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PHP Medicare - Provider Directory - Provider Pharmacy

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PHP Medicare - Provider Directory - Provider Pharmacy Directory2022 Provider Directory Medicare Advantage
This Provider/Pharmacy Directory was updated on 02/02/2022. For more recent information or other questions, please contact PHP Medicare Customer Service at 844.529.3757 (TTY: 711), 8 a.m. to 8 p.m., seven days a week. You may reach a messaging service on weekends from April 1 through Sept. 30 and holidays. Please leave a message, and your call will be returned the next business day, or visit Member.PHPMedicare.com.
Changes to our Provider/Pharmacy Directory may occur during the benefit year. An updated Provider/Pharmacy Directory is located on our website at Member.PHPMedicare.com. You may also call Customer Service for updated provider information.
This directory is current as of February 2, 2022.
This directory provides a list of the PHP Medicare current network providers. This directory is for the is for the PHP Medicare Advantage service area. It includes Bay, Calhoun, Clinton, Eaton, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Livingston, Montcalm, Saginaw, Shiawassee, Tuscola and Washtenaw counties in Michigan. As a member of our plan, you can choose to receive care from out-of-network providers. Our plan will cover services from either in-network or out-of-network providers, as long as the services are medically necessary and covered benefits. However, if you use an out-of-network provider, your share of the costs for your covered services will be higher. If you receive care from a provider who is not eligible to participate in Medicare, you will be responsible for the full cost of services you receive. Please refer to Chapter 3 of your Evidence of Coverage (EOC) for complete details. To access the PHP Medicare online provider directory, you can visit www.phpmedicare.com. For any questions about the information contained in this directory (hardcopy or online), please call our Customer Service Department at 844-529-3757, from 8 a.m. to 8 p.m., seven days a week. You may reach a messaging service on weekends from April 1 through September 30 and holidays. Please leave a message, and your call will be returned the next business day. TTY users should call 711. To request a hard copy of PHP Medicare’s provider directory, please call our Customer Service Department at 844-529-3757, from 8 a.m. to 8 p.m., seven days a week. PHP Medicare will mail a hard copy of the provider directory to you within three (3) business days of your request. PHP Medicare may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the provider directory in hard copy permanently. If you request it, your request for hard copies of the provider directory remains until you leave PHP Medicare or request that hard copies be discontinued. PHP Medicare is an HMO-POS plan with a Medicare contract. Enrollment in PHP Medicare depends on contract renewal. If you need language translation services, call us at 844-529-3757. Your call will be answered by someone who speaks English, who will help connect you to an interpreter for your language. This is a free service.
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This information may also be available in a different format, including Braille, large print or audio. Please call customer service at the number listed above if you need plan information in another format. The provider and/or pharmacy network may change at any time. You will receive notice when necessary.
Provider Directory
TABLE OF CONTENTS
Section 1 - Introduction .............................................................. 6 What is the service area for PHP Medicare? ...................................................... 9 How do you find PHP Medicare providers in your area? ...................................... 9
Section 2 - List of Network Providers ........................................... 10 Hospitals .................................................................................................. 10
Hospitals (45) .................................................................................. 10 Primary Care Providers ............................................................................... 13
Primary Care Physicians (1659) .......................................................... 13 Specialty Care Providers ............................................................................ 142
Allergy & Immunology (70) ............................................................... 142 Cardiothoracic Surgery (76) .............................................................. 146 Cardiovascular Disease (446) ............................................................ 152 Chiropractic (194) ........................................................................... 185 Colorectal Surgery (23) .................................................................... 195 Dermatology (211) .......................................................................... 197 Endocrinology (86) .......................................................................... 212 Female Pelvic Medicine and Reconstruction (4) ..................................... 219 Gastroenterology (215) .................................................................... 220 General Surgery (336) ..................................................................... 246 Geriatric Medicine (24) ..................................................................... 270 Gynecological Oncology (7) ............................................................... 272 Hand Surgery (35)........................................................................... 273 Hematology (34) ............................................................................. 275 Infectious Disease (97) .................................................................... 277 Nephrology (168) ............................................................................ 284 Neurological Surgery (79) ................................................................. 297 Neurology (244) .............................................................................. 304 Nuclear Medicine (3) ........................................................................ 329 Obstetrics / Gynecology (453) ........................................................... 329 Oncology (155) ............................................................................... 365 Ophthalmology (366) ....................................................................... 375 Optometrist (368) ........................................................................... 402 Oral and Maxillofacial Surgery (18) ..................................................... 427 Orthopedic Surgery (244) ................................................................. 429 Otolaryngology (ENT) (180) .............................................................. 446 Pain Management (105) ................................................................... 459 Physical Medicine & Rehabilitation (141) .............................................. 469 Plastic & Reconstructive Surgery (71) ................................................. 481 Podiatry (103) ................................................................................ 486 Pulmonary Disease (148) .................................................................. 493 Radiation Oncology (88) ................................................................... 505 Rheumatology (58) .......................................................................... 510 Sleep Medicine (19) ......................................................................... 516 Sports Medicine (37) ........................................................................ 517
Provider Directory
Urology (202) ................................................................................. 520 Vascular Surgery (81) ...................................................................... 536
