Indiana Opt Out List

Transcription

1 Indiana Opt Out List Specialty Last Name, First Name Street Address City-State-Zip NPI Effective Date End Date 01 Davis, DO,Thomas,M. 8 N Grant Street Brownsburg, IN /01/98 09/30/ Elliot,MD,Stephen,P 05 Lindsey,MD,John,D. 05 Satkamp, MD Brett 179 Fishers Crossing Drive Fishers, IN /01/ /30/ Parkway Ave Suite C Elkhart, IN /11/ /10/ W Oak St Ste 100 Zionsville, IN /01/ /30/ Swan, MD Lori S 2020 Union St Ste 300 Lafayette, IN /01/ /30/20 08 Brengle, MD Blair N Meridian Street Suite 107 Indianapolis, IN /01/ /30/20 Burkholder, MD Susan, E. 703 Pro-Med Lane Carmel, IN /15/ /14/ DeWester,MD,Jeffrey,N 6447 N East Street, Suite C Indianapolis, IN /08/ /08/ Gladd,MD,Jeffrey,E Illinois Road Fort Wayne, IN /01/ /31/ Guyer, Leonard Dale 836 E 86th St Indianapolis, IN /25/ /24/20 08 Hector,MD,Andrew,R. 533 E. County Line Road Greenwood, IN /01/ /31/ Leazenby, MD Erica 1200 W Carmel Dr Carmel, IN /01/ /01/20 10/26/ Page 1 of 21

2 08 Lentz,MD,Kimberly,J 1500 W Oak Street, Suite 500 Zionsville, IN /10/ /09/ Laborsky,MD,Melissa,A 7771 Spring Mill Road Indianapolis, IN /25/ /24/ Maxwell Pflieger, DO, Janelle 225 Hauenstein Road Huntington, IN /14/ /13/ Morris, Amanda, MD 08 Morris, MD, Brian Francis 08 Olp, MD Ashlie 08 Patel, MD Risheet Southeastern Pkwy Ste 208 Fishers, IN /15/ /15/ Southeastern Parkway Suite 208 Fishers, IN /01/ /30/ N Meridan Street Suite 107 Indianapolis, IN /01/ /30/ Lantern Rd Ste 370 Fishers, IN /01/ /30/20 08 Pflieger, DO Matthew 225 Hauenstein Rd Huntington, IN /28/ /27/20 08 Priddy, MD Matthew Jay Naab Road Suite 360 Indianapolis, IN /11/ /10/20 Rader, DO Sarah Lynley 1503 W Oak St Zionsville, IN /01/ /30/20 Schmidt,MD,Jonathan,P Naab Road, Suite 360 Indianapolis, IN /29/ /28/20 08 Selio, MD, Brigitte Generations Dr South Bend, IN /03/ /02/ Stoller,MD,Harry,J. 08 Szewczyk, MD Emily Kae 8604 Allisonville Rd, Ste 220 Indianapolis, IN /01/ /31/ Naab Road Ste 360 Indianpolis, IN /11/ /10/20 10/26/ Page 2 of 21

3 08 09 Turner, MD, Robert Charles Murphy, MD James Patrick 10 Gupta, MD, Rakesh K 11 Busk,MD,Michael,F Fraser, MD Shelagh Anne 3554 Promenade Parkway Suite H Lafayette, IN /02/ /01/ Rolling Creek Drive Suite 100 New Albany, IN /01/ /30/ Wabash Street, Ste 303 Michigan City, IN /14/ /13/ Naab Road, Suite 301 Indianapolis, IN /01/ /31/ Naab Road Suite 360 Indianapolis, IN /11/ /10/20 Hart- Cavallo,MD,Susan,R Generations Dr South Bend, IN /05/ /04/20 11 Logan,MD,Kevin,M Fishers Center Drive Fishers, IN /01/ /31/20 11 Murphy, DO, Derek E 131st Street Fishers, IN /27/ /26/ Veatch, MD Steven Craig 8333 Naab Road Ste 360 Indianapolis, IN /11/ /10/20 12 Feeney,DO,Tamzon,D West 58th Street Indianapolis, IN /18/ /17/20 16 Cavallo,MD,Uthman, 16 Reynolds, DO, Lynnova Generations Drive South Bend, IN /17/ /16/ Carmel Dr Suite 212 Carmel, IN /01/ /30/20 Adams, DDS, Benjamin H Guion Rd #280 Indianapolis, IN /10/ /09/20 Adams,DDS,Timothy,C North Range Line Rd. Suite B Carmel, IN /23/ /22/ /26/ Page 3 of 21

