PARTICIPATING PROVIDER DIRECTORY

Transcription

1 Vantage Health Plan 2019 OGB Medical Home HMO Plan Nationwide Coverage. Nationwide Care. Nationwide Service. PARTICIPATING PROVIDER DIRECTORY CURRENT AS OF March 1, 2019

2

3 Table of Contents Affinity Health Network 1 NCQA PCMH Providers w/level 3 Recognition 11 Tier 1 Network: 15 Hospitals 16 Region 1 18 (Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll, Winn) Primary Care Physicians 18 Specialty Care Physicians 26 Ancillary Services 32 Region 2 44 (Bienville, Bossier, Caddo, Claiborne, DeSoto, Red River, Webster) Primary Care Physicians 44 Specialty Care Physicians 49 Ancillary Services 56 Region 3 65 (Avoyelles, Catahoula, Concordia, Grant, LaSalle, Natchitoches, Rapides, Sabine, Vernon) Primary Care Physicians 65 Specialty Care Physicians 70 Ancillary Services 75 Region 4 83 (Allen, Beauregard, Calcasieu, Cameron, Jefferson Davis) Primary Care Physicians 83 Specialty Care Physicians 87 Ancillary Services 91 Region (Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin, St. Mary, Terrebonne, Vermilion) Primary Care Physicians 101 Specialty Care Physicians 104 Ancillary Services 115 Region (Ascension, Assumption, East Baton Rouge, East Feliciana, Iberville, Livingston, Pointe Coupee, St. Helena, St. James, West Baton Rouge, West Feliciana) Primary Care Physicians 125 Specialty Care Physicians 137 Ancillary Services 152 Region (Jefferson, LaFourche, Orleans, Plaquemines, St. Bernard, St. Charles, St. John the Baptist, St. Tammany, Tangipahoa, Washington) Primary Care Physicians 166 Specialty Care Physicians 179 Ancillary Services 211

4 Affinity Health Network Affinity Health Network (AHN) is a preferred network of providers (physicians and facilities) who have partnered with Vantage Health Plan to offer Vantage members high quality medical services at lower copays. Page 1

5 HOSPITALS DESOTO REGIONAL HEALTH SYSTEM 207 JEFFERSON ST MANSFIELD, LA (318) FRANKLIN PARISH HOSPITAL SERVIC DBA FRANKLIN MEDICAL CENTER 2106 LOOP RD WINNSBORO, LA (318) MONROE SURGICAL HOSPITAL 2408 BROADMOOR BLVD (318) RICHLAND PARISH HOSPITAL 407 CINCINNATI ST DELHI, LA (318) RICHLAND PARISH HOSPITAL SERVICE DBA RICHARDSON MEDICAL CTR 256 HIGHWAY 3048 RAYVILLE, LA (318) WEST CARROLL HEALTH SYSTEMS 706 ROSS ST OAK GROVE, LA (318) REGION 1 Includes Ouachita, Lincoln, Morehouse, Union, Richland, East Carroll, West Carroll, Madison, Jackson, Caldwell, Franklin, Tensas and Winn Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE ANDERS, KERRY L, 3400 MEDICAL PARK DR STE A MONROE, LA (318) ATKINS, LOGAN, 2104 C LOOP RD WINNSBORO, LA (318) BARNES, DAVID L, 3400 MEDICAL PARK DR STE C MONROE, LA (318) CALHOUN, KEITH B, 4400 OLD STERLINGTON RD MONROE, LA (318) CARLISLE, KEVIN M, 256 HWY 3048 RAYVILLE, LA (318) HWY 80 RAYVILLE, LA (318) COLVIN, THOMAS L, 2106 LOOP RD STE A WINNSBORO, LA (318) COMBETTA, JEFFREY J, 2104 LOOP RD STE C WINNSBORO, LA (318) BOOTS RD FARMERVILLE, LA (318) COUGHRAN, JIMMY R, 1010 DAVIS LAKE RD COLUMBIA, LA (318) FAIR AVE WINNSBORO, LA (318) DOMINGUE, CHRISTOPHER M, 708 EAST MAIN ST OAK GROVE, LA (318) ELDRIDGE, JOEL G, DO 2104-C LOOP RD WINNSBORO, LA (318) HWY 17 WINNSBORO, LA (318) VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) ENRIQUEZ, JOSE R, 508 BROADWAY ST DELHI, LA (318) GHANTA, SUMATHA L, 920 OLIVER RD STE J (318) GREEN, GREGORY R, 920 OLIVER RD WAITING AREA L (318) GUINIGUNDO, NOLI, 502 ROSS ST OAK GROVE, LA (318) GUJJULA, RAJESH, 920 OLIVER RD WAITING AREA J (318) HAYWARD SR, MICHAEL T, 3400 MEDICAL PARK STE B MONROE, LA (318) KERR, ALBERT G, 121 CHRISTIAN DR RAYVILLE, LA (318) LAPITE, OLADAPO, 306 STONE AVE (318) LE, DUNG N, 508 BROADWAY DELHI, LA (318) ELM ST DELHI, LA (318) MCDONALD III, KENNETH E, 508 BROADWAY ST DELHI, LA (318) MELTON, STUART L, 920 OLIVER RD WAITING AREA A (318) MEYERS, OWEN M, 920 OLIVER RD WAITING AREA M (318) PRINE, MATTHEW D, 256 HWY 3048 RAYVILLE, LA (318) (Hospitalist/Intensivist) 5975 HWY 80 RAYVILLE, LA (318) RAULERSON, ROBERT M, 920 OLIVER RD WAITING AREA A (318) RICHARD, RINATA K, 5745 HWY 17 WINNSBORO, LA (318) ROSS, THERESA J, 112 SAINT JOHN ST (318) SANSON, MARSHALL V, 2309 ARKANSAS RD (318) SMITH, JAMES MICHAEL, 532 S WASHINGTON BASTROP, LA (318) STOCKSTILL, JAMES DEAN, 3510 MAGNOLIA AVE STE 190 MONROE, LA (318) WALTERS JR, JOSEPH A, 425 S VINE ST BASTROP, LA (318) GUNBY AVE BASTROP, LA (318) WILLIAMS SR, THOMAS ST CLAIR, 502 ROSS ST OAK GROVE, LA (318) WILLIAMS, NORMAN B, 2408 BROADMOOR BLVD STE B (318) YARBROUGH, DAVID A, 3400 MEDICAL PARK DR STE B MONROE, LA (318) INTERNAL MEDICINE ALBRITTON, COREY G, 109 ELM ST DELHI, LA (318) at any time. Please call (318) or go to to verify provider status. Page 2

