Provider Utilization - Product Management Group(s): Report Run On - BidNet
[Pages:12]Service Date Begin: 1/1/2018 Service Date End: 12/31/2018
Group Base LOB
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
193L74
FL Group Fully Insured
193L74
FL Group Fully Insured
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
193L74
193L74
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
193L74 193L74 193L74 193L74
193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
FL Group Fully Insured
FL Group Fully Insured
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
193L74 193L74
193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
Provider Utilization - Product Management
Group(s): FLAGLER COUNTY SCHOOL BOARD
Billing Provider Name
Report Run On :1/23/2019 Rendering ProviderName
ADVANCED DENTAL CARE OF JACKSONVILLE AHMED REDA A SOLIMAN PA ADVANCED DENTAL CARE OF JACKSONVILLE TIGURA REDDY PA ADVANCED DENTAL CARE PALM COAST PL LUIS ALCALDE PRESEDO
Specialty Unknown General Dentistry General Dentistry Multi-Specialty
Address1 Unknown 4540 SOUTHSIDE BLVD STE 1001 4540 SOUTHSIDE BLVD STE 1001 3 PINE CONE DR STE 108
City Unknown JACKSONVILLE JACKSONVILLE PALM COAST
State Zip
NA
FL
32216
Tax ID
Unknown 030438014
FL
32216 030438014
FL
32137 460901603
ADVANCED DENTAL CARE PALM COAST PL MICHAEL R MOORE
ADVANCED DENTAL CARE PALM COAST PL MIECZYSTAWA S ZULINSKI
ADVANCED DENTAL CARE PALM COAST PL TIGURA REDDY
ALEXANDER LEVIN DDS
ALEXANDER LEVIN
ALJONAIDY DENT INC
HUDA I ALJONAIDY
ALL ABOUT SMILES FAMILY DENTISTRY LLC MARCIA M NEMECEK
ALL ABOUT SMILES FAMILY DENTISTRY LLC NATHAN W NEMECEK
ALLISON C HARRIS DMD PA
ALLISON C HARRIS
AMERICAN DENTAL WELLNESS PA
LEYDI BARROS
ANDREW M NAWROCKI DMD MS PA
AMANDA L COBB
ANDREW M NAWROCKI DMD MS PA
ANDREW M NAWROCKI
ANTHONY W LEE DMD
ANTHONY W LEE
ATLANTIC COAST PROSTHODONTICS INC
JOHN A WHITSITT
ATLANTIC DENTAL ARTS LLC
ANGEL A GARCIA
ATLANTIC DENTAL MANAGEMENT CORP
STEVEN J MITCHELL
Multi-Specialty Multi-Specialty Multi-Specialty General Dentistry General Dentistry General Dentistry General Dentistry Orthodonticcs General Dentistry General Dentistry General Dentistry Unknown General Dentistry General Dentistry General Dentistry
3 PINE CONE DR STE 108
PALM COAST
FL
3 PINE CONE DR STE 108
PALM COAST
FL
3 PINE CONE DR STE 108
PALM COAST
FL
120 AIRPORT RD STE 1A
PALM COAST
FL
900 W GRANADA BLVD
ORMOND BEACH
FL
13 SAINT JOHNS MEDICAL PK DR SAINT AUGUSTINE FL
13 SAINT JOHNS MEDICAL PARK DR ST AUGUSTINE
FL
154 MCGREGOR ROAD
DELAND
FL
38 BLANDING BLVD STE A
ORANGE PARK
FL
145 N NOVA RD
ORMOND BEACH
FL
145 N NOVA RD
ORMOND BEACH
FL
Unknown
Unknown
1509 MASON AVE
DAYTONA BEACH
FL
9 PINE CONE DR STE 106A
PALM COAST
FL
611 S DIXIE FWAY
NEW SMYRNA BEACH FL
ATLANTIC DENTAL MANAGEMENT CORP
TODD D WATSON
General Dentistry 611 S DIXIE FWAY
NEW SMYRNA BEACH FL
AUSTIN & FISHBEIN ORTHODONTICS
BARNES AND MCDONNELL PEDIATRIC DBAENRNTIESSTRAYND MCDONNELL PEDIATRIC DBAENRNTIESSTRAYND MCDONNELL PEDIATRIC DBEENNITGISNTORRYAMIREZ DDS BETH E KAILES DMD PA BLUE SKY DENTAL GROUP LLC BRIAN W HAZEN DMD BRYAN M BERGENS DDS CARMEN MACO DMD PA
AUSTIN & FISHBEIN ORTHODONTICS DANIEL P BARNES KATHY PARSONS SEAN T MCDONNELL BENIGNO RAMIREZ BETH E KAILES JONAS J ASHBAUGH BRIAN W HAZEN BRYAN M BERGENS CARMEN MACO
Orthodonticcs
General Dentistry General Dentistry General Dentistry General Dentistry Pediatric Dentistry General Dentistry General Dentistry General Dentistry General Dentistry
4900 MARKET PLACE RD
PENSACOLA
FL
1440 REED CANAL RD STE 3
PORT ORANGE
FL
1440 REED CANAL RD STE 3
PORT ORANGE
FL
1440 REED CANAL RD STE 3
PORT ORANGE
FL
703 E MOODY BLVD STE 2
BUNNELL
FL
1851 GOLDEN EAGLE WAY STE 36 FLEMING ISLAND
FL
14866 OLD SAINT AUGUSTINE RD JACKSONVILLE
FL
S41T0EL1A11KEBRIDGE PLAZA DR
ORMOND BEACH
FL
724 S BEACH ST
DAYTONA BEACH
FL
104 SE 1ST ST
FORT LAUDERDALE FL
CEDAR FAMILY DENTAL PLLC CHARLES HICKS DDS CHARLES HICKS DDS COAST DENTAL OF PALM COAST
DOUGLAS CORRY CHARLES M HICKS SHANNON HICKS COAST DENTAL OF PALM COAST
General Dentistry General Dentistry General Dentistry General Dentistry
427 S MAIN ST STE 101 800 ZEAGLER DR STE 330 800 ZEAGLER DR STE 330 114 PALM COAST PKWY NE
CEDAR CITY
UT
PALATKA
FL
PALATKA
FL
PALM COAST
FL
COAST DENTAL OF PALM COAST
COAST DENTAL PA HOMOSASSA
COAST FLORIDA PA
COAST PALM COAST PL
COHEN SEDGH MANAVI AND PAKRAVAN DENTAL CORPORATION
COHEN SEDGH MANAVI AND PAKRAVAN CDOENMTFAOLRTCAOBRLPEORCAATRIEODNENTAL HEALTH PROFESSIONALS PA COMFORTABLE CARE DENTAL HEALTH PCROOMFFEOSRSTIOANBALLESCPAARE DENTAL HEALTH PCROOMFFEOSRSTIOANBALLESCPAARE DENTAL HEALTH PROFESSIONALS PA
VERNON L GORDON
PAUL J KRAMER
ANNE K BOEHLING
VERNON L GORDON
COHEN SEDGH MANAVI & PAKRAVAN DENTAL CORPORATION FARID PAKRAVAN
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS PA EARL T SPADER
