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2016 PROVIDER AND PHARMACY DIRECTORY - Cigna.com

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  • FINAL_16 Cover_Pharmacy Directory PRINT.indd 1 9/4/15 3:17 PM

    2016

    Directorio de farmacias y proveedores

    PROVIDER AND PHARMACY DIRECTORY

    Cigna-HealthSpring East Tennessee TN Counties/Condados: Bledsoe, Bradley, Grundy, Hamilton, Marion, McMinn, Meigs, Monroe, Polk, Rhea, Sequatchie

    For more information, please contact Cigna-HealthSpring Customer Service at 1-800-668-3813 or, for TTY users, 711, 7 days a week, 8 a.m. - 8 p.m., or visit www.cignahealthspring.com. Para ms informacin, favor de ponerse en contacto con el Departamento de servicio al cliente de Cigna-HealthSpring al 1-800-6683813 o, para usuarios TTY, 711, 7 das de la semana, o bien visite www.cignahealthspring.com. This Provider and Pharmacy Directory was updated on 08/13/15. Este Directorio de proveedores y farmacias se actualiz el 08/13/15. 2015 Cigna 16_D_28_TNE_28 Y0036_16_31997aBL_FINAL_16 Approved 08142015

  • Cigna-HealthSpring HMO Plan Provider Directory

    Provider Directory

    This directory provides a list of Cigna-HealthSprings network providers. This directory is for TN Counties: Bledsoe, Bradley, Grundy, Hamilton, Marion, McMinn, Meigs, Monroe, Polk, Rhea, Sequatchie. This directory is current as of August 2015. Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. To get the most up-to-date information about Cigna-HealthSprings network providers in your area, you can visit www.cignahealthspring.com or call our Customer Service Department at 1-800-668-3813, October 1 February 14, 8:00 a.m. 8:00 p.m. local time, 7 days a week. From February 15 September 30, Monday Friday 8:00 a.m. 8:00 p.m. local time, Saturday 8:00 a.m. 6:00 p.m. local time. Messaging service used weekends, after hours, and on federal holidays. TTY users should call 711. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc., Cigna HealthCare of St. Louis, Inc., HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Tennessee, Inc., HealthSpring of Alabama, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal. The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is available for free in other languages. Please call our customer services number at 1-800-668-3813 (TTY 711), 7 days a week, 8 a.m. - 8 p.m. Esta informacin est disponible de forma gratuita en otros idiomas. Por favor, llame a nuestro servicio al cliente al 1-800-668-3813 (TTY 711), 7 das de la semana, 8 a.m. - 8 p.m. This document may be available in other formats such as Braille, large print or other alternate formats. Contact the plan for more information.

    Y0036_16_31997aBL_FINAL_16 Approved 08142015 16_D_28_TNE_28

  • Section 1 Introduction This directory provides a list of Cigna-HealthSprings network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). The term PCP will be used throughout this directory. Generally, you must get your healthcare services from your PCP. Your PCP is a physician who is trained to provide general medical care. Your PCP can also coordinate the rest of the covered services you need. The network providers listed in this directory have agreed to provide you with your healthcare, vision and dental services. Please note: Not all Cigna-HealthSpring plans have vision and dental benefits. Please check your Evidence of Coverage to see if your plan has a vision and/or dental benefit. You may go to any of our network providers listed in this directory; however, some services may require a referral. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from non-network providers. Other physicians/providers are available in our network. For POS Plans: While you are a member of our plan, you may use providers outside of the network. Your out-of-pocket costs may be higher if you use out-of-network providers, except for emergency care, out-of-area urgent care, or out-of-area dialysis services. You dont need to get a referral, but you may need prior authorization for some plans* when you get care from out-ofnetwork providers. In non-emergent situations, please tell out-of-network providers that you are a Cigna-HealthSpring member before you see them to ensure that they will see Cigna-HealthSpring members. Our payment for out-of-network services is based on the Medicare Allowable Amount. If the out-of-network provider charges more than the Medicare Allowable Amount, you may be liable for the difference between the Medicare Allowable Amount and the providers total charge. (*Cigna-HealthSpring Premier (HMO-POS) and Cigna-HealthSpring Premier Plus (HMO-POS) do require prior authorization for out-of-network providers.) For POS Plans: Cigna-HealthSpring offers a Point-of-Service (POS) option. The POS option allows you to use out-of-network area providers. You must notify Cigna-HealthSpring prior to using out-of-network area providers. If you use an out-of-network area provider for non-emergent services, your out-of-pocket costs may be higher. If you do not notify the plan prior to using an out-of-network provider, you will be responsible for 100% of the cost(s) billed. Neither Cigna-HealthSpring nor Medicare will pay for these services. Please refer to your Evidence of Coverage for details. Even though your PCP is trained to handle the majority of common health needs, there may be a time when you need more specialized treatment. In those situations, you may see a plan specialist. Specialists are doctors who are trained to provide health services for a specific disease or part of the body. For some types of specialists, you will need to obtain a referral from your PCP before you can schedule an appointment with the specialist. Below is a list of provider specialty types that require referrals from your PCP before you can schedule an appointment with them. Please note: Some provider types may have been added or removed from the list after this directory was printed. You should check with your PCP or call Customer Service at the phone number on the cover to see if a referral is required to see a specialist or other provider. Note that a referral is different from prior authorization, which is required before certain services procedures can be performed.

  • Allergy & Immunology Medical Genetics Physical Therapy Anesthesiology Medical Oncology Plastic Surgery Audiology Nephrology Podiatry Cardiovascular Disease Neurosurgery Proctology Cardiovascular Surgery Neurology Prosthodontics Chiropractor Occupational Therapy Pulmonary Disease Colon and Rectal Surgery Ophthalmology Radiology Dermatology Oral Surgery Respiration Therapy Endocrinology Orthopedic Surgery Rheumatology Gastroenterology Otolaryngology Speech Language Pathologist General Surgery Pain Management Speech Therapy Gynecologic Oncology Pediatric Cardiology Sports Medicine Hand Surgery Pediatric Endocrinology Thoracic Surgery Hematology Pediatric Hematology-Oncology Urology Hematology/Oncology Pediatric Rehabilitation Medicine Vascular and Interventional Infectious Disease Pediatric Surgery Vascular Surgery Maxillofacial Surgery Physical Medicine/Rehabilitation In addition, each PCP has certain plan specialists and hospitals they use for referrals. This means that the Cigna-HealthSpring specialists or hospitals you can use may depend on which PCP you select. If there are specialists or hospitals that you want to use, it is important to find out if your chosen PCP refers to them. Cigna-HealthSpring has different types of Primary Care Provider relationships. We have contracts with independent physicians, Independent Physician Associations, Physician Organized Delivery system and clinic based providers. The following paragraphs describe the relationship these providers have with Cigna-HealthSpring. Independent Physician Associations (IPA)

    Independent Physician Associations (IPAs) consist of Primary Care and Specialist Physicians located in and around your area. If you select a Primary Care Physician who belongs to an IPA, you should be aware that your PCP will refer you to specialists and hospitals affiliated with the same IPA and with whom they work closely to coordinate your care. You will receive all of your care, including gynecological and specialty care from the physicians within the same IPA. Gynecological care can be accessed by any Gynecologist in the network. Your IPA is designed to provide a team of primary care and specialty physicians who can manage your care needs. However, if your medical condition should ever require you to seek care outside the IPA, your primary care physician will continue to assist you in the coordination of any needed services outside the IPA. The following IPAs are network providers with your plan.

    Scenic City IPA

    A Physician Organized Delivery (POD) system represents a network of physicians with similar referral patterns,

    organized to administer healthcare services to the plans membership. If you select a Primary Care Physician who belongs to a POD, you should be aware that your PCP will refer you to specialists affiliated with the same POD and with whom they work closely to coordinate your care. However, your primary care physician can refer you to any other in-network physician outside of the POD, and your primary care physician will continue to assist you in the coordination of any needed services outside the POD. The following PODs are network providers with your plan.