6 BRUYNINCKX, KYLE B, 256 HWY 3048 RAYVILLE, LA (318) ZUKOWSKI, NANCY L, 3401 MAGNOLIA CV MONROE, LA (318) COBB, TANYA R, NP 5745 HWY 17 WINNSBORO, LA (318) HALE, ASHLEY N, NP 261 HWY 132 MANGHAM, LA (318) FAKHRE, FAKHRE, 712 SETTOON ST OAK GROVE, LA (318) NON-PHYSICIAN PRACTITIONERS COLEMAN, EULA F, NP 5745 HWY 17 WINNSBORO, LA (318) HARRIS, RECEL, NP 508 BROADWAY ST DELHI, LA (318) SETTOON ST OAK GROVE, LA (318) FAKHRE, GEORGE, 319 NORTH HOOD ST LAKE PROVIDENCE, LA (318) GRANDON, PAUL W, 508 BROADWAY ST DELHI, LA (318) HARTER, HERSCHEL R, 5975 FEDERAL HWY 80 RAYVILLE, LA (318) SAMPOGNARO, MICHAEL J, 1 BANCROFT CIR (318) SMITH JR, WILLIAM D, 2516 BROADMOOR BLVD STE 2A (318) SMITH, ROGER A, 126 WATSON ST WISNER, LA (318) WAGNON, CYNTHIA S, 508 BROADWAY ST DELHI, LA (318) PEDIATRICS DENNISON, SARAH LEE, 920 OLIVER RD WAITING AREA K (318) EASON, MARGOT B, 920 OLIVER RD WAITING AREA K (318) PALKAMSETTI, SIREESHA, 708 E MAIN ST OAK GROVE, LA (318) FAMILY PRACTICE ALDERMAN, MYRA B, NP 121 CHRISTIAN DR RAYVILLE, LA (318) BAILEY, BILLIE JO WILLIAMS, NP 101 FAIR AVE WINNSBORO, LA (318) BAILEY, JESSICA W, NP 2106 LOOP RD STE A WINNSBORO, LA (318) BENNETT, CRYSTAL, NP 256 HWY 3048 RAYVILLE, LA (318) HWY 80 RAYVILLE, LA (318) BENNETT, JENNIFER G, NP 254 HWY 3048 RAYVILLE, LA (318) HWY 80 RAYVILLE, LA (318) BRYANT, RENITA S, NP 420 GUNBY AVE BASTROP, LA (318) CAMPER, YOLANDA S, NP 1140 UNIVERSITY AVE MONROE, LA (318) CASIDAY, JULIA M, NP 2104 LOOP RD STE C WINNSBORO, LA (318) CHAUVIN, JANNA C, NP 104 VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) DEAR, SHARON T, NP 2309 ARKANSAS RD (318) ELEY, EDWINA E, NP 104 VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) ERWIN, LAUREN S, NP 920 OLIVER RD WAITING AREA L (318) FLEMISTER, MELISSA K, NP 920 OLIVER RD WAITING AREA M (318) FLORICE, JOE C, NP 2104 LOOP RD STE C WINNSBORO, LA (318) HWY 17 WINNSBORO, LA (318) VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) GAMBILL, MARIBETH W, NP 420 GUNBY AVE BASTROP, LA (318) GILL, ANGELA C, NP 261 HWY 132 MANGHAM, LA (318) GRIMMETT, RYAN P, NP 112 SAINT JOHN ST (318) HAUGHT, HALEY A, NP 106 TOOMBS ST DELHI, LA (318) MAIN ST DELHI, LA (318) ELM ST DELHI, LA (318) HWY 17 DELHI, LA (318) HAYDEN, ERIN E, NP 510 SOUTH WASHINGTON ST BASTROP, LA (318) OLIVER RD WAITING AREA B (318) SAINT JOHN ST (318) HEUDUCK, JULIE, NP 2104 LOOP RD STE C WINNSBORO, LA (318) HWY 17 WINNSBORO, LA (318) VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) LOCKARD, JOYCE P, NP 2106 LOOP RD STE A WINNSBORO, LA (318) LONSBERRY, KATHRYN A, PA 2106 A LOOP RD WINNSBORO, LA (318) at any time. Please call (318) or go to to verify provider status. Page 3

7 LOWDER, RAYNE W, NP 920 OLIVER RD WAITING AREA A (318) MCCRORY, JULIE, NP 2309 ARKANSAS RD (318) MCVAY, ALISHA N, NP 106 TOOMBS ST DELHI, LA (318) BROADWAY ST DELHI, LA (318) MAIN ST DELHI, LA (318) ELM ST DELHI, LA (318) HWY 17 DELHI, LA (318) MILLER, BRENDA R, NP 2104 LOOP RD STE C WINNSBORO, LA (318) HWY 17 WINNSBORO, LA (318) VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) PARKER, KAREN B, NP 920 OLIVER RD WAITING AREA M (318) PEARSON, NATHAN E, NP 2309 ARKANSAS RD (318) PRUDEN, AMY L, NP 920 OLIVER RD WAITING AREA J (318) SCHOOLEY, JARROD L, PA 2309 ARKANSAS RD (318) SPENCER, ERIKA, NP 920 OLIVER RD WAITING AREA M (318) STEPHENS, MATILDA E, NP 3400 MEDICAL PARK DR STE B MONROE, LA (318) SULLIVAN, SHARLENE C, NP 920 OLIVER ROAD WAITING ROOM A (318) THOMASON, DEANNA W, NP 509 MAIN ST DELHI, LA (318) TOOMBS ST DELHI, LA (318) ELM ST DELHI, LA (318) BROADWAY ST DELHI, LA (318) HWY 17 DELHI, LA (318) THOMPSON, KASEY B, NP 109 ELM ST DELHI, LA (318) TOLLIVER BATTLE, TIFFANY L, NP 221 W HICKORY AVE BASTROP, LA (318) WALDEN, ANNSLEY K, NP 920 OLIVER RD AREA B (318) WALLS, ARIEL D, NP 256 HWY 3048 RAYVILLE, LA (318) WILLSHER, LAURA B, NP 3400 MEDICAL PARK DR STE B MONROE, LA (318) WILSON, TERRY R, PA 920 OLIVER RD STE I (318) INTERNAL MEDICINE PARKS, KALA D, NP 920 OLIVER RD (318) BROADMOOR BLVD STE B (318) PEDIATRICS BAILEY, PAMELA J, NP 2106 LOOP RD STE A WINNSBORO, LA (318) CARR, VIVIAN S, NP 3401 MAGNOLIA CV MONROE, LA (318) DAVIS, MARYANNE S, NP 920 OLIVER RD WAITING AREA K (318) DUCKWORTH-HOWARD, APRIL, NP 920 OLIVER RD WAITING AREA K (318) GRIFFING, PAULA, NP 2106 A LOOP RD WINNSBORO, LA (318) WEBB, STACY D, NP 3401 MAGNOLIA COVE MONROE, LA (318) MEDICAL PARK DR MONROE, LA (318) SPECIALISTS CARDIOVASCULAR DISEASE BARROW, EMILE A, 1100 NORTH 18TH ST (318) HILBUN, JEFFREY M, 2516 BROADMOOR BLVD STE 2C (318) MANRIQUE GARCIA, ALVARO F, 2516 BROADMOOR BLVD STE 2A (318) NAPOLI, MARK C, 1100 N 18TH ST (318) RITTELMEYER, JAMES T, 1100 N 18TH ST (318) SAMPOGNARO, GREGORY C, 2516 BROADMOOR BLVD STE 2B (318) SMITH, THOMAS ROSS, 2516 BROADMOOR BLVD STE 2C (318) EAR, NOSE & THROAT/OTOLARYNGOL OGY BARHAM, WILSON T, 2802 KILPATRICK BLVD (318) MICKEY, LAUREN J, 102 THOMAS RD STE 117 (318) MILLER, LEE A, 2802 KILPATRICK BLVD (318) NORRIS, JOEL W, 2516 BROADMOOR BLVD STE 1B (318) TALIAFERRO JR, HENRY G, 2516 BROADMOOR BLVD STE 1B (318) OBSTETRICIAN AND GYNECOLOGIST BRYAN, DAVID G, 931 NORTH TRENTON ST (318) at any time. Please call (318) or go to to verify provider status. Page 4

8 711 ST JOHN ST STE 2 (318) MCMILLAN RD (318) GRAMMONT ST STE 300 (318) PROFESSIONAL DR (318) TOWER DR STE 406 (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) GULLATT, ERIN M, 931 NORTH TRENTON ST (318) ST JOHN ST STE 2 (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) KLUG, SARA J, DO 312 GRAMMONT ST STE 300 (318) LEBLEU VASZILY, LAURIE R, 931 NORTH TRENTON ST (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) LEE, WON S, 931 NORTH TRENTON ST (318) TOWER DR STE 406 (318) GRAMMONT ST STE 300 (318) ST JOHN ST STE 2 (318) PENNEBAKER, DAWN W, 931 NORTH TRENTON ST (318) ST JOHN ST STE 2 (318) TOWER DR STE 406 (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) PETTY, LAURA R, 931 NORTH TRENTON ST (318) ST JOHN ST STE 2 (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) SHEMWELL, AMBER L, 931 NORTH TRENTON ST (318) ST JOHN ST STE 2 (318) TOWER DR STE 406 (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) TUGWELL, TERRY, 931 NORTH TRENTON ST (318) TOWER DR STE 406 (318) MCMILLAN RD (318) WILLIAMS, ADRIENNE M, 711 ST JOHN ST STE 2 (318) GRAMMONT ST STE 300 (318) MEDICAL PARK DR STE 1 MONROE, LA (318) MCMILLAN RD (318) WILSON, JASON B, 931 NORTH TRENTON ST (318) ST JOHN ST STE 2 (318) TOWER DR STE 406 (318) GRAMMONT ST STE 300 (318) MCMILLAN RD (318) OPHTHALMOLOGY BARRON, JOSEPH B, 3101 MERCEDES DR (318) FERNANDES, JOSHUA K, 3101 MERCEDES DR (318) READ, WILLIAM JASON, 2600 TOWER DR STE 111 (318) ORTHOPEDIC SURGERY BROWN, DOUGLAS C, 312 GRAMMONT ST STE 302 (318) CHRISTIAN DR RAYVILLE, LA (318) EXTINE, JAMES H, DO 2516 BROADMOOR BLVD STE 1A (318) SOELLER SR, CLEMENS E, 2516 BROADMOOR BLVD STE 1A (318) PSYCHIATRY RAGSDILL, ROY R, 920 OLIVER RD WAITING AREA H (318) SURGERY-GENERAL GUTIERREZ, DAVID, 2104 LOOP RD STE E WINNSBORO, LA (318) MARX, DARYL S, 2301 JUSTICE ST (318) SURGERY-NEUROLOGY CAIN, MARSHALL A, 2485 TOWER DR STE 9 MONROE, LA (318) SURGERY-PLASTIC MICKEL, TIMOTHY J, 903 NORTH 2ND ST (318) UROLOGY DEAN JR, ODELL J, 2516 BROADMOOR BLVD STE 3B (318) HUMBLE, ROBERT LEE, 2516 BROADMOOR BLVD STE 3B (318) at any time. Please call (318) or go to to verify provider status. Page 5

