MEDICAL PROVIDERS FOR DISRUPTION REPORT - …

INVITATION TO NEGOTIATE

# 002-18

EMPLOYEE BENEFITS INSURANCE PLANS

ATTACHMENT 3

MEDICAL PROVIDERS FOR DISRUPTION

REPORT

Provider Match

Company: SW FL WATER MGMT DISTRICT

Group: 78159

Current Paid Period: From 01/2016 to 12/2017

Report Type: Combined Report

Group

Number

78159

Provider Tax Blinded Tax

ID

ID

590774199 XXX-XX-4199

Provider

Number

506

Provider Name

ST JOSEPHS

HOSPITAL

Address 1

Address 2

3001 W DR

MARTIN

LUTHER KING

JR BLVD

3100 E

FLETCHER

AVENUE

MULTIPLE

STE 3 EAST

78159

591113901

XXX-XX-3901

553

FLORIDA HOSPITAL

TAMPA

78159

000000000

XXX-XX-0000

00000

WALGREENS

78159

591943502

XXX-XX-3502

125

78159

621113740

XXX-XX-3740

581

78159

000000000

XXX-XX-0000

00000

78159

000000000

XXX-XX-0000

00000

78159

000000000

XXX-XX-0000

00000

78159

000000000

XXX-XX-0000

00000

78159

593458145

XXX-XX-8145

509

TAMPA GENERAL

HOSPITAL

78159

590724459

XXX-XX-4459

302

FLORIDA HOSPITAL

MEDICAL CENTER

1 TAMPA

GENERAL

CIRCLE

601 E ROLLINS

ST

78159

650832790

XXX-XX-2790

532

BAYFRONT HEALTH

BROOKSVILLE

78159

650832790

XXX-XX-2790

585

BAYFRONT HEALTH

SPRING HILL

78159

000000000

XXX-XX-0000

00000

78159

590774199

XXX-XX-4199

569

78159

000000000

XXX-XX-0000

00000

78159

650825133

XXX-XX-5133

30900

78159

590683252

XXX-XX-3252

536

78159

591113901

XXX-XX-3901

Y29

MULTIPLE

SHANDS AND

1600 SW

UNIVERSITY OF

ARCHER RD

FLORIDA HEALTH

CARE NTWK

OAK HILL HOSPITAL 11375 CORTEZ

BOULEVARD

PUBLIX PHARMACY

City

St

Zip

Provider Type

TAMPA

FL

33607

ACUTE CARE

HOSPITAL

TAMPA

FL

33613

ACUTE CARE

HOSPITAL

MULTIPLE

RX

MULTI

PHARMACY

GAINESVILLE

FL

32610

BROOKSVILLE

FL

Provider

Specialty

Network

Indicator

PAR

Members

Claims

Copay

Coinsurance

Deductible

28

104

$13,072.36

$1,473.54

$1,511.20

PAR

40

67

$11,708.94

$942.98

$1,023.28

PHARMACY

613

7,424

$91,879.38

$0.00

$3,893.19

ACUTE CARE

HOSPITAL

PAR

8

119

$4,313.14

$189.64

34613

ACUTE CARE

