | Katherine,Jung,Wei | — | Radiology, Diagnostic | 11411 Brookshire Ave Ste 504, Downey, CA | — | BPPOSL01|CAPESUO|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1477844793 | SUTTER MEDICAL GROUP | Lavina,Malhotra | — | Surgery, General | 2725 Capitol Ave Dept 600, Sacramento, CA | — | CASPIRXX|CASNACNT|CAHMCLNP | — | — | — | — | — | — | CANTWKPPOGRS | — | |
Pending | 1619014503 | ANESTHESIA SPECIALISTS MEDICAL | Ameer,A,Moussa | — | Anesthesiology | 7901 Walker St, La Palma, CA | — | CAWCWC05|CAPBNSOO|CANTWKPPOGRS | — | — | — | — | — | — | CAHMCLNP | — | |
Pending | 1316142490 | SANTA CLARA VALLEY MEDICAL CENTER | Sarah,N,Namath | — | Anesthesiology | 751 S Bascom Ave, San Jose, CA | — | CAPBNSOO|CAHMCLLA|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1720498959 | UCSD MEDICAL GROUP | Arkady,Komsoukaniants | — | Hospitalist | 9300 Campus Point Dr, La Jolla, CA | — | CAPBNSOO|CADHECO|BCCHIN00 | — | — | — | — | — | — | CAHMCLNP | — | |
Pending | 1841229085 | CEDARS SINAI MEDICAL GROUP | Priya,R,Sundaram | — | Cardiology | 127 S San Vicente Blvd, Los Angeles, CA | — | CAPBNSOO|CAHMCLNP | — | — | — | — | — | — | CANTWKPPOGRS | — | |
Pending | 1962340891 | KAISER PERMANENTE WOODLAND | Daniel,T,Okonkwo | — | Internal Medicine | 1207 Fairchild Ct, Woodland, CA | — | CAKAISER|CANTWKPPOGRS | — | — | — | — | — | — | — | — | |
Pending | 1750193827 | SCRIPPS CLINIC MEDICAL GROUP | Maya,L,Goldstein | — | Dermatology | 10666 N Torrey Pines Rd, La Jolla, CA | — | CAPBNSOO|CADHECO | — | — | — | — | — | — | CANTWKPPOGRS | — |
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