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Transcript of Hospital Contact List
Page 1 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameAVENTURA HOSPITAL & MEDICAL CENTER 10-0131
Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
BAPTIST HOSPITAL 10-0093Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
BAPTIST MEDICAL CENTER BEACHES 10-0117Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
BAPTIST MEDICAL CENTER DOWNTOWN 10-0088Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
BAPTIST MEDICAL CENTER NASSAU 10-0140Name:
Title:Mailing Add:
Hospital ID and AHCA File #
Page 2 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #City,Zip:Phone:
Fax:Email:
BAPTIST MEDICAL CENTER SOUTH 2396-0052Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
BAY MEDICAL CENTER 10-0026Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
BLAKE MEDICAL CENTER 10-0213Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
BRANDON REGIONAL HOSPITAL 10-0243Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
BROOKSVILLE REGIONAL HOSPITAL 10-0071Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:
Page 3 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Email:
CENTRAL FLORIDA REGIONAL HOSPITAL 10-0161Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
EMERALD COAST BEHAVIORAL HOSPITAL 11-0034Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
ENGLEWOOD COMMUNITY HOSPITAL 11-0004Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
FLAGLER HOSPITAL 10-0219Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
FLORIDA HOSPITAL 10-0007Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
FLORIDA HOSPITAL CARROLLWOOD 10-0069
Page 4 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
FLORIDA HOSPITAL NORTH PINELLAS 10-0055Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
FLORIDA HOSPITAL TAMPA 10-0173Name:
Title:Mailing Add:
City,Zip:
Page 5 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Phone:
Fax:Email:
FLORIDA HOSPITAL WAUCHULA 10-0282Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
H. LEE MOFFITT CANCER CENTER 11-0009Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
HALIFAX HEALTH MEDICAL CENTER 10-0017Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Page 6 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Mailing Add:
City,Zip:Phone:
Fax:Email:
JAY HOSPITAL 10-0048Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
KENDALL REGIONAL HOSPITALMEDICAL CENTER 10-0209Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
LAKE BULTER HOSPITAL HAND SURGERY CENTER 10-0241Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
LARGO MEDICAL CENTER 10-0248Name:
Title:Mailing Add:
City,Zip:
Page 7 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Phone:
Fax:Email:
LAWNWOOD REGIONAL MEDICAL CENTER 10-0246Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
LEE MEMORIAL HOSPITAL 10-0012Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
LEESBURG REGIONAL MEDICAL CENTER 10-0084Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
LIFESTREAM BEHAVIORAL CENTER 10-4018Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
MARTIN MEMORIAL MEDICAL CENTER 10-0044Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Page 8 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #MEASE DUNEDIN HOSPITAL 10-0043
Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
MEDICAL CENTER OF TRINITY 10-0191Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
MORTON F. PLANT HOSPITAL 10-0127Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
MORTON PLANT NORTH BAY HOSPITAL 10-0063Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
MUNROE REGIONAL MEDICAL CENTER 10-0062Name:
Title:Mailing Add:
Page 9 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #City,Zip:Phone:
Fax:Email:
NORTHSIDE HOSPITAL 10-0238Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Back-up Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
NORTHWEST MEDICAL CENTER 10-0189Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
OAK HILL HOSPITAL 10-0264Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
ORANGE PARK MEDICAL CENTER 10-0226Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Page 10 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Back-up Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
OSCEOLA REGIONAL MEDICAL CENTER 10-0110Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
PALMS WEST HOSPITAL 11-0006Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
PLANTATION GENERAL HOSPITAL 10-0167Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
RAULERSON HOSPITAL 10-0252Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
REGIONAL MEDICAL CENTER BAYONET POINT 10-0256Name:
Page 11 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
SACRED HEART HOSPITAL ON THE GULF 2396-0084Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
SHANDS JACKSONVILLE MEDICAL CENTER 10-0001Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
SOUTH BAY HOSPITAL 10-0259Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
SOUTH FLORIDA BAPTIST HOSPITAL 10-0132Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Page 12 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #ST. JOSEPH'S HOSPITAL 10-0075
Name:Title:
Mailing Add:City,Zip:Phone:
Fax:Email:
ST. LUCIE MEDICAL CENTER 10-0260Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
ST. LUKE'S - ST. VINCENT'S HEALTHCARE 2396-0088Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
ST. VINCENT'S MEDICAL CENTER RIVERSIDE 10-0040Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
TALLAHASSEE MEMORIAL HOSPITAL 10-0135Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
TAMPA GENERAL HOSPITAL 10-0128Name:
Title:
Page 13 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Mailing Add:
City,Zip:Phone:
Fax:Email:
UNIVERSITY HOSPITAL AND MEDICAL CENTER 10-0224Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
WESTSIDE REGIONAL MEDICAL CENTER 10-0228Name:
Title:Mailing Add:
City,Zip:Phone:
Fax:Email:
Agency for Health Care Administration ContactsBureau of Managed Health Care
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:Back-up Name:
Title:Agency:
Mailing Add:City,ZipPhone:
Fax:
Page 14 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Partcipating Hospital NameHospital ID and
AHCA File #Email:
Page 15 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing
Venise Craven Kris PanettaPublic Benefit Coordination Director, Medicaid Eligibility & Support Services20900 Biscayne Boulevard 31975 US Highway 19 NorthAventura, FL 33180 Palm Harbor, FL 34684(305) 937-3961 (727) 773-3410
(727) 773-3411
Roberta Thompson Roberta ThompsonPatient Account Representative Patient Account RepresentativeP.O. Box 17106 P.O. Box 17106Pensacola, FL 32522 Pensacola, FL 32522(850) 469-2023 (850) 469-2023(850) 434-4683 (850) 434-4683
David Pezewski David PezewskiReimbursement Director Reimbursement Director1717 N E Street, Tower 1, Suite 303 1717 N E Street, Tower 1, Suite 303Pensacola, FL 32522 Pensacola, FL 32522(850) 434-4651 (850) 434-4651(850) 434-4682 (850) 434-4682
Eileen Henderlite Eileen HenderliteDirector - Revenue Cycle Management Director - Revenue Cycle Management3563 Philips Highway, Building B, Suite 201B 3563 Philips Highway, Building B, Suite 201BJacksonville, FL 32207 Jacksonville, FL 32207(904) 376-4130 (904) 376-4130(904) 391-5073 (904) 391-5073