9 JOHNSON, BRADLEY J, 2516 BROADMOOR BLVD STE A (318) MARX, ROBERT D, 102 THOMAS RD STE 108 (318) MURPHY, PAUL G, 2516 BROADMOOR BLVD (318) ROBINSON, JED C, DO 2106 LOOP RD STE B WINNSBORO, LA (318) Ancillary Services 24 HOUR FACILITY AFFINITY WALK IN CLINIC 2408 BROADMOOR BLVD STE B (318) AFTER HOURS CLINIC AFFINITY CHILDREN & FAMILY WALK IN CLINIC 920 OLIVER RD WAITING AREA A (318) RICHLAND PARISH HOS SERVICE DBA START COMMUNITY CLINIC 5975 HWY 80 RAYVILLE, LA (318) RICHLAND PARISH HSD DBA NORTHEAST LOUISIANA HEALTH C 256 HWY 3048 RAYVILLE, LA (318) WEST CARROLL HEALTH SYSTEMS DBA COMMUNITY MEDICAL CLINIC 712 SETTOON ST OAK GROVE, LA (318) WEST CARROLL HEALTH SYSTEMS DBA LAKE PROVIDENCE MEDICAL CL 319 NORTH HOOD ST LAKE PROVIDENCE, LA (318) WEST CARROLL HEALTH SYSTEMS DBA OAK GROVE MEDICAL CLINIC 708 EAST MAIN ST OAK GROVE, LA (318) WEST CARROLL HEALTH SYSTEMS DBA WEST CARROLL MEDICAL CLINIC 502 ROSS ST OAK GROVE, LA (318) NUTRITIONAL COUNSELING BRANTLY, CYNTHIA A, RD 1325 LOUISVILLE AVE (318) HODGES, AMANDA L, RD 1325 LOUISVILLE AVE (318) PHARMACY AFFINITY PHARMACY AT OLIVER ROAD 920 OLIVER RD (318) SAINT JOHN PHARMACY 110 ST JOHN ST (318) SUBSTANCE ABUSE/PSYCH CRAYTON, SUZETTE M, LCSW 920 OLIVER RD WAITING AREA H (318) MCDONALD, JONI, LCSW 109 ELM ST DELHI, LA (318) MCDONALD, LAURA L, OT 1325 LOUISVILLE AVE (318) REGION 2 Includes Caddo, Bossier, Red River, Bienville, Claiborne, Webster, and DeSoto Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE EVANS, JEFFREY L, 130 JEFFERSON ST MANSFIELD, LA (318) LEGGIO, BENJAMIN L, 130 JEFFERSON ST MANSFIELD, LA (318) INTERNAL MEDICINE KAMBEROV, DENIS F, 130 JEFFERSON ST MANSFIELD, LA (318) NON-PHYSICIAN PRACTITIONERS FAMILY PRACTICE COMMUNITY/RURAL HEALTH CENTER FRANKLIN MEDICAL CENTER CROWVILLE HEALTH CENTER 5745 HWY 17 WINNSBORO, LA (318) FRANKLIN MEDICAL CENTER DBA WINNSBORO RHC 2104 LOOP RD STE C WINNSBORO, LA (318) FRANKLIN MEDICAL CENTER RHC NEWELLTON 104 VERONA ST NEWELLTON, LA (318) FRANKLIN MEDICAL CENTER RHC ST JOSEPH 448 NEWTON ST SAINT JOSEPH, LA (318) DENTIST CRUSE STRONG, MARIANNE, DDS 502 ROSS ST OAK GROVE, LA (318) FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) HOSP SERV DIST 1A OF RICHLAND PARISH, DELHI COMM HLTH CTR 109 ELM ST DELHI, LA (318) HEARING CENTER/AUDIOLOGIST DE LA O, MELISSA A, AUD 2516 BROADMOOR BLVD STE 1B (318) WILSON, KATHERINE M, LMFT 2600 TOWER DR STE 406 (318) THERAPY CENTER CASTEEL, EMILY E, SLP 1325 LOUISVILLE AVE (318) LAMB, BRIAN K, OT 1325 LOUISVILLE AVE (318) MAJURE, STACEY G, PT 1325 LOUISVILLE AVE (318) MARTIN, EMILY A, SLP 1325 LOUISVILLE AVE (318) EUBANKS, LORI A, NP 130 JEFFERSON ST MANSFIELD, LA (318) RICHARDSON, MELISSA L, NP 808 MAIN ST LOGANSPORT, LA (318) TAYLOR, ANGELA OWENS, NP 808 MAIN ST LOGANSPORT, LA (318) JEFFERSON ST MANSFIELD, LA (318) at any time. Please call (318) or go to to verify provider status. Page 6

10 Ancillary Services COMMUNITY/RURAL HEALTH CENTER DESOTO REGIONAL FAMILY MEDICINE - LOGANSPORT 808 MAIN ST LOGANSPORT, LA (318) DESOTO REGIONAL FAMILY MEDICINE - MANSFIELD 130 JEFFERSON ST MANSFIELD, LA (318) REGION 3 WEBBER JR, JOSEPH K, NP 307 CHISUM ST SICILY ISLAND, LA (318) Ancillary Services FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) CATAHOULA PARISH HOSPITAL DISTRICT #2 307 CHISUM ST SICILY ISLAND, LA (318) REGION 6 BALART, JAMES C, BARBIN, ALLISON B, BENTON, WILLIAM B, BORDELON, ASHLEY D, FONTENOT, DAVID W, GARIKAPATI, KIRAN, 8585 PICARDY AVE (225) GRAVES, KURT W, GREESON, JENNIFER C, Includes Sabine, Natchitoches, Vernon, Rapides, Concordia, Avoyelles, Catahoula, LaSalle, and Grant Parishes. MEDICAL HOME - PCP's INTERNAL MEDICINE SMITH, ROGER A, 302A BUSHLEY ST HARRISONBURG, LA (318) NON-PHYSICIAN PRACTITIONERS FAMILY PRACTICE FRYAR KELONE, SUSAN T, NP 302A BUSHLEY STREET HARRISONBURG, LA (318) HOWARD, SUSAN A, NP 302A BUSHLEY ST HARRISONBURG, LA (318) FOSTER ST JONESVILLE, LA (318) OLIVIER, ASHLEY B, NP 307 CHISUM ST SICILY ISLAND, LA (318) PORTER, MARY E, NP 307 CHISUM ST SICILY ISLAND, LA (318) Includes Livingston, Assumption, West Feliciana, East Feliciana, Iberville, St. Helena, St. James, East Baton Rouge, West Baton Rouge, Pointe Coupee and Ascension Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE VARNADO, ANJANETTE L, 6214 HWY 10 GREENSBURG, LA (225) VARNADO, JIMMIE W, 6214 HWY 10 GREENSBURG, LA (225) INTERNAL MEDICINE ALBERGAMO, IGNAZIO JOSEPH, ALVAREZ, FRANK J, AUSTIN, CHRISTINA URIEGAS, BABIN, KEVIN J, 230 ROBERTS DR STE I NEW ROADS, LA BRANDT, HAROLD D, BRUCE, ZACKARY, CARLISLE, CASEY B, COOLEY, RICHARD TODD, CROCKETT, JEWEL W, DEDEAUX JR, CHARLES E, (225) DOUCET, DONALD W, 230 ROBERTS DR STE I NEW ROADS, LA (225) FALCON, LARA M, FONTENOT, CODEY L, GRUNER, RACHEL M, JONES, MAUREEN E, KADAIR, ROY G, KAHN, JEFFREY M, LANDRY, ADRIAN P, LARRIVIERE, JOSEPH A, LIEUX, THEODORE RICHARD, MAY, KATHERINE E, 3401 NORTH BLVD STE 130 (225) PENN, WESLEY J, ROLFSEN, MICHAEL L, at any time. Please call (318) or go to to verify provider status. Page 7