HELEN N TRUONG
JARED A WATTS
General Dentistry Multi-Specialty Multi-Specialty General Dentistry General Dentistry
114 PALM COAST PKWY NE 1081 A1A BEACH BLVD STE 32 1010 NW 76TH BLVD 114 PALM COAST PKWY NE 2604 S VERMONT AVE STE F
General Dentistry Multi-Specialty
Multi-Specialty Multi-Specialty General Dentistry
2604 S VERMONT AVE STE F 782 BELLE TERR PKWY STE 100
782 BELLE TERR PKWY STE 100 782 BELLE TERR PKWY STE 100 2532 RACE TRACK RD STE B
PALM COAST
FL
SAINT AUGUSTINE FL
GAINESVILLE
FL
PALM COAST
FL
LOS ANGELES
CA
LOS ANGELES
CA
PALM COAST
FL
PALM COAST
FL
PALM COAST
FL
FRUIT COVE
FL
32137 32137 32137 32164 32174 32086 32086 32720 32073 32174 32174 NA 32117 32137 32168
460901603 460901603 460901603 486040651 474407422 205602042 824219664 273039160 462736624 455351812 455351812 Unknown 593666676 471023402 204479543
32168 204479543
Unkno 463189446
32129 32129 32129 32110 32003 32258 32174 32114 33308
273425693 273425693 273425693 593106370 201860255 473585279 593493875 510467892 453993343
84720 32177 32177 32137
463186011 593500060 593500060 593737347
32137 32080 32606 32137 90007
593737347 593508140 593365515 593737347 274060827
90007 32164
32164 32164 32259
274060827 200185918
200185918 200185918 200185918
Claims Count
1
8
Procedure Code Count 15
29
2
10
3
5
21
64
99
290
5
7
4
8
6
14
1
3
7
18
13
13
2
6
12
25
6
14
2
6
3
3
34
78
2
2
2
13
1
1
9
27
16
45
11
27
16
39
4
13
5
10
4
8
4
6
2
10
3
10
4
9
1
1
3
7
54
170
5
17
1
1
12
33
1
3
2
4
1
1
3
4
65
202
8
34
Provider Utilization - Product Management
Group(s): FLAGLER COUNTY SCHOOL BOARD
Service Date Begin: 1/1/2018 Service Date End: 12/31/2018
Report Run On :1/23/2019
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
COMFORTABLE CARE DENTAL HEALTH PCROOMFFEOSRSTIOANBALLESCPAARE DENTAL HEALTH PCROOMFFEOSRSTIOANBALLESCPAARE PA COMFORTABLE CARE PA COMFORTABLE CARE PA COMFORTABLE CARE PA COMFORTABLE CARE PA COMFORTABLE CARE PA COMFORTABLE CARE PA CORNELIUS A LINK DDS CYPRESS POINT DENTISTRY PA CYPRESS POINT DENTISTRY PA CYPRESS POINT DENTISTRY PA CYPRESS POINT DENTISTRY PA CYPRESS POINT DENTISTRY PA CYPRESS POINT DENTISTRY PA D & G DENTAL SERVICES PA D & G DENTAL SERVICES PA DALE D BATTEN DMD DAVID DENTAL ASSOCIATES DMD PA DAVID T TURBYFILL DMD DAVID W MAXWELL DDS DAYN C BOITET DDS PA DENTAL ASSOCIATES OF PLANT CITY PLLC DENTAL CREATIONS OF DAYTONA BEACH DENTAL CREATIONS OF DAYTONA BEACH DENTAL CREATIONS OF DAYTONA BEACH DENTAL CREATIONS OF DAYTONA BEACH PDLECNTAL CREATIONS OF DAYTONA BEACH DPLECNTAL CREATIONS OF DAYTONA BEACH PDLECNTAL DOCTORS FL DENTAL DOCTORS FL DENTAL EXPRESSION PL DENTAL HEALTH GROUP PA DENTAL HEALTH GROUP PA DENTAL HEALTH GROUP PA DENTAL PROFESSIONALS OF INDIANA PC DENTAL SPECIALISTS OF NORTH FLORIDA LDLECNTAL SPECIALISTS OF NORTH FLORIDA LDLECNTAL SPECIALISTS OF NORTH FLORIDA LDLECREK R MORRIS DDS DIRK G PRUSIA DDS PA
MICHAEL L JARRELL TYLER J GRIFFITH BRUNA P LOUNSBERRY CHRISTINA V SCHIMENTI COMFORTABLE CARE PA DIANA MORIATIS SARAH B GIBBS TEDRA N BECKTON WILLIAM E HARRIETT CORNELIUS A LINK DAVID S ROCKEY JESSIE L BECH RICHARD M SECUNDA SHAWN P MAGEE WILLIAM D ROCKEY WILLIAM P DORNE FARAH HASAN RENATA F SANTELI DALE D BATTEN ALBERTO G DAVID DAVID T TURBYFILL DAVID W MAXWELL DAYN C BOITET JOHN I CARTER DENISE TURNER JESSE A REAGIN SAPNA D ADAPPA DENISE TURNER JESSE A REAGIN SAPNA D ADAPPA CHRISTINE J TRUNK MERLIN P OHMER RAMON PADILLA PIERRE GOSSELIN ROBERT A BRODY STEVEN A MANTEGARI STEVEN W BOLLINGER JOHN W THOUSAND ROBERT THOUSAND ROBERT THOUSAND DEREK R MORRIS DIRK G PRUSIA
Multi-Specialty
782 BELLE TERR PKWY STE 100
PALM COAST
FL
32164 200185918
11
38
Multi-Specialty
782 BELLE TERR PKWY STE 100
PALM COAST
FL
32164 200185918
6
14
Multi-Specialty
8624 LEE VISTA BLVD
ORLANDO
FL
32829 200185918
1
2
Multi-Specialty
1345 W GRANADA BLVD UNIT 9
ORMOND BEACH
FL
32174 200185918
17
61
Multi-Specialty
85 CYPRESS POINT PKWY STE 5
PALM COAST
FL
32164 200185918
26
138
Multi-Specialty
6610 20TH ST
VERO BEACH
FL
32966 200185918
1
2
Multi-Specialty
85 CYPRESS POINT PKWY STE 5
PALM COAST
FL
32164 200185918
146
523
Multi-Specialty
85 CYPRESS POINT PKWY STE 5
PALM COAST
FL
32164 200185918
91
311
Multi-Specialty
1980 US 1 SOUTH
ST AUGUSTINE
FL
32086 200185918
20
34
General Dentistry 1910 SE 18TH AVE
OCALA
FL
34471 590859542
2
4
General Dentistry 105 CYPRESS POINT PKWY STE A PALM COAST
FL
32164 592860813
53
118
General Dentistry 105 CYPRESS POINT PKWY STE A PALM COAST
FL
32164 592860813
56
122
General Dentistry 105 CYPRESS POINT PKWY STE A PALM COAST
FL
32164 592860813
85
190
General Dentistry 105 CYPRESS POINT PKWY STE A PALM COAST
FL
32164 592860813
88
194
General Dentistry 105 CYPRESS POINT PKWY STE A PALM COAST
FL
32164 592860813
50
119
General Dentistry 105 CYPRESS POINT PKWY STE A PALM COAST
FL
32164 592860813
46
