Minnesota OAH Intervenor Master List



MASTER SERVICE LIST FOR INTERVENORSUse of this list: The entities on this list have provided the following information to allow parties in workers’ compensation cases to easily contact the company and its representatives regarding an intervention interest under Minn. Stat. § 176.361 in a workers’ compensation case. The left column “intervenor” lists the address to use to serve a Notice of Right to Intervene in a workers’ compensation proceeding along with the date the information was updated. The middle column lists contact information for settlement or case resolution purposes. The right column provides, where available, an alternate contact person if the primary contact person is unavailable. If a Motion to Intervene in an individual case lists a different contact person or persons, please contact the persons listed in the motion. This list is updated per the request of the entities on this list. We cannot guarantee that the information remains accurate. Potential Intervenors: To update this list, please complete and follow the instructions on the Workers’ Compensation Intervenor Contact Information form. To find additional contact information for health care providers, try these links:Hospitals: Hospitals/Minnesota.htmINTERVENORCONTACT PERSONALTERNATE CONTACT PERSONAdvanced Care Chiropractic, P.A.14001 Ridgedale Drive, Suite 390Minnetonka, MN 55305(5/2016)Sheldon Osvold, D.C.(952) 893-8900Fax (952) 893-7399drsosvold@Alaena Wocking(952) 893-8900Fax (952) 893-7399awocking@Advanced Pain Management4131 West Loomis Road, Suite 300Greenfield, WI 53221(7/2018)Melissa Arciga(414) 585-8713Fax (414) 239-6034Melissa.arciga@Alexandria Orthopaedic Associatesk/n/a Heartland Orthopedic Specialists(5/2009)See: Heartland Orthopedic SpecialistsAllied Craftworkers Fringe Benefit Fund(1/2008)See Rosene, Haugrud & Staab, Chtd.Allina Hospitals – District one HospitalInternal Zip 10202P.O. Box 43Minneapolis, MN 55440-0043(6/2020) Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@ Use this information for Abbott Northwestern, Cambridge, Buffalo, Owatonna, Mercy, New Ulm Medical Center, River Falls Area, United, Unity, St. Francis Hospitals, Regina Hospital, Courage Kenny Rehab. Institute, and Phillips Eye Institute.Allina Medical ClinicsConsolidated Business Office Attn: Workers’ Comp InterventionInternal Zip 10202P.O. Box 43Minneapolis, MN 55440-0043(6/2020) Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Use this information for all Allina medical clinics.Altru Health SystemP.O. Box 13780Grand Forks, ND 58208-3780(10/2015)Lori Jacquemart (Alpha A-L)(701) 780-4385Fax (701) 780-1046Ljacquemart@ Diane Schlenk (Alpha M-Z)(701) 780-6164Fax (701)780-1046Ljacquemart@ American Postal Workers Union Health Planc/o O’Donnell, Schwartz & Anderson, P.C.1029 Vermont Avenue Northwest, Suite 850Washington, DC 20005(1/2020)Daryl J. Anderson(202) 898-1075Fax (202) 682-3976subroinfo@Lee C. Anderson(202) 216-1255Fax (202) 682-3976landerson@Apple Valley Chiropractic & Rehab7600 147th Street West, Suite 100Apple Valley, MN 55124(11/2018)Jonathan Taffe(952) 431-3003Fax (952) 431-3016avchiro@Donna Beckmann(952) 431-3003Fax (952) 431-3016avchiro@Apple Valley Medical Clinic14655 Galaxie AvenueApple Valley, MN 55124(1/2016)Debra Kirk(952) 953-4296Fax (952) 891-3921njennissen@Diane Grant(952) 953-9160Fax (952) 891-3921dgrant@Asbestos Workers Local 34 Health & Welfare PlanP.O. Box 220 Minneapolis, MN 55440-0220(952) 544-8332(3/2006)Gary Boline(952) 541-6335Fax (952) 544-8287gabohline@Aspen Medical Group1021 Bandana Blvd. EastSt. Paul, MN 55108(8/2007)Pat Van Ert(651) 642-2726Fax (651) 642-9441pvanert@Beth Bolton(651) 642-2768Fax (651) 642-9441bbolton@Benedictine Health System503 E. Third St. Suite 400Duluth, MN 55805(3/2006)Thomas R. Crook(218) 786-2370Fax (218) 786-7271tom.crook@Kristina Hamann(612) 845-6375kris.hamann@ Blaine Chiropractic Center, P.A.11919 Central Avenue NEBlaine, MN 55434-3911(6/2018)Michael T. Hample, DC(763) 757-1660Fax (763) 757-4108info@Courtney Wenker(763) 757-1660Fax (763) 757-4108courtney.wenker@Blue Cross Blue Shield of IL3200 Robbins Road, Suite 100Springfield, IL 62704(8/2019)Stephanie Ewald(217) 726-0744Fax(217) 698-0146ewalds@bcbsilDrew Colwell(217) 862-5424Fax (217) 698-0146drew_colwell@Blue Cross Blue Shield of MNP.O. Box 