    Erlanger POD

    Memorial POD

    Peerless POD

  • Independent physicians Independent physicians are of Primary Care and Specialist physicians located in and around your area that are not part of an IPA or POD. If you select an independent Primary Care Physician you should be aware that your PCP will refer you to specialists and hospitals with whom he/she is affiliated and with whom they work closely to coordinate your care. Please confirm whether the referred physician or hospital is a network provider with your plan. You will receive all of your care, including gynecological and specialty care from the physicians affiliated with your PCP. Gynecological care can be accessed through any independent Gynecologist.

    There may also be times when you get a bill from a provider for the full cost of medical care you have received. In many cases, you should contact Customer Service or send this bill to us instead of paying it. We will look at the bill and decide whether the services should be covered. If we decide they should be covered, we will pay the provider directly. (Please note that we cannot pay a provider who has opted out of the Medicare program. Check with your provider before receiving services to confirm that they have not opted out of Medicare.) If we determine that the services are not covered or were not medically necessary, we may deny coverage and you will be responsible for the entire cost. You may get emergency medical care whenever you need it, anywhere in the United States or its territories. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health. Please refer to your Evidence of Coverage for details. You may get covered emergency medical care whenever you need it, anywhere in the world. If you have an emergency, we will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Cigna-HealthSpring will be responsible for the costs. For POS Plans: If you obtain routine care from out-of-network providers you will have to pay the out-of-network cost-sharing, except for emergency care, out-of-area urgent care, or out-of-area dialysis services. Please refer to your Evidence of Coverage for more information. Behavioral Healthcare Services Behavioral Health services, including mental health and substance abuse services, for beneficiaries covered by Cigna-HealthSpring are provided through Cigna-HealthSpring Behavioral Healthcare Services. Members and providers may access Cigna-HealthSpring Behavioral Healthcare Services by calling 1-866-780-8546 (TTY 711) for assistance in finding a behavioral healthcare professional or to arrange for inpatient admission authorization. Cigna-HealthSpring Behavioral Healthcare Services is available 24 hours per day, 7 days a week. What is the service area for Cigna-HealthSpring? The counties in our service area are listed below. TN Counties: Bledsoe, Bradley, Grundy, Hamilton, Marion, McMinn, Meigs, Monroe, Polk, Rhea, Sequatchie How do you find Cigna-HealthSpring providers in your area? To choose a PCP from the Provider Directory, turn to the Primary Care Provider section for a listing of primary care providers in your area. You can also call Customer Service at the number listed below for assistance. When you select a PCP, you will find a space on your Enrollment Application to enter the PCPs name. If you choose a PCP after your Enrollment Application has been submitted, call Customer Service and inform them of your PCP selection. Please keep in mind that if you do not select a PCP at the time of enrollment, Cigna-HealthSpring will select one for you based on where you live. If you want to change to another PCP, you may do so at any time by calling Customer Service at the number listed below. The name and office telephone number of your PCP are printed on your membership card.

  • To choose a specialist, hospital, pharmacy or other provider, please turn to the applicable section in the Provider Directory for a listing of providers in your area. For example, to find hospitals in your area, turn to the Hospitals section of the directory. If you have questions about Cigna-HealthSpring or require assistance in selecting a PCP, please call our Customer Service Department at 1-800-668-3813, October 1 February 14, 8:00 a.m. 8:00 p.m. local time, 7 days a week. From February 15 September 30, Monday Friday 8:00 a.m. 8:00 p.m. local time, Saturday 8:00 a.m. 6:00 p.m. local time. Messaging service used weekends, after hours, and on federal holidays. TTY users should call 711. Or, visit www.cignahealthspring.com. Again, if you want to use a particular Cigna-HealthSpring specialist or hospital, you should check with your PCP to make sure they can make referrals to that specialist or hospital. The providers listed in this directory are part of a sub-network of Cigna-HealthSpring providers. You are not limited to the providers in this directory and can get the most-up-to-date list of all available providers in your area by calling Customer Service at 1-800-668-3813 (TTY 711), October 1 February 14, 8:00 a.m. 8:00 p.m. local time, 7 days a week. From February 15 September 30, Monday Friday 8:00 a.m. 8:00 p.m. local time, Saturday 8:00 a.m. 6:00 p.m. local time. Messaging service used weekends, after hours, and on federal holidays or by visiting our website at www.cignahealthspring.com. A hard copy directory is also available by request.

  • Section 2 List of Network Providers This directory is organized to help you find the type of provider you need. Providers are listed in the following sections:

    - Independent Physician Association (IPA) o Primary Care Providers (PCP) o Specialists o Hospitals o Skilled Nursing Facilities o Behavioral Health Providers o Ambulatory Surgical Centers/Urgent Care Facilities o Ancillary Providers o Dental Providers o Vision Providers

    - Physician Organized Delivery System (POD)

    o Primary Care Provider (PCP) o Specialist o Hospitals o Skilled Nursing Facilities o Behavioral Health Providers o Ambulatory Surgical Centers/Urgent Care Facilities o Ancillary Providers o Dental Providers o Vision Providers

    - Independent Providers o Primary Care Provider (PCP) o Specialists o Hospitals o Psychiatric Hospitals o Skilled Nursing Facilities o Behavioral Health Providers o Ambulatory Surgical Centers/Urgent Care Facilities o Ancillary Providers o Dental Providers o Vision Providers

    How to use this directory to choose a Primary Care Provider There are two ways to select a primary care provider:

    - You can choose a particular Primary Care Provider by name; or - You can choose your Primary Care Provider by location.

    If you are looking for a particular Primary Care Provider by name: 1. Go to the Alphabetical Index, which is the last section of the directory. 2. Find the doctor by last name and the page number(s) on which he or she is listed. 3. Go to that page number for information on the Primary Care Provider.

    If you are looking for a Primary Care Provider by location: 1. Go to the Primary Care Provider section.

  • 2. Find the City and/or zip code. 3. Select a Provider.

    How to use this directory to choose a Specialist Specialist physicians and other primary care providers in this directory are listed by specialty of care, followed by geographic location, and name. How to use this directory to choose a Provider that accepts both Medicare and Medicaid Plan providers that accept both Medicare and Medicaid are located throughout this Provider Directory and are marked by an asterisk (*). For example, this provider would be a Medicare and Medicaid provider: Dr. John Doe* However, this provider would not be a Medicare and Medicaid provider: Dr. Jane Doe

    How to use this directory to choose other Plan Providers Plan providers in this directory, other than primary care providers and specialists, are listed by geographic location then the name of the provider. Provider Directory Symbol Key In this directory, some providers will have a symbol at the end of their name. Below are the symbols and what they mean:

    Symbol Meaning * Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^ POS Provider

    Total Number of Providers within this Directory: PCPs: 220 Specialists: 1015 Hospitals: 14 Skilled Nursing Facilities: 29 Behavioral Health Providers: 102 Ambulatory Surgical Centers/Urgent Care Facilities: 16 Ancillary Providers: 205 Dental Providers: 1 Vision Providers: 26 Pharmacies: 1056

  • Directorio de proveedores del Plan HMO de Cigna-HealthSpring Este directorio incluye una lista de los proveedores de la red de Cigna-HealthSpring.