109
Multi-Specialty
1133 AIRPORT BLVD
PENSACOLA
FL
32114 264685215
1
1
Multi-Specialty
1133 AIRPORT BLVD
PENSACOLA
FL
32114 264685215
3
11
General Dentistry 123 W PLYMOUTH AVE
DELAND
FL
32720 592367445
3
7
General Dentistry 1971 OLD MOULTRIE RD
SAINT AUGUSTINE FL
32086 593255631
9
20
Oral Surgery
4850 N 9TH AVE STE 4
PENSACOLA
FL
32503 204653163
1
1
General Dentistry 4 PEARL DR STE 3
ORMOND BEACH
FL
32174 043721044
4
7
General Dentistry 1665 EAGLE HARBOR PKWY
ORANGE PARK
FL
32003 592339289
2
5
General Dentistry 1701 S ALEXANDER ST STE 114
PLANT CITY
FL
33566 451057413
5
10
General Dentistry 1737 N CLYDE MORRIS BLVD STE DAYTONA BEACH
FL
32117 204972796
12
34
General Dentistry
1175307 N CLYDE MORRIS BLVD STE DAYTONA BEACH
FL
32117 204972796
8
18
General Dentistry
1175307 N CLYDE MORRIS BLVD STE DAYTONA BEACH
FL
32117 204972796
4
11
General Dentistry
1175307 N CLYDE MORRIS BLVD STE DAYTONA BEACH
FL
32117 204972796
1
3
General Dentistry
1175307 N CLYDE MORRIS BLVD STE DAYTONA BEACH
FL
32117 204972796
2
5
General Dentistry
1175307 N CLYDE MORRIS BLVD STE DAYTONA BEACH
FL
32117 204972796
1
3
General Dentistry
1285001 SAINT JOHNS BLUFF RD S STE 1 JACKSONVILLE
FL
32246 205427895
1
11
General Dentistry 72 VALENCIA ST
ST AUGUSTINE
FL
32084 472163434
2
6
General Dentistry 5050 TAMIAMI TRL N STE A
NAPLES
FL
34103 200814382
1
4
Multi-Specialty
9 ST JOHNS MEDICAL PARK STE B ST AUGUSTINE
FL
32086 650719035
16
47
Multi-Specialty
6552 GUNN HWY
TAMPA
FL
33625 650719035
2
2
Multi-Specialty
4765 HODGES BLVD STE 5-6
JACKSONVILLE
FL
32224 650719035
2
9
Multi-Specialty
2145 W JONATHAN MOORE PIKE
COLUMBUS
IN
47201 364172006
2
4
General Dentistry 10 ST JOHNS MEDICAL PARK DR STE SAINT AUGUSTINE FL
32086 271396570
15
37
General Dentistry
C10 ST JOHNS MEDICAL PARK DR STE SAINT AUGUSTINE
FL
32086 271396570
6
11
Periodontics
C3 CYPRESS BRANCH WAY STE 107 PALM COAST
FL
32164 271396570
4
6
General Dentistry 500 HIGHWAY 19 S
PALATKA
FL
32177 261119882
1
2
General Dentistry 151 S WYMORE RD STE 6000
ALTAMONTE SPRINGS FL
32714 593226664
2
5
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
DONALD M KEENE DDS AND O MOREJON DDMR DE JPOASEPH LECOMPTE DDS DR ROBERT R THOUSAND III PA DR ROBERT R THOUSAND III PA DR ROBERT R THOUSAND III PA DR TERRENCE R SOULE DDS PA DR THOMAS STAKEM DDS MD LLC DR YOUNG PARK PC DRS MAHEW AND SCHEFFLER
OSCAR MOREJON E J LECOMPTE DAVID W COWLING NEHA M PANDYA ROBERT R THOUSAND TERRANCE R SOULE THOMAS E STAKEM YOUNG C PARK NICOLE M SCHEFFLER
General Dentistry 815 N NOVA RD
DAYTONA BEACH
FL
32117 591488568
2
2
Periodontics
3890 TURTLE CREEK DR STE A
PORT ORANGE
FL
32127 593578526
9
13
Endodontics
10 SAINT JOHNS MEDICAL PK DR SAINT AUGUSTINE FL
32086 263902020
3
11
Endodontics
S10TESACINT JOHNS MEDICAL PK DR
SAINT AUGUSTINE
FL
32086 263902020
4
19
Endodontics
S10TESACINT JOHNS MEDICAL PK DR
SAINT AUGUSTINE
FL
32086 263902020
21
80
General Dentistry
S25T7E8CS VOLUSIA AVE
ORANGE CITY
FL
32763 475391215
1
3
Oral Surgery
7175 HIGHWAY 17 S STE 1
FLEMING ISLAND
FL
32003 432085242
4
14
Multi-Specialty
1600 WOODBURY AVE
PORTSMOUTH
NH 03801 010854701
1
2
General Dentistry 373 BOONE HEIGHTS DR
BOONE
NC 28607 208111410
4
4
Provider Utilization - Product Management
Group(s): FLAGLER COUNTY SCHOOL BOARD
Service Date Begin: 1/1/2018 Service Date End: 12/31/2018
Report Run On :1/23/2019
193L74
FL Group Fully Insured
DUSANKA F ANGELOV DMD LLC
DUSANKA F ANGELOV
General Dentistry 180 PINNACLES DR STE 101
PALM COAST
FL
32137 271824379
102
237
193L74
FL Group Fully Insured
ELIZABETH A MOREJON DMD
AMY E ANDREWS
General Dentistry 163 TOMOKA AVE
ORMOND BEACH
FL
32174 182568537
12
12
193L74
FL Group Fully Insured
ELIZABETH A MOREJON DMD
ELIZABETH A MOREJON
General Dentistry 163 TOMOKA AVE
ORMOND BEACH
FL
32174 182568537
27
27
193L74
FL Group Fully Insured
ENVISION DENTAL
ALINE D BOWERS
Prosthodontics
870 DUNLAWTON AVE STE 110
PORT ORANGE
FL
32127 460732794
7
26
193L74
FL Group Fully Insured
ERNEST A MINGES DDS
ERNEST A MINGES
General Dentistry 4135 HIXSON PIKE
CHATTANOOGA
TN 37415 412786581
1
3
193L74
FL Group Fully Insured
EUGENE Y RHEE DDS PA
EUGENE Y RHEE
General Dentistry 7 BOULDER ROCK DR STE 3
PALM COAST
FL
32137 593732254
44
90
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
FAMILY SMILES PONTE VEDRA FIRST CARE DENTAL ASSOCIATES PA
STEPHANIE N MAPP JORDAN R RIGSBY
General Dentistry 151 SAWGRASS CORNERS DR STE PONTE VEDRA BEACH FL
32082 453342139
5
5
102
General Dentistry 2274 WEDNESDAY ST
TALLAHASSEE
FL
32308 593499380
2
8
193L74
FL Group Fully Insured
FIRST COAST ORAL AND FACIAL SURGERY THOMAS E STAKEM
Oral Surgery
319 W TOWN PLACE STE 3
SAINT AUGUSTINE FL
32092 455237548
1
2
193L74
FL Group Fully Insured
FL DENTAL PA
CHARLES D MILTON
Multi-Specialty
651 NAUTICA DR STE 1
JACKSONVILLE
FL
32225 462529489
