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Montana PacificSource Health Plans
Montana Key for Status: Signed = Part of our network Pending = Awaiting signed agreement (while we are working to add this provider, we cannot confirm they will join our network at this time) MEDICAL GROUP STATUS FIRST NAME LAST NAME LICENSE ADDRESS CITY NATURAL MEDICINE PLUS SIGNED NANCY AAGENES ND 33 NEILL AVE STE 102 HELENA YELLOWSTONE COUNSELING CENTER SIGNED ASHLEY ABBEY LCSW 208 N BROADWAY STE 423 BILLINGS BENEFIS HEALTHCARE HAVRE SIGNED BRIAN ABBOTT MD 40 13TH ST HAVRE BENEFIS ONCOLOGY ASSOCIATES SIGNED BRIAN ABBOTT MD 1117 29TH ST S STE 500 GREAT FALLS MARCUS DALY REHAB SERVICES SIGNED DUAIN ABBOTT PT 1200 WESTWOOD DR HAMILTON NORTHERN MONTANA HOSPITAL SIGNED DANIEL ABBOTT MD 30 13TH ST HAVRE SIGNED SHAWN ABBOTT LCSW 600 CENTRAL AVE STE 302 GREAT FALLS SIGNED ALISSA ABENTROTH MD 400 SADDLE DR HELENA BENEFIS HEALTHCARE PRACTITIONERS PENDING STEPHEN ABERCROMBIE CRNA 1101 26TH ST S GREAT FALLS GREAT FALLS CLINIC SURGERY CENTER SIGNED STEPHEN ABERCROMBIE CRNA 1509 29TH ST S GREAT FALLS BILLINGS CLINIC SIGNED KIMBERLY ACKERMAN NP 1045 N 30TH ST BILLINGS BILLINGS CLINIC COLUMBUS SIGNED LORRAINE ACKERMAN NP 407 N A ST COLUMBUS NORTHERN MONTANA HOSPITAL SIGNED CAMERON ACOR DPM 30 13TH ST HAVRE LINCOLN CO COMMUNITY HEALTH CTR SIGNED ALMA ACUNA PAC 320 E 2ND ST LIBBY BENEFIS PHYSICIAN ASSOCIATES SIGNED ELTON ADAMS MD 400 13TH AVE S STE 206 GREAT FALLS BRIDGER INTERNAL MEDICINE SIGNED TIMOTHY ADAMS MD 925 HIGHLAND BLVD STE 1100 BOZEMAN COGENT HEALTHCARE PENDING MICHAEL ADAMS MD 1101 26TH ST S GREAT FALLS LEWIS & CLARK EMERGENCY PHYSICIANS PENDING BARRETT ADAMS MD 2475 BROADWAY HELENA MARIAS HEALTHCARE SERVICES SIGNED MARC ADAMS MD 670 PARK AVE SHELBY MEDICAL EYE SPECIALISTS SIGNED WESLEY ADAMS MD 205 W MAIN ST BELGRADE MEDICAL EYE SPECIALISTS SIGNED WESLEY ADAMS MD 300 N WILLSON STE 1003 BOZEMAN MEDICAL EYE SPECIALISTS SIGNED WESLEY ADAMS MD 422 S MAIN LIVINGSTON WOMENS COUNSELING CENTER SIGNED DIANE ADAMS LCSW 1600 S AVE W STE A MISSOULA PENDING CHRISTINE ADAMS LCSW 321 E MAIN ST STE 405 BOZEMAN PENDING CHRISTINE ADAMS LCSW 47855 GALLATIN RD BIG SKY SIGNED DIANE ADAMS LCSW 725 W ALDER STE 18 MISSOULA PENDING MARYBETH ADAMS NP 203 W MADISON STE E2 BELGRADE SIGNED RYAN ADAMS MD 500 W BROADWAY MISSOULA HANDS ON PHYSICAL THERAPY SIGNED CATHY "CASS" ADDINGTON PT 2210 HARRISON AVE BUTTE BENEFIS HEALTHCARE SIGNED THOMAS ADDISON MD 1101 26TH ST S GREAT FALLS GREAT FALLS CLINIC SIGNED THOMAS ADDISON MD 3000 15TH AVE S GREAT FALLS NORTH VALLEY HOSPITAL SIGNED THOMAS ADDISON MD 1600 HOSPITAL WAY WHITEFISH SIGNED T BRICE ADDISON MD 1101 26TH ST GREAT FALLS GABERT MEDICAL SERVICES SIGNED DALE ADISHIAN MD 107 DILWORTH GLENDIVE MARCUS DALY MEMORIAL HOSPITAL SIGNED CLINTON ADKINS DO 1200 WESTWOOD DR HAMILTON BILLINGS CLINIC SIGNED DEBORAH AGNEW MD 2800 10TH AVE N BILLINGS AGUAYO CHIROPRACTIC & WELLNESS SIGNED JASON AGUAYO DC 2212 BROADWATER AVE #D BILLINGS PENDING DONNA AHERN GUZA LCPC 2050 FAIRWAY DR STE 101 BOZEMAN BILLINGS CLINIC SIGNED SHAHZAD AHMAD MD 1045 N 30TH ST BILLINGS NORTHERN ROCKIES NEUROSURGICAL SIGNED FARROUKH AJIR MD 350 HERITAGE WAY STE 1300 KALISPELL ANESTHESIA ASSOCIATES OF GT FALLS SIGNED SHARON AKREP MD 401 15TH AVE S STE 109 GREAT FALLS CENTRAL MONTANA COMM HEALTH CENTER SIGNED PEGGY ALBEE LAC 406 1ST AVE S LEWISTOWN CENTRAL MONTANA COMM HEALTH CENTER SIGNED PEGGY ALBEE LAC 406 1ST AVE S LEWISTOWN CATALYST PHYSICAL THERAPY SIGNED CARLA ALBERT PT 117 N 4TH ST #A2 HAMILTON ALBIERO CHIROPRACTIC SIGNED BRIAN ALBIERO DC 104 CRESTVIEW DR STE 202 BIGFORK RIVERSTONE HEALTH SIGNED SANDI ALDEN LAC 123 S 27TH ST BILLINGS RIVERSTONE HEALTH SIGNED SANDI ALDEN LAC 123 S 27TH ST BILLINGS ADVANCED MEDICAL IMAGING SIGNED DANIEL ALDERMAN MD 905 HIGHLAND BLVD STE 4100 BOZEMAN INTERCITY RADIOLOGY SIGNED DANIEL ALDERMAN MD 925 HIGHLAND BLVD STE 1180 BOZEMAN 1 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network ZIP 59601 59102 59501 59405 59840 59501 59401 59601 59405 59403 59101 59019 59501 59923 59405 59715 59405 59601 59474 59714 59715 59047 59801 59715 59716 59802 59714 59802 59701 59405 59405 59937 59405 59330 59840 59101 59102 59715 59101 59901 59405 59457 59457 59840 59911 59101 59101 59715 59715 SPECIALTY NATUROPATH LICENSED CLINICAL SOCIAL WORKER HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY PHYSICAL THERAPY ANESTHESIOLOGY LICENSED CLINICAL SOCIAL WORKER SURGERY GENERAL ANESTHESIOLOGY ANESTHESIOLOGY ENDOCRINOLOGY FAMILY PRACTICE PODIATRY FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE HOSPITALIST EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE HOSPITALIST PHYSICAL THERAPY INTERNAL MEDICINE INTERNAL MEDICINE HOSPITALIST INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE EAR/NOSE/THROAT (ENT) PEDIATRICS CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR ENDOCRINOLOGY SURGERY NEUROSURGERY ANESTHESIOLOGY LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY CHIROPRACTIC LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR RADIOLOGY RADIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 2 of 256 FIRST NAME PATRICK JENNIFER JOHN AMY JENNIFER SHERYL SHERYL ROBERT ROB MOHAMAD DONNA NIMA SARAH SUSAN DEEANN JEFFREY JEFFREY TRAVIS DENISE J MICHAEL ELIZABETH JESSIE JANET DAVID DAVID KERI JUSTIN AARON KARI AIMEE ALAN ROBERTO ERIN RUDO EDWARD FATIMA THOMAS BETH BETH BETH BETH BETH R R ROBERT JESSICA LARRY JOHN CHRISTOPHER CHRISTOPHER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME ALDUENDA ALEXANDER ALEXANDER ALEXANDER ALEXANDER ALEXANDER ALEXANDER ALFIERO ALFIERO AL-HAFEZ ALINE ALINEJAD ALKE ALLEN ALLEN ALLEN ALLEN ALLEN ALLEN ALLEN ALLEN ALLICK ALLISON ALLMACHER ALLMACHER ALLMACHER ALLRED ALME ALTENHOFEN ALVORD-BROWN ALYEA AMADO CATTANEO AMATO AMBAYI AMBERG AMELKIN AMIDON AMMONS AMMONS AMMONS AMMONS AMMONS AMMONS AMMONS AMRINE AMSDEN AMSTUTZ ANDENORO ANDERSEN ANDERSEN LICENSE PA PT MD LCSW PT DC DC PAC PA-C MD PT MD PAC LCSW MD CRNA CRNA PA MD MD LAC LCPC PHD MD MD PA PT MD SLP PAC MD MD MD MD PA LCSW MD MD MD MD MD MD PHD PHD MD PAC MD MD PT PT MEDICAL GROUP ST PETERS URGENT CARE PROFESSIONAL THERAPY ASSOCIATES SIDNEY HEALTH CENTER ST LUKE COMM CLINIC RONAN HOLY ROSARY HEALTHCARE MANGER HARRINGTON PHYSICAL THERAPY GALLATIN COMMUNITY CLINIC ALEPH ANESTHESIA ASSOCIATES OF GT FALLS BARRETT HOSPITAL & HEALTHCARE BENEFIS HEALTHCARE BILLINGS CLINIC CMC REHABILITATION PHYSICIANS PATHWAYS HEALTH CARE ACADIA MONTANA CENTER FOR JOINT CARE COLSTRIP MEDICAL CENTER GLACIER EYE CLINIC PC BILLINES OB/GYN ASSOCIATES TAMARACK MEDICAL CLINIC CARDIO WEST SURGERY MONTANA PSYCHIATRY PLLC NORTHERN MONTANA MEDICAL GROUP ANACONDA INTERNAL MEDICINE ROCKY MOUNTAIN HEART & LUNG CPG ON SOUTH RESERVE CPG ON SOUTH RESERVE MOUNTAIN VIEW FAMILY MED & OB MOUNTAIN VIEW FAMILY MED & OB WESTERN MONTANA CLINIC BILLINGS CLINIC BILLINGS CLINIC CORVALLIS PHYSICAL THERAPY HAMILTON PHYSICAL THERAPY ADDRESS 2475 BROADWAY 1234 WHITEFISH STAGE RD 216 14TH AVE SW 900 N ORANGE 576 SOKANE AVE 20002 E CARLTON CREEK RD 20002 E CARLTON CREEK RD 126 6TH AVE SW #A 6 - 13TH AVE E 2600 WILSON ST 2525 COLONIAL DR STE B 1203 15TH 214 E MENDENHALL 2685 PALMER ST STE A 401 15TH AVE S STE 109 90 HWY 91 S 2519 13TH AVE S 801 N 29TH ST 2825 FORT MISSOULA RD #317 200 HERITAGE WAY 1125 MISSOULA AVE STE C 55 BASIN CREEK RD 128 S 6TH WEST 900 N ORANGE #103 1208 6TH AVE E 1821 S AVE #402 6230 MAIN ST 160 HERITAGE WAY 9885 O'BRIEN CREEK RD 1611 ZIMMERMAN TRAIL 1208 6TH AVE E 1300 28TH ST S STE 1 3737 GRAND AVE STE 6 30 13TH ST 1102 E COMMERCIAL 1125 MISSOULA AVE 350 HERITAGE WAY #2100 1211 S RESERVE ST 1211 S RESERVE ST 2835 FT MISSOULA RD #101 2835 FT MISSOULA RD #101 500 W BROADWAY 2831 FORT MISSOULA RD #201 73500 GRAY WOLF RD 500 W BROADWAY 801 N 29TH ST 1020 N 27TH ST 350 HERITAGE WAY #2300 1050 EASTSIDE HWY 336 FAIRGROUNDS RD CITY HELENA KALISPELL SIDNEY MISSOULA WHITEFISH FLORENCE FLORENCE RONAN POLSON MILES CITY HELENA FORT BENTON BOZEMAN MISSOULA GREAT FALLS DILLON GREAT FALLS BILLINGS MISSOULA KALISPELL HELENA BUTTE MISSOULA MISSOULA SUPERIOR MISSOULA COLSTRIP KALISPELL MISSOULA BILLINGS SUPERIOR GREAT FALLS BILLINGS HAVRE ANACONDA HELENA KALISPELL MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA ARLEE MISSOULA BILLINGS BILLINGS KALISPELL CORVALLIS HAMILTON ZIP 59601 59901 59270 59802 59937 59833 59833 59864 59860 59301 59601 59442 59715 59808 59405 59725 59405 59101 59804 59901 59601 59701 59801 59802 59872 59801 59323 59901 59804 59102 59872 59405 59102 59501 59711 59601 59901 59801 59801 59801 59801 59802 59804 59821 59802 59101 59101 59901 59828 59840 SPECIALTY URGENT CARE PROVIDER PHYSICAL THERAPY RADIOLOGY SOCIAL WORKER PHYSICAL THERAPY CHIROPRACTOR CHIROPRACTOR SURGERY ORTHOPEDIC MEDICINE PHYSICIAN ASSISTANT HOSPITALIST PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY HEMATOLOGY-ONCOLOGY PHYSICAL MEDICINE REHABILITATION PSYCHIATRY ADDICTIONNICOTINECOUNSELOR LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE DERMATOLOGY PHYSICAL THERAPY OPHTHALMOLOGY SPEECH-LANGUAGE PATHOLOGIST OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY CARDIOVASCULAR THORACIC PSYCHIATRY FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER INTERNAL MEDICINE FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE PSYCHOLOGIST PSYCHOLOGIST FAMILY PRACTICE INTERNAL MEDICINE PSYCHIATRY UROLOGY PHYSICAL THERAPY PHYSICAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 3 of 256 FIRST NAME MICHAEL ERIC DAVID DAVID JONATHAN LEAH M DAVID DANIEL LINDSEY WILLIAM DAVID LOY JESSICA NANCY PAUL JULIANNE DENISE STEVEN RACHEL ASHLEY REBECCA BRENDA BRENDA DAVID BRADLEY CHARLES VICTORIA LISA JUDITH JOHN VICKI LAUREL JENNIFER JAMIE ANNE VICTORIA RAYMONE ELIZABETH KATE ANNA BARBARA JOSEPH CHRISTIAN HEIDI HEIDI CHARLES CHARLES MARTHA STEVEN ALEXANDER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON-MANGAN ANDERSON-SMITH ANDRE ANDRE ANDRECHAK ANDRUS ANESI ANGLIM ANGYUS ANNAU ANSLEY ANTONICH ANTONOPULOS ANTONSON APOSTOL APPEL APPLEGATE APPLEGATE ARAGON ARAGON ARAMBEL JUDICE ARBOGAST ARCHIBALD LICENSE DC MD MD MD MD MD CRNA DC OT MD MD MD PAC CRNA CRNA PAC PT PT RD AU MD PAC PAC LCPC MD MD MD LCPC LCPC PHD SLT NP MD LCPC MD OT NP PAC APRN DO NP MD PT NP NP MD MD APRN DO OD MEDICAL GROUP ANDERSON CHIROPRACTIC ANESTHESIA ASSOCIATES OF GT FALLS BENEFIS HEALTHCARE BENEFIS PHYSICIANS ASSOCIATES BIG SKY FAMILY MEDICINE BOZEMAN CREEK FAMILY HEALTH CAPITAL MEDICAL ANESTHESIA CHIROPRACTIC HEALTH ASSOC EPICENTER THERAPY SERVICES FORSYTH FAMILY MEDICINE GREAT FALLS CLINIC GREAT FALLS CLINIC ORTHO MONTANA PACIFIC CATARACT & LASER INSTITUTE PACIFIC CATARACT & LASER INSTITUTE PARK CLINIC REHABILITY REHABILITY RIVERSTONE HEALTH SIDNEY HEALTH CENTER CLINIC SOUND INPATIENT PHYSICIANS THE MONTANA CENTER FOR WELLNESS THE WAL-MART CLINIC AT KRMC WESTERN MONTANA MENTAL HEALTH CTR SOUTHWEST PROFESSIONAL COUNSELING BILLINGS CLINIC BILLINGS CLINIC ST PETERS MEDICAL OFFICE BUILDING AR ENTERPRISES INC FAMILY HEALTH CLINIC INTERNAL MEDICINE FAMILY HEALTH CLINIC PEDIATRIC HOSPITALIST CARDIOVASCULAR CONSULTANTS OF MT GREAT NORTHERN PHYSICAL THERAPY COMMUNITY HOSPITAL OF ANACONDA PINTLER FAMILY PRACTICE ANESTHESIA PARTNERS OF MONTANA NORTHERN ROCKIES REGIONAL PAIN CTR PONDERA MEDICAL CENTER BILLINGS CLINIC PACIFIC CATARACT & LASER INSTITUTE ADDRESS 3031 S RUSSELL STE 2 401 15TH AVE S STE 109 1400 29TH ST S 1101 26TH AVE S 430 WINDWARD WAY #1 316 E BABCOCK 2475 BROADWAY 1407 WYOMING AVE 612 E MAIN ST STE C 383 N 17TH AVE 20 13TH ST 1600 DIVISION RD 2900 12TH AVE N STE 140W 1717 4TH ST S 1717 4TH ST S 1001 RIVER DR 403 W MAIN ST STE B 403 W MAIN ST STE B 123 S 27TH ST 214 14TH AVE SW STE 100 2827 FORT MISSOULA RD 245 WINDWARD WAY STE 101 170 HUTTON RANCH RD 1315 WYOMING ST 2900 12TH AVE NO STE 503E 820 N MONTANA AVE 1233 N 30TH ST 120 23RD AVE NE 3475 MONROE STE 103 1020 N 27TH ST 2475 VILLAGE LN STE 100 190 17TH AVE NW 801 N 29TH ST 40 N LAST CHANCE GULCH 2550 E BROADWAY ST 105 RAVALLI ST 900 6TH ST SW STE 2 1300 28TH ST S STE 10 900 6TH ST SW STE 2 1101 26TH ST S 301 KNAPP ST 1101 N 27TH STE F 612 E MAIN ST STE A 401 W PENNSYLVANIA 305 W PENNSYLVANIA 2900 12TH AVE N STE 205W 2900 12TH AVE N STE 335W 805 SUNSET BLVD 801 N 29TH ST 1717 FOURTH ST S CITY MISSOULA GREAT FALLS GREAT FALLS GREAT FALLS KALISPELL BOZEMAN HELENA BILLINGS BOZEMAN FORSYTH HAVRE GREAT FALLS BILLINGS GREAT FALLS GREAT FALLS LIVINGSTON BELGRADE BELGRADE BILLINGS SIDNEY MISSOULA KALISPELL KALISPELL MISSOULA BILLINGS HELENA BILLINGS GREAT FALLS BUTTE BILLINGS BILLINGS GREAT FALLS BILLINGS HELENA HELENA STEVENSVILLE GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS WOLF POINT BILLINGS BOZEMAN ANACONDA ANACONDA BILLINGS BILLINGS CONRAD BILLINGS GREAT FALLS ZIP 59801 59405 59405 59405 59901 59715 59601 59102 59715 59327 59501 59404 59101 59405 59405 59047 59714 59714 59101 59270 59804 59901 59901 59801 59101 59601 59101 59404 59701 59101 59102 59404 59101 59601 59604 59870 59404 59405 59404 59405 59201 59101 59715 59711 59711 59101 59101 59425 59101 59405 SPECIALTY CHIROPRACTIC ANESTHESIOLOGY PULMONARY DISEASES INTENSIVE/CRITICAL CARE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY CHIROPRACTIC OCCUPATIONAL THERAPY FAMILY PRACTICE PULMONARY DISEASES FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE ANESTHESIOLOGY ANESTHESIOLOGY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY NUTRITION PROFESSIONAL AUDIOLOGY HOSPITALIST PAIN MANAGEMENT FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SURGERY UROLOGICAL UROLOGY NEUROLOGY PSYCHIATRY PROFESSIONAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY SPEECH/LANGUAGE THERAPY PSYCHIATRY EAR/NOSE/THROAT (ENT) LICENSED BEHAVIORAL COUNSELOR INFECTIOUS DISEASES OCCUPATIONAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS NURSE PRACTITIONER CARDIOLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY FAMILY PRACTICE NEUROLOGY OPTOMETRY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 4 of 256 FIRST NAME JENNIFER DAVID FARANAK ENRICO DIANE DIANE MARA ANNE PATRICK PATRICK JANET PATRICK MICHAEL STEVEN STEVEN SARAH ZEFERINO AMBER SUSAN WALKER JIMMIE SANDI ELIZABETH JAMES NANCY MARSHA NIALL MEAGAN DIANA THOMAS THOMAS TERESA GREGORY DANA KYLE KYLE JENNIFER MARK SUSAN LAR LAR SUSAN AIMEE AIMEE BRADLEY BRADLEY STEVEN LAURENCE STEVEN FRANCESCA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME ARCHIBALD ARENDS ARGANI ARGUELLES ARKAVA ARKAVA ARLINGTON ARMSTRONG ARMSTRONG ARMSTRONG ARMSTRONG ARMSTRONG ARNOLD ARNOLD ARNOLD ARONSON ARROYO ARTHUR ASBELL ASHCRAFT ASHCRAFT ASHLEY ASSERSON ASTHALTER ASTRUP ATHERTON ATKINSON AUCH AUERHAMMER AUERHAMMER AUFIERO AUGUSTINE AUSMUS AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUTIO AUTIO AVERY AVISON AVISON AYLOR AYLOR AYRES AYRES AYRES AYTES LICENSE PAC PA MD MD LCSW LCSW PT PAC PA PA MD PA-C PT NP NP LCSW DO PT NP MD MD LCPC PHD DO PT MD NP PA LCPC LCPC MD MD MD PT PAC PAC DO MD MD MD MD MD PAC PA-C MD MD MD MD MD LCSW MEDICAL GROUP ROCKY MOUNTAIN HEART & LUNG PONDERA MEDICAL CENTER BILLINGS CLINIC ARTHRITIS & OSTEOPOROSIS CENTER BILLINGS CLINIC FLORENCE THERAPY AND WELLNESS BIG SKY FAMILY MEDICINE LIBERTY MEDICAL CENTER Sweet Medical Center ARNOLD PHYSICAL THERAPY BIG SANDY MEDICAL CENTER WMMHC ANESTHESIA PARTNERS OF MONTANA BILLINGS CLINIC MILES CITY BILLINGS CLINIC PHYSICIANS CLINIC FAMILY PSYCHOLOGICAL CENTER GREAT FALLS CLINIC ADVANCED PERFORMANCE & REHAB GLACIER COMMUNITY HEALTH CENTER NORTHERN ROCKIES MED CENTER AUERHAMMER PROFESSIONAL SERVICES ST JAMES HEALTHCARE HELENA PEDIATRIC CLINIC NORTHERN PLAINS PATHOLOGISTS DANA AUSTIN PHYSICAL THERAPY FAMILY HEALTH CARE FAMILY HEALTH CARE PINTLER FAMILY MEDICINE SIDNEY HEALTH CENTER SIDNEY HEALTH CENTER BLUE MOUNTAIN CLINIC WESTERN MONTANA CLINIC BOZEMAN SPORT AND SPINE BOZEMAN SPORT AND SPINE BENEFIS PHYSICIAN ASSOCIATES ADDRESS 350 HERITAGE WAY STE 2100 805 SUNSET BLVD 801 N 29TH ST 708 BROADWATER AVE 801 N 29TH ST 404 N 31ST STE STE 2002 5529 OLD US HWY 93 202 CONWAY DR #200 315 W MADISON 419 PENNSYLVANIA ST 221 5TH AVE S 621 3RD ST S 251 SADDLE DR 166 MONTANA AVE E 926 13TH AVE S 418 WINDWARD WAY 2900 12TH AVE N STE 205W 620 S HAYNES 801 N 29TH ST 1170 WESTWOOD DR STE B 221 5TH AVE S 304 BROADWAY 65A W KAGY 2012 14TH ST SW 1532 ELLIS ST #201 519 E MAIN ST 802 2ND ST SE 2360 MULLAN RD STE C 836 HOLT DR #321 836 HOLT DR #321 435 S CRYSTAL ST 1122 N MONTANA 500 15TH AVE S 406 2ND AVE EAST 1287 BURNS WAY 715 NUCLEUS AVE 401 W PENNSYLVANIA 216 14TH AVE SW 216 14TH AVE SW 610 N CALIFORNIA ST 500 W BROADWAY 401 15TH AVE S STE 110 107 6TH AVE SW 6 - 13TH AVE E 925 HIGHLAND STE 1130 925 HIGHLAND STE 1130 2800 11TH AVE S STE 28 2827 FORT MISSOULA RD OR 2800 11TH AVE S #28 500 W BROADWAY CITY KALISPELL CONRAD BILLINGS BILLINGS BILLINGS BILLINGS FLORENCE KALISPELL CHESTER CHINOOK GLASGOW GLASGOW HELENA BIG SANDY GREAT FALLS KALISPELL BILLINGS MILES CITY BILLINGS HAMILTON GLASGOW HELENA BOZEMAN GREAT FALLS BOZEMAN CUT BANK CUT BANK MISSOULA BIGFORK BIGFORK BUTTE HELENA GREAT FALLS SUPERIOR KALISPELL COLUMBIA FALLS ANACONDA SIDNEY SIDNEY MISSOULA MISSOULA GREAT FALLS RONAN POLSON BOZEMAN BOZEMAN GREAT FALLS MISSOULA GREAT FALLS MISSOULA ZIP 59901 59425 59101 59101 59101 59101 59833 59901 59522 59523 59230 59230 59601 59520 59405 59901 59101 59301 59101 59840 59230 59601 59715 59405 59715 59427 59427 59808 59911 59911 59701 59601 59405 59872 59901 59912 59711 59270 59270 59802 59801 59405 59864 59860 59715 59715 59405 59804 59405 59802 SPECIALTY CARDIOLOGY FAMILY PRACTICE INTERNAL MEDICINE RHEUMATOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE PHYSICIAN ASSISTANT PHYSICAL THERAPY FAMILY PRACTICE NURSE PRACTITIONER LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY PHYSICAL THERAPY INTERNAL MEDICINE GENERAL PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR SURGERY THORACIC PEDIATRICS PATHOLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY RADIOLOGY RADIOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE URGENT CARE PROVIDER PHYSICIAN ASSISTANT PAIN MANAGEMENT PHYSICAL THERAPY GASTROENTEROLOGY ANESTHESIOLOGY GASTROENTEROLOGY SOCIAL WORKER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 5 of 256 FIRST NAME KARY DEANNA ROBERT PETE PETE PETE SALLY PAUL ANNETTE MARION MARVIN BROOKS KELLY KELLY JESSALYN MATTHEW SANDRA JESSICA IEVA KENNETH LAURA MICHELLE TARIF GAIL JULIE SHAWNA KRISTA DEBORAH BOB CARMEN TERESA DAVID STEPHEN CHRISTIAN ROBERT JACE TIM TIM BERNARD BRITT JEAN ANDREW MAE GEORGE GEORGE GEORGE GEORGE GEORGE GEORGE GEORGE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME AYTES BABB BABBITT BABCOCK BABCOCK BABCOCK BABCOCK BACH BACHELLER BACHRA BACKER BAER BAGNELL BAGNELL BAHNMILLER BAILEY BAILEY BAILEY BAILEY BAILEY BAILEY BAILEY BAKDASH BAKER BAKER BAKER BAKKEDAHL BAKKEN BAKKO BALDING BALDRIDGE BALDRIDGE BALL BALL BALL BALL BALLARD BALLARD BALLEWEG BALLINGER BALLOU BALSAM BALTAZAR BANDOW BANDOW BANDOW BANDOW BANDOW BANDOW BANDOW LICENSE MD APRN PA OD OD OD LCPC PHD LCSW RD PHD LCPC MD MD PT MD DO MD MD MD LCPC PA-C MD LCSW LCPC MD PT LCPC PHD MD MD MD MD MD MD PA-C LCPC LCPC PHD NP LCSW LCPC PT MD MD MD MD MD MD MD MEDICAL GROUP ALPINE FAMILY MEDICINE ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER PC WHITEPINE COUNSELING SERVICES MONTANA NEUROBEHAVIORAL SPECIALISTS WESTERN MONTANA MENTAL HEALTH CTR GREAT FALLS CLINIC FLATHEAD VALLEY ORTHOPEDICS GREAT FALLS OBGYN ASSOCIATES ST PETERS MEDICAL GROUP SVH SPECIALTY CARE SERVICES CENTER FOR MENTAL HEALTH FLATHEAD THERAPEUTIC SERVICES PINTLER FAMILY MEDICINE BILLINGS CLINIC MAE COUNSELING SERVICES NORTHWEST COUNSELING ST VINCENT HEALTHCARE STEVENSVILLE COMMUNITY MEDICAL CNTR ANESTHESIA PARTNERS OF MONTANA BILLINGS CLINIC PERI & NEONATAL SERVICES AT KRMC BALSAM COUNSELING & CONSULTHING P YELLOWSTONE PHYSICAL THERAPY ADDRESS 902 N ORANGE ST #304 926 13TH AVE S 734 9TH ST W STE 12 120 S 5TH #104 3417 BUSCH ST 700 W KENT 2304 W MAIN STE 8 900 N ORANGE 3RD FLOOR 1643 LEWIS AVE STE 3 RM 8ST 127 SHEIRDAN AVE 502 S 19TH AVE STE 300 410 WINWARD WAY 6 - 13TH AVE E 63351 HWY 93 S 3000 15 SVENUE S 111 SUNNYVIEW LN 1522 9TH ST S 2550 BROADWAY 2900 12TH AVE N STE 245W 2900 12TH AVE N STE 290W 202 S BLACK STE 502 500 W BROADWAY 1230 N 30TH STE 200 900 N JACKSON ST 723 5TH AVE E #132 401 W PENNSYLVANIA 2675 CENTRAL AVE 27 N 27TH ST STE 18C 1597 AVE D STE 7 2900 12TH AVE N STE 201E 3800 EASTSIDE HWY 2300 12TH AVE S STE 101 2900 12TH AVE N STE 205W 2800 10TH AVE N 310 SUNNYVIEW LN 221 5TH AVE S 519 S 4TH ST W 519 S 4TH ST W 125 BANK ST #310 500 W BROADWAY #320 210 N HIGGINS #314 1643 24TH ST W STE 210 1201 US HWY 10 W UNIT E 104 RUFUS LN 110 KENEGEN RD 1101 TEXAS AVE 120 POND ST 1200 WESTWOOD DR 1208 6TH AVE E 126 6TH AVE SW CITY MISSOULA GREAT FALLS COLUMBIA FALLS HAMILTON BUTTE MISSOULA BOZEMAN MISSOULA BILLINGS BOZEMAN BOZEMAN KALISPELL POLSON RONAN GREAT FALLS KALISPELL GREAT FALLS HELENA BILLINGS BILLINGS BOZEMAN MISSOULA BILLINGS GREAT FALLS KALISPELL ANACONDA BILLINGS BILLINGS BILLINGS BILLINGS STEVENSVILLE GREAT FALLS BILLINGS BILLINGS KALISPELL GLASGOW MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA BILLINGS LIVINGSTON POLSON PLAINS DEER LODGE THOMPSON FALLS HAMILTON SUPERIOR RONAN ZIP 59802 59405 59912 59840 59701 59801 59718 59802 59102 59718 59718 59901 59860 59864 59405 59901 59405 59601 59101 59101 59715 59802 59101 59403 59901 59711 59102 59101 59102 59101 59870 59405 59101 59101 59901 59230 59801 59801 59802 59802 59802 59102 59047 59860 59859 59722 59873 59840 59872 59864 SPECIALTY PSYCHIATRY FAMILY PRACTICE FAMILY PRACTICE OPTOMETRY OPTOMETRY OPTOMETRY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER NUTRITION PROFESSIONAL PSYCHOLOGIST LICENSED BEHAVIORAL COUNSELOR OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY PLASTIC/RESTORATIVEBURN LICENSED BEHAVIORAL COUNSELOR PHYSICIAN ASSISTANT PEDIATRIC NEUROLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY DERMATOLOGY INTERNAL MEDICINE DERMATOLOGY ANESTHESIOLOGY EMERGENCY MEDICINE/TRAUMA OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICIAN ASSISTANT LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR PSYCHOLOGY NURSE PRACTITIONER LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED 6 of 256 FIRST NAME GEORGE GEORGE GEORGE GEORGE GEORGE GEORGE GEORGE DIANE KELLY BRADY WILLIAM ANDREW ELAINE MARY NATALIE LINDA LINH MARCELLA TINA TINA JANA JAMIE ESTHER ESTHER MELODY MELODY CHAD PHILIP JAMES JACK DANIEL PETER PETER CHRISTINE KARI MARY JO ROGER JOANNE JULIA CHRISTINE TARA BRIAN BRIAN BRIAN KIM PEGGY MARGARET MARGARET ROGER RICHARD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BANDOW BANDOW BANDOW BANDOW BANDOW BANDOW BANDOW BANKS BANKS BANTA BARAGER BARBER BARBIERI BARDONE BAREFIELD BARGE BARINOWSKI BARKER BARKER BARKER BARNES BARNES BARNES BARNES BARNES BARNES BARNETT BARNEY BARNEY BARNINGS BARRACLOUGH BARRAN BARRAN BARRETT BARRETT BARRETT BARREY BARRIE BARRON BARRY BARRY BARSTAD BARSTAD BARSTAD BARTA BARTA BARTELS BARTELS BARTH BARTLETT LICENSE MD MD MD MD MD MD MD LCSW MD MD DO DO MD LCSW PA PT PAC MD NP APRN PAC PAC DPM DPM LSW LCSW LAC PAC MD OD DC PT MD MD LCPC MD LCSW MD LCPC PAC LCPC DC MD MD MD LCPC LCSW PT PT MD LCPC MEDICAL GROUP ALTA CARE SURGICAL ASSOCIATES OF BOZEMAN GREAT FALLS CLINIC EMERGENCY PHYSICIANS WMMHC MONTANA ORTHOPEDICS THE COZY NEST FAMILY HEALTHCARE BENEFIS PHYSICIAN ASSOCIATES MOUNTAINVIEW MEDICAL PARK CLINIC BARRETT HOSPITAL & HEALTHCARE PONDERA MEDICAL CNTR CLINIC STEP AHEAD FOOT & ANKLE CLINIC WOUND CARE & HYPERBARIC CENTER PEDIATRICS SPECIALTY CLINIC PATHOLOGY CONSULTANTS OF WESTERN MT BARNINGS CHIROPRACTIC BUTTE ORTHOPEDIC FRACTURE CLINIC PONDERA MEDICAL CENTER CENTER FOR INTEGRATIVE CARE NEONATOLOGY ASSOCIATE NEUROLOGICAL ASSOCIATES PC CROSS LIFE COUNSELING SERVICES PRAIRIE COUNTY CLINIC ALTA CARE BACK COUNTRY FAMILY CHIROPRACTIC MEDNORTH KALISPELL URGENT CARE CLIN NORTH VALLEY HOSPITAL ST JOHN'S LUTHERAN HOSPITAL ORTHOPEDIC REHAB ORTHOPEDIC REHAB GLACIER EYE CLINIC BARTLETT COUNSELING ADDRESS 207 N MAIN ST 2809 GREAT NORTHERN LOOP #200 2827 FORT MISSOULA RD 301 SADDLE DR 301 SADDLE DR 3800 EASTSIDE HWY 500 W BROADWAY 1 YELLOWSTONE RD 925 HIGHLAND BLVD STE 1200 2600 WILSON ST 1400 29TH ST S 1110 FRONT ST 401 15TH AVE S 300 N WILLSON STE 3005 435 S CRYSTAL STE 400 1276 N 15TH AVE S STE 101 1287 BURNS WAY 400 13TH AVE S STE 206 16 W MAIN ST 1001 RIVER DR 30 HWY 91 S 809 SUNSET BLVD 175 COMMONS LOOP STE 400 310 SUNNYVIEW LN 336 W SPRUCE 336 W SPRUCE ST 2835 FT MISSOULA RD #301 3550 MULLAN RD 305 W PARK ST 246 MARCUS ST 435 S CRYSTAL STE 400 805 SUNSET BLVD 519 E MAIN ST 516 S ORANGE ST 1233 N 30TH ST 210 N HIGGINS #338 500 W BROADWAY STE 310 359 N MAIN 409 BOWEN 55 BASIN CREEK RD 3210 HENESTA DR STE D 2316 US HWY 93 N 1600 HOSPITAL WAY 350 LOUISIANA AVE 420 1ST ST E 404 N 31ST #202 111 SUNNYVIEW LN #B 906 9TH ST W STE A 160 HERITAGE WAY 234 2ND ST W CITY DARBY MISSOULA MISSOULA HELENA HELENA STEVENSVILLE MISSOULA WHITEHALL BOZEMAN MILES CITY GREAT FALLS FORT BENTON GREAT FALLS BOZEMAN BUTTE BOZEMAN KALISPELL GREAT FALLS WHITE SULPHUR SPRINGS LIVINGSTON DILLON CONRAD KALISPELL KALISPELL MISSOULA MISSOULA MISSOULA MISSOULA LIVINGSTON HAMILTON BUTTE CONRAD CUT BANK MISSOULA BILLINGS MISSOULA MISSOULA KALISPELL TERRY BUTTE BILLINGS KALISPELL WHITEFISH LIBBY POLSON BILLINGS KALISPELL COLUMBIA FALLS KALISPELL KALISPELL ZIP 59829 59808 59804 59601 59601 59870 59802 59759 59715 59301 59405 59442 59405 59715 59701 59715 59901 59406 59645 59047 59725 59425 59901 59901 59802 59802 59804 59808 59047 59840 59701 59425 59427 59801 59101 59802 59802 59901 59349 59701 59102 59901 59937 59923 59860 59101 59901 59912 59901 59901 SPECIALTY CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE LICENSED CLINICAL SOCIAL WORKER SURGERY GENERAL RADIOLOGY NEPHROLOGY EMERGENCY MEDICINE/TRAUMA ALLERGY & IMMUNOLOGY LICENSED CLINICAL SOCIAL WORKER SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PODIATRY PODIATRY LICENSED CLINICAL SOCIAL WORKER ADDICTION COUNSELOR PEDIATRICS PATHOLOGY OPTOMETRIST CHIROPRACTIC PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PEDIATRIC NEONATOLOGY LICENSED CLINICAL SOCIAL WORKER SURGERY NEUROLOGICAL LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC URGENT CARE PROVIDER EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY PHYSICAL THERAPY OPHTHALMOLOGY LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 7 of 256 FIRST NAME RICHARD FRED RICHARD KAREN MICHAEL STEPHEN SALLY KATHLEEN MARY ASHLEY SHELLY JULIE ROBERT ROBERT WILLIAM WILLIAM DAVID WENDIE ALAN ALAN INDIA KAREN KAREN THOMAS D RANDALL ANITA SHERRY ROLLIN BENJAMIN JENNIFER PATRICK PATRICK RACHAEL JENNIFER JASON CARTER CATHERINE JOHN WILLIAM MICHAEL STEPHEN JOY MICHELE MICHELE KEVIN THOMAS STEPHEN GREGORY KERSTIN WILLIAM Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BARTLETT BARTOLETTI BARTON BARTON BARTS BASE BASKETT BASKETT BASSINGTHWAIGHTE BASTEN BASYE BATES BATES BATES BATEY BATEY BAUER BAUER BAUER BAUER BAUER BAUMANN BAUMANN BAUMGARTNER BEACH BEACH BEACH BEARSS BEASLEY BEATTY BEATTY BEATTY BEATTY BEATTY BECHARD BECK BECK BECK BECK BECKEL BECKER BECKER BEEBE BEEBE BEECHER BEESON BEHLMER BEHM BEIJER BEKEMEYER LICENSE LCPC MD MD PAC CRNA MD APRN MD MD DO MD CNMW MD MD MD MD OD LCPC EDD EDD LCSW LCPC LCPC MD MD APRN LCPC MD MD LCPC MD MD OD LCPC MD MD LCPC LPC MD PAC MD PAC NP NP LCSW MD MD MD MD MD MEDICAL GROUP COMMUNITY HOSPITAL OF ANACONDA GALLATIN VALLEY ANESTHESIA PRIMARY CARE PHYSICIANS BENEFIS HEALHCARE BILLINGS CLINIC MILES CITY HOT SPRINGS FAMILY MEDICINE WEIGHT MANAGEMENT CLINIC ST PETER'S HOSPITAL BILLINGS CLINIC FAMILY BORN MATERNITY & HEALTH KALISPELL REGIONAL MEDICAL CENTER SILVERTIP EMERGENCY PHYSICIANS ST PETERS MEDICAL GROUP ST PETERS MEDICAL GROUP BAUER & CLAUSEN PC WESTERN MONTANA MENTAL HEALTH CTR CENTER FOR MENTAL HEALTH CENTER FOR MENTAL HEALTH ALPINE WOMEN'S CENTER GLACIER MEDICAL ASSOCIATES PLAINS UROLOGY BILLINGS CLINIC COMPASS PROFESSIONAL SERVICES MONTANA CANCER SPECIALISTS MONTANA CANCER SPECIALISTS AT CMC ROCKY MOUNTAIN EYE CENTER PC WESTERN MONTANA MENTAL HEALTH CTR NORTHWEST HOSPITALISTS NEUROLOGICAL ASSOCIATES SANO CONNECTION WESTERN MONTANA MENTAL HEALTH CTR NORTHWEST IMAGING RIVERSTONE HEALTH CLINIC LDS FAMILY SERVICES ASSOCIATED DERMATOLOGY RAVALLI ORTHOPEDICS & SPORTS MED ST VINCENT PHYSICIAN NETWORK WESTERN MONTANA CLINIC ADDRESS 410 WINDWARD WAY 401 W PENNSYLVANIA 931 HIGHLAND BLVD 400 13TH AVE S STE 206 1101 26TH ST S 620 S HAYNES AVE 209 MAIN ST 1101 N 27TH ST 125 BANK ST STE 310 2475 BROADWAY 2800 10TH AVE N 210 SUNNYVIEW LN #101 310 SUNNYVIEW LN 310 SUNNYVIEW LN 2550 BROADWAY 3150 N MONTANA AVE STE A 2675 CENTRAL AVE STE L1 410 WINDWARD WAY 1925 GRAND AVE #125 2 N BROADWAY 2001 11TH AVE STE 2 621 1ST AVE S PO BOX 3089 2825 FORT MISSOULA RD STE 304 2002 HOSPITAL WAY 1111 BAKER AVE 321 E MAIN STE 311 2800 11TH AVE S STE 14 2800 10TH AVE N 2510 CONTINENTAL DR 500 W BROADWAY 2827 FORT MISSOULA RD 700 W KENT 106 W BROADWAY 310 SUNNYVIEW LN 500 W BROADWAY STE 310 1946 STADIUM DR STE 2 232 S MAIN ST 6 - 13TH AVE E 202 S MONTANA 320 SUNNYVIEW LN 123 S 27TH ST 221 5TH AVE S 818 2ND AVE EAST 2620 COLONIAL DR STE D 2600 WILSON 50 S LAST CHANCE GULCH STE 3 1190 WESTWOOD DR 1139 N 27TH ST STE A 500 W BROADWAY CITY KALISPELL ANACONDA BOZEMAN GREAT FALLS GREAT FALLS MILES CITY HOT SPRINGS BILLINGS MISSOULA HELENA BILLINGS KALISPELL KALISPELL KALISPELL HELENA HELENA BILLINGS MISSOULA BILLINGS RED LODGE HELENA GREAT FALLS GREAT FALLS MISSOULA WHITEFISH WHITEFISH BOZEMAN GREAT FALLS BILLINGS BUTTE MISSOULA MISSOULA MISSOULA BUTTE KALISPELL MISSOULA BOZEMAN BOZEMAN POLSON BUTTE KALISPELL BILLINGS GLASGOW CULBERTSON HELENA MILES CITY HELENA HAMILTON BILLINGS MISSOULA ZIP 59901 59711 59715 59405 59405 59301 59845 59101 59802 59601 59101 59901 59901 59901 59601 59601 59102 59804 59102 59068 59601 59401 59403 59804 59937 59937 59715 59406 59101 59701 59807 59804 59801 59701 59901 59802 59715 59718 59860 59701 59901 59101 59230 59218 59601 59301 59601 59840 59101 59801 SPECIALTY LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA ANESTHESIOLOGY FAMILY PRACTICE ANESTHESIOLOGY INTERNAL MEDICINE FAMILY PRACTICE GENERAL PRACTICE PSYCHIATRY HOSPITALIST HOSPITALIST OB/GYN-OBSTETRICS/GYNECOLOGY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE OPTOMETRY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGIST PSYCHOLOGIST LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SURGERY UROLOGICAL UROLOGY EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY OPTOMETRY LICENSED BEHAVIORAL COUNSELOR HOSPITALIST SURGERY NEUROSURGERY PSYCHOLOGY LICENSED BEHAVIORAL COUNSELOR OBSTETRICS & GYNECOLOGY SURGERY HEAD & NECK RADIOLOGY FAMILY PRACTICE NURSE PRACTITIONER NURSE PRACTITIONER LICENSED CLINICAL SOCIAL WORKER SURGERY DERMATOLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE PULMONARY DISEASES Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 8 of 256 FIRST NAME MELODEE ROCHELLE ROCHELLE ROCHELLE ROCHELLE MICHAEL ANDREW SHERRI SHERRI AMY DOUGLAS JERALD JULIA JULIA BRIAN GORDON LISA CAROLYN DAVID CAROLYN DAVID BRENDAN BARBARA JAVIER GABOR GABOR BRETT WILLIAM CARISSA CLAY CLAY CLAY RONALD MARK LAURA LAURA LAURA LESLIE BRETT ADAM ADAM SUSAN DANIEL ADAM JAMES JOANNE JOANNE LOTFI NICOLE THOMAS Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BELANGIE BELEY BELEY BELEY BELEY BELFORT BELICE BELL BELL BELL BELL BELL BELL BELL BELL BELL BELL BELLAMAH BELLAMAH BELLAMAH BELLAMAH BELLEW BELT BELTRAN BENDA BENDA BENDER BENEDETTO BENJAMIN BENKELMAN BENKELMAN BENKELMAN BENNER BENNETT BENNETT BENNETT BENNETT BENNINGTON III BENNION BENSON BENSON BENSON BENSON BENSON BENTLER BENTS BENTS BEN-YOUSSEF BENZEL BERBOS LICENSE LCPC LCPC LCPC LCPC LCPC MD DC LCSW LCSW MD MD MD MD MD MD MD CRNA APRN MD NP MD MD LCSW MD MD MD MD MD PT OD OD OD OD PT MD PAC MD OT MD MD MD APRN PT MD MD NP NP MD LCPC MD MEDICAL GROUP PERI & NEONATAL SERVICES AT KRMC AWARE INC AWARE INC BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC CPG ON SOUTH RESERVE WESTERN MONTANA MENTAL HEALTH CTR COMMUNITY MEDICAL CENTER MISSOULA SURGICAL ASSOCIATES BILLINGS CLINIC MONTANA INTERVENTIONAL & DIAGNOSTIC FAMILY DOCTORS URGENT CARE THE BOZEMAN CLINIC NORTHWEST IMAGING GLACIER EYE CLINIC RONAN EYE CLINIC SOUTHERN MONTANA OPTOMETRIC CENTER HEUISER PHYSICAL THERAPY JUDITH MOUNTAIN FAMILY PRACTICE URGENT CARE NORTH MEDICAL GROUP BILLINGS CLINIC WEST SIDNEY HEALTHC CENTER CLINIC ADVANCED IMAGING @ CMC ADVANCED IMAGING AT CMC BILLINGS CLINIC LONE PEAK PHYSICAL THERAPY @ BELGRA MISSOULA RADIOLOGY ST VINCENT EMERGENCY MEDICINE DEPT ELIZABETH SETON PRENATAL CLINIC MOUNTAIN VIEW EYECARE ADDRESS 101 E BROADWAY #405 1020 13TH ST 138 3RD ST NW 5TH & HOOPER HWY 223 & MONROE 310 SUNNYVIEW LN 330 S IDAHO ST #1 227 E MERCURY 524 E PARK ST 801 N 29TH ST 2800 10TH AVE N 801 N 29TH ST 1211 S RESERVE ST 209 N 10TH STE A 621A 2ND ST S 221 5TH AVE S 621 3RD ST S 2827 FORT MISSOULA RD 500 W BROADWAY 5TH FLOOR 500 W BROADWAY #320 500 W BROADWAY 801 N 29TH ST 25 S EWING STE 423 2969 AIRPORT RD STE C 120 N 19TH AVE STE A 931 HIGHLAND BLVD STE 3360 500 W BROADWAY 320 SUNNYVIEW LN 420B N HIGGINS 160 HERITAGE WAY 417 MAIN ST SW 308 LOUISIANA AVE 210 1ST AVE 3180 DREDGE DR STE F 310 WENDELL AVE 3330 PTARMIGAN LN 310 WENDELL AVE #8 2675 CENTRAL AVE 214 14TH AVE SW STE 101 GRANT CREEK TOWN CENTER 2803 S AVE 1020 N 27TH ST 403 GALLATIN FARMERS AVE STE 102 3205 RUSSELL 1233 N 30TH ST 1230 N 30TH ST STE 200 PO BOX 21156 214 14TH AVE SW 1102 20TH ST W 301 SADDLE DR CITY MISSOULA FORT BENTON HARLOWTON BIG TIMBER CHESTER KALISPELL DILLON BUTTE ANACONDA BILLINGS BILLINGS BILLINGS MISSOULA HAMILTON GLASGOW GLASGOW GLASGOW MISSOULA MISSOULA MISSOULA MISSOULA BILLINGS HELENA HELENA BOZEMAN BOZEMAN MISSOULA KALISPELL MISSOULA KALISPELL RONAN LIBBY LAUREL HELENA LEWISTOWN HELENA LEWISTOWN BILLINGS SIDNEY MISSOULA MISSOULA BILLINGS BELGRADE MISSOULA BILLINGS BILLINGS BILLINGS SIDNEY BILLINGS HELENA ZIP 59801 59442 59036 59011 59522 59901 59725 59701 59711 59101 59101 59101 59801 59840 59230 59230 59230 59804 59802 59802 59802 59101 59601 59601 59718 59715 59802 59901 59802 59901 59864 59923 59044 59602 59457 59602 59457 59102 59270 59801 59806 59101 59714 59801 59102 59101 59104 59270 59102 59601 SPECIALTY LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR PROFESSIONAL COUNSELOR PROFESSIONAL COUNSELOR PROFESSIONAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY CHIROPRACTOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OB/GYN-OBSTETRICS/GYNECOLOGY RADIOLOGY OPHTHALMOLOGY PSYCHIATRY PSYCHIATRY OBSTETRICS & GYNECOLOGY FAMILY PRACTICE NURSE ANESTHETIST EMERGENCY MEDICINE/TRAUMA SURGERY GENERAL NURSE PRACTITIONER SURGERY PULMONARY DISEASES LICENSED CLINICAL SOCIAL WORKER RADIOLOGY URGENT CARE PROVIDER FAMILY PRACTICE EMERGENCY MEDICINE RADIOLOGY PHYSICAL THERAPY OPTOMETRY OPTOMETRY OPTOMETRY OPTOMETRY PHYSICAL THERAPY FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE OCCUPATIONAL THERAPY EAR/NOSE/THROAT (ENT) RADIOLOGY RADIOLOGY PSYCHIATRY PHYSICAL THERAPY RADIOLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE NURSE PRACTITIONER SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR OPHTHALMOLOGY Montana STATUS SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED 9 of 256 FIRST NAME ALEECE JACK PAUL AMY TODD RENEE AMY BRADFORD ROSEMARY CAMILLA CAMILLA KARLENE GELENE GELENE PAUL PAUL ASHLEY KEVIN BRADLEY SHERRY LYNN BRIAN LORAL LEE SARAH DON ADRIAN DIEDRA FREDERICK JENNIFER DIRK MICHELLE DINESH GEORGE GEORGE MICHAEL MICHAEL KEVIN KEVIN DORIS JOSEPH NORMA MEAGAN BRUCE STEVEN WILLIAM JACE KARRIE PERRY FRANK NILDA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BERG BERG BERGER BERGHOLD BERGLAND BERGLUND BERGLUND-WOOD BERGMAN BERGROOS BERGSTROM-HURD BERGSTROM-HURD BERISH BERKRAM BERKRAM BERKRAM BERKRAM BERKRAM BERNARD BERRY BERSANTI BERTANE BERTHA BESOLA BESTWICK BESTWICK BETHEL BETHUNE BETZ BEVERLY BEYER BEZ BHASKARAN BIANCARELLI BIANCARELLI BIDDULPH BIDDULPH BIEGEL BIEGEL BIERSDORF BILAU BILBOOL BINENSTOCK BINKLEY BIONDICH BIRCK BIRD BIRD BIRKY BISHOP BISHOP LICENSE LAC DC MA NP MD LCPC DC MD PAC LCSW LCSW DC NP NP MD MD PA-C LCPC MD LCPC APRN MD LCPC LMT PT MD NP LCPC PAC OD DO MD MD MD MD MD OD OD RD PT MD PT LCPC LCPC MD DO LCPC MD MD LCPC MEDICAL GROUP FLORENCE CRITTENTON HOME AND SERV MONTANA CHIROPRACTIC & NUTRITION BODY MECHANIX COMMUNITY HEALTH PARTNERS GLACIER MEDICAL ASSOC ACTIVE CARE FAMILY CHIROPRACTIC BENEFIS PHYSICIAN ASSOCIATES BERISH CHIROPRACTIC CLINIC FAMILY HEALTH CARE FAMILY HEALTH CARE FAMILY HEALTH CARE FAMILY HEALTH CARE PARKSIDE COMMUNITY FAMILY CARE ANESTHESIA ASSOCIATES OF GT FALLS WESTERN MONTANA MENTAL HEALTH CTR MATZ FAMILY CHIROPRACTIC NORTHERN PHYSICAL THERAPY NORTHERN ROCKIES REGIONAL PAIN CTR MENTAL HEALTH CENTER BILLINGS CLINIC BIG SKY EYE CARE CLINIC & OPTICAL BILLINGS CLINIC MONTANA HEART PC NORTHERN MONTANA HOSPITAL PINTLER FAMILY MEDICINE MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAG ASSOC OF IDAHO FALLS INTERNAL MEDICINE & DIABETES THE MONTANA CENTER FOR WELLNESS YELLOWSTONE NEUROSURGICAL ASSOC ADVANCED PERFORMANCE & REHAB MENTAL HEALTH CENTER BIONDICH INC MISSOULA RADIOLOGY PC BENEFIS PHYSICIAN ASSOC QUICK CARE CENTER FOR MENTAL HEALTH OUTREACH SERVICES NEUROSCIENCE & SPINE INSTITUTE ADDRESS 901 N HARRIS 513 HILLTOP STE 2 645 GRAND AVE STE D 214 E MENDENHALL 111 BAKER AVE 128 S 6TH ST W 504 MAIN ST 2800 11TH AVE S STE 23 350 LOUISIANA AVE 1601 2ND AVE N STE 650 208 N 29TH ST STE 236-237 1690 RIMROCK RD STE G 1287 BURNS WAY 715 NUCLEUS AVE 1287 BURNS WAY 715 NUCLEUS AVE 301 KNAPP ST 205 N BOZEMAN AVE #A 500 W BROADWAY #320 8 W PARK ST STE 411 2831 FORT MISSOULA RD STE 146 401 15TH AVE S STE 109 232 S MAIN ST 1519 S RESERVE ST 1111 BAKER AVE STE 2 2900 12TH AVE N STE 335W 901 N ORANGE #107 1245 N 29TH ST 1020 N 27TH ST 820 W MAIN ST 2800 10TH AVE N 1300 28TH ST S STE 8 30 13TH ST 305 W PENNSYLVANIA 310 SANSOME ST 90 HWY 91 S 111 S 24TH ST W 236 MAIN 2019 BROADWATER AVE 245 WINDWARD WAY STE 101 2900 12TH AVE N STE 400E 1532 ELLIS ST STE 201 1245 N 29TH ST 926 MAIN ST #18 3205 RUSSELL ST 500 15TH AVE S STE 1 900 N JACKSON ST 202 CONWAY DR STE 100 200 COMMONS WAY STE 2 109 N 4TH ST STE 203 CITY HELENA BILLINGS BILLINGS BOZEMAN WHITEFISH MISSOULA STEVENSVILLE GREAT FALLS LIBBY GREAT FALLS BILLINGS BILLINGS KALISPELL COLUMBIA FALLS KALISPELL COLUMBIA FALLS WOLF POINT BOZEMAN MISSOULA BUTTE MISSOULA GREAT FALLS LIVINGSTON MISSOULA WHITEFISH BILLINGS MISSOULA BILLINGS BILLINGS HAMILTON BILLINGS GREAT FALLS HAVRE ANACONDA PHILIPSBURG DILLON BILLINGS ROUNDUP BILLINGS KALISPELL BILLINGS BOZEMAN BILLINGS BILLINGS MISSOULA GREAT FALLS HELENA KALISPELL KALISPELL HAMILTON ZIP 59601 59105 59102 59715 59937 59801 59870 59405 59923 59401 59101 59102 59901 59912 59901 59912 59201 59715 59802 59701 59804 59405 59047 59801 59937 59101 59802 59101 59101 59840 59101 59405 59501 59711 59858 59725 59102 59072 59102 59901 59101 59715 59101 59105 59801 59405 59601 59901 59901 59840 SPECIALTY LICENSED ADDICTION COUNSELOR CHIROPRACTIC LICENSED MASSAGE THERAPIST FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC INTERNAL MEDICINE URGENT CARE PROVIDER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE PHYSICIAN ASSISTANT LICENSED BEHAVIORAL COUNSELOR CARDIOVASCULAR DISEASE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED MASSAGE THERAPIST PHYSICAL THERAPY PHYSICAL MEDICINE REHABILITATION NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY OPTOMETRY PEDIATRICS CARDIOLOGY FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY RADIOLOGY OPTOMETRIST OPTOMETRY NUTRITION PROFESSIONAL PHYSICAL THERAPY NEUROLOGY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR RADIOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY NEUROSURGERY LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 10 of 256 FIRST NAME BETSY DIANA DIANA BRAD MARY GRACE BRAD BRAD KATHLEEN ROBERT ROBERT KATHLEEN ROBERT CARSON MICHAEL CARSON KATE KIMBERLY ANN PAMELA LISA ZACHARY ZACHARY CHERYL JAMES NICHOLAS THERESA AMANDA BENJAMIN RICHARD RICHARD JULIE JOHN J WILLIAM STEVEN GARY JOSEPH CAROL TARA KELSEY JONATHAN KYLE KYLE ERIK JOHN DAVID DAVID DAVID KRISTY KRISTY LAURIE LAURIE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BITTMAN BJORGEN BJORGEN BLACK BLACK BLACK BLACK BLAIR BLAIR BLAIR BLAIR BLAKE BLAKE BLAKE BLAKE BLAKESLEE BLAKESLEE BLANCHARD BLAND BLAND BLAND BLANK BLASINGAME BLAVATSKY BLAZEK BLEA BLEND BLEVINS BLEVINS BLISS BLODGETT BLOEMENDAAL BLOHM BLOM BLOYDER BLUM BLUNK BOCK BODINE BODLEY BODLEY BODTKER BOERSMA BOES BOES BOES BOESE BOESE BOGART BOGART LICENSE MD PHD PHD MD LCSW MD MD DO MD MD DO MD MD MD MD PAC DO DC MD MD MD LAC MD MD LCPC DO MD MD MD PT MD MD NP DC PT PHD LAC PA DO DO DO MD PT MD MD MD NP NP LCPC LCPC MEDICAL GROUP WESTERN MONTANA MENTAL HEALTH CTR FACILITATING LIFE CHANGES FACILITATING LIFE CHANGES CNTR FOR ASBESTOS RELATED DISEASE FAMILY PSYCHOLOGICAL CENTER BENEFIS PHYSICIAN ASSOCIATES KALISPELL REGIONAL MEDICAL CENTER SILVERTIP EMERGENCY PHYSICIANS BRIDGER ORTHOPEDICS MADISON VALLEY MED CENTER MEDICAL ASSOCIATES BILLINGS CLINIC CPG ON NORTH RESERVE FAMILY CHIROPRACTIC CLINIC BILLINGS CLINIC BILLINGS CLINIC LIVINGSTON HEALTHCARE NORTHWEST ORTHOPEDIC & SPORTS MEDIC MONTANA ORTHOPEDICS YELLOWSTONE COUNSELING CENTER PHYSICIANS LABORATORY SERVICE BIG SKY PULMONARY & CRITICAL CARE BIG SKY PULMONARY & CRITICAL CARE GREAT FALLS CLINIC BILLINGS CLINIC GREAT FALLS ORTHOPEDIC ASSOC BILLINGS CLINIC CAPITAL CHIROPRACTIC CENTER BILLINGS CLINIC MENTAL HEALTH CENTER BENEFIS PHYSICIAN ASSOC QUICK CARE ST VINCENT PHYSICIAN NETWORK PEDIAT ST VINCENT PHYSICIAN NETWORK PEDIAT GALLATIN VALLEY ANESTHESIA LONE PEAK PHYSICAL THERAPY @ BLEGRA BOES EYE CENTER GREAT FALLS CLINIC GREAT FALLS CLINIC NORTHERN ROCKIES MEDICAL CENTER URGENT CARE PLUS ART WORKS COUNSELING SERVICES ADDRESS 1315 WYOMING ST 101 E BROADWAY STE 605 301 W SPRUCE ST 214 E 3RD ST 48 MEDICAL PARK DR 66112 MT HWY 37 66112 MT HWY 37 1300 28TH ST S STE 10 310 SUNNYVIEW LN 310 SUNNYVIEW LN 1101 26TH ST S 1450 ELLIS ST STE 201 305 N MAIN 935 HIGHLAND BLVD STE 2200 1003 S WASHINGTON 2800 10TH AVE N 2230 N RESERVE #402 411 13TH AVE S 801 N 29TH ST 2800 10TH AVE N 504 S 13TH ST 65 A W KAGY BLVD 350 HERITAGE WAY #1200 435 S CRYSTAL STE 400 208 N BROADWAY STE 423 6 - 13TH AVE E 931 HIGHLAND BLVD SUTE 3220 1117 29TH ST S 1300 28TH ST S STE 4 3000 15TH AVE S 1020 N 27TH ST 1401 25TH ST S 1020 N 27TH ST 1732 PROSPECT AVE 2702 8TH AVE N 603 S 5TH ST 1245 N 29TH 500 15TH AVE S STE 1 401 S ALABAMA #3B 1232 N 30TH ST 3401 AVE E 931 HIGHLAND BLVD 403 GALLATIN FARMERS AVE STE 102 2800 11TH AVE S STE 14 1400 29TH ST S 20 13TH ST 802 2ND ST SE 39 NEILL 1720 BROOKS #B 1720 BROOKS ST #B CITY MISSOULA MISSOULA MISSOULA LIBBY HELENA EUREKA EUREKA GREAT FALLS KALISPELL KALISPELL GREAT FALLS BOZEMAN ENNIS BOZEMAN DILLON BILLINGS MISSOULA GREAT FALLS BILLINGS BILLINGS LIVINGSTON BOZEMAN KALISPELL BUTTE BILLINGS POLSON BOZEMAN GREAT FALLS GREAT FALLS GREAT FALLS BILLINGS GREAT FALLS BILLINGS HELENA BILLINGS HAMILTON BILLINGS GREAT FALLS BUTTE BILLINGS BILLINGS BOZEMAN BELGRADE GREAT FALLS GREAT FALLS HAVRE CUT BANK HELENA MISSOULA MISSOULA ZIP 59801 59802 59802 59923 59601 59917 59917 59405 59901 59901 59405 59715 59729 59715 59725 59101 59804 59405 59101 59101 59047 59715 59901 59701 59101 59860 59715 59405 59405 59405 59101 59405 59101 59601 59101 59840 59101 59405 59701 59102 59102 59715 59714 59405 59405 59501 59427 59601 59801 59801 SPECIALTY PSYCHIATRY PSYCHOLOGY PSYCHOLOGY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER PEDIATRICS PEDIATRICS INTERNAL MEDICINE EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE PEDIATRICS FAMILY PRACTICE HOSPITALIST FAMILY PRACTICE CHIROPRACTIC SURGERY UROLOGICAL UROLOGY RADIOLOGY RADIOLOGY PSYCHOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PATHOLOGY PULMONARY DISEASES PULMONARY DISEASES PHYSICAL THERAPY PSYCHIATRY CHILD SURGERY ORTHOPEDIC MEDICINE CARDIOLOGY CHIROPRACTIC PHYSICAL THERAPY PSYCHOLOGY LICENSED ADDICTION COUNSELOR FAMILY PRACTICE INTERNAL MEDICINE PEDIATRICS PEDIATRICS ANESTHESIOLOGY PHYSICAL THERAPY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 11 of 256 FIRST NAME DAVID THEODORE DAVID MICHAEL LANCE JOHN ROBIN JOSEPH JULIA JUDY WILLIAM VICKI BRUCE JILL JILL JILL MICHELLE DEREK JOAN LARRY DEREK ALBERT NICHOLAS EDWARD SHARON REBECCA REBECCA EARL PHYLLIS N CHRISTOPHER THOMAS INNA SARAH SARAH KATHRYNANN KATHRYN MARY TERESA KIMBERLY JUDY SCOTT MARCY PHILIP HALLIE MARGARET KEITH MARY FERNANDO JAMES Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BOGGS BOGSRUD BOHARSKI BOHARSKI BOHLMAN BOHNERT BOLAND BOLAND BOLDING BOLEWICZ BOLEY BOLING BOLLEN BOLSTAD BOLSTAD BOLSTAD BOLTZ BOND BOND DESCHAMPS BONDERUD BONDS BONE BONFILIO BONIECKI BONOGOFSKY-PARKER BONTADELLI BONTADELLI BOOK BOOKBINDER BOOKS BOOR BOOTH BORDEWIC BORGE BORGE BORGEN BORGENICHT BORGRUD-KRENIK BORINO BORKE BORLAND BORN BORNSTEIN BORNSTEIN BORNSTEIN BANZIGER BORTKO BORTNEM BOSCAMP BOSCHINI BOSLOUGH LICENSE MD CRNA CRNA MD DC MD NP LCSW MD OT LCPC APRN MD MD MD MD NP LCPC PAC OD LCPC PT MD OT NP MD MD MD LCPC MD PT DO PAC MD MD RD MD OT MD MD MD MD PHD PHD PHD NP MD PAC MD MD MEDICAL GROUP CAPITAL MEDICAL ANESTHESIA PACIFIC CATARACT & LASER INSTITUTE PLAINS FAMILY MEDICINE MISSOULA ANESTHESIOLOGY BENEFIS PHYSICIAN ASSOCIATES BILLINGS CLINIC FREESTONE REHABILITATION BOLEYS COUNSELING SERVICE MENTAL HEALTH CENTER MISSOULA ANESTHESIOLOGY ANACONDA PEDIATRICS CENTRAL MONTANA COMM HEALTH CENTER THE CENTER FOR FAMILY HEALTH CENTER FOR ABESTOS RELATED DISE MISSOULA BONE & JOINT CENTER FOR MENTAL HEALTH BILLINGS CLINIC GREAT FALLS CLINIC URGENT CARE NORTH MEDICAL GROUP SYNAPSE PHYSICAL THERAPY NORTHERN MONTANA MEDICAL GROUP W URGENT CARE NORTH MEDICAL COMMUNITY MEDICAL CENTER PHYS SERV CPG ON NORTH RESERVE ALLERGY & ASTHMA CENTER INTERNAL MEDICINE ASSOCIATES PHYSICAL THERAPY IN MOTION FAMILY MEDICINE CENTER OF BITTERROO BOZEMAN DEACONESS HOSPITAL TETON MEDICAL CENTER KALISPELL DIAGNOSITC SERVICE ROCKY MOUNTAIN CLINIC GREAT FALLS ORTHOPAEDIC ASSOC FAMILTY DOCTORS URGENT CARE BILLINGS CLINIC NORTH VALLEY HOSPITAL ADDRESS 2475 BROADWAY 1717 4TH ST S 10 KRUGER RD 430 WINDWARD WAY #203 3027 HWY 83 STE M 2825 STOCKYARD RD BLDG I-200 400 13TH AVE S STE 206 320 1/2 CENTRAL AVE 801 N 29TH ST 1532 ELLIS ST STE 103 15 PIKE ST 1245 N 29TH ST 2825 STOCKYARD RD BLDG I-200 200 MAIN ST 406 1ST AVE S 834 S MONTANA 214 E 3RD ST 1601 2ND AVE N STE 343 2360 MULLAN RD STE C 865 OILFIELD AVE 915 1ST AVE S 2702 8TH AVE N 3000 15TH AVE S 239 ROPERS WAY 44 WICKS LN 500 W BROADWAY 6 - 13TH AVE E 3330 PTARMIGAN LN 1135 CATHERINE LN 221 5TH AVE S 2023 STADIUM DR STE 2B 20 13TH ST 3330 PTARMIGAN LN 2835 FORT MISSOULA RD #101 2230 N RESERVE #402 20 FOUR MILE DR #2 905 HIGHLAND BLVD STE 4500 50 27TH ST W 330 N 10TH ST #A 915 HIGHLAND BLVD 915 4TH ST NW 135 COMMONS WAY 125 BANK ST #310 125 BANK ST STE 310 125 BANK ST STE 310 435 S CRYSTAL STE 300 1401 25TH ST S 120 N 19TH STE A 1020 N 27TH ST 1600 HOSPITAL WAY CITY HELENA GREAT FALLS PLAINS KALISPELL SEELEY LAKE MISSOULA GREAT FALLS GREAT FALLS BILLINGS BOZEMAN HAVRE BILLINGS MISSOULA ANACONDA LEWISTOWN BUTTE LIBBY GREAT FALLS MISSOULA SHELBY GREAT FALLS BILLINGS GREAT FALLS FLORENCE BILLINGS MISSOULA POLSON HELENA CORVALLIS GLASGOW BOZEMAN HAVRE HELENA MISSOULA MISSOULA KALISPELL BOZEMAN BILLINGS HAMILTON BOZEMAN CHOTEAU KALISPELL MISSOULA MISSOULA MISSOULA BUTTE GREAT FALLS BOZEMAN BILLINGS WHITEFISH ZIP 59601 59405 59859 59901 59868 59808 59405 59401 59101 59715 59501 59101 59808 59711 59457 59701 59923 59401 59808 59474 59401 59101 59405 59833 59105 59802 59860 59602 59828 59230 59715 59501 59602 59804 59808 59901 59715 59102 59840 59715 59422 59901 59802 59802 59802 59701 59406 59718 59101 59937 SPECIALTY ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY GASTROENTEROLOGY CHIROPRACTIC ANESTHESIOLOGY FAMILY PRACTICE SOCIAL WORKER RHEUMATOLOGY OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHIATRY ANESTHESIOLOGY PEDIATRICS PEDIATRICS PEDIATRICS FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE OPTOMETRY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE OCCUPATIONAL THERAPIST NURSE PRACTITIONER EMERGENCY MEDICINE EMERGENCY MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE FAMILY PRACTICE NUTRITION PROFESSIONAL GERIATRIC MEDICINE OCCUPATIONAL THERAPY FAMILY PRACTICE PEDIATRICS EMERGENCY MEDICINE/TRAUMA NEPHROLOGY PSYCHOLOGY PSYCHOLOGY PSYCHOLOGY FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE CARDIOLOGY EMERGENCY MEDICINE/TRAUMA Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 12 of 256 FIRST NAME JAMES ROBERT ERIC ERIC ANTHONY GREG ROBERTA MIRNA KITTIE SCOT DEBRA BETTY BETTY DEBRA DEBRA JENNIFER ROCH JENNIFER ANDREW BRAD JOSEPH CINNA AARON CHRISTINA KEVIN BEVERLY DANIEL JEAN JEAN TYLER KATHLEEN JAMES WILLIAM DAREN CHANTELLE JOEL SUSAN MARCY MARIA DEANNA ERIC ERIC JOHN RODNEY RODNEY BENNY BENNY LAURA CRAIG JOSEPH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BOSLOUGH BOTKIN BOUGHTON BOUGHTON BOULDIN BOURDON BOURGON BOWDEN BOWEN BOWEN BOYCE BOYCE BOYCE BOYCE BOYCE BOYER BOYER BOYER BOYKO BOYLAN BOYLE BOYLE BOYSEN BOYSEN BOZARTH BRAAK BRABY BRADEN BRADEN BRADFORD BRADFORD BRADLEY BRADLEY BRAGET BRAHAM BRAKE BRAKEFIELD BRAKEFIELD BRAMAN BRAME BRANDEBERRY BRANDEBERRY BRANDON BRANDT BRANDT BRANDVOLD BRANDVOLD BRAUN BRAYKO BRAZILL LICENSE MD PT DC DC MD PAC ND MD LCPC DC MD PT PT MD MD CRNA MD CRNA MD LCPC LCSW LAC LCSW LCSW MD MD MD NP NP MD LCPC CRNA DC MD LCSW MD LAC MD APRN MD MD MD MD MD MD MD PT MD PT MEDICAL GROUP ST VINCENT HEALTHCARE MISSOULA BONE & JOINT SVH SPECIALTY CARE SERVICES BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC ALPINE WOMEN'S CENTER E3 CONSULTING INC LOCKWOOD CHIROPRACTIC HEALTH CENTER MARCUS DALY MEMORIAL HOSPITAL NORTHERN MONTANA HOSPITAL PHYSICAL THERAPY DOWN UNDER SOUND INPATIENT PHYSICIANS ST PETERS MEDICAL GROUP CAPITAL MEDICAL ANESTHESIA NORTHWEST MONTANA SURGICAL ASSOCIATES ABSORKA EMERGENCY PHYSICIANS CROSSROADS COUNSELING & CONSULTING WESTERN MONTANA ADDICTION SERVICES WESTERN MONTANA MENTAL HEALTH CTR WESTERN MONTANA MENTAL HEALTH CTR GALLATIN VALLEY ANESTHESIA ROCKY MOUNTAIN EAR NOSE & THROAT CHILDREN'S CLINIC PC THE CHILDRENS CLINIC BOZEMAN OB/GYN BENEFIS PHYSICIAN ASSOCIATES MISSOULA RADIOLOGY PROFESSIONAL THERAPY ASSOCIATES TEEN RECOVERY CENTER HELENA LABORATORY PHYSICIANS BOZEMAN DEACONESS HOSPITAL FAMILY HEALTH CARE FAMILY HEALTH CARE FLATHEAD VALLEY ORTHOPEDICS FLATHEAD VALLEY ORTHOPEDICS GREAT FALLS CLINIC NEUROSCIENCE & SPINE INSTITUTE ABSAROKA PAIN & REHAB CANYON FERRY PHYSICAL THERAPY ADDRESS 1233 N 30TH ST 2360 MULLAN RD #C 14686 SHORE ACRES DR 63228 US HWY 93 1230 N 30TH ST STE 200 90 HWY 91 S 801 N 29TH ST 2002 HOSPITAL WAY 2023 STADIUM DR STE 1C 2850 OLD HARDIN RD 1200 WESTWOOD DR 30 13TH ST 820 2ND ST W 2827 FORT MISSOULA RD 2475 BROADWAY 2475 BROADWAY 1273 BURNS WAY 6 - 13TH AVE E 915 HIGHLAND BLVD 1720 BROOKS #B 2 FIFTH ST N STE 204 1325 WYOMING ST 418 WINDWARD WAY 418 WINDWARD WAY 931 HIGHLAND BLVD 2831 FT MISSOULA RD #203 700 W KENT 1232 N 30TH ST STE 200 3401 AVE E 925 HIGHLAND BLVD STE 1210 1515 FAIRVIEW AVE STE 235 6 - 13TH AVE E 7720 SHEDHORN DR STE B 400 13TH AVE S STE 203 124 S MAIN ST #205 3205 RUSSELL ST 1234 WHITEFISH STAGE RD 1467 HAYES DR 2475 BROADWAY 915 HIGHLAND BLVD 1287 BURNS WAY 715 NUCLEUS AVE 2900 12TH AVE N STE 220W 111 SUNNYVIEW LN 710 E 13TH ST 3000 15TH AVE S 200 COMMONS WAY STE 2 1707 W OAK ST STE D 401 15TH AVE S #201 510 N FRONT ST CITY BILLINGS MISSOULA BIGFORK RONAN BILLINGS DILLON BILLINGS WHITEFISH BOZEMAN BILLINGS HAMILTON HAVRE HAVRE MISSOULA HELENA HELENA KALISPELL POLSON BOZEMAN MISSOULA GREAT FALLS MISSOULA KALISPELL KALISPELL BOZEMAN MISSOULA MISSOULA BILLINGS BILLINGS BOZEMAN MISSOULA POLSON BOZEMAN GREAT FALLS LIVINGSTON MISSOULA KALISPELL MISSOULA HELENA BOZEMAN KALISPELL COLUMBIA FALLS BILLINGS KALISPELL WHITEFISH GREAT FALLS KALISPELL BOZEMAN GREAT FALLS TOWNSEND ZIP 59101 59808 59911 59864 59101 59725 59101 59937 59715 59101 59840 59501 59501 59804 59601 59601 59901 59860 59715 59801 59401 59801 59901 59901 59715 59804 59801 59101 59102 59715 59801 59860 59718 59405 59047 59801 59901 59808 59601 59715 59901 59912 59101 59901 59937 59405 59901 59715 59405 59644 SPECIALTY EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY CHIROPRACTOR CHIROPRACTOR PEDIATRIC NEUROLOGY EMERGENCY MEDICINE/TRAUMA NATUROPATH OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY HOSPITALIST HOSPITALIST ANESTHESIOLOGY SURGERY GENERAL NURSE ANESTHETIST EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY EAR/NOSE/THROAT (ENT) PEDIATRICS PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR NURSE ANESTHETIST CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER RADIOLOGY PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR PATHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE SURGERY NEUROLOGICAL SURGERY NEUROSURGERY PHYSICAL THERAPY GASTROENTEROLOGY PHYSICAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 13 of 256 FIRST NAME PAMELA WILLIAM JANET GARY KAREN ALTHEA ANDREA ANDREA SERENA SERENA KELLY SERENA KELLY CYNTHIA ALICIA ALICIA PATRICIA KENNETH DAVID ROBYN CAROL RICHARD RICHARD PETER BRUCE CHARLES ELIZABETH SARAH SARAH KATHY DANIEL JEFF CHERYL MARIA MARIA BRIAN DAVID DAVID HEIDI LAWRENCE LAWRENCE LAWRENCE MARK CARLIN JESSE LAURIE MICHAEL CODY ELAINE ROGER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BRECHT BREDEHOFT BREEDEN BREETZ BREETZ BRESE BREUER BREUER BREWER BREWER BREWER BREWER BREWER BREWER BREWER BREWER BREWER BREWINGTON II BRICE BRIDGES BRIDGES BRILES BRILES BRINKLEY BRITTON BROCKMAN BRONEC BRONSKY BRONSKY BRONSON BROOKE BROOKS BROOKS BROSNAN BROSNAN BROSS BROST BROST BROTT BROUWER BROUWER BROUWER BROWN BROWN BROWN BROWN BROWN BROWN BROWN BROWN LICENSE LAC PHD LCSW MD MD RD PT MD MD LCSW MD LCSW DO LCPC LCPC PA-C MD MD LCPC MD MD MD MD MD PT LCPC MD MD NP MD PT LCSW NP NP MD PAC PAC OD MD MD MD PT NP PAC PAC MD PA-C MD MD MEDICAL GROUP MENTAL HEALTH CENTER BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC ORTHOPEDIC REHAB INC PROFESSIONAL THERAPY ASSOCIATES COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER INTERMOUNTAIN CHILDRENS HOME SHERIDAN COMMUNITY HEALTH CENTER THE MONTANA CENTER WEST GRAND FAMILY MEDICINE NEUROLOGICAL ASSOCIATES BARRETT HOSP & HEALTHCARE REGENESIS COUNSELING SOUND INPATIENT PHYSICIANS SILVERTIP EMERGENCY PHYSICIANS SILVERTIP EMERGENCY PHYSICIANS MISSOULA ANESTHESIOLOGY PATHOLOGY CONSULTANTS OF WESTERN MT NORTHERN ROCKIES REHABILITATION BOZEMAN CREEK FAMILY HEALTH MEDICAL ASSOCIATES 4 MY KIDS FAMILY PRACTICE WESTERN MONTANA CLINIC LEWIS & CLARK EMERGENCY PHYSICIANS ST PETERS URGENT CARE ANESTHESIA PARTNERS OF MONTANA FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST MARCUS DALY CONVENIENT CARE MARCUS DALY MEMORIAL HOSPITAL RAVALLI FAMILY MEDICINE BARRETT HOSPITAL & HEALTHCARE INTERNAL MEDICINE ASSOCIATES NORTHWEST ORTHOPEDICS & SPORTS URGENT CARE PLUS YELLOWSTONE PATHOLOGISTS PC ADDRESS 1245 N 29TH 1020 N 27TH ST 410 CENTRAL AVE STE 502 2800 10TH AVE N 2800 10TH AVE N 2800 10TH AVE N 710 E 13TH ST STE B 1234 WHITEFISH STAGE RD 445 CENTENNIAL AVE 41 BARRETT ST 500 S LAMBORN 317 MADISON ST 245 WINDWARD WAY STE 101 2750 GRAND AVE 4 DAGMAR PLACE 190 ROSEBUD ST 500 W BROADWAY 500 W BROADWAY STE 310 30 HWY 91 S 17 E STORY RD #2 2827 FORT MISSOULA RD 310 SUNNYVIEW LN 310 SUNNYVIEW LN 2825 STOCKYARD RD BLDG I-200 2827 FORT MISSOULA RD 2831 FORT MISSOULA RD 104 W CUSTER STE 2 316 E BABCOCK 935 HIGHLAND BLVD STE 4400 20 FOUR MILE DR STE 2 2600 WILSON STE 1 500 W BROADWAY 445 SO 5TH WEST 2475 BROADWAY 2475 BROADWAY 2900 12TH AVE N STE 205W 1315 GOLDEN VALLEY CIRCLE 400 S CLARK ST 4000 HWY 93 S 1150 WESTWOOD DR STE E 1200 WESTWOOD DR 411 W MAIN 90 HWY 91 S 2900 12TH AVE N STE 310W 350 HERITAGE WAY STE 1200 39 NEILL AVE 2900 12TH AVE N #295W 6 - 13TH AVE E 1655 SHILOH RD #E 1297 BURNS WAY CITY BILLINGS BILLINGS GREAT FALLS BILLINGS BILLINGS BILLINGS WHITEFISH KALISPELL BUTTE DILLON HELENA SHERIDAN KALISPELL BILLINGS FORSYTH FORSYTH MISSOULA MISSOULA DILLON BOZEMAN MISSOULA KALISPELL KALISPELL MISSOULA MISSOULA MISSOULA HELENA BOZEMAN BOZEMAN KALISPELL MILES CITY MISSOULA MISSOULA HELENA HELENA BILLINGS BILLINGS BUTTE MISSOULA HAMILTON HAMILTON HAMILTON DILLON BILLINGS KALISPELL HELENA BILLINGS POLSON BILLINGS KALISPELL ZIP 59103 59101 59401 59101 59101 59101 59937 59901 59701 59725 59601 59749 59901 59102 59327 59327 59802 59802 59725 59715 59804 59901 59901 59808 59804 59804 59602 59715 59715 59901 59301 59801 59801 59601 59601 59101 59102 59701 59801 59840 59840 59840 59725 59101 59901 59601 59101 59860 59106 59901 SPECIALTY LICENSED ADDICTION COUNSELOR PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE/TRAUMA PEDIATRICS NUTRITION PROFESSIONAL PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICIAN ASSISTANT SURGERY NEUROSURGERY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR URGENT CARE PROVIDER EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA ANESTHESIOLOGY PATHOLOGY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE/TRAUMA URGENT CARE PROVIDER ANESTHESIOLOGY HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY OPTOMETRY HOSPITALIST HOSPITALIST FAMILY PRACTICE PHYSICAL THERAPY INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE PATHOLOGY PHYSICIAN ASSISTANT OBSTETRICS & GYNECOLOGY SURGERY PLASTIC/RESTORATIVEBURN Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 14 of 256 FIRST NAME ANN CLARE HAROLD HAROLD HAROLD KEVIN ERICA WILLIAM JENNIFER DEAN CLINT BLACKSHEAR LYNNE JIM CINDY DANIEL JAMES BRENTLEY BRENTLEY FRANCES THERESA FIONA MENDY MENDY MENDY JONI CHARLES LOUIS GARY GARY NATHANIEL ANN EVA DARIUSZ J PETER BEN JUSTIN ANGELA VICKI SUSANNE LESLIE JOY SCOTT JAMES S LORINNE TIMOTHY JAMES JAMES JAMES Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BROWNBACK BROWNLEE BRUCE BRUCE BRUCE BRUEN BRUEN BRUNETT BRUNSDON BRUSCHWEIN BRYAN BRYAN III BRYANT BRYNGELSON BRYSON BRZOZOWSKI BUCHAN BUCHELE BUCHELE BUCK BUCKALEW BUCKLEY BUCY BUCY BUCY BUECHLER-PRICE BUEHLER BUFFALINO BUFFINGTON BUFFINGTON BUFFINGTON BUKACEK BUKER BULCZAK BULGER BULLEY BULLINGTON BULS BUNDY BURFORD BURGESS BURGESS BURK BURK BURKE BURKE BURKE BURKHOLDER BURKHOLDER BURKHOLDER LICENSE LCSW MD NP NP NP MD MD PT MD MD DC MD APRN LCPC LCSW LCSW MD MD MD PHD LCSW MD LCSW LCSW LCSW MD MD DC MD MD MD MD OD MD MD PAC MD MD PAC LCSW APRN LCPC MD MD MD LCPC MD MD MD MD MEDICAL GROUP CPG NORTHGATE PRIMARY CARE COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER SHERIDAN COMMUNITY HEALTH CENTER CARDIOVASCULAR & THORACIC SURGEONS INTERNAL MEDICINE ASSOCIATES ORTHOPEDIC REHAB MOUNTAINVIEW MEDICAL CENTER BILLINGS CLINIC BELGRADE BACK & NECK CLINIC PHYSICAL MEDICINE CLINIC HELENA OBGYN ASSOCIATES ASSOC IN PROFESSIONAL COUNSELING WESTERN MONTANA MENTAL HEALTH CTR SVH EMERGENCY MEDICINE DEPT BUCHELE PLASTIC SURGERY GALLATIN VALLEY ANESTHESIA MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA NEUROBEHAVIORAL SPECIALISTS FRONTIER CANCER CENTER & BLOOD INST MONTANA ORTHOPEDICS BENEFIS HEALTHCARE BIG SKY NEONATOLOGY HOSANNA HEALTH CARE RONAN EYE CLINIC SIDNEY HEALTH CENTER TALLMAN DERMATOLOGY PIONEER MEDICAL CENTER NORTH VALLEY HOSPITAL BILLINGS CLINIC MILES CITY WOMENS HEALTH GREAT FALLS CLINIC NORTHWEST PHYSICIANS BILLINGS CLINIC NORTHWEST COUNSELING BOULDER MEDICAL CLINIC ST PETERS MEDICAL GROUP ST PETERS MEDICAL GROUP ADDRESS 415 LOUISIANA AVE 2230 N RESERVE #402 445 CENTENNIAL 41 BARRETT ST 317 MADISON ST 2900 12TH AVE N STE 502E 2900 12TH AVE N STE 310W 734 9TH ST W #7 16 W MAIN ST 2800 10TH AVE N 227 SPOONER RD STE B 2900 12 AVE N STE 400E 45 MEDICAL PARK DR 3203 3RD AVE N STE 208 725 W ALDER #1 1315 WYOMING ST 1233 N 30TH ST 40 4 MILE DR STE 5 202 CONWAY DR STE 100 1018 BURLINGTON STE 106 6230 MAIN ST 915 HIGHLAND BLVD 1184 N 15TH STE 3 1610 S AVE W 900 N ORANGE 3RD FLOOR 1315 GOLDEN VALLEY CIRCLE 435 S CRYSTAL STE 400 1201 US HWY 10 W UNIT C 1101 26TH ST S 1101 26TH ST S 6 - 13TH AVE E 160 HERITAGE WAY STE 102 417 MAIN ST SW 216 14TH AVE SW 500 W BROADWAY 2294 GRANT RD 701 STOCK ST 1600 HOSPITAL WAY 620 S HAYNES 902 WYOMING AVE 75 CLAREMONT ST STE A 821 S ORANGE ST 20 13TH ST 401 15TH AVE SO STE 201 801 N 29TH ST 1597 AVE D STE 7 2835 FORT MISSOULA RD 305 214 S MAIN ST 2550 BROADWAY 3150 N MONTANA AVE STE A CITY LIBBY MISSOULA BUTTE DILLON SHERIDAN BILLINGS BILLINGS COLUMBIA FALLS WHITE SULPHUR SPRINGS BILLINGS BELGRADE BILLINGS HELENA BILLINGS MISSOULA MISSOULA BILLINGS KALISPELL KALISPELL MISSOULA COLSTRIP BOZEMAN BOZEMAN MISSOULA MISSOULA BILLINGS BUTTE LIVINGSTON GREAT FALLS GREAT FALLS POLSON KALISPELL RONAN SIDNEY MISSOULA BILLINGS BIG TIMBER WHITEFISH MILES CITY BILLINGS KALISPELL MISSOULA HAVRE GREAT FALLS BILLINGS BILLINGS MISSOULA BOULDER HELENA HELENA ZIP 59923 59808 59701 59725 59749 59101 59101 59912 59645 59101 59714 59101 59601 59102 59802 59801 59101 59901 59901 59801 59323 59715 59715 59801 59802 59102 59701 59047 59405 59405 59860 59901 59864 59270 59802 59102 59011 59937 59301 59101 59901 59801 59501 59405 59101 59102 59804 59632 59601 59601 SPECIALTY SOCIAL WORKER INTERNAL MEDICINE GENERAL PRACTICE GENERAL PRACTICE GENERAL PRACTICE SURGERY VASCULAR INTERNAL MEDICINE PHYSICAL THERAPY FAMILY PRACTICE RADIOLOGY CHIROPRACTIC PHYSICAL MEDICINE REHABILITATION OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE/TRAUMA SURGERY PLASTIC/RESTORATIVEBURN SURGERY PLASTIC/RESTORATIVEBURN PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER RADIATION ONCOLOGY SURGERY ORTHOPEDIC MEDICINE CHIROPRACTIC HOSPITALIST PEDIATRIC NEONATOLOGY FAMILY PRACTICE INTERNAL MEDICINE OPTOMETRY RADIOLOGY EMERGENCY MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER GYNECOLOGY-NO OB LICENSED BEHAVIORAL COUNSELOR PEDIATRICS INTERNAL MEDICINE HEMATOLOGY-ONCOLOGY LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE Montana STATUS SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 15 of 256 FIRST NAME KIMBERLY DEBRA RONALD BRYN PATRICK SCOTT HANLY SUSAN SHAWN SHAWN TINA MICHAEL SHARA LEE RONALD RICHARD DON STEVEN LYNN ROBYN JOHN MICHAEL JASON JASON PAUL LEE ANNE ROBERT KAREN DEBORAH ANDREA CAROL LAURA TERRENCE SUSAN JAMES KACI RAELYNNE RAELYNNE RAELYNNE KAREN MARK MARK CAROL MARK DAVID CHRISTOPHER J J ROBERT ROBERT ROBERT Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME BURKHOLZ BURLEIGH-GILBERT BURNAM BURNHAM BURNS BURRY BURTON BURTON BURWELL BURWELL BUSBY BUSH BUSHMAN BUSS BUSWELL BUTLER BUTLER BUTLER BUTLER HALL BUTTRAM BUTZ BUYSE BUYSE BYORTH BYRNE BYRON CABELL CADES CADY CADY CAHILL CAHILL CAHILL CAIN CALAWAY CALBICK CALBICK CALBICK CALDEMEYER CALDERWOOD CALDERWOOD CALDERWOOD CALDERWOOD CALDWELL CALDWELL CALDWELL CALDWELL CALDWELL CALDWELL II CALE LICENSE MD NP MD DO DO MD DO CNMW MD MD MD MD OT MD MD DC MD DC LCPC LCPC PHD LCSW LCSW MD LCSW MD DO PAC MD MD PT MD PA-C MD PT LCPC LCPC LCPC MD MD MD MD MD PT DO MD MD MD MD MD MEDICAL GROUP SIDNEY HEALTH CENTER SYNERGY MEDICAL CARE SVH HOSPITALIST PROGRAM GLACIER HEADACHE & SLEEP MEDICINE SILVERTIP EMERGENCY PHYSICIANS BOZEMAN CREEK FAMILY HEALTH WESTSIDE MIDWIFERY AND WOMENS HEALT COMMUNITY HEALTH PARTNERS PARK CLINIC BIGFORK MEDICAL CLINIC SVH EMERGENCY MEDICINE DEPT BILLINGS CLINIC STILLWATER COMMUNITY HOSPITAL BUTLER CHIROPRACTIC EAR NOSE & THROAT ASSOCIATES ASPEN PRACTICE HEAD QUARTERS FOR HEART CHANGE PINE RIDGE COUNSELING BILLINGS CLINIC IMAGINE HEALTH ST VINCENT PHYSICIAN NETWORK BILLINGS CLINIC ABSORKA EMERGENCY PHYSICIANS BOZEMAN CREEK FAMILY HEALTH WESTERN MONTANA CLINIC BILLINGS CLINIC BILLINGS CLINIC KALISPELL REHABILITATION ASSOC INC CALBICK COUNSELING & CONSULTING CALBICK COUNSELING & CONSULTING CENTER FOR MENTAL HEALTH SIDNEY HEALTH CENTER BITTERROOT VALLEY EYE ASSOCIATES BITTERROOT VALLEY EYE ASSOCIATES CONVENIENT CARE CLINIC C & C PHYSICAL THERAPY CENTER FOR MENTAL HEALTH TETON MEDICAL CENTER ADDRESS 216 14TH AVE SW 1101 26TH ST S 2900 12TH AVE N #300E 1233 N 30TH ST 200 COMMONS WAY STE C 310 SUNNYVIEW LN 316 E BABCOCK 401 S ALABAMA ST STE 9 126 S MAIN ST 1001 RIVER DR 8299 MONTANA HWY 35 1233 N 30TH ST 801 N 29TH ST 44 W 4TH AVE N 2600 WINNE AVE STE B 1802 DEARBORN ST 101 2900 12TH AVE N #330W 1802 DEARBORN AVE STE 101 1645 AVE D STE D 38 E WASHINGTON ST STE 4 1430 COUNTRY MANOR BLVD STE 5 225 N 23RD ST 225 N 23RD ST 801 N 29TH ST 305 FIRST AVE W 1233 N 30TH ST 801 N 29TH ST 915 HIGHLAND BLVD 316 E BABCOCK 500 W BROADWAY 2702 8TH AVE N 801 N 29TH ST 1060 N MERIDIAN RD 601 W SPRUCE #K 1234 WHITEFISH STAGE RD 1601 2ND AVE N STE 343 1601 2ND AVE N STE 343 915 1ST AVE S 216 14TH AVE SW 300 N 10TH ST STE A 401 MAIN ST #A 1200 WESTWOOD DR STE H 300 N 10TH ST #A 2119 10TH AVE S 500 W BROADWAY 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 1125 MISSOULA AVE STE B PO BOX 3089 915 4TH ST NW CITY SIDNEY GREAT FALLS BILLINGS BILLINGS KALISPELL KALISPELL BOZEMAN BUTTE LIVINGSTON LIVINGSTON BIGFORK BILLINGS BILLINGS COLUMBUS HELENA MISSOULA BILLINGS MISSOULA BILLINGS KALISPELL BILLINGS BILLINGS BILLINGS BILLINGS COLUMBIA FALLS BILLINGS BILLINGS BOZEMAN BOZEMAN MISSOULA BILLINGS BILLINGS KALISPELL MISSOULA KALISPELL GREAT FALLS GREAT FALLS GREAT FALLS SIDNEY HAMILTON STEVENSVILLE HAMILTON HAMILTON GREAT FALLS MISSOULA MISSOULA MISSOULA HELENA GREAT FALLS CHOTEAU ZIP 59270 59405 59101 59101 59901 59901 59715 59701 59047 59047 59911 59101 59101 59019 59601 59801 59101 59801 59102 59901 59102 59101 59101 59101 59912 59101 59101 59715 59715 59802 59101 59101 59901 59802 59901 59401 59401 59401 59270 59840 59870 59840 59840 59405 59802 59802 59802 59601 59403 59422 SPECIALTY RADIOLOGY EMERGENCY MEDICINE/TRAUMA PULMONARY DISEASES HOSPITALIST NEUROLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE CERTIFIED NURSE MIDWIFE OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA OCCUPATIONAL THERAPY EMERGENCY MEDICINE/TRAUMA ALLERGY/IMMUNOLOGY CHIROPRACTIC SURGERY HEAD & NECK CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER EAR/NOSE/THROAT (ENT) LICENSED CLINICAL SOCIAL WORKER HOSPITALIST INTERNAL MEDICINE EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE ALLERGY/IMMUNOLOGY PHYSICAL THERAPY PHYSICAL MEDICINE REHABILITATION PHYSICIAN ASSISTANT GASTROENTEROLOGY PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR RADIOLOGY OPHTHALMOLOGY OPHTHALMOLOGY URGENT CARE PROVIDER OPHTHALMOLOGY PHYSICAL THERAPY PAIN MANAGEMENT INTERNAL MEDICINE INTERNAL MEDICINE PSYCHIATRY PSYCHIATRY FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED PENDING SIGNED 16 of 256 FIRST NAME TERRY KIMBERLY RICHARD ANNE TODD MICHELLE SALLY JOHN CARLA CARLA NICHOLAS CARLA CORRINE KIMBERLY LORRIE TIMOTHY SHARON DELIA STACIE KARLA CHRISTOPHER JUDITH REBECCA REBECCA KARA PATRICIA NICHOLAS STEPHANIE BRYAN KIM ANGELO ANGELO CATHY THOMAS BRIAN MICHELE JANEL LEAH THOMAS JEREMY COLLIN LESLIE LINDSAY MARY ANN KYLA MARY ANN JACLYN LINDSAY DAN ALICEANN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME CALKINS CALNAN HOLT CAMBARERI CAMBER CAMERON CAMERON DONALDSON CAMERON RUSSELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL CAMPBELL SHAW CAMPFIELD CAMPO CANAVAN CANCRO CANFIELD CANNER CANNER CANNON CANTRELL CANTRELL CANTY CANTY CAPRATA CAPRICCHIONE CAPRICCHIONE CARDNEAUX CAREY CAREY CAREY CARINO CARLBURG CARLIN CARLISLE CARLSON CARLSON CARLSON CARLSON CARLSON CARLSON CARLSON CARLSON CARLSON-THOMPSON CARLTON LICENSE OT OD MD MD DO MD LCSW MD NP NP MD NP PT LCPC LCPC DC LCSW PHD MD MD PT MD MD OT PAC MD MD MD PAC MD MD LCPC MD MD LCPC MD MD LCPC CRNA DC NP MD MD DO MD LCPC MD LCSW LCPC MEDICAL GROUP ORTHO MONTANA PACIFIC CATARACT & LASER INSTITUTE GREAT FALLS CLINIC ST JOHN'S LUTHERAN HOSPITAL GREAT FALLS ORTHOPEDIC ASSOC LIVINGSTON HEALTHCARE BRIDGER ORTHOPEDICS COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER FAMILY MEDICAL CLINIC SHERIDAN COMMUNITY HEALTH CENTER WESTERN MONTANA MENTAL HEALTH CTR MISSOULA SURGICAL ASSOCIATES SILVER BOW PHYSICAL THERAPY WEST GRAND FAMILY MEDICINE BOZEMAN CREEK FAMILY HEALTH CONVENIENT CARE CLINIC THE COZY NEST BRIDGER ORTHOPEDICS NORTHWEST IMAGING BILLINGS CLINIC HARDIN CLINIC ADVANCED CARE HOSPITAL OF MONTANA ADVANCED CARE HOSPITAL OF MONTANA INNER JOURNEYS NORTHER PLAINS PATHOLOGISTS PACIFIC CATARACT & LASER INSTITUTE BIG SKY FAMILY MEDICINE MONTANA CITY COUNSELING CENTER NORTHERN MONTANA HOSPITAL CARLSON CHIROPRACTIC OFFICES COMMUNITY HEALTH PARTNERS LIVINGSTON HEALTHCARE NORTH VALLEY OB CLINIC ST VINCENT PHYSICIAN NETWORK THE PROFESSIONAL CENTER CENTER FOR MENTAL HEALTH EASTERN MONTANA COMMUNITY MHC ADDRESS 2900 12TH AVE N STE 140W 1717 4TH AVE S 3000 15TH AVE S 350 LOUISIANA AVE 1401 25TH ST S 504 S 13TH ST 286 5TH AVE EN 1450 ELLIS ST STE 201 445 CENTENNIAL 41 BARRETT ST 100 N OAK ST 317 MADISON 4828 EASTSIDE HWY #101 315 S 4TH ST E STE 204 305 W MERCURY STE 207B 2235 GRAND AVE 232 S MAIN ST 129 W KENT AVE 500 W BROADWAY 5TH FL 3718 E LAKE ST STE A 2750 GRAND AVE 2525 N BROADWAY AVE 316 E BABCOCK 1200 WESTWOOD DR 1276 N 15TH AVE STE 101 1450 ELLIS ST STE 201 320 SUNNYVIEW LN 801 N 29TH ST 2800 1OTH AVE N 16 N MILES AVE STE 101 3528 GABEL RD 3528 GABEL RD 2139 BROADWATER LOWER LEVEL 500 15TH AVE S 1717 4TH ST S 2050 FAIRWAY STE 101 420 MEADOWLARK DR 202 CONWAY DR STE 200 11 FRIENDSHIP LN STE 201 30 13TH ST 410 1ST AVE W 126 S MAIN ST 1001 RIVER DR 2165 9TH ST W 1611 ZIMMERMAN TRAIL 2165 9TH ST W 1600 2ND AVE N #614 126 S MAIN ST 900 N JACKSON ST 2508 WILSON CITY BILLINGS GREAT FALLS GREAT FALLS LIBBY GREAT FALLS LIVINGSTON KALISPELL BOZEMAN BUTTE BUTTE TOWNSEND SHERIDAN STEVENSVILLE MISSOULA BUTTE BILLINGS GARDINER MISSOULA MISSOULA BUTTE BILLINGS RED LODGE BOZEMAN HAMILTON BOZEMAN BOZEMAN KALISPELL BILLINGS BILLINGS HARDIN BILLINGS BILLINGS BILLINGS GREAT FALLS GREAT FALLS BOZEMAN BOZEMAN KALISPELL MONTANA CITY HAVRE KALISPELL LIVINGSTON LIVINGSTON COLUMBIA FALLS BILLINGS COLUMBIA FALLS GREAT FALLS LIVINGSTON HELENA MILES CITY ZIP 59101 59405 59405 59923 59405 59047 59901 59715 59701 59701 59644 59749 59870 59802 59701 59102 59030 59801 59802 59701 59102 59068 59715 59840 59715 59715 59901 59101 59101 59034 59102 59102 59102 59405 59405 59715 59718 59901 59634 59501 59901 59047 59047 59912 59102 59912 59401 59047 59601 59301 SPECIALTY OCCUPATIONAL THERAPY OPTOMETRY HEMATOLOGY-ONCOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPIST LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTOR LICENSED CLINICAL SOCIAL WORKER PSYCHOLOGY SURGERY GENERAL LICENSED MASSAGE THERAPIST FAMILY PRACTICE PHYSICAL THERAPIST FAMILY PRACTICE GENERAL PRACTICE OCCUPATIONAL THERAPY SURGERY ORTHOPEDIC MEDICINE RADIOLOGY FAMILY PRACTICE RADIOLOGY FAMILY PRACTICE INTERNAL MEDICINE HOSPITALIST LICENSED BEHAVIORAL COUNSELOR PATHOLOGY OPHTHALMOLOGY LICENSED BEHAVIORAL COUNSELOR PSYCHIATRY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY CHIROPRACTIC FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 17 of 256 FIRST NAME MEG FREDERICK KRISTI PATRICIA PATRICIA JUDY ROBERTA JEFFREY RICHARD LESLIE TIMOTHY TIMOTHY TIMOTHY ALISON SHERRY COURTNEY THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS HARVEY MICHAEL TIMOTHY ANGELA MELISSA CAROLIN CAROLIN JOSEPH ANNIE ROGER ROGER ROGER SHELLY MARY MICHAEL VALERIE STEPHANIE STEPHANIE LIBBY LIBBY THOMAS CHERYL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME CARNEGIE CARR CARR CARRICK CARRICK CARRIGAN CARRLSON CARROLL CARSON CARSON CARTE CARTE CARTE CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CARTER CASEBEER CASELNOVA CASEY CASMIER CASPER CASSEL CASSEL CASSIDY CASTILLO CASTILLO CASTILLO CASTILLO CASTLES CATER CATER CATON CATRON CATRON CATRON-GINGERELLI CATRON-GINGERELLI CAUGHLAN CAVALLI LICENSE MD MD LCSW APRN APRN OT OT MD MD LCPC MD MD MD CRNA MD MD RPA RPA RPA RPA RPA RPA RPA RPA RPA RPA RPA RPA MD MD PHD MD MD FNP FNP LCPC MD PA-C PA-C PA-C MD OT LCPC NP APRN NP LCPC LCPC MD MD MEDICAL GROUP MOUNTAIN VIEW FAMILY MEDICINE & OB BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR BARRETT HOSPITAL & HEALTHCARE DILLON COMMUNITY HEALTH CENTER ST PETERS HOSPITAL REHABILITATION PEDIATRIC THERAPY CLINIC NEONATOLOGY ASSOCIATES BENEFIS MEDICAL GROUP WESTERN MONTANA CLINIC WESTERN MONTANA CLINIC BRADEN ANESTHESIA SERVICES GLACIER EAR NOSE & THROAT SIDNEY HEALTH CENTER AMERICAN EYECARE CENTRAL MONTANA MEDICAL CENTER CENTER FOR MENTAL HEALTH BOZEMAN DEACONESS WOMENS SPEC ST VINCENT HEALTHCARE ST VINCENT HEALTHCARE BILLINGS CLINIC BOZEMAN DEACONESS CANCER CENTER BILLINGS CLINIC WEST RIVERSTONE HEALTH