Provider Directory Individual Plans - Health First

Provider Directory

Individual Plans

(HMO)

This directory provides a list of AdventHealth Advantage Plans network providers.

This directory is for Brevard, Flagler, Hardee, Highlands, Indian River, Orange, Osceola, Seminole and Volusia counties in Florida.

For information about additional providers who participate in our network, please contact us or visit our website.

This directory is current as of September 15, 2020.

Providers' participation status is subject to change at any time. Some network providers may have been added or removed from our network after this directory was printed. For the most up-to-date list, please call us at 1-844-522-5279. Customer Service is available weekdays from 8am to 6pm TTY/TDD users should call 1-800-955-8771.

For information about alternative provider directory formats, please contact us or visit our website at .

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Table of Contents

Introduction .............................................................................................................................................................. 2 Primary Care Physicians......................................................................................................................................... 7 Specialists .............................................................................................................................................................. 67 Behavioral & Mental Health Providers ............................................................................................................... 235 Hospitals & Emergency Departments................................................................................................................ 293 Ancillary Services ................................................................................................................................................ 294 Pharmacies ........................................................................................................................................................... 308

Important Phone Numbers

Customer Service Department............................................................................................................ 1.844.522.5279 TDD relay ..................................................................................................................................... 1.800.955.8771 E-mail ..............................................................................................................................................AHAP@

Mail Order Prescription drug inquiries ..........................................................healthfirst. 1.866.469.1506 TDD .............................................................................................................................................. 1.800.955.8771

Mail Order Prescription drug inquiries (for deliveries outside of Florida).......... or 1.866.744.0621 TDD .............................................................................................................................................. 1.800.642.6410

Mental/nervous and alcohol/drug services assistance line................... 1.800.424.4347 (TDD/TTY: 1.800.424.1694)

Health First Commercial Plans, Inc. is doing business under the name of AdventHealth Advantage Plans. AdventHealth Advantage Plans does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. 36194_MPINFO8634AH(07/2020)

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Introduction

Individual Plans

Welcome to AdventHealth Advantage Plans. We have designed this directory to provide you with valuable information about the health care providers participating with AdventHealth Advantage Plans.

Choosing a Primary Care Provider

We encourage you to choose your personal health care provider, known as a Primary Care Provider (PCP), from our network of local physicians and advanced practitioners. Primary care providers are family and general practitioners, internal medicine physicians, and pediatricians. The primary care provider coordinates all of your medical care, including offering preventive care, ordering necessary laboratory, x-ray, and other routine diagnostic tests, arranging for hospital admissions, and working with specialists when medically necessary. Local participating providers are also most familiar with our plans and benefits.

All participating PCPs are on call 24 hours a day, 7 days a week. If you need urgent care after normal office hours, you may visit an urgent care or walk-in clinic. For 24/7 access, Nurse 24 SM is a toll-free call away to get advice on health concerns, big or small.

We recommend you establish a relationship with your PCP and seek services from him or her before seeing a specialist. By becoming "established" with a PCP, you'll be able to receive care in the event your provider no longer accepts new patients. Your PCP will help make sure you're seeing the appropriate specialist and will keep track of all your medications to reduce the chance of any complications. Many times your PCP will be able to get you an appointment with a specialist more quickly than if you tried on your own. We urge you to take advantage of the care coordination offered by PCPs to assist in managing your entire spectrum of care.

Specialty Care

There may be occasions when a medical service is needed that your primary care provider is unable to offer. AdventHealth Advantage Plans' members have "open access" to see specialists without first obtaining a referral from their PCP. When treatment is required from a specialist, you may contact specialist offices to make appointments as necessary and pay the applicable cost share at the time services are rendered.

It's important to note that while AdventHealth Advantage Plans does not require referrals for specialty care, some specialists still ask patients to get a PCP referral to ensure the proper care is provided and medical records are available.

For HMO members: If services are not available within

our network, your PCP will coordinate approval with us and make arrangements for you to receive care outside the network. If you directly access care outside our network without a referral from your PCP and approval from AdventHealth Advantage Plans, you may be responsible for the entire cost.

Behavioral and Mental Health

We contract with Magellan Behavioral Health (Magellan) to manage mental health and substance abuse services for our members. Magellan is a leader in behavioral healthcare management with services that help individuals and families to recover, improve their overall health, and achieve wellness. Magellan connects members with the right care when it is needed most. Magellan manages care for both inpatient and outpatient services and also provides crisis intervention at any time day or night.