64560St. Paul, MN 55164(2/2021)Mary LemieuxKari MadsenYolanda RaichertXia VangSharon Mulvihill1-866-229-7398Fax (651) 662-p.intervention@ Blue Cross Blue Shield of ND4510 13th Avenue SouthFargo, ND 58121(5/2010)Kristi Schlosser Carlson(701) 277-2539Fax (701) 282-1554kristi.carlson@Britton Center360 Sherman Street, Suite 400St. Paul, MN 55102-2425(9/2015)Abigail M. Thomas(651) 340-3854Athomas@Burke Chiropractic Center7250 France Avenue South, Suite 111Edina, MN 55435Adam Burke(952) 835-0006Fax (952) 835-9355dr.adamburke@Danielle Burke(952) 224-4423Fax (952) 835-9355burkebilling2@Carpenters & Joiners Health & Welfare Fund3001 Metro Drive, Suite 500Bloomington, MN 55425(9/2017)Bryan Morben(612) 435-6352Fax (612) 435-6379Anderson, Helgen, Davis & Nissen, P.A.bjm@Kim Tuckner(612) 435-6358Fax (612) 435-6379bjm@Cass Lake Indian Hospital(4/2007)See U.S. Department of Health and Human ServicesCenter for Diagnostic Imaging (CDI)5775 Wayzata Blvd. Suite 500ASt. Louis Park, MN 55416 (6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Center for Sports Medicine & Rehabilitation - Northfield2000 North AvenueNorthfield, MN 55057(4/2020)Melissa Peterson(507) 646-1002Fax (507) 646-1392legal@ CentraCare Health AnesthesiaAttn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Construction Suppliers Health and Welfare Trust Fund A(1/2008)See Rosene, Haugrud & Staab, Chtd.Consulting Radiologists, Ltd.7505 Metro Boulevard, Suite 400Edina, MN 55439 (3/2021)Emily Tovar(612) 573-2260Fax (612) 573-2273Emily.tovar@Shelli Pareanteau(612) 573-2210Fax (612) 573-2250shelli.pareanteau@Department of Employment and Economic DevelopmentSee MN Department of Employment and Economic DevelopmentDepartment of Human ServicesSee MN Department of Human Services Department of Labor and IndustryVocational Rehabilitation UnitSee MN Department of Labor and IndustryDouglas County Hospital111 17th Avenue EastAlexandria, MN 56308(1/2016)Sue N.(320) 762-6061Fax (320) 762-6101snack@Nancy J.(320) 762-6054Fax (320) 762-6101njennissen@Drews Family Chiropractic(12/2015)See HealthSource of WoodburyEagan Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(2/2020)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@East Metro Imaging(8/2020)See Midwest RadiologyEastview Family Chiropractic Clinic1125 Woodbury Drive, Suite 500Woodbury, MN 55125(10/2014)Andrew Erlandson, D.C.(651) 436-2606Fax (651) 436-2909andrewerlandsondc@Elevator Constructors Local 9433 Little Canada Road EastLittle Canada, MN 55117(9/2019)Alex M. Bollman(612) 465-0108Fax (612) 465-0109alex@cummins-Brendan D. Cummins(612) 465-0108Fax (612) 465-0109brendan@cummins-Emergency Physicians, P.A.4300 MarketPointe Drive, Suite 100Bloomington, MN 55435(12/2020)Nate Heikkinen(952) 767-4575Fax (952) 835-4403nheikkinen@ Paul Jacobson (952) 857-1522Fax (952) 835-4403PFS@ Essentia Health520 East 4th Street, Suite 2Duluth, MN 55805Including:Essentia Health East RegionAurora-Northern Pines Clinic and Medical CenterBabbitt ClinicChisholm ClinicDeer River Clinic and Healthcare CenterDuluth Clinic--Duluth, Hermantown, Proctor, Lakewalk, Lakeside, West Duluth, Essentia Health Duluth, St. Mary’s Medical CenterEly ClinicGrand Rapids ClinicHibbing ClinicEssentia Health Sandstone Clinic, Health Center (aka Pine Medical Center)Essentia Health International FallsEssentia Health Moose LakeRemer ClinicVirginia Clinic, Virginia Regional Medical CenterCentral RegionBaxter Specialty ClinicSt. Joseph’s Baxter ClinicSt. Joseph’s Brainerd ClinicSt. Joseph’s Brainerd Medical CenterSt. Joseph’s Crosslake ClinicSt. Joseph’s Emily ClinicCentral Region (continued from above)Hackensack ClinicSt. Joseph’s Pequot Lakes ClinicSt. Joseph’s Pierz ClinicSt. Joseph’s Pillager ClinicSt. Joseph’s Pine River ClinicWest RegionAda Clinic, Bridges Medical CenterBagley ClinicCasselton ClinicChokio ClinicDetroit Lakes: St. Mary’s Detroit Lakes Clinic, St. Mary’s Innovis Health HospitalFosston Clinic, First Care Medical ServicesFrazee ClinicGraceville Clinic and Holy Trinity HospitalJamestown ClinicSt. Mary’s Lake Park ClinicSt. Mary’s Mahnomen ClinicMenahga ClinicMoorehead ClinicOklee ClinicPark Rapids ClinicSt. Mary’s Pelican Rapids ClinicWalker Clinic(3/2021)Karen A. Sirois, Paralegal(218) 786-3122Fax (218) 723-8093karen.sirois@ Sue Shelgren(218)786-3062 Fax (218)723-8093susan.shelgren@ Fairview Health ServicesWork Comp Interventions400 Stinson BoulevardMinneapolis, MN 55413-2614(10/2020)Includes all Fairview facilities [hospitals, clinics, home care, Infusion, Institute for Athletic Medicine, University of MN Heart, Surgical Consultants, (Fairview) Diagnostic Labs (excluding Mesaba/Hibbing/Range area).