FAIRFIELD MEDICAL CENTER TETON MEDICAL CENTER TAMARACK MEDICAL CLINIC BOULDER MEDICAL CLINIC ADDRESS 2835 FORT MISSOULA RD #102 801 N 29TH ST 410 WINDWARD WAY 90 HWY 91 S #100 41 BARRETT ST 2475 BROADWAY 50 27TH ST W STE A 1233 N 30TH ST 1101 26TH ST S 415 1/2 E LAMME 311 HWY 93 S 6 13TH AVE E STE 1 63351 HWY 93 S 401 N 31ST ST STE 1260 160 HERITAGE WAY 216 14TH AVE SW 10 KRUGER RD 1287 BURNS WAY 1600 HOSPITAL WAY 310 SUNNYVIEW LN 320 SUNNYVIEW LN 350 LOUISIANA AVE 450 OSLOSKI RD 640 W PARK DR 802 2ND ST SE 805 SUNSET BOULEVARD HOSPITAL CIRCLE PO BOX 810 100 W PARK ST 408 WENDELL AVE 907 E 3RD ST 591 1ST AVE S 905 HIGHLAND BLVD STE 4440 & 50 1101 N 27TH ST STE 201 2223 MISSION WAY 1020 N 27TH ST 931 HIGHLAND BLVD STE 3130 16862 BECKWITH ST 3050 MT HWY 83 N 3075 N RESERVE #Q 2675 CENTRAL AVE 234 E BABCOCK ST 205 HAGGERTY LN #280 123 S 27TH ST 223 W MAIN 915 4TH ST NW 800 KENSINGTON #101 800 KENSINGTON #101 150 COMMONS WAY 214 S MAIN ST CITY MISSOULA BILLINGS KALISPELL DILLON DILLON HELENA BILLINGS BILLINGS GREAT FALLS BOZEMAN RONAN POLSON RONAN BILLINGS KALISPELL SIDNEY PLAINS KALISPELL WHITEFISH KALISPELL KALISPELL LIBBY EUREKA SHELBY CUT BANK CONRAD BROWNING EUREKA ANACONDA LEWISTOWN ANACONDA GREAT FALLS BOZEMAN BILLINGS BILLINGS BILLINGS BOZEMAN FRENCHTOWN SEELEY LAKE MISSOULA BILLINGS BOZEMAN BOZEMAN BILLINGS FAIRFIELD CHOTEAU MISSOULA MISSOULA KALISPELL BOULDER ZIP 59804 59101 59901 59725 59725 59601 59102 59101 59401 59715 59864 59860 59864 59101 59901 59270 59859 59901 59937 59901 59901 59923 59917 59474 59427 59425 59417 59917 59711 59457 59711 59405 59715 59101 59102 59101 59715 59834 59868 59808 59102 59715 59715 59101 59436 59422 59801 59801 59901 59632 SPECIALTY FAMILY PRACTICE INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY PEDIATRIC NEONATOLOGY PATHOLOGY LICENSED BEHAVIORAL COUNSELOR PEDIATRICS PEDIATRICS PEDIATRICS ANESTHESIOLOGY AUDIOLOGY RADIOLOGY RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT RADIOLOGIST ASSISTANT OPHTHALMOLOGY FAMILY PRACTICE PSYCHOLOGIST PSYCHIATRY OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR HEMATOLOGY-ONCOLOGY PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT FAMILY PRACTICE OCCUPATIONAL THERAPIST PROFESSIONAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE FAMILY PRACTICE Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 18 of 256 FIRST NAME SHIRLEY HUGH KEDRIC DEAN DANIEL DAVID DAVID NICK S WAYNE WILLIAM TAMMY LAUREL RHONDA NYLA LUKE MARK MARK DEAN AMMIE VICKI GREGORY HEIDI HEIDI GABRIEL ALISON CHARLES ALISON DOUGLAS LESLEE DAVID LESLEE SUSAN MICHELLE JAMES BETHANY TERESA BRIAN BRUCE BRUCE KENDALL ADAM ADAM ANANTHAKRISHNA JAMI JENNIFER JOYCE JOSEPH JOSEPH KATHERINE KERT Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME CAYKO CECIL CECIL CENTER CERISE CHAMBERLAIN CHAMBERLAIN CHAMBERLAIN CHAMBERLIN CHAMBERLIN CHAMBERS CHAMBERS CHAMPAGNE CHANDLER CHANNER CHANNER CHANNER CHAPEL CHAPMAN CHAPMAN CHAPMAN CHAPNICK CHAPNICK CHARBONNEAU CHARMAN CHARMAN CHARMAN CHASE CHAVEZ CHAVEZ CHAVEZ CHEESEMAN CHENEY CHEREWATENKO CHERNICH CHERRY CHERRY CHESSEN CHESSEN CHILD CHILDERS CHILDERS CHILUKURI CHISDAK CHIVERS CHOE CHOPYAK CHOPYAK CHRISTECK CHRISTENSEN LICENSE LCSW MD LCPC MD LCPC MD MD OD MD MD NP PAC LCSW NP MD MD MD PAC DC DO DC DC DC MD NP MD NP PT APRN MD NP NP NP PA-C DO MD LAC PHD PHD APRN DO DO MD MD SLP MD PAC PAC RD DO MEDICAL GROUP CENTER FOR MENTAL HEALTH NORTHWEST IMAGING FAMILY DOCTORS URGENT CARE MERCURY STREET MEDICAL SOUND INPT PHYSICIANS AT ST JAMES VISION CLINIC ST PETERS HOSPITAL ST VINCENT PHYSICIAN NETWORK ROUNDUP MEMORIAL HEALTHCARE TAMARACK MEDICAL CLINIC BRIDGER CLINIC HAMILTON GENERAL SURGERY MISSOULA BONE & JOINT MISSOULA BONE & JOINT DEER LODGE MEDICAL CENTER AM CHIROPRACTIC BENEFIS PHYSICIAN ASSOCIATES MONTANA PAIN & REHAB BLUE MOUNTAIN CLINIC SOUND INPATIENT PHYSICIANS WEST BILLINGS PHYSICAL THERAPY ROCKY MOUNTAIN HEART & LUNG YELLOWSTONE UROLOGY PERI & NEONATAL SERVICES @ KRMC GLACIER NEUROSCIENCE AND SPINE MISSOULA OSTEOPATHIC CLINIC BILLINGS ANESTHESIOLOGY BRIDGER CLINIC ROCKY MOUNTAIN CLINIC ST JAMES HEALTHCARE PRIMARY CARE SIDNEY HEALTH CENTER BOZEMAN DEACONESS WOMENS SPEC PACIFIC CATARACT & LASER INSTITUTE LINCOLN CO COMMUNITY HEALTH CENTER NORTHERN MONTANA HOSPITAL ANESTHESIA PARTNERS OF MONTANA ADDRESS 621 1ST AVE S 38 W WASHINGTON STE 5 109 W 2 ST 120 N 19TH AVE STE A 1701 AVE E STE E 300 W MERCURY ST 400 S CLARK ST 100 WESTVIEW PARK PLACE 2475 BROADWAY 1144 N 28TH ST STE C 1207 2ND ST W 1208 6TH AVE E 1125 MISSOULA AVE 300 N WILLSON #2001 1150 WESTWOOD DR STE D 10 KRUGER RD 2360 MULLAN RD STE C 1100 HOLLENBACK LN 618 W MAIN ST STE 203 400 13TH AVE S STE 203 1526 S RESERVE ST 670 KING PARK DR #1 10 AVANTA WAY STE 1 715 MAIN ST #A 610 N CALIFORNIA 2827 FORT MISSOULA RD 1111 BAKER AVE 3307 GRAND AVE STE 203 350 HERITAGE WAY STE 2100 2900 12TH AVE NO STE 503E 350 LOUISANA AVE 310 SUNNYVIEW LN 200 COMMONS WAY 1300 28TH ST S #3 341 W PINE ST 2800 10TH AVE N 101 CHURCH ST 1250 15TH ST W #203 1250 15TH ST W STE 203 300 N WILLSON STE 2001 435 S CRYSTAL ST STE 300 400 S CLARK 216 14TH AVE SW 905 HIGHLAND BLVD STE 4440 & 50 2525 N BROADWAY AVE 1717 4TH ST S 711 CALIFORNIA AVE 6575 US HWY 93 S 30 13TH ST 2900 12TH AVE N STE 205W CITY GREAT FALLS KALISPELL HAVRE BOZEMAN BILLINGS BUTTE BUTTE KALISPELL HELENA BILLINGS ROUNDUP SUPERIOR HELENA BOZEMAN HAMILTON PLAINS MISSOULA DEER LODGE LEWISTOWN GREAT FALLS MISSOULA BILLINGS BILLINGS STEVENSVILLE MISSOULA MISSOULA WHITEFISH BILLINGS KALISPELL BILLINGS LIBBY KALISPELL KALISPELL GREAT FALLS MISSOULA BILLINGS STEVENSVILLE BILLINGS BILLINGS BOZEMAN BUTTE BUTTE SIDNEY BOZEMAN RED LODGE GREAT FALLS LIBBY WHITEFISH HAVRE BILLINGS ZIP 59401 59901 59501 59718 59102 59701 59701 59901 59601 59101 59072 59872 59601 59715 59840 59859 59808 59722 59457 59405 59801 59102 59108 59870 59802 59804 59937 59102 59901 59101 59923 59901 59901 59405 59802 59101 59870 59102 59102 59715 59701 59701 59270 59715 59068 59405 59923 59937 59501 59101 SPECIALTY LICENSED CLINICAL SOCIAL WORKER RADIOLOGY LICENSED BEHAVIORAL COUNSELOR URGENT CARE PROVIDER LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE HOSPITALIST OPTOMETRY ANESTHESIOLOGY GASTROENTEROLOGY FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY GENERAL SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY CHIROPRACTOR CHIROPRACTIC CHIROPRACTOR FAMILY PRACTICE FAMILY PRACTICE HOSPITALIST FAMILY PRACTICE PHYSICAL THERAPY CARDIOLOGY SURGERY UROLOGICAL UROLOGY CARDIOLOGY PERINATOLOGY PAIN MANAGEMENT PHYSICIAN ASSISTANT OSTEOPATHIC MANIPULATIVE MEDICINE ANESTHESIOLOGY ADDICTION COUNSELOR PSYCHOLOGY PSYCHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY SPEECH-LANGUAGE PATHOLOGIST OPHTHALMOLOGY FAMILY PRACTICE FAMILY PRACTICE NUTRITION PROFESSIONAL ANESTHESIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 19 of 256 FIRST NAME CHARLES KERT JOSHUA JOSHUA LANCE DAWN DAVID DAVID JOAN JOAN DAVID ARNOLD STEVEN ALEXANDER PAUL NATHAN NATHAN KYLE PAUL PATRICK CHRISTINA BENJAMIN KAREN JAN D MICHAEL STEVEN DESSYE DEE NICOLE MICHAEL ROBERT MELISSA ROBYN LOREN PAMELA JAMES JOEL PAMELA TAYLOR (TY) KATHRYN JUSTIN NEAL NEAL JEREMIAH MICHAEL JAMES THOMAS DAWN DAWN MARY LESLIE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME CHRISTENSEN CHRISTENSEN CHRISTENSEN CHRISTENSEN CHRISTENSEN CHRISTIAN CHRISTIANSEN CHRISTIANSEN CHRISTIANSEN CHRISTIANSEN CHRISTIANSON CHRISTOPHER CHRZANOWSKI CHUNG CHUNG CHURCH CHURCH CICERO CIMMINO CINDRICH CIPRIANO CLACK CLAES CLARK CLARK CLARK CLARK CLARK CLARK CLARY CLATER CLAUSEN CLAUSEN CLAUSEN CLEARY CLEARY CLEGG CLEMENT CLEMENTS CLINE CLINGER CLINGER CLINTON CLOSE CLOUGH CLUCAS CLUTTER CLUTTER COAR COATES LICENSE MD DO MD MD DO PT MD MD LCPC LCPC MD MD MD MD MD LCSW LCSW PT LCSW MD LCPC DC PAC DPM DC MD APRN MD DC DO LCSW CRNA LCPC MD MD MD LCSW LCSW LCSW MD MD MD PT DPM PHD PT PT PT RD MEDICAL GROUP MONARC INJURY CENTER NORTHERN ROCKIES REGIONAL PAIN CTR BIG SKY PHYSICAL THERAPY FRONTIER CANCER CENTER & BLOOD INST SVH OCCUPATIONAL HEALTH BENEFIS PHYSICIAN ASSOCIATES GREAT FALLS ORTHOPEDIC ASSOC PACIFIC CATARACT & LASER INSTITUTE MENTAL HEALTH CENTER MENTAL HEALTH CENTER HEUISER PHYSICAL THERAPY COMMUNITY BRIDGES CLACK CHIROPRACTIC CENTER PC BRIDGER ORTHOPEDICS BOZEMAN PODIATRIC CLINIC CLARK CHIROPRACTIC ROCKY MOUNTAIN PERINATOLOGY SOUND VIEW COUNSELING ASSSOCIATES ST PETER'S MEDICAL GROUP MARIAS HEALTHCARE MEADOWLARK COUNSELING BAUER & CLAUSEN PC ST JOHN'S LUTHERAN HOSPITAL BELGRADE CLINIC BOZEMAN DEACONESS NORTHERN MONTANA MEDICAL GROUP YELLOWSTONE PATHOLOGISTS PC ALEPH MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAG ASSOC OF IDAHO FALLS BITTERROOT ORTHOPEDICS & SPORTS MED BIGFORK PHYSICAL THERAPY FOOT AND ANKLE CLINIC OF MONTANA ADVANCED PRACTICE PHYSICAL THERAPY U OF M PHYSICAL THERAPY CLINIC CHRONIC DISEASE OUTREACH ADDRESS 500 15TH AVE S 2900 12TH AVE N STE 335W 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 2900 12TH AVE N STE 205W 316 W SPRUCE ST 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 206 CALLAHAN RD 211 MINERAL AVE 1315 GOLDEN VALLEY CIRCLE 1027 N 27TH ST 2800 11TH AVE S STE 23 1401 25TH ST S 1717 4TH ST S 1245 N 29TH 809 CUSTER 3180 DREDGE DR STE F 1004 DIVISION ST 2835 FORT MISSOULA RD #303 2685 PALMER #D 3180 DREDGE DRVIE STE C 1450 ELLIS ST STE 201 300 N WILLSON STE 801H 3031 S RUSSELL STE 4 2935 FORT MISSOULA RD #303 301 W SPRUCE 2550 BROADWAY POD 1D 3031 S RUSSELL 670 PARK AVE 2525 S 3RD ST W 2675 CENTRAL AVE STE L1 350 LOUISIANA AVE 800 KENSINGTON #101 33 W MAIN ST 30 13TH ST 2900 12TH AVE N STE 295W 2685 PALMER ST STE A 804 3RD ST 913 SW HIGGINS AVE STE 104B 310 SANSOME ST 90 HWY 91 S 1200 WESTWOOD DR 6400 MT HWY 35 1301 11TH AVE S STE 6 125 BANK ST STE 310 900 2ND ST S 914 13TH AVE S U OF M SKAGGS BLDG #129 310 SUNNYVIEW LN CITY GREAT FALLS BILLINGS MISSOULA MISSOULA BILLINGS MISSOULA MISSOULA MISSOULA TROY LIBBY BILLINGS BILLINGS GREAT FALLS GREAT FALLS GREAT FALLS BILLINGS HARDIN HELENA BILLINGS MISSOULA MISSOULA HELENA BOZEMAN BOZEMAN MISSOULA MISSOULA MISSOULA HELENA MISSOULA SHELBY MISSOULA BILLINGS LIBBY MISSOULA BELGRADE HAVRE BILLINGS MISSOULA WHITEFISH MISSOULA PHILIPSBURG DILLON HAMILTON BIGFORK GREAT FALLS MISSOULA GREAT FALLS GREAT FALLS MISSOULA KALISPELL ZIP 59405 59101 59802 59802 59101 59802 59802 59802 59935 59923 59102 59101 59405 59405 59405 59103 59034 59602 59101 59804 59808 59602 59715 59715 59802 59804 59802 59601 59801 59804 59102 59923 59801 59714 59501 59101 59808 59937 59803 59858 59725 59840 59911 59405 59802 59405 59405 59812 59901 SPECIALTY PEDIATRICS ANESTHESIOLOGY HOSPITALIST INFECTIOUS DISEASE ANESTHESIOLOGY PHYSICAL THERAPY HOSPITALIST INTERNAL MEDICINE PROFESSIONAL COUNSELOR PROFESSIONAL COUNSELOR HEMATOLOGY-ONCOLOGY OCCUPATIONAL/INDUSTRIAL MEDICINE INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE OPHTHALMOLOGY LICENSED ADDICTION COUNSELOR LICENSED ADDICTION COUNSELOR PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER SURGERY NEUROSURGERY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC SURGERY ORTHOPEDIC MEDICINE PODIATRY CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY PSYCHIATRY NEUROLOGY CHIROPRACTOR OSTEOPATHIC MANIPULATIVE MEDICINE LICENSED CLINICAL SOCIAL WORKER OPTOMETRY ANESTHESIOLOGY PROFESSIONAL COUNSELOR FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PATHOLOGY LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER RADIOLOGY RADIOLOGY SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY PODIATRY PSYCHOLOGY PHYSICAL THERAPY PHYSICAL THERAPIST PHYSICAL THERAPY NUTRITION PROFESSIONAL Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 20 of 256 FIRST NAME PAUL ALISON PATRICK PATRICK PATRICK PATRICK GRETCHEN CHAD MICHAEL DOUGLAS DOUGLAS GLENN GLENN GLENN BRUCE BARRY BARRY JASON SHARON JESSE PATRICIA JENNIFER JOSEPH SCOTT DOYLE TYLER DAVID DAVID PAULA PAULA PAULA LISA MELISSA KELLY KELLY ILYAS EMILY EMILY EMILY KEVEN ANNETTE ANNETTE JEREMY EMILY CLANCY KIM KIM JENI GERARD BERNARD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME COATES COBB COBB COBB COBB COBB COBLE COCHRAN COCHRANE COCHRAN-ROBERTS COCHRAN-ROBERTS COCKRELL COCKRELL COCKRELL COEN COHAN COHAN COHEN COLCHIN COLE COLE COLEGROVE COLELLA COLEMAN COLEMAN COLEMAN COLETTA COLETTA COLLEDGE COLLEDGE COLLEDGE COLLINS COLLINS COLOFF COLOFF COLOMBOWALA COLSON COLSON COLSON COMER COMES COMES COMIN COMSTOCK CONE CONLIN CONLIN CONNELL CONNOR CONNOR LICENSE RN PHD MD MD MD MD PT MD LAC LCPC LCPC LAC LCSW LCSW OD MD MD MD NP MD MD RD OD PAC MD LCPC PT PT PA PAC PAC LPC LAC NP APRN MD MD MD MD NP MD MD DO PAC MD PAC PA-C LMFT MD PAC MEDICAL GROUP LAKESIDE FAMILY HEALTH 121 PSYCHOTHERAPY PLLC FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST ARNOLD PHYSICAL THERAPY EMERGENCY PHYSICIANS WESTERN MONTANA ADDICTION SERVICES EASTER SEALS GOODWILL HEADWATERS COUNSELING WESTERN MONTANA ADDICTION SERVICES HELENA VISION CENTER ST PETERS MEDICAL GROUP MARCUS DALY MEMORIAL HOSPITAL WESTERN MONTANA CLINIC ST PETERS HOSPITAL ADVANCED EYECARE ASSOCIATES COMPREHENSIVE MEDICAL REHAB SERVICE PARK CLINIC EXCEL ORTHOPEDIC PHYSICAL THERAPY EXCEL ORTHOPEDIC PHYSICAL THERAPY ADVANCED PAIN CENTERS OF MONTANA CMC REHABILITATION PHYSCIANS NEUROLOGICAL ASSOCIATES BELGRADE COUNSELING CLINIC WMMHC EVERGREEN CLINIC ROCKY MOUNTAIN HEART & LUNG LINCOLN CO COMMUNITY HEALTH CENTER MEDICAL ASSOCIATES RIVERSTONE HEALTH BRIDGER INTERNAL MEDICINE CENTRAL MONTANA MEDICAL CENTER BILLINGS ANESTHESIOLOGY GREAT FALLS CLINIC NORTHWEST ORTHOPEDICS & SPORTS MED BILLINGS CLINIC EXPRESS CARE ADDRESS 77 LAME DEER CREEK RD 121 HICKORY ST #1 1315 GOLDEN VALLEY CIRCLE 202 PROSPECT DR 2600 MAIN ST 400 S CLARK ST 251 SADDLE DR 1110 FRONT ST 1325 WYOMING ST 2825 STOCKYARD RD STE A23 3510 MOUNTAIN DR 1325 WYOMING ST 210 N HIGGINS STE 235 210 N HIGGINS STE 235 534 N LAST CHANCE GULCH 2475 BROADWAY 400 13TH AVE S STE 206 1200 WESTWOOD DR 500 W BROADWAY 401 S ALABAMA #6B 5938 HWY 93 S 2475 BROADWAY 4265 FALLON STE 1 1400 29TH ST S 2ND FL 1001 RIVER DR 115 W 3RD ST STE 107 1125 W KAGY BLVD STE 101A 220 WOODEN SHOE LN STE C 2835 FT MISSOULA RD STE 204 2825 FORT MISSOULA RD #317 500 W BROADWAY #310 129 VILLAGE DR STE 303 T9 FT MISSOULA RD 2181 HWY 2 E #9 734 9TH ST W STE 12 350 HERITAGE WAY #2100 320 E 2ND ST 935 HIGHLAND BLVD STE 4400 123 S 27TH ST 925 HIGHLAND BLVD STE 1100 408 WENDELL AVE 310 WENDELL AVE STE 7 401 N 31ST ST STE 1260 1400 29TH ST S 2825 FORT MISSOULA RD STE 234 350 HERITAGE WAY #1200 350 HERITAGE WAY #2300 612 W MAIN ST 801 N 29TH ST 435 S CRYSTAL STE 200 CITY SOMERS MISSOULA BILLINGS GLENDIVE MILES CITY BUTTE HELENA FORT BENTON MISSOULA MISSOULA CLINTON MISSOULA MISSOULA MISSOULA HELENA HELENA GREAT FALLS HAMILTON MISSOULA BUTTE WHITEFISH HELENA BOZEMAN GREAT FALLS LIVINGSTON STEVENSVILLE BOZEMAN MANHATTAN MISSOULA MISSOULA MISSOULA BELGRADE MISSOULA KALISPELL COLUMBIA FALLS KALISPELL LIBBY BOZEMAN BILLINGS BOZEMAN LEWISTOWN LEWISTOWN BILLINGS GREAT FALLS MISSOULA KALISPELL KALISPELL BOZEMAN BILLINGS BUTTE ZIP 59932 59801 59102 59330 59301 59701 59601 59442 59801 59808 59825 59801 59802 59802 59601 59601 59405 59840 59802 59701 59937 59601 59718 59405 59047 59870 59715 59741 59804 59804 59802 59714 59801 59901 59912 59901 59923 59715 59101 59715 59457 59457 59101 59405 59804 59901 59901 59715 59101 59701 SPECIALTY FAMILY PRACTICE PSYCHOLOGY HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA ADDICTIONNICOTINECOUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR ADDICTION MEDICINE LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER OPTOMETRY HOSPITALIST ENDOCRINOLOGY HOSPITALIST FAMILY PRACTICE RADIOLOGY FAMILY PRACTICE NUTRITION PROFESSIONAL OPTOMETRY FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL MEDICINE REHABILITATION SURGERY NEUROSURGERY LICENSED BEHAVIORAL COUNSELOR LICENSED ADDICTION COUNSELOR FAMILY PRACTICE FAMILY PRACTICE CARDIOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE PHYSICIAN ASSISTANT PROFESSIONAL COUNSELOR GYNECOLOGY ONCOLOGY URGENT CARE PROVIDER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 21 of 256 FIRST NAME STACIE TAMI DIANE ROGER CHRISTOPHER KATIE JOHN CHERYL LOGAN WILLIAM DARCY DARCY JULIE WILLIAM WILLIAM PATRICIA JAMES ROBERT MICHAEL MICHAEL DONNA EMILY MICHELLE CLINT TIM DOUGLAS DOUGLAS GREGORY JAMES ANN CHRISTOPHER RISHONA FLORIAN FLORIAN JOY JULIE PATRICIA PATRICIA PATRICIA RALPH NANCY NANCY STEPHEN AMBER JOHN JOHN YVONNE NEWTON NEWTON NEWTON Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME CONNORS CONRAD CONTI COOK COOK COOK COOK COOK COOK COOK COOK COOK COOK COOK COOK COON COOPER COOPER COPELAND COPELAND COPPICK COPPS CORBIN CORDIAL CORDIAL CORNELIUS CORNELIUS CORNELL CORNETET CORSI CORSI CORSON CORTESE CORTESE CORWIN CORWIN COSGROVE COSGROVE COSGROVE COSTANZO COTTEN COTTEN COTTLE COULTER COURCHESNE COURCHESNE COURCHESNE COUTINHO COUTINHO COUTINHO LICENSE APRN LCPC LCPC MD DO MD MD LAC PHD PT MSPT NP PHD PHD MD MD MD MD MD CRNA PAC MD DC PT MD MD LCPC MD MD MD MD MD MD PT PT MD MD MD MD DO DO PAC PT MD MD MD MD MD MD MEDICAL GROUP ANACONDA PEDIATRICS CONRAD COUNSELING & CONSULTING WESTERN MONTANA MENTAL HEALTH ANESTHESIA ASSOCIATES OF GT FALLS BILLINGS CLINIC MILES CITY KATIE COOK STRUCTURAL MASSAGE & BOD SURGICAL ASSOCIATES SVH DERMATOLOGY TURNING POINT ADDICTION SERVICES WILLIAM COOK PSYCHOLOGICAL OFFICES BILLINGS CLINIC GLACIER COMMUNITY HEALTH CENTER INTERNAL MEDICINE & DIABETES ST JOHN'S LUTHERAN HOSPITAL THE MONTANA CENTER FOR WELLNESS PREMIER FAMILY PRACTICE CORDIAL PHYSICAL THERAPY ANESTHESIA PARTNERS OF MONTANA NORTHERN ROCKIES REGIONAL PAIN CTR WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC WESTERN MONTANA CLINIC WESTERN MONTANA CLINIC COMMUNITY HOSPITAL OF ANACONDA MERCURY STREET MEDICAL SOUND INPT PHYSICIANS AT ST JAMES C & C PHYSICAL THERAPY MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS ORTHO MONTANA PARTNERSHIP HEALTH CENTER PARTNERSHIP HEALTH CENTER ALPINE ORTHOPEDICS & SPORTS MEDICIN VALLEY PHYSICAL THERAPY BITTERROOT CLINIC CONVENIENT CARE CLINIC CORVALLIS FAMILY MEDICINE CARDIAC RHYTHM SERVICES CMC CARDIOLOGY OUTREACH CMC CARDIOLOGY OUTREACH ADDRESS 200 MAIN ST 401 RIVERVIEW 300 N WILLSON AVE STE 3005 401 15TH AVE S STE 109 620 S HAYNES 438 E MENDENHALL STE 2 2900 12TH AVE N #355W 2900 12 AVE N STE 201E 1325 WYOMING ST T-214 FORT MISSOULA 1201 US HWY 10 W STE E 316 E BABCOCK 75 CLAREMONT ST STE A 125 W GRANITE #206 T214 FORT MISSOULA 801 N 29TH ST 519 E MAIN ST 2019 BROADWATER AVE 2600 WILSON ST 2900 12TH AVE N #315 W 350 LOUISANA AVE 245 WINDWARD WAY STE 101 600 MAIN ST 701 W SPRUCE 701 W SPRUCE 2900 12TH AVE N STE 205W 2900 12TH AVE N STE 335W 1315 WYOMING 801 N 29TH ST 500 W BROADWAY 500 W BROADWAY 401 W PENNSYLVANIA 300 W MERCURY 400 S CLARK ST 2119 10TH AVE S 725 6TH AVE E 205 W MAIN ST 300 N WILLSON AVE STE 1003 422 S MAIN 2900 12TH AVE N #140W 323 W ALDER ST 401 W RAILROAD ST 536 S COTTONWOOD RD STE 100 3802 EASTSIDE HWY 1224 W MAIN 1200 WESTWOOD DR STE H 1037 MAIN ST 2827 FORT MISSOULA RD 1101 TEXAS AVE 1208 6TH AVE E CITY ANACONDA GLENDIVE BOZEMAN GREAT FALLS MILES CITY BOZEMAN BILLINGS BILLINGS MISSOULA MISSOULA LIVINGSTON BOZEMAN KALISPELL BUTTE MISSOULA BILLINGS CUT BANK BILLINGS MILES CITY BILLINGS LIBBY KALISPELL DEER LODGE MISSOULA MISSOULA BILLINGS BILLINGS MISSOULA BILLINGS MISSOULA MISSOULA ANACONDA BUTTE BUTTE GREAT FALLS KALISPELL BELGRADE BOZEMAN LIVINGSTON BILLINGS MISSOULA MISSOULA BOZEMAN STEVENSVILLE HAMILTON HAMILTON CORVALLIS MISSOULA DEER LODGE SUPERIOR ZIP 59711 59330 59718 59405 59301 59718 59101 59101 59801 59804 59047 59715 59901 59701 59804 59101 59427 59101 59301 59101 59923 59901 59722 59802 59802 59101 59101 59801 59101 59801 59801 59711 59701 59701 59405 59901 59714 59715 59047 59101 59802 59802 59718 59870 59840 59840 59828 59804 59722 59872 SPECIALTY PEDIATRICS LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED MASSAGE THERAPIST SURGERY GENERAL DERMATOLOGY LICENSED ADDICTION COUNSELOR PSYCHOLOGY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE PSYCHOLOGIST PSYCHOLOGY GERIATRIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY INTERNAL MEDICINE NEUROLOGICAL SURGERY NEUROLOGICAL SURGERY ANESTHESIOLOGY PAIN MANAGEMENT FAMILY PRACTICE CHIROPRACTIC PHYSICAL THERAPY ANESTHESIOLOGY ANESTHESIOLOGY PSYCHOLOGY OPHTHALMOLOGY RHEUMATOLOGY ENDOCRINOLOGY EMERGENCY MEDICINE/TRAUMA GASTROENTEROLOGY HOSPITALIST PHYSICAL THERAPY PHYSICAL THERAPIST OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY INTERNAL MEDICINE INTERNAL MEDICINE FAMILY PRACTICE CARDIOLOGY CARDIOLOGY CARDIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 22 of 256 FIRST NAME NEWTON NEWTON NEWTON NEWTON ANN PHILIP SANDRA SANDRA CARLA SANDRA CAROLYN JESSICA MARLA LORENA JOHN SCOTT ARLENA ARLENA TREVOR COLLEEN COLLEEN SIMON KATHERINE MICHAEL KIRK KIRK EULA PHILIP TANA MARGARET MARGARET CANDACE LYNETTE DAVID DAVID ELISSA COURTNAY COURTNAY SANDRA LINDA LAURA LAURA MICHELLE ELIAD KATHLEEN WILLIAM WILLIAM WILLIAM JEFFREY JEFFREY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME COUTINHO COUTINHO COUTINHO COUTINHO COWLEY COWMEY COX COX COX COX COYLE COZZENS CRAGO CRAIG CRAIG CRAMTON CRANDELL CRANDELL CRANE CRANE CRANE CRAWFORD CREMER VOGEL CREWS CREWS CREWS CRIPPEN CRISSMAN CROMWELL CRONIN CRONIN CROSBY CROSS CROSSLEY CROTEAU CROWE CROWELL CROWELL CRUICKSHANK CRUMMETT CSAPLAR CSAPLAR CUDDY CULCEA CULLEN CULLIS CULLIS CULLIS CUMMINS CUMMINS LICENSE MD MD MD MD PT MD MD MD RD MD MD MD PT LCPC MD PHD LCSW LCSW DC LCSW LCSW PA LCPC MD MD LCPC LCPC PT MD MD LCPC NP PAC MD LCPC MD MD NP LCSW MD MD LCPC MD LCPC MD MD MD LCSW LCSW MEDICAL GROUP CMC CARDIOLOGY OUTREACH CMC CARDIOLOGY OUTREACH EPICENTER THERAPY SERVICES MISSOULA ANESTHESIOLOGY PATHWAYS HEALTH CARE SMHS WESTERN MONTANA CLINIC ST PETERS MEDICAL GROUP BILLINGS CLINIC MISSOULA BONE & JOINT ANACONDA COUNSELING BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR NEW DIRECTIONS CENTER CRANE CHIROPRACTIC WMMHC ST LUKE COMMUNITY CLINIC A MATTER OF COMMUNICATION MARCUS DALY MEMORIAL HOSPITAL INTERMOUNTAIN CHILDRENS HOME MANGER HARRINGTON PHYSICAL THERAPY NOW CARE NOW CARE INTERNAL MEDICINE ASSOCIATES NORTHERN MONTANA MEDICAL GROUP W STEVENSVILLE COMMUNITY MEDICAL CNTR WESTERN MONTANA MENTAL HEALTH CTR HELENA INDIAN ALLIANCE CENTER FOR HEALTHY LIVING FAMILY HEALTH CARE MENTAL HEALTH MATTERS CO CENTER F0R MENTAL HEALTH NEUROLOGY MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE JEFFREY S CUMMINS ADDRESS 126 6TH AVE SW 3800 EASTSIDE HWY 2831 FORT MISSOULA RD #131 2831 FORT MISSOULA RD #131 612 E MAIN ST STE C 2825 STOCKYARD RD BLDG I-200 200 HERITAGE WAY 14 RIVER RD 500 W BROADWAY 211 PARKWAY DR 2550 BRAODWAY 2675 CENTRAL AVE 2360 MULLAN RD STE C 118 E 7TH ST STE 2H 801 N 29TH ST 1315 WYOMING ST 621 1ST AVE S 104 W CUSTER AVE 1400 16TH AVE SW 232 S MAIN ST 706 N 7TH AVE 126 6TH AVE SW #A 8759 TROOPER TRAIL 800 KENSINGTON AVE STE 100 1200 WESTWOOD DR 715 MAIN ST #A 500 S LAMBORN 307 1ST AVE E #21 2525 COLONIAL DR STE B 2901 BROOK ST 500 W BROADWAY 815 E FRONT ST STE 1 2900 12TH AVE N 310W 20 13TH ST 3800 EASTSIDE HWY 300 N WILSON AVE STE 3005 435 N LAST CHANCE GULCH PARKER MEDICAL CLINIC 2223 MISSION WAY 304 GRAND AVE 715 NUCLEUS AVE 1287 BURNS WAY 900 N JACKSON 2800 11TH AVE S STE 23 2006 STADIUM DR STE 103 104 RUFUS LN 126 6TH AVE SW #A 330-6 TRACT LN 902 WYOMING AVE 902 WYOMING AVE CITY RONAN STEVENSVILLE MISSOULA MISSOULA BOZEMAN MISSOULA KALISPELL KALISPELL MISSOULA KALISPELL HELENA BILLINGS MISSOULA ANACONDA BILLINGS MISSOULA GREAT FALLS HELENA GREAT FALLS LIVINGSTON BOZEMAN RONAN BOZEMAN MISSOULA HAMILTON STEVENSVILLE HELENA KALISPELL HELENA MISSOULA MISSOULA MISSOULA BILLINGS HAVRE STEVENSVILLE BOZEMAN HELENA LINCOLN BILLINGS BILLINGS COLUMBIA FALLS KALISPELL HELENA GREAT FALLS BOZEMAN POLSON RONAN SAINT IGNATIUS BILLINGS BILLINGS ZIP 59864 59870 59804 59804 59715 59808 59901 59901 59801 59901 59601 59102 59808 59711 59101 59801 59401 59602 59404 59047 59715 59864 59715 59801 59840 59870 59601 59901 59601 59801 59802 59802 59101 59501 59870 59715 59601 59639 59102 59101 59912 59901 59601 59405 59715 59860 59864 59865 59101 59101 SPECIALTY CARDIOLOGY CARDIOLOGY CARDIOLOGY CARDIOLOGY PHYSICAL THERAPY ANESTHESIOLOGY PSYCHIATRY PSYCHIATRY NUTRITION PROFESSIONAL PSYCHIATRY RHEUMATOLOGY FAMILY PRACTICE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR SURGERY GENERAL PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY HOSPITALIST FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR PHYSICAL THERAPY URGENT CARE PROVIDER URGENT CARE PROVIDER LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR NEUROLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 23 of 256 FIRST NAME KRISTOPHER KARI ROBERT BARBARA EVA EVA KIMBERLY MICHAEL WILLIAM MONA MONA SHANE BRANDON DOROTHY ALAN MELISSA BRENDA CHIMENE RICHARD RICHARD HOLLY ANGELA DAVID ANTHONY KYLE KYLE DOUGLAS MARCY MARCY KATHY ANTHONY ANTHONY ANTHONY DANA KIMBERLY DONALD DONALD DUDLEY PATRICK PATRICK JULIE JULIE REBECCA MICHELE MICHELE SUZANNE SUSAN SUSAN JEFFREY RICH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME CUNNINGHAM CUNNINGHAM CURRENCE CURRY CURRY CURRY CURTIS CURTIS CUSKELLY CUTHBERT CUTHBERT CUTTING CYCHOLL DACAR DACRE DACUMOS PIZARRO DAHL DAHL DAHLEN DAHLEN DAHLKE DAILEY DAINES DAL NOGARE DALE DALE DALTON DALY DALY DAMBERGER DAMICO DAMICO DAMICO DAMRON DAMROW DAMSCHEN DAMSCHEN DANA DANAHER DANAHER DANAHER DANAHER DANFORTH DANICICH DANICICH DANIELL DANIELS DANIELS DANIELS DANIELSON LICENSE MD NP OD MD NP NP MD MD MD MD MD DC MD LCPC MD OD PT MD MD MD PT LCSW MD MD MD MD PA PT PT APRN MD MD MD MD MD MD MD PHD MD MD MD MD MD MD MD MD MD MD MD PT MEDICAL GROUP CENTRAL MONTANA COMM HEALTH CENTER ST PETERS URGENT CARE BILLINGS CLINIC MERCURY STREET MEDICAL ROCKY MOUNTAIN CLINIC LIBBY CLINIC FLATHEAD VALLEY WOMEN'S CENTER THE MONTANA CENTER FOR WELLNESS ORTHO MONTANA PACIFIC CARARACT & LASER INSTITUTE PHYSICAL THRPY SPECIALISTS FLORENCE ADVANCED IMAGING MISSOULA RADIOLOGY ARNOLD PHYISICAL THERAPY BILLINGS ANESTHESIOLOGY ROCKY MOUNTAIN HEART & LUNG ADVANCED IMAGING MISSOULA RADIOLOGY BILLINGS CLINIC MILES CITY VICTOR PHYSICAL THERAPY WILLOW CREEK PHYSICAL THERAPY BRIDGER CLINIC INC ADVANCED IMAGING ADVANCED IMAGING AT CMC MISSOULA RADIOLOGY BILLINGS CLINIC ROCKY MOUNTAIN HEART & LUNG MISSOULA SURGICAL ASSOCIATES WILDHORSE GENERAL SURGERY ADVANCED PAIN CENTERS OF MONTANA MISSOULA ANESTHESIOLOGY PLANNED PARENTHOOD OF MONTANA PLANNED PARENTHOOD OF MONTANA COMMUNITY MEDICAL CENTER PHYSICIANS DIABETES AND ENDOCRINOLOGY ASSOC DIABETES AND ENDOCRINOLOGY ASSOC GLACIER MEDICAL ASSOCIATES ACORN PEDIATRICS BOZEMAN DEAC MEDICAL CLINIC OF BIG SKY ADVANTAGE PHYSICAL THERAPY ADDRESS 406 1ST AVE S 2475 BROADWAY 2499 GABLE RD #3 2800 10TH AVE N 300 W MERCURY ST 435 S CRYSTAL STE 300 601 W SPRUCE #K 500 W BROADWAY 211 E SECOND ST 210 SUNNYVIEW LN #107 245 WINDWARD WAY STE 101 2419 MULLAN RD STE A 3075 N RESERVE #Q 502 S 19TH STE 305 2900 12TH AVE N #140W 1717 4TH ST S 293 RODEO DR #1 1611 ZIMMERMAN TRAIL 2803 S AVE W 3205 RUSSELL ST 251 SADDLE DR 423 CENTRAL AVE 2800 10TH AVE N 350 HERITAGE WAY STE 2100 2803 S AVE 3205 S RUSSELL 620 S HAYNES 2386 HWY 93 N 1016 BROOKS AVE 300 N WILLSON STE 2001 GRANT CREEK TOWN CENTER 2803 S AVE 3205 S RUSSELL 801 N 29TH ST 350 HERITAGE WAY STE 2100 500 W BROADWAY 10 KRUGER RD 815 E FRONT #1 2825 STOCKYARD RD BLDG I-200 2825 STOCKYARD RD BLDG I-200 1844 BROADWATER AVE STE 4 721 N 29TH ST 1211 S RESERVE 1211 S RESERVE ST #202 126 6TH AVE SW 1111 BAKER AVE 280 W KAGY BLVD STE G 915 HIGHLAND BLVD 100 BEAVERHEAD TR 435 S CRYSTAL STE 400 CITY LEWISTOWN HELENA BILLINGS BILLINGS BUTTE BUTTE MISSOULA MISSOULA LIBBY KALISPELL KALISPELL MISSOULA MISSOULA BOZEMAN BILLINGS GREAT FALLS BONNER BILLINGS MISSOULA MISSOULA HELENA FAIRFIELD BILLINGS KALISPELL MISSOULA MISSOULA MILES CITY VICTOR CORVALLIS BOZEMAN MISSOULA MISSOULA MISSOULA BILLINGS KALISPELL MISSOULA PLAINS MISSOULA MISSOULA MISSOULA BILLINGS BILLINGS MISSOULA MISSOULA RONAN WHITEFISH BOZEMAN BOZEMAN BIG SKY BUTTE ZIP 59457 59601 59102 59101 59701 59701 59802 59802 59923 59901 59901 59808 59808 59718 59101 59405 59823 59102 59806 59801 59601 59436 59101 59901 59804 59801 59301 59875 59828 59715 59801 59806 59806 59101 59901 59802 59859 59802 59808 59808 59102 59101 59801 59804 59864 59937 59715 59715 59716 59701 SPECIALTY FAMILY PRACTICE URGENT CARE PROVIDER OPTOMETRIST EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE GASTROENTEROLOGY HOSPITALIST FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE CHIROPRACTIC FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE OPTOMETRY PHYSICAL THERAPY OB/GYN-OBSTETRICS/GYNECOLOGY RADIOLOGY RADIOLOGY PHYSICAL THERAPY SOCIAL WORKER ANESTHESIOLOGY INTERNAL MEDICINE RADIOLOGY RADIOLOGY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE RADIOLOGY RADIOLOGY RADIOLOGY PERINATOLOGY SLEEP STUDIES SURGERY GENERAL SURGERY GENERAL PSYCHOLOGY ANESTHESIOLOGY ANESTHESIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY INTERNAL MEDICINE ENDOCRINOLOGY ENDOCRINOLOGY INTERNAL MEDICINE PEDIATRICS PEDIATRICS FAMILY PRACTICE PHYSICAL THERAPY Montana STATUS PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED 24 of 256 FIRST NAME LIANNA LIANNA GREG MICHELLE KOREY RICH RONALD RONALD JANIE RONALD ANDREA SUSANNA WADE PETER MICHAEL KRISTA DENISE SIMONE WAYNE BRADLEY REBECCA KATHLEEN CLIFFORD PATRICK BRETT VICTOR CHARLES BRADLEY CLIFFORD MARK CLIFF KATHLEEN CARLA CHARLES CHARLES CORY HOWARD MICHELLE PATRICK BLAIR JAMES NAFAA RICHARD SUSAN SUSAN IRENO DOROTHY GINA JOSE MARY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME DANIELSON DANIELSON DANIELSON DANIELSON DANIELSON DANIELSON DARBY DARBY DARBY DARBY DARILEK DARR DARR D'ASCOLI DAUGHERTY DAVID DAVIES DAVION DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVIS DAVISON DAVY DAWAD DAY DAY DAY DE GUZMAN DE HART DE MERS DE SOUZA DE SOUZA LICENSE NP APRN PAC MD PT PT MD MD APRN MD MD APRN DC MD MD MD OT MD MD MD PHD MD PA PHD DO MD MD MD PAC MD PAC LCPC MD MD MD PSYD LCSW LCSW PHD MD DO MD MD PHD PHD CRNA OT CST MD NP MEDICAL GROUP BIGFORK FAMILY PRACTICE BIGFORK HEALTH AND WELLNESS FLATHEAD VALLEY ORTHOPEDICS PARTNERS IN PEDIATRICS ST PETERS HOSPITAL REHABILITATION BILLINGS CLINIC LIVINGSTON MEMORIAL HOSPITAL PARK CLINIC WEST CRAWFORD ROUNDUP MEMORIAL HEALTHCARE BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC MILES CITY SURGERY CLINIC AT NORTH VALLEY HOSP AWARE INC TRACY HAND & OCCUPATIONAL THERAPY BILLINGS CLINIC ADVANCED IMAGING ADVANCED NEUROLOGY SPECIALISTS BEHAVIORAL HEALTH ASSOCIATES BILLINGS CLINIC COMMUNITY HOSPITAL OF ANACONDA DAVIS CONSULTANTS EMERGENCY PHYSICIANS GARDEN WALL CLINIC MARCUS DALY HOSPITAL NORTHERN MONTANA MEDICAL GROUP PONDERA MEDICAL CENTER SIDNEY HEALTH CENTER TETON MEDICAL CENTER WESTERN MONTANA MENTAL HEALTH CTR MARCUS DALY MEMORIAL HOSPITAL ANESTHESIA ASSOCIATES OF GT FALLS MONTANA NEUROSURGERY CENTER CENTRAL MONTANA MEDICAL CENTER SWEET MEDICINE THERAPY NORTHWEST ENDOCRINOLOGY NORTHWEST GASTROENTEROLOGY ADDRESS 191 JEWEL BASIN CRT #2A 191 JEWEL BASIC CT UNIT 2A 111 SUNNYVIEW LN 2525 BROADWAY STE 101 2475 BROADWAY 3031 S RUSSELL ST #5 2800 10TH AVE N 504 S 13TH ST 1315 W CRAWFORD 1202 3RD ST W 2800 10TH AVE N 300 N WILLSON STE 3005 1188 N 15TH AVE UNIT 1 620 S HAYNES 1111 BAKER AVE #2 616 HELENA AVE STE 305 111 SUNNYVIEW LN STE C 2800 10TH AVE N 2803 S AVE W 400 15TH AVE S STE 206 1101 N 27TH ST #201 2675 CENTRAL AVE 401 W PENNSYLVANIA 300 W BROADWAY STE 2 1110 FRONT ST 101 ARROW ST 1200 WESTWOOD DR 20 W 13TH ST 805 SUNSET BLVD 216 14TH AVE SW 915 4TH ST NW 106 W BROADWAY 3075 N RESERVE #Q 1200 WESTWOOD DR 504 S 13TH ST 700 SW HIGGINS AVE #200 535 SADDLE DR 30 FORT MISSOULA RD BOX 10 500 W BROADWAY 902 N ORANGE ST #206 1200 WESTWOOD DR 401 15TH AVE S STE 109 2835 FORT MISSOULA RD STE 202 119 W FRONT #309 119 W FRONT STE 309 408 WENDELL AVE 401 BARRETT ST 500 W BROADWAY #310 1297 BURNS WAY #4 75 CLAREMONT ST STE H CITY BIGFORK BIGFORK KALISPELL HELENA HELENA MISSOULA BILLINGS LIVINGSTON LIVINGSTON ROUNDUP BILLINGS BOZEMAN BOZEMAN MILES CITY WHITEFISH HELENA KALISPELL BILLINGS MISSOULA GREAT FALLS BILLINGS BILLINGS ANACONDA MISSOULA FORT BENTON SAINT IGNATIUS HAMILTON HAVRE CONRAD SIDNEY CHOTEAU BUTTE MISSOULA HAMILTON LIVINGSTON MISSOULA HELENA MISSOULA MISSOULA MISSOULA HAMILTON GREAT FALLS MISSOULA MISSOULA MISSOULA LEWISTOWN DILLON MISSOULA KALISPELL KALISPELL ZIP 59911 59911 59901 59601 59601 59801 59101 59047 59047 59072 59101 59715 59715 59301 59937 59601 59901 59101 59804 59405 59101 59101 59711 59807 59442 59865 59840 59501 59425 59270 59422 59701 59808 59840 59047 59803 59601 59804 59802 59802 59840 59405 59804 59802 59802 59457 59725 59802 59901 59901 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PEDIATRICS PHYSICAL THERAPY PHYSICAL THERAPIST RADIOLOGY RADIOLOGY SURGERY ORTHOPEDIC MEDICINE RADIOLOGY HOSPITALIST PSYCHIATRY CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY GENERAL PSYCHIATRY OCCUPATIONAL THERAPY PATHOLOGY RADIOLOGY NEUROLOGY PSYCHOLOGY ALLERGY/IMMUNOLOGY FAMILY PRACTICE PSYCHOLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE RADIOLOGY NEUROLOGY FAMILY PRACTICE RADIOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE RADIOLOGY RADIOLOGY PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER PSYCHOLOGIST PSYCHIATRY EMERGENCY MEDICINE/TRAUMA ANESTHESIOLOGY SURGERY NEUROSURGERY PSYCHOLOGIST PSYCHOLOGY ANESTHESIOLOGY OCCUPATIONAL THERAPY SURGICAL TECHNOLOGIST ENDOCRINOLOGY GASTROENTEROLOGY Montana STATUS SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED 25 of 256 FIRST NAME MARY JOHN EDWARD BONNIE GORDAN VICKI VICKI KARI GABRIELLA DONALD DONALD BRENDA THOMAS MARK MARY FRED DONNA SCOTT DAVID DAVID JAMES JOHN BRANDT TERESA PENNY DEL LORRI CAROL TIMOTHY PATTI AARON ERIC LEONARD LAUREL JOSE DEVIN ADAM TRACY TIMOTHY TIMOTHY RICHARD ELLEN MICHAEL MICHAEL CHAD LAURA ROB CHARLOTTE JOAN ROGER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME DE SOUZA DEA DEAN DEAN DEAN DEBOER DEBOER DEBOO DECKE DECKER DECKER DEGRAZIO DEHOOP DEIBERT DEIGERT DELEPPER DELICH DEMARS DEMEY DEMEY DEMING DENEGRE DENNEHY DENNEY DENNING DENTON DENTON DERBY DERNBACH DEROSA DERRY DESETH DESMUL DESNICK DESOUZE DESPAIN DEUTCHMAN DEVALL DEVRIES DEVRIES DEWEY DEWOLFE DICELLO DICELLO DICKEMORE DICKERSON DICKEY DICKSON DICKSON DIEGEL LICENSE NP NP MD MD DC LCSW LAC LCSW LAC NP PAC MD MD CNMW MD MD PAC PT LCSW DPM DC DC PSYD MD OD MD PAC LAC LCPC LAC MD LCPC PA-C OT MD MD MD OD MD PT PAC PAC MD APRN MD MD DPM LAC LCPC LCPC MD MD MEDICAL GROUP NORTHWEST MONTANA SURGICAL ASSOC SYNERGY MEDICAL CARE MONTANA HEART INSTITUTE PHYSICAL MEDICINE CLINIC BOULDER MEDICAL CLINIC ADVANCED CARE HOSPITAL OF MONTANA NORTH VALLEY ANESTHESIOLOGY MISSOULA OB-GYN ASSOCIATES KALISPELL OBGYN ALPINE ORTHOPEDICS & SPORTS MEDICIN BILLINGS CLINIC DELEPPER PHYSICAL THERAPY COMMUNITY HEALTH PARTNERS RIMROCK PODIATRY PSYCHOLOGY SERVICES BILLINGS CLINIC TETON MEDICAL CENTER GABERT MEDICAL CLINIC DENTON COUNSELING SERVICES BOYD ANDREWS COMMUNITY SERVICES CARDIOVASCULAR & THORACIC SURGEONS ACADIA MONTANA SILVERTIP EMERGENCY PHYSICIANS COMMUNITY HEALTH PARTNERS ROCKY MOUNTAIN CLINIC BILLINGS FAMILY EYECARE MISSOULA SURGICAL ASSOCIATES VALLEY PHYSICAL THERAPY BRIDGER ORTHOPEDICS FLATHEAD VALLEY ORTHOPEDIC CENTER NORTHERN ROCKIES NEUROSURGICAL ALLERGY & ASTHMA CONSULTANTS OF MT ALLERGY & ASTHMA CONSULTANTS OF MT BITTERROOT FOOT & ANKLE CLINIC DICKERSON COUNSELING TAMARACK MEDICAL CLINIC ADDRESS 1273 BURNS WAY 1110 FRONT ST 2900 12TH AVE N #204E 2900 12TH AVE N STE 400E 128 9TH AVE N 205 HAGGERTY LN #250 219 E MAIN 214 S MAIN 3528 GABEL RD 1600 HOSPITAL WAY 6575 HWY 93 S 2825 FORT MISSOULA RD STE 217 210 SUNNYVIEW LN STE 201 536 S COTTONWOOD RD STE 100 801 N 29TH ST 40 2ND ST E STE 222 126 S MAIN 1690 RIMROCK RD #L 950 N MONTANA 950 N MONTANA AVE 935 HIGHLAND BLVD STE 2150 1020 N 27TH ST 2410 AMHERST 915 4TH ST NW 107 DILWORTH ST 404 N 31ST ST STE 106 404 N 31ST STE 106 60 S LAST CHANCE GULCH 2900 12TH AVE N STE 502E 55 BASIN CREEK RD 500 W BROADWAY 2600 WILSON STE 1 310 SUNNYVIEW LN 126 S MAIN 1101 S MONTANA 1540 LAKE ELMO DR STE 1 500 W BROADWAY 3802 EASTSIDE HWY 1450 ELLIS ST STE 201 111 SUNNYVIEW LN 350 HERITAGE WAY #1300 900 N ORANGE #301 2055 N 22ND AVE STE 1 402 S ALABAMA ST STE 6A 330 N 10TH ST STE B 2302 HWY 2E STE 7 616 HELENA AVE STE 301 321 E MAIN #317 2600 WILSON ST 150 COMMONS WAY CITY KALISPELL FORT BENTON BILLINGS BILLINGS FORSYTH BOZEMAN ENNIS BOULDER BILLINGS WHITEFISH WHITEFISH MISSOULA KALISPELL BOZEMAN BILLINGS KALISPELL LIVINGSTON BILLINGS HELENA HELENA BOZEMAN BILLINGS BUTTE CHOTEAU GLENDIVE BILLINGS BILLINGS HELENA BILLINGS BUTTE MISSOULA MILES CITY KALISPELL LIVINGSTON BUTTE BILLINGS MISSOULA STEVENSVILLE BOZEMAN KALISPELL KALISPELL MISSOULA BOZEMAN BUTTE HAMILTON KALISPELL HELENA BOZEMAN MILES CITY KALISPELL ZIP 59901 59442 59101 59101 59327 59715 59729 59632 59102 59937 59937 59804 59901 59718 59101 59901 59047 59102 59601 59601 59715 59101 59701 59422 59330 59101 59101 59601 59101 59701 59802 59301 59901 59047 59701 59105 59802 59870 59715 59901 59901 59802 59718 59701 59840 59901 59601 59718 59301 59901 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE CARDIOLOGY PHYSICAL MEDICINE REHABILITATION CHIROPRACTIC SOCIAL WORKER SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY ORTHOPEDIC MEDICINE HEMATOLOGY-ONCOLOGY PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER PODIATRY CHIROPRACTIC CHIROPRACTOR PSYCHOLOGY PSYCHIATRY OPTOMETRIST EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED ADDICTION COUNSELOR SURGERY CARDIOVASCULAR THORACIC LICENSED BEHAVIORAL COUNSELOR PHYSICIAN ASSISTANT OCCUPATIONAL THERAPY EMERGENCY MEDICINE/TRAUMA INTERNAL MEDICINE INTERNAL MEDICINE OPTOMETRY SURGERY GENERAL PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE SURGERY NEUROSURGERY PSYCHIATRY ALLERGY/IMMUNOLOGY ALLERGY/IMMUNOLOGY PODIATRY LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE RHEUMATOLOGY Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 26 of 256 FIRST NAME WANDA HEATH DENNIS LISA LISA NICK SUSAN GARY TRACY CONNIE MIRI SUSAN DARRIN CHARLES CHARLES MICHAEL BRYCE AUTUMN AUTUMN ALANE KATHERINE BRENT JENIFER MARK BRENNAN LORINDA JULIE KEVIN PAUL EUGEN WILLIAM KATHRYN KATHRYN KATHLEEN COE PHILLIP JOHN JOHN DAVID BETH BETH APRIL JANELLE JANELLE APRIL JANELLE TIMOTHY KAREN JOHN STEPHANIE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME DIEKHANS DIEL DIETRICH DIGHANS DIGHANS DIGIOVINE DILATUSH DILDY III DILL DILTS DISNEY FALLER DITCHEYHELLEMS DIXON DIXON DIXON DIXON DOAK DOBBS DOBBS DOBIE DOBIE DODGE DODGE DODSON DODSON DOEDE DOERNER DOHR DOKEY DOLAN DOLAN DOLESE DOLESE DOLEZAL DOLVEN DONAHUE DONALD DONALD DONALDSON DONE DONE DONOVAN DONOVAN DONOVAN DONOVAN DONOVAN DONOVAN DORN DORR DOSTER LICENSE LCPC MD MD NP NP MD DC MD MD LCPC PT CNMW CRNA MD MD MD PAC LAC LAC SLT MD PT MD MD MD APRN APRN PHD LCSW MD PT PT PT APRN LCPC NP LCSW LCSW LAC LAC LAC APRN MD MD NP MD MD MD MD OT MEDICAL GROUP GOOD GRIEF COUNSELING ANESTHESIA ASSOCIATES OF GT FALLS ADVANCED NEUROLOGY SPECIALISTS HOLY ROSARY HEALTHCARE CLINIC MONTANA ORTHOPEDICS PERI & NEONATAL SERVICES AT KRMC MARCUS DALY MEMORIAL HOSPITAL BACK ON TRACK PHYSICAL THERAPY HELENA OBGYN ASSOCIATES BENEFIS HEALTHCARE PRACTITIONERS FAMILY HEALTH CARE FAMILY HEALTH CARE HELENA EAR NOSE & THROAT CLINIC ORTHO MONTANA CMC OUTPATIENT THERAPIES GALLATIN VALLEY ANESTHESIA ASSOC ALPINE PHYSICAL THERAPY ST PETERS MEDICAL GROUP BENEFIS ONCOLOGY ASSOCIATES BRIDGER EAR NOSE & THROAT BRIDGER CLINIC SULLIVAN SPEECH-LANGUAGE ASSOCIATES WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC BILLINGS CLINIC VALLEY PHYSICAL THERAPY VALLEY PHYSICAL THERAPY SYNERGY MEDICAL CARE WESTERN MONTANA ADDICTION SERVICES WESTERN MONTANA ADDICTION SERVICES BILLINGS CLINIC NOW CARE NOW CARE BOZEMAN DEACONESS HEALTH GROUP ORTHO MONTANA EASTER SEALS ADDRESS 410 CENTRAL STE 602 401 15TH AVE S STE 109 400 15TH AVE S STE 206 2600 WILSON ST 818 2ND AVE EAST 435 S CRYSTAL STE 400 1015 MOUNT AVE 310 SUNNYVIEW LN 1200 WESTWOOD DR 902 WYOMING AVE 3031 S RUSSELL HEALTH OPTIONS PLAZA 45 MEDICAL PARK DR 1101 26TH ST S 1287 BURNS WAY 715 NUCLEUS AVE 2525 E BROADWAY STE 105 2900 12TH AVE NORTH 1245 N 29TH ST 5 E 9TH ST 2827 FORT MISSOULA RD 915 HIGHLAND BLVD 2965 STOCKYARD RD 3150 N MONTANA STE A 1117 29TH ST S 1648 ELLIS ST STE 301 300 N WILLSON STE 2001 720 STONERIDGE STE 1 128 S 6TH ST W 1315 WYOMING ST 801 N 29TH ST 2702 8TH AVE N 1001 SW HIGGINS STE 205 2105 BOW 616 HELENA AVE STE 301 825 W KENT 1110 FRONT ST 800 KENSINGTON 800 KENSINGTON 1325 WYOMING ST 1325 WYOMING ST 103 BEDFORD ST 2800 10TH AVE N 2901 BROOKS ST 500 W BROADWAY 1844 BROADWATER AVE #4 500 W BROADWAY 500 W BROADWAY 905 HIGHLAND BLVD STE 4500 2900 12TH AVE N #100E 1537 AVE D STE 150 CITY GREAT FALLS GREAT FALLS GREAT FALLS MILES CITY CULBERTSON BUTTE MISSOULA KALISPELL HAMILTON BILLINGS MISSOULA HELENA GREAT FALLS KALISPELL COLUMBIA FALLS HELENA BILLINGS BILLINGS RED LODGE MISSOULA BOZEMAN MISSOULA HELENA GREAT FALLS BOZEMAN BOZEMAN BOZEMAN MISSOULA MISSOULA BILLINGS BILLINGS MISSOULA MISSOULA HELENA MISSOULA FORT BENTON MISSOULA MISSOULA MISSOULA MISSOULA HAMILTON BILLINGS MISSOULA MISSOULA BILLINGS MISSOULA MISSOULA BOZEMAN BILLINGS BILLINGS ZIP 59401 59405 59405 59301 59218 59701 59801 59901 59840 59102 59801 59601 59405 59901 59912 59601 59101 59101 59068 59804 59715 59808 59601 59405 59715 59715 59718 59801 59801 59101 59101 59803 59801 59601 59801 59442 59801 59801 59801 59801 59840 59101 59801 59801 59102 59802 59802 59715 59101 59102 SPECIALTY LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY NEUROLOGY FAMILY PRACTICE NURSE PRACTITIONER SURGERY ORTHOPEDIC MEDICINE CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY HOSPITALIST LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY OB/GYN-OBSTETRICS/GYNECOLOGY ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE EAR/NOSE/THROAT (ENT) SURGERY ORTHOPEDIC MEDICINE ADDICTION COUNSELOR ADDICTION COUNSELOR SPEECH/LANGUAGE THERAPY ANESTHESIOLOGY PHYSICAL THERAPY FAMILY PRACTICE RADIATION ONCOLOGY EAR/NOSE/THROAT (ENT) FAMILY PRACTICE SPEECH/LANGUAGE THERAPY PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER SURGERY NEUROSURGERY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER ADDICTIONNICOTINECOUNSELOR ADDICTIONNICOTINECOUNSELOR ADDICTION COUNSELOR HOSPITALIST URGENT CARE PROVIDER URGENT CARE PROVIDER FAMILY PRACTICE INTERNAL MEDICINE EMERGENCY MEDICINE HOSPITALIST SURGERY ORTHOPEDIC MEDICINE OCCUPATIONAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 27 of 256 FIRST NAME LOIS SARSFIELD SARSFIELD CARA SAMUEL MARGARET NANETTE DANIEL DAVID KELLY TROY TROY DARCI WILLIAM KATE CHRISTA MARY KIRSTEN STEPHANIE JOHANNA JOHANNA HEIDI HEIDI ERIC EVELYN CHRISTINE CHRISTINE GEORGE NOEL NOEL JOHN JOHN LESLEY MICHAEL STEPHANIE LORI COURTNEY DANA DANA BARBARA LASS TERESA PATRICK JENNELL ERIKA ERIKA SHELLEY SHELLEY SHELLEY ELLA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME DOUBLEDAY DOUGHERTY DOUGHERTY DOUGLASS DOUGLASS DOW DOWLING DOWNEY DOWNEY DOWNING DOXEY DOXEY DOYLE DOYLE DOYLE DRAB DRAKE DRAKE DRAPER DREILING DREILING DRESCHER DRESCHER DRINGMAN DRISCOLL DRIVDAHL SMITH DRIVDAHL-SMITH DRUGAS DRURY DRURY DRYE DRYE DUBAY DUBE DUBRAVAC DUCHENE DUCHIN DUCOTE DUCOTE DUDCZAK DUDLEY DUDZINSKI DUEY DUEY DUFFY DUFFY DUGAN DUGAN DUGAN DUGAN-LAEMMIE LICENSE LCPC MD MD DO MD MD DO MD MD LCSW DC DC SLT MD MD SLT MD PAC MD MD MD PA PA-C MD MD MD MD MD MD MD MD MD LAC MD MD DC LCPC MD MD MD LCPC PAC MD MD NP NP PAC PAC PAC LCPC MEDICAL GROUP BLUE MOUNTAIN CLINIC ADVANCED IMAGING MISSOULA RADIOLOGY BENEFIS PHYSICIAN ASSOCIATES EMERGENCY PHYSICIANS NORTHERN MONTANA HOSPITAL DOXEY CHIROPRACTIC BILLINGS CLINIC WEST MARCUS DALY MEMORIAL HOSPITAL SIDNEY HEALTH CENTER ABSORKA EMERGENCY PHYSICIANS SURGICAL ASSOCIATES CENTER FOR MENTAL HEALTH BILLINGS CLINIC MILES CITY PEDIATRIC SURGERY OF MONTANA ADULT MENTAL HEALTH SERVICES PATHWAYS HEALTH CARE HOT SPRINGS FAMILY MEDICINE PLAINS FAMILY MEDICINE LAKE COUNTY CHEMICAL DEPENDENCY GREAT FALLS ORTHOPEDIC ASSOC BOZEMAN OB/GYN COMMUNITY HEALTH PARTNERS BIGFORK MEDICAL CLINIC BIGFORK MEDICAL CLINIC BILLINGS CLINIC BOZEMAN URGENT CARE BILLINGS ANESTHESIOLOGY BILLINGS CLINIC WEST CENTRAL MONTANA FP SVH WALK-IN CLINIC KALISPELL DIAGNOSTIC SERVICES ROCKY MOUNTAIN HEART & LUNG THE MONTANA CENTER FOR WELLNESS BILLINGS CLINIC ADDRESS 610 N CALIFORNIA 2803 S AVE 3205 RUSSELL ST 400 13TH AVE S STE 206 1110 FRONT ST 30 13TH ST 902 N ORANGE ST #206 30 HWY 91 S STE 106 5549 OLD HWY 93 111 N LAST CHANCE GULCH STE 2A 16332 BECKWITH 2330 S HIGGINS AVE #100 2675 CENTRAL AVE 1200 WESTWOOD DR 216 14TH AVE SW 612 E MAIN ST STE C 915 HIGHLAND BLVD 124 13TH ST 500 W BROADWAY 500 W BROADWAY 5549 OLD HWY 93 2831 FORT MISSOULA RD #303 500 W BROADWAY 2900 12TH AVE N #355W PO BOX 3089 620 S HAYNES 818 2ND AVE EAST 2835 FT MISSOULA RD #301 410 WINDWARD WAY 200 HERITAGE WAY 209 MAIN ST 10 KRUGER RD 802 AOM ST STE C 1401 25TH ST S 925 HIGHLAND BLVD STE 1210 1001 E PARK AVE 214 E MENDENHALL ST 8299 HWY 35 8299 MONTANA HWY 35 1020 N 27TH ST 612 E MAIN STE B 1006 W MAIN 2800 10TH AVE N 2675 CENTRAL AVE 505 W MAIN ST STE 108 1233 N 30TH ST 135 COMMONS WAY 350 HERITAGE WAY STE 2100 245 WINDWARD WAY STE 101 801 N 29TH ST CITY MISSOULA MISSOULA MISSOULA GREAT FALLS FORT BENTON HAVRE MISSOULA DILLON FLORENCE HELENA FRENCHTOWN MISSOULA BILLINGS HAMILTON SIDNEY BOZEMAN BOZEMAN HAVRE MISSOULA MISSOULA FLORENCE MISSOULA MISSOULA BILLINGS GREAT FALLS MILES CITY CULBERTSON MISSOULA KALISPELL KALISPELL HOT SPRINGS PLAINS POLSON GREAT FALLS BOZEMAN ANACONDA BOZEMAN BIGFORK BIGFORK BILLINGS BOZEMAN BOZEMAN BILLINGS BILLINGS LEWISTOWN BILLINGS KALISPELL KALISPELL KALISPELL BILLINGS ZIP 59802 59804 59801 59405 59442 59501 59802 59725 59833 59601 59834 59801 59101 59840 59270 59715 59715 59501 59802 59802 59833 59804 59802 59101 59403 59301 59218 59804 59901 59901 59845 59859 59860 59405 59715 59711 59715 59911 59911 59101 59715 59715 59101 59102 59457 59101 59901 59901 59901 59101 SPECIALTY LICENSED BEHAVIORAL COUNSELOR RADIOLOGY RADIOLOGY INTERNAL MEDICINE EMERGENCY MEDICINE/TRAUMA OB/GYN-OBSTETRICS/GYNECOLOGY PSYCHIATRY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC CHIROPRACTOR SPEECH/LANGUAGE THERAPY EMERGENCY MEDICINE/TRAUMA RADIOLOGY SPEECH/LANGUAGE THERAPY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE HOSPITALIST FAMILY PRACTICE FAMILY PRACTICE GASTROENTEROLOGY PHYSICIAN ASSISTANT SURGERY GENERAL PSYCHIATRY FAMILY PRACTICE FAMILY PRACTICE PEDIATRIC SURGERY PSYCHIATRY PSYCHIATRY FAMILY PRACTICE FAMILY PRACTICE ADDICTIONNICOTINECOUNSELOR SURGERY ORTHOPEDIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY CHIROPRACTOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE GENERAL PRACTICE CARDIOLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE CARDIOLOGY PAIN MANAGEMENT LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 28 of 256 FIRST NAME ELLA JEFFREY SCOTT JENNIFER TIMOTHY HEIDI DOUGLAS MAREN CHRISTINA KEE LINDA LINDA RACHEL MELANIE ANGELA GILBERT LORI CARSON JENNIFER PADY JAMES BASKAR KEVIN KEVIN KRISTINA ANTHONY MICHELLE BENNETT JEAN-PAUL ELIZABETH JAMI JAMIE ANNA MICHAEL JOLEEN TAMMIE CHARLOTTA CHARLOTTA JULIA ANNE TREVOR ARTURO EEVA STEVEN MARY KENNETH JENNIE MARGARET KENNETH JAMES Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME DUGAN-LAEMMLE DUKEMAN DULL DULL DUMONTIER DUNCAN DUNHAM DUNN DUNN DUNNING DUPREE DUPREE DUPUY DURAN DURDEN DURITZ DUROCHER DURR DURWARD DUSING DUSING DUVAL DUWE DUWE DWYER DYE DYKMAN DYKSTRA DYM DYRDAHL EADS EADS EARL EASTMAN EASTMAN-SPANG EASTON EATON EATON EATON EBY ECCLES ECHEVERRI ECHEVERRI ECKLUND ECKMANN ECKSTEIN ECKSTROM EDDY EDEN EDLIN LICENSE LCPC PAC MD OD MD MD DO DO PAC LCPC PAC PAC MD LCPC MD MD NP DC NP CNMW MD MD MD MD LCPC MD SLT MD MD LCPC LCPC LCPC MD PAC LAC LCPC MD MD LCPC NP PT MD MD MD DC MD MD MD MD MD MEDICAL GROUP FLATHEAD VALLEY ORTHOPEDICS BILLINGS CLINIC HEIGHTS EYECARE INC NORTHWEST ORTHOPEDIC & SPORTS MEDIC BILLINGS CLINIC WEST COMMUNITY HOSPITAL OF ANACONDA GALLATIN FAMILY MEDICINE SOUTH HILLS INTERNAL MEDICINE DUNNING COUNSELING & CONSULTING SWEET MEDICAL CENTER SWEET MEDICAL CENTER CROSSROADS COUNSELING YELLOWSTONE PATHOLOGISTS BENEFIS PHYSICIAN ASSOCIATES GREAT FALLS OB/GYN ASSOC BOZEMAN BACK & NECK CLINIC NORTHERN MONTANA HOSPITAL FLATHEAD VALLEY WOMENS CENTER NORTH VALLEY HOSPITAL BILLINGS CLINIC ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY SUNRISE CITY COUNSELING BILLINGS ANESTHESIOLOGY MOSAIC NORTHWEST MONTANA SURGICAL ASSOCIATES SIDNEY HEALTH CENTER EASTERN MONTANA COMMUNITY MHC ACADIA MONTANA LIBERTY MEDICAL CENTER EASTON COUNSELING & CONSULTING CENTER FOR HEALTHY LIVING PALLIATIVE CARE SERVICES WMMHC COGENT HEALTHCARE OF MONTANA KALISPELL REHABILITATION ASSOC NEUROLOGY ASSOCIATES BOZEMAN RHEUMATOLOGY ECKMANN FAMILY CHIROPRACTIC CENTER MARCUS DALY MEMORIAL HOSPITAL GLACIER MEDICAL ASSOCIATES MEDICAL SPECIALISTS OF HELENA MEDICAL IMAG ASSOC OF IDAHOL FALLS ADDRESS 1001 S 24TH ST W 111 SUNNYVIEW LN 801 N 29TH ST 430 LAKE ELMO DR 350 HERITAGE WAY #1200 2675 CENTRAL AVE 401 W PENNSYLVANIA 18 MEADOW VILLAGE DR 301 SADDLE DR 3021 6TH AVE N STE 110 116 S MAIN 419 PENNSYLVANIA 6 - 13TH AVE E 726 HWY 10 WEST 2900 12TH AVE N 295W 1101 26TH ST S 1522 9TH ST S 120 N 19TH AVE STE B 30 13TH ST 210 SUNNYVIEW LN #107 1600 HOSPITAL WAY 801 N 29TH ST 905 HIGHLAND BLVD STE 400 925 HIGHLAND BLVD STE 1180 919 S LINCOLN AVE 401 N 31ST STE 1260 6325 JACKRABBIT LN STE A 1273 BURNS WAY 216 14TH AVE SW 2508 WILSON 55 BASIN CREEK RD 306 MONTANA AVE 418 W MONROE 200 CONWAY DR 422 WILLOW 3021 6TH AVE N STE 110 2223 MISSION WAY 1233 N 30TH ST 232 S MAIN ST 1101 26TH ST S 1234 WHITEFISH STAGE RD 2900 12TH AVE N #402E 208 N 29TH ST #216 1925 N 22ND AVE 103 900 N MONTANA AVE #B2 1200 WESTWOOD DR 1111 BAKER AVE 500 W BROADWAY 2525 BROADWAY STE 200 310 SANSOME ST CITY BILLINGS KALISPELL BILLINGS BILLINGS KALISPELL BILLINGS ANACONDA BIG SKY HELENA BILLINGS HARLEM CHINOOK POLSON LIVINGSTON BILLINGS GREAT FALLS GREAT FALLS BOZEMAN HAVRE KALISPELL WHITEFISH BILLINGS BOZEMAN BOZEMAN SIDNEY BILLINGS BELGRADE KALISPELL SIDNEY MILES CITY BUTTE DEER LODGE CHESTER KALISPELL COLSTRIP BILLINGS BILLINGS BILLINGS LIVINGSTON GREAT FALLS KALISPELL BILLINGS BILLINGS BOZEMAN HELENA HAMILTON WHITEFISH MISSOULA HELENA PHILIPSBURG ZIP 59102 59901 59101 59105 59901 59102 59711 59716 59601 59101 59526 59523 59860 59047 59101 59405 59405 59718 59501 59901 59937 59101 59715 59715 59270 59101 59714 59901 59270 59301 59701 59722 59522 59901 59323 59101 59102 59101 59047 59405 59901 59101 59102 59718 59601 59840 59937 59802 59601 59858 SPECIALTY PROFESSIONAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE SURGERY GENERAL OPTOMETRY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE SURGERY LICENSED BEHAVIORAL COUNSELOR PATHOLOGY PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY CHIROPRACTIC PSYCHIATRY OB/GYN-OBSTETRICS/GYNECOLOGY EMERGENCY MEDICINE/TRAUMA INTERNAL MEDICINE RADIOLOGY RADIOLOGY LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY SPEECH/LANGUAGE THERAPY SURGERY GENERAL RADIOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PAIN MANAGEMENT ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PHYSICAL THERAPY NEUROLOGY PSYCHIATRY RHEUMATOLOGY CHIROPRACTIC EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE NEPHROLOGY GASTROENTEROLOGY RADIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 29 of 256 FIRST NAME JAMES KARLA KEITH TERRY KEITH KEITH MARK STEVEN ALFRED ERIC QUESTA SHELLY COLLEEN RONALD RONALD BEN DONALD PAULA KRISTY KEVIN JERROLD JERROLD RHONDA PAUL PAUL JUSTIN JUSTIN REBECCA ABDALLAH LANCE LANCE MARK SARAH MARK JAMES DEBORAH DEBORAH RANDI CHARLES WILLIAM JESSICA ALICE SCOTT THOMAS DOUGLAS HEIDI KERRIE JAN MICHAEL MICHAEL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME EDLIN EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EDWARDS EGAN EGAN EGAN EGGLESTON EHRLICH EHRMANTRAUT EHRMANTRAUT EICHHORN EICHNER EICHNER EICKHOLT EIKENS EIKENS EISEL EISEL ELGER ELIAS ELLER ELLER ELLIOTT ELLIOTT ELLIOTT ELLIOTT ELLIOTT-PEARSON ELLIOTT-PEARSON ELLIS ELLIS ELLIS ELLIS ELROD ELROD ELSEMORE ELSON ELWOOD EMERICK EMERSON EMERSON EMERSON LICENSE MD PT MD MD MD MD CRNA LCSW PT NP OT LCSW NP MD MD MD MD LCPC PAC MD MD APRN MD MD MD MD LCSW MD LAC LAC MD SLT MD MD MD MD PAC MD MD CNMW DC MD APRN MD LCSW MD LCPC LCPC LCPC MEDICAL GROUP MEDICAL IMAGING ASSOCIATES ADVANCED PERFORMANCE & REHAB INTERMOUNTAIN IMAGING CENTER MEDICAL ASSOCIATES MONTANA INTERVENTIONAL & DIAG RADIOLOGY ST JAMES HEALTHCARE ST JOHN'S LUTHERAN HOSPITAL WMMHC DEAN CREEK COMMUNITY CLINIC MONTANA INTERVENTIONAL & DIAG RADIOLOGY SIDNEY HEALTH CENTER MISSOULA ANESTHESIOLOGY COUNSELING SOLUTIONS WHITEFISH PLASTIC SURGERY GREAT FALLS CLINIC NORTHERN MONTANA HOSPITAL ADVANCED IMAGING MISSOULA RADIOLOGY COMMUNITY HEALTH PARTNERS GALLATIN COMMUNITY CLINIC PARTNERSHIP HEALTH CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER ADVANCED IMAGING CMC PHYSICAL THERAPY & REHAB MISSOULA RADIOLOGY ORTHO MONTANA LIVINGSTON MEMORIAL HOSPITAL BILLINGS CLINIC CENTER FOR MENTAL HEALTH SOUND INPATIENT PHYSICIANS WOMEN'S HEALTHCARE CENTER PACIFIC CATARACT & LASER INSTITUTE ABSORKA EMERGENCY PHYSICIANS WMMHC YELLOWSTONE PATHOLOGISTS PC ADDRESS 90 HWY 91 S 1532 ELLIS ST STE 201 435 S CRYSTAL ST STE 250 935 HIGHLAND BLVD STE 2200 2475 BROADWAY 400 S CLARK ST 305 LOUISIANA 1315 WYOMING 3511 1ST AVE N 3050 MT HWY 83 N 126 COTTONWOOD RD 111 N LAST CHANCE GULCH STE 2A 522 DEAN CREEK RD 2475 BROADWAY PO BOX 4819 216 14TH AVE SW 2825 STOCKYARD RD BLDG I-200 18 N 8TH 5850 HWY 93 S 500 W BROADWAY 20 13TH ST 30 13TH ST 520 PATTEE ST NORTH 2803 S AVE 3205 RUSSELL ST 126 S MAIN ST 214 E MENDENHALL T9 FT MISSOULA RD 323 W ALDER ST 212 WENDELL 212 WENDELL 2803 S AVE 2827 FORT MISSOULA RD 3205 RUSSELL ST 2900 12TH AVE N STE 140W 504 S 13TH ST 504 S 13TH ST 2702 8TH AVE N 915 1ST AVE SO 400 S CLARK ST 2525 E BROADWAY ST STE 204 343 HWY 93 N 125 BANK ST #310 1717 4TH ST S 915 HIGHLAND BLVD 405 BROOKLYN AVE 2900 12TH AVE N STE 295W 2023 STADIUM DR STE 2B 11 FRIENDSHIP LN #202 11 FRIENDSHIP LN STE 202 CITY DILLON BOZEMAN BUTTE BOZEMAN HELENA BUTTE LIBBY MISSOULA GREAT FALLS SEELEY LAKE CARDWELL HELENA LAVINA HELENA HELENA SIDNEY MISSOULA MILES CITY WHITEFISH MISSOULA HAVRE HAVRE MISSOULA MISSOULA MISSOULA LIVINGSTON BOZEMAN MISSOULA MISSOULA LEWISTOWN LEWISTOWN MISSOULA MISSOULA MISSOULA BILLINGS LIVINGSTON LIVINGSTON BILLINGS GREAT FALLS BUTTE HELENA EUREKA MISSOULA GREAT FALLS BOZEMAN SUPERIOR BILLINGS BOZEMAN MONTANA CITY MONTANA CITY ZIP 59725 59715 59701 59715 59601 59701 59923 59801 59401 59868 59721 59601 59046 59601 59604 59270 59808 59301 59937 59802 59501 59501 59802 59804 59801 59047 59715 59804 59802 59457 59457 59802 59804 59801 59101 59047 59047 59101 59405 59701 59601 59917 59802 59405 59715 59872 59101 59715 59634 59634 SPECIALTY RADIOLOGY PHYSICAL THERAPY RADIOLOGY FAMILY PRACTICE RADIOLOGY RADIOLOGY ANESTHESIOLOGY LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPIST NURSE PRACTITIONER OCCUPATIONAL THERAPY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE RADIOLOGY RADIOLOGY RADIOLOGY ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR SURGERY PLASTIC/RESTORATIVEBURN EMERGENCY MEDICINE PULMONARY DISEASES PULMONARY DISEASES PSYCHIATRY RADIOLOGY RADIOLOGY FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR RADIOLOGY SPEECH/LANGUAGE THERAPY RADIOLOGY SURGERY ORTHOPEDIC MEDICINE EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PSYCHIATRY HOSPITALIST CERTIFIED NURSE MIDWIFE CHIROPRACTOR PSYCHIATRY ANESTHESIOLOGY EMERGENCY MEDICINE/TRAUMA LICENSED CLINICAL SOCIAL WORKER PATHOLOGY LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 30 of 256 FIRST NAME DALE CAROL CHAD DAVID ANDERS ALISSA KARY MICHAEL DAWN DAWN DAWN DAWN MARGARET DAWN SUSAN CATHRYN CATHRYN DIANE EDWARD PATRICIA PATRICIA BLAIR EDWARD LANCE DONALD KARA JAY LILA TONJA SALLY KRISTI JEFFREY LARRY LARRY NANCY JAMI JOY DAVID C JANE JOHN JODEE SHAHIN THERESE BLAINE KELLY MARILYN WILLIAM DIANE MEGAN KRISTIN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME EMERY ENDERLE ENGAN ENGBRECHT ENGDAHL ENGEL ENGLE ENGLEHART ENGLISH ENGLISH ENGLISH ENGLISH ENGLISH ENGLISH ENGLISH ENGLISH-STRAUB ENGLISH-STRAUB EODICE EQUIBEL ERA ERA ERB ERBE ERCANBRACK ERICKSEN ERICKSON ERICKSON ERICKSON ERICKSON ERICKSON RYE ERICKSON-ROBERTS ERNST ERPENBACH ERPENBACH ERREBO ESCHLER ESHLEMAN ESMAIL ESTELLE ETCHART ETCHART ETEBAR ETTEL ETZEL ETZELL EULER EVANS EVANS EVANS EVANS LICENSE MD NP MD MD MD LCPC PAC MD LCSW LCSW LCSW LCSW LCSW LCSW MD LCSW LCSW DO LCSW APRN APRN MD MD MD MD PA MD PAC LCPC LCPC PHD PA OD OD PSYD MD PAC MD LCPC PAC PA-C MD PSYD PAC PA-C LCSW LCSW NP MD LCSW MEDICAL GROUP BILLINGS CLINIC HEIGHTS GREAT FALLS SURGICAL ASSOCIATES GREAT FALLS CLINIC NORTHWEST IMAGING PARK CLINIC WEST BILLINGS CLINIC ACADIA MONTANA ACADIA MONTANA COMMUNITY HEALTH CENTER DILLON COMMUNITY CENTER RIVERSTONE HEALTH CLINIC SHERIDAN COMMUNITY HEALTH CNETER WESTERN MONTANA CLINIC BIG SKY MEDICAL CLINIC WESTERN MONTANA MENTAL HEALTH CTR BIG SKY ONCOLOGY BIG SKY ONCOLOGY BOZEMAN DEACONESS CARDIOLOGY CON WESTERN MONTANA MENTAL HEALTH CTR NW MONTANA SURGICAL ASSOCIATES FLATHEAD VALLEY ORTHOPEDICS BILLINGS CLINIC MILES CITY GLACIER MEDICAL ASSOCIATES PARTNERSHIP HEALTH CENTER FAMILY PSYCHOLOGICAL CENTER NORTHERN MONTANA HOSPITAL LAGRECA EYE CLINIC THE EYE CLINIC PSYCHIATRY ASSOCIATES LIVINGSTON HEALTHCARE BILLINGS ORTHOPEDICS & SPORTS PLLC NEUROSURGERY FOR BENEFIS HEALTH SYS BILLINGS CLINIC ADULT & CHILD COUNSELING BENEFIS MEDICAL GROUP PEDIATRICS DILLON COMMUNITY HEALTH CENTER EVANS PSYCHOTHERAPY & CONSULTING ADDRESS 760 WICKS LN 500 W BROADWAY 400 13TH AVE S STE 102 1600 DIVISION RD 320 SUNNYVIEW LN 1601 2ND AVE N #650 1315 W CRAWFORD 801 N 29TH ST 55 BASIN CREEK RD 55 BASIN CREEK RD 445 CENTENNIAL AVE 41 BARRETT ST 123 S 27TH ST 317 MADISON 500 W BROADWAY 616 HELENA AVE STE 301 616 HELENA AVE STE 301 820 N MONTANA AVE 106 W BROADWAY 1117 29TH ST S STE 500 40W 13TH ST 915 HIGHLAND BLVD STE 4330 1315 WYOMING ST 308 LOUISIANA AVE STE 1 111 SUNNYVIEW LN 620 S HAYNES 1111 BAKER AVE 323 W ALDER ST 109 N 4TH ST STE 201 1212 STEFFANICH DR 48 MEDICAL PARK DR 20 13TH ST W 2475 VILLAGE LN #202 113 N BROADWAY 300 W BROADWAY #2 A 2078 STADIUM DR STE 101 123 S 27TH ST 504 S 13TH ST 902 WYOMING AVE 2900 12TH AVE N STE 305E 1655 SHILOH RD #E 1101 26TH ST S 902 WYOMING AVE 2702 8TH AVE N 621 3RD ST S 3021 6TH AVE STE 107 111 N LAST CHANCE GULCH STE 2A 1300 28TH ST S STE 6 41 BARRETT ST 17 S 5TH AVE CITY BILLINGS MISSOULA GREAT FALLS GREAT FALLS KALISPELL GREAT FALLS LIVINGSTON BILLINGS BUTTE BUTTE BUTTE DILLON BILLINGS SHERIDAN MISSOULA HELENA HELENA HELENA BUTTE GREAT FALLS HAVRE BOZEMAN MISSOULA LIBBY KALISPELL MILES CITY WHITEFISH MISSOULA HAMILTON BILLINGS HELENA HAVRE BILLINGS RED LODGE MISSOULA BOZEMAN BILLINGS LIVINGSTON BILLINGS BILLINGS BILLINGS GREAT FALLS BILLINGS BILLINGS GLASGOW BILLINGS HELENA GREAT FALLS DILLON BOZEMAN ZIP 59105 59802 59405 59404 59901 59401 59047 59101 59701 59701 59701 59725 59101 59749 59802 59601 59601 59601 59701 59405 59501 59715 59801 59923 59901 59301 59937 59802 59840 59105 59601 59501 59102 59068 59802 59715 59101 59047 59101 59101 59106 59405 59101 59102 59230 59101 59601 59405 59725 59715 SPECIALTY INTERNAL MEDICINE NURSE PRACTITIONER SURGERY GENERAL FAMILY PRACTICE RADIOLOGY PROFESSIONAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE SURGERY GENERAL LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER RHEUMATOLOGY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY CARDIOLOGY PSYCHIATRY SURGERY GENERAL SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY FAMILY PRACTICE OPTOMETRY OPTOMETRY PSYCHOLOGY PSYCHIATRY FAMILY PRACTICE RADIOLOGY LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE PHYSICIAN ASSISTANT SURGERY NEUROSURGERY PSYCHOLOGY SURGERY ORTHOPEDIC MEDICINE PHYSICIAN ASSISTANT LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PEDIATRICS FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER Montana STATUS PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 31 of 256 FIRST NAME STEPHEN KRISTIN MARY ANN EDWARD NANCY KIMBERLY JENNIFER DAVID ERIC JACK NANCY DOUGLAS SARAH ROXANNE TRACY DAVID KARRIE CORA GLENN JARROD TONY TONY ERICA SHAWNEE MICHELE CINDY CINDY JEFFREY JEFFREY LINDA AMANDA JENNIFER AARON JAMES SARA RICHARD MICHELLE MICHELLE CATHLEEN TOM GWEN IRA IRA DEANNA KERI LAURI LAURA TOM MATHIAS JAN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME EVANS EVANS EVANS EVE EVERETT EVERINGHAM EVERS EX EX EXLEY EYLER EZELL FAABORG FAHRENWALD FAIRBANKS FAIRBANKS FAIRBROTHER FAITH FAITH FANCHER FANTOZZI FANTOZZI FARMER FARNHAM FARRELL FEDDES FEDDES FEENSTRA FEENSTRA FEGAN FEHRER FEIGHNER FEIST FEIST FELDMANN FELIX FELLER FELLER FELLOWS FELSTET FELTEN FENDER FENDER FERESTAD FERGUSON FERRARO FERRIES FERRO FETTIG FIASCHETTI LICENSE MD LCSW MD PAC CNMW OD LCSW MD MD MD MD MD MD MD MD MD APRN OT MD DC PAC PAC OD MD CNMW APRN APRN DC DC LCSW PT MD MD MD NP MD LCPC LCPC DC OD LCPC MD MD NP PA CRNA MD LCPC DPM LCPC MEDICAL GROUP FAMILY HEALTH CARE GALLATIN COMMUNITY CLINIC NORTHWEST ORTHOPEDIC & SPORTS MED WESTERN MONTANA CLINIC ROCKY MOUNTAIN EYE CENTER ACADIA MONTANA MONTANA IMAGING CENTER ABSAROKEE MEDICAL CLINIC DIABETES AND ENDOCRINOLOGY ASSOC BILLINGS OB/GYN ASSOCIATES PC CPG NORTHGATE PRIMARY CARE RIVERSTONE HEALTH FAMILY PRACTICE ASSOCIATES LIVINGSTON MEMORIAL HOSPITAL ST PETERS HOSPITAL WHITEFISH PHYSICAL THERAPY ROCKPOINT UPPER CERVICAL CENTER MEDNORTH KALISPELL URGENT CARE CLIN NORTHERN MONTANA HOSPITAL WESTSIDE MIDWIFERY & WOMENS HEALTH ALLERGY & ASTHMA CONSULTANTS OF MT ALLERGY & ASTHMA CONSULTANTS OF MT CHIRO KENTICS PC CHIROPRACTIC CLINIC OF THREE FORKS MOSAIC REHABILITATION CLARK FORK EMERGENCY PHYS PLLC MEDICAL ASSOCIATES WESTERN MONTANA MENTAL HEALTH FELLOWS CHIROPRACTIC CLINIC GRANITE COUNTY MEDICAL CENTER SHERIDAN MEMORIAL HOSPITAL BELGRADE URGENT CARE PEAK ANESTHESIA SERVICE BILLINGS CLINIC ASSOCIATES IN COUNSELING MONTANA FOOT CLINIC PATHWAYS HEALTH CARE ADDRESS 1287 BURNS WAY 214 E MENDENHALL 202 17TH AVE NW 350 HERITAGE WAY #1200 2835 FORT MISSOULA RD #3 700 W KENT 55 BASIN CREEK RD 1610 POLY DR 500 W BROADWAY 55 N MONTANA 1211 S RESERVE ST #202 1611 ZIMMERMAN TRAIL 2230 N RESERVE #402 123 S 27TH ST 935 HIGHLAND BLVD STE 2210 504 S 13TH ST 2475 BROADWAY 2006 HOSPITAL WAY 221 5TH AVE S 2419 MULLAN RD STE A 2316 US HWY 93 N 350 LOUISANA AVE 30 13TH ST 1125 MISSOULA AVE STE B 401 S ALABAMA STE 9 2055 N 22ND AVE STE 1 402 S ALABAMA ST STE 6A 108 N 11TH AVE STE 1 217 MAIN ST 210 N HIGGINS #214 6325 JACKRABBIT LN STE A 500 W BROADWAY 2827 FORT MISSOULA RD 935 HIGHLAND BLVD STE 2200 8 2ND AVE SW 902 N ORANGE ST #304 505 W MAIN #225 505 W MAIN STE 225 753 S 24TH ST W 2499 GABLE RD #3 1597 AVE D STE 7 310 SANSOME ST 706 E PARK AVE 440 W LAUREL AVE 403 W MAIN ST 925 HIGHLAND BLVD #1180 1045 N 30TH ST 1643 LEWIS AVE STE 4 3419 CENTRAL AVE STE B 200 HERITAGE WAY CITY KALISPELL BOZEMAN GREAT FALLS KALISPELL MISSOULA MISSOULA BUTTE BILLINGS MISSOULA ABSAROKEE MISSOULA BILLINGS MISSOULA BILLINGS BOZEMAN LIVINGSTON HELENA WHITEFISH GLASGOW MISSOULA KALISPELL LIBBY HAVRE HELENA BUTTE BOZEMAN BUTTE BOZEMAN THREE FORKS MISSOULA BELGRADE MISSOULA MISSOULA BOZEMAN RONAN MISSOULA LEWISTOWN LEWISTOWN BILLINGS BILLINGS BILLINGS PHILIPSBURG ANACONDA PLENTYWOOD BELGRADE BOZEMAN BILLINGS BILLINGS BILLINGS KALISPELL ZIP 59901 59715 59404 59901 59804 59801 59701 59102 59802 59001 59804 59102 59808 59101 59715 59047 59601 59937 59230 59808 59901 59923 59501 59601 59701 59718 59701 59715 59752 59802 59714 59802 59804 59715 59864 59802 59457 59457 59102 59102 59102 59858 59711 59254 59714 59715 59101 59102 59102 59901 SPECIALTY PEDIATRICS LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY SURGERY ORTHOPEDIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY OPTOMETRY LICENSED CLINICAL SOCIAL WORKER RADIOLOGY HOSPITALIST FAMILY PRACTICE ENDOCRINOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA CLINICAL NURSE SPECIALIST OCCUPATIONAL THERAPY FAMILY PRACTICE CHIROPRACTIC URGENT CARE PROVIDER URGENT CARE PROVIDER OPTOMETRY PSYCHIATRY CERTIFIED NURSE MIDWIFE ALLERGY/IMMUNOLOGY ALLERGY/IMMUNOLOGY CHIROPRACTIC CHIROPRACTIC SOCIAL WORKER PHYSICAL THERAPY HOSPITALIST EMERGENCY MEDICINE/TRAUMA PEDIATRICS PSYCHIATRY PSYCHIATRY PROFESSIONAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC OPTOMETRIST LICENSED BEHAVIORAL COUNSELOR GENERAL PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY ENDOCRINOLOGY LICENSED BEHAVIORAL COUNSELOR PODIATRY LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 32 of 256 FIRST NAME LYNDA TROY TROY RICHARD MEGAN MEGAN JEFFREY JEFFREY JANE JODY JODY DANA MARK ARTHUR DANA GERRY NICOLE KAREN LYNNELL SCOTT MARTHA BRITT LYNNELL JENNIFER TORGEIR JOHN JOHN MICHAEL STEVEN KRISTI MATTHEW AMY AMY DELBERT ANDREA AMY BRUCE CATHY JANE JASON JOAN MARY MARY NANCY MARY MATTHEW MEGHEN JOYCE JULIE LISA FRED Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME FICHTNER FIDDLER FIDDLER FIELDS FIERO FIERO FIFE FIFE FINEBERG FINK FINK FINK FINK FINK FINK FINK FINKE FINKE FINLEY FINLEY FINLEY FINLEY FINLEY FINN FINSAAS FIORE FISCHER FISCHER FISCHER FISCHER FISCHER FISCHER FISCHER FISCUS FISHBURN FISHER FISHER FISHER FITZGERALD FITZGERALD FITZPATRICK FITZPATRICK FITZPATRICK FITZPATRICK FITZWATER FLAIG FLANSBURG FLECK FLEISCHER FLEMING LICENSE LCSW MD MD NP LCPC LCPC DC DC LCSW OD OD PAC PT DO PA CRNA MD LCPC PT DC LCSW RN LAC PT LCSW MD PT MD MD PT PT PT PT LCPC PHD MD DPM SLT PHD MD LCSW LAC LAC PA LCPC LCPC PT LCSW LCSW MD MD MEDICAL GROUP FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST NORTH VALLEY PROFESSIONAL CENTER TURNING POINT TOWN CENTER CHIROPRACTIC JANE FINEBERG COUNSELING SERVICES ADVANCED EYE CARE BELGRADE ADVANCED EYECARE ASSOCIATES EAR NOSE & THROAT ASSOCIATES EUREKA HEALTH GABERT MEDICAL SERVICES SVH WALK IN CLINIC PATHOLOGY CONSULTANTS OF WESTERN MT ADVANCED REHABILITATION FINLEY CHIROPRACTIC WMMHC BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR SAPPHIRE PHYSICAL THERAPY BILLINGS CLINIC BILLINGS CLINIC EASTER SEALS GOODWILL FISCHER PHYSICAL THERAPY ORTHOPEDIC REHAB ORTHOPEDIC REHAB WESTERN MONTANA MENTAL HEALTH CTR SVH HOSPITALIST PROGRAM ADVANCED FOOT & ANKLE CENTER NEURO REHAB ASSOCIATES CARDIOVASCULAR & THORACIC SURGEONS FAMILY PSYCHOLOGICAL CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER PIONEER MEDICAL CNETER CLINIC SILVER BOW PHYSICAL THERAPY CITY LIFE COUNSELING CENTER SUNBURST MENTAL HEALTH SERVICES BIG SKY FAMILY MEDICINE MISSOULA ANESTHESIOLOGY ADDRESS 101 E BROADWAY STE 608 1315 GOLDEN VALLEY CIRCLE 400 S CLARK ST 2165 9TH ST W 1325 WYOMING ST 1630 SHERWOOD ST 827 N LAST CHANCE GULCH 4185 N MONTANA AVE #6 1946 STADIUM DR STE 2 91 W MADISON AVE 4265 FALLON STE 1 2900 12TH AVE N #401E 298 OSLOSKI RD 107 DILWORTH 1233 N 30TH ST 621 3RD ST S 2827 FORT MISSOULA RD 716 S 20TH AVE STE 201 200 COMMON WAY STE B 419 MAIN ST 34169 US HWY 2 31 FORT MISSOULA RD #1 314 BLANCHARD HOLLOW 801 N 29TH ST 1305 WYOMING 1705 BOW ST 801 N 29TH ST 2702 8TH AVE N 1537 AVE D 210 1313 N LAST CHANCE GULCH 111 SUNNYVIEW LN STE B 710 E 13TH ST STE B 106 W BROADWAY 1597 AVE D STE 3 1233 N 30TH ST 1016 9TH ST S 2135 CHARLOTTE STE 3 304 E BROADWAY ST 2900 12TH AVE N STE 502E 48 MEDICAL PARK DR 1245 N 29TH 1245 N 29TH 701 STOCK ST 631 CLARK AVE 418 WINDWARD WAY 3718 E LAKE ST STE A 1515 FAIRVIEW AVE 14 RIVER RD 202 CONWAY DR #200 2825 STOCKYARD RD BLDG I-200 CITY MISSOULA BILLINGS BUTTE COLUMBIA FALLS MISSOULA MISSOULA HELENA HELENA BOZEMAN BELGRADE BOZEMAN BILLINGS EUREKA GLENDIVE BILLINGS GLASGOW MISSOULA BOZEMAN KALISPELL STEVENSVILLE LIBBY MISSOULA WHITEFISH BILLINGS MISSOULA MISSOULA BILLINGS BILLINGS BILLINGS HELENA KALISPELL WHITEFISH BUTTE BILLINGS BILLINGS GREAT FALLS BOZEMAN HELENA BILLINGS HELENA BILLINGS BILLINGS BIG TIMBER BILLINGS KALISPELL BUTTE MISSOULA KALISPELL KALISPELL MISSOULA ZIP 59802 59102 59701 59912 59801 59802 59601 59602 59715 59714 59718 59101 59917 59330 59101 59230 59804 59718 59901 59870 59923 59804 59937 59101 59801 59801 59101 59101 59102 59601 59901 59937 59701 59102 59101 59405 59718 59601 59101 59601 59101 59101 59011 59101 59901 59701 59801 59901 59901 59808 SPECIALTY LICENSED CLINICAL SOCIAL WORKER HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC CHIROPRACTOR LICENSED CLINICAL SOCIAL WORKER OPTOMETRY OPTOMETRY EAR/NOSE/THROAT (ENT) PHYSICAL THERAPY INTERNAL MEDICINE FAMILY PRACTICE NURSE ANESTHETIST PATHOLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER REGISTERED NURSE PHYSICAL THERAPIST LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY PHYSICAL THERAPY GASTROENTEROLOGY SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY INTERNAL MEDICINE PODIATRY SPEECH/LANGUAGE THERAPY PSYCHOLOGY SURGERY CARDIOVASCULAR THORACIC LICENSED CLINICAL SOCIAL WORKER LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PROFESSIONAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE ANESTHESIOLOGY Montana STATUS SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 33 of 256 FIRST NAME JEREMY STANLEY ALEXANDRA ALEX ALEX CHERYL LINDSEY TRICIA JOSH BENJAMIN KATHERINE KIMBERLY PATRICIA JOSEPH JOSEPH KARIN KARIN DOLLY JILL CHARLA NICHOLAS KERRY KERRY ROBERT ALISON ALISON LORI DAVID DAVID DAVID LYNNE PAMELA AMY SCOTT KRISTY JACQUELINE JACQUELINE JOHN JACQUELINE SHANNON JACQUELINE MARY THOMAS THOMAS GRETCHEN GRETCHEN JENNIFER KAREN LINDA JAMES Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME FLEMING FLEMING FLERCHINGER FLERCHINGER FLERCHINGER FLETCHER FLINT FLOHR FLOHR FLOOK FLOREZ FLOYD FLYNN FLYNN FLYNN FODNESS FODNESS FOLEY FOLLETT FONTAINE FORD FORD FORD FORD FORNEY-GORMAN FORNEY-GORMAN FORSETH FORTENBERRY FORTENBERRY FORTENBERRY FOSS FOSS FOSS FOSS FOSS STONE FOSTER FOSTER FOSTER FOSTER FOSTER FOSTER FOUHY-THURSTON FOUTS FOUTS FOWELL FOWELL FOWLER FOWLER FOWLER FOX LICENSE LCPC LCPC NP NP NP NP PT PT DC MD LCSW DO LAC MD MD LCSW LSW OT MSPT PAC DO MD MD MD MD MD MD MD MD MD NP DC DC DC AU LCSW LCSW MD LCSW MD LCSW NP MD MD NP NP DO LCPC LCSW CRNA MEDICAL GROUP WESTERN MONTANA MENTAL HEALTH CTR POLSON HEALTH BILLINGS CLINIC SAPPHIRE PHYSICAL THERAPY GREAT NORTHERN PHYSICAL THERAPY SPINE AND SPORTS CHIROPRACTIC PARK CLINIC MENTAL HEALTH CENTER PEDIATRICS SPECIALTY CLINIC TRACY HAND AND OT WEST BILLINGS PHYSICAL THERAPY WESTERN MONTANA CLINIC GREAT FALLS CLINIC PEDIATRICS SPECIALTY CLINIC ST PETERS MEDICAL OFFICE BLDG PARTNERSHIP HEALTH CENTER PARTNERSHIP HEALTH CENTER ST VINCENT PHYSICIAN NETWORK LAUR NORTHWEST MONTANA SURGICAL ASSOCIATES NORTHWEST SURGICAL ASSOCIATES WOUND CARE & HYPERBARIC CENTER ACORN PEDIATRICS ALBIERO CHIROPRACTIC BIG MOUNTAIN CHIROPRACTIC FOSS CHIROPRACTIC BILLINGS CLINIC COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER HARDIN CLINIC SHERIDAN COMMUNITY HEALTH CENTER WESTERN MONTANA CLINIC BELGRADE URGENT CARE MOUNTAIN VIEW CLINIC GREAT FALLS OBGYN ASSOCIATES PREMIER CARE PEDIATRICS CENTRAL MONTANA MEDICAL CENTER ADDRESS 106 W BROADWAY ST 30 ROUND BUTTE RD 102 13TH AVE E 6 - 13TH AVE E 63351 HWY 93 S 2675 CENTRAL AVE 1705 BOW ST 612 E MAIN ST STE A 321 W MAIN ST 1001 RIVER DR 725 W CENTRAL AVE #102 500 W BROADWAY 1245 N 29TH 2835 FT MISSOULA RD #301 1400 29TH ST S 334 E BROADWAY 815 E FRONT ST #3 111 SUNNYVIEW LN #C 3307 GRAND AVE STE 203 500 W BROADWAY 1509 29TH ST S 2835 FT MISSOULA RD #301 2550 E BROADWAY ST 1717 4TH ST S 323 W ALDER ST 401 W RAILROAD ST 1035 1ST AVE 1273 BURNS WAY 1273 BURNS WAY 310 SUNNYVIEW LN 280 W KAGY STE G 104 CRESTVIEW DR STE 202 6446 HWY 93 S 22 COLLINS AVE 801 N 29TH ST 445 CENTENNIAL AVE 41 BARRETT ST 16 N MILES AVE STE 101 317 MADISON ST 500 W BROADWAY 1118 E SEBREE 403 W MAIN ST 10 ROBINSON LN 410 S 2ND ST 1522 9TH ST S 1300 28TH ST S STE 6 221 5TH AVE S 335 6TH ST E 500 S LAMBORN 408 WENDELL AVE CITY BUTTE RONAN POLSON POLSON RONAN BILLINGS MISSOULA BOZEMAN BELGRADE LIVINGSTON MISSOULA MISSOULA BILLINGS MISSOULA GREAT FALLS MISSOULA MISSOULA KALISPELL BILLINGS MISSOULA GREAT FALLS MISSOULA HELENA GREAT FALLS MISSOULA MISSOULA LAUREL KALISPELL KALISPELL KALISPELL BOZEMAN BIGFORK WHITEFISH LIBBY BILLINGS BUTTE DILLON HARDIN SHERIDAN MISSOULA DILLON BELGRADE RED LODGE BRIDGER GREAT FALLS GREAT FALLS GLASGOW EUREKA HELENA LEWISTOWN ZIP 59701 59864 59860 59860 59864 59102 59801 59715 59714 59047 59802 59802 59101 59804 59405 59802 59802 