    Directorio de proveedores

    Este directorio es para los Condados en TN de: Bledsoe, Bradley, Grundy, Hamilton, Marion, McMinn, Meigs, Monroe, Polk, Rhea, Sequatchie. Este directorio est actualizado a partir de agosto de 2015. Es posible que se hayan agregado o eliminado de la lista algunos proveedores de la red, despus de la impresin de este directorio. No garantizamos que los proveedores estn aceptando miembros nuevos. Para obtener informacin actualizada sobre los proveedores de la red de Cigna-HealthSpring en su rea, visite www.cignahealthspring.com o bien, llame al Departamento de servicio al cliente al 1-800-668-3813, del 1 de octubre al 14 de febrero, 8:00 a.m. 8:00 p.m. hora local, 7 das de la semana. Del 15 de febrero al 30 de septiembre, de lunes a viernes, 8:00 a.m. 8:00 p.m. hora local, sbado 8:00 a.m. 6:00 p.m. hora local. Si llama los fines de semana, fuera del horario de servicio o un da festivo federal, entrar el servicio de contestadora automtica. Los usuarios de TTY deben llamar al 711. Todos los productos y servicios de Cigna se brindan exclusivamente por o a travs de subsidiarias operativas de Cigna Corporation, incluyendo Cigna Health and Life Insurance Company, Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc., HealthSpring of St. Louis, Inc., HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Tennessee, Inc., HealthSpring of Alabama, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., y Bravo Health Pennsylvania, Inc. El nombre de Cigna, los logotipos, y otras marcas de Cigna son propiedad de Cigna Intellectual Property, Inc. Cigna-HealthSpring tiene contrato con Medicare para planes PDP, planes HMO y PPO en ciertos estados, y con ciertos programas estatales de Medicaid. La inscripcin en Cigna-HealthSpring depende de la renovacin de contrato. La red de farmacias, y/o la red de proveedores pueden cambiar en cualquier momento. Recibir un aviso cuando sea necesario. This information is available for free in other languages. Please call our customer services number at 1-800-668-3813 (TTY 711), 7 days a week, 8 a.m. - 8 p.m. Esta informacin est disponible de forma gratuita en otros idiomas. Por favor, llame a nuestro servicio al cliente al 1-800-668-3813 (TTY 711), 7 das de la semana, 8 a.m. - 8 p.m. Este documento est disponible en otros formatos como Braille, impresin grande u otros formatos alternativos. Para ms informacin, pngase en contacto con el plan.

    Y0036_16_31997aBL_FINAL_16 Approved 08142015 16_D_28_TNE_28

  • Seccin 1 Introduccin Este directorio incluye una lista de los proveedores de la red de Cigna-HealthSpring. Para obtener informacin detallada acerca de su cobertura de atencin mdica, por favor consulte su Evidencia de Cobertura.

    Deber elegir uno de nuestros proveedores de la red que figuran en este directorio para que sea su Mdico de cabecera (PCP, por sus siglas en ingls). El trmino PCP se usar en todo este directorio. Por lo general, debe recibir sus servicios de atencin mdica de su PCP. Su PCP es un mdico capacitado para brindarle atencin mdica general. Su PCP tambin puede coordinar el resto de los servicios en cobertura que usted necesite.

    Los proveedores de la red que aparecen en este directorio han aceptado brindarle sus servicios de atencin mdica, cuidado de la vista y atencin dental. Por favor tenga en cuenta: No todos los planes de Cigna-HealthSpring tienen beneficios del cuidado de la vista y atencin dental. Por favor lea su Evidencia de cobertura para ver si su plan tiene el beneficio de cuidado de la vista y/o atencin dental. Usted puede acudir a cualquiera de los proveedores de nuestra red que figuran en este directorio; no obstante, es posible que algunos servicios requieran una referencia. Si usted ha estado acudiendo a un proveedor de la red, no es necesario que contine consultando a dicho proveedor. En algunos casos, puede recibir servicios cubiertos de proveedores que no pertenecen a la red. Otros mdicos/proveedores estn disponibles en nuestra red.

    For POS Plans: Mientras sea miembro de nuestro plan, puede acudir a proveedores que no pertenezcan a la red. Es posible que sus costos no reembolsables sean ms altos si acude con proveedores fuera de la red, excepto para atencin de emergencia, atencin urgente fuera del rea, o servicios de dilisis fuera del rea. No necesita una referencia, pero es posible que necesite la autorizacin previa de algunos planes* para recibir atencin de proveedores que no pertenezcan a la red. En situaciones que no son de emergencia, antes de acudir con un proveedor fuera de la red, infrmele que usted es miembro de Cigna-HealthSpring para asegurarse de que dicho proveedor atiende a miembros de Cigna-HealthSpring. Nuestro pago por los servicios fuera de la red se basa en el Monto permitido de Medicare. Si los honorarios del proveedor fuera de la red son superiores al Monto permitido de Medicare, es posible que usted deba pagar la diferencia entre el Monto permitido de Medicare y los honorarios totales del proveedor. (*Cigna-HealthSpring Premier (HMO-POS) y Cigna-HealthSpring Premier Plus (HMO-POS) requieren de autorizacin previa para los proveedores fuera de la red). For POS Plans: Cigna-HealthSpring ofrece la opcin de Punto de servicio (POS). La opcin POS le permite acudir con proveedores fuera del rea de la red. Debe avisarle a Cigna-HealthSpring antes de que acuda con proveedores fuera del rea de la red. Si acude con proveedores fuera del rea de la red, para recibir servicios que no sean de emergencia, es posible que sus costos no reembolsables sean ms altos. Si no le avisa al plan que va a acudir con un proveedor fuera del rea de la red, usted ser responsable de pagar el 100% del(los) costo(s) facturados(s). Ni Cigna-HealthSpring ni Medicare pagarn por dichos servicios. Para ms detalles, por favor consulte su Evidencia de cobertura.

    A pesar de que su PCP est capacitado para manejar la mayora de las necesidades comunes de salud, es posible que, en ocasiones, usted necesite un tratamiento ms especializado. En esas situaciones, puede consultar un especialista del plan. Los especialistas son mdicos que estn capacitados para proporcionar servicios mdicos para una enfermedad o parte del cuerpo especficos. Para algunos tipos de especialistas, deber obtener una "referencia" de su PCP antes de que pueda programar una cita con el especialista. A continuacin est una lista de los tipos de proveedores especialistas que requieren referencias de su PCP antes de que pueda programar una cita con ellos. Recuerde: Es posible que se hayan agregado o eliminado de la lista algunos tipos de proveedores, despus de la impresin de este directorio. Usted debe consultar con su PCP o llamar al Departamento de servicio al cliente al telfono que est en la portada para saber si requiere una referencia para visitar un especialista u otro proveedor. Tenga en cuenta que una referencia es diferente a un "autorizacin previa", misma que se requiere antes de que se puedan realizar ciertos servicios o procedimientos.

  • Alergia e inmunologa Endocrinologa peditrica Oftalmologa Anestesiologa Enfermedad infecciosa Oncologa Ginecolgica Audiologa Enfermedad pulmonar Oncologa mdica Cardiologa peditrica Enfermedades cardiovasculares Otorrinolaringologa Ciruga cardiovascular Fisioterapia Patlogo del habla y del lenguaje Ciruga de la mano Gastroenterologa Podologa Ciruga General Gentica mdica Proctologa Ciruga maxilofacial Hematologa Prostodoncia Ciruga oral Hematologa-Oncologa peditrica Quiroprctico Ciruga ortopdica Hematologa/Oncologa Radiologa Ciruga peditrica Manejo del dolor Radiologa vascular e Ciruga plstica Medicina de rehabilitacin peditrica intervencionista Ciruga rectal y de colon Medicina del deporte Reumatologa Ciruga torcica Medicina fsica / rehabilitacin Terapia del habla Ciruga vascular Nefrologa Terapia ocupacional Dermatologa Neurociruga Terapia respiratoria Endocrinologa Neurologa Urologa Adems, cada PCP tiene ciertos especialistas y hospitales del plan que debe usar para las referencias. Esto significa que es posible que los especialistas u hospitales de Cigna-HealthSpring a los que puede acudir dependan de los que su PCP haya seleccionado. En caso de que desee acudir con ciertos especialistas o a ciertos hospitales, es importante que verifique si su PCP lo enviar con los mismos. Cigna-HealthSpring tiene diferentes tipos de relaciones con los mdicos de cabecera. Tenemos contrato con mdicos independientes, Asociaciones de mdicos independientes, el sistema organizado de prestaciones mdicas y proveedores que trabajan en clnicas. Los siguientes prrafos describen la relacin que los proveedores tienen con Cigna-HealthSpring. Asociaciones de mdicos independientes (IPA)