HOSPITAL

PAR

68

117

$11,854.41

PHARMACY

Charged Amt

NWB

PPO

HMO

$1,785,326.22 $758,683.36

YES

YES

YES

$1,589,054.26 $694,425.01

YES

YES

YES

$611,783.13

YES

YES

YES

$112.82

$1,580,595.38 $552,999.57

YES

YES

YES

$5,944.48

$8,011.34

$3,386,077.94 $429,431.75

YES

YES

YES

$711,194.76

Plain Paid

MULTIPLE

MULTIPLE

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

PHARMACY

494

7,171

$71,640.29

$0.00

$4,918.23

$481,691.84

$404,142.89

YES

YES

YES

CAREMARK KANSAS MULTIPLE

SPECIALTY

PHARMACY LLC DBA

CVS/SPECIALTY

MULTIPLE

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

PHARMACY

2

35

$850.00

$0.00

$0.00

$363,775.35

$362,925.35

YES

YES

YES

MULTIPLE

MULTIPLE

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

PHARMACY

471

5,505

$67,596.95

$0.00

$5,131.04

$430,105.75

$355,682.90

YES

YES

YES

ALLIANCERX

MULTIPLE

WALGREENS PRIME

MULTIPLE

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

PHARMACY

8

64

$1,820.00

$0.00

$0.00

$298,262.38

$296,442.38

YES

YES

YES

TAMPA

FL

33606

ACUTE CARE

HOSPITAL

PAR

25

67

$9,924.93

$655.08

$278.49

$772,056.88

$262,788.37

YES

YES

YES

ORLANDO

FL

32803

ACUTE CARE

HOSPITAL

PAR

9

17

$1,050.00

$1,455.10

$1,000.00

$467,696.19

$242,648.62

YES

YES

YES

17240 CORTEZ

BOULEVARD

BROOKSVILLE

FL

34601

ACUTE CARE

HOSPITAL

PAR

34

68

$4,300.00

$0.00

$523.94

$1,504,417.30 $238,964.83

YES

YES

YES

10461 QUALITY

DRIVE

SPRING HILL

FL

34609

ACUTE CARE

HOSPITAL

PAR

65

104

$11,500.00

$1,322.52

$2,657.03

$2,038,455.49 $219,961.79

YES

YES

YES

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

7

45

$1,005.00

$0.00

$0.00

$208,766.54

$207,761.54

YES

YES

YES

TAMPA

FL

33607

ACUTE CARE

HOSPITAL

PAR

24

53

$4,136.48

$5,909.99

$2,206.08

$404,349.73

$207,536.28

YES

YES

YES

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

1

25

$1,000.00

$0.00

$0.00

$205,419.37

$204,419.37

YES

YES

YES

TAMPA

FL

33607

PHYSICIAN - HEMATOLOGY/

M.D.

