Statements: CUSTIS KEVIN T MD

Canonical ID: NK-FDLpd4mzU35SGwiVvzmVsh · Entity type: Person (reference)

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Property	Value	Lang	Source dataset	Source ID	First seen
`Person:address`	BELLE MEAD, NJ 8502	eng	us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2025-12-29
`Person:address`	86 E 49TH ST, SUITE A, BROOKLYN, NY 112031901		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`Person:address`	63 MEADOW LARK LANE, APT 1, BELLE MEAD, NJ 08502	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-06-06
`Person:address`	63 MEADOW LARK LN, BELLE MEAD, NJ 085024929		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`LegalEntity:address`	908 MAIN STREET, ASBURY PARK, NJ 07712	eng	us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`LegalEntity:addressEntity`	`addr-a2a310f8bcbfecfa04d1dbbb443af44e5c362fee`		us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`Person:birthDate`	1964-10-03		us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:country`	us		us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-05-09
`Person:country`	us		us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:country`	us		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`LegalEntity:country`	us		us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`LegalEntity:country`	us		us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-03
`Person:createdAt`	2023-12-11		us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-05-09
`Person:firstName`	KEVIN	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:firstName`	KEVIN	eng	us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-05-09
`Person:firstName`	KEVIN		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`Person:id`	79179aa2b934d4ed3719485df44eb39fdbba9286		us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2026-01-06
`LegalEntity:id`	1a2e5e53a99c42d2fd4ac3c1d610ccd16033d496		us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`Person:id`	a36dd0039492a4bdf3308e103869492b1d749dc6		ext_us_cms_npi	`us-npi-1811976970`	2026-02-05
`LegalEntity:id`	66eb1a7a24a4f4f4ddd1167a06ff5d7e39abf1da		us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-03
`Person:id`	b70ef3959ef769152995c6ca033714b7d32cab08		us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2026-01-06
`LegalEntity:idNumber`	00211807	eng	us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-02
`Person:lastName`	CUSTIS	eng	us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-05-09
`Person:lastName`	CUSTIS	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:lastName`	CUSTIS		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`Person:middleName`	TYRONE		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`Person:middleName`	TYRONE	eng	us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-10-11
`Person:middleName`	TYRONE	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-10-11
`LegalEntity:name`	CUSTIS KEVIN T MD	eng	us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-02
`Person:name`	KEVIN TYRONE CUSTIS		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`Person:name`	KEVIN TYRONE CUSTIS	eng	us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-05-09
`LegalEntity:name`	CUSTIS, KEVIN	eng	us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`Person:name`	KEVIN TYRONE CUSTIS	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:npiCode`	1811976970		ext_us_cms_npi	`us-npi-1811976970`	2026-02-04
`LegalEntity:npiCode`	1811976970	eng	us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-02
`Person:npiCode`	1811976970	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-06-06
`LegalEntity:npiCode`	1811976970	eng	us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`Person:position`	FAMILY PRACTICE (PHYSICIAN (MD, DO))	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:programId`	US-HHS-OIG	eng	us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2025-09-12
`LegalEntity:sector`	MD	eng	us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`LegalEntity:sector`	Physician	eng	us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-02
`Person:topics`	debarment		us_hhs_exclusions	`us-fed-excl-kevin-tyrone-custis-08502-belle-mead`	2024-05-08
`Person:topics`	debarment		us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-05-09
`LegalEntity:topics`	debarment		us_ny_med_exclusions	`us-medny-2af719218ed00d3f851a5004a221eb7fcabb4182`	2024-09-02
`LegalEntity:topics`	debarment		us_nj_med_exclusions	`us-mednj-115840301178a3c2b5bb71322a3adb98e21042f5`	2024-11-08
`Person:uniqueEntityId`	PHNTN47NLV21	eng	us_sam_exclusions	`us-fed-excl-kevin-tyrone-custis-8502-belle-mead`	2024-12-03

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