provider referral guide – volusia/flagler counties

Transcription

PROVIDER REFERRAL GUIDE – VOLUSIA/FLAGLER COUNTIES
CHECK OUT OUR WEBSITE!!! www.fhcp.com
FHCP Central Referral Department
386 / 238-3230 or 800 / 352-9824 (Ext. 3230)
Fax: 386 / 238-3253 or 877 / 659-3427
Manager of Central Referrals and Call Center Services
Sue Schack, L.P.N.
386 / 676-7100 or 800 / 352-9824 (Ext. 3230)
Central Referrals Clinical Supervisor / Susan Dreggors, L.P.N.
386 / 676-7100 or 800 / 352-9824 (Ext. 3230)
Provider Relations Coordinator / Carol Cooper, L.P.N.
386 / 615-4001 or 800 / 352-9824 (Ext. 4001)
FHCP Case Management Utilization Review Department
386 / 676-7187 or 866 / 676-7187
Case Management Coordination of Care Department
386 / 238-3284 or 800 / 321-1227 (Ext. 7288)
Provider Benefit & Eligibility Questions
386 / 615-4024 or 844 / 615-4024
****************************************************************************************************
Indicates pre-authorization needed By FHCP Central Referrals Department.
For URGENT requests that require pre-authorization, the requesting provider/staff MUST CALL FHCP Central
Referrals at 386 / 238-3230.
**********************************************************************************************
Services that require pre-authorization must have documentation as to the medical necessity. If that documentation is not available, your request may
be denied. Please refer to your Provider Referral Guide for assistance in referring your patients for services. There are guideline variations
for HECN members.
HECN, VOTRAN, STATE OF FLORIDA, DAYTONA STATE COLLEGE & BETHUNE-COOKMAN
COLLEGE MEMBERS CAN SEE ALL LISTED HMO PROVIDERS AS WELL AS ADDITIONAL
PROVIDERS THAT HAVE BEEN INDICATED WITHIN THIS DOCUMENT
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TABLE OF CONTENTS
The Table of Contents listed below outlines Florida Health Care Plan’s Preferred Participating Providers
ACUTE LOW BACK & NECK PROGRAM .................................................................................................................................................................... 9
OUTPATIENT REHABILITATION LOCATIONS ....................................................................................................................................................... 10
OUTPATIENT REHABILITATION LOCATIONS ....................................................................................................................................................... 11
ALLERGY ........................................................................................................................................................................................................................ 12
ARTERIAL BLOOD GASES (ABG’S) .......................................................................................................................................................................... 13
AUTISM SPECTRUM DISORDER (ASD) .................................................................................................................................................................... 14
BIRTH CENTER .............................................................................................................................................................................................................. 15
BARIATRIC SURGERY PROGRAM ............................................................................................................................................................................ 16
BONE DENSITY STUDIES ............................................................................................................................................................................................ 16
BONE SCANS .................................................................................................................................................................................................................. 17
BRACES / ORTHOTICS / PROSTHETICS .................................................................................................................................................................... 18
DIABETIC SHOE PROVIDERS ................................................................................................................................................................................. 19
CARDIAC CATHETERIZATION .................................................................................................................................................................................. 21
CARDIAC MONITORING .............................................................................................................................................................................................. 22
CARDIAC REHABILITATION ...................................................................................................................................................................................... 23
CARDIOLOGY ................................................................................................................................................................................................................ 24
CARDIOLOGY (CONTINUED) ..................................................................................................................................................................................... 26
CARDIOLOGY - PEDIATRIC ........................................................................................................................................................................................ 27
CASE MANAGEMENT COORDINATION OF CARE DEPARTMENT ..................................................................................................................... 27
CASE MANAGEMENT COORDINATION OF CARE DEPARTMENT (CONTINUED) .......................................................................................... 28
CASE MANAGEMENT UTILIZATION REVIEW DEPARTMENT............................................................................................................................ 29
CHIROPRACTIC ............................................................................................................................................................................................................. 30
CHIROPRACTIC (CONTINUED) .................................................................................................................................................................................. 31
CHIROPRACTIC (CONTINUED) .................................................................................................................................................................................. 32
COLONOSCOPY / SCREENING (CONTINUED) ........................................................................................................................................................ 34
CT SCANS........................................................................................................................................................................................................................ 35
CT SCANS (CONTINUED)............................................................................................................................................................................................. 36
DENTAL SERVICES ....................................................................................................................................................................................................... 37
DENTAL SERVICES (CONTINUED) ............................................................................................................................................................................ 38
URGENT (NOT LATER THAN 72 HOURS) / ACCIDENTAL DENTAL INJURY SERVICES ............................................................................ 38
TMJ SERVICES ........................................................................................................................................................................................................... 38
ORAL SLEEP APNEA APPLIANCES ....................................................................................................................................................................... 38
DERMATOLOGY ............................................................................................................................................................................................................ 39
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DERMATOLOGY (CONTINUED) ................................................................................................................................................................................. 40
DIABETES EDUCATION ............................................................................................................................................................................................... 40
DIAGNOSTIC TESTING ................................................................................................................................................................................................ 41
DIAGNOSTIC TESTING (CONTINUED) ..................................................................................................................................................................... 42
DIALYSIS SERVICES .................................................................................................................................................................................................... 43
DISEASE MANAGEMENT PROGRAMS ..................................................................................................................................................................... 44
DISEASE MANAGEMENT PROGRAMS (CONTINUED) .......................................................................................................................................... 45
DURABLE MEDICAL EQUIPMENT ............................................................................................................................................................................ 48
DURABLE MEDICAL EQUIPMENT (CONTINUED) ................................................................................................................................................. 49
OXYGEN ORDERS ..................................................................................................................................................................................................... 49
DURABLE MEDICAL EQUIPMENT (CONTINUED) ................................................................................................................................................. 50
POV’S / ELECTRIC WHEELCHAIR ORDERS - ...................................................................................................................................................... 50
EAR LAVAGE ................................................................................................................................................................................................................. 50
EAR, NOSE AND THROAT (ENT) ................................................................................................................................................................................ 51
ECHOCARDIOGRAMS .................................................................................................................................................................................................. 52
EEG TESTING ................................................................................................................................................................................................................. 53
EEG TESTING – AMBULATORY ................................................................................................................................................................................. 54
EEG TESTING – MOBILE SERVICES .......................................................................................................................................................................... 54
ELECTROCARDIOGRAMS (EKG’S)........................................................................................................................................................................... 55
EMERGENCY FACILITIES ........................................................................................................................................................................................... 56
EMG TESTING (CONTINUED) ..................................................................................................................................................................................... 58
ENDOCRINOLOGY ........................................................................................................................................................................................................ 59
ENDOCRINOLOGY (CONTINUED) ............................................................................................................................................................................. 60
EVENT MONITOR .......................................................................................................................................................................................................... 60
EXTENDED HOUR PRIMARY CARE .......................................................................................................................................................................... 61
PROVIDERS OR FACILITIES NOT LISTED IN FHCP DIRECTORIES .................................................................................................................... 62
FLIGHT PHYSICALS...................................................................................................................................................................................................... 63
GASTROENTEROLOGY................................................................................................................................................................................................ 63
GASTROENTEROLOGY (CONTINUED) ..................................................................................................................................................................... 64
GASTROENTEROLOGY (CONTINUED) ..................................................................................................................................................................... 65
GENETIC TESTING ........................................................................................................................................................................................................ 65
BRCA TESTING .......................................................................................................................................................................................................... 65
GLUCOMETERS ............................................................................................................................................................................................................. 66
GYNECOLOGY AND WELL WOMAN’S ASSESSMENTS........................................................................................................................................ 67
GYNECOLOGY AND WELL WOMAN’S ASSESSMENTS (CONTINUED)............................................................................................................. 68
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GYNECOLOGY AND WELL WOMAN’S ASSESSMENTS (CONTINUED)............................................................................................................. 69
HAND THERAPY SERVICES ........................................................................................................................................................................................ 70
HEARING / AUDIOLOGY SERVICES.......................................................................................................................................................................... 70
HEARING / AUDIOLOGY SERVICES.......................................................................................................................................................................... 71
HEPATITIS C ................................................................................................................................................................................................................... 71
HIV ................................................................................................................................................................................................................................... 72
HOLTER MONITOR ....................................................................................................................................................................................................... 72
HOME HEALTH CARE .................................................................................................................................................................................................. 73
HOME INFUSION PHARMACIES ................................................................................................................................................................................ 73
HOSPICE .......................................................................................................................................................................................................................... 74
HOSPITAL ADMISSIONS .............................................................................................................................................................................................. 75
LTACH ADMISSIONS – LONG TERM ACUTE CARE HOSPITALS ................................................................................................................... 76
HOSPITALIST ................................................................................................................................................................................................................. 77
HOSPITALIST (CONTINUED) ...................................................................................................................................................................................... 78
HYPERBARIC OXYGEN THERAPY (HBO) ................................................................................................................................................................ 78
INFECTIOUS DISEASES ............................................................................................................................................................................................... 79
INFECTIOUS DISEASES - PEDIATRICS ..................................................................................................................................................................... 80
INFUSION CLINICS ....................................................................................................................................................................................................... 80
INFUSION SERVICES (WEST VOLUSIA & SEMINOLE COUNTY) ...................................................................................................................... 81
INFUSION SERVICES (INFUSION PUMPS FOR CHEMOTHERAPY) ................................................................................................................... 81
INJECTION CLINIC ........................................................................................................................................................................................................ 82
INSULIN PUMPS ............................................................................................................................................................................................................ 83
INSULIN PUMPS (CONTINUED) ................................................................................................................................................................................. 84
INTERPRETER SERVICES ............................................................................................................................................................................................ 85
INTERPRETER SERVICES (CONTINUED) ................................................................................................................................................................. 86
LABORATORY SERVICES – ROUTINE ...................................................................................................................................................................... 87
LABORATORY SERVICES – ROUTINE (CONTINUED) ........................................................................................................................................... 88
LABORATORY SERVICES – STAT ............................................................................................................................................................................. 89
LABORATORY SERVICES – STAT (CONTINUED) .................................................................................................................................................. 90
LABORATORY SERVICES – STAT (CONTINUED) .................................................................................................................................................. 91
LABORATORY SERVICES-HOME .............................................................................................................................................................................. 92
LITHOLINK SERVICES ................................................................................................................................................................................................. 92
LACTATION SERVICES/BREASTFEEDING CLASSES ............................................................................................................................................ 93
LYMPHEDEMA CLINIC ................................................................................................................................................................................................ 93
MAMMOGRAMS (DIAGNOSTIC OR SCREENING) ................................................................................................................................................. 94
MEDICATIONS (REQUIRING PRIOR AUTHORIZATIONS) .................................................................................................................................... 95