4 Adams, DDS, Joseph B Guion Rd #280 Indianapolis, IN /10/ /09/20 Adams, DDS, William R Guion Rd #280 Indianapolis, IN /14/ /13/20 Allen,DDS,Ronald, 9524 E Washington St Indianapolis, IN /01/ /31/2017 Ancich,DDS,John, 1802 Robinhood Blvd Ste 1 Schereville, IN /12/ /11/20 Angelo,DDS,Robert,S 221 Medical Plaza Michigan City, IN /15/ /14/20 Anglis,DDS,Leonard,F S Court St Crown Point, IN /02/ /01/2018 Arnold,DDS,Eric,J 2206 N Wheeling Avenue Muncie, IN /13/ /12/20 Awadallah,DDS,Iyad, 1613 East 80th St Merriville, IN /21/ /21/20 Ayers, DMD, Haviland, J. 202 E 17th Street Huntingburg, IN /01/ /31/2018 Bagnoli,DDS,Michael,L Union Street, Suite 200 Lafayette, IN /20/ //2018 Bamesberger, DDS, Larry, George 3223 Heavilin Rd Valparaiso, IN /14/ /13/2018 Bendush,DDS,Bradley, Benson,DDS,Dawn,J 115 N Shortridge Rd Ste 200 Indianapolis, IN /15/ /14/ W Jefferson Boulevard fort Wayne, IN /17/ /16/20 Bianco,DDS,Ruoy, 165 W University Dr Mishawaka, IN /01/ /30/ /26/ Page 4 of 21

5 Biggs,DDS,Jeffery,C N Meridian Street, Suite 301 Indianapolis, IN /01/ /30/2018 Blanchard,DDS,Steven, B 1121 W Michigan St Indianapolis, IN /01/ /31/2017 Bly,DDS,Phillip,M. Bringas,DDS,Josef, 7126 N Shadeland Ave Suite B Indianapolis, IN /01/ /31/ Guion Road, Suite 280 Indianapolis, IN /17/ /16/2018 Brown,DDS,Justin,D. 5 Logan Street Peru, IN /01/ /01/2017 Bryan,DDS,Norman,E. 505 Vistula Street Elkhart, IN /31/ /30/20 Campbell,DDS,Tyrus,W. 931 E 86th St Suite 207 Indianapolis, IN /17/ /16/2017 Cloyd,DDS,G Thomas, 1792 E State Rd 163 Clinton, IN /01/ /31/2017 Combs,DDS,Julie,L. Cooper,DDS,Craig,D. 120 W. Mckenzie Rd Suite J Greenfield, IN /01/ /28/ N Shadeland Ave Indianapolis, IN /01/ /28/2018 Cornils- Golliher,DDS,Ashley, 449 E Main Street Hagerstown, IN // /18/2018 Crider,DDS,Kristin, Day,DDS,Rachel,A 1003 W McGalliard Rd. Muncie, IN /01/ /31/ Professional court, Suite A Lafayette, IN /01/ /30/20 Dellinger, DDS, Aron E 1120 E Dupont Road Fort Wayne, IN /10/ /09/20 10/26/ Page 5 of 21