Eileen Henderlite Eileen HenderliteDirector - Revenue Cycle Management Director - Revenue Cycle Management3563 Philips Highway, Building B, Suite 201B 3563 Philips Highway, Building B, Suite 201BJacksonville, FL 32207 Jacksonville, FL 32207(904) 376-4130 (904) 376-4130(904) 391-5073 (904) 391-5073
Eileen Henderlite Eileen HenderliteDirector - Revenue Cycle Management Director - Revenue Cycle Management3563 Philips Highway, Building B, Suite 201B 3563 Philips Highway, Building B, Suite 201B
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
Page 16 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims ProcessingJacksonville, FL 32207 Jacksonville, FL 32207(904) 376-4130 (904) 376-4130(904) 391-5073 (904) 391-5073
Eileen Henderlite Eileen HenderliteDirector - Revenue Cycle Management Director - Revenue Cycle Management3563 Philips Highway, Building B, Suite 201B 3563 Philips Highway, Building B, Suite 201BJacksonville, FL 32207 Jacksonville, FL 32207(904) 376-4130 (904) 376-4130(904) 391-5073 (904) 391-5073
Sheila SteinzorUncompensated Care Analyst615 North Bonita AvenuePanama City, FL 32401(850) 747-6113(850) [email protected]
Debbie Pancake Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services2020 59th Street West 31975 US Highway 19 NorthBradenton, FL 34209 Palm Harbor, FL 34684(941) 798-6001 (727) 773-3410
(727) 773-3411
Ana Almodovar Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services119 Oakfield Drive 31975 US Highway 19 NorthBrandon, FL 33511 Palm Harbor, FL 34684(813) 681-5551, ext. 3366 (727) 773-3410
(727) 773-3411
Rick Carlton Vickie NorrisDirector of Financial Planning Business Office ManagerP.O. Box 37 P.O. Box 37Brooksville, FL 34605 Brooksville, FL 34605(352) 544-6156 (352) 796-5151(352) 754-3210 (352) 754-3210
[email protected] [email protected]
[email protected] [email protected]
Page 17 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing
Ivellys Gonzalez Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services1401 West Seminole Boulevard 31975 US Highway 19 NorthSanford, FL 32771 Palm Harbor, FL 34684(407) 321-4500, ext. 5259 (727) 773-3410
(727) 773-3411
Ruth Jenkins Donna DozierChief Financial Officer Biller1940 Harrison Avenue 1940 Harrison AvenuePanama City, FL 32405 Panama City, FL 32405(850) 532-6463 (850) 763-0017, ext. 117(850) 785-0580 (850) 785-0580
Katherine Weinmann Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services700 Medical Boulevard 31975 US Highway 19 NorthEnglewood, FL 34223 Palm Harbor, FL 34684(941) 629-1181, ext. 6890 (727) 773-3410
(727) 773-3411
Lynda Kirker Lynda KirkerChief Financial Officer Chief Financial Officer400 Health Park Blvd. 400 Health Park Blvd.St. Augustine, FL 32086 St. Augustine, FL 32086(904) 819-4400 (904) 819-4400(904) 819-4472 (904) 819-4472
Michelle MoralesDepartment Secretary for Patient Financial Services900 Winderly Place, Suite 2100Maitland, FL 32751(407) 200-2307(407) 200-4965
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
Page 18 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims ProcessingCoy IngramRegional Director of Patient Financial Services7171 North Dale Mabry HighwayTampa, FL 33514(813) 615-7219(813) 615-7704
Tracy Goodwin Tracy GoodwinManager - MEDS Manager - MEDS4200 Sun 'N Lake Boulevard 4200 Sun 'N Lake BoulevardSebring, FL 33872 Sebring, FL 33872(863) 402-5329 (863) 402-5329(863) 402-3197 (863) 402-3197
Kelly Smith Coy IngramPatient Access Manager Director of Patient Financial Services1395 South Pinellas Avenue 1395 South Pinellas AvenueTarpon Springs, FL 34689 Tarpon Springs, FL 34689(727) 942-5126 (727) 942-5000(727) 942-5158 (727) 942-5161
Coy IngramRegional Director of Patient Financial Services3100 East Fletcher AvenueTampa, FL 33613
Page 19 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing(813) 615-7219(813) 615-7704
Tracy Goodwin Tracy GoodwinManager - MEDS Manager - MEDS533 West Carlton Street 533 West Carlton StreetWauchula, FL 33873 Wauchula, FL 33873(863) 402-5329 (863) 402-5329(863) 402-3197 (863) 402-3197
Deborah Vicedo Jill MartinLead Funding Specialist Govt. Account Resource Specialist12902 Magnolia Drive 12902 Magnolia DriveTampa, FL 33612 Tampa, FL 33612(813) 745-4022 (813) 745-7825(813) 745-7166 (813) 449-8374
Alyson Capone Alyson CaponeCollector Collector303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114(386) 226-4590, ext. 12039 (386) 226-4590, ext. 12039(386) 232-2395 (386) 232-2395
Glen Stockhammer Glen StockhammerCollections Manager Collections Manager303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114(386) 425-4597 (386) 425-4597(386) 232-2395 (386) 232-2395
Joni Rahn Joni RahnDirector of Patient Financial Services Director of Patient Financial Services
[email protected] [email protected]
[email protected] [email protected]
Page 20 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114(386) 425-2452 (386) 425-2452(386) 232-2395 (386) 232-2395
Roberta Thompson Roberta ThompsonPatient Account Representative Patient Account RepresentativeP.O. Box 17106 P.O. Box 17106Pensacola, FL 32522 Pensacola, FL 32522(850) 469-2023 (850) 469-2023(850) 434-4683 (850) 434-4683
David Pezewski David PezewskiReimbursement Director Reimbursement Director1717 N E Street, Tower 1, Suite 303 1717 N E Street, Tower 1, Suite 303Pensacola, FL 32522 Pensacola, FL 32522(850) 434-4651 (850) 434-4651(850) 434-4682 (850) 434-4682
Rosa Canseco Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services11750 Bird Road 31975 US Highway 19 NorthMiami, FL 33175 Palm Harbor, FL 34684(305) 227-5576 (727) 773-3410
(727) 773-3411
Marta YarleyPatient Account RepresentativeP.O. Box 748Lake Butler, FL 32054(386) 496-2323, ext. 9203(386) 496-4734
Beth Weekes Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services201 14th Street Southwest 31975 US Highway 19 NorthLargo, FL 33770 Palm Harbor, FL 34684
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
Page 21 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing(727) 588-5489 (727) 773-3410
(727) 773-3411
Guadelupe Deloera Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services1700 South 23rd Street 31975 US Highway 19 NorthFort Pierce, FL 34950 Palm Harbor, FL 34684(772) 467-2851 (727) 773-3410
(727) 773-3411
Courtney Murray Debbie YeaterRegistration Services Director Central Business Office SupervisorP.O. Box 2218 224 Santa Barbara Boulevard, Suite 203Fort Myers, FL 33902-2218 Cape Coral, FL 33991(239) 343-2036 (239) 242-6015(239) 343-3967
Carol Lewis Gerald LiparitoMEDS Holdings Manager PFS Billing Manager600 East Dixie Avenue PO Box 490717Leesburg, FL 34748 Leesburg, FL 34749(352) 323-5052 (352) 323-5520(352) 323-5439 (352) 323-5239
Vickie Anderson Vickie AndersonBilling Supervisor Billing SupervisorP.O. Box 491000 P.O. Box 491000Leesburg, FL 34749-1000 Leesburg, FL 34749-1000(352) 315-7537 (352) 315-7537(352) 315-7587 (352) 315-7587
John Creider Carol PlatoReimbursement Specialist Administrative Director301 SE Hospital Avenue 301 SE Hospital AvenueStuart, FL 34995 Stuart, FL 34995(772) 223-2828 (772) 223-5656(772) 223-5621 (772) 223-5622
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
Page 22 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing
Jessica Villafana Opyd Jessica Villafana OpydSupervisor- Financial Assistance Department Supervisor- Financial Assistance Department3986 Tampa Road 3986 Tampa RoadOldsmar, FL 34677 Oldsmar, FL 34677(813) 852-3305 (813) 852-3305(813) 635-7731 (813) 635-7731