MRI’S ............................................................................................................................................................................................................................. 100
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MRI’S (CONTINUED) .................................................................................................................................................................................................. 101
NEONATAL & PERINATAL HIGH RISK PREGNANCY & INFANT CASE MANAGEMENT .......................................................................... 102
NEPHROLOGY ............................................................................................................................................................................................................. 102
NEPHROLOGY (CONTINUED) .................................................................................................................................................................................. 103
NEUROLOGY ................................................................................................................................................................................................................ 104
NEUROLOGY (CONTINUED) ..................................................................................................................................................................................... 105
NEUROLOGY (CONTINUED) ..................................................................................................................................................................................... 106
NUTRITIONAL ASSESSMENT AND COUNSELING............................................................................................................................................... 107
OBSTETRICS................................................................................................................................................................................................................. 108
OBSTETRICS (CONTINUED)...................................................................................................................................................................................... 109
OCULAR PROSTHETICS LAB .................................................................................................................................................................................... 110
ONCOLOGY–MEDICAL/HEMATOLOGY................................................................................................................................................................. 111
ONCOLOGY–MEDICAL/HEMATOLOGY (CONTINUED) ..................................................................................................................................... 112
ONCOLOGY- RADIATION.......................................................................................................................................................................................... 113
ONCOLOGY - RADIATION THERAPY ................................................................................................................................................................. 113
OPHTHALMOLOGY .................................................................................................................................................................................................... 114
OPHTHALMOLOGY (CONTINUED) ......................................................................................................................................................................... 115
OPHTHALMOLOGY-RETINAL SERVICES ONLY .................................................................................................................................................. 115
OPHTHALMOLOGY-CORNEAL SERVICES ONLY ................................................................................................................................................ 116
OPTOMETRY ................................................................................................................................................................................................................ 117
OPTOMETRY – LOW VISION .................................................................................................................................................................................... 118
ORAL SLEEP APNEA APPLIANCES ......................................................................................................................................................................... 118
ORTHOPAEDICS – SPORTS MEDICINE- NON-SURGICAL TREATMENT ........................................................................................................ 119
OUTPATIENT REHABILITATION ............................................................................................................................................................................. 120
PHYSICAL THERAPY.............................................................................................................................................................................................. 120
OCCUPATIONAL THERAPY .................................................................................................................................................................................. 120
SPEECH THERAPY .................................................................................................................................................................................................. 120
OUTPATIENT REHABILITATION LOCATIONS ..................................................................................................................................................... 121
OUTPATIENT REHABILITATION LOCATIONS ..................................................................................................................................................... 122
BALANCE & VESTIBULAR THERAPY ................................................................................................................................................................ 123
HAND THERAPY SERVICES .................................................................................................................................................................................. 124
VIDEOSTROBOSCOPY AND VOICE THERAPY EVALUATION ...................................................................................................................... 124
PAIN MEDICINE ........................................................................................................................................................................................................... 125
PAIN MEDICINE ........................................................................................................................................................................................................... 125
PAIN MEDICINE (CONTINUED) ................................................................................................................................................................................ 126
PATHOLOGY – OUT-PATIENT/AMBULATORY..................................................................................................................................................... 127
PATHOLOGY – OUT-PATIENT/AMBULATORY (CONTINUED).......................................................................................................................... 128
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PEDIATRICS ................................................................................................................................................................................................................. 129
PEDIATRIC SUB-SPECIALTIES ................................................................................................................................................................................. 129
PEG TUBE FEEDING ASSESSMENT ......................................................................................................................................................................... 129
PELVIC HEALTH PROGRAM ..................................................................................................................................................................................... 130
PERINATAL & NEONATAL HIGH RISK PREGNANCY & INFANT CASE MANAGEMENT ........................................................................... 130
PERINATOLOGY .......................................................................................................................................................................................................... 131
PERIPHERAL VASCULAR INTERVENTION ........................................................................................................................................................... 132
PHARMACY-PREFERRED RETAIL PHARMACY ................................................................................................................................................... 133
PHARMACY-STANDARD RETAIL PHARMACY .................................................................................................................................................... 134
PHYSICAL MEDICINE AND REHABILITATION SERVICES ................................................................................................................................ 135
PHYSICAL MEDICINE AND REHABILITATION SERVICES ................................................................................................................................ 136
PODIATRY .................................................................................................................................................................................................................... 136
PRIMARY CARE........................................................................................................................................................................................................... 137
PROVIDERS OR FACILITIES NOT LISTED IN FHCP DIRECTORIES .................................................................................................................. 137
PSYCHIATRY / BEHAVIORAL HEALTH ................................................................................................................................................................. 138
PSYCHIATRY / BEHAVIORAL HEALTH (CONTINUED) ...................................................................................................................................... 139
PSYCHIATRY / BEHAVIORAL HEALTH ................................................................................................................................................................. 146
PSYCHIATRY / BEHAVIORAL HEALTH – CHILD & ADOLESCENT .............................................................................................................. 147
PULMONARY FUNCTION TESTS (PFTS) / SPIROMETRY .................................................................................................................................... 148
PULMONARY FUNCTION TESTS (PFTS) WITH DLCO) ........................................................................................................................................ 149
PULMONARY REHABILITATION ............................................................................................................................................................................. 150
PULMONOLOGY .......................................................................................................................................................................................................... 151
PULMONOLOGY(CONTINUED) ................................................................................................................................................................................ 152
PULMONOLOGY - PEDIATRIC ................................................................................................................................................................................. 154
REPORTABLE DISEASES/CONDITIONS ................................................................................................................................................................. 155
REPORTABLE DISEASES/CONDITIONS (CONTINUED) ..................................................................................................................................... 156
RHEUMATOLOGY ....................................................................................................................................................................................................... 157
RHEUMATOLOGY - PEDIATRICS ............................................................................................................................................................................ 158
SKILLED NURSING FACILITY .................................................................................................................................................................................. 159
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SKILLED NURSING FACILITY (CONTINUED) ....................................................................................................................................................... 160
SLEEP DISORDER PROVIDERS................................................................................................................................................................................. 160
SLEEP DISORDER PROVIDERS (CONTINUED) ..................................................................................................................................................... 161
SLEEP DISORDER PROVIDERS (CONTINUED ....................................................................................................................................................... 164
SLEEP DISORDER PROVIDER – HOME STUDIES.................................................................................................................................................. 165
SLEEP DISORDER PROVIDER – PEDIATRIC .......................................................................................................................................................... 166
SUBSTANCE ABUSE / RESIDENTIAL ...................................................................................................................................................................... 167
SUBSTANCE ABUSE – OUTPATIENT CARE / INTENSIVE OUTPATIENT PROGRAMS.................................................................................. 167
SUBSTANCE ABUSE – OUTPATIENT CARE / INTENSIVE OUTPATIENT PROGRAMS.................................................................................. 168
SURGERY-CARDIOVASCULAR ................................................................................................................................................................................ 169
SURGERY-COLON & RECTAL .................................................................................................................................................................................. 170
SURGERY-GENERAL .................................................................................................................................................................................................. 171
SURGERY-GENERAL (CONTINUED) ....................................................................................................................................................................... 172
MINOR SURGICAL CLINIC ........................................................................................................................................................................................ 172
SURGERY-HAND ......................................................................................................................................................................................................... 173
SURGERY-NEURO ....................................................................................................................................................................................................... 174
SURGERY-NEURO (CONTINUED) ............................................................................................................................................................................ 175
SURGERY-ORAL.......................................................................................................................................................................................................... 175
SURGERY-ORTHOPAEDICS ...................................................................................................................................................................................... 176
SURGERY-ORTHOPAEDICS (CONTINUED) ........................................................................................................................................................... 177
SURGERY-ORTHOPAEDICS (CONTINUED) ........................................................................................................................................................... 178
SURGERY-PLASTIC .................................................................................................................................................................................................... 179
SURGERY–VASCULAR .............................................................................................................................................................................................. 181
PERIPHERAL VASCULAR INTERVENTION ........................................................................................................................................................... 181
SURGERY–VASCULAR (CONTINUED) ................................................................................................................................................................... 182
SURGERY–VASCULAR (CONTINUED) ................................................................................................................................................................... 183
SURGICAL FACILITIES .............................................................................................................................................................................................. 184
SURGICAL FACILITIES (CONTINUED) ................................................................................................................................................................... 185
SUTURE AND STAPLE REMOVAL ........................................................................................................................................................................... 186
TERTIARY CARE CENTERS ...................................................................................................................................................................................... 186
TRANSPLANTS ............................................................................................................................................................................................................ 187
ULTRASOUND TESTING ............................................................................................................................................................................................ 188
URGENT CARE SERVICES ......................................................................................................................................................................................... 189
URGENT CARE SERVICES (CONTINUED) .............................................................................................................................................................. 190
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UROLOGY ..................................................................................................................................................................................................................... 192
VACUUM ASSISTED CLOSURE DEVICES .............................................................................................................................................................. 193
VARICOSE VEIN TREATMENT ................................................................................................................................................................................. 193
VNG TESTING .............................................................................................................................................................................................................. 194
WEIGHT MANAGEMENT PROGRAMS .................................................................................................................................................................... 195
WOUND CARE.............................................................................................................................................................................................................. 196
WOUND CARE.......................................................................................................................................................................................................... 196
HYPERBARIC OXYGEN THERAPY (HBO) AND VACUUM ASSISTED CLOSURE DEVICES.................................................................... 196
X-RAYS (PLAIN FILMS) ............................................................................................................................................................................................. 197
X-RAYS (PLAIN FILMS) (CONTINUED) .................................................................................................................................................................. 198
X-RAYS (STAT READINGS) ....................................................................................................................................................................................... 199
X-RAYS (STAT READINGS) (CONTINUED) .......................................................................................................................................................... 200
X-RAYS (UNABLE TO BE DONE AT FHCP) ............................................................................................................................................................ 201
X-RAYS (UNABLE TO BE DONE AT FHCP) (CONTINUED) ................................................................................................................................. 202
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ACUTE LOW BACK & NECK PROGRAM
This low back and neck pain program is for FHCP members age 17 years and above. This program is for acute pain, less than 2 week duration.