6 Dragoo,DDS,Joel,R Union Street, Suite 200 Lafayette, IN /20/ //2018 Friedman,DDS,Gary, 20 Airport Rd Ste 1100 Brownsburg, IN /22/ /21/20 Geyman,DDS,Bethany,J Giesler, DDS, Nicholas W Weston Pointe Dt Ste 100 Zionsville, IN /31/ /30/ rd Avenue Suite D Jasper, IN /15/ /14/2018 Gillum,DDS,Richard,S 1259 N State Rd 135 Greenwood IN /01/ /31/20 Golding,DDS,Joseph,E 3240 Middle Road Columbus, IN /07/ /06/20 Gomes,DDS,Daniel, 8235 Country Village Dr Indianapolis, IN /01/ /31/2017 Gooding,DDS,Brittany, 1792 E State Rd 163 Clinton, IN /01/ /31/2017 Goodpaster,DDS,James, 3800 Industrial Blvd Bloomington, IN /30/ /29/20 Gossweiler,DDS,Timoth y,k Greyhound Court Carmel, IN /01/ /30/20 Greco,DDS,Brandy, 800 First Ave Evansville, IN /24/ /23/2018 Guthrie,DDS,Thomas,J 5 W Logan Street Peru, IN /01/ /30/2017 Guzek,DDS,David,V Airport Road Portage, IN /17/ /16/2018 Haley,DDS,Sharon,M 1036 W Jefferson Street Franklin, IN /09/ /08/ /26/ Page 6 of 21

7 Hansen,DMD,Vincent,J. Hart, DDS, William R N Meridian Street, Suite 301 Indianapolis, IN /01/ /30/ State Road #662 Newburgh, IN /01/ /31/2018 Hertig,DDS,Adam,R 4341 Flagstaff Cove Fort Wayne, IN /01/ /30/20 Holm,DDS,Steven, 3465 Airport Road Portage, IN /17/ /16/2018 Hornaday,DDS,Anthony, J. 620 S Tillotson Avenue Muncie, IN /01/ /30/2018 Hornaday,DDS,James, 620 S Tillotson Ave. Muncie, IN /01/ /31/2018 Issa,DDS,Yasir, 7102 N Keystone Avenue Indianapolis, IN /01/ /30/20 James,DDS,John,P 3412 Klondike Road West Lafayette, IN /01/ /30/20 Jacobs, DDS, Jordon C Guion Rd #280 Indianapolis, IN /14/ /13/20 John, DDS Vanchit 3750 Guion Rd #280 Indianapolis, IN /16/ /15/20 Johnson,DDS,Arthur,D 1202 W Buena ivsta, Suite 206 Evansville, IN /15/ /14/20 Jones,DDS,Heath,W Rome Dr Suite A Lafayette, IN /01/ /31/2017 Kenfield,DDS,Melissa, 9247 Broadway Ste C Merrillville, IN /02/ /01/2017 Ketcham,DDS,Robert,L E DuPont Road Fort Wayne, IN /01/ /30/ /26/ Page 7 of 21

8 Kinney, DDS, Chris D Fairview Drive Anderson, IN /01/ /30/2018 Klauer,DDS,Daniel,G Turners Drive South Bend, IN /11/ /10/20 Kolb,DDS,David,R 137 E Morton Street Oakland city, IN /01/ /30/20 Kroczek,DDS,Catherine, 2025 West Glen Park Ave Griffith, IN /17/ /16/2017 Lau, DDS, Kenneth U 210 E Water ST Pendleton, IN /18/ /17/2018 Lee,DDSAshley, 411 Clifty Dr Madison, IN /01/ /30/2017 Ley, DDS, Paul J Guion Rd #280 Indianapolis, IN /10/ /09/20 Lipton,DDS,James,M Cline Avenue Highland, IN /04/ /04/2018 Lutz,DDS,James,E Rome Dr Suite A Lafayette, IN /01/ /31/2017 Macri,DDS,James,V 5156 Bittersweet Road Granger, IN /17/ /16/20 Mahan, DDS Vanessa 710 Averitt Rd Ste D Greenwood, IN /13/ /12/20 Mahler,DDS,Thomas, 165 W University Dr Mishawaka, IN /01/ /30/2017 Mahoney,DDS,Terrance,P Turners Drive South Bend, IN /11/ /10/20 Marrs,DDS,Lucas, 6535 E 82nd St Suite 211 Indianapolis, IN /01/ /31/ /26/ Page 8 of 21

