Providers for Acute Care Services

[Pages:3]Medicaid and CHIP Managed Care Services RFP Procurement Library ? Sample Network Providers Table (Acute Care) RFP No. 529-12-0002

Service Area: Jefferson

(Texas Children's Health Plan)

Providers for Acute Care Services

Applicable HMO Program(s): CHIP

Service: Acute Care Hospitals

Number Provider Name 1 Christus Jasper Memorial Hospital 2 Christus St. Elizabeth 3 Christus St. Mary Hospital 4 Cleveland Imaging & Surgical Hospital 5 Cleveland Regional Medical Center 6 Huntsville Memorial Hospital 7 Liberty-Dayton Community Hospital 8 Memorial Hermann Baptist Beaumont Hospital 9 Memorial Hermann Baptist Orange Hospital

10 Memorial Medical Center - Livingston 11 The Medical Center of Southeast Texas 12 Tyler County Hospital 13 Winnie Community Hospital

Street Address 1275 Marvin Hancock Drive 2830 Calder St. 3600 Gates Blvd. 1017 S. Travis Ave 300 E. Crockett St. 110 Memorial Hospital Drive 1353 N. Travis St. 3080 College St. 608 Strickland Dr. 1717 Hwy. 59 Bypass 2555 Jimmy Johnson Blvd. 1100 W. Bluff St. 538 Broadway

Service: Level 1 Trauma Care

Number Provider Name

Street Address

1 There are no Level 1 Trauma Care Hospitals in the Jefferson Service Area

2

etc

Service: Level 2 Trauma Care

Number Provider Name

Street Address

1 There are no Level 2 Trauma Care Hospitals in the Jefferson Service Area

2

etc

Service: Transplant Centers

Number Provider Name

Street Address

1 There are no HHSC designated Transplant Centers in the Jefferson Service Area

2

etc

Service: CMS designated Children's Hospitals

Number Provider Name

Street Address

1 There are no CMS designated Children's Hospitals in the Jefferson Service Area

2

etc

City/Town Jasper Beaumont Port Arthur Cleveland Cleveland Huntsville Liberty Beaumont Orange Livingston Port Arthur Woodville Winnie

Zip Code NPI 75951 77702 77642 77327 77327 77340 77575 77701 77630 77351 77640 75979 77665

Comment 1598749707 1679557888 1679557888 1972540532 1043281330 1144225699 1154324952 1093744187 1295764330 1689650616 1861467573 1447259627 1295781227

City/Town

Zip Code TPIN, if applicable Comment The information was acquired/confirmed on the following website:

City/Town

Zip Code TPIN, if applicable Comment The information was acquired/confirmed on the following website:

City/Town

Zip Code TPIN, if applicable Comment

City/Town

Zip Code TPIN, if applicable Comment

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Medicaid and CHIP Managed Care Services RFP Procurement Library ? Sample Network Providers Table (Acute Care) RFP No. 529-12-0002

Service Area: Jefferson

(Texas Children's Health Plan)

Service: Other hospitals with specialized children's services

Number Provider Name 1 Memorial Hermann Baptist Beaumont Hospital 2

etc

Service: Psychiatric hospitals

Street Address 3080 College St.

City/Town Beaumont

Zip Code NPI 77701

Comment 1093744187

Number Provider Name 1 Memorial Hermann Baptist Beaumont Hospital 2 The Medical Center of Southeast Texas

etc

Street Address 3080 College St. 2555 Jimmy Johnson Blvd.

Service: Other facilities or clinics providing outpatient mental health services

City/Town Beaumont Port Arthur

Zip Code NPI 77701 77640

Comment 1093744187 1861467573

Number Provider Name 1 Alan W. Apperson, LPC 2 Charles L. Olliff, LPC 3 Barbara K. James, LCSW 4 David Cozadd, LPC 5 David W. Meyer, LPC 6 Donna Moore, LPC 7 James Buckingham, MD 8 James Smith, LPC 9 John Janes, MD

10 Kevin J. Simmons, MD 11 Mary Ruth Roberts, LPC 12 Robert Carroll, MD 13 Clayton L. Williamson, LPC 14 Colleen J. Christie, LPC, LMFT 15 Amber M. Banken, LPC 16 Cynthia I. Nicolini, LMFT 17 Donna L. Rizzotto, LPC, LMFT 18 Ben W. Bell, LPC 19 Edward B. Gripon, MD 20 Joanne M. Roper, LPC 21 Joel W. Pinnt, LPC 22 Judy Bolton, LPC 23 Keitha J. Van Ness, LPC 24 Patricia S. Robert, LMSW, LMFT 25 Frani Scates, LPC 26 George E. Groves, MD 27 David W. Hamel, LPC, LMFT 28 Jana K. Windle, LPC 29 Karen R. Jensen, LPC 30 Land Manor, Inc. 31 Edward H. Pendleton, LPC, LCDS 32 Mohammad K. Hamza, PhD 33 Nancy R. Lyons, LPC 34 Ravikumar Kanneganti, MD 35 Pamela A. Kyler, LPC 36 Sara D. Bruhn, LPC, LMFT, LCSW 37 Sharad B. Kulkarni, MD

