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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