59901 59102 59802 59405 59804 59601 59405 59802 59802 59044 59901 59901 59901 59715 59911 59937 59923 59101 59701 59725 59034 59749 59802 59725 59714 59068 59014 59405 59405 59230 59917 59601 59457 SPECIALTY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE NURSE PRACTITIONER NURSE PRACTITIONER OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY PHYSICAL THERAPY CHIROPRACTIC FAMILY PRACTICE SOCIAL WORKER HOSPITALIST LICENSED ADDICTION COUNSELOR PEDIATRICS PEDIATRIC NEPHROLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OCCUPATIONAL THERAPY PHYSICAL THERAPY DERMATOLOGY ANESTHESIOLOGY PEDIATRIC SURGERY SURGERY ORTHOPEDIC MEDICINE OPHTHALMOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY GENERAL SURGERY GENERAL SURGERY GENERAL PEDIATRICS CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC AUDIOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER DERMATOLOGY LICENSED CLINICAL SOCIAL WORKER URGENT CARE PROVIDER FAMILY PRACTICE FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY PEDIATRICS FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY Montana STATUS PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 34 of 256 FIRST NAME MARY DUSTIN JOHN JOHN CLAIRE CLAIRE MARY PETER RAYLENE WILLIAM CAROL PETER PETER JAN JAMEE FANEE GREGORY LUANNE BAYNE DEAN DEAN RONALD RONALD CURTIS LINDA LINDA LINDA PATRICIA PATRICIA RICHARD CHARLES LARRY HEIDI BLAYNE CARLA CARLA DANIEL ROBIN BRIAN RUTH RANDY TISHA BRADLEY ANDREA MELISSA BRADLEY MELISSA BRIAN LAUREL THOMAS Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME FOX FRAKER FRANCIS JR FRANCIS SR FRANCOEUR FRANCOEUR FRANK FRANKLIN FRANKLIN FRAWLEY FRAZER FRECH FRECH FREDERICK FREE FREEMAN FREEMAN FREER FRENCH FRENCH FRENCH FREUND FREUND FREWIN FREY FREY FREY FRICKSON FRICKSON FRIEDMAN FRITZ FRITZ FRITZ FRITZ FRITZ FRITZ FRUECHTE FRY FRYKMAN FUGLEBERG FUHRMANN FUJII FULLER FULLER FULLER FULLER FULLER FULLERTON FULLERTON FULLERTON LICENSE LCSW DC DC DC NP NP APRN MD LAC LCSW LCPC MD MD OT LCPC MD AU MD MD MD MD CRNA CRNA MD PHD PHD PHD LCPC LCPC MD MD LCPC NP MD MD MD MD PA PAC AUD LCPC DO MD FNP NP MD NP MD PT DC MEDICAL GROUP WELLNESS WORX FAMILY CHIROPRACTIC & WELLNESS VALLEY CHIROPRACTIC CENTER ADVANCED NEUROLOGY SPECIALISTS MONTANA INTERVENTIONAL & DIAGNOSTIC WESTERN MONTANA MENTAL HEALTH CTR COOPERATIVE HEALTH CENTER ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY YELLOWSTONE COUNSELING CENTER BOZEMAN OB/GYN GLACIER HEARING SERVICES ABSORKA EMERGENCY PHYSICIANS GLACIER MEDICAL ASSOCIATES PLAINS MEDICAL CLINIC PLAINS MEDICAL CLINIC ROCKY MOUNTAIN EYE SURGERY CENTER BILLINGS CLINIC MONTANA NEUROBEHAVIORAL NORTHERN LIGHTS COUNSELING CLINIC NORTHWEST IMAGING ABSORKA EMERGENCY PHYSICIANS BEARTOOTH COUNSELING BENEFIS PHYSICIAN ASSOCIATES HELENA PEDIATRIC CLINIC NOW CARE WESTERN MONTANA CLINIC ADVANCED IMAGING BULL RIVER FAMILY MEDICINE BRIDGER ORTHOPEDICS RANDALL R FUHMANN COUNSELING BENEFIS MEDICAL GROUP BILLINGS CLINIC ST VINCENT HEALTHCARE SVH WALK IN CLINIC BILLINGS CLINIC ADDRESS 433 MAIN ST #4B 2622 W MAIN STE B 2117 HWY 2 E 2117 HWY 2 E 2819 GREAT NORTHERN LOOP #200 901 N ORANGE #107 400 15TH AVE S #206 2969 AIRPORT RD STE C 1325 WYOMING 1930 9TH AVE 535 SADDLE DR 905 HIGHLAND BLVD STE 4100 925 HIGHLAND BLVD STE 1180 90 OLD TIMER RD 208 N BROADWAY STE 423 925 HIGHLAND BLVD STE 1210 160 HERITAGE WAY 915 HIGHLAND BLVD 1111 BAKER AVE 10 KRUGER RD 1027 HWY 200 E 700 W KENT AVE 400 S CLARK ST 801 N 29TH ST 900 N ORANGE 3RD FLOOR 121 HICKORY ST #1 900 N ORANGE #301 102 11TH AVE E 14TH AVE W GRANDVIEW CLINIC BLDG 320 SUNNYVIEW LN 915 HIGHLAND BLVD 1597 AVE D STE 1 1101 26TH AVE S 5TH FLOOR 1122 N MONTANA AVE 2901 BROOKS ST 500 W BROADWAY 2803 S AVE 1029 HWY 200 E 1450 ELLIS ST STE 201 2831 FORT MISSOULA RD #300 616 HELENA AVE STE 301 1101 26TH ST S 2800 10TH AVE NORTH 2900 12TH AVE N STE 400E 1233 N 30TH ST 4045 AVE B 4045 AVE B 2800 10TH AVE N 770 W RESERVE DR 720 2ND ST E CITY KALISPELL BOZEMAN KALISPELL KALISPELL MISSOULA MISSOULA GREAT FALLS HELENA MISSOULA HELENA HELENA BOZEMAN BOZEMAN ANACONDA BILLINGS BOZEMAN KALISPELL BOZEMAN WHITEFISH PLAINS NOXON MISSOULA BUTTE BILLINGS MISSOULA MISSOULA MISSOULA POLSON POLSON KALISPELL BOZEMAN BILLINGS GREAT FALLS HELENA MISSOULA MISSOULA MISSOULA NOXON BOZEMAN MISSOULA HELENA GREAT FALLS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS KALISPELL KALISPELL ZIP 59901 59718 59901 59901 59808 59802 59405 59601 59801 59601 59601 59715 59715 59711 59101 59715 59901 59715 59937 59859 59853 59801 59701 59101 59802 59801 59802 59860 59860 59901 59715 59102 59405 59601 59801 59807 59804 59853 59715 59804 59601 59405 59101 59101 59101 59106 59106 59101 59901 59901 SPECIALTY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC NURSE PRACTITIONER NURSE PRACTITIONER NEUROLOGY RADIOLOGY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR RADIOLOGY RADIOLOGY OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY AUDIOLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY ANESTHESIOLOGY ANESTHESIOLOGY OPHTHALMOLOGY PSYCHOLOGY PSYCHOLOGIST PSYCHOLOGIST LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR RADIOLOGY EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY PEDIATRICS URGENT CARE PROVIDER URGENT CARE PROVIDER RADIOLOGY FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE AUDIOLOGIST LICENSED BEHAVIORAL COUNSELOR INTENSIVE/CRITICAL CARE HOSPITALIST NEUROLOGY URGENT CARE PROVIDER INTERNAL MEDICINE NURSE PRACTITIONER HOSPITALIST PHYSICAL THERAPY CHIROPRACTIC Montana STATUS SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 35 of 256 FIRST NAME EUGENIA DONALD DONALD DONALD HILLARY HILLARY ADELE ROGER ROGER ROGER ROGER ELENA ELENA CHARLOTTE MARY MARY MARY IRA RACHEL GARY DANIEL KATHLEEN ROSLYN SARAH SARAH MICHAEL SARAH MARIAN WILLIAM WILLIAM SUSAN JOHN PATRICK DANIEL DANIEL DAVID HOWARD STEVEN KIMBERLY CAMERON PHILIP GREY CAMERON JAMES LYNN RONALD DEVRY MARK DOROTHY TIFFANY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME FUNK FUNKE FUNKE FUNKE FUNK-WELTZENBACH FUNK-WELZENBACH FURBY FURLONG FURLONG FURLONG FURLONG FURROW FURROW FUSON GADDY GADDY GADDY GADDY GAIDYS GALES GALL GALLACHER GALLAGHER GALLAGHER GALLAGHER GALLAGHER GALLAGHER GALLAGHER GALLEA GALLEA GALLO GALT GALVAS GANNON GANNON GANO GARBER GARCIA GARDNER GARDNER GARDNER GARDNER GARDNER GARDNER GARDNER GARDNER GARITY GARNAAS GARNER GARNER LICENSE PHD DC DC DC LCPC LCPC LCPC MD MD MD MD MD MD LCPC MD MD MD MD MD PT MD LCPC LCPC RD RD MD RD CA MD MD MD MD DO MD MD MD MD MD LCPC MD MD DC MD MD LCPC MD NP MD LCSW LCPC MEDICAL GROUP ADVANCED SPINE AND WELLNESS CLINIC CHIROPRACTIC CLINIC OF 3 FORKS FRIENDS TO YOUTH ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER LOLO FAMILY PRACTICE WESTERN MONTAN CLINIC BEARTOOTH HOSPITAL BEARTOOTH HOSPITAL BILLINGS CLINIC PATHWAYS HEALTH CARE SVH HOSPITALIST PROGRAM ALPINE PHYSICAL THERAPY BILLINGS CLINIC WEST FULL CIRCLE COUNSELING SOLUTIONS CENTERS FOR MENTAL HEALTH COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER MONTANA ORTHOPEDICS SHERIDAN COMMUNITY HEALTH CENTER LEWIS & CLARK EMERGENCY PHYSICIANS ST PETERS URGENT CARE BILLINGS CLINIC MILES CITY COMPREHENSIVE MEDICAL REHAB BOZEMAN DEACONESS HOSPITAL BRIDGER ORTHOPEDICS PACIFIC CATARACT & LASER INSTITUTE ANESTHESIA ASSOCIATES OF GT FALLS INTERMOUNTAIN CHILDRENS HOME NORTH VALLEY PROFESSIONAL CENTER ROCKY MOUNTAIN EAR NOSE & THROAT VAN CHIROPRACTIC CLINIC WESTERN MONTANA CLINIC ROCKY MOUNTAIN PSYCHOTHERAPY & NEUR ADDRESS 3400 WAGON WHEEL RD 1425 W MAIN #C 217 MAIN ST 1707 W OAK ST STE D 334 E BROADWAY 2801 S RUSSELL STE 32 302 1ST ST W STE 203 120 S FIFTH #104 3417 BUSCH 700 W KENT ONE 14TH AVE W 11350 S HWY 93 11350 HWY 93 S 535 SADDLE DR 600 W 21ST ST 600 W 21ST ST 801 N 29TH ST 200 HERITAGE WAY 1233 N 30TH ST 5000 BLUE MOUNTAIN RD 2675 CENTRAL AVE 1501 N AVE W 915 FIRST AVE S 445 CENTENNIAL AVE 41 BARRETT ST 435 S CRYSTAL STE 400 317 MADISON ST 1100 1ST AVE N 2475 BROADWAY 2475 BROADWAY 620 S HAYNES AVE 400 SADDLE DR 1400 29TH ST S 2ND FLOOR 915 HIGHLAND BLVD 1450 ELLIS ST STE 201 1717 FOURTH ST S 1200 WESTWOOD DR 401 15TH AVE S STE 109 500 S LAMBORN 2165 9TH ST W 700 W KENT 1644 BROADWATER AVE 221 5TH AVE S 500 W BROADWAY 25 S EWING #402A 6 - 13TH AVE E 5549 OLD HWY 93 2835 FORT MISSOULA RD #3 2525 S 3RD ST W 304 GRAND AVE CITY BOZEMAN BOZEMAN THREE FORKS BOZEMAN MISSOULA MISSOULA POLSON HAMILTON BUTTE MISSOULA POLSON LOLO LOLO HELENA RED LODGE RED LODGE BILLINGS KALISPELL BILLINGS MISSOULA BILLINGS MISSOULA GREAT FALLS BUTTE DILLON BUTTE SHERIDAN GREAT FALLS HELENA HELENA MILES CITY HELENA GREAT FALLS BOZEMAN BOZEMAN GREAT FALLS HAMILTON GREAT FALLS HELENA COLUMBIA FALLS MISSOULA BILLINGS GLASGOW MISSOULA HELENA POLSON FLORENCE MISSOULA MISSOULA BILLINGS ZIP 59715 59715 59752 59715 59802 59801 59860 59840 59701 59801 59860 59847 59847 59601 59068 59068 59101 59901 59101 59804 59102 59801 59403 59701 59725 59701 59749 59401 59601 59601 59301 59601 59405 59715 59715 59405 59840 59405 59601 59912 59801 59102 59230 59802 59601 59860 59833 59804 59804 59101 SPECIALTY PSYCHOLOGY CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR NEUROLOGY PSYCHIATRY NEUROLOGY PSYCHIATRY HOSPITALIST PHYSICAL THERAPY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR NUTRITION PROFESSIONAL NUTRITION PROFESSIONAL SURGERY ORTHOPEDIC MEDICINE NUTRITION PROFESSIONAL ACUPUNCTURIST EMERGENCY MEDICINE/TRAUMA URGENT CARE PROVIDER FAMILY PRACTICE SURGERY GENERAL PHYSICAL MEDICINE REHABILITATION SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE OPHTHALMOLOGY EMERGENCY MEDICINE/TRAUMA ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE EAR/NOSE/THROAT (ENT) CHIROPRACTIC FAMILY PRACTICE EMERGENCY MEDICINE PROFESSIONAL COUNSELOR SURGERY NURSE PRACTITIONER OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 36 of 256 FIRST NAME JOSEPH DANIEL SCOTT LLOYD MICHAEL SANDEEP R JOSEPH DANIELE DANIELE CARLEEN JUSTINE JUSTINE CARLY DEREK MARIA DANIEL PATRICIA GERALD MARTIN ROBERT WILLIAM WILLIAM THOMAS JEFFREY EVE PAOLO PAOLO NORA KAMMERON KAMMERON LAWRENCE STEVEN DONNA MICHAEL RAYMOND RICHARD RANDALL TIMOTHY ROBERT KELLI THAD CARLA ELIZABETH ARTHUR DEREK ANDREW CATHERINE JONATHAN JONATHAN JONNIE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME GARNIC GARR GARRELS GARVER GARWIN GASKILL GASSENBERG GASTINEAU GASTINEAU GAUB GAVAGAN GAVAGAN GEBHARDT GEDLAMAN GEE GEE GEHMAN GEISZLER GELBKE GELLER GEORGE GEORGE GEORGE GEORGIA GERASIMOU GERBASI GERBASI GERRITY GERSBACH GERSBACH GERSTLE GERSTNER GETTLE GEURIN GEYER GIALIANI GIBB GIBBS GIBBS GIBBS GIBLETTE GIBSON GIBSON GIEBEL GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT-TAYLOR LICENSE MD DC MD MD MD OD MD PT PT PA MD MD PT DO PT MD PT MD MD MD MD MD MD MD MD MD MD MD DC DC MD MD LCPC MD DO LCPC MD PT OD PA-C APRN APRN APRN MD MD MD PT MD MD DC MEDICAL GROUP RADIOLOGY MONTANA HEALTHSOURCE OF MISSOULA PINTLER FAMILY MEDICINE PREMIER CARE PEDIATRICS CRITICAL CARE UNIT OPHTHALMIC ASSOC OF BILLINGS HELENA INDIAN ALLIANCE GABERT MEDICAL SERVICES NORTHWEST MONTANA SURGICAL ASSOC THE SURGERY CLINIC AT NORTH VALLEY ADVANCED PERFORMANCE & REHAB ALPINE FAMILY MEDICINE GREAT FALLS CLINIC HEALTH IN MOTION PHYSICAL THERAPY BENEFIS PHYSICIAN ASSOCIATES BRIDGER ORTHOPEDICS & SPORTS MED BILLINGS CLINIC BEARTOOTH BILLINGS CLINIC BILLINGS CLINIC DERMATOLOGY ASSOCIATES ST PETERS COMMUNITY HOSPITAL RIVERSTONE HEALTH WEST GRAND FAMILY MEDICINE BENEFIS MEDICAL GROUP PEDIATRICS ACTIVE RELIEF CHIROPRACTIC SOUND INPATIENT PHYSICIANS BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR RIVERSTONE HEALTH GREAT FALLS CLINIC BILLINGS CLINIC ADVANCED REHABILITATION SERVICES PACIFIC CATARACT & LASER INSTITUTE PHILLIPS CO FAMILY HEALTH CLINIC HEALTH SOLUTIONS ROCKY MOUNTAIN NEONATOLOGY PACIFIC CATARACT & LASER INSTITUTE HOLY ROSARY HEALTHCARE CLINIC ST PETERS MEDICAL GROUP WESTERN MONTANA CLINIC ADDRESS 401 15TH AVE S STE 204 3487 W BROADWAY 305 W PENNSYLVANIA 916 13TH AVE S 1101 26TH AVE S 1232 NO 30TH STE 100 435 N LAST CHANCE GULCH 2316 US HWY 93 N 333 BAKER AVE 107 DILWORTH 1273 BURNS AVE 1111 BAKER AVE #2 1532 ELLIS ST STE 201 734 9TH ST W STE 12 3000 15TH AVE S 500 W BROADWAY 3985 VALLEY COMMONS DR 500 15TH AVE S 1450 ELLIS ST STE 201 801 N 29TH ST 2525 N BROADWAY AVE 801 N 29TH ST 175 COMMONS LOOP STE 300 2475 BROADWAY ST 1417 9TH ST S #302 123 S 27TH ST 2750 GRAND AVE 1300 28TH ST S STE 6 921 EUCLID AVE 830 FRONT ST STE B 2827 FORT MISSOULA RD 801 N 29TH ST 81 W PARK 123 S 27TH ST 1400 29TH ST S 415 N HIGGINS #12 801 N 29TH ST 200 COMMONS WAY STE B 1717 4TH ST S 500 W BROADWAY 311 S 8TH AVE E 1001 SW HIGGINS AVE STE 103 2825 FORT MISSOULA RD #121 1717 FOURTH ST S 2600 WILSON ST 2550 E BROADWAY ST 500 W BROADWAY 500 W BROADWAY 901 N ORANGE ST #107 1308 12TH AVE S CITY GREAT FALLS MISSOULA ANACONDA GREAT FALLS GREAT FALLS BILLINGS HELENA KALISPELL WHITEFISH GLENDIVE KALISPELL WHITEFISH BOZEMAN COLUMBIA FALLS GREAT FALLS MISSOULA BOZEMAN GREAT FALLS BOZEMAN BILLINGS RED LODGE BILLINGS KALISPELL HELENA GREAT FALLS BILLINGS BILLINGS GREAT FALLS HELENA HELENA MISSOULA BILLINGS BUTTE BILLINGS GREAT FALLS MISSOULA BILLINGS KALISPELL GREAT FALLS MISSOULA MALTA MISSOULA MISSOULA GREAT FALLS MILES CITY HELENA MISSOULA MISSOULA MISSOULA GREAT FALLS ZIP 59405 59801 59711 59405 59405 59101 59601 59901 59937 59330 59901 59937 59715 59912 59405 59802 59718 59405 59715 59101 59068 59101 59901 59601 59405 59101 59102 59405 59601 59601 59804 59101 59701 59101 59403 59802 59101 59901 59405 59802 59538 59803 59804 59403 59301 59601 59801 59802 59802 59405 SPECIALTY RADIOLOGY CHIROPRACTIC FAMILY PRACTICE PEDIATRICS INTERNAL MEDICINE OPTOMETRY FAMILY PRACTICE PHYSICAL THERAPIST PHYSICAL THERAPIST FAMILY PRACTICE SURGERY GENERAL SURGERY GENERAL PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY EMERGENCY MEDICINE PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA PHYSICAL MEDICINE REHABILITATION HEMATOLOGY-ONCOLOGY FAMILY PRACTICE FAMILY PRACTICE DERMATOLOGY RADIOLOGY CARDIOVASCULAR DISEASE FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS CHIROPRACTIC CHIROPRACTIC HOSPITALIST INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE INFECTIOUS DISEASES LICENSED BEHAVIORAL COUNSELOR GYNECOLOGY ONCOLOGY PHYSICAL THERAPY OPTOMETRY PHYSICIAN ASSISTANT FAMILY PRACTICE FAMILY PRACTICE PEDIATRIC NEONATOLOGY OPHTHALMOLOGY FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY HOSPITALIST PEDIATRICS CHIROPRACTOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED 37 of 256 FIRST NAME JON SCOTT CHRISTOPHER CHRISTOPHER ROBERT EVE EVE LORI DIRK DIRK SHAUN KRISTINA KRISTINA ALLYSON BRENDA SONYA SUSAN BRUCE PETER STEVEN BRUCE WM TERRY JAMES MEGAN KIMBERLY JANICE KATHERINE LAWREN MICHAEL RANDALL MILTON JASON JASON JAMIE SARA JESSICA JULIAN MARK MARK PAUL PAUL PAUL PAUL KRIS DIANE DONALD WAVA CAMMI MITCHELL P DUANE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME GILDEA GILL GILL GILL GILLESPIE GILLESPIE GILLESPIE GILLET GILLETTE GILLETTE GILLIS GILLISPIE GILLISPIE GILMORE GILMORE GILSON GINGRICH GIOIA GIOIA GIPE GIPE GIPSON GIROLAMI GITTINGS GIVLER GIVLER GJELTEN GLADEN GLANZER GLASER GLATTERER GLEASON GLEASON GLENN GLENN GLOVER GNECCO GOBIN GOBIN GOCHIS GOCHIS GOCHIS GOCHIS GODLEWSKI GOEDDE GOEKE GOETZ GOETZE GOFF GOICOECHEA LICENSE MD PAC MD MD PT MD MD PT PAC PAC MD LCSW LCSW OT NP APRN MD MD MD DO MD MD MD NP PT MD LCSW LCSW OD PAC MD FNP NP CNMW ACU NP MD DO DO MD MD MD MD MD APRN LCSW LCPC OT MD OD MEDICAL GROUP CLARK FORK EMERGENCY PHYSICIANS BOZEMAN URGENT CARE CENTER FAMILY HEALTH CARE FAMILY HEALTH CARE AXIS PHYSICAL THERAPY CARING HEARTS OF THE ROCKIES ROCKY MOUNTAIN HEART & LUNG FAMILY HEALTH CARE FAMILY HEALTH CARE BOZEMAN DEACONESS WOMENS SPEC CENTER FOR MENTAL HEALTH CHANGING CURRENTS COUNSELING EPICENTER THERAPY SERVICES SVH WALK IN CLINIC COMPREHENSIVE MEDICAL REHAB BILLINGS CLINIC NORTHERN MONTANA MEDICAL GROUP ABSORKA EMERGENCY PHYSICIANS KALISPELL REGIONAL MEDICAL CENTER PATHWAYS HEALTH CARE BILLINGS CLINIC ASSOCIATED DERMATOLOGY KALISPELL REHAB ASSOC WESTERN MONTANA CLINIC WESTERN MONTANA MENTAL HEALTH CTR PACIFIC CATARACT & LASER INSTITUTE ORTHO MONTANA ROCKY MOUNTAIN HEART & LUNG BENEFIS WALK IN CLINIC SYNERGY MEDICAL CARE WESTSIDE MIDWIFERY BIG SKY FAMILY MEDICINE BILLINGS CLINIC ADVANCED CARE HOSPITAL OF MONTANA INTERNAL MEDICINE & DIABETES MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE ST LUKE COMMUNITY HOSPITAL ST PETER'S CARDIOLOGY CLINIC BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR THE COUNSELING CENTER BILLINGS CLINIC WEST ROCKY MOUNTAIN RETINA CONSULTANTS ROCKY MOUNTAIN EYE CENTER ADDRESS 2827 FORT MISSOULA RD 1006 W MAIN 1287 BURNS WAY 715 NUCLEUS AVE 420 B N HIGGINGS 350 HERITAGE WAY STE 2100 350 HERITAGE WAY STE 2100 3985 VALLEY COMMONS DR 1287 BURNS WAY 715 NUCLEUS AVE 905 HIGHLAND BLVD STE 4440 & 50 900 N JACKSON ST 40 LAST CHANCE GULCH 612 E MAIN ST STE C 1233 N 30TH ST 914 13TH AVE S 801 N 29TH ST 30 13TH ST 228 W MAIN ST STE B 915 HIGHLAND BLVD 310 SUNNYVIEW LN 200 HERITAGE WAY 801 N 29TH ST 50 S LAST CHANCE GULCH 1234 WHITEFISH STAGE RD 2835 FORT MISSOULA RD #3 1305 WYOMING 1018 BURLINGTON AVE STE 107 1717 4TH ST S 2900 12TH AVE N STE 140W 350 HERITAGE WAY STE 2100 1401 25TH ST S 1110 FRONT ST 401 S ALABAMA STE 1 417 S 2ND ST 202 CONWAY DR STE 200 801 N 29TH ST 3528 GABEL RD 2019 BROADWATER AVE 104 RUFUS LN 126 6TH AVE SW #A 330-6 TRACT LN 107 6TH AVE SW 2525 BROADWAY STE 203 2800 10TH AVE N 1315 WYOMING ST 410 CENTRAL AVE STE 509 2675 CENTRAL AVE 2475 VILLAGE LN STE 202 120 S FIFTH #104 CITY MISSOULA BOZEMAN KALISPELL COLUMBIA FALLS MISSOULA KALISPELL KALISPELL BOZEMAN KALISPELL COLUMBIA FALLS BOZEMAN HELENA HELENA BOZEMAN BILLINGS GREAT FALLS BILLINGS HAVRE MISSOULA BOZEMAN KALISPELL KALISPELL BILLINGS HELENA KALISPELL MISSOULA MISSOULA MISSOULA GREAT FALLS BILLINGS KALISPELL GREAT FALLS FORT BENTON BUTTE LIVINGSTON KALISPELL BILLINGS BILLINGS BILLINGS POLSON RONAN SAINT IGNATIUS RONAN HELENA BILLINGS MISSOULA GREAT FALLS BILLINGS BILLINGS HAMILTON ZIP 59804 59715 59901 59912 59802 59901 59901 59718 59901 59912 59715 59601 59604 59715 59101 59405 59101 59501 59802 59715 59901 59901 59101 59601 59901 59804 59801 59801 59405 59101 59901 59405 59442 59701 59047 59901 59101 59102 59102 59860 59864 59865 59864 59601 59101 59801 59401 59102 59102 59840 SPECIALTY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY CARDIOLOGY CARDIOLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OCCUPATIONAL THERAPY FAMILY PRACTICE FAMILY PRACTICE HEMATOLOGY-ONCOLOGY INTERNAL MEDICINE PSYCHIATRY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA PSYCHIATRY FAMILY PRACTICE DERMATOLOGY PHYSICAL THERAPY OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OPTOMETRY SURGERY ORTHOPEDIC MEDICINE SURGERY CARDIOVASCULAR THORACIC FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA CERTIFIED NURSE MIDWIFE ACUPUNCTURIST FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE CARDIOLOGY HOSPITALIST LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY OPHTHALMOLOGY OPTOMETRY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 38 of 256 FIRST NAME STACY DARLENE NEIL JEFFREY MARK JANICE JANICE NATALIE LAURA LAURA ANGELA MICHAEL STUART KIM RACHEL SARAH SARAH SUZANNE ANNE ANNE LYNETTE CAROLYN DAVID DAVID DAWN SARA DALE PAUL W SHARON SHARON DIRK RICHARD AMBER CHRISTOPHER KENNETH MONICA ANDREW CATHY ANDREW ANDREW SHARLA CHRISTINE DAVID RICHARD JONATHAN JONATHAN JON CHRISTOPHER KENNETH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME GOINS GOLAS GOLDENBERG GOLDES GOLDY GOMERSALL GOMERSALL GONZALES GOODELL GOODELL GOODMAN GOODMAN GOODMAN GOODMAN GOOEN GOOGE GOOGE GOOLD GORDON GORDON GORDY GOREN GORMAN GORMAN GORMELY GOROSKI GORSKI GORSUCH GORSUCH GOTTARDI GOTTARDI GOTTMAN GOULAH GOULET GOULET GOW GRABRIAN GRACE GRACE GRACE GRACE GRADEN GRADEN GRADSKY GRADY GRAEVE GRAEVE GRAEVE GRAHAM GRAHAM LICENSE PAC LCSW MD PT MD MD DO MD MD MD MD MD LCSW LCSW MD MD MSW LCSW LCSW NP MD MD MD APRN APRN DO MD MD APRN NP MD MD SLT MD MD APRN MD MD MD MD APRN OT MD MD MD MD MD PAC MD MEDICAL GROUP SPASTICITY REHAB CLINIC MEDICINE WHEEL THERAPEUTICS SVH SPECIALTY CARE SERVICES ASSOCIATED DERMATOLOGY BILLINGS CLINIC MOUNTAIN VIEW FAMILY MEDICINE & OB SOUND INPATIENT PHYSICIANS BUTTE SILVER BOW PRIMARY RIVERSTONE HEALTH BILLINGS CLINIC GLACIER ONCOLOGY SVH NEUROSURGERY ALEPH SHERIDAN COMMUNITY HEALTH CENTER SHERIDAN COMMUNITY HEALTH CENTER BILLINGS CLINIC CARDIOPULMONARY ASSOCIATES THE COOPERATIVE HEALTH CENTER BENEFIS MEDICAL GROUP NORTHERN MONTANA HOSPITAL BILLINGS CLINIC GREAT FALLS ORTHOPEDIC ASSOC CENTRAL MONTANA FAMILY PLANNING WESTERN MONTANA CLINIC BILLINGS CLINIC BILLINGS CLINIC PEDIATRIC SURGERY OF MONTANA BLUE DIAMOND PSYCHIATRIC SERV BOZEMAN DEACONESS HEALTH GROUP FAMILY PRACTICE ASSOCIATES MONTANA SURGICAL CLINIC SURGICAL ASSOCIATES OF BOZEMAN MONTANA ORTHOPEDICS SAGE HILL THERAPY SERVICES WMMHC PEDIATRICS SPECIALTY CLINIC BIG HORN HOSPITAL ASSOC BILLINGS CLINIC NORTHERN ROCKIES REGIONAL PAIN CTR PARTNERS IN PEDIATRICS ADDRESS 2900 12TH AVE N 202E 801 1/2 S 1ST ST 1230 N 30TH ST STE 200 50 S LAST CHANCE GULCH STE 3 2702 8TH AVE N 2835 FORT MISSOULA RD #101 2827 FORT MISSOULA RD 400 SADDLE DR 445 CENTENNIAL AVE 123 S 27TH ST 2675 CENTRAL AVE 75 CLAREMONT 2900 12TH AVE N STE 315W 7 W 6TH AVE STE 2C 2685 PALMER ST STE A 317 MADISON 317 MADISON ST 902 N ORANGE 101 E BROADWAY STE 601 101 E BROADWAY STE 601 801 N 29TH ST 601 W SPRUCE #A 500 W BROADWAY 601 W SPRUCE #D 1930 9TH AVE #207 1300 28TH ST S STE 6 30 13TH ST 801 N 29TH ST 1401 25TH ST S 505 W MAIN STE 108 310 WENDELL AVE STE 7 2835 FORT MISSOULA RD #3 500 W BROADWAY #320 801 N 29TH ST 801 N 29TH ST 2835 FT MISSOULA RD #301 432 LAST CHANCE GULCH STE G 905 HIGHLAND BLVD STE 4440 & 4450 935 HIGHLAND BLVD 2210 905 HIGHLAND BLVD #4450 925 HIGHLAND BLVD STE 1200 435 S CRYSTAL STE 400 800 KENSINGTON AVE STE 100 699 FARMHOUSE LN 2835 FT MISSOULA RD #301 17 N MILES 2800 10TH AVE N 504 S 13TH ST 2900 12 AVE N STE 335W 2525 E BROADWAY STE 101 CITY BILLINGS HAMILTON BILLINGS HELENA BILLINGS MISSOULA MISSOULA HELENA BUTTE BILLINGS BILLINGS KALISPELL BILLINGS HELENA MISSOULA SHERIDAN SHERIDAN MISSOULA MISSOULA MISSOULA BILLINGS MISSOULA MISSOULA MISSOULA HELENA GREAT FALLS HAVRE BILLINGS GREAT FALLS LEWISTOWN LEWISTOWN MISSOULA MISSOULA BILLINGS BILLINGS MISSOULA HELENA BOZEMAN BOZEMAN BOZEMAN BOZEMAN BUTTE MISSOULA BOZEMAN MISSOULA HARDIN BILLINGS LIVINGSTON BILLINGS HELENA ZIP 59101 59840 59101 59601 59101 59804 59804 59601 59701 59101 59102 59901 59101 59601 59808 59749 59749 59802 59802 59802 59101 59802 59802 59802 59601 59405 59501 59101 59405 59457 59457 59804 59802 59101 59101 59804 59601 59715 59715 59715 59715 59701 59801 59715 59804 59034 59101 59047 59101 59601 SPECIALTY PHYSICAL MEDICINE REHABILITATION LICENSED CLINICAL SOCIAL WORKER HEMATOLOGY-ONCOLOGY DERMATOLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE SURGERY GENERAL FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE HEMATOLOGY-ONCOLOGY SURGERY NEUROSURGERY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE SOCIAL WORKER LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER SURGERY NEUROSURGERY CARDIOLOGY HOSPITALIST FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS HOSPITALIST SURGERY NEUROSURGERY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS CARDIOVASCULAR DISEASE SPEECH/LANGUAGE THERAPY RADIATION ONCOLOGY PEDIATRIC SURGERY PSYCHIATRY SURGERY GENERAL FAMILY PRACTICE SURGERY GENERAL SURGERY GENERAL SURGERY ORTHOPEDIC MEDICINE OCCUPATIONAL THERAPY PSYCHIATRY PEDIATRICS RADIOLOGY RADIOLOGY RADIOLOGY FAMILY PRACTICE PEDIATRICS Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 39 of 256 FIRST NAME ADAM KENNETH ADAM LYNN CHRISTOPHER MARILYN CATHERINE CATHERINE JAMIE BEVERLY BARTON BARTON PATRICIA PATRICIA PATRICIA ROBERT DOUGLAS WALTER JO ANN PETER MARY ELLEN COREY DAVID DIANE DARREN GORDON BRUCE EDWARD REBECCA JEFF JOSHUA JUSTIN KRISTIN KRISTIN STARLYN KARI JULIE KARI DWYNN DAVID DANIEL DANIEL DANIEL ANN JOHN JOE DEBORAH CAROLYN PATRICIA DENISE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME GRAHAM GRAHAM GRAHAM GRAHAM GRAHAM GRAMS GRAMS GRAMS GRANGER GRANSBERY GRANT GRANT GRANTHAM GRANTHAM GRANTHAM GRASSESCHI GRATWOHL GRAVES GRAVES-GILL GRAY GRAY GRAY GRAY GRAY GRAY GRAY GRAY GRAY GRAY GREEN GREEN GREEN GREEN GREEN GREEN GREENBERG GREENBERG GREENBERG GREENFIELD GREENWALD GREGERSON GREGERSON GREGERSON GREGG-ROSS GREGORY GREGORY GREGORY GREIMANN GRENA GRESHAM LICENSE PA MD PA PA PAC MD LAC LAC NP PT DC DC MD MD MD MD OD MD LCPC PA NP DC DC OD MD MD MD LCPC CNM ND PT ACU PT PT CRNA LCPC PT LCPC DO MD LCPC LCPC LCPC OT MD DO NP MD MD APRN MEDICAL GROUP PLAINS FAMILY MEDICINE ROCKY MOUNTAIN CLINIC SHERIDAN MEMORIAL HOSPITAL SHERIDAN MEMORIAL HOSPITAL SVH NEUROSURGERY BENEFIS PHYSICIAN ASSOCIATES MENTAL HEALTH CENTER MENTAL HEALTH CENTER BUTTE PHYSICAL THERAPY GRANT CHIROPRACTIC & WELLNESS CTR BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC- MILES CITY BIG SKY PULMONARY & CRITICAL CARE CARDIOVASCULAR & THORACIC SURGEONS ALPINE ORTHOPEDICS & SPORTS MEDICIN BENEFIS PHYSICIAN ASSOCIATES GRAY CHIROPRACTIC OFFICES GRAY CHIROPRACTIC OFFICES HELENA VISION CENTER MISSOULA ANESTHESIOLOGY MISSOULA ANESTHESIOLOGY BIG SKY INTEGRATIVE HEALTH LONE PEAK PHYSICAL THERAPY AT BELGR MONTANA CENTER FOR WELLNESS & PAIN MGMT NORTHERN ROCKIES PHYSICAL THERAPY NORTH LIGHT COUNSELING VAIL PHYSICAL THERAPY MISSION MOUNTAIN MEDICINE NEUROSURGERY FOR BENEFIS HEALTH SYS EUREKA HEALTH PROMPT CARE THE MONTANA CENTER FOR WELLNESS BILLINGS CLINIC ST JAMES HEALTHCARE PRIMARY CARE TIMOTHY F BURKE MD HARDIN CLINIC PONDERA MEDICAL CNTR CLINIC ADDRESS 10 KRUGER RD 435 S CRYSTAL STE 300 440 W LAUREL AV 440 W LAUREL AVE 2900 12TH AVE N STE 315W 400 13TH AVE S STE 206 1245 N 29TH 5 E 9TH 3075 N RESERVE #Q 200 S CLARK ST 3429 CENTRAL AVE STE A 3429 CENTRAL AVE #A 90 HWY 91 S 620 S HAYNES 2600 WILSON 1300 28TH ST S STE 4 215 W 3RD ST 2900 12TH AVE N STE 502E 725 6TH AVE EAST 536 S COTTONWOOD RD STE 100 1300 28TH ST S STE 1 3031 S RUSSELL ST STE 3 3031 S RUSSELL ST STE 3 534 N LAST CHANCE GULCH 2825 STOCKYARD RD BLDG I-200 2825 STOCKYARD RD BLDG I-200 210 SUNNYVIEW LN 25 S EWING STE 502 209 1/2 H ST E 8707 JACKRABBIT LN STE A 403 GALLATIN FARMERS AVE STE 201 245 WINDWARD WAY #101 2831 FORT MISSOULA RD #200 2831 FT MISSOULA RD STE 200 124 SUNRISE CT 244 SPOKANE AVE STE 7 316 E BABCOCK 244 SPOKANE AVE #7 330-6 TRACT LN 1101 26TH ST S 298 OSLOSKI RD 245 WINDWARD WAY STE 101 690 N MERIDIAN RD #211 2842 SPURGIN RD 801 N 29TH ST 435 S CRYSTAL STE 300 2835 FORT MISSOULA RD #305 16 N MILES STE 101 809 SUNSET BLVD 3511 1ST AVE N CITY PLAINS BUTTE PLENTYWOOD PLENTYWOOD BILLINGS GREAT FALLS BILLINGS RED LODGE MISSOULA BUTTE BILLINGS BILLINGS DILLON MILES CITY MILES CITY GREAT FALLS HARDIN BILLINGS KALISPELL BOZEMAN GREAT FALLS MISSOULA MISSOULA HELENA MISSOULA MISSOULA KALISPELL HELENA POPLAR BELGRADE BELGRADE KALISPELL MISSOULA MISSOULA BOZEMAN WHITEFISH BOZEMAN WHITEFISH SAINT IGNATIUS GREAT FALLS EUREKA KALISPELL KALISPELL MISSOULA BILLINGS BUTTE MISSOULA HARDIN CONRAD GREAT FALLS ZIP 59859 59701 59254 59254 59101 59405 59101 59068 59808 59701 59102 59102 59725 59301 59301 59405 59034 59101 59901 59718 59405 59801 59801 59601 59808 59808 59901 59601 59255 59714 59714 59901 59804 59804 59715 59937 59715 59937 59865 59405 59917 59901 59901 59804 59101 59701 59804 59034 59425 59401 SPECIALTY EMERGENCY MEDICINE/TRAUMA PEDIATRICS FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE LICENSED ADDICTION COUNSELOR LICENSED ADDICTION COUNSELOR NURSE PRACTITIONER PHYSICAL THERAPY CHIROPRACTIC CHIROPRACTOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PULMONARY DISEASES OPTOMETRIST SURGERY THORACIC LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC OPTOMETRY ANESTHESIOLOGY ANESTHESIOLOGY RADIOLOGY LICENSED BEHAVIORAL COUNSELOR NURSE MIDWIFE NATUROPATH PHYSICAL THERAPY ACUPUNCTURIST PHYSICAL THERAPY PHYSICAL THERAPY ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PROFESSIONAL COUNSELOR GENERAL PRACTICE SURGERY NEUROSURGERY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR OCCUPATIONAL THERAPIST SURGERY GENERAL FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 40 of 256 FIRST NAME DENISE DENISE DONALD DONALD GEORGE MANDI TACEY JONATHAN CATHERINE CATHERINE JEN DIANA DOUGLAS DIANA JEFFREY THOMAS KAREN ELIZABETH ELIZABETH PAUL GERALD HEIDI ROBERT VIRGINIA JESS LISA LINDA TIMOTHY STEVEN LYNN CHRIS ANNA ANNA KRISTIN KIMBERLY ADAM JOHN RACHEL MARION MARION SALLY WILLIAM SCOTT GARY WARREN PEGGY PHILIP PAULA SHAN PATRICK Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME GRESHAM GRESHAM GREWELL GREWELL GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIS GRIFFITH GRIFFITH GRIFFITH GRIGGS GRIGGS GRIGRY GRIMLEY GRIMLEY GRMOLJEZ GROGGEL GRONDAHL GROSS GROSS GROSSMAN GROSSMAN GROSSMAN GROSSMAN GROSSO GROSULAK GROTBO GROTBO GROTBO GROTE GROVER GROVES GROW GRUBB GRUMMETT GRUMMETT GRUNST GRUZENSKY GUESS GUEST GUFFIN GUHN GUIGNARD GUINNIP GUISINGER GULICK LICENSE NP NP DO DO MD MD PAC MD SLT SLP LCSW MD MD MD PA MD LAC MD MD MD MD APRN MD LAC MD PT APRN MD MD LCPC NP NP NP DC PT PT PHD PT LCPC LCPC LCPC MD MD DC MD LCPC DC MD PHD PT MEDICAL GROUP BILLINGS CLINIC BILLINGS CLINIC WEST BIG SKY MUSCUOSKELETAL AND PAIN BITTERROOT CLINIC NEUROSCIENCE & SPINE INSTITUTE ST PETERS MEDICAL GROUP STATE OF THE HEART THERAPY PINTLER THERAPY CLARK FORK EMERGENCY PHYSICIANS NEUROSCIENCE & SPINE INSTITUTE ST LUKE COMMUNITTY HOSPITAL ER FLATHEAD VALLEY ORTHOPEDICS SPMG BROADWAY NOW CARE NOW CARE BILLINGS CLINIC BOZEMAN DEAC HEALTH GROUP SIDNEY HEALTH CENTER CLINIC BENEFIS MEDICAL GROUP MENTAL HEALTH CENTER BILLINGS ANESTHESIOLOGY GREAT FALLS CLINIC BILLINGS PLASTIC SURGERY PATSY VARGO MD PC ROCKY MOUNTAIN CHIROPRACTIC REJUVENATE EXCEL PHYSICAL THERAPY NORTHERN MONTANA MEDICAL GROUP KALISPELL REHABILITATION ASSOCIATES MENTAL HEALTH CENTER MENTAL HEALTH CENTER YELLOWSTONE COUNSELING CENTER PACIFIC CATARACT & LASER INSTITUTE ROCKY MOUNTAIN EYE CENTER GUEST FAMILY CHIROPRACTIC NEW LEAF CHIROPRACTIC COMMUNITY MEDICAL CENTER PHYS SERV ORTHOPEDIC REHAB ADDRESS 3511 1ST AVE N #1 601 1ST AVE N 2675 CENTRAL AVE 2675 CENTRAL AVE 700W GOLD ST STE A 1224 W MAIN ST 200 COMMONS WAY STE 2 2550 E BROADWAY ST 209 TAYLOR DR 209 TAYLOR DR 307 E PARK AVE STE 415 2827 FORT MISSOULA RD 200 COMMONS WAY STE 2 107 6TH AVE SW 111 SUNNYVIEW LN 2550 E BROADWAY POD 1A 1609 W BABCOCK STE C 2901 BROOKS ST 500 W BROADWAY 801 N 29TH ST 935 HIGHLAND BLVD STE 3260 214 14TH AVE SW STE 102 1101 26TH ST S 1245 N 29TH ST 401 N 31ST STE 1260 3000 15TH AVE S 1280 BURNS WAY 2550 E BROADWAY ST 2510 17TH ST W 710 GRAND AVE #7 3511 1ST AVE N STE 1 3511 1ST AVE N #1 601 1ST AVE N 1440 HOLMES AVE 3027 HWY 83 LAZY PINE MALL STE A 1125 W KAGY BLVD STE 101A 20 W 13 ST 1234 WHITEFISH STAGE RD 1245 N 29TH ST 410 E PIKE AVE 208 N BROADWAY STE 423 1717 4TH ST S 700 W KENT 2304 N 7TH STE E 500 W BROADWAY 1650 AVE D #101 3031 S RUSSELL 2831 FORT MISSOULA RD #206 210 N HIGGINS #310 111 SUNNYVIEW LN B CITY GREAT FALLS GREAT FALLS BILLINGS BILLINGS BUTTE HAMILTON KALISPELL HELENA DILLON DILLON ANACONDA MISSOULA KALISPELL RONAN KALISPELL HELENA BOZEMAN MISSOULA MISSOULA BILLINGS BOZEMAN SIDNEY GREAT FALLS BILLINGS BILLINGS GREAT FALLS KALISPELL HELENA BILLINGS BILLINGS GREAT FALLS GREAT FALLS GREAT FALLS BUTTE SEELEY LAKE BOZEMAN HAVRE KALISPELL BILLINGS COLUMBUS BILLINGS GREAT FALLS MISSOULA BOZEMAN MISSOULA BILLINGS MISSOULA MISSOULA MISSOULA KALISPELL ZIP 59401 59401 59102 59102 59701 59840 59901 59601 59725 59725 59711 59804 59901 59864 59901 59601 59715 59801 59801 59101 59715 59270 59405 59101 59101 59405 59901 59601 59102 59102 59401 59401 59401 59701 59868 59715 59501 59901 59101 59019 59101 59405 59801 59715 59802 59101 59801 59804 59802 59901 SPECIALTY NURSE PRACTITIONER NURSE PRACTITIONER FAMILY PRACTICE FAMILY PRACTICE PAIN MANAGEMENT FAMILY PRACTICE NEUROLOGY FAMILY PRACTICE AUDIOLOGY SPEECH-LANGUAGE PATHOLOGIST LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE/TRAUMA SURGERY NEUROSURGERY EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE EAR/NOSE/THROAT (ENT) LICENSED BEHAVIORAL COUNSELOR URGENT CARE PROVIDER URGENT CARE PROVIDER SURGERY GENERAL NEPHROLOGY FAMILY PRACTICE SURGERY NEUROSURGERY LICENSED ADDICTION COUNSELOR ANESTHESIOLOGY PHYSICAL THERAPY INTERNAL MEDICINE SURGERY UROLOGICAL UROLOGY SURGERY PLASTIC/RESTORATIVEBURN PROFESSIONAL COUNSELOR FAMILY PRACTICE NURSE PRACTITIONER NURSE PRACTITIONER CHIROPRACTIC PHYSICAL THERAPY PHYSICAL THERAPY PSYCHOLOGY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR OPHTHALMOLOGY OPHTHALMOLOGY CHIROPRACTIC EMERGENCY MEDICINE PROFESSIONAL COUNSELOR CHIROPRACTIC SURGERY VASCULAR PSYCHOLOGY PHYSICAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 41 of 256 FIRST NAME PATRICK PATRICK SHANNON SHANNON SUZANNE DANIEL DANIEL DAVID RYAN RYAN CORTNEE CORTNEE FRED LISA JUDITH KARL KARL BETTY BARBARA ASHLEY JAMES GLENN JENNIFER DAVID AMANDA AIMEE KIM DIANE DIANE KELLIE TANVIR MICHAEL SUSAN SUSAN MICHAEL MONICA PHIL ROBERT CONNIE WILLIAM VICTORIA FRANK DONNA TYSON CARLIN KERRY WILLIAM BETH CARRIE LAURA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME GULICK GULICK GULLEY GULLEY GULLOTTA GULLOTTA GULLOTTA GUMM GUNLIKSON GUNLIKSON GUNLOCK GUNLOCK GUNVILLE GUSHWA GUSTAFSON GUTER GUTER GUTMAN GUTSCHENRITTER GUY GUYER GUZMAN HAARR HABEL HABER HACHIGIAN-GOULD HACKL HADDON HADDON HADNOT HAFIZ HAGAN HAGEN HAGEN HAGENLOCK HAGERMAN HAGGERTY HAGSTROM HAHN HAHNSTADT HAHUS HAIDLE HALE HALE HALE HALE FORD HALL HALL HALL HALL LICENSE PT PT MD MD NP PT PT PHD MD MD PT PT MD MD NP MD MD LCSW MD PT MD MD PT MD OD MD CRNA LCSW LCSW OD PAC MD LCPC LCPC LAC NP DO LCPC DO PHD LCPC PT LCSW MD LCPC MD MD RD PAC NP MEDICAL GROUP ORTHOPEDIC REHAB SILVER BOW SURGICAL ASSOCIATES PC SILVERBOW SURGICAL ASSOCIATES LAKESIDE FAMILY HEALTH LAKESIDE PHYSICAL THERAPY POLSON PHYSICAL THERAPY BEHAVIORAL HEALTH ASSOCIATES NORTH VALLEY SURGICAL SERVICES NORTH VALLEY SURGICAL SERVICES KALISPELL REHAB ASSOCIATES PROFESSIONAL THERAPY ASSOCIATES BILLINGS CLINIC MEDICAL ASSOCIATES GREAT FALLS CLINIC SLETTEN CANCER INSTITUTE ORTHOPEDIC REHAB RIVERSTONE HEALTH BILLINGS CLINIC HEIGHTS BILLINGS CLINIC KALISPELL REGIONAL MEDICAL CENTER HEIGHTS EYECARE INC SAME DAY SURGERY CENTER BIG SKY EYE CARE CLINIC & OPTICAL PODER RIVER MEDICAL CLINIC INTERNAL MEDICINE & DIABETES EASTERN MONTANA COMMUNITY MHC WMMHC HELPING HANDS BEHAVIORAL HEALTH CEN BILLINGS CLINIC CHRISTOS THERAPY BOZEMAN DEACONESS MEDICAL ASSOC WESTERN MONTANA MENTAL HEALTH CTR EUREKA HEALTH SOUTH HILLS PSYCHOTHERAPY ST PETERS HOSPITAL STILLWATER THERAPUTIC SERVICE BILLINGS CLINIC BENEFIS PHYSICIANS ASSOCIATES BILLINGS CLINIC BILLINGS CLINIC FAMILY HEALTH CARE ADDRESS 906 9TH ST W STE A 710 E 13TH ST STE B 400 W PORPHYRY ST 1100 HOLLENBACK LN 77 DEER CREEK RD 100 BIERNEY CREEK RD #D 211 A MAIN ST 1101 N 27TH ST #201 2000 HOSPITAL WAY 2000 HOSPITAL WAY 1234 WHITEFISH STAGE RD 1234 WHITEFISH STAGE RD 2800 10TH AVE N 935 HIGHLAND BLVD STE 2200 902 N ORANGE 4TH FLOOR 20 13TH ST 3000 15TH AVE S 516 FULLER AVE STE 1 1117 29TH ST S 906 9TH ST W STE A 123 S 27TH ST 760 WICKS LN 801 N 29TH ST 310 SUNNYVIEW LN 430 LAKE ELMO DR 1220 CENTRAL AVE #2-B 300 N WILLSON STE 600F 210 N HIGGINS AVE STE 324 210 N HIGGINS AVE STE 324 820 W MAIN ST 507 N LINCOLN AVE 2019 BROADWATER AVE 1009 6TH AVE N 410 WINDWARD WAY 201 W MADISON STE 301 801 N 29TH ST 303 N 3RD ST 1500 POLY DR STE 201 935 HIGHLAND STE 2200 1018 BURLINGTON #106 209 N 10TH ST STE A 298 OSLOSKI RD 535 SADDLE DR 2475 BROADWAY 418 WINDWARD WAY 2702 8TH AVE N 2800 11TH AVE S STE A 2800 10TH AVE N 801 N 29TH ST 1287 BURNS WAY CITY COLUMBIA FALLS WHITEFISH BUTTE DEER LODGE SOMERS LAKESIDE POLSON BILLINGS WHITEFISH WHITEFISH KALISPELL KALISPELL BILLINGS BOZEMAN MISSOULA HAVRE GREAT FALLS HELENA GREAT FALLS COLUMBIA FALLS BILLINGS BILLINGS BILLINGS KALISPELL BILLINGS GREAT FALLS BOZEMAN MISSOULA MISSOULA HAMILTON BROADUS BILLINGS GLASGOW KALISPELL BELGRADE BILLINGS HAMILTON BILLINGS BOZEMAN MISSOULA HAMILTON EUREKA HELENA HELENA KALISPELL BILLINGS GREAT FALLS BILLINGS BILLINGS KALISPELL ZIP 59912 59937 59701 59722 59932 59922 59860 59101 59937 59937 59901 59901 59101 59715 59802 59501 59405 59601 59405 59912 59101 59105 59101 59901 59105 59401 59715 59802 59802 59840 59317 59102 59230 59901 59714 59101 59840 59102 59715 59801 59840 59917 59601 59601 59901 59101 59405 59101 59101 59901 SPECIALTY PHYSICAL THERAPY PHYSICAL THERAPY SURGERY GENERAL SURGERY GENERAL FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY PSYCHOLOGY SURGERY GENERAL SURGERY GENERAL PHYSICAL THERAPY PHYSICAL THERAPY PEDIATRICS FAMILY PRACTICE NURSE PRACTITIONER HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY LICENSED CLINICAL SOCIAL WORKER RADIATION ONCOLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY GENERAL PRACTICE OPTOMETRY SURGERY ORTHOPEDIC MEDICINE ANESTHESIOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OPTOMETRY FAMILY PRACTICE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED ADDICTION COUNSELOR GERIATRIC MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE PSYCHOLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER RADIOLOGY LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE SURGERY UROLOGICAL UROLOGY NUTRITION PROFESSIONAL FAMILY PRACTICE FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 42 of 256 FIRST NAME LAURA MIKE MICHAEL JANA THOMAS JACKIE JENNIFER WILLIAM WENDY JEFFREY ATHENA SETH STEVE TONY TONY MICHAEL BETH ALICIA TANYA BETH ALICIA ALICIA PHILLIP PHILLIP RONALD STEVEN LAWRENCE ROBERT SALLY JO MARCIA MARCIA PAULA BURKE BURKE MICHAEL KATHRYN JAMES JULIET PAUL CAROL JAIMEE MARY PAT JOY SCOTT JAMI JAMI SCOTT TERRY PETER CHERYL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HALL HALL HALL HALL HALL HALL HALL HALL HALLER HALLER HALOL HALVERSON HALVORSON HAM HAM HAMBLOCK HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMM HAMMOND HAMMOND HANCOCK HAND HANKS HANKS HANSEL ALLEN HANSEN HANSEN HANSEN HANSEN HANSEN HANSEN HANSEN HANSEN HANSEN HANSEN HANSEN WHITE HANSING HANSING HANSING HANSING HANSON HANSON HANSON LICENSE NP PAC PAC MD OD PT MD MD NP MD MD PT MD MD MD PT PAC PAC MD PAC PA-C PA-C LCSW LCSW PAC MD MD MD LCPC NP NP PAC MD MD OD MD MD MD LCPC APRN OT NP LCPC DC DC DC DC LCPC MD PT MEDICAL GROUP FAMILY HEALTH CARE GREAT FALLS CLINIC GREAT FALLS CLINIC IMMEDIATE CARE LINCOLN CO COMMUNITY HEALTH CENTER MONTANA FAMILY VISION CARE VAIL PHYSICAL THERAPY WESTERN MONTANA CLINIC MISSOULA VALLEY PEDIATRICS ROCKY MOUNTAIN EAR NOSE & THROAT GLACIER COMMUNITY HEALTH CENTER GREAT NORTHERN PHYSICAL THERAPY LIVINGSTON MEMORIAL HOSPITAL ROUNDUP MEMORIAL HEALTHCARE SIDNEY HEALTH CENTER CLINIC SILVER BOW PHYSICAL THERAPY BILLINGS CLINIC PATSY VARGO MD PC RIVERSTONE HEALTH SVH WALK IN CLINIC MOUNTAIN VIEW MEDICAL BILLINGS CLINIC BITTERROOT CLINIC BILLINGS CLINIC HEART AND HAND CENTER FORT MISSOULA MEDICAL ASSOCIATES BARRETT HOSPITAL & HEALTHCARE BEAVERHEAD COUNTY PUBLIC HEALTH BILLINGS FAMILY EYECARE DERMATOLOGY ASSOCIATES MARCUS DALY MEMORIAL HOSPITAL MEDICAL ASSOCIATES WMMHC ACADIA MONTANA INTERMOUNTAIN CHIIROPRACTIC INTERMOUNTAIN CHIROPRACTIC INTERMOUNTAIN CHIROPRACTIC INTERMOUNTAIN CHIROPRACTIC CHOICES PSYCHOTHERAPY & CONSULTING HELENA ORTHOPAEDIC CLINIC HELENA PT ASSOCIATES ADDRESS 715 NUCLEUS AVE 1400 29TH ST S 1400 29TH ST S 711 CALIFORNIA AVE 2829 GREAT NORTHERN LOOP #100 316 E BABCOCK 2835 FORT MISSOULA RD #3 2800 11TH AVE S #14 2835 FORT MISSOULA RD #205 700 W KENT 519 E MAIN ST 612 E MAIN ST STE A 504 S 13TH 1207 SECOND ST WEST 214 14TH AVE SW 3718 E LAKE ST STE A 801 N 29TH ST 3511 1ST AVE N 123 S 27TH ST 1233 N 30TH ST 3511 1ST AVE N #1 601 1ST AVE N 101 E BROADWAY STE 602 101 E BROADWAY STE 602 16 W MAIN 801 N 29TH ST 1224 W MAIN ST 801 N 29TH ST 111 S GRAND STE 260 500 W BROADWAY 3RD FLOOR 5549 OLD HWY 93 2835 FORT MISSOULA RD #101 30 HWY 91 S STE #205 41 BARRETT ST 1540 LAKE ELMO DR STE 1 175 COMMONS LOOP STE 300 1200 WESTWOOD DR 935 HIGHLAND BLVD STE 2200 232 S MAIN 2009 OLD RANCH RD 30 13TH ST 901 N ORANGE #107 604 EISENHOWER ST SW 308 MILWAUKEE AVE 308 MILWAUKEE AVE 62 S LAST CHANCE GULCH STE A 62 S LAST CHANCE GULCH 706 2ND AVE SE 2442 WINNE AVE 2615 COLONIAL DR CITY COLUMBIA FALLS GREAT FALLS GREAT FALLS LIBBY MISSOULA BOZEMAN MISSOULA GREAT FALLS MISSOULA MISSOULA CUT BANK BOZEMAN LIVINGSTON ROUNDUP SIDNEY BUTTE BILLINGS GREAT FALLS BILLINGS BILLINGS GREAT FALLS GREAT FALLS MISSOULA MISSOULA WHITE SULPHUR SPRINGS BILLINGS HAMILTON BILLINGS BOZEMAN MISSOULA FLORENCE MISSOULA DILLON DILLON BILLINGS KALISPELL HAMILTON BOZEMAN LIVINGSTON HAMILTON HAVRE MISSOULA RONAN DEER LODGE DEER LODGE HELENA HELENA CUT BANK HELENA HELENA ZIP 59912 59405 59405 59923 59808 59715 59804 59405 59804 59801 59427 59715 59047 59072 59270 59701 59101 59401 59101 59101 59401 59401 59802 59802 59645 59101 59840 59101 59715 59802 59833 59804 59725 59725 59101 59901 59840 59715 59047 59840 59501 59802 59864 59722 59722 59601 59601 59427 59601 59601 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE OPTOMETRY PHYSICAL THERAPY PEDIATRICS UROLOGY PEDIATRICS EAR/NOSE/THROAT (ENT) FAMILY PRACTICE PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE URGENT CARE PROVIDER NURSE PRACTITIONER NURSE PRACTITIONER LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE GASTROENTEROLOGY INTERNAL MEDICINE SURGERY VASCULAR LICENSED BEHAVIORAL COUNSELOR NURSE PRACTITIONER NURSE PRACTITIONER FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE OPTOMETRY DERMATOLOGY EMERGENCY MEDICINE/TRAUMA PEDIATRICS LICENSED BEHAVIORAL COUNSELOR PSYCHIATRY OCCUPATIONAL THERAPY NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 43 of 256 FIRST NAME KIRK COURTNEY GREGORY SHARON DEBORAH KASEY DANNY DANNY KATHLEEN DAVID SARAH MARK STEPHEN STEPHEN ROBERT BRUCE DAVID CHRISTOPHER CHRISTOPHER KIMBERLY JAMES JOHN ROBERT WILLIAM GRANT GRANT GRANT BRIAN JOHN HEATHER HEATHER JAMES TODD JAMES BRADLEY DON TODD JAMES JAMES ARTHUR JAMES NANCY LYNN LYNN ANNE ANNE ARTHUR ARTHUR ARTHUR JOHN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HANSON HANSON HANSON HANTON HAPCIC HARBINE HARBOUR HARBOUR HARDER-BROUWER HARDIN HARDIN HARDING HARDY HARDY HARDY HARDY HARDY HARKER HARKER HARKINS-SCHUELKE HARKNESS HARLAN HARPER HARPER HARRER HARRER HARRER HARRINGTON HARRINGTON HARRINGTON HARRINGTON HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRIS HARRISON LICENSE RPT PT MD LCSW PT MD MD MD MD DC DC MD MD MD MD MD OD MD MD PHD DO MD DO MD MD MD MD MD PT PA-C PA-C MD DO MD DC PT DO MD MD MD MD PT SLT SLT LCSW LCSW MD MD MD PHD MEDICAL GROUP HELENA PT ASSOCIATES NASH SPINE & JOINT REHABILITATION PLAINS FAMILY MEDICINE HEALTH IN MOTION PHYSICAL THERAPY BAIR MEMORIAL CLINIC CENTRAL MONTANA MEDICAL CENTER RAVALLI FAMILY MEDICINE W CHIROPRACTIC W CHIROPRACTIC SILVERTIP EMERGENCY PHYSICIANS NORTHWEST PLASTIC SURGERY NORTHWEST PLASTIC SURGERY SIDNEY CLINIC WESTERN MONTANA CLINIC MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING ASSOC AESTHETIC PLASTIC SURGERY CENTER EMERGENCY PHYSICIANS BIG SKY ONCOLOGY BIG SKY ONCOLOGY SLETTEN CANCER INSTITUTE BILLINGS ANESTHESIOLOGY MANGER HARRINGTON PHYSICAL THERAPY BILLINGS CLINIC FAMILY DOCTORS URGENT CARE GREAT FALLS CLINIC HARRIS CHIROPRACTIC CLINIC MANGER HARRINGTON PHYSICAL THERAPY MEDICAL ASSOCIATES MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING OF IDAHO FALLS NORTHERN MONTANA HOSPITAL RADIOLOGY MONTANA WEL HOME HEALTH OF BOZEMAN WESTERN MONTANA CLINIC WESTERN MONTANA CLINIC COMMUNITY BRIDGES ADDRESS 2615 COLONIAL DR 2748 COLONIAL DR STE A 10 KRUGER RD 716 S 20TH AVE STE 201 3985 VALLEY COMMONS DR 500 W BROADWAY 530 3RD ST NW 408 WENDELL AVE 411 W MAIN 2801 GREAT NORTHERN LOOP 2801 GREAT NORTHERN LOOP 310 SUNNYVIEW LN 2802 GREAT NORTHERN LOOP 614 W SPRUCE 214 14TH AVE SW 2835 FORT MISSOULA RD 12 OLD MONTANA STATE HWY 310 SANSOME ST 90 HWY 91 S 1610 S THIRD W STE 104 2800 11TH AVE S #29 900 N ORANGE #106 1110 FRONT ST 400 SADDLE DR 1117 29TH ST S STE 500 40 W 13TH ST 1117 29TH ST S 2800 10TH AVE N 2525 COLONIAL DR STE B 16862 BECKWITH ST 3050 HWY 83 N 801 N 29TH ST 120 N 19TH AVE STE A 1400 29TH ST S 960 S 24TH ST W STE J 2525 COLONIAL DR STE B 935 HIGHLAND BLVD STE 2200 310 SANSOME ST 90 HWY 91 S 30 13TH ST W 401 15 AVE S STE 204 205 N TRACY AVE 500 W BROADWAY 500 W BROADWAY 490 N 31ST ST #107 TRANSWESTERN 2 490 N 31ST ST #107 TRANSWESTERN 2 107 6TH AVE SW 1200 WESTWOOD DR 621 3RD ST S 2685 PALMER #D CITY HELENA HELENA PLAINS BOZEMAN BOZEMAN MISSOULA HARLOWTON LEWISTOWN HAMILTON MISSOULA MISSOULA KALISPELL MISSOULA MISSOULA SIDNEY MISSOULA MONTANA CITY PHILIPSBURG DILLON MISSOULA GREAT FALLS MISSOULA FORT BENTON HELENA GREAT FALLS HAVRE GREAT FALLS BILLINGS HELENA FRENCHTOWN SEELEY LAKE BILLINGS BOZEMAN GREAT FALLS BILLINGS HELENA BOZEMAN PHILIPSBURG DILLON HAVRE GREAT FALLS BOZEMAN MISSOULA MISSOULA BILLINGS BILLINGS RONAN HAMILTON GLASGOW MISSOULA ZIP 59601 59601 59859 59718 59718 59802 59036 59457 59840 59808 59808 59901 59808 59802 59270 59804 59634 59858 59725 59801 59405 59802 59442 59601 59405 59501 59405 59101 59601 59834 59868 59101 59718 59405 59102 59601 59715 59858 59725 59501 59405 59715 59801 59801 59101 59101 59864 59840 59230 59808 SPECIALTY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY HOSPITALIST FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC EMERGENCY MEDICINE/TRAUMA SURGERY PLASTIC/RESTORATIVEBURN SURGERY PLASTIC/RESTORATIVEBURN OB/GYN-OBSTETRICS/GYNECOLOGY CARDIOLOGY OPTOMETRY RADIOLOGY RADIOLOGY PSYCHOLOGY FAMILY PRACTICE SURGERY PLASTIC/RESTORATIVEBURN EMERGENCY MEDICINE/TRAUMA SURGERY GENERAL HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY ANESTHESIOLOGY PHYSICAL THERAPY PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT OB/GYN-OBSTETRICS/GYNECOLOGY URGENT CARE PROVIDER RADIOLOGY CHIROPRACTIC PHYSICAL THERAPY FAMILY PRACTICE RADIOLOGY RADIOLOGY RADIOLOGY RADIOLOGY PHYSICAL THERAPY AUDIOLOGY SPEECH/LANGUAGE THERAPY LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER GENERAL PRACTICE RADIOLOGY NUCLEAR RADIOLOGY PSYCHOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 44 of 256 FIRST NAME V LEE CHRISTEL JOHN EARL CRAIG ROBIN JAMIE LYLE VIRGINIA CHRISTEL ROBIN CRAIG BARBARA BARBARA CARRA CARRA MARY HEATHER SHARLA NADINE TRENAY TRENAY BELINDA MELISSA WALLACE DANIEL DANIEL DOUGLAS RUSSELL DANA GARY GLENN RITA WILLIAM MICHAEL KATHRYN GEORGE HOLLY SHELBY TINALYNNE ANGELA HOLLY ROBERTA KIM ILENE MICHAEL BRACE BRACE TRACY KATHLEEN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARRISON HARROLD HARROLD HARROP HARROP HARSH HART HART HART HART HART HARTLEY HARTMAN HARTMAN HARTMANN HARTMANN HARTNETT HARVEY HARVEY HARVEY HARWELL HASKINS HASQUET HASSELLE HATCH HATCH HATCH HAUGAN HAUGEN HAUGO HAUSMANN HAWK HAWKINS HAWKINSON HAY HAYDEN HAYDEN HAYDEN HAYDEN LICENSE MD OT PHD MD MD MD OT MD MD OT MD MD PHD PHD MD MD PHD PAC MD PAC PAC PA-C MD LCSW LCPC MD MD MD MD NP MD LCPC OT OD MD PT MD LCSW MD LCSW DO PAC MD PT PAC MD PT PT CCCA LCSW MEDICAL GROUP HOSPITALISTS OF ST PETERS MANGER HARRINGTON PHYSICAL THERAPY MONTANA NEUROCARE NORTHERN MONTANA HOSPITAL NORTHWEST GASTROENTEROLOGY NORTHWEST MONTANA SURGICAL ASSOCIATES ORTHO MONTANA SIDNEY HEALTH CENTER CLINIC SOUND IN PHYSICIOANS AT ST JAMES ST PETERS HOSPITAL REHABILITATION SURGERY CLINIC AT NORTH VALLEY HOSP MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE CORNERSTONE COUNSELING INTERNAL MEDICINE ASSOCIATES MISSION MOUNTAIN MEDICINE SVH WALK IN CLINIC SVH WALK IN CLINIC MONTANA PSYCHIATRY PLLC COMMUNITY HOSPITAL OF ANACONDA CONVENIENT CARE CLINIC BILLINGS ANESTHESIOLOGY DILLON COMMUNITY HEALTH CENTER MONTANA EYECARE BILLINGS CLINIC BARRETT HOSPITAL & HEALTHCARE EYE PHYSICIANS AND SURGEONS BOZEMAN OB/GYN ST JOHNS MINISTRY LUTHERAN SOCIAL S BRIDGER CLINIC THE MONTANA CENTER FOR WELLNESS PONDERA MEDICAL CENTER WOMEN'S HEALTH CARE CENTER ALPINE PHYSICAL THERAPY PEAK PERFORMANCE PHYSICAL THERAPY REHDER HEARING CLINIC ADDRESS 2475 BROADWAY 2525 COLONIAL DR STE B 2835 FORT MISSOULA RD STE 202 30 13TH ST 75 CLAREMONT ST #F 1273 BURNS WAY 2900 12TH AVE N STE 140W 214 14TH AVE SW STE 106 400 S CLARK ST 2475 BROADWAY 1111 BAKER AVE #2 75 CLAREMONT ST #F 710 GRAND AVE STE 8 710 GRAND AVE STE 8 104 RUFUS LN 126 6TH AVE SW 516 FULLER AVE STE 1 905 HIGHLAND BLVD STE 4500 126 6TH AVE SW #A 1233 N 30TH ST 1233 N 30TH ST 2900 12TH AVE N #315W 3737 GRAND AVE STE 6 100 E 2ND ST STE 210 307 FIRST AVE E STE 20A 401 PENNSYLVANIA 1224 W MAIN ST 925 HIGHLAND BLVD 2800 10TH AVE N 41 BARRETT ST 2825 FORT MISSOULA RD STE 115 25 S EWING STE 425 660 LOST CREEK DR 550 N MONTANA AVE 801 N 29TH ST 90 HWY 91 S 1221 N 26TH ST 418 1ST ST 925 HIGHLAND BLVD STE 1210 1515 FAIRVIEW STE 230 715 MAIN ST #A 300 N WILLSON STE 2001 2900 12TH AVE N #240W 245 WINDWARD WAY STE 101 805 SUNSET BLVD 2525 E BROADWAY STE 204 5000 BLUE MOUNTAIN RD 2360 MULLAN RD #D 1101 N 27TH ST STE E 307 1ST AVE E #17 CITY HELENA HELENA MISSOULA HAVRE KALISPELL KALISPELL BILLINGS SIDNEY BUTTE HELENA WHITEFISH KALISPELL BILLINGS BILLINGS POLSON RONAN HELENA BOZEMAN RONAN BILLINGS BILLINGS BILLINGS BILLINGS WHITEFISH KALISPELL ANACONDA HAMILTON BOZEMAN BILLINGS DILLON MISSOULA HELENA KALISPELL HELENA BILLINGS DILLON BILLINGS BIG TIMBER BOZEMAN MISSOULA STEVENSVILLE BOZEMAN BILLINGS KALISPELL CONRAD HELENA MISSOULA MISSOULA BILLINGS KALISPELL ZIP 59601 59601 59804 59501 59901 59901 59101 59270 59701 59604 59937 59901 59102 59102 59860 59864 59601 59715 59864 59101 59101 59101 59102 59937 59901 59711 59840 59715 59101 59725 59804 59601 59901 59601 59101 59725 59101 59011 59715 59801 59870 59715 59101 59901 59425 59601 59804 59808 59101 59901 SPECIALTY HOSPITALIST OCCUPATIONAL THERAPY PSYCHOLOGY RADIOLOGY GASTROENTEROLOGY SURGERY HAND OCCUPATIONAL THERAPY RADIATION ONCOLOGY HOSPITALIST OCCUPATIONAL THERAPY SURGERY GENERAL GASTROENTEROLOGY LICENSED BEHAVIORAL COUNSELOR PSYCHIATRY FAMILY PRACTICE FAMILY PRACTICE PSYCHOLOGY INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PHYSICIAN ASSISTANT PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR GENERAL PRACTICE URGENT CARE PROVIDER ANESTHESIOLOGY ANESTHESIOLOGY PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY OPTOMETRY RADIATION ONCOLOGY PHYSICAL THERAPY OPHTHALMOLOGY LICENSED CLINICAL SOCIAL WORKER OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE DERMATOLOGY PHYSICAL THERAPY FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY PHYSICAL THERAPY AUDIOLOGY LICENSED CLINICAL SOCIAL WORKER Montana STATUS PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 45 of 256 FIRST NAME LESLIE MARK MARK DEBRA BRUCE DANA ROBERT MICHELLE MICHELLE DAVID BRETT CHARLES RODNEY LOUELLA KAREN KAREN KAREN ROBERT RONALD DONALD LAURA JULIE SHARON SHARON SHAWNA NICOLE KURT HAYDN DAVID DORIS JERI EMILY QUINTON EMILY JEFFREY KATHERINE CYNTHIA TINA PATRICK SARA MINDY MARJEAN DENISE SYLVIA SYLVIA DIANE DENISE DENISE DON CONNIE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HAYDEN HAYNES HAYNES HAYTON HAYWARD HEADAPOHL HEADLEY HEALD HEALD HEALOW HEATH HEATH HEATON HEAVY RUNNER HEBERLING HEBERLING HEBERLING HECHT HECHT HECHT HECK HECKER HECKER HECKER HECKEROTH HECOCK HECOX HEDRICK HEETDERKS HEFFNER HEGER HEGGEM HEHN HEID HEIDER HEIDER HEIDT HEIKENS HEIL HEINEMAN HEINZ HEISLER HEITLER HELD HELD HELGATH HELIN HELIN HELLAND HELLER LICENSE PT DC DC LCSW DO MD MD LAC LAC MD MD LCPC DO LAC NP APRN NP DC DC DC OT LCPC MD MD LCSW PT MD LCPC MD LCSW MD RD EDD MD PHD SLT LCPC PT PT NP SLP PT LCSW PHD PHD RN MD MD MD APRN MEDICAL GROUP MONTANA PAIN & REHAB CENTER MONTANA PAIN & REHAB CENTER HELENA INDIAN ALLIANCE COMMUNITY HOSPITAL OF ANACONDA WESTERN MONTANA CLINIC WESTERN MONTANA ADDICTION SERVICES WESTERN MONTANA ADDICTION SVC FAMILY MEDICINE CENTER OF BITTERROO SOUTH SOUND INPATIENT WMAS EUREKA HEALTH PROMPT CARE THE MONTANA CENTER FOR WELLNESS THE WAL-MART CLINIC AT KRMC ADVANCED SPINAL FITNESS BIG SKY CHIROPRACTIC CLINIC COMMUNITY CHIROPRACTIC CENTER THE COZY NEST ALL SEASONS COUNSELING & CONSULTING THREE FORKS PHYSICAL THERAPY GREAT FALLS COUNSELING ASSOCIATES HELENA ORTHOPAEDIC CLINIC CORNERSTONE COUNSELING BILLINGS ANESTHESIOLOGY BILLINGS CLINIC HEADWATERS COUNSELING NORTHERN ROCKIES ORTHOPAEDICS EASTERN MONTANA COMM MENTAL HEALTH CTR BILLINGS CLINIC THE MONTANA CENTER FOR WELLNESS BENEFIS WALKIN CLINIC ABOVE & BEYOND THERAPY SERVICES ST PETERS HOSPITAL REHABILITATION EASTERN MONTANA COMMUNITY MENTAL HEALTH COMMUNITY HEALTH PARTNERS PARK CLINIC CENTRAL MONTANA FAMILY PLANNING ADDRESS 80 FOUR MILE DR STE 14B 670 KING PARK DR STE 1 670 KING PARK DR STE 1 435 N LAST CHANCE GULCH 401 W PENNSYLVANIA 500 W BROADWAY 500 W BROADWAY 1325 WYOMING ST 802 MAIN ST STE C 940 N 30TH ST 330 N 10TH ST #A 404 N 31ST ST STE 202 2827 FORT MISSOULA RD 802 MAIN ST STE C 298 OSLOSKI RD 245 WINDWARD WAY STE 101 170 HUTTON RANCH RD 932 ASPEN ST 120 N 19TH AVE STE B 1620 W MAIN 1276 N 15TH AVE STE 101 2116 BROADWATER STE 308 435 S CRYSTAL ST #300 500 W BROADWAY 1050 EASTSIDE HWY 201 MAIN ST 1101 26TH ST S 926 13TH AVE S 2442 WINNE 501 FULLER STE 1 2800 10TH AVE N 2800 10TH AVE N 725 W CENTRAL #209 2831 FORT MISSOULA RD STE 232 955 N MERIDIAN RD 955 N MERIDIAN RD 313 W VALENTINE 2800 10TH AVE N 245 WINDWARD WAY STE 101 2516 13TH AVE S 1931 S 3RD ST W 2475 BROADWAY 2508 WILSON ST 22 SECOND AVE W STE 3100 22 SECOND AVE W STE 3100 835 HIGHLAND DR 126 S MAIN ST 1001 RIVER DR 818 2ND AVE EAST 505 W MAIN ST STE 108 CITY WHITEFISH BILLINGS BILLINGS HELENA ANACONDA MISSOULA MISSOULA MISSOULA POLSON BILLINGS HAMILTON BILLINGS MISSOULA POLSON EUREKA KALISPELL KALISPELL HELENA BOZEMAN LEWISTOWN BOZEMAN BILLINGS BUTTE MISSOULA CORVALLIS THREE FORKS GREAT FALLS GREAT FALLS HELENA HELENA BILLINGS BILLINGS MISSOULA MISSOULA KALISPELL KALISPELL GLENDIVE BILLINGS KALISPELL GREAT FALLS MISSOULA HELENA MILES CITY KALISPELL KALISPELL WHITEFISH LIVINGSTON LIVINGSTON CULBERTSON LEWISTOWN ZIP 59937 59102 59102 59601 59711 59802 59802 59801 59860 59101 59840 59101 59804 59860 59917 59901 59901 59601 59718 59457 59715 59102 59701 59802 59828 59752 59405 59405 59601 59601 59101 59101 59801 59804 59901 59901 59330 59101 59901 59405 59801 59601 59301 59901 59901 59937 59047 59047 59218 59457 SPECIALTY PHYSICAL THERAPY CHIROPRACTIC CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER GENERAL PRACTICE OCCUPATIONAL MEDICINE EMERGENCY MEDICINE/TRAUMA LICENSED ADDICTION COUNSELOR LICENSED ADDICTION COUNSELOR ANESTHESIOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR HOSPITALIST LICENSED ADDICTION COUNSELOR FAMILY PRACTICE PAIN MANAGEMENT FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY NEUROLOGY LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY NUTRITION PROFESSIONAL LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE PSYCHOLOGIST SPEECH/LANGUAGE THERAPY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE SPEECH/LANGUAGE THERAPY PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER LICENSED ADDICTION COUNSELOR PSYCHOLOGY REGISTERED NURSE OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE FAMILY PRACTICE Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED 46 of 256 FIRST NAME MICHELLE MICHELLE MICHELLE JENNIFER LOURIE JENNIFER JENNIFER JIM THERESA KEVIN LAWRENCE MIKE LANCE SHARON ROMAN ROMAN ROMAN JEFFREY JILL KATIE MICHAEL WILLIAM BETH WILLIAM KATIE NICOLE DOUGLAS THOMAS ERIC TENNILE JACK PEPPER AMANDA MARK TARI MARK LAWRENCE BRITTNIE THOMAS STACY STACY EMILY MICHAEL LISA LISA LISA ROSEMARY MARK RACHAEL MARISA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HELLWIG HELLWIG HELLWIG HELME HELMER HELMER HELMER HELMER HELMER HELVIK HEMMER HENDERSON HENDRICKS HENDRICKS HENDRICKSON HENDRICKSON HENDRICKSON HENINGER HENLEY HENLEY HENNESSY HENNING HENNING HENNING HENRICHS HENRIKSEN HENRY HENRY HENSEN HENSLEY HENSOLD HENYON HENZEL HEPPE HEPPE HEPPE HERBERT HERBST HERIZA HERMILLER HERMILLER HERNDON HERRING HERRYGERS HERRYGERS HERRYGERS HERTEL HERTENSTEIN HERYNK HESS LICENSE APRN NP NP PT LCPC PT PT DC LCPC PT MD LCSW PT CNM MD MD MD OD RD APRN MD MD SLT MD SLT OD PAC MD MD PAC MD MD MD MD LCSW MD MD PT MD PAC PAC PT MD MD MD MD LCPC DC PT OD MEDICAL GROUP BIG FORK FAMILY PRACTICE HAMILTON PHYSICAL THERAPY ACADIA MONTANA NORTHERN ROCKIES PHYSICAL THERAPY NORTHERN ROCKIES REHABILITATION ARNOLD PHYSICAL THERAPY BILLINGS CLINIC WEST MONTANA PHYSICAL THERAPY RUBY VALLEY HOSPITAL RUBY VALLEY MEDICAL CLINIC TWIN BRIDGES RURAL HEALTH CLINIC POLSON FAMILY EYECARE BILLNGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR CMMC CLINIC PHYSICIANS ADVANCED NEUROLOGY SPECIALISTS PEDIATRIC THERAPY CLINIC BILLINGS CLINIC HELENA VISION CENTER MISSOULA BONE & JOINT SIDNEY HEALTH CENTER BOZEMAN DEACONESS HOSPITAL BOZEMAN DEACONESS CANCER CENTER MEDICAL ASSOCIATES CNTR FOR ASBESTOS RELATED DISEASES NEW HORIZONS COUNSELING ST JOHN LUTHERAN HOSPITAL BILLINGS CLINIC PSYCHIATRY ASSOCIATES BENEFIS MONARC CENTER GREAT FALLS CLINIC PLAINS PHYSICAL THERAPY INTERNAL MEDICINE ASSOCIATES MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS 15TH STREET CHIROPRACTIC PC SAPPHIRE PHYSICAL THERAPY ADDRESS 191 JEWEL BASIN CT #2A 7935 MT HWY 35 #201 802 2ND ST SE 336 55 BASIN CREEK RD 2831 FORT MISSOULA RD #200 2831 FORT MISSOULA RD STE 200 436 S 3RD ST W 1701 AVE E STE H 251 SADDLE DR 2675 CENTRAL AVE 212 LAKESHORE DR 2370 AVE C STE 6 301 KNAPP ST 220 E CROFOOT 210 E CROFOOT 104 S MADISON ST 410 FIRST ST E STE A 2800 10TH AVE N 410 WINDWARD WAY 310 WENDELL AVE STE 5 400 15TH AVE S STE 206 50 27TH ST W STE A 20 W 13 ST 801 N 29TH ST 534 N LAST CHANCE GULCH 2360 MULLAN RD STE C 216 14TH AVE SW 400 13TH AVE S STE 103 915 HIGHLAND BLVD 931 HIGHLAND BLVD STE 3130 935 HIGHLAND BLVD STE 2200 400 13TH AVE S STE 203 214 E 3RD ST 406 GARBER #1 350 LOUISIANA AVE 2800 10TH AVE N 435 S CRYSTAL STE 400 2078 STADIUM DR STE 101 500 15TH AVE S 3000 15TH AVE S 200 S HUBBARD 905 HIGHLAND BLVD STE 4500 205 W MAIN ST 300 N WILLSON STE 1003 422 S MAIN 511 MAIN ST 222 15TH ST S STE C 1705 BOW ST 305 W PARK ST CITY BIGFORK BIGFORK CUT BANK HAMILTON BUTTE MISSOULA MISSOULA MISSOULA BILLINGS HELENA BILLINGS KALISPELL BILLINGS WOLF POINT SHERIDAN SHERIDAN TWIN BRIDGES POLSON BILLINGS KALISPELL LEWISTOWN GREAT FALLS BILLINGS HAVRE BILLINGS HELENA MISSOULA SIDNEY GREAT FALLS BOZEMAN BOZEMAN BOZEMAN GREAT FALLS LIBBY PLAINS LIBBY BILLINGS BUTTE BOZEMAN GREAT FALLS GREAT FALLS PLAINS BOZEMAN BELGRADE BOZEMAN LIVINGSTON DEER LODGE GREAT FALLS MISSOULA LIVINGSTON ZIP 59911 59911 59427 59840 59701 59804 59804 59801 59102 59601 59102 59901 59102 59201 59749 59749 59754 59860 59101 59901 59457 59405 59102 59501 59101 59601 59808 59270 59405 59715 59715 59715 59405 59923 59859 59923 59101 59701 59715 59405 59405 59859 59715 59714 59715 59047 59722 59405 59801 59047 SPECIALTY FAMILY PRACTICE NURSE PRACTITIONER FAMILY PRACTICE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY CHIROPRACTOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY NURSE MIDWIFE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE OPTOMETRY NUTRITION PROFESSIONAL PSYCHOLOGY SURGERY ORTHOPEDIC MEDICINE NEUROLOGY SPEECH/LANGUAGE THERAPY NEUROLOGY SPEECH/LANGUAGE THERAPY OPTOMETRY SURGERY ORTHOPEDIC MEDICINE RADIOLOGY SURGERY GENERAL HOSPITALIST HEMATOLOGY-ONCOLOGY PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE/TRAUMA RADIOLOGY PHYSICAL THERAPY PSYCHIATRY OCCUPATIONAL/INDUSTRIAL MEDICINE FAMILY PRACTICE PHYSICAL THERAPY INTERNAL MEDICINE OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC PHYSICAL THERAPY OPTOMETRIST Montana STATUS SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 47 of 256 FIRST NAME JOAN CHERYL CHERYL HUGH SHANNON JANIE JANIE BRIAN MICHAEL MICHAEL JAMES JAMES OSCAR KATHLEEN PETER PETER PAMELA BRUCE BRUCE JEAN JULIE WILLIAM WILLIAM WILLIAM CAROL BRYAN THOMAS THOMAS NIKKI KERI SARAH SHANE RICHARD SHANE MARIAH R WAYNE DEBRA CHRISTINE JANET JANET LAURA LAURA DANA JAMES MICHAEL JONIE V ANNE JAMES LANCE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HESS-HOMEIER HESTER HESTER HETHERINGTON HETLETVEDT HETT HETT HEUISER HEWETT HEWITT HEYBOER HEYBOER HEYMAN HEYNEMAN HICKS HICKS HIEBERT HIETALA HIETALA HIGGINS-PERETTO HIGGS HIGHFILL HIGHFILL HIGHFILL HIGHLAND-FRITZ HILBORN HILDNER HILDNER HILL HILL HILL HILL HILL HILL HILL HILL HILL HILL BUSSELLE HILLEGASS HILLER HILLER HILLIS HILLIS HILLYER HINDE HINES HINES HINGLE HINSHAW HINTHER LICENSE PHD NP NP MD LCPC PT PT PT PAC PA-C MD MD DO LCSW DC DC MD LCSW LCSW PA-C CRNA MD MD MD LCSW DC MD MD NP MD OD MD CRNA MD PSYD MD MD MD PSYD MD MD PAC PAC APRN MD PAC MD MD MD MD MEDICAL GROUP BIG SKY NEONATOLOGY BIG SKY NEONATOLOGY BIG SKY EAR NOSE & THROAT ALTACARE MENTAL HEALTH CENTER VICTOR PHYSICAL THERAPY WILLOW CREEK PHYSICAL THERAPY HEUISER PHYSICAL THERAPY MONARC INJURY CLINIC FAMILY HEALTH CARE FAMILY HEALTH CARE ABSOLUTE HEALTH FAMILY CHIROPRACTIC INTERNAL MEDICINE ASSOCIATES ALTACARE WESTERN MONTANA MENTAL HEALTH CTR POLSON OUTREACH CLINIC ROCKY MOUNTAIN HEART & LUNG BILLINGS CLINIC HELENA CHIROPRACTIC CENTER FAMILY DOCTORS URGENT CARE FAMILY PRACTICE ASSOCIATES BELGRADE URGENT CARE BILLINGS CLINIC HEIGHTS EYECARE MEDNORTH KALISPELL URGENT CARE PONDERA MEDICAL CENTER ST LUKE COMMUNITY HOSPITAL ROCKY MOUNTAIN NEONATOLOGY ROCKY MOUNTAIN NEONATOLOGY BIG SANDY MEDICAL CENTER HI LINE SLETTEN CANCER CENTER MONTANA PLAINS REHABILITATION BILLINGS CLINIC ALL WOMENS CARE ADDRESS 445 S FIFTH ST W 1101 26TH ST S 400 13TH AVE S STE 206 925 HIGHLAND BLVD STE 1160 150 EDUCATION WAY 2386 HWY 93 N 1016 BROOKS AVE 3180 DREDGE DR 500 15TH AVE S 621 3RD ST S 1287 BURNS WAY 715 NUCLEUS AVE 500 W BROADWAY 2475 VILLAGE LN STE 102 1831 S 3RD ST W 1831 S 3RD ST W 905 HIGHLAND BLVD STE 4500 4255 KIMBERWICKE 1305 WYOMING 500 W BROADWAY 3RD FLOOR 504 S 13TH 102 13TH AVE EAST 350 HERITAGE WAY STE 2100 350 HERITAGE WAY STE 2100 801 N 29TH ST 900 N MONTANA STE B1 120 N 19TH AVE STE A 935 HIGHLAND BLVD STE 2210 403 W MAIN ST 801 N 29TH ST 430 LAKE ELMO DR 2316 US HWY 93 N 805 SUNSET BLVD 107 6TH AVE SW 1141 YELLOWSTONE AVE 211 E 2ND 621 3RD ST S 2075 CHARLOTTE ST STE 3 320 N MAIN ST STE D 2825 FORT MISSOULA RD #130 2825 FORT MISSOULA RD #130 3 MONTANA AVE 40 W 13TH ST 1125 MISSOULA AVE STE B 1300 28TH ST S STE 9-A 801 N 29TH ST 2820 CENTRAL AVE #A 408 WENDALL AVE 4239 LONG RIDER TRAIL #1 2825 FORT MISSOULA RD #201 CITY MISSOULA GREAT FALLS GREAT FALLS BOZEMAN LIBBY VICTOR CORVALLIS HELENA GREAT FALLS GLASGOW KALISPELL COLUMBIA FALLS MISSOULA BILLINGS MISSOULA MISSOULA BOZEMAN BOZEMAN MISSOULA MISSOULA LIVINGSTON POLSON KALISPELL KALISPELL BILLINGS HELENA BOZEMAN BOZEMAN BELGRADE BILLINGS BILLINGS KALISPELL CONRAD RONAN BOZEMAN LIBBY GLASGOW BOZEMAN LIVINGSTON MISSOULA MISSOULA BIG SANDY HAVRE HELENA GREAT FALLS BILLINGS BILLINGS LEWISTOWN BILLINGS MISSOULA ZIP 59801 59405 59405 59715 59923 59875 59828 59602 59405 59230 59901 59912 59802 59102 59801 59801 59715 59718 59801 59802 59047 59860 59901 59901 59101 59601 59718 59715 59714 59101 59105 59901 59425 59864 59718 59923 59230 59718 59047 59804 59804 59520 59501 59601 59405 59101 59102 59457 59106 59804 SPECIALTY PSYCHOLOGY HEMATOLOGY-ONCOLOGY PEDIATRIC NEONATOLOGY EAR/NOSE/THROAT (ENT) LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE PHYSICIAN ASSISTANT FAMILY PRACTICE FAMILY PRACTICE PHYSICAL MEDICINE REHABILITATION LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC CHIROPRACTOR INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICIAN ASSISTANT ANESTHESIOLOGY CARDIOLOGY INTERNAL MEDICINE CARDIOLOGY HEMATOLOGY-ONCOLOGY CHIROPRACTIC URGENT CARE PROVIDER FAMILY PRACTICE URGENT CARE PROVIDER GASTROENTEROLOGY OPHTHALMOLOGY URGENT CARE PROVIDER ANESTHESIOLOGY EMERGENCY MEDICINE/TRAUMA PSYCHOLOGY CARDIOVASCULAR DISEASE RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PSYCHOLOGY PEDIATRIC NEONATOLOGY PEDIATRICS FAMILY PRACTICE FAMILY PRACTICE PSYCHIATRY PHYSICAL MEDICINE REHABILITATION SURGERY UROLOGICAL UROLOGY FAMILY PRACTICE RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY DERMATOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 48 of 256 FIRST NAME REBECCA JEFFREY STEPHEN LISA GLENN CHRISTINA ELEANORE RANDALL BENJAMIN GRACE THOMAS CHRISTINE MARK DANIEL GREGORY GREG DEBRA DAVID BEN NOEL CHRISTOPHER RICHARD RICHARD RANDY RANDY ROLF ROLF ROLF ROLF ROLF PAUL ERIN H MARGARET SHERRY JOHN MIMI EMILY ROBERT MEGAN REBECCA TOBIN DON JACK ROBIN WILLIAM SHEILA SHEILA SHEILA JULIA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HINTZE HINZ HISEY HJELMSTAD HLADEK HO HOBBS HOCH HOCKIN HODGES HODGETTS HODGSON HODGSON HODSON HOELL HOELL HOERTH HOFFMAN HOFFMAN HOKLIN HOLDHUSEN HOLGATE HOLGATE HOLLAND HOLLAND HOLLE HOLLE HOLLE HOLLE HOLLE HOLLEY HOLM HOLMES HOLWICK HONG HONSKY HOOD DAYHUFF HOOKER HOOLSEMA HOOVER HOOVER HOPPES HOPWOOD HORNBY HORRELL HORST HORTON HORTON HORTON HORTON LICENSE PAC MD PT LCSW AU MD MD OD DPM LCPC LCSW NP MD DPM DC DC CRNA MD PA-C DC MD MD MD PAC PAC MD MD MD MD MD MD PT LCPC MD NP LCPC APRN MD PT MD MD MD MD MD MD PT PT PT SLT MEDICAL GROUP COMMUNITY HEALTH PARTNERS GREAT FALLS CLINIC WELLNESS POSSEBILITIES INC ROCKY MOUNTAIN SPEECH & HEARING CARDIO VASCULAR CONSULTANTS OF MT ST LUKE COMM CLINIC EYECARE ASSOCIATES OF LEWISTOWN COMPLETE FOOT CARE WMMHC ACORN PEDIATRICS MEDICAL ASSOCIATES GREAT FALLS CLINIC BOZEMAN BACK & NECK CLINIC MANHATTAN BACK & NECK CLINIC FAMILY DOCTORS URGENT CARE HOKLIN CHIROPRACTIC FLATHEAD CITY COUNTY HEALTH ADVANCED MRI HOLY ROSARY HEALTHCARE SVH WALK IN CLINIC MARCUS DALY MEMORIAL HOSPITAL SLEEP MARCUS DALY MEMORIAL HOSPITAL SLEEP MARCUS DALY MEMORIAL HOSPITAL SLEEP WESTERN MONTANA CLINIC WESTERN MONTANA CLINIC YELLOWSTONE PATHOLOGISTS PC ARNOLD PHYSICAL THERAPY NATUROPATHIC ACUPUNCTURE CLINIC GREAT FALLS CLINIC BRIDGER CARE MISSOULA ANESTHESIOLOGY REHABILITY WESTERN MONTANA CLINIC KALISPELL DIAGNOSTIC SERVICE GABERT MEDICAL SERVICES STILLWATER THERAPUTIC SERVICES BILLINGS CLINIC GREAT FALLS CLINIC ABSAROKEE MEDICAL CLINIC MOUNTAIN VIEW CLINIC RED LODGE PHYSICAL THERAPY THE COZY NEST ADDRESS 126 S MAIN ST 1600 DIVISION RD 1700 W KOCH STE 12 26 E 6TH ST 700 W KENT 1101 N 27TH ST STE F 126 6TH AVE SW #A 119 E MAIN ST 951 BROADWATER SQ 616 HELENA AVE STE 301 405 BROOKLYN AVE 280 W KAGY BLVD STE G 935 HIGHLAND BLVD STE 2200 3000 15TH AVE S 120 N 19TH AVE STE B 114 W MAIN ST 621 3RD ST S 120 N 19TH AVE STE A 2820 CENTRAL AVE #A 1643 24TH ST W STE 203 1035 1 AVE WEST 1099 N 27TH ST 1099 N 27TH ST 2600 WILSON ST 1233 N 30TH ST 1200 WESTWOOD DR 1200 WESTWOOD DR 1200 WESTWOOD DR 500 W BROADWAY 500 W BROADWAY 2900 12TH AVE N #295W 251 SADDLE DR 3860 MCHUGH DR 635 N JACKSON 1101 26TH ST S 500 W BROADWAY 2050 FAIRWAY DR STE 209 300 N WILLSON STE 2001 2825 STOCKYARD RD BLDG I-200 403 W MAIN STE B 2835 FORT MISSOULA RD #3 135 COMMONS WAY 107 DILWORTH 418 WINDWARD WAY 801 N 29TH ST 20 13TH ST 55 N MONTANA 10 ROBINSON LN 810 N BROADWAY 1276 N 15TH STE 101 CITY LIVINGSTON GREAT FALLS BOZEMAN HARDIN MISSOULA BILLINGS RONAN LEWISTOWN BILLINGS HELENA SUPERIOR BOZEMAN BOZEMAN GREAT FALLS BOZEMAN MANHATTAN GLASGOW BOZEMAN BILLINGS BILLINGS KALISPELL BILLINGS BILLINGS MILES CITY BILLINGS HAMILTON HAMILTON HAMILTON MISSOULA MISSOULA BILLINGS HELENA HELENA HELENA GREAT FALLS MISSOULA BOZEMAN BOZEMAN MISSOULA BELGRADE MISSOULA KALISPELL GLENDIVE KALISPELL BILLINGS HAVRE ABSAROKEE RED LODGE RED LODGE BOZEMAN ZIP 59047 59404 59715 59034 59801 59101 59864 59457 59102 59601 59872 59715 59715 59405 59718 59741 59230 59718 59102 59102 59901 59101 59101 59301 59101 59840 59840 59840 59801 59801 59101 59601 59602 59601 59405 59802 59715 59715 59808 59714 59807 59901 59330 59901 59101 59501 59001 59068 59068 59715 SPECIALTY FAMILY PRACTICE PEDIATRICS PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER AUDIOLOGY FAMILY PRACTICE PSYCHIATRY OPTOMETRY PODIATRY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER PEDIATRICS PEDIATRICS PODIATRY CHIROPRACTIC CHIROPRACTIC NURSE ANESTHETIST URGENT CARE PROVIDER PHYSICIAN ASSISTANT CHIROPRACTIC FAMILY PRACTICE RADIOLOGY RADIOLOGY FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE PULMONARY DISEASES SLEEP STUDIES PULMONARY DISEASES SLEEP STUDIES PATHOLOGY PHYSICAL THERAPY PROFESSIONAL COUNSELOR LICENSED MASSAGE THERAPIST INTERNAL MEDICINE NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY ANESTHESIOLOGY PHYSICAL THERAPY FAMILY PRACTICE NEPHROLOGY FAMILY PRACTICE PSYCHIATRY EAR/NOSE/THROAT (ENT) SURGERY UROLOGICAL UROLOGY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY SPEECH/LANGUAGE THERAPY Montana STATUS SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 49 of 256 FIRST NAME VERN LINDA GREGORY GREGORY PHILIP PHILIP VICTOR TERRY MICHAEL MICHAEL SHARON GARY RAYMOND WILLIAM KRISTINA WILLIAM BARBARA KRISTINA SHERI SHIRLEY SHIRLEY SHIRLEY BRENDA ZAN JAMES THERESE STACYE STACYE DUNCAN JOY ANDY MARY MARY LEE WADE JAMES JAMES JAMES JAMES BONNIE MICHAEL LARRY ANGELA H H TODD WILLIAM WILLIAM WILLIAM WILLIAM Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HORTON HOSEK HOULIHAN HOULIHAN HOUSE HOUSE HOUSER HOUSINGER HOVLAND HOVLAND HOWARD HOWARD HOWARD HOWARD HOWARD HOWARD HOWE HOWELL HOWELL HOWELL HOWELL HOWELL HOWKE HOXSEY HOYNE HRNCIRIK HUBBARD HUBBARD HUBBARD HUBER HUDAK HUDDLE HUDDLE HUDSON HUDSON HUEFTLE HUEFTLE HUEFTLE HUEFTLE HUESTIS HUGGARD HUGHES HUGHES HUGHSON HUGHSON HULL HULL HULL HULL HULL LICENSE MD PT DO DO PSYD PSYD MD MD MD MD APRN CRNA DO LAC MD LCSW MD MD LCSW LCSW LCSW PT LCPC MD RD FNP NP MD APRN LCPC NP NP DC PAC MD MD MD MD LCPC LCPC PAC NP MD MD PAC DO DO DO DO MEDICAL GROUP NORTHERN PHYSICAL THERAPY BENEFIS HEALTHCARE PRACTITIONERS TAMARACK MEDICAL CLINIC BILLINGS CLINIC ANESTHESIA PARTNERS OF MONTANA NORTHERN ROCKIES REGIONAL PAIN CTR FAMILY HEALTH CLINIC GREAT FALLS CLINIC MISSOULA FAMILY MEDICAL CENTER NEURORAD WESTERN MONTANA ADDICTION SERVICE GREAT FALLS CLINIC SAGE MEDICAL CLINIC WESTERN MONTANA MENTAL HEALTH WESTERN MONTANA MENTAL HEALTH WESTERN MONTANA MENTAL HEALTH NASH SPINE & JOINT REHABILITATION PSYCHIATRY ASSOCIATES BAIR MEMORIAL CLINIC BILLINGS CLINIC KALISPELL MEDICAL OFFICES THE WAL-MART CLINIC BY KRMC HOLY ROSARY HEALTHCARE NORTHWEST FAMILY RECOVERY ADVANCED CHIROPRACTIC CENTER WESTERN MONTANA CLINIC FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST BRIDGER ORTHOPEDICS ORTHO MONTANA ADDRESS 500 W BROADWAY 1111 BAKER AVE STE 2 400 15TH AVE S STE 207 1208 6TH AVE E 1629 AVE D BLDG B #2 1629 AVE D BLDG B #2 355 1ST AVE W N 801 N 29TH ST 2900 12TH AVE N STE 205W 2900 12TH AVE N STE 335W 900 6TH ST SW STE 2 1509 29TH ST S 621 W ALDER 417 LOWER LYNCH CREEK RD 1325 WYOMING ST 107 6TH AVE SW 304 BROADWAY 1509 29TH ST S 820 N MONTANA AVE 410 WINDWARD WAY 410 WINDWARD WAY 410 WINDWARD WAY 2748 COLONIAL DR STE 1 2006 STADIUM DR STE 103 530 3RD ST NW 1045 N 30TH ST 1280 BURNS WAY 170 HUTTON RANCH RD 2831 FORT MISSOULA RD #304 2600 WILSON ST 309 WISCONSIN AVE 500 W BROADWAY 601 W SPRUCE #C 1400 29TH ST S 2ND FLOOR 500 W BROADWAY 1315 GOLDEN VALLEY CIRCLE 1315 GOLDEN VALLEY CIRCLE 400 S CLARK ST 400 S CLARK ST 5200 9TH AVE S 1553 PEONY DR 1450 ELLIS ST STE 201 221 5TH AVE S 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 2900 12TH AVE N STE 140W 104 RUFUS LN 110 KENEGEN RD 1101 TEXAS AVE 120 POND ST CITY MISSOULA WHITEFISH GREAT FALLS SUPERIOR BILLINGS BILLINGS KALISPELL BILLINGS BILLINGS BILLINGS GREAT FALLS GREAT FALLS MISSOULA PLAINS MISSOULA RONAN HELENA GREAT FALLS HELENA KALISPELL KALISPELL KALISPELL HELENA BOZEMAN HARLOWTON BILLINGS KALISPELL KALISPELL MISSOULA MILES CITY WHITEFISH MISSOULA MISSOULA GREAT FALLS MISSOULA BILLINGS BILLINGS BUTTE BUTTE GREAT FALLS BILLINGS BOZEMAN GLASGOW MISSOULA MISSOULA BILLINGS POLSON PLAINS DEER LODGE THOMPSON FALLS ZIP 59802 59937 59405 59872 59102 59102 59901 59101 59101 59101 59404 59405 59802 59859 59801 59864 59601 59405 59601 59901 59901 59901 59601 59715 59036 59101 59901 59901 59804 59301 59937 59802 59802 59405 59802 59102 59102 59701 59701 59405 59105 59715 59230 59802 59802 59101 59860 59859 59722 59873 SPECIALTY SURGERY PHYSICAL THERAPY FAMILY PRACTICE GENERAL PRACTICE PSYCHOLOGIST PSYCHOLOGIST PSYCHIATRY SURGERY GENERAL ANESTHESIOLOGY ANESTHESIOLOGY FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE RADIOLOGY LICENSED ADDICTION COUNSELOR RADIOLOGY LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY FAMILY PRACTICE LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY PSYCHOLOGY FAMILY PRACTICE NUTRITION PROFESSIONAL FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR NURSE