*Includes HealthEast facilities *Includes University of MN Physicians (except M Health Fairview University Anesthesia Services)Melissa Dietrich(612) 672-7679Fax (612) 365-0396(Attn: Interventions)mdietri1@***Prefer notice to be e-mailed instead of by fax, if possible. If applicable, on cover sheet list sites you are serving. Sarah Bishop(612) 672-5010Fax (612) 365-0396(Attn: Interventions)sbishop1@ Family Health Medical Clinics2000 North AvenueNorthfield, MN 55057(4/2020)Melissa Peterson(507) 646-1002Fax (507) 646-1392legal@ Family Practice Medical Center502 Second Street S.W.P.O. Box 957Willmar, MN 56201Anne Moudry(320) 231-8627Fax (320) 231-8609amoudry@fpmc-Gary McDowell(320) 231-8642gmcdowell@fpmc-First Class Recoveries, Inc. (for Preferred One Administrative Services7900 International Drive, Suite 300Bloomington, MN 55425(10/2014)Bill Brady(952) 883-3250bill.brady@First Plan of MN525 S. Lake Ave. Suite 222Duluth, MN 55802(4/2006)Greg WalshP. O. Box 64560St. Paul, MN 55164(651) 662-6278Fax (651) 662-1099greg_walsh@First Unum Life Insurance Company1 Fountain SquareChattanooga, TN 37402(12/2017)Jennifer Majic(423) 294-5673Fax (423) 294-2424jmajic@Firstlight Health System301 South Highway 65Mora, MN 55051Kelly Caswell(320) 225-3337Fax (320) 225-3345kcaswell@fl-Lisa Wren(320) 225-3534Fax (320) 225-3345lwren@fl-Fortis Benefits Insurance Company (see Union Security Insurance Company) (3/06)Gallery Imaging(8/2020)See Midwest RadiologyGalvin Rehabilitation ServicesP.O. Box 66New Ulm, MN 56073(3/2006)Craig Galvin(507) 233-7733Fax (507) 354-7287galvin@ Grand Itasca Clinic and Hospital111 Southeast Third StreetGrand Rapids, MN 55744(11/2018)Ruth Hoolihan (218) 999-1713 Fax (218) 999-1709rhoolih1@Roxanne Christie(218) 999-1711 Fax (218) 999-1709rchris13@ Gravon’s Natural Chiropractic Center1024 Oxford StreetP.O. Box 396Worthington, MN 56187(2/2021)Dr. Janine Bremer(507) 376-9771Fax (507) 376-9798gravons@ Alexis(507) 376-9771Fax (507) 376-9798gravons@ Greater Metropolitan Hotel-Employers-Employees Health and Welfare Fund(1/2008)See Rosene, Haugrud & Staab, Chtd.Group Health Plan d/b/a HealthPartnersP.O. Box 244Mailstop 25508BMinneapolis, MN 55440(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@HartfordSee The HartfordHealthEastSee Fairview Health ServicesHealthPartners, Inc.P.O. Box 1309Mail Stop 21114AMinneapolis, MN 55440-1309(6/2019)Brian Albrecht(952) 883-5687Fax (952) 853-8728lawdeptsubrogation@ Troy Szczepanksi(952) 883-5192Fax (952) 853-8728lawdeptsubrogation@ HealthSource of Woodbury7060 Valley Creek Plaza, Suite 121Woodbury, MN 55125(12/2015)(Drews Family Chiropractic d/b/a HealthSource of Woodbury)Christopher Drews, D.C.(651) 735-8646Fax (651) 730-9210cdrews@651-329-3124Heartland Orthopedic Specialists1500 Irving StreetAlexandria, MN 56308(5/2009)Melissa Baas(320) 762-0857 Ext. 6061Fax (320) 762-1935mbaas@Kim Blake(320) 762-0857 Ext. 6058Fax (320) 762-1935kblake@Hennepin County Medical Center & Physicians701 Park Ave., S8.200Minneapolis, MN 55415-1829(11/2017)Korrie Murphy(816) 524-9477 Ext. 274Fax (816) 524-2328korrie.murphy@Latasha Pettis(816) 524-9477 Ext. 231Fax (816) 524-2328latasha.pettis@High Point Surgery Center8650 Hudson Blvd. Suite 235Lake Elmo, MN 55042(3/2006)Lori A. Gavin(651)702-7401Fax (651)702-7414lgavin@Traci Albers(651) 702-7408Fax (651)702-7414talbers@Hospitals-For Allina Hospitals,See Allina Hospitals Health System Humana1850 Wayzata Boulevard West, Suite 100Long Lake, Minnesota 55356(5/2017)Kathryn Hipp Carlson(612) 333-8600Fax (612) 333-9100kathy@Hutchinson Health1095 Hwy 15 SouthHutchinson, MN 55350(6/2020)Syverson Law Office, P.A.P.O. Box 138Delano, MN? 55328(763) 595-1105Fax: (763) 595-1139Indian Health Service(4/2007)See U.S. Department of Health and Human ServicesIndependent School District #465307 East 6th Street, Suite 100Litchfield, MN 55355Rebecca Boll(320) 693-2444 Ext. 8105(320) 593-6528rboll@Barba Wagner(320) 693-2444 Ext. 8104(320) 593-6528bwagner@Infinitive Health (i-Health)4200 Dahlberg Drive, Suite 300Golden Valley, MN 