Local providers are listed in this directory. You can find a complete nationwide listing of providers at . You can also find online tools, resources and general educational information addressing health and well-being issues.

For more information or to access behavioral health services, including services outside of the service area, call Magellan directly at 1.800.424.4347 (TDD/TTY: 1.800.424.1694).

You don't need a referral to access your behavioral health benefits. However, we recommend you call the help line for assistance in selecting a provider and understanding your benefits.

Magellan Behavioral Health, Inc. is a subsidiary of Magellan Health Services, Inc.

More Information about Providers

Physician assistants, nurse practitioners, and others who are not licensed as physicians offer many medical services. These services are rendered in accordance with Florida regulations and may require the same cost-share as you would pay for seeing a physician.

Providers' participation status is subject to change at any time. For the most up-to-date list, please call us at 1.844.522.5279. Customer Service is available weekdays from 8 am to 6 pm.

Services That Require Prior Authorization

While AdventHealth Advantage Plans does not require a referral to see network specialists, there are certain

Individual Plans

services that require prior authorization whether you are an HMO or POS member. This ensures the right care is provided in the right setting. Local network providers have information on the services that require prior authorization from AdventHealth Advantage Plans and the steps required to obtain approval. Some examples of services that require prior authorization include MRI, PET, CT scans and nuclear cardiology studies.

If you're a POS member and using an out-of-network provider or an in-network provider that is outside of our local area, please be sure you've discussed the authorization process with your provider and have notified AdventHealth Advantage Plans before receiving care. You have the ultimate responsibility to notify your provider that authorization is required for these procedures. For more information on which procedures require prior authorization or how to obtain approval, please contact our Customer Service Department.

For POS Members

Point of Service (POS) members can see any provider they choose for covered services, regardless of whether or not the provider is an AdventHealth Advantage Plans participating provider. Your plan documents show your share of the cost for receiving services both in and out of our network.

Since your cost depends on whether the provider participates with us, you can save money by using AdventHealth Advantage Plans providers while in Volusia, Flagler and Seminole Counties, or First Health providers when outside of Volusia, Flagler and Seminole Counties, whenever possible. Actual costs will depend on the benefit plan you have, the providers you see, and the services you receive.

Your cost can vary quite a bit depending on which providers you choose:

$ If you choose to see a participating (in-network) provider, you are responsible for paying only for your "in-network" cost-share. We have contracts with these providers limiting the amount they can bill for services.

$$ If you choose to see a non-participating (out-ofnetwork) provider, you are responsible for paying the higher "out-of-network" cost-share. We do not have contracts with these providers limiting the amount they can charge for services, so if they charge more than our allowable amount, you may be responsible for the additional cost (also called "balance billing").

When seeking out-of-network services, we encourage you to talk with your provider in advance--ask what the charges for service will be and if they will accept a lower amount. Some providers will agree, which could reduce your total cost.

AdventHealth Advantage Plans 3

Finding a participating physician or provider

Local participating physicians and other health care providers are listed in this Provider Directory and at . The directory includes information on their credentials, languages spoken, age limitations, if any, and whether they are accepting new patients. It also lists other participating providers like hospitals, outpatient surgery centers, pharmacies, labs, etc. You can also contact Customer Service for additional information on a provider's professional qualifications.

There are some providers outside of our network and service area (Volusia, Flagler and Seminole Counties) who are part of a national network we have contracted with, and have already agreed to accept a reduced rate. If this rate is higher than our allowable fee schedule, you'll still be responsible for the difference, but seeing these providers is another way to help limit your out-of-pocket expenses.

The participating providers located outside of the service area are listed at .

Click on the "Start now" Click on the "Type of Provider" Enter the type of physician or facility you are looking

for and click the green search icon (a zip code will be auto populated, if this is not near your location, click on the zip code and edit as needed) Follow the prompts to refine results for your search criteria.

The customer service representatives at First Health can also help you find a provider outside of Volusia, Flagler and Seminole Counties. Simply call 1.800.226.5116 Monday through Friday from 8 am to 8 pm (Eastern Standard Time), and identify yourself as a health plan participant accessing the First Health Network.