Pat Cooper Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services9330 State Road 54 31975 US Highway 19 NorthTrinity, FL 34655 Palm Harbor, FL 34684(727) 834-5720 (727) 773-3410
(727) 773-3411
Jessica Villafana Opyd Jessica Villafana OpydSupervisor- Financial Assistance Department Supervisor- Financial Assistance Department3986 Tampa Road 3986 Tampa RoadOldsmar, FL 34677 Oldsmar, FL 34677(813) 852-3305 (813) 852-3305(813) 635-7731 (813) 635-7731
Jessica Villafana Opyd Jessica Villafana OpydSupervisor- Financial Assistance Department Supervisor- Financial Assistance Department3986 Tampa Road 3986 Tampa RoadOldsmar, FL 34677 Oldsmar, FL 34677(813) 852-3305 (813) 852-3305(813) 635-7731 (813) 635-7731
Michelle Smith Traci BrysonDirector of Patient Accounting & Admitting1500 SW 1st Avenue 1500 SW 1st Avenue
[email protected] [email protected]
[email protected] [email protected]
Page 23 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims ProcessingOcala, FL 34471 Ocala, FL 34471(352) 368-3419 (352) 351-7259(352) 671-2125 (352) 671-2119
Cynthia Bacon Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services6000 49th Street North 31975 US Highway 19 NorthSt. Petersburg, FL 33709 Palm Harbor, FL 34684(727) 521-5558 (727) 773-3410
(727) 773-3411
Robb Hurlock Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services2801 North State Road 7 31975 US Highway 19 NorthMargate, FL 33063 Palm Harbor, FL 34684(954) 956-3060 (727) 773-3410
(727) 773-3411
Linda Murphy Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services11375 Cortez Boulevard 31975 US Highway 19 NorthBrooksville, FL 34613 Palm Harbor, FL 34684(352) 597-6371 (727) 773-3410
(727) 773-3411
Mark Redditt Lisa PrinceRegional Director, HFMI Director of Patient Account Services1202 Washington Street 335 Crossing BoulevardWilliamston, NC 27892 Orlando, FL 32073(800) 584-5545 (904) 688-6614(954) 513-2058 (904) 688-7614
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
Page 24 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims ProcessingArdra JonesPublic Benefit Cooridnator2001 Kingsley AvenueOrange Park, FL 32073(904) 276-8715
Maria Celebre Kris PanettaPublic Benefit Cooridnator Director, Medicaid Eligibility & Support Services700 West Oak Street 31975 US Highway 19 NorthKissimmee, FL 34741 Palm Harbor, FL 34684(407) 518-3658 (727) 773-3410
(727) 773-3411
Maria Cortes-Bolivar Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services13001 Southern Boulevard 31975 US Highway 19 NorthLoxahatchee, FL 33470 Palm Harbor, FL 34684(561) 798-6078 (727) 773-3410
(727) 773-3411
Fabiola Dickson Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services401 Northwest 42nd Avenue 31975 US Highway 19 NorthPlantation, FL 33317 Palm Harbor, FL 34684(954) 587-5010, ext. 6650 (727) 773-3410
(727) 773-3411
Marla Wandrum Kris PanettaPublic Benefit Cooridnator Director, Medicaid Eligibility & Support Services1796 Highway 441 North 31975 US Highway 19 NorthOkeechobee, FL 34972 Palm Harbor, FL 34684(863) 824-2870 (727) 773-3410
(727) 773-3411
Kathleen Troutwine Kris Panetta
[email protected] [email protected]
[email protected] [email protected]
Page 25 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims ProcessingPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services14000 Fivay Road 31975 US Highway 19 NorthHudson, FL 34667 Palm Harbor, FL 34684(727) 819-2929, ext. 5365 (727) 773-3410
(727) 773-3411
Kaycee KrumPatient Access Supervisor3801 East Highway 98Port St. Joe, FL 32456(850) 229-5738(850) 229-5719
Shakawn Jones Shakawn JonesManager Manager655 West 8th Street 655 West 8th StreetJacksonville, FL 32209 Jacksonville, FL 32209(904) 244-1877 (904) 244-1877
Veronica Vargas Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services4016 Sun City Boulevard 31975 US Highway 19 NorthSun City Center, FL 33573 Palm Harbor, FL 34684(813) 634-0488 (727) 773-3410
(727) 773-3411
Jessica Villafana Opyd Jessica Villafana OpydSupervisor- Financial Assistance Department Supervisor- Financial Assistance Department3986 Tampa Road 3986 Tampa RoadOldsmar, FL 34677 Oldsmar, FL 34677(813) 852-3305 (813) 852-3305(813) 635-7731 (813) 635-7731
[email protected] [email protected]
[email protected] [email protected]
Page 26 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing
Jessica Villafana Opyd Jessica Villafana OpydSupervisor- Financial Assistance Department Supervisor- Financial Assistance Department3986 Tampa Road 3986 Tampa RoadOldsmar, FL 34677 Oldsmar, FL 34677(813) 852-3305 (813) 852-3305(813) 635-7731 (813) 635-7731
Placida Suarez Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services1800 SE Tiffany Avenue 31975 US Highway 19 NorthPort St. Lucie, FL 34952 Palm Harbor, FL 34684(727) 341-4929 (727) 773-3410
(727) 773-3411
Thomas Duncan Juquanda GeorgeSenior Director Medicaid Billing Specialist4201 Belfort Road 4201 Belfort RoadJacksonville, FL 32216 Jacksonville, FL 32216(313) 309-2143 (312) 462-6085(586) 698-0071 (312) 462-6293
Thomas Duncan Juquanda GeorgeSenior Director Medicaid Billing Specialist4201 Belfort Road 4201 Belfort RoadJacksonville, FL 32216 Jacksonville, FL 32216(313) 309-2143 (312) 462-6085(586) 698-0071 (312) 462-6293
George MacLafferty LaTrenda CooperAssistant Director, Patient Financial Services Business Office Manager1309 Miccosukee Road 1309 Miccosukee RoadTallahassee, FL 32303 Tallahassee, FL 32303(850) 431-7210 (850) 431-6205(850) 431-6951 (850) 431-6900
Kim ShepherdER and FAS Manager
[email protected] [email protected]
[email protected] [email protected]
[email protected] [email protected]
Page 27 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims Processing1 Tampa General CircleTampa, FL 33601(813) 844-7406(813) 844-4391
Jose Martinez Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services7201 North University Drive 31975 US Highway 19 NorthTamarac, FL 33321 Palm Harbor, FL 34684(954) 724-6144 (727) 773-3410
(727) 773-3411
Zac Williams Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services8201 West Broward Boulevard 31975 US Highway 19 NorthPlantation, FL 33324 Palm Harbor, FL 34684(954) 916-5458 (727) 773-3410
(727) 773-3411
Agency for Health Care Administration ContactsBureau of Managed Health Care Bureau of Certificate of Need/Financial Analysis
HCRA Liaison Hospital Eligibility
Kirsten Jacobson Mills Smith
Medical Health Care Program Analyst Regulatory Analyst Supervisor
Bureau Chief's Office Bureau of Certificate of Need/Financial Analysis
2727 Mahan Drive, Mail Stop Code 26Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 414-6912 (850) 922-6964
Karin Boatwright Felton BradleyMedical Health Care Program Analyst Economic AnalystMedicaid Compliance Unit II Bureau of Certificate of Need/Financial Analysis
Tallahassee, FL 32308 Tallahassee, FL 32308(850) 412-4312 (850) 412-4350(850) 414-6912 (850) 922-6964
[email protected] [email protected]
[email protected] [email protected]
2727 Mahan Drive, Mail Stop Code 28
[email protected] [email protected]
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Page 28 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
Date Last Revised:
HCRA Eligibility Determination HCRA Claims [email protected] [email protected]
Page 29 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator
Heather J. Rohan Chief Executive Officer20900 Biscayne Boulevard Aventura, FL 33180(305) 682-7000
David WildebrandtAdministrator1000 W. Moreno StreetPensacola, FL 32501(850) 434-4011
