Subject Numbers Regarding Health Provider Authorizations

Authorization No. PA004779-5W

September 22, 2021

Pursuant to Workers' Compensation Law Section 13-d(4), the Chair of the New York State Workers' Compensation Board has exercised her authority to temporarily suspend Odette Eugenie Davis' authorization to treat injured workers within the New York State workers' compensation system effective September 10, 2021. Ms. Davis' last known business address is:

Medalliance Medical Health Services
625 East Fordham Road
Bronx, New York 10458

The Chair's designee's investigation has revealed that, on or about August 17, 2021, this office served an Administrative Warning letter upon Ms. Davis. Ms. Davis was required to register the name of her properly authorized supervising physician with the Board by or before August 27, 2021. As of this date, she has not done so.

Ms. Davis is prohibited from rendering treatment and care to injured workers, and from conducting reviews of records regarding variance requests pursuant to 12 NYCRR § 324.3(b)(2)(ii)(a), while her authorization is temporarily suspended. Reports submitted by Ms. Davis for services rendered prior to September 10, 2021, are valid but are invalid for any services rendered on or after that date. Requests to cross-examine Ms. Davis for services rendered prior to September 10, 2021, should not be denied due to the suspension of her authorization.

This suspension remains in effect until further notice. Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.