PRACTITIONER NURSE PRACTITIONER CHIROPRACTIC SURGERY ORTHOPEDIC MEDICINE GERIATRIC MEDICINE HEMATOLOGY-ONCOLOGY GERIATRIC MEDICINE HEMATOLOGY-ONCOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE NURSE PRACTITIONER INTERNAL MEDICINE INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 50 of 256 FIRST NAME WILLIAM WILLIAM WILLIAM WILLIAM WILLIAM WILLIAM WILLIAM WILLIAM WILLIAM WILLIAM STEVEN RANDALL MELISSA LANCE KATHERINE JEFF AARON WILLIAM WILLIAM KAREN M BROOKE M BROOKE LAURA LAURA MARIA ROBERT RIK JAMES JAMES CHARLES CHRISTINE LUCINDA FRED MICHAEL CYNTHIA JOHN TYRA WILLIAM CYNTHIA MARK YOKO SHEILA SHEILA BRADLEY BRADLEY BRADLEY CHERYL FREDERICK ARIN JODY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME HULL HULL HULL HULL HULL HULL HULL HULL HULL HULL HULSEY HULTGREN HULVAT HUMMEL HUMPHREY HUMPHREY HUMPHREYS HUNT HUNT HUNT HUNTER HUNTER HUNTER HUNTER HUNTLEY HURD HURLESS HURM HURM HURST HURST HUSBY HUSKEY HUTCHINS HUTCHINSON HUTCHISON HUVAL HUVAL IBES IBSEN ICHIMURA IDZERDA IDZERDA IHRIG IHRIG IHRIG IKEDA ILGENFRITZ IMAN INBODY LICENSE DO DO DO DO DO DO DO DO DO DO MD DC MD PT PT PT MD PAC PAC MD MD MD NP APRN MD MD LCPC MD MD PT LCPC MD LCPC MD LCPC OD MD MD OT MD LCPC MD MD MD MD MD LCSW MD DO PA MEDICAL GROUP MISSOULA ANESTHESIOLOGY HULTGREN CHIROPRACTORS THE BREAST SURGICAL ONCOLOGY CENTER MINERAL COMMUNITY HOSPITAL ALTA PHYSICAL THERAPY & FITNESS WILLOW CREEK PHYSICAL THERAPY CMMC CLINIC PHYSICIANS FAMILY HEALTH CARE FAMILY HEALTH CARE NORTHWEST ONCOLOGY & HEMOTOLOGY HELENA ORTHOPAEDIC CLINIC HELENA ORTHOPAEDIC CLINIC KALISPELL MEDICAL OFFICES MEDNORTH KALISPELL URGENT CARE WOMEN'S HEALTH CARE CENTER BILLINGS CLINIC GRACE THERAPY INC SHERIDAN MEMORIAL HOSPITAL ADVANCED REHAB BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR RAVALLI FAMILY EYE CARE GREAT FALLS CLINIC GREAT FALLS CLINIC LIVINGSTON HEALTH & REHAB CENTER URGENT CARE PLUS WMMHC ACORN PEDIATRICS MEDICAL ASSOCIATES CMC PHYSICIAN SERV CPG NORTHGATE PRIMARY CARE CPG PARKSIDE COMMUNITY FAMILY CARE BILLINGS CLINIC HAMILTON GENERAL SURGERY ST PETERS MEDICAL OFFICE BLDG ADDRESS 1200 WESTWOOD DR 1208 6TH AVE E 126 6TH AVE SW 207 N MAIN ST 2809 GREAT NORTHERN LOOP #200 2827 FORT MISSOULA RD 301 SADDLE DR 301SADDLE DR 3800 EASTSIDE HWY 500 W BROADWAY 2825 STOCKYARD RD BLDG I-200 944 AVE B 310 SUNNYVIEW LN 1208 6TH AVE E 81 8TH ST #9 1016 BROOKS AVE 310 WENDELL AVE STE 5 1287 BURNS WAY 715 NUCLEUS AVE 350 HERITAGE WAY S1100 2442 WINNE 2442 WINNE 1280 BURNS WAY 2316 US HWY 93 N 2525 E BROADWAY STE 204 801 N 29TH ST 205 HAGGERTY LN STE 270 440 W LAUREL AVE 818 2ND AVE EAST 417 N BENTON AVE 690 N MERIDIAN #211 801 N 29TH ST 209 N 10TH STE A 2819 GREAT NORTHERN LOOP #200 420 BEVERLY HILLS BLVD 109 N 4TH ST STE 105 1400 29TH ST S 1400 29TH ST S 510 S 14TH ST 39 NEILL AVE 1315 WYOMING ST 280 W KAGY BLVD STE G 935 HIGHLAND BLVD STE 2200 1211 S RESERVE ST 2230 N RESERVE #402 2831 FORT MISSOULA RD #146 1020 N 27TH ST 1150 WESTWOOD DR STE D 221 5TH AVE S 2550 E BROADWAY ST CITY HAMILTON SUPERIOR RONAN DARBY MISSOULA MISSOULA HELENA HELENA STEVENSVILLE MISSOULA MISSOULA BILLINGS KALISPELL SUPERIOR BELGRADE CORVALLIS LEWISTOWN KALISPELL COLUMBIA FALLS KALISPELL HELENA HELENA KALISPELL KALISPELL HELENA BILLINGS BOZEMAN PLENTYWOOD CULBERTSON HELENA KALISPELL BILLINGS HAMILTON MISSOULA BILLINGS HAMILTON GREAT FALLS GREAT FALLS LIVINGSTON HELENA MISSOULA BOZEMAN BOZEMAN MISSOULA MISSOULA MISSOULA BILLINGS HAMILTON GLASGOW HELENA ZIP 59840 59872 59864 59829 59808 59804 59601 59601 59870 59802 59808 59102 59901 59872 59714 59828 59457 59901 59912 59901 59601 59601 59901 59901 59601 59101 59715 59254 59218 59601 59901 59101 59840 59808 59101 59840 59405 59403 59047 59601 59801 59715 59771 59801 59808 59804 59101 59840 59230 59601 SPECIALTY CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE ANESTHESIOLOGY CHIROPRACTIC SURGICAL ONCOLOGY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE HEMATOLOGY-ONCOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE URGENT CARE PROVIDER OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY GENERAL LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY PROFESSIONAL COUNSELOR INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR OPTOMETRY PEDIATRICS SURGERY GENERAL OCCUPATIONAL THERAPY URGENT CARE PROVIDER LICENSED BEHAVIORAL COUNSELOR PEDIATRICS PEDIATRICS FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER SURGERY GENERAL FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 51 of 256 FIRST NAME KATHLEEN ANN DAVID RALUCA SERBAN ARLYNN R KATHERINE PATTI B MAX RENEE B MAX LAWRENCE PADMA KAREN KENDALL GORDON DAVID JOHN JOHN WAYNE KURT RACHEL RACHEL RACHEL RACHEL RACHEL RACHEL JUSTIN TANYA TANYA SCOTT SCOTT THOMAS PIETRO PIETRO DONALD THOMAS KRISTIN JENNIFER DANIEL HETTIE SANDRA SANDRA GLENN HOLLY LESZEK PATRICK MARY JO ALEXANDER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME INGALLS INGRAM INGRAM IONESCU IONESCU IRISH IRWIN ISAACSON IVERSEN IVERSON IVERSON IVERSON IWERSEN IYER IZBICKI JACKSON JACKSON JACKSON JACKSON JACKSON JACOBSMEYER JACOBSON JACOBSON JACOBSON JACOBSON JACOBSON JACOBSON JACOBSON JACOBSON JAGODZINSKI JAGODZINSKI JAHNKE JAHNKE JAMES JAMES JAMES JAMES JAMES JANCZEWSKI JANETSKI JANS JANS-WORTELBOER JANZEN JANZEN JARRETT JARVIS JASZCZAK JAVID JEFFRES JEHLE LICENSE PT APRN MD MD MD PA MD LCPC APRN MD NP MD MD MD PAC LCPC LCSW MD DO DO DC MD LAC LAC LAC LAC LAC LAC MD MD MD DO DO MD MD MD OD MD MD RD PAC LCPC PAC PA-C MD PT MD MD PHD MD MEDICAL GROUP MINDFUL MOTION PHYSICAL THERAPY & W FLATHEAD VALLEY ORTHOPEDICS NORTH COUNTRY MEDICAL CLINIC NORTH COUNTRY MEDICAL CLINIC HOLY ROSARY HEALTHCARE WESTERN MONTANA MENTAL HEALTH CTR SIDNEY MEDICAL CENTER HELENA ORTHOPAEDIC CLINIC ROCKY MOUNTAIN HEART & LUNG FLATHEAD VALLEY ORTHOPEDICS SIDNEY HEALTH CENTER HATHAWAY INTERNAL MEDICINE BILLINGS CLINIC EASTERN MONTANA COMMUNITY MHC FETAL DIAGNOSTIC CENTER JACOBSMEYER CHIROPRACTIC CLINIC BILLINGS CLINIC MENTAL HEALTH CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER NORTHERN ROCKIES ORTHOPAEDICS THE CHILDRENS CLINIC FLATHEAD VALLEY ORTHOPEDIC CENTER GRIZZLY SPINE PAIN & REHAB ADVANCED CARE HOSPITAL OF MONTANA ORAL & MAXILLOFACIAL SURGERY ORAL & MAXILLOFACIAL SURGERY PACIFIC CATARACT & LASER INSTITUTE RIVERSTONE HEALTH DR J GENERAL SURGERY CHRONNIC DISEASE OUTREACH LIBERTY MEDICAL CENTER GLENDIVE MEDICAL CENTER MISSOULA BONE & JOINT MARCUS DALY MEMORIAL HOSPITAL PEDIATRIC SURGERY OF MONTANA ADDRESS 30 4TH ST EAST 111 SUNNYVIEW LN 111 SUNNYVIEW LN 1343 HWY 93 N 1343 HWY 93 N 2600 WILSON ST 6 - 13TH AVE E 300 N WILLSON STE 3005 214 14TH AVE SW 2442 WINNE AVE 350 HERITAGE WAY #2100 110 N OAK 111 SUNNYVIEW LN 216 14TH AVE SW 931 HIGHLAND BLVD STE 3330 1020 N 27TH ST 2508 WILSON 2900 12TH AVE N STE 130W 209-1/2 H ST E 301 KNAPP ST 430 NUCLEUS AVE 1020 N 27TH ST 1245 N 29TH 1245 N 29TH 26 W MAIN 26 W MAIN 410 E PIKE 410 E PIKE 2831 FORT MISSOULA RD #232 3401 AVE E 1232 N 30TH ST STE 200 111 SUNNYVIEW LN 3 MERIDIAN COURT STE 2 3528 GABEL RD 65 MEDICAL PARK DR 65 MEDICAL PARK DR 1717 4TH ST S 123 S 27TH ST 2835 FORT MISSOULA RD #306 310 SUNNYVIEW LN 418 W MONROE AVE 215 E LEWIS #100 202 PROSPECT DR 605 SULLIVAN AVE 2360 MULLAN RD STE C 1200 WESTWOOD DR 621 3RD ST S 2835 FT MISSOULA RD #301 48 MEDICAL PARK DR 500 W BROADWAY #320 CITY KALISPELL KALISPELL KALISPELL EUREKA EUREKA MILES CITY POLSON BELGRADE SIDNEY HELENA KALISPELL TOWNSEND KALISPELL SIDNEY BOZEMAN BILLINGS MILES CITY BILLINGS POPLAR WOLF POINT COLUMBIA FALLS BILLINGS BILLINGS BILLINGS ROUNDUP ROUNDUP COLUMBUS COLUMBUS MISSOULA BILLINGS BILLINGS KALISPELL KALISPELL BILLINGS HELENA HELENA GREAT FALLS BILLINGS MISSOULA KALISPELL CHESTER LIVINGSTON GLENDIVE CIRCLE MISSOULA HAMILTON GLASGOW MISSOULA HELENA MISSOULA ZIP 59901 59901 59901 59917 59917 59301 59860 59714 59270 59601 59901 59644 59901 59270 59715 59101 59301 59101 59255 59201 59912 59101 59101 59101 59072 59072 59019 59019 59804 59102 59101 59901 59901 59102 59601 59601 59404 59101 59804 59901 59522 59047 59330 59215 59808 59840 59230 59804 59601 59802 SPECIALTY PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE ANESTHESIOLOGY FAMILY PRACTICE INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE RADIOLOGY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER PERINATOLOGY FAMILY PRACTICE FAMILY PRACTICE CHIROPRACTIC CARDIOLOGY LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE PEDIATRICS PEDIATRICS PAIN MANAGEMENT PAIN MANAGEMENT FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY OPTOMETRY FAMILY PRACTICE SURGERY GENERAL NUTRITION PROFESSIONAL FAMILY PRACTICE PROFESSIONAL COUNSELOR FAMILY PRACTICE PHYSICIAN ASSISTANT SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY RADIOLOGY PEDIATRIC SURGERY PSYCHOLOGY INTERNAL MEDICINE Montana STATUS SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 52 of 256 FIRST NAME CARROLL MARGARET THOMAS THOMAS LYNNE MARY DONNA CHARLES MIANNE CRAIG MICHAEL AMY AMY ALLISUN INDY JAMES NATHAN RACHEL MARTHA MARTHA ANGELA RONNY DAVID DAVID CINDIE MELISSA MELISSA KARIN KARIN GORDON KARIN CYNTHIA ANDREA CHRISTOPHER N RAGNER MIKE PAUL ANGELICA PAUL CARI JANICE LINDA SANDRA TIMOTHY J CHRIS MARIBETH FRANK DEANN DEANN JERROLD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME JENKINS JENKINS JENKO JENKO JENKO JENNI JENNINGS JENNINGS JENRICH JENSEN JENSEN JENSEN JENSEN JENSEN JENSEN JENSEN JENSON JERGENSON JESSOP JESSOP JEZ JIJI JINICH JINICH JOBE JOECKS JOECKS JOHNS JOHNS JOHNS JOHNS JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON LICENSE LCSW LCSW MD MD PT PHD APRN MD NP LCPC PT SLT SLT PAC LCSW LPC DO PSYD NP NP PSYD MD MD MD LCPC LCPC LCPC PA PAC MD PA-C OD PT MD MD MD MD APRN MD RD AU MD MD MD DC PT MD PT PT MD MEDICAL GROUP COUNSELING CONSORTIUM COUNSELING CONSORTIUM BIGFORK MEDICAL CLINIC BIGFORK MEDICAL CLINIC WESTERN MONTANA CLINIC ALEPH GREAT FALLS ORTHOPEDIC ASSOC CONTINENTAL DIVIDE OB/GYN EAGLE VISION COUNSELING FRONTIER PHYSICAL THERAPY NORTHERN ROCKY MOUNTAINS PEDIATRIC PEDIATRIC THERAPY CLINIC RAVALLI FAMILY MEDICINE BILLINGS CLINIC BIGFORK MEDICAL CLINIC EUREKA PROMPT CARE INTEGRATIVE CLINICAL SERVICES BILLINGS CLINIC CARDIAC RHYTHM SERVICES COMMUNITY MEDICAL CENTER PHYS SERV ALTACARE GALLATIN MENTAL HEALTH CENTER BLUE MOUNTAIN CLINIC CPG ON NORTH RESERVE PACIFIC CATARACT & LASER INSTITUTE ADVANCED EYECARE ASSOCIATES ADVANCED PRACTICE PHYSICAL THERAPY ANESTHESIA ASSOCIATES OF GREAT FALL BENEFIS CRITICAL UNIT BENEFIS MONARC CENTER BENEFIS QUICK CARE BENTON MEDICAL CENTER BENTON MEDICAL CENTER BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC BOZEMAN DEACONESS GI CLINIC CHIROPRACTIC HEALTH ASSOCIATES CMC OUTPATIENT THERAPIES CMMC CLINIC PHYSICIANS CTR FOR PHYSICAL THERAPY & WELLNESS CTR FOR PHYSICAL THERAPY & WELLNESS GALLATIN COMMUNITY CLINIC ADDRESS 1002 N BENTON AVE 1002 N BENTON AVE 8299 HWY 35 8299 MONTANA HWY 35 500 W BROADWAY 137 CRESTVIEW LN 2685 PALMER ST STE A 1401 25TH ST S 305 W PORPHYRY ST 1601 SECOND AVE N #616 115 SMELTER AVE NE STE 104 1537 AVE D STE 150 50 27TH ST W STE A 411 W MAIN ST 402 MONTANA AVE 1643 LEWIS AVE STE 3 2800 10TH AVE N 124 S MAIN STE 201 8299 MT HWY 35 298 OSLOSKI RD 723 5TH AVE E STE 112C 1020 N 27TH ST 2827 FORT MISSOULA RD 2831 FORT MISSOULA RD #102 1480 MEMORY LN 611 S 8TH 699 FARMHOUSE LN 610 N CALIFORNIA ST 2230 N RESERVE #402 1717 4TH ST S 500 W BROADWAY 4265 FALLON STE 1 900 2ND ST S 401 15TH AVE S STE 109 1101 26TH AVE S 500 15TH AVE S 500 15TH AVE S 1203 15TH ST 1203 15TH ST 2800 10TH AVE N 801 N 29TH ST 2800 10TH AVE N 2675 CENTRAL AVE 931 HIGHLAND BLVD STE 3350 1407 WYOMING AVE 2827 FORT MISSOULA RD 310 WENDELL AVE STE 1 1309 HARRISON AVE 1309 HARRISON AVE 214 E MENDENHALL CITY HELENA HELENA BIGFORK BIGFORK MISSOULA MISSOULA MISSOULA GREAT FALLS BUTTE GREAT FALLS GREAT FALLS BILLINGS BILLINGS HAMILTON LIBBY BILLINGS BILLINGS LIVINGSTON BIGFORK EUREKA KALISPELL BILLINGS MISSOULA MISSOULA KALISPELL BOZEMAN BOZEMAN MISSOULA MISSOULA GREAT FALLS MISSOULA BOZEMAN GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS FORT BENTON FORT BENTON BILLINGS BILLINGS BILLINGS BILLINGS BOZEMAN BILLINGS MISSOULA LEWISTOWN BUTTE BUTTE BOZEMAN ZIP 59601 59601 59911 59911 59801 59803 59808 59405 59701 59401 59404 59101 59102 59840 59923 59102 59101 59047 59911 59917 59901 59101 59804 59804 59903 59715 59715 59802 59808 59405 59802 59718 59405 59405 59405 59405 59405 59442 59442 59101 59101 59101 59102 59715 59102 59804 59457 59701 59701 59715 SPECIALTY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY PSYCHOLOGY PSYCHIATRY SURGERY ORTHOPEDIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY SPEECH/LANGUAGE THERAPY SPEECH/LANGUAGE THERAPY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA PSYCHOLOGY FAMILY PRACTICE URGENT CARE PROVIDER PSYCHOLOGY CARDIOLOGY CARDIOLOGY CARDIOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE OPHTHALMOLOGY PHYSICIAN ASSISTANT OPTOMETRY PHYSICAL THERAPY ANESTHESIOLOGY INTENSIVE/CRITICAL CARE OCCUPATIONAL/INDUSTRIAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE NUTRITION PROFESSIONAL AUDIOLOGY PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY GASTROENTEROLOGY CHIROPRACTIC PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 53 of 256 FIRST NAME DAVID JEFFREY STEPHEN MIKE MARK RENNAE RYAN VERNON JON PAUL DERRICK DERRICK DAVID DAVID VERNON ANDREA ANDREA BROOKS CARMEN CHARLES DONNA DONNA HARLEN JAMES LYNN MARCUS MARISE PAUL PAUL STEPHEN STEVEN TIMOTHY GWENDA KENNETH ROXANNE DEBRA DIANE MARK LESLIE MICHAEL BERT SPENCER HEATHER HEATHER HEATHER TERRY KIM PATRICK EMERY GORDON Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSON JOHNSTON JONAS JONAS JONAS JONES JONES JONES JONES JONES JONES JONES JONES JONES JONES JONES JONES JONES JONES JONES LICENSE MD MD MD MD PHD PHD PT MD MD MD MD MD PA MD MD RD PT LCPC MD MD LCPC LPC DC MD PHD MD MD MD MD MD MD CRNA MD MD MD MD APRN MD PA DC MD DC MD MD MD MD LCPC LCPC LCPC PT MEDICAL GROUP INTERNAL MEDICINE ASSOCIATES INTERNAL MEDICINE ASSOCIATES MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA WOUND MANAGEMENT NEUROSCIENCES NEUROSCIENCES PERFORMANCE MUSCLE ACTIVATION RIVERSTONE HEALTH ROCKY MOUNTAIN HEART & LUNG SIDNEY CLINIC ST JAMES HEALTHCARE PRIMARY CARE ST JAMES HEALTHCARE PRIMARY CARE SVH OCCUPATIONAL HEALTH THE ARTHRITIS & OSTEOPOROSIS CENTER WEST GRAND FAMILY MEDICINE KALISPELL OB-GYN ASSOCIATES NORTHWEST HOSPITALISTS ANESTHESIA PARTNERS OF MONTANA BAIR MEMORIAL CLINIC BILLINGS CLINIC BOZEMAN DEACONESS HOSPITAL BRIDGER CHIROPRACTIC CLINIC FLATHEAD VALLEY ORTHOPEDICS JONES FAMILY CHIROPRACTIC MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE ROUNDUP MEMORIAL HEALTHCARE SOUTH HILLS PSYCHOTHERAPY THE RELATIONSHIP COUNSELING CTR ADDRESS 2900 12TH AVE N #310W 2900 12TH AVE N #310W 900 N ORANGE #306 500 15TH AVE S 400 15TH AVE S STE 205 400 15TH AVE S STE 205 922 FORESTGLEN DR 123 S 27TH ST 350 HERITAGE WAY STE 2100 214 14TH AVE SW 400 S CLARK 400 S CLARK 1027 N 27TH ST 708 BROADWATER AVE 2750 GRAND AVE 825 W KENT AVE 914 13TH AVE S 2376 MAIN ST STE 804 818 2ND AVE EAST 221 5TH AVE S 1925 GRAND AVE #124 2709 3RD AVE NORTH 8250 MONTANA HWY 35 2820 CENTRAL AVE #A 401 15TH AVE S STE 206 500 15 AVE S 1280 BURNS WAY 500 15TH AVE S 500 15TH AVE S 6 - 13TH AVE E 430 WINDWARD WAY #101 621 3RD ST S 210 SUNNYVIEW LN STE 201 310 SUNNYVIEW LN 221 5TH AVE S 2900 12TH AVE N STE 205W 530 3RD ST NW 801 N 29TH ST 925 HIGHLAND BLVD STE 1120 517 S 22ND AVE STE 7 111 SUNNYVIEW LN 3307 GRAND AVE STE 101 104 RUFUS LN 126 6TH AVE SW #A 330-6 TRACT LN 1207 SECOND ST W 535 SADDLE DR 710 GRAND AVE STE 10 415 N HIGGINS #8 2613 GOLD RUSH CITY BILLINGS BILLINGS MISSOULA GREAT FALLS GREAT FALLS GREAT FALLS BOZEMAN BILLINGS KALISPELL SIDNEY BUTTE BUTTE BILLINGS BILLINGS BILLINGS MISSOULA GREAT FALLS BILLINGS CULBERTSON GLASGOW BILLINGS GREAT FALLS BIGFORK BILLINGS GREAT FALLS GREAT FALLS KALISPELL GREAT FALLS GREAT FALLS POLSON KALISPELL GLASGOW KALISPELL KALISPELL GLASGOW BILLINGS HARLOWTON BILLINGS BOZEMAN BOZEMAN KALISPELL BILLINGS POLSON RONAN SAINT IGNATIUS ROUNDUP HELENA BILLINGS MISSOULA HELENA ZIP 59101 59101 59802 59405 59405 59405 59718 59101 59901 59270 59701 59701 59101 59101 59102 59801 59405 59105 59218 59230 59102 59401 59911 59102 59405 59406 59901 59405 59405 59860 59901 59230 59901 59901 59230 59101 59036 59101 59715 59718 59901 59102 59860 59864 59865 59072 59601 59101 59802 59601 SPECIALTY ENDOCRINOLOGY INTERNAL MEDICINE NEUROLOGY FAMILY PRACTICE PSYCHOLOGY PSYCHOLOGY PHYSICAL THERAPY FAMILY PRACTICE CARDIOLOGY FAMILY PRACTICE FAMILY PRACTICE SPORTS MEDICINE OCCUPATIONAL THERAPY ENDOCRINOLOGY FAMILY PRACTICE DIETITIAN PHYSICAL THERAPIST LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE SURGERY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTOR PHLEBOLOGY PSYCHOLOGY FAMILY PRACTICE INTERNAL MEDICINE SPORTS MEDICINE SPORTS MEDICINE INTERNAL MEDICINE ANESTHESIOLOGY NURSE ANESTHETIST OB/GYN-OBSTETRICS/GYNECOLOGY HOSPITALIST FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE DERMATOLOGY FAMILY PRACTICE CHIROPRACTIC SURGERY ORTHOPEDIC MEDICINE CHIROPRACTIC FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 54 of 256 FIRST NAME REBECCA SPENCER TERRY WILLIAM KATHY KATHY RAE DONALD MARY SARA SUSAN JEAN CHARLOTTE JAMES JAMES DAVID HOLLY ABDULMAJEED KATHIE FREDERICK CYNTHIA JOAN DEBORAH DEBORAH DEBORAH DEBORAH JOHN KARI YVONNE JOAN RACHEL DAVID REBECCA PERRY MARK MICHAEL MICHAEL JOHN JOHN MOHAMMAD RICHARD BRENDA ROBERT LINDA TIMOTHY LOUIS TORY RAYMOND RAYMOND ROBERT Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME JONES JONES JONES JONES JORGENSEN JORGENSON JOSELSON JOYNER JOZWIAK JUERS JUROVICH JUSTAD JUTILA JUTZY JUTZY KADERIS KADESH KADRI KADRI KAHN KAISER KAISER KALARCHIK KALARCHIK KALARCHIK KALARCHIK KALBFLEISCH KALE KAMMERZELL KAMPS KANALEY KANE KANE KANERIYA KANETA KANTOR KAPPY KARATH KARATH KARBASSI KARSH KASER KASMER KASTELOWITZ KATSMA KATTINE KATZ KAUFMAN KAUFMAN KAUTZ LICENSE LCSW DC MD MD APRN APRN MD MD MD PAC PT MD MD MD MD DO LCPC MD MD MD CNMW LCPC NP NP APRN APRN MD MD NP LCSW PT MD NP MD MD LCPC MD LCSW LCSW MD MD ACU LCSW PHD PAC MD MD MD MD OD MEDICAL GROUP HOUSE CALLS PLANNED PARENTHOOD OF MONTANA HELENA LAB PHYSICIANS GREAT FALLS OBGYN ASSOCIATES ST PETERS MEDICAL GROUP NORTH BILLINGS CLINIC SOUTH HILLS INTERNAL MEDICINE BAIR MEMORIAL CLINIC ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY SOUTHEASTERN MONTANA SURGICAL KADESH COUNSELING SERVICES INTERNAL MEDICINE & DIABETES INTERNAL MEDICINE & DIABETES BENEFIS HEALTHCARE BENEFIS PHYSICIAN ASSOCIATES GRANITE COUNTY MEDICAL CENTER GRANITE COUNTY MEDICAL CENTER GLACIER MEDICAL ASSOCIATES BILLINGS CLINIC WEST BILLINGS CLINIC WMMHC PROFESSIONAL THERAPY ASSOCIATES BILLINGS CLINIC COLUMBUS BOZEMAN DEACONESS CANCER CENTER SIDNEY HEALTH CENTER ROCKY MOUNTAIN NEONATOLOGY WESTERN MONTANA MENTAL HEALTH CTR SVH SPECIALTY CARE SERVICES WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC LIVINGSTON HEALTHCARE LONGEVITY ACUPUNCTURE BOZEMAN CENTER FOR RELATIONSHIPS WESTERN MONTANA CLINIC MISSOULA SURGICAL ASSOCIATES ACORN PEDIATRICS MONTANA FACIAL SURGERY MONTANA FACIAL SURGERY KAUTZ OPTOMETRY ADDRESS 25 S EWING RM 105 182 S 32ND ST W #4 6 - 13TH AVE E 216 14TH ST SW 603 14TH ST SW 211 9TH ST S 2475 BROADWAY AVE 1522 9TH ST S 2900 12TH AVE N STE 202E 3330 PTARMIGAN LN 801 N 29TH ST 301 SADDLE DR 530 3RD ST NW 905 HIGHLAND BLVD STE 4100 925 HIGHLAND BLVD STE 1180 2600 WILSON ST STE 10 2817 2ND AVE S STE 200 2019 BROADWATER AVE 2019 BROADWATER AVE 2900 12TH AVE N #300E 445 CENTENNIAL AVE 600 CENTRAL PLAZA STE 310 1101 26TH ST S 500 15TH AVE S 26 E BROAD ST 310 SANSOME 1111 BAKER AVE 2675 CENTRAL AVE 2675 CENTRAL AVE 699 FARMHOUSE LN 1234 WHITEFISH STAGE RD 407 N A ST 931 HIGHLAND BLVD STE 3130 216 14TH AVE SW 2825 FORT MISSOULA RD #130 1315 WYOMING ST 1230 N 30TH ST STE 200 300 N WILLSON AVE STE 3005 321 E MAIN ST STE 304 801 N 29TH ST 504 S 13TH ST 2123 DURSTON RD STE 20 300 N WILLSON STE STE 605F 519 S 4TH W 6 13TH AVE E 500 W BROADWAY 5TH FLOOR 280 W KAGY BLVD 1727 W COLLEGE 801 DEWEY BOULEVARD 805 24TH ST W #9 CITY HELENA BILLINGS POLSON SIDNEY GREAT FALLS GREAT FALLS HELENA GREAT FALLS BILLINGS HELENA BILLINGS HELENA HARLOWTON BOZEMAN BOZEMAN MILES CITY BILLINGS BILLINGS BILLINGS BILLINGS BUTTE GREAT FALLS GREAT FALLS GREAT FALLS DRUMMOND PHILIPSBURG WHITEFISH BILLINGS BILLINGS BOZEMAN KALISPELL COLUMBUS BOZEMAN SIDNEY MISSOULA MISSOULA BILLINGS BOZEMAN BOZEMAN BILLINGS LIVINGSTON BOZEMAN BOZEMAN MISSOULA POLSON MISSOULA BOZEMAN BOZEMAN BUTTE BILLINGS ZIP 59601 59102 59860 59270 59404 59401 59601 59405 59101 59602 59101 59601 59036 59715 59715 59301 59101 59102 59102 59101 59701 59401 59405 59405 59832 59858 59937 59102 59102 59715 59901 59019 59715 59270 59804 59801 59101 59715 59715 59101 59047 59718 59715 59801 59860 59802 59715 59715 59701 59102 SPECIALTY LICENSED CLINICAL SOCIAL WORKER CHIROPRACTOR EMERGENCY MEDICINE RADIOLOGY FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY PATHOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL MEDICINE REHABILITATION FAMILY PRACTICE PHYSICAL THERAPY INTERNAL MEDICINE INTERNAL MEDICINE RADIOLOGY RADIOLOGY SURGERY GENERAL LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE INTERNAL MEDICINE PULMONARY DISEASES CERTIFIED NURSE MIDWIFE LICENSED BEHAVIORAL COUNSELOR HOSPITALIST FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY FAMILY PRACTICE HEMATOLOGY-ONCOLOGY RADIOLOGY PEDIATRIC NEONATOLOGY LICENSED BEHAVIORAL COUNSELOR ENDOCRINOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OPHTHALMOLOGY RADIOLOGY ACUPUNCTURIST LICENSED CLINICAL SOCIAL WORKER PSYCHOLOGY FAMILY PRACTICE SURGERY GENERAL PEDIATRICS SURGERY HEAD & NECK SURGERY HEAD & NECK OPTOMETRY Montana STATUS SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED 55 of 256 FIRST NAME JESSIE RACHEL CHAD RACHAEL GREG MARGARET LINDA ERIN AMY JOSEPH CHRISTINE DEBORAH JESSICA ALAN PAUL PETER HARRY BRIAN SUSAN ROSEMARY JOSEPH JOSEPH JOSEPH SUSAN MARCUS DONALD ROBERT KATHLEEN JENNIFER PATRICIA PATRICIA THOMAS MICHAEL JULIE PATRICIA STEVE STEVE CLAIRE DOREEN KIRK MARIE LLOYAL TERRY SARAH LISA LISA LISA THOMAS BRADLEY DEBORAH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME KAUTZMAN KAY KAY KAY KAZEMI KEARNEY KEDDINGTON KEEFE KEEFER KEEL KEENER KEENUM KEHOE KEITHLEY KELKER KELLEHER KELLEHER KELLEHER KELLER KELLER KELLER KELLER KELLER KELLER KELLEY KELLEY KELLEY KELLOGG KELLY KELLY KELLY KELLY KELSEY KELSO KEMP KEMPLE KEMPLE KENAMORE KENFIELD KENFIELD KENNEDY KENNEDY KENNEDY KENNEY KENNY KENNY KENNY KENT KEPP KERN LICENSE MD PT PT PT MD LCSW APRN MD LCSW MD APRN MD PT DC MD MD MD MD LCSW PT LCSW LCSW LCSW LAC LCSW OD LCPC OD MD FNP MD MD MD PT MD LCPC MD DO MD PAC PAC PAC LCPC PT MD APRN APRN APRN MD OD NP MEDICAL GROUP ROCKY MOUNTAIN CLINIC NORTHERN ROCKIES PHYSICAL THERAPY NORTHERN ROCKIES REHABILITATION NORTHERN ROCKIES REHABILITATION PSYCHIATRY ASSOCIATES HELENA PEDIATRIC CLINIC DEERING CLINIC BILLINGS CLINIC PEAK PERFORMANCE PHYSICAL THERAPY CORNERSTONE CHIROPRACTIC CENTER BILLINGS CLINIC ALPINE ORTHOPEDICS & SPORTS MEDICIN BOZEMAN DEACONESS HOSPITAL MARCUS DALY MEMORIAL HOSPITAL KELLER COUNSELING THREE FORKS PT INC MONTANA EYECARE ST PETERS MEDICAL GROUP BILLINGS CLINIC SAME DAY CARE CARDIAC RHYTHM SERVICES CMC CARDIAC ELECTROPHYSIOLOGY INTERNAL MEDICINE ASSOCIATES WEST BILLINGS PHYSICAL THERAPY BILLINGS CLINIC CORNERSTONE COUNSELING ADVANCED PAIN CENTERS OF MONTANA MISSOULA ANESTHESIOLOGY BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC CENTER FOR MENTAL HEALTH BENEFIS PHYSICIAN ASSOCIATES COOPERATIVE HEALTH CENTER INTERMOUNTAIN PLANNED PARENTHOOD INTERMOUNTAIN PLANNED PARENTHOOD COMMUNITY HEALTH PARTNERS ADDRESS 435 S CRYSTAL STE 300 2931 FORT MISSOULA RD #200 2831 FORT MISSOULA RD STE 200 2831 FORT MISSOULA RD STE 200 500 W BROADWAY 1201 MAIN ST STE A 2078 STADIUM DR STE 101 1122 N MONTANA AVE 1600 ELLIS ST STE 1C 123 S 27TH ST 111 N LAST CHANCE GULCH STE 2A 801 N 29TH ST 2360 MULLAN RD STE D 715 KENSINGTON AVE STE 24A 2800 10TH AVE N 536 S COTTONWOOD RD STE 100 915 HIGHLAND BLVD 1200 WESTWOOD DR 307 FIRST AVE E STE 3 201 MAIN ST 33 - 2ND ST E STE 4 33 - 2ND ST E STE 4 5 AUSTIN ST 5 AUSTIN ST 550 N MONTANA AVE 1714 S RESERVE ST 401 MAIN ST 2550 E BROADWAY ST 801 N 29TH ST 2827 FORT MISSOULA RD 2831 FORT MISSOULA RD #131 905 HIGHLAND BLVD STE 4500 3307 GRAND AVE STE 203 1020 N 27TH ST 516 FULLER STE 1 2825 STOCKYARD RD BLDG I-200 2825 STOCKYARD RD BLDG I-200 2675 CENTRAL AVE 801 N 29TH ST 801 N 29TH ST 2675 CENTRAL AVE 301 1ST ST S 3985 VALLEY COMMONS DR 1101 26TH ST S 1930 9TH AVE 1500 CANNON ST 1500 CANNON ST 2900 12TH AVE N STE 245 25 JOHNSON AVE 126 S MAIN CITY BUTTE MISSOULA MISSOULA MISSOULA MISSOULA POLSON BOZEMAN HELENA BOZEMAN BILLINGS HELENA BILLINGS MISSOULA MISSOULA BILLINGS BOZEMAN BOZEMAN HAMILTON KALISPELL THREE FORKS KALISPELL KALISPELL KALISPELL KALISPELL HELENA MISSOULA THOMPSON FALLS HELENA BILLINGS MISSOULA MISSOULA BOZEMAN BILLINGS BILLINGS HELENA MISSOULA MISSOULA BILLINGS BILLINGS BILLINGS BILLINGS SHELBY BOZEMAN GREAT FALLS HELENA HELENA HELENA BILLINGS DILLON LIVINGSTON ZIP 59701 59804 59804 59804 59802 59860 59715 59601 59715 59101 59601 59101 59808 59801 59101 59718 59715 59840 59901 59752 59901 59901 59901 59901 59601 59801 59873 59601 59101 59804 59808 59715 59102 59101 59601 59808 59808 59101 59101 59101 59101 59474 59718 59405 59601 59601 59601 59101 59725 59047 SPECIALTY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY EMERGENCY MEDICINE LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY PEDIATRICS LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE PSYCHOLOGY OPHTHALMOLOGY PHYSICAL THERAPY CHIROPRACTIC PEDIATRICS SURGERY ORTHOPEDIC MEDICINE EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER SOCIAL WORKER OPTOMETRY LICENSED BEHAVIORAL COUNSELOR OPTOMETRY INTERNAL MEDICINE URGENT CARE PROVIDER CARDIOLOGY CARDIOLOGY INTERNAL MEDICINE PHYSICAL THERAPY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY ANESTHESIOLOGY PEDIATRICS GYNECOLOGY ONCOLOGY SURGERY GENERAL FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PEDIATRICS FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY OPTOMETRIST FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 56 of 256 FIRST NAME JEFFREY JEFFREY PHILLIP THOMAS DAVID DAVID NEIL STUART KAREN KARI JO KRISTINE PATI KELLY JAMES PAUL JIN-CHUL DOUGLAS DOUGLAS BRAD NICOLE DANIELLE DAVID WADE CARROLL MARTA STACY CARLA REBECCA REBECCA NANCY KRISSA COLETTE MARSHA JOHN BRENDA AMY CHRISTINA DENISE KILEY DREW TAMARA PETER PAULA HEATHER JASON MELANIE KAREN LAWRENCE RICHARD STUART Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME KESSLER KESSLER KEY KEY KHOE KIDDER KIDWELL KIERAN KIETZMAN KIFF KILEN KILLBREW HALL KILLHAM KILLPACK KILZER KIM KIMBALL KIMBALL KIMBALL KIMBALL KIMBRELL KING KING KING KING KINGSLAND KINGSLEY KING-TUCKER KINNEY KINSEY KIRBY KIRCHHOFF KIRCHNER KIRKEIDE KIRKLAND KIRKLAND KIRKPATRICK KIRKPATRICK KIRKSEY KIRSHNER KITTELSON-ALDRED KITTS KITZENBERG KJERSTAD KJONO KLAWITER KLEE KLEE KLEE KLEIN LICENSE MD MD MD MD MD DO LCSW MD PSYD RN RD LAC LCSW MD MD MD OD OD OD PT LCSW MD NP MD MD MD DO MD MD OT PSYD MD LCPC MD MD PAC MD LCPC MD MD OT APRN OT MD PA MD MD MD MD LCPC MEDICAL GROUP GREAT FALLS CLINIC RADIOLOGY MONTANA BILLINGS CLINIC GREAT FALLS OBGYN ASSOCIATES BILLINGS ANESTHESIOLOGY PINTLER FAMILY MEDICINE HEAD QUARTERS FOR HEART CHANGE BITTERROOT NEUROLOGY BILLINGS CLINIC MILES CITY HI-LINE RECOVERY INC INTERMOUNTAIN CHILDRENS HOME ACADIA MONTANA PATHOLOGY CONSULTANTS OF WESTERN MT CANCER TREATMENT CENTER OF ST PETER ADVANCED EYECARE ASSOCIATES ADVANCED EYECARE BELGRADE HEIGHTS EYECARE YELLOWSTONE PHYSICAL THERAPY BELGRADE CLINIC BOZEMAN DEACONESS NORTHERN ROCKIES REGIONAL PAIN CTR PEDITRIX MED GROUP OF MONTANA NORTHWEST PHYSICIANS ST PETERS CARDIOLOGY CLINIC NORTHERN MONTANA MEDICAL GROUP W PARTNERSHIP HEALTH CENTER CMC OUTPATIENT THERAPIES NORTHERN MONTANA HOSPITAL FAMILY PRACTICE ASSOCIATES CIRCLE OF LIGHT COUNSELING MISSOULA ANESTHESIOLOGY WEST GRAND FAMILY MEDICINE HOSPITALISTS OF ST PETERS BOULDER MEDICAL CLINIC ROCKY MOUNTAIN HEART & LUNG LIBBY CLINIC EASTER SEALS GOODWILL OT BELGRADE CLINIC BOZEMAN DEACONESS BIG SKY PULMONARY & CRITICAL CARE ADVANCED NEUROLOGY SPECIALISTS BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC COLUMBUS BIG SKY COUNSELING ADDRESS 3000 15TH AVE S 401 15TH AVE S STE 204 801 N 29TH ST 1522 9TH ST S 2800 10TH AVE N 305 W PENNSYLVANIA 225 N 23RD ST 1019 W MAIN 2475 VILLAGE LN #104 16 W MAIN ST 620 S HAYNES 111 11TH ST W STE 101 500 S LAMBORN 55 BASIN CREEK RD 2827 FORT MISSOULA RD 2475 BROADWAY 4265 FALLON STE 1 91 W MADISON AVE 430 LAKE ELMO DR 1201 US HWY 10 W UNIT E 99 MILLS SPRING RD 33 W MAIN ST 2900 12TH AVE N STE 335W 1233 30TH ST 2600 WILSON ST 401 15TH AVE S STE 201 2525 BROADWAY STE 203 20 13TH ST W 323 W ALDER ST 2827 FORT MISSOULA RD 30 13TH ST 935 HIGHLAND BLVD STE 2210 2819 GREAT NORTHERN LP STE B-5 2825 STOCKYARD RD BLDG I-200 2750 GRAND AVE 220 E CROFOOT 2475 BROADWAY 765 W PARK 214 S MAIN ST 350 HERITAGE WAY STE 2100 501 E CENTRAL AVE 211 E SECOND ST 1537 AVE D #150 33 W MAIN ST 1300 28TH ST S STE 4 400 15TH AVE S STE 206 801 N 29TH ST 801 N 29TH ST 407 N A ST 2969 AIRPORT RD STE 1F CITY GREAT FALLS GREAT FALLS BILLINGS GREAT FALLS BILLINGS ANACONDA BILLINGS HAMILTON BILLINGS WHITE SULPHUR SPRING MILES CITY HAVRE HELENA BUTTE MISSOULA HELENA BOZEMAN BELGRADE BILLINGS LIVINGSTON EUREKA BELGRADE BILLINGS BILLINGS MILES CITY GREAT FALLS HELENA HAVRE MISSOULA MISSOULA HAVRE BOZEMAN MISSOULA MISSOULA BILLINGS SHERIDAN HELENA DILLON BOULDER KALISPELL MISSOULA LIBBY BILLINGS BELGRADE GREAT FALLS GREAT FALLS BILLINGS BILLINGS COLUMBUS HELENA ZIP 59405 59405 59101 59405 59101 59711 59101 59840 59102 59645 59301 59501 59601 59701 59804 59601 59718 59714 59105 59047 59917 59714 59101 59107 59301 59405 59601 59501 59802 59804 59501 59715 59808 59808 59102 59749 59601 59725 59632 59901 59801 59923 59102 59714 59405 59405 59101 59101 59019 59601 SPECIALTY RADIOLOGY RADIOLOGY EAR/NOSE/THROAT (ENT) PERINATOLOGY ANESTHESIOLOGY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER NEUROLOGY PSYCHOLOGY REGISTERED NURSE NUTRITION PROFESSIONAL LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY PATHOLOGY RADIATION ONCOLOGY OPTOMETRY OPTOMETRY OPTOMETRY PHYSICAL THERAPY SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE PEDIATRIC CRITICAL CARE MEDICINE OPHTHALMOLOGY FAMILY PRACTICE CARDIOLOGY FAMILY PRACTICE FAMILY PRACTICE OCCUPATIONAL THERAPY PSYCHOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE HOSPITALIST LICENSED BEHAVIORAL COUNSELOR GENERAL PRACTICE SURGERY THORACIC OCCUPATIONAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE PULMONARY DISEASES NEUROLOGY INTERNAL MEDICINE SURGERY UROLOGICAL UROLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED 57 of 256 FIRST NAME DAVID DEBRA GAIL ELIZABETH ELIZABETH STEVEN WILLIAM DAVID NANCY NANCY NANCY ALEXANDER ALEXANDER JOSEPH JOSEPH JOSHUA MELODY BERNADETTE CAMDEN SARAH GEORGE ALAINA AMY JEFFREY JEFFREY STEPHEN SEAN JAMES DEBORAH DEBORAH DEBORAH DEBORAH VALERIE DEBBY MICHAEL TODD DALE DAVID PHILIP BRENDA BRENDA BRENDA JENNIFER ROY ROY ELIZABETH ANGIE JASPUR CAROL CASEY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME KLEIN KLEIN KLEMAN KLEPPEN KLEPPEN KLEPPS KLIPPER KLUGE KNAFF KNAFF KNAFF KNAPIK KNAPIK KNAPP KNAPP KNAPPENBERGER KNAUF KNEEFE KNEELAND KNELL KNIGHT KNIGHT KNIGHT KNIGHT KNIGHT KNIGHT KNIGHTON KNOSTMAN KNOX KNOX KNOX KNOX KNUDSEN KNUDSON KOBOS KOCH KOCH KOEPLIN KOERPER KOESSL KOESSL KOESSL KOFFLER KOHLER KOHLER KOHLSTEADT KOLAR KOLAR KOLAR KOLENDICH LICENSE MD MD MD PA PA-C MD MD MD APRN APRN NP MD MD MD MD MD MD LCSW MD LCPC MD LCPC NP MD MD LSW NP MD LAC LAC LAC LAC MD LAC LCSW NP PT MD MD NP NP NP PAC MD MD PSYD PT PAC CNMW MD MEDICAL GROUP BILLINGS CLINIC DANIELS MEMORIAL HEALTHCARE CENTER ORTHO MONTANA ROCKY MOUNTAIN HEART & LUNG ROCKY MOUNTAIN HEART & LUNG ROCKY MOUNTAIN HEART & LUNG ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY INTERNAL MED ASSOC WESTERN MONTANA CLINIC BLUE MOUNTAIN CLINIC THE MONTANA CENTER FOR WELLNESS EVOLUTION COUNSELING BILLINGS CLINIC LIBERTY MEDICAL CENTER BILLINGS CLINIC HI LINE RECOVERY VERTICAL ASSENT COUNSELING PEDIATRIC HOSPITALISTS ST PETERS HOSPITAL REHABILITATION BOZEMAN RADIATION ONCOLOGY BILLINGS ANESTHESIOLOGY SHEIDAN MEMORIAL HOSPITAL SVH WALK IN CLINIC BIG SKY INTERNAL MEDICINE INTERMOUNTAIN CHILDREN'S HOME BILLINGS CLINIC BILLINGS CLINIC WOMENS HEALTH CARE CENTER PINTLER SURGICAL SPECIALISTS ADDRESS 501 MAIN ST 75 CLAREMONT STE C 801 N 29TH ST 105 5TH AVE E 818 2ND AVE EAST 2900 12TH AVE N #140W 202 CONWAY DR #100 3000 15 AVE S 202 CONWAY DR STE 1 350 HERITAGE WAY STE 2100 350 HERITAGE WAY STE 2100 905 HIGHLAND BLVD STE 4100 915 HIGHLAND BLVD 301 SADDLE DR 500 W BROADWAY #320 935 HIGHLAND BLVD STE 3260 500 W BROADWAY 610 N CALIFORNIA 245 WINDWARD WAY STE 101 321 E MAIN ST STE 206 2800 10TH AVE N 321 E MAIN ST STE 402B 500 W BROADWAY 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 101 E BROADWAY STE 605 418 W MONROE 801 N 29TH ST 100 W LAUREL 1009 SIXTH AVE N 105 5TH AVE E 124 CUSTER ST 2831 FORT MISSOULA RD STE 306 111 11TH ST W STE 101 820 DIVISION ST 1101 26TH ST S 2475 BROADWAY 931 HIGHLAND BLVD STE 3130 2800 10TH AVE N 440 W LAUREL AVE 621 3RD ST S 818 2ND AVE EAST 1233 N 30TH ST 310 WENDELL AVE STE 101 310 WENDELL AVE #101 500 S LAMBORN 1020 N 27TH ST 2675 CENTRAL AVE 2525 E BROADWAY STE 204 401 W PENNSYLVANIA CITY ASHLAND KALISPELL BILLINGS SCOBEY CULBERTSON BILLINGS KALISPELL GREAT FALLS KALISPELL KALISPELL KALISPELL BOZEMAN BOZEMAN HELENA MISSOULA BOZEMAN MISSOULA MISSOULA KALISPELL BOZEMAN BILLINGS BOZEMAN MISSOULA MISSOULA MISSOULA MISSOULA CHESTER BILLINGS PLENTYWOOD GLASGOW SCOBEY WOLF POINT MISSOULA HAVRE BILLINGS GREAT FALLS HELENA BOZEMAN BILLINGS PLENTYWOOD GLASGOW CULBERTSON BILLINGS LEWISTOWN LEWISTOWN HELENA BILLINGS BILLINGS HELENA ANACONDA ZIP 59003 59901 59101 59263 59218 59101 59901 59405 59901 59901 59901 59715 59715 59601 59802 59715 59807 59802 59901 59715 59101 59715 59802 59802 59802 59802 59522 59101 59254 59230 59263 59201 59804 59501 59101 59405 59601 59715 59101 59254 59230 59218 59102 59457 59457 59601 59101 59102 59601 59711 SPECIALTY SURGERY OB/GYN-OBSTETRICS/GYNECOLOGY DERMATOLOGY FAMILY PRACTICE PHYSICIAN ASSISTANT SURGERY ORTHOPEDIC MEDICINE INTERNAL MEDICINE EAR/NOSE/THROAT (ENT) CARDIOLOGY CARDIOLOGY CARDIOLOGY RADIOLOGY RADIOLOGY CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE NEUROLOGY RHEUMATOLOGY LICENSED CLINICAL SOCIAL WORKER PAIN MANAGEMENT LICENSED BEHAVIORAL COUNSELOR RADIOLOGY LICENSED BEHAVIORAL COUNSELOR NURSE PRACTITIONER INTERNAL MEDICINE INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE NEPHROLOGY ADDICTION COUNSELOR ADDICTION COUNSELOR ADDICTION COUNSELOR ADDICTION COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER PEDIATRICS PHYSICAL THERAPY RADIATION ONCOLOGY ANESTHESIOLOGY FAMILY PRACTICE NURSE PRACTITIONER NURSE PRACTITIONER FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE PSYCHOLOGY CHILD PHYSICAL THERAPY OCCUPATIONAL/INDUSTRIAL MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY GASTROENTEROLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 58 of 256 FIRST NAME CASEY PETER JOHN JOHN THOMAS ANASTASIOS DEBRA JUSTIN MALIE MATTHEW THOMAS ROBERT JEANNE MICHAEL GLORIA GLORIA AMY KATHERINE MARGARET MARGARET JAMES CURTIS TRUDY TRUDY MICHAEL DAVID THOMAS STEPHEN KAY BETH DENNIS WILLIAM EUGENE MONIQUE MARK MICHAEL ERIC KEVIN STEVEN MARYELLEN SUSAN BRETT BRETT KEVIN BECKY TERESA JENNIFER ROBERT DIANA EMILY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME KOLENDICH KOLLROS KOMINSKY KOMINSKY KONEN KONSTANTAKOS KONTNY KOPP KOPPLIN KOPPLIN KORB KORENBERG KORN KORNISH KORNISH KORNISH KORTEN KOSMA KOSNAR KOSNAR KOSTECKI KOSTELECKY KOSTER KOSTER KOUWENHOVEN KRAINACKER KRAJACICH KRAMER KRAMER KRAMER KRAMER KRAUSE KREBSBACH KREBSBACH KREISBERG KREMKAU KRESS KRIEG KRINER KRIVONEN KRONENBERGER KRONENBERGER KRONENBERGER KRONNER KRONSKE KROPP KRUEGER KRUM KRUMM KRUSHEFSKI LICENSE MD MD MD MD DC MD DO LCPC MD MD MD MD PT MD PA-C PA-C MD LCSW MD MD DC DC PAC PA-C PT MD PHD MD OT LCPC CRNA MD MD PT MD MD MD DC DO SLT LCSW MD MD MD LCPC PT PAC CRNA LCPC LCPC MEDICAL GROUP WESTERN MONTANA CLINIC PEDIATRICS SPECIALTY CLINIC HOLY ROSARY HEALTHCARE SVH EMERGENCY MEDICINE DEPT POLSON HEALTH BILLINGS CLINIC RIVERSTONE HEALTH BILLINGS CLINIC BILLINGS CLINIC BILLINGS GASTROINTESTINAL ASSOCIATE VAIL PHYSICAL THERAPY ST LUKES COMMUNITY HOSPITAL BOZEMAN OB/GYN BILLINGS CLINIC RIVERSTONE HEALTH CANYON CHIROPRACTIC KOSTELECKY CHIROPRACTIC CLINIC RIVERSTONE HEALTH NORTHERN ROCKY MOUNTAINS PEDIATRIC NORTH MONTANA CLINIC NEUROSCIENCES BILLINGS CLINIC HANDS IN MOTION FAMILY DOCTORS URGENT CARE ST PETER'S HOSPITAL WESTERN MONTANA CLINIC KRIEG CHIROPRACTIC BILLINGS ANESTHESIOLOGY PEDIATRIC THERAPY CLINIC HELENA INDIAN ALLIANCE SOUND INPATIENT PHYSICIANS SOUND INPT PHYSICIANS AT ST JAMES FIVE VALLEY UROLOGY ORTHOPEDIC REHAB MONTANA NEUROBEHAVORIAL SPECIALISTS GREAT FALLS CLINIC SURGERY CENTER ADDRESS 500 W BROADWAY 2835 FT MISSOULA RD #301 2600 WILSON 1233 N 30TH ST 102 13RTH AVE 801 N 29TH ST 3130 SADDLE DR #2 123 S 27TH ST 2800 10TH AVE N 2702 8TH AVE N 2900 12TH AVE N #500E 1821 S AVE W #402 316 E BABCOCK 107 6TH AVE SW 16862 BECKWITH ST 3050 MT HWY 83 N 925 HIGHLAND BLVD STE 1210 902 N ORANGE ST #102 2675 CENTRAL AVE 123 S 27TH ST 3972 B US HWY 93N 236 4TH AVE 123 S 27TH ST 501 MAIN ST 1537 AVE D STE 150 3330 PTARMIGAN LN 400 15TH AVE S STE 205 801 N 29TH ST 2360 MULLAN RD #D 100 2ND ST E 401 N 31ST STE 1020 2475 BROADWAY 120 N 19TH AVE STE A 309 SW HIGGINS 2475 BROADWAY 500 W BROADWAY 2835 FORT MISSOULA RD #3 1070 N RUSSELL ST 2800 10TH AVE N 50 27TH ST W STE A 435 N LAST CHANCE GULCH 2827 FORT MISSOULA RD 400 S CLARK ST 2875 TINA AVE #101 205 HAGGERTY LN STE 255 111 SUNNYVIEW LN #B 900 N ORANGE 3RD FLOOR 1509 29TH ST S 3300 2ND AVE N STE 8 321 E MAIN ST STE 321 CITY MISSOULA MISSOULA MILES CITY BILLINGS POLSON BILLINGS HELENA BILLINGS BILLINGS BILLINGS BILLINGS MISSOULA BOZEMAN RONAN FRENCHTOWN SEELEY LAKE BOZEMAN MISSOULA BILLINGS BILLINGS STEVENSVILLE HAVRE BILLINGS ASHLAND BILLINGS HELENA GREAT FALLS BILLINGS MISSOULA WHITEFISH BILLINGS HELENA BOZEMAN MISSOULA HELENA MISSOULA MISSOULA MISSOULA BILLINGS BILLINGS HELENA MISSOULA BUTTE MISSOULA BOZEMAN KALISPELL MISSOULA GREAT FALLS BILLINGS BOZEMAN ZIP 59802 59804 59301 59101 59860 59101 59601 59101 59101 59101 59107 59801 59715 59864 59834 59868 59715 59802 59102 59101 59870 59501 59101 59003 59101 59602 59405 59101 59808 59937 59101 59601 59718 59803 59601 59802 59804 59808 59101 59102 59601 59804 59701 59808 59715 59901 59802 59405 59101 59715 SPECIALTY GASTROENTEROLOGY PEDIATRIC NEUROLOGY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA CHIROPRACTIC SURGERY CARDIOVASCULAR THORACIC SURGERY LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE GASTROENTEROLOGY DERMATOLOGY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT OB/GYN-OBSTETRICS/GYNECOLOGY SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC FAMILY PRACTICE PHYSICIAN ASSISTANT PHYSICAL THERAPY FAMILY PRACTICE PSYCHOLOGY EAR/NOSE/THROAT (ENT) OCCUPATIONAL THERAPY PROFESSIONAL COUNSELOR ANESTHESIOLOGY PULMONARY DISEASES URGENT CARE PROVIDER PHYSICAL THERAPY INTERNAL MEDICINE EMERGENCY MEDICINE FAMILY PRACTICE CHIROPRACTIC ANESTHESIOLOGY SPEECH/LANGUAGE THERAPY LICENSED CLINICAL SOCIAL WORKER HOSPITALIST HOSPITALIST SURGERY UROLOGICAL UROLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY NEUROLOGY ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 59 of 256 FIRST NAME MEREDITH JULIE BETTY JENNIFER JUDI KELLY BRITTANY JENNIFER ROBYN MARIAN MARIAN KYLE RICHARD DOUG ERIN ROBERT JOHN JULIE GARY JESSICA SCOTT DALE GAYLIN TYLER ERIN HELEN ANDREA ANDREA ANDREA LORI CHARLES BRIAN PATRICIA CHARLES THEODORE BARBARA JOHN LIBBY MATTHEW CHAD KELLI KELLI CHAD PATRICIA BRUCE ANTHONY JAY WANDA ROBERT CLARISSE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME KRUTAR KRUTZFELDT KUFFEL KUHR KUIPERS KUKES KUKES KUKLENSKI KUKR KUMMER KUMMER KUNTZ KUNTZELMAN KUNTZWEILER KUNTZWEILER KUSHNER KUSTAN KUYKENDALL KUYKENDALL KYSER LACEFIELD LACHER LACK LADENBURG LAFAVOR LAFERRIERE LAFLEUR LAFLEUR LAFLEUR LAGERQUIST LAGOY LAGRECA LAHAIE LAIN LAINE LAIR MURRY LAKATUA LAKE LAKE LALA LALA LALA LALA LAMB LAMB LAMBERT LAMBERT LAMBOTT LAMME LANDRY LICENSE FNP LCPC MD PAC PT LCPC DC PT LCPC MD MD OD PT MD NP MD MD MD PT LCSW PAC PAC MD PT PA NP PAC PAC PAC PAC DO MD MD MD MD LCSW MD MD DC PAC PAC PAC PA FNP PT DC PA-C PT MD PT MEDICAL GROUP LEWIS & CLARK EMERGENCY PHYSICIANS SOUTHEAST CONSULTING SERVICES ORTHO MONTANA YELLOWSTONE PHYSICAL THERAPY LAUREL FAMILY COUNSELING ROCKY MOUNTAIN CHIROPRACTIC CLINIC AXIS PHYSICAL THERAPY CHILDRENS CLINIC THE CHILDRENS CLINIC CAPITAL OPTOMETRISTS CANYON FERRY PHYSICAL THERAPY LEWIS & CLARK EMERGENCY PHYSICIANS PIN POINT RADIOLOGY MONTANA INTERVENTIONAL & DIAGNOSTIC GREAT FALLS OBGYN ASSOCIATES ORTHO MONTANA INTERMOUNTAIN CHILDRENS HOME NORTHWEST CHC CARDIOVASCULAR & THORACIC SURGEONS CMMC CLINIC PHYSICIANS ORTHOPEDIC REHAB BILLINGS CLINIC CARDIOLOGY ST VINCENT PHYSICIAN NETWORK ABSAROKEE MEDICAL CLINIC BROADWATER WALK-IN CLINIC MOUNTAIN VIEW CLINIC EXPRESS CARE NW COMMUNITY HEALTH CENTER LAGRECA EYE CLINIC PHYSICAL MEDICINE CLINIC ST PETERS MEDICAL GROUP ACCESS COUNSELING AND CONSULTING GREAT FALLS CLINIC LAKES FAMILY CHIROPRACTIC ADVANCED CARE HOSPITAL OF MONTANA ADVANCED CARE HOSPITAL OF MONTANA NORTHERN ROCKIES REGIONAL PAIN CTR ST VINCENT HEALTHCARE ALEPH NORTHERN MONTANA HOSPITAL LAMBERT FAMILY CHIROPRACTIC CANYON FERRY PHYSICAL THERAPY CENTRAL MONTANA COMMUNITY HEALTH CE VALLEY PHYSICAL THERAPY ADDRESS 2475 BROADWAY 2314 PEARL 500 W BROADWAY 2900 12TH AVE N STE 140W 1313 W PARK ST UNIT 7 15 1/2 COLORADO 314 N LAST CHANCE GULCH STE 106 420-B N HIGGINS AVE 1004 DIVISION ST STE 213 1232 N 30TH ST STE 200 3401 AVE E 1234 CEDAR ST 510 N FRONT ST 2475 BROADWAY 820 N MONTANA AVE 2475 W BROADWAY ST 2969 AIRPORT RD STE C 1522 9TH ST S 2900 12TH AVE N STE 140W 322 2ND AVE W 320 E 2ND ST 2900 12TH AVE N STE 502E 310 WENDALL AVE STE 5 906 9TH ST W STE H 1020 N 27TH ST 2900 12TH AVE NORTH 55 N MONTANA 2019 BROADWATER AVE 501 W 20TH ST 435 S CRYSTAL STE 200 320 E 2ND 2475 VILLAGE LN #202 2900 12TH AVE N STE 400E 2550 BROADWAY POD 1C 2825 FORT MISSOULA RD #201 1087 STONERIDGE DR STE 2C 500 W BROADWAY 1400 29TH ST S 505 1ST AVE E 3528 GABEL RD 3528 GABEL RD 2900 12TH AVE N STE 335W 2900 12TH AVE N STE 310 W 2685 PALMER ST STE A 30 13TH ST 1320 S 3RD ST W 818 2ND AVE EAST 510 N FRONT ST 406 1ST AVE S 2105 BOW CITY HELENA MILES CITY MISSOULA BILLINGS LIVINGSTON LAUREL HELENA MISSOULA BILLINGS BILLINGS BILLINGS HELENA TOWNSEND HELENA HELENA HELENA HELENA GREAT FALLS BILLINGS KALISPELL LIBBY BILLINGS LEWISTOWN COLUMBIA FALLS BILLINGS BILLINGS ABSAROKEE BILLINGS RED LODGE BUTTE LIBBY BILLINGS BILLINGS HELENA MISSOULA BOZEMAN MISSOULA GREAT FALLS KALISPELL BILLINGS BILLINGS BILLINGS BILLINGS MISSOULA HAVRE MISSOULA CULBERTSON TOWNSEND LEWISTOWN MISSOULA ZIP 59601 59301 59802 59101 59047 59044 59601 59802 59101 59101 59102 59601 59644 59601 59601 59601 59601 59405 59101 59901 59923 59101 59457 59912 59101 59101 59001 59102 59068 59701 59923 59102 59101 59601 59804 59718 59802 59405 59901 59102 59102 59101 59101 59808 59501 59801 59218 59644 59457 59801 SPECIALTY URGENT CARE PROVIDER LICENSED BEHAVIORAL COUNSELOR HOSPITALIST SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR PEDIATRICS PEDIATRICS OPTOMETRY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE RADIOLOGY RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE SURGERY CARDIOVASCULAR THORACIC SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY CARDIOLOGY GERIATRIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE URGENT CARE PROVIDER INTERNAL MEDICINE OPHTHALMOLOGY PHYSICAL MEDICINE REHABILITATION RHEUMATOLOGY PEDIATRICS LICENSED CLINICAL SOCIAL WORKER NEPHROLOGY FAMILY PRACTICE CHIROPRACTIC FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE FAMILY PRACTICE PHYSICAL THERAPY CHIROPRACTIC PHYSICIAN ASSISTANT PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY Montana STATUS SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 60 of 256 FIRST NAME BRIAN MARY PAMELA PATRICIA SARAH TERRY DEB MICHAEL STEFANIE DAVID MARY MARY LAUREN JANIS JANIS DONNA ANN JEFFREY LIBBIE WILLIAM KEITH J DAVID DANIEL RUTH JILL ANNA JAY KELLI LISA ROBERT ZACHARY CAROL CAROL TARA JAMES JAMES ANDREW BECKY JUDY JOHN ANITA PATTY PATTY LINDA LINDA LINDA LINDA LINDA JASON SARAH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LANDSVERK LANE LANE LANE LANE LANES LANG LANG LANGE LANGE LANGENDERFER LANGENDERFER LANGMEAD LANGOHR LANGOHR LANGSTON LANSING LAPORTE LAPP LARA LARA LARAWAY LARSEN LARSEN LARSON LARSON LARSON LARSON LARSON LARSON LASALLE LASKIN LASKIN LASLOVICH LATRAY LATRAY LAUE LAUGEL LAURIDSEN LAVIN LAVIN LAVIN LAVIN LAW LAW LAW LAW LAW LAWN LAWRENCE LICENSE MD APRN LCPC PT ND APRN PSYD ND MD LCPC MD MD LCPC MD MD LCPC CRNA MD PAC MD MD MD OD LCSW OT PT MD LCPC DC DC PT PT PT NP PA PAC LCSW LCPC NP MD CNS CNS MD MD MD MD MD PA LCPC MEDICAL GROUP BOZEMAN DEACONESS GI CLINIC BRIDGER CLINIC EASTERN MONTANA COMMUNITY MHC GREAT FALLS CLINIC WESTERN MONTANA MENTAL HEALTH CTR CREATING CHOICES NATURES WISDOM COMMUNITY HEALTH PARTNERS CHILDRENS CLINIC THE CHILDRENS CLINIC CAPITAL MEDICAL ANES PLLP WESTERN MONTANA CLINIC DERMATOLOGY ASSOCIATES THE MONTANA CENTER FOR WELLNESS HAMILTON OB/GYN ROCKY MOUNTAIN EYE CENTER WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC WEST HEUISER PHYSICAL THERAPY SOUTH HILLS INTERNAL MEDICINE NEW DIRECTIONS PHYSICAL THERAPY VALLEY PHYSICAL THERAPY WESTERN MONTANA CLINIC BENEFIS QUICK CARE GREAT FALLS ORTHOPEDIC ASSOC KALISPELL OB-GYN ASSOCIATES PROFESSIONAL THERAPY ASSOCIATES COLUMBIA FALLS CLINIC FAMILY HEALTH CARE FAMILY HEALTH CARE MEDNORTH KALISPELL URGENT CARE CLIN NORTH VALLEY HOSPITAL INC BRIDGER ORTHOPEDICS & SPORTS MED WESTERN MONTANA MENTAL HEALTH CTR ADDRESS 931 HIGHLAND BLVD STE 3350 300 N WILSON STE 2001 2508 WILSON 3000 15TH AVE S 3031 S RUSSELL ST #1 106 W BROADWAY ST 65 B W KAGY BLVD 2419 W MAIN ST STE 3 126 S MAIN 30 E WASHINGTON ST STE A 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 180 KALLNER LN 1232 N 30TH ST STE 200 3401 AVE E 252 UPPER LUTHER RD 2475 BROADWAY 500 W BROADWAY 175 COMMONS LOOP STE 300 245 WINDWARD WAY STE 101 430 WINDWARD WAY STE 101 1150 WESTWOOD DR STE G 700 W KENT 8 SECOND AVE SW 2675 CENTRAL AVE 3180 DREDGE DR STE F 301 SADDLE DR 101 E BROADWAY #511 947 BROADWATER SQ 2147 OVERLAND AVE STE 101 734 9TH ST W STE 12 32 CAMPUS DR SKAGGS BLDG #113 2105 BOW 2835 FORT MISSOULA RD #3 500 15TH AVE S 1401 25TH ST S 2825 STOCKYARD RD #F4 109 N 4TH ST STE 201 209 1/2 H ST E 210 SUNNYVIEW LN STE 201 1234 WHITEFISH STAGE RD 204 N KENDRICK 2508 WILSON ST 715 NUCLEUS AVE 1287 BURNS WAY 715 NUCLEUS AVE 2316 US HWY 93 N 1600 HOSPITAL WAY 1450 ELLIS ST STE 201 699 FARMHOUSE LN CITY BOZEMAN BOZEMAN MILES CITY GREAT FALLS MISSOULA BUTTE BOZEMAN BOZEMAN LIVINGSTON KALISPELL MISSOULA MISSOULA WHITEFISH BILLINGS BILLINGS RED LODGE HELENA MISSOULA KALISPELL KALISPELL KALISPELL HAMILTON MISSOULA RONAN BILLINGS HELENA HELENA MISSOULA BILLINGS BILLINGS COLUMBIA FALLS MISSOULA MISSOULA MISSOULA GREAT FALLS GREAT FALLS MISSOULA HAMILTON POPLAR KALISPELL KALISPELL GLENDIVE MILES CITY COLUMBIA FALLS KALISPELL COLUMBIA FALLS KALISPELL WHITEFISH BOZEMAN BOZEMAN ZIP 59715 59715 59301 59405 59801 59701 59715 59718 59047 59901 59802 59802 59937 59101 59102 59068 59601 59801 59901 59901 59901 59840 59801 59864 59102 59601 59601 59802 59101 59102 59912 59801 59801 59804 59405 59405 59808 59840 59255 59901 59901 59330 59301 59912 59901 59912 59901 59937 59715 59715 SPECIALTY GASTROENTEROLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY NATUROPATH PSYCHIATRY PSYCHOLOGY NATUROPATH FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR PEDIATRICS PEDIATRICS PROFESSIONAL COUNSELOR ANESTHESIOLOGY SURGERY ORTHOPEDIC MEDICINE DERMATOLOGY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA OB/GYN-OBSTETRICS/GYNECOLOGY OPTOMETRY LICENSED CLINICAL SOCIAL WORKER OCCUPATIONAL THERAPY PHYSICAL THERAPY INTERNAL MEDICINE PROFESSIONAL COUNSELOR CHIROPRACTIC CHIROPRACTIC PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PEDIATRICS FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR NURSE PRACTITIONER OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY CLINICAL NURSE SPECIALIST CLINICAL NURSE SPECIALIST FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE URGENT CARE PROVIDER EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 61 of 256 FIRST NAME CATHY MICHAEL MORGAN JENNIFER ADAM JENNIFER TANA TANA TRENT JENI EDWARD DAYNA DAYNA DAYNA DAVID DAVID DANIEL KATHRYN TYE RODNEY CURTIS RUTH RUTH MICHAEL MARY SHANNON CHRISTOPHER DALE RUTH COLLEEN DOROTHY JAMES REBECCA ALEXANDER ALEXANDER DAVID JENNIFER T T ROBERT MARY JASON TONY AMY ANNE JODI SHANNON RONI RANDI JAY RICHARD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LAY LAYMAN LEACH LEACH LEACHMAN LEACHMAN LEANDER LEANDER LEAR LEARY LEAS LEAVENS LEAVENS LEAVENS LECHNER LECHNER LEDBETTER LEDERER LEDUC LEE LEE LEE LEE LEE LEE LEE LEE LEE LEE LEE LEE-EVENSON LEGAN LEGG LEGRAND LEGRAND LEHNHERR LEIGHT LEMIRE LEMIRE LEMLEY LEN LENG LENZ LEPAGE LESLIE LESTER LETT LEVIN LEVY LEWALLEN LICENSE MD MD OD LCPC PT PT LCPC LCSW LCSW LCSW PA-C APRN APRN APRN MD MD MD NP DC MD MD PAC PAC MD LCSW PA MD LCPC PAC LCPC MD MD MD MD MD MD PHD MD MD ND MD MD MD MD PHD NP PHD LCSW MD MD MEDICAL GROUP ST PETERS MEDICAL GROUP NORTH BELGRADE URGENT CARE TRUE VISION CLINIC VERITAS PSYCHOTHERAPY BILLINGS CLINIC BILLINGS CLINIC WEST STILLWATER THERAPUTIC SERVICES WMMH CENTER FOR MENTAL HEALTH COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER SHERIDAN COMMUNITY HEALTH CENTER BOULDER MEDICAL CLINIC ST PETERS MEDICAL GROUP PEDIATRIC SURGERY OF MONTANA STILLWATER CHIROPRACTIC BILLINGS ANESTHESIOLOGY BILLINGS CLINIC COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER MARIA DEAN MEDICAL SPECIALISTS MONTANA NEUROBEHAVIORAL SPECIALISTS NORTHWEST ORTHOPEDIC & SPORTS PARK CLINIC WEST POWERS COMPASSION COUNSELING SHERIDAN COMMUNITY HEALTH CENTER TOUCHSTONE COUNSELING & CONSULTING BENEFIS PHYSICIAN ASSOCIATES NORTHWEST PHYSICIANS ST VINCENT PHYSICIAN NETWORK BRIDGER ORTHOPEDICS LIVINGSTON HEALTHCARE BILLINGS CLINIC BRIDGER NATURAL MEDICINE CLINIC PEDIATRICS SPECIALTY CLINIC PACIFIC CATARACT & LASER INSTITUTE GREAT FALLS CLINIC EMERGENCY PHYSICIANS LIGHTSPACE INTERNAL MEDICINE ASSOCIATES BILLINGS CLINIC ORTHO MONTANA ADDRESS 3330 PTARMIGAN LN 403 W MAIN ST 1900 4TH ST NE STE 5 1601 2ND AVE N 2702 8TH AVE N 2675 CENTRAL AVE 418 WINDWARD WAY 443 OSBORN AVE 110 A 915 1ST AVE S 25 S EWING STE 415 6 - 13TH AVE E 445 CENTENNIAL AVE 41 BARRETT ST 317 MADISON ST 214 S MAIN ST 2550 BROADWAY 2835 FT MISSOULA RD #301 210 S WINCHESTER #136 80 FOUR MILE DR STE 16 2800 10TH AVE N 2800 10TH AVE N 445 CENTENNIAL AVE 41 BARRETT ST 2525 BROADWAY STE 200 900 N ORANGE 3RD FLOOR 350 HERITAGE WAY #1200 1315 W CRAWFORD 359 N MAIN ST 317 MADISON ST 359 N MAIN 400 13TH AVE S STE 203 401 15TH AVE S STE 201 1233 N 30TH ST 1450 ELLIS ST STE 201 504 S 13 ST 2800 10TH AVE N 935 HIGHLAND BOULEVARD #2200 2825 FORT MISSOULA RD #317B 500 W BROADWAY 2419 W MAIN STE 1 2835 FT MISSOULA RD #301 1717 4TH ST S 1400 29TH ST S 1110 FRONT ST 1275 BIG FLAT RD 905 HIGHLAND BLVD STE 4500 128 S 6TH ST W 21 N LAST CHANCE GULCH 209 801 N 29TH ST 2900 12TH AVE N 140W CITY HELENA BELGRADE GREAT FALLS GREAT FALLS BILLINGS BILLINGS KALISPELL BIGFORK GREAT FALLS HELENA POLSON BUTTE DILLON SHERIDAN BOULDER HELENA MISSOULA MILES CITY KALISPELL BILLINGS BILLINGS BUTTE DILLON HELENA MISSOULA KALISPELL LIVINGSTON KALISPELL SHERIDAN KALISPELL GREAT FALLS GREAT FALLS BILLINGS BOZEMAN LIVINGSTON BILLINGS BOZEMAN MISSOULA MISSOULA BOZEMAN MISSOULA GREAT FALLS GREAT FALLS FORT BENTON MISSOULA BOZEMAN MISSOULA HELENA BILLINGS BILLINGS ZIP 59602 59714 59404 59401 59101 59102 59901 59911 59405 59601 59860 59701 59725 59749 59632 59601 59804 59301 59901 59101 59101 59701 59725 59601 59807 59901 59047 59901 59749 59901 59405 59405 59101 59715 59047 59101 59715 59804 59802 59718 59804 59405 59405 59442 59804 59715 59801 59601 59101 59101 SPECIALTY FAMILY PRACTICE URGENT CARE PROVIDER OPTOMETRY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICIAN ASSISTANT PEDIATRICS PEDIATRICS PEDIATRICS FAMILY PRACTICE FAMILY PRACTICE PEDIATRIC SURGERY NURSE PRACTITIONER CHIROPRACTIC ANESTHESIOLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE GASTROENTEROLOGY LICENSED CLINICAL SOCIAL WORKER SURGERY ORTHOPEDIC MEDICINE SURGERY GENERAL LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY INTERNAL MEDICINE INTENSIVE/CRITICAL CARE SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE RADIOLOGY PSYCHOLOGIST PULMONARY DISEASES PULMONARY DISEASES NATUROPATH PEDIATRIC GASTROENTEROLOGY OPHTHALMOLOGY INTERNAL MEDICINE EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE PSYCHOLOGY LICENSED CLINICAL SOCIAL WORKER SURGERY NEUROSURGERY SURGERY ORTHOPEDIC MEDICINE Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 62 of 256 FIRST NAME LEA ANNE VIRGINIA VIRGINIA JOHN WINSLOW DEBRA AMANDA AMANDA DEBORAH KATHLEEN JOHN PAM LAURIE TIARA CHRISTOPHER VICTOR JULIE JULIE KAREN KAREN MICHAEL PETER SYDNEY KEVIN PHEBE FARHAD AMY PATRICIA GREGAR BRIAN BENNY JEFFRY JAMES JEFFREY JEFFREY JEFFREY GRETCHEN CHRISTOPHER BRET KURT KURT KURT STACI CLETE RONALD ENID ROBERT CAROL WILLIAM JANET Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LEWIS LEWIS LEWIS LEWIS LEWIS LEWIS LEWIS LEWIS LEWIS LEWISON LEWISON LEY LIANG CARTER LIBERTY LIEB LIEBERMAN LIEN LIEN LIEN LIEN LIFSON LIGHT LILLARD LIMBAUGH LIME LIMONADI LINCOLN LINCOLN LIND LINDE LINDEMAN LINDENBAUM LINDERMAN LINDLEY LINDLEY LINDLEY LINDNER LINDSAY LINDSAY LINDSAY LINDSAY LINDSAY LINDSAY LINEBARGER LINFESTY LING-STOWERS LININGER LINK LINK LINSE FROST LICENSE LCPC APRN NP LAC PAC MD LCSW LCSW NP MD MD LAC MD MD PHD PT PT MD MD MD MD MD MD PHD MD PHD LAC MD OD PAC MD PAC MD MD MD PHD MD MD MD MD MD LCPC DC MD MD PAC PT LCPC LCPC MEDICAL GROUP CENTER FOR MENTAL HEALTH CHRONIC DISEASE CARE & PREVENTION FLATHEAD CITY COUNTY CO HEALTH DEPT MENTAL HEALTH CENTER PARTNERSHIP HEALTH CENTER ST JAMES HEALTHCARE TOGETHER LETS ALPINE WOMEN'S CENTER NORTH VALLEY HOSPITAL EASTERN MONTANA COMM MENTAL HEALTH CMC PEDIATRIC HOSPITALISTS MARQUARDT CHIROPRACTIC CLINIC HOLY ROSARY HEALTHCARE ALTA PHYSICAL THERAPY & FITNESS ALTA PHYSICAL THERAPY & FITNESS HILL COUNTY FAMILY PLANNING NORTHERN MONTANA MEDICAL GROUP E BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC NORTHWEST MONTANAN SURGICAL ASSOC RADIOLOGY MONTANA PC NEUROSURGERY FOR BENEFIS HEALTH SYS EPICENTER THERAPY SERVICES WESTERN MONTANA ADDICTION SERVICE MISSOULA ANESTHESIOLOGY HEIGHTS EYECARE BROADWATER HEALTH CENTER BILLINGS CLINIC SOUND INPATIENT PHYSICIANS GALLATIN PSYCHOTHERAPY MONTANA INTERVENTIONAL & DIAGNOSTIC NEUROSCIENCE & SPINE INSTITUTE NEUROSCIENCE & SPINE INSTITUTE THE INTEGRATED SPINE PROGRAM THE INTEGRATED SPINE PROGRAM LINEBARGER CHIROPRACTIC BILLINGS CLINIC BENEFIS WOUND CARE ALPINE ORTHOPEDICS & SPORTS MEDICIN HEALTH LINK PHYSICAL THERAPY ADDRESS 236 INDIANA 1297 BURNS WAY #1 1035 1ST AVE WEST 1245 N 29TH 323 W ALDER 400 S CLARK ST 2475 VILLAGE LN STE 102 225 N 23RD ST 3000 15TH AVE S 2002 HOSPITAL WAY 1600 HOSPITAL WAY 2508 WILSON ST 2827 FORT MISSOULA RD 1203 MOUNT AVE 2600 WILSON ST 510 S 4TH WEST 2430 N 7TH UNIT 2 81 8TH ST 302 4TH AVE 124 13TH ST 30 HWY 91 S 2800 10TH AVE N 1273 BURNS WAY 401 15TH AVE S STE 204 723 5TH AVE E #1106 1101 26TH ST S 612 E MAIN ST STE C 1325 WYOMING ST 2825 STOCKYARD RD BLDG I-200 430 LAKE ELMO DR STE 1 110 N OAK ST STE 100 2800 10TH AVE N 2600 WILSON STE 1 2827 FORT MISSOULA RD 3075 N RESERVE #Q 500 W BROADWAY 1902 W DICKERSON ST STE 208 2969 AIRPORT RD STE 1C 202 COMMONS WAY 200 COMMONS WAY 350 HERITAGE WAY #1300 350 HERITAGE WAY #1300 1001 SW HIGGINS STE 207 2411 W MAIN ST STE 1B 2800 10TH AVE N 500 15TH AVE S 536 S COTTONWOOD RD STE 100 134 S MAIN 415 N HIGGINS AVE #115 1643 24TH ST W STE 108 CITY CHINOOK KALISPELL KALISPELL BILLINGS MISSOULA BUTTE BILLINGS BILLINGS GREAT FALLS WHITEFISH WHITEFISH MILES CITY MISSOULA MISSOULA MILES CITY MISSOULA BOZEMAN BOZEMAN HAVRE HAVRE DILLON BILLINGS KALISPELL GREAT FALLS KALISPELL GREAT FALLS BOZEMAN MISSOULA MISSOULA BILLINGS TOWNSEND BILLINGS MILES CITY MISSOULA MISSOULA MISSOULA BOZEMAN HELENA KALISPELL KALISPELL KALISPELL KALISPELL MISSOULA BOZEMAN BILLINGS GREAT FALLS BOZEMAN BUTTE MISSOULA BILLINGS ZIP 59523 59901 59901 59101 59802 59701 59102 59101 59405 59937 59937 59301 59804 59801 59301 59801 59715 59715 59501 59501 59725 59101 59901 59405 59901 59405 59715 59801 59808 59105 59644 59101 59301 59804 59808 59802 59718 59601 59901 59901 59901 59901 59803 59718 59101 59405 59718 59701 59802 59102 SPECIALTY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE LICENSED ADDICTION COUNSELOR FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER NURSE PRACTITIONER OB/GYN-OBSTETRICS/GYNECOLOGY HOSPITALIST LICENSED ADDICTION COUNSELOR PEDIATRICS LICENSED MASSAGE THERAPIST INTERNAL MEDICINE PSYCHOLOGY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE GYNECOLOGY-NO OB EMERGENCY MEDICINE/TRAUMA SURGERY GENERAL RADIOLOGY PSYCHOLOGIST SURGERY NEUROSURGERY SPEECH/LANGUAGE THERAPY LICENSED ADDICTION COUNSELOR ANESTHESIOLOGY OPTOMETRY FAMILY PRACTICE RADIOLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE HOSPITALIST PSYCHOLOGY RADIOLOGY NEUROLOGY NEUROLOGY SURGERY NEUROSURGERY SURGERY VASCULAR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC PATHOLOGY EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 63 of 256 FIRST NAME MARK SANDRA SANDRA ANGELA GARY GARY CINDY L MEGAN MILICA LETA DENISE KIM JAMES C PAUL MARIE GREGORY ANNA RONALD IRENE SUSAN CLIFFORD ALYSON ALYSAN KENDRA STEWART DIANA MEGAN STEPHEN JOSEPH JOSEPH LINDA RACHEL MIGUEL THEODORE THEODORE ROBERT CARMEN KATHY CATHERINE CATHERINE CATHERINE LISA DOUGLAS RANDY RANDY MARCIE JEFFREY THOMAS KATHRYN ERIC Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LIPA LIPPY LIPPY LISTUG LITLE LITLE LITTLE LITTLEFIELD LIVESAY LIVOTI LLOVETT LOCKWOOD LOEFFELHOLZ LOEHNEN LOGAN LOGAN LOGE LOGE LOHKAMP LOMBARDI LONG LONG LONG LONG LONG LONGDON LONGENECKER LOOMIS LOOS LOOS JR LOOSER LOPEZ LOPEZ-GONZALES LOSEY LOSEY LOTSTEIN LOUSEN LOVE LOVE LOVE LOVE LOVEJOY LOVELESS LOVELL LOVELL LOVGREN LOVIN LOWDER LOWE LOWE LICENSE MD LCSW LCSW DC DC LCSW MD PT PHD MSW NP LCPC MD MD LCPC SLT MD MD MD MA MD PT PT MD MD LCSW PT DC LCSW LCSW PT LAC MD MD MD MD LCPC SLT APRN FNP FNP MD MD DO DO PA MD MD MD MD MEDICAL GROUP ANESTHESIA PARTNERS OF MONTANA ALPINE PHYSICAL THERAPY FAMILY PSYCHOLOGICAL CENTER RIVERSTONE HEALTH RIVER CITY FAMILY HEALTH ADOLESCENT CHILD & FAMILY INTERNAL MEDICINE ASSOCIATES CARDIOPULMONARY ASSOCATES EASTERN MONTANA COMMUNITY MHC WHITEFISH PHYSICAL THERAPY BARRETT HOSPITAL & HEALTHCARE BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC GABERT MEDICAL SERVICES GREAT NORTHERN PHYSICAL THERAPY TOTAL HEALTH PHYSICAL THERAPY WESTERN MONTANA CLINIC WEST BILLINGS PHYSICAL THERAPY BUTTE CHIROPRACTIC FRIENDS OF YOUTH YOUTH HOMES INC HI-LINE RECOVERY BILLINGS CLINIC NORTH VALLEY HOSPITAL SILVERTIP EMERGENCY PHYSICIANS ABOVE & BEYOND THERAPY SERVICES EVERGREEN CLINIC NORTH VALLEY HOSPITAL OUTPOST CLINIC NORTH VALLEY HOSPITAL WEST GLACIER WESTERN MONTANA CLINIC BILLINGS ANESTHESIOLOGY MAIN STREET MEDICAL PONDERA MEDICAL CENTER BRIDGER ORTHOPEDICS & SPORTS MED GREAT DIVIDE RADIOLOGY CMC PEDIATRIC HOSPITALISTS ACORN PEDIATRICS BOZEMAN DEACONESS HOSPITAL ADDRESS 2900 12TH AVE N STE 205W 1004 DIVISION ST STE 212B 1004 DIVISION ST STE 212B 2965 STOCKYARD RD 101 B ST STE B 2245 W KOCH ST STE A 48 MEDICAL PARK DR 123 S 27TH ST 1532 ELLIS ST STE 103 115 BROAD ST 714 KENSINGTON AVE 2023 STADIUM DR 2B 905 HIGHLAND BLVD STE 4500 601 W SPRUCE STE A 1201 W HOLLY STE 4 2006 HOSPITAL WAY 30 HWY 91 S 30 HWY 91 S 801 N 29TH ST 100 2ND ST EAST 107 DILWORTH ST 612 E MAIN ST STE A 321 W MAIN ST 500 W BROADWAY 500 W BROADWAY #320 535 SADDLE DR 3307 GRAND AVE STE 203 1220 HARRISON AVE 2801 S RUSSELL STE 32 550 N CALIFORNIA 120 S 5TH ST STE 102 220 3RD AVE STE 110 801 N 29TH ST 1600 HOSPITAL WAY 310 SUNNYVIEW LN 621 3RD ST S 210 N HIGGINS STE 202 1931 S 3RD ST W 2181 HWY 2 E STE 9 1045 GLADES DR 100 REA RD 500 W BROADWAY 2800 10TH AVE N 907 MAIN ST 805 SUNSET BLVD 1450 ELLIS ST STE 201 2475 E BROADWAY 2827 FORT MISSOULA RD 280 W KAGY BLVD STE G 915 HIGHLAND BLVD CITY BILLINGS BILLINGS BILLINGS MISSOULA TOWNSEND BOZEMAN HELENA BILLINGS BOZEMAN THOMPSON FALLS MISSOULA BOZEMAN BOZEMAN MISSOULA SIDNEY WHITEFISH DILLON DILLON BILLINGS WHITEFISH GLENDIVE BOZEMAN BELGRADE MISSOULA MISSOULA HELENA BILLINGS BUTTE MISSOULA MISSOULA HAMILTON HAVRE BILLINGS WHITEFISH KALISPELL GLASGOW MISSOULA MISSOULA KALISPELL WHITEFISH WEST GLACIER MISSOULA BILLINGS THOMPSON FALLS CONRAD BOZEMAN HELENA MISSOULA BOZEMAN BOZEMAN ZIP 59101 59101 59101 59808 59644 59718 59601 59101 59715 59873 59801 59715 59715 59807 59270 59937 59725 59725 59101 59937 59330 59715 59714 59802 59802 59601 59102 59701 59801 59807 59840 59501 59101 59937 59901 59230 59802 59801 59901 59937 59936 59801 59101 59873 59425 59715 59601 59804 59715 59715 SPECIALTY ANESTHESIOLOGY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY CHIROPRACTIC CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER PEDIATRICS PHYSICAL THERAPY SOCIAL WORKER FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE PULMONARY DISEASES LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY INTERNAL MEDICINE INTERNAL MEDICINE GERIATRIC MEDICINE LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE CARDIOVASCULAR/THORACIC SURGERY LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR SURGERY NEUROSURGERY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE RADIOLOGY PEDIATRICS PEDIATRICS EMERGENCY MEDICINE/TRAUMA Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED 64 of 256 FIRST NAME JOANNE JOHN MAUREEN MARTY MELINDA MICHAEL JARED BROOK RENEE JASON JASON RANDALL DEKE GARY MARY JO RODNEY DENNIS SALLY GERALDINE LINDSEY KATHRYN DAVID TREVA JOANNA SHARON KATHRYN JERIMIAH CHERYL LINDA HIKMAT ALISTAIR JAMES CHRISS RANDALL CATHERINE LYNNDA JOHN JOHN DAVID VINCENT HEATHER JAMES NIALL NIALL JUSTIN JUSTIN EDWARD MONCIA MONICA JAMES Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LOWELL LOWELL LUCAS LUCAS LUCE LUCKETT LUND LUND LUND LUNDEN LUNDEN LUNDGREN LUNDMAN LUSIN LUSIN LUTES LUTZ LYDON LYMAN LYMAN LYNCH LYNCH LYNG LYON LYONS LYSINGER LYSINGER LYSON LYSON MAALIKI MACDONALD MACK MACK MACK MACLEAN MACMILLAN MADANY MADANY MADDEN MADDIO MADDOX MADDUX MADIGAN MADIGAN MADILL MADILL MADRID MAHER MAHER MAHER LICENSE LCPC LCPC MD MD PAC MD MD CRNA OT PT PT DC PT PT PT PA MD NP CRNA MEDICAL GROUP MD LCSW LAC LCPC FNP MD MD LCPC APRN MD MD MD MD PAC PHD NP MD MD MD DC MD MD MD MD DO DO DC MD NP MD BOZEMAN DEACONESS GI CLINIC BILLINGS CLINIC FRONTIER CANCER CENTER & BLOOD INST BILLINGS CLINIC GREAT FALLS ORTHOPEDIC ASSOC BILLINGS CLINIC EXCEL ORTHOPEDIC PHYSICAL THERAPY EXCEL ORTHOPEDIC PHYSICAL THERAPY LUNDGREN CHIROPRACTIC CLINIC BILLINGS CLINIC ADVANCED PERFORMANCE & REHAB ADVANCED PERFORMANCE & REHAB COMPREHENSIVE MEDICAL REHAB BILLINGS CLINIC MILES CITY SAME DAY SURGERY CENTER BENTON MEDICAL CENTER BILLINGS CLINIC SVH PEDIATRIC SPECIALTY CLINIC BEHAVIORAL HEALTH ASSOCIATES INTERMOUNTAIN PLANNED PARENTHOOD MISSION MOUNTAIN MEDICINE MISSOULA ANESTHESIOLOGY BILLINGS CLINIC NEUROLOGICAL ASSOCIATES PLAINS FAMILY MEDICINE HOLY ROSARY BARRETT HOSPITAL & HEALTHCARE BARRETT HOSPITAL & HEALTHCARE TOWN CENTER CHIROPRACTIC WESTERN MONTANA CLINIC NORTHERN MONTANA MEDICAL GROUP ROCKY MOUNTAIN HEART & LUNG LEWIS & CLARK EMERGENCY PHYSICIANS LEWIS & CLARK EMERGENCY PHYSICIANS PFAFF CLINIC OF CHIROPRACTIC BIG HORN HOSPITAL ASSOC SVH WALK IN CLINIC URGENT CARE NORTH MEDICAL ADDRESS 114 MISSION BAY DR 114 MISSION BAY DR 801 N 29TH ST 1315 GOLDEN VALLEY CIRCLE 801 N 29TH ST 1401 25TH ST S 801 N 29TH ST 6 - 13TH AVE E 2827 FORT MISSOULA RD 1125 W KAGY BLVD STE 101A 220 WOODEN SHOE LN STE C 102 S 19TH AVE STE 3 2702 8TH AVE N 1532 ELLIS ST STE 201 1532 ELLIS ST STE 201 1400 29TH ST S 2ND FLOOR 620 S HAYNES 115 4TH ST S 300 N WILLSON STE 600F 2442 WINNE AVE STE 2 931 HIGHLAND BLVD STE 3350 205 E PARK 2116 BROADWATER AVE #310 4 SUNSET PLAZA STE 201 1203 15TH ST 2800 10TH AVE N 1230 N 30TH STE 200 1101 N 27TH ST #201 1500 CANNON ST 126 6TH AVE SW STE A 2825 STOCKYARD RD BLDG I-200 1045 N 30TH ST 500 W BROADWAY #310 10 KRUGER RD 3825 VALLEY COMMONS DR STE 4 2600 WILSON ST 30 HWY 91 S 90 HWY 91 S 2969 AIRPORT RD STE 1C 827 N LAST CHANCE GULCH 500 W BROADWAY 500 W BROADWAY #320 30 13TH ST 350 HERITAGE WAY #2100 2475 BROADWAY 2475 BROADWAY 104 E 1ST ST 17 N MILES 1233 N 30TH ST 3330 PTARMIGAN LN CITY POLSON POLSON BILLINGS BILLINGS BILLINGS GREAT FALLS BILLINGS POLSON MISSOULA BOZEMAN MANHATTAN BOZEMAN BILLINGS BOZEMAN BOZEMAN GREAT FALLS MILES CITY GREAT FALLS BOZEMAN HELENA BOZEMAN ANACONDA BILLINGS KALISPELL FORT BENTON BILLINGS BILLINGS BILLINGS HELENA RONAN MISSOULA BILLINGS MISSOULA PLAINS BOZEMAN MILES CITY DILLON DILLON HELENA HELENA MISSOULA MISSOULA HAVRE KALISPELL HELENA HELENA LAUREL HARDIN BILLINGS HELENA ZIP 59860 59860 59101 59102 59101 59405 59101 59860 59804 59715 59741 59718 59101 59715 59715 59405 59301 59401 59715 59601 59715 59711 59102 59901 59442 59101 59101 59101 59601 59864 59808 59101 59802 59859 59718 59301 59725 59725 59601 59601 59802 59802 59501 59901 59601 59601 59044 59034 59101 59602 SPECIALTY PROFESSIONAL COUNSELOR PROFESSIONAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY HEMATOLOGY-ONCOLOGY PHYSICAL MEDICINE REHABILITATION SURGERY ORTHOPEDIC MEDICINE DERMATOLOGY NURSE ANESTHETIST OCCUPATIONAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY CHIROPRACTIC PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL MEDICINE REHABILITATION OB/GYN-OBSTETRICS/GYNECOLOGY NURSE PRACTITIONER ANESTHESIOLOGY SURGERY ORTHOPEDIC MEDICINE GASTROENTEROLOGY LICENSED CLINICAL SOCIAL WORKER ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PEDIATRICS PEDIATRIC PULMONOLOGY LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE ANESTHESIOLOGY ENDOCRINOLOGY SURGERY NEUROSURGERY FAMILY PRACTICE PSYCHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY CHIROPRACTIC FAMILY PRACTICE CARDIOVASCULAR DISEASE CARDIOLOGY CARDIOLOGY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA CHIROPRACTIC FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING 65 of 256 FIRST NAME JOSEPH JOSEPH BRENDA MICHAEL MICHAEL SYLVIA SYLVIA SYLVIA KERRY ADRIAN KATHERINE R JAMES BOBBIN STEPHEN STANLEY ANDREW SHERYL REGINA LINDA JOHN LINDA BRIAN SCOTT LISA MICHELLE JAY JESSICA DEBORAH EDWARD DEBORAH JONI REID MARILYN DIANE DIANE KARL KARL DAVID DAVID DIANA ORVILLE TERESA MARTHA CALVIN ALAN NICHOLAS MARK SCOTT BENJAMIN GERIANNE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MAHERAS MAHERAS MAHLUM MAHONEY MAHONEY MAHR MAHR MAHR MAIER MAJID MAJOR MAJXNER MAKI MAKI MAKMAN MALANY MALINOWSKI MALLORY MALLOY MALLOY MALLOY MALLOY MALLOY MALODY MALONEY MALONEY MALOUF MALTERS MALTERS MALTERS MAMICA MAMIYA MANCO JOHNSON MANCUSO MANCUSO MANGOLD MANGOLD MANGOLD MANGOLD MANN MANN MANN MANN MANN MANNHEIMER MANSUETTA MARAMAN MARCHANT MARCHELLO MARCHION LICENSE MD MD PT MD MD LCSW LCSW LCSW LCPC MD PT MD LCPC LCSW MD MD APRN LCSW OT MD OT MD LSW MD LCPC MD PT MD MD MD MSW OD MD APRN APRN DPM DPM PAC PAC LCSW MD MD MD LCPC MD DO MD DPM MD LCPC MEDICAL GROUP THE SLEEP CENTER THE SLEEP CENTER U OF M PHYSICAL THERAPY CLINIC MEDNORTH URGENT CARE CLINIC RIVERFRONT COUNSELING RED WILLOW COUNSELING COGENT HEALTHCARE OF MONTANA MOUNTAIN PHYSICAL THERAPY ABSORKA EMERGENCY PHYSICIANS FLATHEAD VALLEY ORTHOPEDICS HELENA OBGYN ASSOCIATES BILLINGS CLINIC BILLINGS PUBLIC SCHOOLS DEERING CLINIC PEDIATRIC THERAPY CLINIC PLAINS UROLOGY WESTERN MONTANA MENTAL HEALTH INTERNAL MEDICINE ASSOCIATES CENTER FOR MENTAL HEALTH ST JOHN'S LUTHERAN HOSPITAL NEW DIRECTIONS PHYSICAL THERAPY BEHAVIORAL HEALTH ASSOCIATES INTERNAL MEDICINE ASSOCIATES MONTANA PSYCHIATRY PLLC PACIFIC CATARACT & LASER INSTITUTE SVH SPECIALTY CARE SERVICES CENTER FOR MENTAL HEALTH JK BEIGHLE ASSOCIATES MONTANA FOOT AND ANKLE INSTITUTE PL THE ALLERGY & ASTHMA CENTER THE ALLERGY & ASTHMA CENTER CENTER FOR MENTAL HEALTH GALLATIN VALLEY ANESTHESIA ROGERS DERMATOLOGY CLINIC WMMHC MONTANA PEDIATRIC CRITICAL CARE PC ST LUKE COMMUNITY CLINIC RONAN PACIFIC CATARACT & LASER INSTITUTE BILLINGS CLINIC FRONTIER CANCER CENTER & BLOOD INST AWARE INC ADDRESS 1233 N 30TH ST 3RD ALLARD 1233 N 30TH ST 3RD ALLARD U OF M SKAGGS BLDG #129 2316 US HWY 93 N 711 CALIFORNIA AVE 209 N 10TH ST STE A 127 W MAIN SIGNAL SQUARE #A 300 MAIN ST STE B #204 825 W KENT 1101 26TH ST S 2593 HWY 2 E #6 915 HIGHLAND BLVD 410 CENTRAL AVE #502 410 CENTRAL AVE #502 111 SUNNYVIEW LN 45 MEDICAL PARK DR 801 N 29TH ST 565 N 9TH ST #35 415 N 30TH 123 S 27TH ST 50 27TH ST W STE A 2800 11TH AVE S STE 14 699 FARMHOUSE LN 2900 12TH AVE N STE 310 W 621 1ST AVE S 350 LOUISIANA AVE 32 CAMPUS DR SKAGGS BLDG #113 1101 N 27TH ST #201 2900 12TH AVE N #310W 3737 GRAND AVE STE 6 38 E WASHINGTON #3 1717 4TH ST S 1230 N 30TH ST #200 900 N JACKSON 314 N LAST CHANCE GULCH #211 A&D 2825 FORT MISSOULA RD STE 106 2825 FT MISSOULA RD STE 106 75 CLAREMONT 900 N ORANGE #207 900 N JACKSON 925 HIGHLAND BLVD 1727 W COLLEGE AVE 81 W PARK ST 55 BASIN CREEK RD 1233 N 30TH ST 126 6TH AVE SW #A 1717 4TH ST S 801 N 29TH ST 1315 GOLDEN VALLEY CIRCLE 524 E PARK ST CITY BILLINGS BILLINGS MISSOULA KALISPELL LIBBY HAMILTON HAMILTON STEVENSVILLE MISSOULA GREAT FALLS KALISPELL BOZEMAN GREAT FALLS GREAT FALLS KALISPELL HELENA BILLINGS COLUMBUS BILLINGS BILLINGS BILLINGS GREAT FALLS BOZEMAN BILLINGS GREAT FALLS LIBBY MISSOULA BILLINGS BILLINGS BILLINGS KALISPELL GREAT FALLS BILLINGS HELENA HELENA MISSOULA MISSOULA KALISPELL MISSOULA HELENA BOZEMAN BOZEMAN BUTTE BUTTE BILLINGS RONAN GREAT FALLS BILLINGS BILLINGS ANACONDA ZIP 59101 59101 59812 59901 59923 59840 59840 59870 59801 59405 59901 59715 59401 59401 59901 59601 59101 59019 59101 59101 59102 59405 59715 59101 59401 59923 59812 59101 59101 59102 59901 59405 59101 59601 59601 59804 59804 59901 59802 59601 59715 59715 59701 59701 59101 59864 59405 59101 59102 59711 SPECIALTY INTERNAL MEDICINE SLEEP STUDIES PHYSICAL THERAPY URGENT CARE PROVIDER FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA PROFESSIONAL COUNSELOR SOCIAL WORKER SURGERY ORTHOPEDIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE SOCIAL WORKER OCCUPATIONAL THERAPY FAMILY PRACTICE OCCUPATIONAL THERAPY SURGERY UROLOGICAL UROLOGY LICENSED CLINICAL SOCIAL WORKER INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY PSYCHIATRY INTERNAL MEDICINE PSYCHIATRY SOCIAL WORKER OPTOMETRY HEMATOLOGY-ONCOLOGY PSYCHIATRY PSYCHIATRY PODIATRY PODIATRY ALLERGY/IMMUNOLOGY ALLERGY/IMMUNOLOGY LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY DERMATOLOGY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR PEDIATRIC CRITICAL CARE MEDICINE SURGERY ORTHOPEDIC MEDICINE OPTOMETRY PODIATRY HEMATOLOGY-ONCOLOGY LICENSED BEHAVIORAL COUNSELOR Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 66 of 256 FIRST NAME GERIANNE LISA MELCHISEDEK SARA OFELIA KATHERINE KATHERINE KARRA ROBERT CHARLES CHARLES MICHELE MICHELE DEBBIE ELAINE JAMES CYNTHIA KIMBERLY KIMBERLY KELLY COLLEEN MEGAN JAMES CINDY SANDRA MICHELLE MICHELLE A ELIZABETH A ELIZABETH KRISTINE KRISTY DOUGLAS HEIDI WAYNE DOUGLAS HEIDI LARYN BRYAN BRYAN BRYAN WILLIAM SHERRI STEVEN STEVEN STEVEN LIBBI LIBBI MICHELLE BART BART Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MARCHION MARCILLE MARGARIS MARIA MARIN MARKETTE MARKETTE MARKLEY MARKS MARLER MARLER MARLER MARLER MARLER MARONICK MARQUARDT MARQUARDT MARQUIS MARQUIS MARRINAN MARRON MARSH MARSHALL MARSHALL MARSTON MARTI MARTI MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTIN MARTINEZ MARTINI MARTINI MARTINI MARTINO MARTINO MARTIN-THOMPSON MARTYAK MARTYAK LICENSE LPC NP MD ACU MD MD MD MD MD MD MD MD MD LCPC LCPC DC LCSW MD MD AU MD LCPC PAC PT PT PAC PA MD MD PT NP PT MSPT MD PT MSPT PT MD MD MD LAC PT MD MD MD NP APRN MD MD MD MEDICAL GROUP HIGHER GROUND COUNSELING PARTNERS IN PEDIATRICS NORTHWEST