1
1
193L74
FL Group Fully Insured
FL DENTAL PA
REHAM EL HENNAWEY
Multi-Specialty
4030 PARK BLVD N
PINELLAS PARK
FL
33781 462529489
1
1
193L74
FL Group Fully Insured
FL DENTAL PA
STACIE LECLAIR
Multi-Specialty
4030 PARK BLVD N
PINELLAS PARK
FL
33781 462529489
1
1
193L74
FL Group Fully Insured
FL DENTAL PA
VANJA ALAGIC
Multi-Specialty
4030 PARK BLVD N
PINELLAS PARK
FL
33781 462529489
1
1
193L74
FL Group Fully Insured
FLAGLER DENTAL ASSOCIATES PA
BEN W LACY
General Dentistry 30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
1
1
193L74
FL Group Fully Insured
FLAGLER DENTAL ASSOCIATES PA
ERIK J OLSON
General Dentistry 30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
4
13
193L74
FL Group Fully Insured
FLAGLER DENTAL ASSOCIATES PA
JEREMIAH J MAHONEY
General Dentistry 30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
125
279
193L74
FL Group Fully Insured
FLAGLER DENTAL ASSOCIATES, PA
RYAN T SMITH
General Dentistry 30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
46
89
193L74
FL Group Fully Insured
FLORIDA DENTAL PA
KEVON E RENNIE
Multi-Specialty
1747 US HIGHWAY 1 S
ST AUGUSTINE
FL
32084 462529489
1
5
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
FLORIDA FAMILY DENTISTRY ORMOND BFLEOARCIHDALLHCEALTH CARE PLANS INC
GREGORY A JOHNSTON NICHOLAS TANTURRI
General Dentistry 555 W GRANADA BLVD STE F-9
ORMOND BEACH
FL
32174 473981783
7
11
General Dentistry 350 N CLYDE MORRIS BLVD
DAYTONA BEACH
FL
32114 263238817
12
23
193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
FLORIDA ORAL & FACIAL SURGICAL FALSOSORICDIAATOERSAPLA& FACIAL SURGICAL AFLSOSORICDIAATOERSAPLA& FACIAL SURGICAL AFLSOSORICDIAATOERSAPLA& FACIAL SURGICAL AFLSOSORICDIAATPEASRPKAFAMILY DENTISTRY PA
BRADLEY MARK PINKER CURTIS J SCHALIT JOHN O AKERS ROGER R THAYER GREGORY A JOHNSTON
Oral Surgery Oral Surgery Oral Surgery Oral Surgery General Dentistry
549 HEALTH BLVD 549 HEALTH BLVD 549 HEALTH BLVD 549 HEALTH BLVD 4 OLD KINGS RD N STE A
DAYTONA BEACH
FL
32114 591226840
2
2
DAYTONA BEACH
FL
32114 591226840
8
11
DAYTONA BEACH
FL
32114 591226840
9
24
DAYTONA BEACH
FL
32114 591226840
17
70
PALM COAST
FL
32137 593471299
44
78
193L74
FL Group Fully Insured
FLORIDA PARK FAMILY DENTISTRY PA
JORDAN S JOHNSTON
General Dentistry 4 OLD KINGS RD N STE A
PALM COAST
FL
32137 593471299
89
178
193L74
FL Group Fully Insured
FLORIDA PARK FAMILY DENTISTRY PA
MARGARET WALSH
General Dentistry 4 OLD KINGS RD N STE A
PALM COAST
FL
32137 593471299
1
1
193L74
FL Group Fully Insured
FLORIDA PARK FAMILY DENTISTRY PA
SELYCETTE D HAMNER
General Dentistry 4 OLD KING RD N STE A
PALM COAST
FL
32137 593471299
66
141
193L74
FL Group Fully Insured
FLORIDA PARK FAMILY DENTISTRY PA
SELYCETTE D HAMNER
General Dentistry 4 OLD KINGS RD N STE A
PALM COAST
FL
32137 593471299
5
14
193L74
FL Group Fully Insured
FLORIDA PARK FAMILY DENTISTRY PA
TRAVIS E RAY
General Dentistry 4 OLD KINGS RD N STE A
PALM COAST
FL
32137 593471299
30
58
193L74
FL Group Fully Insured
FOUR TOWNS DENTAL SERVICES PA
MELISSA COLON
General Dentistry 2490 ENTERPRISE ROAD
ORANGE CITY
FL
32763 650202733
2
9
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
FRANCISCO DIAZ DMD GREENBERG DENTAL & ORTHODONTICS
FRANCISCO DIAZ LISSET GONZALEZ
General Dentistry 1301 PLANTATION ISLAND DR S STE SAINT AUGUSTINE FL
32080 593129558
7
11
Multi-Specialty
1140642BW GRANADA BLVD STE 210
ORMOND BEACH
FL
32174 263975070
2
11
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS
MICHAEL J FREEMAN
Multi-Specialty
50 PLAZA DR STE 201
PALM COAST
FL
32137 263975070
1
2
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA AMIT S KAMAT
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
2
4
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA CAROLINE E PAWLAK
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
20
20
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA ELIZABETH A CHERRY
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
4
13
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA GREENBERG DENTAL ASSOCIATES Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
3
12
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA LISSET GONZALEZ
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
14
70
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA MICHAEL J FREEMAN
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
2
5
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA NADINE M FERBINTEANU
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
7
36
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA NICOLE DOHERTY
Periodontics
1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
3
6
193L74
FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA SCOTT D LAWSON
Multi-Specialty
926 GREAT POND DR STE 1000
ALTAMONTE SPRINGS FL
32714 263975070
1
5