9 Marszalek,DDS,Laura, 2628 Western Avenue Connersville, IN /01/ /30/2017 Martinsen,DDS,Scott,W 1011 Michigan Avenue Laporte, IN /01/ /31/2018 Martinsen,DDS,Valerie, R Michigan Avenue Laporte, IN /01/ /31/2018 Mcquinn,DDS,Jeffrey,M. 650 Fairgrounds Rd Tipton, IN /21/ /20/2018 McQuinn,DDS,Kassey,J. 650 Fairgrounds Road Tipton, IN /25/ /24/2018 Mcquinn,DDS,Mark,A. 650 Fairgrounds Rd Tipton, IN // /18/2018 Middaugh,DDS,Glen, 5404 E Bill Farr Drive Terre Haute, IN /23/ /22/20 Montefalco, DDS, Amy Nowakowski,DDS,Allan, R Ogle, DDS, David G. 303 North Alabama St, Ste 270 Indianapolis, IN /01/ /30/ N Everbrook Lane Muncie, IN /01/ /30/ State Road #662 Newburgh, IN /01/ /31/2018 Orr, DDS Katherine E 5430 E 86th St Indianapolis, IN /24/ /23/2018 Pete, DDS Joseph 710 Averitt Rd Ste D Greenwood, IN /13/ /12/20 Pfotenhauer, DDS, David H Kingston St #500 Avon, IN /15/ /14/20 Phelps,DDS,Jason,M W. Mcgalliard Rd Muncie, IN /22/ /21/ /26/ Page 9 of 21

10 Phillips,DDS,Gregory, 3180 Middle Dr Columbus, IN /15/ /14/2017 Ploeger, DDS, Amy Meyer Poulsen,DDS,William,B 8788 S State Rd 109 Box 1 Knightstown, IN /01/ /31/ Washington Avenue Evansville, IN /29/ /28/20 Pumphrey,DDS,Jeffrey, R. 311 N Broadway St Seymour, IN /01/ /31/2018 Rector,DDS,Thomas,C 1003 E McGalliard Rd. Muncie, IN /01/ /31/2017 Reef,DDS,Scott,A 415 N 26th Street, Suite 303 Lafayette, IN /01/ /31/2017 Rexford, DMD, Ashleigh M Guion Rd #280 Indianapolis, IN /15/ /14/20 Rheinlander,DDS,Ronal d, 2229 W Virginia St Evansville, IN /30/ /29/20 Roberts,DDS,John,R 724 N Grand Ave Connersville IN /31/ /30/2017 Sadler, Jr,,DDS,Charles, 121 Lakeside Dr Fishers, IN /23/ /23/20 Salkeld,DDS,Steven, Coldwater Rd Fort Wayne, IN /14/ /13/20 Schaefer,DDS,James,J. Schmitz, DDS, Samuel Edward 135 N Shortridge Rd Suite A1 Indianapolis, IN /17/ /16/ State Road #662 Newburgh, IN /01/ /31/2018 Schymik,DDS,Mark, 800 First Ave Evansville, IN /24/ /23/ /26/ Page 10 of 21