PHYSICIANS MONTANA CENTER FOR WELLNESS & PAIN MGMT RADIATION ONCOLOGY PATHOLOGY CONSULTANTS OF WESTERN MT MADISON VALLEY MEDICAL CENTER MARIAS HEALTHCARE MARIAS HEALTHCARE MARIAS HEALTHCARE MARIAS HEALTHCARE MARQUARDT CHIROPRACTIC CLINIC INTERNAL MEDICINE ASSOCIATES INTERNAL MEDICINE ASSOCIATES ST PETER'S MEDICAL GROUP GREAT FALLS CLINIC ACADIA MONTANA BOZEMAN DEACONESS HOSPITAL ADVANCED REHAB COMMUNITY HEALTH PARTNERS LIVINGSTON HEALTHCARE BENEFIS HEALTHCARE PRACTITIONERS BENEFIS HEALTHCARE PRACTITIONERS BILLINGS CLINIC BILLINGS CLINIC DARBY PHYSICAL THERAPY DARBY PHYSICAL THERAPY DEER LODGE MEDICAL CENTER HAMILTON PT & REHAB AT CANYONS CLUB HAMILTON PT & REHAB AT CANYONS CLUB MISSOULA BONE & JOINT SLETTEN CANCER INSTITUTE HEALTH IN MOTION PT BIG SKY NEUROSCIENCE PINTLER SURGICAL SPECIALISTS FAMILY BORN MATERNITY & WOMENS KALISPELL OB/GYN NORTH COUNTRY MEDICAL CLINIC ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ADDRESS 307 E PARK AVE #208 2525 BROADWAY STE 101 401 15TH AVE S #201 245 WINDWARD WAY #101 1645 PARKILL DR STE 1 500 W BROADWAY 500 W BROADWAY 2827 FORT MISSOULA RD - LAB 305 N MAIN 5 1ST AVE WEST 670 N PARK 422 MONTANA 670 PARK DR 1004 DIVISION #213 7 W 6TH AVE STE 512 1203 MOUNT AVE 725 W ALDER STE 1 905 HIGHLAND BLVD STE 4500 905 HIGHLAND BLVD STE 4500 2475 BROADWAY ST #2E 1400 29TH ST S 55 BASIN CREEK RD 915 HIGHLAND BLVD 205 WAGNER RD 417 N BENTON 126 S MAIN ST 504 S 13TH ST 400 13TH AVE S STE 101 400 13TH AVE S STE 101 2675 CENTRAIL AVE 2675 CENTRAL AVE 502 N MAIN #900 502 N MAIN ST #900 1100 HOLLENBACK LN 472 TAMMANY LN 472 TAMMANY LN 2360 MULLAN RD #C 1117 29TH ST S 3000 15TH AVE S 401 15TH ST S STE 201 220 3RD AVE STE 110 3985 VALLEY COMMONS DR 700 W GOLD ST 401 W PENNSYLVANIA AVE 1500 AIRPORT RD STE #1 210 SUNNYVIEW LN #101 210 SUNNYVIEW LN #201 1343 US HWY 93 N 3417 BUSCH 700 W KENT CITY ANACONDA HELENA GREAT FALLS KALISPELL BILLINGS MISSOULA MISSOULA MISSOULA ENNIS SUNBURST SHELBY VALIER SHELBY BILLINGS HELENA MISSOULA MISSOULA BOZEMAN BOZEMAN HELENA GREAT FALLS BUTTE BOZEMAN CORAM HELENA LIVINGSTON LIVINGSTON GREAT FALLS GREAT FALLS BILLINGS BILLINGS DARBY DARBY DEER LODGE HAMILTON HAMILTON MISSOULA GREAT FALLS GREAT FALLS GREAT FALLS HAVRE BOZEMAN BUTTE ANACONDA KALISPELL KALISPELL KALISPELL EUREKA BUTTE MISSOULA ZIP 59711 59601 59405 59901 59102 59802 59802 59804 59729 59482 59474 59486 59474 59101 59601 59801 59802 59715 59715 59601 59405 59701 59715 59913 59601 59047 59047 59405 59405 59102 59102 59829 59829 59722 59840 59840 59808 59405 59405 59405 59501 59718 59701 59711 59901 59901 59901 59917 59701 59801 SPECIALTY LICENSED BEHAVIORAL COUNSELOR PEDIATRICS FAMILY PRACTICE ACUPUNCTURIST PEDIATRIC GASTROENTEROLOGY RADIATION ONCOLOGY RADIATION ONCOLOGY PATHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER INTERNAL MEDICINE PULMONARY DISEASES AUDIOLOGY PEDIATRICS LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PHYSICAL THERAPIST PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE SURGERY GENERAL SURGERY GENERAL PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY INTERNAL MEDICINE HEMATOLOGY/ONCOLOGY INTERNAL MEDICINE LICENSED ADDICTION COUNSELOR PHYSICAL THERAPY PAIN MANAGEMENT PAIN MANAGEMENT INTERNAL MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY CERTIFIED NURSE MIDWIFE PEDIATRICS GENERAL PRACTICE GENERAL PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 67 of 256 FIRST NAME JODI LAURA KARLA FARAZ LORINA LORINA HASSAN HASSAN HASSAN LARRY CRAIG MUKTAK HEIDI THOMAS ANGELA ANGELA ALISA GARY ADAM SUSAN LARA LARA VINCENT MICHAEL LINDA S SCOTT JOHN PHILIP SUNNY SARAH NEAL DANIELLE DANIELLE KIMBERLY KIMBERLY MICHAEL ROXANNE LADONNA ANNE ANNE J STEFFAN BEVERLY ALAN GEORGIANNA GEORGIANNA GEORGIANNA BOBBY NANCY JENNIFER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MARTZ MARX MASLOWSKI MASOOD MASSEY MASSEY MASSOUH MASSOUH MASSOUH MASTERSON MATELICH MATHUR MATLACK-LARSON MATSKO MATTA MATTA MATTHEWS MATTHEWS MATTINGLY MATTOCKS MATTSON MATTSON-RADLE MATULE MATURY MATZ MATZ MATZ MAURER MAVOR MAXELL MAXFIELD MAXFIELD MAXFIELD MAXWELL MAXWELL MAXWELL MAXWELL MAXWELL MAXWELL MAXWELL MAXWELL MAY MAYBERRY MAYER MAYER MAYER MAYER MAYNARD MAYNARD MAYO LICENSE LCPC APRN LAC MD NP NP MD MD MD PA MD MD MSW MD LCSW LCSW MD LCPC PA-C PSYD LCPC LCPC LCSW DC DC DC DC DC LCPC OT CRNA NP NP DC DC MD DC APRN APRN APRN MD MD APRN MD NP NP NP MD MD MD MEDICAL GROUP WESTERN MONTANA MENTAL HEALTH CTR BLUE MOUNTAIN CLINIC BILLINGS CLINIC INTERMOUNTAIN IMAGING CENTER MONTANA INTERVENTIONAL & DIAG RADIOLOGY ST JAMES HEALTHCARE BILLINGS CLINIC GREAT FALLS CLINIC SOUND INPT PHYSICIANS AT ST JAMES MATSKO EYE CLINIC YELLOWSTONE COUNSELING CENTER YELLOWSTONE COUNSELING CENTER BILLINGS CLINIC FRIENDS TO YOUTH GREAT FALLS CHIROPRACTIC MATZ FAMILY CHIROPRACTIC MATZ FAMILY CHIROPRACTIC MAURER CHIROPRACTIC PC ST PETERS HOSPITAL REHABILITATION BENEFIS HEALTH SYSTEMS ABUNDANT CARE FAMILY CHIROPRACTIC ABUNDANT HEALTH FAMILY CHIROPRACTIC BOZEMAN DEACONESS BROADWATER FAMILY CHIROPRACTIC MISSOURI RIVER HEALTHCARE PSYCHIATRY ASSOCIATES WESTERN MONTANA MENTAL HEALTH BOZEMAN DEACONESS HEALTH GROUP THE SPINE & PAIN CENTER GREAT FALLS CLINIC GREAT FALLS CLINIC WESTERN MONTANA CLINIC ADDRESS 106 W BROADWAY 610 N CALIFORNIA 123 S 27TH ST 2950 10TH AVE N 900 N ORANGE ST #102 902 N ORANGE ST #206 435 S CRYSTAL ST STE 250 2475 BROADWAY 400 S CLARK ST 801 N 29TH ST 1400 29TH ST S 400 S CLARK ST 501 E FRONT ST #511B 2800 11TH AVE S STE18 208 N BROADWAY STE 423 208 N BROADWAY STE 423 2800 10TH AVE N 2115 DURSTON RD STE 9 1739 SPRING CREEK LN 2600 WILSON 2801 S RUSSELL STE 32 3700 S RUSSELL #B110 25 S EWING STE 204 400 13TH AVE S STE 104 1519 S RESERVE ST 1519 S REVERSE ST 1519 S RESERVE ST 113 E MAIN ST 2023 STADIUM DR STE 2B 2475 BROADWAY 1101 26TH ST S 30 HWY 91 S #106 90 HWY 91 S 642 COTTONWOOD RD STE 1 50 MEADOW VILLAGE DR STE 207 915 HIGHLAND BLVD 310 BROADWAY ST 926 13TH AVE S 2078 STADIUM DR STE 101 699 FARMHOUSE LN 500 W BROADWAY #320 905 HIGHLAND BLVD STE 4500 430 WINDWARD WAY STE 101 500 W BROADWAY 500 W BROADWAY 500 W BROADWAY 500 W BROADWAY 1101 26TH ST S 1400 29TH ST S 2835 FORT MISSOULA RD #3 CITY BUTTE MISSOULA BILLINGS BILLINGS MISSOULA MISSOULA BUTTE HELENA BUTTE BILLINGS GREAT FALLS BUTTE BUTTE GREAT FALLS BILLINGS BILLINGS BILLINGS BOZEMAN BILLINGS MILES CITY MISSOULA MISSOULA HELENA GREAT FALLS MISSOULA MISSOULA MISSOULA LAUREL BOZEMAN HELENA GREAT FALLS DILLON DILLON BOZEMAN BIG SKY BOZEMAN TOWNSEND GREAT FALLS BOZEMAN BOZEMAN MISSOULA BOZEMAN KALISPELL MISSOULA MISSOULA MISSOULA MISSOULA GREAT FALLS GREAT FALLS MISSOULA ZIP 59701 59802 59101 59101 59802 59802 59701 59601 59701 59101 59405 59701 59701 59405 59101 59101 59101 59718 59102 59301 59801 59801 59601 59405 59801 59801 59801 59044 59715 59601 59405 59725 59725 59718 59716 59715 59644 59405 59715 59715 59802 59715 59901 59802 59802 59802 59802 59405 59405 59804 SPECIALTY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED ADDICTION COUNSELOR HOSPITALIST NURSE PRACTITIONER NURSE PRACTITIONER RADIOLOGY RADIOLOGY RADIOLOGY NEPHROLOGY PEDIATRICS HOSPITALIST SOCIAL WORKER OPHTHALMOLOGY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER PATHOLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICIAN ASSISTANT PSYCHOLOGIST LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC SURGERY VASCULAR CHIROPRACTIC FAMILY PRACTICE PSYCHIATRY PSYCHIATRY CARDIOVASCULAR/THORACIC SURGERY FAMILY PRACTICE PAIN MANAGEMENT HOSPITALIST NURSE PRACTITIONER NURSE PRACTITIONER NURSE PRACTITIONER INTERNAL MEDICINE PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 68 of 256 FIRST NAME JOHN JOHN STEVEN JACQUELINE CHRIS DOROTHY DOROTHY KEVIN DOUGLAS JOHN MICHELLE FRANK PETER LINDSAY SHANNON ELIZABETH CHARLES CHARLES ALLEN KRISTIN HEIDI JANEL MARY PAUL CRAIG ANDREW PATRICIA BRADLEY CLAYTON DENNIS EMILY BRYAN BRYAN BRYAN BRYAN AMY ROBERT KARLA DANIEL CHRISTENE PATRICK PATRICK GREGORY JOSEPH SHAEN SUSAN SUSAN CHRISTOPHER KENNETH CHRISTINE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MAZUR MAZUR MAZUR MCADAM MCBEE MCBRIDE MCBRIDE MCBRIDE MCBRIDE MCCAHAN MCCALL MCCANN MCCARREN MCCARTHY MCCARTHY MCCARTHY MCCLAVE MCCLAVE MCCLINTICK MCCOLLY MCCORMICK MCCORMICK MCCORMICK MCCORMICK MCCOY MCCOY MCCOY MCCPHERS MCCRACKEN III MCCREA MCCREA-PLOYHAR MCDANIEL MCDANIEL MCDANIEL MCDANIEL MCDANIEL MCDERMOTT JR MCDONALD MCDONELL MCDONNELL MCDONNELL MCDONNELL MCDOWELL MCELHINNY MCELRAVY MCEWEN MCEWEN MCEWEN MCFADDEN MCFADYEAN LICENSE MD MD DC PT LCPC FNP NP OD OD MD MD PAC MD NP PT NP MD MD DC NP LCSW PAC PAC LAC MD DC LCPC MD MD PT LCPC PAC PAC PAC PAC PT MD LCPC LAC DC PAC MD MD MD PSYD LAC NP NP MD MD PT MEDICAL GROUP BENEFIS PHYSICIAN ASSOCIATES GREAT FALL CLINIC VALLEY FAMILY CHIROPRACTIC ADVANTAGE PHYSICAL THERAPY EUREKA HEALTH PROMPT CARE LIN CO COMMUNITY HEALTH CENTER MCBRIDE & MCBRIDE OPTOMETRISTS INTERMOUNTAIN CHILDRENS HOME NORTHERN MONTANA HOSPITAL ASSOCIATED DERMATOLOGY GREAT NORTHERN PHYSICAL THERAPY HELENA INDIAN ALLIANCE ADVANCED CARE HOSPITAL OF MONTANA INTERNAL MEDICINE & DIABETES ACADIA MONTANA LOLO FAMILY PRACTICE SVH WALK IN CLINIC MISSOULA OB-GYN ASSOCIATES BILLINGS ANESTHESIOLOGY BILLINGS CLINIC PEAK PERFORMANCE PHYSICAL THERAPY ABSORKA EMERGENCY PHYSICIANS ALPINE ORTHOPEDICS & SPORTS MEDICIN COMMUNITY HEALTH PARTNERS MONTANA OCCUPATIONAL HEALTH LLC BILLINGS CLINIC BOZEMAN OB/GYN NORTHWEST IMAGING ST PETER'S HOSPITAL ORTHO MONTANA WESTERN MONTANA ADDICTION SERVICES NORTHWEST FAMILY MEDICINE THE WAL-MART CLINIC BY KRMC NORTH VALLEY HOSPITAL BILLINGS CLINIC WEST ADDRESS 1101 26TH AVE S 1400 29TH ST S 3880 S AVE W 435 S CRYSTAL 121 W MAGNOLA 304 OSLOSKI RD 320 E SECOND ST 2120 GRAND AVE 2120 GRAND AVE 935 HIGHLAND BLVD STE 3260 500 S LAMBORN 1821 S AVE W #402 30 13TH ST 50 S LAST CHANCE GULCH 612 E MAIN ST #A 435 N LAST CHANCE GULCH 3528 GABEL RD 2019 BROADWATER AVE 2240 HWY 93 N 440 W LAUREL AVE 55 BASIN RD 11350 S HWY 93 1233 N 30TH ST 111 N LAST CHANCE GULCH STE 2A 2825 FORT MISSOULA RD STE 217 316 BRIDGE ST 320 1/2 CENTRAL AVE 2800 10TH AVE N 801 N 29TH ST 2360 MULLAN RD #D 1305 WYOMING 915 HIGHLAND BLVD 536 S COTTONWOOD RD STE 100 126 S MAIN ST 935 HIGHLAND BLVD STE 2180 1532 ELLIS ST #103 1020 N 27TH ST 501 MAIN ST 3700 S RUSSELL STE B100 925 HIGHLAND BLVD STE 1210 320 SUNNYVIEW LN 2475 BROADWAY 2900 12TH AVE N STE 140W 1643 LEWIS AVE #7 1325 WYOMING ST 1250 BURNS WAY #1 170 HUTTON RANCH RD 111 SUNNYVIEW LN 1600 HOSPITAL WAY 2675 CENTRAL AVE CITY GREAT FALLS GREAT FALLS MISSOULA BUTTE BELGRADE EUREKA LIBBY BILLINGS BILLINGS BOZEMAN HELENA MISSOULA HAVRE HELENA BOZEMAN HELENA BILLINGS BILLINGS VICTOR PLENTYWOOD BUTTE LOLO BILLINGS HELENA MISSOULA BELT GREAT FALLS BILLINGS BILLINGS MISSOULA MISSOULA BOZEMAN BOZEMAN LIVINGSTON BOZEMAN BOZEMAN BILLINGS ASHLAND MISSOULA BOZEMAN KALISPELL HELENA BILLINGS BILLINGS MISSOULA KALISPELL KALISPELL KALISPELL WHITEFISH BILLINGS ZIP 59405 59405 59804 59701 59714 59917 59923 59102 59102 59715 59601 59801 59501 59601 59715 59601 59102 59102 59875 59254 59701 59847 59101 59601 59804 59412 59401 59107 59101 59808 59801 59715 59718 59047 59715 59715 59101 59003 59801 59715 59901 59601 59101 59102 59801 59901 59901 59901 59937 59102 SPECIALTY INTERNAL MEDICINE PULMONARY DISEASES CHIROPRACTIC PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE OPTOMETRY OPTOMETRY RHEUMATOLOGY PSYCHIATRY DERMATOLOGY INTERNAL MEDICINE DERMATOLOGY PHYSICAL THERAPY FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE CHIROPRACTOR FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE ADDICTIONNICOTINECOUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY CHIROPRACTOR PROFESSIONAL COUNSELOR ANESTHESIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE PHYSICAL MEDICINE REHABILITATION PHYSICAL THERAPIST PSYCHIATRY PROFESSIONAL COUNSELOR CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY RADIOLOGY RADIOLOGY SURGERY ORTHOPEDIC MEDICINE PSYCHOLOGIST ADDICTIONNICOTINECOUNSELOR FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY INTERNAL MEDICINE PHYSICAL THERAPY Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 69 of 256 FIRST NAME MARSHA LAURIE MARY S BETH NATALIE NANCY NANCY NANCY NANCY PATRICK HEATHER CHRIS CHRIS BRIAN CHRIS CRAIG BEVERLY FRANK BEVERLY MAUREEN CHARLEEN TIMOTHY TIMOTHY TIMOTHY LACEY SANDRA DANETTE ELIZABETH JOY NATASHA SHERYL BARRY LEZLIE AMY JAMES MICHELE PHIL MATTHEW GLENN GLENN DAVID SCOTT DAVID GLENN DIANE CRAIG JIM GEORGE RICHARD JOAN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MCFARLAND MCGAFFNEY MCGEE MCGEE MCGILLEN MCGRADE MCGRADE MCGRADE MCGRADE MCGREE MCGUIRE MCGUIRE MCGUIRE MCGUIRE MCGUIRE MCHOOD MCHUGH MCHUGH MCHUGH MCINNIS MCINNIS MCINNIS MCINNIS MCINNIS MCINTOSH MCINTYRE MCINTYRE MCINTYRE MCKAY MCKEE MCKEE MCKENZIE MCKENZIE MCKERROW MCKIERNAN MCKINNIE MCLAIN MCLAREN MCLAUGHLIN MCLAUGHLIN MCLAUGHLIN MCLAUGHLIN MCLAUGHLIN MCLAUGHLIN MCLAVERTY MCLAWS MCLEAN MCLEAN MCLEOD MCMAHON LICENSE PHD LCSW PT NP LCPC LCPC LCPC LCPC LCPC MD MD NP NP MD NP MD RD MD RD LCPC MD MD MD MD APRN MD NP LCSW PT PAC LCPC MD APRN MD DC PSYD MD MD MD MD MD MD MD MD LCPC DPM PT MD LCPC MD MEDICAL GROUP FAMILY PSYCHOLOGICAL CENTER HAMILTON PT & REHAB AT CANYONS CLUB MONTANA NEUROLOGY WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER GALLATIN VALLEY ANESTHESIA SHERIDAN COMMUNITY HEALTH CENTER WESTERN MONTANA CLINIC INTERNAL MEDICINE & DIABETES MARCUS DALY MEMORIAL HOSPITAL WEIGHT MANAGEMENT CLINIC FAMILIES IN TRANSITION MEDICAL ASSOCIATES MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS CENTERS FOR MENTAL HEALTH BARRETT HOSPITAL & HEALTHCARE VALLEY PHYSICAL THERAPY WESTERN MONTANA CLINIC SURGICAL ASSOCIATES PC MCKIERNAN CHIROPRACTIC GLACIER COMMUNITY HEALTH CLINIC ST PETERS MEDICAL OFFICE BUILDING BILLINGS CLINIC MILES CITY CONTINENTAL DIVIDE OBGYN FAMILY DOCTORS URGENT CARE NORTH COUNTRY MEDICAL CLINIC THE BOZEMAN CLINIC THE FOOT CARE CENTER FRENCHTOWN PHYSICAL THERAPY CENTRAL MONTANA MEDICAL CENTER ADDRESS 48 MEDICAL PARK DR 25 S EWING #412 472 TAMMANY LN 2835 FT MISSOULA RD STE 204 106 W BROADWAY 1 N BROADWAY 1 N BROADWAY 208 N 29TH #215 208 N 29TH #215 225 S CLARK 801 N 29TH ST 445 CENTENNIAL AVE 41 BARRETT ST 935 HIGHLAND BLVD 317 MADISON ST 500 W BROADWAY 2019 BROADWATER AVE 1200 WESTWOOD DR 1101 N 27TH ST 600 CENTRAL AVE STE 418 935 HIGHLAND BLVD STE 2200 205 W MAIN ST 300 N WILLSON AVE STE 1003 422 S MAIN 915 1ST AVE S 30 HWY 91 S STE 105 301 KNAPP ST 700 S AVE W #B 1001 SW HIGGINS #205 500 W BROADWAY 404 N 31ST ST #201 2900 12TH AVE N STE 355W 126 E BROADWAY #8 350 HERITAGE WAY #2300 1031 S MAIN ST 1648 ELLIS ST #302 519 E MAIN ST 2550 E BROADWAY ST 620 S HAYNES 305 W PORPHYRY ST 120 N 19TH AVE STE A 1343 HWY 93 N 931 HIGHLAND BLVD STE 3360 401 S ALABAMA #9 1119 W KENT STE J 1139 N 27TH STE B1 16400 FRENCHTOWN FRONTAGE RD 210 SUNNYVIEW LN STE 105 520 N PATTEE 408 WENDELL AVE CITY HELENA HELENA HAMILTON MISSOULA BUTTE RED LODGE RED LODGE BILLINGS BILLINGS BUTTE BILLINGS BUTTE DILLON BOZEMAN SHERIDAN MISSOULA BILLINGS HAMILTON BILLINGS GREAT FALLS BOZEMAN BELGRADE BOZEMAN LIVINGSTON GREAT FALLS DILLON WOLF POINT MISSOULA MISSOULA MISSOULA BILLINGS BILLINGS MISSOULA KALISPELL KALISPELL BOZEMAN CUT BANK HELENA MILES CITY BUTTE BOZEMAN EUREKA BOZEMAN BUTTE MISSOULA BILLINGS FRENCHTOWN KALISPELL MISSOULA LEWISTOWN ZIP 59601 59601 59840 59804 59701 59068 59068 59101 59101 59701 59101 59701 59725 59715 59749 59802 59102 59840 59101 59403 59715 59714 59715 59047 59405 59725 59201 59801 59803 59807 59101 59101 59802 59901 59901 59715 59427 59601 59301 59701 59718 59917 59715 59701 59801 59101 59834 59901 59802 59457 SPECIALTY PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY NEUROLOGY LICENSED BEHAVIORAL COUNSELOR ADDICTIONNICOTINECOUNSELOR LICENSED BEHAVIORAL COUNSELOR ADDICTIONNICOTINECOUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE NEPHROLOGY FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE NUTRITION PROFESSIONAL EMERGENCY MEDICINE/TRAUMA NUTRITION PROFESSIONAL LICENSED BEHAVIORAL COUNSELOR PEDIATRICS OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY PSYCHIATRY INTERNAL MEDICINE NURSE PRACTITIONER SOCIAL WORKER PHYSICAL THERAPY DERMATOLOGY PROFESSIONAL COUNSELOR SURGERY GENERAL PSYCHIATRY UROLOGY CHIROPRACTIC PSYCHOLOGIST FAMILY PRACTICE PAIN MANAGEMENT OB/GYN-OBSTETRICS/GYNECOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY URGENT CARE PROVIDER INTERNAL MEDICINE FAMILY PRACTICE OBSTETRICS & GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR PODIATRY PHYSICAL THERAPY DERMATOLOGY PROFESSIONAL COUNSELOR PEDIATRICS Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 70 of 256 FIRST NAME JACK THOMAS RICHARD JAMES JAMES JAMES KYLE KYLE FRED KIMBERLY LISA DEIRDRE SARAH LAURIE HEIDI ROBERT HEATHER TANYA NANCY JOHN BRENTON EDWIN WALTER JOHN DEBORAH DENISE JEANNE ANDERSON ALBERT ALBERT JEFFREY KIMBERLY JEFFREY KIMBERLY JERRY JERRY JERRY SCOTT LESLIE JENET RICHARD KATINA ANTHONY MARGARET MARC MARC JEANIE JONATHAN JONATHAN JONATHAN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MCMAHON MCMAHON MCMASTER MCMEEKIN MCMEEKIN MCMEEKIN MCMURRAY MCMURRAY MCMURRY MCNAMARA MCNAMEE MCNAMER MCNERNEY MCNEW MCNULTY MCNUTT MCREE MCULLOUGH MCVEAN MEANS MEDA MEDINA MEDLIN MEEHAN MEEKS MEHIA MEHRENS MEHRLE MEIER MEIER MEIER MEIER MEIER MEIER MEISLIK MEISLIK MEISLIK MEISSNER MELLGREN MELTON MELZER MENDIS MENENDEZ MENENDEZ MENTEL MENTEL MENTIKOV MERCER MERCER MERCER LICENSE MD MD OD MD MD MD OD OD MD LAC LCPC MD APRN PAC DO MD DO NP LCPC MD MD MD MD MD APRN MD PAC MD MD MD DC DC DC DC MD MD MD PA OT OD MD LCPC MD MD DO DO PAC MD MD MD MEDICAL GROUP HELENA OBGYN ASSOCIATES PINTLER SURGICAL SPECIALISTS ALL FAMILY VISION CARE ST VINCENT PHYSICIAN NETWORK ST VINCENT PHYSICIAN NETWORK THE RESPIRATORY CENTER ADVANCED EYE CARE BELGRADE ADVANCED EYECARE ASSOCIATES YELLOWSTONE NEUROSURGICAL ASSOC SECOND STORY MOUNTAIN VIEW CLINIC WESTERN MONTANA CLINIC INTERNAL MEDICINE & DIABETES FIRST CARE NORTH MONTANA RHEUMATOLOGY COOPERATIVE HEALTH CENTER NORTHERN MONTANA HOSPITAL NORTHWEST MONTANA SURGICAL ASSOC NORTHERN PLAINS PATHOLOGISTS PHILLIPS CO FAMILY HEALTH CLINIC BILLINGS CLINIC PEDIATRIC SURGERY OF MONTANA BENTON MEDICAL CENTER MERCURY STREET MEDICAL CARDIOLOGY CONSULTANTS OF BOZEMAN ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY MEIER CHIROPRACTIC MEIER CHIROPRACTIC MEIER FAMILY CHIROPRACTIC MEIER FAMILY CHIROPRACTIC GLACIER EYE CLINIC BENEFIS PHYSICIAN ASSOC BILLINGS CLINIC QUALITY VISION CARE BILLINGS CLINIC AURORA COUNSELING MISSOULA ANESTHESIOLOGY COMMUNITY PHYSICIANS ON RESERVE MOUNTAIN VIEW FAMILY MEDICINE & OB RIVERSTONE HEALTH FALTHEAD UROLOGY FLATHEAD UROLOGY FLATHEAD UROLOGY ADDRESS 45 MEDICAL PARK DR 401 W PENNSYLVANIA 821 W MAIN ST 1233 N 30TH ST 1233 N 30TH ST 2900 12TH AVE N #300E 91 W MADISON AVE 4265 FALLON STE 1 2900 12TH AVE N #400E 15 N 26TH ST #306 119 1/2 W PARK ST STE 5 10 ROBINSON LN 2835 FORT MISSOULA RD #3 2019 BROADWATER AVE 2230 N RESERVE #402 121 N LAST CHANCE GULCH STE H 1930 9TH AVE 30 13TH ST 3210 COONEY DR 1273 BURNS WAY 500 15TH AVE S 315 S 8TH AVE E 801 N 29TH ST 2835 FT MISSOULA RD #301 1203 15TH ST 1111 MAIN ST STE 1 300 W MERCURY ST 905 HIGHLAND BLVD STE 4330 905 HIGHLAND BLVD STE 4100 925 HIGHLAND BLVD STE 1180 3419 CENTRAL AVE STE C 3419 CENTRAL AVE STE C 308 E PIKE ST 318 E PIKE ST 160 HERITAGE WAY 308 LOUISIANA AVE 410 1ST ST E STE A 500 15TH AVE S 801 N 29TH ST 1040 PARTRIDGE PLACE #10 801 N 29TH ST 1101 N 32ND ST 2825 STOCKYARD RD BLDG I-200 500 W BROADWAY 2230 N RESERVE #402 2835 FORT MISSOULA RD #101 123 S 27TH ST 210 SUNNYVIEW LN #106 1343 HWY 93 N 2000 HOSPITAL WAY CITY HELENA ANACONDA LEWISTOWN BILLINGS BILLINGS BILLINGS BELGRADE BOZEMAN BILLINGS BILLINGS LIVINGSTON RED LODGE MISSOULA BILLINGS MISSOULA HELENA HELENA HAVRE HELENA KALISPELL GREAT FALLS MALTA BILLINGS MISSOULA FORT BENTON BILLINGS BUTTE BOZEMAN BOZEMAN BOZEMAN BILLINGS BILLINGS COLUMBUS COLUMBUS KALISPELL LIBBY POLSON GREAT FALLS BILLINGS HELENA BILLINGS BILLINGS MISSOULA MISSOULA MISSOULA MISSOULA BILLINGS KALISPELL EUREKA WHITEFISH ZIP 59601 59711 59457 59101 59101 59101 59714 59718 59101 59101 59047 59068 59804 59102 59808 59601 59601 59501 59602 59901 59405 59538 59101 59804 59442 59105 59701 59715 59715 59715 59102 59102 59019 59019 59901 59923 59860 59405 59101 59601 59101 59101 59808 59802 59808 59804 59101 59901 59917 59937 SPECIALTY OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY GENERAL OPTOMETRY INTENSIVE/CRITICAL CARE PULMONARY DISEASES PULMONARY DISEASES OPTOMETRY OPTOMETRY SURGERY NEUROSURGERY ADDICTIONNICOTINECOUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE FAMILY PRACTICE RHEUMATOLOGY FAMILY PRACTICE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR SURGERY GENERAL PATHOLOGY FAMILY PRACTICE SURGERY GENERAL PEDIATRIC SURGERY FAMILY PRACTICE GENERAL PRACTICE FAMILY PRACTICE CARDIOLOGY RADIOLOGY RADIOLOGY CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC CHIROPRACTIC OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY FAMILY PRACTICE OCCUPATIONAL THERAPY OPTOMETRY SURGERY UROLOGICAL UROLOGY LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY RADIATION ONCOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY UROLOGICAL UROLOGY SURGERY UROLOGICAL UROLOGY SURGERY UROLOGICAL UROLOGY Montana STATUS SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 71 of 256 FIRST NAME JONATHAN ROBERT ROBERT TERESA TYLENE GARY ANGELA CLINT CLINT TIMOTHY STEPHEN THERESA MIRANDA DAVID JOHN YVES YVES CHRISTINA ZACHERY ANDI ANDI ANDREW ANDREW ANDREW JOHN SURRENA FRANK BRUCE BRUCE BRUCE DIANNE DIANNE GEORGIA AMBER LISA STEPHEN ANNE BRIAN JAMES CHAD BERNADETTE MICHELLE MICHELLE LISA JON RONALD DEBRA FREDERICK DEBRA JON Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MERCER MERCHANT MERCHANT MERKEL MERKEL MERMEL MERRIN MERRITT MERRITT MESSER MEST METROPOULOS MEUNIER MEURER MEYER MEYER MEYER MEYERS MEYERS MICHAELSON MICHALSON MICHEL MICHEL MICHEL MICHELOTTI MICHELS MICHELS MIKESELL MIKESELL MIKESELL MIKLOS MIKLOS MILAN MILBURN MILCH MILHEIM MILLARD MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER LICENSE MD MD MD LCPC LCPC MD PAC PA-C PA-C PT MD SLT NP LCSW MD MD MD MD MD PT PT MD MD MD MD PT MD MD MD MD OT OT MD DC MD MD MD PT DO PT LCPC LCSW LCSW SLT MD MD NP DO NP MD MEDICAL GROUP FLATHEAD UROLOGY BILLINGS CLINIC NORTHERN MONTANA HOSPITAL ANESTHESIA PARTNERS OF MONTANA SVH WALK IN CLINIC ACTIVE PHYSICAL THERAPY HOSPITALISTS OF ST PETERS ST PETERS HOSPITAL REHABILITATION BILLINGS CLINIC GALLATIN VALLEY ANESTHESIA GALLATIN COMMUNITY CLINIC RIVERSTONE HEALTH HEUISER PHYSICAL THERAPY HEUISER PHYSICAL THERAPY LEWIS & CLARK EMERGENCY PHYSICIANS LEWIS & CLARK EMERGENCY PHYSICIANS ST PETERS URGENT CARE HELENA ORTHOPEDIC CLINIC PHYSICAL THERAPY IN MOTION WEST GRAND FAMILY MEDICINE BIG SANDY MEDICAL CENTER ST LUKE COMMUNITY CLINIC RONAN LYMPHEDEMIA & OCCUPATIONAL THERAPY LYMPHEDEMIA & OCCUPATIONAL THERAPY LONE TREE CHIROPRACTIC & WELLNESS BITTERROOT CLINIC NORTHWEST MONTANA SURGICAL ASSOCIATES ADVANCED REHABILITATION SERVICES BILLINGS CLINIC BILLINGS CLINIC WEST BRAINWORKS COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER EPICENTER THERAPY SERVICES GLACIER MEDICAL ASSOCIATES GLACIER MEDICAL ASSOCIATES GRANITE COUNTY MEDICAL CENTER GREAT FALLS CLINIC MARGO BOWER COMMUNITY HEALTH CLINIC NORTH VALLEY HOSPITAL ADDRESS 308 LOUISIANA AVE #5 801 N 29TH ST 30 13TH ST 4185 N MONTANA AVE STE 5 820 DIVISION ST 2900 12TH AVE N STE 205W 1233 N 30TH ST 1739 SPRING CREEK LN 2877 OVERLAND AVE #C 1410 S RESERVE ST 2475 BROADWAY 2475 BROADWAY 801 N 29TH ST 415 N HIGGINS 931 HIGHLAND BLVD 2900 12TH AVE N #315W 621 3RD ST S 214 E MENDENHALL 123 S 27TH ST 3180 DREDGE DR 3180 DREDGE DR STE F 2475 BROADWAY 2475 BROADWAY 2475 BROADWAY 2442 WINNE 50 27TH ST W STE B 2750 GRAND AVE 166 MONTANA AVE EAST 126 6TH AVE SW #A 1208 6TH AVE EAST 185 COMMONS LOOP STE D 80 FOUR MILE DR STE 14A 500 W BROADWAY 3RD FLOOR 215 3RD ST S 1224 W MAIN ST 1273 BURNS WAY 221 5TH AVE S 200 COMMONS WAY STE B 2800 10TH AVE N 2675 CENTRAL AVE 2001 11TH AVE STE 20 445 CENTENNIAL AVE 41 BARRETT ST 09012011 1111 BAKER AVE 1111 BAKER AVE 310 SANSOME 1400 29TH ST S 26 E BROAD 1600 HOSPITAL WAY CITY LIBBY BILLINGS HAVRE HELENA BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS MISSOULA HELENA HELENA BILLINGS MISSOULA BOZEMAN BILLINGS GLASGOW BOZEMAN BILLINGS HELENA HELENA HELENA HELENA HELENA HELENA BILLINGS BILLINGS BIG SANDY RONAN SUPERIOR KALISPELL KALISPELL MISSOULA STANFORD HAMILTON KALISPELL GLASGOW KALISPELL BILLINGS BILLINGS HELENA BUTTE DILLON BOZEMAN WHITEFISH WHITEFISH PHILIPSBURG GREAT FALLS DRUMMOND WHITEFISH ZIP 59923 59101 59501 59602 59101 59101 59101 59102 59102 59801 59601 59601 59101 59802 59715 59101 59230 59715 59101 59602 59602 59601 59601 59601 59601 59102 59102 59520 59864 59872 59901 59901 59802 59479 59840 59901 59230 59901 59101 59102 59601 59701 59725 59715 59937 59937 59858 59405 59832 59937 SPECIALTY SURGERY UROLOGICAL UROLOGY PULMONARY DISEASES PULMONARY DISEASES LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY URGENT CARE PROVIDER PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT PHYSICAL THERAPY HOSPITALIST SPEECH/LANGUAGE THERAPY GERIATRIC MEDICINE LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY NEUROLOGICAL SURGERY NEUROLOGICAL SURGERY FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA URGENT CARE PROVIDER SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY FAMILY PRACTICE CHIROPRACTIC INTERNAL MEDICINE SURGERY GENERAL FAMILY PRACTICE PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER SPEECH/LANGUAGE THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE Montana STATUS SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 72 of 256 FIRST NAME JOAN PAUL BRIAN MICHELLE MARK JOAN JASON GERALD ROBIN BENJAMIN BENJAMIN BENJAMIN BENJAMIN CINDY DOUGLAS MICHELLE J SCOTT PAUL PAULA CAROL SAMUEL SAMUEL DANA CRES THOMAS DAYTON HARLEY BLAKE PETER ELIZABETH MARIE ROBERT CHRISTINE JEFFREY JEFFREY JEREMY JOHN JAY SAMANTHA JAMES MAGGIE GINNY VIRGINIA TODD TODD LAURA JON MARY ANNE DANIEL MOLLY JOHN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLER MILLIKAN MILLOY MILLS MILNE MINTZ MINTZ MIQUELLE MIRANDA MIRICH MISFELDT MISNER MITCHELL MITCHELL MITCHELL MITCHELL MITCHELL MITCHELL MITCHELL MITCHELL MITCHELL MITMAN MODDERMAN MOELLER MOFFATT MOHL MOHL MOHR MOHR MOIRE MOLIN MOLINEUX MOLLOY MOLLOY MOLLOY LICENSE MD DC PT LCSW DC MD PT LCPC LCPC NP NP NP NP PHD DC LCPC LCSW MD MD LCPC APRN PAC PAC LCPC MD MD MD DC MD MD LCPC APRN MD MD DC DC DO PT PT MD LCPC MD MD PAC PA MD MD SLT MD LCSW MD MEDICAL GROUP NORTH VALLEY PROFESSIONAL CENTER PAUL J MILLER DC PC PROFESSIONAL THERAPY ASSOCIATION SHERIDAN COMMUNITY HEALTH CENTER SPINAL HEALTH & HEALING CHIROPRACTI THE PROFESSIONAL CENTER WESTERN MONTANA CLINIC WESTERN MONTANA MENTAL HEALTH CTR WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC NORTHERN MONTANA MEDICAL GROUP PERCEPTIONS COUNSELING INC BULLHOOK COMMUNITY HEALTH CENTER PRAIRIE COMMUNITY HEALTH CENTER PRAIRIE COMMUNITY HEALTH CENTER BOZEMAN DEACONESS CARDIOLOGY CON GREAT FALLS CLINIC CHIROPRACTIC HEALTH ASSOCIATES ANESTHESIA PARTNERS OF MONTANA BILLINGS CLINIC ELIZABETH S MITCHELL LCPC FOUR CORNERS HEALTH CARE ROCKY MOUNTAIN HEART & LUNG THE BOZEMAN CLINIC MARCUS DALY MEMORIAL HOSPITAL KALISPELL REHABILITATION ASSOCIATES BEARTOOTH BILLINGS CLINIC BILLINGS CLINIC HELENA URGENT CARE PLUS MERCURY STREET MEDICAL GROUP MARCUS DALY MEMORIAL HOSPITAL BILLINGS ANESTHESIOLOGY SPEECH & LANGUAGE CLINIC BIG SKY OB-GYN BUTTE SILVER BOW PRIMARY CARE CLINI ADDRESS 2165 9TH ST W 1004 S AVE W 1234 WHITEFISH STAGE RD 317 MADISON ST 1103 REEVES RD W STE A 2165 9TH ST W 500 W BROADWAY BLDG T9 FORT MISSOULA 1315 WYOMING 301 KNAPP ST 500 W BROADWAY 621 3RD ST S 818 2ND AVE EAST 129 W KENT AVE E604 1ST AVE N 24 E BROADWAY ST 801 N 29TH ST 30 13TH ST 716 S 20TH STE 201 110 13TH ST 406 312 S ADAMS 406 312 S ADAMS 1648 ELLIS ST STE 302 905 HIGHLAND BLVD STE 4330 621 3RD ST S 3000 15TH AVE S 1407 WYOMING AVE 2900 12TH AVE N STE 205W 2800 10TH AVE N 114 GRAND AVE 7720 SHEDHORN DR STE D 350 HERITAGE WAY STE 2100 931 HIGHLAND BLVD STE 3360 1918 BROADWATER AVE 1918 BROADWATER AVE 6 - 13TH AVE E 1200 WESTWOOD DR 1234 WHITEFISH STAGE RD 621 3RD ST S 5376 HORN RD 2525 N BROADWAY AVE 801 N 29TH ST 39 NEILL AVE 300 W MERCURY 1200 WESTWOOD DR 2800 10TH AVE N 309 16TH ST 2900 12TH AVE N #230W 445 CENTENNIAL AVE 1300 28TH ST S #3 CITY COLUMBIA FALLS MISSOULA KALISPELL SHERIDAN BOZEMAN COLUMBIA FALLS MISSOULA MISSOULA MISSOULA WOLF POINT MISSOULA GLASGOW CULBERTSON MISSOULA COLUMBUS BUTTE BILLINGS HAVRE BOZEMAN HAVRE TERRY TERRY BOZEMAN BOZEMAN GLASGOW GREAT FALLS BILLINGS BILLINGS BILLINGS BILLINGS BOZEMAN KALISPELL BOZEMAN BILLINGS BILLINGS POLSON HAMILTON KALISPELL GLASGOW MISSOULA RED LODGE BILLINGS HELENA BUTTE HAMILTON BILLINGS HELENA BILLINGS BUTTE GREAT FALLS ZIP 59912 59801 59901 59749 59718 59912 59801 59804 59801 59201 59802 59230 59218 59801 59019 59701 59101 59501 59718 59501 59349 59349 59715 59715 59230 59405 59102 59101 59101 59101 59718 59901 59715 59102 59102 59860 59840 59901 59230 59808 59068 59101 59601 59701 59840 59101 59601 59101 59701 59405 SPECIALTY FAMILY PRACTICE CHIROPRACTIC PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC FAMILY PRACTICE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR NURSE PRACTITIONER NURSE PRACTITIONER NURSE PRACTITIONER NURSE PRACTITIONER PSYCHOLOGIST CHIROPRACTOR SOCIAL WORKER SURGERY CARDIOVASCULAR THORACIC GASTROENTEROLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE PHYSICIAN ASSISTANT LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY ORTHOPAEDIC SURGERY INTERNAL MEDICINE CHIROPRACTIC ANESTHESIOLOGY HOSPITALIST LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE CARDIOLOGY FAMILY PRACTICE CHIROPRACTOR CHIROPRACTOR FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY RADIOLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA ANESTHESIOLOGY SPEECH/LANGUAGE THERAPY OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER GASTROENTEROLOGY Montana STATUS SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED 73 of 256 FIRST NAME KATHRYN MICHAEL MIKE PAUL MICHAEL CHAR-EL PATRICK CHRISTOPHER MICHELLE MATTHEW KRISTI GREGORY LAURA JOHN JOHN JEFF JEFF CARALYNN CHRISTOPHER CHRISTOPHER JOHN KRISTI KRISTI DODIE MICHAEL MICHAEL AMY JOHN JOHN JOHN AMANDA BRUCE MARY CINDY SARAH EDWARD KIRSTEN KIRSTEN KIRSTEN SCOTT DIANE MICHAEL DIANE MICHAEL WENDY ELLIOT EUGENE MIMI MIMI TINA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MONCE MONDLOCH MONDLOCH MONIE MONSON MONTANA MONTGOMERY MONTVILLE MONTVILLE MOOG MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOORE MOQUIN MORAN MORAN MORAN MORELAND MORELAND MORELAND MOREY MORGAN MORGAN MORGAN MORGAN EDWARDS MORIARITY MORISSETTE MORISSETTE MORISSETTE MORLEDGE HAMPTON MORLEDGE-HAMPTON MORONE MORRIN MORRIS MORRIS MORRIS MORRIS MORRIS MORRIS MORRISON LICENSE MD MD CRNA MD OD LCPC DC MD MD PT MD MD MD MD PT PT APRN DC DC MD PT PT LCPC MD MD OT MD MD MD MD MD LCSW NP MD LCSW MD MD MD MD OT MD LCPC DC MD DDS NP NP LCPC MEDICAL GROUP GABERT MEDICAL SERVICES CAPITAL MEDICAL ANESTHESIA ROCKY MOUNTAIN EYE SURGERY CENTER RIVERSTONE HEALTH WESTERN MONTANA MENTAL HEALTH CTR HEALTH WISE BILLINGS CLINIC BILLINGS CLINIC GALLATIN VALLEY ANESTHESIA ALPINE PHYSICAL THERAPY BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC CENTRAL MONTANA MEDICAL CENTER COMMUNITY HOSPITAL OF ANACONDA EXCEL ORTHOPEDIC PHYSICAL THERAPY EXCEL PHYSICAL THERAPY MOORE MEDICAL CLINIC BITTERROOT CLINIC CONVENIENT CARE CLINIC ST PETERS HOSPITAL REHABILITATION MARCUS DALY MEMORIAL PHYSICIANS CLINIC CPG VASCULAR SURGERY WMMHC ABSORKA EMERGENCY PHYSICIANS HARDIN CLINIC RIVERSTONE HEALTH MORLEDGE FAMILY EYE CLINIC MORLEDGE FAMILY EYE CLINIC BILLINGS CLINIC FULL SPECTRUM PSYCHOTHERAPY CHIROPRACTIC CENTER MISSOULA ANESTHESIOLOGY MISSOULA GASTROENTEROLOGY ORAL SURGICAL ASSOCIATES CUSTER AVENUE COUNSELING ADDRESS 107 DILWORTH ST 2440 WINNE AVE #100 700 W KENT AVE 123 S 27TH ST 1240 DEWEY BOULEVARD 8 2ND AVE SW 1004 S AVE W 801 N 29TH ST 801 N 29TH ST 915 HIGHLAND BLVD STE 3215 2965 STOCKYARD RD 90 HWY 91 S 801 N 29TH ST 408 WENDELL AVE 401 W PENNSYLVANIA 220 WOODEN SHOE LN STE C 1125 W KAGY STE 101A 19 1ST ST NE 1802 DEARBORN AVE #101 1802 DEARBORN AVE STE 101 307 E PARK STE 209 20331 E MULLAN RD 316 W SPRUCE ST 210 N HIGGINS STE 214 1224 W MAIN ST 1200 WESTWOOD DR STE H 2475 BROADWAY 1200 WESTWOOD DR 1170 WESTWOOD DR STE B 1224 W MAIN 500 W BROADWAY 2831 FORT MISSOULA RD #206 106 W BROADWAY 1111 MAIN ST 915 HIGHLAND BLVD 101 E BROADWAY STE 405 16 N MILES AVE STE 101 123 S 27TH ST 17 N MILES 1747 PLOY DR 1747 POLY DR 801 N 29TH ST 1119 MAIDEN LN 827 N LAST CHANCE GULCH 2825 STOCKYARD RD BLDG I-200 2825 FORT MISSOULA RD #113 1547 S HIGGINS AVE 902 N ORANGE ST #206 902 N ORANGE ST #206 104 W CUSTER AVE STE 1 CITY GLENDIVE HELENA MISSOULA BILLINGS BUTTE RONAN MISSOULA BILLINGS BILLINGS BOZEMAN MISSOULA DILLON BILLINGS LEWISTOWN ANACONDA MANHATTAN BOZEMAN CHOTEAU MISSOULA MISSOULA ANACONDA CLINTON MISSOULA MISSOULA HAMILTON HAMILTON HELENA HAMILTON HAMILTON HAMILTON MISSOULA MISSOULA BUTTE THOMPSON FALLS BOZEMAN MISSOULA HARDIN BILLINGS HARDIN BILLINGS BILLINGS BILLINGS THOMPSON FALLS HELENA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA HELENA ZIP 59330 59601 59801 59101 59701 59864 59801 59102 59101 59715 59808 59725 59101 59457 59711 59741 59715 59422 59801 59801 59711 59825 59802 59802 59840 59840 59601 59840 59840 59840 59802 59804 59701 59873 59715 59802 59034 59101 59034 59102 59102 59101 59873 59601 59808 59804 59801 59802 59802 59602 SPECIALTY FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY FAMILY PRACTICE OPTOMETRIST LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC ENDOCRINOLOGY/REPRODUCTIVE MED OB/GYN-OBSTETRICS/GYNECOLOGY ANESTHESIOLOGY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA ALLERGY/IMMUNOLOGY SURGERY GENERAL EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE CHIROPRACTOR CHIROPRACTIC SURGERY GENERAL PHYSICAL THERAPIST PHYSICAL THERAPIST LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE OCCUPATIONAL THERAPY INTERNAL MEDICINE INTERNAL MEDICINE INTERNAL MEDICINE EMERGENCY MEDICINE SURGERY GENERAL LICENSED CLINICAL SOCIAL WORKER NURSE PRACTITIONER EMERGENCY MEDICINE/TRAUMA LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE OPHTHALMOLOGY OCCUPATIONAL THERAPY SURGERY NEUROSURGERY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC ANESTHESIOLOGY GASTROENTEROLOGY SURGERY ORAL/MAXILLOFACIAL NURSE PRACTITIONER NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING PENDING PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 74 of 256 FIRST NAME JULIE CAROL DALE STEPHANIE JOHN JOSH JANE ERIC JOHN JOHN MARCIA GERALDINE GERALDINE LYNN RONALD RONALD MARLENE JEAN JEAN MARK PATRICE KATHRYN TRUDIE THOMAS THOMAS SHARON TARA EDWIN JAN JAN MATTHEW CHRISTOPHER DANIEL ROBERT DANIEL DAVID TODD TODD TODD DENNIS JAMES ALLISON REBECCA MARY MARILYN ANNE ANNE COLLEEN JEANANNE JOE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MORSE MORSE MORTENSON MORUP MOSELEY MOSER MOSES MOSQUEDA MOTT MOTT MOUDREE MOURNIAN MOURNIAN MOUSEL MOW MOW MOWERY MOYLAN MOYLAN MOZER MUDIE MUENZBERG MUIR MULGREW MULGREW MULVEHILL MUND MUNDALL MUNDAY MUNDAY MUNDING MUNDY MUNIAK MUNJAL MUNZING MURDOCK MURDOCK MURDOCK MURDOCK MURI MURPHEY MURPHINE MURPHY MURPHY MURPHY MURPHY MURPHY MURPHY MURPHY MURPHY LICENSE NP SLT MD PAC MD PAC LCPC MD MD MD MD MD MD MD MD MD PHD LCPC LCPC MD LCPC PT MD MD MD MD PT MD LCSW LCSW MD LCPC PA MD MD MD MD MD LCSW PHD PT APRN MD LCPC MD MD LCSW LCPC MD MEDICAL GROUP BILLINGS CLINIC BILLINGS CLINIC WEST GREAT FALLS SURGICAL ASSOCIATES BILLINGS CLINIC YELLOWSTONE NEUROSURGICAL ASSOC ROCKY MOUNTAIN EAR NOSE & THROAT ROCKY MOUNTAIN CLINIC CAPITAL MEDICAL ANESTHESIA CAPITAL MEDICAL ANESTHESIA ST VINCENT PHYSICIAN NETWORK ST VINCENT PHYSICIAN NETWORK AWARE INC ST PETERS MEDICAL GROUP SANO SONNECTION WMMHC NEUROSCIENCES BEHAVIORAL CONSULTANTS LONE PEAK PHYSICAL THERAPY BILLINGS CLINIC PHYSICIAN CLINICS OF ST PETERS PHYSICIAN CLINICS OF ST PETERS DEERING CLINIC ALPINE PHYSICAL THERAPY THOMPSON FALLS FAMILY MEDICINE BUTTE SILVER BOW PRIMARY RAVALLI UROLOGY BADLANDS MEDICAL GLACIER MEDICAL ASSOCIATES DERMATOLOGY ASSOCIATES ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER SAFE HARBOR THERAPEUTIC SERVICES BILLINGS CLINIC BOZEMAN DEACONESS MEDICAL GROUP GREAT DIVIDE RADIOLOGY WESTERN MONTANA MENTAL HEALTH CTR ADDRESS 2800 10TH AVE N 2675 CENTRAL AVE 400 13TH AVE S 2702 8TH AVE N 2900 12TH AVE N #400E 700 W KENT 303 N BROADWAY STE 822 1101 S MONTANA ST 2475 BROADWAY 65 MEDICAL PARK DR 2475 BROADWAY 1233 N 30TH ST 1233 N 30TH ST 600 6TH ST NW STE 4 2550 BROADWAY 1730 CHOTEAU COLUMBUS SENTER 1601 2ND AVE N #338 1946 STADIUM DR STE 2 699 FARMHOUSE LN 400 15TH AVE S STE 205 101 E BROADWAY ST 135 PROSPECT LOOP 2800 10TH AVE N 2550 E BROADWAY 2550 E BROADWAY 123 S 27TH ST 2965 STOCKYARD RD 120 POND ST 445 CENTENNIAL 24 E BROADWAY 1224 W MAIN ST 27 N 27TH ST STE 18C 332 LEAVITT AVE 902 N ORANGE ST #206 1111 BAKER AVE 175 COMMONS LOOP STE 300 120 S FIFTH #104 3417 BUSCH 700 W KENT 2475 VILLAGE LN STE 102 333 HAGGERTY LN STE 1 2675 CENTRAL AVE 915 HIGHLAND BLVD 2475 E BROADWAY 11395 HWY 93 S 500 W BROADWAY 500 W BROADWAY 25 S EWING STE 200 118 E 7TH ST 2475 BROADWAY CITY BILLINGS BILLINGS GREAT FALLS BILLINGS BILLINGS MISSOULA BILLINGS BUTTE HELENA HELENA HELENA BILLINGS BILLINGS GREAT FALLS HELENA HELENA GREAT FALLS BOZEMAN BOZEMAN GREAT FALLS MISSOULA BOZEMAN BILLINGS HELENA HELENA BILLINGS MISSOULA THOMPSON FALLS BUTTE BUTTE HAMILTON BILLINGS JORDAN MISSOULA WHITEFISH KALISPELL HAMILTON BUTTE MISSOULA BILLINGS BOZEMAN BILLINGS BOZEMAN HELENA LOLO MISSOULA MISSOULA HELENA ANACONDA HELENA ZIP 59101 59102 59405 59101 59101 59801 59101 59701 59601 59601 59601 59101 59101 59404 59601 59601 59401 59715 59715 59405 59802 59718 59101 59601 59601 59101 59808 59873 59701 59701 59840 59101 59337 59802 59937 59901 59840 59701 59801 59102 59715 59102 59715 59601 59847 59802 59802 59601 59711 59601 SPECIALTY OB/GYN-OBSTETRICS/GYNECOLOGY SPEECH/LANGUAGE THERAPY SURGERY GENERAL SURGERY ORTHOPEDIC MEDICINE SURGERY NEUROSURGERY EAR/NOSE/THROAT (ENT) LICENSED BEHAVIORAL COUNSELOR PEDIATRICS ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY FAMILY PRACTICE HOSPITALIST PSYCHIATRY SURGERY UROLOGICAL UROLOGY UROLOGY PSYCHOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PATHOLOGY NEUROLOGY SLEEP STUDIES FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER SURGERY UROLOGICAL UROLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PSYCHIATRY FAMILY PRACTICE DERMATOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY LICENSED CLINICAL SOCIAL WORKER PSYCHOLOGY PHYSICAL THERAPY FAMILY PRACTICE RADIOLOGY LICENSED BEHAVIORAL COUNSELOR HOSPITALIST INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 75 of 256 FIRST NAME JODI GEORGE BRET RONALD TJ DAWN GREGORY MAX SHEILA MELODY SIMONE ALAN GARY ALAA CARL KRISTINE COLLEEN DEEANN TIMOTHY DAVID JAMES CHRISTOPHER ROBERT WILLIAM WILLIAM BENJAMIN BEN BEN BEN BENJAMIN DIANNE MOHAN RON ANDREA ANDREA ANDREA NATHAN NATHAN JULIE ANN SARAH MICHAEL ANNA MICHAEL DIANE DIANE SHARON SHERRI HARING DANIEL DANIEL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME MURRAY MURRAY MURRAY MURRAY MURRAY MURRAY MURRAY MURRAY MURRAY MURTER MUSCO MUSKETT MUSKETT MUSLIMANI MUUS MUUS MUZYNOSKI MYER MYERS MYERS MYERS NADASI NAEF NAGEL NAGEL NAGEL NAGEL NAGEL NAGEL NAGEL NAGY NANDALUR NAPIERALA NAPLES NAPLES NAPLES NAPRSTEK NAPRSTEK NARDI NARGI NARKEWICZ NASH NASH NASH BOEHM NASH BOEHM NASON NASSAR NAUTA NAUTS NAUTS LICENSE LCPC FNP MD MD PA NP PAC NP LCPC APRN MD MD MD MD MD MD MD LCSW LCSW MD PHD PHD MD MD MD PA PA-C PAC PAC PA-C APRN MD LAC LAC LCSW LCSW OT OT LCPC MD MD PT LCPC LCPC LCPC NP MD MD MD MEDICAL GROUP ABOUT FAMILIES CNSLNG & CONSULTING BIG SKY DERMATOLOGY BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC GLACIER ONCOLOGY WESTERN MONTANA CLINIC BILLINGS CLINIC BILLINGS PLASTIC SURGERY BILLINGS CLINIC PATHOLOGY CONSULTANTS OF WESTERN MT PATHOLOGY CONSULTANTS OF WESTERN MT BILLINGS CLINIC EXTRACARE WMMHC THE MONTANA CENTER FOR WELLNESS MARCUS DALY MEMORIAL HOSPITAL BITTERROOT CLINIC CONVENIENT CARE CLINIC MERCURY STREET MEDICAL BIG SKY OB-GYN MONTANA HEART CENTER BOYD ANDREW COMMUNITY SERVICES WESTERN MONTANA ADDICTION SERVICES WMAS FREESTONE REHABILITATION HEUISER PHYSICAL THERAPY NARDI & STUBE COUNSELING WHITEFISH PLASTIC SURGERY SVH SPECIALTY CARE SERVICES NASH SPINE & JOINT REHABILITATION WESTERN MONTANA MENTAL HEALTH CTR ADJUSTMENTS IN LIFE ROGERS DERMATOLOGY CLINIC BILLINGS CLINIC BENEFIS HEALTHCARE WESTERN MONTANA ADDICTION SERVICES ADDRESS 321 E MAIN ST STE 405 1600 ELLIS ST STE 3B 801 N 29TH ST 801 N 29TH ST 1020 N 27TH ST 75 CLAREMONT ST STE E 500 W BROADWAY 2900 12TH AVE N #240W 310 S MAIN ST 801 N 29TH ST 500 W BROADWAY #320 2510 17TH ST W 500 W BROADWAY 801 N 29TH ST 2827 FORT MISSOULA RD 2827 FORT MISSOULA RD 2800 10TH AVE N 515 E CALLENDAR 1315 WYOMING ST 1903 CAMDEN DR 1317 DAKOTA AVE 245 WINDWARD WAY STE 101 1200 WESTWOOD DR 1224 W MAIN ST 1200 WESTWOOD DR 300 W MERCURY ST 621 3RD ST S 90 HWY 91 S 90 HWY 91 S 6 - 13TH AVE E 2900 12TH AVE N #230W 2827 FORT MISSOULA RD 60 S LAST CHANCE GULCH 1325 WYOMING ST 1325 WYOMING ST 101 E BROADWAY STE 408 1532 ELLIS ST STE 103 3180 DREDGE DR STE F 537 STEPHENS 5850 HWY 93 S 1230 N 3TH ST STE 200 2748 COLONIAL DR 300 N WILLSON AVE STE 3005 PO BOX 1682 3490 OLD YELLOWSTONE 2450 FLOWEREE 1727 W COLLEGE AVE 801 N 29TH ST 500 15TH AVE S 1325 WYOMING ST CITY BOZEMAN BOZEMAN BILLINGS BILLINGS BILLINGS KALISPELL MISSOULA BILLINGS CONRAD BILLINGS MISSOULA BILLINGS MISSOULA BILLINGS MISSOULA MISSOULA BILLINGS LIVINGSTON MISSOULA BILLINGS LIBBY KALISPELL HAMILTON HAMILTON HAMILTON BUTTE GLASGOW DILLON DILLON POLSON BILLINGS MISSOULA HELENA MISSOULA MISSOULA MISSOULA BOZEMAN HELENA MISSOULA WHITEFISH BILLINGS HELENA BOZEMAN EMIGRANT LIVINGSTON HELENA BOZEMAN BILLINGS GREAT FALLS MISSOULA ZIP 59718 59715 59101 59101 59101 59901 59802 59101 59425 59101 59802 59102 59802 59101 59804 59804 59101 59047 59801 59102 59923 59901 59840 59840 59840 59701 59230 59725 59725 59860 59101 59804 59601 59801 59801 59801 59715 59602 59801 59937 59101 59601 59715 59027 59047 59601 59715 59101 59405 59801 SPECIALTY LICENSED BEHAVIORAL COUNSELOR DERMATOLOGY SURGERY GENERAL NEUROLOGY OCCUPATIONAL/INDUSTRIAL MEDICINE HEMATOLOGY-ONCOLOGY FAMILY PRACTICE NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR NEUROLOGY CARDIOVASCULAR DISEASE SURGERY PLASTIC/RESTORATIVEBURN EMERGENCY MEDICINE INTERNAL MEDICINE PATHOLOGY PATHOLOGY PEDIATRICS LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER SURGERY GENERAL PROFESSIONAL COUNSELOR PSYCHOLOGY GENERAL PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PHYSICIAN ASSISTANT EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA PHYSICIAN ASSISTANT OB/GYN-OBSTETRICS/GYNECOLOGY CARDIOLOGY LICENSED ADDICTION COUNSELOR ADDICTIONNICOTINECOUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR SURGERY PLASTIC/RESTORATIVEBURN PEDIATRIC GASTROENTEROLOGY PHYSICAL THERAPY PSYCHOLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR DERMATOLOGY SURGERY NEUROSURGERY INTERNAL MEDICINE ADDICTION MEDICINE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED 76 of 256 FIRST NAME TAMMERA TAMMERA TAMMERA ABIGAIL DOUGLAS CHAD CHARLES JAMES JAMES MELISSA KATHRYN GREGG GREGG GREGG DEBORAH DEBORAH KRYSTIE DOUGLAS DOUGLAS KATHLEEN SHELDON RAYMOND CHARLOTTE GINA KATHLEEN JOSEPH JOSEPH CHRISTOPHER DAVID RICK RICK RICK RICK GAIL CHARLES LORI MICHAEL MICHAEL RUTH MIKE KATY SHARON ROBERT WILLIAM WILLIAM DAVID DAVID PATRICIA SHARON SHARON Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME NAUTS NAUTS NAUTS NEAL NEBEKER NEDRUD NEEDHAM NEELEY NEELEY NEFF NEFF NEIBAUER NEIBAUER NEIBAUER NELLES NELLES NELSON NELSON NELSON NELSON NELSON NELSON NELSON NELSON NELSON NEMES NEMES NERO NEUMANN NEUMEISTER NEUMEISTER NEUMEISTER NEUMEISTER NEVIN NEWELL NEWMAN NEWMAN NEWMAN NGUYEN NICHOLES NICHOLLS NICHOLS NICHOLS NICHOLS NICHOLS NICHOLS NICHOLS NICHOLS NICHOLS NICHOLS LICENSE LCSW LCSW LCSW OD DC MD MD MD MD PHD MD DPM DPM DPM LCSW LCSW RD MD MD MD MD MD MD MD LCPC MD MD MD DPM MD MD MD MD PT LCPC NP MD MD MD LCSW LCSW MD MD MD MD MD MD LCPC DO DO MEDICAL GROUP WESTERN MONTANA MENTAL HEALTH CTR PACIFIC CATARACT & LASER INSTITUTE CHIROPRACTIC FIRST OF BILLINGS PC ROCKY MOUNTAIN EYE CENTER BILLINGS CLINIC MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING OF IDAHO FALL FRIENDS TO YOUTH GLACIER MEDICAL ASSOCIATES ALPINE FOOT & ANKLE CLINIC ALPINE FOOT & ANKLE CLINIC ALPINE FOOT & ANKLE CLINIC BILLINGS CLINIC FAMILY HEALTH CARE FAMILY HEALTH CARE KALISPELL OB-GYN ASSOCIATES SVH EMERGENCY MEDICINE DEPT THOMPSON FALLS FAMILY MEDICINE SWEET MEDICAL CENTER SWEET MEDICAL CENTER YELLOWSTONE PATHOLOGISTS PC MONTANA VALLEY EYE CLINIC MONTANA VALLEY EYE CLINIC MONTANA VALLEY EYE CLINIC MONTANA VALLEY EYE CLINIC GAIL NEVIN PHYSICAL THERAPY NORTHWEST COUNSELINGS ASSOCIATES BOZEMAN OB/GYN KALISPELL REGIONAL MEDICAL CENTER BEHAVIORAL HEALTH ASSOCIATES NICHOLLS COUNSELING SERVICES CLARK FORK VALLEY CARDIOLOGY HEIGHTS FAMILY PRACTICE MONTANA CANCER SPECIALISTS MONTANA CANCER SPECIALISTS AT CMC NORTH VALLEY ANESTHESIOLOGY NORTH VALLEY HOSPITAL ADDRESS 1325 WYOMING ST 300 W BROADWAY STE 2 500 W BROADWAY 1717 4TH ST S 10 AVANTA WAY STE 1 700 W KENT 801 N 29TH ST 310 SANSOME ST 90 HWY 91 S 1515 E BROADWAY 1111 BAKER AVE 10 KRUGER RD 120 POND 1845 BANCROFT 1640 S AVE WEST 510 LESLIE AVE 2800 10TH AVE N 1287 BURNS WAY 715 NUCLEUS AVE 210 SUNNVIEW LN STE 201 1233 N 30TH ST 120 POND ST 500 W BROADWAY 210 SUNNYVIEW LN STE 104 17 S 5TH AVE 116 S MAIN 419 PENNSYLVANIA 2900 12TH AVE N #295W BILLINGS 604 CALIFORNIA AVE 10 KRUGER RD 401 W PENNSYLVANIA AVE 513 MAIN ST 601 W SPRUCE ST STE E 309 SW HIGGINS 1597 AVE D STE 7 925 HIGHLAND BLVD STE 1210 310 SUNNYVIEW LN 301 2ND ST E STE 1A 818 2ND AVE EAST 1101 N 27TH ST #201 410 CENTRAL AVE STE 502 10 KRUGER RD 32 WICKS LN 500 W BROADWAY 2827 FORT MISSOULA RD 1600 HOSPITAL WAY 1600 HOSPITAL WAY 1643 24TH ST W #108-109 1208 6TH AVE E 500 W BROADWAY #320 CITY MISSOULA MISSOULA MISSOULA GREAT FALLS BILLINGS MISSOULA BILLINGS PHILIPSBURG DILLON MISSOULA WHITEFISH PLAINS THOMPSON FALLS MISSOULA MISSOULA HELENA BILLINGS KALISPELL COLUMBIA FALLS KALISPELL BILLINGS THOMPSON FALLS MISSOULA KALISPELL BOZEMAN HARLEM CHINOOK BILLINGS LIBBY PLAINS ANACONDA DEER LODGE MISSOULA MISSOULA BILLINGS BOZEMAN KALISPELL WHITEFISH CULBERTSON BILLINGS GREAT FALLS PLAINS BILLINGS MISSOULA MISSOULA WHITEFISH WHITEFISH BILLINGS SUPERIOR MISSOULA ZIP 59801 59801 59802 59405 59102 59801 59101 59858 59725 59802 59937 59859 59873 59801 59801 59601 59101 59901 59912 59901 59102 59873 59802 59901 59715 59526 59523 59101 59923 59859 59711 59722 59802 59803 59102 59715 59901 59937 59218 59101 59401 59859 59105 59807 59804 59937 59937 59102 59872 59802 SPECIALTY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER SOCIAL WORKER OPTOMETRY CHIROPRACTIC OPHTHALMOLOGY SURGERY CARDIOVASCULAR THORACIC RADIOLOGY RADIOLOGY PSYCHOLOGY FAMILY PRACTICE PODIATRY PODIATRY PODIATRY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER NUTRITION PROFESSIONAL FAMILY PRACTICE FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY EMERGENCY MEDICINE/TRAUMA GENERAL PRACTICE HOSPITALIST OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR PEDIATRICS PEDIATRICS PATHOLOGY PODIATRIST OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY PSYCHIATRY PSYCHIATRY SURGERY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER CARDIOLOGY FAMILY PRACTICE HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY ANESTHESIOLOGY ANESTHESIOLOGY PROFESSIONAL COUNSELOR CARDIOVASCULAR/THORACIC SURGERY CARDIOVASCULAR/THORACIC SURGERY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 77 of 256 FIRST NAME SHARON MARK LAURA MARK LAURA GAYLA JENNA STEPHEN JOSEPH JOSEPH JOSEPH KILLEEN TIMOTHY TONY TONY JORGE AMY AMY AMY MICHAEL MICHAEL DEANNA ROBERT JEANNETTE JEANNETTE ANNA ROBERT MICHELLE MICHAEL DAVID THOMAS THOMAS SHANNON PENNY BETH CHRISTOPHER JERRY TIM REBECCA DENNIS DIANA DIANE SHANNON SHANNON MARIA MARCUS SARA STEVEN THERESA THERESA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME NICHOLS NICHOLSON NICHOLSON NICHOLSON NICHOLSON NICHOLSON NICKELS NICKISCH NICOLETTO NICOLETTO NICOLETTO NIELSEN NIELSEN NIETER NIETER NIEVA NIGHTENGALE NIGHTENGALE NIGHTENGALE NILE NILE NILES NITSCHELM NOBLE NOBLE NOBLE NOBLE NOFTSINGER NOLAN NOLAN NOLTE NOLTE NOON NORD NORDSTROM NORDSTROM NORDSTROM NORDSTROM NORTON NOTEBOOM NOTIS NOWAK NUNLIST NUNLIST NYBERG NYNAS NYQUIST NYSTUEN OAKLAND OAKLAND LICENSE DO MD MD MD MD RD PAC MD MD MD MD APRN PT DC DC MD APRN APRN FNP LCSW LCSW PA MD NP NP LCPC MD NP MD PA MD MD LCPC LCPC PT LCSW LCSW LCSW OT MD PT MD PT PT LCSW DC MD PT LAC LAC MEDICAL GROUP BEHAVIORAL HEALTH ASSOCIATES CHILDRENS CLINIC MENTAL HEALTH CENTER THE CHILDRENS CLINIC ORTHO MONTANA BOZEMAN DEACONESS WOMENS SPEC NORTHWEST UROLOGY ST JOHN'S LUTHERAN HOSPITAL CMC REHABILITATION PHYSICIANS VALLEY PHYSICAL THERAPY BILLINGS CLINIC GLACIER MEDICAL ASSOCIATES MEDNORTH KALISPELL URGENT CARE NORTH VALLEY HOSPITAL BILLINGS CLINIC CPG ON SOUTH RESERVE CPG PARKSIDE COMMUNITY FAMILY CARE FLATHEAD COMMUNITY HEALTH CENTER NORTHERN MONTANA MEDICAL GROUP W RAVALLI ORTHOPEDICS & SPORTS MED WMMHC CHOICES COUNSELING SERVICE BEARTOOTH BILLINGS CLINIC COMPASS PRSFESSIONAL SERVICES FAMILY COUNSELING CENTER HAND WORKS INC LIVINGSTON MEMORIAL HOSPITAL BILLINGS CLINIC ST PETERS MEDICAL GROUP FLORENCE CRITTENTON HOME BILLINGS FAMILY CHIROPRACTIC BILLINGS CLINIC NORTHERN ROCKIES PHYSICAL THERAPY LAKE COUNTY CHEMICAL DEPENDENCY WESTERN MONTANA ADDICTION SVC ADDRESS 6 - 13TH AVE E 1101 N 27TH ST STE 201 1232 N 30TH STE 200 1245 N 29TH 3401 AVE E 321 E MAIN ST STE 202 2900 12TH AVE N STE 140W 905 HIGHLAND BLVD STE 4440 & 50 308 LOUISIANA AVE STE 1 350 LOUISIANA AVE 500 W BROADWAY 2825 FORT MISSOULA RD #317 3802 EASTSIDE HWY VILLAGE LOOP RD #46 VILLAGE LOOP RD #46 801 N 29TH ST 1111 BAKER AVE 2316 US HWY 93 N 1600 HOSPITAL WAY 101 E BROADWAY STE 604 101 E BROADWAY STE 604 801 N 29TH ST 202 CONWAY DR #200 1211 S RESERVE ST 2831 FORT MISSOULA RD #146 2420 HAYWIRE GULCH 832 S MONTANA ST 1035 1ST AVE WEST 20 13TH ST 1190 WESTWOOD DR 106 W BROADWAY 902 N ORANGE ST #206 1515 FAIRVIEW AVE STE 235 126 E BROADWAY STE 18 2525 N BROADWAY AVE 2510 CONTINENTAL DR 2475 VILLAGE LN #101 1004 DIVISION ST 419 SPOKANE AVE #1 504 S 13TH ST 1020 N 27TH ST 2550 E BROADWAY 211 A MAIN ST 2212 EMORY LN 901 N HARRIS 3307 GRAND AVE STE 201 2800 10TH AVE N 2831 FORT MISSOULA RD #200 802 MAIN ST STE C 802 MAIN ST STE C CITY POLSON BILLINGS BILLINGS BILLINGS BILLINGS LIVINGSTON BILLINGS BOZEMAN LIBBY LIBBY MISSOULA MISSOULA STEVENSVILLE KALISPELL KALISPELL BILLINGS WHITEFISH KALISPELL WHITEFISH MISSOULA MISSOULA BILLINGS KALISPELL MISSOULA MISSOULA KALISPELL BUTTE KALISPELL HAVRE HAMILTON BUTTE MISSOULA MISSOULA MISSOULA RED LODGE BUTTE BILLINGS BILLINGS WHITEFISH LIVINGSTON BILLINGS HELENA POLSON RONAN HELENA BILLINGS BILLINGS MISSOULA POLSON POLSON ZIP 59860 59101 59101 59101 59102 59047 59101 59715 59923 59923 59802 59804 59870 59901 59901 59101 59937 59904 59937 59802 59802 59101 59901 59801 59804 59901 59701 59901 59501 59840 59701 59802 59801 59802 59068 59701 59102 59101 59937 59047 59101 59601 59860 59864 59601 59102 59101 59804 59860 59860 SPECIALTY CARDIOVASCULAR/THORACIC SURGERY PSYCHIATRY PEDIATRICS PSYCHIATRY PEDIATRICS NUTRITION PROFESSIONAL SURGERY ORTHOPEDIC MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY UROLOGICAL UROLOGY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE PHYSICAL MEDICINE REHABILITATION PHYSICAL THERAPY CHIROPRACTOR CHIROPRACTOR HEMATOLOGY-ONCOLOGY FAMILY PRACTICE URGENT CARE PROVIDER FAMILY PRACTICE LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PROFESSIONAL COUNSELOR OPHTHALMOLOGY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PSYCHIATRY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OCCUPATIONAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE PHYSICAL THERAPY PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR LICENSED ADDICTION COUNSELOR Montana STATUS PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING PENDING PENDING SIGNED 78 of 256 FIRST NAME LIBBIE TIMOTHY TIMOTHY LARRY GREGORY TIMOTHY DENNIS LISA SHANA DEBORA KERRIGAN MARY ELIZABETH MICHAEL CONNIE MARK JANE KARL KARL FREDERICKA ARNT PEGGY LEE ROBERT LEE LYNN DAVID GARTH EVY ERIN ERIN WILLIAM WILLIAM DOMINICK ASHLEY LYNN ASHLEY JEFF THOMAS KENNETH JILL LINSEY PAUL RUSSELL ALBERT TAFFORD AMY LUKE ALEXANDER MICHAEL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME OBERLY OBERMILLER OBERMILLER OBIE OBLANDER OBRIEN OBRIEN OBRIEN OBRIEN OBRIEN OCONNELL OCONNELL OCONNOR OCONNOR OCONNOR ODELL O'DRISCOLL OEHRTMAN OEHRTMAN OFARRELL OFSTAD OHARA OINES OKASINSKI OLDENBURG OLDENBURG OLDHAM OLDS OLEARY OLEY OLEY OLEY III OLEY III OLIVO OLSEN OLSEN OLSEN OLSGAARD OLSON OLSON OLSON OLSON OLSON OLSTAD OLSZEWSKI OLTZ OLWELL OMOHUNDRO OMURA ONEIL II LICENSE LCPC MD MD OD DC MD MD LCSW PT LCPC SLP PT APRN MD MD LCPC PT MD MD LCSW OD MD AU MD LCPC LCPC DO MD LCPC NP NP MD MD DPM LCSW LCSW LCSW LCPC MD MD PT PT PHD PAC MD CRNA LCSW MD MD MD MEDICAL GROUP A TURNING POINT COUNSELING ROCKY MOUNTAIN HEART & LUNG HAVRE OPTOMETRIC CLINIC ALPINE ORTHOPEDICS & SPORTS MEDICIN BILLINGS CLINIC GREAT FALLS CLINIC THE MONTANA CENTER FOR WELLNESS ABOVE & BEYOND THERAPY SERVICES CMC OUTPATIENT THERAPIES BENEFIS PHYSICIAN ASSOCIATES ST LUKES COMMUNITY PROVIDERS GLACIER HAVEN COUNSELING ST PETERS HOSPITAL GLACIER ENT HEAD & NECK SURGERY LIBBY CLINIC ALTACARE RONAN EYE CLINIC PARK CLINIC ROCKY MOUNTAIN EAR NOSE & THROAT BARRETT HOSPITAL & HEALTHCARE OLDENBURG COUNSELING OLDENBURG COUNSELING BENTON MEDICAL CENTER SURGICAL ASSOCIATES OF BOZEMAN BEARTOOTH BILLINGS CLINIC BILLINGS CLINIC BEARTOOTH BILLINGS CLINIC BILLINGS CLINIC CENTRAL MONTANA MEDICAL FACILITIES BOZEMAN DEACONESS HEALTH GROUP LDS FAMILY SERVICES MONTANA PRAXIC PAIN SOLUTIONS BILLINGS CLINIC BRIDGER PSYCHIATRIC SERVICES PEAK PERFORMANCE PHYSICAL THERAPY NORTHERN ROCKIES MEDICAL CENTER FLATHEAD VALLEY ORTHOPEDICS THE MONTANA CENTER FOR WELLNESS FAMILY PRACTICE ASSOCIATES MISSOULA ANESTHESIOLOGY BILLINGS ANESTHESIOLOGY ADDRESS 211 HAGGERTY LN STE A 350 HERIGATE WAY STE 2100 350 HERITAGE WAY STE 2100 416 3RD AVE 3307 GRAND AVE STE 101 536 S COTTONWOOD RD STE 100 801 N 29TH ST 3000 15TH AVE S 245 WINDWARD WAY STE 101 579 E MAIN 1931 S 3RD ST W 2827 FORT MISSOULA RD 1101 26TH AVE S 5TH FLOOR 126 6TH AVE SW #A 2001 11TH AVE STE 1 33 2ND ST E STE 4 2475 BROADWAY 160 HERITAGE WAY 308 LOUISANA AVE 444 MONTANA AVE 417 MAIN ST SW 1001 RIVER DR 700 W KENT 90 HWY 91 S 1629 AVE D BLDG B STE 2 1629 AVE D BLDG B STE 2 1203 15TH ST 925 HIGHLAND BLVD STE 1200 127 N HIGGINS RM 206 2525 N BROADWAY AVE 801 N 29TH ST 2525 N BROADWAY 801 N 29TH ST 310 WENDALL AVE STE 5 915 HIGHLAND BLVD 2620 COLONIAL DR STE D 905 HIGHLAND BLVD STE 4500 1645 AVE D STE E 1045 N 30TH ST 2040 N 22ND AVE STE 2 2360 MULLAN RD #D 5000 BLUE MOUNTAIN RD 359 N MAIN ST 802 2ND ST SE 111 SUNNYVIEW LN 245 WINDWARD WAY STE 101 115 W 3RD ST STE 212 935 HIGHLAND BLVD STE 2210 2825 STOCKYARD RD BLDG I-200 2800 10TH AVE N CITY BOZEMAN KALISPELL KALISPELL HAVRE BILLINGS BOZEMAN BILLINGS GREAT FALLS KALISPELL CUT BANK MISSOULA MISSOULA GREAT FALLS RONAN HELENA KALISPELL HELENA KALISPELL LIBBY DEER LODGE RONAN LIVINGSTON MISSOULA DILLON BILLINGS BILLINGS FORT BENTON BOZEMAN MISSOULA RED LODGE BILLINGS RED LODGE BILLINGS LEWISTOWN BOZEMAN HELENA BOZEMAN BILLINGS BILLINGS BOZEMAN MISSOULA MISSOULA KALISPELL CUT BANK KALISPELL KALISPELL STEVENSVILLE BOZEMAN MISSOULA BILLINGS ZIP 59715 59901 59901 59501 59102 59718 59101 59405 59901 59427 59801 59804 59405 59864 59601 59901 59601 59901 59923 59722 59864 59047 59801 59725 59102 59102 59442 59715 59802 59068 59101 59068 59101 59457 59715 59601 59715 59102 59101 59718 59808 59804 59901 59427 59901 59901 59870 59715 59808 59101 SPECIALTY LICENSED BEHAVIORAL COUNSELOR PULMONARY DISEASES PULMONARY DISEASES OPTOMETRY CHIROPRACTIC SURGERY ORTHOPEDIC MEDICINE NEUROLOGY LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY PHYSICAL THERAPY FAMILY PRACTICE SURGERY GENERAL PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY EAR/NOSE/THROAT (ENT) EAR/NOSE/THROAT (ENT) LICENSED CLINICAL SOCIAL WORKER OPTOMETRY PEDIATRICS AUDIOLOGY EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE SURGERY GENERAL LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PODIATRY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY PSYCHIATRY PHYSICAL THERAPY PHYSICAL THERAPY PSYCHIATRY FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE ANESTHESIOLOGY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 79 of 256 FIRST NAME JEN JEN MICHALE JEN STEVEN LYLE ANGELA MINDY MICHAEL NELLIE WILLIAM KEITH KEITH S DANTE THOMAS DENNY ERNESTO MARY JOSE CAMILLE J BARRY J BARRY REBECCA DANA DANA ANGELIKA SHELLEY SHELLEY TERESA JANET JOELEEN CATHERINE PAUL CYNTHIA SYLVIA ROBIN MICHAEL MARK LISA JEFFREY TOMAS CYNTHIA SUSAN GINA AMY AMY ANDREW MICHAEL RYE GRANT Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME ONEILL ONEILL ONEILL O'NEILL ONSTAD ONSTAD OPITZ OPPER ORCUTT OREILLY OREILLY ORI ORI ORIENTE ORIGITANO ORME ORNELAS OROURKE ORTIZ OSBORN OSER OSER OSS OSTERMILLER OSTERMILLER OSTROWSKI OTOUPALIK OTOUPOLIK OTTO OTTO OTTUN OUELLETTE OURADNIK OVERTURF OWEN OWEN OWEN OZOG PACHECO PACKER PADILLA PADILLA PAGLIA PAINTER PAKULA PAKULA PALCHAK PALCISKO PALIN PALM LICENSE APRN APRN MD NP MD MD LCPC PAC MD LCSW DPM PT PT MD MD DO APRN MD MD MD MD LCSW MD MD MD NP NP MD MD DC LCPC DPM RD MD LCPC MD MD DO MD MD MD MD DPM PT PT MD MD LCSW MD MEDICAL GROUP ALPINE FAMILY MEDICINE ALPINE FAMILY MEDICINE WESTERN MONTANA MENTAL HEALTH CTR ALPINE FAMILY MEDICINE MISSOULA ANESTHESIOLOGY NORTHWEST PHYSICIANS BLUE MOUNTAIN CLINIC CENTERS FOR ADVANCED VEIN CARE OF M ACADIA MONTANA RIMROCK PODIATRY ORTHOPEDIC REHAB ORTHOPEDIC REHAB INJURY CENTER/SPORTS MEDICINE NEUROSCIENCE & SPINE INSTITUTE BILLINGS ANESTHESIOLOGY TAMARACK MEDICAL CLINIC BOZEMAN DEACONESS HOSPITAL BILLINGS CLINIC PREMIER FAMILY PRACTICE PC URGENT CARE PLUS BILLINGS CLINIC MILES CITY MEDICAL ASSOCIATES ST JAMES HEALTHCARE PRIMARY CARE COMMUNITY HOSPITAL OF ANACONDA BILLINGS ANESTHESIOLOGY BILLINGS CLINIC OTTUN CHIROPRACTIC RIMROCK PODIATRY ST PETERS HOSPITAL DERMATOLOGY ASSOCIATES FAMILY COUNSELING CENTER ST VINCENT HEALTHCARE MISSOULA OSTEOPATHIC CLINIC SIDNEY HEALTH CENTER GREAT FALLS CLINIC GALLATIN VALLEY ANESTHESIA GREAT FALLS ORTHOPEDIC ASSOC EXCEL ORTHOPEDIC PHYSICAL THERAPY EXCEL ORTHOPEDIC PHYSICAL THERAPY HELENA PEDIATRIC CLINIC WESTERN MONTANA MENTAL HEALTH CTR LIVINGSTON MEMORIAL ADDRESS 734 9TH ST W STE 12 734 9TH ST W STE 12 234 E REEDER ST 734 9TH ST W STE 12 2825 STOCKYARD RD BLDG I-200 401 15TH AVE S STE 201 1720 BROOKS ST #B 610 N CALIFORNIA 1417 9TH ST S STE 201 55 BASIN CREEK RD 1690 RIMROCK RD STE L 111 SUNNYVIEW LN #B 906 9TH ST W STE A 1401 25TH ST S 200 COMMONS WAY STE 2 401 N 31ST ST STE 1260 1208 6TH AVE E 915 HIGHLAND BLVD 6230 MAIN 2675 CENTRAL AVE 600 MAIN ST 39 NEILL AVE 7 W 6TH AVE #2C 620 S HAYNES AVE 935 HIGHLAND BLVD STE 2200 435 S CRYSTAL ST STE 300 401 W PENNSYLVANIA 6 - 13TH AVE E 2800 10TH AVE N 1020 N 27TH ST 3307 GRAND AVE STE 201 410 WINDWARD WAY 1690 RIMROCK RD STE L 2475 BROADWAY 175 COMMONS LOOP STE 300 1704 W BABCOCK 2900 12TH AVE STE 315W 1417 9TH ST S STE 100 341 W PINE ST 216 14TH AVE SW 3000 15 AVE S 1101 26TH ST 931 HIGHLAND BLVD 1401 25TH ST S 1125 W KAGY BLVD STE 101A 220 WOODEN SHOE LN STE C 210 SUNNYVIEW LN STE 205 1122 N MONTANA AVE 1305 WYOMING 504 S 13TH ST CITY COLUMBIA FALLS COLUMBIA FALLS DILLON COLUMBIA FALLS MISSOULA GREAT FALLS MISSOULA MISSOULA GREAT FALLS BUTTE BILLINGS KALISPELL COLUMBIA FALLS GREAT FALLS KALISPELL BILLINGS SUPERIOR BOZEMAN COLSTRIP BILLINGS DEER LODGE HELENA HELENA MILES CITY BOZEMAN BUTTE ANACONDA POLSON BILLINGS BILLINGS BILLINGS KALISPELL BILLINGS HELENA KALISPELL BOZEMAN BILLINGS GREAT FALLS MISSOULA SIDNEY GREAT FALLS GREAT FALLS BOZEMAN GREAT FALLS BOZEMAN MANHATTAN KALISPELL HELENA MISSOULA LIVINGSTON ZIP 59912 59912 59725 59912 59808 59405 59801 59802 59405 59701 59102 59901 59912 59405 59901 59101 59872 59715 59323 59101 59722 59601 59601 59301 59715 59701 59711 59860 59101 59101 59102 59901 59102 59601 59901 59715 59101 59405 59802 59270 59405 59405 59715 59405 59715 59741 59901 59601 59801 59047 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE PSYCHIATRY FAMILY PRACTICE ANESTHESIOLOGY FAMILY PRACTICE PROFESSIONAL COUNSELOR FAMILY PRACTICE SURGERY VASCULAR LICENSED CLINICAL SOCIAL WORKER PODIATRY PHYSICAL THERAPY PHYSICAL THERAPY PAIN MANAGEMENT SURGERY NEUROSURGERY ANESTHESIOLOGY FAMILY PRACTICE INTERNAL MEDICINE FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER PEDIATRICS PEDIATRICS PEDIATRICS EMERGENCY MEDICINE/TRAUMA NURSE PRACTITIONER ANESTHESIOLOGY CARDIOLOGY CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR PODIATRY NUTRITION PROFESSIONAL DERMATOLOGY LICENSED BEHAVIORAL COUNSELOR SURGERY NEUROSURGERY OPHTHALMOLOGY OSTEOPATHIC MANIPULATIVE MEDICINE RADIOLOGY OPHTHALMOLOGY PEDIATRIC NEONATOLOGY ANESTHESIOLOGY PODIATRY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE PEDIATRICS LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 80 of 256 FIRST NAME JAY DENNIS DENNIS DENNIS KEVIN KAM CRAIG WENDY LINDY LINDY VARGHESE VARGHESE MICHAEL SCOTT CHRISTOPHER DONNA DOUGLAS JAMES BETH DONNA THOMAS THOMAS THOMAS THOMAS ROBERT KENDALL DAVID KRISTEN JOSEPH MATTHEW DAIMON HANNAH PAMELA VIRGINIA VIRGINIA PAULA BLAKE WILLIAM WILLIAM SARA SARA JOHN JOHN JAMES MARK MARK MARK MARK MARK MARC Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME PALMATIER PALMER PALMER PALMER PANCICH PANG PANOS PAPA PARADISE PARADISE PARAMBI PARAMBI PARDIS PARGOT PARIS PARKER PARKER PARKER PARKER PARKER PARKHILL PARKHILL PARKHILL PARKHILL PARKINSON PARKS PARKS PARKS PARKS PARLIAMENT PARROTTE PARSONS PARSONS PASCUAL PASCUAL PASEK PASSMORE PATENAUDE PATENAUDE PATTERSON PATTERSON PATTERSON PATTERSON PATTERSON PAUL PAUL PAUL PAUL PAUL PAUL LICENSE PHD MD MD MD PT MD MD LCSW MD MD MD DC DO PT MD LCPC LCPC PT PT PT PT PT MD PA MD MD OD DC PT PA CNMW MD MD OT LCPC PHD PHD PAC PAC MD MD DO MD MD MD MD MD MD MEDICAL GROUP WESTERN MONTANA MENTAL HEALTH CTR INTERMOUNTAIN IMAGING CENTER MONTANA INTERVENTIONAL & DIAG RADIOLOGY ST JAMES HEALTHCARE WESTERN MONTANA CLINIC ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY GREAT FALLS CLINIC NORTHERN MONTANA HOSPITAL PARDIS CHIROPRACTIC CLINIC HELENA EAR NOSE & THROAT CLINIC GREAT FALLS CLINIC SVH EMERGENCY MEDICINE DEPT WESTERN MONTANA MENTAL HEALTH CTR CORVALLIS SPORTS REHAB DARBY PHYSICAL THERAPY HAMILTON PHYSICAL THERAPY HAMILTON PT & REHAB AT CANYONS CLUB GALLATIN COMMUNITY CLINIC SURGICAL ASSOCIATES OF BOZEMAN SVH SPECIALTY CARE SERVICES PARLIAMENT CHIROPRACTIC PHYSICAL THERAPY DOWN UNDER BOZEMAN DEACONESS HOSPITAL NORTH VALLEY GLACIER MATERNITY LIVINGSTON HEALTHCARE SLEEP CENTER SLEEP MONTANA BILLINGS CLINIC WEST WESTERN MONTANA MENTAL HEALTH CTR BENEFIS MEDICAL GROUP BENEFIS MEDICAL GROUP FAMILY DOCTORS URGENT CARE MEDICAL ASSOCIATES TAMARACK MEDICAL CLINIC CPG MOUNTAIN VIEW FAMILY MED & OB CPG NORTHGATE PRIMARY CARE CPG ON NORTH RESERVE WALK IN CPG ON SOUTH RESERVE CPG PARKSIDE COMMUNITY FAMILY CARE SIDNEY HEALTH CENTER ADDRESS 1315 WYOMING ST 435 S CRYSTAL ST STE 250 2475 BROADWAY 400 S CLARK ST 1532 ELLIS ST STE 201 1101 26TH ST S 6 13TH AVE E STE 1 3021 6TH AVE N STE 105 905 HIGHLAND BLVD STE 4100 925 HIGHLAND BLVD STE 1180 20 13TH ST 30 13TH ST 950 N MONTANA AVE 2525 BROADWAY STE 105 2820 CENTRAL AVE #B 1400 29TH ST S 1233 N 30TH ST 1305 WYOMING ST 210 N HIGGINS #320 3000 15TH AVE S 1039 EASTSIDE HWY 502 N MAIN #900 336 FAIRGROUNDS RD 472 TAMMANY LN 216 14TH AVE SW 214 E MENDENHALL 925 HIGHLAND BLVD STE 1200 1230 N 30TH ST 127 VILLAGE DR STE 300 1075 N RODNEY ST #104 820 2ND ST W 915 HIGHLAND BLVD 195 COMMON LOOP STE D 504 S 13TH ST 935 HIGHLAND BLVD STE 2120 2675 CENTRAL AVE BLDG T9 FORT MISSOULA 125 BANK ST STE 310 500 W BROADWAY 1401 25TH ST S 1401 25TH ST S 120 N 19TH AVE STE A 935 HIGHLAND BLVD STE 2200 1208 6TH AVE E 2835 FORT MISSOULA RD #101 2230 N RESERVE #402 2230 N RESERVE #402 1211 S RESERVE ST 2831 FORT MISSOULA RD #146 216 14TH AVE SW CITY MISSOULA BUTTE HELENA BUTTE BOZEMAN GREAT FALLS POLSON BILLINGS BOZEMAN BOZEMAN HAVRE HAVRE HELENA HELENA BILLINGS GREAT FALLS BILLINGS MISSOULA MISSOULA GREAT FALLS CORVALLIS DARBY HAMILTON HAMILTON SIDNEY BOZEMAN BOZEMAN BILLINGS BELGRADE HELENA HAVRE BOZEMAN KALISPELL LIVINGSTON BOZEMAN BILLINGS MISSOULA MISSOULA MISSOULA GREAT FALLS GREAT FALLS BOZEMAN BOZEMAN SUPERIOR MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA SIDNEY ZIP 59801 59701 59601 59701 59715 59405 59860 59101 59715 59715 59501 59501 59601 59601 59102 59405 59101 59801 59802 59405 59828 59829 59840 59840 59270 59715 59715 59101 59714 59601 59501 59715 59901 59047 59715 59102 59804 59802 59802 59405 59405 59718 59715 59872 59804 59808 59808 59801 59804 59270 SPECIALTY PSYCHOLOGY RADIOLOGY RADIOLOGY RADIOLOGY PHYSICAL THERAPY HOSPITALIST FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER RADIOLOGY RADIOLOGY NEPHROLOGY NEPHROLOGY CHIROPRACTIC EAR/NOSE/THROAT (ENT) OPHTHALMOLOGY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPIST PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY RADIOLOGY FAMILY PRACTICE SURGERY GENERAL PEDIATRIC NEUROLOGY OPTOMETRY CHIROPRACTIC PHYSICAL THERAPY FAMILY PRACTICE CERTIFIED NURSE MIDWIFE SLEEP STUDIES SLEEP STUDIES OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY PSYCHOLOGIST FAMILY PRACTICE PEDIATRICS URGENT CARE PROVIDER FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 81 of 256 FIRST NAME MARK SCOTT DEBORAH KATRINA FRANK EDITH MELINDA CHRISTINE MEGAN MEGAN KAREN RANDAL SANDRA JASON IVY GWYNNETH KEVIN JODIE BRIAN BARBARA KATHERINE MARY KEITH RICHARD RICHARD NATASHA CHAR CHAR JEANNE BECKETT PAUL GERALD LUCAS DEBRA JOHN JOHN KAREN ANDERS LIESL LIESL REBECCA MICHAEL WILLIAM DAWN DAWN GWENNA SONIA SUSAN KIMBERLEY MARK Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME PAUL PAULSEN PAULSEN PAULSON PAWLAK PAXMAN PAYNE PAYNTER PEACH PEACH PEARSON PEARSON PEASLEY PECCIA PEDERSEN PEDERSON PEI PEKOVICH PELCZAR PELLANT MENDE PELLETT PENBERTHYMACKI PENDILL PENNEY PENNEY PENNOCK PEPPENGER PEPPINGER PERELES-ORTIZ PERKINS PERKINS PERNAK PERNSTEINER PERRIGO PERRY PERRY PERSER PERSSON PESSL PESSL PESTLE PETAJA PETERS PETERS PETERS PETERS PETERSEN PETERSEN PETERSEN PETERSON LICENSE MD MD PA PAC NP LCSW MD PA DPT DPT LCPC PAC NP LCPC PT LCPC MD RD MD LCPC NP LCPC LAC MD MD NP LCSW LCSW MD APRN MD PAC DC LAC MD MD MD MD NP NP PAC LPC MD NP NP PT OT MD NP MD MEDICAL GROUP STEVENSVILLE COMMUNITY MEDICAL CNTR BILLINGS CLINIC NORTHERN MONTANA MEDICAL GROUP INTERNAL MEDICINE WEST GRANITE COUNTY MEDICAL CENTER EXCEL PHYSICAL THERAPY EXCEL PHYSICAL THERAPY ALPINE COUNSELING ASSOCIATES BILLINGS CLINIC CPG ON SOUTH RESERVE CLEARWATER THERAPEUTICS MENTAL HEALTH CENTER ST JAMES HEALTHCARE BILLINGS CLINIC EAR NOSE & THROAT ASSOCIATES MPM SERVICES CO MENTAL HEALTH CENTER MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING ASSOC OF ID FALLS LIBBY CLINIC WMMHC COLSTRIP MEDICAL CLINIC BIG SKY NEONATOLOGY MARCUS DALY MEMORIAL HOSPITAL BELGRADE URGENT CARE LIGHTHOUSE ADDICTION COUNSELING SER BENEFIS MEDICAL GROUP HEART & VASCU CARDIO WEST NORTHWEST ORTHOPEDIC & SPORTS MEDIC INTERNAL MEDICINE ASSOCIATES COMMUNITY HEALTH PARTNERS GALLATIN COMMUNITY CLINIC BILLINGS CLINIC BOZEMAN OB/GYN FAMILY HEALTH CARE FAMILY HEALTH CARE ORTHO MONTANA ALL ABOUT KIDS WEST GRAND FAMILY MEDICINE WESTERN MONTANA MENTAL HEALTH SERV ANESTHESIA ASSOCIATES OF GT FALLS ADDRESS 3800 EASTSIDE HWY 2800 10TH AVE NORTH 20 W 13TH ST 400 13TH AVE S STE 206 310 SANSOME 305 3RD AVE E 902 WYOMING AVE 500 W BROADWAY 1125 W KAGY BLVD STE 101A 220 WOODEN SHOE LN STE C 1001 S 24TH ST W 310 801 N 29TH ST 1211 S RESERVE ST 104 W CUSTER AVE 1648 ELLIS ST STE 201 1245 N 29TH ST 435 S CRYSTAL 2800 10TH AVE N 2900 12TH AVE N #330W 2475 VILLAGE LN #102 115 4TH ST S 1597 AVE D STE 1 515 HOOPER 310 SANSOME ST 90 HWY 91 S 211 E 2ND ST 2935 STOCKYARD RD #K 1305 WYOMING ST 6630 MAIN ST 1101 26TH ST S 1200 WESTWOOD DR 403 W MAIN ST 289 RODEO DR #2 308 E 1ST ST 1101 26TH AVE S 5TH FLOOR 1300 28TH ST S STE 10 350 HERITAGE WAY #1200 905 HIGHLAND BLVD STE 4500 126 S MAIN ST 214 E MENDENHALL 801 N 29TH ST 48 MEDICAL PARK DR 925 HIGHLAND BLVD STE 1210 1287 BURNS WAY 715 NUCLEUS AVE 3838 AVE B STE B 1675 BROWNS MEADOW RD 2750 GRAND AVE 1315 WYOMING ST 401 15TH AVE S STE 109 CITY STEVENSVILLE BILLINGS HAVRE GREAT FALLS PHILIPSBURG KALISPELL BILLINGS MISSOULA BOZEMAN MANHATTAN BILLINGS BILLINGS MISSOULA HELENA BOZEMAN BILLINGS BUTTE BILLINGS BILLINGS BILLINGS GREAT FALLS BILLINGS BIG TIMBER PHILIPSBURG DILLON LIBBY MISSOULA MISSOULA COLSTRIP GREAT FALLS HAMILTON BELGRADE FLORENCE LAUREL GREAT FALLS GREAT FALLS KALISPELL BOZEMAN LIVINGSTON BOZEMAN BILLINGS HELENA BOZEMAN KALISPELL COLUMBIA FALLS BILLINGS KILA BILLINGS MISSOULA GREAT FALLS ZIP 59870 59101 59501 59405 59858 59901 59101 59802 59715 59741 59102 59101 59801 59602 59715 59101 59701 59101 59101 59102 59401 59102 59011 59858 59725 59923 59808 59801 59323 59405 59840 59714 59833 59044 59405 59405 59901 59715 59047 59715 59101 59601 59715 59901 59912 59101 59920 59102 59801 59405 SPECIALTY FAMILY PRACTICE RADIOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SOCIAL WORKER PSYCHIATRY GASTROENTEROLOGY PHYSICAL THERAPY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR SURGERY NEUROSURGERY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR SURGERY GENERAL NUTRITION PROFESSIONAL EAR/NOSE/THROAT (ENT) SOCIAL WORKER NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR LICENSED ADDICTION COUNSELOR RADIOLOGY RADIOLOGY FAMILY PRACTICE SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE PEDIATRIC NEUROLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE CHIROPRACTOR LICENSED ADDICTION COUNSELOR CARDIOLOGY CARDIOLOGY SURGERY ORTHOPEDIC MEDICINE INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY OCCUPATIONAL THERAPY FAMILY PRACTICE PSYCHIATRY ANESTHESIOLOGY Montana STATUS SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED PENDING PENDING PENDING PENDING PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 82 of 256 FIRST NAME PAMELA DAWN KEZIA DENNIS KRISTINE BRADLEY MICHAEL MICHAEL MICHAEL MICHAEL DENNIS ANDREW CHERI CHERI RONALD JANINE JOHN AMY AMY GARY HEATHER HEATHER CELESTE JENNIFER WILLIAM WILLIAM JACI JACI JOSHUA JEANNETTE MICHELLE DEANNA CHRISTINE BENJAMIN BENJAMIN SHAUN BEAU ROBERT JAMES JAMES L BRADLEY BRADLEY LAUREN JANE ROBERT EDWARD DANIEL JENNIFER ROBERT Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON PETERSON-HALE PETRISKO PETRULIS PEZO PFAFF PFEIFFER PFEIFFER PFISTER PFLUG PHILLIPS PHILLIPS PHILLIPS PHILLIPS PHILLIPS PHILLIPS PHILLIPS PHINNEY PHIPPS PHIPPS PHIPPS PHOENIX PICARD PICCOLO PICKARD PICKENS PICKENS PICKHARDT PICKHARDT PIERCE PIERCE PIERCE PIERCE PIERCE PIERCE PIERSALL LICENSE APRN DO OT MD PT MD MD MD MD MD MD LCPC LCSW LCSW MD MD MD LCSW DC DC NP NP MD MD DO DO NP NP PA LCPC LCPC MD OT MD MD LCPC DC LCSW OD DC DC MD MD PT PAC DC MD MD SLP LSW MEDICAL GROUP CENTER FOR JOINT CARE COGENT HEALTHCARE OF MONTANA EPICENTER THERAPY SERVICES NORTH VALLEY HOSPITAL ORTHO MONTANA PATHOLOGY CONSULTANTS OF WESTERN MT ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER ROCKY MOUNTAIN EYE CENTER WOODLAND CLINIC CLARK FORK EMERGENCY PHYSICIANS BILLINGS CLINIC COMMUNITY HEALTH PARTNERS GREAT NORTHERN CHIROPRACTIC CLINIC PFAFF CHIROPRACTIC CLINIC COLUMBIA FALLS CLINIC FAMILY HEALTHCARE AWARE INC BILLINGS CLINIC BROADWATER WALK-IN CLINIC CENTER FOR HEALTHY LIVING CUSTER COUNTY PUBLIC HEALTH & FAMIL HOLY ROSARY HEALTHCARE CLINIC MONTANA ORTHOPEDICS CPG ON SOUTH RESERVE FLORENCE THERAPY AND WELLNESS ORTHO MONTANA RIVERSTONE HEALTH SAFE PASSAGE COUNSELING BERISH CHIROPRACTIC CLINIC BOB PICCOLO COUNSELING RONAN EYE CLINIC HEIGHTS CHIROPRACTIC CLINIC MISSOULA SURGICAL ASSOCIATES ARNOLD PHYSICAL THERAPY COLSTRIP MEDICAL CENTER PIERCE CHIROPRACTIC SIDNEY HEALTH CENTER ADDRESS 900 N ORANGE #103 1101 26TH ST S 612 E