193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
GREENBERG DENTAL & ORTHODONTICS PA GREENBERG DENTAL & ORTHODONTICS PA GREENBERG DENTAL & ORTHODONTICS PA GREENBERG DENTAL ASSOCIATES
SCOTT D LAWSON
Periodontics
SHIJU CHERIAN
Periodontics
TOMMIE L BURCHFIELD
Periodontics
GREENBERG DENTAL ASSOCIATES General Dentistry
1515 S NOVA RD 1515 S NOVA RD 1515 S NOVA RD 1515 S NOVA RD
DAYTONA BEACH
FL
32714 593431240
6
22
DAYTONA BEACH
FL
32714 593431240
3
3
DAYTONA BEACH
FL
32714 593431240
1
8
DAYTONA BEACH
FL
32114 592960505
1
1
193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
GREG T RUSSELL DMD GRETCHEN B JUNGERMANN DMD HALIFAX DENTAL ASSOCS
GREG T RUSSELL
General Dentistry 2520 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32086 592495436
1
3
GRETCHEN B JUNGERMANN
Endodontics
3641 10TH ST N STE A
NAPLES
FL
34103 595465737
1
1
DANIEL R DRAKE
General Dentistry 1089 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 591496389
3
8
Provider Utilization - Product Management
Group(s): FLAGLER COUNTY SCHOOL BOARD
Service Date Begin: 1/1/2018 Service Date End: 12/31/2018
Report Run On :1/23/2019
193L74
FL Group Fully Insured
HEALTHY SMILE DENTAL
JACQUES BENCHIMOL
General Dentistry 1264 PALM COAST PKWY SW
PALM COAST
FL
32137 274064663
15
34
193L74
FL Group Fully Insured
HEALTHY SMILE DENTAL
KEHINDE A AYOOLA
General Dentistry 1264 PALM COAST PKWY SW
PALM COAST
FL
32137 274064663
1
1
193L74
FL Group Fully Insured
HEALTHY SMILE DENTAL
MICHAEL LOPEZ
General Dentistry 1264 PALM COAST PKWY SW
PALM COAST
FL
32137 274064663
18
41
193L74
FL Group Fully Insured
HEALTHY SMILES DENTAL
JACQUES BENCHIMOL
General Dentistry 1264 PALM COAST PKWY SW
PALM COAST
FL
32137 274064663
6
11
193L74
FL Group Fully Insured
HELEN T SMILLIE DMD
HELEN N TRUONG
General Dentistry 1345 W GRANADA BLVD UNIT 9
ORMOND BEACH
FL
32174 200185918
1
1
193L74
FL Group Fully Insured
IMRAY AND GESEK DMD PA
DANIEL J GESEK
Oral Surgery
2047 PARK ST
JACKSONVILLE
FL
32204 593216228
2
8
193L74
FL Group Fully Insured
J KIM PERIODONTICS
JEFFREY M KIM
General Dentistry 4570 S CLYDE MORRIS BLVD STE 1 PORT ORANGE
FL
32129 352230551
2
7
193L74
FL Group Fully Insured
JACK D MANIKOWSKI DDS
KAREN C KASINSKI
General Dentistry 1701 N SHEFFIELD AVE STE 101
CHICAGO
IL
60614 364345220
4
11
193L74
FL Group Fully Insured
JACK D MANIKOWSKI DDS
LAUREN N PEARCE
General Dentistry 1701 N SHEFFIELD AVE
CHICAGO
IL
60614 364345220
3
8
193L74
FL Group Fully Insured
JACKSONVILLE EMERGENCY DENTAL
MICHAEL J THOMASINO
General Dentistry 1716 UNIVERSITY BLVD S
JACKSONVILLE
FL
32216 204206572
1
3
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
JACKSONVILLE UNIVERSITY SCHOOL OF OJARMTHESODCOMNCTKICESNZIE DMD
JORGE J FARILL GUZMAN JAMES D MCKENZIE
Orthodonticcs General Dentistry
2800 UNIVERSITY BLVD N 382 N CAUSEWAY
JACKSONVILLE
FL
32211 590624412
24
24
NEW SMYRNA BEACH FL
32169 592106190
3
4
193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
JAMES P ALEXANDER DMD JAMES W DAVIS DDS JASON L LARKIN DDS MSD PA
JAMES P ALEXANDER JAMES W DAVIS JASON L LARKIN
General Dentistry General Dentistry General Dentistry
46 TUSCAN WAY STE 306 59 GEORGIA RD 811 STATE ROAD 44
SAINT AUGUSTINE FL
32092 800373567
4
14
FRANKLIN
NC 28734 561319043
4
4
NEW SMYRNA BEACH FL
32168 200131597
5
5
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
JAYRAJ J PATEL DMD PLLC JBA DENTAL PL JBA DENTAL PL JENNIFER E KEY DMD JENNIFER L FRASER DMD JENNIFER SANZARI DMD PA JEREMIAH D GORDON JOEL DAVID AND ASSOCIATION JOHN F HOWARD DDS JOHNSON ORTHODONTICS PA JOSEPH G CHIAFAIR DDS MS PA JULIUS R ALDRIDGE DDS PA KEVON E RENNIE DMD KEVON E RENNIE DMD PA KEVON E RENNIE DMD PA
JAYRAJ J PATEL
General Dentistry 50 CYPRESS POINT PKWY STE A3 PALM COAST
FL
32164 463025690
55
196
BRIAN S YOON
General Dentistry 942 SAXON BLVD
ORANGE CITY
FL
32174 264712594
4
7
FLORENCE L YOON
General Dentistry 1180 W GRANADA BLVD STE A
ORMOND BEACH
FL
32174 264712679
10
42
JENNIFER E KEY
General Dentistry 201 E CHESTNUT ST STE A
ASHEVILLE
NC 28801 204177604
1
1
JENNIFER L FRASER
General Dentistry 35 CAROLINE ST
BUNNELL
FL
32110 432081964
2
6
JENNIFER C SANZARI
General Dentistry 9401 BELAIR RD
BALTIMORE
MD 21236 870697616
1
2
JEREMIAH D GORDON
General Dentistry 135 JENKINS ST STE 105A
SAINT AUGUSTINE FL
32086 263366235
11
17
JOHN M BURBANK
General Dentistry 10991 SAN JOSE BLVD STE 54
JACKSONVILLE
FL
32223 592560185
1
3
JOHN F HOWARD
General Dentistry 3706 BLANDING BLVD
JACKSONVILLE
FL
32210 650719035
3
5
PAUL D JOHNSON
General Dentistry 25 PINE CONE DR STE 1
PALM COAST
FL
32164 593579025
171
183
CATHERINE E CHIAFAIR
General Dentistry
9471 BAYMEADOWS RD STE 101
JACKSONVILLE
FL
32256 454555548
1
5
JULIUS R ALDRIDGE
General Dentistry 342 OAK AVE
SPRUCE PINE
NC 28777 562255192
3
10
SAVANNA M PETERSON
General Dentistry 651 NAUTICA DR UNIT 1