Access to this program can be made by either the physician or the patient.
INSTRUCTIONS:
Physician:
•
•
•
Member:
•
•
•
For members you have recently treated for low back or neck pain, you must complete the FHCP Rehabilitation Services
Request form indicating Acute Low Back & Neck Program.
Instruct the member to call for an appointment at the nearest location (Location List on next page) and to bring the request
form to the initial visit.
Member is responsible for co-payment.
Direct access (i.e. call to self-refer). Must not be currently receiving care from a physician for low back/neck pain)
Appointment will be limited to no more than 4 visits in 2 weeks
Responsible for Physical Therapy co-payment.
The following page is a listing of all locations, which can be printed or ordered for the convenience of your office.
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FLORIDA HEALTH CARE PLANS
OUTPATIENT REHABILITATION LOCATIONS
Please call to schedule your initial appointment
Within one week of the date of the request.
Ability Health Services – Deltona
1565 Saxon Blvd., Suite 301
Deltona, FL 32725
Phone: (386) 851-0901
Fax: (386) 851-2426
Stetson/FH Hospital Deland
141 East Pennsylvania Ave.
Deland, FL 32724
Phone: (386) 822-5649
Fax: (386) 822-7809
Ability Health Services – South Daytona
401 Venture Blvd., Suite C
South Daytona, FL 32119
Phone: (386) 763-0084
Fax: (386) 763-0085
Ability Health Services – Altamonte Springs
801 Douglas Ave., Suite 103
Altamonte Springs, FL 32714
Phone: (407) 865-7153
Fax:
(407) 865-7159
Ability Health Services - Daytona Beach
614 N. Peninsula Drive
Daytona Beach, FL 32118
Phone: (386) 258-6212
Fax:
(386) 676-7572
Ability Health Services – Lake Mary
1337 S. International Pkwy., Suite 1321
Lake Mary, FL 32746
Phone: (407) 833-0802
Fax:
(407) 833-8931
Ability Health Services – Sanford
1200 Lexington Green Lane
Sanford, FL 32771
Phone: (407) 322-3442
.
Fax:
(407) 322-8404
Ability Health Services – Oviedo
7400 Red Bug Lake Road
Oviedo, FL 32765
Phone: (407) 971-2774
Fax:
(407) 971-2776
Professional Physical Therapy –
Edgewater
1316 S. Ridgewood Ave., Suite 1
Edgewater, FL 32132
Phone: (386) 423-0100
Fax:
(386) 428-8631
Progressive Physical Therapy-Ormond Beach
290 Clyde Morris Blvd., Ste. B2
Ormond Beach, FL 32174
Phone: (386) 898-0443
Fax: (386) 898-0459
Additional locations on the following page.
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Blue Water Therapy-New Smyrna Beach
916 North Dixie Freeway
New Smyrna Beach, FL 32168
Phone: (386) 426-7885
Fax:
(866) 239-9013
Palm Coast Sports Medicine and Rehabilitation Center
35 Old Kings Road
Palm Coast, FL 32137
Phone: (386) 445-5555
Fax:
(386) 445-9800
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ALLERGY
Robert DiNicolo, M.D. # 001853
Nisha Patel, M.D. #052404
Infants and older
Records needed prior to scheduling
Please send by courier
Juan C. Mas, M.D. #000557
Edward McLaughlin, M.D. #000003
Patients 2 years and older
Asthma, Allergy and Sinus Clinic
353 N. Clyde Morris Blvd., Daytona Beach, FL 32114
Asthma & Allergy Specialists
890 N. Boundary Avenue, Suite 101, DeLand, FL 32720
9 Pine Cone Drive, Ste. 105, Palm Coast, FL 32137
785 W. Granada Blvd., Ste. 2, Ormond Beach, FL 32174
386 / 252-6622
386 / 736-3911
Fax: 386 / 736-2293
386 / 446-3006
Fax: 386 / 446-2909
386 / 673-1323
Fax: 386 / 676-7448
Prior authorization from the FHCP Central Referrals is not needed. The requesting provider will send an order to the specialist. Appointments can
be made by the physician’s office or the member can call after the order has been received by the specialty office. The specialty office will advise
you of their scheduling protocol.
Michael D. Kohen, M.D. #010319
Michael Diamond, M.D. #003850
HECN PROVIDERS
Yong Tsai, M.D. #010315
HECN, DAYTONA STATE COLLEGE &
BETHUNE-COOKMAN COLLEGE
PROVIDER
Allergy, Asthma, Arthritis & Lung Center
386 / 252-1632
Fax: 386 / 257-5526
1545 Hand Ave., Ste. 2, Ormond Beach, FL 32174
Arthritis, Autoimmune and Allergy
1893 N. Clyde Morris Blvd., Ste. 110, Daytona Beach, FL 32117
386 / 676-0307
Fax: 386 / 677-7842
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ARTERIAL BLOOD GASES (ABG’s)
Central Florida Regional Hospital #00Y009
1401 West Seminole Blvd., Sanford, FL 32771
407 / 321-4500
Florida Hospital – DeLand #00YG80
701 W. Plymouth Ave., DeLand, FL 32720
Florida Hospital – Fish Memorial #00YG34
1055 Saxon Blvd., Orange City, FL 32763
Florida Hospital – Flagler #00Y015
Outpatient Laboratory
Florida Hospital – New Smyrna #00Y010
60 Memorial Medical Parkway, Palm Coast, FL 32168
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 424-5044
Fax: 386 / 424-5048
386 / 238-2251
Fax: 386 / 238-2252
Halifax Health #00Y007
401 Palmetto Street, New Smyrna Beach, FL 32168
NO APPOINTMENT NECESSARY
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AUTISM SPECTRUM DISORDER (ASD)
FHCP Psychiatric Department
Easter Seals Society of Volusia & Flagler
Counties #10J850
FHCP Center
1340 N. Ridgewood Ave., Holly Hill, FL 32117
386 / 676-7175
Fax: 386 / 676-7134
1219 Dunn Ave., Daytona Beach, FL 32114
156 McGregor., Deland, FL 32720
FHCP members will need to first be referred to a designated FHCP Psychiatrist noted above for evaluation and recommendation into the program.
There are specific health plan benefit requirements that must be met for FHCP coverage of ASD. Therefore, once the member is appropriately
diagnosed by Psychiatry, the FHCP Referral Department must verify that benefit requirements are met.
INSTRUCTIONS: PCP’s should refer members with suspected autism disorder to the FHCP Psychiatric Department. Preauthorization is
NOT needed for this referral. The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office
will advise you of their scheduling protocol.
The FHCP Psychiatrist shall evaluate and diagnosis the member. A FHCP Referral form shall be completed by FHCP Psychiatry for members with
qualifying diagnoses. Psychiatry shall attach pertinent documentation to substantiate the request and forward by fax (386 / 238-3253) or courier, to
FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and notify Psychiatry of their benefit
determination decision. If approved, FHCP will contact Easter Seals. Easter Seals will work with the member directly on appointment scheduling.
Easter Seals will extend a discounted rate to FHCP members who do not have ASD benefits.