It is your responsibility to confirm your providers' continued participation in the First Health Provider Network and accessibility under your benefit plan. Please also be sure to follow any required pre-authorization procedures, and always present your benefits ID card upon arrival at your appointment.

Prescription Drugs

You can get your covered prescriptions filled by any participating AdventHealth Advantage Plans pharmacy throughout our service area. Local pharmacies as well as participating national chain locations are listed in this Provider Directory. For the most recent updates, visit our web site, or contact our Customer Service Department.

AdventHealth Advantage Plans has a drug formulary, which is defined as a list of drugs, both brand name and generic, approved by the plan as covered medications. A committee comprised of physicians, pharmacists and other

4 AdventHealth Advantage Plans

health care professionals evaluates formulary drugs. Our Pharmacy and Therapeutics Committee regularly reviews the formulary list to be certain it meets the medical needs of our members and providers.

Providers are expected to prescribe the appropriate medication for you from this list. Non-formulary drugs are not covered unless approved by the health plan. If you need a copy of the current formulary, please call the AdventHealth Advantage Plans Customer Service Department at 1.844.522.5279 (TTY/TDD relay: 1.800.955.8771) weekdays from 8 am to 6 pm.

Anytime you receive a prescription for a new drug, be sure to ask your provider if the prescribed drug is on our formulary.

Emergency Services and Care

Your health is always our most important concern. In case of an emergency, go to the closest medical facility or call 911. AdventHealth Advantage Plans will provide coverage for any emergency medical condition, anywhere in the world. An emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain or other acute symptoms, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: serious jeopardy to the health of a patient, including a

pregnant woman or fetus; serious impairment of bodily functions; or, serious dysfunction of any body organ or part.

During pregnancy, the condition may be considered an emergency when: there is inadequate time to safely transfer to another

hospital prior to delivery; a transfer may pose a threat to the health and safety of

the patient or the fetus; or, there is evidence of the onset and persistence of

uterine contractions or rupture of the membranes.

AdventHealth Advantage Plans will provide emergency services and care that includes screening, examination, and evaluation by a physician or, to the extent permitted by applicable law, other appropriate personnel under the supervision of a physician to determine if an emergency medical condition exists and, if it does, the care, treatment, or surgery for a covered service by a physician necessary to relieve or eliminate the emergency medical condition, within the service capability of the medical facility.

Urgent or Walk-in Care

If you need care right away but your condition is not a true emergency, call your primary care provider (PCP) to coordinate your care. All primary care providers are on call 24 hours a day, 7 days a week. If your PCP cannot see

Individual Plans

you quickly enough, you can visit an urgent care or walkin clinic. For 24/7 access, Nurse 24 SM is a toll-free call away to get advice on health concerns, big or small.

Urgent care and walk-in providers can treat sinus and ear infections, colds, bronchitis, strep throat, pink eye, strains, minor burns, skin infections, rashes and cuts. Urgent care centers can also treat minor fractures and cuts that need stitches. Visiting an urgent care center or walk-in clinic instead of a hospital emergency department can often save you time and money.

Participating providers are listed in the ancillary section of this directory. Locations, phone numbers, and hours of local participating urgent and walk-in providers are also online at . No appointment is needed.

Confidentiality

To safeguard your privacy, your personal health information is released only with your written consent or if required by law. To maintain the strict confidentiality of members' health information: AdventHealth Advantage Plans has confidentiality

policies and procedures in place based on good practices and legal requirements. AdventHealth Advantage Plans requires facilities, providers and their medical record departments to keep members' records confidential. All AdventHealth Advantage Plans employees adhere to a confidentiality policy as well as adhere to Standards of Conduct that prohibit release of medical records.

Use of members' identifiable information Identifiable information is data that may cause the member to be recognized or known. Examples of identifiable information include the member's name, address, and date of birth or social security number. At the time of enrollment, AdventHealth Advantage Plans members authorize AdventHealth Advantage Plans to use their member identifiable information for general treatment, coordination of care, quality assessment, utilization review, fraud detection, and accreditation purposes. If member-identifiable information is to be used for any other purpose or shared with any other organization, AdventHealth Advantage Plans must obtain clear and specific consent from you, unless such release is mandated by law.

As an AdventHealth Advantage Plans' member, you have the right to . . . Review your health information as well as review

which departments or agencies have access to your identifiable health information. Protect against unauthorized disclosure of identifiable health information.