MAIN ST STE C 1600 HOSPITAL WAY 2900 12TH AVE N STE 140W 2827 FORT MISSOULA RD 120 S 5TH STE 104 3417 BUSCH ST 417 MAIN ST SW 700 W KENT 705 6TH AVE E 402 E BECKWITH 2700 LYON CREEK RD 2700 LYON CREEK RD 301 KNAPP ST 2827 FORT MISSOULA RD 1020 N 27TH ST 126 S MAIN 1617 EUCLID AVE 104 E 1ST ST 715 NUCLEUS AVE 1287 BURNS WAY 616 HELENA AVE STE 305 2800 10TH AVE N 2019 BROADWATER AVE 2223 MISSION WAY 2000 CLARK ST 2600 WILSON ST 435 S CRYSTAL STE 400 820 DIVISION ST 225 N 23RD ST 1211 S RESERVE ST 5529 OLD US HWY 2900 12TH AVE N STE 140W 123 S 27TH ST 321 E MAIN #314 1690 RIMROCK RD STE G 555 FULLER AVE STE 1 417 MAIN ST SW 410 WICKS LN 410 WICKS LN 500 W BROADWAY 5TH FLOOR 500 W BROADWAY 251 SADDLE DR 6230 MAIN ST 2304 N 7TH AVE STE E 216 14TH AVE SW 500 W BROADWAY 202 W PARK ST 725 6TH AVE E STE 12 CITY MISSOULA GREAT FALLS BOZEMAN WHITEFISH BILLINGS MISSOULA HAMILTON BUTTE RONAN MISSOULA KALISPELL MISSOULA MISSOULA MISSOULA WOLF POINT MISSOULA BILLINGS LIVINGSTON HELENA LAUREL COLUMBIA FALLS KALISPELL HELENA BILLINGS BILLINGS BILLINGS MILES CITY MILES CITY BUTTE BILLINGS BILLINGS MISSOULA FLORENCE BILLINGS BILLINGS BOZEMAN BILLINGS HELENA RONAN BILLINGS BILLINGS MISSOULA MISSOULA HELENA COLSTRIP BOZEMAN SIDNEY MISSOULA BUTTE KALISPELL ZIP 59802 59405 59715 59937 59101 59804 59840 59701 59864 59801 59901 59801 59801 59801 59201 59804 59101 59047 59601 59044 59912 59901 59601 59101 59102 59102 59301 59301 59701 59101 59101 59801 59833 59101 59101 59715 59102 59601 59864 59105 59105 59802 59802 59601 59323 59715 59270 59802 59701 59901 SPECIALTY SURGERY ORTHOPEDIC MEDICINE INTERNAL MEDICINE OCCUPATIONAL THERAPY HOSPITALIST PHYSICAL THERAPY PATHOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE EMERGENCY MEDICINE/TRAUMA OCCUPATIONAL/INDUSTRIAL MEDICINE LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC CHIROPRACTIC FAMILY PRACTICE FAMILY PRACTICE PSYCHIATRY HOSPITALIST FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE OCCUPATIONAL THERAPY SPORTS MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR OPTOMETRY CHIROPRACTIC CHIROPRACTOR SURGERY GENERAL SURGERY PHYSICAL THERAPY FAMILY PRACTICE CHIROPRACTIC INTERNAL MEDICINE EMERGENCY MEDICINE SPEECH-LANGUAGE PATHOLOGIST LICENSED CLINICAL SOCIAL WORKER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 83 of 256 FIRST NAME MICHELLE MARK GREGG MALINDA LORI LYNN GWEN JONATHAN BRUCE GREGORY BECKY BRENT BRENT BRENT DOUGLAS AARON REBECCA REBECCA JESSE MICHELLE LARRY SUSAN JOHN STEVEN ERIK EMILIA HOLLY HOLLY HOLLY SARAH LESLIE BENJAMIN NEIL JEY JULIE JULIE JULIE KATHRYN PETER KEITH ANTHONY RICHARD RICHARD NANCY JENNIFER SHELLEY RAMONA ANGELA JILL KIM Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME PIERSON PIERSON PIKE PIKE PIKE PILLMAN PINCOMB PINE PINKERTON PISK PISKE PISTORESE PISTORESE PISTORESE PITMAN PITMAN PITT PITT PITT PITTACK PLANT PLATT PLATT PLEASANTS PLOOT PLOPLYS POAG POAG POAG POCKER POLING POMERANTZ PONDER PONTI PONTI PONTI PONTI PONTO POP POPOVICH POPP POPWELL POPWELL PORTER PORTER POSS POTTER POTTS-HANSEN POWELL POWELL LICENSE MD PAC MD MD LCSW LCPC MD DO MD DC PT MD MD MD MD PAC OD OD MD LCPC PT LCPC PHD DC DPM MD DO MD DO PT MD MD DO PT PAC PAC PA MD MD MD DC MD MD PT LAC NP MD SLP PAC APRN MEDICAL GROUP BILLINGS CLINIC ORTHO MONTANA GREAT FALLS CLINIC GREAT FALLS CLINIC ROCKY MOUNTAIN COUNSELING RIVER GATES NEPHROLOGY PINTLER SURGICAL SPECIALISTS BILLINGS CLINIC PISK CHIROPRACTIC & PHYSIOTHERAPY ST PETERS HOSPITAL REHABILITATION ROCKY MOUNTAIN HEART & LUNG ROCKY MOUNTAIN HEART & LUNG COLUMBIA FALLS CLINIC ST PETER'S MED GROUP NORTH BITTERROOT VALLEY EYE ASSOCIATES BITTERROOT VALLEY EYE ASSOCIATES PHYSICAL THERAPY ON THE MOVE GALLATIN PSYCHOLOGICAL ASSOC GALLATIN PSYCHOLOGICAL ASSOCIATES PLEASANTS CHIROPRACTIC GLACIER FOOT & ANKLE ASSOC PLASTIC SURGERY BELGRADE URGENT CARE LEWIS & CLARK EMERGENCY PHYSICIANS ST PETERS HOSPITAL WHITEFISH PHYSICAL THERAPY BILLINGS CLINIC NORTHWEST IMAGING GREAT FALLS OB/GYN ASSOC KALISPELL REHABILITATION ASSOC NORTHWEST ORTHOPEDICS & SPORTS MED THE MONTANA CENTER FOR WELLNESS BLUE MOUNTAIN CLINIC ST PETERS HOSPITAL BOZEMAN DEACONESS NEUROLOGY INTERNAL MED ASSOC BILLINGS CLINIC WEST BIG SKY INTERNAL MEDICINE BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC NORTHERN ROCKIES ORTHOPAEDICS ADDRESS 2675 CENTRAL AVE 2900 12TH AVE N STE 140W 20 13TH ST 1400 29TH ST S 1601 2ND AVE N STE 650 516 FULLER AVE 2525 BROADWAY STE 202A 305 W PENNSYLVANIA AVE 2800 10TH AVE N 178 2ND AVE E N 2475 BROADWAY 202 CONWAY DR STE 1 350 HERITAGE WAY STE 2100 350 HERITAGE WAY STE 2100 715 NUCLEUS AVE 33330 PTARMIGAN LN 300 N 10TH ST #A 401 MAIN ST #A 2825 FORT MISSOULA RD STE 225 1643 LEWIS AVE #4 1219 TULIP LN 121 W KAGY BLVD STE N 121 W KAGY BLVD STE N 533 SPOKANE AVE 95 INDIAN TRAIL RD 400 13TH AVE S STE 103 403 W MAIN ST 2475 BROADWAY 2475 BROADWAY 2006 HOSPITAL WAY 2800 10TH AVE N 320 SUNNYVIEW LN 1522 9TH ST S 115 COMMONS WAY STE 101 350 HERITAGE WAY #1200 245 WINDWARD WAY STE 101 350 HERITAGE WAY #1300 610 N CALIFORNIA 2475 BROADWAY 505 W PARK ST STE A 5 S MERIDIAN RD 905 HIGHLAND BLVD #4500 9325 HIGHLAND BLVD STE 3260 2675 CENTRAL AVE 208 N 29TH STE 236 310 WENDELL AVE STE 101 90 HWY 91 S 205 STAGERIDGE 760 WICKS LN 2831 FORT MISSOULA RD STE 232 CITY BILLINGS BILLINGS HAVRE GREAT FALLS GREAT FALLS HELENA HELENA ANACONDA BILLINGS KALISPELL HELENA KALISPELL KALISPELL KALISPELL COLUMBIA FALLS HELENA HAMILTON STEVENSVILLE MISSOULA BILLINGS MISSOULA BOZEMAN BOZEMAN WHITEFISH KALISPELL GREAT FALLS BELGRADE HELENA HELENA WHITEFISH BILLINGS KALISPELL GREAT FALLS KALISPELL KALISPELL KALISPELL KALISPELL MISSOULA HELENA BUTTE KALISPELL BOZEMAN BOZEMAN BILLINGS BILLINGS LEWISTOWN DILLON BIGFORK BILLINGS MISSOULA ZIP 59102 59101 59501 59405 59401 59601 59601 59711 59101 59901 59601 59901 59901 59901 59912 59602 59840 59870 59804 59102 59802 59715 59715 59937 59901 59405 59714 59601 59601 59937 59101 59901 59405 59901 59901 59901 59901 59802 59601 59701 59901 59715 59715 59102 59101 59457 59725 59911 59101 59804 SPECIALTY PEDIATRICS SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE PSYCHIATRY CHILD LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR NEPHROLOGY SURGERY ORTHOPEDIC MEDICINE RADIOLOGY CHIROPRACTIC PHYSICAL THERAPY PULMONARY DISEASES PULMONARY DISEASES PULMONARY DISEASES FAMILY PRACTICE URGENT CARE PROVIDER OPTOMETRY OPTOMETRY OB/GYN-OBSTETRICS/GYNECOLOGY PROFESSIONAL COUNSELOR PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY CHIROPRACTIC PODIATRY SURGERY PLASTIC/RESTORATIVEBURN EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY PEDIATRICS RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE PAIN MANAGEMENT FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY RADIOLOGY PULMONARY DISEASES CHIROPRACTOR NEUROLOGY NEUROLOGY PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR INTERNAL MEDICINE EMERGENCY MEDICINE/TRAUMA SPEECH-LANGUAGE PATHOLOGIST FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE Montana STATUS SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING PENDING SIGNED PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED 84 of 256 FIRST NAME STEPHEN CARRIE DYLAN DYLAN CATHRYN DYLAN MICHAEL HEATHER MYIA LAURA THEODORE THEODORE CLINTON RACHELLE KRISTY CHRISTOPHER JUSTIN SUSAN MICHAEL J THOMAS DANIEL MILISSA BRIAN VIRGINIA WHITNEY GREGORY CHARLES DENNIS DENNIS DENNIS DENNIS DANIEL DANIEL TIMOTHY SKY RICHARD PAUL ROBERT JILL RICK JULIE RICKIE JOHN JOHN GWENN LYNDA JOSEPH ELLEN JULIA THERESA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME POWELL POWELL POWELL POWELL POWELL POWELL POWER POWERS POWERS PRATT PREISS PREISS PRESTON PREVOST PRICE PRICE PRICE PRICE SAYLOR PRIDDY PRIDDY PRIDEAUX PRIEBE PRIEST PRIOR PRITHAM PRITHAM PROBERT PROBST PROBST PROBST PROBST PROPP PROPP PROVOW PRUITT PUCHTA PUCKETT PUERINGER PULASKI PULLEN PULLEN PULLEN PULLMAN PULLMAN PURCELL PURDY PURKETT PURSER PURVIS PUTMAN LICENSE MD APRN PAC PAC NP PAC MD AU LCSW MD PAC PAC MD PT SLT MD MD LCSW MD MD DC NP MD LCPC NP MD MD DO DO DO DO MD MD MD PT DC MD MD RD DO APRN DO MD MD PSYD DC SLT DC DC LAC MEDICAL GROUP NORTHERN ROCKIES ORTHOPAEDICS NORTHWEST PHYSICIANS ST JAMES HEALTHCARE TETON MEDICAL CENTER THOMAS BAUMGARTNER MD URGENT CARE PLUS OPHTHALMIC ASSOC OF BILLINGS ST PETERS MEDICAL GROUP THERAPY ARTS CLINIC THE MONTANA CENTER FOR WELLNESS BELGRADE URGENT CARE ST VINCENT NETWORK BROADWATER CLINIC BILLINGS CLINIC BILLINGS CLINIC MISSOULA BONE & JOINT RIVER STONE HEALTH MISSOULA FAMILY MEDICAL CENTER OPHTHALMIC ASSOC OF BILLINGS PULMONOLOGY/CRITICAL CARE MEDICINE CENTRAL MONTANA MEDICAL CENTER BILLINGS COUPLE & FAMILY THERAPY BOZEMAN DEACONESS CANCER CENTER BOZEMAN DEACONESS HEALTH GROUP ANESTHESIA PARTNERS OF MONTANA BIGFORK HEALTH AND WELLNESS WESTERN MONTANA CLINIC WESTERN MONTANA CLINIC MA CRITICAL CARE SERVICES MISSOULA ANESTHESIOLOGY MISSOULA ANESTHESIOLOGY WILLOW CREEK PHYSICAL THERAPY MISSOULA BONE & JOINT BILLINGS CLINIC BARRETT HOSPITAL & HEALTHCARE BEHAVIORAL HEALTH ASSOCIATES CENTER FOR HEALTHY LIVING MERCURY STREET MEDICAL SOUND INPT PHYSICIANS AT ST JAMES WMMHC HOME BONE CARE BRIDGER CHIROPRACTIC CLINIC PURVIS CHIROPRACTIC MENTAL HEALTH CENTER ADDRESS 2831 FORT MISSOULA RD STE 232 401 15TH AVE S STE 201 400 S CLARK ST 915 44TH ST NW 2825 FORT MISSOULA RD STE 304 39 NEILL AVE 1232 N 30TH ST STE 100 2575 E BROADWAY 355 1ST AVE WN 245 WINDWARD WAY STE 101 403 W MAIN 915 HIGHLAND BLVD 2019 BROADWATER AVE 2702 8TH AVE N 801 N 29TH ST 2360 MULLAN RD STE C 123 S 27TH ST 118 E 7TH ST STE 2L 621 W ADLER 1232 N 30TH ST STE 100 1001 SW HIGGINS #102 1300 28TH ST S STE 4 408 WENDELL AVE 2475 VILLAGE LN #102 931 HIGHLAND BLVD STE 3130 935 HIGHLAND BLVD STE 3260 2900 12TH AVE N STE 205W 191 JEWEL BASIN COURT #2A 311 HWY 93 S 6 13TH AVE E 6 - 13TH AVE E 2825 STOCKYARD RD BLDG I-200 2825 STOCKYARD RD BLDG I-200 2825 STOCKYARD RD BLDG I-200 1016 BROOKS AVE 690 N MERIDIAN RD #214 2360 MULLAN RD STE C 801 N 29TH ST 30 HWY 91 S 1101 N 27TH ST STE 201 2223 MISSION WAY 1231 N 29TH ST 300 W MERCURY 400 S CLARK ST 232 S MIAN ST 847 W CENTER ST 40 GARDNER PARK DR 517 S 22ND STE 7 1308 12TH AVE S 1245 N 29TH ST CITY MISSOULA GREAT FALLS BUTTE CHOTEAU MISSOULA HELENA BILLINGS HELENA KALISPELL KALISPELL BELGRADE BOZEMAN BILLINGS BILLINGS BILLINGS MISSOULA BILLINGS ANACONDA MISSOULA BILLINGS MISSOULA GREAT FALLS LEWISTOWN BILLINGS BOZEMAN BOZEMAN BILLINGS BIGFORK RONAN POLSON POLSON MISSOULA MISSOULA MISSOULA CORVALLIS KALISPELL MISSOULA BILLINGS DILLON BILLINGS BILLINGS BILLINGS BUTTE BUTTE LIVINGSTON KALISPELL BOZEMAN BOZEMAN GREAT FALLS BILLINGS ZIP 59804 59405 59701 59422 59804 59601 59101 59601 59901 59901 59714 59715 59102 59101 59101 59808 59101 59711 59802 59101 59803 59405 59457 59102 59715 59715 59101 59911 59864 59860 59860 59808 59808 59808 59828 59901 59808 59101 59725 59101 59102 59101 59701 59701 59047 59901 59715 59718 59405 59101 SPECIALTY SURGERY HAND FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY URGENT CARE PROVIDER OPHTHALMOLOGY AUDIOLOGY LICENSED CLINICAL SOCIAL WORKER PAIN MANAGEMENT URGENT CARE PROVIDER INTERNAL MEDICINE FAMILY PRACTICE PHYSICAL THERAPY SPEECH/LANGUAGE THERAPY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE OPHTHALMOLOGY CHIROPRACTIC FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA ADDICTIONNICOTINECOUNSELOR FAMILY PRACTICE SURGERY UROLOGICAL UROLOGY ANESTHESIOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY PHYSICAL THERAPY CHIROPRACTOR SURGERY ORTHOPEDIC MEDICINE PULMONARY DISEASES NUTRITION PROFESSIONAL PSYCHIATRY FAMILY PRACTICE PSYCHIATRY INFECTIOUS DISEASES HOSPITALIST PSYCHOLOGY CHIROPRACTIC SPEECH/LANGUAGE THERAPY CHIROPRACTIC CHIROPRACTIC LICENSED ADDICTION COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING 85 of 256 FIRST NAME ROBERT ROYCE LANCE JAMES ASHLEY MARY ANTHONY LOWELL DIANE EDWARD CHRISTINA MARY ROBERT MARK MARK THOMAS THOMAS MATTHEW KERMIT BRIAN FRANK FRANK EILEEN JENNY AMY GEOFF JAMES LEONARD ANDREW MARK THOMAS LAURIE JESSICA KATHE KATHE LISA LISA SUSAN RONALD GIGI ANNA JEFFERY WES WAHID ROBERTA TRACI TRACI ROSS ANN RENEE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME PUTZKER PYETTE PYSHER QUAN QUANBECK QUANDT QUEBEDEAUX QUENEMOEN QUICK QUICK QUIJANO QUINT RABIEA RABOLD RABOLD RACHIE RACHNER RADLOWSKI RAGAIN RAH RAISER RAISER RALICKE RAMBUR RAMER RAMSAY RAMSEY RAMSEY RANDAK RANDAK RANDALL RANDALL RANDAZZO RANDLE RANDLE RANES RANES RANGITSCH RANKIN RAPPAPORT RAPSON RASCH RASHID RASHIDZADA RASMANN RASMUSSON RASMUSSON RASSA RATHE RATLIFF LICENSE PT MD MD MD MD MD DPM MD APRN MD MD LCSW MD MD MD DC MD LAC MD MD MD MD NP PT FNP DC LCPC MD MD MD MD LAC LCSW LCPC LCPC RD RD LCPC MD PT LCSW DO DPM MD PT DC DC MD MD LCPC MEDICAL GROUP NASH SPINE & JOINT REHABILITATION BRIDGER ORTHOPEDICS HARDIN CLINIC BILLINGS CLINIC NEUROLOGY ASSOCIATES MENTAL HEALTH CENTER BILLINGS CLINIC MONTANA INTERVENTIONAL & DIAGNOSTIC LEWIS & CLARK EMERGENCY PHYSICIANS ST PETERS URGENT CARE POWELL COUNTY CLINIC SIDNEY HEALTH CENTER WESTERN MONTANA ADDICTION CENTER GLENDIVE MEDICAL CENTER BILLINGS CLINIC SILVER BOW SURGICAL ASSOCIATES SILVERBOW SURGICAL ASSOCIATES BOZEMAN DEACONESS HOSPITAL BILLINGS CLINIC MILES CITY DEER LODGE MEDICAL CENTER CLINIC RAMSAY BACK & BODY HEALTH ALETHEIA COUNSELING THE BOZEMAN CLINIC BILLINGS ANESTHESIOLOGY BILLINGS CLINIC MISSOULA VALLEY PEDIATRICS WESTERN MONTANA ADDICTION SERVICES WESTERN MONTANA MENTAL HEALTH CTR SOLUTION FAMILY COUNSELING CENTER SOLUTION FAMILY COUNSELING CENTER BILLINGS CLINIC NORTHERN MONTANA HOSPITAL INTEGRITAS GREAT DIVIDER RADIOLOGY ALPINE ORTHOPEDICS & SPORTS MEDICIN KALISPELL FOOT & ANKLE CLINIC ST VINCENT HEALTHCARE FISCHER PHYSICAL THERAPY HICKORY STREET CHIROPRACTIC CLINIC HIGH PLAINS PSYCHIATRIC ASSOC CHOICES PSYCHOTHERAPY & CONSULTING ADDRESS 2748 COLONIAL DR STE A 1450 ELLIS ST STE 201 1200 WESTWOOD DR 2827 FORT MISSOULA RD 16 N MILES AVE STE 101 2800 10TH AVE N 2646 WINNE AVE 2900 12TH AVE N #402E 1245 N 29TH 715 KENSINGTON AVE STE 20 1020 N 27TH ST 1601 2ND AVE N STE 200 2969 AIRPORT RD STE C 2475 BROADWAY 2475 BROADWAY 1101 TEXAS AVE 216 14TH AVE SW 1325 WYOMING ST 202 PROSPECT DR 1020 N 27TH ST 400 W PORPHYRY ST 1100 HOLLENBACK LN 915 HIGHLAND BLVD 620 S HAYNES 1100 HOLLENBACK LN 825 W KENT AVE 2870 ST MICHAEL DR 931 HIGHLAND BLVD STE 3360 2800 10TH AVE N 801 N 29TH ST 2835 FORT MISSOULA RD STE 205 1325 WYOMING ST 209 N 10TH STE A 28 LITLER LN 28 LITLER LN 2800 10TH AVE N 30 13TH ST 7235 OLD GRANT CREEK RD 2475 BROADWAY 244 SPOKANE AVE #6 2200 BOX ELDER 536 S COTTONWOOD RD STE 100 907 S MAIN ST 2900 12TH AVE N STE 400E 1313 LAST CHANCE GULCH 225 HICKORY ST S STE 2003 225 HICKORY ST 621 3RD ST S 1601 LEWIS AVE #4 2229 5TH AVE #108 CITY HELENA BOZEMAN HAMILTON MISSOULA HARDIN BILLINGS HELENA BILLINGS BILLINGS MISSOULA BILLINGS GREAT FALLS HELENA HELENA HELENA DEER LODGE SIDNEY MISSOULA GLENDIVE BILLINGS BUTTE DEER LODGE BOZEMAN MILES CITY DEER LODGE MISSOULA MISSOULA BOZEMAN BILLINGS BILLINGS MISSOULA MISSOULA HAMILTON POLSON POLSON BILLINGS HAVRE MISSOULA HELENA WHITEFISH MILES CITY BOZEMAN KALISPELL BILLINGS HELENA MISSOULA MISSOULA GLASGOW BILLINGS HAVRE ZIP 59601 59715 59840 59804 59034 59101 59601 59101 59101 59801 59101 59401 59601 59601 59601 59722 59270 59801 59330 59101 59701 59722 59715 59301 59722 59801 59803 59715 59101 59101 59804 59801 59840 59860 59860 59101 59501 59808 59601 59937 59301 59718 59901 59101 59601 59801 59801 59230 59102 59501 SPECIALTY PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE RADIOLOGY INTERNAL MEDICINE FAMILY PRACTICE HOSPITALIST PODIATRY NEUROLOGY PSYCHIATRY GENERAL PRACTICE PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER RADIOLOGY EMERGENCY MEDICINE/TRAUMA URGENT CARE PROVIDER CHIROPRACTIC RADIOLOGY LICENSED ADDICTION COUNSELOR RADIOLOGY CARDIOLOGY SURGERY GENERAL SURGERY GENERAL FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE ANESTHESIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PEDIATRICS LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER ADDICTIONNICOTINECOUNSELOR LICENSED BEHAVIORAL COUNSELOR NUTRITION PROFESSIONAL NUTRITION PROFESSIONAL LICENSED BEHAVIORAL COUNSELOR RADIOLOGY PHYSICAL THERAPIST LICENSED CLINICAL SOCIAL WORKER INTERNAL MEDICINE PODIATRY NEUROLOGY PHYSICAL THERAPY CHIROPRACTIC CHIROPRACTOR RADIOLOGY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 86 of 256 FIRST NAME CHRISTINE DENNIS KRISTIN NEALA DANIEL CRAIG ERIC DAVID RONALD RONALD PEGGY RON REBECCA PENNI KIMBERLEE DOUGLAS ALLAN SAMUEL CHARLES MARIA LINDA DANIELLE DANIELLE KELLY PAUL MARY MICHAEL THERESA DENNIS CAROLINE DOUGLAS CAROLINE SALLY DOROTHY STEPHANIE ELIZABETH ELIZABETH GENEVIEVE GENEVIEVE SHERRY KATHY TERRY TERRY JULIE MARK LYNDA LINDA TANNER WILLIAM MONICA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME RATTIN RAU RAUCH RAUSCH RAUSCH RAVESLOOT RAVITZ RAWLINSON RAY RAY RAY RAY RAY RAYMOND RAYNOVICH REAGAN REBCHOOK RECK RECKSON REDFERN REDFERN REDFIELD REDFIELD REDFIELD REEB REED REED REED REGAN REHDER REHDER REHDER REICHERT REICHERT REICHHARDT REID REID REID REID REID REID REIFF REIFF REIL REILLY REIMAN REINHARDT REINHART REITER REKIEL LICENSE DO PT MD OT MD PHD DO DPM CRNA DPM MSPT CRNA CRNA LCPC PT MD MD MD MD PT PT APRN NP MD MD PHD MD PHD MD PT CCCA PT CRNA LAC LCSW PT PT MD MD MD PT DO DO MD MD LAC LCSW PA MD LCPC MEDICAL GROUP BILLINGS CLINIC SHAFER RAU PHYSICAL THERAPY EASTER SEALS PEDIATRIC THERAPY SERV POLSON HEALTH BLUE SKY COUNSELING BLUE MOUNTAIN CLINIC BILLINGS CLINIC BENEFIS PHYSICIANS ASSOCIATES FOOT & ANKLE CLINIC OF MONTANA FOOT AND ANKLE CLINIC OF MONTANA ST LUKE COMMUNITY HOSPITAL EPICENTER THERAPY SERVICES NORTHWEST ORTHOPEDICS & SPORTS NORTHERN MONTANA MEDICAL GROUP BILLINGS CLINIC CATALYST PHYSICAL THERAPY VALLEY PHYSICAL THERAPY BOULDER MEDICAL CLINIC ST PETERS MEDICAL GROUP WOODLAND CLINIC GLACIER MEDICAL ASSOCIATES MISSOULA PSYCHOLOGICAL MEDICINE BILLINGS CLINIC COMMUNITY HEALTH PARTNERS REHDER HEARING CLINIC YELLOWSTONE PHYSICAL THERAPY GLENDIVE MEDICAL CENTER MENTAL HEALTH CENTER BILLINGS CLINIC MILES CITY COLSTRIP MEDICAL CENTER COMMUNITY HEALTH PARTNERS LIVINGSTON MEMORIAL HOSPITAL MONTANA NEUROBEHAVIORAL SPECIALISTS PHYSICAL THERAPY SOLUTIONS ACADIA MONTANA WHITEHALL MEDICAL CLINIC BENEFIS PHYSICIAN ASSOCIATES MENTAL HEALTH CENTER BILLINGS CLINIC- ENT ANACONDA INTERNAL MEDICINE WESTERN MONTANA MENTAL HEALTH CTR ADDRESS 1020 N 27TH ST 2625 BROADWAY 2825 FORT MISSOULA RD #115 1537 AVE D STE 150 102 13TH AVE E 101 E BROADWAY STE 310 610 N CALIFORNIA 801 N 29TH ST 1101 26TH ST S 1301 11TH AVE S STE 6 1301 11TH AVE S STE 6 107 6TH AVE SW 6 - 13TH AVE E 415 N HIGGINS STE 114 612 E MAIN STE C 350 HERITAGE WAY #1200 20 13TH ST W 801 N 29TH ST 1200 WESTWOOD DR 117 N 4TH ST #A2 1001 SW HIGGINS #205 214 S MAIN ST 2550 BROADWAY 705 6TH AVE E 111 BAKER AVE 910 BROOKS #202 500 W BROADWAY #320 119 W FRONT STE #309 2800 10TH AVE N 126 S MAIN ST 1101 N 27TH ST STE E 1313 W PARK STE 7 202 PROSPECT DR 1245 N 29TH 24 E BROADWAY 620 S HAYNES 6230 MAIN ST 126 S MAIN ST 504 S 13TH ST 900 N ORANGE 3RD FLOOR 2100 S HIGGINS 55 BASIN CREEK RD 108 1ST ST W 1655 SHILOH RD #E 1117 29TH ST S 212 WENDELL 121 1/2 E CALLENDAR 801 N 29TH ST 1102 E COMMERCIAL 1305 WYOMING ST CITY BILLINGS HELENA MISSOULA BILLINGS POLSON MISSOULA MISSOULA BILLINGS GREAT FALLS GREAT FALLS GREAT FALLS RONAN POLSON MISSOULA BOZEMAN KALISPELL HAVRE BILLINGS HAMILTON HAMILTON MISSOULA BOULDER HELENA KALISPELL WHITEFISH MISSOULA MISSOULA MISSOULA BILLINGS LIVINGSTON BILLINGS LIVINGSTON GLENDIVE BILLINGS BUTTE MILES CITY COLSTRIP LIVINGSTON LIVINGSTON MISSOULA MISSOULA BUTTE WHITEHALL BILLINGS GREAT FALLS LEWISTOWN LIVINGSTON BILLINGS ANACONDA MISSOULA ZIP 59101 59601 59804 59102 59860 59802 59802 59101 59405 59405 59405 59864 59860 59802 59715 59901 59501 59101 59840 59840 59803 59632 59601 59901 59937 59801 59802 59802 59101 59047 59101 59047 59330 59101 59701 59301 59323 59047 59047 59802 59801 59701 59759 59106 59405 59457 59047 59101 59711 59801 SPECIALTY CARDIOLOGY PHYSICAL THERAPY OB/GYN-OBSTETRICS/GYNECOLOGY OCCUPATIONAL THERAPY FAMILY PRACTICE PSYCHOLOGY FAMILY PRACTICE PODIATRY ANESTHESIOLOGY PODIATRY PHYSICAL THERAPY ANESTHESIOLOGY NURSE ANESTHETIST LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE SURGERY GENERAL DERMATOLOGY RADIOLOGY PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE GENERAL PRACTICE PSYCHOLOGY CARDIOVASCULAR DISEASE PSYCHOLOGY HOSPITALIST PHYSICAL THERAPY AUDIOLOGY PHYSICAL THERAPY ANESTHESIOLOGY ADDICTIONNICOTINECOUNSELOR LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE NEUROLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIATION ONCOLOGY LICENSED ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER EAR/NOSE/THROAT (ENT) INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR Montana STATUS PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 87 of 256 FIRST NAME FRANK FRANK DEBRA MARK MARK MARK KELI ALISON JEFFREY JOHN NANCY JOHN ALBERT PHYLLIS LOURDES SUSAN SUSAN JOHN CODA ALEECE JIM KAREN MARTHA MARTHA JOHN GREGORY NANCY DENNIS DENNIS GRIFFYTH LISA TIMOTHY JAMES TRACI SUZANNE JEFF KRISTEN BRUCE BRIAN BRIAN THOMAS SHERRY JONATHAN JASON SETH PHILIP JONATHAN ANNE LINDA LINDA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME REMBERT REMBERT REMILLARD REMINGTON REMINGTON REMINGTON REMUS RENTZ RENTZ REPAC REPPE REX SR REYNAUD REYNOLDS REYNOLDS REYNOLDS REYNOLDS REYNOLDS REYNOLDS REYNOLDS REYNOLDS REYNOLDS RHOADES RHOADES RIBIC RICE RICE RICH RICH RICHARD RICHARDS RICHARDS RICHARDS RICHARDS RICHARDS RICHARDSON RICHARDSON RICHARDSON RICK RICK RICKARD RICKEL RICKER RICKS RIDDLE RIEDEL RIEGLER RIEMER RIES RIES LICENSE MD MD PAC MD MD MD LCSW MD MD OT LCPC LAC MD LCPC MD APRN NP MD NP LCSW LAC LAC LCSW MD MD MD MD SLT MD MD PAC PT MD MD LCSW LCSW LAC PT MD PAC PA-C MD APRN MD OD MD MD MD LCPC MD MD MEDICAL GROUP BOZEMAN RADIOLOGY SIDNEY HEALTH CENTER ASSOCIATED DERMATOLOGY GLACIER EYE CLINIC NEONATOLOGY ASSOCIATES BILLINGS CLINIC EASTERN MONTANA COMMUNITY MHC BILLINGS CLINIC ADULT & CHILD COUNSELING SERVICE BILLINGS CLINIC MILES CITY BITTERROOT CLINIC FAMILY MEDICINE CTR OF BITTERROOT HELENA PEDIATRIC CLINIC THE CENTER FOR FAMILY HEALTH BEHAVIORAL HEALTH CLINIC ST PETERS CARDIOLOGY CLINIC LIBBY CLINIC RICE AND ASSOCIATES ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY NASH SPINE & JOINT REHABILITATION ROCKY MOUNTAIN SURGICAL SOLUTIONS SVH NEUROLOGY CLINIC WESTERN MONTANA MENTAL HEALTH CTR EASTERN MONTANA COMMUNITY MHC MONTANA PHYSICAL THERAPY NORTHERN MONTANA MEDICAL GROUP E MINERAL COMMUNITY HOSPITAL NORTHERN ROCKIES ORTHOPAEDICS PHILLIPS CO FAMILY HEALTH CLINIC ACORN PEDIATRICS EYECARE ASSOCIATES OF LEWISTOWN GLACIER EAR NOSE & THROAT BENEFIS PHYSICIAN ASSOCIATES MEDICAL SPECIALISTS OF HELENA JOURNEYS COUNSELING MONTANA CANCER SPECIALISTS MONTANA CANCER SPECIALISTS AT CMC ADDRESS 4119 RAIN ROPER DR 216 14TH AVE SW 50 S LAST CHANCE GULCH STE 3 160 HERITAGE WAY 308 LOUISIANA AVE 410 1ST ST E STE A 4700 12TH ST NE 1233 N 30TH ST 2900 12TH AVE N STE 355W 1020 N 27TH ST 1321 8TH AVE N #203 2508 WILSON ST 801 N 29TH ST 111 N LAST CHANCE GULCH STE 2A 620 S HAYNES AVE 1224 W MAIN ST 1201 WESTWOOD DR 1122 N MONTANA AVE 834 S MONTANA ST 600 CENTRAL AVE #312 1643 LEWIS AVE #4 100 E BROADWAY STE 7 1020 N 27TH ST 902 WYOMING 2525 BROADWAY STE 203 211 E SECOND ST 2475 VILLAGE LN STE 100 905 HIGHLAND BLVD STE 4100 925 HIGHLAND BLVD STE 1180 1207 SECOND ST W 2748 COLONIAL DR STE A 2831 FORT MISSOULA RD #104 2900 12TH AVE N STE 400E 106 W BROADWAY 300 W BROADWAY STE 2 400 2ND AVE S 2370 AVE C 124 13TH ST 1208 6TH AVE E 621 3RD ST S 2831 FORT MISSOULA RD STE 232 311 S 8TH AVE E 280 W KAGY BLVD STE G 119 E MAIN ST 160 HERITAGE WAY 1101 26TH ST S 2525 BROADWAY STE 200 201 W PARK ST STE 216 500 W BROADWAY 2827 FORT MISOSULA RD CITY BOZEMAN SIDNEY HELENA KALISPELL LIBBY POLSON GREAT FALLS BILLINGS BILLINGS BILLINGS GREAT FALLS MILES CITY BILLINGS HELENA MILES CITY HAMILTON HAMILTON HELENA BUTTE GREAT FALLS BILLINGS BUTTE BILLINGS BILLINGS HELENA LIBBY BILLINGS BOZEMAN BOZEMAN ROUNDUP HELENA MISSOULA BILLINGS BUTTE MISSOULA WOLF POINT BILLINGS HAVRE SUPERIOR GLASGOW MISSOULA MALTA BOZEMAN LEWISTOWN KALISPELL GREAT FALLS HELENA LIVINGSTON MISSOULA MISSOULA ZIP 59715 59270 59601 59901 59923 59860 59404 59101 59101 59101 59401 59301 59101 59601 59301 59840 59840 59601 59701 59401 59102 59701 59101 59101 59601 59923 59102 59715 59715 59072 59601 59804 59101 59701 59802 59201 59102 59501 59872 59230 59804 59538 59715 59457 59901 59405 59601 59047 59802 59804 SPECIALTY RADIOLOGY RADIOLOGY DERMATOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY SOCIAL WORKER PEDIATRIC NEONATOLOGY SURGERY GENERAL OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR ADDICTIONNICOTINECOUNSELOR DERMATOLOGY LICENSED BEHAVIORAL COUNSELOR PEDIATRICS FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS FAMILY PRACTICE SOCIAL WORKER ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY PSYCHIATRY CARDIOLOGY FAMILY PRACTICE SPEECH/LANGUAGE THERAPY RADIOLOGY RADIOLOGY FAMILY PRACTICE PHYSICAL THERAPY SURGERY GENERAL NEUROLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER ADDICTIONNICOTINECOUNSELOR PHYSICAL THERAPY FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA PHYSICIAN ASSISTANT SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE PEDIATRICS OPTOMETRY EAR/NOSE/THROAT (ENT) PEDIATRIC NEONATOLOGY GASTROENTEROLOGY LICENSED BEHAVIORAL COUNSELOR HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 88 of 256 FIRST NAME JUSTIN STACEY STACEY JUDY SCOTT MICHAEL VIRGINIA TIFFANY SARAH RENEE RENEE JEAN JEAN ANN JILL GEORGE GEORGE DUSTIN RACHEL CAMILLE KARI VINCENT STEVEN GEORGE GEORGE DOUGLAS M JOANN JOHN EILEEN MARY PAMELA BRADLEY DONALD CHERISH STEVEN PAM AIMEE KATHY MARK CARLEY JAMES BRUCE MARK CARLEY MARK JULIE LEE KACIE KATHARINE RICHARD RICHARD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME RIES RIFFE RIFFE RIGBY RIGGINS RIGHETTI RIGHTMIER RILEY RILEY RILEY FINNEGAN RILEY FINNEGAN RINGO-MACDONALD RINGO-MCDONALD RIPLEY RIPLEY RISI RISI RISING RISING RISTROPH RITTER RIVER RIZZOLO RO RO ROANE ROBBINS ROBBINS ROBBINS ROBERT ROBERTS ROBERTS ROBERTS ROBERTS ROBERTS ROBERTS ROBERTS ROBERTS-GREEN ROBERTSON ROBERTSON ROBERTSON ROBERTSON ROBERTSON ROBERTSON ROBERTSON ROBERTSON ROBERTUS ROBINETT ROBINS ROBINS LICENSE MD NP NP MD MD MD LCSW LCPC PT LCPC LCPC LCSW LCSW PT NP MD MD DC DC MD MD PHD MD MD MD MD CNMW MD APRN OT MD APRN DMD LCPC MD MD OT PA-C PT MD MD PT MD PT PT MD APRN LCPC OD OD MEDICAL GROUP MOUNTAIN VIEW FAMILY MEDICINE & OB MISSOULA VALLEY PEDIATRICS PARKSIDE COMMUNITY FAMILY CARE PERI & NEONATAL SERVICES AT KRMC BILLINGS CLINIC CROSSROADS THERAPEUTIC SERVICES ALTACARE THE COZY NEST WESTERN MONTANA MENTAL HEALTH CTR CENTER FOR MENTAL HEALTH NEW DIRECTIONS CENTER ALPINE PHYSICAL THERAPY EVERGREEN CLINIC INFECTIOUS DISEASE SPECIALISTS GALLATIN VALLEY CHIROPRACTIC PROCHIROPRACTIC BARRETT HOSP & HEALTHCARE CLINIC INTERNAL MEDICINE ASSOCIATES FLATHEAD VALLEY ORTHOPEDICS GREAT FALLS CLINIC RADIOLOGY MONTANA ARTHRITIS & OSTEOPOROSIS CENTER GREAT FALLS OBGYN ASSOCIATES INTERNAL MEDICINE ASSOCIATES WESTERN MONTANA MENTAL HEALTH CTR BIG SKY FAMILY MEDICINE BILLINGS CLINIC BILLINGS CLINIC CROSSWAY COUNSELING THE BOZEMAN CLINIC THE MONTANA CENTER FOR WELLNESS ABSAROKEE MEDICAL CLINIC BIG SANDY MEDICAL CENTER BOZEMAN DEACONESS UROLOGY MOUNTAIN VIEW CLINIC NORTHERN MONTANA HOSPITAL RED LODGE PHYSICAL THERAPY RIVERSTONE HEALTH GLACIER EYE CLINIC ADDRESS 2835 FORT MISSOULA RD #101 2835 FORT MISSOULA RD #205 2831 FORT MISSOULA RD #146 310 SUNNYVIEW LN 801 N 29TH ST 6 - 13TH AVE E 926 MAIN ST STE 18 215 S MARYLAND 1276 N 15TH AVE STE 101 106 W BROADWAY 307 E PARK STE 310A 621 1ST AVE S 621 FIRST AVE S 330 11TH AVE 2181 HWY 2 E STE 9 614 W SPRUCE 500 W BROADWAY 3RD FLOOR 626 S FERGUSON AVE STE 4 8757 JACKRABBIT LN STE A 30 HWY 91 S 905 HIGHLAND BLVD STE 4500 1201 MAIN ST STE A 111 SUNNYVIEW LN 3000 15TH AVE S 401 15TH AVE S STE 204 708 BROADWATER AVE 1522 9TH ST S 905 HIGHLAND BLVD STE 4500 1315 WYOMING 1302 24TH ST W #319 202 CONWAY DR #200 801 N 29TH ST 801 N 29TH ST 848 MAIN ST STE 8A 931 HIGHLAND BLVD STE 3360 245 WINDWARD WAY STE 101 2500 GRAND AVE #R 601 W SPRUCE #C 55 N MONTANA 3 MONTANA AVE 935 HIGHLAND BLVD STE 2160 10 ROBINSON LN 110 13TH ST 810 N BROADWAY 115 COMMONS WAY #101 209 1/2 H ST E 123 S 27TH ST 2050 FAIRWAY DR #104 160 HERITAGE WAY 308 LOUISIANA AVE CITY MISSOULA MISSOULA MISSOULA KALISPELL BILLINGS POLSON BILLINGS CONRAD BOZEMAN BUTTE ANACONDA GREAT FALLS GREAT FALLS HELENA KALISPELL MISSOULA MISSOULA BOZEMAN BELGRADE DILLON BOZEMAN POLSON KALISPELL GREAT FALLS GREAT FALLS BILLINGS GREAT FALLS BOZEMAN MISSOULA BILLINGS KALISPELL BILLINGS BILLINGS BILLINGS BOZEMAN KALISPELL BILLINGS MISSOULA ABSAROKEE BIG SANDY BOZEMAN RED LODGE HAVRE RED LODGE KALISPELL POPLAR BILLINGS BOZEMAN KALISPELL LIBBY ZIP 59804 59804 59804 59901 59101 59860 59105 59425 59715 59701 59711 59401 59401 59601 59901 59802 59802 59718 59714 59725 59715 59860 59901 59405 59405 59101 59405 59715 59801 59102 59901 59101 59101 59105 59715 59901 59102 59802 59001 59520 59715 59068 59501 59068 59901 59255 59101 59718 59901 59923 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PEDIATRIC NEONATOLOGY NEUROLOGY ORTHOPAEDIC SURGERY LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY FAMILY PRACTICE INFECTIOUS DISEASES INFECTIOUS DISEASE CHIROPRACTIC CHIROPRACTIC FAMILY PRACTICE INTERNAL MEDICINE PSYCHOLOGY SURGERY ORTHOPEDIC MEDICINE RADIOLOGY RADIOLOGY RHEUMATOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY INTERNAL MEDICINE PSYCHIATRY OCCUPATIONAL THERAPIST FAMILY PRACTICE SURGERY GENERAL SURGERY ORAL/MAXILLOFACIAL LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PAIN MANAGEMENT OCCUPATIONAL THERAPY PHYSICIAN ASSISTANT PHYSICAL THERAPY FAMILY PRACTICE SURGERY UROLOGICAL UROLOGY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY PHYSICAL THERAPY EMERGENCY MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR OPTOMETRY OPTOMETRY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 89 of 256 FIRST NAME RICHARD WILLIAM THOMAS LAURA WHITNEY JON RYAN WANDA SARAH L KAY REGINA JENNIFER ANTHONY ANTHONY BRENDA CHRISTOPHER WENDY GARY MARTIN LYNETTE EDWIN PATRICIA ROBERT ROBERT TERRY TRANG NEAL P BRIAN KATHLEEN ROBERT LUCINDA DEBORAH DAVID ROBERT ROBERT CHRISTOPHER VONNIE CHERYL BEVERLY BEVERLY PAULA DIANE PHILLIP PHILLIP MELANIE MICHAEL JENNIFER ROSALIND MICHELLE BILL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME ROBINS ROBINSON ROBINSON ROBINSON ROBINSON ROBINSON ROBINSON ROBINSON ROBINSON ROBISON ROBISON ROBOHM ROCCISANO ROCCISANO ROCHE ROCK RODABOUGH RODEWALD RODGERS RODI RODRIGUEZ RODRIQUE ROEPER ROEPER ROGER ROGERS ROGERS ROGERS ROGERS ROGERS ROGINSKE KULTGEN ROHM ROHRER ROLLINS ROLLINS ROMANN RONESS-BROWN RONISH ROOPE ROOPE ROOS ROOSA ROPER ROPER ROSA ROSATTI ROSE ROSE ROSEN ROSEN LICENSE OD MD MD PAC MD MD PT DC MD NP APRN PHD DO DO PHD MD LCPC CRNA DC LCPC MD PT DO PT AU MD MD MD MD LCSW LCPC MD MD MD MD LCSW LCSW APRN APRN MD PT MD MD PT CRNA OD LCPC OT MD MEDICAL GROUP ABSORKA EMERGENCY PHYSICIANS ANESTHESIA PARTNERS OF MONTANA BILLINGS CLINIC BILLINGS CLINIC BRIDGER ORTHOPEDICS KALISPELL REHABILITATION ASSOC PISK CHIROPRACTICE & PHYSIOTHERAPY WOODLAND CLINIC BEAVERHEAD COUNTY PUBLIC HEALTH WMMHC ORTHO MONTANA SVH ORTHOPEDIC CLINIC MISSOULA ANESTHESIOLOGY MARCUS DALY MEMORIAL HOSPITAL JOURNEYS COUNSELING BROADWATER WALK IN CLINIC POLSON PHYSICAL THERAPY CLARK FORK EMERGENCY PHYSICIANS MARCUS DALY MEMORIAL HOSPITAL BIG SKY ENT DIVIDE CREEK ROGERS DERMATOLOGY CLINIC WESTERN MONTANA CLINIC WOMENS HEALTH MONTANA NEUROBEHAVIORAL SPECIALISTS BILLINGS CLINIC NORTHERN MONTANA HOSPITAL PATHWAYS HEALTH CARE CORNERSTONE COUNSELING BOULDER MEDICAL CLINIC ST PETERS MEDICAL GROUP BILLINGS ANESTHESIOLOGY VALLEY PHYSICAL THERAPY BUTTE PHYSICAL THERAPY EYE PHYSICIANS AND SURGEONS NEURO REHAB ASSOCIATES ADDRESS 410 1ST ST E STE A 915 HIGHLAND BLVD 2900 12TH AVE N STE 205W 801 N 29TH ST 2702 8TH AVE N 1450 ELLIS ST STE 201 1234 WHITE FISH STAGE 178 2ND AVE E N 705 6TH AVE E 41 BARRETT ST 701 FARMHOUSE LN 1444 MANSFIELD AVE 2900 12TH AVE N #140W 2900 12TH AVE N STE 140W 1501 14TH ST W #230 2825 STOCKYARD RD BLDG I-200 3021 6TH AVE N STE 106 1200 WESTWOOD DR 1707 W OAK ST STE D 201 W PARK ST STE 215 2019 BROADWATER AVE 211A MAIN ST 2827 FORT MISSOULA RD 1200 WESTWOOD DR 435 S CRYSTAL STE 400 925 HIGHLAND BLVD STE 1160 202 S MONTANA ST 1727 W COLLEGE AVE 2835 FORT MISSOULA RD #3 75 CLAREMONT STE A 900 N ORANGE 3RD FLOOR 2100 FAIRWAY DR STE 210 400 13TH AVE S STE 101 801 N 29TH ST 30 13TH ST 200 HERITAGE WAY 1321 8TH AVE N STE 105 501 FULLER STE 1 PO BOX 28 2550 BROADWAY 2800 10TH AVE N 1001 SW HIGGINS STE 205 500 W BROADWAY #320 601 W SPRUCE #A 200 S CLARK ST 6 - 13TH AVE E 1221 N 26TH ST 22 2ND AVE WEST 2135 CHARLOTTE STE 3 1637 S HIGGINS AVE CITY POLSON BOZEMAN BILLINGS BILLINGS BILLINGS BOZEMAN KALISPELL KALISPELL KALISPELL DILLON BOZEMAN MISSOULA BILLINGS BILLINGS BILLINGS MISSOULA BILLINGS HAMILTON BOZEMAN LIVINGSTON BILLINGS POLSON MISSOULA HAMILTON BUTTE BOZEMAN BUTTE BOZEMAN MISSOULA KALISPELL MISSOULA BOZEMAN GREAT FALLS BILLINGS HAVRE KALISPELL GREAT FALLS HELENA BOULDER HELENA BILLINGS MISSOULA MISSOULA MISSOULA BUTTE POLSON BILLINGS KALISPELL BOZEMAN MISSOULA ZIP 59860 59715 59101 59101 59101 59715 59901 59901 59901 59725 59715 59801 59101 59101 59101 59808 59101 59840 59718 59047 59102 59860 59804 59840 59701 59715 59701 59715 59804 59901 59802 59715 59405 59101 59501 59901 59401 59601 59632 59601 59101 59803 59802 59802 59701 59860 59101 59901 59718 59801 SPECIALTY OPTOMETRY EMERGENCY MEDICINE/TRAUMA ANESTHESIOLOGY SURGERY GENERAL SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY CHIROPRACTIC INTERNAL MEDICINE FAMILY PRACTICE PSYCHIATRY PSYCHOLOGY SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE PSYCHOLOGIST ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY AUDIOLOGY SURGERY HEAD & NECK DERMATOLOGY PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR SURGERY GENERAL PULMONARY DISEASES PULMONARY DISEASES PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY PHYSICAL THERAPY CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE PHYSICAL THERAPY NURSE ANESTHETIST OPTOMETRY LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY PHYSICAL MEDICINE REHABILITATION Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 90 of 256 FIRST NAME ROBERT ROBERT JESSICA KENT SCOTT LISA MICHAEL MICHAEL WILLOW KARL CHRISTOPHER MARK DONALD DAVID DAVID CARL CHARLES MARK JAMES RENEE JEFFREY JEFFREY TIMOTHY CHEROKEE DERRICK WILLIAM WILLIAM PAM CYNTHIA ROBERT SUSAN SUSAN JUSTEN THOMAS THOMAS BRADY BRADY DENNIS DEBRA WENDY WENDY MARK SCOTT CHADLEY BETSY MARY KATHLEEN KATHLEEN VALERI MARY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME ROSENBAUM ROSENBAUM ROSENCRANZ ROSENGREN ROSS ROSS ROSSI ROSSI ROSSMILLER ROSSTON ROST ROTAR ROTEN ROTH ROTH ROTH ROTHBERG ROTHMAN ROUGLE ROULLIER-MADRIGAL ROUSH ROUSH ROUX ROVA ROWE ROWE ROWE ROX RUBIO RUBLE RUCINSKI RUCINSKI RUDOLPH RUDOLPH RUDOLPH RUFF RUFF RUGGERIE RUGGIERO RUGGLES RUGGLES RUMANS RUNDLE RUNYAN RUSHWORTH RUSSELL RUSSELL RUSSELL RUSSELL RUSSELL LICENSE MD MD PT PSYD MD MD PAC PAC LCPC LCSW PA-C MD MD MD MD OD MD LCPC DO LCSW ND ND MD PA PAC MD MD CNMW MD MD PT MD PA PAC PA PA-C DO PHD PAC PA MD MD MD PHD OT APRN APRN PA OT MEDICAL GROUP CENTER FOR HEALTHY LIVING CENTER FOR HEALTHY LIVING BILLINGS CLINIC NORTHERN MONTANA HOSPITAL BILLINGS CLINIC SVH OB-GYN CLINIC NORTHERN ROCKIES ORTHOPAEDICS MISSOULA BONE & JOINT GREAT FALLS CLINIC NORTHWEST CARDIO PULMONARY ASSOC ROCKY MOUNTAIN HEART & LUNG YOU AND EYE OPTICAL NEUROSURGERY FOR BENEFIS HEALTH SYS PATHWAYS HEALTH CARE CAPITAL CITY NATURAL MEDICINE BENEFIS PHYSICIAN ASSOCIATES ROBERT J KORENBERG MD PC BOZEMAN DEACONESS HOSPITAL UROLOGY GREAT FALLS CLINIC ELIZABETH SETON PRENATAL CLINIC INTERNAL MEDICINE ASSOCIATES KALISPELL REHAB ASSOCIATES PROFESSIONAL THERAPY ASSOCIATES INTERNAL MEDICINE & DIABETES LEWIS & CLARK EMERGENCY PHYSICIANS ST PETERS URGENT CARE ROSEBUD HEALTH CARE GREAT FALLS CLINIC DEERING CLINIC SVH WALK IN CLINIC BILLINGS CLINIC NORTH VALLEY HOSPITAL BENEFIS QUICK CARE BULL RIVER FAMILY MEDICINE COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER HOLY ROSARY HOT SPRINGS FAMILY MEDICINE ADDRESS 2223 MISSION WAY 2223 MISSION WAY 620 S HAYNES 30 13TH ST 1020 N 27TH ST 1611 ZIMMERMAN TRAIL 2831 FORT MISSOULA RD #232 90 HWY 91 S 410 CENTRAL AVE #514 1125 MISSOULA AVE 195 COMMONS LOOP #E 2360 MULLAN RD STE C 3000 15TH AVE S 350 HERITAGE WAY STE 2100 350 HERITAGE WAY STE 2100 120 N 7TH AVE 1101 26TH ST S 336 W SPRUCE ST 200 HERITAGE WAY 32009 TERRACE LAKE RD 33 NEILL AVE STE 102 33 NEILL AVE 1300 28TH ST S STE 10 1821 S AVE W #402 935 HIGHLAND BLVD STE 2160 3000 15TH AVE S 1101 26TH ST S 1230 N 30TH STE 200 905 HIGHLAND BLVD STE 4500 2820 CENTRAL AVE #A 1234 WHITEFISH STAGE RD 1234 WHITEFISH STAGE RD 2019 BROADWATER AVE 2475 BROADWAY 2475 BROADWAY 383 N 17TH AVE 818 2ND AVE EAST 20 13TH ST 715 MAIN ST STE C 123 S 27TH ST 1233 N 30TH ST 801 N 29TH ST 1600 HOSPITAL WAY 500 15TH AVE S 906 7TH ST S 1029 HWY 200 445 CENTENNIAL AVE 41 BARRETT ST 2600 WILSON ST 209 MAIN ST CITY BILLINGS BILLINGS MILES CITY HAVRE BILLINGS BILLINGS MISSOULA DILLON GREAT FALLS HELENA KALISPELL MISSOULA GREAT FALLS KALISPELL KALISPELL BOZEMAN GREAT FALLS MISSOULA KALISPELL RONAN HELENA HELENA GREAT FALLS MISSOULA BOZEMAN GREAT FALLS GREAT FALLS BILLINGS BOZEMAN BILLINGS KALISPELL KALISPELL BILLINGS HELENA HELENA FORSYTH CULBERTSON HAVRE STEVENSVILLE BILLINGS BILLINGS BILLINGS WHITEFISH GREAT FALLS GREAT FALLS NOXON BUTTE DILLON MILES CITY HOT SPRINGS ZIP 59102 59102 59301 59501 59101 59102 59804 59725 59403 59601 59901 59808 59405 59901 59901 59715 59405 59802 59901 59864 59601 59601 59405 59801 59715 59405 59405 59101 59715 59102 59901 59901 59102 59601 59601 59327 59218 59501 59870 59101 59101 59101 59937 59405 59405 59853 59701 59725 59301 59845 SPECIALTY GERIATRIC MEDICINE INTERNAL MEDICINE PHYSICAL THERAPY PSYCHIATRY OCCUPATIONAL/INDUSTRIAL MEDICINE OB/GYN-OBSTETRICS/GYNECOLOGY SURGERY ORTHOPEDIC MEDICINE EMERGENCY MEDICINE/TRAUMA PROFESSIONAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER PHYSICIAN ASSISTANT SURGERY ORTHOPEDIC MEDICINE SURGERY GENERAL CARDIOLOGY CARDIOLOGY OPTOMETRY SURGERY NEUROSURGERY LICENSED BEHAVIORAL COUNSELOR PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER NATUROPATH NATUROPATH INTERNAL MEDICINE DERMATOLOGY FAMILY PRACTICE CARDIOLOGY CARDIOLOGY CERTIFIED NURSE MIDWIFE INTERNAL MEDICINE ANESTHESIOLOGY PHYSICAL THERAPY PHYSICAL THERAPY INTERNAL MEDICINE EMERGENCY MEDICINE/TRAUMA URGENT CARE PROVIDER FAMILY PRACTICE PHYSICIAN ASSISTANT PEDIATRIC CARDIOLOGY PSYCHOLOGY FAMILY PRACTICE FAMILY PRACTICE GASTROENTEROLOGY EMERGENCY MEDICINE/TRAUMA SPORTS MEDICINE PSYCHOLOGY OCCUPATIONAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE OCCUPATIONAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 91 of 256 FIRST NAME ERIN MARY LESLIE KATHLEEN MARY TERRI ANTHONY AIMEE SCOTT ROBERT EDWARD SARAH TIMOTHY MARK KRISTI KATIE LINDA MARILYN DONNA ERIC CAMILLA ROBERT GAYLE STEVEN DOUGLAS WILLIAM WAYNE ROBERT JESSE JESSE DENNIS JESSE SUZY BETH SCOTT RUTH MARJORIE SONJA KERRY RUBEN RENEE RENEE TIMOTHY HANNA CHARLOTTE JOHN MICHAEL MICHAEL ROGER ANTONIO Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME RUSSELL RUSSELL RUSSELL RUSSELL RUSSELL RUSSELL RUSSO RUST RUTA RUTH RYAN RYAN RYAN RYAN RYDEEN RYE RYKOWSKI RYLEY RYNGALA SABERHAGEN SABERHAGEN SACHS SACRY SACRY SAFLEY SAGE SAGER SAHLI SALISBURY SALISBURY SALISBURY SALISBURY SALTIEL SALUSSO SAMPLE SAMPSON SAMSOE SAMSOONDAR SANCHEZ SANCHEZ SANCHEZ SANCHEZ SANDERS SANDERS SANDERSON SANDO SANDRY SANDRY SANTALA SANTIN LICENSE OT OT MD APRN OT LAC MD LCPC MSPT MD LCPC MD DC LCPC NP LCPC LCPC PHD MD MD MD MD PAC OD MD MD PT MD MD MD MD LCSW PT DO MD PAC OD OD LCPC LCPC PAC MD NP DC PT PT MD MD MEDICAL GROUP MOSAIC INC PLAINS FAMILY MEDICINE RADIOLOGY MONTANA SHERIDAN COMMUNITY HEALTH CENTER THOMPSON FALLS FAMILY MEDICINE MONTANA ORTHOPEDICS YELLOWSTONE COUNSELING CENTER WHITEFISH PHYSICAL THERAPY & SPORTS GABERT MEDICAL SERVICES BEHAVIORAL HEALTH ASSOCIATES BILLINGS CLINIC RYAN CHIROPRACTIC CLINIC WHITEHALL ALTACARE PROGRAM RYDEEN CLINICAL SERVICES BILLINGS CLINC WEST BILLINGS CLINIC BILLINGS CLINIC WHITEHALL MEDICAL CLINIC WHITEHALL MEDICAL CLINIC HAVRE OPTOMETRIC CLINIC ST PETERS MEDICAL GROUP ROCKY MOUNTAIN CLINIC ENNIS PHYSICAL THERAPY COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER ROCKY MOUNTAIN CLINIC SHERIDAN COMMUNITY HEALTH CENTER SILVERBOW PHYSICAL THERAPY BILLINGS CLINIC GABERT MEDICAL SERVICES BILLINGS EYE CARE BILLINGS EYE CARE BILLINGS CLINIC INJURY CENTER/SPORTS MEDICINE BILLINGS CLINIC LOLO PHYSICAL THERAPY BILLINGS CLINIC MONTANA PLASTIC SURGERY CENTER ADDRESS 6325 JACKRABBIT LN STE A 10 KRUGER RD 401 15TH AVE S STE 204 317 MADISON ST 120 POND ST 25 S EWING ST STE 424 435 S CRYSTAL STE 400 208 N BROADWAY STE 423 2006 HOSPITAL WAY 107 DILWORTH ST 1101 N 27TH ST STE 201 801 N 29TH ST 690 N MERIDIAN RD #214 401 N DIVISION ST 1014 CLARK ST 219 E MAIN ST 2434 12 LILLIS LN 1609 W BABCOCK 125 BANK ST STE 310 2675 CENTRAL AVE 801 N 29TH ST 801 N 29TH ST 108 1ST ST W 108 1ST ST W 416 3RD AVE 2550 BROADWAY 435 S CRYSTAL STE 300 110 S 1ST ST 445 CENTENNIAL 41 BARRETT ST 435 S CRYSTAL STE 300 317 MADISON ST 2006 STADIUM DR #C 3718 E LAKE ST STE A 1020 N 27TH ST 900 N ORANGE STE 207 2835 FORT MISSOULA RD 107 DILWORTH ST 1445 AVE B 1445 AVE B FINLEN HOTEL 100 E BROADWAY FINLEN HOTEL 100 E BROADWAY 2702 8TH AVE N 1401 25TH ST S 1020 N 27TH ST 22 W FRONT ST 106 TYLER WAY 106 TYLER WAY 801 N 29TH ST 1600 9TH ST S CITY BELGRADE PLAINS GREAT FALLS SHERIDAN THOMPSON FALLS HELENA BUTTE BILLINGS WHITEFISH GLENDIVE BILLINGS BILLINGS KALISPELL WHITEHALL DEER LODGE MISSOULA BILLINGS BOZEMAN MISSOULA BILLINGS BILLINGS BILLINGS WHITEHALL WHITEHALL HAVRE HELENA BUTTE ENNIS BUTTE DILLON BUTTE SHERIDAN BOZEMAN BUTTE BILLINGS MISSOULA MISSOULA GLENDIVE BILLINGS BILLINGS BUTTE BUTTE BILLINGS GREAT FALLS BILLINGS BUTTE LOLO LOLO BILLINGS GREAT FALLS ZIP 59714 59859 59405 59749 59873 59601 59701 59101 59937 59330 59101 59101 59901 59759 59722 59801 59102 59715 59802 59102 59101 59101 59759 59759 59501 59601 59701 59729 59701 59725 59701 59749 59715 59701 59101 59801 59804 59330 59102 59102 59701 59701 59101 59405 59101 59701 59847 59847 59101 59405 SPECIALTY OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY RADIOLOGY FAMILY PRACTICE OCCUPATIONAL THERAPY LICENSED ADDICTION COUNSELOR SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SURGERY UROLOGICAL UROLOGY CHIROPRACTIC LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY INTERNAL MEDICINE INFECTIOUS DISEASES INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE OPTOMETRY EAR/NOSE/THROAT (ENT) PEDIATRICS PHYSICAL THERAPY INTERNAL MEDICINE INTERNAL MEDICINE FAMILY PRACTICE INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY CARDIOLOGY ENDOCRINOLOGY EMERGENCY MEDICINE/TRAUMA INTERNAL MEDICINE OPTOMETRY OPTOMETRY LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE PHYSICAL MEDICINE REHABILITATION CARDIOLOGY CHIROPRACTIC PHYSICAL THERAPY PHYSICAL THERAPIST HEMATOLOGY-ONCOLOGY SURGERY PLASTIC/RESTORATIVEBURN Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED 92 of 256 FIRST NAME MARK PHYLLIS PHYLLIS PHYLLIS PHYLLIS ANGELA ANGELA ANGELA MARY RICHARD RICHARD SHEILA DAN THOMAS CARISA J PATRICK LINDA KAREN ANDREA ELLEN LON DONALD ROBERT JESSICA KARRIN LISA PEGGY THOMAS KELLY JOHN KATHRYN KATHLEEN CYRIL DAVID DALE JOHN JEFFREY JOHN ERIC ERIC LARRY CRISTIN JESSE JOHN ANDREW KRISTI JOHN MARTIN ELIZABETH ELIZABETH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SANZ SAPIENZA SAPIENZA SAPIENZA SAPIENZA SAPORITA SAPORITA SAPORITA SARFF SARGENT SARGENT SARMIENTO SATCHELL SATHER SAUBY SAUER SAUNDERS SAUNDERS SAVAGE SAVAGE SAVIK SAWDEY SAWIN SAWYER SAX SCALPCANE SCANSON SCARBOROUGH SCARIANO SCHAACK SCHABEL SCHACHMAN SCHAEFER SCHAEFER SCHAEFER SCHAEFFER SCHAFFER SCHALLENKAMP SCHALLOCK SCHALLOCK SCHARFE SCHARNWEBER SCHARNWEBER SCHATTELES SCHIEBER SCHIED SCHIEFFELBEIN SCHIFFERT SCHILLING SCHILLING LICENSE MD MD MD DO DO PT PT PT LCPC MD MD PAC DC OD OT MD DO LCSW LCPC LCPC DC DO MD NP APRN LAC APRN MD LAC LCPC LAC MD NP APRN MD MD DO MD MD PAC PAC PAC DC DC MD DC OD LCSW MD MD MD MEDICAL GROUP CPG ON NORTH RESERVE CPG STEVENSVILLE COMMUNITY MED CNTR CORVALLIS PHYSICAL THERAPY DARBY PHYSICAL THERAPY HAMILTON PHYSICAL THERAPY BEHAVIORAL HEALTH ASSOCIATES SAGE MEDICAL CLINIC ST PETERS MEDICAL GROUP BILLINGS CLINIC SPINE AND SPORTS CHIROPRACTIC BILLINGS CLINIC BILLINGS CLINIC SVH HOSPITALIST PROGRAM AWARE INC SAVIK CHIROPRACTIC PEDIATRIC SURGERY OF MONTANA BILLINGS CLINIC WOMENS HEALTH WESTERN MONTANA ADDICTION SVC PARK CLINIC MONTANA ALLERGY TURNING POINT ADDICTION SERVICES BRIDGER ORTHOPEDIC AND SPORTS BELGRADE URGENT CARE ANACONDA INTERNAL MEDICINE SCHAEFER PSYCHIATRIC SERVICES MONTANA NEUROBEHAVIORAL SPECIALISTS SIDNEY HEALTH CENTER CLINIC BILLINGS CLINIC BILLINGS CLINIC ST LUKE COMM CLINIC POLSON BILLINGS CLINIC CORNERSTONE WELLNESS CENTER CORNERSTONE WELLNESS CENTER MATZ FAMILY CHIROPRACTIC CENTER FOR MENTAL HEALTH HEIGHTS FAMILY PRACTICE SILVERTIP EMERGENCY PHYSICIANS SILVERTIP EMERGENCY PHYSICIANS ADDRESS 500 W BROADWAY #320 2230 N RESERVE #402 3800 EASTSIDE HWY 5549 OLD HWY 93 715 MAIN ST #A 1050 EASTSIDE HWY 502 N MAIN #900 336 FAIRGROUNDS RD 1101 N 27TH ST #201 820 N MONTANA AVE 2550 BROADWAY 801 N 29TH ST 321 W MAIN ST 1007 W COLLEGE ST 801 N 29TH ST 2800 10TH AVE N 1233 N 30TH ST 230 14TH ST E 600 6TH ST NW STE 4 325 10TH ST 112 3RD ST E 105 5TH AVE EAST 2835 FT MISSOULA RD #301 1020 N 27TH ST 75 CLAREMONT ST STE A 802 MAIN ST STE C 1001 RIVER DR 2900 12TH AVE N 302E 1325 WYOMING ST 1501 14TH ST W #230 1450 ELLIS ST STE 201 403 W MAIN ST 1102 E COMMERCIAL 4185 N MONTANA AVE STE 5 1300 28TH ST S STE 7 900 N ORANGE 3RD FLOOR 214 14TH AVE SW 801 N 29TH ST 1020 N 27TH ST 104 RUFUS LN 801 N 29TH ST 2722 BILLINGS AVE 2722 BILLINGS AVE 221 5TH AVE S 1519 S RESERVE ST 2203 BROADWATER AVE 514 S FRONT ST 32 WICKS LN 310 SUNNYVIEW LN 310 SUNNYVIEW LN CITY MISSOULA MISSOULA STEVENSVILLE FLORENCE STEVENSVILLE CORVALLIS DARBY HAMILTON BILLINGS HELENA HELENA BILLINGS BELGRADE BOZEMAN BILLINGS BILLINGS BILLINGS KALISPELL GREAT FALLS HAVRE KALISPELL SCOBEY MISSOULA BILLINGS KALISPELL POLSON LIVINGSTON BILLINGS MISSOULA BILLINGS BOZEMAN BELGRADE ANACONDA HELENA GREAT FALLS MISSOULA SIDNEY BILLINGS BILLINGS POLSON BILLINGS HELENA HELENA GLASGOW MISSOULA BILLINGS GREAT FALLS BILLINGS KALISPELL KALISPELL ZIP 59802 59808 59870 59833 59870 59828 59829 59840 59101 59624 59601 59101 59714 59715 59101 59101 59101 59901 59404 59501 59901 59263 59804 59101 59901 59860 59047 59101 59801 59102 59715 59714 59711 59602 59405 59802 59270 59101 59101 59860 59101 59601 59601 59230 59801 59102 59403 59105 59901 59901 SPECIALTY CARDIOVASCULAR DISEASE GENERAL PRACTICE GENERAL PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE SURGERY UROLOGICAL UROLOGY CHIROPRACTIC OPTOMETRIST OCCUPATIONAL THERAPY PEDIATRICS HOSPITALIST LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC GENERAL PRACTICE PEDIATRIC SURGERY PSYCHIATRY OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED ADDICTION COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY ALLERGY/IMMUNOLOGY LICENSED ADDICTION COUNSELOR PROFESSIONAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE PSYCHIATRY SURGERY NEUROSURGERY NEUROLOGY OB/GYN-OBSTETRICS/GYNECOLOGY RADIATION ONCOLOGY CARDIOLOGY FAMILY PRACTICE NEUROLOGY CHIROPRACTIC CHIROPRACTIC INTERNAL MEDICINE CHIROPRACTIC OPTOMETRY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA Montana STATUS SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 93 of 256 FIRST NAME ROBERT PATRICIA MARGARET PEGGY TAMARA SARAH GUY RODNEY RODNEY ANGELA FRANK FRANK LISA ANDREW MELANIE CHARLENE JAMES JAMES DAVID LANNY JANET SHIRLEY SHIRLEY RONALD MARIA BRIAN SUZANNE ROBERT ROBERT SAMANTHA KATHLEEN TRACIE ERIK TERRY JEFFREY JEFFREY PHILIP AMY MARK MARK ALISON ROBERT DONALD DUANE THOMAS GARY DONALD GARY ERICA RALF Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SCHIMPFF SCHINDELDECKER SCHLESINGER SCHLESINGER SCHMALZ SCHMAUTZ SCHMIDT SCHMIDT SCHMIDT SCHMIDT SCHMIDT SCHMIDT SCHMIESING SMITH SCHMITT SCHMITZ SCHMITZ SCHMUTZ SCHMUTZ SCHNEIDER SCHNEIDER SCHNEIDER SCHNEITER SCHNEITER SCHNIER SCHNITZER SCHNITZER SCHOELCH SCHOENE SCHOENE SCHOENEMAN SCHRETENTHALER SCHROEDER SCHROEDER SCHROEDER SCHROEDER SCHROEDER SCHRUMPF SCHUETT SCHULEIN SCHULKE SCHULTE SCHULTZ SCHULTZ SCHULTZ SCHULTZ SCHUMACHER SCHUMACHER SCHUMACHER SCHUPPE SCHURMANN LICENSE MD LCPC MD MD LCPC LAC PT MD PA PA LCPC MD MD LCSW MD PAC LCSW MD MD MD PAC LCSW RD RD MD MD MD MD MD MD PT PT PT MD LCPC PHD PHD DPM MD MD MD LCPC MD MD MD CRNA MD MD MD OT DC MEDICAL GROUP PEDIATRICS SPECIALTY CLINIC BILLINGS CLINIC EUREKA HEALTH NORTHWEST ORTHOPEDIC & SPORTS MED SCHMIDT COUNSELING AND CONSULTING L CENTER FOR MENTAL HEALTH BILLINGS ANESTHESIOLOGY BILLINGS CLINIC CENTER FOR MENTAL HEALTH MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING ASSOC OF IDAHO FALL ANESTHESIA PARTNERS OF MONTANA BILLINGS CLINIC CROSSWAY COUNSELING CMC DIABETES AND NUTRITION CENTER CPG DIABETES & NUTRITION PLAINS FAMILY MEDICINE ROGERS DERMATOLOGY CLINIC INTERNAL MEDICINE ASSOCIATES INTERNAL MEDICINE ASSOCIATES ALPINE PHYSICAL THERAPY YELLOWSTONE PHYSICAL THERAPY ADVANCED REHABILITATIVE SERVICES FLATHEAD VALLEY ORTHOPEDICS WESTERN MONTANA MENTAL HEALTH CTR ACTIVE FEET CLINIC BILLINGS CLINIC LIVINGSTON MEMORIAL HOSPITAL ST VINCENT PHYSICIAN NETWORK ADULT & CHILD COUNSELING BILLINGS CLINIC HELENA LABORATORY PHYSICIANS YELLOWSTONE PATHOLOGISTS PC GREAT FALLS CLINIC NORTHWEST IMAGING RADIOLOGY MONTANA CAPITOL CHIROPRACTIC ADDRESS 495 N MAIN ST 115 W 3RD ST #107 2835 FT MISSOULA RD #301 PO BOX 2427 208 N 29TH ST #235 111 SUNNYVIEW LN STE B 2702 8TH AVE N 298 OSLOSKI RD 350 HERITAGE WAY STE 1200 1643 24TH ST W STE 210 1739 SPRING CREEK LN 2877 OVERLAND AVE #C 900 N JACKSON ST 401 N 31ST ST STE 1260 801 N 29TH ST 312 3RD ST 310 SANSOME ST 90 HWY 91 S 2900 12TH AVE N STE 205W 2702 8TH AVE N 848 MAIN ST STE 8A 2827 FORT MISSOULA RD 1211 S RESERVE ST #202 210 SUNNYVIEW LN STE 101 10 KRUGER RD 3419 CENTRAL AVE STE B 1727 W COLLEGE AVE 905 HIGHLAND BLVD STE 4500 905 HIGHLAND BLVD STE 4500 5000 BLUE MOUNTAIN RD 1201 US HWY 10 W STE E 200 COMMONS WAY STE B 111 SUNNYVIEW LN 410 WINDWARD WAY 500 W BROADWAY 5549 OLD HWY 93 610 W SPRUCE ST 1020 N 27TH ST 504 S 13TH ST 2019 BROADWATER AVE 111 N LAST CHANCE GULCH STE 2A 2702 8TH AVE N 2475 BROADWAY 2900 12TH AVE N #295W 221 5TH AVE S 3000 15TH AVE S 320 SUNNYVIEW LN 401 15TH AVE S STE 204 2500 GRAND AVE #R 1732 PROSPECT AVE CITY KALISPELL STEVENSVILLE MISSOULA MISSOULA BILLINGS KALISPELL BILLINGS EUREKA KALISPELL BILLINGS BILLINGS BILLINGS HELENA BILLINGS BILLINGS GREAT FALLS PHILIPSBURG DILLON BILLINGS BILLINGS BILLINGS MISSOULA MISSOULA KALISPELL PLAINS BILLINGS BOZEMAN BOZEMAN BOZEMAN MISSOULA LIVINGSTON KALISPELL KALISPELL KALISPELL MISSOULA FLORENCE MISSOULA BILLINGS LIVINGSTON BILLINGS HELENA BILLINGS HELENA BILLINGS GLASGOW GREAT FALLS KALISPELL GREAT FALLS BILLINGS HELENA ZIP 59901 59870 59804 59806 59101 59901 59101 59917 59901 59102 59102 59102 59601 59101 59101 59403 59858 59725 59101 59101 59105 59804 59804 59901 59859 59102 59715 59715 59715 59804 59047 59901 59901 59901 59802 59833 59802 59101 59047 59102 59601 59101 59601 59101 59230 59405 59904 59405 59102 59601 SPECIALTY NEUROLOGY LICENSED BEHAVIORAL COUNSELOR RHEUMATOLOGY RHEUMATOLOGY PROFESSIONAL COUNSELOR PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR ORTHOPAEDIC SURGERY ORTHOPAEDIC SURGERY LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER RADIOLOGY RADIOLOGY ANESTHESIOLOGY SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER NUTRITION PROFESSIONAL NUTRITION PROFESSIONAL SURGERY GENERAL FAMILY PRACTICE FAMILY PRACTICE DERMATOLOGY INTERNAL MEDICINE PULMONARY DISEASES PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY SPORTS MEDICINE LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGIST PSYCHOLOGIST PODIATRY PSYCHIATRY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE PATHOLOGY PATHOLOGY NURSE ANESTHETIST RADIOLOGY RADIOLOGY RADIOLOGY OCCUPATIONAL THERAPIST CHIROPRACTIC Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 94 of 256 FIRST NAME MICHAEL JOHN RYAN AMY STEPHANIE SUSANNE CAROL ERIN TANYA TED GEORGE JOHN SALLY SARAH TAMMY JEFFREY JOHN LESLIE SARAH SARAH TAMMY SUSAN JAMES TERRENCE ANNE KRISTIN ERIC PATRICK LAURELI NATALIE DALLAS SCOTT STANLEY GEORGE MARK CASSIE CASSIE SCOTT ERICA MICHAEL MICHAEL MICHAEL DANIEL KELLI RANDALE ANDREW MEG NADINE DAVID JAMES TYLER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SCHUTTE SCHVANEVELDT SCHWANKE SCHWANKE SCHWARZ SCHWEIZER SCHWEND SHOPE SCHWISOW SCIUCHETTI SCOFIELD SCORDALAKES SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT SCOTT-MARKLE SCOTT-TILLERY SCRANTON SCRENAR SCRIBNER SEA BURGER SEABER SEAGER SEAGRAVES SEAL SEARLE SEARLE SEARS SEAS SEATON SEATON SEATON SEBASTIAN SEBESTYEN SECHREST SEDDON SEGAL SEGER SEGERSTROM SEIBLY SEICK LICENSE MD MD MD MD DO OT PT SLT OT MD MD PA PT MD PA MD PA MD MD MD PA NP MD MD LCPC MD PAC PT NP LCPC ACU PAC MD MD PA PA MD MD MD MD MD PT PAC MD MD LCPC MD LCSW MD PAC MEDICAL GROUP NORTHERN ROCKIES ORTHOPAEDICS GLACIER EAR NOSE & THROAT BILLINGS CLINIC RIVERSTONE HEALTH SOUND INPATIENT ST PETERS HOSPITAL REHABILITATION ST PETERS HOSPITAL CMC OUTPATIENT THERAPIES BILLINGS CLINIC WEST PARK CLINIC SIDNEY CLINIC BENEFIS QUICK CARE BILLINGS CLINIC CANCER SPECIALISTS OF CMC COMMUNITY PHYSICIANS ON RESERVE GREAT FALLS CLINIC INJURY CENTER MISSOULA VALLEY PEDIATRICS MONTANA CANCER SPECIALISTS MONTANA CANCER SPECIALISTS AT CMC MOUNTAIN VIEW FAMILY MEDICINE & OB SHIELDS VALLEY HEALTH CENTER SIDNEY HEALTH CENTER BILLINGS CLINIC ABSORKA EMERGENCY PHYSICIANS HEUISER PHYSICAL THERAPY ACUPUNCTURE CLINIC OF MISSOULA NEUROSCIENCE & SPINE INSTITUTE BENEFIS PHYSICIAN ASSOCIATES ST PETERS URGENT CARE INTERNAL MEDICINE ASSOCIATES WEST GRAND FAMILY MEDICINE COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER SHERIDAN COMMUNITY HEALTH CENTER WEST BILLINGS PHYSICAL THERAPY HELENA ORTHOPAEDIC CLINIC BILLINGS CLINIC BILLINGS CLINIC ADVANCED PAIN CENTERS OF MONTANA ST PETERS HOSPITAL ROCKY MOUNTAIN HEART & LUNG ADDRESS 2831 FORT MISSOULA RD STE 232 160 HERITAGE WAY 2675 CENTRAL AVE 123 S 27TH ST 2827 FORT MISSOULA RD 2475 BROADWAY 2475 BROADWAY 2827 FORT MISSOULA RD 2675 CENTRAL AVE 1001 RIVER DR 214 14TH AVE SW 500 15TH AVE S 2800 10TH AVE NORTH 2827 FT MISSOULA RD 2230 N RESERVE #402 1400 29TH ST S 1401 25TH ST S 2835 FORT MISSOULA RD #205 500 W BROADWAY 2827 FORT MISSOULA RD 2835 FORT MISSOULA RD #101 309 ELLIOT ST N 216 14TH AVE SW 401 S ALABAMA 305 1ST AVE W 1020 N 27TH ST 915 HIGHLAND BLVD 3180 DREDGE DR STE F 25 1ST AVE W 201 W MADISON STE 205 3031 S RUSSELL STE 1 200 COMMONS WAY STE 2 500 W BROADWAY 2800 11TH AVE S STE 14 2475 BROADWAY 2475 BROADWAY 2900 12TH AVE N STE 310W 2750 GRAND AVE 445 CENTENNIAL AVE 41 BARRETT ST 317 MADISON ST 3307 GRAND AVE STE 203 2442 WINNE AVE 500 W BROADWAY 801 N 29TH ST 1600 ELLIS ST 1C 2800 10TH AVE N 2835 FT MISSOULA RD STE 204 2475 BROADWAY 350 HERITAGE WAY #2100 CITY MISSOULA KALISPELL BILLINGS BILLINGS MISSOULA HELENA HELENA MISSOULA BILLINGS LIVINGSTON SIDNEY GREAT FALLS BILLINGS MISSOULA MISSOULA GREAT FALLS GREAT FALLS MISSOULA MISSOULA MISSOULA MISSOULA WILSALL SIDNEY BUTTE COLUMBIA FALLS BILLINGS BOZEMAN HELENA ROUNDUP BELGRADE MISSOULA KALISPELL MISSOULA GREAT FALLS HELENA HELENA BILLINGS BILLINGS BUTTE DILLON SHERIDAN BILLINGS HELENA MISSOULA BILLINGS BOZEMAN BILLINGS MISSOULA HELENA KALISPELL ZIP 59804 59901 59102 59101 59804 59601 59601 59804 59102 59047 59270 59405 59101 59801 59808 59405 59405 59804 59802 59804 59804 59086 59270 59701 59912 59101 59715 59602 59072 59714 59801 59901 59802 59405 59601 59601 59101 59102 59701 59725 59749 59102 59601 59802 59101 59715 59101 59804 59601 59901 SPECIALTY SURGERY ORTHOPEDIC MEDICINE EAR/NOSE/THROAT (ENT) FAMILY PRACTICE FAMILY PRACTICE HOSPITALIST OCCUPATIONAL THERAPY PHYSICAL THERAPY SPEECH/LANGUAGE THERAPY OCCUPATIONAL THERAPY INTERNAL MEDICINE PEDIATRICS SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY HEMATOLOGY-ONCOLOGY FAMILY PRACTICE PEDIATRICS SURGERY ORTHOPEDIC MEDICINE PEDIATRICS HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE UROLOGY LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY EMERGENCY MEDICINE/TRAUMA PHYSICAL THERAPY NURSE PRACTITIONER LICENSED BEHAVIORAL COUNSELOR ACUPUNCTURIST SURGERY NEUROSURGERY HOSPITALIST SURGERY UROLOGICAL UROLOGY URGENT CARE PROVIDER EMERGENCY MEDICINE/TRAUMA INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE ORTHOPAEDIC SURGERY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PEDIATRICS LICENSED CLINICAL SOCIAL WORKER RADIOLOGY CARDIOLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING 95 of 256 FIRST NAME FRANK TRISTAN NANCY TRACI RICHARD RICHARD AMY AMY RICHARD KATE PAUL PAUL JOAN STEPHANIE KAREN ROSEMARY LISA CURTIS MICHAEL SHANNON PHILIP LARRY SAUNDRA MARC VANESSA HANNAH HANNAH HANNAH TIM TIM JAMES DARCI JAMES SHAFI JOAN SHAWN STEVEN GREGORY SHEILA DAVID RENEE COURTNIE STEPHEN JAY ALAN SUZANNE SUZANNE SIDNEY LORNA KATHLEEN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SEIDELMANN SEITZ SELDIN SELL SELLMAN SELLMAN SELLMAN SELLMAN SELLMAN SELLS SELLS SELLS SELTZER SELZLER SENFFT SEPPI SESSIONS SETTERGREN SETTEVENDEMIE SETZER POOLE SEU SEVERA SEWELL SEWELL SEXSON SEXTON SEXTON SEXTON SEYMOUR SEYMOUR SEYMOUR SGRIGNOLI SHAD SHAFAIEH SHALLCROSS SHANAHAN SHANEYFELT SHANKS SHAPIRO SHAPNICK SHARPSTEN SHATWELL SHAUB SHAVER SHAW SHAW SHAW SHAW SHEA SHEA LICENSE DO MD LCPC SLT MD MD PT PT MD LAC LCSW LCSW LAC RD LCPC OT MD MD LCPC MD MD MD NP LCPC LCPC PAC PAC PA PAC PAC LCPC OT PT MD PT APRN MD LCPC NP MD PAC RD DO PT DPM MD MD LCPC APRN LCSW MEDICAL GROUP MONTANA INTERVENTIONAL & DIAGNOSTIC CENTER FOR INTEGRATIVE CARE PEDIATRIC THERAPY CLINIC ALLERGY & ASTHMA CENTER ALLERGY & ASTHMA CENTER ELEMENT PHYSICAL THERAPY WESTERN MONTANA ADDICTION SERVICES WESTERN MONTANA MENTAL HEALTH CTR WESTERN MONTANA ADDICTION SERVICES BILLINGS CLINIC CENTER FOR MENTAL HEALTH THE COZY NEST ROCKY MOUNTAIN CLINIC ORTHO MONTANA BLACKFOOT BEHAVORIAL HEALTH BIG SKY DERMATOLOGY & SKIN CANCER BILLINGS CLINIC BOZEMAN DEACONESS HEALTH GROUP PALL SEWELL COUNSELING BALGRADE URGENT CARE PARK CLINIC TETON MEDICAL CNTR COMMUNITY/CLINIC OUTPOST CLINIC WEST GLACIER OF NORTH VALLEY HOSP NEURO REHAB ASSOC BARRETT HOSPITAL & HEALTHCARE WOMENS HEALTH SHANEYFELT GASTROENTEROLOGY MONTANA NEUROBEHAVIORAL FLATHEAD VALLEY WOMEN'S CENTER BIG SKY EYE LLC GREAT FALLS CLINIC INTERNAL MEDICINE & DIABETES HEIGHTS FAMILY PRACTICE NORTHERN PHYSICAL THERAPY COMMUNITY HEALTH PARTNERS GREAT FALLS CLINIC RADIOLOGY MONTANA LIBBY CLINIC ADDRESS 2969 AIRPORT RD STE C 2475 BROADWAY 336 W SPRUCE ST 50 27TH ST N STE A 75 CLAREMONT 900 N ORANGE #207 2455 DIXON AVE #A U OF M SKAGGS BLDG #129 601 W SPRUCE STE K 1325 WYOMING ST 1315 WYOMING 815 E FRONT #1 1325 WYOMING ST 2800 10TH AVE N 1900 2ND AVE S 1276 N 15TH AVE STE 101 435 S CRYSTAL STE 300 2900 12TH AVE N #140W 415 N HIGGINS 1600 ELLIS ST STE 3B 2820 CENTRAL AVE #A 801 N 29TH ST 915 HIGHLAND BLVD 2139 BROADWAY AVE LOWER LEVEL 2115 DURSTON RD #9 403 W MAIN ST 1001 RIVER DR 915 4TH ST NW 1045 GLADES DR 100 RHEA RD 1125 MISSOULA AVE 2135 CHARLOTTE ST STE 3 234 ANNIE GLADE DR 30 HWY 91 S #102 90 HWY 91 S 75 CLAREMONT STE A 931 HIGHLAND BLVD STE 3330 900 N ORANGE 3RD FLOOR 210 SUNNYVIEW LN #107 401 S ALABAMA ST 3000 15TH AVE S 2019 BROADWATER AVE 32 WICKS LN 1111 BAKER AVE STE 2 126 S MAIN 3000 15TH AVE S 401 15TH AVE S STE 204 500 N HIGGINS AVE #109 211 E SECOND ST 21 N LAST CHANCE GULCH #200 CITY HELENA HELENA MISSOULA BILLINGS KALISPELL MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA BILLINGS GREAT FALLS BOZEMAN BUTTE BILLINGS MISSOULA BOZEMAN BILLINGS BILLINGS BOZEMAN BILLINGS BOZEMAN BELGRADE LIVINGSTON CHOTEAU WHITEFISH WEST GLACIER HELENA BOZEMAN BOZEMAN DILLON DILLON KALISPELL BOZEMAN MISSOULA KALISPELL BUTTE GREAT FALLS BILLINGS BILLINGS WHITEFISH LIVINGSTON GREAT FALLS GREAT FALLS MISSOULA LIBBY HELENA ZIP 59601 59601 59802 59102 59901 59802 59801 59812 59802 59801 59801 59802 59801 59101 59405 59715 59701 59101 59801 59715 59102 59101 59715 59102 59718 59714 59047 59422 59937 59936 59601 59718 59718 59725 59725 59901 59715 59802 59901 59701 59405 59102 59105 59937 59047 59405 59405 59802 59923 59601 SPECIALTY RADIOLOGY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY PULMONARY DISEASES PULMONARY DISEASES PHYSICAL THERAPY PHYSICAL THERAPY PULMONARY DISEASES ADDICTIONNICOTINECOUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER ADDICTIONNICOTINECOUNSELOR NUTRITION PROFESSIONAL LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR DERMATOLOGY SURGERY FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR URGENT CARE PROVIDER FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY PHYSICAL THERAPY SURGERY PHYSICAL THERAPY OB/GYN-OBSTETRICS/GYNECOLOGY GASTROENTEROLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE OPHTHALMOLOGY FAMILY PRACTICE NUTRITION PROFESSIONAL FAMILY PRACTICE PHYSICAL THERAPY PODIATRY RADIOLOGY RADIOLOGY PROFESSIONAL COUNSELOR FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 96 of 256 FIRST NAME KEVIN MARGARET ALAN GEORGE CLIFFORD KEVIN KEVIN JOEL MARK DAVID DAVID ERIC CARYL LAURA LAURA ALFRED LYNN PAUL DAVID ROBERT TRUDY SANDRA DEBRA SANDRA RACHEL RACHEL RACHEL FLYNN ROBERT ROBERT COLIN COLIN CRYSTAL SANG STACY MOHAN KIETH ELIZABETH HEIDI RANDY RANDY RANDY PAUL PAUL MOLLY RALPH RALPH RALPH MARY BETH MARY BETH Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SHEA SHEA SHEAR SHECKLETON SHEEHAN SHEEHAN SHEEHAN SHEHAN SHEIKO SHELDON SHELDON SHELKEY SHELTON SHELTON SHELTON SHEN SHENK SHENK SHENTON SHEPARD SHEPARD SHEPHERD SHEPPARD SHEPPARD SHERBA SHERBA SHERBA SHERICK SHERRICK SHERRICK SHERRILL SHERRILL SHETLEY SHIN SHOMENTO SHRESTHA SHULTZ SHUMAKER SHURSON SIBBITT SIBBITT SIBBITT SIDDOWAY SIDDOWAY SIDDOWAY KING SIEVERS SIEVERS SIEVERS SIEWART SIEWERT LICENSE MD LCSW LAC PA MD MD MD MD MD MD MD RPT LCSW MD MD MD DO MD MD MD NP MD PHD OD PT PT PT DPM MD MD MD MD APRN MD MD MD MD PT MD MD MD MD MD LCPC MD MD MD APRN APRN MEDICAL GROUP HOT SPRINGS FAMILY MEDICINE PROFESSIONAL THERAPY ASSOCIATES BILLINGS CLINIC NORTHWEST MONTANA SURGICAL ASSOC SURGERY CLINIC AT NORTH VALLEY HOSP ACTIVE PHYSICAL THERAPY LDS FAMILY SERVICES BENEFIS MEDICAL GROUP BILLINGS CLINIC PACIFIC CATARACT & LASER INSTITUTE ORTHO MONTANA MOUNTAIN VIEW FAMILY MEDICINE & OB NORTHERN ROCKIES NEUROPSYCHOLOGY CNTR FOR PHYSICAL THERAPY FLORENCE THERAPY AND WELLNESS SAPPHIRE PHYSICAL THERAPY ANKLE & FOOT CARE CLINIC PATHWAYS TREATMENT CENTER PATHWAYS TREATMENT CENTER MISSOULA BONE & JOINT MISSOULA BONE & JOINT CONVENIENT CARE CLINIC CLARK FORK EMERGENCY PHYSICIANS BOZEMAN OB/GYN COGENT HEALTHCARE OF MONTANA ANESTHESIA PARTNERS OF MONTANA CREATVIE HEALING LONE PEAK PHYSICAL THERAPY @ BELGRA INTERMOUNTAIN IMAGING CENTER MONTANA INTERVENTIONAL & DIAG RADIOLOGY ST JAMES HEALTHCARE MERCURY STREET MEDICAL SOUTH INPT PHYSICIANS AT ST JAMES BIG SKY RADIOLOGY MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAG ASSOC OF IDAHO FALLS ABSORKA EMERGENCY PHYSICIANS ALPINE ORTHOPEDICS & SPORTS MEDICIN ADDRESS 500 15TH AVE S 305 S 4TH ST E #201 209 MAIN ST 1231 N 29TH ST 500 W BROADWAY #320 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 1234 WHITEFISH STAGE RD 2800 10TH AVE N 1273 BURNS WAY 1111 BAKER AVE #2 618 W GRIFFIN DR STE G 2620 COLONIAL DR STE D 303 N 3RD ST 5549 OLD HWY 93 1101 26TH ST S 801 N 29TH ST 1717 4TH ST S 2900 12TH AVE N 140W 214 S MAIN ST 500 W BROADWAY 2835 FORT MISSOULA RD #101 1655 SHILOH RD STE D 700 S AVE W 1309 HARRISON AVE 5529 OLD US HWY 93 2207 S 3RD ST W 2831 FORT MISSOULA RD #302 200 CONWAY DR 310 SUNNYVIEW LN 10 KRUGER RD 2360 MULLAN RD STE C 1200 WESTWOOD DR 2827 FORT MISSOULA RD 925 HIGHLAND BLVD STE 1210 1101 26TH ST S 2900 12TH AVE N STE 205W 2108 BROADWATER AVE STE 301 403 GALLATIN FARMERS AVE STE 102 435 S CRYSTAL ST STE 250 2475 BROADWAY 400 S CLARK ST 300 W MERCURY 400 S CLARK ST 104 E MAIN ST #204 1101 TEXAS AVE 310 SANSOME ST 90 HWY 91 S 915 HIGHLAND BLVD 536 S COTTONWOOD RD STE 100 CITY GREAT FALLS MISSOULA HOT SPRINGS BILLINGS MISSOULA MISSOULA MISSOULA KALISPELL BILLINGS KALISPELL WHITEFISH BOZEMAN HELENA HAMILTON FLORENCE GREAT FALLS BILLINGS GREAT FALLS BILLINGS BOULDER MISSOULA MISSOULA BILLINGS MISSOULA BUTTE FLORENCE MISSOULA MISSOULA KALISPELL KALISPELL PLAINS MISSOULA HAMILTON MISSOULA BOZEMAN GREAT FALLS BILLINGS BILLINGS BELGRADE BUTTE HELENA BUTTE BUTTE BUTTE BOZEMAN DEER LODGE PHILIPSBURG DILLON BOZEMAN BOZEMAN ZIP 59405 59801 59845 59101 59802 59802 59802 59901 59101 59901 59937 59715 59601 59840 59833 59405 59101 59405 59101 59632 59802 59804 59105 59801 59701 59833 59801 59804 59901 59901 59859 59808 59840 59804 59715 59405 59101 59102 59714 59701 59601 59701 59701 59701 59715 59722 59858 59725 59715 59718 SPECIALTY SURGERY ORTHOPEDIC MEDICINE SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE CARDIOVASCULAR DISEASE INTERNAL MEDICINE INTERNAL MEDICINE PHYSICAL THERAPY PATHOLOGY SURGICAL ONCOLOGY SURGERY GENERAL PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE SURGERY NEUROSURGERY PHYSICAL MEDICINE REHABILITATION OPHTHALMOLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE NURSE PRACTITIONER FAMILY PRACTICE PSYCHOLOGY OPTOMETRY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PODIATRY INTERNAL MEDICINE INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA ENDOCRINOLOGY/REPRODUCTIVE MED HOSPITALIST ANESTHESIOLOGY LICENSED MASSAGE THERAPIST PHYSICAL THERAPY RADIOLOGY RADIOLOGY RADIOLOGY INTERNAL MEDICINE HOSPITALIST LICENSED BEHAVIORAL COUNSELOR RADIOLOGY RADIOLOGY RADIOLOGY EMERGENCY MEDICINE/TRAUMA OCCUPATIONAL THERAPY Montana STATUS SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 97 of 256 FIRST NAME MARYBETH MARY BETH PETER JACQUELINE DAVID HELEN JOHN JOHN SAMUEL CATHERINE SUE MICHAEL MICHAEL JUDITH MEGAN MEGAN MEGAN MICHELE CATHLEEN SHERYL GARRICK GARRICK GARRICK SANDRA MEGHAN KATHERINE JENNIFER MARCUS MICHAEL WILLIAM CINDY CINDY RALPH MARY CORNELIA GEORGE Z'EVA HARNEK HARNEK TIMOTHY TIMOTHY BRIAN AARON RINDO CAROL ALETA ADAM TIMOTHY PATRICIA DONALD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SIEWERT SIEWERT SIKOSKI SIKOSKI SILK SILKMAN SILLERY SILLERY SILLITTI SILVA SILVERBERG SILVERGLAT SILVERGLAT SILVERMAN SILZLY SILZLY SILZLY SIMARD SIMENSEN SIMKINS SIMMONS SIMMONS SIMMONS SIMMONS SIMMS SIMON SIMON THOMAS SIMONICH SIMONS SIMONS SIMPKINS SIMPKINS SIMPSON SIMS SIMUNIC SINELNIK SINGER SINGH SINGH SINTON SINTON SIPPY SIRONI SIRONI SISK SISSON SIX SIX SKERGAN SKILLMAN LICENSE NP NP DO RD MD DC MD MD MD APRN LCPC MD MD LCPC LCSW LCSW LCSW PT NP PT MD MD MD MD APRN LCSW PHD OD OD OD NP NP MSPT MD NP MD LCPC MD MD PAC PA MD LCPC MD NP LCPC DC DC DC MD MEDICAL GROUP MONTANA OCCUPATIONAL HEALTH MONTANA OCCUPATIONAL HEALTH LLC BOZEMAN URGENT CARE CENTER LEWIS & CLARK EMERGENCY PHYSICIANS BILLINGS CLINIC LIVINGSTON HEALTHCARE BILLINGS CLINIC BOZEMAN INTERMOUNTAIN CHILDRENS HOME WESTERN MONTANA MENTAL HEALTH CTR COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER SHERIDAN COMMUNITY HEALTH CENTER ALTA PHYSICAL THERAPY & FITNESS WOMENS HEALTH EPICENTER THERAPY SERVICES FIVE VALLEY UROLOGY FIVE VALLEYS UROLOGY FIVE VALLEYS UROLOGY MISSOULA VALLEY PEDIATRICS INTERMOUNTAIN OPMHC THE CENTER FOR INTEGRATIVE CARE GLACIER PSYCHOLOGICAL SERVICES RONAN EYE CLINIC MONTANA EYECARE MONTANA EYECARE GREAT FALLS CLINIC PREMIER CARE PEDIATRICS MANUAL ORTHOPEDIC & SPORTS THERAPY GLACIER COMMUNITY HEATH CENTER HOLY ROSARY HEALTHCARE CLINIC SOUTH INPT PHYSICIANS AT ST JAMES GREAT FALLS CLINIC LEWIS & CLARK EMERGENCY PHYSICIANS ROCKY MOUNTAIN EYE CENTER CHRISTIAN COUNSELING & EDUCATION FO CONTINENTAL DIVIDE OBGYN BOZEMAN DEACONESS HEALTH GROUP BROADWATER FAMILY CHIROPRACTIC ST PETERS HOSPITAL ADDRESS 935 HIGHLAND BLVD STE 2180 935 HIGHLAND BLVD STE 2180 1006 W MAIN 1006 W MAIN 2475 BROADWAY 2801 GREAT NORTHERN LOOP 2800 10TH AVE N 504 S 13TH ST 925 HIGHLAND BLVD #1210 500 S LAMBORN 1315 WYOMING 401 W MAIN ST #B 910 BROOKS #202 2817 2ND AVE N #210 445 CENTENNIAL 41 BARRETT ST 317 MADISON ST 4739 MEADOW LN 75 CLAREMONT STE A 612 E MAIN STE C 1200 WESTWOOD DR 1208 6TH AVE E 2875 TINA AVE #101 2835 FORT MISSOULA RD STE 205 1225 BIRCH ST 210 N HIGGINS #337 723 5TH AVE E #126 417 MAIN ST SW 726 KENSINGTON AVE 550 N MONTANA AVE 1400 29TH ST S 916 13TH AVE S 576 SPOKANE AVE 140 WEASEL CREEK RD 519 E MAIN ST 500 W BROADWAY 2835 FORT MISSOULA RD #303 2600 WILSON ST 400 S CLARK ST 1400 29TH ST S 2475 BROADWAY 700 W KENT 2590 HOLMAN AVE STE A 305 W PORPHYRY ST 905 HIGHLAND BLVD STE 4500 332 FROST LN 310 BROADWAY ST 1424 10TH AVE S 255 W FRONT ST #B 2525 BROADWAY #201 CITY BOZEMAN BOZEMAN BOZEMAN BOZEMAN HELENA MISSOULA BILLINGS LIVINGSTON BOZEMAN HELENA MISSOULA HAMILTON MISSOULA BILLINGS BUTTE DILLON SHERIDAN BOZEMAN KALISPELL BOZEMAN HAMILTON SUPERIOR MISSOULA MISSOULA HELENA MISSOULA KALISPELL RONAN MISSOULA HELENA GREAT FALLS GREAT FALLS WHITEFISH WINSTON CUT BANK MISSOULA MISSOULA MILES CITY BUTTE GREAT FALLS HELENA MISSOULA BILLINGS BUTTE BOZEMAN CORVALLIS TOWNSEND GREAT FALLS MISSOULA HELENA ZIP 59715 59715 59715 59715 59601 59808 59101 59047 59715 59601 59801 59840 59801 59101 59701 59725 59749 59715 59901 59715 59840 59872 59808 59804 59601 59802 59901 59864 59801 59601 59405 59405 59937 59647 59427 59802 59804 59301 59701 59405 59601 59801 59102 59701 59715 59828 59644 59405 59802 59601 SPECIALTY OCCUPATIONAL THERAPY PHYSICAL MEDICINE REHABILITATION FAMILY PRACTICE NUTRITION PROFESSIONAL EMERGENCY MEDICINE/TRAUMA CHIROPRACTIC RADIOLOGY RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR SLEEP MEDICINE SLEEP MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY GYNECOLOGY-NO OB PHYSICAL THERAPY SURGERY UROLOGICAL UROLOGY SURGERY UROLOGICAL UROLOGY SURGERY UROLOGICAL UROLOGY PEDIATRICS PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER PSYCHOLOGY OPTOMETRY OPTOMETRY OPTOMETRY FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY NEUROLOGY FAMILY PRACTICE EMERGENCY MEDICINE PROFESSIONAL COUNSELOR HOSPITALIST HOSPITALIST FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA OPHTHALMOLOGY LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE PROFESSIONAL COUNSELOR CHIROPRACTIC CHIROPRACTOR CHIROPRACTOR INTERNAL MEDICINE Montana STATUS SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 98 of 256 FIRST NAME KATE RONALD KAREN PAMELA KAREN KAREN PAM AMBER RICHARD GREGORY GREGORY LAURIE KATHERINE JAMIE ERNA BOWMAN DENISE DAVID DAVID JENNIFER NICHOLAS BRIAN DEIDRE JUDITH BROCK JEFFREY KANYON BARRY JEFFREY DAVID CHRISTOPHER DONNA GARY PAUL JOHN JUDITH MICHELLE CECIL STEVEN STEVEN EDIE RICHARD KRISTINA JENNIFER GORDON BRIAN DONNA JOE WALTER TERRY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SKINNER SKIPPER SKONARD SKONORD SKONORD SKONORD SKONORD SKORPIL SLONE SLOOP SLOOP SLOVARP SLUDER SMALL SMEETS SMELKO SMIGAJ SMIRNOW SMIRNOW SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH LICENSE PT MD NP PT APRN APRN PT PA MD MD MD SLT NP SLT LCPC PSYD APRN MD MD PT DC MD ACU NP CRNA MD DC MD MD NP PAC DO MD DO MD NP APRN MD MD MD PT PT OT PT PT DO DO PT MD DO MEDICAL GROUP FRENCHTOWN PHYSICAL THERAPY HEART OF MONTANA SURGICAL SERVICE EVERGREEN CLINIC PROFESSIONAL THERAPY ASSOCIATES SUNBURST MENTAL HEALTH THERAPY ARTS CLINIC SIDNEY HEALTH CENTER BENEFIS MEDICAL GROUP NORTH PLAINS PATHOLOGISTS CMC OUTPATIENT THERAPIES HELENA INDIAN ALLIANCE ROCKY MOUNTAIN EAR NOSE & THROAT INTERMOUNTAIN CHILDRENS HOME HELENA OBGYN ASSOCIATES GLACIER REGIONAL PATHOLOGY ABSOROKA PAIN AND REHAB ACTIVE LIFE CHIROPRACTIC CENTER ANESTHESIA PARTNERS OF MONTANA ARCADIA CLINIC BASE LODGE CLINIC BENEFIS PHYSICIAN ASSOC BENEFIS PHYSICIAN ASSOCIATES BIG MOUNTAIN CHIROPRACTIC BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC MILES CITY BILLINGS CLINIC WEST BITTERROOT CLINIC BITTERROOT CLINIC CMC PEDIATRIC HOSPITALISTS CPG ON SOUTH RESERVE EVERGREEN CLINIC EVERGREEN CLINIC LAGRECA EYE CLINIC MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAG ASSOC OF IDAHO