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BIRTH CENTER
Agape Birth & Wellness Center
1346 Mason Ave., Daytona Beach, FL 32117
386 / 258--5400
Fax: 386 / 258-5005
Heart2Heart Birth Center, LLC
1110 Lexinton Green Ln., Sanford, FL 32771
407 / 322-9944
Fax: 407 / 878-5858
The above providers will provide complete outpatient obstetrical services, including vaginal deliveries at the Center, to FHCP members for
uncomplicated, low-risk pregnancies.
INSTRUCTIONS: Member can self-refer to this specialty and will be able to call and schedule an appointment without an order from physician.
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BARIATRIC SURGERY PROGRAM
All Florida Health Plan Members (FHCP) members that are considering entering the Bariatric Surgery Program must obtain Prior Authorization from
the FHCP Central Referral Department before entering the program.
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / 2383253) or courier, to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review to see if the patient meets the
guidelines and if they have the benefit of Bariatric Surgery.
A FHCP member can attend the free public Information Sessions that are held in Daytona Beach and Orange City. The members will be advised at
the meeting that acceptance into the program will require a referral to be submitted to the FHCP Central Referral Department for consideration.
BONE DENSITY STUDIES
Florida Health Care Plans (N)
Patients 350 lbs. & under
Wednesdays only
Cyrus Diagnostic Imaging, Inc. #109138 (N)
LAD Imaging, LLC #008160 (N)
Palm Coast Imaging #005448 (N)
Town Center Imaging #10P733 (N)
FHCP Center
FHCP Center-Edgewater
239 N. Ridgewood Ave., Edgewater, FL 32132
165 Waymont Court, Lake Mary, FL 32746
PATIENTS SCREENED FOR MOBILITY
1555 Saxon Blvd., Bldg. 4, Suite 401, Deltona, FL 32725
3 Pine Cone Drive, #101, Palm Coast, FL 32137
WILL NOT SCHEDULE SNF PATIENTS
21 Hospital Drive, Palm Coast, FL 32164
386 / 238-3200 Ext. 3229
Fax: 386 / 238-3292
386 / 427-4868
Fax: 386 / 427-6350
407 / 321-3012
Fax: 407 / 321-9006
386 / 860-9336
Fax: 386 / 860-2225
386 / 446-5200
Fax: 386 / 446-1866
386 / 446-5200
Fax: 386 / 446-1866
(H) – Outpatient Hospital Department/Facility
(N) – Outpatient Non-Hospital Facility
Out of pocket costs may vary depending on location or benefit plan
FHCP will cover this testing once every 24 months.
16
10/01/16
BONE SCANS
Florida Hospital - DeLand #00YG80 (H)
Florida Hospital Fish Imaging #00YG34 (H)
701 W. Plymouth Avenue, DeLand, FL 32720
Florida Hospital – Flagler #00Y015 (H)
1053 Medical Center Drive, Suite 151, Orange City, FL 32763
Centralized scheduling – 386 / 917-5428
Florida Hospital – New Smyrna #00Y010 (H)
1195 Dunlawton Avenue, Port Orange, FL 32127
1890 LPGA Blvd., Suite 110, Daytona Beach, FL 32124
Florida Hospital - Fish Memorial #00YG34 (H)
Palm Coast Imaging Center #005448 (N)
Port Orange Imaging Center #F00002 (N)
Open MRI Unit also available
Town Center Imaging #F00004 (N)
Twin Lakes Imaging Center #F00001 (N)
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4522
Fax: 386 / 943-4461
386 / 917-7500
Fax: 386 / 917-7501
386 / 851-5000
Fax: 386 / 917-5576
386 / 437-2211
Fax: 386 / 586-4618
386 / 424-5044
Fax: 386 / 424-5075
386 / 860-9336
Fax: 386 / 860-2225
386 / 446-5200
Fax: 386 / 446-1866
386 / 322-1616
Fax: 386 / 322-5330
386 / 446-5200
Fax: 386 / 446-1866
386 / 274-5454
Fax: 386 / 274-5440
17
10/01/16
BRACES / ORTHOTICS / PROSTHETICS
American Ortho – Tech #001917
1320 Mason Avenue, Daytona Beach, FL 32117
386 / 258-0401
Fax: 386 / 252-1013
766 N. Sun Drive, Suite 2000, Lake Mary, FL 32746
Dynasplint Systems
Hanger Prosthetics & Orthotics, Inc.
Orthotic Spinal Devices Only
21 Hospital Drive, Suite 270, Palm Coast, FL 32164
770 Ritchie Hwy., Suite #W21, Severna Park, MD 21146
1400 Mason Ave., Suite C, Daytona Beach, FL 32117
2730 Enterprise Rd., Ste. B, Orange City, FL 32763
Hanger Prosthetics & Orthotics, Inc.
819 East 1st. Street, Sanford, FL 32771 *
* FHCP members residing in Seminole 124 Underwood Street, Orlando, FL 32806 *
County can obtain all prosthetic/orthotic
1100 South Orlando Ave., Winter Park, FL 32789 *
services and devices at these locations
866 / 293-9406
Fax: 866 / 641-0006
386 / 274-4907
Fax: 376 / 238-5620
386 / 774-5678
Fax: 386 / 774-4644
407 / 321-2053
Fax: 407 / 321-2102
407 / 422-8200
Fax: 407 / 422-5941
407 / 740-8774
Fax: 407 / 740-7930
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 /
238-3253) or courier, to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and notify you of their
decision. If approved, FHCP will schedule the member’s appointment and also confirm the appointment with the patient.
The form needed for the above services is available at fhcp.com – For Providers under Related Documents
18
10/01/16
DIABETIC SHOE PROVIDERS
Atlantic Foot & Ankle Associates
All ages
790 Dunlawton Avenue, Suite C, Port Orange, FL 32127
963 Town Center Dr., Ste. 200, Orange City, FL 32763
1404 S. Ridgewood Ave., Edgewater, FL 32132
Dale’s Shoes
2595 West International Speedway Blvd., Daytona Beach, FL 32114
Hanger Prosthetics & Orthotics, Inc
1400 Mason Ave., Suite C, Daytona Beach, FL 32117
2730 Enterprise Rd., Orange City, FL 32763
JSC Pedorthics, Inc.
All ages
819 East 1st. Street, Sanford, FL 32771
407 / 321-2053
Fax: 407 / 321-2102
100 S. State Street, Suite D, Bunnell, FL 32110
386 / 437-0272
Fax: 386 / 437-0256
Additional Diabetic Shoe Provider information on the following page.
19
10/01/16
386 / 788-6333
Fax: 386 / 788-3993
386 / 274-3336
Fax: 386 / 274-3660
386 / 775-2281
Fax: 386 / 775-2482
386 / 586-7373
Fax: 386 / 586-7346
386 / 957-4818
Fax: 386 / 788-3993
386 / 252-2138
Fax: 386 / 252-0928
386 / 274-4907
Fax: 376 / 274-1229
386 / 774-5678
Fax: 386 / 774-4644
DIABETIC SHOE PROVIDERS (continued)
Vienna Medical #010291
985 Harley Strickland Blvd., Suite 100, Orange City, FL 32763
386 / 774-2440 or
1-800-489-8165
Fax: 386 / 774-2441
INSTRUCTIONS: Diabetic shoes, inserts and/or modifications to the shoes are covered if the following criteria are met:
1. The patient has diabetes mellitus (ICD-10-CM diagnosis codes Type 1 E10.10 – E10.9 and Type 2 E11.00 – E11.9); and
2. The patient has one or more of the following conditions:
a) Previous amputation of the other foot, or part of either foot, or
b) History of previous foot ulceration of either foot, or
c) History of pre-ulcerative calluses of either foot, or
d) Peripheral neuropathy with evidence of callus formation of either foot, or
e) Foot deformity of either foot, or
f) Poor circulation in either foot
FHCP will follow Medicare guidelines for this service. In one year, the patient is eligible for 1 pair of off the shelf diabetic shoes and 3 pairs of
custom molded inserts or 1 pair of custom molded shoes with 2 pairs of replacement insoles. Custom molded shoes are only available through
Hanger Prosthetics and JSC Pedorthics, Inc.
To request this service please place your order on a prescription pad and include applicable covered criteria as listed above. Please indicate if both
shoes and inserts are needed. The patient should then be directed to bring the prescription to the provider of their choice. Discounts will be offered
for patients not meeting above criteria.
20
10/01/16
CARDIAC CATHETERIZATION
407 / 321-4500
Florida Hospital - DeLand #00YG80
Florida Hospital - Fish Memorial #00YG34
386 / 943-4710
Fax: 386 / 943-4759
386 / 917-5796
Fax: 386 / 917-5512
386 / 586-4372
Fax: 386 / 586-4618
386 / 676-6105
Fax: 386 / 676-6498
Florida Hospital Memorial Medical Center 301 Memorial Medical Pkwy., Daytona Beach, FL 32117
#00Y004
Out-patient Cardiac Cath. Lab
Out-patient Cardiac Cath. Lab
386 / 424-5091
Fax:: 386 / 424-6364
386 / 254-4338
Fax: 386 / 258-4803
INSTRUCTIONS: The Cardiologist should schedule the procedure with the hospital, make arrangements for pre-op as needed and notify the
member. The requesting Cardiologist should then complete the FHCP Surgical & Special Procedure Form. Fax the form to the FHCP’s Central
Referrals at the Holly Hill facility 386 / 238-3253. The Referral Department will review the request. The Cardiologist will be notified only if the
procedure is not approved.