Joseph MitrickHospital President1350 13th Avenue SouthJacksonville Beach, FL 32250(904) 627-2905(904) 627-1008
Michael MayoHospital President800 Prudential Drive, Howard 1st FloorJacksonville, FL 32202(904) 202-2001(904) 202-2285
Stephen LeeHospital President1250 South 18th Street
Page 30 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
AdministratorFernandina Beach, FL 32034(904) 321-3502(904) 321-3511
Ron RobinsonHospital President14550 Old St. Augustine RoadJacksonville, FL 32258(904) 271-6002(904) 271-6650
Steven JohnsonChief Executive Officer615 N. Bonita AvenuePanama City, FL 32401(850) 747-6045(850) [email protected]
Daniel FriedrichChief Executive Officer2020 59th Street WestBradenton, FL 34209(941) 792-6611
Bland EngChief Executive Officer119 Oakfield Drive Brandon, FL 33511(813) 681-5551
Patrick MaloneyChief Executive OfficerP.O. Box 37Brooksville, FL 34605(352) 688-8200
Page 31 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator
Wendy H. BrandonChief Executive Officer1401 West Seminole BoulevardSanford, FL 32771(407) 321-4500
Tim BedfordChief Executive Officer1940 Harrison AvenuePanama City, FL 32405(850) 763-0017, ext. 147(850) 785-0580
Thomas RiceChief Executive Officer700 Medical BoulevardEnglewood, FL 34223(941) 475-6571
Joseph GordyChief Executive Officer400 Health Park Blvd.St. Augustine, FL 32086(904) 819-4400(904) 819-4472
Page 32 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
AdministratorShane CoxChief Financial Officer7171 North Dale Mabry HighwayTampa, FL 33514(813) 558-8001
Tim CookChief Executive Officer4200 Sun 'N Lake BoulevardSebring, FL 33872(863) 402-3366(863) 402-3415
Dima DidenkoChief Financial Officer4200 Sun 'N Lake BoulevardSebring, FL 33872(863) 402-3366(863) 402-3415
Bruce BerghermPresident / Chief Executive Officer1395 South Pinellas AvenueTarpon Springs, FL 34689(727) 942-5107(727) 942-5161
Michael MewhirterVice President / Chief Financial Officer1395 South Pinellas AvenueTarpon Springs, FL 34689(727) 942-5022(727) 942-5161
Janice HagensickerMarket Chief Financial Officer3100 East Fletcher AvenueTampa, FL 33613
Page 33 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator(813) 615-7129
Tim CookChief Executive Officer533 West Carlton StreetWauchula, FL 33873(863) 402-3366(863) 402-3415
Dima DidenkoChief Financial Officer533 West Carlton StreetWauchula, FL 33873(863) 402-3366(863) 402-3415
Dr. Alan ListCenter Director12902 Magnolia DriveTampa, FL 33612(813) 745-7101(813) 745-3090
Jeff FeaselPresident and Chief Executive Officer303 N. Clyde Morris BoulevardDaytona Beach, FL 32114(386) 254-4000, ext. 54771
Arvin LewisChief Revenue Officer303 N. Clyde Morris BoulevardDaytona Beach, FL 32114(386) 258-4826(386) 239-2325
Page 34 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator
Mike HutchinsAdministrator14114 Alabama StreetJay, FL 32565(850) 675-8015
Scott A. CihakChief Executive Officer11750 Bird RoadMiami, FL 33175(305) 223-3000
Pamela HowardChief Executive OfficerP.O. Box 748Lake Butler. FL 32054(386) 496-2323 Ext. 225(386) 496-1611
Anthony DeginaChief Executive Officer201 14th Street SouthwestLargo, FL 33770
Page 35 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator(727) 588-5200
Rodney SmithChief Executive Officer1700 South 23rd StreetFort Pierce, FL 34950(772) 461-4000
Lisa SgarlataChief Administrative Officer2776 Cleveland AvenueFort Myers, FL 33901(239) 343-2000
Grant GlinesDirector of Financial Planning & AnalysisPO Box 490717Leesburg, FL 34749(352) 323-5695(352) 323-5039
Rick HankeySenior Vice PresidentP.O. Box 491000Leesburg, FL 34749-1000(352) 315-7800(352) 360-6656
Mark E. RobitailleChief Executive Officer301 SE Hospital AvenueStuart, FL 34995
Mark.Robitaille@martinhealth,org
Page 36 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator
Louis GaldieriChief Operating Officer601 Main StreetDunedin, FL 34698(727) 734-6395(727) 734-6887
Leigh MassengillChief Executive Officer9330 State Road 54Trinity, FL 34655(727) 834-4000
Kristopher HoceAdministrator300 Pinellas StreetClearwater, FL 33756(727) 462-7100(727) 461-8101
Neil HoceChief Operating Officer300 Pinellas StreetClearwater, FL 33756(727) 462-7100(727) 461-8101
Harrell ZiecheckChief Operating Officer6600 Madison StreetNew Port Richey, FL 34652(727) 843-4599(727) 848-8762
Stephen A. PurvesPresident & Chief Executive Officer1500 SW 1st Avenue
Page 37 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
AdministratorOcala, FL 34471(352) 351-7393(352) 368-3433
Stephen DaughertyChief Executive Officer6000 49th Street NorthSt. Petersburg, FL 33709(727) 521-4411
Gary SearlsChief Financial Officer6000 49th Street NorthSt. Petersburg, FL 33709(727) 521-5004(727) 521-5007
Dianne GoldenbergChief Executive Officer2801 North State Road 7Margate, FL 33063(954) 974-0400
Mickey SmithChief Executive Officer11375 Cortez BoulevardBrooksville, FL 34613(352) 596-6632
Thomas R. PentzChief Executive Officer2001 Kingsley AvenueOrange Park, FL 32073(904) 276-8500
Page 38 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator
Kathryn J. GilletteChief Executive Officer700 West Oak StreetKissimmee, FL 34741(407) 846-2266
Eric GoldmanChief Executive Officer13001 Southern BoulevardLoxahatchee, FL 33470(561) 798-3300
Barbara SimmonsChief Executive Officer401 Northwest 42nd AvenuePlantation, FL 33317(954) 587-5010
Robert LeeChief Executive Officer1796 Highway 441 NorthOkeechobee, FL 34972(863) 763-2151
Shayne George
Page 39 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
AdministratorChief Executive Officer14000 Fivay RoadHudson, FL 34667(727) 819-2929
Roger HallPresident7800 West highway 98Miramar Beach, FL 32550(850) 278-3000(850) 278-3201
James BurkhartPresident655 West 8th StreetJacksonville, FL 32209(904) 244-4000
Sharon RoushChief Executive Officer4016 Sun City BoulevardSun City Center, FL 33573(813) 634-3301
Stephen NiermanChief Operating Officer301 North Alexander StreetPlant City, FL 33566(813) 757-1205(813) 757-8204
Page 40 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator
Lorraina LuttonChief Operating Officer3001 W. Dr. M.L. King, Jr. Blvd.Tampa, FL 33607(813) 870-4020(813) 870-4639
Gary CantrellChief Executive Officer1800 SE Tiffany AvenuePort St. Lucie, FL 34952(772) 335-4000
G. Mark O'BryantPresident and Chief Executive Officer1300 Miccosukee RoadTallahassee, FL 32308(850) 431-5380(850) 431-5883
Ronald A. HytoffPresident, Chief Executive Officer
Page 41 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013
April 12, 2013
Administrator1 Tampa General CircleTampa, FL 33601(813) 844-7662(813) 844-4144
W. Mark RaderChief Executive Officer7201 North University DriveTamarac, FL 33321(954) 724-2200 ext. 6101(954) 724-6567
Lee B. ChaykinChief Executive Officer8201 West Broward BoulevardPlantation, FL 33324(954) 473-6600
Agency for Health Care Administration Contacts
Page 42 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Kempton Smith Kris Panetta Heather J. Rohan Hosp. Code: 10-0131 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 20900 Biscayne Blvd. Palm Harbor, FL 34684 Aventura, FL 33180
Phone: (727) 773-3410 (305) 682-7100Fax: (727) 773-3411 (305) 682-7105
Email:
All Children's Hospital Kathryn B. Forbes Gary A. CarnesHosp. Code: 10-0250 Title: Reimbursement Manager President/CEO
Mailing Add: 501 6th Avenue S., Dept. 1950 501 6th Avenue S., Dept. 1950St. Petersburg, FL 33701 St. Petersburg, FL 33701
Phone: (727) 767-8210 (727) 767-4474Fax: (727) 767-4191 (727) 767-8944