55422(11/2019)Samantha Cain(952) 456-7268Fax (952) 512-5651samanthacain@Institute for Low Back and Neck Care, PA (ILBNC)3001 Metro Drive, Suite 330Bloomington, MN 55425(6/2007)Laura Tolbert(952) 814-6663ltolbert@Nicole Taft(952) 814-6619ntaft@International Brotherhood of Electrical Workers 292 Health Care Plan312 Central Avenue SE, Suite 292Minneapolis, MN 55414 (10/2015)Thomas McCormick (atty)222 South 9th StreetSuite 1600Minneapolis, MN 55402(612) 337-9550Fax (612) 337-9049tom@ Julie Gessell(952) 591-7733Fax (952) 591-7728julie@ Itasca Medical Care1219 S.E. 2nd AvenueGrand Rapids, MN 55744(6/2020)IMCare Recoveries(218) 327-6769Fax (218) 327-5545IMCare.Recoveries@co.itasca.mn.usLaura Grover(218) 327-6769Fax (218) 327-5545laura.grover@co.itasca.mn.usKittson Memorial Healthcare Center1010 South Birch AvenueHallock, MN 56728(2/2016)Kim Klegstad(218) 843-3810Fax (218) 843-2311kim.klegstad@Liz LaPlant(218) 843-3612Fax (218) 843-2311liz.laplant@Klick, Joseph CRNAAttn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Lakeview Hospital927 West Churchill StreetStillwater, MN 55082(6/2020)Scott Phillips(651) 430-4533Fax (651) 430-8591Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Lakewalk Surgery Center1420 London Road, Suite 100Duluth, MN 55805(11/2015)Joe Majerus(218) 728-8505Fax (281) 728-8557jmajerus@Billing Specialist (Gloria, Jody or Tina)(218) 728-0650Fax (218) 728-8557billers@Landmark Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(4/2019)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@Leno Chiropractic Clinic, Ltd.123 Avenue CCloquet, MN 55720(5/2017)Bri Simmons(218) 879-1556Fax (218) 879-1568bsimmons@Kayla Ellison, D.C.(218) 879-1556Fax (218) 879-1568drellison@Madison National Life Insurance Co., Inc.P.O. Box 5008Madison, WI 53705(10/207)Joe E. Thompson (atty)JMSK LawP.O. Box 913Willmar, MN 56201Office (320) 235-2000Cell (320) 212-7273Fax (320) 235-0480joethompson@Paul Butters(608) 830-2411pjb@Maple Grove HospitalIntervention Notice-Business Office3300 Oakdale Avenue NorthRobbinsdale, MN 55442(6/2020)North Memorial Health Care(763) 520-5400Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@MAPSSee Medical Advanced Pain SpecialistsMayo ClinicAttn: Recovery and Claims Services200 First Street SWRochester, MN 55905Includes all Mayo Clinic facilities:St. Mary’s HospitalRochester Methodist HospitalMayo Clinic PharmacyMayo Clinic StoreMayo Clinic Ambulance f/k/a Gold Cross Ambulance ServiceMayo Clinic Health System – Southeast Minnesota Region, including d/b/a Mayo Clinic Health System-Albert Lea and Austin, d/b/a Mayo Clinic Health System – Cannon Falls, d/b/a Mayo Clinic Health System – Owatonna, d/b/a Mayo Clinic Health System – Red WingMayo Clinic Health System – Southwest Minnesota Region, including d/b/a Mayo Clinic Health System – Mankato, d/b/a Mayo Clinic Health System – New Prague, d/b/a Mayo Clinic Health System – Springfield, d/b/a Mayo Clinic Health System – WasecaMayo Clinic Health System – FairmontMayo Clinic Health System – Lake CityMayo Clinic Health System – St. JamesMayo Clinic Health System – Northwest Wisconsin Region, including d/b/a Mayo Clinic Health System – Eau Claire, Inc, d/b/a Mayo Clinic Health System – Chippewa Valley, Inc., d/b/a Mayo Clinic Health System – Northland, Inc., d/b/a Mayo Clinic Health System – Oakridge, Inc., d/b/a Mayo Clinic Health System – Red Cedar, Inc.Mayo Clinic Health System – Franciscan Medical Center, Inc.(7/2020)Recovery & Claims Services(507) 266-0484Fax (507) 284-9229RSTRCSBAS@mayo.edu***Prefer notice to be e-mailed instead of by fax if possible. If applicable, on cover sheet list sites you are serving.Stacie Schmid(507) 266-0484Fax: (507) 284-9229Schmid.Stacie@mayo.eduMayo Medical PlanAttn: Recovery and Claim Services200 First Street SWRochester, MN 55905(8/2020)Recovery & Claims Services(507) 266-0484Fax (507) 284-9229RSTRCSBAS@mayo.edu***Prefer notice to be e-mailed instead of by fax if possible. If applicable, on cover sheet list sites you are serving.Stacie Schmid(507) 266-0484Fax (507) 284-9229Schmid.Stacie@mayo.eduMcGuire Family Chiropractic, P.A.215 3rd StreetP.O. Box 226Gaylord, MN 55334Dr. Cassie McGuire(507) 237-2777Fax (507) 237-3777mcguirefamilychiro@Melissa Cochrane(507) 237-2777Fax (507) 237-3777mcguirefamilychiro@Medica Health Plans/Optum(4/2014)See OptumMedical Advanced Pain