    Las Asociaciones de mdicos independientes (IPA) estn formadas por mdicos generales y especialistas que se encuentran en y alrededor de su rea. Si selecciona a un mdico independiente que sea parte de una IPA, debe saber que su PCP lo enviar nicamente con especialistas y a hospitales que estn afiliados a la misma IPA, y con quienes trabaje de cerca para coordinar su atencin. Recibir toda su atencin mdica, incluyendo la atencin de gineclogos y especialistas, de mdicos que estn afiliados a la misma IPA. Podr recibir la atencin de cualquier gineclogo de la red. Su IPA est diseada para proveer un equipo de mdicos generales y mdicos especialistas que pueden manejar sus necesidades de atencin mdica. Sin embargo, si su condicin mdica alguna vez requiere que usted busque atencin fuera de la IPA, su mdico de cabecera seguir asistindolo en la coordinacin de cualquier servicio necesario fuera de la IPA. Las siguientes IPA son proveedores de la red de su plan. Scenic City IPA

    Un Sistema organizado de prestaciones mdicas (POD) representa una red de mdicos con patrones de referencia

    similares, organizados para administrar los servicios de atencin mdica para los miembros del plan. Si selecciona un Mdico de cabecera que sea parte de un POD debe saber que su PCP lo enviar nicamente con especialistas que estn afiliados al mismo POD, y con quienes trabaje de cerca para coordinar su atencin. Sin embargo, su PCP puede enviarlo con cualquier otro doctor de la red que no sea del POD, y su mdico de cabecera seguir ayudndole con la coordinacin de cualquier servicio que necesite fuera del POD. Los siguientes POD son proveedores de la red de su plan.

  • Erlanger POD Memorial POD Peerless POD

    Mdicos independientes

    Los mdicos Independientes son mdicos generales y especialistas que se encuentran en y alrededor de su rea que no son parte de una IPA o un POD. Si selecciona a un mdico independiente, debe saber que su PCP lo enviar nicamente con especialistas y a hospitales con los que l o ella est afiliado/a y con quienes trabaje de cerca para coordinar su atencin. Por favor confirme si el mdico u hospital al que se le envi pertenece a la red del plan. Recibir toda su atencin mdica, incluyendo la atencin de gineclogos y especialistas, de mdicos que estn afiliados con su PCP. Podr recibir la atencin de cualquier gineclogo de la red de gineclogos independientes.

    Adems, es posible que algunas veces reciba una factura de un proveedor por el costo total de la atencin mdica que haya recibido. En muchos casos, debe comunicarse con el Departamento de servicio al cliente o enviarnos esta factura en lugar de pagarla. Revisaremos la factura y decidiremos si los servicios deberan cubrirse. Si decidimos que deberan estar cubiertos, le pagaremos directamente al proveedor. (Tenga en cuenta que no podemos pagarle a un proveedor que ha decidido retirarse del programa de Medicare. Consulte a su proveedor antes de recibir los servicios para confirmar que no se retir del programa de Medicare). Si determinamos que los servicios no son cubiertos o no fueron mdicamente necesarios, podemos rechazar la cobertura y usted deber pagar el costo total. Puede recibir atencin mdica de emergencia cuando lo necesite, en cualquier lugar de los Estados Unidos o sus territorios. Nuestro plan cubre servicios de ambulancia en situaciones en las que llegar a una sala de urgencias por otro medio podra poner en peligro su salud. Para ms detalles, por favor consulte su Evidencia de cobertura. Puede recibir atencin mdica de emergencia siempre que la necesite, en cualquier parte del mundo. Si tiene una emergencia, nos comunicaremos con los mdicos que le proporcionen la atencin de emergencia para ayudar a manejar su atencin y darle el seguimiento a la misma. Los mdicos que le proporcionen la atencin mdica decidirn cundo su estado es estable y ya no representa una emergencia mdica. Cuando termine la emergencia, usted tendr derecho a recibir atencin de seguimiento para asegurarse de que su estado contina estable. Su atencin de seguimiento estar cubierta por nuestro plan. Si su atencin de emergencia es proporcionada por proveedores fuera de la red, intentaremos organizar para que proveedores de la red se hagan cargo de su atencin inmediatamente cuando su afeccin mdica y las circunstancias lo permitan. Debe acudir con los proveedores del plan excepto en situaciones de emergencia o atencin mdica urgente o para dilisis renal fuera del rea u otros servicios. Si recibe atencin de rutina de proveedores fuera de la red, ni Medicare ni Cigna-HealthSpring sern responsables de los costos. Para Planes POS: Si recibe atencin de rutina de proveedores fuera de la red, tendr que pagar el costo compartido fuera de la red, excepto para atencin de emergencia, atencin urgente fuera del rea, o servicios de dilisis fuera del rea. Para ms detalles, por favor consulte su Evidencia de cobertura. Servicios de atencin de la salud emocional Los servicios de atencin de la salud emocional, incluyendo los servicios de salud mental y de abuso de sustancias, para los beneficiarios en cobertura de Cigna-HealthSpring se reciben a travs de los Servicios de atencin de la salud emocional de Cigna-HealthSpring. Los miembros y los proveedores pueden acceder a los Servicios de atencin de la salud emocional de Cigna-HealthSpring llamando al 1-866-780-8546 (TTY 711) para recibir ayuda para encontrar un profesional de atencin de la salud emocional o para solicitar una autorizacin de internamiento. Los Servicios de atencin de la salud emocional de Cigna-HealthSpring estn disponibles las 24 horas del da, los 7 das de la semana. Cul es el rea de servicio de Cigna-HealthSpring? Los condados que son parte de nuestra rea de servicio son: Condados de TN: Bledsoe, Bradley, Grundy, Hamilton, Marion, McMinn, Meigs, Monroe, Polk, Rhea, Sequatchie

  • Cmo encontrar proveedores de Cigna-HealthSpring en su rea? Para elegir un PCP del Directorio de proveedores, dirjase a la seccin Mdicos de cabecera para consultar la lista de mdicos de cabecera dentro de su rea. Tambin puede llamar al Departamento de servicio al cliente al nmero que aparece ms abajo, donde con gusto le ayudarn. Una vez que haya elegido un PCP, deber ingresar el nombre del PCP en el espacio correspondiente en su Solicitud de inscripcin. Si elige un PCP despus de haber presentado su Solicitud de inscripcin, llame al Departamento de servicio al cliente e infrmeles su eleccin de PCP. Recuerde que si no elige un PCP al momento de la inscripcin, Cigna-HealthSpring elegir uno por usted segn su lugar de residencia. Si desea cambiar por otro PCP, puede hacerlo en cualquier momento llamando al Departamento de servicio al cliente al nmero que figura aparece ms abajo. El nombre y el nmero de telfono del consultorio de su PCP estn impresos en su tarjeta de membresa. Para elegir un especialista, hospital, farmacia u otro proveedor, dirjase a la seccin correspondiente del Directorio de proveedores para ver la lista de proveedores de su rea. Por ejemplo, para encontrar hospitales en su rea, dirjase a la seccin Hospitales del directorio. Deber tambin elegir un podlogo. Para elegir un podlogo de este directorio, consulte la Seccin de Podlogos para ver la lista de podlogos en su rea. Una vez que elija un podlogo, encontrar un espacio en su Solicitud de inscripcin para ingresar el nombre del podlogo. Si elige un podlogo cuando ya se haya enviado su Solicitud de inscripcin, llame al Departamento de servicio al cliente y dgales cul el podlogo que eligi. Por favor recuerde que si no elige un podlogo en el momento de la inscripcin, Cigna-HealthSpring elegir uno por usted en base al lugar en el que vive. Si desea cambiar a otro podlogo, puede hacerlo en cualquier momento llamando al Departamento de servicio al cliente al nmero siguiente. El nombre y el nmero de telfono del Pdologo van impresos en su tarjeta de membresa. Si tiene alguna pregunta sobre Cigna-HealthSpring o necesita ayuda para seleccionar un PCP, por favor llame al Departamento de servicio al cliente al 1-800-668-3813, del 1 de octubre al 14 de febrero, 8:00 a.m. 8:00 p.m. hora local, 7 das de la semana. Del 15 de febrero al 30 de septiembre, de lunes a viernes, 8:00 a.m. 8:00 p.m. hora local, sbado 8:00 a.m. 6:00 p.m. hora local. Si llama los fines de semana, fuera del horario de servicio o un da festivo federal, entrar el servicio de contestadora automtica. Los usuarios de TTY deben llamar al 711. O, visite www.cignahealthspring.com. Nuevamente, si desea acudir con ciertos especialistas o a ciertos hospitales de Cigna-HealthSpring, es importante que verifique si su PCP lo enviar a ese especialista u hospital. Los proveedores mencionados en este directorio son parte de una sub-red de provedores de Cigna-HealthSpring. Usted no est limitado a los proveedores de este directorio y puede consultar una lista ms actualizada de todos los proveedores disponibles en su area llamando al Departamento de servicio al cliente al 1-800-668-3813 (TTY 711), del 1 de octubre al 14 de febrero, 8:00 a.m. 8:00 p.m. hora local, 7 das de la semana. Del 15 de febrero al 30 de septiembre, de lunes a viernes, 8:00 a.m. 8:00 p.m. hora local, sbado 8:00 a.m. 6:00 p.m. hora local. Si llama los fines de semana, fuera del horario de servicio o un da festivo federal, entrar el servicio de contestadora automtica o vistando nuestra pgina de Internet www.cignahealthspring.com. Puede recibir una copia impresa de este directorio si as lo solicita.