Other Contracted Providers ........................................................................ 542 Ambulatory Surgical Center (9) ......................................................... 542 Audiology (43) ................................................................................ 542 Audiology Center (22) ...................................................................... 545 Dialysis Center (87) ......................................................................... 547 Durable Medical Equipment (54) ........................................................ 552 Free Standing Radiology (4) .............................................................. 555 Home Health Agency (22) ................................................................. 555 Home Infusion Therapy (5) ............................................................... 556 Independent Lab (11) ...................................................................... 557 Long Term Care Facility (1) ............................................................... 558 Orthotics and Prosthetics (6) ............................................................. 558 Rehabilitation Hospital (10) ............................................................... 559 Routine Hearing Exams and Hearing Aids (1) ....................................... 559 Skilled Nursing Facility (49) ............................................................... 559 Therapy - Occupational (5) ............................................................... 562 Therapy - Physical (31) .................................................................... 562 Therapy - Speech (2) ....................................................................... 564 Transportation (1) ........................................................................... 564 Urgent Care Center (31) ................................................................... 564
Mental Health, Chemical Dependency and Substance Abuse Providers ............... 567 Facilities Behavioral Health - Outpatient (14) ...................................... 567 Facilities Behavioral Health - Inpatient (13) ......................................... 568 Facilities Substance Abuse - Inpatient (4) ............................................ 568 Facilities Substance Abuse - Outpatient (5) .......................................... 569 Licensed Clinical Social Worker (1086) ................................................ 569 Licensed Professional Counselor (33) .................................................. 635 Psychiatry (336) .............................................................................. 636 Psychology (356) ............................................................................ 669
Dental Care Providers ............................................................................... 696 Dental Health (5) ............................................................................ 696
Routine Vision Care Providers ..................................................................... 697 Routine Vision (1) ............................................................................ 697
Pharmacy Directory .................................................................................. 698 Retail Pharmacies including Chain Pharmacies (1316) ............................ 699 Mail Order Pharmacy ........................................................................ 763 Mail Order Pharmacies (1) ................................................................ 763 Home Infusion Pharmacies ................................................................ 764 Home Infusion (84) ......................................................................... 764 Long Term Care Pharmacies .............................................................. 769 Long Term Care (155) ...................................................................... 769
Alphabetical Provider Index ........................................................................ 778
Section 1 - Introduction
Section 1 - Introduction This directory provides a list of the PHP Medicare network providers. To get detailed information about your healthcare coverage, please see your Evidence of Coverage (EOC). You will have to choose one of our network providers listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your healthcare services from your PCP. The name and telephone number of your PCP are printed on your Member ID card. The network providers listed in this directory have agreed to provide you with your healthcare, vision and dental services. 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 out-of-network providers. Please refer to your EOC for details. Providers identified with an asterisk (*) also accept Medicaid. The number following the 10-digit number listed below the provider’s name is the provider’s National Provider Identifier (NPI) number. In the Hospital section of this directory, the capital letters following the word “Code” show that hospital’s code. When a hospital’s code follows a provider’s information, it indicates to which hospital(s) that provider has privileges for admitting patients. You will get your routine or basic care from your PCP. Your PCP will coordinate the rest of the covered services you need. This includes x-rays, laboratory tests, therapies, specialist visits, hospital admissions and follow-up care. Your PCP also contacts other providers for updates about your care and/or treatment. If you need certain types of covered services or supplies, your PCP must give approval ahead of time. Your PCP must give you a referral to see a specialist. When your PCP thinks you need specialized treatment, he or she will give you a “referral” (approval ahead of time) to see a specialist. A specialist is a doctor who provides healthcare services for a specific disease or part of the body. If you want to use a particular specialist or hospital, you should check with your PCP to make sure he or she can make referrals to that specialist or hospital. It is very important to get a referral from your PCP before you see a specialist. If you do not have a referral before you get services from a specialist, you may have to pay for these services yourself. If the specialist wants you to come back for follow-up visits, be sure to check the original referral to see if these were included. In some cases, your PCP will need to get prior authorization from PHP Medicare. A prior authorization is an approval from the plan for medical services and must be requested before services are received. Since your PCP will provide and coordinate your healthcare, you should have all of your past medical records sent to your new PCP’s office. The law requires us to protect the privacy of your medical records and personal health information. For more information about privacy, see your Evidence of Coverage (EOC). You may change your PCP for any reason, at any time. To change your PCP, call our Customer Service Department. PCP changes take effect the first day of the following month. Requests for retroactive changes are typically not approved. When you call, be
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sure to let the customer service representative know if you are seeing specialists or getting other covered services that needed your PCP’s approval (such as home health services and durable medical equipment). The customer service representative will change your membership record to show the name of your new PCP. You will receive an updated Member ID card with the name and telephone number of your new PCP. Some services you may get on your own. There are only a few types of covered services you can get without seeing your PCP first. “Self-referred” means you get service on your own. If you get self-referred services, you still have to pay a copayment. If you get a self- referred service from a network provider, you will only have to pay the in-network copayment. If you obtain routine care from an out-of-network provider, you will pay a higher share of the cost.