Email:
BAPTIST HOSPITAL Kempton Smith David Pezewski David WildebrandtHosp. Code: 10-0093 Title: Corporate Director Reimbursement Administrator
Mailing Add: 1000 W. Moreno Street, Tower 1 Ste. 303 1000 W. Moreno StreetPensacola, FL 32501 Pensacola, FL 32501
Phone: (850) 434-4651 (850)469-2319Fax: (850) 454-4682 (850) 469-2307
Email:
Eileen Henderlite Michael MayoHosp. Code: 10-0088 Title: Director - Revenue Cycle Management Hospital President
Mailing Add: 3563 Phillips Hwy, Suite 201 800 Prudential DriveJacksonville, FL 32207 Jacksonville, FL 32207
Phone: (904) 376-4130 (904) 202-2001Fax: (904) 391-5073 (904) 202-2285
Email:
BAPTIST MEDICAL CENTER BEACHESEileen Henderlite Joe Mitrick
Hosp. Code: 10-0117 Title: Director - Revenue Cycle Management Hospital PresidentMailing Add: 3563 Phillips Hwy, Suite 201 1350 13th Avenue South
Jacksonville, FL 32207 Jacksonville Beach, FL 32250Phone: (904) 376-4130 (904) 627-2901
Fax: (904) 391-5073 (904) 627-1008Email:
BAPTIST MEDICAL CENTER NASSAUEileen Henderlite Jim L. Mayo
Hosp. Code: 10-0140 Title: Director - Revenue Cycle Management AdministratorMailing Add: P.O. Box 45094 1250 S. 18th Street
Jacksonville, FL 32207 Fernandina Beach, FL 32034Phone: (904) 376-4130 (904) 321-3501
Fax: (904) 391-5073 (904) 321-3511Email: [email protected]
BAY MEDICAL CENTER Sheila Steinzor Steven JohnsonHosp. Code: 10-0026 Title: Uncompensated Care Analyst Chief Executive Officer
ADVENTURA HOSPITAL AND MEDICAL CENTER
Certified - 9/27/11 City,Zip
[email protected] [email protected]
Certified - 2/22/11 City,Zip
[email protected] [email protected]
Certified - 5/23/11 City,Zip
[email protected] [email protected]
BAPTIST MEDICAL CENTER JACKSONVILLE
Certified - 4/12/11 City,Zip
[email protected] [email protected]
Certified - 3/22/11 City,Zip
[email protected] [email protected]
Certified - 4/12/11 City,Zip
Page 43 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Mailing Add: 615 N. Bonita Avenue 615 N. Bonita AvenueCity,Zip Panama City, FL 32401 Panama City, FL 32401Phone: (850) 747-6113 (850) 747-6045
Fax: (850) 747-6258 (850) 763-8827Email: [email protected] [email protected]
BAYFRONT MEDICAL CENTER Christopher Kroker Sue G. BrodyHosp. Code: 10-0032 Title: Patient Financial Counseling Coordinator President/CEO
Mailing Add: 701 6th Street South 701 6th Street SouthSt. Petersburg, FL 33701 St. Petersburg, FL 33701
Phone: (727) 893-3611 (727) 893-6015Fax: (727) 893-6914 (727) 893-6910
Email:
BRANDON REGIONAL HOSPITALKris Panetta Michael M. Fencel
Hosp. Code: 10-0243 Title: Director of Patient Account Services Chief Executive OfficerMailing Add: 31975 US Highway 19 North 119 Oakfield Drive
Palm Harbor, FL 34684 Brandon, FL 33511Phone: (727) 773-3410 (813) 681-5551 ext. 5100
Fax: (727) 773-3411 (813) 654-7203Email:
BROOKSVILLE REGIONAL HOSP Rick Carlton Patrick MahoneyHosp. Code: 10-0071 Title: Director of Financial Planning Chief Executive Officer
Mailing Add: 17240 Cantez Blvd. 17240 Cantez Blvd.Brooksville, FL 34601 Brooksville, FL 34601
Phone: (352) 544-6156 (352) 544-6020Fax: (352) 754-3210
Email:
CAPE CORAL HOSPITAL Same Scott KashmanHosp. Code: 10-0244 Title: Chief Administrative Officer
Mailing Add: 636 Del Prado Blvd.Cape Coral, FL 33990
Phone: (239) 424-3851Fax: (239) 424-4004
Email:
Lisa Prince Wendy H. BrandonHosp. Code: 10-0161 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 335 Crossing Blvd. 1401 West Seminole Blvd.City,Zip Orlando, FL 32073 Sanford, FL 32771Phone: (904) 688-6614 (407) 302-7392
Fax: (904) 688-7614 (407) 324-4790Email:
DESOTO MEMORIAL HOSPITAL Vincent A. Sica Robert WinklerHosp. Code: 10-0175 Title: President/ CEO President/ CEO
Mailing Add: P.O. Box 2180 P.O. Box 2180City,Zip Arcadia, FL 34265 Arcadia, FL 34265Phone: (863) 494-8402 (863) 494-8402
Fax: (863) 494-8400 (863) 494-8400
Certified - 9/28/11 City,Zip
[email protected] [email protected]
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 9/9/11 City,Zip
Certified - 3/9/11 City,Zip
CENTRAL FLORIDA REGIONAL HOSPITAL
Page 44 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Email:
DOCTORS HOSPITAL OF SARASOTAKris Panetta Robert C. Meade
Hosp. Code: 10-0166 Title: Director Chief Executive OfficerMailing Add: 31975 US Highway 19 North 5731 Bee Ridge Road
Palm Harbor, FL 34684 Sarasota, FL 34233Phone: (727) 773-3410 (941) 342-1100
Fax: (727) 773-3411 (941) 379-8342Email:
DOCTORS MEMORIAL HOSPITALSara Grambling Richard Huth
Hosp. Code: 10-0106 Title: Patient Financial Services Director CEOMailing Add: PO Box 1847 PO Box 1847
Perry, FL 32348 Perry, FL 32348Phone: (850) 584-0800 ext. 860 (850) 584-0800 ext. 885
Fax: (850) 584-0679 (850) 223-2308Email:
Donna Boroughs JoAnn BakerHosp. Code: 10-0078 Title: Business Office Manager Administrator
Mailing Add: Post Office Box 188 Post Office Box 188Bonifay, FL 32425 Bonifay, FL 32425
Phone: (850) 547-8015 (850) 547-8001Fax: (850) 547-8025 (850) 547-8006
Email:
EDWARD WHITE HOSPITAL Kris Panetta Roland MetivierHosp. Code: 10-0239 Title: Director of Patient Account Services President, Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 2323 9th Avenue NorthCity,Zip Palm Harbor, FL 34684 St. Petersburg, FL 33713Phone: (727) 773-3410 (727) 328-6133
Fax: (727) 773-3411 (727) 328-6135Email:
ENGLEWOOD COMMUNITY HOSPITAL Kris Panetta Mary Ann Conroy
Hosp. Code: 11-0004 Title: Director CEOMailing Add: 31975 US Highway 19 North 700 Medical Blvd.
Palm Harbor, FL 34684 Englewood, FL 34223Phone: (727) 773-3410 (941) 473-5043
Fax: (727) 773-3411 (941) 473-5015Email:
FLAGLER HOSPITAL-WEST Lynda Kirker Joseph GordyHosp. Code: 10-0219 Title: CFO CEO
Mailing Add: 400 Health Park Blvd. 400 Health Park Blvd.St. Augustine, FL 32086 St. Augustine, FL 32086
Phone: (904) 819-4400 (904) 819-4400Fax: (904) 819-4472 (904) 819-4472
Email:
Certified - 8/18/11 City,Zip
[email protected] [email protected]
City,Zip
[email protected] [email protected]
DOCTORS MEMORIAL HOSPITAL- BONIFAY
Certified - 5/11/11 City,Zip
[email protected] [email protected]
[email protected] roland.metivier@hcahealthcare,com
Certified - 8/23/11 City,Zip
[email protected] [email protected]
Certified - 3/17/11 City,Zip
Page 45 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
FLORIDA HOSPITAL Tammie Rikansrud Lars HoumannHosp. Code: 10-0007 Title: Assistant Vice President, PFS President, Chief Executive Officer
Mailing Add: 6010 E. Rollins Street 601 E. Rollins StreetOrlando, FL 32805 Orlando, FL 32805
Phone: (407) 200-2307 (407) 303-6611Fax: (407) 200-4965 (407) 303-1755
Email:
FLORIDA HOSPITAL HEARTLANDRyan Willis Dima Didenko
Hosp. Code: 10-0109 Title: Controller CFOMailing Add: 4200 Sun 'N Lake Boulevard 4200 Sun 'N Lake Boulevard
Sebring, FL 33872 Sebring, FL 33872Phone: (863) 386-6392 (863) 402-3366
Fax: (863) 386-6432 (863) 402-3110Email:
FLORIDA HOSPITAL - WAUCHULARyan Willis Linda B. Adler
Hosp. Code: 10-0282 Title: Controller AdministratorMailing Add: 4200 Sun 'N Lake Boulevard 533 West Carlton Street
Sebring, FL 33872 Wauchula, FL 33873Phone: (863) 386-6392 (863) 773-3101 ext. 8342
Fax: (863) 386-6432 (863) 773-0126Email:
GULF COAST MEDICAL CENTER Yuriy Kukin Barbara MelbyHosp. Code: 10-0220 Title: Sr. Financial Analyst Controller
Mailing Add: P.O Box 151247 P.O Box 151247Cape Coral, FL 33991 Cape Coral, FL 33991
Phone: (239) 242-6227 (239) 242-6200Fax: (239) 242-6248 (239) 242-6248
Email:H. LEE MOFFITT Deborah Vicedo William S. Dalton, Phd.