Specialists (MAPS) 2104 Northdale Boulevard NW, Suite 220Coon Rapids, MN 55433(4/2018)Juli Lemke(763) 537-6000 Ext. 7196Fax (763) 767-7172Juli.lemke@Meds-1 Ambulance Service, Inc.1328 N.W. 5th StreetGrand Rapids, MN 55744Timothy J. George(218) 326-0020Fax (218) 326-1402tjgeorge@meds-Sherri L. Beddoe(218) 326-0020Fax (218) 326-1402Meds1billing@Methodist HospitalThird Party-Workers’ Compensation6500 Excelsior Blvd.St. Louis Park, MN 55426(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@MHC Anesthesia ServicesAttn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@?Midwest Radiology2355 Highway 36 West, Suite 100Roseville, MN 55113(8/2020)Liz Fuller(651) 292-2051Fax (651) 681-1152lizz.fuller@Midwest Spine & Brain Institute, L.L.C.1950 Northwestern Avenue, Suite 102Stillwater, MN 55082(10/2015)Christi Wulf(651) 430-9884Fax (651) 430-3827Businessoffice@Gayle Schaber(651) 430-9884Fax (651) 430-3827Businessoffice@MII Life, Inc.P.O. Box 64560St. Paul, MN 55164(4/2006)Greg Walsh (651) 662-6278Fax (651) 662-1099greg_walsh@Dr. Gary Miller2627 E. Franklin, Suite 201Minneapolis, MN 55406(9/2015)Dr. Gary Miller(612) 870-1500Fax (612) 870-1551ohwdc@Mary Miller(612) 870-1500Fax (612) 870-1551sreysau@Minneapolis On-Sale Liquor Trust Fund(01/2008)See Rosene, Haugrud & Staab, Chtd.Minneapolis Orthopaedics825 South 8th Street, Suite 550Minneapolis, MN 55404(4/2020)Sara Peplinski(612) 333-5000Fax (612) 333-6922speplinski@ Minneapolis Pain Centers2104 Northdale Boulevard NW, Suite 220Coon Rapids, MN 55433(4/2018)Juli Lemke(763) 537-6000 Ext. 7196Fax (763) 767-7172Juli.lemke@MMH AnesthesiaAttn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@MN and North Dakota Bricklayers and Allied Craftworkers Fringe Benefit Funds(1/2008)See Rosene, Haugrud & Staab, Chtd.MN and North Dakota Bricklayers and Allied Craftworkers Health Fund(1/2008)See Rosene, Haugrud & Staab, Chtd.MN Cement Masons Health and Welfare Fund(1/2008)See Rosene, Haugrud & Staab, Chtd.MN Department of Employment and Economic Development332 Minnesota St. Suite E200St. Paul, MN 55101-1351Tax ID# 41-1681137(1/2015)Rachel Cornell (atty)(651) 259-7633Fax (651) 205-4007workcomp.DEED@state.mn.usMN Department of Human ServicesBenefit Recovery Section/Tort Recovery UnitP.O. Box 64994St. Paul, MN 55164-0994(9/2019)Hlee Vang (651) 431-3187Fax (651) 431-7431 Hlee.Vang@state.mn.usBritt Kringle(651) 431-3151Fax (651) 431-7431Britt.Kringle@state.mn.usMN Department of Labor and IndustryVocational Rehabilitation Unit443 Lafayette Rd. N.St. Paul, MN 55155doli.state.mn.us (3/2006)Cheryl Eliason(651) 284-5414Fax (651) 284-5734cheryl.eliason@state.mn.usGerald Meyer, Director(651) 284-5007Fax (320) 255-3951gerald.meyer@state.mn.us MN Surgery Center4131 West Loomis Road, Suite 300Greenfield, WI 53221(7/2015)Je’Nean Lessard(414) 324-4625Fax (414) 324-3720jlessard@ MN Teamsters Health & Welfare FundC/o Wilson McShane Co.3001 Metro DriveSuite 500Bloomington, MN 55425(3/2006)Mike Theirl(952) 854-0795Fax (952) 854-1632mtheirl@wilson- Thomas McCormick (atty)222 South 9th StreetSuite 1600Minneapolis, MN 55402 (612) 337-9550Fax (612) 337-9049tom@ MN Teamsters Local 638 Health & Welfare Fundc/o Erickson, Bell, Beckman & Quinn, P.A.1700 Highway 36 West, Suite 110Roseville, MN 55113(6/2019)Caroline Bell Beckman(651) 223-4999Fax (651) 223-4987cbellbeckman@Minnesota Occupational Health710 Commerce Drive, Suite 200Woodbury, MN 55125(2/2020)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@Minnetonka Imaging MRI, P.A.13767 Nicollet Avenue SouthBurnsville, MN 553374/6/2015Dr. Carlos A. Rivera, D.C.(952) 303-6648Fax (952) 426-1826carlos@Jose A. Rivera(612) 803-0589jose@Mobile Imaging(3/2006)See Consulting RadiologyMSPRC-NGHP (Medicare)P.O. Box 138832Oklahoma City, OK 73113Toll free: 866-677-7220Fax: (405) 869-3309(08/2012)Neurosurgical Associates, Ltd.Piper Building, Suite 305800 E. 28th St.Minneapolis, MN 55407-3723(9/2015)Carrean Wallraff(612) 879-7157Fax (612) 879-7189cwallraff@Kathy Kleinboehl(612) 879-7156Fax (612) 879-7189kklienboehl@New River Medical Center1013 Hart BoulevardMonticello, MN 55362(08/2012)Lynn Wicezorek (attorney)(763) 271-1365Fax (763) 271-2299lynn.wicezorek@Heather Hooper (Business Office)(763) 271-2306Fax (763) 271-2344Heather.hooper@North Memorial Ambulance Service4501 68th Avenue NorthBrooklyn Center, MN 