The following services may be self-referred:
• Routine eye exam – an annual exam for the purposes of determining changes to your vision and the possible need for eyeglasses or contact lenses. Please see the “Routine Vision Care Provider” section at the end of this directory for information on how to find network providers that you may use without a referral from your PCP.
• Routine women’s healthcare – this includes breast exams, mammograms (x-rays of the breast), pap tests and pelvic exams. This care is covered without a referral from your PCP.
• Flu shots and pneumonia vaccinations – you will pay no deductible, copayment or co- insurance if you receive these from an in-network provider.
• Emergency services – whether you get these services from network providers or out-of- network providers, emergency services including hospital care after you are stable (known as post-stabilization) are also covered.
• Urgently needed care – this includes care you receive from out-of-network providers.
• Renal dialysis – kidney services that you get when you are temporarily outside the plan’s service area are covered. If possible, please let us know before you leave the service area and where you will be. We can help arrange for you to have maintenance dialysis while you are away.
Getting care when traveling or when you are away from the plan’s service area. If you need medical care when you are outside the service area, your healthcare coverage is very limited. The only services we cover when you are outside our service area are care for a medical emergency, including maintenance care and hospital care after you are stable (known as post-stabilization care), urgently needed care, renal dialysis (kidney), and care that PHP Medicare has approved in advance. If you question whether a service is covered when you travel, please call our Customer Service Department. The difference between a medical emergency and urgently needed care is the seriousness of the condition.
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• A medical emergency is when you believe your health is in serious danger—when every second counts. You may have a bad injury, sudden illness or an illness that is quickly getting much worse.
• Urgently needed care is care you get for a sudden illness or injury that needs medical care right away, but is not life threatening. Treatment for a sprained ankle is an example of urgently needed care.
If you have a medical emergency:
• Get medical help as quickly as possible. Call 911 for help or go directly to the nearest emergency room. In any emergency, you do not need permission (authorization) or a referral before getting medical assistance.
• Emergency medical care is covered whenever you need it, anywhere in the world. • Ambulance services are covered in situations where other means of transportation,
anywhere in the world, would endanger your health. • As soon as possible, you or someone else should contact your PCP about your
emergency. Your PCP’s telephone number is located on your Member ID card. Your PCP needs to know about your emergency because he/she will provide or arrange follow-up care. Please try to contact your PCP about your emergency within 48 hours.
Your PCP will help manage and follow up on your emergency care. It is important to know that every emergency has two stages. When the doctors or hospital providing emergency care consider your condition stable, the first stage of the medical emergency ends. However, even after your condition is stabilized, you are still considered in an emergency situation and PHP Medicare must pay for post-stabilization treatment provided by the hospital (whether or not this hospital is a network provider or not). The second stage of the emergency, after your condition is stabilized, is called post-stabilization. Generally, the hospital, or doctors, providing emergency care will try to talk to your PCP. This helps the plan arrange for network providers to take over your care as soon as your condition and circumstances get better. Once your PCP takes over your care or agrees with the attending hospital on an appropriate course of action (or once you are discharged, if you are fully recovered), you are no longer in an emergency or post-stabilization situation. When you are past the emergency and post-stabilization stages, you may still need follow-up care. PHP Medicare is responsible for your follow-up care. PHP Medicare will only pay for follow-up care (care provided after your emergency and post-stabilization stages) if you follow the plan rules. Your PCP can assist you with finding providers and securing the appropriate referrals and authorizations. You should never pay any out-of-network provider more than what the provider is allowed by Medicare. The provider has a right to get his or her fees but does not have a right to receive them from you. Ask the out-of-network provider to bill us first. If you have already paid for the covered services, we will reimburse you for our share of the cost. If you get a bill for the services, you can send the bill to us for payment. We will pay the out-of-network provider for our share of the bill if it meets the criteria noted above and will let you know what, if anything, you must pay. If an out-of-network provider asks you to pay for covered services you get in these situations, please call our Customer Service Department.