FALLS MISSOULA PHYSICAL THERAPY MISSOULA PHYSICAL THERAPY MOSAIC MOSAIC REHABILITATION MOUNTAIN PHYSICAL THERAPY NORTHERN MONTANA HOSPITAL NORTHWEST COMMUNITY HEALTH CENTER PHYSICAL THERAPY IN MOTION PIN POINT RADIOLOGY PLAINS FAMILY MEDICINE ADDRESS 16400 FRENCHTOWN FRONTAGE RD 310 WENDELL AVE STE 4 2181 HWY 2 E STE 9 1234 WHITEFISH STAGE RD 14 RIVER RD 355 1ST AVE W NORTH 115 COMMONS WAY STE 101 448 W LAUREL AVE 216 14TH AVE SW 1101 26TH ST S 1101 26TH ST S 2827 FORT MISSOULA RD 435 N LAST CHANCE GULCH 700 W KENT 612 W MAIN 500 S LAMBORN 45 MEDICAL PARK DR 310 SUNNYVIEW LN 310 SUNNYVIEW LN 1707 W OAK ST STE D 103 E 6TH AVE 2900 12TH AVE N STE 205W 1216 CANNON ST 1045 GLADES DR 1101 26TH ST S 1101 26TH AVE S 5TH FLOOR 6446 HWY 93 S 2702 8TH AVE N 2800 10TH AVE N 620 S HAYNES 2675 CENTRAL AVE 1224 W MAIN 1224 W MAIN 2827 FORT MISSOULA RD 1211 S RESERVE ST 2181 HWY 2 E STE 9 2181 HWY 2 E #9 2475 VILLAGE LN STE 202 310 SANSOME ST 90 HWY 91 S 1805 BANCROFT ST 1805 BANCROFT 6325 JACKRABBIT LN STE A 11 W MAIN STE 218 2593 HWY 2 E #6 30 13TH ST 320 E 2ND ST 50 27TH ST W #B 2475 W BROADWAY ST 10 KRUGER RD CITY FRENCHTOWN LEWISTOWN KALISPELL KALISPELL KALISPELL KALISPELL KALISPELL PLENTYWOOD SIDNEY GREAT FALLS GREAT FALLS MISSOULA HELENA MISSOULA BOZEMAN HELENA HELENA KALISPELL KALISPELL BOZEMAN HELENA BILLINGS HELENA WHITEFISH GREAT FALLS GREAT FALLS WHITEFISH BILLINGS BILLINGS MILES CITY BILLINGS HAMILTON HAMILTON MISSOULA MISSOULA KALISPELL KALISPELL BILLINGS PHILIPSBURG DILLON MISSOULA MISSOULA BELGRADE BELGRADE KALISPELL HAVRE LIBBY BILLINGS HELENA PLAINS ZIP 59834 59457 59901 59901 59901 59901 59901 59254 59270 59401 59405 59804 59601 59801 59715 59601 59601 59901 59901 59715 59601 59101 59601 59937 59405 59405 59937 59101 59101 59301 59102 59840 59840 59804 59801 59901 59901 59102 59858 59725 59801 59801 59714 59714 59901 59501 59923 59102 59601 59859 SPECIALTY PHYSICAL THERAPY SURGERY GENERAL FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE RADIOLOGY PATHOLOGY PATHOLOGY SPEECH/LANGUAGE THERAPY FAMILY PRACTICE SPEECH/LANGUAGE THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PATHOLOGY PATHOLOGY PHYSICAL THERAPY CHIROPRACTIC ANESTHESIOLOGY ACUPUNCTURIST URGENT CARE PROVIDER ANESTHESIOLOGY CARDIOLOGY CHIROPRACTIC SURGERY ORTHOPEDIC MEDICINE PATHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE PEDIATRICS RHEUMATOLOGY FAMILY PRACTICE FAMILY PRACTICE OPHTHALMOLOGY RADIOLOGY RADIOLOGY PHYSICAL THERAPY PHYSICAL THERAPY OCCUPATIONAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY HOSPITALIST FAMILY PRACTICE PHYSICAL THERAPY RADIOLOGY FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 99 of 256 FIRST NAME TERRY SHAWN BRIAN TERESA SHELBY JUDITH CHRISTOPHER SHEILA CHAD ADAM ANGELA BRIAN BRUCE CLEVELAND JUSTIN JUSTIN KELLY MARIANNE NANCY PETER STANLEY TYLER WALKER WALTER WANDA BO WARREN MATTHEW WILLIAM WILLIAM KIMBERLY MARK MICHAEL DOUGLAS TODD KIMBERLY ELIZABETH DANE REBECCA JOSEPH KURT VICKI JAMES MYRA RONALD LARRY KATIE LARRY LARRY TRISTAN NEAL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMITH SMOLKIN SNIDER SNIDER SNYDER SNYDER SNYDER SNYDER SNYDER SNYDER SOBBA SOBEK SOBIN SOFIANEK SOLARI SOLONIUK SOMMERS SOMMERS SONKEN SONNA SONNEK SONNENBERG SONNENBERG SOPHIA SORENSEN LICENSE DO MD DO NP DC NP MD LCPC DPM MD PAC DO MD DPM MD MD LCSW LCPC LCSW LAC MD OD DC LCPC MD LCPC DC MD DO DO APRN MD MD MD NP PT MD ACU MD DC MD LCSW LCSW MD MD RD MD MD PSYD MD MEDICAL GROUP PLAINS MEDICAL CLINIC ST JAMES HEALTHCARE PRIMARY CARE ST VINCENT PHYSICIAN NETWORK TETON MEDICAL CENTER VITALITY CHIROPRACTIC CLINIC WEST GLACIER CLINIC OF NVH WESTERN MONTANA CLINIC WESTERN MONTANA MENTAL HEALTH CTR YELLOWSTONE FOOT AND ANKLE BIG SKY DIAGNOSTIC LABS COOPERATIVE HEALTH CENTER LEWIS & CLARK COUNTY HEALTH DEPT BULLHOOK COMMUNITY HEALTH CENTER MISSOULA ANESTHESIOLOGY MONTANA CANCER SPECIALISTS PROFESSIONAL THERAPY ASSOCIATES SILVERTIP EMERGENCY PHYSICIANS BOZEMAN DEACONESS CARDIOLOGY CON INTEGRATIVE MEDICINE CLINIC MEDICAL ASSOCIATES SUMMIT CHIROPRACTIC MISSOULA VALLEY PEDIATRICS WESTERN MONTANA MENTAL HEALTH CTR WESTERN MONTANA MENTAL HEALTH CTR SIDNEY HEALTH CENTER CRITICAL CARE UNIT BOZEMAN OBGYN FAMILY DOCTORS URGENT CARE THE BOZEMAN CLINIC INTERNAL MEDICINE ASSOCIATES ADDRESS 10 KRUGER RD 400 S CLARK 1233 N 30TH ST 915 4TH ST NW 410 FW SPRUCE ST 100 REA RD 500 W BROADWAY 418 WINDWARD WAY 1139 N 27TH ST STE B1 6 - 13TH AVE E 17 N MILES 621 3RD ST S 111 N LAST CHANCE GULCH #4J 1800 11TH AVE 221 5TH AVE S PARKER MEDICAL CLINIC 535 SADDLE DR 1469 HWY 2 S 304 4TH AVE 310 SUNNYVIEW LN 100 WESTVIEW PARK PLACE 2646 WINNE AVE #2 1315 WYOMING 621 3RD ST S 710 GRAND AVE STE 7 1454 DEWEY BLVD 2475 BROADWAY 1930 9TH AVE 1930 9TH AVE 110 13TH ST 2825 STOCKYARD RD BLDG I-200 500 W BROADWAY 1234 WHITEFISH STAGE RD 310 SUNNYVIEW LN 802 2ND ST SE 333 BAKER AVE 915 HIGHLAND BLVD 1400 29TH ST S 2ND FLOOR 935 HIGHLAND BLVD STE 2200 2409 DEARBORN STE I 2835 FORT MISSOULA RD STE 205 234 E REEDER ST 234 E REEDER ST 216 14TH AVE SW 1101 26TH AVE S 925 HIGHLAND BLVD STE 1210 120 N 19TH AVE STE A 931 HIGHLAND BLVD STE 3360 38 E WASHINGTON #7 2900 12TH AVE N #310W CITY PLAINS BUTTE BILLINGS CHOTEAU MISSOULA WEST GLACIER MISSOULA KALISPELL BILLINGS POLSON HARDIN GLASGOW HELENA HELENA GLASGOW LINCOLN HELENA LIBBY SUPERIOR KALISPELL KALISPELL HELENA MISSOULA GLASGOW BILLINGS BUTTE HELENA HELENA HELENA HAVRE MISSOULA MISSOULA KALISPELL KALISPELL CUT BANK WHITEFISH BOZEMAN GREAT FALLS BOZEMAN MISSOULA MISSOULA DILLON DILLON SIDNEY GREAT FALLS BOZEMAN BOZEMAN BOZEMAN KALISPELL BILLINGS ZIP 59859 59701 59101 59422 59802 59936 59802 59901 59101 59860 59034 59230 59601 59601 59230 59639 59601 59923 59872 59901 59901 59601 59801 59230 59101 59701 59601 59601 59601 59501 59808 59807 59901 59901 59427 59937 59715 59405 59715 59801 59807 59725 59725 59270 59405 59715 59718 59715 59903 59101 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE HOSPITALIST FAMILY PRACTICE CHIROPRACTIC URGENT CARE PROVIDER FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PODIATRY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PSYCHIATRY PODIATRIST FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR ADDICTION COUNSELOR PATHOLOGY OPTOMETRY CHIROPRACTOR LICENSED BEHAVIORAL COUNSELOR RADIOLOGY LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC PATHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY HEMATOLOGY-ONCOLOGY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE PHYSICAL THERAPY CARDIOLOGY ACUPUNCTURIST FAMILY PRACTICE CHIROPRACTIC PEDIATRICS LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER RADIOLOGY INTENSIVE/CRITICAL CARE NUTRITION PROFESSIONAL URGENT CARE PROVIDER FAMILY PRACTICE PSYCHOLOGY INTERNAL MEDICINE Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 100 of 256 FIRST NAME BETH MARK JOAN CHERI PETER PETER CHRISTOPHER ELIE KRISTIN JOAN TERESA TERESA SETH KAROL REX RANDY REX SHANE E JERRY WENDI MICHAEL GERALD MICHELLE STEVEN RICHARD RICHARD ELAINE THOMAS MARIANNE LISA LAUREN CASSIE SHERI JOSHUA JEFFREY KIM ANGELA ANGELA CAROL VALLI SUSAN KAREN REBEKAH VICTOR DAVID DAVID JEANETTE STAN STAN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SORENSEN SORENSEN SORENSON SORG-HACKLER SORINI SORINI SORLI SOUEIDI SPANJIAN SPANNRING SPANOGLE SPANOGLE SPANOS SPAS-OTTE SPEAR SPEAR SPEAR SPEARS SPEARS SPEER SPENCE SPENCE SPENCER SPENNY SPETH SPILLMAN SPILLMAN SPINO SPINUZZA SPITZFORM SPORS MURPHY SPRING SPRINGER SPUHLER SPUHLER SQUIRE SQUIRES ST JOHN ST JOHN STABEN-BURROUGHS STAGER STAHLEY STAINTON STAMP STAMPLEY STANDISH STANDISH STANGL STANHOPE STANHOPE LICENSE PAC MD MD LP MD MD MD PAC MD NP LCPC LCPC MD RN MD PAC MD PT PT MD LMT MD MD MD MD PAC PAC SLT MD PHD OT PT PA PAC PAC OD APRN NP NP LCPC APRN LCPC NP PT LCSW MD MD LCSW PT PT MEDICAL GROUP BILLINGS CLINIC SULLIVAN SPEECH-LANGUAGE ASSOCIATES BIG SKY NEUROSCIENCE & SPINE PINTLER SURGICAL SPECIALISTS BILLINGS CLINIC BILLINGS CLINIC INTERNAL MEDICINE ASSOCIATES GLACIER COMMUNITY HEALTH CENTER ADVANCED MEDICAL IMAGING BILLINGS CLINIC INTERCITY RADIOLOGY ADVANTAGE PHYSICAL THERAPY BENEFIS QUICK CARE MATZ FAMILY CHIROPRACTIC WOUND CARE & HYPERBARIC CENTER GREAT FALLS GASTROENTEROLOGY BILLINGS CLINIC BRIDGER ORTHOPEDIC BILLINGS CLINIC RIVERSTONE HEALTH ST PETERS HOSPITAL REHABILITATION SIDNEY HEALTH CENTER EUREKA HEALTH DEBRA L HILL BUSSELLE MD ABSAROKEE MEDICAL CLINIC ALPINE ORTHOPEDICS & SPORTS REHAB PRIMARY EYECARE RAVALLI COUNTY PUBLIC HEALTH DIABETES CARE AND PREVENTION THE WAL-MART CLINIC BY KRMC ROCKY MOUNTAIN CLINIC BILLINGS CLINIC CATALYST PHYSICAL THERAPY CHILDRENS CLINIC THE CHILDRENS CLINIC HOT SPRINGS FAMILY MEDICINE PLAINS FAMILY MEDICINE ADDRESS 75 CLAREMONT ST 75 CLAREMONT ST 2800 10TH AVE N 720 STONERIDGE DR STE 2 700 W GOLD ST 401 W PENNSYLVANIA 1045 N 30TH ST 2702 8TH AVE N 1233 N 30TH ST 905 HIGHLAND BLVD STE 4500 1205 W MAIN ST 836 HOLT DR STE 100 519 E MAIN ST 66112 MT HWY 37 905 HIGHLAND BLVD STE 4100 801 N 29TH ST 925 HIGHLAND BLVD STE 1180 435 S CRYSTAL STE 400 600 MAIN ST #1 500 15TH AVE S 1519 S RESERVE ST 202 CONWAY DR STE 100 1300 28TH ST S STE 3 801 N 29TH ST 1450 ELLIS ST STE 201 2950 10TH AVE N 123 S 27TH ST 2475 BROADWAY 216 14TH AVE SW 821 S ORANGE ST 298 OSLOSKI RD 50 27TH ST W STE B 2075 CHARLOTTE ST STE 3 55 N MONTANA 536 S COTTONWOOD RD #100 1425 W MAIN ST STE B 205 BEDFORD STE L 1287 BURNS WAY #1 170 HUTTON RANCH RD 2023 STADIUM DR STE B 1101 S MONTANA ST 3021 6TH AVE STE 110 801 N 29TH ST 117 N 4TH ST #A2 126 E BROADWAY STE 11 1232 N 30TH ST STE 200 3401 AVE E 821 S ORANGE ST 209 MAIN ST 10 KRUGER RD CITY KALISPELL KALISPELL BILLINGS BOZEMAN BUTTE ANACONDA BILLINGS BILLINGS BILLINGS BOZEMAN HAMILTON BIGFORK CUT BANK EUREKA BOZEMAN BILLINGS BOZEMAN BUTTE DEER LODGE GREAT FALLS MISSOULA KALISPELL GREAT FALLS BILLINGS BOZEMAN BILLINGS BILLINGS HELENA SIDNEY MISSOULA EUREKA BILLINGS BOZEMAN ABSAROKEE BOZEMAN BOZEMAN HAMILTON KALISPELL KALISPELL BOZEMAN BUTTE BILLINGS BILLINGS HAMILTON MISSOULA BILLINGS BILLINGS MISSOULA HOT SPRINGS PLAINS ZIP 59901 59901 59101 59718 59701 59711 59101 59101 59101 59715 59840 59911 59427 59917 59715 59101 59715 59701 59722 59405 59801 59901 59405 59101 59715 59101 59101 59601 59270 59801 59917 59102 59718 59001 59718 59715 59840 59901 59901 59715 59701 59101 59101 59840 59801 59101 59102 59801 59845 59859 SPECIALTY HEMATOLOGY-ONCOLOGY PEDIATRICS PEDIATRICS SPEECH/LANGUAGE THERAPY SURGERY NEUROSURGERY SURGERY NEUROSURGERY ENDOCRINOLOGY SURGERY ORTHOPEDIC MEDICINE ANESTHESIOLOGY INTERNAL MEDICINE LICENSED ADDICTION COUNSELOR LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE REGISTERED NURSE RADIOLOGY FAMILY PRACTICE RADIOLOGY PHYSICAL THERAPY PHYSICAL THERAPIST FAMILY PRACTICE LICENSED MASSAGE THERAPIST GENERAL PRACTICE GASTROENTEROLOGY DERMATOLOGY SURGERY ORTHOPEDIC MEDICINE PSYCHIATRY FAMILY PRACTICE SPEECH/LANGUAGE THERAPY RADIOLOGY PSYCHOLOGY OCCUPATIONAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE OPTOMETRY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR INFECTIOUS DISEASES PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER PEDIATRICS PEDIATRICS LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY PHYSICAL THERAPY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 101 of 256 FIRST NAME RICHARD JAY JERRY BRIAN NARDY JANA MICHELLE LARRY CANDACE PHILLIP EDWARD EDWARD KENNETH MARC MARC CEARA JOSEPH KARIN SHARON STACY MONA GERALD ROBERT ROBERT KEVIN KEVIN CATHERINE CATHERINE BONNIE JOHN JEFFREY MICHAEL ALICE GEORGE GEORGE GEORGE MINDY RICHARD NATHAN KATHLEEN RICHARD JOHN SHELLI JEROME SARAH JEROME JEANNE LANCE MICHAEL RICHARD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME STANICH STANLEY STANLEY STARR STASCAVAGE STATON STAVNES STAYNER STEARNS STEELE STEIN STEIN STEIN STEINBERG STEINBERG STEINER STEINER STEINKE STEINMAN STELLFLUG STENBERG STENEHJEM STENGER STENGER STENSON STENSON STEPHENS STEPHENS STEPHENS STEPHENS STEPHENSON STERBIS STERLING STERN STERN STERN STERNER LEACH STEVENS STEVENS STEVENS STEVENS STEVENSON STEVENSON STEWART STEWART STEWART STEWART STEWART STEWART STEWART LICENSE OD DC DC MD CRNA LCPC NP MD FNP MD MD MD DC MD MD OD OD PT MD NP LCPC LCSW MD MD PT PT MD MD MD MD MD MD LCPC LAC MD MD MD OD MD DO MD MD MD PT DO MD DO MD MD MD NP MEDICAL GROUP BILLINGS CLINIC STANLEY CHIROPRACTIC STANLEY CHIROPRACTIC OFFICE BILLINGS CLINIC MINERAL COMMUNITY HOSPITAL BILLINGS CLINIC NORTHERN ROCKIES ORTHOPAEDICS BIG HORN HOSPITAL ASSOCIATION HELENA ORTHOPAEDIC PROMPTCARE EUREKA HEALTH EUREKA HEALTH STEIN CHIROPRACTIC & SPORTS CLINIC DIABETES & BEHAVIORAL HEALTH WESTERN MONTANA CLINIC MCBRIDE & MCBRIDE OPTOMETRISTS MCBRIDE & MCBRIDE OPTOMETRISTS PC FOOT & ANKLE CLINIC HELENA LAB PHYSICIANS ST VINCENT WALK IN BIG SKY NEUROSCIENCE & SPINE STENSON PHYSICAL THERAPY BILLINGS CLINIC NORTHERN MONTANA HOSPITAL ROCKY MOUNTAIN NEONATOLOGY BENEFIS PHYSICIAN ASSOC MISSOULA ANESTHESIOLOGY THREE RIVERS EYE CARE CENTER THREE RIVERS EYE CARE CENTER THREE RIVERS EYE CARE CENTER GREAT FALLS CLINIC CHILDRENS CLINIC MORLEDGE FAMILY EYE CLINIC NEONATOLOGY ASSOCIATES THE CHILDRENS CLINIC ST JAMES HEALTHCARE BEARTOOTH BILLINGS CLINIC BEARTOOTH BILLINGS CLINIC BILLINGS CLINIC GLENDIVE MEDICAL CENTER MARIAS HEALTHCARE MISSOULA RADIOLOGY SVH WALK IN CLINIC ADDRESS 801 N 29TH ST 1120 BROADWATER AVE 103 N 8TH ST 2800 10TH AVE N 1208 6TH AVE E 415 N HIGGINS AVE #116 1020 N 27TH ST 2831 FORT MISSOULA RD STE 232 17 N MILES 2442 WINNE AVE 298 OSLOSKI RD 298 OSLOSKI RD 511 MAIN ST 336 W SPRUCE 500 W BROADWAY 2120 GRAND AVE 2120 GRAND AVE 1301 11TH AVE S 2475 BROADWAY AVE 1233 N 30TH ST 2023 STADIUM DR STE 1C 621 FIRST AVE S 3075 N RESERVE #Q 500 W BROADWAY 700 W GOLD ST 524 E PARK ST 801 N 29TH ST 30 13TH ST 2825 FORT MISSOULA RD #121 1250 BURNS WAY 1117 29TH ST S STE 200 2825 STOCKYARD RD BLDG I-200 PO BOX 1838 112 W 3RD ST 1200 S RESERVE #H 417 MAIN ST SW 3000 15TH AVE S 1232 N 30TH STE 200 1747 POLY DR 1233 N 30TH ST 3401 AVE E 400 S CLARK ST 3307 GRAND AVE STE 203 2525 N BROADWAY AVE 2525 N BROADWAY AVE 801 N 29TH ST 107 DILWORTH ST 670 PARK AVE 3905 RUSSELL ST 1233 N 30TH ST CITY BILLINGS BILLINGS MILES CITY BILLINGS SUPERIOR MISSOULA BILLINGS MISSOULA HARDIN HELENA EUREKA EUREKA MILES CITY MISSOULA MISSOULA BILLINGS BILLINGS GREAT FALLS HELENA BILLINGS BOZEMAN GREAT FALLS MISSOULA MISSOULA BUTTE BUTTE BILLINGS HAVRE MISSOULA KALISPELL GREAT FALLS MISSOULA EUREKA ANACONDA MISSOULA RONAN GREAT FALLS BILLINGS BILLINGS BILLINGS BILLINGS BUTTE BILLINGS RED LODGE RED LODGE BILLINGS GLENDIVE SHELBY MISSOULA BILLINGS ZIP 59101 59102 59301 59101 59872 59802 59101 59804 59034 59601 59917 59917 59301 59802 59807 59102 59102 59405 59601 59107 59715 59401 59808 59802 59701 59701 59101 59501 59804 59901 59405 59808 59917 59711 59801 59864 59405 59101 59102 59101 59102 59701 59102 59068 59068 59101 59330 59474 59801 59101 SPECIALTY OPTOMETRY CHIROPRACTIC CHIROPRACTIC PEDIATRICS ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE FAMILY PRACTICE CHIROPRACTIC GENERAL PRACTICE GENERAL PRACTICE OPTOMETRY OPTOMETRY PHYSICAL THERAPY PATHOLOGY URGENT CARE PROVIDER LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE HOSPITALIST PHYSICAL THERAPY PHYSICAL THERAPY PULMONARY DISEASES PULMONARY DISEASES PEDIATRIC NEONATOLOGY PHYSICAL MEDICINE REHABILITATION RADIATION ONCOLOGY ANESTHESIOLOGY PROFESSIONAL COUNSELOR OPHTHALMOLOGY OPHTHALMOLOGY OPHTHALMOLOGY OPTOMETRY PEDIATRICS OPHTHALMOLOGY PEDIATRIC NEONATOLOGY PEDIATRICS RADIATION ONCOLOGY PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE GENERAL PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE RADIOLOGY FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 102 of 256 FIRST NAME BONNIE KEVIN LANCE LANCE LANCE MARK TAD JILLIAN LILI LORETTA TROY MELISSA GORDON BLAINE BRITNE MARGARET KIM PETER ANGELA ANGELA DAVID DARREL ROBERT KRISTIN GAIL JEFFREY MARGARET MARK CHARLES STEPHANIE DANA CALEB LIZ DONALD PATRICIA JESSICA KIRK TOD CAILLE JOHN TRAVIS PEGGY JAMIE EUGENE RYAN TIMOTHY EDNA RINDY GARY JENNIFER Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME STEWART STEWART STEWART STEWART STEWART STEWART STICHMAN STIEG STIFF STIFFLER STILES STILES STILLIE STIMAC STIMAC STIMATIZ STIMPSON STIVERS STJOHN STJOHN STOCK STOCK STOCKDALE STOCKHAM STOCKMAN STOCKWELL STOCKWELL STOEBE STOHEL STOKE STOKKE STOLTE STONE STONE STONE STONE STONER STORM STOVALL STOWERS STRATFORD STRATTON STRAUB STRAYHORN STRECKER STREET STREIT STRELOW STREMCHA STRINE LICENSE LAC LAC MD MD MD MD PAC SLT LCPC LCSW DO PT DO PT OT LCPC MD PHD APRN APRN DO DO MD PT MD NP MD DC DC MD DC MSPT LCPC MD CNMW MD MD DPM PSYD MD MD APRN DO MD PT PAC PAC OT OD PAC MEDICAL GROUP WESTERN MONTANA ADDICTION SERVICES WESTERN MONTANA ADDICTION SERVICES ORTHO MONTANA BIG SKY PSYCHIATRIC SERVICES ST PETERS HOSPITAL REHABILITATION KALISPELL REGIONAL RADIATION ONCOLO KALISPELL REHABILITATION ASSOC KALISPELL REHABILITATION ASSOC CENTER FOR MENTAL HEALTH NORTHWEST ORTHOPEDICS & SPORTS MED EVERGREEN CLINIC HOSANNA HEALTHCARE BULLHOOK CLINIC NORTHERN ROCKIES MEDICAL CENTER YELLOWSTONE UROLOGY ADVANCED REHABILITATION SERVICES ROCKY MOUNTAIN HEART & LUNG GLENDIVE MEDICAL CENTER ST PETERS MEDICAL GROUP GREAT FALLS CHIROPRACTIC CLINIC BILLINGS CLINIC STOLTE PHYSICAL THERAPY & PILATES LIZ MUHS STONE COUNSELING NEUROSCIENCE & SPINE INSTITUTE PLANNED PARENTHOOD OF MONTANA PLENTYWOOD CLINIC BOZEMAN FOOT AND ANKLE RIVERSTONE HEALTH CLINIC EMERGENCY PHYSICIANS BIG SKY FAMILY MEDICINE BIGFORK HEALTH AND WELLNESS BILLINGS CLINIC GREAT FALLS CLINIC BIG SANDY MEDICAL CENTER FREESTONE REHABILITATION HAVRE OPTOMETRIC CLINIC THOMPSON FALLS FAMILY MEDICINE ADDRESS 1325 WYOMING ST 1325 WYOMING ST 3511 1ST AVE N #1 3511 1ST AVE N STE 1 601 1ST AVE N 2835 FORT MISSOULA RD #302 2900 12TH AVE N STE 140W 1537 AVE D #210 205 HAGGERTY LN STE 270 700 E FRONT ST 820 DIVISION ST 2475 BROADWAY 343 SUNNYVIEW LN 115 COMMONS WAY STE 101 115 COMMONS WAY #101 900 N JACKSON 350 HERITAGE WAY #1200 401 15TH AVE S STE 205 2181 HWY 2 E STE 9 160 HERITAGE WAY #102 110 13TH ST 802 2ND ST SE 2900 12TH AVE NO STE 503E 175 COMMONS LOOP STE B 350 HERITAGE WAY #2100 107 DILWORTH ST 2550 BROADWAY 400 13TH AVE S #104 913 SW HIGGINS AVE STE 101 1020 N 27TH ST 175 N 9TH AVE 46 VILLAGE LOOP RD STE 2 119 1/2 W PARK ST STE 5 200 COMMONS WAY 219 E MAIN ST 1648 ELLIS ST STE 302 448 W LAUREL AVE 931 HIGHLAND BLVD STE 3310 123 S 27TH ST 1110 FRONT ST 2800 CENTRAL AVE #A 202 CONWAY DR #200 6 - 13TH AVE E 191 JEWEL BASIN COURT UNIT 2A 801 N 29TH ST 1400 29TH ST S 166 MONTANA AVE E 1532 ELLIS ST STE 103 416 3RD AVE 120 POND ST CITY MISSOULA MISSOULA GREAT FALLS GREAT FALLS GREAT FALLS MISSOULA BILLINGS BILLINGS BOZEMAN BUTTE BILLINGS HELENA KALISPELL KALISPELL KALISPELL HELENA KALISPELL GREAT FALLS KALISPELL KALISPELL HAVRE CUT BANK BILLINGS KALISPELL KALISPELL GLENDIVE HELENA GREAT FALLS MISSOULA BILLINGS FORSYTH KALISPELL LIVINGSTON KALISPELL MISSOULA BOZEMAN PLENTYWOOD BOZEMAN BILLINGS FORT BENTON BILLINGS KALISPELL POLSON BIGFORK BILLINGS GREAT FALLS BIG SANDY BOZEMAN HAVRE THOMPSON FALLS ZIP 59801 59801 59401 59401 59401 59804 59101 59102 59715 59701 59101 59601 59901 59901 59901 59601 59901 59405 59901 59901 59501 59427 59101 59901 59901 59330 59601 59405 59803 59101 59327 59901 59047 59901 59801 59715 59254 59715 59101 59442 59102 59901 59860 59911 59101 59405 59520 59715 59501 59873 SPECIALTY ADDICTIONNICOTINECOUNSELOR ADDICTIONNICOTINECOUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE DERMATOLOGY SURGERY ORTHOPEDIC MEDICINE SPEECH/LANGUAGE THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY PHYSICAL THERAPY RADIATION ONCOLOGY PHYSICAL THERAPY OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR SPORTS MEDICINE PSYCHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY UROLOGICAL UROLOGY PHYSICAL THERAPY CARDIOLOGY NURSE PRACTITIONER FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC OCCUPATIONAL/INDUSTRIAL MEDICINE CHIROPRACTIC PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR NEUROLOGY CERTIFIED NURSE MIDWIFE PSYCHIATRY FAMILY PRACTICE PODIATRY PSYCHOLOGY EMERGENCY MEDICINE/TRAUMA RADIOLOGY FAMILY PRACTICE OBSTETRICS & GYNECOLOGY INTERNAL MEDICINE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE OCCUPATIONAL THERAPY OPTOMETRY FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING PENDING 103 of 256 FIRST NAME THOMAS JOHN JOHN HOLLY PAMELA BENJAMIN SHERI CRAIG MARIAN DAVID JESSE COLLEEN KIMBERLY MICHAEL CHRISTOPHER JESSICA TIMOTHY TIMOTHY ANN KERRY WILLIAM DONNA DONNA JESSICA DEAN KAE KAE DEBRA SHELLEY BRIAN CRISTINA MARK MICHAEL ELIZABETH CRYSTAL JANNA ANNE CARLOS CHARLES SHELLEY JAMES JANA JANELLE ALLAN MICHAEL WILLIAM LIBBY EDWARD WALLACE WALLACE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME STRIZICH STROBEL STROBEL STRONG STRONG STRONG STROPPEL STRUBLE STUART STUBE STUCKEY STUCKEY STUDINER STUEHM STURDEVANT STUTTS STUTZMAN STUTZMAN STYRVOKY SUAREZ SUDA SUDEN SUDEN SUESS SUKIN SUKUT SUKUT SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SULLIVAN SUMMERS SUND SUNVOLD-PALMER SUPAK SURA SURBER SUTHERLAND SUTLIFFE SUTTER SUTTER LICENSE MD MD MD MD LAC MD PT LAC LCSW PHD PT PAC PAC LCPC PT PA MD MD MD PT PHD LCPC LCPC MD MD PA-C PA-C PT PT PAC MD PAC LCSW SLT LAC APRN LCPC MD MD PT DO CNMW NP MD MD MD LCPC NP LCSW LCSW MEDICAL GROUP PARTNERS IN PEDIATRICS MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING OF IDAHO FALLS NORTHWEST PHYSICIANS WESTERN MONTANA ADDICTION SERVICES HAMILTON PT & REHAB AT CANYONS CLUB REHABILITY HOLY ROSARY HEALTHCARE CLINIC MENTAL HEALTH CENTER BILLINGS CLINIC HEIGHTS BILLINGS CLINIC NORTHWEST FAMILY MEDICINE MONTANA ORTHOPEDICS CLARK FORK EMERGENCY PHYSICIANS ORTHO MONTANA ADVANCED REHABILITATION SERVICES BALANCED PHYSICAL THERAPY BILLINGS CLINIC MISSOULA ANESTHESIOLOGY PC ORTHO MONTANA SOUTH CENTRAL TREATMENT ASSOCIATES SULLIVAN SPEECH-LANGUAGE ASSOCIATES WMMHC WOMENS HEALTH FAMILY BORN MATERNITY & WOMENS HEAL BILLINGS CLINIC PARK CLINIC SPRING CREEK FAMILY MEDICINE MISSOULA ANESTHESIOLOGY WESTERN MONTANA MENTAL HEALTH CTR SVH OCCUPATIONAL HEALTH AWARE INC AWARE INC ADDRESS 2525 BROADWAY STE 101 310 SANSOME ST 90 HWY 91 S 401 15TH AVE S STE 202 1325 WYOMING ST 216 14TH AVE SW 472 TAMMANY LN 45 MEDICAL PARK LOWER LEVEL 418 WINDWARD WAY 537 STEPHENS AVE 403 W MAIN ST STE B 403 W MAIN ST 2600 WILSON ST 212 WENDELL AVE 760 WICKS LN 801 N 29TH ST 1250 BURNS WAY #1 1250 BURNS WAY 902 N ORANGE ST #206 435 S CRYSTAL 1201 WESTWOOD DR STE C 251 N 17TH ST 422 WILLOW 2827 FORT MISSOULA RD 2900 12TH AVE N #100E 221 5TH AVE S 621 3RD ST S 200 COMMON WAY STE B 1515 S RUSSELL ST 2702 8TH AVE N 2825 STOCKYARD RD BLDG I 200 2900 12TH AVE N #140W 304 GRAND AVE 720 STONERIDGE DR STE 2 307 E PARK STE 207B 75 CLAREMONT STE A 205 N 11TH ST 1720 FOUR MILE RD 2630 MULLAN RD #C 1309 HARRISON AVE 2825 FORT MISSOULA RD #304 210 SUNNYVIEW LN #101 2675 CENTRAL AVE 1001 RIVER DR 310 WENDELL AVE STE 1 2825 STOCKYARD RD BLDG I-200 418 WINDWARD WAY 1027 N 27TH ST 1044 COOK AVE 1345 ELAINE ST CITY HELENA PHILIPSBURG DILLON GREAT FALLS MISSOULA SIDNEY HAMILTON HELENA KALISPELL MISSOULA BELGRADE BELGRADE MILES CITY LEWISTOWN BILLINGS BILLINGS KALISPELL KALISPELL MISSOULA BUTTE HAMILTON FORSYTH COLSTRIP MISSOULA BILLINGS GLASGOW GLASGOW KALISPELL MISSOULA BILLINGS MISSOULA BILLINGS BILLINGS BOZEMAN ANACONDA KALISPELL BOZEMAN BUTTE MISSOULA BUTTE MISSOULA KALISPELL BILLINGS LIVINGSTON LEWISTOWN MISSOULA KALISPELL BILLINGS BILLINGS BILLINGS ZIP 59601 59858 59725 59405 59801 59270 59840 59601 59901 59801 59714 59714 59301 59457 59105 59101 59901 59901 59802 59701 59840 59327 59323 59804 59101 59230 59230 59901 59801 59101 59808 59101 59101 59715 59711 59901 59715 59701 59808 59701 59804 59901 59102 59047 59457 59808 59901 59101 59102 59105 SPECIALTY PEDIATRICS RADIOLOGY RADIOLOGY INTERNAL MEDICINE ADDICTIONNICOTINECOUNSELOR RADIOLOGY PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY URGENT CARE PROVIDER FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL MEDICINE REHABILITATION FAMILY PRACTICE FAMILY PRACTICE PSYCHIATRY PHYSICAL THERAPY PSYCHOLOGY PROFESSIONAL COUNSELOR PROFESSIONAL COUNSELOR EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT PHYSICAL THERAPY PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE ANESTHESIOLOGY SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER SPEECH/LANGUAGE THERAPY LICENSED ADDICTION COUNSELOR GYNECOLOGY-NO OB LICENSED BEHAVIORAL COUNSELOR NEUROLOGY SURGERY HAND PHYSICAL THERAPY OBSTETRICS & GYNECOLOGY CERTIFIED NURSE MIDWIFE INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER Montana STATUS PENDING PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 104 of 256 FIRST NAME WALLACE WALLACE WALLACE WALLACE MEGAN JOHN LOUISE CHARLES CHARLES JOHN CHAD JULIE CHAD JULIE CARL JAMES BRUCE KATHLEEN TERRANCE NANCY JAMES NOLITA LORI JERRI SUSAN SUZANNE JEFF DOUGLAS CARLY MICHAEL MICHAEL BENJAMIN DEBORAH JAMES JAMES JORDAN JILL LAURA ANN PETER PETER LEXI LEXI BILL ANNA DAVID STEPHEN STEPHEN FREDERICK JEN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME SUTTER SUTTER SUTTER SUTTER SVEE SVEEN SWANBERG SWANNACK SWANNACK SWANSON SWANSON SWANSON SWANSON SWANSON SWANSON SWANTON SWARNY SWEENEY SWEENEY SWEENEY SWEET SWEET SWENSON SWENSON SWIERC SWIETNICKI SWIFT SWIFT SWINGLEY SWINYARD SWINYARD SWOBODA SYBRANT SYKES SYKES SYMONS SYTH SZABO SZALDA-PETREE SZEKELY SZEKELY TABOR-MANAKER TABOR-MANAKER TACKE TAFT TAGUE TAHTA TAHTA TAI TAINTER LICENSE LCSW LCSW LCSW LCSW PT PT MD MD MD PAC OD SLT OD MD OD PT MD PT MD MD MD LCPC OT LCPC PHD MD PT MD LCPC MD MD MD PA-C PT PT MD SLT MD LCSW MD MD MD MD MD LCSW MD MD MD MD LCPC MEDICAL GROUP AWARE INC AWARE INC AWARE INC AWARE INC MANGER HARRINGTON PHYSICAL THERAPY ADVANCED PERFORMANCE & REHAB WOODLAND CLINIC MISSOULA SURGICAL ASSOCIATES BILLINGS CLINIC HELENA EYE CLINIC ST PETERS HOSPITAL REHABILITATION THE OPTICAL SHOP WEST GRAND FAMILY MEDICINE ORTHO MONTANA GABERT MEDICAL SERVICES CMC OUTPATIENT THERAPIES GREAT FALLS CLINIC NANCY J SWEENEY MD PC BILLINGS CLINIC WESTERN MONTANA MENTAL HEALTH CTR FREESTONE REHAB NORTHERN MONTANA MEDICAL GROUP W RIVER'S EDGE PHYSICAL THERAPY DIABETES CARE & PREVENTION PEDIATRICS SPECIALTY CLINIC CAPITAL ANESTHESIA GREAT NORTHERN PHYSICAL THERAPY SVH SPECIALTY CARE SERVICES THE COZY NEST BILLINGS CLINIC FAMILY HEALTH CARE FAMILY HEALTH CARE MONTANA PLAINS REHABILITATION CPG CARDIOLOGY CPG NORTHGATE PRIMARY CARE ADDRESS 415 BROADWATER 4188 KING AVE E 615 N 19TH ST 820 N 31ST ST 2525 COLONIAL DR STE B 1532 ELLIS ST STE 201 705 6TH AVE E 500 W BROADWAY 5TH FLOOR 500 W BROADWAY 760 WICKS LN 3116 SADDLE DR 2475 BROADWAY 301 SADDLE DR 2750 GRAND AVE 2509 7TH AVE S C-3 2900 12TH AVE N STE 104W 107 DILWORTH ST 2827 FORT MISSOULA RD 1400 29TH ST S 940 N 30TH ST 801 N 29TH ST 300 N WILLSON AVE STE 3005 1532 ELLIS ST STE 103 100 2ND ST E 125 BANK ST #310 20 13TH ST 1000 25TH ST N 1101 26TH ST S 225 17TH AVE NW 1297 BURNS WAY #1 2835 FT MISSOULA RD #301 2475 BROADWAY 500 W BROADWAY #320 612 E MAIN ST STE A 612 E MAIN ST STE A 1230 N 30TH ST STE 200 1276 N 15TH AVE STE 101 2800 10TH AVE N 735 MICHIGAN AVE 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 1287 BURNS WAY 715 NUCLEUS AVE 1300 28TH ST S STE 9-A 1640 S AVE W 216 14TH AVE SW 2831 FORT MISSOULA RD #102 500 W BROADWAY #320 2230 N RESERVE #402 1940 W DICKERSON STE 102 CITY BILLINGS BILLINGS BILLINGS BILLINGS HELENA BOZEMAN KALISPELL MISSOULA MISSOULA BILLINGS HELENA HELENA HELENA BILLINGS GREAT FALLS BILLINGS GLENDIVE MISSOULA GREAT FALLS BILLINGS BILLINGS BOZEMAN BOZEMAN WHITEFISH MISSOULA HAVRE GREAT FALLS GREAT FALLS GREAT FALLS KALISPELL MISSOULA HELENA MISSOULA BOZEMAN BOZEMAN BILLINGS BOZEMAN BILLINGS MISSOULA MISSOULA MISSOULA KALISPELL COLUMBIA FALLS GREAT FALLS MISSOULA SIDNEY MISSOULA MISSOULA MISSOULA BOZEMAN ZIP 59102 59102 59101 59102 59601 59715 59901 59802 59802 59105 59601 59601 59601 59102 59405 59101 59330 59804 59405 59101 59101 59715 59715 59937 59802 59501 59401 59403 59404 59901 59804 59601 59802 59715 59715 59101 59715 59101 59802 59802 59802 59901 59912 59405 59801 59270 59804 59802 59808 59718 SPECIALTY LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER PHYSICAL THERAPY PHYSICAL THERAPY INTERNAL MEDICINE SURGERY GENERAL SURGERY FAMILY PRACTICE OPTOMETRY SPEECH/LANGUAGE THERAPY OPTOMETRY FAMILY PRACTICE OPTOMETRY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE ANESTHESIOLOGY ALLERGY/IMMUNOLOGY LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR PSYCHOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY PHYSICAL THERAPY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR ENDOCRINOLOGY PEDIATRICS ANESTHESIOLOGY PHYSICIAN ASSISTANT PHYSICAL THERAPY PHYSICAL THERAPY PEDIATRICS SPEECH/LANGUAGE THERAPY HOSPITALIST LICENSED CLINICAL SOCIAL WORKER INTERNAL MEDICINE INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE PHYSICAL MEDICINE REHABILITATION LICENSED CLINICAL SOCIAL WORKER RADIOLOGY CARDIOLOGY CARDIOVASCULAR/THORACIC SURGERY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR Montana STATUS SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 105 of 256 FIRST NAME PHILIP CHARLES CHARLES GISELLE LACY LIONEL LIONEL JAMES JACOB GEOFFREY HOLLY NANCI RICHARD JANE JAMES JAY SUSAN RICHARD RAINYA RICHARD ALICIA RICHARD DENIZ JORDAN JUDITH RICHARD JOEL JAMIE VIM MARJORIE MARJORIE MARJORIE MARJORIE RONALD RONALD MARCIA KATHI THOMAS THOMAS DAVID DALE DUANE WILLIAM PATRICK ALAN ALAN HEIDI JUSTIN AMY NEIL Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME TALLMAN TALTON TALTON TAN TANGEDAHL TAPIA TAPIA TARVER TAVERNA TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR JR TEAUSANT TEFF TEK TELLER TEN HARMSEL TENNEY TERRITO TERRY TESAR TEVLIN TEVLIN TEVLIN TEVLIN THARP THARP THARP THEADE THIGPEN THIGPEN THIRY THOMAN THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS THOMAS LICENSE MD MD MD MD NP MD MD MD MD DO PT APRN MD PAC DO MD SLT MD LCPC MD DPM MD MD NP NP MD DC PT LCPC MD MD MD MD MD MD LCSW MD MD MD DC OD MD MD MD MD MD PT MD DC DC MEDICAL GROUP COGENT HEALTHCARE OF MONTANA PINTLER FAMILY MEDICINE BILLINGS CLINIC BILLINGS CLINIC CHILDRENS CLINIC THE CHILDRENS CLINIC ST PETERS COMMUNITY HOSPITAL ROCKY MOUNTAIN CLINIC ANESTHESIA ASSOCIATES OF GT FALLS BILLINGS CLINIC WEST BUTTE FAMILY PLANNING CMMC CLINIC PHYSICIANS MAINSTREET MEDICAL CLINIC MEDICAL IMAG ASSOC OF IDAHO FALLS PONDERA MEDICAL CENTER TAYLORED SPEECH-LANGUAGE THERAPY WOMENS HEALTH FOOT & ANKLE CLINIC OF MONTANA SVH NEUROSURGERY SVH EMERGENCY MEDICINE DEPT CENTER FOR HEALTHY LIVING BILLINGS CLINIC CENTRAL MONTANA COMM HEALTH CENTER ALPINE PHYSICAL THERAPY HOLY ROSARY HEALTHCARE CLINIC HOLY ROSARY HEALTHCARE CLINIC MONTANA NEPHROLOGY ASSOCIATES ADVANCED MEDICAL IMAGING INTERCITY RADIOLOGY SUNBURST MENTAL HEALTH SERVICES SVH EMERGENCY MEDICINE DEPT THE SLEEP CENTER THE SLEEP CENTER THIRY CHIROPRACTIC CAPITAL MEDICAL ANESTHESIA FAMILY VISION CARE GREAT FALLS ORTHOPEDIC ASSOC MONTANA CANCER SPECIALISTS MONTANA CANCER SPECIALISTS AT CMC MOSAIC REHABILITATION ST PETERS CANCER TREATMENT CENTER THOMAS FAMILY CHIROPRACTIC THOMAS FAMILY CHIROPRACTIC ADDRESS 2294 GRANT RD 1101 26TH ST S 401 W PENNSYLVANIA 2702 8TH AVE N 801 N 29TH ST 1232 N 30TH STE 200 3401 AVE E 2475 BROADWAY 435 S CRYSTAL STE 300 401 15TH AVE S STE 109 2675 CENTRAL AVE 25 W FRONT ST 310 WENDELL AVE STE 6 907 MAIN ST 310 SANSOME ST 805 SUNSET BLVD 626 S SANDERS ST 75 CLAREMONT STE A 220 GRAND AVE 310 WENDELL STE 6 1301 11TH AVE S 2900 12 AVE N STE 315W 1233 N 30TH ST 2223 MISSION WAY 801 N 29TH ST 406 1ST AVE S 5035 HWY 2 5000 BLUE MOUNTAIN RD 307 1ST AVE E #7 2600 WILSON ST 2600 WILSON ST 2411 VILLAGE LN 2411 VILLAGE LN 905 HIGHLAND BLVD STE 4100 925 HIGHLAND BLVD STE 1180 14 RIVER RD 1233 N 30TH ST 1233 N 30TH ST 3RD ALLARD 1233 N 30TH ST 3RD ALLARD 403 W PARK ST 2901 BROOKS ST 2475 BROADWAY 2106 OXFORD ST 1401 25TH ST S 500 W BROADWAY 2827 FORT MISSOULA RD 11 W MAIN ST STE 218 2475 BROADWAY ST 1924 W STEVENS STE 101 1924 W STEVENS STE 101 CITY BILLINGS GREAT FALLS ANACONDA BILLINGS BILLINGS BILLINGS BILLINGS HELENA BUTTE GREAT FALLS BILLINGS BUTTE LEWISTOWN THOMPSON FALLS PHILIPSBURG CONRAD HELENA KALISPELL BILLINGS LEWISTOWN GREAT FALLS BILLINGS BILLINGS BILLINGS BILLINGS LEWISTOWN COLUMBIA FALLS MISSOULA KALISPELL MILES CITY MILES CITY BILLINGS BILLINGS BOZEMAN BOZEMAN KALISPELL BILLINGS BILLINGS BILLINGS LIVINGSTON MISSOULA HELENA MISSOULA GREAT FALLS MISSOULA MISSOULA BELGRADE HELENA BOZEMAN BOZEMAN ZIP 59102 59405 59711 59101 59101 59101 59102 59601 59701 59405 59102 59701 59457 59873 59858 59425 59601 59901 59101 59457 59405 59101 59101 59102 59101 59457 59912 59804 59901 59301 59301 59102 59102 59715 59715 59901 59101 59101 59101 59047 59801 59601 59801 59406 59807 59804 59714 59601 59718 59718 SPECIALTY DERMATOLOGY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE INTERNAL MEDICINE PEDIATRICS PEDIATRICS RADIOLOGY INTERNAL MEDICINE ANESTHESIOLOGY PHYSICAL THERAPY FAMILY PRACTICE INTERNAL MEDICINE FAMILY PRACTICE RADIOLOGY FAMILY PRACTICE SPEECH/LANGUAGE THERAPY GYNECOLOGY-NO OB PROFESSIONAL COUNSELOR INTERNAL MEDICINE PODIATRY SURGERY NEUROSURGERY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE INTERNAL MEDICINE INTERNAL MEDICINE CHIROPRACTOR PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR INTERNAL MEDICINE NEPHROLOGY NEPHROLOGY GENERAL PRACTICE RADIOLOGY RADIOLOGY LICENSED CLINICAL SOCIAL WORKER EMERGENCY MEDICINE/TRAUMA PULMONARY DISEASES SLEEP STUDIES CHIROPRACTIC OPTOMETRIST ANESTHESIOLOGY OPTOMETRY SURGERY ORTHOPEDIC MEDICINE HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY PHYSICAL THERAPY HEMATOLOGY-ONCOLOGY CHIROPRACTIC CHIROPRACTIC Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED 106 of 256 FIRST NAME NATHAN NATHAN NATHAN ALAN DWIGHT RANDY JOHANNA DWIGHT FRANK CARRIE STEVEN STEVEN MARY AUDREY BETH DAVID DWIGHT STEVEN P KURT PAUL PAUL JILL KERI KERI CARL MICHELLE ARIC RAGNA KARYN KARYN JAMES KAREN KARYN JAMES JAMES KARYN TIMOTHY NANCY JAMES LEAH VICKI VICKI HOWARD HOWARD GREG KELLY R ERIC JASON REGINA JEFFREY Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME THOMAS THOMAS THOMAS THOMETZ THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THOMPSON THORDERSON THORMAHLEN THORMAHLEN THORN THORN THORN THORNBLADE THORNBLADE THORNE-THOMSEN THORNE-THOMSEN THORNTON THORNTON THORNTON THORNTON THORNTON THORNTON THORNTON THORNTON THORNTON THORSON THREATT THRONSON THUESEN THUESEN TICE TICE TIERNEY TIMMER TINER TINGEY TITAK TJADEN LICENSE DPM DPM DPM MD PAC MD OT PAC MD NP DO DO OT LCPC MD MD PA-C DO MD PT PT PA MD MD MD PA PT PT PA PA DC PT PA DC DC PA-C PA-C LCSW MD MD NP NP MD MD MD NP LCPC MD LCPC MD MEDICAL GROUP BILLINGS CLINIC BAIR MEMORIAL CLINIC BILLINGS CLINIC BLUE SKIES PEDIATRIC BROADWATER HEALTH CENTER CENTRAL MONTANA COMM HEALTH CENTER NORTHWEST MONTANA RADIATION ONC NOW CARE NOW CARE WEL HOME HEALTH OF BOZEMAN NORTHWEST ORTHOPEDIC & SPORTS MED NORTHERN ROCKIES PHYSICAL THERAPY NORTHERN ROCKIES REHABILITATION BIG SKY FAMILY MEDICINE CLARK FORK EMERGENCY PHYSICIANS SILVERTIP EMERGENCY PHYSICIANS MONTANA ALLERGY PRACTICE MONTANA ALLERGY PRACTICE AXIS PHYSICAL THERAPY AXIS PHYSICAL THERAPY CLARK FORK EMERGENCY PHYS MINERAL COMMUNITY HOSPITAL ER MISSION CHIROPRACTIC NORTHERN ROCKIES MEDICAL CENTER TAMARACK MEDICAL CLINIC HEADQUARTERS FOR HEART CHANGE KALISPELL GASTROENTEROLOGY GREAT FALLS ORTHOPEDIC ASSOC BENEFIS PHYSICIANS ASSOCIATES ANESTHESIA ASSOCIATES OF GT FALLS NORTHWEST ENDOCRINOLOGY ADDRESS 110 S AVE W 1100 HOLLENBACK LN 505 W PARK 1020 N 27TH ST 530 3RD ST NW 2800 10TH AVE N 5340 LEIGH DR 110 N OAK ST 406 1ST AVE S 343 SUNNYVIEW LN 2901 BROOKS ST 500 W BROADWAY 205 N TRACY AVE 2001 11TH AVE STE 25 500 W BROADWAY 310 WENDELL AVE #5 621 3RD ST S 16862 BECKWITH ST 350 HERITAGE WAY STE #1200 2831 FORT MISSOULA RD #200 2831 FORT MISSOULA RD STE 200 202 CONWAY DR #200 2827 FORT MISSOULA RD 310 SUNNYVIEW LN 610 W SPRUCE 610 W SPRUCE 420 B N HIGGINS 420 B N HIGGINS 2827 FORT MISSOULA RD 1208 6TH AVE E 200 MOUNTAIN VIEW 802 2ND ST SE 1208 6TH AVE E 200 MOUNTAINVIEW HWY 93 N 6 - 13TH AVE E 6 - 13TH AVE E 225 N 23RD ST 907 BROADWATER SQUARE 103 S MAIN ST 3050 MT HWY 83 N 500 W BROADWAY 3RD FLOOR 75 CLAREMONT ST STE F 75 CLAREMONT ST #F 1401 25TH ST S 400 13TH AVE S STE 203 124 GEORGE ST 401 15TH AVE S STE 109 129 VILLAGE DR STE 303 1297 BURNS WAY #4 CITY MISSOULA DEER LODGE BUTTE BILLINGS HARLOWTON BILLINGS BILLINGS TOWNSEND LEWISTOWN KALISPELL MISSOULA MISSOULA BOZEMAN HELENA MISSOULA LEWISTOWN GLASGOW FRENCHTOWN KALISPELL MISSOULA MISSOULA KALISPELL MISSOULA KALISPELL MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA SUPERIOR ST IGNATIUS CUT BANK SUPERIOR ST IGNATIUS ARLEE POLSON POLSON BILLINGS BILLINGS LIVINGSTON SEELEY LAKE MISSOULA KALISPELL KALISPELL GREAT FALLS GREAT FALLS BILLINGS GREAT FALLS BOZEMAN KALISPELL ZIP 59801 59722 59701 59101 59036 59101 59106 59644 59457 59901 59801 59801 59715 59601 59802 59457 59230 59834 59901 59804 59804 59901 59804 59901 59802 59802 59802 59802 59804 59872 59865 59427 59872 59865 59821 59860 59860 59101 59101 59047 59868 59802 59901 59901 59405 59405 59102 59405 59715 59901 SPECIALTY PODIATRY PODIATRY PODIATRY CARDIOLOGY FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA OCCUPATIONAL THERAPY FAMILY PRACTICE FAMILY PRACTICE HEMATOLOGY-ONCOLOGY URGENT CARE PROVIDER URGENT CARE PROVIDER OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR HOSPITALIST ORTHOPAEDIC SURGERY PHYSICIAN ASSISTANT FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA ALLERGY/IMMUNOLOGY ALLERGY/IMMUNOLOGY PHYSICAL THERAPY PHYSICAL THERAPY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE CHIROPRACTIC PHYSICAL THERAPY FAMILY PRACTICE CHIROPRACTOR CHIROPRACTOR PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT LICENSED CLINICAL SOCIAL WORKER OPHTHALMOLOGY PSYCHIATRY NURSE PRACTITIONER NURSE PRACTITIONER GASTROENTEROLOGY GASTROENTEROLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR ANESTHESIOLOGY LICENSED BEHAVIORAL COUNSELOR INFECTIOUS DISEASES Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 107 of 256 FIRST NAME KATHERINE STEPHEN MARY TERRY JOHN NINA ROBERT ROBERT BRENDA WILLIAM CLAUDE CLAUDE GERALDINE LYUDMILA LYUDMILA RICHARD JON JAZPER MARY LEIGH-ANNE KRISTEN FRANK GEORGE GEORGE TIMOTHY PATRICIA DANA NED NANCY KATHLEEN KATHLEEN KATHLEEN JOHN LEE ALISON CHERYL CHRISTINE M TANIS CRAIG ERIC CARLOS THOMAS STEVEN FLOYD LINDSAY THOMAS THOMAS RONALD KENDRICK Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME TOBIN TOBIN TOLBERT TOLLAKSON TOLLERSON TOMASZEWSKI TOMPKINS TOMPKINS TONER TONIDANDEL TONNERRE TONNERRE TOOKEY TOOLE TOOLE TOOTHMAN TORGERSON TORRES TOTH TOWNES TOWNLEY TOWSLEY TOYNE TOYNE TRACY TRAFTON TRANDAHL TRANEL TRANGMOE TRAPP TRAPP TRAPP TRAUSCHT TRAVIS TRAVIS TREINEN TREMAIN TRENFIELD-JOYNER TRENKA TREPTOW TREVELLINE TREVINO TRIEHY TRIMBLE TRINIDAD TRIPP TROOP TROOP TROSPER TROSTEL LICENSE MD LCSW AU LCPC DO MD EDD PHD OT MD MD MD NP PAC PA-C MD MD DC NP PHD MD PAC DC DC OT LCPC LCPC PHD MD MD MD MD MD MD LCSW LCPC LCPC NP SLT MD MD MD DO PAC MD PT MD MD DC MD MEDICAL GROUP SIDNEY HEALTH CENTER CORNERSTONE COUNSELING BIG SKY FAMILY MEDICINE BILLINGS GASTROINTESTINAL ASSOCIATE BILLINGS CLINIC COMMUNITY BRIDGES CAPITAL MEDICAL ANESTHESIA GREAT FALLS CLINIC MONTANA HEART CENTER SIDNEY HEALTHCARE NORTH VALLEY HOSPITAL BLACKTAIL CHIROPRACTIC CLINIC HIGHLAND HEALTHCARE COUNSELING CTR WESTERN MONTANA CLINIC TAMARACK MEDICAL CLINIC NORTHERN CHIROPRACTIC TRACY HAND & OCCUPATIONAL THERAPY CLARK FORK EMERGENCY PHYSICIANS BROADWATER HEALTH CENTER TRAPP MEDICAL CLINIC MONTANA CANCER SPECIALISTS HOSPITALISTS OF ST PETERS WELL BEING TRENKA SPEECH-LANGUAGE SERVICES NORTHWEST PHYSICIANS SIDNEY CLINIC GREAT FALLS CLINIC FLATHEAD VALLEY ORTHOPEDICS BELGRADE URGENT CARE BIG SKY PHYSICAL THERAPY SVH HOSPITALIST PROGRAM SVH HOSPITALIST PROGRAM BILLINGS CLINIC ADDRESS 216 14TH AVE SW 225 N 23RD ST 160 HERITAGE WAY 516 FULLER AVE STE 1 202 CONWAY DR STE 200 1144 N 28TH ST STE C 1020 N 27TH ST 1018 N 30TH ST 2685 PALMER #D 2475 BROADWAY 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 1400 29TH ST S 2827 FORT MISSOULA RD 500 W BROADWAY #320 216 14TH AVE SW 1600 HOSPITAL WAY 35 SECOND ST EAST 400 13TH AVE S STE 206 925 HIGHLAND BLVD STE 1170 500 W BROADWAY 1208 6TH AVE E 503 BOX ELDER 201 W 4TH ST 111 SUNNYVIEW LN 2101 E 5TH 3209 FLORAL BOULEVARD 1645 AVE D #E 2827 FORT MISSOULA RD 110 N OAK ST 110 N OAK ST STE 200 110 N OAK ST STE 200 500 W BROADWAY 2475 BROADWAY 507 SO 8TH AVE 410 CENTRAL AVE #507 625 NE MAIN ST STE 3 500 W BROADWAY 1122 E MAIN STE 4 401 15TH AVE S STE 201 2831 FORT MISSOULA RD STE 303 214 14TH AVE SW 2012 14TH ST SW 111 SUNNYVIEW LN 403 W MAIN ST 316 W SPRUCE STE A 1233 N 30TH ST 1233 N 30TH ST 1500 6TH AVE N 801 N 29TH ST CITY SIDNEY BILLINGS KALISPELL HELENA KALISPELL BILLINGS BILLINGS BILLINGS MISSOULA HELENA MISSOULA MISSOULA GREAT FALLS MISSOULA MISSOULA SIDNEY WHITEFISH KALISPELL GREAT FALLS BOZEMAN MISSOULA SUPERIOR COLSTRIP HARDIN KALISPELL HELENA BUTTE BILLINGS MISSOULA TOWNSEND TOWNSEND TOWNSEND MISSOULA HELENA BOZEMAN GREAT FALLS LEWISTOWN MISSOULA BOZEMAN GREAT FALLS MISSOULA SIDNEY GREAT FALLS KALISPELL BELGRADE MISSOULA BILLINGS BILLINGS GREAT FALLS BILLINGS ZIP 59270 59101 59901 59601 59901 59101 59101 59101 59808 59601 59802 59802 59405 59804 59802 59270 59937 59901 59405 59715 59802 59872 59323 59034 59901 59601 59701 59102 59804 59644 59644 59644 59807 59601 59715 59401 59457 59802 59715 59405 59804 59270 59404 59901 59714 59802 59101 59101 59401 59101 SPECIALTY RADIOLOGY LICENSED CLINICAL SOCIAL WORKER AUDIOLOGY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE GASTROENTEROLOGY PSYCHOLOGY PSYCHOLOGIST OCCUPATIONAL THERAPY ANESTHESIOLOGY HOSPITALIST INFECTIOUS DISEASE PEDIATRICS CARDIOLOGY PHYSICIAN ASSISTANT RADIOLOGY FAMILY PRACTICE CHIROPRACTIC FAMILY PRACTICE PSYCHOLOGY DERMATOLOGY FAMILY PRACTICE CHIROPRACTIC CHIROPRACTIC OCCUPATIONAL THERAPY LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR PSYCHOLOGIST EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE HEMATOLOGY-ONCOLOGY HOSPITALIST LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR NURSE PRACTITIONER SPEECH/LANGUAGE THERAPY FAMILY PRACTICE GASTROENTEROLOGY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE URGENT CARE PROVIDER PHYSICAL THERAPY FAMILY PRACTICE HOSPITALIST CHIROPRACTOR NEPHROLOGY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 108 of 256 FIRST NAME TARA LYNN LINDA DIANE RANDY JOHN ELIZABETH LYNETTE MICHAEL PETER JONNELLE MARY CHARLES ANASTASIA WILLLIAM BRUCE ERIN WILLIAM JAMES MELISSA "KATIE" JULIE HEIDI HEIDI HEIDI SHARI DONALD SHANTELL ROBINETTE JOE ERIN ROBERT MICHAEL KELLY KELLY MICHAEL MICHAEL MICHAEL STACY LEANN SAMUEL JOSHUA AMBER AMBER ANNIE GREGORY GREGORY A LEWIS JULIETTE MAVIS DAVID Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME TROTTER TROY TROYER TRUCHOT TRUDEAU TRUE TRUEBLOOD TRUELSON TRYHUS TUBERTY TUCKER TUCKER TUPPER TURECK TURK TURLINGTON TURNER TURNER TURNER TURRIN TURUNEN TUTHILL TUTHILL TUTHILL TWIGG TWITO TWOBEARS TYLER UHL ULANO ULRICH ULRICH UNDERHILL UNDERHILL UPHUES UPHUES UPHUES UPTON URBAN URSO URVATER USSIN-DAVEY USSIN-DAVEY USSIN-HUNTER UTTER UTTER VADHEIM VAIL VAILLANCOURT VAINIO LICENSE LCPC ND APRN NP PA-C MD PT APRN MD MD PA PAC MD PT OD MD OT MD MD PAC LCSW MD MD MD MD MD MD CRNA LCSW DO MD LCSW MD MD DO DO DO PT CRNA DO MD LCPC LCPC SLT MD MD MD PT LAC OD MEDICAL GROUP WESTERN MONTANA MENTAL HEALTH CTR NORTHWEST ONCOLOGY & HEMOTOLOGY BIG HORN COUNTY MEMORIAL HOSPITAL BILLINGS CLINIC NORTHERN MONTANA HOSPITAL MOUNTAIN PHYSICAL THERAPY PC INTERNAL MEDICINE ASSOCIATES MISSOULA RADIOLOGY BIG SANDY MEDICAL CENTER CARDIOVASCULAR CONSULTANTS OF MT AWARE INC MANGER HARRINGTON PHYSICAL THERAPY COMPLETE EYE CENTER MISSOULA RADIOLOGY BILLINGS CLINIC COMMUNITY HOSPITAL OF ANACONDA GREAT FALLS CLINIC ADVANCED MEDICAL IMAGING INTERCITY RADILOLOGY INTERCITY RADIOLOGY SIDNEY HEALTH CENTER CLINIC BILLINGS CLINIC BILLINGS CLINIC MILES CITY CRNA (BENEFIS HEALTH SYSTEMS) CENTER FOR MENTAL HEALTH NORTHERN MONTANA MEDICAL GROUP W LAUREL MEDICAL CENTER BENEFIS ONCOLOGY ASSOCIATES BENEFIS SLETTEN HI-LINE CANCER CENT ADVANCED CARE HOSPITAL OF MONTANA SHERIDAN MEMORIAL HOSPITAL WHITEFISH PT & SPORTS REHAB COMMUNITY HOSPITAL OF ANACONDA MARCUS DALY MEMORIAL ST JOHNS LUTHERAN HOSPITAL BILLINGS CLINIC PEDIATRIC THERAPY CLINIC PERI & NEONATAL SERVICES ROCKY MOUNTAIN PERINATOLOGY BILLINGS CLINIC MILES CITY VAIL PHYSICAL THERAPY TURNING POINT ADDITION SERVICES AMERICAN EYECARE ADDRESS 418 WINDWARD WAY 350 HERITAGE WAY #1100 17 N MILES 801 N 29TH ST 621 3RD ST S 20 13TH ST 1297 BURNS WAY STE 3 2900 12TH AVE N STE 310W 3205 RUSSELL ST 500 W BROADWAY 166 MONTANA AVE 1101 N 27TH ST STE F 616 HELENA AVE STE 305 2525 COLONIAL DR STE B 611 N E MAIN 3205 RUSSELL ST 801 N 29TH ST 401 W PENNSYLVANIA 216 14TH AVE SW 1600 DIVISION RD 101 E BROADWAY STE 402 925 HIGHLAND BLVD 925 HIGHLAND BLVD STE 1180 925 HIGHLAND BLVD 214 14TH AVE SW 801 N 29TH ST 620 S HAYNES 1101 26TH ST S 312 THIRD ST 20 13TH ST W 1035 1ST AVE N 926 MAIN ST #18 1117 29TH ST S STE 200 40 W 13TH ST 3528 GABEL RD 440 W LAUREL AVE 301 KNAPP ST 1600 HOSPITAL WAY 401 W PENNSYLVANIA 1200 WESTWOOD DR 350 LOUISIANA AVE 801 N 29TH ST 2020 GRAND AVE STE 2 50 27TH ST W STE A 310 SUNNYVIEW LN 2835 FORT MISSOULA RD #303 620 S HAYNES 316 E BABCOCK ST 1325 WYOMING ST 100 W PARK AVE CITY KALISPELL KALISPELL HARDIN BILLINGS GLASGOW HAVRE KALISPELL BILLINGS MISSOULA MISSOULA BIG SANDY BILLINGS HELENA HELENA LEWISTOWN MISSOULA BILLINGS ANACONDA SIDNEY GREAT FALLS MISSOULA BOZEMAN BOZEMAN BOZEMAN SIDNEY BILLINGS MILES CITY GREAT FALLS HAVRE HAVRE LAUREL BILLINGS GREAT FALLS HAVRE BILLINGS PLENTYWOOD WOLF POINT WHITEFISH ANACONDA HAMILTON LIBBY BILLINGS BILLINGS BILLINGS KALISPELL MISSOULA MILES CITY BOZEMAN MISSOULA ANACONDA ZIP 59901 59901 59034 59101 59230 59501 59901 59101 59801 59802 59520 59101 59601 59601 59457 59801 59101 59711 59270 59404 59802 59715 59715 59715 59270 59101 59301 59405 59501 59501 59044 59105 59405 59501 59102 59254 59201 59937 59711 59840 59923 59101 59102 59102 59901 59804 59301 59715 59801 59711 SPECIALTY LICENSED BEHAVIORAL COUNSELOR NATUROPATH EMERGENCY MEDICINE/TRAUMA GERIATRIC MEDICINE PHYSICIAN ASSISTANT SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY NURSE PRACTITIONER RADIOLOGY HOSPITALIST FAMILY PRACTICE CARDIOLOGY PSYCHIATRY CHILD PHYSICAL THERAPY OPTOMETRY RADIOLOGY OCCUPATIONAL THERAPY EMERGENCY MEDICINE/TRAUMA RADIOLOGY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER RADIOLOGY RADIOLOGY RADIOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY HEMATOLOGY-ONCOLOGY FAMILY PRACTICE ANESTHESIOLOGY LICENSED CLINICAL SOCIAL WORKER PSYCHIATRY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER RADIATION ONCOLOGY RADIATION ONCOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PHYSICAL THERAPY ANESTHESIOLOGY EMERGENCY MEDICINE/TRAUMA SURGERY ORTHOPEDIC MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY PERINATOLOGY PERINATOLOGY INTERNAL MEDICINE PHYSICAL THERAPY LICENSED ADDICTION COUNSELOR OPTOMETRY Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 109 of 256 FIRST NAME DAVID DAVID DAVID DAVID DAVID HENRIKA JOHN JOHN BERNADETTE JOAN THOMAS IVAN TANJARIITTA JAMIE PETER PETER TAMELA MARK MARK MARK GREG MICHAEL PATSY PATSY PATSY DIANA NED DAVID DAVID READ TRACY RODNEY RICARDO ROBERT ROBERT ROBERT ROBERT MARY MARY MARY LAWRENCE KRISTIN NANCY DONNA PHILIP GARY ENRICO LEAH ERIC JANNA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME VAINIO VAINIO VAINIO VAINIO VAINIO VAITKEVICIUS VALLIN VAN ARENDONK VAN BELOIS VAN DUYNHOVEN VAN DYK VAN EERDEN VAN HOOVER VAN HORSSEN VANCE VANCE VANDERAARDE VANDOLAH VANDOLAH VANDOLAH VANICHKACHORN VANNATTA VARGO VARGO VARGO VASHRO VASQUEZ VAUGHAN VAUGHAN VAUGHAN VAUGHN VAUGHT VEGA VELIN VELIN VELIN VELIN VELK VELK VELK VELK VENEMAN VENTRESCA VERALDI VERCIO VERNON VERSACE VERSTEEGEN VILEN VILEN LICENSE OD OD OD OD OD PA MD MD MD CNMW MD DC LCSW APRN MD MD MD CRNA CRNA CRNA MD PT MD MD MD LCPC MD NP NP MD LCPC MD DO PHD PHD PHD PHD PAC PAC PAC RN DO LCPC PHD MD DC MD PT MD MD MEDICAL GROUP AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE EYECARE USA GLENDIVE MEDICAL CENTER BRIDGER ORTHOPEDICS SILVERTIP EMERGENCY PHYSICIANS TAMARACK MEDICAL CLINIC BUTTE FAMILY SERVICE CENTER BEHAVIORAL HEALTH ASSOCIATES HICKORY STREET CHIROPRACTIC CLINIC THE MONTANA CENTER FOR WELLNESS MOUNTAIN VIEW FAMILY HEALTH CARE MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING OF IDAHO FALLS ANESTHESIA ASSOCIATES OF GT FALLS COMMUNITY HOSPITAL OF ANACONDA ROCKY MOUNTAIN EYE SURGERY CENTER SAME DAY SURGERY CENTER THE MONTANA CENTER FOR WELLNESS LONE PEAK PHYSICAL THERAPY LOLO FAMILY PRACTICE MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE NORTHWEST IMAGING COMPASS PROFESSIONAL SERVICES EMERGENCY PHYSICIANS MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA NEUROBEHAVIORAL SPECIALISTS MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE BEAR PAW PEDIATRICS ANESTHESIA ASSOCIATES OF GT FALLS PEAK CHIROPRACTIC ADVANCED CARE HOSPITAL OF MONTANA ALPINE PHYSICAL THERAPY HOLY ROSARY HEALTHCARE CLINIC HOLY ROSARY HEALTHCARE CLINIC ADDRESS 1313 HARRISON AVE 1429 S HIGGINS AVE 513 MAIN ST CAPITOL HILL MALL GALLATIN VALLEY MALL #53 202 PROSPECT DR 1450 ELLIS ST STE 201 310 SUNNYVIEW LN 150 COMMONS WAY 25 W FRONT ST 1101 N 27TH ST STE 201 225 HICKORY ST 245 WINDWARD WAY STE 101 2619 COLONIAL DR STE A 310 SANSOME ST 90 HWY 91 S 401 15TH AVE S STE 109 401 W PENNSYLVANIA 700 W KENT 300 N WILLSON STE 600F 245 WINDWARD WAY STE 101 135 PROSPECT LOOP 3511 1ST AVE N 3511 1ST AVE N #1 601 1ST AVE N 1101 MARYLAND AVE 11350 S HWY 93 104 RUFUS LN 126 6TH AVE SW #A 320 SUNNYVIEW LN 2510 CONTINENTAL DR 6575 HWY 93 S 1110 FRONT ST 1184 N 15TH STE 3 1610 S AVE W 834 S MONTANA 900 N ORANGE #301 104 RUFUS LN 126 6TH AVE SW STE A 330-6 TRACT LN 107 6TH AVE SW 505 E 6TH ST 1018 BURLINGTON #107 1018 N 30TH ST 401 15TH AVE S STE 109 1111 N RODNEY ST 3528 GABEL RD 5000 BLUE MOUNTAIN RD 2600 WILSON ST 2600 WILSON ST CITY BUTTE MISSOULA DEER LODGE HELENA BOZEMAN GLENDIVE BOZEMAN KALISPELL KALISPELL BUTTE BILLINGS MISSOULA KALISPELL HELENA PHILIPSBURG DILLON GREAT FALLS ANACONDA MISSOULA BOZEMAN KALISPELL BOZEMAN GREAT FALLS GREAT FALLS GREAT FALLS DEER LODGE LOLO POLSON RONAN KALISPELL BUTTE WHITEFISH FORT BENTON BOZEMAN MISSOULA BUTTE MISSOULA POLSON RONAN SAINT IGNATIUS RONAN WHITEFISH MISSOULA BILLINGS GREAT FALLS HELENA BILLINGS MISSOULA MILES CITY MILES CITY ZIP 59701 59801 59722 59601 59715 59330 59715 59901 59901 59701 59101 59801 59901 59601 59858 59725 59405 59711 59801 59715 59901 59718 59405 59401 59401 59722 59847 59860 59864 59901 59701 59937 59442 59715 59801 59701 59802 59860 59864 59865 59864 59937 59801 59101 59405 59601 59102 59804 59301 59301 SPECIALTY OPTOMETRY OPTOMETRY OPTOMETRY OPTOMETRY OPTOMETRY PHYSICIAN ASSISTANT SURGERY ORTHOPEDIC MEDICINE EMERGENCY MEDICINE/TRAUMA INTERNAL MEDICINE CERTIFIED NURSE MIDWIFE PSYCHIATRY CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE RADIOLOGY RADIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY FAMILY PRACTICE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA PSYCHOLOGY PSYCHOLOGY PSYCHOLOGY PSYCHOLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY PEDIATRICS PROFESSIONAL COUNSELOR PSYCHOLOGY ANESTHESIOLOGY CHIROPRACTIC INTERNAL MEDICINE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 110 of 256 FIRST NAME JANNA ERIC JANNA RICHARD KEBRINA KEBRINA DONNA DONNA JODI MICHELE JOHN JOHN TIMOTHY TIMOTHY JUDY TIMOTHY TINA ED ED ED MICHAEL BOBBIE DWAYNE KEVIN KEVIN CLAUDIA KATHIE MELISSA JULIE LESLEY THERESA PETER LESLEY JUDITH TRACI LOREN LOREN MARIA DOUGLAS KELSEY ROBERT ROBERT JEFF TROY ALEXIS KRISTIN PETER CHRISTINE ROBERT RICHARD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME VILEN VILEN VILEN VINGLAS VINGLAS VINGLAS VINNEDGE VINNEDGE VIOLETT VIOLI VIPPERMAN VIPPERMAN VISSCHER VISSCHER VISSCHER VISSCHER VISSCHER VIZCARRA VIZCARRA VIZCARRA VLASES VOEGER VOGEL VOGELZANG VOGELZANG VOGL VOIGT VOLLER VOLLERTSEN VON ESCHEN VONADA VONDOERSTEN VONESCHEN VOS FERNEAU VOSS VRANISH VRANISH WADE WADLE WADSWORTH WAGENAAR WAGENAAR WAGENER WAGNER WAGNER WAGNER WAGNER WAGNER WAGNER WAGNER LICENSE MD MD MD MD PT PT PT PT MD LCSW PAC PAC MD MD MD MD LCSW MD MD MD MD LCPC DC PT PT LCSW DO SLT DC PAC PA MD PAC LCPC PA-C MD MD MD MD PT MD MD MD PA NP LCPC MD LCSW DC LSW MEDICAL GROUP RIVERSTONE HEALTH SVH WALK IN CLINIC SVH WALK IN CLINIC BRIDGER ORTHOPEDICS RIDGELINE REHAB ADVANCED PRACTICE PHYSICAL THERAPY NORTHWEST PHYSICIANS COMMUNITY HEALTH PARTNERS BLEGRAD FRONTIER CANCER CENTER & BLOOD INST FRONTIER CANCER CENTER & BLOOD INST COMMUNITY HEALTH PARTNERS PSYCHIATRY ASSOCIATES WESTERN MONTANA CLINIC WESTERN MONTANA MENTAL HEALTH CTR MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE MISSION MOUNTAIN MEDICINE INTERNAL MEDICINE ASSOCIATES VOGEL CHIROPRACTIC VOGELZANG PHYSICAL THERAPY WESTERN MONTANA CLINIC WESTERN MONTANA MENTAL HEALTH CTR PEDIATRIC SPEECH THERAPY SOLUTIONS THE WELLNESS STUDIO BARRETT HOSPITAL & HEALTHCARE ST PETERS MEDICAL GROUP ROCKY MOUNTAIN EAR NOSE & THROAT WESTERN MONTANA MENTAL HEALTH CTR FAMILY HEALTH CARE FAMILY HEALTH CARE BARRETT HOS & HEALTHCARE CLINIC PARK CLINIC WEST ADVANCED PERFORMANCE & REHAB HEIGHTS FAMILY PRACTICE RIVERSTONE HEALTH SVH SPECIALTY CARE SERVICES BILLINGS CLINIC CONVINIENT CARE CLINIC HEAD QUARTERS FOR HEART CHANGE NORTHWEST ONCOLOGY & HEMATOLOGY THOMPSON FALLS MENTAL HEALTH CENTER WAGNER CHIROPRACTIC WESTERN MONTANA MENTAL HEALTH CTR ADDRESS 123 S 27TH ST 1233 N 30TH ST 1233 N 30TH ST 1450 ELLIS ST STE 201 403 GALLATIN FARMS AVE 1532 ELLIS ST STE 103 900 2ND ST S 914 13TH AVE S 401 15TH AVE S STE 201 19 E MAIN ST 1315 GOLDEN VALLEY CIRCLE 400 S CLARK 126 S MAIN 2078 STADIUM DR STE 101 500 W BROADWAY 234 E REEDER ST 1609 W BABCOCK STE B 104 RUFUS LN 126 6TH AVE SW #A 330-6 TRACT LN 905 HIGHLAND BLVD STE 4500 1601 2ND AVE N #200 71 25TH ST W STE 6 1639 S 8TH ST W 500 W BROADWAY 100 DEWEY AVE 670 PARK AVE 800 KENSINGTON AVE STE 100 425 N LAST CHANCE GULCH 90 HWY 91 S 2550 BROADWAY 700 W KENT 90 HWY 91 S 106 W BROADWAY 818 2ND AVE EAST 1287 1287 BURNS WAY 715 NUCLEUS AVE 30 HWY 91 S 1315 W CRAWFORD 1532 ELLIS ST STE 201 32 WICKS LN 123 S 27TH ST 1230 N 30TH ST STE 100 2702 8TH AVE N 1200 WESTWOOD DR 225 N 23RD ST 350 HERITAGE WAY STE 1100 704 MAIDEN LN 213 N HAYNES AVE 106 W BROADWAY CITY BILLINGS BILLINGS BILLINGS BOZEMAN BELGRADE BOZEMAN GREAT FALLS GREAT FALLS GREAT FALLS LIVINGSTON BILLINGS BUTTE LIVINGSTON BOZEMAN MISSOULA DILLON BOZEMAN POLSON RONAN SAINT IGNATIUS BOZEMAN GREAT FALLS BILLINGS MISSOULA MISSOULA EUREKA SHELBY MISSOULA HELENA DILLON HELENA MISSOULA DILLON BUTTE CULBERTSON KALISPELL COLUMBIA FALLS DILLON LIVINGSTON BOZEMAN BILLINGS BILLINGS BILLINGS BILLINGS HAMILTON BILLINGS KALISPELL THOMPSON FALLS MILES CITY BUTTE ZIP 59101 59101 59101 59715 59714 59715 59405 59405 59405 59047 59102 59701 59047 59715 59801 59725 59715 59860 59864 59865 59715 59401 59102 59801 59802 59917 59474 59801 59601 59725 59601 59801 59725 59701 59218 59901 59912 59725 59047 59715 59105 59101 59101 59101 59840 59101 59901 59873 59301 59701 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPIST FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY FAMILY PRACTICE PSYCHIATRY CHILD FAMILY PRACTICE PSYCHIATRY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR CHIROPRACTIC PHYSICAL THERAPY PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE SPEECH/LANGUAGE THERAPY CHIROPRACTIC EMERGENCY MEDICINE/TRAUMA SURGERY GENERAL SURGERY HEAD & NECK EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR PHYSICIAN ASSISTANT FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE PEDIATRIC PULMONOLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR HEMATOLOGY-ONCOLOGY LICENSED CLINICAL SOCIAL WORKER CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED 111 of 256 FIRST NAME ALEXIS ALEXIS ALEXIS ALEXIS KATHLEEN JAMES ERIC ZILLAH TAMARA KATHRYN ROBERT BEVERLY JOHN DOUGLAS DOUGLAS JEANNETTE SARAH LARRY TRAVIS WALLACE WALLACE CRAIG DANIEL DANIEL JOHN ROGER LESLIE SAM RICHARD SHEILA COLLEEN SARAH WILLIAM JENNIFER MATTHEW ELIZABETH ELIZABETH ELIZABETH ROME MICHAEL MICHAEL LOU IRENE MISTY SARAH SARAH PATRICK JENNIFER TODD TODD Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WAGNER WAGNER WAGNER WAGNER WAGNER WAHLBERG WAHLER WAINE-SHOTLAND WAITE WAITMAN WALDCHEN WALDEISEN WALDHAUSEN WALDO WALDO WALDRON WALKER WALKER WALKER WALKER WALKER WALKER WALKER WALKER WALKER WALLACE WALLACE WALLACE WALLACE WALLER WALL-HOEBEN WALLICK WALLICK WALROD WALSH WALTER WALTER WALTER WALTER WALTERS WALTERS WALTERS WALTERS WALTERS-TERRITO WALTON WALTON WALTON WALTZ WAMPLER WAMPLER LICENSE NP NP NP NP LCSW PHD LCPC SLT RD NP PT OT MD MD MD MD PAC PA MD MD MD LCPC MD MD MD DO MD DO CA PT PSYD DO DC LCSW PAC MD MD MD DO MD MD ND APRN DC NP APRN MD PHD MD MD MEDICAL GROUP MOSAIC REHABILITATION BILLINGS CLINIC BILLINGS CLINIC ONCOLOGY/HEM HEALTH IN MOTION PHYSICAL THERAPY PEDIATRIC SURGERY OF MONTANA BENEFIS HOSPITAL HEART VASCULAR SPECIALISTS FAMILY PRACTICE ASSOCIATES FAMILY HEALTH CARE FAMILY PRACTICE ASSOCIATES HOLY ROSARY HEALTHCARE CLINIC NORTHERN MONTANA HOSPITAL PIONEER MEDICAL CENTER MATERNAL FETAL MEDICINE CLINIC MISSION VALLEY OCCUPATIONAL MISSOULA OSTEOPATHIC CLINIC PHYSICAL THERAPY IN MOTION BILLINGS CLINIC MONTANA NEUROBEHAVIORAL SPECIALISTS BILLINGS CLINIC BEHAVIORAL HEALTH ASSOCIATES BILLINGS CLINIC HIGH PLAINS PSYCHIATRIC ASSOC NORTHERN MONTANA HOSPITAL GREAT FALLS CLINIC RADIOLOGY MONTANA THE SOURCE WELLNESS CENTER PLLC WMMHC LIVINGSTON HEALTHCARE PIONEER MEDICAL CENTER PLASTIC & RECONSTRUCTIVE SURGERY BOULDER MEDICAL CLINIC ST PETERS MEDICAL GROUP ADDRESS 401 W MAIN #B 401 W MAIN ST #B 910 BROOKS #202 910 BROOKS ST #201 820 DIVISION ST 2831 FORT MISSOULA RD STE 201 616 HELENA AVE #301 6325 JACKRABBIT LN STE A 2800 10TH AVE N 801 N 29TH ST 1707 OAK ST D 3985 VALLEY COMMONS DR 2835 FT MISSOULA RD #301 1101 26TH ST S 1101 26TH ST S 5TH FLOOR 935 HIGHLAND BLVD STE 2210 1287 BURNS WAY 935 HIGHLAND BLVD #2210 2600 WILSON ST 30 W 13TH ST 301 W 7TH ST 8299 HWY 35 2510 BOBCAT WAY 401 15TH AVE S STE 104 310 SUNNYVIEW LN 2900 12TH AVE N STE 130W 43922 CANAL RD 341 W PINE 1100 1ST AVE N 50 27TH ST W STE B 127 W MAIN ST STE C 801 N 29TH ST 2717 MAIN ST 900 N ORANGE 3RD FLOOR 2702 8TH AVE N 1101 N 27TH ST #201 1020 N 27TH ST 1601 LEWIS AVE #4 30 13TH ST 3000 15TH AVE S 401 15TH AVE S STE 204 1924 W STEVENS ST STE 101 209 N 10TH STE A 5035 HWY 2 504 S 13TH ST 301 W 7TH AVE 715 GETCHELL ST 519 S 4TH ST WEST 214 S MAIN ST 2550 BROADWAY CITY HAMILTON HAMILTON MISSOULA MISSOULA BILLINGS MISSOULA HELENA BELGRADE BILLINGS BILLINGS BOZEMAN BOZEMAN MISSOULA GREAT FALLS GREAT FALLS BOZEMAN KALISPELL BOZEMAN MILES CITY HAVRE BIG TIMBER BIGFORK GREAT FALLS GREAT FALLS KALISPELL BILLINGS RONAN MISSOULA GREAT FALLS BILLINGS HAMILTON BILLINGS MILES CITY MISSOULA BILLINGS BILLINGS BILLINGS BILLINGS HAVRE GREAT FALLS GREAT FALLS BOZEMAN HAMILTON COLUMBIA FALLS LIVINGSTON BIG TIMBER HELENA MISSOULA BOULDER HELENA ZIP 59840 59840 59801 59801 59101 59804 59601 59714 59101 59101 59715 59718 59804 59405 59405 59715 59901 59715 59301 59501 59011 59911 59405 59405 59901 59101 59864 59802 59401 59102 59840 59101 59301 59802 59101 59101 59101 59102 59501 59405 59405 59718 59840 59912 59047 59011 59601 59801 59632 59601 SPECIALTY SLEEP STUDIES NURSE PRACTITIONER NURSE PRACTITIONER SLEEP STUDIES LICENSED CLINICAL SOCIAL WORKER PSYCHOLOGY LICENSED BEHAVIORAL COUNSELOR SPEECH/LANGUAGE THERAPY NUTRITION PROFESSIONAL HEMATOLOGY-ONCOLOGY PHYSICAL THERAPY OCCUPATIONAL THERAPY PEDIATRIC SURGERY CARDIOLOGY SURGERY CARDIOVASCULAR THORACIC FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE PEDIATRICS EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY CARDIOLOGY PATHOLOGY OB/GYN-OBSTETRICS/GYNECOLOGY OCCUPATIONAL THERAPY OSTEOPATHIC MANIPULATIVE MEDICINE ACUPUNCTURIST PHYSICAL THERAPY PSYCHOLOGIST FAMILY PRACTICE CHIROPRACTIC LICENSED CLINICAL SOCIAL WORKER SURGERY ORTHOPEDIC MEDICINE PSYCHIATRY PSYCHIATRY PSYCHIATRY FAMILY PRACTICE RADIOLOGY RADIOLOGY NATUROPATH PSYCHIATRY CHIROPRACTOR FAMILY PRACTICE FAMILY PRACTICE SURGERY PLASTIC/RESTORATIVEBURN PSYCHOLOGY FAMILY PRACTICE FAMILY PRACTICE Montana STATUS PENDING PENDING SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 112 of 256 FIRST NAME ALAN ALAN CHUN-JU LINNEA RONDA RONDA KIM ROBERT JOHN DAVID DAVID TOMMY LINDA TROY MARILYN MARVIN MARILYN GAYLE JAMES MARK KIM ANGELA MARY WILLIAM MICHAEL PATRICK PATRICK MICHAEL MARGARET VIRGINIA LAURA DANIEL KIPP KIPP SIMONE SIMONE KIPP KIPP RANDY KIRWAN SARAH ELIZABETH DOUGLAS REBBECCA STEVE KYLE MARY ERIKA DARRYL MARK Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WANDERER WANDERER WANG WANG WANGERIN WANGERIN WAPLES WARD WARD WARDEN WARDEN WARDEN WARING WARLING WARREN WARREN WARREN WASH WASHBURN WASHBURN WATERFALL WATSCHKE WATSON WATSON WATSON WATSON WATSON WATSON WATSON WATTS WAYLANDER WEAVER WEBB WEBB WEBB WEBB WEBB WEBB WEBB WEBB WEBB WEBB WEBBER WEBBER-DERESZNSKI WEBER WEBER WEBER WEBER WEBER WEBER LICENSE MD MD DO LCPC PT PT LCSW CRNA MD MD MD DC MD NP APRN MD LCPC LCSW LCPC MD PT LCPC MD PAC PAC PAC PAC LCSW LCPC CNMW MD MD MD DC DC MD MD MD MD LCSW LCSW MD LCPC MD MD NP LCSW LCPC MD MEDICAL GROUP ALLERGY & ASTHMA CONSULTANTS OF MT ALLERGY & ASTHMA CONSULTANTS OF MT DEER LODGE VALLEY THERAPY DEER LODGE VALLEY THERAPY CENTERS FOR MENTAL HEALTH MARCUS DALY MEMORIAL HOSPITAL NORTHWEST ONCOLOGY & HEMOTOLOGY MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAGING OF IDAHO FALLS STILLWATER CHIROPRACTIC BILLINGS CLINIC ADVANCED PAIN CENTERS OF MONTANA ACADIA MONTANA BILLINGS ANESTHESIOLOGY WESTERN MONTANA MENTAL HEALTH CTR YELLOWSTONE COUNSELING CENTER WESTERN MONTANA MENTAL HEALTH CTR BITTERROOT CLINIC WATSCHKE PHYSICAL THERAPY ALTACARE BARRETT HOSPITAL & HEALTHCARE RUBY VALLEY MEDICAL CLINIC RUBY VALLEY MEDICAL CLINIC RUBY VALLEY MEDICAL CLINIC TWIN BRIDGES MEDICAL CLINIC WESTERN MONTANA MENTAL HEALTH CTR BELGRADE COUNSELING CLINIC ELIZABETH SETON PRENATAL CLINIC BILLINGS CLINIC BOZEMAN DEACONESS CARDIOLOGY CONSULTANTS OF BOZEMAN CHIROPRACTIC FIRST CHIROPRACTIC FIRST OF BILLINGS PC MERCURY STREET MEDICAL MERCURY STREET MEDICAL NORTHERN ROCKIES MEDICAL CLINIC ROCKY MOUNTAIN CLINIC SARAH WEBB COUNSELING PLANNED PARENTHOOD OF MONTANA RWD PSYCHOTHERAPY PPLC GLACIER EYE CLINIC SILVERTIP EMERGENCY PHYSICIANS TAMARACK MEDICAL CLINIC WMMHC ADDRESS 2055 22ND AVE STE 1 402 S ALABAMA ST STE 6A 500 W BROADWAY 5767 FOSTER LN 310 MAIN ST 310 MAIN ST 900 N JACKSON 1200 WESTWOOD DR 350 HERITAGE WAY S1100 310 SANSOME ST 90 HWY 91 S 80 FOUR MILE DR STE 16 801 N 29TH ST 2825 STOCKYARD RD BLDG I-200 55 BASIN CREEK RD 2800 10TH AVE N 106 W BROADWAY 208 N BROADWAY STE 423 1315 WYOMING ST 1305 WYOMING ST 1224 W MAIN 2917 ROSE ST 1924 PHILLIPS AVE 90 HWY 91 S 210 E CROFOOT ST 210 E CROFOOT 210 E CROFOOT 104 S MADISON 1315 WYOMING 129 VILLAGE DR STE 303 1230 N 30TH STE 200 801 N 29TH ST 905 HGIHLAND BLVD STE 4300 935 HIGHLAND BLVD STE 4330 10 AVANTA WAY STE 1 3307 GRAND AVE STE 101 300 W MERCURY 300 W MERCURY 226 9TH AVE SE 1101 S MONTANA ST 2023 STADIUM DR STE 2B 104 E MAIN ST STE 310 219 E MAIN 1601 LEWIS AVE STE 202C 160 HERITAGE WAY 310 SUNNYVIEW LN 1208 6TH AVE E 81 W PARK 1643 LEWIS AVE STE 6 902 N ORANGE 4TH FLOOR CITY BOZEMAN BUTTE MISSOULA BELGRADE DEER LODGE DEER LODGE HELENA HAMILTON KALISPELL PHILIPSBURG DILLON KALISPELL BILLINGS MISSOULA BUTTE BILLINGS BUTTE BILLINGS MISSOULA MISSOULA HAMILTON BOZEMAN BUTTE DILLON SHERIDAN SHERIDAN SHERIDAN TWIN BRIDGES MISSOULA BELGRADE BILLINGS BILLINGS BOZEMAN BOZEMAN BILLINGS BILLINGS BUTTE BUTTE CUT BANK BUTTE BOZEMAN BOZEMAN MISSOULA BILLINGS KALISPELL KALISPELL SUPERIOR BUTTE BILLINGS MISSOULA ZIP 59718 59701 59802 59714 59722 59722 59601 59840 59901 59858 59725 59901 59101 59808 59701 59101 59701 59101 59801 59801 59840 59718 59701 59725 59749 59749 59749 59754 59803 59714 59101 59101 59715 59715 59102 59102 59701 59701 59427 59701 59715 59715 59802 59102 59901 59901 59872 59701 59102 59802 SPECIALTY ALLERGY/IMMUNOLOGY ALLERGY/IMMUNOLOGY PHYSICAL MEDICINE REHABILITATION LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY HEMATOLOGY-ONCOLOGY RADIOLOGY RADIOLOGY CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY PAIN MANAGEMENT PSYCHIATRY ANESTHESIOLOGY PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR CERTIFIED NURSE MIDWIFE OPHTHALMOLOGY CARDIOLOGY INTERNAL MEDICINE CHIROPRACTIC CHIROPRACTIC CARDIOLOGY INTERNAL MEDICINE FAMILY PRACTICE INTERNAL MEDICINE LICENSED CLINICAL SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR OPHTHALMOLOGY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR PHYSICAL MEDICINE REHABILITATION Montana STATUS PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 113 of 256 FIRST NAME STEVEN KAREN KAREN THAIS TIMOTHY TIMOTHY APRIL APRIL ERIC THOMAS ALLEN LISA DERIC GLORIA GLORIA GLORIA LAURA KATE MARK STEPHANIE MICHAEL DAWNA DAWNA LYNN DAWNA JANE TAMARA CAREY MIMI JAMES ROBERTA LAURA PETER NINA VICTOR SHAUNDA JOSEPH KATY RUTH STEWART JACK KARL KARL LOUIS OIVIND OIVIND OIVIND MICHELA NICOLETT MARK REBECCA Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WEBER WEED WEEDING WEIBEL WEILL WEILL WEINBERGER WEINBERGER WEINER WEINER WEINERT WEINREICH WEISS WEISS WEISS WEISS WEISS WEISS WELCH WELCH WELKER WELLS WELLS WELLS WELLS WELSH WELSH WELSH WEMPLE WENDEROTH WENDLANDT WENDT WENDT WENG WENGER WENTZELL WESSEL WEST WEST WEST WESTENFELDER WESTENFELDER WESTENFELDER WESTERENG WESTERENG WESTERENG WESTHOFF WESTON WESTON WESTON LICENSE MD MD LCPC MD MD MD MD MD MD MD MD PAC MD LCPC LCPC LCPC APRN LCPC MD MD DC PAC PAC PA MD DO MD APRN LCPC LCPC PHD MD PHD DO LCPC MD DO PA MD DC MD MD PAC PA-C PA-C PA-C PA NP MD LCSW MEDICAL GROUP BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC GREAT FALLS FAMILY MEDICINE CONVENIENT CARE CLINIC CORVALLIS FAMILY MEDICINE KALISPELL DIAGNOSTIC SERVICE ST PETERS HOSPITAL HELENA ORTHOPAEDIC CLINIC HELENA ORTHOPAEDIC PROMPT CARE BILLINGS CLINIC MENTAL HEALTH CENTER MENTAL HEALTH CENTER MENTAL HEALTH CENTER PLANNED PARENTHOOD OF MONTANA NORTHWEST HOSPITALISTS BARRETT HOSPITAL & HEALTHCARE BARRETT HOSPITAL & HEALTHCARE SVH WALK IN CLINIC CENTRAL MONTANA MEDICAL CENTER GREAT FALLS CLINIC WMMHC PINTLER SURGICAL SPECIALISTS BENEFIS BILLINGS CLINIC ST PETERS MED GROUP NORTH ALLERGY AND ASTHMA CENTER GREAT FALLS CLINIC FIVE VALLEY UROLOGY FIVE VALLEYS UROLOGY MISSOULA BONE & JOINT BENEFIS MEDICAL GROUP CORVALLIS FAMILY MEDICINE ADDRESS 160 HERITAGE WAY 30 HWY 91 S 2200 BOX ELDER 801 N 29TH ST 2800 11TH AVE S #3 3117 3RD ST NE 1200 WESTWOOD DR 1037 MAIN ST 135 COMMONS WAY 2475 BROADWAY 2442 WINNE 2442 WINNE AVE STE 2 801 N 29TH ST 1245 N 29TH 5 E 9TH 515 HOOPER 211 9TH ST S 321 E MAIN ST STE 306 310 SUNNYVIEW LN 500 W BROADWAY 2210 HARRISON AVE 90 HWY 91 S 90 HWY 91 S 1233 N 30TH ST 700 S AVE W STE B 408 WENDELL AVE 1600 DIVISION RD 81 W PARK ST 28 FORT MISSOULA RD STE 1 415 N HIGGINS AVE #110 3528 GABLE RD 305 W PENNSYLVANIA AVE 600 CENTRAL AVE STE 18B 1011 26TH ST S 109 W 2 ST 801 N 29TH ST 3330 PTARMIGAN LN 900 N ORANGE ST STE 207 20 13TH ST 154 14TH ST E 2875 TINA AVE #101 1200 WESTWOOD DR 2360 MULLAN RD #C 16862 BECKWITH ST 3050 HWY 83 N 601 W SPRUCE #C 500 15TH AVE S STE 1 1037 MAIN ST 500 W BROADWAY 901 N ORANGE #107 CITY KALISPELL DILLON MILES CITY BILLINGS GREAT FALLS GREAT FALLS HAMILTON CORVALLIS KALISPELL HELENA HELENA HELENA BILLINGS BILLINGS RED LODGE BIG TIMBER GREAT FALLS BOZEMAN KALISPELL MISSOULA BUTTE DILLON DILLON BILLINGS MISSOULA LEWISTOWN GREAT FALLS BUTTE MISSOULA MISSOULA BILLINGS ANACONDA GREAT FALLS GREAT FALLS HAVRE BILLINGS HELENA MISSOULA HAVRE EUREKA MISSOULA HAMILTON MISSOULA FRENCHTOWN SEELEY LAKE MISSOULA GREAT FALLS CORVALLIS MISSOULA MISSOULA ZIP 59901 59725 59301 59101 59405 59404 59840 59828 59901 59601 59601 59601 59101 59101 59068 59011 59404 59715 59901 59802 59701 59725 59725 59101 59801 59457 59404 59701 59804 59802 59102 59711 59401 59405 59501 59101 59602 59802 59501 59917 59808 59840 59808 59834 59868 59802 59405 59828 59802 59802 SPECIALTY OPHTHALMOLOGY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR NEUROLOGY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE HEMATOLOGY-ONCOLOGY PHYSICAL MEDICINE REHABILITATION SURGERY ORTHOPEDIC MEDICINE INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR OB/GYN-OBSTETRICS/GYNECOLOGY LICENSED BEHAVIORAL COUNSELOR HOSPITALIST HOSPITALIST CHIROPRACTIC EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE PSYCHIATRY EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE PSYCHIATRY LICENSED BEHAVIORAL COUNSELOR PROFESSIONAL COUNSELOR PSYCHOLOGIST SURGERY ORTHOPEDIC MEDICINE PSYCHOLOGY HOSPITALIST LICENSED BEHAVIORAL COUNSELOR DERMATOLOGY FAMILY PRACTICE ALLERGY/IMMUNOLOGY DERMATOLOGY CHIROPRACTOR SURGERY UROLOGICAL UROLOGY SURGERY UROLOGICAL UROLOGY SURGERY ORTHOPEDIC MEDICINE PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT FAMILY PRACTICE FAMILY PRACTICE EMERGENCY MEDICINE SOCIAL WORKER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 114 of 256 FIRST NAME ASHLEY ASHLEY ASHLEY LAURA CHRISTOPHER LEWIS HEATHER KERRIE KERRIE ANNA KENNETH MARC CATHERINE CATHERINE ELIZABETH SEBASTIAN ELIZABETH WILLIAM CATHERINE BROOKE GARY MARY DOUGLAS DONNA LESLIE STEPHEN BROCK SUSAN SUSAN SUSAN JAMES JAMES CHRISTOPHER TASHA MICHAEL DIANNE ELLEN DAVID DAVID MICHAEL KARI RICHARD JAMES RYAN CHRISTINE SUZANNE DENNIS MICHAEL WALLACE WALLACE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WESTPHAL WESTPHAL WESTPHAL WETHERELT WHALEY WHATLEY WHEELER WHEELER WHEELER WHERRY WHIPPLE WHITACRE WHITE WHITE WHITE WHITE WHITE WHITE WHITE WHITE WHITE WHITE WHITEHEAD WHITMAN WHITNEY WHITNEY WHITTENBERGER WHITTINGHILL WHITTINGHILL WHITTINGHILL WHITTLE WHITWORTH WICHER WICKENS WICKERSHAM WICKHAM WICKLUND WIDDEKIND WIDDEKIND WIENCEK WIENS WIESEMANN WIGGINS WIGNESS WIKE WIKEN WILCOX WILCOX WILDER WILDER LICENSE NP NP NP NP CRNA MD MD LCPC LCPC PT DO MD MD MD MD NP MD MD MD SLT OD LCPC PAC PAC MD LCPC MD PAC PAC PAC MD MD MD LCPC MD NP DC CRNA CRNA CRNA NP PAC MD DC PT RD MD MD MD MD MEDICAL GROUP NORTHERN ROCKIES MEDICAL CENTER ROCKY MOUNTAIN HEART & LUNG THE WAL-MART CLINIC BY KRMC FORSYTH FAMILY MEDICINE PACIFIC CATARACT & LASER INSTITUTE MARCUS DALY HOSPITAL THE BOZEMAN CLINIC SILVER BOW PHYSICAL THERAPY ANESTHESIA ASSOC OF GREAT FALLS NORTHERN MONTANA HOSPITAL COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER GLACIER MEDICAL ASSOCIATES INTERNAL MEDICINE ASSOCIATES NORTH VALLEY HOSPITAL PEAK ORTHOPEDIC & SPORTS MEDICINE SHERIDAN COMMUNITY HEALTH CENTER WHITEFISH PT & SPORTS REHAB BILLINGS CLINIC FIRST CARE FAST TRACK WESTERN STATES INFECTIOUS DISEASE BILLINGS CLINIC FAMILY DOCTORS URGENT CARE MEDICAL ASSOCIATES PEAK HEALTH AND WELLNESS BENEFIS PHYSICIAN ASSOCIATES MENTAL HEALTH CENTER FIVE VALLEY UROLOGY NORTHWEST IMAGING SOUND VIEW COUNSELING RONAN CHIROPRACTIC NORTHERN MONTANA HOSPITAL PONDERA MEDICAL CENTER MARCUS DALY MEMORIAL HOSPITAL FIVE VALLEY UROLOGY SVH PEDIATRIC CARDIOLOGY WHITEFISH CHIROPRACTICE CENTER NASH SPINE & JOINT REHABILITATION NORTHERN MONTANA HOSPITAL MONTANA INTERVENTIONAL & DIAGNOSTIC SURGICAL ASSOCIATES KALISPELL REGIONAL HOSPITAL SUNNYVIEW PEDIATRICS ADDRESS 802 2ND ST SE 350 HERITAGE WAY #2100 170 HUTTON RANCH RD 383 N 17TH AVE 1717 4TH ST S 1200 WESTWOOD DR 931 HIGHLAND BLVD STE 3360 111 N LAST CHANCE GULCH STE 2A 600 CENTRAL AVE STE 219 3718 E LAKE ST STE A 401 15TH AVE S STE 109 30 13TH ST 445 CENTENNIAL 41 BARRETT ST 1111 BAKER AVE 905 HIGHLAND BLVD STE 4500 1600 HOSPITAL WAY 1111 BAKER AVE #2 317 MADISON 2006 HOSPITAL WAY 101 BERNHARDT RD 900 N ORANGE ST 3RD FLOOR 801 N 29TH ST 2805 S AVE W 2831 FORT MISSOULA RD STE 301 125 W GRANITE 801 N 29TH ST 120 N 19TH AVE STE A 935 HIGHLAND BLVD STE 4400 403 W MAIN ST 1101 26TH AVE S 5TH FLOOR 1245 N 29TH ST 2875 TINA AVE #101 404 N 31ST ST STE 216 320 SUNNYVIEW LN 301 W SPRUCE 206 MAIN ST SW 30 13TH ST 805 SUNSET BLVD 1200 WESTWOOD DR 221 5TH AVE S 2875 TINA AVE #101 1232 N 30TH ST STE 300 5938 HWY 93 S 2748 COLONIAL DR 30 13TH ST 2969 AIRPORT RD STE C 2900 12TH AVE NORTH 310 SUNNYVIEW LN 210 SUNNYVIEW LN STE 103 CITY CUT BANK KALISPELL KALISPELL FORSYTH GREAT FALLS HAMILTON BOZEMAN GREAT FALLS GREAT FALLS BUTTE GREAT FALLS HAVRE BUTTE DILLON WHITEFISH BOZEMAN WHITEFISH