Individual Plans

Approve the release of any identifiable information beyond AdventHealth Advantage Plans unless mandated by law.

Give explicit consent prior to your employer having access to your identifiable health information unless mandated by law.

Protect against release of any identifiable health information for the collection, use or sharing of data.

Expect that all information used for research or performance measurement will be limited, in that all data will be de-identified or aggregated before release.

Contact the AdventHealth Advantage Plans Compliance Officer to file a complaint or appeal if you feel that your health information was used without proper consent.

Provider Overview

This directory provides the following provider specific information: Provider's name and gender Specialty--Visit for an explanation of what

body part or condition each type of specialist treats. Hospital affiliations--Indicates which hospital(s)

have granted that provider privileges to see patients in their facility. If you want to use a particular hospital, it's important to choose a provider who can see you there. Medical group affiliations--Indicates whether the provider is part of a group of providers. Board certification--To achieve and maintain board certification, physicians must complete an extensive process of specialty education and exams to demonstrate competency with the latest advances in medical science and technology in his or her specialty as well as best practices in patient safety, quality health care and creating a responsive patient-focused environment. To learn more, visit the American Board of Medical Specialties () or American Osteopathic Association (). Board eligible--Indicates a provider whose boards have expired or those who are awaiting testing or test results. Accepting new patients--Indicates whether a provider will see new patients. If not, you must be an "established" patient to see this provider. Languages spoken--Indicates any language(s) the provider may speak other than English. Office locations--Includes street addresses and phone numbers.

AdventHealth Advantage Plans 5

Education and post graduate training--If not already included within the provider listing you can locate this information through the following resources: American Medical Association (AMA) "DoctorFinder" ; Federation of State Medical Boards (FSMB) ; or the Department of Health License verification site /HealthCareProviders

Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of AdventHealth Advantage Plans. Although we make every effort to maintain this information as accurately as possible, the availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. The provider directory is continually updated as information becomes available.

Providers in our network have undergone a thorough evaluation and verification of their education and credentials. Our providers submit their medical credentials (education, board certification, hospital privileges, etc.), and office information (group affiliation, address, phone, office hours, foreign languages spoken, etc.). AdventHealth Advantage Plans then verifies medical credentials directly with each corresponding organization, and confirms office information with the provider's office staff. After initial verification, this process is repeated every three years. The web-based directory is updated within five days of receipt of changes and the written version is updated quarterly.

AdventHealth Advantage Plans does not use quality, member experience or cost-related measures when selecting hospitals, ancillary services, and practitioners to participate in our Marketplace plans. We use the same criteria when approving any providers to participate in our networks, regardless of which plans they accept.

Visit Us On The Web

You can also see the latest version of this Provider Directory (as well as other health plan information) on our web site -- .

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Individual Plans

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Individual & Fully-Insured Groups

Primary Care Providers

Primary Care Providers 7 September 15, 2020

BREVARD

BREVARD COUNTY

Concierge Medicine - Primary Care Providers

Berk, Danny P., MD

Gender: Male

Medical Associates of Brevard, LLC

A Concierge Primary Care Physician is a physician to which the member pays an annual fee or retainer to be part of the physician's panel. This fee is paid directly to the physician. The member is still required to pay any cost share required.

8057 Spyglass Hill Rd, Ste 104, Melbourne 32940................ (321) 241-4877

Age Requirement: 3 years and older

Hernesman, Shane C., MD*

Gender: Male

Shane C. Hernesman, MD, PA

A Concierge Primary Care Physician is a physician to which the member pays an annual fee or retainer to be part of the physician's panel. This fee is paid directly to the physician. The member is still required to pay any cost share required.

1980 N. Atlantic Ave, Ste 602, Cocoa Beach 32931.............. (321) 453-5888

Certification(s): American Board of Family Medicine, American Board of Family

Medicine (Sub: Sports Medicine)

Hospital Privileges:

Cape Canaveral Hospital

Age Requirement: 7 years and older

Ireland, Mark L., DO

Gender: Male

Medical Associates of Brevard, LLC

A Concierge Primary Care Physician is a physician to which the member pays an annual fee or retainer to be part of the physician's panel. This fee is paid directly to the physician. The member is still required to pay any cost share required.