Street Address

City/Town

415 S. 11th St.

Beaumont

415 S. 11th St.

Beaumont

2721 Nall St.

Port Neches

302 S. Mound St.

Nacogdoches

105 Mayo Place

Lufkin

4632 Northeast Stallings Dr., Ste. 200 Nacogdoches

302 S. Mound St.

Nacogdoches

2001 S. Medford Drive

Lufkin

2001 S. Medford Drive

Lufkin

2001 S. Medford Drive

Lufkin

105 Mayo Place

Lufkin

105 Mayo Place

Lufkin

411 N. Washington Ave.

Livingston

3160 Fannin, Ste. 108

Beaumont

4757 Main Ave.

Groves

13012 N. Highway 146

Dayton

1102 Longfellow Dr., Ste B1

Beaumont

3560 Delaware St., Ste. 502

Beaumont

3560 Delaware St., Ste. 502

Beaumont

3550 Fannin St.

Beaumont

3550 Fannin St.

Beaumont

3550 Fannin St.

Beaumont

3550 Fannin St.

Beaumont

3550 Fannin St.

Beaumont

1095 Plantation Dr

Livingston

740 Hospital Drive, Ste. 220

Beaumont

8700 Ninth Ave., Ste. 106

Port Arthur

1025 Interstate Highway 10 N., Ste. 106Beaumont

1102 Longfellow, Ste. A

Beaumont

4655 Collier St.

Beaumont

2004 US Highway 190 W.

Livingston

2300 Highway 365, Ste. 330

Nederland

3560 Delaware St., Ste. 1205

Beaumont

3250 Medical Center Drive

Beaumont

7980 Anchor Drive, Bldg. 500

Port Arthur

1325 Windsor St.

Huntsville

3400 Highway 365, Ste. 303

Port Arthur

Zip Code NPI 77701 77701 77651 75961 75904 75965 75961 75901 75901 75901 75904 75904 77351 77701 77619 77535 77706 77706 77706 77701 77701 77701 77701 77701 77351 77701 77642 77706 77706 77706 77351 77627 77706 77701 77642 77340 77642

Comment 1326056763 Apperson & Olliff 1477562056 Apperson & Olliff 1558554568 Barbara K. James, LCSW 1780754564 Burke Center 1700944543 Burke Center 1497813232 Burke Center 1841284882 Burke Center 1104988427 Burke Center 1497813224 Burke Center 1255479887 Burke Center 1205820115 Burke Center 1760486468 Burke Center 1982762795 Clayton L Williamson 1427004878 Colleen J. Christi 1568677664 Community Counseling Center 1871678813 Counseling Corner 1114006400 Donna L. Rizzotto, LPC, LMFT 1487775003 Edward B. Gripon, MD, PA 1063411775 Edward B. Gripon, MD, PA 1437214319 Family Services of Southeast Texas Inc. 1104960186 Family Services of Southeast Texas Inc. 1750365946 Family Services of Southeast Texas Inc. 1497087084 Family Services of Southeast Texas Inc. 1073657078 Family Services of Southeast Texas Inc. 1902995244 Frani Scates, LPC 1114023223 G. E. Groves, MD, PA 1225083884 Hamel & Myer 1730198698 Jana Windle, LPC 1275568685 January & Jensen 1083838585 Land Manor, Inc. 1265437495 Life Enrichment Counseling Center 1487860425 M. K. Hamza, PhD, PA 1538145321 Nancy Lyons 1679643191 Ravikumar Kanneganti, MD 1568781912 Samaritan Counseling Center of Southeast TX 1124181144 Sara D. Bruhn 1851313985 Sharad B. Kulkarni, MD PA

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Medicaid and CHIP Managed Care Services RFP Procurement Library ? Sample Network Providers Table (Acute Care) RFP No. 529-12-0002

38 Sherry J. Loeb, LPC 39 Sudheer Kaza, MD 40 Tri County MHMR Services-Cleveland 41 Tri County MHMR Services-Huntsville 42 Tri County MHMR Services-Liberty 43 TRS Solutions Plus Beaumont 44 Walisha M. Blackmore, LPC

Service: Hospitals providing substance abuse services

13012 N Highway 146 3560 Delaware St., Ste. 905 406 N. Washington 7045 Highway 75 S. 612 Highway 90 4347 Phelan Blvd., Ste. 101 2300 Hwy 365, Ste. 330

Number Provider Name 1 Memorial Hermann Baptist Beaumont Hospital 2

etc

Street Address 3080 College St.

Service: Other facilities or clinics providing outpatient substance abuse services

Number Provider Name 1 Land Manor, Inc. 2 Tri County MHMR Services-Cleveland 3 Tri County MHMR Services-Huntsville 4 Tri County MHMR Services-Liberty 5 TRS Solutions Plus Beaumont

Street Address 4655 Collier St. 406 N. Washington 7045 Highway 75 S. 612 Highway 90 4347 Phelan Blvd., Ste. 101

Service Area: Jefferson

(Texas Children's Health Plan)

Mont Belvieu Beaumont Cleveland Huntsville Liberty Beaumont Nederland

77580 77706 77327 77340 77575 77707 77627

1730265182 Sherry J. Loeb, LPC 1548260391 SUDHEER KAZA, MD PA 1851333074 Tri County MHMR Services 1851333074 Tri County MHMR Services 1851333074 Tri County MHMR Services 1518020692 TRS (The Right Step) Behavioral Care, Inc. 1992853063 Walisha M Blackmore, LPC

City/Town Beaumont

Zip Code NPI 77701

Comment 1093744187

City/Town Beaumont Cleveland Huntsville Liberty Beaumont

Zip Code NPI 77706 77327 77340 77575 77707

Comment 1083838585 1851333074 1851333074 1851333074 1518020692

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