ONCOLOGY

PAR

1

41

$872.20

$76.54

$0.00

$340,054.00

$186,267.95

YES

YES

YES

SAINT

PETERSBURG

FL

33701

CHILDRENS

HOSPITAL

PAR

23

57

$9,248.73

$237.09

$378.94

$576,941.70

$166,825.52

YES

YES

YES

TAMPA

FL

33614

ACUTE CARE

HOSPITAL

PAR

6

11

$1,175.65

$0.00

$0.00

$264,363.92

$156,767.26

YES

YES

YES

CVS PHARMACY

CAREMARK FLORIDA MULTIPLE

SPECIALTY

PHARMACY DBA

CVS/SPECIALTY

ST JOSEPH'S

3030 W DR

WOMENS HOSPITAL MARTIN

LUTHER KING

JR BLVD

EXPRESS SCRIPTS MULTIPLE

SPECIALTY DIST

SVCS

GEORGE,

3402 W DR

CHRISTOPHER B

MARTIN

LUTHER KING

JR BLVD

JOHNS HOPKINS ALL 501 6TH AVE S

CHILDRENS

HOSPITAL

FLORIDA HOSPITAL 7171 N DALE

CARROLLWOOD

MABRY

HIGHWAY

MULTIPLE

MULTIPLE

FL 1

PHARMACY

PHARMACY

Group

Number

78159

Provider Tax Blinded Tax

ID

ID

621113740 XXX-XX-3740

Provider

Number

579

Provider Name

Address 1

Address 2

REGIONAL MED CTR 14000 FIVAY

BAYONET POINT

ROAD

4211 VAN DYKE

RD

City

St

Zip

Provider Type

HUDSON

FL

34667

ACUTE CARE

HOSPITAL

LUTZ

FL

33558

TAMPA

FL

33612

WESLEY

CHAPEL

FL

33544

MULTIPLE

RX

MULTI

PHARMACY

CLEARWATER

FL

33764

ACUTE CARE

HOSPITAL

MULTIPLE

RX

MULTI

PHARMACY

SPRING HILL

FL

34609

BROOKSVILLE

FL

34613

MULTIPLE

RX

MULTI

LAKELAND

FL

33805

SAFETY

HARBOR

FL

TAMPA

Provider

Specialty

Network

Indicator

PAR

Members

Claims

Copay

Coinsurance

Deductible

Charged Amt

11

19

$2,800.00

$0.00

$0.00

ACUTE CARE

HOSPITAL

PAR

22

35

$3,700.00

$1,955.00

$686.64

$302,589.09

SPECIAL

CANCER

HOSPITAL

ACUTE CARE

HOSPITAL

PAR

21

102

$11,962.28

$782.26

$592.39

PAR

24

63

$4,361.60

$0.00

PHARMACY

40

305

$7,372.08

PAR

7

13

PHARMACY

34

PHYSICIAN - HEMATOLOGY/

M.D.

ONCOLOGY

PAR

PHYSICIAN M.D.

PHARMACY

Plain Paid

NWB

PPO

HMO

YES

YES

YES

$129,720.76

YES

YES

YES

$456,476.50

$126,423.08

YES

YES

YES

$0.00

$444,408.90

$109,990.62

YES

YES

YES

$0.00

$132.28

$109,933.37

$102,429.01

YES

YES

YES

$850.00

$1,145.06

$2,785.11

$642,082.27

$98,692.75

YES

YES

YES

802

$10,076.56

$0.00

$245.97

$106,378.94

$96,056.41

YES

YES

YES

9

59

$1,481.59

$0.00

$0.00

$160,383.00

$87,811.29

YES

YES

YES

PAR

2

105

$1,260.00

$255.02

$266.53

$181,260.00

$80,720.21

YES

YES

YES

PHARMACY

97

1,515

$15,991.86

$0.00

$302.53

$93,822.93

$77,478.54

YES

YES

YES

ACUTE CARE

HOSPITAL

PAR

10

17

$2,884.00

$0.00

$0.00

$169,953.94

$70,649.48

YES

YES

YES

34695

ACUTE CARE

HOSPITAL

PAR

6

10

$850.00

$0.00

$0.00

$124,383.02

$66,414.61

YES

YES

YES

FL

33614

INJECTABLE

DRUG

SUPPLIER

SPECIALTY

PHARMACIES

PAR

10

34

$0.00

($27.33)