1380 S. Patrick Dr, Satellite Beach 32937 ............................. (321) 773-2659

Certification(s): American Board of Family Medicine

Age Requirement: All Ages

Nunes, Christopher S., MD

Gender: Male

Medical Associates of Brevard, LLC

A Concierge Primary Care Physician is a physician to which the member pays an annual fee or retainer to be part of the physician's panel. This fee is paid directly to the physician. The member is still required to pay any cost share required.

8057 Spyglass Hill Rd, Ste 104, Melbourne 32940................ (321) 241-4877

Certification(s): American Board of Internal Medicine

Hospital Privileges:

Holmes Regional Medical Center

Age Requirement: 4 years and older

Pinsky, Mark F., DO*

Gender: Male

Medical Associates of Brevard, LLC

A Concierge Primary Care Physician is a physician to which the member pays an annual fee or retainer to be part of the physician's panel. This fee is paid directly to the physician. The member is still required to pay any cost share required.

8045 Spyglass Hill Rd, Ste 101, Melbourne 32940................ (321) 255-2289

Hospital Privileges:

Holmes Regional Medical Center

Age Requirement: 5 years and older

Family Medicine

Anderson, Thomas, DO

Gender: Male

Medical Associates of Brevard, LLC 3040 N. Wickham Rd, Ste 10, Melbourne 32935 ................... (321) 428-4840

Certification(s): American Osteopathic Board of Family Practice

Age Requirement: 6 years and older

Antonio, Amanda, MD

Gender: Female

Health First Medical Group 730 Malabar Rd, Ste B, Malabar 32950.................................. (321) 312-3470

Certification(s): American Board of Family Medicine

Age Requirement: All Ages

Arcand, Josee J., MD*

Gender: Female

Arcand Family Practice, LLC

8055 Spyglass Hill Rd, Ste 103, Melbourne 32940 ................ (321) 255-7334

Certification(s): American Board of Family Medicine

Additional language(s) spoken: French

Age Requirement: 5 years and older

Arias, Erich A., MD

Gender: Male

Healthy Living Clinic, LLC

1300 Florida Ave, Rockledge 32955....................................... (321) 549-2273

Certification(s): American Board of Family Medicine

Hospital Privileges:

Cape Canaveral Hospital

Viera Hospital

Additional language(s) spoken: Spanish

Age Requirement: 2 years and older

Ault, Crystal G., APRN

Gender: Female

Health First Medical Group

3425 Bayside Lakes Blvd, SE, Ste 110, Palm Bay 32909 ...... (321) 434-3430

Age Requirement: All Ages

Badolato, David W., MD*

Gender: Male

Premier Primary Care

6300 N. Wickham Rd, Ste 101, Melbourne 32940.................. (321) 253-2169

Certification(s): American Board of Family Medicine

Hospital Privileges:

Viera Hospital

Age Requirement: 1 year and older

Badolato, Stephen K., MD*

Gender: Male

Premier Primary Care 6300 N. Wickham Rd, Ste 101, Melbourne 32940.................. (321) 253-2169

Certification(s): American Board of Family Medicine, American Board of Family

Medicine (Sub: Sports Medicine)

Age Requirement: 1 year and older

Bhatt, Ami A., MD

Gender: Female

Suntree Internal Medicine 6619 N. Wickham Rd, Melbourne 32940 ................................ (321) 259-9500

Certification(s): American Board of Family Medicine

Hospital Privileges:

Viera Hospital

Age Requirement: 18 years and older

Bisset, Robert K., MD*

Gender: Male

Health First Medical Group

1220 Hwy A1A, Ste 147, Indialantic 32903 ............................ (321) 549-0830

Certification(s): American Board of Family Medicine

Hospital Privileges:

Holmes Regional Medical Center

Age Requirement: 18 years and older

Black, Janis G., DO

Gender: Female

Family Health Center at Port St John

3740 Curtis Blvd, Ste 108, Port Saint John 32927.................. (321) 633-5500

Age Requirement: All Ages

Blanchard, Tamsin L., APRN

Gender: Female

Steward Medical Group, Inc

8000 Ron Beatty Blvd, Ste A3, Barefoot Bay 32976 .............. (772) 664-1388

Age Requirement: 6 years and older

Bonnell, Tiffany A., APRN

Gender: Female

Health First Medical Group

220 N. Sykes Creek Pkwy, Ste 301, Merritt Island 32953 ...... (321) 361-5534

Age Requirement: All Ages

* Accepting established patients only

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