21
10/01/16
CARDIAC MONITORING
iRhythm Technologies, Inc. #050404
650 Townsend St., Ste. 380, San Francisco, CA 94103
224 / 543-2200
Fax: 1/ 888 / 693-2402
iRhythm Technologies, Inc. provide a long term continuous ambulatory cardiac monitoring device (Zio Patch) to FHCP members to record and store
elect electrocardiogram (ECG) data. Prior authorization from the FHCP Central Referral Department is not required. Participating providers can contact
the company directly at the above telephone number.
The medical device shall be affixed to the FHCP member at the Participating Provider’s office and the member shall wear the device for up to fourteen
(14) days as medically necessary. Interpretation and reporting of the ECG data captured by the supplier’s medical device will be the responsibility of the
ordering Participating Provider.
22
10/01/16
CARDIAC REHABILITATION
1401 West Volusia Seminole Blvd., Sanford, FL 32771
Florida Hospital – New Smyrna
#00Y010
407 / 321-4500
386 / 424-5091
Fax: 386 / 424-5079
386 / 943-4716
Fax: 386 / 943-4776
386 / 851-5125
Fax: 386 / 917-5167
386 / 586-4480
Fax: 386 / 586-4644
386 / 676-6000
#00Y004
Fax: 386 / 231-3691
201 N. Clyde Morris Blvd., 3rd. Floor, Daytona Beach, FL 386 / 254-4338
32114
Fax: 386 / 258-4803
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / 2383253) or courier, to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and notify you of their
decision. If approved, FHCP will schedule the member’s appointment and also confirm the appointment with the patient
Indicate what phase of the program is being requested.
The form needed for the above services is available at fhcp.com – For Providers, under Related Documents
23
10/01/16
CARDIOLOGY
Stephen Minor, M.D. #10P180
David Williams, M.D. #000706
FHCP Center
386 / 238-3289
Fax: 386 / 238-3296
FHCP Center
315 Palm Coast Pkwy., N.E., Ste. 4, Palm Coast, FL 32137
MEDICAL RECORDS FAX – 386 / 481-5009
Jacob K. Agamasu, M.D. #138215
Ratan Ahuja, M.D. #000397
1355 S. International Parkway, Suite 1481, Lake Mary, FL 32746
Central Florida Cardiovascular Consultants
759 Harley Strickland Blvd., Orange City, FL 32763
Robert Bianco, M.D. #005086
Janak Bhavsar, M.D. #10X469
Chad Broome-Webster, M.D. #005530
Marielle Lazard, M.D. #10A228
Oscar D. West, M.D. #002073
Roy Venzon, M.D. #048999
Janak Bhavsar, M.D. #10X469
Chad Broome-Webster, M.D. #005530
Marielle Lazard, M.D. #10A228
Oscar D. West, M.D. #002073
Roy Venzon, M.D. #048999
Consultative Cardiology
14 Office Park Drive, Ste. 1, Palm Coast, FL 32137
Daytona Heart Group
Daytona Heart Group
938 Saxon Blvd., Suite 101-C, Orange City, FL 32763
Additional Cardiology information on the following page.
24
10/01/16
407 / 804-9616
Fax: 407 / 804-8331
386 / 456-0300
Fax: 386 / 456-0303
407 / 268-3660
Fax: Same as Orange City
386 / 446-2305
Fax: 386 / 446-1043
386 / 734-3654
Fax: 386 / 943-8087
386 / 774-5485
Fax: 386 / 775-0761
CARDIOLOGY (continued)
Mubeen Chida, M.D. #004826
Gary D. Hecht, M.D. #004008
Rajendra Hippalgoankar, M.D. #004674
Robert Rosemond, M.D. #004655
Cardiovascular Specialists, P.A.
305 Mangoustine Ave., Suite 200, Sanford, FL 32771
Cardiology Associates of West Volusia, P.A.
1000 W. New York Avenue, DeLand, FL 32720
Central Florida Heart Associates, PA
932 Saxon Blvd., Suite A, Orange City, FL 32763
1403 Medical Plaza Drive, Suite 106, Sanford, FL 32771
James Kim, M.D. #053447
Ravi Rao, M.D. #10E081
Yogesh Shah, M.D. #010450
Wing Yi Liu, M.D. #038604
Eric Lo, M.D. #002786
Huijan, Wang M.D. 10H333
Heart Care Centers of Florida
600 Palmetto St., New Smyrna Beach, FL 32168
501 Live Oak Street, Suite A, New Smyrna Beach, FL 32168
Complete Cardiology Care
161 N. Causeway, Suite C, New Smyrna Beach, FL 32169
Additional Cardiology information on the following page.
25
10/01/16
407 / 321-1415
Fax: 407 / 321-1597
386 / 736-3110
Fax: 386 / 738-1683
386 / 774-2100
Fax: 386 / 774-0326
407 / 330-9900
Fax: 386 / 774-0326
386 / 774-2100
Fax: 386 / 774-0326
386 / 424-3870
Fax: 386 / 424-3871
386 / 426-2060
Fax: 386 / 426-6533
386 / 424-8440
Fax: 386 / 426-8839
CARDIOLOGY (continued)
Dinesh Arab, M.D. #011602
Cardiology Physicians Memorial, LLC
305 Memorial Medical Pkwy., Suite 301, Daytona Beach, FL 32117
David Henderson, M.D. #000901
Barton Sickinger, D.O. #054636
John L. Walker, M.D. #003452
Beth Bartholomew, M.D. # 011244
Pedro Cox-Alomar, M.D. #057905
Alan Goldsmith, M.D. # 006461
Joshua Horenstein, M.D. #10L042
Kim Klancke, M.D. #003820
Vincent Peterson, D.O. #058364
Glenn Rayos, M.D. #002655
Hancy Seide, M.D. #010393
Vance Wilson, M.D. #005336
Surya Rao, M.D. #10E082
Humayun Jamidar, M.D. 000027
Otakar Quadrat, M.D. #10I198
COOKMAN COLLEGE PROVIDERS
Daytona Heart Group
386 / 671-0691
Fax: 386 / 671-0694
386 / 671-0691
Fax: 386 / 671-0694
386 / 615-1521
Fax: 386 / 673-2787
BETHUNE- 386 / 677-5351
Fax: 386 / 615-1521
386 / 258-8722
Fax: 386 / 258-8659
780 Dunlawton Ave., Unit 101, Port Orange, FL 32127
386 / 265-5926
Fax: 386 / 265-5928
HECN PROVIDERS
386 / 265-5926
Fax: 386 / 265-5928
Cardiology Physicians Memorial, LLC
386 / 255-5331
Fax: 386 / 254-8945
HECN, DAYTONA STATE COLLEGE & BETHUNE-COOKMAN
COLLEGE PROVIDERS
PLEASE SEND RECENT EKG AND LABS.
26
10/01/16
CARDIOLOGY - PEDIATRIC
CASE MANAGEMENT COORDINATION OF CARE DEPARTMENT
Florida Health Care Plans Case Management Coordination of Care Program is designed to address the needs of all members helping to navigate the
health care system. The program is voluntary and the member has the right to decline or discontinue participation. Members are engaged
telephonically and face-to-face.
Criteria for consideration may include members with acute or chronic diseases i.e., asthma, coronary artery disease (CAD), congestive heart failure
(CHF), stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), diabetes, depression, transplants, or major trauma.
Members may need coordination of care to assistance with issues involving home safety, life planning, end of life issues, self-management of health
conditions, educational and community resources.
Members are identified as potential candidates for coordination of care by using the following data sources:
1. On a monthly basis, the FHCP Clinical Measurement Analysis and Reporting department (CMAR) develops reports for review by CM
Coordination of Care Department:
• Claims data - three or more emergency department visits in a three month period of time
• Pharmacy data - 16 or greater medications (in a month)
• Data supplied by practitioners - identification of members experiencing late effects of stroke via electronic health record (EHR)
• Laboratory data - i.e. elevated HgbA1c or LDL-Cholesterol.
2. Case management staff reviews other data sources to identify potential candidates for case
management:
• Hospital discharge data - length of stay greater than 14 days
• Data collected through the UM process - all hospital readmissions
• Data supplied by member or caregiver - based on Health Risk Assessment (HRA) quality of life responses (QOL)
Additional Case Management Coordination of Care information on the following page
27
10/01/16
CASE MANAGEMENT COORDINATION OF CARE DEPARTMENT (continued)
Please submit The CM Coordination of Care Referral form as located in the Provider Handbook or at www.fhcp.com, to the CM Coordination of Care
Department:
• Telephone Contact: (386) 238-3284, Toll Free (800)321-1227
• Fax: (386) 238-3271
• Website: www.fhcp.com
• Email: [email protected]
• Internal: E.H.R. Task
Referrals to Community Resource Coordinators
Referrals to Community Resource Coordinators (CRC) may be initiated when a member is experiencing psychosocial barriers that impacts health or healthcare
delivery that is social or financial in nature.
The Community Resource Coordinators will complete individualized assessments and connect members with appropriate existing resources offered within their
communities.
Services provided by Community Resource Coordinators do not replace discharge planning provided to members in the hospital, skilled nursing facilities, or any
services already being provided to members receiving home health care. A referral to the Community Resource Coordinators is not a substitute for urgent
evaluation or intervention by their healthcare providers.