$500.00

$140,671.80

$61,254.57

YES

YES

YES

MULTIPLE

RX

MULTI

PHARMACY

PHARMACY

PHARMACY

35

261

$4,959.99

$0.00

$54.53

$62,482.14

$57,467.62

YES

YES

YES

PITTSBURGH

PA

15224

PAR

1

1

$0.00

$0.00

$0.00

$76,409.88

$57,060.58

YES

YES

NO

ZEPHYRHILLS

FL

33541

ACUTE CARE

HOSPITAL

PAR

7

67

$1,286.27

$0.00

$0.00

$177,450.65

$50,243.24

YES

YES

YES

WINTER

HAVEN

FL

33881

ACUTE CARE

HOSPITAL

PAR

6

10

$1,650.00

$421.69

$0.00

$72,831.64

$45,794.78

YES

YES

YES

TEMPLE

TERRACE

FL

33637

AMBULATORY

SURGICAL

CENTER

PAR

8

12

$700.00

$438.02

$358.43

$145,987.40

$41,673.90

YES

YES

YES

OCALA

FL

34471

ACUTE CARE

HOSPITAL

PAR

1

1

$500.00

$0.00

$0.00

$97,569.57

$39,681.00

YES

YES

YES

$1,298,266.36 $155,209.19

78159

590774199

XXX-XX-4199

415

ST. JOSEPH'S

HOSPITAL - NORTH

78159

593238634

XXX-XX-8634

584

H LEE MOFFITT

CANCER CENTER

78159

208488713

XXX-XX-8713

186

FLORIDA HOSPITAL

WESLEY CHAPEL

78159

000000000

XXX-XX-0000

00000

PRIME

THERAPEUTICS LLC

78159

592047041

XXX-XX-7041

563

78159

000000000

XXX-XX-0000

00000

WINN DIXIE

MULTIPLE

78159

650825133

XXX-XX-5133

13626

LI, MARY M

4003 MARINER

BLVD

78159

593314210

XXX-XX-4210

26860

78159

000000000

XXX-XX-0000

00000

78159

592650456

XXX-XX-0456

515

78159

590855412

XXX-XX-5412

582

78159

953382344

XXX-XX-2344

T9041

78159

000000000

XXX-XX-0000

00000

78159

250969492

XXX-XX-9492

777

78159

592108057

XXX-XX-8057

533

78159

590724462

XXX-XX-4462

507

78159

593646134

XXX-XX-6134

69T

78159

591479652

XXX-XX-9652

339

78159

590624462

XXX-XX-4462

548

MORTON PLANT

6600 MADISON

NORTHBAY HOSPITAL ST

NEW PORT

RICHEY

FL

34652

ACUTE CARE

HOSPITAL

PAR

1

3

$500.00

$0.00

$0.00

$94,461.24

$37,530.83

YES

YES

YES

78159

364764806

XXX-XX-4806

381

MEMORIAL HOSPITAL 2901 W SWANN

OF TAMPA LP

AVENUE

TAMPA

FL

33609

ACUTE CARE

HOSPITAL

PAR

6

11

$1,450.00

$0.00

$0.00

$228,482.07

$34,361.08

YES

YES

YES

78159

471455535

XXX-XX-5535

397

INVERNESS

FL

34452

ACUTE CARE

HOSPITAL

PAR

8

16

$1,838.88

$264.52

$0.00

$139,137.82

$31,974.92

YES

YES

YES

78159

610947837

XXX-XX-7837

574

BRANDON

FL

33511

ACUTE CARE

HOSPITAL

PAR

10

16

$2,100.00

$0.00

$0.00

$169,504.13

$31,887.39

YES

YES

YES

78159

900336929

XXX-XX-6929

09441

BROOKSVILLE

FL

34613

PHYSICIAN M.D.

PAR

1

116

$1,470.00

$0.00

$0.00

$139,111.00

$31,222.06

YES

YES

YES

12902 USF

MAGNOLIA

DRIVE

2600 BRUCE B

DOWNS

BOULEVARD

MULTIPLE

MEDICAL CENTER OF 18167 US 19 N

TRINITY

MULTIPLE

STE 650

MULTIPLE

SASTRY, VATSALA S 15435 CORTEZ

BLVD

WALMART

MULTIPLE

MULTIPLE

PHARMACY

LAKELAND REGIONAL 1324 LAKELAND

MEDICAL CENTER HILLS

BOULEVARD

MEASE

COUNTRYSIDE

HOSPITAL

CAREMARK LLC

PRIME

THERAPEUTICS

THE WESTERN

PENNSYLVANIA

HOSPIT

FLORIDA HOSPITAL

ZEPHYRHILLS, INC.

WINTER HAVEN

HOSPITAL, INC.

