EXCLUDEDPROVIDER
Individual Revocation

Donovan Paul Shively

Fairfield, CA 94534

Public HHS-OIG LEIE exclusion record

Donovan Paul Shively of Fairfield, CA is registered in the CMS NPI Registry under National Provider Identifier (NPI) 1063485217 with a primary specialty of Obstetrics & Gynecology. According to the HHS-OIG List of Excluded Individuals/Entities (LEIE), Donovan Paul Shively is currently excluded from participation in federally funded health care programs due to license revocation, suspension, or surrender, as of December 20, 2015.

Status
Currently listed by HHS-OIG
Record type
Individual
Location
Fairfield, CA 94534
Exclusion date
December 20, 2015
Exclusion type
Revocation (1128b4)
NPI
1063485217

Record summary

Donovan Paul Shively appears in the HHS-OIG List of Excluded Individuals/Entities (LEIE) public dataset as an individual record associated with Fairfield, California. 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 December 20, 2015, 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 dateDecember 20, 2015
Exclusion typeLicense revocation, suspension, or surrender (1128b4)
NPI1063485217
UPINA41413
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 Fairfield, CA 94534. The listed provider category is Physician (MD, DO). The listed specialty is OB/GYN.

NPI Registry context

The LEIE record lists NPI 1063485217. CMS NPPES public registry data lists this NPI as an individual record with primary taxonomy Obstetrics & Gynecology (207V00000X). Registered practice location: Fairfield, CA. NPI enumeration date: Feb 8, 2006. NPPES status: Active. The NPI Registry lists credential: MD.

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 Fairfield, CA

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

Chiyon Speakman Individual Revocation
Fairfield, CA · License revocation, suspension, or surrender · Excluded Jun 2025
Aaron Bert Ruiz Individual Revocation
Fairfield, CA · License revocation, suspension, or surrender · Excluded Feb 2024
Jay Louis Batilo Concepcion Individual Revocation
Fairfield, CA · License revocation, suspension, or surrender · Excluded Nov 2022
Lolita Togni Cunanan Individual Patient Abuse
Fairfield, CA · Conviction relating to patient abuse or neglect · Excluded Mar 2022
Julie Leanna Pagliero Individual Drug Felony
Fairfield, CA · Felony conviction relating to controlled substance · Excluded Dec 2020
Pamela Kay Juarez Individual Revocation
Fairfield, CA · License revocation, suspension, or surrender · Excluded Aug 2018
Yolandra Forney Individual Revocation
Fairfield, CA · License revocation, suspension, or surrender · Excluded Feb 2018
Beverly Delorce Cloudy Individual Drug Felony
Fairfield, CA · Felony conviction relating to controlled substance · Excluded Jul 2017

See all 34 excluded providers in Fairfield →

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 this record with the official HHS-OIG source Save or print this record Monitor this provider/entity Need to screen a list? Join the bulk screening beta

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Related

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