Hosp. Code: 11-0009 Title: Title-Lead Funding Specialist Chief Executive OfficerMailing Add: 12902 Magnolia Drive 12902 Magnolia Drive
Tampa, FL 33612 Tampa, FL 33612Phone: (800) 456-3434, ext. 4022 (813) 972-4673
Fax: (813) 745-7166 (813) 979-3090Email:
HALIFAX MEDICAL CENTER Joni Rahn Arvin LewisHosp. Code: 10-0017 Title: Director, Patient Financial Services Chief Revenue Officer
Mailing Add: 303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114
Phone: (386) 425-2452 (386) 258-4826Fax: (386) 239-2325 (386) 239-2325
Email:
HELEN ELLIS MEMORIAL HOSPITAL Kelly Smith Bruce BerghermHosp. Code: 10-0055 Title: Interim Director President/CEO
Mailing Add: 1395 South Pinellas Avenue 1395 South Pinellas Avenue
Certified - 5/17/11 City,Zip
[email protected] [email protected]
Certified - 7/11/11 City,Zip
[email protected] [email protected]
Certified - 6/8/11 City,Zip
[email protected] [email protected]
Certified - 3/14/11 City,Zip
[email protected] [email protected]
Certified -11/15/10 City,Zip
Certified - 3/29/11 City,Zip
Page 46 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Tarpon Springs, FL 34689 Tarpon Springs, FL 34689Phone: (727) 942-5126 (727) 942-5107
Fax: (727) 942-5161 (727) 942-5161Email:
John Beltz Lynn BeasleyHosp. Code: 10-0098 Title: CFO CEO
Mailing Add: 524 W. Sagamore Ave 524 W. Sagamore AveClewiston, FL 33440 Clewiston, FL 33440
Phone: (863) 902-3076 (863) 902-3076Fax: (863) 983-1809 (863) 983-1809
Email:
JACKSON MEMORIAL HOSPITALTelisa Lyons Carmen Pla
Hosp. Code: 10-0022 Title: Corporate Director, Access Management Vice President, Revenue CycleMailing Add: 1801 NW 9th Avenue, Room 212F 1801 NW 9th Avenue, Room 200D
Miami, FL 33136 Miami, FL 33136Phone: (305) 355-5364 (305) 355-5354
Fax: (305) 355-5386 (305) 355-5380Email:
JAY HOSPITAL Vickie Baxley Michael T. HutchinsHosp. Code: 10-0048 Title: Patient Access Manager Administrator
Mailing Add: 14114 Alabama Street 14114 Alabama StreetJay, FL 32565 Jay, FL 32565
Phone: (850) 675-8021 (850) 675-8015Fax: (850) 675-8203 (850) 675-8070
Email: [email protected]
JFK Medical Center Kris Panetta Gina A. MelbyHosp. Code: 10-0080 Title: Director CEO
Mailing Add: 31975 US Highway 19 North 5301 S. Congress Ave.Palm Harbor, FL 34684 Atlantis, FL 33462
Phone: (727) 773-3410 (561) 548-3850Fax: (727) 773-3411 (561) 548-3685
Email:
KENDALL REGIONAL HOSPITAL Ricardo PavonKris Panetta Scott A. CihakHosp. Code: 10-0209 Title: Director Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 11750 Bird RoadPalm Harbor, FL 34684 Miami, FL 33175
Phone: (727) 773-3410 (305) 227-5500Fax: (727) 773-3411 (305) 229-2444
Email:
Lorna Boyce-Lowe Pamela HowardHosp. Code: 10-0241 Title: Patient Accounts Director Chief Executive Officer
Mailing Add: P.O. Box 748 P.O. Box 748Lake Butler, FL 32054 Lake Butler. FL 32054
Phone: (386) 496-3540 (386) 496-2323 Ext. 225
Certified - 9/9/11 City,Zip
[email protected] [email protected]
HENDRY REGIONAL MEDICAL CENTER
Certified - 9/9/11 City,Zip
[email protected] [email protected]
Certified - 5/9/11 City,Zip
[email protected] [email protected]
Certified - 6/6/11 City,Zip
Certified - 9/9/11 City,Zip
[email protected] [email protected]
Certified - 9/28/11 City,Zip
[email protected] [email protected]
LAKE BULTER HOSPITAL/ HAND SURGERY CENTER
Certified - 6/22/11 City,Zip
Page 47 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Fax: (386) 496-4734 (386) 496-1611Email:
LARGO MEDICAL CENTER Kris Panetta Richard H. SathcerHosp. Code: 10-0248 Title: Director, Medicaid Eligibility & Support Service President/CEO
Mailing Add: 31975 US Highway 19 North 201 14th Street S.W.Palm Harbor, FL 34684 Largo, FL 33770
Phone: (727) 773-3410 (727) 588-5801Fax: (727) 773-3411 (727) 588-5906
Email:
Kris Panetta Rodney SmithHosp. Code: 10-0246 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 1700 S. 23rd StreetPalm Harbor, FL 34684 Fort Pierce, FL 34950
Phone: (727) 773-3410 (772) 468-4500 Fax: (727) 773-3411 (772) 460-1353
Email:
LEE MEMORIAL HOSPITAL Cindy Boots Jim NathanHosp. Code: 10-0012 Title: Director, Central Insurance Verification President/CEO
Mailing Add: Post Office Box 150107 8300 College Parkway, Suite 200Cape Coral, FL 33915-0107 Ft. Myers, FL 33919
Phone: (239) 242-6016 (239) 332-1111Fax: (239) 242-6116 (239) 437-5276
Email: [email protected]
James Ward Timothy F. HawkinsHosp. Code: 10-0084 Title: Senior Reimbursement Analyst EVP/COO
Mailing Add: 600 East Dixie Avenue 600 East Dixie AvenueLeesburg, FL 34748 Leesburg, FL 34748
Phone: (352) 323-4284 (352) 751-8002Fax: (352) 323-5039 (352) 751-8011
Email:
LIFESTREAM BEHAVIORAL CENTER
Vickie Parr Rick HankeyHosp. Code: 10-4018 Title: Billing Supervisor Senior Vice President/Hospital Adminstrator
Mailing Add: P.O. Box 491000 P.O. Box 491000Leesburg, FL 34749 Leesburg, FL 34749
Phone: (352) 315-7500 (352) 315-7800Fax: (352) 315-7587 (352) 315-7893
Email:
MARTIN MEMORIAL HOSPITAL Carol Plato Nicosia Mark RobitailleHosp. Code: 10-0044 Title: Director Corporate Business Serv. Chief Executive Officer
Mailing Add: Post Office Box 9033 300 Hospital AvenueStuart, FL 34995 Stuart, FL 34994
Phone: (772) 223-5656 (772) 287-5200Fax: (772) 223-5946
Email:
[email protected] [email protected]
Certified - 8/18/11 City,Zip
[email protected] [email protected]
LAWNWOOD REGIONAL MEDICAL CENTER
Certified - 9/9/11 City,Zip
[email protected] [email protected]
Certified - 3/9/11 City,Zip
LEESBURG REGIONAL MEDICAL CENTER
Certified - 9/27/11 City,Zip
[email protected] [email protected]
Certified - 3/29/11 City,Zip
[email protected] [email protected]
Certified - 6/22/11 City,Zip
Page 48 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
MAYO CLINIC FLORIDA Robert Howey Hilary MathewsHosp. Code: 10-0151 Title: Manager Reimbursement Hospital Administrator
Mailing Add: 4500 San Pablo Road 4500 San Pablo RoadJacksonville, FL 32224 Jacksonville, FL 32224
Phone: (904) 953-2698 (904) 953-0444Fax: (904) 953-0885
Email:
MEASE HEALTH CARE Jessica Villafana Opyd Louis GaldieriHosp. Code: 10-0043 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer
Mailing Add: 3986 Tampa Road 601 Main StreetOldsmar, FL 34677 Dunedin, FL 34698
Phone: (813) 852-3305 (727) 734-6395Fax: (813) 635-7731 (727) 734-6887
Email:
MEDICAL CENTER OF TRINITY Kris Panetta Leigh MassengillHosp. Code: 10-0191 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 5637 Marine ParkwayPalm Harbor, FL 34684 New Port Richey, FL 34652
Phone: (727) 773-3410 (727) 848-1733Fax: (727) 773-3411 (727) 848-5136
Email:
MUNROE REG. MED. CENTER Michelle Smith Stephen A. PurvesHosp. Code: 10-0062 Title: Director of Patient Accounting and Admitting President, Chief Executive Officer
Mailing Add: 1500 S.W. 1st Avenue 1500 S.W. 1st AvenueCity,Zip Ocala, FL 34471 Ocala, FL 34471Phone: (352) 368-3419 (352) 351-7393
Fax: (352) 671-2125 (352)368-3433Email:
MORTON PLANT HOSPITAL Jessica Villafana Opyd Neil HoceHosp. Code: 10-0127 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer
Mailing Add: 3986 Tampa Road 300 Pinellas StreetOldsmar, FL 34677 Clearwater, FL 33756
Phone: (813) 852-3305 (727) 462-7100Fax: (813) 635-7731 (727) 461-8101
Email:
MORTON PLANT NORTH BAY Jessica Villafana Opyd Harrell ZiecheckHosp. Code: 10-0063 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer
Mailing Add: 3986 Tampa Road 6600 Madison StreetOldsmar, FL 34677 New Port Richey, FL 34652
Phone: (813) 852-3305 (727) 843-4599Fax: (813) 635-7731 (727) 848-8762
Email:
MOUNT SINAI MEDICAL CENTERHosp. Code: 10-0034 Title:
Mailing Add:
Phone:Fax:
Certified - 6/20/11 City,Zip
[email protected] [email protected]
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 8/16/11 City,Zip
[email protected] [email protected]
[email protected] [email protected]
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 5/5/11 City,Zip
Page 49 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Email:
NATURE COAST REG. HOSPITAL Barbie Miller Alan BirdHosp. Code: 10-0139 Title: Business Manager Chief Executive Officer
Mailing Add: 125 S.W. Seventh Street 125 S.W. Seventh StreetWilliston, FL 32696 Williston, FL 32696
Phone: (352) 528-2801 (352) 528-2801 ext. 425Fax: (352) 528-3824 (352) 528-3824
Email: [email protected] [email protected] Krueger
Title: Account Rep.Mailing Add: 125 S.W. Seventh Street
City,Zip Williston, FL 32696Phone: (352) 528-2801
Fax: (352) 528-3824Email:
NORTHSIDE HOSPITAL Kris Panetta Stephen DaughertyHosp. Code: 10-238 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 6000 49th Street NorthPalm Harbor, FL 34684 St. Petersburg, FL 33709
Phone: (727) 773-3410 (727) 521-5004Fax: (727) 773-3411 (727) 521-5007
Email:
Kathy Mitchell Patrick A. SchlenkerHosp. Code: 10-0147 Title: Patient Financial Services Manager President/CEO
Mailing Add: 1360 Brickyard Road, PO Box 889 1360 Brickyard Road, PO Box 889Chipley, FL 32428 Chipley, FL 32428
Phone: (850) 415-8184 (850) 415-8103Fax: (850) 415-638-0622 (850) 638-5764
Email:
NORTHWEST MEDICAL CENTER Kris Panetta Dianne GoldbergHosp. Code: 10-0189 Title: Director - PAS Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 2801 N. State RoadPalm Harbor, FL 34684 Margate, FL 33063
Phone: (727) 773-3410 (954) 978-4000Fax: (727) 773-3411 (954) 978-4183
Email:OAK HILL HOSPITAL Kris Panetta Mickey Smith
Hosp. Code: 10-0264 Title: Director - PAS Chief Executive OfficerMailing Add: 31975 US Highway 19 North 11375 Cortez Blvd.