11 Shock,DDS,David, Town Center Blvd #200 Noblesville, IN /15/ /14/2018 Schroeder,DDS,Geralyn, 8028 E 10th St Ste C Indianapolis, IN /01/ /30/20 Schroeder,DDS,Miles, 8028 E 10th St Ste C Indianapolis, IN /01/ /30/20 Sergio,DDS,Paul,A. 18 Edison Road South Bend, IN /20/ //20 Shambaugh,DDS,Jeffre y,j 4341 Flagstaff Cove Fort Wayne, IN /01/ /30/20 Shattuck,DDS,Lori, 1035 W Jefferson St Franklin, IN /04/ /03/2018 Shaw, DDS Chad 1409 N Michigan St Plymouth, IN /01/ /01/20 Shoemaker,DDS,Debor ah 2310 Allison Lane Jeffersonville, IN // /18/2017 Sitzman, DDS Mark Sondhi,DDS,Anoop, Souers,DDS,James,M 320 W Buena Vista Road Evansville, IN /26/ /26/ N Meridian St, Ste 301 Indianapolis, IN /01/ /30/ South Emerson Ave. Beech Grove, IN /01/ /30/2017 Stapp,MD,Emily, 1572 Plank Rd Jeffersonville, IN /01/ /31/2017 Steckbeck, DDS, Thomas J 8007 South Merdian St Indianapolis, IN /31/ /31/2018 Steed,DDS,Pamela,A Harcourt Road, Ste 724 Indianapolis, IN /01/ /31/ /26/ Page 11 of 21

12 Steffey,DDS,Christian,M Union Street, Suite 200 Lafayette, IN /20/ //2018 Terry,DDS,Scott,A 501 Henry Street North Vernon, IN /01/ /31/20 Thompson,DDS,Nell, 1035 W Jefferson St. Franklin, IN /04/ /03/2018 Tiek, DDS Brandon Clay Terrace Blvd Ste 249 Carmel, IN /17/ /17/2018 Tromley, DDS, Patrick A 431 Main Street Evansville, IN /01/ /31/2018 Troutman, DDS, Kenneth R. 202 E 17th Street Huntingburg, IN /01/ /31/2018 Turner,DDS,Veronica, 3280 Middle Road Columbus, IN /12/ /11/2018 Wiland,DDS,Bruce,B Willison, DMD, Tracey Tabor 5162 E Stop 11 Road Suite 2 Indianapolis, IN // /18/ North Alabama St, Ste 270 Indianapolis, IN /01/ /30/2018 Wolf, DDS Michael 320 W Buena Vista Rd Evansville, IN /26/ /25/ Phillips, MD Frank 9200 Calumet Ave Suite 300 Munster, IN /01/ /31/20 20 Sasso,MD,Rick, N Meridian St Carmel, IN /01/ /31/ Singh, MD Kern 24 Aker,MD,John,S Calumet Ave Suite 300 Munster, IN /01/ /31/ N Meridian Street, Suite 225 Carmel, IN /31/ /30/20 10/26/ Page 12 of 21

13 24 Galante,MD,Gustavo,E Indianapolis Boulevard, Suite 103 Schererville, IN /01/ /31/2018 Plantis, Jr, MD, James M. 210 E 86th Place Merrillville, IN /29/ /28/ Sando,MD,William,C 25 Johnson,MD,David,W N Meridian Street, Suite 225 Carmel, IN /31/ /30/ Washington Square Mall Evansville, IN /01/ /31/2017 Bojrab,MD,Christopher, D. 703 Pro Med Lane Carmel, IN /01/ /31/ Cady, Louis, MD 4727 Rosebud Lane Ste F Newburgh, IN /01/ /01/ Butler,MD,Jonathan, 703 Pro Med Lane Carmel, IN /01/ /31/ Dong,MD,Beili, 703 Pro-Med Lane Carmel, IN /01/ /31/ Esch,MD,Brian,K. 218 W Washington Street, Suite 430 South Bend, IN /01/ /30/ Flaningham,MD,Tyler,C. 703 Pro Med Lane Carmel, IN /01/ /31/ Hinchman,DO,Kearn,D. 26 Hwang,MD,Kara,Z Generations Drive, Suite 1 south Bend, IN /31/ /30/ Lantern Rd Ste 209 Fishers, IN /01/ /31/ Irick,MD,Shiela,L. 703 Pro Med Lane Carmel, IN /01/ /31/ Knapp, DO, Jennifer, Shirck 2955 McKinley Ave Suite C South Bend, IN /25/ /24/ /26/ Page 13 of 21