11 SAY, GEORGE D, (225) BRUMUND, TRACI T, WAGGENSPACK, MARK J, (225) WAMPOLD, JAN B, (225) STUMPF, MICHAEL W, CALANDRO, MINDY L, WHATLEY, PATRICIA D, (225) EAR, NOSE & THROAT/OTOLARYNGOL OGY TALBOT, KRISTEN D, DRUMM, ROBERT, (225) WOOD, DANNY S, (225) BRINGAZE, VIRGINIA A, TREUIL, REBECCA S, (225) FRANZ, SANDRA A, NON-PHYSICIAN PRACTITIONERS CLEMENTS, KELLY S, (225) TUMMINELLO JR, VINCENT V, VINCI, EDMUND B, (225) WAGUESPACK, ERIC M, WEST, J DAVID, (225) WHARTON, J SCOTT, (225) WINBURN, RICKY C, PEDIATRICS BANKSTON, SUSAN M, BOMBET, RONALD L, BOUDREAUX, LAURA M, INDUSTRIPLEX BLVD (225) GUIDROZ, JENNIFER T, HOLMES, CHRISTINA H, (225) KATZENMEYER, CATHERINE C, MARTIN, SHELLEY, MASON, LYNN S, (225) MELTON, JAMAR A, RAMEY, STEWART, SEITER, ELIZABETH D, (225) TRIBOU, ARTHUR G, (225) VICK, DAWN R, INDUSTRIPLEX BLVD (225) FAMILY PRACTICE BROUSSARD, KRISTEN F, NP GELPI, HILLARY RYLAND, NP SPECIALISTS ALLERGY & IMMUNOLOGY REDHEAD JR, JOSEPH N, 7373 PERKINS ROAD DERMATOLOGY FREDERIC, JEFFREY E, FREDERIC, STEPHANIE R, JACKSON, SCOTT M, 1401 N FOSTER DR (225) MURPHY, COURTNEY M, (225) HARDY, ELLIOT T, (225) KATZENMEYER, WILLIAM K, KRUPALA, JAMES L, PETIT, BRIAN J, (225) ENDOCRINOLOGY FIELD, GARY H, HINKLE, JEANNEMARIE D, MILLER, GENA T, (225) MORAN, TIMOTHY P, (225) MURAD, SHATHA Y, at any time. Please call (318) or go to to verify provider status. Page 8

12 SILVERBERG, JOEL D, (225) WELDEN, JONATHAN G, (225) GASTROENTEROLOGY ARBOUR JR, GERALD T, BOUDREAUX, RONALD L, CAUBLE, STEPHANIE M, GUIDROZ, ANDREW D, (225) HIRSCH, GARY S, NEUROLOGIST - PEDIATRIC GAHAGAN, DEBORAH K, NP HOLLMAN, CHARLOTTE A, 8415 GOODWOOD BLVD STE 202 (225) SCHEXNAYDER, LALANIA K, 8415 GOODWOOD BLVD STE 202 (225) (225) NEUROLOGY DYNES, GERARD J, GLADNEY JR, WILLIAM W, LEBOURGEOIS, LINDA, MURPHY, BRIAN P, (225) OLIVEIRA, PEDRO S, PULMONARY DISEASES HINKLE, ROBERT C, HODGES, MARK K, MCCARTHY, MICHAEL P, (225) RHEUMATOLOGY BOURG, ANGELE D, CERUTI, RONALD P, CUCURULL, ELENA C, 5131 ODONOVAN DR STE 400 (225) MARSHALL, JOHN E, MENA, HECTOR R, (225) NESHEIWAT, JOSEPH P, 6110 MAIN ST STE C ZACHARY, LA (225) (225) POLLET, STEPHEN M, 5131 ODONOVAN STE 400 BATON ROUGE, LA (225) SURGERY-GENERAL BONNER JR, EVERETT J, COOK, THOMAS W, FROELICH, JAMES A, TAYLOR, JONATHAN P, (225) SURGERY-VASCULAR SCHWARTZBERG, GLEN J, (225) UROLOGY COCKRELL, ROSS T, PORTA, WESLEY R, (225) SCHMEECKLE, AYME V, (225) Ancillary Services HEARING CENTER/AUDIOLOGIST SIMONEAUX, SABRINA T, AUD OPTOMETRIST MARTIN, ADAM C, OD (225) REGION 7 Includes Tangipahoa, LaFourche, St. Charles, St. John the Baptist, St. Tammany, Plaquemines, Jefferson, Orleans, Washington and St. Bernard Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE GAUDIN, STEVE L, 105 EAST OAK ST PONCHATOULA, LA (985) KOZEL, MICHAEL J, 165 W OAK ST PONCHATOULA, LA (985) SMITH, SMITTY, DOCTORS BLVD (985) TREANOR, LEONARD C, PELICAN PROFESSIONAL PARK (985) WALKER JR, JOHN A, DOCTORS BLVD (985) at any time. Please call (318) or go to to verify provider status. Page 9

13 INTERNAL MEDICINE CAULFIELD, KYLE L, PELICAN PROFESSIONAL PK (985) DRUMMOND, DARREN M, PELICAN PROFESSIONAL PARK (985) PICOU, SCOTT B, PELICAN PROFESSIONAL PARK (985) ROBLEDO, RAPHAEL O, PELICAN PROFESSIONAL PARK (985) STEVENS, NICHOLAS, PELICAN PROFESSIONAL PARK (985) WINKLER, MARGARET L, MEDICAL ARTS PLZ (985) at any time. Please call (318) or go to to verify provider status. Page 10

14 NCQA PCMH Providers w/ Level 3 Recognition The National Committee for Quality Assurance ( NCQA ) is a private, nonprofit organization that accredits and certifies a wide range of health care organizations and physicians. The physicians listed below are recognized by the NCQA for their efforts in the advancement of health care quality. The Patient-Centered Medical Home (PCMH) program emphasizes the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement. Page 11