  • Seccin 2 Lista de proveedores de la red Este directorio est organizado para ayudarlo a encontrar el tipo de proveedor que necesita. Los proveedores figuran en las siguientes secciones:

    - Asociacin de mdicos independientes (IPA) o Mdico de cabecera (PCP) o Especialistas o Hospitales o Centros de enfermera especializada o Proveedores de atencin de la salud emocional o Centros de ciruga ambulatoria/Centros de atencin de emergencia o Proveedores auxiliares o Proveedores de atencin dental o Proveedores del cuidado de la vista

    - Sistema organizado de prestaciones mdicas (POD)

    o Mdico de cabecera (PCP) o Especialistas o Hospitales o Centros de enfermera especializada o Proveedores de atencin de la salud emocional o Centros de ciruga ambulatoria/Centros de atencin de emergencia o Proveedores auxiliares o Proveedores de atencin dental o Proveedores del cuidado de la vista

    - Proveedores independientes

    o Mdico de cabecera (PCP) o Especialistas o Hospitales o Hospitales Psiquitricos o Centros de enfermera especializada o Proveedores de atencin de la salud emocional o Centros de ciruga ambulatoria/Centros de atencin de emergencia o Proveedores auxiliares o Proveedores de atencin dental o Proveedores del cuidado de la vista

    Cmo usar este directorio para elegir un Mdico de cabecera? Hay dos maneras de elegir un Mdico de cabecera:

    - Puede elegir un Mdico de cabecera particular por nombre; o - Puede elegir un Mdico de cabecera por ubicacin.

    Si busca un Mdico de cabecera en particular por nombre: 1. Consulte el ndice alfabtico, que se encuentra en la ltima seccin del directorio. 2. Encuentre el mdico por apellido y el(los) nmero(s) de pgina en los que figura. 3. Vaya a ese nmero de pgina para obtener informacin acerca del Mdico de cabecera.

  • Si busca un Mdico de cabecera por ubicacin: 1. Vaya a la seccin Mdico de cabecera. 2. Busque la ciudad y/o el cdigo postal. 3. Seleccione un proveedor.

    Cmo usar este directorio para elegir un especialista? Los mdicos especialistas y otros mdicos de cabecera de este directorio se encuentran por especialidad de atencin, seguidos de la ubicacin geogrfica y el nombre. Cmo usar este directorio para elegir un proveedor que acepte tanto Medicare como Medicaid? Los proveedores del plan que aceptan tanto Medicare como Medicaid se encuentran en todo este Directorio de proveedores y estn marcados con un asterisco (*). Por ejemplo, este proveedor sera un proveedor de Medicare y de Medicaid: Dr. John Doe* No obstante, este proveedor no sera un proveedor de Medicare y de Medicaid: Dr. Jane Doe Cmo usar este directorio para elegir otros proveedores del plan? Los proveedores del plan de este directorio, que no sean mdicos de cabecera y especialistas, figuran por ubicacin geogrfica seguida por el nombre del proveedor. Clave del smbolo del Directorio de proveedores En este directorio, algunos proveedores tendrn un smbolo al final de su nombre. A continuacin estn los smbolos y lo que significan:

    Smbolo Significado * Acepta Medicare y Medicaid Slo acepta pacientes existentes No acepta pacientes nuevos ^ Proveedor POS

    Nmero total de proveedores dentro de este directorio: Mdicos de cabecera (PCP): 220 Especialistas: 1015 Hospitales: 14 Centros de enfermera especializada: 29 Proveedores de atencin de la salud emocional: 102 Centros de ciruga ambulatoria/Centros de atencin de emergencia: 16 Proveedores auxiliares: 205 Proveedores de atencin dental: 1 Proveedores del cuidado de la vista: 26 Farmacias: 1056

  • Table of Contents / tabla de contenidos

    Provider Directory / Directorio de proveedores IPA Scenic City IPA Primary Care Providers / Mdico de cabecera ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................1

    POD Erlanger POD Primary Care Providers / Mdico de cabecera ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................2

    Memorial POD Primary Care Providers / Mdico de cabecera ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................5

    Peerless POD Primary Care Providers / Mdico de cabecera ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................8

    Independent Provider / Los proveedores independientes Primary Care Providers / Mdico de cabecera ..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................9Specialists / Especialistas .............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................12

    Hospitals / Hospitales ...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................45Skilled Nursing Facilities / Centros de Enfermeria Especializada .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................46Behavioral Health Providers / Proveedores de atencin de la salud emocional ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................47Ambulatory Surgical Centers / Urgent Care Facilities / Centros de ciruga ambulatoria/Centros de atencin de

    emergencia ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................51Ancillary Providers / Proveedores Auxiliarios ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................52Dental Providers / Proveedores odontolgicos .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................59Vision Providers / Proveedores del cuidado de la vista .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................60Cigna-HealthSprings Network Pharmacies / Farmacias de la red de Cigna-HealthSpringRetail Pharmacies, including Chain Pharmacies / Farmacias de venta al menudeo, incluyendo Farmacias de cadena ...........................................................................................63Mail Order Pharmacies / Farmacias de orden por correo ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................67Home Infusion Pharmacies / Farmacias de infusin en el hogar ...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................68Long-Term Care Pharmacies / Farmacias de atencin a largo plazo .......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................69

    Last Name Index / ndice de Apellidos ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................71Group Name Index / Grupo ndice de nombres ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................80IPA/POD Index / IPA/POD ndice ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................83Language Index / ndice de idioma ...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................84

  • Scenic City IPA

    Primary Care Providers / Mdico de cabecera

    IPA Scenic City IPA Hamilton

    Primary Care Providers /Mdico de cabecera

    Family Practice / MedicinaFamiliar

    Caplan, Emma J MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-24506031348 Haun, Julie MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-2450H60808 Pickett, Kimberly MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-2450QMP000004056688 Richards, Browyn P MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-2450QMP000004017215 Internal Medicine / Medicina

    InternaBhushan, Susan D MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-2450H30185