14 26 Konkle,MD,Amy,D 26 Landy,MD,Mary,J 8 E 64th Street, Suite 220 Indianapolis, IN /04/ /03/ N Meridian Street, Suite 185 Indianapolis, IN /20/ //20 26 Mishra,MD,Sanjay, 703 Pro Med Lane Carmel, IN /01/ /31/ Peters,MD,Jayanthi, 703 Pro-Med Lane Carmel, IN /01/ /31/ Posey,MD,David,J. 26 Posey,MD,Kerrie,L N Meridian Street, Suite 210 Indianapolis, IN /28/ /27/ N Meridian Street, Suite 210 Indianapolis, IN /04/ /03/ Rapinchuk,MD,Jane, 703 Pro Med Land Carmel, IN /01/ /31/ Ricke,MD,Amy,K. 703 Pro Med Lane Carmel, IN /01/ /31/ Shoot,MD,James,L. 703 Pro Med Lane Carmel, IN /01/ /31/ Troy,MD,Benjamin, 26 Waldo, MD, Ralph E Day Road Suite 160 Mishawaka, IN /27/ /26/ N Meridian Street #220 Carmel, IN /11/ /10/20 Webber, MD, Michael, A. 703 Pro-Med Lane Carmel, IN /15/ /14/ Richmond, MD, Bruce 37 Andary,MD,Katherine, 9801 Fallcreek Rd, Ste 327 Indianapolis, IN /30/ /29/ Fall Creek Rd #327 Indianpolis, IN /01/ /31/20 10/26/ Page 14 of 21

15 37 Aull, MD Edward North Meridian St Ste 354 Carmel, IN /07/ /06/ Embree,OD,Rodney,C 1710 Apple Glen Blvd Fort Wayne, IN /01/ /30/ VanHoy,OD,Mary,W. 50 Barile,NP,Karen,B Bledsoe, NP Branden Allen 9302 N Meridian Street Indianapolis, IN /24/ /23/ Illinois Road, Suite C1 Fort Wayne, IN /01/ /30/ Spring Street Ste 3B Jeffersonville, IN /01/ /30/20 Bykowski,APRN,Debora h, 703 Pro-Med Lane Carmel, IN /01/ /31/ Doggett, ANP, Karen R. 720 Rolling Creek Drive Suite 100 New Albany, IN /01/ /30/20 50 Gladd,FNP,Neely 4930 Illinois Road Fort Wayne, IN /01/ /30/ Hancock, NP, Holly M 7855 S emerson Ave, Ste H Indianapolis, IN /01/ /31/ Jungemann, NP Nancy 703 Pro-Med Lane Carmel, IN /01/ /31/20 50 Langeloh,FNP,Paula, 695 N Opportunity Dr. Columbia City, IN /30/ /29/ Luking, NP Carissa 903 N 7th St Vincennes, IN /01/ /30/20 50 Miller,APRN,Randee, 8424 Naab Road, Suite 3P Indianapolis, IN /01/ /31/20 50 Mundy,NP,Beth,A 157 Teke Burton Drive Mitchell, IN /01/ /31/20 10/26/ Page 15 of 21