15 REGION 1 Includes Ouachita, Lincoln, Morehouse, Union, Richland, East Carroll, West Carroll, Madison, Jackson, Caldwell, Franklin, Tensas and Winn Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE GHANTA, SUMATHA L, 920 OLIVER RD STE J (318) GREEN, GREGORY R, 920 OLIVER RD WAITING AREA L (318) GUJJULA, RAJESH, 920 OLIVER RD WAITING AREA J (318) HAYWARD SR, MICHAEL T, 3400 MEDICAL PARK STE B MONROE, LA (318) MELTON, STUART L, 920 OLIVER RD WAITING AREA A (318) MEYERS, OWEN M, 920 OLIVER RD WAITING AREA M (318) RAULERSON, ROBERT M, 920 OLIVER RD WAITING AREA A (318) YARBROUGH, DAVID A, 3400 MEDICAL PARK DR STE B MONROE, LA (318) INTERNAL MEDICINE ALBRITTON, COREY G, 109 ELM ST DELHI, LA (318) SAMPOGNARO, MICHAEL J, 1 BANCROFT CIR (318) SMITH JR, RICHARD D, 3510 MAGNOLIA CV STE 120 MONROE, LA (318) PEDIATRICS ZUKOWSKI, NANCY L, 3401 MAGNOLIA CV MONROE, LA (318) NON-PHYSICIAN PRACTITIONERS FAMILY PRACTICE FLEMISTER, MELISSA K, NP 920 OLIVER RD WAITING AREA M (318) GRIMMETT, RYAN P, NP 112 SAINT JOHN ST (318) HAUGHT, HALEY A, NP 106 TOOMBS ST DELHI, LA (318) MAIN ST DELHI, LA (318) ELM ST DELHI, LA (318) HWY 17 DELHI, LA (318) LOWDER, RAYNE W, NP 920 OLIVER RD WAITING AREA A (318) POPE, SHEILA Y, NP 2913 DESIARD ST (318) BETIN AVE (318) S 2ND ST MONROE, LA (318) PRUDEN, AMY L, NP 920 OLIVER RD WAITING AREA J (318) STEPHENS, MATILDA E, NP 3400 MEDICAL PARK DR STE B MONROE, LA (318) WILLSHER, LAURA B, NP 3400 MEDICAL PARK DR STE B MONROE, LA (318) PEDIATRICS CARR, VIVIAN S, NP 3401 MAGNOLIA CV MONROE, LA (318) DUCKWORTH-HOWARD, APRIL, NP 920 OLIVER RD WAITING AREA K (318) WEBB, STACY D, NP 3401 MAGNOLIA COVE MONROE, LA (318) MEDICAL PARK DR MONROE, LA (318) SPECIALISTS OBSTETRICIAN AND GYNECOLOGIST REID, LINDA F, NP 2915 BETIN AVE (318) REGION 4 Includes Beauregard, Allen, Calcasieu, Cameron, and Jefferson Davis Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE BAROOTES, BRYAN G, 1525 OAK PARK BLVD (337) LEBATO, ALAN L, 1525 OAK PARK BLVD (337) NULL, DANETTE B, 1525 OAK PARK BLVD (337) REGION 5 Includes Evangeline, Acadia, Vermilion, Lafayette, St. Mary, Terrebonne, St. Landry, Iberia and St. Martin Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE MARSHALL, MARILYN D, 800 CHARITY ST ABBEVILLE, LA (337) MENARD, DARRIN, 202 WESTGATE RD (337) MIRE, GEOFFREY A, 202 WESTGATE ST (337) RAMSEY, KEITH G, 806 JEFFERSON TERRACE BLVD NEW IBERIA, LA (337) CHARITY ST ABBEVILLE, LA (337) at any time. Please call (318) or go to to verify provider status. Page 12

16 REGION 6 Includes Livingston, Assumption, West Feliciana, East Feliciana, Iberville, St. Helena, St. James, East Baton Rouge, West Baton Rouge, Pointe Coupee and Ascension Parishes. MEDICAL HOME - PCP's INTERNAL MEDICINE MCKNIGHT, GEORGE T, 203 ALLENDALE DR PORT ALLEN, LA (225) NON-PHYSICIAN PRACTITIONERS FAMILY PRACTICE BLACKMON, BETTIE T, NP PLANK RD CLINTON, LA (225) DART JR, WILLIAM D, NP JACKSON ST CLINTON, LA (225) DILLARD, JUSTIN J, NP 203 ALLENDALE DR PORT ALLEN, LA (225) ESTERS, TANISHA, NP WAGLEY RD MARINGOUIN, LA (225) LA HWY 1 BATCHELOR, LA (225) NEWFIELD DR LIVONIA, LA (225) ROBERTS DR STE H NEW ROADS, LA (225) POINTE COUPEE RD NEW ROADS, LA (225) GILLIAM, DARIE S, NP JACKSON ST CLINTON, LA (225) GUILLOT, MARY L, NP HWY 42 SPRINGFIELD, LA (225) HANEY, AHLECIA, NP 6450 LA HWY 1 BATCHELOR, LA (225) HORNBOSTEL BAKER, JUDY, NP JACKSON ST CLINTON, LA (225) JOHNIGAN, LATASHA L, NP 8366 POINTE COUPEE RD NEW ROADS, LA (225) MARTIN DUHE, MONTRELL, NP 230 ROBERTS DR STE H NEW ROADS, LA (225) ROSCOE, NARKITA W, NP 3140 FLORIDA ST (225) THOMAS, LAKESHA T, NP 500 RUE DE LA VIE STE 310 BATON ROUGE, LA (225) RIVER WEST DR STE A&B PLAQUEMINE, LA (225) GENERAL PRACTICE SMITH, TAMMY D, NP 490 SITMAN ST GREENSBURG, LA (225) PEDIATRICS MILES, DARAKA Y, NP 6351 MAIN ST ZACHARY, LA (888) ST ROMAIN, JENNIFER F, NP OLD BATON ROUGE HWY ALBANY, LA (225) SPECIALISTS INFECTIOUS DISEASES CAMPBELL JR, WALTER L, 3140 FLORIDA BLVD (225) REGION 7 Includes Tangipahoa, LaFourche, St. Charles, St. John the Baptist, St. Tammany, Plaquemines, Jefferson, Orleans, Washington and St. Bernard Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE ANDERSON, DANITA C, 3201 S CARROLLTON AVE (504) WARRINGTON DR NEW ORLEANS, LA (504) READ BLVD NEW ORLEANS, LA (504) IMSAIS, KHALIL Y, 1936 MAGAZINE ST NEW ORLEANS, LA (504) LAGARDE MAY, MICHELE T, 100 WARRINGTON DR NEW ORLEANS, LA (504) GENERAL PRACTICE NANJAPPA, NAGARAJ, OLD BATON ROUGE HWY (225) INTERNAL MEDICINE ABELL, MARY M, 1936 MAGAZINE STREET NEW ORLEANS, LA (504) CENTANNI, EVA B, 3201 S CARROLTON AVE (504) DUMAS, JEREMY G, 7017 LAPALCO BLVD (504) US HWY 90 AVONDALE, LA (504) FRANCIONI, SCOTT M, 1936 MAGAZINE ST NEW ORLEANS, LA (504) KAUTZMAN, MICHELE G, 5140 CHURCH ST LAFITTE, LA (504) LEVI, TANIA A, 1980 NORTH HWY 190 (985) URBIZO, CAROLINA, 3201 S CARROLTON AVE STE B (504) WINFREY, KEITH L, CHEF MENTEUR HWY NEW ORLEANS, LA (504) PEDIATRICS BEVROTTE, LOUIS H, 5630 READ BLVD NEW ORLEANS, LA (504) NON-PHYSICIAN PRACTITIONERS FAMILY PRACTICE COLLINS, LYNETTE D, NP 1030 LESSEPS ST NEW ORLEANS, LA (504) DARENSBOURG, SARA P, NP 111 N CAUSEWAY BLVD (504) GEHRING, VANESSA N, NP CHEF MENTEUR HWY NEW ORLEANS, LA (504) GRIFFIN, NICOLE C, NP 3943 ST BERNARD AVE NEW ORLEANS, LA (504) at any time. Please call (318) or go to to verify provider status. Page 13

17 HOWARD, KRYSTAL, NP 111 N CAUSEWAY BLVD (504) JOHNSON, WINIFRED E, NP 1020 ST ANDREW ST NEW ORLEANS, LA (504) OBSTETRICIAN AND GYNECOLOGIST AGE, CHANIEL F, NP 1936 MAGAZINE ST NEW ORLEANS, LA (504) MORNAY, YOLONDA R, NP 5630 READ BLVD NEW ORLEANS, LA (504) READ BLVD NEW ORLEANS, LA (504) THERIAULT, TANYA A, NP 111 N CAUSEWAY BLVD (504) S CARROLLTON AVE (504) READ BLVD NEW ORLEANS, LA (504) INTERNAL MEDICINE MCNEIL, VONDER W, NP 7017 LAPALCO BLVD (504) US 90 AVONDALE, LA (504) PEDIATRICS SIMONEAUX, KIMBERLY, NP 721 AVENUE G KENTWOOD, LA (225) ST ROMAIN, JENNIFER F, NP BERRY BOWL RD. INDEPENDENCE, LA (888) AVE G KENTWOOD, LA (225) SPECIALISTS INFECTIOUS DISEASES FUGATE, TOBY L, DO 2601 TULANE AVE STE 500 NEW ORLEANS, LA (504) at any time. Please call (318) or go to to verify provider status. Page 14

