2019 Provider Directory - BCBSIL

[Pages:3]2019 Provider Directory

Blue Cross Medicare Advantage Basic (HMO)SM Blue Cross Medicare Advantage Basic Plus (HMO-POS)SM Blue Cross Medicare Advantage Premier Plus (HMO-POS)SM

Y0096_BEN_IL_HMOPRDR19_NM_C

Last updated 10/19 850774.1019

Blue Cross Medicare AdvantageSM

2019 Provider Directory

This directory is current as of October 4, 2019.

This directory provides a list of Blue Cross Medicare Advantage's current network providers.

This directory is for the entire Blue Cross Medicare Advantage provider network offered to people that are Medicare eligible and residing in Cook, DuPage, Kane, and Will counties.

To access Blue Cross Medicare Advantage's online provider directory, you can visit mapd/providers. For any questions about the information contained in this directory, please call our Customer Service Department at 1-877-774-8592, 8:00 a.m. ? 8:00 p.m., local time, 7 days a week.TTY users should call: 711.

HMO and HMO-POS plans provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC's plans depends on contract renewal. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-774-8592 (TTY: 711) We are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays. ATENCI?N: si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-877-774-8592 (TTY: 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 d?as de la semana. Si usted llama del 1 de abril al 30 de septiembre, durante los fines de semana y feriados, se usar?n tecnolog?as alternas (por ejemplo, correo de voz). This document is available in other formats such as Braille and large print. For additional information, call us at 1-877-774-8592. (TTY users should call 711).

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Table of Contents

Section 1 ? Introduction ........................................................................................................................ iii

What is the service area for Blue Cross Medicare Advantage?....................................................iv

How do you find Blue Cross Medicare Advantage providers in your area?..................................iv

Section 2 ? List of Network Providers .................................................................................................. 1

Primary Care Physicians ................................................................................................................ 1

Specialist ................................................................................................................................... 275

Specialty Alphabetic Listing .................................................................................................... 1498

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Section 1 ? Introduction

This directory provides a list of Blue Cross Medicare Advantage (HMO) and Blue Cross Medicare Advantage (HMO-POS) network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).

If you join the Blue Cross Medicare Advantage Basic (HMO) Plan, you will have to choose one of our network providers listed in this directory to be your Primary Care Physician (PCP). The term "PCP" will be used throughout this directory. Generally, you must get your health care services from your PCP.

It is not required but recommended that you select a PCP if you join the Blue Cross Medicare Advantage Basic Plus (HMO-POS) Plan or Blue Cross Medicare Advantage Premier Plus (HMO-POS) Plan.

A PCP is a doctor who is a family practitioner, internist or geriatric physician. The PCP is trained to provide general medical care. The PCP you select provides or manages your health care. The PCP also helps you make informed decisions about your care. When necessary the PCP makes referrals to specialists, generally within your medical group network.

The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory; however, some services may require a referral. If you have been going to one network provider, you are not required to continue to go to the same provider. In some cases, you may get covered services from non-network providers. If you require medical care beyond the scope of your PCP, the PCP will coordinate with providers most appropriate to render the medical treatment. It is important to note that the PCP belongs to a network. The PCP has certain network specialists and hospitals that they use for coordinated specialty, diagnostic and hospital medical care. The specialist and hospitals that the PCP may refer you to will be within the PCP network affiliation.

If you receive authorization to see an out-of-network provider for covered health care services, you simply pay your usual copay (if any). However, if you see an out-of-network provider for covered health care services without Plan authorization, you pay a deductible and coinsurance.

You may be financially responsible to pay for some or possibly all services if you choose to go to a doctor outside of your affiliated medical group without authorization from your PCP. Your PCP will coordinate the authorization process. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.

If you are traveling and are out of the Blue Cross Medicare Advantage Basic (HMO) Plan, Blue Cross Medicare Advantage Basic Plus (HMO-POS) Plan or Blue Cross Medicare Advantage Premier Plus (HMO-POS) Plan service area and need urgent care or emergency care, you should go to the nearest provider to seek care.

You do not need prior authorization to seek medical help in an urgent or emergency situation. The physician treating your emergency needs will discuss your condition with your Primary Care Physician. When your condition is stable the physicians will coordinate the transfer of your care back to your Primary Care Physician network.

If you enroll in Blue Cross Medicare Advantage Basic Plus (HMO-POS) Plan or Blue Cross Medicare Advantage Premier Plus (HMO-POS) Plan, you are not required to pay an out-of-network provider more than what the provider is allowed by Medicare. Ask the out-of-network provider to bill us first. If you pay for services that are covered and in benefit for your plan, we will reimburse you for our share of the cost. If you get a bill from the provider, you can send the bill to us for consideration of benefits at the address given below. If the services are considered covered and in benefit for your plan, we will reimburse the out-of-network provider and you will be informed of your financial liability.