3231

MCMULLEN

BOOTH ROAD

7930

WOODLAND

CENTER BLVD

MULTIPLE

STE 500

MULTIPLE

4800

FRIENDSHIP

AVENUE

7050 GALL

BOULEVARD

200 AVENUE F

NE

FLORIDA

13060 N

ORTHOPAEDIC

TELECOM

INSTITUTE SURGERY PKWY

CENTER, LLC

OCALA REGIONAL

MEDICAL CENTER

1431 SW 1ST

AVE

CITRUS MEMORIAL

HOSPITAL

502 W

HIGHLAND

BOULEVARD

BRANDON REGIONAL 119 OAKFIELD

HOSPITAL

DRIVE

CARADONNA,

RICHARD R

11373 CORTEZ

BLVD

STE 200

PHARMACY

PHARMACY

INFECTIOUS

DISEASES

PHARMACY

ONCOLOGY

Group

Number

78159

Provider Tax Blinded Tax

ID

ID

200195256 XXX-XX-5256

Provider

Number

577

Provider Name

Address 1

SEVEN RIVERS

REGIONAL MEDICAL

CENTER

SARASOTA

MEMORIAL HOSPITAL

6201 N

SUNCOAST

BOULEVARD

1700 S TAMIAMI

TRAIL

Address 2

78159

596012500

XXX-XX-2500

513

78159

000000000

XXX-XX-0000

00000

CVS/SPECIALTY

MULTIPLE

78159

113454103

XXX-XX-4103

R008M

INSULET

CORPORATION

78159

113454103

XXX-XX-4103

R002T

DEXCOM INC

600

STE 200

TECHNOLOGY

PARK DR

6340

SEQUENCE DR

78159

351611050

XXX-XX-1050

583

78159

000000000

XXX-XX-0000

00000

78159

271575144

XXX-XX-5144

L00A0

ENGLEWOOD

COMMUNITY

HOSPITAL

CLERMONT

COMMUNITY

PHARMACY

COURTAGEN LIFE

SCIENCES INC

78159

270330374

XXX-XX-0374

145UU

HAMOUI, OMAR

78159

462259197

XXX-XX-9197

6EV

BIOSPINE LLC

78159

200973405

XXX-XX-3405

V3024

SUMMIT IMAGING

78159

205276923

XXX-XX-6923

U21

78159

593384750

XXX-XX-4750

27219

78159

593214855

XXX-XX-4855

F16

78159

731666433

XXX-XX-6433

142

LAKEWOOD RANCH

MEDICAL CENTER

78159

113454103

XXX-XX-4103

R00K3

NUMOTION

78159

746001118

XXX-XX-1118

777

78159

300759177

XXX-XX-9177

191

UNIVERSITY OF

TEXAS MD

ANDERSON

BAYFRONT HEALTH

ST PETERSBURG

78159

590714831

XXX-XX-4831

107

78159

621449272

XXX-XX-9272

78159

650825133

78159

78159

MULTIPLE

700 MEDICAL

BOULEVARD

City

St

Zip

Provider Type

CRYSTAL

RIVER

FL

34428

ACUTE CARE

HOSPITAL

SARASOTA

FL

34239

ACUTE CARE

HOSPITAL

MULTIPLE

RX

MULTI

PHARMACY

BILLERICA

MA

01821

SAN DIEGO

CA

92121

ENGLEWOOD

FL

34223

DURABLE

MEDICAL

EQUIPMENT

DURABLE

MEDICAL

EQUIPMENT

ACUTE CARE

HOSPITAL

Provider

Specialty

PHARMACY

Members

Claims

Copay

Coinsurance

Deductible

Charged Amt

Plain Paid

NWB

PPO

HMO

3

8

$1,050.00

$0.00

$0.00

$142,882.83

$30,926.49

YES

YES

YES

PAR

12

25

$2,250.00

$0.00