18 Tier 1 Provider Network Members seeing Tier 1 providers pay the Deductible (if applicable), Copayments and Co-insurance as described in the Tier 1 In-Network column in the Certificate of Coverage and/or the Cost Share Schedule. Tier 1 Providers cannot balance bill the Member. Page 15

19 HOSPITALS ACADIA ST LANDRY PARISH HOSPITAL 810 SOUTH BROADWAY CHURCH POINT, LA (337) ALLEN PARISH HOSPITAL 108 6TH AVE KINDER, LA (337) ASHLEY COUNTY MEDICAL CENTER 1015 UNITY RD CROSSETT, AR (870) ASSUMPTION COMMUNITY HOSPITAL 135 HWY 402 NAPOLEONVILLE, LA (985) AVOYELLES HOSPITAL 4231 HWY 1192 MARKSVILLE, LA (318) BEAUREGARD MEMORIAL HOSPITAL 600 S PINE ST DERIDDER, LA (337) BIENVILLE MEDICAL CENTER LLC 1175 PINE ST STE 200 ARCADIA, LA (318) BRADLEY COUNTY MEDICAL CENTER 404 S BRADLEY ST WARREN, AR (870) BRFHH MONROE OCHSNER LSU HEALTH, UNIVERSITY HEALTH CONWAY 4864 JACKSON ST MONROE, LA (318) BRFHH SHREVEPORT DBA OCHSNER LSU, UNIV HEALTH SHREVEPORT 1541 KINGS HWY SHREVEPORT, LA (318) BUNKIE GENERAL HOSPITAL 427 EVERGREEN ST BUNKIE, LA (318) BYRD REGIONAL HOSPITAL 1020 FERTITTA BLVD LEESVILLE, LA (337) CALDWELL MEMORIAL HOSPITAL 411 MAIN ST COLUMBIA, LA (318) CENTRAL LA SURGICAL HOSPITAL LLC 651 NORTH BOLTON AVE (318) CHRISTUS COUSHATTA HEALTH CARE CENTER 1635 MARVEL ST COUSHATTA, LA (318) CHRISTUS OCHSNER LAKE AREA HOSPITAL 4200 NELSON RD (337) CHRISTUS OCHSNER ST PATRICK HOSPITAL 524 DR MICHAEL DEBAKEY DR (337) CHRISTUS SAINT FRANCES CABRINI HOSPITAL 3330 MASONIC DR (318) CHRISTUS SCHUMPERT HIGHLAND 2531 VIKING DR BOSSIER CITY, LA (318) EAST BERT KOUNS (318) CITIZENS MEDICAL CENTER 7939 HWY 165 COLUMBIA, LA (318) CLHG VILLE PLATTE LLC DBA MERCY REGIONAL MEDICAL CENTER 800 E MAIN ST VILLE PLATTE, LA (337) US HWY 190 EUNICE, LA (337) CYPRESS POINTE SURGICAL HOSPITAL SOUTH AIRPORT RD (985) DALLAS COUNTY MEDICAL CENTER 201 N CLIFTON FORDYCE, AR (870) DEQUINCY MEMORIAL HOSPITAL 110 W 4TH ST DEQUINCY, LA (337) DESOTO REGIONAL HEALTH SYSTEM 207 JEFFERSON ST MANSFIELD, LA (318) DOCTORS HOSPITAL AT DEER CREEK 815 S TENTH ST LEESVILLE, LA (337) EAST CARROLL PARISH HOSPITAL 336 N HOOD ST LAKE PROVIDENCE, LA (318) EAST JEFFERSON GENERAL HOSPITAL 4200 HOUMA BLVD (504) FAIRWAY MEDICAL CENTER INDUSTRY LN (985) FRANKLIN FOUNDATION HOSPITAL 1097 NORTHWEST BLVD FRANKLIN, LA (337) FRANKLIN PARISH HOSPITAL SERVIC DBA FRANKLIN MEDICAL CENTER 2106 LOOP RD WINNSBORO, LA (318) GARDEN PARK MEDICAL CENTER COMMUNITY RD GULFPORT, MS (228) HARDTNER MEDICAL CENTER 1102 NORTH PINE RD OLLA, LA (318) HEART HOSPITAL OF ACADIANA OF LAFAYETTE 1105 KALISTE SALOOM RD (337) HOLMES COUNTY HOSPITAL & CLINIC 239 BOWLING GREEN RD LEXINGTON, MS (662) HOMER MEMORIAL HOSPITAL DBA CLAIBORNE MEMORIAL MEDICAL CTR 620 EAST COLLEGE DR HOMER, LA (318) HOOD MEMORIAL HOSPITAL 301 WEST WALNUT ST AMITE, LA (985) HOSPITAL SERVICE DISTRICT DBA LANE REGIONAL MEDICAL CTR 6300 MAIN ST ZACHARY, LA (225) HOWARD MEMORIAL HOSPITAL 130 MEDICAL CIR NASHVILLE, AR (870) IASIS GLENWOOD REGIONAL MEDICAL CENTER 1275 GLENWOOD DR (318) RIDGEDALE DR (318) MCMILLAN RD (318) JACKSON PARISH HOSPITAL 165 BEECH SPRINGS RD JONESBORO, LA (318) JENNINGS AMERICAN LEGION HOSPITAL 1634 ELTON RD JENNINGS, LA (337) KINGS DAUGHTERS MEDICAL CENTER 427 HWY 51 NORTH BROOKHAVEN, MS (601) at any time. Please call (318) or go to to verify provider status. Page 16

20 LAFAYETTE SURGICAL SPECIALTY HOSPITAL 1101 KALISTE SALOOM RD (337) MONROE SURGICAL HOSPITAL 2408 BROADMOOR BLVD (318) PHYSICIANS MEDICAL CENTER 218 CORPORATE DR (985) SAINT FRANCIS MEDICAL CENTER 309 JACKSON ST (318) KALISTE SALOOM RD (337) LAKE CHARLES MEMORIAL HOSPITAL 1701 OAK PARK BLVD (337) GAUTHIER RD (337) LAKE SURG HOSP SLIDELL DBA SOUTHERN SURGICAL HOSPITAL 1700 W LINDBERG DR (985) LALLIE KEMP MEDICAL CENTER HWY 51 SOUTH INDEPENDENCE, LA (985) LASALLE GENERAL HOSPITAL 187 NINTH ST JENA, LA (318) MADISON PARISH HOSPITAL 900 JOHNSON ST TALLULAH, LA (318) MEDICAL CENTER OF SOUTH ARKANSAS 700 W GROVE EL DORADO, AR (870) MENA REGIONAL HEALTH SYSTEM 311 N MORROW ST MENA, AR (479) MERIT HEALTH NATCHEZ 54 SEARGENT S PRENTISS DR NATCHEZ, MS (601) MERIT HEALTH RIVER REGION HEALTH SYSTEM 2100 HWY 61 N VICKSBURG, MS (601) MINDEN MEDICAL CENTER 1 MEDICAL PLAZA PL MINDEN, LA (318) MOREHOUSE GENERAL HOSPITAL 323 W WALNUT BASTROP, LA (318) NATCHITOCHES REGIONAL MEDICAL CENTER 501 KEYSER AVE NATCHITOCHES, LA (318) NEW ORLEANS EAST HOSPITAL 5620 READ BLVD NEW ORLEANS, LA (504) NORTH CADDO MEDICAL CENTER 1000 SOUTH SPRUCE ST VIVIAN, LA (318) NORTHERN LOUISIANA MEDICAL CENTER 1118 S FARMERVILLE ST (318) EAST VAUGHN AVE (318) OAKDALE COMMUNITY HOSPITAL 130 N HOSPITAL DR OAKDALE, LA (318) OUR LADY OF LOURDES REGIONAL MEDICAL CENTER 4801 AMBASSADOR CAFFERY PKWY (337) OUR LADY OF THE ANGELS HOSPITAL INC 433 PLAZA ST BOGALUSA, LA (985) OUR LADY OF THE LAKE RMC 5000 HENNESSY BLVD (225) PARK PLACE SURGICAL HOSPITAL 4811 AMBASSADOR CAFF PKWY (337) POINTE COUPEE GENERAL HOSPITAL 2202 FALSE RIVER DR NEW ROADS, LA (225) PREVOST MEMORIAL HOSPITAL 301 MEMORIAL DR DONALDSONVILLE, LA (225) RAPIDES REGIONAL MEDICAL CENTER 211 4TH ST (318) TH ST (318) REEVES MEMORIAL MEDICAL CENTER 409 FIRST ST BERNICE, LA (318) RICHLAND PARISH HOSPITAL 407 CINCINNATI ST DELHI, LA (318) RICHLAND PARISH HOSPITAL SERVICE DBA RICHARDSON MEDICAL CTR 256 HIGHWAY 3048 RAYVILLE, LA (318) RIVERLAND MEDICAL CENTER 1700 EE WALLACE BLVD FERRIDAY, LA (318) RIVERSIDE MEDICAL CENTER 1900 SOUTH MAIN ST FRANKLINTON, LA (985) SABINE MEDICAL CENTER 240 HIGHLAND DR MANY, LA (318) SAINT CHARLES PARISH HOSPITAL 1057 PAUL MAILLARD RD LULING, LA (985) GRAMMONT ST (318) SLIDELL MEMORIAL HOSPITAL 1001 GAUSE BLVD (985) FLORIDA AVE (985) ROBERT BLVD (985) GAUSE BLVD (985) SOUTH CAMERON MEMORIAL HOSPITAL 5360 WEST CREOLE HWY CAMERON, LA (337) SPECIALISTS HOSPITAL SHREVEPORT 1500 LINE AVE SHREVEPORT, LA (318) SPRINGHILL MEDICAL CENTER 2001 DOCTORS DR SPRINGHILL, LA (318) ST BERNARD PARISH HOSPITAL 8000 W JUDGE PEREZ HWY CHALMETTE, LA (504) ST ELIZABETH HOSPITAL 1125 W HWY 30 (225) ST HELENA PARISH HOSPITAL HWY 43 GREENSBURG, LA (225) ST JAMES PARISH HOSPITAL 1645 LUTCHER AVE LUTCHER, LA (225) at any time. Please call (318) or go to to verify provider status. Page 17