Please submit The Community Resource Coordination Referral form as located in the Provider Handbook, to the CM Coordination of Care Department:
• Telephone Contact: (386) 238-3284, Toll Free (800)321-1227
• Fax: (386) 238-3271
• Website: www.fhcp.com
• Email: [email protected]
• Internal: E.H.R. Task.
28
10/01/16
CASE MANAGEMENT UTILIZATION REVIEW DEPARTMENT
The FHCP Case Management Utilization Review Department is a multi-faceted case management program designed to monitor, evaluate, assist
physicians, members, providers in the care of FHCP members that are in an acute hospital, Skilled Nursing Home, Home Health Care or Long term
acute care facility.
Office Coordinator – Screens incoming calls and coordinates departmental needs
Admissions Coordinator – Manages authorizations for members admitted to hospitals
Data Coordinator – Assists both office and admission coordinators, maintains forms, correspondence and manage reporting data as well as
authorization management for SNF and HHC
Case Management Nurses – RN’s that review inpatient clinical information for appropriateness of admission and coordinates care upon discharge
to ensure that member’s needs are met, both locally and out of area. These functions involve physicians, facility Case Mangers/Discharge planners,
FHCP administration, FHCP Case Management team and other providers as needed.
HHC Coordinator – RN that reviews and monitors related clinical information as pertinent to Skilled HHC needs with providers as well as
contacting members to assist with potential continued care needs. Assist Triage RN as needed.
Skilled Nursing Facility (SNF) Coordinator – RN’s that coordinate’s care and completes on site reviews during a members confinement to a SNF.
They work closely with the SNF physicians, facility nursing, therapy, discharge planning staff.
Discharge Coordinators - RN’s and clerical staff that contact members post discharge from acute hospital for evaluation. This call includes
discharge needs in place, appointments in place, medication reconciliation; members are also screened for placement into the short term complex care
or referred to the Complex Care Program.
To access the FHCP Case Management Department, please call 386 - 676-7187 or fax 386 - 615-4058
29
10/01/16
CHIROPRACTIC
Rebecca Bruno, D.C. #011736
Susan Cox, D.C. #047857
Linda Lombardo, D.C. #102242
All ages
John P. Gingras, D.C. # 008694
Chris Tatalovich, D.C. #10S342
Natalie Tran, D.C. #10P967
James Jeremy Hether, D.C. 011914
All ages
Elizabeth Jurenko, D.C. #049963
J. Randall Timko, D.C. #00WG79
All ages
Carol Learned, D.C. #10N499
Roger Learned, D.C. #10Q034
Tiffany N. Moulterie, D.C. #040259
Koteuaisa Wilson, D.C. #10V698
Maria Romano-Young, D.C. #048814
All ages
Lombardo Chiropractic Clinic, PA
1400 Hand Ave., Suite S, Ormond Beach, FL 32174
Gingras Chiropractic
3113 S. Ridgewood Ave., South Daytona, FL 32119
2719 S. Woodland Blvd., DeLand, FL 32720
Complete Wellness Medical Center
844 N. Stone St., Suite 202, DeLand, FL 32720
Ormond’s Family Chiropractic Center
147 E. Granada Blvd., Ormond Beach, FL 32176
Adkore Rehabilitation Center
1670 Providence Blvd., Deltona, FL 32725
1081 WP Ball Blvd., Sanford, FL 32771
386 / 673-0400
Fax: 386 / 673-1825
386 / 767-6602
Fax: Same as phone
386 / 734-0702
Fax: 386 / 734-6924
386 / 734-2592
Fax: 386 / 734-1773
386 / 265-5968
Fax: 386 / 265-5970
386 / 218-5979
Fax: 386 / 218-5980
407 / 328-7595
Fax: 407 / 328-7372
Matt Nirschl, D.C. #011439
53 N. Old Kings Rd., Ste. C, Ormond Beach, FL 32174
386 / 672-6565
Fax : 386 / 672-6550
A. Michael Petker, D.C. #005553
220 Mason Ave., Holly Hill, FL 32117
386 / 258-7474
Fax: 386 / 248-1466
Additional Chiropractic information on the following page.
30
10/01/16
CHIROPRACTIC (continued)
Robert Poss, D.C. #005528
Poss Clinic of Chiropractic
819 Beresford Road, DeLand, FL 32720
Amanda Prokop, D.C. #10E187
1205 N. Dixie Freeway, New Smyrna Beach, FL 32168
Patrick Reed, D.C. #010969
All ages
Alicia Rivera, D.C. #10S129
All ages
Patrick Reed, D.C., P.A.
4601 East Highway 100, Suite G4, Bunnell, FL 32110
Rivera Family Chiropractic Center
3950 US HWY 17-92, Ste. 1000, Casselberry, FL 32707
821 DeBary Ave., Deltona, FL 32725
Omar Rivera, D.C. #10S997
All ages
Michael J. Rodriguez, D.C. #003980
Gregory Walsh, D.C. #10T369
Trudi Vogel, D.C. #000123
All ages
Jennifer Smith, D.C. #10F257
All ages
Timothy Steflik, D.C. #10V838
All ages
Rivera Family Chiropractic Center
900 W. 25th. St., Sanford, FL 32771
Ormond Medical Center
545 W. Granada Blvd., Ormond Beach, FL 32174
Vogel Chiropractic Clinic
1780 S. Nova Road, Suite 4, South Daytona, FL 32119
Health & Wellness Chiropractic Center
1051 Town Center Dr., Orange City, FL 32763
Coastal Integrative Healthcare, Inc.
Additional Chiropractic information on the following page.
31
10/01/16
386 / 738-0643
Fax: Same as phone
386 / 423-5259
Fax: 386 / 423-0929
386 / 437-9990
Fax: Same as phone
407 / 767-4878
Fax: 407 / 767-4881
386 / 860-5448
Fax: 386 / 668-3665
407 / 878-5848
Fax: 407 / 878-5850
386 / 672-6243
Fax: 386 / 677-7463
386 / 788-4778
Fax: 386 / 788-8110
386 / 775-3600
Fax: 386 / 775-3602
386 / 427-8403
Fax: 386 / 427-8410
CHIROPRACTIC (continued)
Donald B. Walsh, D.C. #10K176
All ages
Synergy Chiropractic and Wellness Solutions, LLC
130 Wallace Rd., New Smyrna Beach, FL 32168
386 / 423-2415
Fax: 423-2417
INSTRUCTIONS: Member can self-refer to this specialty and will be able to call and schedule an appointment without an order from a physician.
32
10/01/16
COLONOSCOPY / SCREENING
Beatrice Bratu, M.D. #005470
Ammar Hemaidan, M.D. #000104
Issam R. Nasr, M.D. #10S757
Saud El-Sayed Suleiman, M.D. #001166
Hassan Zulfiqar, M.D. #009959
Advanced GI
1690 Dunlawton Ave., Suite 210, Port Orange, FL 32127
386 / 763-4920
Fax: 386 / 481-5429
239 N. Ridgewood Avenue, Ste. 3, Edgewater, FL 32132
315 Palm Coast Pkwy., Palm Coast, Fl 32137
1240 E. Normandy Blvd., Ste. 100, Deltona, FL 323725
All appointment scheduling will be through the Port Orange office
Raul J. Badillo, M.D. #049415
Christina Covelli, M.D. #038577
Vishal Gupta, M.D. #143207
Kalyani Gaddipati, M.D. #003542
Gastroenterology of Greater Orlando, P.A.
2728 Enterprise Road, Ste. 100, Orange City, FL 32763
1319 S. International Pkwy., Ste. 1171, Lake Mary, FL 32746
917 Rinehart Road, Suite 2051, Lake Mary, FL 32746
Mid-Florida Gastroenterology Group, P.A.
1565 Saxon Blvd., Suite 102, Deltona, FL 32725
Lenkala Mallaiah, M.D. #005629
311 N. Mangoustine Ave., Sanford, FL 32771
Additional Colonoscopy information on the following page
33
10/01/16
MEDICAL RECORDS
FAX – 386 / 481-5009
386 / 668-2221
Fax: 386 / 668-2228
Phone & Fax the same as
above
407 / 936-2444
Fax: 407 / 936-2448
386 / 789-5400
Fax: 386 / 532-0889
407 / 321-4570
Fax: 407 / 321-7690
COLONOSCOPY / SCREENING (continued)
Felix A. Navarrro, Jr., M.D. #001881
Bharat C. Patel, M.D. #00451
Martin Gino F. Prado, M.D. #007629
Maria Soriano Co, M.D. #043830
Gastroenterology & Liver Consultants, P.A.
1403 Medical Plaza Dr., Suite 206, Sanford, FL 32771
Digestive Health Specialists
1070 N. Stone Street, Suite D, DeLand, FL 32720
407 / 322-9530
Fax: 407 / 322-9534
386 / 822-9410
Fax: 386 / 822-9112
FHCP members have to either reside in or be assigned to a PCP in
West Volusia County to be referred to this group.
34
10/01/16
CT SCANS
Advanced Imaging (N)
1639 North Volusia Ave., Orange City, FL 32763
#00Y010 (H)
New Smyrna Imaging #135587 (N)
CT’s & MRI’s – Breast MRI’s not available
405 East 3rd. Avenue, New Smyrna Beach, FL 32169
EXCEPTIONS NOTED ON THE FOLLOWING PAGE
Additional CT Scan information on the following page.