55429(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@North Memorial Health CareIntervention Notice-Business Office3300 Oakdale Avenue NorthRobbinsdale, MN 55442(6/2020)North Memorial Health Care(763) 520-5400Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Northland AnesthesiaAttn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@?Northfield Hospital & Clinics2000 North AvenueNorthfield, MN 55057(4/2020)Melissa Peterson(507) 646-1002Fax (507) 646-1392legal@ NovaCare Rehabilitation555 Railroad Drive, Suite CElk River, MN 55330(6/2015)Peggy PattenCell (763) 350-2058 Office (763)-441-8111 Fax (717) 635-3915ppatten@Nura Precision Pain Management2104 Northdale Boulevard N.W., Suite 220Coon Rapids, Minnesota 55433(9/2018)Juli Lemke(763) 537-6000 Ext. 7196Fax (763) 767-7172jlemke@Nurse Anesthesia Services, P.A.Attn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Oleson Chiropractic, Inc.514 First AvenueP.O. Box 246Armstrong, IA 50514(5/2019)Diana Johnson(712) 868-3265Fax (712) 868-3499diana@Dr. Greg E. Oleson, D.C., CCSP(712) 868-3265Fax (712) 868-3499greg@Operating Engineers Local 49 Health & Welfare Fund3001 Metro Dr. Suite 500Bloomington, MN 55425(6/2019)Mike TheirlWilson McShane(952) 854-0795Fax (952) 854-1632Optum (for Medica, UCare and United HealthCare)11000 Optum CircleMN102-0300Eden Prairie, MN 55344(1/2020)Amelia Diedrich-Koch(844) 709-6877Fax (844) 881-2839amelia.diedrich-koch1@Kristie Viscasillas(952) 205-0661Fax (800) 708-6401kristie.viscasillas@Orthopedic & Fracture Clinic - Northfield2000 North AvenueNorthfield, MN 55057(4/2020)Melissa Peterson(507) 646-1002Fax (507) 646-1392legal@ Pain Centers of Minnesota-Chaska4131 West Loomis Road, Suite 300Greenfield, WI 53221(7/2018)Melissa Arciga(414) 585-8713Fax (414) 239-6034Melissa.arciga@Pain Centers of Minnesota-Mankato4131 West Loomis Road, Suite 300Greenfield, WI 53221(7/2018)Melissa Arciga(414) 585-8713Fax (414) 239-6034Melissa.arciga@Park Nicollet Health ServicesThird Party-Workers’ Compensation3800 Park Nicollet Blvd.St. Louis Park, MN 55426(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Parker Chiropractic, P.A.1320 S. Frontage Rd. Suite 102Hastings, MN 55033(3/2006)Dr. Bill Parker (651) 480-2200Fax (651) 480-1551billparkerdc@PHS WestHealth, Inc. d/b/a Interlude West Health2845 Hamline Avenue NorthRoseville, MN 55113(9/2019)Janna Severance(651) 631-6125Fax (651) 631-6122jseverance@Sheri Fischer(651) 631-6450Fax (651) 631-6122sfischer@Physical Therapy Consultants, Inc.139 Main StreetBethel, MN 55005(3/2016)Nicole Pietila(763) 269-8065Fax (763) 269-8053npietila@Beth Churchsmith(763) 269-8065Fax (763) 269-8053bchurchsmith@Plumbers and Steamfitters Local 6 Health and Welfare Fund(1/2008)See Rosene, Haugrud & Staab, Chtd.Plymouth Surgery Center (Previously known as ILBNC Special Procedures)710 Commerce Drive, Suite 200Woodbury, MN 55125(2/2020)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@Preferred One Administrative Services/First Class Recoveries, Inc.(3/2009)See First Class Recoveries, Inc.Primary Behavioral Health Clinics, Inc.3433 Broadway St. NE Suite 160Minneapolis, MN 55413(9/2015)John Patrick Cronin, Ph.D., MPH, LP(612) 378-2363(612) 791-1119Fax (612) 378-2215pbhc423280@Fax (612) 378-2215Carol SaxOffice (612) 378-2363Cell (612) 743-3447Fax (612) 378-2215pbhc423280@Prime Meridian, Inc.2627 E Franklin, Suite 201Minneapolis, MN 55406(9/2015)Jared Madsen, LAC(612) 870-1500Fax (612) 870-1551jedmadsen@Mary Miller(612) 870-1500Fax (612) 870-1551sreysau@Prime West Health3905 Dakota StreetAlexandria, MN 56308(10/2015)Shelly Steidl(320) 335-5271Fax (320) 335-5323shelly.steidl@Professional Associates of Rehabilitation, Inc. (PAR, Inc.)P.O. Box 270100St. Paul, MN 55127(2/2012)Lisa Fischer(651) 330-5151Fax (651) 330-5426lisaf@Deb Rush(651) 330-5151Fax (651) 330-5426debr@Public Health Service(4/2007)See U.S. Department of Health and Human ServicesProgressive ChiropracticP.O. Box 317Mountain Lake, MN 56159(12/2019)Phillip Skow(507) 427-3878Fax (507) 427-3531progressive@Janell Bargen(507) 427-3878Fax (507) 427-3531progressive@Red Lake Indian Hospital(4/2007)See U.S. Department of Health and Human ServicesRegions Hospital640 Jackson St.Mail Stop 12403ASt. Paul, MN 55101(6/2020)Work Comp Billing Manager(651) 254-4791Fax (651) 254-5649Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Rehabauthority, LLC1560 