    Gooden, Katrina V MDGalen Medical Group1651 Gunbarrel Rd Suite 302 Chattanooga, TN 37421(423) 899-2904HSSPC0000012896 Helton, David K MDGalen Medical Group1651 Gunbarrel Rd Suite 302 Chattanooga, TN 37421(423) 899-2904F96994 Holsey, Tanja A MDGalen Medical Group1651 Gunbarrel Rd Suite 301 Chattanooga, TN 37421(423) 899-2580F83958 Parkhurst, Walter D MDGalen Medical Group2051 Hamill Rd Suite 201 Hixson, TN 37343(423) 870-2450B03216 Smith, William H MD*Galen Medical Group1651 Gunbarrel Rd Suite 302 Chattanooga, TN 37421(423) 899-2904G91322 Stanko, James A MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-2450B59331 Williamson, Ivey MDGalen Medical Group2051 Hamill Rd Suite 204 Hixson, TN 37343(423) 870-2450G05110

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    1

  • Erlanger POD

    Primary Care Providers / Mdico de cabecera

    POD Erlanger POD Bledsoe

    Primary Care Providers /Mdico de cabecera

    Internal Medicine / MedicinaInterna

    Dibrell, Fredrick S MDErlanger Bledsoe InternalMedicine 136 Wheelertown Ave Pikeville, TN 37367(423) 447-35246055041 Sapp, Robert MDUT Erlanger Health Network136 Wheelertown Ave Pikeville, TN 37367(423) 447-3524HSSPC0000049069

    Catoosa Family Practice / Medicina

    Familiar Kelleher, Sonja B MDErlanger Physician Group60 Erlanger South DrSuite A Ringgold, GA 30736(706) 937-9292Pending

    Hamilton Family Practice / Medicina

    Familiar Adams, Stephen M MD*Erlanger Physician Group1100 E 3rd St Chattanooga, TN 37403(423) 778-8837G24306 Adams, Stephen M MD*Erlanger Physician Group501 Houston St Metro Bldg Anx Suite 202Chattanooga, TN 37403(423) 425-4453G24306

    Arnold, Kelly R MDErlanger Physician Group1100 E 3rd St Chattanooga, TN 37403(423) 778-88376033322 Bruncoll, Terri MDErlanger Physician Group1025 Executive Dr Suite 100 Hixson, TN 37343(423) 870-2030QMP000003869886 Bustamante, Georgina MDErlanger Physician Group1200 Dodson Ave Chattanooga, TN 37406(423) 778-2800Pending Bustamante, Georgina MDErlanger Physician Group100 E 37th St Chattanooga, TN 37410(423) 778-2700Pending Close, Elizabeth MDErlanger Physician Group1100 E 3rd St Chattanooga, TN 37403(423) 778-93006024527 Close, Elizabeth MDErlanger Physician Group1200 Pineville Rd Chattanooga, TN 37405(423) 265-00636024527 Close, Elizabeth MDErlanger Physician Group579 Alexian WaySuite 409 Signal Mountain, TN 37377(423) 778-93006024527 Close, Elizabeth MDErlanger Physician Group2600 Taft HwySignal Mountain, TN 37377(423) 778-94346024527

    Conner, David C MD* Furr, Helen MDErlanger Physician Group Erlanger Physician Group100 E 37th St 979 E 3rd St Chattanooga, TN 37410 Suite 601 B (423) 778-2700 Chattanooga, TN 37403B04878 (423) 778-8179

    I40261 Conner, David C MD*Erlanger Physician Group Ghamgosar, Farrokh MD*1200 Dodson Ave Erlanger Physician GroupChattanooga, TN 37404 100 E 37th St (423) 778-2700 Chattanooga, TN 37410B04878 (423) 778-2700

    F70025 Cromer, Stephen F MD*Erlanger Physician Group Ghamgosar, Farrokh MD*632 Morrison Springs Rd Erlanger Physician GroupSuite 202 1200 Dodson Ave Chattanooga, TN 37415 Chattanooga, TN 37406(423) 778-3329 (423) 778-2800Pending F70025 Cromer, Stephen F MD* Griffin, Leslie MDErlanger Physician Group Erlanger Physician Group720 E 4th St 1100 E 3rd St Chattanooga, TN 37403 Chattanooga, TN 37403(423) 778-6627 (423) 778-8837Pending 6050498 Cromer, Stephen F MD* Hart, Lisa L MD*Erlanger Physician Group Erlanger Physician Group1100 E 3rd St 632 Morrison Springs RdChattanooga, TN 37403 Suite 202 (423) 778-8837 Chattanooga, TN 37415Pending (423) 778-3329

    6031302 Cromer, Stephen F MD*Erlanger Physician Group Hart, Lisa L MD*979 E 3rd St Erlanger Physician GroupSuiteB200 1200 Pineville Rd Chattanooga, TN 37403 Chattanooga, TN 37405(423) 778-2570 (423) 265-0063QMP000003459023 6031302 Dassow, Paul MD Haynes, James W MDErlanger Physician Group Erlanger Physician Group1100 E 3rd St 1100 E 3rd St Chattanooga, TN 37403 Chattanooga, TN 37403(423) 778-8837 (423) 778-88376040410 6050101 Fox, Steven MD* Miller, Stephen C DOErlanger Physician Group Erlanger Physician Group1100 E 3rd St 979 E 3rd St Chattanooga, TN 37403 Suite 601 B (423) 788-8837 Chattanooga, TN 37403HSSPC0000031827 (423) 778-8179