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If an out-of-network provider asks you to pay for covered services you receive, please call Customer Service at 1-877-774-8592 (TTY 711) or send the bill(s) with a note explaining the situation to:

Blue Cross Medicare Advantage P.O. Box 805107 Chicago, IL 60680

You must use network providers except in emergency or urgent care situations. If you obtain routine care from out-of-network providers neither Medicare nor Blue Cross Medicare Advantage will be responsible for the costs. You may receive covered urgent or emergency medical care whenever you need it. You are covered for emergency care worldwide. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health after your co-pay. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

What is the service area for Blue Cross Medicare Advantage?

The counties in our service area are listed below.

? Cook

? DuPage

? Kane

? Will

How do you find Blue Cross Medicare Advantage providers in your area?

The directory includes hospitals, physicians and other providers participating in the Blue Cross Medicare Advantage Basic (HMO) Plan, Blue Cross Medicare Advantage Basic Plus (HMO-POS) Plan or Blue Cross Medicare Advantage Premier Plus (HMO-POS) Plan. Please refer to the provider listings in this directory for section names. Each section is organized alphabetically by city. Within each city, the city and/or physician names are listed in alphabetical order along with the address and phone number. For the most updated Blue Cross Medicare Advantage provider information, please visit our Provider Finder at mapd/providers. While every provider listed in this directory is affiliated with or employed by a contracting medical group, not every provider listed will be accepting new patients. Although Blue Cross Medicare Advantage has identified those providers who were not accepting patients at the time this directory was created, the status of any physicians practice may have changed. For the most current information regarding the status of any physician's practice, please contact either the physician or the medical group you have selected at the phone number listed in this directory. If you have questions about Blue Cross Medicare Advantage or require assistance in selecting a PCP, please call our Customer Service Department at 1-877-774-8592. We are open 8:00 a.m.? 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays. TTY users should call 711. Or, visit mapd/providers.

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HOW TO READ THE PHYSICIAN LISTING

Example: CHICAGO (Alphabetical listing of towns and cities)

FAMILY PRACTICE (Specialty)

Smith, John, MD (Physician's name)

(555)123-4567 (Phone number)

1234 First St., Chicago, IL, 60601 (Physician's address)

This information changes on a frequent basis. Please refer to the online directory or call Customer Service below

for current updates.

Participation by providers in this directory is not guaranteed and may be subject to change. Please ask your

provider whether he/she is still participating in the network. If you have questions about Blue Cross Medicare

Advantage, please call our Customer Service number at 1-877-774-8592 (TTY users should call 711).

We are open 8:00 a.m. ? 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September

30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

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COOK COUNTY ARLINGTON HEIGHTS

Section 2 ? List of Network Providers

Primary Care Physicians

ARLINGTON HEIGHTS

ARLINGTON HEIGHTS COOK COUNTY

FAMILY PRACTICE

Abraham, Naveen K MD PCP# 0535446769 3 East Golf Rd Arlington Heights, IL 60005 (224) 225-0226 M,Tu 07:00 AM-07:00 PM W 07:00 AM-06:30 PM Th 08:00 AM-07:00 PM F 07:00 AM-05:00 PM Sa 08:00 AM-02:00 PM

Medical Group: Advocate Lutheran Gen Phys Prtnrs

Crystal, Nurit MD PCP# 0098249010 1700 W Central Rd Suite 140 Arlington Heights, IL 60005 (847) 259-6200 M,F 08:00 AM-04:30 PM Tu 07:00 AM-07:00 PM W,Th 07:00 AM-05:00 PM Sa 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners Language: Hebrew

Dragisic, Peter B MD PCP# 0215147266 135 E Algonquin Rd Ste A2 Arlington Heights, IL 60005 (877) 877-4827 Tu 08:00 AM-04:00 PM

Medical Group: Advocate Christ Hospital Physn Language: Serbian

Edwards, Elena MD PCP# 0168548665 3295 N Arlington Heights Rd Arlington Heights, IL 60004 (847) 392-7400 M,W 11:00 AM-07:00 PM Tu 10:00 AM-02:00 PM Th 10:00 AM-06:00 PM F 10:00 AM-03:00 PM Sa 09:00 AM-02:00 PM

Medical Group: Northwest Community Hlth Partners Language: Russian, Ukrainian

Hasan, Benjamin A MD PCP# 0458345979 1700 West Central Road Ste 140 Arlington Heights, IL 60005 (847) 259-6200 M,F 07:30 AM-05:00 PM Tu,W,Th 07:30 AM-07:00 PM Sa 07:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners

Hennegan, Ena E DO PCP# 0098249021 1700 W Central Rd Ste 140 Arlington Heights, IL 60005 (847) 259-6200 M,Tu,Th 08:30 AM-04:30 PM F 08:30 AM-03:30 PM

Medical Group: Northwest Community Hlth Partners

Jacover, Brian E DO PCP# 0540446935 1051 West Rand Road Suite 102 Arlington Heights, IL 60004 (847) 342-8220 M,Tu,W,Th 07:00 AM-07:00 PM F 07:00 AM-05:00 PM Sa 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners

Jurkonie, Michelle DO PCP# 0098449237 1538 N Arlington Heights Rd Arlington Heights, IL 60004 (847) 253-6464 M,Tu,W,Th,F 07:00 AM-05:00 PM Sa 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners Language: English

Lightfoot, John D MD PCP# 0098249220 1700 W Central Rd Ste 140 Arlington Heights, IL 60005 (847) 259-6200 M 07:00 AM-04:00 PM W,Th 07:30 AM-04:00 PM F 07:30 AM-03:00 PM

Medical Group: Northwest Community Hlth Partners

Skyba, Nicholas DO PCP# 0962149922 1051 W Rand Rd Ste 102 Arlington Heights, IL 60004 (847) 342-8220 M,Tu,W,Th 07:00 AM-07:00 PM F 07:00 AM-05:00 PM Sa 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners Language: English, Spanish, Ukrainian

Stefaniuk, Mark A MD PCP# 0098249027 1051 W Rand Rd Arlington Heights, IL 60004 (847) 618-5450 M,Tu,W,Th,F 08:00 AM-04:30 PM

Medical Group: Northwest Community Hlth Partners Language: Spanish, Ukrainian

Board Certified in Listed Specialty. Primary Care Physician Number. Office Hours. 1

COOK COUNTY ARLINGTON HEIGHTS

Primary Care Physicians

ARLINGTON HEIGHTS

ARLINGTON HEIGHTS COOK COUNTY (continued)

FAMILY PRACTICE (continued)

Tomczyk, Stanley G MD PCP# 0230043174 1614 West Central Road Suite 209 Arlington Heights, IL 60005 (847) 259-8777 M,Tu 09:00 AM-05:00 PM W 01:00 PM-05:00 PM Th,F,Sa 09:00 AM-01:00 PM

Medical Group: Northwest Community Hlth Partners Language: Italian, Polish

Trevino, Kristin M MD PCP# 0527541847 1051 W Rand Rd Ste 102 Arlington Heights, IL 60004 (847) 342-8220 M,Tu,W,Th 07:00 AM-07:00 PM F 07:00 AM-05:00 PM Sa 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners Language: English

GERIATRIC MEDICINE

Homa, Theodore M MD PCP# 0434742112 800 W Oakton Arlington Heights, IL 60004 (847) 222-9901 M,Tu,W,Th,F 09:00 AM-05:00 PM

Medical Group: Northwest Community Hlth Partners

INTERNAL MEDICINE

Ahn, Chong H MD PCP# 0098249121 1430 N Arlington Hts Rd Ste 104 Arlington Heights, IL 60004 (847) 253-5985 M,Th 02:00 PM-06:30 PM Tu,F 02:00 PM-05:30 PM

Medical Group: Northwest Community Hlth Partners Language: Korean

Bains, Rushim MD PCP# 0358949761 1051 W Rand Rd Suite 102 Arlington Heights, IL 60004 (847) 342-8220 M,Tu,W,Su 07:00 AM-07:00 PM Th 07:00 AM-05:00 PM F 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners

Bakken, Carl D MD PCP# 0098248895 1538 N Arlington Hts Rd Arlington Heights, IL 60004 (847) 253-6464 M,Tu,W 07:00 AM-07:00 PM Th 07:00 AM-05:00 PM F 07:00 AM-04:00 PM

Medical Group: Northwest Community Hlth Partners

Bakken, Carl D MD PCP# 0098248900 605 W Central Ave Ste 201 Arlington Heights, IL 60005 (847) 253-6464 M,Tu,W,Th,F 08:30 AM-05:00 PM

Medical Group: Northwest Community Hlth Partners

Bartels, Stephanie A MD PCP# 0098248847 1051 W Rand Rd Ste 102 Arlington Heights, IL 60004 (847) 342-8220 M,Tu,W,Th 07:00 AM-07:00 PM F 07:00 AM-05:00 PM Sa 08:00 AM-12:00 PM

Medical Group: Northwest Community Hlth Partners

Brown, Cory A MD PCP# 0262743780 415 W Golf Rd Ste 16 Arlington Heights, IL 60005 (847) 797-0528 M,Tu,W,Th,F 09:00 AM-04:00 PM

Medical Group: Advocate Il Masonic Phys

Cohen, Monika MD PCP# 0044940476 1410 N Arlington Heights Rd Arlington Heights, IL 60004 (847) 618-1640 M,Tu,W 08:00 AM-05:00 PM Th 07:00 AM-05:00 PM F 07:00 AM-04:00 PM

Medical Group: Northwest Community Hlth Partners Language: English

Devarapalli, Heyer C MD PCP# 0553541595 1635 North Arlington Hts Rd Suite 203 Arlington Heights, IL 60004 (847) 392-1500 M,Tu,W,Th,F 09:00 AM-05:00 PM

Medical Group: Northwest Community Hlth Partners Language: Hindi, Telugu

Board Certified in Listed Specialty. Primary Care Physician Number. Office Hours. 2

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