$0.00

$100,818.51

$29,499.03

YES

YES

YES

PHARMACY

2

16

$555.00

$0.00

$0.00

$29,517.47

$28,962.47

YES

YES

YES

PAR

3

25

$0.00

$0.00

$0.00

$27,647.73

$27,647.73

YES

YES

YES

PAR

3

34

$0.00

$0.00

$0.00

$31,998.51

$25,904.70

YES

YES

YES

PAR

2

7

$350.00

$0.00

$0.00

$249,163.86

$22,171.33

YES

YES

YES

PHARMACY

15

44

$940.00

$0.00

$345.40

$22,714.43

$21,429.03

YES

YES

YES

NON PAR

1

20

$0.00

$1,470.00

$0.00

$83,429.00

$20,768.66

NO

NO

NO

PAR

16

88

$2,061.89

$543.21

$777.11

$57,965.39

$20,638.72

YES

YES

YES

PAR

2

2

$100.00

$0.00

$0.00

$20,728.34

$19,413.00

YES

YES

YES

PAR

91

175

$7,934.63

$0.00

$171.94

$70,200.58

$19,324.12

YES

YES

YES

PAR

1

4

$0.00

$0.00

$0.00

$19,313.88

$19,130.01

YES

YES

YES

PAR

5

39

$1,050.00

$0.00

$0.00

$125,075.00

$19,004.77

YES

YES

YES

MULTIPLE

MULTIPLE

MULTIPLE

RX

MULTI

PHARMACY

12 GILL ST

STE 3700

WOBURN

MA

01801

CLINICAL

LABORATORY

11373 CORTEZ

BLVD

4211 W BOY

SCOUT

BOULEVARD

STE 405

BROOKSVILLE

FL

34613

TAMPA

FL

33607

PHYSICIAN M.D.

AMBULATORY

SURGICAL

CENTER

BROOKSVILLE

FL

34613

LAKELAND

FL

33815

BROOKSVILLE

FL

34613

PHYSICIAN M.D.

TAMPA

FL

33612

V.A.

HOSPITAL

PAR

7

47

$2,350.00

$153.60

$4,107.77

$46,571.12

$18,902.12

YES

YES

YES

LAKEWOOD

RANCH

FL

34202

ACUTE CARE

HOSPITAL

PAR

5

11

$1,400.00

$0.00

$0.00

$64,979.00

$18,809.87

YES

YES

YES

TAMPA

FL

33610

DURABLE

MEDICAL

EQUIPMENT

PAR

1

1

$0.00

$0.00

$0.00

$19,179.16

$18,260.58

YES

YES

YES

PO BOX 4434

HOUSTON

TX

77210

PAR

1

4

$750.00

$0.00

$0.00

$25,859.40

$18,196.53

YES

YES

NO

701 6TH ST S

SAINT

PETERSBURG

FL

33701

ACUTE CARE

HOSPITAL

PAR

4

6

$800.00

$0.00

$232.43

$123,715.21

$17,883.45

YES

YES

YES

MAYO CLINIC

FLORIDA HOSPITAL

4500 SAN

PABLO RD S

JACKSONVILLE

FL

32244

ACUTE CARE

HOSPITAL

PAR

1

1

$457.81

$0.00

$0.00

$38,580.59

$17,874.07

YES

YES

YES

61X

ALL SAINTS

SURGERY CENTER

11377 CORTEZ

BLVD

BROOKSVILLE

FL

34613

AMBULATORY

SURGICAL

CENTER

PAR

9

11

$900.00

$0.00

$0.00

$123,513.40

$17,546.54

YES

YES

YES

XXX-XX-5133

71423

TANG, HUAYANG

SPRING HILL

FL

34609

PAR

5

38

$376.68

$8.72

$0.00

$26,766.00

$17,490.86

YES

YES

YES

200670560

XXX-XX-0560

6H5

HUDSON

FL

34667

PHYSICIAN - HEMATOLOGY/

M.D.