JACKSONVILLE
FL
32218 766403717
1
2
CHARLES D MILTON
Multi-Specialty
4873 BELLE TERRE PKWY
PALM COAST
FL
32137 811949572
3
13
JASMINE MCCAULLEY RENNIE
Multi-Specialty
4873 BELLE TERRE PKWY
PALM COAST
FL
32137 811949572
6
19
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
KEVON E RENNIE DMD PA KEVON E RENNIE DMD PA KEVON E RENNIE DMD PA KEVON E RENNIE DMD PA L&L BEVILLE DENAL LLC LACY & OLSON MAHONEY PA LACY & OLSON MAHONEY PA LACY & OLSON MAHONEY PA LACY & OLSON MAHONEY PA LACY & OLSON MAHONEY PA LACY & OLSON MAHONEY PA LLOYD FAMILY DENTISTRY PA LOUIS LATULIPPE DMD PA LUIS A CRUZ DMD PA LUIS A CRUZ DMD PA LUIS A CRUZ DMD PA LYDIA MARIN CALIMAREA DMD PA MANNE AND BORER ENDODONTICS MANNE AND BORER ENDODONTICS MANNE AND BORER ENDODONTICS
JAVIER MALDONADO
Multi-Specialty
4873 BELLE TERRE PKWY
PALM COAST
FL
32137 811949572
1
2
KEVON E RENNIE
Multi-Specialty
4873 BELLE TERRE PKWY
PALM COAST
FL
32137 811949572
1
1
PIMENDENT PA
Multi-Specialty
4873 BELLE TERRE PKWY
PALM COAST
FL
32137 811949572
1
2
SAVANNA M PETERSON
Multi-Specialty
4873 BELLE TERRE PKWY
PALM COAST
FL
32137 811949572
36
76
JOSE F MATOS
General Dentistry 911 BEVILLE RD STE 1
DAYTONA BEACH
FL
32119 823415095
1
4
BEN W LACY
Multi-Specialty
30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
5
13
ERIK J OLSON
Multi-Specialty
30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
21
49
HOPE L FELDMAN
Multi-Specialty
30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
1
2
JEREMIAH J MAHONEY
Multi-Specialty
30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
210
403
LACY & OLSON MAHONEY PA
Multi-Specialty
30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
68
148
RYAN T SMITH
Multi-Specialty
30 OFFICE PARK DR
PALM COAST
FL
32137 592438969
66
140
SUSAN J MACKENZIE
General Dentistry 5100 S CLYDE MORRIS BLVD STE 200 PORT ORANGE
FL
32127 593353623
1
3
LOUIS J LATULIPPE
General Dentistry 6 PEARL DR
ORMOND BEACH
FL
32174 593576894
5
11
BRIANNE C DESANTIS
General Dentistry 105 CYPRESS POINT PKWY STE D PALM COAST
FL
32164 208033037
36
36
LUIS A CRUZ
General Dentistry 105 CYPRESS POINT PKWY STE D PALM COAST
FL
32164 208033037
101
349
LUIS A CRUZ LYDIA M CALIMAREA
General Dentistry 1301 PLANTATION ISLAND DR S STE SAINT AUGUSTINE FL
32080 208033037
2
3
General Dentistry
3150255 HERBERT ST STE 101
PORT ORANGE
FL
32129 205315873
7
10
BRUCE D MANNE
Endodontics
150 SAGEBRUSH TRL
ORMOND BEACH
FL
32174 205933188
2
7
ROBERT E BORER
Endodontics
150 SAGEBRUSH TRL
ORMOND BEACH
FL
32174 205933188
4
14
SIDNI P MANNE
Endodontics
150 SAGEBRUSH TRL
ORMOND BEACH
FL
32174 205933188
1
4
Provider Utilization - Product Management
Group(s): FLAGLER COUNTY SCHOOL BOARD
Service Date Begin: 1/1/2018 Service Date End: 12/31/2018
Report Run On :1/23/2019
193L74
FL Group Fully Insured
MANUEL STEFAN DDS
MANUEL STEFAN
General Dentistry 2525 CURRY FORD RD
ORLANDO
FL
32806 593422042
6
14
193L74
FL Group Fully Insured
MARK L JOHNSON DDS
MARK L JOHNSON
General Dentistry 215 S 3RD ST
FLAGLER BEACH
FL
32136 593622516
117
270
193L74
FL Group Fully Insured
MARK L JOHNSON DDS PA
MARK L JOHNSON
General Dentistry 215 S 3RD ST
FLAGLER BEACH
FL
32136 593622516
13
27
193L74
FL Group Fully Insured
MARSHALL S BAILEY DMD LLC
MARSHALL S BAILEY
General Dentistry 75 SAN MARCO AVE
SAINT AUGUSTINE FL
32084 454150153
8
23
193L74
FL Group Fully Insured
MARTHA V SMYTH DMD PA
MARTHA V SMYTH
General Dentistry 115 E GRANADA BLVD STE 11
ORMOND BEACH
FL
32176 593656542
1
3
193L74
FL Group Fully Insured
MARVIN WELLS DMD
MARVIN WELLS
Oral Surgery
19 ST JOHNS MEDICAL PARK
SAINT AUGUSTINE FL
32216 592517676
1
1
193L74
FL Group Fully Insured
MCD DENTISTRY PA
REHAM EL HENNAWEY
Multi-Specialty
10955 CAUSEWAY BLVD
BRANDON
FL
33511 455540256
1
1
193L74
FL Group Fully Insured
MCLELLAN DENTAL INC
MARIA S FRASER
Pediatric Dentistry 1100 S PONCE DE LEON BLVD STE 2 SAINT AUGUSTINE FL
32084 593493889
45
144
193L74
FL Group Fully Insured
MCLELLAN DENTAL INC
MATTHEW A MCLELLAN
Pediatric Dentistry 1100 S PONCE DE LEON BLVD STE 2 SAINT AUGUSTINE FL
32084 593493889
62
196
193L74
FL Group Fully Insured
MICHAEL A KROMBACH DDS
MICHAEL A KROMBACH
General Dentistry 1774 UNIVERSITY BLVD S
JACKSONVILLE
FL
32216 390544472
2
4
193L74
FL Group Fully Insured
MICHAEL AND MORIA DOMINGOES PA
MICHAEL W DOMINGOES
General Dentistry 3534 A1A S
SAINT AUGUSTINE FL
32080 593322886
3
6
193L74
FL Group Fully Insured
MICHAEL V MURPHY DMD
MICHAEL V MURPHY
General Dentistry 821 BIG TREE RD
DAYTONA BEACH
FL
32119 592803533
1
3
193L74
FL Group Fully Insured
MIELLIE DENTAL PC
MIELLIE DENTAL PC
Multi-Specialty
286 MADISON AVE STE 1000
NEW YORK
NY 10017 262868808
1
1
193L74
FL Group Fully Insured
NICHOLAS NAIM TAWIL DDS
NICHOLAS N TAWIL
Multi-Specialty
425 W TOWN PL STE 106
SAINT AUGUSTINE FL
32092 203295783
1
1