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While PHP Medicare does not contract with specialists who provide certain services at a healthcare facility (such as anesthesiologists and pathologists), we do pay the facility for the cost of these services when provided at a facility that is contracted with PHP Medicare. If you receive a bill for such services, please contact PHP Medicare customer service. What is the service area for PHP Medicare? The counties in our service area are listed below. Bay, Calhoun, Clinton, Eaton, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Livingston, Montcalm, Saginaw, Shiawassee, Tuscola and Washtenaw counties in Michigan. How do you find PHP Medicare providers in your area? This directory includes individual sections for our Network Hospitals, Primary Care Providers, Specialists, Other Contracted Providers, Mental Health Providers, Routine Vision Care Providers and Pharmacies. Each section is organized first by state, then by county. An alphabetical index of providers can be found at the end of the directory. If you have questions about PHP Medicare or require assistance in selecting a PCP, please call our Customer Service Department at 844-529-3757, from 8 a.m. to 8 p.m., seven days a week. You may reach a messaging service on weekends from April 1 through September 30 and holidays. Please leave a message, and your call will be returned the next business day. TTY users should call 711. You can also visit www.phpmedicare.com.
PHP Medicare Hospitals
Hospitals (45) MICHIGAN Barry County, MI Spectrum Health Pennock Hospital #1932695525 Code: SHPH 1009 W Green St Hastings, MI 49058 (269) 945-3451
Bay County, MI McLaren Bay Region #1528031226 Code: MCBR 1900 Columbus Ave Bay City, MI 48708 (989) 894-3000
Calhoun County, MI Bronson Battle Creek Hospital #1083644579 Code: BBCH 300 North Ave Battle Creek, MI 49017 (269) 245-8000
Oaklawn Hospital #1861475360 Code: OLH 200 N Madison St Marshall, MI 49068 (269) 781-4271
Clinton County, MI Sparrow Clinton Hospital #1093809824 Code: SPCH 805 S Oakland St Saint Johns, MI 48879 (989) 224-6881
Eaton County, MI Sparrow Eaton Hospital #1942254529 Code: SEH 321 E Harris St Charlotte, MI 48813 (517) 543-1050
Genesee County, MI McLaren Flint #1902894512 Code: MCFT 401 S Ballenger Hwy Flint, MI 48532 (810) 342-2000
Hillsdale County, MI Hillsdale Community Health Center #1730115940 Code: HILL 168 S Howell St Hillsdale, MI 49242 (517) 437-4451
Huron County, MI McLaren Thumb Region #1518991744 Code: MLTR 1100 S Van Dyke Rd Bad Axe, MI 48413 (989) 269-9521
Scheurer Hospital #1437102993 Code: SCHE 170 N Caseville Rd Pigeon, MI 48755 (989) 453-3223
Ingham County, MI Edward W Sparrow Hospital #1073588711 Code: EWSH 1215 E Michigan Ave Lansing, MI 48912 (517) 364-1000
McLaren Greater Lansing #1134104672 Code: MLGL 2727 S Pennsylvania Ave Lansing, MI 48910 (517) 372-8220 –– 401 W Greenlawn Ave Lansing, MI 48910 (517) 975-9475
Sparrow Health System - St Lawrence Campus #1073588711 Code: SHSL 1210 W Saginaw St Lansing, MI 48915 (517) 364-1000
Ionia County, MI Sparrow Ionia Hospital #1700820065 Code: SIH 3565 S State Rd Ionia, MI 48846 (616) 523-1400
Isabella County, MI McLaren Central Michigan #1619941317 Code: MCCM 1221 South Dr Mt Pleasant, MI 48858 (989) 772-6700
Hospitals
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Jackson County, MI Henry Ford Allegiance Health #1053403402 Code: HFAH 205 N East Ave Jackson, MI 49201 (517) 205-4800
Kalamazoo County, MI Bronson Methodist Hospital #1831116441 Code: BMH 601 John St Kalamazoo, MI 49007 (269) 341-7654
Kent County, MI Mary Free Bed Rehabilitation Hospital #1730133463 Code: MFBR 235 Wealthy St SE Grand Rapids, MI 49503 (616) 840-8000
Spectrum Health Blodgett Hospital #1922090554 Code: SPBL 1840 Wealthy St SE Grand Rapids, MI 49506 (616) 774-7444
Spectrum Health Butterworth Hospital #1922090554 Code: SPBW 100 Michigan St NE Grand Rapids, MI 49503 (616) 391-1774
Livingston County, MI Saint Joseph Mercy Livingston Hospital #1093748642 Code: SJML 620 Byron Rd Howell,…