WHITEFISH SHERIDAN WHITEFISH LAUREL MISSOULA BILLINGS MISSOULA MISSOULA BUTTE BILLINGS BOZEMAN BOZEMAN BELGRADE GREAT FALLS BILLINGS MISSOULA BILLINGS KALISPELL MISSOULA RONAN HAVRE CONRAD HAMILTON GLASGOW MISSOULA BILLINGS WHITEFISH HELENA HAVRE HELENA BILLINGS KALISPELL KALISPELL ZIP 59427 59901 59901 59327 59405 59840 59715 59401 59401 59701 59405 59501 59701 59725 59937 59715 59937 59937 59749 59937 59044 59802 59101 59804 59804 59701 59101 59718 59715 59714 59405 59101 59808 59101 59901 59802 59864 59501 59425 59840 59230 59808 59101 59937 59601 59501 59601 59101 59901 59901 SPECIALTY FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE ANESTHESIOLOGY RADIOLOGY FAMILY PRACTICE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY ANESTHESIOLOGY OPHTHALMOLOGY PEDIATRICS PEDIATRICS INTERNAL MEDICINE INTERNAL MEDICINE HOSPITALIST SURGERY ORTHOPEDIC MEDICINE PEDIATRICS SPEECH/LANGUAGE THERAPY OPTOMETRY LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA INFECTIOUS DISEASES PROFESSIONAL COUNSELOR HEMATOLOGY-ONCOLOGY URGENT CARE PROVIDER FAMILY PRACTICE URGENT CARE PROVIDER CARDIOLOGY PSYCHIATRY SURGERY UROLOGICAL UROLOGY LICENSED BEHAVIORAL COUNSELOR RADIOLOGY PSYCHIATRY CHIROPRACTIC ANESTHESIOLOGY ANESTHESIOLOGY ANESTHESIOLOGY NURSE PRACTITIONER SURGERY UROLOGICAL UROLOGY PEDIATRIC CARDIOLOGY CHIROPRACTIC PHYSICAL THERAPY NUTRITION PROFESSIONAL RADIOLOGY SURGERY GENERAL RADIOLOGY PEDIATRICS Montana STATUS SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 115 of 256 FIRST NAME JAMES FRANK JONATHAN CRAIG STEVEN TYLER TYLER JOHN PATRICIA JEFFREY ARLYS DALE JEFF DEREK JACOB JOHN BRETT TAMI JEANNE JEANNE LANAE ALAN JACOB RAYMOND "DEL" ALAN ANNE BRETT LINDA LORRAINE PATRICIA MISTY ERIN SIDNEY CHRISTOPHER STEVEN CHRISTOPHER CHRISTOPHER CHRISTOPHER JASON MICHAEL BRENDA JOHN GARY KEVIN WILLIAM WILLIAM JUDITH CARY TARA KATHLEEN Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WILEY WILEY WILHELM WILKERSON WILL WILL WILL WILLCUT WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS WILLIAMS GARDNER WILLIAMS LEBER WILLIAMSON WILLIAMSON WILLIAMSON WILLIAMSON WILLIAMSON WILLIAMSON WILLIS WILLIS WILLKOM WILLOUGHBY WILLSTEIN WILMOT WILSHIRE WILSHIRE WILSON WILSON WILSON WILSON LICENSE PAC MD DC MD MD MD MD NP OT MD APRN DC MD MD PA MD MD LCPC MD MD PA MD PA MD MD MD NP LCSW EDD OT PT PAC MD PAC MD PAC PAC PAC MD MD APRN MD MD DC DPM DPM MD PAC PT PAC MEDICAL GROUP BRIDGER ORTHOPEDICS MOUNTAIN VIEW FAMILY HEALTH CARE PROCHIROPRACTIC INC HELENA EYE CLINIC BILLINGS CLINIC GREAT FALLS CLINIC RADIOLOGY MONTANA MEDNORTH KALISPELL URGENT CARE BIG SKY NEUROSCIENCE & SPINE BILLINGS CLINIC BULLHOOK COMMUNITY HEALTH CENTER CHIROPRACTIC FIRST HOLY ROSARY LEWIS & CLARK EMERGENCY PHYSICIANS LEWIS & CLARK EMERGENCY PHYSICIANS MISSION MOUNTAIN MEDICINE MONTANA HEART MONTANA NEUROBEHAVIORAL SPECIALISTS PLAINS FAMILY MEDICINE PLAINS FAMILY MEDICINE PONDERA MEDICAL CENTER ROCKY MOUNTAIN HEART & LUNG ST PETERS URGENT CARE SURGERY CLINIC AT NORTH VALLEY HOSP PEDIATRIC THERAPY CLINIC MERCURY MEDICAL ABSORKA EMERGENCY PHYSICIANS BARRETT HOSPITAL & HEALTHCARE BILLINGS CLINIC RUBY VALLEY HOSPITAL RUBY VALLEY MEDICAL CLINIC TWIN BRIDGES RURAL HEALTH CLINIC BENEFIS PHYSICIAN ASSOC BILLINGS CLINIC BIG SKY OB-GYN WESTERN MONTANA CLINIC NORTHERN LIGHTS CHIROPRACTIC BOZEMAN FOOT AND ANKLE BOZEMAN FOOT AND ANKLE BARRETT HOSPITAL & HEALTHCARE CHP WEST YELLOWSTONE CORVALLIS PHYSICAL THERAPY FLATHEAD VALLEY ORTHOPEDIC CENTER ADDRESS 1450 ELLIS ST STE 201 2619 COLONIAL DR STE A 8757 JACKRABBIT LN STE A 3116 SADDLE DR 801 N 29TH ST 3000 15TH AVE S 401 15TH AVE S STE 204 2316 US HWY 93 NORTH 700 W GOLD ST 2825 8TH AVE N 110 13TH ST 10 AVANTA WAY STE 1 2600 WILSON ST 2475 BROADWAY 2475 BROADWAY 104 RUFUS LN 1300 28TH ST S STE 8 900 N ORANGE 3RD FLOOR 10 KRUGER RD 10 KRUGER RD 805 SUNSET BLVD 350 HERITAGE WAY #2100 2475 BROADWAY ST 1111 BAKER AVE #2 350 HERITAGE WAY STE 2100 621 3RD ST S 16 W MAIN 1925 GRAND AVE #107 2709 HUMBLE RD 700 W GOLD ST 50 27TH ST W STE A 300 W MERCURY 915 HIGHLAND BLVD 30 HWY 91 S 801 N 29TH ST 220 E CROFOOT 210 E CROFOOT 104 S MADISON ST 2800 11TH AVE S STE 14 2702 8TH AVE N 2900 12TH AVE N #230W 902 N ORANGE ST #206 500 W BROADWAY 1066 N MERIDIAN RD STE A 931 HIGHLAND BLVD STE 3310 931 HIGHLAND BLVD STE 3310 30 HWY 91 S 11 S ELECTRIC 1050 EASTSIDE HWY 111 SUNNYVIEW LN CITY BOZEMAN HELENA BELGRADE HELENA BILLINGS GREAT FALLS GREAT FALLS KALISPELL BUTTE BILLINGS HAVRE BILLINGS MILES CITY HELENA HELENA POLSON GREAT FALLS MISSOULA PLAINS PLAINS CONRAD KALISPELL HELENA WHITEFISH KALISPELL GLASGOW WHITE SULPHUR SPRINGS BILLINGS MISSOULA BUTTE BILLINGS BUTTE BOZEMAN DILLON BILLINGS SHERIDAN SHERIDAN TWIN BRIDGES GREAT FALLS BILLINGS BILLINGS MISSOULA MISSOULA KALISPELL BOZEMAN BOZEMAN DILLON WEST YELLOWSTONE HAMILTON KALISPELL ZIP 59715 59601 59714 59601 59101 59405 59405 59901 59701 59101 59501 59102 59301 59601 59601 59860 59405 59802 59859 59859 59425 59901 59601 59937 59901 59230 59645 59102 59804 59701 59102 59701 59715 59725 59101 59749 59749 59754 59405 59101 59101 59802 59801 59901 59715 59715 59725 59758 59840 59901 SPECIALTY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE CHIROPRACTIC OPHTHALMOLOGY SURGERY NEUROSURGERY RADIOLOGY RADIOLOGY URGENT CARE PROVIDER OCCUPATIONAL THERAPY DERMATOLOGY PEDIATRICS CHIROPRACTIC OB/GYN-OBSTETRICS/GYNECOLOGY EMERGENCY MEDICINE/TRAUMA EMERGENCY MEDICINE/TRAUMA FAMILY PRACTICE SURGERY CARDIOVASCULAR THORACIC LICENSED BEHAVIORAL COUNSELOR FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE CARDIOLOGY EMERGENCY MEDICINE/TRAUMA SURGERY GENERAL CARDIOLOGY SURGERY FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER LICENSED BEHAVIORAL COUNSELOR OCCUPATIONAL THERAPY PHYSICAL THERAPY FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA SURGERY GENERAL FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE INTERNAL MEDICINE SURGERY ORTHOPEDIC MEDICINE GYNECOLOGY-NO OB PSYCHIATRY SURGERY ORTHOPEDIC MEDICINE CHIROPRACTIC PODIATRY PODIATRY INTERNAL MEDICINE FAMILY PRACTICE PHYSICAL THERAPY SURGERY ORTHOPEDIC MEDICINE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 116 of 256 FIRST NAME NED KATHLEEN TARA DAVID KALLY DAVID KATHLEEN JOHN SETH DEBORAH DEBORAH MARK ARVIN KATHLEEN LENNARD W W M CALANTHE MEREDITH WENDY LINDA KATHLEEN KATHLEEN KATHLEEN R DENNIS R DENNIS RICK ANNABELLE GLENN STEPHANIE RONALD HANK BARRY MARK ELIZABETH MICHAEL RICHARD NADINE JEAN PATRICIA CHARLES CHRISTOPHER CHRISTOPHER CHRISTOPH DOUGLAS MELISSA ROCHELLE SCOTT MELISSA DANNETTE Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON WILSON-PANT WILTSIE WILTZEN WINFIELD WING WING WING WINKEL WINKEL WINKING WINNE WINSLOW WINTER WINTERS WINTERS WINTON WINTON WIOME WISE WISE WISNIEWSKI WITTERS WITTKOPP WITTNAM WOERLEIN WOERLEIN WOERLEIN WOERNER WOLF WOLFE WOLFF WOLFSON WOLLERSHEIM LICENSE MD PAC PT PAC MD PAC MD PAC NP NP DC DC PA MD MD MD MD APRN NP APRN OT OT OT MD MD LCPC LAC LCSW MD PAC MD LCPC MD MD RD MD MD PSYD LCPC PA-C MD MD MD MD DO MD MD MD MD PHD MEDICAL GROUP FLATHEAD VALLEY ORTHOPEDICS GLACIER EAR NOSE & THROAT HAMILTON PT & REHAB AT CANYONS CLUB MARCUS DALY REHAB SERVICES MEDNORTH KALISPELL URGENT CARE CLIN MISSOULA ANESTHESIOLOGY NEUROLOGICAL CLINIC ORTHO MONTANA RIVERSTONE HEALTH SLETTEN CANCER INSTITUTE SLETTEN CANCER INSTITUTE W CHIROPRACTIC INTERNAL MEDICINE ASSOCIATES SIDNEY CLINIC MEDICAL WEIGHT MANAGEMENT NORTH VALLEY HOSPITAL OCCUPATIONAL THERAPY EXP WHITEFISH PHYSICAL THERAPY NORTHWEST FAMILY MEDICINE ALEPH GREAT FALLS SURGICAL ASSOC GREAT FALLS CLINIC BILLINGS CLINIC CARDIOVASCULAR & THORACIC SURGEONS INTERNAL MEDICINE ASSOCIATES BILLINGS CLINIC BOZEMAN URGENT CARE CENTER THE MONTANA CENTER FOR WELLNESS WESTERN MONTANA MENTAL HEALTH CTR BILLINGS CLINIC WEST BENEFIS MEDICAL GROUP PINTLER SURGICAL SPECIALISTS WESTERN MONTANA CLINIC LAUREL FAMILY MEDICINE BOZEMAN DEACONESS WESTERN MONTANA CLINIC COMMUNITY HOSPITAL OF ANACONDA ABSORKA EMERGENCY PHYSICIANS ADDRESS 111 SUNNYVIEW LN 160 HERITAGE WAY 472 TAMMANY LN 1200 WESTWOOD DR 2316 US HWY 93 N 2825 STOCKYARD RD BLDG I-200 350 HERITAGE WAY #1300 2900 12TH AVE N #140W 123 S 27TH ST 1117 29TH ST S 1117 29TH ST S 2801 GREAT NORTHERN LOOP 559 EDGEWOOD PLACE 1292 BURNS WAY 2835 FORT MISSOULA RD STE 203 500 W BROADWAY #320 601 W SPRUCE #A 700 W GOLD ST STE A 905 HIGHLAND BLBD STE 4500 181 12TH AVE SW 25 S EWING ST STE 521 6575 US HWY 93 S 135 CLEARVIEW PLACE 2006 HOSPITAL WAY 1250 BURNS WAY #1 1250 BURNS WAY #1 205 HAGGERTY LN #270 2685 PALMER ST STE A 400 13TH AVE S 1400 29TH ST S 2800 10TH AVE N 217 N 3RD ST #G 2900 12TH AVE N STE 502E 905 HIGHLAND BLVD STE 4500 2800 10TH AVE N 1006 W MAIN 245 WINDWARD WAY STE 101 27 FT MISSOULA RD STE B 704 MAIDEN LN 205 SULLIVAN AVE 2675 CENTRAL AVE 1101 26TH ST S 401 W PENNSYLVANIA 500 W BROADWAY 1035 1ST AVE 905 HIGHLAND BLVD STE 4440 & 50 2835 FORT MISSOULA RD #3 401 W PENNSYLVANIA 915 HIGHLAND BLVD 129 W KENT AVE CITY KALISPELL KALISPELL HAMILTON HAMILTON KALISPELL MISSOULA KALISPELL BILLINGS BILLINGS GREAT FALLS GREAT FALLS MISSOULA WHITEFISH KALISPELL MISSOULA MISSOULA MISSOULA BUTTE BOZEMAN SIDNEY HELENA WHITEFISH KALISPELL WHITEFISH KALISPELL KALISPELL BOZEMAN MISSOULA GREAT FALLS GREAT FALLS BILLINGS HAMILTON BILLINGS BOZEMAN BILLINGS BOZEMAN KALISPELL MISSOULA THOMPSON FALLS CIRCLE BILLINGS GREAT FALLS ANACONDA MISSOULA LAUREL BOZEMAN MISSOULA ANACONDA BOZEMAN MISSOULA ZIP 59901 59901 59840 59840 59901 59808 59901 59101 59101 59405 59405 59808 59937 59901 59804 59802 59802 59701 59715 59270 59601 59937 59901 59937 59901 59901 59715 59808 59405 59405 59101 59840 59101 59715 59101 59715 59901 59804 59873 59215 59102 59405 59711 59802 59044 59715 59804 59711 59715 59801 SPECIALTY SURGERY ORTHOPEDIC MEDICINE EAR/NOSE/THROAT (ENT) PHYSICAL THERAPY OCCUPATIONAL THERAPY URGENT CARE PROVIDER ANESTHESIOLOGY NEUROLOGY SURGERY ORTHOPEDIC MEDICINE FAMILY PRACTICE HEMATOLOGY-ONCOLOGY HEMATOLOGY-ONCOLOGY CHIROPRACTIC CHIROPRACTIC SURGERY GENERAL NEUROLOGY CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE OCCUPATIONAL/INDUSTRIAL MEDICINE INTERNAL MEDICINE FAMILY PRACTICE NUTRITION PROFESSIONAL OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY FAMILY PRACTICE FAMILY PRACTICE ADDICTION COUNSELOR LICENSED CLINICAL SOCIAL WORKER SURGERY GENERAL FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA LICENSED BEHAVIORAL COUNSELOR SURGERY CARDIOVASCULAR THORACIC INTERNAL MEDICINE NUTRITION PROFESSIONAL INTERNAL MEDICINE FAMILY PRACTICE PSYCHOLOGY LICENSED BEHAVIORAL COUNSELOR PHYSICIAN ASSISTANT INTERNAL MEDICINE GASTROENTEROLOGY GASTROENTEROLOGY GASTROENTEROLOGY FAMILY PRACTICE OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE FAMILY PRACTICE EMERGENCY MEDICINE/TRAUMA PSYCHOLOGIST Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 117 of 256 FIRST NAME JANET MATTHEW NICHOLAS DOUGLAS RYAN KRISTEN JULIE CATHERINE MICHAEL TODD DOUGLAS DOUGLAS WILLIAM SHARI ALAN ALAN BILLIE RAYMOND MATTHEW CHESTER LAURA ROBERT ROBERT ROBERT ROBERT DIANE DIANE KRISTIN L WAYNE L WAYNE BRYCE BRYCE ATI BROOKE SHAWNA SHAWNA SHAWNA MATTHEW DAVID CHARLOTTE DAMIAN THOMAS MICHAEL STACY ROSEMARY TYE JAMES ALLISON KATHLEEN GLADYS Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME WOLLERSHEIM WOLPOE WOLTER WOMACK WOOD WOOD WOOD WOODS WOODS WOODWARD WOOLARD WOOLLEY WOOLSTON WORKS WRAY WRAY WRAY WRIGHT WRIGHT WRIGHT WYMAN YACAVONE YACAVONE YACAVONE YACAVONE YAHN YAHN YANDORA YANKOFF YANKOFF YASENAK YASENAK YATES YATES YATES YATES YATES YATES YELVINGTON YEOMANS YMZON YOCHEM YORGASON YORK YOUDERIAN YOUNG YOUNG YOUNG YOUNG YOUNG LICENSE PHD MD MD ACU DC PT MD MD MD DC MD MD PHD PT MD MD LCPC MD MD MD PT MD MD MD MD MD MD DO LCPC LCPC PT PT MD PAC DO DO DO MD MD MD MD OD MD LCSW FNP DO MD MD APRN MD MEDICAL GROUP BILLINGS CLINIC BILLINGS CLINIC MONTANA ACUPUNCTURE ASSOC LLC ACTIVE CARE FAMILY CHIROPRACTIC FREEDOM PHYSICAL THERAPY BOZEMAN CREEK FAMILY HEALTH MISSOULA BONE & JOINT FLORENCE-CARLTON CHIROPRACTIC SIDNEY HEALTH CENTER FLATHEAD PHYSICAL THERAPY MEDICAL IMAG ASSOC OF IDAHO FALLS MEDICAL IMAG ASSOC OF IDAHO FALLS BILLINGS CLINIC BOZEMAN DEACONESS HOSPITAL EUREKA HEALTH THERAPY CENTER NORTH VALLEY HOSPITAL NORTH VALLEY HOSPITAL NORTHWEST GASTROENTEROLOGY NEUROSCIENCE & SPINE INSTITUTE GOOD EARTH COUNSELING INTERMOUNTAIN CHILDRENS HOME DARBY PHYSICAL THERAPY HAMILTON PT & REHAB AT CANYONS CLUB ANACONDA INTERNAL MEDICINE CLINIC BILLINGS CLINIC HEIGHTS CLINIC COMMUNITY HEALTH CENTER DILLON COMMUNITY HEALTH CENTER SHERIDAN COMMUNITY HEALTH CENTER SIDNEY HEALTH CENTER BILLINGS CLINIC SOUND INPATIENT PHYSICIANS NORTHER MONTANA MEDICAL GROUP ANACONDA EYECARE ORTHO MONTANA HEAD QUARTERS FOR HEART CHANGE CMMC CLINIC PHYSICIANS BILLINGS CLINIC BILLINGS CLINIC MILES CITY COMMUNITY MEDICAL CENTER PHYS SERV KALISPELL OB-GYN ASSOCIATES LIBERTY MEDICAL CENTER ADDRESS 1900 BROOKS ST STE 115 801 N 29TH ST 801 N 29TH ST 901 SW HIGGINS STE 2 504 MAIN ST 715 KENSINGTON STE 18 115 4TH ST S 316 E BABCOCK ST 2360 MULLAN RD STE C 5537 OLD HWY 93 STE A 216 14TH AVE SW 900 N ORANGE STE 103 1211 GRAND AVE #5 8299 MONTANA HWY 35 #7 310 SANSOME ST 90 HWY 91 S 1202 COLTON BOULEVARD 2800 10TH AVE N 915 HIGHLAND BLVD 2819 GREAT NORTHERN LOOP #200 298 OSLOSKI RD 1600 HOSPITAL WAY 1600 HOSPITAL WAY 75 CLAREMONT DT STE H 75 CLAREMONT ST #F 500 W BROADWAY 500 W BROADWAY 3RD FLOOR 200 COMMONS WAY 104 W CUSTER AVE STE 2 500 LAMBORN 501 N MAIN ST 472 TAMMANY LN 1102 E COMMERCIAL 760 WICKS LN 445 CENTENNIAL AVE 41 BARRETT ST 317 MADISON ST 216 14TH AVE SW 1020 N 27TH ST 400 S CLARK ST 20 13TH ST W 112 W 3RD 2900 12TH AVE N 140W 225 N 23RD ST 310 WENDELL AVE 2800 10TH AVE N 620 S HAYNES AVE 2835 FORT MISSOULA RD #205 210 SUNNYVIEW LN STE 201 418 W MONROE CITY MISSOULA BILLINGS BILLINGS MISSOULA STEVENSVILLE MISSOULA GREAT FALLS BOZEMAN MISSOULA FLORENCE SIDNEY MISSOULA BILLINGS BIGFORK PHILIPSBURG DILLON BILLINGS BILLINGS BOZEMAN MISSOULA EUREKA WHITEFISH WHITEFISH KALISPELL KALISPELL MISSOULA MISSOULA KALISPELL HELENA HELENA DARBY HAMILTON ANACONDA BILLINGS BUTTE DILLON SHERIDAN SIDNEY BILLINGS BUTTE HAVRE ANACONDA BILLINGS BILLINGS LEWISTOWN BILLINGS MILES CITY MISSOULA KALISPELL CHESTER ZIP 59801 59101 59101 59803 59870 59801 59401 59715 59808 59833 59270 59802 59102 59911 59858 59725 59102 59101 59715 59808 59917 59937 59937 59901 59901 59802 59802 59901 59602 59601 59829 59840 59711 59105 59701 59725 59749 59270 59101 59701 59501 59711 59101 59101 59457 59101 59301 59804 59901 59522 SPECIALTY PSYCHOLOGY EAR/NOSE/THROAT (ENT) PULMONARY DISEASES ACUPUNCTURIST CHIROPRACTIC PHYSICAL THERAPY FAMILY PRACTICE FAMILY PRACTICE SURGERY ORTHOPEDIC MEDICINE CHIROPRACTIC RADIOLOGY SURGERY ORTHOPEDIC MEDICINE PSYCHOLOGIST PHYSICAL THERAPY RADIOLOGY RADIOLOGY PROFESSIONAL COUNSELOR EMERGENCY MEDICINE/TRAUMA HOSPITALIST INTERNAL MEDICINE PHYSICAL THERAPY GASTROENTEROLOGY INTERNAL MEDICINE GASTROENTEROLOGY GASTROENTEROLOGY INTERNAL MEDICINE INTERNAL MEDICINE NEUROLOGY LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR PHYSICAL THERAPY PHYSICAL THERAPY INTERNAL MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE RADIOLOGY PSYCHIATRY HOSPITALIST SURGERY GENERAL OPTOMETRY SURGERY ORTHOPEDIC MEDICINE LICENSED CLINICAL SOCIAL WORKER FAMILY PRACTICE HOSPITALIST PEDIATRICS PEDIATRICS OB/GYN-OBSTETRICS/GYNECOLOGY FAMILY PRACTICE Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 118 of 256 FIRST NAME ANTHONY LEANNE KENNETH KENNETH TROY JAMES GRACE BOB VASILIKI SHAWN JOHN ELIZABETH DENISE DENISE JOYCE THOMAS MEGAN LAWRENCE LAWRENCE MICHAEL STEVEN ROBERT MATTHEW MATTHEW MATTHEW STEVE IRIS STEVEN MICHAEL PAGE MARK ANDREW ANDREW VALARIE ROY DUSTIN DONALD BRADLEY ROBERT AMBER AMBER JOHN IMRAN RAYMOND VERNON Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME YOUNG YOUNG YOUNGER YOUNGER YPMA YTURRI ZACAROLI ZADOW ZAFIRIDOU ZAHN ZAKRZEWSKI ZALUSKI ZANDER ZANDER ZARANSKY ZAVORAL ZAWACKI ZAZZO ZAZZO ZEHNPFENNIG ZELLMER ZELMAN ZEMACKE ZEMACKE ZEMACKE ZIEGLER ZIEGLER ZIEGLER ZIESKE ZIESKE ZILKOSKI ZIMET ZIMET ZIMMER ZIMMER ZIMMER ZINKE ZINS ZIRPOLI JR ZITO ZITO ZOMBRO ZUBAIR ZURCHER ZURICK LICENSE CRNA LCPC MD MD OD MD LCPC LCPC LCSW LAC PT LCPC OT OT PA-C MD PAC DO DO MD LCPC DO PAC PA PAC PA LCSW PAC MD LCPC MD MD MD SLT MD LCSW CRNA MD MD PAC PAC PT MD MD MD MEDICAL GROUP MEDICAL EYE SPECIALISTS MEDICAL EYE SPECIALISTS COLUMBIA FALLS EYE CARE COGENT HEALTHCARE OF MONTANA FAMILY PSYCOLOGICAL CENTER MOUNTAIN LAND REHABLITIATION MARRIAGE & THERAPY CENTER NORTHWEST ORTHOPEDICS & SPORTS TRACY HAND & OCCUPATIONAL THERAPY RIVERSTONE HEALTH ST JAMES HEALTHCARE PHYSICIAN BILLI ST PETER'S MEDICAL GROUP BIGFORK HEALTH AND WELLNESS HOSANNA HEALTH CARE PC THE MONTANA CENTER FOR WELLNESS BENEFIS QUICK CARE INTERMOUNTAIN CHILDREN'S HOME NORTHWEST ORTHOPEDICS & SPORTS MED BILLINGS CLINIC NORTH VALLEY ANESTHESIOLOGY EASTER SEALS GOODWILL PEDIATRIC MISSOULA RADIOLOGY PACIFIC CATARACT & LASER INSTITUTE BILLINGS CLINIC BILLINGS CLINIC BILLINGS CLINIC BOZEMAN DEACONESS CARDIOLOGY CON ST JOHNS LUTHERAN HOSPITAL GREAT DIVIDE RADIOLOGY ACADIA MONTANA ADVANCED CARE HOSPITAL OF MONTANA ADVANCED EYECARE ASSOCIATES ADVANCED IMAGING ADVANCED IMAGING AT CMC ADDRESS 6 - 13TH AVE E 111 N HIGGINS #508 300 N WILLSON AVE STE 1003 422 S MAIN 211 5TH ST W 1101 26TH ST S 225 N 23 RD ST 2000 CLARK ST 48 MEDICAL PARK DR 305 W MERCURY ST #207D 2059 BROADWATER AVE STE C 501 E FRONT STE 529A 350 HERITAGE WAY STE 1200 111 SUNNYVIEW LN STE C 902 N ORANGE ST #206 221 5TH AVE S 123 S 27TH ST 209-1/2 H ST E 301 KNAPP ST 400 S CLARK ST 336 W SPRUCE 2550 BROADWAY 191 JEWEL BASIN CT UNIT 2A 160 HERITAGE WAY 245 WINDWARD WAY STE 101 500 15TH AVE S 500 S LAMBORN 350 HERITAGE WAY #1200 2800 10TH AVE N 120 E MAIN ST 301 KNAPP ST 1600 HOSPITAL WAY 1600 HOSPITAL WAY 1537 AVE D STE 150 3205 RUSSELL ST 228 17TH AVE NW 1717 4TH ST S 801 N 29TH ST 1020 N 27TH ST 1020 N 27TH ST 2800 10TH AVE NORTH 600 N WALLACE LOFT 2 905 HIGHLAND BLVD STE 4330 350 LOUISIANA AVE 2475 BROADWAY 55 BASIN CREEK RD 3528 GABEL RD 4265 FALLON STE 1 2803 S AVE 2803 S AVE CITY POLSON MISSOULA BOZEMAN LIVINGSTON COLUMBIA FALLS GREAT FALLS BILLINGS MILES CITY HELENA BUTTE BILLINGS BUTTE KALISPELL KALISPELL MISSOULA GLASGOW BILLINGS POPLAR WOLF POINT BUTTE MISSOULA HELENA BIGFORK KALISPELL KALISPELL GREAT FALLS HELENA KALISPELL BILLINGS SIDNEY WOLF POINT WHITEFISH WHITEFISH BILLINGS MISSOULA GREAT FALLS GREAT FALLS BILLINGS BILLINGS BILLINGS BILLINGS BOZEMAN BOZEMAN LIBBY HELENA BUTTE BILLINGS BOZEMAN MISSOULA MISSOULA ZIP 59860 59802 59715 59047 59912 59405 59101 59301 59601 59701 59102 59701 59901 59901 59802 59230 59101 59255 59201 59701 59802 59601 59911 59901 59901 59405 59601 59901 59101 59270 59201 59937 59937 59102 59801 59404 59405 59101 59101 59101 59101 59715 59715 59923 59601 59701 59106 59715 59804 59804 SPECIALTY NURSE ANESTHETIST LICENSED BEHAVIORAL COUNSELOR OPHTHALMOLOGY OPHTHALMOLOGY OPTOMETRY INTERNAL MEDICINE LICENSED BEHAVIORAL COUNSELOR LICENSED BEHAVIORAL COUNSELOR LICENSED CLINICAL SOCIAL WORKER LICENSED ADDICTION COUNSELOR PHYSICAL THERAPY LICENSED BEHAVIORAL COUNSELOR SURGERY ORTHOPEDIC MEDICINE OCCUPATIONAL THERAPY PHYSICIAN ASSISTANT EMERGENCY MEDICINE FAMILY PRACTICE FAMILY PRACTICE FAMILY PRACTICE SURGERY GENERAL LICENSED BEHAVIORAL COUNSELOR CARDIOLOGY FAMILY PRACTICE FAMILY PRACTICE PAIN MANAGEMENT FAMILY PRACTICE LICENSED CLINICAL SOCIAL WORKER SURGERY ORTHOPEDIC MEDICINE EMERGENCY MEDICINE/TRAUMA PROFESSIONAL COUNSELOR FAMILY PRACTICE ANESTHESIOLOGY ANESTHESIOLOGY SPEECH/LANGUAGE THERAPY RADIOLOGY LICENSED CLINICAL SOCIAL WORKER ANESTHESIOLOGY GASTROENTEROLOGY CARDIOLOGY CARDIOLOGY CARDIOLOGY PHYSICAL THERAPY CARDIOLOGY EMERGENCY MEDICINE/TRAUMA RADIOLOGY BEHAVIORAL HEALTH FACILITY SPECIALTY HOSPITAL OPTOMETRY DIAGNOSTIC CENTER RADIOLOGY/IMAGING CENTER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 119 of 256 FIRST NAME Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP ADVANCED MEDICAL IMAGING ALLIANCE HEALTHCARE SERVICES AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE AMERICAN EYECARE ANACONDA OXYGEN SERVICE ANACONDA PINTLER HOSPICE ANDERSON ORTHOTICS & PROSTHETICS ANDERSON ORTHOTICS & PROSTHETICS ANDERSON ORTHOTICS & PROSTHETICS APEX APEX OF ST PETERS APRIA HEALTHCARE APRIA HEALTHCARE APRIA HEALTHCARE APRIA HEALTHCARE ARTISTIC DESIGNS ASPEN HOSPICE OF MONTANA ASPEN MEADOWS ASPEN MEADOWS RETIREMENT BAIR MEDICAL CLINIC BARRETT HOSPITAL & HEALTHCARE BARRETT HOSPITAL & HEALTHCARE BARTOW WELDING BEAR PAW HOSPICE BEARTOOTH BILLINGS CLINIC BENEFIS HEALTHCARE BENEFIS HEALTHCARE BENEFIS HEALTHCARE BENEFIS HEALTHCARE BARIATRIC INST BENEFIS HEALTHCARE CANCER INST BENEFIS HEIGHTS SURGERY CENTER BENEFIS HEIGHTS SURGERY CENTER BENEFIS HOSPITALS BENEFIS WOUND CARE & HYPERBARIC MED CTR BENTON MEDICAL CENTER BIG HORN COUNTY HOSPITAL BIG SANDY MEDICAL CENTER BIG SANDY MEDICAL CENTER BIG SKY DIAGNOSTIC IMAGING BIG SKY DIAGNOSTIC LABS BIG SKY DIAGNOSTICS BIG SKY HOSPICE BIG SKY IV CARE BIG SKY IV CARE ADDRESS 925 HIGHLAND BLVD STE 1180 3000 15TH AVE S 100 W PARK AVE 11 3RD AVE W 124 1/2 S MONTANA 1313 HARRISON AVE 1429 S HIGGINS AVE 513 MAIN ST CAPITAL HILL MALL GALLATIN VALLEY MALL #53 2711 N CABLE RD 305 W PENNSYLVANIA AVE 1250 HARRISON AVE 2121 EUCLID 2121 EUCLID AVE 201 S CALIFORNIA 201 S CALIFORNIA 102 BARTZ LN 2110 OVERLAND AVE #128 & #129 2221 LIVINGSTON AVE 815 26TH ST N 216 E FRONT 107 BELL CROSSING W 3155 AVE C 3155 AVE C 16 W MAIN 90 HWY 91 S 90 MT HWY 91 S 806 1ST ST E 30 13TH ST 2525 N BROADWAY 1101 26TH ST S 30 13TH ST 30 13TH ST 400 15TH AVE S 1117 29TH ST S 500 15TH AVE S 500 15TH AVE S 1101 26TH ST S 500 15TH AVE S 1203 15TH 17 N MILES AVE 166 MONTANA AVE E 3 MONTANA AVE 401 S ALABAMA STE 7 2475 BROADWAY 2900 12TH AVE N STE 3E 123 S 27TH ST 20 FOUR MILE DR #3 20 FOUR MILE DR STE 300 CITY BOZEMAN GREAT FALLS ANACONDA POLSON DILLON BUTTE MISSOULA DEER LODGE HELENA BOZEMAN ANACONDA ANACONDA BUTTE HELENA HELENA HELENA HELENA BELGRADE BILLINGS MISSOULA GREAT FALLS BUTTE STEVENSVILLE BILLINGS BILLINGS WHITE SULPHUR SPRINGS DILLON DILLON ROUNDUP HAVRE RED LODGE GREAT FALLS HAVRE HAVRE GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS FORT BENTON HARDIN BIG SANDY BIG SANDY BUTTE HELENA BILLINGS BILLINGS KALISPELL KALISPELL ZIP 59715 59405 59711 59860 59725 59701 59801 59722 59601 59715 59711 59711 59701 59601 59601 59601 59601 59714 59102 59801 59401 59701 59870 59102 59102 59645 59725 59725 59072 59501 59068 59405 59501 59501 59405 59405 59405 59405 59405 59405 59442 59034 59520 59520 59701 59601 59101 59101 59901 59901 SPECIALTY RADIOLOGY/IMAGING CENTER DIAGNOSTIC CENTER VISION CARE CENTER VISION CARE CENTER VISION CARE CENTER VISION CARE CENTER VISION CARE CENTER VISION CARE CENTER VISION CARE CENTER VISION CARE CENTER DURABLE MEDICAL EQUIPMENT HOSPICE MEDICAL SUPPLIER MEDICAL SUPPLIER PROSTETHICS AND ORTHOTICS MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER HOSPICE SKILLED NURSING FACILITY SKILLED NURSING FACILITY CLINIC HOSPITAL GENERAL ACUTE CARE HOSPITAL MEDICAL SUPPLIER HOSPICE HOSPITAL HOSPITAL HOSPITAL HOSPITAL AMBULATORY SURGERY CENTER CANCER TREATMENT CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER GENERAL ACUTE CARE HOSPITAL SPECIAL TREATMENT PROGRAM CLINIC HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL RADIOLOGY/IMAGING CENTER LAB RADIOLOGY HOSPICE INFUSION THERAPY PROGRAM HOME INFUSION THERAPY Montana STATUS FIRST NAME SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 120 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP BIG SKY MEDICAL BIG SKY ORTHOPEDICS BIG SKY SURGERY CENTER BIG SKY SURGERY CENTER BIG SKY ULTRASOUND BILLINGS ANESTHESIOLOGY BILLINGS CLINIC HOME OXYGEN & MEDICAL EQUIP BILLINGS CLINIC HOSPITAL BILLINGS CLINIC HOSPITAL BILLINGS MRI CENTER BITTERROOT IMAGING OPEN MRI BITTERROOT IMAGING OPEN MRI BLUE MOUNTAIN CLINIC BLUE MOUNTAIN CLINIC BONE HEALTH AWARENESS BOULDER MEDICAL CLINIC BOZEMAN DEACONESS HOME OXYGEN BOZEMAN DEACONESS HOSPITAL BOZEMAN DEACONESS HOSPITAL BOZEMAN DEACONESS HOSPITAL BOZEMAN DEACONESS HOSPITAL BOZEMAN HEALTH & REHABILITATION CTR BRIDGER REHAB & CARE CENTER BRIGHTER DAY PEDIATRIC SOLUTIONS BROADWATER HEALTH CENTER BULL RIVER MEDICAL CLINIC BUTTE CARE AND REHAB CENTER CENTRAL MONTANA FAMILY PLANNING CENTRAL MONTANA FAMILY PLANNING CENTRAL MONTANA HME CENTRAL MONTANA IMAGING LLC CENTRAL MONTANA LABORATORY CENTRAL MONTANA MEDICAL CENTER CENTRAL MONTANA MEDICAL CENTER CENTRAL MONTANA SURGICAL HOSPITAL CLARK FORK VALLEY HOSPITAL CLARK FORK VALLEY HOSPITAL COLONIAL MANOR WHITEFISH COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN ADDRESS 241 BEVERLY AVE 1020 S 24TH ST W 2833 FORT MISSOULA RD 2833 FT MISSOULA RD 2800 CENTRAL AVE #A 2800 10TH AVE N 801 N 27TH ST 2800 10TH AVE N 2800 10TH AVE N 1041 N 29TH ST 1103 WESTWOOD DR 1103 WESTWOOD DR 610 N CALIFORNIA 610 N CALIFORNIA 1280 BURNS WAY 214 S MAIN ST 915 HIGHLAND BLVD STE 4420 915 HIGHLAND BLVD 915 HIGHLAND BLVD 915 HIGHLAND BLVD 915 HIGHLAND BLVD 320 N 5TH AVE 320 N 5TH AVE 509 LANDMARK DR 110 N OAK 1029 HWY 200 2400 CONTINENTAL DR 224 W MAIN ST #603 505 W MAIN ST #108 202 4TH AVE S 1417 9TH ST S STE 102 3511 1ST AVE N 408 WENDELL AVE 408 WENDELL AVE 1411 9TH ST S 10 KRUGER RD 10 KRUGER RD 1305 E 7TH ST 109 COMMERICAL DR 114 S PACIFIC ST 114 W BENHAM 15 N 8TH 1911 MEADOW LARK LN STE 1 2030 4TH AVE N 2111 S AVE W 2617 17TH ST 3103 PROSPECT AVE 327 PARKWAY DR 701 1ST ST 76 CENTRAL AVE CITY MISSOULA BILLINGS MISSOULA MISSOULA BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS HAMILTON HAMILTON MISSOULA MISSOULA KALISPELL BOULDER BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN TOWNSEND NOXON BUTTE LEWISTOWN LEWISTOWN LEWISTOWN GREAT FALLS GREAT FALLS LEWISTOWN LEWISTOWN GREAT FALLS PLAINS PLAINS WHITEFISH BOZEMAN DILLON GLENDIVE MILES CITY BUTTE BILLINGS MISSOULA BLACK EAGLE HELENA KALISPELL HAVRE STANFORD ZIP 59801 59102 59804 59804 59102 59101 59101 59101 59101 59101 59840 59840 59802 59802 59901 59632 59715 59715 59715 59715 59715 59715 59715 59772 59644 59853 59701 59457 59457 59457 59405 59401 59457 59457 59405 59859 59859 59937 59715 59725 59330 59301 59701 59101 59801 59414 59601 59901 59501 59479 SPECIALTY DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER DIAGNOSTIC CENTER CLINIC/GROUP PRACTICE MEDICAL SUPPLIER GENERAL ACUTE CARE HOSPITAL HOSPITAL RADIOLOGY/IMAGING CENTER DIAGNOSTIC CENTER RADIOLOGY/IMAGING CENTER CLINIC CLINIC/GROUP PRACTICE RADIOLOGY CLINIC DURABLE MEDICAL EQUIPMENT HOSPITAL PHYSICAL THERAPY RADIOLOGY/IMAGING CENTER REHABILITATION CENTER SKILLED NURSING FACILITY SKILLED NURSING FACILITY DURABLE MEDICAL EQUIPMENT HOSPITAL CLINIC/GROUP PRACTICE SKILLED NURSING FACILITY CLINIC CLINIC/GROUP PRACTICE DURABLE MEDICAL EQUIPMENT RADIOLOGY/IMAGING CENTER LAB GENERAL ACUTE CARE HOSPITAL HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL SKILLED NURSING FACILITY DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT Montana STATUS FIRST NAME SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED 121 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP COMMUNITY HOME OXYGEN COMMUNITY HOME OXYGEN COMMUNITY HOSPITAL OF ANACONDA COMMUNITY HOSPITAL OF ANACONDA COMMUNITY MEDICAL CENTER COMMUNITY MEDICAL CENTER CONVENIENT CARE CLINIC CONVENIENT CARE CLINIC COPPER RIDGE HEALTH & REHAB CPAP SOLUTIONS CPAP SOLUTIONS INC CPAP SOLUTIONS INC DANIELS MEMORIAL HEALTHCARE CENTER DEAP DEER LODGE CARE & REHAB CTR DEER LODGE MED CENTER HOSPITAL DEER LODGE MEDICAL CENTER DILLON MEDICAL SUPPLY DILLON MEDICAL SUPPLY DURAMED PLUS EAGLE CLIFF MANOR ELKHORN MOUNTAIN CYTOLOGY EUREKA PROMPT CARE EYE PHYSICIANS OPTICAL DEPT FAITH LUTHERAN HOME FIRST CHOICE HOME HEALTH FLATHEAD CITY/COUNTY HEALTH DEPT FLATHEAD COUNTY HOME HEALTH FLORENCE COMMUNITY PHARMACY FLORENCE FAMILY PRACTICE FRANCES MAHON DEACONESS HOSPITAL FRENCHTOWN DRUG FRENCHTOWN FAMILY PRACTICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE FRONTIER HOME HEALTH & HOSPICE GARFIELD COUNTY HEALTH CENTER GFC SURGERY CENTER GLACIER COMMUNITY HEALTH CENTER GLACIER MEDICAL ASSOCIATES GLACIER PROSTHETIC & ORTHOTIC CARE GLENDIVE MEDICAL CENTER GRANITE CO MEDICAL CENTER HOSPITAL GRANITE COUNTY MEDICAL CENTER GREAT FALLS CLINIC ADDRESS 835 W 3RD ST SEE BLACK EAGLE ADDRESS 401 W PENNSYLVANIA 401 W PENNSYLVANIA AVE 2827 FORT MISSOULA RD 2827 FORT MISSOULA RD 1150 WESTWOOD DR #E 1200 WESTWOOD DR 3251 NETTIE ST 1026 CENTRAL AVE 1917 4TH ST S 401 S ALABAMA ST STE 3A 105 5TH AVE E 220 BOX ELDER 1100 TEXAS AVE 1100 HOLLENBACK LN 1100 HOLLENBACK LN 19 E SEBREE ST 19 E SEBREE ST 216 14TH AVE SW 1415 YELLOWSTONE RIVER RD 21 N LAST CHANCE GULCH STE 205 450 OSLOSKI RD 1221 N 26TH ST 1000 6TH AVE N 1547 N HUNTERS WAY STE 124 1035 1ST AVE WEST 736 S MAIN ST 5549 OLD HWY 93 5549 OLD HWY 93 621 3RD ST S 16862 BECKWITH ST 16862 BECKWITH ST 1940 DEWEY BLVD 1940 DEWEY BLVD 29 2ND ST EAST 29 2ND ST EAST 3810 VALLEY COMMONS DR STE 1 3810 VALLEY COMMONS DR STE 1 800 FRONT ST 800 FRONT ST 332 LEAVITT AVE 1509 29TH ST S 519 E MAIN ST 1111 BAKER AVE 985 N MERIDIAN RD 202 PROSPECT DR 310 SANSOME 310 SANSOME ST 1400 29TH ST S CITY HARDIN GREAT FALLS ANACONDA ANACONDA MISSOULA MISSOULA HAMILTON HAMILTON BUTTE GREAT FALLS GREAT FALLS BUTTE SCOBEY MILES CITY DEER LODGE DEER LODGE DEER LODGE DILLON DILLON SIDNEY BILLINGS HELENA EUREKA BILLINGS WOLF POINT BOZEMAN KALISPELL KALISPELL FLORENCE FLORENCE GLASGOW FRENCHTOWN FRENCHTOWN BUTTE BUTTE KALISPELL KALISPELL BOZEMAN BOZEMAN HELENA HELENA JORDAN GREAT FALLS CUT BANK WHITEFISH KALISPELL GLENDIVE PHILIPSBURG PHILIPSBURG GREAT FALLS ZIP 59034 59405 59711 59711 59804 59804 59840 59840 59701 59401 59405 59701 59263 59301 59722 59722 59722 59725 59725 59270 59105 59601 59917 59101 59201 59718 59901 59901 59833 59833 59230 59834 59834 59701 59701 59901 59901 59718 59718 59601 59601 59337 59405 59427 59937 59901 59330 59858 59858 59405 SPECIALTY DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT HOSPITAL GENERAL ACUTE CARE HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL URGENT CARE CENTER URGENT CARE CENTER SKILLED NURSING FACILITY MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT HOSPITAL AUTISM CLINIC SKILLED NURSING FACILITY HOSPITAL GENERAL ACUTE CARE HOSPITAL DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER MEDICAL SUPPLIER HOME HEALTH AGENCY LAB CLINIC/GROUP PRACTICE VISION CARE CENTER SKILLED NURSING FACILITY HOME HEALTH AGENCY PUBLIC HEALTH CLINIC HOME HEALTH AGENCY DURABLE MEDICAL EQUIPMENT CLINIC/GROUP PRACTICE GENERAL ACUTE CARE HOSPITAL DURABLE MEDICAL EQUIPMENT CLINIC/GROUP PRACTICE HOME HEALTH AGENCY HOSPICE HOME HEALTH AGENCY HOSPICE HOME HEALTH AGENCY HOSPICE HOME HEALTH AGENCY HOSPICE HOSPITAL AMBULATORY SURGERY CENTER CLINIC CLINIC/GROUP PRACTICE PROSTETHICS AND ORTHOTICS HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL CLINIC Montana STATUS FIRST NAME SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING SIGNED PENDING PENDING PENDING SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED 122 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP GREAT FALLS CLINIC MEDICAL GREAT FALLS ORTHOPAEDIC ASSOC HAMILTON PHYSICAL THERAPY HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HANGER PROSTHETICS & ORTHOTICS HEALTHCARE PLUS HEALTHCARE PLUS HEALTHCARE PLUS HEALTHCARE PLUS HEALTHCARE PLUS HEALTHCARE PLUS HEALTHCARE PROVIDERS INC HEALTHCENTER NORTHWEST HELENA ORTHOPAEDIC CLINIC HELENA SLEEP DIAGNOSTICS HELENA SURGICENTER HELENA SURGICENTER HI-LINE HOME PROGRAMS INC HILL COUNTY HEALTH DEPT HOLY ROSARY HEALTHCARE HOLY ROSARY HEALTHCARE HOME HEALTH OF MONTANA HOME HEALTH OF MONTANA HOME HEALTH OF MONTANA HOME HEALTH OF MONTANA HOME HEALTH OF ST PETERS HOME OPTIONS HOME OPTIONS HOME OXYGEN & MEDICAL EQUIPMENT HOME OXYGEN & MEDICAL EQUIPMENT HOMELINK HOSPICE OF MISSOULA HOSPICE OF SOUTHWEST MONTANA HOSPICE OF ST PETERS HOT SPRINGS HEALTH & REHAB CTR HOT SPRINGS MEDICAL CLINIC INTERNATIONAL HEART INSTITUTE OF MT INTERNATIONAL HEART INSTITUTE OF MT JOURNEY HOSPICE JUROS MEDICAL INC KALISPELL MEDICAL EQUIPMENT KALISPELL REGIONAL MED CENTER KC WESTERN DRUG KIDS BEHAVIORAL HEALTH ADDRESS 1411 9TH ST S 1401 25TH ST S 336 FAIRGROUNDS RD 1014 9TH ST S 1014 9TH ST S 124 LYNDALE AVE 1505 S RUSSELL ST 2401 BAYARD 2401 BAYARD 3400 1ST AVE NORTH 65 MEDICAL PARK DR STE A 1 7TH AVE E #C 1304 HWY 93 E 1900 N 1ST ST 1900 N 1ST ST 3194 HWY 83 ONE 7TH AVE EAST 1900 N 1ST ST 320 SUNNYVIEW LN 2442 WINNE AVE STE 1 900 N MONTANA AVE 2440 WINNE #100 2440 WINNE AVE 605 3RD AVE S 315 4TH ST 2600 WILSON ST 2600 WILSON ST 1900 N FIRST 1900 N 1ST 1903 S RUSSELL #1 1903 S RUSSELL STE 1 2475 BROADWAY 275 CORPORATE WAY STE 600 275 CORPORATE WAY STE 600 1111 S HAYNES AVE 1124 16TH ST W STE 6 201 S CALIFORNIA 800 KENSINGTON AVE #204 3810 VALLEY COMMONS DR STE 1 2475 BROADWAY 600 1ST AVE N 209 MAIN 500 W BROADWAY #320 500 W BROADWAY #320 712 CARBON ST STE 5 2043 GRAND AVE 55 3RD AVE E NORTH 310 SUNNYVIEW LN 1313 W PARK ST 55 BASIN CREEK RD CITY GREAT FALLS GREAT FALLS HAMILTON GREAT FALLS GREAT FALLS HELENA MISSOULA BUTTE BUTTE BILLINGS HELENA POLSON POLSON HAMILTON HAMILTON SEELEY LAKE POLSON HAMILTON KALISPELL HELENA HELENA HELENA HELENA GLASGOW HAVRE MILES CITY MILES CITY HAMILTON HAMILTON MISSOULA MISSOULA HELENA KALISPELL KALISPELL MILES CITY BILLINGS HELENA MISSOULA BOZEMAN HELENA HOT SPRINGS HOT SPRINGS MISSOULA MISSOULA BILLINGS BILLINGS KALISPELL KALISPELL LIVINGSTON BUTTE ZIP 59405 59405 59840 59405 59405 59601 59801 59701 59701 59101 59601 59860 59860 59840 59840 59868 59860 59840 59901 59601 59601 59601 59601 59230 59501 59301 59301 59840 59840 59801 59801 59601 59901 59901 59301 59102 59601 59801 6E+08 59601 59845 59845 59802 59802 59102 59102 59901 59901 59047 59701 SPECIALTY HOSPITAL AMBULATORY SURGERY CENTER CLINIC/GROUP PRACTICE MEDICAL SUPPLIER PROSTETHICS AND ORTHOTICS MEDICAL SUPPLIER PROSTETHICS AND ORTHOTICS MEDICAL SUPPLIER PROSTETHICS AND ORTHOTICS PROSTETHICS AND ORTHOTICS PROSTETHICS AND ORTHOTICS MEDICAL SUPPLIER MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT HOSPITAL CLINIC SLEEP STUDIES AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER AUTISM CLINIC CLINIC GENERAL ACUTE CARE HOSPITAL HOSPITAL HOME HEALTH AGENCY HOME HEALTH AGENCY HOME HEALTH AGENCY HOME HEALTH AGENCY HOME HEALTH AGENCY HOME HEALTH AGENCY HOSPICE DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT HOME HEALTH AGENCY HOSPICE HOSPICE HOSPICE SKILLED NURSING FACILITY CLINIC/GROUP PRACTICE CLINIC/GROUP PRACTICE CLINIC/GROUP PRACTICE HOSPICE DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT HOSPITAL DURABLE MEDICAL EQUIPMENT RESIDENTIAL TREATMENT CENTER Montana STATUS FIRST NAME SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED PENDING PENDING SIGNED PENDING SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 123 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP LAKE COUNTY HOME HEALTH LAUREL HEALTH & REHABILITATION CENTER LEWIS & CLARK CITY COUNTY HEALTH DEPT LIBERTY COUNTY CAH LIBERTY COUNTY CAH LIBERTY COUNTY HOSPITAL & NURSING HM LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LINCARE LISTERUD RURAL HEALTH CLINIC LITTLE LIGHT HOUSE PHYSICAL THERAPY LIVINGSTON HEALTH & REHAB CENTER LIVINGSTON HEALTH & REHAB CENTER LIVINGSTON HOMECARE LIVINGSTON MEMORIAL HOSP LIVINGSTON MEMORIAL HOSPITAL LOLO FAMILY PRACTICE MADISON VALLEY HOSPITAL MARCUS DALY HOSPICE OF THE BITTERROOT MARCUS DALY HOSPICE OF THE BITTERROOT MARCUS DALY HOSPITAL HOME HEALTH MARCUS DALY HOSPITAL HOME HEALTH MARCUS DALY HOSPITAL HOME IV THERAPY MARCUS DALY HOSPITAL HOME IV THERAPY MARCUS DALY HOSPITAL HOME OXYGEN MARCUS DALY HOSPITAL HOME OXYGEN MARCUS DALY MEMORIAL MARCUS DALY MEMORIAL HOSPITAL MARGO BOWERS HEALTH CLINIC MARIAS HEALTHCARE ADDRESS 711 MAIN ST SW 820 3RD AVE 1930 9TH AVE 315 W MADISON AVE 315 W MADISON AVE 315 W MADISON AVE 1010 S MAIN ST 1010 S MAIN ST 107 2ND ST SW 115 W 2ND ST 116 CENTRAL AVE 1505 US HWY 2 S 28A PRONGHORN TRAIL 314 MAIN ST 3330 COLTON DR #B 3330 COLTON DR STE B 34299 US HWY 2 416 MAIN ST 465 ASH RD #D 465 ASH RD UNIT D 521 N 21ST ST 521 N21ST ST 7 S 8TH ST 7 S 8TH ST 715 KENSINGTON #17 715 KENSINGTON STE 17 7585 SHEDHORN 908 14TH ST S #A 908 14TH ST STE A 301 KNAPP ST 420 N 9TH AVE 510 S 14TH ST 510 S 14TH ST 504 S 13TH ST 504 S 13TH ST 504 S 13TH ST 11350 US HWY 93 S 305 N MAIN 1150 WESTWOOD DR 1150 WESTWOOD DR #H 1150 WESTWOOD DR 1150 WESTWOOD DR #H 1200 WESTWOOD DR 1200 WESTWOOD DR 1200 WESTWOOD DR 1200 WESTWOOD DR 1200 WESTWOOD DR 1200 WESTWOOD DR 26 E BROAD 422 MONTANA CITY RONAN LAUREL HELENA CHESTER CHESTER CHESTER BUTTE BUTTE SIDNEY HAVRE BROWNING LIBBY BOZEMAN DEER LODGE HELENA HELENA LIBBY DEER LODGE KALISPELL KALISPELL BILLINGS BILLINGS MILES CITY MILES CITY MISSOULA MISSOULA BOZEMAN GREAT FALLS GREAT FALLS WOLF POINT BOZEMAN LIVINGSTON LIVINGSTON LIVINGSTON LIVINGSTON LIVINGSTON LOLO ENNIS HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON HAMILTON DRUMMOND VALIER ZIP 59864 59044 59601 59522 59522 59522 59701 59701 59270 59501 59417 59923 59718 59722 59601 59602 59923 59722 59901 59901 59101 59101 59301 59301 59801 59801 59718 59404 59404 59201 59715 59047 59047 59047 59047 59047 59847 59729 59840 59840 59840 59840 59840 59840 59840 59840 59840 59840 59832 59486 SPECIALTY HOME HEALTH AGENCY SKILLED NURSING FACILITY CLINIC HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT CLINIC/GROUP PRACTICE DURABLE MEDICAL EQUIPMENT REHABILITATION CENTER SKILLED NURSING FACILITY HOME HEALTH AGENCY HOSPITAL GENERAL ACUTE CARE HOSPITAL CLINIC/GROUP PRACTICE HOSPITAL HOSPICE HOSPICE HOME HEALTH AGENCY HOME HEALTH AGENCY HOME INFUSION THERAPY INFUSION THERAPY PROGRAM HOME HEALTH AGENCY MEDICAL SUPPLIER HOSPITAL GENERAL ACUTE CARE HOSPITAL CLINIC CLINIC Montana STATUS FIRST NAME SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED 124 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP MARIAS HEALTHCARE MARIAS HEALTHCARE MARIAS MEDICAL CENTER MARIAS MEDICAL CENTER MCCONE COUNTY HEALTH CENTER MCHSDBA MINERAL COMM HOSPITAL MCHSDBA MINERAL COMM HOSPITAL MEAGHER COUNTY HEALTH DEPT MEDALLION MEDICAL CENTER MEDICAL LABORATORY SERVICES MINERAL COMMUNITY HOSPITAL MINERAL COUNTY HEALTH DEPT MINERAL COUNTY HEALTH DEPT MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MIRACLE-EAR CENTER MISSION MOUNTAIN MEDICINE MISSOULA BONE & JOINT SURGERY CENTER MISSOULA HEALTH & REHABILITATION CTR MISSOULA ORTHOTICS & PROSTHETICS MISSOULA ORTHOTICS & PROSTHETICS LAB MISSOULA SLEEP MEDICINE MISSOULA SLEEP MEDICINE MISSOULA SURGICAL MISSOURI RIVER MANOR MISSOURI RIVER MEDICAL CENTER MONARC INJURY CENTER MONTANA CANCER SPECIALISTS MONTANA FAMILY VISION CARE MONTANA HEALTH RESEARCH INSTITUTE MONTANA HEART ANGIO LAB MONTANA MEDICAL TRANSPORT MONTANA NEUROBEHAVIORAL SPECIALISTS MONTANA ORTHOTICS & PROSTHETICS MONTANA ORTHOTICS & PROSTHETICS MONTANA OXYCARE MONTANA REGIONAL IMAGING LLC MORLEDGE FAMILY SURGERY CENTER MOTION MEDICAL SOLUTIONS MOUNTAINVIEW MED CENTER NORCO MEDICAL NORCO MEDICAL NORCO MEDICAL NORCO MEDICAL ADDRESS 5 1ST AVE W 670 PARK AVE 640 PARK AVE 640 PARK DR 205 SULLIVAN AVE 1208 6TH AVE E 1208 6TH AVE E 16 W MAIN ST 815 2ND ST S 300 N WILLSON STE 1001 1208 6TH AVE E 1208 6TH AVE E 1208 6TH AVE E 1123 EUCLID 1200 10TH AVE S 1212 GRAND AVE 1300 AVNEUE C 1659 N 1ST ST 1753 HWY 2 WEST 333 1/2 BAKER AVE 625 SUNSET BOULEVARD 715 KENSINGTON #4 126 6TH AVE SW 2360 MULLAN RD STE B 3018 RATTLESNAKE DR 120 S AVE W 120 S AVE W 910 BROOKS #201 910 BROOKS #201 500 W BROADWAY 5TH FLOOR 1130 17TH AVE S 1501 ST CHARLES ST 500 15TH AVE S 500 W BROADWAY 2829 GREAT NORTHERN LOOP #100 2101 BROADWATER AVE 2827 FORT MISSOULA RD 2430 AIRPORT RD STE 2 900 N ORANGE #303 3400 1ST AVE N 3400 1ST AVE N 5549 OLD HWY 93 3510 PTARMIGAN LN 1747 POLY DR 601 W SPRUCE ST 16 W MAIN 1911 MEADOWLARK STE A 2555 HWY #2 E 2850 STOCKYARD RD 518 N 1ST ST CITY SUNBURST SHELBY SHELBY SHELBY CIRCLE SUPERIOR SUPERIOR WHITE SULPHUR SPRING GREAT FALLS BOZEMAN SUPERIOR SUPERIOR SUPERIOR HELENA GREAT FALLS BILLINGS BILLINGS HAMILTON HAVRE WHITEFISH KALISPELL MISSOULA RONAN MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA GREAT FALLS FORT BENTON GREAT FALLS MISSOULA MISSOULA BILLINGS MISSOULA HELENA MISSOULA BILLINGS BILLINGS FLORENCE HELENA BILLINGS MISSOULA WHITE SULPHUR SPRINGS BUTTE KALISPELL MISSOULA HAMILTON ZIP 59482 59474 59474 59474 59215 59872 59872 59645 59401 59715 59872 59872 59872 59601 59405 59102 59102 59840 59501 59937 59901 59801 59864 59808 59802 59801 59801 59801 59801 59802 59405 59442 59405 59807 59808 59102 59804 59601 59802 59101 59101 59833 59602 59102 59802 59645 59701 59901 59801 59840 SPECIALTY CLINIC CLINIC HOSPITAL GENERAL ACUTE CARE HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL HOSPITAL CLINIC/GROUP PRACTICE HOME HEALTH AGENCY LAB GENERAL ACUTE CARE HOSPITAL CLINIC/GROUP PRACTICE PUBLIC HEALTH CLINIC HEARING AID DISTRIBUTOR HEARING AID DISTRIBUTOR HEARING AID DISTRIBUTOR AUDIOLOGY HEARING AID DISTRIBUTOR HEARING AID DISTRIBUTOR HEARING AID DISTRIBUTOR HEARING AID DISTRIBUTOR HEARING AID DISTRIBUTOR CLINIC AMBULATORY SURGERY CENTER SKILLED NURSING FACILITY DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER DIAGNOSTIC CENTER SLEEP STUDIES CLINIC/GROUP PRACTICE HEMATOLOGY HOSPITAL SPECIAL TREATMENT PROGRAM CLINIC/GROUP PRACTICE OPTOMETRY DIAGNOSTIC CENTER CLINIC AMBULANCE/TRANSPORTATION CLINIC/GROUP PRACTICE DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT RADIOLOGY/IMAGING CENTER AMBULATORY SURGERY CENTER DURABLE MEDICAL EQUIPMENT HOSPITAL DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT Montana STATUS FIRST NAME PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 125 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP NORTH VALLEY DEXA SCAN NORTH VALLEY HOSPITAL NORTH VALLEY HOSPITAL NORTHEAST MONTANA HEALTH SERVICES NORTHERN CARE INC NORTHERN MONTANA DIALYSIS NORTHERN MONTANA HOME HEALTH NORTHERN MONTANA HOSPITAL NORTHERN MONTANA HOSPITAL NORTHERN MONTANA HOSPITAL ER PHYS NORTHERN MONTANA MEDICAL EQUIPMENT NORTHERN MONTANA MEDICAL EQUIPMENT NORTHERN MONTANA MEDICAL GROUP NORTHERN MONTANA MEDICAL GROUP E NORTHERN MONTANA MEDICAL GROUP W NORTHERN PLAINS PATHOLOGY NORTHERN ROCKIES MEDICAL CENTER NORTHERN ROCKIES PHYSICAL THERAPY NORTHERN ROCKIES RADIATION ONCOLOGY NORTHERN ROCKIES SURGERY CENTER LP NORTHWEST HORIZONS NORTHWEST HORIZONS NOW CARE DOWNTOWN NOW CARE SOUTHGATE MALL ORTHOPEDIC CENTER OF MONTANA ASC ORTHOPEDIC SURGERY CENTER PACIFIC MEDICAL PACIFIC MEDICAL PARK CLINIC PARTNERS HOSPICE PARTNERS IN HOME CARE PARTNERS MEDICAL EQUIPMENT PARTNERS SOLUTIONS PATHOLOGY ASSOCIATES MED LABS PATHOLOGY ASSOCIATES MED LABS PATHOLOGY CONSULTANTS OF WESTERN MT PATHWAYS TREATMENT CENTER PATHWAYS TREATMENT CENTER PCLI GREAT FALLS ASC PEACE HOSPICE OF MONTANA PEACE HOSPICE OF MONTANA PHILLIPS COUNTY FAMILY HEALTH CLINIC PHILLIPS COUNTY HOSPITAL PHYSICIANS LABORATORY SERVICES PICTURE PERFECT ULTRASOUND PINTLER HOME HEALTH PINTLER HOME OPTIONS PIONEER MEDICAL CENTER PIONEER MEDICAL CENTER PLAINS MEDICAL CLINIC ADDRESS 1111 BAKER AVE 1600 HOSPITAL WAY 1600 HOSPITAL WAY 315 KNAPP ST 210 WINDWARD WAY 30 13TH ST 30 13TH ST 30 13TH ST 30 13TH ST 30 13TH ST 30 13TH ST 30 13TH ST 30 13TH ST 124 13TH ST 20 13TH ST WEST 500 15TH AVE S 802 2ND ST 2831 FORT MISSOULA RD STE 200 1041 N 29TH ST 940 N 30TH ST 350 CONWAY DR 350 CONWAY DR 500 W BROADWAY 2901 BROOKS ST 1401 25TH ST S 111 SUNNYVIEW LN 2145 S AVE W 2475 VILLAGE LN STE 300 1001 RIVER DR 500 N HIGGINS #201 2687 PALMER ST STE F 2687 PALMER ST STE F 2687 PALMER ST STE B 2819 GREAT NORTHERN LOOP 2900 12TH AVE N #105W 2825 STOCKYARD RD BLDG I #2100 200 HERITAGE WAY 200 HERITAGE WAY 1717 4TH ST S 1101 26TH S 2600 15TH AVE S 315 S 8TH AVE E 311 S 8TH AVE EAST 931 HIGHLAND BLVD STE 3220 1216 16TH ST S #21 305 W PENNSYLVANIA AVE 305 W PENNSYLVANIA STE 1 301 W 7TH AVE 301 W 7TH AVE 10 KRUGER RD CITY WHITEFISH WHITEFISH WHITEFISH WOLF POINT KALISPELL HAVRE HAVRE HAVRE HAVRE HAVRE HAVRE HAVRE HAVRE HAVRE HAVRE GREAT FALLS CUT BANK MISSOULA BILLINGS BILLINGS KALISPELL KALISPELL MISSOULA MISSOULA GREAT FALLS KALISPELL MISSOULA BILLINGS LIVINGSTON MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA BILLINGS MISSOULA KALISPELL KALISPELL GREAT FALLS GREAT FALLS GREAT FALLS MALTA MALTA BOZEMAN BILLINGS ANACONDA ANACONDA BIG TIMBER BIG TIMBER PLAINS ZIP 59937 59937 59937 59201 59901 59501 59501 59501 59501 59501 59501 59501 59501 59501 59501 59405 59427 59804 59101 59101 59901 59901 59802 59801 59405 59901 59801 59101 59047 59802 59808 59808 59808 59808 59101 59801 59901 59901 59405 59405 59405 59538 59538 59715 59102 59711 59711 59011 59011 59859 SPECIALTY RADIOLOGY/IMAGING CENTER GENERAL ACUTE CARE HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL PROSTETHICS AND ORTHOTICS DIALYSIS CENTER HOME HEALTH AGENCY GENERAL ACUTE CARE HOSPITAL HOSPITAL CLINIC/GROUP PRACTICE DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER CLINIC/GROUP PRACTICE CLINIC CLINIC PATHOLOGY HOSPITAL DURABLE MEDICAL EQUIPMENT CANCER TREATMENT CENTER AMBULATORY SURGERY CENTER SKILLED NURSING FACILITY SKILLED NURSING FACILITY URGENT CARE CENTER URGENT CARE CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT CLINIC/GROUP PRACTICE HOSPICE HOME HEALTH AGENCY DURABLE MEDICAL EQUIPMENT HOME INFUSION THERAPY CLINICAL LABORATORY CLINICAL LABORATORY CLINICAL LABORATORY BEHAVIORAL HEALTH FACILITY RESIDENTIAL TREATMENT CENTER AMBULATORY SURGERY CENTER HOSPICE HOSPICE CLINIC/GROUP PRACTICE HOSPITAL LAB DIAGNOSTIC CENTER HOME HEALTH AGENCY HOME HEALTH AGENCY GENERAL ACUTE CARE HOSPITAL HOSPITAL CLINIC/GROUP PRACTICE Montana STATUS FIRST NAME SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 126 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP POLSON HEALTH & REHABILITATION CENTER PONDERA MEDICAL CENTER PONDERA MEDICAL CENTER POPLAR COMMUNITY HOSPITAL PRAIRIE COMMUNITY HEALTH CENTER PREMIER OUTPATIENT SURGERY PRICE RITE MEDICAL EQUIPMENT PRIME MEDICAL SUPPLY QUEST DIAGNOSTICS QUEST DIAGNOSTICS QUEST DIAGNOSTICS REGION IV FAMILY OUTREACH INC RIDGEWAY MAIL ORDER PHARMACY RIMROCK FOUNDATION RIMROCK PROSTHETICS RIVERSIDE FAMILY CLINIC RNH MEDICAL SUPPLY RNH MEDICAL SUPPLY INC ROCKY MOUNTAIN EYE SURGERY CENTER ROCKY MOUNTAIN HOME CARE ROCKY MOUNTAIN MOBILITY ROCKY MOUNTAIN SLEEP DISORDERS CTR ROCKY MOUNTAIN SLEEP DISORDERS CTR ROCKY MOUNTAIN SLEEP DISORDERS CTR ROCKY MOUNTAIN SLEEP DISORDERS CTR ROCKY MOUNTAIN SLEEP DISORDERS CTR ROCKY MOUNTAIN SURGICAL CENTER ROCKY MOUNTAIN TREATMENT CENTER ROCKY MOUNTAIN TREATMENT CENTER ROCKY MOUNTAIN VASCULAR ASSOCIATES ROOSEVELT MEMORIAL MEDICAL CENTER ROSEBUD HEALTH CARE CENTER ROSEBUD HEALTHCARE CENTER ROUNDUP MEMORIAL HEALTHCARE ROUNDUP MEMORIAL HEALTHCARE ROUNDUP MEMORIAL HEALTHCARE CLINIC RUBY VALLEY HOSPITAL RUBY VALLEY HOSPITAL SAME DAY CARE SAME DAY SURGERY CENTER SAME DAY SURGERY CENTER SAPPHIRE PHYSICAL THERAPY SCOOTERS AMERICA SCOOTERS AMERICA SEELEY SWAN MEDICAL CLINIC SHERIDAN MEMORIAL HSPTL SHODAIR HOSPITAL SHODAIR HOSPITAL SIDNEY HEALTH CENTER SLEEP DISORDERS CENTER OF ST PETERS ADDRESS 9 14TH AVE W 805 SUNSET BLVD 805 SUNSET BOULEVARD 209 1/2 H ST E 312 S ADAMS 2510 17TH ST W 515 W TAMARACK 1040 S 24TH ST W 1411 9TH ST S #B100 2900 12TH AVE N #270W 401 S ALABAMA 1236 HELENA AVE 2824 US HWY 93 NORTH 1231 N 29TH ST 1139 N 27TH ST STE C-2 209 1/2 H ST E PO BOX 57 1517 37TH AVE 700 W KENT 2110 OVERLAND AVE #114 3660 N MONTANA AVE 1917 4TH ST S 1917 4TH ST S 2271 DEERFIELD LN 2271 DEERFIELD LN 401 S ALABAMA 1450 ELLIS ST STE 101 920 4TH AVE N 920 4TH AVE NORTH 2900 12TH AVE N #301E 818 2ND AVE EAST 383 N 17TH AVE 383 N 17TH AVE 1202 3RD W 1202 THIRD ST W 1207 2ND ST W 220 E CROFOOT 220 E CROFOOT ST 801 N 29TH ST 300 N WILLSON STE 600F 300 N WILLSON STE 600F 1705 BOW ST 547 S 20TH ST W #10 547 S 20TH ST W #10 3050 MT HWY 83 N 440 W LAUREL 2755 COLONIAL DR 2755 COLONIAL DR 216 14TH AVE SW 2475 BROADWAY CITY POLSON CONRAD CONRAD POPLAR TERRY BILLINGS BOZEMAN BILLINGS GREAT FALLS BILLINGS BUTTE HELENA VICTOR BILLINGS BILLINGS POPLAR MISSOULA MISSOULA MISSOULA BILLINGS HELENA GREAT FALLS GREAT FALLS HELENA HELENA BUTTE BOZEMAN GREAT FALLS GREAT FALLS BILLINGS CULBERTSON FORSYTH FORSYTH ROUNDUP ROUNDUP ROUNDUP SHERIDAN SHERIDAN BILLINGS BOZEMAN BOZEMAN MISSOULA BILLINGS BILLINGS SEELEY LAKE PLENTYWOOD HELENA HELENA SIDNEY HELENA ZIP 59860 59425 59425 59255 59349 59101 59715 59102 59405 59101 59701 59601 59875 59101 59101 59255 59806 59804 59801 59102 59602 59405 59405 59601 59601 59701 59715 59401 59401 59101 59218 59327 59327 59072 59072 59072 59749 59749 59101 59715 59715 59801 59102 59102 59868 59254 59601 59604 59270 59601 SPECIALTY SKILLED NURSING FACILITY HOSPITAL GENERAL ACUTE CARE HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL AMBULATORY SURGERY CENTER DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER CLINICAL LABORATORY CLINICAL LABORATORY CLINICAL LABORATORY AUTISM CLINIC DURABLE MEDICAL EQUIPMENT RESIDENTIAL TREATMENT CENTER PROSTETHICS AND ORTHOTICS CLINIC/GROUP PRACTICE MEDICAL SUPPLIER DURABLE MEDICAL EQUIPMENT AMBULATORY SURGERY CENTER HOME HEALTH AGENCY DURABLE MEDICAL EQUIPMENT DIAGNOSTIC CENTER SLEEP STUDIES DIAGNOSTIC CENTER SLEEP STUDIES SLEEP STUDIES AMBULATORY SURGERY CENTER BEHAVIORAL HEALTH FACILITY RESIDENTIAL TREATMENT CENTER DIAGNOSTIC CENTER GENERAL ACUTE CARE HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL CLINIC/GROUP PRACTICE GENERAL ACUTE CARE HOSPITAL HOSPITAL URGENT CARE CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER CLINIC/GROUP PRACTICE MEDICAL SUPPLIER MEDICAL SUPPLIER CLINIC/GROUP PRACTICE HOSPITAL HOSPITAL SPECIALTY HOSPITAL HOSPITAL SLEEP STUDIES Montana STATUS FIRST NAME PENDING PENDING PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED PENDING SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 127 of 256 Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP SLEEP MONTANA PLLC SLEEP MONTANA PLLC SLEEP MONTANA PLLC SOUND HEALTH IMAGING SOUND HEALTH IMAGING SOUND HEALTH IMAGING SPECIALIZED MEDICAL SPECTRUM HOME HEALTH SPECTRUM HOME SOLUTIONS SPECTRUM MEDICAL INC ST JAMES HEALTHCARE ST JAMES HEALTHCARE ST JOHN'S LUTHERAN HOME ST JOHNS LUTHERAN HOSPITAL ST JOHN'S LUTHERAN HOSPITAL ST JOSEPH MEDICAL CENTER ST JOSEPH MEDICAL CENTER HOME HEALTH ST JOSEPH MEDICAL CLINIC ST LUKE COMMUNITY HOSPITAL ST LUKE COMMUNITY HOSPITAL ST LUKE COMMUNITY HOSPITAL ST PATRICK HOSPITAL ST PETERS HOSPITAL ST PETER'S HOSPITAL ST VINCENT HEALTHCARE STEP AHEAD FOOT & ANKLE STILLWATER COMMUNITY HOSPITAL STILLWATER COMMUNITY HOSPITAL SUMMIT LABORATORY SUMMIT LIMB TECHNOLOGIES SUMMIT SURGERY CENTER SVH HOME OXYGEN MEDICAL SVH HOME OXYGEN MEDICAL SWEET MEDICAL CENTER SWEET MEMORIAL NURSING HOME TETON COUNTY HEALTH DEPT TETON MEDICAL CENTER THE EYE CLINIC SURGICENTER THE SLEEP MEDICINE CENTER THOMPSON FALLS MEDICAL CLINIC TREASURE STATE O & P CLINIC TREASURE STATE O & P CLINIC VALLEY MEDICAL SUPPLY VALLEY PHYSICAL THERAPY VISITING NURSE SERVICE WALGREENS INFUSION SERVICES WALGREENS-OPTIONCARE WALGREENS-OPTIONCARE WALGREENS-OPTIONCARE WEB PROPERTIES INC ADDRESS 1429 W MONTANA 30 13TH ST 935 HIGHLAND BLVD STE 2120 2646 WINNE 435 S CRYSTAL 435 S CRYSTAL AVE 3660 N MONTANA AVE 2900 10TH AVE S 2509 7TH AVE S 2900 10TH AVE S 400 S CLARK ST 400 S CLARK ST 3940 RIMROCK RD 350 LOUISIANA AVE 350 LOUISIANA AVE 6 - 13TH AVE E 6 - 13TH AVE E 6 - 13TH AVE E 107 6TH AVE SW 107 6TH AVE SW 107 6TH AVE SW 500 W BROADWAY 2475 BROADWAY 2475 BROADWAY 1233 N 30TH ST 175 COMMONS LOOP STE 400 44 W FOURTH AVE 44 W FOURTH AVE 435 S CRYSTAL #210 1505 S RUSSELL ST 434 S CLARK ST 1111 S HAYNES 1124 16TH ST W STE 6 419 PENNSYLVANIA AVE 125 AIRPORT RD 905 4TH ST NW 915 4TH ST NW 2475 VILLIAGE LN STE 202 200 COMMONS WAY 120 POND ST 1648 ELLIS ST STE 102 506 N 32ND ST 3804 EASTSIDE HWY 1001 SW HIGGINS AVE #205 123 S 27TH ST 800 W PLATINUM #D 404 N 31ST ST STE 401 682 FERGUSON RD STE 1 800 W PLATINUM STE D 1221 N 26TH ST CITY LIVINGSTON HAVRE BOZEMAN HELENA BUTTE BUTTE HELENA GREAT FALLS GREAT FALLS GREAT FALLS BUTTE BUTTE BILLINGS LIBBY LIBBY POLSON POLSON POLSON RONAN RONAN RONAN MISSOULA HELENA HELENA BILLINGS KALISPELL COLUMBUS COLUMBUS BUTTE MISSOULA BUTTE MILES CITY BILLINGS CHINOOK CHINOOK CHOTEAU CHOTEAU BILLINGS KALISPELL THOMPSON FALLS BOZEMAN BILLINGS STEVENSVILLE MISSOULA BILLINGS BUTTE BILLINGS BOZEMAN BUTTE BILLINGS ZIP 59047 59501 59715 59601 59701 59701 59602 59405 59405 59405 59701 59701 59102 59923 59923 59860 59860 59860 59864 59864 59864 59802 59601 59601 59101 59901 59019 59019 59701 59801 59701 59301 59102 59523 59523 59422 59422 59102 59901 59873 59715 59101 59870 59803 59101 59701 59101 59715 59701 59101 SPECIALTY SLEEP STUDIES SLEEP STUDIES SLEEP STUDIES DIAGNOSTIC CENTER RADIOLOGY/IMAGING CENTER DIAGNOSTIC CENTER DURABLE MEDICAL EQUIPMENT HOME HEALTH AGENCY HOME INFUSION THERAPY DURABLE MEDICAL EQUIPMENT GENERAL ACUTE CARE HOSPITAL HOSPITAL NURSING HOME HOSPITAL GENERAL ACUTE CARE HOSPITAL GENERAL ACUTE CARE HOSPITAL HOME HEALTH AGENCY CLINIC/GROUP PRACTICE GENERAL ACUTE CARE HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL GENERAL ACUTE CARE HOSPITAL HOSPITAL DURABLE MEDICAL EQUIPMENT GENERAL ACUTE CARE HOSPITAL HOSPITAL CLINICAL LABORATORY MEDICAL SUPPLIER AMBULATORY SURGERY CENTER DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT CLINIC SKILLED NURSING FACILITY PUBLIC HEALTH CLINIC HOSPITAL AMBULATORY SURGERY CENTER SLEEP STUDIES CLINIC/GROUP PRACTICE DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT MEDICAL SUPPLIER CLINIC/GROUP PRACTICE HOME HEALTH AGENCY INFUSION THERAPY PROGRAM HOME INFUSION THERAPY HOME INFUSION THERAPY HOME INFUSION THERAPY AMBULATORY SURGERY CENTER Montana STATUS SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED SIGNED 128 of 256 FIRST NAME Revised 5/31/12 PacificSource Health Plans - PPO Provider Network LAST NAME LICENSE MEDICAL GROUP WESTERN MONTANA CLINIC WESTERN MONTANA CLINIC LAB WESTERN MONTANA CLINIC LAB WESTERN MONTANA ORTHOTICS & PROSTHETICS WHEATLAND MEMORIAL HOSPITAL & NURSING WMC LABORATORY WMC LABORATORY YELLOWSTONE BOYS AND GIRLS RANCH YELLOWSTONE IMAGING & BREAST CENTER YELLOWSTONE PATHOLOGY INSTITUTE YELLOWSTONE SURGERY CENTER ADDRESS 500 W BROADWAY 500 W BROADWAY PO BOX 202950 1300 S RESERVE ST STE G 530 3RD ST NW 515 W FRONT ST 515 W FRONT ST 1732 S 72ND ST W 2900 12TH AVE N #210W 2900 12TH AVE N STE 295W 1144 N 28TH ST CITY MISSOULA MISSOULA HELENA MISSOULA HARLOWTON MISSOULA MISSOULA BILLINGS BILLINGS BILLINGS BILLINGS ZIP 59802 59802 59620 59801 59036 59802 59802 59106 59101 59101 59101 SPECIALTY CLINIC/GROUP PRACTICE CLINICAL LABORATORY CLINICAL LABORATORY DURABLE MEDICAL EQUIPMENT HOSPITAL LAB LAB RESIDENTIAL TREATMENT CENTER DIAGNOSTIC CENTER LAB AMBULATORY SURGERY CENTER Montana PHONE 406-327-1841 129 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3362 406-544-5663 406-544-5663 406-883-5377 406-543-3125 406-327-1670 406-728-8818 406-824-2079 406-752-8456 130 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-443-7733 406-453-6784 406-653-2150 131 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-228-3400 406-228-3500 406-216-3211 406-228-3400 406-837-1289 406-883-5377 406-455-6677 406-327-3209 132 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3362 406-587-9558 406-883-5680 406-676-5680 406-327-1841 406-228-3400 406-240-7924 406-442-8777 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 133 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-233-2671 406-771-9050 406-721-2070 406-222-0250 134 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-248-3558 406-248-3558 406-883-5377 406-228-3400 406-787-6401 406-233-2543 135 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-622-5414 406-632-4517 406-932-5243 406-759-5181 406-683-9600 406-228-3684 406-228-3400 406-228-3500 406-329-5615 406-543-7271 406-327-1670 406-535-6289 136 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-653-2150 406-329-5615 406-329-5776 406-652-4141 137 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-297-2023 406-297-2023 406-683-9435 406-883-5680 406-723-4312 406-493-7313 138 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-866-0981 406-531-6658 406-256-7038 406-329-5636 406-883-5377 406-228-3400 139 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-871-8347 406-871-8347 406-883-5377 406-883-5377 406-727-2121 140 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-728-7388 406-883-5377 406-252-0022 141 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-293-4329 406-883-5377 406-543-7271 142 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-238-6800 406-755-1647 406-327-1670 406-327-1900 406-327-1766 143 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-777-2679 406-651-0000 406-446-1671 406-585-5490 144 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-676-5680 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-751-7519 406-563-3155 406-626-5769 406-677-2277 406-327-1850 406-579-6853 406-587-3097 145 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-721-5780 406-294-6750 406-777-5522 406-455-5870 406-360-2708 406-446-4218 146 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1841 406-327-1732 406-327-1841 406-327-1732 406-293-7900 406-293-7900 406-721-8825 406-550-0524 406-250-8559 406-761-3767 147 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-723-2132 406-752-8456 406-696-1062 148 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-782-2265 406-233-2500 406-237-5760 406-755-8811 149 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-442-3869 406-777-5522 406-756-6815 406-259-8633 150 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-652-9339 406-327-1841 406-327-1850 406-467-2700 151 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-531-0043 406-327-1850 406-363-2211 406-550-1212 406-327-1670 406-327-3362 406-327-9992 406-728-6520 152 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-600-4073 406-600-4073 406-449-7500 406-494-6692 406-327-1841 153 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-787-6400 406-252-5658 406-446-2500 406-375-1717 406-327-1900 406-543-7271 154 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3362 406-273-4923 406-728-0222 406-327-1841 406-327-3057 406-273-4923 406-543-7271 406-787-6401 406-563-6721 155 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-860-4265 406-883-8250 406-748-2800 406-721-5600 156 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-771-7800 406-677-2277 406-543-7271 406-222-3541 406-297-3422 406-495-0956 157 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-543-7271 406-788-8929 406-252-0022 406-228-3500 158 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1841 406-228-3400 406-721-6349 406-327-1841 406-327-3362 406-535-5990 406-652-9339 159 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-443-4142 406-228-3500 406-728-2000 406-261-8311 406-252-3851 160 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-5680 406-676-5680 406-543-3485 406-327-1841 406-454-2171 406-454-2202 406-228-3400 161 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-543-1197 406-329-5776 406-830-3116 406-327-3350 406-542-5200 406-651-9355 406-651-9355 162 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-771-6545 406-228-3400 406-543-7271 406-495-1936 406-883-5377 406-273-4923 163 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-755-3991 406-755-3991 406-543-7271 406-771-7700 406-329-7870 406-327-1841 406-329-5776 406-453-1369 164 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 165 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3219 406-327-1841 406-728-7388 406-329-5615 166 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1850 406-281-8262 406-665-1204 406-768-5171 406-862-0337 406-756-6764 406-327-7402 167 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-727-5778 406-727-5778 406-683-5806 406-855-9446 406-727-5778 406-727-5778 406-543-7271 406-245-6539 168 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3260 406-363-5056 169 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-771-1172 406-727-5778 406-727-5778 406-327-3057 406-273-4923 406-329-5776 170 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1841 406-453-3600 406-626-5769 406-677-2277 406-860-3754 406-228-3630 171 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-752-7441 406-237-5760 406-777-5522 406-238-6115 172 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-543-7271 406-855-1799 406-496-3658 406-541-7000 406-752-6107 406-787-6401 173 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-837-4357 406-830-3333 406-653-2150 406-222-0250 174 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-228-3500 406-327-1670 406-549-7171 406-327-3057 509-838-7711 406-228-3630 406-252-8346 175 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-228-3500 406-252-8346 406-254-0005 406-439-0756 406-532-9700 176 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-245-4446 406-245-4446 406-327-3057 406-329-5746 406-228-3400 406-327-1900 406-327-1766 406-541-7000 406-541-7000 406-541-7000 406-541-7000 177 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-541-7000 406-787-6401 406-471-4515 406-543-1197 406-228-3400 178 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-5680 406-768-5171 406-653-2150 406-223-0206 406-485-3381 406-228-3630 406-329-5615 179 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-329-5746 180 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-370-5322 406-761-3767 406-787-6401 406-228-3400 406-837-3966 406-252-8346 406-455-2860 406-455-2860 406-883-5377 406-756-8488 406-228-3500 406-228-3400 181 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-969-2468 406-883-5377 406-238-6800 182 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-543-7271 406-257-5290 406-257-5290 406-683-2020 183 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-547-3234 406-297-7900 184 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-784-2346 406-787-6401 406-442-8777 406-329-5615 406-327-1670 406-327-1900 406-327-1766 406-765-2550 406-228-9349 406-765-7420 406-653-1872 406-228-3500 406-787-6401 406-535-1490 185 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-513-1962 406-626-5769 406-677-2277 406-327-3034 406-784-2346 406-249-2800 406-447-2503 406-543-7271 186 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1841 406-721-5600 406-787-6401 187 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-541-3040 406-327-1900 406-327-1766 406-861-2873 406-241-8213 406-768-5171 406-377-6075 406-234-0234 188 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-8479 406-234-8793 406-531-1801 406-721-8608 406-329-5615 189 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-454-2171 406-471-6379 406-327-1850 406-327-1841 190 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-827-0700 406-329-5615 406-228-3500 191 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-2805 406-883-2805 406-883-5377 406-454-6973 406-294-9606 406-329-5615 192 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-727-3152 406-727-3152 406-298-0810 406-260-2281 193 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-329-5655 406-261-2447 406-454-2171 194 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3273 406-327-3362 406-782-0008 866-414-1955 406-233-2600 406-370-7747 406-329-5615 406-327-1841 406-327-3057 406-543-7271 406-327-1841 195 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-642-3761 406-277-3233 406-599-7218 406-586-5694 406-784-2346 406-252-2626 196 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE (406) 431-5764 406-653-2150 406-541-0202 406-256-5655 406-752-8456 406-582-1321 406-723-8051 406-549-3727 197 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-329-5655 198 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 866-414-1955 866-414-1955 406-237-5760 406-237-5760 406-327-3057 406-228-3400 199 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-653-2150 406-327-1841 406-228-3500 406-787-6401 406-542-7365 406-322-4793 406-560-6600 406-228-3536 406-652-1923 406-652-1923 406-883-5680 406-228-3630 406-455-5870 200 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-494-2222 406-728-7763 406-825-6000 406-541-9507 406-543-7271 406-827-6925 406-327-3362 406-327-3362 201 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-442-2113 406-327-3362 406-327-1841 406-728-7388 202 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-238-6115 406-329-5615 406-543-7271 406-293-6492 406-228-3500 406-883-5377 203 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1670 406-327-1841 406-293-6937 406-787-6400 406-670-3956 406-826-4810 406-329-5615 204 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-826-4810 406-543-7271 406-257-4001 406-257-4001 406-756-7746 406-327-3300 205 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 206 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-360-4006 406-883-5377 207 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-454-2171 406-327-1670 208 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-752-5355 406-647-4077 406-454-6973 406-370-3839 406-273-0237 209 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-653-2150 406-256-8215 406-542-0001 406-543-7271 406-723-4830 210 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-255-0209 406-755-1001 406-249-5914 211 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-5680 406-752-7289 406-248-3175 212 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-375-4426 406-270-0969 406-542-3327 406-228-3630 213 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-5377 406-329-5615 406-252-0022 214 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-727-3314 406-781-7317 406-255-0209 406-228-3500 215 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-8250 406-327-1732 406-652-0253 406-329-5746 406-768-5171 216 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-294-9510 406-329-5615 406-329-2945 406-883-5377 217 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-453-3384 406-257-6494 406-252-8346 406-787-6401 218 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-273-3730 219 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-329-5615 406-273-4923 406-777-5522 406-587-9610 406-294-9510 406-228-3400 220 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-549-2374 406-696-4479 866-414-1955 866-414-1955 406-327-1670 406-273-4923 406-228-3400 406-652-3730 221 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-723-4026 406-323-4002 406-327-1841 406-327-1670 222 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-252-8346 406-683-6861 406-546-2363 223 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-543-2743 406-248-3175 406-329-5615 406-327-1900 406-327-1766 406-363-5056 406-273-4923 406-225-4201 406-327-1841 224 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-375-2331 406-541-8060 406-543-7271 406-721-3351 406-363-3353 406-452-6929 406-728-7777 225 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-752-1789 226 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-5377 406-228-3500 406-449-7323 406-228-3400 406-822-5422 406-752-1789 406-422-5809 406-228-3630 227 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-237-5862 406-297-2023 406-846-7770 228 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1850 406-327-1841 406-293-6118 229 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-727-5778 406-727-5778 406-252-8346 406-883-5680 230 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3300 406-356-2670 406-748-2800 406-228-3400 406-228-3536 406-542-2116 231 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-329-5866 406-329-5615 406-327-1900 406-327-1766 406-329-5615 232 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-252-7510 406-752-2282 406-549-9779 233 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1841 406-535-1540 406-228-3500 406-626-5769 406-745-3131 406-726-3333 406-883-5377 406-883-8423 406-677-2277 406-327-3057 406-752-7441 234 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-860-8359 406-327-1841 406-327-1732 406-329-5615 406-491-2550 406-252-6620 406-761-5747 406-327-1670 406-452-7585 235 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-228-3500 406-327-1841 406-653-2150 236 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-727-5778 406-727-5778 406-240-3150 237 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-761-3767 406-787-6400 238 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-375-2331 406-541-8060 406-752-1789 406-771-6545 406-375-2570 406-752-2282 239 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-3260 406-327-3260 240 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-327-1841 406-207-3342 406-697-1040 406-297-2811 406-626-5769 406-677-2277 406-329-5746 406-543-7271 406-329-5776 241 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-723-0190 406-228-3400 242 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-228-3585 406-327-3362 243 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-329-5615 406-329-2945 406-586-4145 406-485-2063 406-542-7365 244 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-454-6973 406-655-4904 406-259-0303 406-543-1197 406-752-7441 406-327-1900 406-327-1766 245 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-5377 406-327-3362 406-228-3400 406-768-5171 406-653-2150 406-480-2491 406-653-2150 406-863-3500 406-373-8000 406-327-3950 246 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 800-530-0912 406-563-6471 406-883-4733 406-683-4734 406-782-2359 406-549-5550 406-846-2854 406-449-8682 406-587-7050 406-563-8667 406-723-3402 406-443-7743 406-447-2739 406-388-9040 406-245-7050 406-549-3866 406-452-9296 406-782-5775 406-642-3010 406-656-8818 406-683-3000 406-323-2532 406-455-2814 406-731-8200 406-455-2081 406-455-5153 406-455-2680 406-378-2188 406-752-0440 247 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-655-1933 406-542-6559 406-839-1063 406-896-2447 406-657-4999 406-657-4000 406-363-7439 406-721-1646 406-587-4404 406-587-4404 406-847-2100 406-535-8811 406-535-7711 406-826-3601 248 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-563-8500 406-728-4100 406-363-0597 406-723-3225 406-761-0706 406-846-2212 406-683-6848 406-488-2100 406-296-3145 406-252-5058 406-653-1400 406-862-9030 406-273-4923 406-228-4351 406-626-5769 406-862-2515 406-859-3271 249 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-375-0980 406-761-8408 406-495-9450 406-494-5776 406-883-3838 406-883-3838 406-363-6203 406-677-2424 406-457-4200 406-233-2600 406-375-0122 406-541-1800 406-444-2244 406-543-4408 406-741-2992 406-741-3602 406-728-4558 406-728-4558 406-494-4183 250 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-628-8251 406-759-5181 406-723-1212 406-482-2366 406-265-8882 406-338-2888 406-293-8671 406-585-5582 406-449-2253 406-846-2222 406-257-2454 406-652-0771 406-232-6561 406-543-1832 406-771-6668 406-653-2150 406-222-0672 406-222-3541 406-273-0045 406-363-2211 406-363-2211 406-363-2211 406-363-2211 406-363-2211 251 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 403-434-3210 406-485-3381 406-547-3234 406-822-4841 406-822-3564 406-771-4063 406-771-4063 406-252-7358 406-543-5690 406-265-4720 406-862-8008 406-755-5910 406-543-5690 406-549-0988 406-549-0921 406-829-8053 406-542-7525 406-455-2130 406-728-2539 406-652-6630 406-327-3350 406-252-5833 252 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-863-2501 406-653-6500 406-265-2211 406-265-2211 406-265-2211 406-265-2211 406-329-7500 406-721-0918 406-731-8990 406-222-0800 406-549-3967 406-259-7605 406-721-2604 406-756-3950 406-455-3040 406-654-1800 406-969-4340 406-563-8667 406-932-4603 406-826-4800 253 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-883-4378 406-271-3211 406-768-6100 406-245-3238 406-252-7225 406-761-1007 406-238-1800 406-782-9154 406-248-3175 406-768-5171 406-327-9200 406-652-8883 406-453-7570 406-442-7570 406-727-8832 406-238-6835 406-787-6401 406-346-2161 406-323-2301 406-323-3337 406-842-5453 406-238-2627 406-549-5283 406-651-0055 406-651-0055 406-677-2277 406-444-7500 254 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-442-6356 406-723-0023 406-723-2500 406-293-0100 406-883-5377 406-883-5273 406-883-5680 406-676-4441 406-676-4441 406-329-5630 406-442-2480 406-322-5316 406-496-3600 406-721-9244 406-827-4442 406-777-5885 406-721-3096 406-782-3221 255 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12 Montana PHONE 406-721-5600 406-721-5600 406-721-5600 406-655-2100 406-237-4373 406-237-5900 256 of 256 PacificSource Health Plans - PPO Provider Network Revised 5/31/12