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
NORTH FL ORAL AND FACIAL SURGERY PA OANA MIERLOI DDS PA
GREGORY W HARTLEY OANA MIERLOI
Oral Surgery
11481 OLD ST AUGUSTINE RD STE JACKSONVILLE
FL
32225 592880470
1
1
General Dentistry
2140235 HAND AVE STE J
ORMOND BEACH
FL
32174 205919853
7
16
193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
OCEANSIDE ENDODONTICS OF ST AUGUSTINE EMILY W TYLER OPLCEANSIDE ENDODONTICS OF ST AUGUSTINE HOPE L FELDMAN POLRANGE PARK DENTAL PROFESSIONALS PA MICHAEL T MCCLURE
Endodontics
2510 US HIGHWAY 1 S STE B
ST AUGUSTINE
FL
32086 452671661
26
88
Endodontics
2510 US HIGHWAY 1 S STE B
ST AUGUSTINE
FL
32086 452671661
7
64
General Dentistry 1409 KINGSLEY AVE STE 7A
ORANGE PARK
FL
32073 264508220
4
18
193L74
FL Group Fully Insured
ORLANDO ORAL & FACIAL SURGERY PLLC SRAVANTHI GANNE
Oral Surgery
10131 W COLONIAL DR STE 3
OCOEE
FL
34761 460796483
2
4
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
ORMOND BEACH DENTAL PROFESSIONALS LPALCCIFIC DENTAL PA
KERRI ANN GRAHAM ADRIANA C PORTER
General Dentistry 802 STERTHAUS DR STE A
ORMOND BEACH
FL
32174 900444294
6
16
General Dentistry 911 BEVILLE ROAD STE 1
DAYTONA BEACH
FL
32119 522442295
4
12
193L74
FL Group Fully Insured
PACIFIC DENTAL PA
ADRIANA C PORTER
General Dentistry 911 BEVILLE ROAD STE 1
DAYTONA BEACH
FL
32119 522442295
1
2
193L74
FL Group Fully Insured
PANAMA CITY SMILES PA
ANISHKUMAR T PATEL
General Dentistry 1022 HARRISON AVE
PANAMA CITY
FL
32401 275142729
1
2
193L74
FL Group Fully Insured
PARRISH FAMILY DENTISTRY
DANNY C PARRISH
General Dentistry 729 DUNLAWTON AVE
PORT ORANGE
FL
32127 464019224
5
9
193L74
FL Group Fully Insured
PAUL PIMENTEL DDS HOLDINGS PLLC
ALLYSON R SUIT
Multi-Specialty
1298 WEST GRANADA BLVD
ORMOND BEACH
FL
32174 474665148
2
10
193L74
FL Group Fully Insured
PAUL PIMENTEL DDS HOLDINGS PLLC
PIMENDENT PA
Multi-Specialty
1298 WEST GRANADA BLVD
ORMOND BEACH
FL
32174 474665148
1
1
193L74
FL Group Fully Insured
PIMENDENT II PA
FARAH HASAN
Multi-Specialty
1812 DUNLAWTON AVE STE 101
PORT ORANGE
FL
32127 465090377
1
6
193L74
FL Group Fully Insured
PONCE DE LEON FAMILY DENTISTRY PA
THEODORE D HAEUSSNER
General Dentistry 4 SAINT JOHNS MEDICAL PK DR
ST AUGUSTINE
FL
32086 205715360
8
21
193L74
FL Group Fully Insured
POTENTCO MANAGEMENT CORPORATION MICHAEL C WESTCOTT
General Dentistry 10625 N MILITARY TRL STE 201
WEST PALM BEACH FL
33410 650176784
7
18
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
REBECCA A FAUNCE DMD PA RICHARD C RAMPI DMD RICHARD CARLSON DMD ROBERT R THOUSAND III DDS ROBERT R THOUSAND III DDS ROBERT R THOUSAND III DDS ROBERTO SANTIAGO DDS RODNEY DOBROWOLSKI DMD PC ROGER W SCOTT DDS RONALD F JACOB DMD SALT RUN FAMILY DENTISTRY LLC SARA M DROKER DMD SCOTT T MESSICK DDS SILVA DENTAL PA SNH LLCN HATE DMD SNH LLCN HATE DMD SNH LLCN HATE DMD SONDRA L AVANT DDS MS PA ST JOHNS ENDODONTICS PA ST JOHNS FAMILY DENTISTRY ST JOHNS FAMILY DENTISTRY
REBECCA A FAUNCE
Orthodonticcs
160 CYPRESS POINT PKWY STE D217 PALM COAST
FL
32164 593328565
74
86
RICHARD C RAMPI
General Dentistry 5940 TURKEY LAKE RD
ORLANDO
FL
32819 223850537
4
6
KHOI M LE DAVID W COWLING
General Dentistry 13241 BARTRAM PARK BLVD UNIT JACKSONVILLE
FL
32258 273385367
1
3
Endodontics
137C0Y5 PRESS BRANCH WAY STE 107 PALM COAST
FL
Unkno 263902020
7
33
ROBERT R THOUSAND
Endodontics
3 CYPRESS BRANCH WAY STE 107 PALM COAST
FL
Unkno 263902020
3
13
ROBERT R THOUSAND
Periodontics
3 CYPRESS BRANCH WAY STE 107 PALM COAST
FL
NA
271396570
1
4
ROBERTO SANTIAGO
General Dentistry 109 WHITEHALL DR STE 118
SAINT AUGUSTINE FL
32086 593725848
3
6
RODNEY M DOBROWOLSKI
General Dentistry 828 3RD ST
WHITEHALL
PA
18052 232312867
1
4
ROGER W SCOTT
General Dentistry 212 OAKRIDGE BLVD
DAYTONA BEACH
FL
32118 593284888
10
14
RONALD F JACOB
General Dentistry 29 OLD KINGS RD N STE 1A
PALM COAST
FL
32137 290821564
158
470
VINCENT M LETH
General Dentistry 700 ANASTASIA BLVD
SAINT AUGUSTINE FL
32080 593393220
10
13
SARA M DROKER
General Dentistry 106 N OLD KINGS RD STE A
ORMOND BEACH
FL
32174 260702833
5
11
SCOTT T MESSICK
General Dentistry 840 DUNLAWTON AVE STE C
PORT ORANGE
FL
32127 593714467
4
15
GLADSTON SILVA
General Dentistry 1667 N CLYDE MORRIS BLVD STE 1 DAYTONA BEACH
FL
32117 465363595
2
6
BOBBY C GARFINKEL
Oral Surgery
870 DUNLAWTON AVE STE 210
PORT ORANGE
FL
32127 412254447
6
28
SAMEER N HATE
Oral Surgery
105 CYPRESS POINT PKWY STE B PALM COAST
FL
32164 412254447
31
80
SAMEER N HATE
Oral Surgery
870 DUNLAWTON AVE STE 210
PORT ORANGE
FL
Unkno 412254447
15
98
SONDRA L AVANT
Endodontics
731 DUNLAWTON AVE STE 105
PORT ORANGE
FL
32127 593451390
1
7
THOMAS P CURRIE ANTHONY R CORRAL
Endodontics
9770 OLD BAYMEADOWS RD STE JACKSONVILLE
FL
32256 271905543
1
3
General Dentistry
2121235 A1A S STE A3
SAINT AUGUSTINE FL
32080 262857544
2
4