Palm Harbor, FL 34684 Brooksville, FL 34613Phone: (727) 773-3410 (352) 597-3023
Fax: (727) 773-3411 (352) 597-3024Email:
OCALA REGIONAL MEDICAL CENTER Lisa Prince H. Rex EtheredgeHosp. Code: 10-0212 Title: Director - PAS Chief Executive Officer
City,Zip
Certified - 8/16/11 City,Zip
[email protected] [email protected]
NORTHWEST FLORIDA COMMUNITY HOSPITAL
Certified - 4/19/11 City,Zip
[email protected] [email protected]
Certified - 8/18/11 City,Zip
[email protected] [email protected]
Certified - 8/18/11 City,Zip
Page 50 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Mailing Add: 335 Crossing Blvd. 1431 SW First AveneuOrange Park, FL 32073 Ocala, FL 34471
Phone: (904) 688-6614 (352) 401-1101Fax: (904) 688-7614 (352) 401-1198
Email:
Bridget Walters Keith EggerHosp. Code: 10-0006 Title: Billing/Government Manager Corporate Dir. Patient Financial Serv.
Mailing Add: 3090 Caruso Court 1414 Kuhl AvenueOrlando, FL 32806-2093 Orlando, FL 32806-2093
Phone: (407) 650-3771 (407) 237-6393Fax: (407) 650-5044 (407) 237-6328
Email: [email protected]
Lisa W. Prince Thomas R. PentzHosp. Code: 10-0226 Title: Collections Director - PAS Chief Executive Officer
Mailing Add: 335 Crossing Blvd. 2001 Kingsley AvenueOrange Park, FL 32073 Orange Park, FL 32073
Phone: (904) 688-6614 (904) 276-8769Fax: (904) 688-7614 (904) 276-8610
Email:
ORLANDO REGIONAL MED. CNTR. Mari Anne Moore Sherrie SitarikHosp. Code: 10-0006 Title: Manager Patient Financial Services President/CEO
Mailing Add: 3090 Caruso Court 1414 Kuhl AvenueOrlando, FL 32806 Orlando, FL 32806
Phone: (407) 650-3750 (321) 841-5111 ext. 6308Fax: (321) 843-6129 (321) 843-6797
Email:
PALMS WEST HOSPITAL Kris Panetta Bland EngHosp. Code: 11-0006 Title: Director of Patient Account Services Chief Operating Officer
Mailing Add: 31975 US Highway 19 North 13001 Southern Blvd.Palm Harbor, FL 34684 Loxhatchee, FL 33470
Phone: (727) 773-3410 (561) 798-3300Fax: (727) 773-3411 (561) 791-8108
Email:
PLANTATION GENERAL HOSPITAL Kris Panetta Barbara J. SimmonsHosp. Code: 11-0167 Title: Director RN, CEO
Mailing Add: 31975 US Highway 19 North 401 NW 42nd AvenuePalm Harbor, FL 34684 Plantation, FL 33317
Phone: (727) 773-3410 (954) 513-6006Fax: (727) 773-3411 (954) 587-3220
Email:
RAULERSON HOSPITAL Lisa Prince Robert LeeHosp. Code: 10-0252 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 335 Crossing Blvd. 1796 Highway 441 North City,Zip Orlando, FL 32073 Okeechobee, FL 34972
City,Zip
[email protected] [email protected]
ORLANDO REGIONAL MEDICAL CENTER
City,Zip
ORANGE PARK MEDICAL CENTER, INC.
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 2/1/11 City,Zip
[email protected] [email protected]
Certified - 8/15/11 City,Zip
[email protected] [email protected]
Certified - 9/7/11 City,Zip
Page 51 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Phone: (904) 688-6614 (863) 824-2760Fax: (904) 688-7614 (863) 824-2991
Email:
Kris Panetta Steve RectorHosp. Code: 10-0256 Title: Director of Patient Account Services CEO
Mailing Add: 31975 US Highway 19 North 14000 Fivay RoadPalm Harbor, FL 34684 Hudson, FL 34667
Phone: (727) 773-3410 (727) 869-5414Fax: (727) 773-3411 (727) 869-5491
Email:
Rick Hess Roger HallHosp. Code: 2396-0041 Title: Director of Reimbursement CEO
Mailing Add: 5130 Bayou Blvd. 7800 US Highway 98 WestPensacola, FL 32504 Miramar Beach, FL 32550
Phone: (850) 416-7029 (850) 278-30014Fax: (850) 416-7014
Email:
Rick Hess Carol SchmidtHosp. Code: 10-0025 Title: Director of Reimbursement President
Mailing Add: 5130 Bayou Blvd. 5151 North 9th AvenuePensacola, FL 32504 Pensacola, FL 32504
Phone: (850) 416-7029 (850) 416-6497Fax: (850) 416-7014 (850) 416-6119
Email:
[email protected] [email protected]
REGIONAL MEDICAL CENTER BAYONET POINT
Certified - 8/18/11 City,Zip
[email protected] [email protected]
SACRED HEART HOSPITAL - EMERALD COAST
Certified - 4/20/11 City,Zip
[email protected] [email protected]
SACRED HEART HOSPITAL - PENSACOLA
Certified - 1/11/11 City,Zip
Page 52 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
ST. JOSEPH'S HOSPITAL Jessica Villafana Opyd Lorraina LuttonHosp. Code: 10-0075 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer
Mailing Add: 3986 Tampa Road 3001 W. Dr. M.L. King, Jr. Blvd.Oldsmar, FL 34677 Tampa, FL 33607
Phone: (813) 852-3305 (813) 870-4020Fax: (813) 635-7731 (813) 870-4639
Email:
ST. LUCIE MEDICAL CENTER Lisa Prince Gary CantrellHosp. Code: 10-0260 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 335 Crossing Blvd. 1800 SE Tiffany Avenue City,Zip Orlando, FL 32073 Port St. Lucie, FL 34952
Phone: (904) 688-6614 (772) 335-4000 ext. 3100Fax: (904 688-7614 (772) 398-3670
Email:
ST. LUKE'S HOSPITAL Mike Duclos Donnie RomineHosp. Code: 2396-0088 Title: Director President
Mailing Add: 4201 Belfort Road 4201 Belfort RoadJacksonville, FL 32216 Jacksonville, FL 32216
Phone: (904) 450-6020 (904) 296-4368Fax: (904) 296-3760 (904) 296-3760
Email:
Kris Panetta Robert B. Conroy, Jr. Hosp. Code: 10-0180 Title: Director of Patient Account Services Chief Executive Officer
Mailing Add: 31975 US Highway 19 North 6500 38th Avenue NorthPalm Harbor, FL 34684 St. Petersburg, FL 33710
Phone: (727) 773-3410 (727) 341-4801Fax: (727) 773-3411 (727) 341-4889
Email:
ST. VINCENT'S HOSPITAL Susan Lindahl Mark DoyleHosp. Code: 10-0040 Title: Financial Analyst III EVP/CFO
Mailing Add: 4201 Belfor Rd., Joe Adams Bldg, 4th Flr 1 Shircliff WayJacksonville, FL 32216 Jacksonville, FL 32204(904) 450-6029 (904) 308-1258
Fax: (904) 281-5461 (904) 308-1233Email:
Wendy Martin Steven SalyerHosp. Code: 10-0113 Title: Chief Financial Officer Chief Executive Officer
Mailing Add: 922 East Call Street 922 East Call StreetStarke, FL 32091 Starke, FL 32091
Phone: (904) 368-2374 (904) 368-2351Fax: (904) 368-2306 (904) 368-2306
Email:
Shakawn Jones James R. BurkhartHosp. Code: 10-0001 Title: Manager, Patient Financial Services President & CEO