South Carol StreetMeridian, ID 836469/2017Amy Roe(888) 467-9117Fax (208) 287-9426amy@Reimann Counseling Clinic7365 Kirkwood Court, Suite 360Maple Grove, MN 55369(12/2018)Jenny Reimann(763) 424-9591Fax (763) 496-0635jreimann@Patty Walczak(763) 424-9591Fax (763) 496-0635pwalczak@Ridgeview Sibley Medical Center601 West Chandler StreetArlington, MN 55307(1/2020)Jane Scharpe(507) 964-8420Fax (507) 964-5898jane.scharpe@ Nicole Weber(952) 442-2191 Ext. 62255nicole.weber@Rivera Chiropractic Center, L.L.C.7600 Parklawn Avenue South, Suite 358Edina, Minnesota 55435(6/2020)Jose Rivera(612) 803-0589Fax (952) 426-1826contact@ Carlos Rivera(952) 303-6648Fax (952) 426-1826carlos@Roofers Local No. 96 Health andWelfare Fund(1/2008)See Rosene, Haugrud & Staab, Chtd.Sanford HealthLegal DepartmentP.O. Box 2010Fargo, ND 58122-0786(8/2010)Penny Hoppe, Business Services(701) 234-1232Fax (701) 234-1005penny.hoppe@St. Cloud Orthopedics 1901 Connecticut Avenue SouthSartell, MN 56377(5/2018)Patricia Elyea(320) 257-7838Fax (320) 259-8044pelyea@Shelley Gerads(320) 202-5519Fax (320) 259-8044sgerads@St. Croix County Department of Health & Human ServicesOffice of Corporation CounselSt. Croix County Government Center1101 Carmichael RoadHudson, WI 54016(8/2006)Donald GillenAssistant Corporation Counsel(715) 381-4313Fax (715) 381-4301donjg@co.saint-croix.wi.usNancy MullerFraud/FEV Coordinator(715) 246-8304Fax (715)246-8220nancym@co.saint-croix.wi.usSt. Croix Regional Medical Center235 East State StreetSt. Croix Falls, MN 54024(10/2018)Katie Knutson(715) 483-0487Fax (715) 483-0505Katie.Knutson@Nicole Stone(715) 483-0425Fax (715) 483-0505Nicole.Stone@St. Croix Orthopedics5803 Neal Avenue NorthOak Park Heights, MN 55082(12/16)Prior to 7/1/15:St. Croix Orthopedics7/1/15-Present:See Twin Cities OrthopedicsLaura EggenBusiness Office Manager(651) 439-8807Fax (651) 439-0232lauraeggen@ St. Luke’s Hospital and Regional Trauma Center915 East 1st StreetDuluth, MN 55805(218) 733-5737(2/2015)Bernadette Katich(218) 249-6871Fax (218) 249-6880bkatich@Kelly M. Johnson(218) 249-6878Fax (218) 249-6879Kelly.Johnson4@ St. Paul Radiology(8/2020)See Midwest RadiologySmart Spine Community Chiropractic, Inc.Foley Wellness CenterP.O. Box 570Foley, MN 56329(9/2019)Dr. Matthew Hoffman(320) 968-7413Fax (320) 968 7469drmatthewhoffman@South Lake Chiropractic24000 Highway 7, Suite 215Shorewood, MN 55331(5/2016)Kelly O’Donoghue(952) 474-2395Fax (952) 401-1690office@Jane Wickstrom(952) 474-2395Fax 952-401-1690office@South Metro AnesthesiaAttn: Debra Larson400 E. 10th StreetWaconia, MN 55387(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@?State Farm InsuranceLincoln Operations Center500 South 84th St.Lincoln, NE 68510-2611(4/2010)Mark Tolzin(402) 327-3460Fax (402) 327-3469mark.tolzin.a4g1@Jay Rine(402) 327-3580Fax (402) 327-3469jay.rine.i54r@StoneRiver Pharmacy Solutions(f/k/a Third Party Solutions and Working RX)6410 Poplar Avenue, Suite 800Memphis, TN 38119(1/2016)Michael Crislip(800) 541-5234 Ext. 1638Fax (901) 260-6194michael.crislip@Suburban Imaging or Suburban Radiologic Consultants2355 Highway 36 West, Suite 100Roseville, MN 55113 (11/2020)Liz Fuller(651) 292-2051Fax (651) 681-1152lizz.fuller@ Summit Orthopedics710 Commerce Drive, Suite 200Woodbury, MN 55125(2/2020)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@Teamsters See MN TeamstersThe Hartford (a/k/a Hartford Life)200 Colonial Center Parkway, Suite 500Lake Mary, FL 32746(8/2020)Anna Lund(407) 871-4768Fax (855) 211-3771anna.lund@Kassi Erickson GroveKassi.ericksongrove@ Therapy Partners, Inc./Progressive Care Therapy, LLC7551 9th Street N., Suite 100Oakdale, MN 55128(6/2019)Website: Kayla Koeneman(651) 219-5426Fax (651)-748-2892kkoeneman@Pam Simonet(651) 747-4315Fax (651)-748-2892psimonet@Third Party Solutions n/k/a StoneRiver Pharmacy Solutions(3/2009)See StoneRiver Pharmacy SolutionsTieri Chiropractic L.L.C.d/b/a Total Spine Health and Injury Center13324 Bass Lake RoadMaple Grove, MN 55311(6/2016)Brent Tieri(763) 568-7869Fax (763) 568-7872drtieri@Total Health Solutions, Inc.1310 East Highway 96, Suite 206White Bear Lake, MN 55110(11/2018)Mitchel V. Mondo, D.C.