    Pending

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    2

  • Erlanger POD

    Primary Care Providers / Mdico de cabecera

    Hamilton (cont.) Family Practice / Medicina

    Familiar (cont.) Peixoto, Lincoln MDErlanger Physician Group

    100 E 37th StChattanooga, TN 37410

    (423) 778-2700

    QMP000003993289Peixoto, Lincoln MDErlanger Physician Group

    1200 Dodson AveChattanooga, TN 37406

    (423) 778-2800

    QMP000003993289Rapp, Susan MD7380 Volkswagen Dr

    Chattanooga, TN 37421

    (423) 778-8950

    6046721Sharma, Naina MDErlanger Physician Group

    1200 Dodson AveChattanooga, TN 37406

    (423) 778-2800

    H72100Shepherd, Michael D MDErlanger Physician Group

    1100 E 3rd StChattanooga, TN 37403

    (423) 778-9300

    6056786Smith Jr, Bill Moore MDErlanger Physician Group

    1200 Pineville RdChattanooga, TN 37405

    (423) 265-0063

    Language(s): Spanish

    B06347Smith Jr, Bill Moore MDErlanger Physician Group

    632 Morrison Springs Rd

    Suite 202Chattanooga, TN 37415

    (423) 778-3329

    Language(s): Spanish

    B06347

    Smith Jr, Bill Moore MDErlanger Physician Group

    720 E 4th StChattanooga, TN 37403

    (423) 778-9303

    Language(s): Spanish

    B06347Sohi, Shahnaz A MD*Erlanger Physician Group

    1200 Dodson AveChattanooga, TN 37406

    (423) 778-2800

    6094827Sohi, Shahnaz A MD*Erlanger Physician Group

    100 E 37th StChattanooga, TN 37410

    (423) 778-2721

    6094827Wilcox, Kirk MD*Erlanger Physician Group

    1025 Executive DrSuite 100Hixson, TN 37343

    (423) 870-2030

    QMP000004079317Worthington, J Mack MD*Erlanger Physician Group

    1100 E 3rd StChattanooga, TN 37403

    (423) 778-8837

    B04060Worthington, J Mack MD*Erlanger Physician Group

    501 Houston StMetro Bldg Anx Suite 202

    Chattanooga, TN 37403

    (423) 425-4453

    B04060Geriatrics / Medicina

    GeritricaTalbert, Malissa G MD*Erlanger Physician Group

    1100 E 3rd StChattanooga, TN 37403

    (423) 778-8837

    6018458

    Internal Medicine / Medicina

    Interna

    Alvarez, David M MD*Erlanger Physician Group

    979 E 3rd StSuite 601 BChattanooga, TN 37403

    (423) 778-8179

    HSSPC0000042343Ayyoub, Shadi MDErlanger Physician Group

    960 E 3rd StSuite 208Chattanooga, TN 37403

    (423) 778-2550

    6046867Blake, Melanie MDErlanger Physician Group

    960 E 3rd StSuite 208Chattanooga, TN 37403

    (423) 778-2550

    6031321Blake, Melanie MDErlanger Physician Group

    979 E 3rd StSuite 601 BChattanooga, TN 37403

    (423) 778-8179

    6031321Blake, Melanie MDErlanger Physician Group

    2600 Taft Hwy

    Signal Mountain, TN 37377

    (423) 778-9434

    6031321Cranwell, John D MD*Erlanger Physician Group

    2600 Taft Hwy

    Suite 100Signal Mountain, TN 37377

    (423) 778-9434

    QMP000003782006DeVersa, Peter MD*Erlanger Physician Group

    979 E 3rd StSuite 601 BChattanooga, TN 37403

    (423) 778-8179

    HSVEN0000013815

    DeVersa, Peter MD*Erlanger Physician Group

    960 E 3rd StSuite 208Chattanooga, TN 37403

    (423) 778-2550

    HSVEN0000013815Douglas, Michael MDErlanger Physician Group

    1720 Gunbarrel RdSuite 110Chattanooga, TN 37421

    (423) 899-5241

    HSSPC0000034987Dozier, Tracy M MDErlanger Physician Group

    979 E 3rd StSuite 601 BChattanooga, TN 37403

    (423) 778-8179

    6052824Dozier, Tracy M MDErlanger Physician Group

    960 E 3rd StSuite 208Chattanooga, TN 37403

    (423) 778-2550

    6052824Gefter, Monica L MDErlanger Physician Group

    960 E 3rd StSuite 208Chattanooga, TN 37403

    (423) 778-2550

    B59554Gefter, Monica L MDErlanger Physician Group

    979 E 3rd StSuite 601 BChattanooga, TN 37403

    (423) 778-8179

    B59554Kolade, Victor MDErlanger Physician Group

    960 E 3rd StSuite 208Chattanooga, TN 37403

    (423) 778-2550

    6031334

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    3

  • Erlanger POD

    Primary Care Providers / Mdico de cabecera

    Hamilton (cont.) Internal Medicine / Medicina

    Interna (cont.) Lawrence, Paul MDErlanger Physician Group1720 Gunbarrel Rd Suite 110 Chattanooga, TN 37421(423) 899-5241HSSPC0000041030 Panda, Mukta MDErlanger Physician Group960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-2550G76554 Panda, Mukta MDErlanger Physician Group979 E 3rd St Suite 601 B Chattanooga, TN 37403(423) 778-8179G76554 Qayyum, Rehan MDUT Erlanger Health Network960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-2550Pending Rigsby, Lonard MD*Erlanger Physician Group979 E 3rd St Suite 601 B Chattanooga, TN 37403(423) 778-8179HSSPC0000037002 Rigsby, Lonard MD*Erlanger Physician Group960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-7610HSSPC0000037002

    Salim, Howiada MDErlanger Physician Group960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-25506064148 Staton, Lisa J MDErlanger Physician Group960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-25506031313 Staton, Lisa J MDErlanger Physician Group979 E 3rd St Suite 601 B Chattanooga, TN 37403(423) 778-76106031313 Tudor, Maria E MDErlanger Physician Group960 E 3rd St Suite 208 Chattanooga, TN 37404(423) 778-2550I49909 Whitley, Jennifer MDErlanger Physician Group960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-25506046724 Young, Tye B DOErlanger East Family Practice1751 Gunbarrel Rd Suite 201 Chattanooga, TN 37421(423) 778-89096128564 Young, Tye B DOErlanger-Health and WellnessSignal Mountain1200 Pineville Rd Chattanooga, TN 37405(423) 265-00636128564

    Young, Tye B DOErlanger East Family Practice2600 Taft HwySignal Mountain, TN 37377(423) 778-94346128564 Young, Tye B DOErlanger East Family Practice960 E 3rd St Suite 208 Chattanooga, TN 37403(423) 778-25506128564

    Sequatchie Family Practice / Medicina

    Familiar Cromer, Stephen F MD*Erlanger Physician Group16931 Rankin Ave Sports MedicineDunlap, TN 37327(423) 265-0063QMP000003459023 Internal Medicine / Medicina

    InternaCranwell, John D MD*Erlanger Physician Group16931 Rankin Ave Suite BG100 Dunlap, TN 37327(423) 949-2801QMP000003782006

    Walker Family Practice / Medicina

    Familiar Smith Jr, Bill Moore MDErlanger Physician Group101 McFarland Ave Lookout Mountain, GA 30750(706) 820-8133Language(s): SpanishB06347

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    4

  • Memorial PODPrimary Care Providers / Mdico de cabecera

    POD Memorial POD Bradley

    Primary Care Providers /Mdico de cabecera

    Family Practice / MedicinaFamiliar

    Bates, William T MD*Memorial Health Partners Foundation 645 Paul Huff PkwySuite 105 Cleveland, TN 37312(423) 790-7750HSSPC0000007165

    Catoosa Family Practice / Medicina

    Familiar Chaudhari, Kaushal S MDMemorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-4990QMP000004115773 Cornwell, William O MDMemorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-4990B58996 Dant, Michael E MDMemorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-4990A99242 Denman, David A MDMemorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-49906031155

    Greene, Christopher M MDMemorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-49906031156 Ireland, Stanley M MDMemorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-4990C36365 Phillips, Melissa J MD*Memorial Health Partners Foundation 4700 Battlefield PkwySuite 200 Ringgold, GA 30736(706) 861-4990B04256

    Hamilton Family Practice / Medicina

    Familiar Bilbrey, Julie M MD*Memorial Health Partners Foundation 210 Walmart Dr Soddy Daisy, TN 37379(423) 332-61556031153 Boroughs, Eileen Y MD*Memorial Health Partners Foundation 3370 Jenkins Rd Chattanooga, TN 37421(423) 648-8005QMP000003664447 Castrilli, David MD* Memorial Health Partners Foundation 1720 Gunbarrel Rd Suite 206 Chattanooga, TN 37421(423) 648-8110QMP000004084149

    Crago, Mark S MD* Johnson, Bruce W MD*Memorial Health Partners Memorial Health Partners Foundation Foundation 6401 Mountain View Rd 6401 Mountain View Rd Suite 109 Suite 109 Ooltewah, TN 37363 Ooltewah, TN 37363(423) 495-5951 (423) 495-5951Pending D45758 Davis, Jimmy B MD* Jump, Jeffrey MDMemorial Health Partners Memorial Health Partners Foundation Foundation 3905 Hixson Pk 320 E Main St Suite 103 Suite 200 Chattanooga, TN 37415 Chattanooga, TN 37408(423) 756-1506 (423) 643-2246B02033 Pending Davis, Jimmy B MD* McClanahan, Matthew MDMemorial Health Partners Memorial Health Partners Foundation Foundation 1200 Grove St 320 E Main St Chattanooga, TN 37402 Suite 200 (423) 634-0225 Chattanooga, TN 37408B02033 (423) 643-2246

    Pending Grotefendt, Kent A MD*Memorial Health Partners McKenzie, Mary MD*Foundation Memorial Health Partners 6401 Mountain View Rd Foundation Suite 109 320 E Main St Ooltewah, TN 37363 Suite 200 (423) 495-5951 Chattanooga, TN 37408G35849 (423) 643-2246

    QMP000004207700 Harless, Renee R MDMemorial Health Partners Naik, Janak H MDFoundation Memorial Health Partners 725 Glenwood Dr Foundation Suite 490 E 6800 Harrison Park Dr Chattanooga, TN 37404 Harrison, TN 37341(423) 624-8866 (423) 344-7095A99498 G24837 Jarl, Ronald W MD Pigg, Richard W MD*Memorial Health Partners Memorial Health Partners Foundation Foundation 210 Walmart Dr 2051 Hamill Rd Soddy Daisy, TN 37379 Suite 301 (423) 332-6155 Hixson, TN 37343G41135 (423) 877-1249