KELLY L CARROTHERS
General Dentistry 2225 A1A S STE A3
SAINT AUGUSTINE FL
32080 262857544
25
52
Service Date Begin: 1/1/2018 Service Date End: 12/31/2018
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
193L74 193L74 193L74 193L74 193L74 193L74 193L74
FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured FL Group Fully Insured
193L74 193L74
FL Group Fully Insured FL Group Fully Insured
Provider Utilization - Product Management
Group(s): FLAGLER COUNTY SCHOOL BOARD
Report Run On :1/23/2019
ST JOHNS FAMILY DENTISTRY
MICHELLE DEFELICE
General Dentistry 2225 A1A S STE A3
SAINT AUGUSTINE FL
32080 262857544
2
ST JOHNS PEDIATRIC DENTISTRY
LAURA G SULLIVAN
Pediatric Dentistry 1949 COUNTY ROAD 210 W
SAINT JOHNS
FL
32259 453735382
4
STANLEY D KANOWITZ DDS
STANLEY D KANOWITZ
General Dentistry 8383 PINES BLVD
PEMBROKE PINES
FL
33024 591483409
2
STEPHANIE MAPP DMD PA
STEPHANIE N MAPP
General Dentistry 1515 BUSINESS CENTER DR STE 1 FLEMING ISLAND
FL
32003 593736546
3
STEPHEN L BECKETT DDS PA
STEPHEN L BECKETT
General Dentistry 700 ZEAGLER DR STE 11
PALATKA
FL
32177 591710305
2
STEPHEN L STROUT DMD
STEPHEN L STROUT
Periodontics
1301 PLANTATION ISLAND DR S STE SAINT AUGUSTINE FL
32080 203806026
3
STEVE R COOPER DMD JENNIFER S COOPER DENISE TURNER
General Dentistry
2120745 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 593439782
1
SDTMEDVE R COOPER DMD JENNIFER S COOPER FREDERICK A FOX
General Dentistry 1275 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 593439782
5
DSTMEDVE R COOPER DMD JENNIFER S COOPER MOHAMMAD U BAWANY
General Dentistry 1275 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 593439782
4
DSTMEDVE R COOPER DMD JENNIFER S COOPER SAPNA D ADAPPA
General Dentistry 1275 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 593439782
2
SDTMEDVE R COOPER DMD JENNIFER S COOPER STEPHEN N OBENG
General Dentistry 1275 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 593439782
19
DSTMEDVE R COOPER DMD JENNIFER S COOPER STEVE R COOPER DMD JENNIFER S General Dentistry
1275 W GRANADA BLVD STE 1
ORMOND BEACH
FL
32174 593439782
1
DMD
COOPER DMD
STUDIO 32 ORTHODONTICS LLC
NATALIE MULLALLY
Orthodonticcs
2222 NW 40TH TERRACE STE B
GAINESVILLE
FL
32605 275422463
5
SUZANNE M WILBUR DMD
SUZANNE M WILBUR
General Dentistry 800 ZEAGLER DR STE 420
PALATKA
FL
32177 593594085
5
TAYLOR F TOWNSEND DDS
TAYLOR F TOWNSEND
General Dentistry 54 BROAD ST
SPRUCE PINE
NC 28777 263151281
2
THAI THANH NONG
THAI T NONG
General Dentistry 5234 EAST HIGHWAY 100 STE 103 PALM COAST
FL
32164 262599302
487
THAI THANH NONG
THAI THANH NONG
General Dentistry 5234 EAST HIGHWAY 100 STE 103 PALM COAST
FL
32164 262599302
1
THOMAS H CARTLEDGE DDS MS
BRIANNE C DESANTIS
Orthodonticcs
106 N OLD KINGS RD STE C
ORMOND BEACH
FL
Unkno 260536901
29
THOMAS PARHAM DMD
THOMAS R PARHAM
General Dentistry 800 S NOVA RD STE L
ORMOND BEACH
FL
32174 461326159
1
TOMOKA PERIODONTICS & IMPLANT DTOEMNTPIKSITNRDYENTAL
MICHELE P MCCALL RAMINDER SINGH
General Dentistry General Dentistry
7 BOULDER ROCK DR STE 2 2309 N TRIPHAMMER RD
PALM COAST ITHACA
FL
32137 591488658
2
NY 14850 300076300
2
UNIVERSAL SMILES DENTISTRY VALLEY FORGE DENTAL OF FL PA
ARTURO PEREZ ALFREDO E TORRAS CEBALLOS
General Dentistry Multi-Specialty
6735 CONROY WINDERMERE RD STE ORLANDO
1200521 PORT MALABAR NE BLVD
PALM BAY
FL
32835 460781561
2
FL
32935 593356849
1
VOLUSIA ENDODONTICS EAST PA WEST COAST DENTAL PARTNERS WEST VIRGINIA UNIVERSITY DENTAL CORP WHISPERING PINES DENTAL LLC WILLIAM J GLENOS DDS WILLIAM J MORSE FAMILY DENTISTRY INC WILLIAM J MORSE FAMILY DENTISTRY INC
WITTEN & WITTEN PA WITTEN & WITTEN PA
GRETCHEN B JUNGERMANN GAURANG R NANAVATI BRYAN D WEAVER SUZANNE M WILBUR WILLIAM J GLENOS SEUNG C YANG WILLIAM J MORSE FAMILY DENTISTRY INC ANDREW L WITTEN ANDREW L WITTEN
Endodontics Multi-Specialty General Dentistry General Dentistry Orthodonticcs General Dentistry General Dentistry
General Dentistry General Dentistry
1148 PELICAN BAY DR
DAYTONA BEACH
37221 MERIDIAN AVE
DADE CITY
1 MEDICAL CENTER DR
MORGANTOWN
109 NATURE WALK PKWY UNIT 105 ST AUGUSTINE
22 SAINT JOHNS MEDICAL PK DR SAINT AUGUSTINE
2199 A1A S
SAINT AUGUSTINE
2199 A1A S
SAINT AUGUSTINE
223 W ADAMS ST 223 W ADAMS ST
JACKSONVILLE JACKSONVILLE
FL
32119 464279068
2
FL
33618 260357554
1
WV 26506 550524309
1
FL
32092 475000514
2
FL
32086 593421268
34
FL
32080 461495928
7
FL
32080 461495928
11
FL
32202 591225912
1
FL
32202 591225912
2
Total: 4,373
4 15 10 7 5 6 3 11 11 7 47 1
5 9 5 1,306 2 31 2 2 6 4 2
3 6 1 4 34 16 27
6 2
10,876
Member Count
1 2
1
2
12 41 4 3 1 1 5 1 1 7 4 2 1 16 2
1
1
6 11 9 8 2 1 2 2 1
2 2 1 3
30 3 1 9 1
2 1
3 33 4
9 3 1 9 19 1 66 46 2 1 34 27 45 56 40 26 1 1 1 6 1 2 1 1 8 6 4 1 2 1 1 1 1 9 1 1 1 11 4 3 1 1
1 1 2 2 9 1 2 1 2
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