35
10/01/16
386 / 774-7226
Fax: 386 / 774-7227
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 851-5000
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 860-9336
Fax: 386 / 860-2225
386 / 426-1900
Fax: 386 / 426-5939
386 / 446-5200
Fax: 386 / 446-1866
CT SCANS (continued)
386 / 322-1616
Fax: 386 / 322-5330
386 / 446-5200
Fax: 386 / 446-1866
386 / 274-5454
Fax: 386 / 274-5440
See specific instructions in other sections for: Ultrasounds, X-Rays, Mammograms, Event Monitors, Holtor Monitors, EMG’s, EKG’s, ABG’s, PFT’s
and Echocardiograms.
The exceptions to the above are:
•
Breast MRI’s
•
Sestamibi Scan (Endocrinologists and Cardiologists can order with no prior authorization)
•
Stereotactic Breast Biopsy
•
Ultrasound Guided Needle Breast Biopsy
•
CT Colonography (Virtual Colonoscopy)
•
Pill Cam
•
Genetic Testing
•
Hida Scans
•
PET SCAN (PCP’s ordering PET SCANS must have prior authorization)
•
Knee MRI’s (PCP’s ordering Knee MRI’s must have prior authorization)
INSTRUCTIONS FOR EXCEPTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and
forward by fax (386 / 238-3253) or courier, to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request
and notify you of their decision. If approved, FHCP will schedule the member’s appointment and also confirm the appointment with the patient.
36
10/01/16
DENTAL SERVICES
Nicholas Tanturri, D.D.S. #037411
Vamsi Kallepalli, D.M.D. #00003N
All Ages
Terry Blanks, D.D.S. #002047
All ages
James R. Davis, D.D.S. #000846
Jack Goldey, D.D.S. #000406
Martin Honerlaw, D.D.S. #000850
All ages
Mark Johnson, D.D.S. #008481
Benjamin Lacy, D.D.S. #002046
Jeremiah Mahoney, D.M.D. #136859
Ryan Smith, D.M.D. #10AJ85
All ages
FHCP Center
FHCP Center
2777 Enterprise Road, Orange City, FL 32763
Florida Dental Associates, Inc.
895 South Dexter Avenue, DeLand, FL 32720
Commercial Members Only
1111 S. Dixie Freeway, New Smyrna Beach, FL 32168
3943 South Nova Road, Port Orange, FL 32127
Florida Dental Associates
215 S. Third Street, Flagler Beach, FL 32136
Florida Dental Associates
30 Office Park Drive, Palm Coast, FL 32137
Additional Dental information on the following page.
37
10/01/16
386 / 238-3280
Fax: 386 / 238-3279
386 / 481-6886
Fax: 386 / 774-6638
386 / 738-2002
Fax: 386 / 738-9523
386 / 424-1631
Fax: 386 / 424-1314
386 / 761-9440
Fax: 386 / 788-6992
386 / 439-9688
Fax: 386 / 439-1915
386 / 446-3883
Fax: 386 / 445-9318
DENTAL SERVICES (continued)
INSTRUCTIONS: Members can schedule appointments with Florida Dental Associates and/or FHCP’s Dental Department after being assigned to a
dentist through Member Services Department in the Holly Hill facility at 386 / 615-4022. FHCP coverage of dental examinations, cleaning and x-ray
services are in accordance with the member’s FHCP benefits. Dental services are available to our members on a discounted fee-for-service basis
through FHCP Dental Providers.
Urgent (not later than 72 hours) / accidental dental injury services - Call FHCP’s Dental Department in the Daytona Beach Facility at 386 /
238-3280 and describe the presenting problem. They will advise you if FHCP covers the problem and who you should call within FHCP’s
Provider Network to arrange for treatment of the member.
TMJ services - Please send the Completed FHCP Referral form along with the completed FHCP TMJ Screening Questionnaire via courier directly
to FHCP’s Dental Dept. in either the Daytona Beach or Orange City Facility for review and scheduling.
Oral Sleep Apnea Appliances - Please complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward
by fax (386 / 238-3253) or courier, to FHCP’s Central Referrals at the Holly Hill facility. The Central Referral Department will review the request
Patient must have a Sleep Apnea evaluation with Sleep Studies prior to submitting your request.
38
10/01/16
DERMATOLOGY
James Bernard, D.O.
William Bethea, D.O.
David Boyd, M.D.
Steven Glanz, M.D.
Matt Leavitt, M.D.
Stephen McAskill, M.D.
Herbert E. Mendelsohn, M.D.
Panagiotis Mitropoulos, D.O.
Christine Moorhead, M.D.
Scott Podnos, M.D.
Rafael Schulze, M.D.
Kevin Spohr, D.O.
William Steffes, M.D.
James Taylor, M.D.
Martin Youngman, D.O.
All ages
Jesleen Ahluwalia, M.D.
Enid F. Burnett, M.D.
Rodolfo Chirinos, M.D.
Thomas Graham, M.D.
Michael Gutierrez, M.D.
Oscar Saffold, M.D.
Leavitt Medical Associates of Fla., Inc.
106 Boston Ave., Suite 105, Altamonte Springs, FL 32701
818 North Woodland Blvd., DeLand, FL 32720
2893 Enterprise Rd., Ste. 100, Debary, FL 32713
725 W. Granada Blvd., Suite 44, Ormond Beach, FL 32174
1720 Dunlawton Ave., Port Orange, FL 32127
3 Pine Cone Drive, Suite 102, Palm Coast, FL 32137
Additional listings available in the Provider Referral Guide –
Seminole County
SCHEDULING NUMBER 888 / 540-9660
Mid Florida Dermatology Associates, PA
386 / 428-2223
Fax: 386 / 428-6222
4106 W. Lake Mary Blvd., Suite 324, Lake Mary, FL 32746
407 / 444-0123
Fax: 407 / 444-0131
Additional Dermatology information on the following page.
39
10/01/16
407 / 834-9091
Fax: 407 / 834-6157
386 / 738-0322
Fax: 386 / 738-0628
386 / 738-8000
Fax: 386 / 738-0929
386 / 789-8600
Fax: 386 / 789-0219
386 / 898-0547
Fax: 386 / 898-0551
386 / 322-8310
Fax: 386 / 322-8370
386 / 864-6005
Fax: 386 / 864-6110
DERMATOLOGY (continued)
Ronald Sherman, D.O.
Patients infants and older
Gina Mollis Sevigny, M.D.
Reena Sachdev, M.D.
All Ages
HECN, STATE OF FLORIDA,
DAYTONA STATE COLLEGE &
PROVIDERS
Acclaimed Dermatology
106 North Old Kings Road, Suite D, Ormond Beach, FL 32174
Skin Emergencies – Seen same day
Ormond Beach Dermatology
305 Clyde Morris Blvd., Suite 150, Ormond Beach, FL 32174
386 / 673-5969
Fax: 386 / 615-9952
386 / 615-1771
Fax: 386 / 615-1545
INSTRUCTIONS: Member can self refer to this specialty and will be able to call and schedule an appointment without an order from a physician.
DIABETES EDUCATION
Melissa Baumann MS, RD, CDE
Kathyann Carmona, R.N.
Cara Karner, MS, RD, LD, CDE
Catherine Robinson, MS, RD, LD, CDE
Pat Weiss, RN, CDE
Adults only
FHCP Center
330 N. Clyde Morris Blvd., Daytona Beach, FL 32114 - Main Office
386 / 676-7133 or
1 / 877 / 229-4518
Classes available at various locations or on an individual basis Fax: 386 / 238-3228
depending on the need.
INSTRUCTIONS: Send Task through EHR or complete the one page sheet titled, FHCP Referral for Diabetes or Nutritional Counseling (Form #
17-105/1/09RX 06-606-04/Rev. 10-10-11). Follow the instructions on the bottom of the form. Always document ICD-10 Code for service
requested.
Services provided include:
10 Hour Diabetes Self-Management Class
Pre-Diabetes
Gestational Diabetes
1:1 Individual classes for patients with special circumstances
40
10/01/16
DIAGNOSTIC TESTING
#00Y010 (H)
CT’s & MRI’s – Breast MRI’s not available
Open MRI of Daytona #000297 (N)
201 Bill France Blvd., Daytona Beach, FL 32114
Additional Diagnostic Testing information on the following page.
41
10/01/16
386 / 774-7226
Fax: 386 / 774-7227
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 860-9336
Fax: 386 / 860-2225
386 / 426-1900
Fax: 386 / 426-5939
386 / 254-6800
Fax: 386 / 254-6995
386 / 446-5200
Fax: 386 / 446-1866
386 / 322-1616
Fax: 386 / 322-5330
386 / 446-5200
Fax: 386 / 446-1866
386 / 274-5454
Fax: 386 / 274-5440
DIAGNOSTIC TESTING (continued)
•
Breast MRI’s
•
•
•
•
•
Pill Cam
•
Genetic Testing
•
Hida Scans
•
•
42
10/01/16
DIALYSIS SERVICES
Dialysis Care Center of Daytona
Medicare members only
Dialysis Care Center of Palm Coast
Medicare members only
DVA Renal Healthcare, Inc.