(651) 429-0101Fax (651) 407-3163dr.mitch@Lynn Otto(651) 429-0101Fax (651) 407-3163thfinancial@Tria Orthopaedic Center3800 Park Nicollet BoulevardSt. Louis Park, MN 55426(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Trustmark Insurance Co.c/o Erickson, Bell, Beckman & Quinn1700 West Highway 36, Suite 110Roseville, MN 55113(10/2015)Caroline Bell Beckman (atty)(651) 223-4999Fax (651)223-4987Kari Quinn (atty)(651) 223-4999Fax (651) 223-4987Twin Cities Iron Workers Health and Welfare Fundc/o Wilson-McShane Co.3001 Metro Drive Suite 500Bloomington, MN 55425(3/2006)Rick Lemke(952) 854-0795Fax (952) 854-1632rlemke@wilson- Thomas McCormick (atty)222 South 9th StreetSuite 1600Minneapolis, MN 55402 (612) 337-9550Fax (612) 337-9049tom@ Twin Cities Orthopedics4200 Dahlberg Drive, Suite 300Golden Valley, MN 55422(9/2019)Samantha Cain(952) 456-7268Fax (952) 512-5651samanthacain@Christine Helmbrecht(952) 512-5623 Ext. 21180Fax (952) 512-5651christinehelmbrect@Twin Cities Spine Center (Allina Health d/b/a)913 E 26th Street, Suite 600Minneapolis, MN 55404(6/2020)Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@Pipe Trades Services MN Welfare Fund f/k/a Twin City Pipe Trades Health & Welfare FundAttention: Gail Gross4461 White Bear Parkway, Suite 1White Bear Lake, MN 55101 (1/2019)Stacey L. Drentlaw, AttorneyLeonard, O’Brien, Spencer, Gale & Sayre, Ltd.(612) 332-1030Fax 612-332-2740sdrentlaw@UCare MN/Optum(4/2014)See OptumUnion Security Insurance Company (f/k/a Fortis Benefits Insurance Company)(3/2006)Dana L. Boyle (atty)411 E. Wisconsin St. Suite 1800Milwaukee, WI 53202(414) 273-3910Fax (414) 273-1986dboyle@lindner- website: lindner-United Food & Commercial Workers Local 789 Health & Welfare Fund3001 Metro Drive Suite 500Bloomington, MN 55425(3/2006)McGrann Shea Law Firm (Amy Court)800 Nicollet Mall Suite 2600Minneapolis, MN 55402(612) 338-2525Fax (612) 339-2386Mary Pat Baily(952) 854-0795Fax (952) 851-3521UFCW National Health and Welfare Fund66 Grand AvenueEnglewood, NJ 07631-3545(6/2015)Maurce Hodos, Fund Administrator(201) 569-8801Fax (201) 569-1085mhodos@United Healthcare/Optum(4/2014)See OptumU.S. Department of Health and Human ServicesOffice of General Counsel233 N. Michigan Ave., Ste. 700Chicago, IL 60601(4/2007)C. Douglas FergusonAssistant Regional CounselOffice of the General Counsel(312) 886-3605Fax (312) 886-1718Douglas.ferguson@Barbara Altman, Assistant Regional CounselOffice of the General Counsel(312) 353-1640Fax (312) 886-1718U.S. Department of Veterans AffairsOffice of Regional Counsel (438/02)2506 West 22nd Street, Building 16P.O. Box 5046Sioux Falls, SD 57117(7/2014)Sara DannenOffice of Regional Counsel (605) 336-3230 x6015Fax (605) 333-6884Sarah.dannen@Unum Life Insurance Company of America1 Fountain SquareChattanooga, TN 37402(12/2017)Jennifer Majic(423) 294-5673Fax (423) 294-2424jmajic@V.A. Medical CenterSee U.S. Dept. of Veteran’s AffairsVadnais Heights Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(2/2020)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@Valley Professionals Anesthesia, P.C.Attn: Debra Larson400 E. 10th StreetWaconia, MN 55387Syverson Law OfficeP.O. Box 138Delano, MN 55328(763) 595-1105Fax (763) 595-1139jsyverson@?Vocational Consultants of Minnesota1551 Livingston Avenue, Suite 101West St. Paul, MN 55118(11/2018)Adam TeBrake(507) 382-9874Fax (612) 278-2266atebrake@Laura Hokeness(612) 353-8594Fax (612) 278-2266lhokeness@Walgreen Co.1901 E. Voorhees Mail Stop 615Danville, IL 61834(3/2006)Various Collectors(217) 554-8888 for contact nameFax (217)554-8620Wausau Benefits, Inc.115 W. Wausau Ave.P.O. Box 8073Wausau, WI 54402(3/2006)Barb Schubring(715) 841-2113Fax (715) 841-7254subrogation@ Subrogation Technician(715) 841-2113Fax (715) 841-7254subrogation@ White Earth Health Center(4/2007)See U.S. Department of Health and Human ServicesWest Wind Village1001 Scotts AvenueMorris, MN 56267(1/2016)Paul Viker(320) 589-7900Fax (320) 589-7955pviker@Deb Starner(320) 589-4948Fax (320) 585-5398dstarner@Wisconsin Physicians Service Insurance Corporation1717 West BroadwayP.O. Box 8190Madison, WI 53708-8190(2/2009)Beth Eyster Shore (atty)(608) 221-7137Fax (608) 223-5898Beth.Shore@Holly D. Jensen (atty)(608) 221-5062Fax (608) 223-5898Holly.Jensen@Woodbury Ambulatory Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(2/2020)Anne GauvinOffice (651) 968-5406 Fax (651) 968-5900interventions@Jim Cleary(651) 968-5007Fax (651) 968-5900interventions@Updated 3/23/2021 ................
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