    Pending

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    5

  • Memorial PODPrimary Care Providers / Mdico de cabecera

    Hamilton (cont.) Family Practice / Medicina

    Familiar (cont.) Salt, Nicholas J MD*Memorial Health PartnersFoundation6800 Harrison Park DrHarrison, TN 37341

    (423) 344-7095

    G11306Sherwood, Allen T MDErlanger Physician Group

    6401 Mountain View RdSuite 109Ooltewah, TN 37363

    (423) 495-5951

    E50714Speer, Owen F MDMemorial Health PartnersFoundation2051 Hamill RdSuite 301Hixson, TN 37343

    (423) 877-1249

    PendingWagg, Christopher A MD*Memorial Health PartnersFoundation3739 Hixson PkHixson, TN 37363

    (423) 875-0999

    QMP000004134654Wagg, Christopher A MD*Memorial Health PartnersFoundation2051 Hamil RdSuite 301Hixson, TN 37363

    (423) 877-1249

    QMP000004134654Winters, David R MD*Memorial Health PartnersFoundation6401 Mountain View RdSuite 109Ooltewah, TN 37363

    (423) 495-5951

    C36473

    Internal Medicine / Medicina

    Interna

    Alay, Rohini MDMemorial Health PartnersFoundation1720 Gunbarrel RdSuite 206Chattanooga, TN 37421

    (423) 648-8110

    HSSPC0000042391Andreescu, Oana MDMemorial Health PartnersFoundation2051 Hamill RdSuite 301Hixson, TN 37343

    (423) 877-1249

    6037537Cooke, Justin T MDMemorial Health PartnersFoundation1238 Taft Hwy

    Suite 170Signal Mountain, TN 37377

    (423) 886-2004

    6042414Cooke, Justin T MDMemorial Health PartnersFoundation437 Alexian Way

    Signal Mountain, TN 37377

    (423) 362-7900

    6042414Donowitz, Arlene J MD*Memorial Health PartnersFoundation605 Glenwood DrSuite 404Chattanooga, TN 37404

    (423) 629-7220

    A99986Dowlen, Steven H MD*Memorial Health CareSystems

    605 Glenwood DrSuite 300Chattanooga, TN 37404

    (423) 495-2690

    A96896

    Duplooy, Johannes J MD* Mariani, Mario E MD*Memorial Health Partners Memorial Health PartnersFoundation Foundation605 Glenwood Dr 3739 Hixson PkSuite 300 Chattanooga, TN 37415

    Chattanooga, TN 37404 (423) 875-0999

    (423) 495-2960 G52082G49336 Nieckula, Gregory MDElias, David B MD Memorial Health PartnersMemorial Health Partners FoundationFoundation 1238 Taft Hwy

    605 Glenwood Dr Suite 170Suite 300 Signal Mountain, TN 37377

    Chattanooga, TN 37404 (423) 886-2004

    (423) 495-2690 QMP000004115773E50916 Nieckula, Gregory MDHeinsohn, Mark E MD* Memorial Health PartnersMemorial Health Partners FoundationFoundation 437 Alexian Way

    605 Glenwood Dr Signal Mountain, TN 37377

    Suite 404 (423) 362-7900

    Chattanooga, TN 37404 QMP000004115773(423) 629-7220

    C73463 Oconnell, James J MDMemorial Health PartnersJolley, Kellie A MD FoundationMemorial Health Partners 2051 Hamill RdFoundation Suite 301725 Glenwood Dr Hixson, TN 37343

    Suite 788 (423) 877-1249

    Chattanooga, TN 37404 G09621(423) 495-3940

    G71596 Ozborn, George MichaelMD* Jurgens, Liezelle MD* Memorial Health PartnersMemorial Health Partners FoundationFoundation 3739 Hixson Pk725 Glenwood Dr Chattanooga, TN 37415

    Suite 788 E (423) 875-0999

    Chattanooga, TN 37404 B03212(423) 495-3940

    G74528 Parker, Christine MDMemorial Health PartnersLaramore, John W MD* FoundationMemorial Health Partners 725 Glenwood DrFoundation Suite 788 E605 Glenwood Dr Chattanooga, TN 37404

    Suite 404 (423) 495-3940

    Chattanooga, TN 37404 H05738(423) 629-7720

    B02889

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    6

  • Memorial PODPrimary Care Providers / Mdico de cabecera

    Hamilton (cont.) Internal Medicine / Medicina

    Interna (cont.)

    Rheumatology /

    Reumatologa

    Rhyne, Patrick N MDMemorial Health Partners Foundation 605 Glenwood Dr Suite 300 Chattanooga, TN 37404(423) 495-2690H35890 Selzer, Jerrold L MD*Memorial Health Partners Foundation 3739 Hixson Pk Chattanooga, TN 37415(423) 875-0999B04103 Sowell, Richard ForrestMD* Memorial Health Partners Foundation 605 Glenwood Dr Suite 300 Chattanooga, TN 37404(423) 495-2690G71598 Strickland, Adrien K MD*Memorial Health Partners Foundation 605 Glenwood Dr Suite 404 Chattanooga, TN 37404(423) 629-7220QMP000003930408 Williams, Robert Henry MDMemorial Health Partners Foundation 605 Glenwood Dr Suite 300 Chattanooga, TN 37404(423) 495-2690B03800 Wood, Michael J MD*Memorial Health Partners Foundation 3739 Hixson Pk Chattanooga, TN 37415(423) 877-0999C37528

    Garcia-Rosell, Melinda MDMemorial Health Partners Foundation 725 Glenwood Dr Suite E-884 Chattanooga, TN 37404(423) 362-7990QMP000004177212

    Rhea Family Practice / Medicina

    Familiar Casady, Beth A MDMemorial Health Partners Foundation 215 Clinton Ave Spring City, TN 37381(423) 365-21716056926

    Walker Family Practice / Medicina

    Familiar Scoggins, Ted A MDMemorial Health Partners Foundation 611 E Villanow St LaFayette, GA 30728(706) 638-16066031140 Storey, Suzanne MDMemorial Health Partners Foundation 611 E Villanow St LaFayette, GA 30728(706) 638-16066031144

    *Accepts Medicare and Medicaid Accepting Existing Patients Only Not Accepting New Patients ^POS Provider *Acepta Medicare y Medicaid Slo acepta pacientes recurrentes No acepta pacientes nuevos ^Proveedor del POS

    7

  • Peerless PODPrimary Care Providers / Mdico de cabecera

    POD Peerless POD Bradley

    Primary Care Providers /Mdico de cabecera

    Family Practice / MedicinaFamiliar

    Breetzke, Cecil B MD*Skyridge Clinical Associates1060 Peerless CrossingSuite 200 Cleveland, TN 37312(423) 479-4165E99401 Campbell, Brent Jeremy MDSkyridge Clinical Associates1060 Peerless CrossingSuite 200 Cleveland, TN 37312(423) 479-41656026652 Djernes, Karisten MD1060 Peerless CrossingCleveland, TN 37312(423) 479-4165QMP000004129661 Petersen, Anders E MDSkyridge Clinical Associates1060 Peerless CrossingSuite 101 Cleveland, TN 37312(423) 479-41656062361 Internal Medicine / Medicin

    InternaChastain, G Kent MDSkyridge Clinical Associates1060 Peerless CrossingSuite 200 Cleveland, TN 37312(423) 479-4165A97905 Finch, Susan G MDSkyridge Clinical Associates1060 Peerless CrossingSuite 200 Cleveland, TN 37312(423) 479-41656059323

    Huebschman, Jon C MDSkyridge Clinical Associates1060 Peerless CrossingSuite 200 Cleveland, TN 37312(423) 479-4165A99368 Marquez, Obadias MDOoltewah Medical Services 6059 Arbury WaySuite 101 Cleveland, TN 37312(423) 238-8880Language(s): SpanishH60155 Taylor, Owen C MDSkyridge Clinical Associates1060 Peerless CrossingSuite 200 Cleveland, TN 37312(423) 479-4165B04061 Tilson, F