Mailing Add: 655 West 8th Street 655 West 8th Street
Certified - 8/16/11 City,Zip
[email protected] [email protected]
[email protected] [email protected]
Certified - 10/28/11 City,Zip
[email protected] [email protected]
ST. PETERSBURG GENERAL HOSPITAL
Certified - 8/22/11 City,Zip
[email protected] [email protected]
Certified - 11/2/11 City,Zip Phone:
[email protected] [email protected]
SHANDS TEACHING HOSPITAL AND CLINICS
Certified - 11/4/10 City,Zip
[email protected] [email protected]
SHANDS JACKSONVILLE MEDICAL CENTER
Page 53 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Jacksonville, FL 32209 Jacksonville, FL 32209Phone: (904) 244-1877 (904) 244-4000
Fax: (904) 244-1957 (904) 244-4027Email:
SHANDS HOSPITAL @ Lakeshore
Vivian Pearson Rhonda SherrodHosp. Code: 10-0102 Title: Patient Access Director Chief Executive Officer
Mailing Add: 368 N.E. Franklin Street 368 N.E. Franklin StreetLake City, FL 32055 Lake City, FL 32055
Phone: (386) 292-8029 (386) 292-8120Fax: (386) 292-8070 (386) 292-8121
Email:
Certified - 11/8/10 City,Zip
Certified - 1/10/11 City,Zip
Page 54 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
SHANDS HOSPITAL @ Live Oak Neysa Lewis Ricardo DiazHosp. Code: 10-0146 Title: Business Office Manager CEO
Mailing Add: 1100 S.W. 11th Street 1100 S.W. 11th StreetLive Oak, FL 32064 Live Oak, FL 32064
Phone: (386) 362-0830 (386) 362-0840Fax: (386) 362-0829 (386) 362-0841
Email:
SHANDS HOSPITAL @ StarkeFaye Swilley Jeannie Baker
Hosp. Code: 10-0103 Title: Financial Counselor AdministratorMailing Add: 922 E. Call Street 922 E. Call Street
Starke, FL 32091 Starke, FL 32091Phone: (904) 368-2300 ext. 236 (904) 368-2300 ext. 345
Fax: (904) 964-3451 (904) 964-3451Email:
SOUTH FLORIDA BAPTIST HOSPITAL
Jessica Villafana Opyd Stephen NiermanHosp. Code: 10-0132 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer
Mailing Add: 3986 Tampa Road 301 North Alexander StreetOldsmar, FL 34677 Plant City, FL 33566
Phone: (813) 852-3305 (813) 757-1205Fax: (813) 635-7731 (813) 757-8204
Email:SUN CITY HOSPITAL, INC. Kris Panetta Sharon L. Roush
Hosp. Code: 10-0259 Title: Director, Patient Account Services Chief Executive OfficerMailing Add: 31975 US Hwy 19 North 4016 Sun City Center Blvd
Palm Harbor, FL 34684 Sun City Center, FL 33573Phone: (727) 773-3410 (813) 634-3301 ext. 1101
Fax: (727) 773-3411 (813) 634-8712Email:
TALLAHASSEE MEMORIAL HOSPITALJulie Burnett G. Mark O'Bryant
Hosp. Code: 10-0135 Title: Director, Medical Data Systems President, Chief Executive OfficerMailing Add: 1309 Thomasville Road 1300 Miccosukee Road
Tallahassee, FL 32303 Tallahassee, FL 32308Phone: (850) 431-5781 (850) 431-5380
Fax: (850) 431-6915 (850) 431-5883Email:
TAMPA GENERAL HOSPITAL Kimberly Shepherd Ronald A. HytoffHosp. Code: 10-0128 Title: Manager, ED Registrations and Financial Ass President, Chief Executive Officer
Mailing Add: 1 Tampa General Circle 1 Tampa General CircleTampa, FL 33606 Tampa, FL 33606
Phone: (813) 844-7406 (813) 844-7662Fax: (813) 844-4391 (813) 844-4144
Email:
THE VILLAGES REGIONAL HOSPITALGrant L. Glines Timothy F. Hawkins
Certified - 1/10/11 City,Zip
[email protected] [email protected]
Certified - 1/10/11 City,Zip
[email protected] [email protected]
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 9/16/11 City,Zip
[email protected] [email protected]
Certified - 10/27/11 City,Zip
[email protected] [email protected]
Certified - 3/24/11 City,Zip
Page 55 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
Hosp. Code: 2396-0032 Title: Assistant Controller EVP/COOMailing Add: 600 East Dixie Avenue 1351 El Camino Real
Leesburg, FL 34748 The Villages, FL 32159Phone: (352) 323-5695 (352) 751-8002
Fax: (352) 323-5039 (352) 751-8011Email:
Certified - 9/22/11 City,Zip
Page 56 of 56
AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care
Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012
Last Updated:
March 20, 2012Hospital Name HCRA Contact Hospital Administrator
UNIVERSITY COMMUNITY HOSPITALJed Chilton Janice Hagensicker
Hosp. Code: 10-0173 Title: Manager, Medical Finance Assistance CFOMailing Add: 3102 East 183th Avenue 3100 E. Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613Phone: (813) 615-7481 (813) 615-7853
Fax: (813) 615-7704 (813) 615-7339Email:
Vertie Nail Donald EvansHosp. Code: 10-0069 Title: Patient Accounting Support Rep. Chief Executive Officer
Mailing Add: 7171 N. Dale Mabry Hwy. 7171 N. Dale Mabry Hwy.Tampa, FL 33614 Tampa, FL 33614-2670
Phone: (813) 558-8006 (813) 932-2222, ext. 8001Fax: (813) 558-8007 (813) 558-8011
Email:
UNIVERSITY HOSPITAL, LTD Kris Panetta William Mark RaderHosp. Code: 10-0224 Title: Director, Patient Access Services Tampa Chief Executive Officer
Mailing Add: 31975 US Hwy. 19 North 7201 N. University DrivePalm Harbor, FL 34684 Tamarac, FL 33321
Phone: (727) 773-3410 (954) 724-2200 ext. 6101Fax: (727) 773-3411 (954) 724-6567
Email:
Kris Panetta Kevin CorcoranHosp. Code: 10-0228 Title: Director of Patient Account Services CFO
Mailing Add: 31975 US Highway 19 North 8201 West Broward Blvd.Palm Harbor, FL 34684 Plantation, FL 33324
Phone: (727) 773-3410 (954) 476-3987Fax: (727) 773-3411 (954) 452-2133
Email:
WINTER HAVEN HOSPITAL Kim Kinney Lance AnatasioHosp. Code: 10-0052 Title: Reimbursement Coordinator Chief Executive Officer
Mailing Add: 200 Avenue F NE 200 Avenue F NEWinter Haven, FL 33881 Winter Haven, FL 33881
Phone: (863) 293-1121 ext. 3054 (863) 297-1899Fax: (863) 291-6757 (863) 297-1867
Email:
Certified - 4/27/11 City,Zip
[email protected] [email protected]
UNIVERSITY COMMUNITY HOSPITAL @ CARROLWOOD
Certified - 4/27/11 City,Zip
Certified -9/9/11 City,Zip
[email protected] [email protected]
WESTSIDE REGIONAL MEDICAL CENTER
Certified - 8/16/11 City,Zip
[email protected] [email protected]
Certified - 5/31/11 City,Zip