ONCOLOGY

AMBULATORY

SURGICAL

CENTER

PAR

10

12

$800.00

$463.81

$0.00

$124,515.00

$17,119.84

YES

YES

YES

000000000

XXX-XX-0000

00000

MULTIPLE

RX

MULTI

PHARMACY

9

286

$2,844.90

$0.00

$0.00

$19,829.62

$16,984.72

YES

YES

YES

SUITE 400

12037 CORTEZ

BLVD

GOOD SHEPHERD 320 W MAIN ST

HOSPICE INC

MOUREIDEN, ANAS M 11325 CORTEZ

BLVD

US DEPARTMENT OF 13000 BRUCE B

VETERANS AFFAIRS DOWNS BLVD

8330

LAKEWOOD

RANCH

BOULEVARD

5903 HAMPTON STE B

OAKS PKWY

11063 COUNTY

LINE RD

BAYONET POINT

14104

SURGERY AND

YOSEMITE

ENDOSCOPY CENTER DRIVE

BENZER PHARMACY MULTIPLE

MULTIPLE

PHARMACY

Network

Indicator

PAR

UROLOGY

INDEPENDEN

T

DIAGNOSTIC

TESTING

HOSPICE

PHARMACY

RHEUMATOLO

GY, INTERNAL

MEDICINE

PHARMACY

Group

Number

78159

Provider Tax Blinded Tax

ID

ID

593622500 XXX-XX-2500

Provider

Number

68P

Provider Name

Address 1

Address 2

City

St

Zip

Provider Type

FLORIDA

ENDOSCOPY AND

SURGERY FAC

12900 CORTEZ

BLVD

STE 103

Network

Indicator

PAR

Members

Claims

Copay

Coinsurance

Deductible

Charged Amt

Plain Paid

NWB

PPO

HMO

BROOKSVILLE

FL

34613

AMBULATORY

SURGICAL

CENTER

17

20

$700.00

$99.13

$286.35

$61,650.00

$16,794.50

YES

YES

YES

38010 MEDICAL

CENTER AVE

ZEPHYRHILLS

FL

33540

PHYSICIAN M.D.

PAR

2

27

$735.80

$0.00

$0.00

$43,274.00

$16,719.07

YES

YES

YES

13720 JETPORT STE 6

COMMERCE

PKWY

FORT MYERS

FL

33913

DURABLE

MEDICAL

EQUIPMENT

NON PAR

1

47

$0.00

$3,550.75

$1,000.00

$54,138.04

$16,080.50

NO

NO

NO

11373 CORTEZ

BLVD

1600 SW

ARCHER RD

STE 200

BROOKSVILLE

FL

34613

ONCOLOGY

GAINESVILLE

FL

32610

PHYSICIAN M.D.

CLINICAL

LABORATORY

PAR

1

34

$720.00

$0.00

$0.00

$105,146.39

$16,008.22

YES

YES

YES

PAR

53

86

$0.00

$106.97

$0.00

$27,319.00

$15,985.57

YES

YES

YES

14540 CORTEZ

BLVD

STE 118

BROOKSVILLE

FL

34613

PHYSCIAN OSTEOPATH

FAMILY

PRACTICE

PAR

30

149

$1,995.00

$0.00

$0.00

$30,237.00

$15,794.98

YES

YES

YES

SPRING HILL

FL

34606

PHYSCIAN OSTEOPATH

PEDIATRIC

MEDICINE

PAR

27

193

$2,625.00

$24.14

$188.77

$41,320.27

$15,406.57

YES

YES

YES

TAMPA

FL

33607

AMBULATORY

SURGICAL

CENTER

NON PAR

1

1

$0.00

$204.59

$0.00

$169,949.74

$15,313.71

YES

YES

YES

BROOKSVILLE

FL

34613

SPRING HILL

FL

34609

PHYSICIAN M.D.

URGENT

CARE

CENTER

PAR

28

86

$2,040.00

$22.12

$554.71

$32,174.00

$15,278.85

YES

YES

NO

PAR

83

129

$3,420.80

$0.00

$515.50

$24,588.13

$14,599.48

YES

YES

YES

HENDERSONVI

LLE

NC

28791

PAR

2

9

$293.42

$0.00

$0.00

$24,248.40

$14,569.17

YES

YES

NO

BAY PINES

FL

33744

PAR

22

53

$1,560.00

$0.00

$0.00

$37,810.00

$14,327.37

YES

YES

YES

BROOKSVILLE

FL

34613

AMBULATORY

SURGICAL

CENTER

PAR

18

19

$600.00

$131.29

$405.70

$64,898.00

$14,245.36

YES

YES

YES

BRADENTON

FL

34208

ACUTE CARE

HOSPITAL

PAR

5

6

$550.00

$0.00

$0.00

$64,394.00

$14,147.89

YES

YES

YES

DADE CITY

FL

33525

ACUTE CARE

HOSPITAL

PAR

7

10

$850.00

$0.00

$1,074.00

$67,150.73

$13,977.00

YES

YES

YES

TAMPA

FL

33615

ACUTE CARE

HOSPITAL

PAR

1

1

$500.00

$0.00

$0.00

$95,005.18

$13,936.00

YES

YES

YES

ORLANDO

FL

32803

PAR

30

65

$870.00

$0.00

$0.00

$25,112.78

$13,631.63

YES

YES

YES

2021 KINGSLEY STE 109

AVE

ORANGE PARK

FL

32073

CONVENIENT

CARE

CENTER

PHYSICIAN M.D.