21 STATE OF MS UNIVERSITY OF MISSISSIPPI MEDICAL CENTER 2500 NORTH STATE ST JACKSON, MS (601) SURGICAL SPECIALTY CENTER OF BATON ROUGE 8080 BLUEBONNET BLVD BATON ROUGE, LA (225) TECHE REGIONAL MEDICAL CENTER 1125 MARGUERITE ST MORGAN CITY, LA (985) TOURO INFIRMARY 1401 FOUCHER ST 1ST FLOOR (504) TULANE MEDICAL CENTER DBA TULANE UNIV HOSPITAL AND CLINIC 4700 S I-10 SERVICE RD E (504) TULANE AVE (504) JUDGE TANNER BLVD (985) UMMC GRENADA 960 AVENT DR GRENADA, MS (662) UNION GENERAL HOSPITAL 901 JAMES AVE FARMERVILLE, LA (318) UNIVERSITY MEDICAL CTR NEW ORLEANS DBA UNIV MED CTR MGT CORP 2000 CANAL ST (504) WEST CALCASIEU CAMERON HOSPITAL 701 CYPRESS ST SULPHUR, LA (337) WEST CARROLL HEALTH SYSTEMS 706 ROSS ST OAK GROVE, LA (318) WEST FELICIANA PARISH HOSPITAL 5266 COMMERCE ST SAINT FRANCISVILLE, LA (225) WEST JEFFERSON MEDICAL CENTER 1101 MEDICAL CENTER BLVD (504) WINN PARISH MEDICAL CENTER 301 WEST BOUNDARY WINNFIELD, LA (318) WOMANS HOSPITAL 100 WOMANS WAY BATON ROUGE, LA (225) WOMENS & CHILDRENS HOSPITAL 4600 AMBASSADOR CAFFERY (337) REFERRAL CENTERS/ PHYSICIANS with Prior Plan Approval ARKANSAS CHILDRENS HOSPITAL 1 CHILDRENS WAY LITTLE ROCK, AR (501) CHILDRENS HOSPITAL 200 HENRY CLAY AVE (504) M D ANDERSON CANCER CENTER 1515 HOLCOMB BLVD HOUSTON, TX (713) SAINT JUDE CHILDRENS RESEARCH HOSPITAL 262 DANNY THOMAS PL MEMPHIS, TN (866) SHRINERS HOSPITALS FOR CHILDREN 3100 SAMFORD AVE SHREVEPORT, LA (318) UAB HOSPITAL TH AVE SOUTH BIRMINGHAM, AL (205) REGION 1 Includes Ouachita, Lincoln, Morehouse, Union, Richland, East Carroll, West Carroll, Madison, Jackson, Caldwell, Franklin, Tensas and Winn Parishes. MEDICAL HOME - PCP's FAMILY PRACTICE ABRAHAM, RALPH L, 115 CHRISTIAN DR RAYVILLE, LA (318) ANDERS, KERRY L, 3400 MEDICAL PARK DR STE A MONROE, LA (318) ATKINS, LOGAN, 2104 C LOOP RD WINNSBORO, LA (318) BAILEY, DON W, 300 SCARBROUGH LAKE PROVIDENCE, LA (318) BAINES, JOHNATHAN, 1200 SOUTH FARMERVILLE ST (318) BALL JR, JAMES E, 1962 JULIA ST RAYVILLE, LA (318) BANKS III, TOMMY G, 1900 NORTH 7TH ST (318) BARNES, DAVID L, 3400 MEDICAL PARK DR STE C MONROE, LA (318) BELUE, JAMES MICHAEL, 707 SOUTH VIENNA ST (318) BREARD, ERIN R, 3995 STERLINGTON RD STE A MONROE, LA (318) CALHOUN, KEITH B, 4400 OLD STERLINGTON RD MONROE, LA (318) CARLISLE, KEVIN M, 256 HWY 3048 RAYVILLE, LA (318) HWY 80 RAYVILLE, LA (318) COATS, JOHN M, 2913 DESIARD ST (318) COLVIN, THOMAS L, 2106 LOOP RD STE A WINNSBORO, LA (318) COMBETTA, JEFFREY J, 2104 LOOP RD STE C WINNSBORO, LA (318) BOOTS RD FARMERVILLE, LA (318) CONVILLE, STACY D, 103 WATTS ST STE 101 JONESBORO, LA (318) COUGHRAN, JIMMY R, 1010 DAVIS LAKE RD COLUMBIA, LA (318) FAIR AVE WINNSBORO, LA (318) COX JR, CARTER, 206 S VINE ST BASTROP, LA (318) CROUCH, REBECCA L, 166 BEECH SPRINGS RD JONESBORO, LA (318) CUMMINGS JR, RUSSELL O, 484 COLLINS RD COLUMBIA, LA (318) DANSBY JR, THOMAS, 100 SOUTH SECOND ST (318) at any time. Please call (318) or go to to verify provider status. Page 18

