EXCLUDEDPROVIDER
Individual Revocation

Timothy Brock Ray

Maynard, AR 72444

Public HHS-OIG LEIE exclusion record

Timothy Brock Ray of Maynard, AR is registered in the CMS NPI Registry under National Provider Identifier (NPI) 1629282025 with a primary specialty of Licensed Practical Nurse. According to the HHS-OIG List of Excluded Individuals/Entities (LEIE), Timothy Brock Ray is currently excluded from participation in federally funded health care programs due to license revocation, suspension, or surrender, as of June 17, 2021.

Status
Currently listed by HHS-OIG
Record type
Individual
Location
Maynard, AR 72444
Exclusion date
June 17, 2021
Exclusion type
Revocation (1128b4)
NPI
1629282025

Record summary

Timothy Brock Ray appears in the HHS-OIG List of Excluded Individuals/Entities (LEIE) public dataset as an individual record associated with Maynard, Arkansas. The latest imported LEIE dataset lists this record as currently excluded from participation in federally funded health care programs. The exclusion date shown in the source record is June 17, 2021, and the exclusion type is 1128b4, identified by HHS-OIG as license revocation, suspension, or surrender.

Source record

SourceHHS-OIG LEIE (public dataset)
Record typeIndividual
Current statusCurrently listed by HHS-OIG
Exclusion dateJune 17, 2021
Exclusion typeLicense revocation, suspension, or surrender (1128b4)
NPI1629282025
Source dataset dateMay 2026

What this exclusion type means

HHS-OIG identifies exclusion type 1128b4 as “License revocation, suspension, or surrender.” License revocation, suspension, or surrender (permissive exclusion).

This exclusion type is a statutory category used by HHS-OIG in the LEIE dataset. The category describes the legal authority associated with the exclusion record, not a separate investigation or additional reporting by Excluded Provider.

Location and provider classification

This LEIE record is associated with Maynard, AR 72444. The listed provider category is Individual - Licensed Health Care Service Provider. The listed specialty is Nurse / Nurses Aide.

NPI Registry context

The LEIE record lists NPI 1629282025. CMS NPPES public registry data lists this NPI as an individual record with primary taxonomy Licensed Practical Nurse (164W00000X). Registered practice location: Jonesboro, AR. NPI enumeration date: May 9, 2007. NPPES status: Active. The NPI Registry lists credential: LPN.

NPI Registry data is administrative provider-identification data from CMS. It does not independently verify or explain the HHS-OIG exclusion record above. Verify exclusion status directly with HHS-OIG.

Other excluded providers in Maynard, AR

Other individuals and entities currently listed in the HHS-OIG LEIE public dataset with a Maynard, AR address.

Kristy Lee Hanson Individual Program Crime
Maynard, AR · Conviction of program-related crimes · Excluded Apr 2008

How to verify this record

This page is a public-record summary and should be treated as a possible LEIE match, not final identity verification. To verify the record, use the official HHS-OIG LEIE search and compare available identifying information through the official process. Name, location, provider category, specialty, exclusion date, and NPI should be treated as matching clues rather than final proof of identity.

What this page does not include

This page summarizes the HHS-OIG LEIE public dataset only. It does not search state Medicaid exclusion lists, state licensing-board actions, court records, malpractice records, employment history, civil lawsuits, or non-public investigations.

Verify with HHS-OIG Remove / correct this record

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