16 50 Owen Jennifer, NP 304 W HOWE ST Bloomington, IN /27/ /27/ Riewe, NP, Cheryl Generations Dr South Bend, IN /26/ /25/20 50 Sauer, NP Julie 50 Winet,NP,Elisabeth,F. 68 Barnhill,PhD,Laurence, R Generations Drive South Bend, IN /10/ /09/ Grape Road, Suite 07B Mishawak, IN /28/ /27/ N College Ave, Ste 614 Bloomington, IN /12/ /11/20 68 Bigelow,PhD,Nirav,O. 703 Pro Med Lane Carmel, IN /01/ /31/ Bradley, PsyD Jennifer E. 205 N College Ave Suite 514 Bloomington, IN /08/ /07/20 68 Brothers,PhD,Andrew,J. 703 Pro Med Lane Carmel, IN /01/ /31/ Brown,PhD,Lisa,B 68 Christy, PSYD Pamela Corning, Alexandra, PHD Cummings, PhD, Jennifer 6284 Rucker Rd Suite N Indianapolis, IN /30/ /29/ E 91ST STREET STE 210 Indianapolis, IN 46240* /13/ /12/ N Eddy St Ste 200 South Bend, IN /23/ /23/ Park Place West Suite 150 Mishawaka, IN /15/ /14/ Dalton,PsyD,Victoria,B. 703 Pro Med Lane Carmel, IN /01/ /31/ Essig, PhD, Gregory 3625 Park Place West Suite 150 Mishawaka, IN /06/ /05/20 10/26/ Page 16 of 21

17 68 Feathergill,PhD,Jeffrey, T 68 Henein, PSYD Nandy 68 Hinkle,PhD,Linda,K 3625 Park Place West Suite 150 Mishawaka, IN /01/ /31/ E 91ST STREET STE 210 INDIANAPOLIS, IN /13/ /12/ Illinois Street, Suite 321 Carmel, IN /01/ /30/20 68 Jeffries,PhD,Robert,W. 703 Pro Med Lane Carmel, IN /01/ /31/ Jones,PhD,Richard,H. 703 Pro Med Lane Carmel, IN /01/ /31/ Kennedy,PsyD,Mary,M. 7 Napoleon Street Valparaiso, IN /01/ /31/ Kroin, PHD Loretta 68 Lokken, PhD, Cami R 68 Magnus, PSYD Keith 9292 North Meridian Street Ste 311 Indianapolis, IN /01/ /31/ East Hagan St, Ste 203 Bloomington, IN /22/ /21/ E 91ST STREET SUITE 120 Indianapolis, IN /13/ /12/ Miracle, Louise, PSYD 2525 W Vernal Pike Bloomington, IN /30/ /30/ Taylor McGee,EDD,Debra, 320 N Meridian St Ste 814 Indianapolis, IN /01/ /30/ Ridel,PsyD,Stephanie,V. 703 Pro Med Lane Carmel, IN /01/ /31/ Sexton- Villalta,PhD,Camille, 703 Pro Med Lane Carmel, IN /01/ /31/ Sipes,PhD,Gregory,P. 703 Pro Med Lane Suite 200 Carmel, IN /03/ /02/ /26/ Page 17 of 21

18 68 Stote,PhD,Joseph,J Northbrook Drive Indianpolis, IN /17/ /16/ Ward, PSYD Courtney 70 E 91ST STREET SUITE 210 Indianapolis, IN /13/ /12/ Westcott, PsyD Polly 703 Pro-Med Lane Carmel, IN /08/ /07/20 72 Cassaro,MD,Michael,G. 72 Kochert,MD,Carolyn,G 200 Missouri Avenue, Suite B Jeffersonville, IN /01/ /28/ Daughtery Drive, Suite 110 Lafayette, IN /01/ /30/20 80 Batta,LCSW,Nichole,L 420 E Main Street Greenwood, IN /29/ /28/20 80 Child,LCSW,Jeffrey,F. 703 Pro Med Lane Carmel, IN /01/ /31/ Collins,MSW,Richard,A. 703 Pro-Med Lane Carmel, IN /01/ /31/ Dailey,LCSW,Jennifer,J 4214 Hobson Court Fort Wayne, IN /01/ /30/20 80 Falink,LCSW,Christina, 703 Pro Med Lane Carmel, IN /01/ /31/ Frantz, LCSW, Dana 703 Pro-Med Lane Carmel, IN /15/ /14/ Fogle, CSW Jessica 703 Pro-Med Lane Carmel, IN /10/ /09/20 80 Friesen,CSW,Rachel, 703 Pro-Med Lane Carmel, IN /01/ /31/ Glassburn- Larimer,LCSW,Susan,L. 703 Pro Med Lane Carmel, IN /01/ /31/ /26/ Page 18 of 21