22 DOCENA, CHRISTIAN P, 109 ELM ST DELHI, LA (318) DOLLAR, MARK F, 1900 N 7 TH ST (318) DOMINGUE, CHRISTOPHER M, 708 EAST MAIN ST OAK GROVE, LA (318) DUPREE, ERIC C, 639 WEST LAFAYETTE ST WINNFIELD, LA (318) ELDRIDGE, JOEL G, DO 2104-C LOOP RD WINNSBORO, LA (318) HWY 17 WINNSBORO, LA (318) VERONA ST NEWELLTON, LA (318) NEWTON ST SAINT JOSEPH, LA (318) ELLIOTT, CLYDE E, 200 PROFESSIONAL DR (318) ENRIQUEZ, JOSE R, 508 BROADWAY ST DELHI, LA (318) ENSMINGER, BOBBY T, 1200 CELEBRITY ST STE 1 (318) GHANTA, SUMATHA L, 920 OLIVER RD STE J (318) GIVLER JR, DONALD N, 4864 JACKSON ST MONROE, LA (318) GIVLER, AMY M, 4864 JACKSON ST MONROE, LA (318) (Hospitalist/Intensivist) GREEN, GREGORY R, 920 OLIVER RD WAITING AREA L (318) GRIGSBY, BENSON A, 2916 N TRENTON ST (318) GUINIGUNDO, NOLI, 502 ROSS ST OAK GROVE, LA (318) GUJJULA, RAJESH, 920 OLIVER RD WAITING AREA J (318) HARRIS, ROBERT BRIAN, 402 SECOND ST BERNICE, LA (318) HAYWARD SR, MICHAEL T, 3400 MEDICAL PARK STE B MONROE, LA (318) HENRY, JOE BYRON, 3995 STERLINGTON RD STE A MONROE, LA (318) HERBERT, ALLEN J, 411 E VAUGHN AVE STE 201 (318) IGLESIAS, JULIO E, 301 A WEST BOUNDARY WINNFIELD, LA (318) JONES, TAMMY V, DO 4864 JACKSON ST MONROE, LA (318) N 7TH ST STE 1 (318) KERR, ALBERT G, 121 CHRISTIAN DR RAYVILLE, LA (318) KOVAC, KAY B, 300 SCARBROUGH ST LAKE PROVIDENCE, LA (318) KUTNIKAR, DHAYA N, 1805 LAMY LN (318) LAPITE, OLADAPO, 306 STONE AVE (318) LE, DUNG N, 508 BROADWAY DELHI, LA (318) ELM ST DELHI, LA (318) LODGEN, KELLY R, 3326 FRONT ST STE B WINNSBORO, LA (318) MARQUARDT, AARON L, 1801 N 7TH ST STE A (318) MASSENGALE, GORDON B, 111 CHRISTIAN DR RAYVILLE, LA (318) MCDONALD III, KENNETH E, 508 BROADWAY ST DELHI, LA (318) MCMAHAN, STEVEN H, 1117 CHENIERE DREW RD (318) MELTON, STUART L, 920 OLIVER RD WAITING AREA A (318) METOYER JR, KENNETH P, 1200 S FARMERVILLE ST (318) MEYERS, OWEN M, 920 OLIVER RD WAITING AREA M (318) MICKAIL, MAOUH G, 501 DURHAM STREET BASTROP, LA (318) DURHAM ST BASTROP, LA (318) N 16TH ST MER ROUGE, LA (318) NETHERLAND, CLINTON, 427 S VINE ST BASTROP, LA (318) NEUMANN, THOMAS A, 808 JOHNSON ST TALLULAH, LA (318) (Hospitalist/Intensivist) ONEAL, TERI, 4864 JACKSON ST MONROE, LA (318) OPERARIO, MARK A, 421 MAIN ST COLUMBIA, LA (318) PANDEY, SHIVLAL, 4864 JACKSON ST MONROE, LA (318) PARKERSON, PAULA L, 121 WATTS ST STE B JONESBORO, LA (318) PATTERSON, JAMES D, 1511 ORANGE ST MONROE, LA (318) PERRY, DONALD R, 808 JOHNSON ST TALLULAH, LA (318) PHILLIPS, M SHANE, 1402 CELEBRITY DR (318) PORTACCI, MARK, 103 WATTS ST JONESBORO, LA (318) PRINE, MATTHEW D, 256 HWY 3048 RAYVILLE, LA (318) (Hospitalist/Intensivist) 5975 HWY 80 RAYVILLE, LA (318) PROCTOR, MICHAEL D, 4864 JACKSON ST MONROE, LA (318) at any time. Please call (318) or go to to verify provider status. Page 19

23 256 HIGHWAY 3048 RAYVILLE, LA (318) QAYYUM, TAHIR, 540 DURHAM ST BASTROP, LA (318) MEDICAL PARK DR STE 8 MONROE, LA (318) RAULERSON, ROBERT M, 920 OLIVER RD WAITING AREA A (318) REED, CHARLES E, 3326 FRONT ST STE B WINNSBORO, LA (318) RICHARD, RINATA K, 5745 HWY 17 WINNSBORO, LA (318) ROBERTS, LYNDA R, 804 N BEECH ST TALLULAH, LA (318) ROSS, THERESA J, 112 SAINT JOHN ST (318) SANDERS, WILLIAM P, 1402 CELEBRITY DR (318) SANSON, MARSHALL V, 2309 ARKANSAS RD (318) SHAFIEI, KHALED, 2503 BROADMOOR BLVD (318) SINGLETON, MARK N, DO 431 W LAFAYETTE ST WINNFIELD, LA (318) SLUSHER, WILLIAM J, 107 WATTS ST JONESBORO, LA (318) SMITH, CHERYL A, 712 SETTOON ST OAK GROVE, LA (318) SMITH, JAMES MICHAEL, 532 S WASHINGTON BASTROP, LA (318) SMITH, JERRY A, 902 S VIENNA ST RUSTON, LA (318) SPIRES, ALLEN L, 301 DAVENPORT AVE MER ROUGE, LA (318) STOCKSTILL, JAMES DEAN, 3510 MAGNOLIA AVE STE 190 MONROE, LA (318) STRAIN, THOMAS W, 401 E VAUGHN AVE STE MONROE, LA (318) SUMMERS, TERESA D, 1205 HWY 15 BASKIN, LA (318) THOMPSON, DANIEL P, 402 2ND ST BERNICE, LA (318) UNKEL, STEVEN P, 811 JAMES AVE STE A FARMERVILLE, LA (318) WALTERS JR, JOSEPH A, 425 S VINE ST BASTROP, LA (318) GUNBY AVE BASTROP, LA (318) WATERFALLEN, GEORGE T, 103 WATTS ST JONESBORO, LA (318) WILLIAMS SR, THOMAS ST CLAIR, 502 ROSS ST OAK GROVE, LA (318) WILLIAMS, NORMAN B, 2408 BROADMOOR BLVD STE B (318) WOODS, GEORGE R, 101 PROFESSIONAL DR (318) WORSHAM, CANDACE, DO 200 PROFESSIONAL DR (318) WRIGHT, KENNETH J, 256 HWY 3048 RAYVILLE, LA (800) YARBROUGH, DAVID A, 3400 MEDICAL PARK DR STE B MONROE, LA (318) YEMBE, ENAKA M, 421 MAIN ST COLUMBIA, LA (318) AFFINITY HEALTH GROUP LLC 130 DESIARD ST STE 355 (318) GENERAL PRACTICE PATEL, DARSHAN J, 2600 TOWER DR STE 309 (318) HWY 165 STE 2 STERLINGTON, LA (318) WATSON, MICHAEL P, 3510 MEDICAL PARK DR STE 1 MONROE, LA (318) INTERNAL MEDICINE ADAMS, ALYCE R, 309 JACKSON ST (318) AGARWAL, KUSHAL C, 1401 EZELL ST (318) E VAUGHN AVE (318) ALBRITTON, COREY G, 109 ELM ST DELHI, LA (318) BLACKWELDER, MARK A, 1200 S FARMERVILLE ST (318) BRANCH, BILLY, 9052 US HWY 165 STERLINGTON, LA (318) BRUYNINCKX, KYLE B, 256 HWY 3048 RAYVILLE, LA (318) DONALD, DONNA A, 309 JACKSON ST (318) (Hospitalist/Intensivist) 309 JACKSON ST (318) (Hospitalist/Intensivist) EL MALAH, AMIN M, 2503 BROADMOOR BLVD (318) FAKHRE, FAKHRE, 712 SETTOON ST OAK GROVE, LA (318) SETTOON ST OAK GROVE, LA (318) FAKHRE, GEORGE, 319 NORTH HOOD ST LAKE PROVIDENCE, LA (318) GRANDON, PAUL W, 508 BROADWAY ST DELHI, LA (318) HAMMETT, DONALD K, 6198 CYPRESS ST STE 2 (318) HARTER, HERSCHEL R, 5975 FEDERAL HWY 80 RAYVILLE, LA (318) HUBBARD, RONALD C, 2600 TOWER DR STE 309 (318) KIDD, HOLLY A, DO 1200 S FARMERVILLE ST (318) at any time. Please call (318) or go to to verify provider status. Page 20