PAR

2

14

$240.00

$0.00

$0.00

$34,822.00

$13,536.73

YES

YES

YES

12220 CORTEZ

BLVD

BROOKSVILLE

FL

34613

PAR

84

145

$4,050.00

$0.00

$254.00

$23,945.00

$13,476.00

YES

YES

YES

TAMPA

FL

33615

PAR

1

3

$30.00

$0.00

$0.00

$66,300.00

$13,065.17

YES

YES

YES

LAKELAND

FL

33803

PAR

2

2

$0.00

$0.00

$0.00

$12,990.64

$12,990.64

YES

YES

YES

78159

650825133

XXX-XX-5133

04730

GANDLE, LARRY

78159

223184508

XXX-XX-4508

R0015

MILLENNIUM

RESPIRATORY

SERVICES

78159

451444883

XXX-XX-4883

09441

78159

591680273

XXX-XX-0273

L8486

78159

770686817

XXX-XX-6817

44256

CARADONNA,

RICHARD R

FLORIDA CLINICAL

PRACTICE

ASSOCIATION INC

JACOBS, JERRY R

78159

385025507

XXX-XX-5507

09545

78159

462259197

XXX-XX-9197

6EV

BIOSPINE LLC

78159

593322434

XXX-XX-2434

07140

REED, OLIVER M

78159

204371727

XXX-XX-1727

B918E

78159

562084959

XXX-XX-4959

777

HENDERSON

COUNTY HOSPITAL

CORP

MARG R

PARDEE

MEMORIAL HO

78159

593282073

XXX-XX-2073

03134

ESGUERRA, DAVID

10000 BAY

PINES BLVD

78159

650832790

XXX-XX-2790

6AT

HERNANDO

ENDOSCOPY AND

SURGERY CENTER

12180 CORTEZ

BLVD

78159

232798290

XXX-XX-8290

539

78159

593649652

XXX-XX-9652

566

BAYFRONT HEALTH

DADE CITY

78159

800935908

XXX-XX-5908

383

TAMPA COMMUNITY 6001 WEBB

HOSPITAL

ROAD

78159

020769966

XXX-XX-9966

000ZT

VAXCARE

CORPORATION

78159

593156212

XXX-XX-6212

28653

RIVERA, ABRAHAM

78159

251924516

XXX-XX-4516

B918J

CARE ONE OF

FLORIDA LLC

78159

208110795

XXX-XX-0795

12580

78159

113667807

XXX-XX-7807

899

GRIFFEN, MICHAEL B 8391 OMAHA

CIR

4211 W BOY

SCOUT

BOULEVARD

12900 CORTEZ

BLVD

SUNCOAST URGENT 4112 MARINER

CARE

BLVD

SUITE 400

STE 205

800 N

JUSTICE

STREET

MANATEE MEMORIAL 206 2ND

HOSPITAL

STREET E

13100 FORT

KING ROAD

3113 LAWTON

RD

STE 250

FREEMAN, DEBRA E 5935 WEBB RD

IMPLANTABLE

PROVIDER GROUP

INC

3616 HARDEN

BLVD

STE 187

Provider

Specialty

RADIATION

THERAPY

DERMATOLOG

Y

PHYSCIAN - DERMATOLOG

OSTEOPATH

Y

URGENT

CARE

CENTER

PHYSICIAN M.D.

MEDICAL

SUPPLY

COMPANY

WITH

ORTHOTIST

AND

PROSTHETIS

T

HEADACHE

PAIN

MANAGEMENT

RADIATION

THERAPY

 ................
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