19 80 George,CSW,Paul, 6284 Rucker Rd Ste N Indianapolis, IN /09/ /08/ Harber Porter,LCSW,Jeanne, 4214 Hobson Court Fort Wayne, IN /01/ /31/20 80 Hartman,LCSW,Paul,N. 703 Pro Med Lane Carmel, IN /01/ /31/ Herrmann,LCSW,Micha el,f N Pennsylvania Street Carmel, IN /01/ /30/20 80 Hojnacki, LCSW, Jason 703 Pro-Med Lane Carmel, IN /15/ /14/ Hosier Ada, CSW 5660 Caito Dr Ste 122 Indianapolis, IN /17/ /16/ Jansen, Jennifer C. 703 Pro-Med Lane Carmel, IN /12/ /11/ Joray, LCSW Bruce Little John Lane Granger, IN /01/ /31/20 80 Lake,LCSW,Maryann, 703 Pro Med Lane Carmel, IN /01/ /31/ Lang, CSW Kathi 303 S Perry ST Attica, IN /24/ /24/ Leonard,LCSW,Erin,K E Day Road, Suite 160 Mishawaka, IN /06/ /05/20 Moffett,LCSW,Kimberly, A. 703 Pro Med Lane Carmel, IN /01/ /31/ Myers,LCSW,Kevin,N. 703 Pro Med Lane Carmel, IN /01/ /31/ Oser,LCSW,Jean,A 4214 Hobson Court Fort Wayne, IN /01/ /30/20 10/26/ Page of 21

20 80 Roth, Mary, LCSW 703 Pro-Med Lane Carmel, IN /15/ /14/ Rubin,CSW,Sara, Schaefer 703 Pro-Med Lane Carmel, IN /01/ /31/2017 Robbins,LCSW,Carrie,L Pro Med Lane Carmel, IN /01/ /31/ Sharp,LCSW,Marlene, 6801 Lake Plaza Drive, Suite D 407 Indianapolis, IN /20/ //20 80 Shoot,LCSW,Carol,L. 703 Pro Med Lane Carmel, IN /01/ /31/ Strobel,LCSW,Amy,T 703 Pro Med Lane Carmel, IN /01/ /31/ Tyler, CSW Steven 703 Pro-Med Lane Carmel, IN /10/ /10/ Walter,LCSW,Evelyn,K. 703 Pro Med Lane Carmel, IN /01/ /31/ Burns,DDS,Christopher, A Oaklandon Road, Suite B Indianapolis, IN /24/ /23/ Whitaker,CNS,Kathleen, 209 W North St Lebanon, IN // /17/20 93 Antoine,DO,Ellen, 40 North Rangeline Road Carmel, IN /06/ /05/ Morris,PA-C,Ann,M 703 Pro Med Lane Carmel, IN /01/ /31/ Sheets, PA-C, Cassandra N Union Street, Suite 300 Lafayette, IN /01/ /30/20 C5 Hadley,DDS,Thomas,L 210 W Harrison Street Monticello, IN /01/ /31/20 10/26/ Page 20 of 21

21 C5 Miller, DMD, Abigale 505 Vistula Street Elkhart, IN /12/ /11/20 C5 Vail,DDS,Mychel, Lantern Road Fishers, IN /18/ /17/ /26/ Page 21 of 21