(Davita)
515 Palm Coast Parkway, SW, Palm Coast, FL 32137
578 Health Blvd., Daytona Beach, FL 32114
1801 South Nova Road, Suite 306, South Daytona, FL 32119
350 East New York Avenue, DeLand, FL 32720
110 S. Orange St., New Smyrna Beach, FL 32168
2575 S. Volusia Ave., Ste. 400, Orange City, FL 32763
495 S. Nova Road, # 109, Ormond Beach, FL 32174
13 Kingswood Drive, Palm Coast, FL 32137
1701 W. 1ST St., Sanford, FL 32771
2235 South Babcock St., Melbourne, FL 32901
39 Skyline Drive, Suite 1001, Lake Mary, FL 32746
1200 Deltona Blvd., Ste. 26, Deltona, FL 32725
7560 Red Bug Lake Rd., Suite 1048, Oviedo, FL 32763
New Smyrna Beach Artificial Kidney Center
821 State Road 44, New Smyrna Beach, FL 32168
386 / 947-9872
Fax : 386 / 947-9873
386 / 447-4477
Fax : 386 / 447-4476
386 / 258-7322
Fax: 386 / 258-0191
386 / 322-3625
Fax: 386 / 322-3695
386 / 738-2570
Fax: 386 / 738-9576
386 / 409-0025
Fax: 386 / 409-0410
386 / 774-0101
Fax: 386 / 774-0249
386 / 676-2405
Fax: 386 / 676-6738
386 / 445-4445
Fax: 386 / 445-3312
407 / 268-9425
Fax : 407 / 268-9899
321 / 956-6252
Fax: 321 / 956-6464
407 / 833-8667
Fax : 407 / 833-8672
386 / 574-0225
Fax: 386 / 574-6460
407 / 366-0211
Fax: 407 / 366-4269
386 / 409-8855
Fax: 386 / 409-8755
INSTRUCTIONS: The Nephrologists office should call the dialysis center directly to schedule an appointment. Pre-authorization from the Referral
Department is not needed and you do not need to complete a FHCP Referral form.
43
10/01/16
DISEASE MANAGEMENT PROGRAMS
Florida Health Care Plans
Health and Disease Management Programs
Below is a summary of programs available to FHCP, members.
Members can participate in programs by calling the number listed on the program or request in writing by completing the FHCP DM
Program Enrollment Form located at FHCP facilities and online at www.fhcp.com or by calling (386) 676-7100 ext. 7788.
Hearing impaired may call TRS Relay 711.
Members are not limited in the number of programs they can participate in.
Balance Improvement Class
This program is intended for members of any age; designed to help you manage falls and increase activity levels, balance, and
coordination. Currently being offered at various FHCP and YMCA facility locations. FHCP will cover the cost of the program for
members in the FHCP Preferred Fitness Program. A nominal fee will be charged for individuals who are not members of our Preferred
Fitness Program. Call Member Services at (386) 615-4022 for a list of class location and times or for more information.
Acute Low Back and Neck Pain
This physical therapy program addresses low back or neck pain that is acute (sudden) or chronic (due to an old problem). It is
open to all members age 17 and above; utilizing all Ability Health Services locations and Palm Coast Sports Medicine. Members can
call directly to these facilities for more information or to see if they qualify. Co-pay and policy limits apply. Call Member Services at
(386) 615-4022 to determine cost and locations.
Asthma
This is a program that provides education to assist members manage asthma and follow your doctor’s treatment. Some
members meeting certain criteria may receive a phone call from a nurse for health coaching. Additionally asthma tool kits (handouts)
are available free. You can request a tool kit by contacting your doctor’s office or by calling the disease management department at
(386) 676-7100 ext. 7788. For questions about your medicines, stop by any FHCP pharmacy to discuss with a pharmacist.
Case Management Care Coordination Program
Available to all FHCP members, this program offers telephonic management and care coordination. Members must meet
screening criteria; such as multiple health problems, medically needy, polypharmacy, or service utilization issues. This service is free
to our members. Any provider or staff may refer members to the program. Physician offices or member may call (386) 676-7187 to
request a referral form.
Additional Disease Management information on the following page.
44
10/01/16
DISEASE MANAGEMENT PROGRAMS (continued)
Chronic Obstructive Pulmonary Disease (COPD)
This is a program that provides education to members to effectively manage COPD and follow your doctor’s treatment.
Education is mailed by way of disease management newsletter and covers the basics for good self-management. Some members
meeting certain criteria may receive a phone call from a nurse for health coaching and participation in a prevention program aimed at
early intervention when symptoms are worsening. This program is free to all members. Call (386) 676-7100 ext. 7788 and request to
participate.
Controlling High Blood Pressure (Hypertension)
This program is designed in the form of a tool kit that is mailed to you and includes education handouts that increase awareness
of the risk of blood pressures that are not at the best possible levels. It includes information for taking your BP, medications, diet,
exercises, reduction of risk factors, and other self-management tools. Included is a coupon for reduced cost of a blood pressure
machine at our FHCP pharmacies. To receive this free tool kit through the mail please call (386) 676-7100 ext. 7788.
Depression Program
This program is for members age 18 and above who have recently been prescribed antidepressant medications. Education
materials discussing depression, taking prescribed medications and coping is mailed by way of disease management newsletter and
covers the basics for good self management. Some members who have a new diagnosis of depression and are having trouble taking
their medications may receive a phone call from the Mental Health physician or therapist. This program is free to all members. Call
(386) 676-7100 ext 7788 and request to participate.
Diabetes
FHCP provides educational information via email or mail through the disease management newsletter several times a year to
members with diabetes. It includes useful up to date information for you or a family member with diabetes. This newsletter is free and
will be sent automatically if you have diabetes. If you do not have diabetes but would like to receive the information anyway please call
(386) 676-7150 and request to participate.
FHCP provides a comprehensive Diabetes Education Program approved by the American Diabetes Association. Ten (10) hours
of classroom instruction is provided by Certified Diabetes Educators (Registered Nurses and Registered Dietitians). The goal of this
program is to provide the tools, skills and techniques necessary to follow treatment plans safely and accurately. Classes are offered in
various facilities. We encourage you to take these classes every two years as a refresher. Call (386) 676-7133 to request information or
register. Depending on your benefit plan fees may apply. Call Member Services at (386) 615-4022 to determine if there will be a cost.
45
10/01/16
Heart Disease
This program is for those members who have heart disease. Education is mailed by way of disease management newsletter and
covers the basics for good self-management. Some members meeting certain criteria may receive a phone call from a nurse for health
coaching and participation in a prevention program aimed at controlling elevated cholesterol levels and reduction of risk factors such as
smoking and uncontrolled blood pressure. This program is free to all members. Call (386) 676-7100 ext 7788 and request to
participate.
Heart Failure
This program is for those members who have heart failure. Education is mailed by way of disease management newsletter and
covers the basics for good self-management. Some members meeting certain criteria may receive a phone call from a nurse for health
coaching and participation in a program that provides follow up following a discharge from the emergency room for heart failure or
discharge from a hospital admission for heart failure. This program is free to all members. Call (386) 676-7100 ext 7788 and request to
participate.
Nutrition Programs
Classes are offered by a registered dietitian in the Diabetes/Health Education Department.
Pre-diabetes course-consists of two; two hour sessions. Designed to help identify risk factors for developing Diabetes, how to
reduce calorie intake to achieve weight loss, how to start a moderate activity exercise program, how to identify multiple behavioral
change strategies and provide resources for keeping weight off and health eating. Pre-registration is requested.
Healthy Heart Eating Course- consists of one 2 ½ hour class. Designed to help identify risk factors for heart disease and
lifestyle choices that reduce this risk. Pre-registration is required.
Nutrition Game Plan for Diabetes- a two (2) hour session designed for members who completed the ten hour Diabetes SelfManagement Education program to reinforce nutrition education and answer questions/concerns regarding diabetes. Pre-registration is
required.
Classes and appointments are offered in various faculties. Depending on your benefit plan fees may apply. Call (386) 676-7133 to
request information or register for class. To determine if there is a cost call Member Services at (386) 615-4022.
46
10/01/16
Osteoporosis
This is a wellness program for members at risk for or diagnosed with Osteoporosis or Osteopenia. Ability Health Services will
perform an evaluation and physical assessment to determine strength, endurance, and activity level. Members can call direct, no
referral is needed. Co-pay or co-insurance and policy limits apply. Call Member Services at (386) 615-4022 to determine cost and
available locations.
Preferred Fitness
This is a fitness program provided at no additional charge to all FHCP Medicare members and certain employer group members.
There is access to a variety of quality Health and Fitness facilities in Volusia and Flagler counties. For a current list of exercise/fitness
facilities, visit our website at www.fhcp.com or call Member Services at (386) 615-4022 for more information.
23
Weight Management
Lighter Lifestyles is a weight loss program offered to all FHCP members age 18 and above who have been FHCP members for
at least 6 months. Members must have a body mass index (BMI) of 30 or above to participate. FHCP will pay half of the program cost
(excluding supplements and medications). Call (386) 254-4031 for more information.
Eat Right, Move Right is a lifestyle change approach to weight loss. This program targets members with a BMI >27. Class
content includes how to improve exercise, eating habits, and change behavior for permanent weight loss. The focus is setting realistic
goals, behavior change, USDA plate method, exercise, changing habits, eating out, changing what’s in our pantry, etc. It is based on
the LEARN concepts for weight loss (lifestyle, exercise, attitudes, relationships, and nutrition) and scientific research. This program is
free to all Florida Health Care Plans members. Call (386) 676-7133.
For questions regarding any of the FHCP program please call (386) 615-4022 or 1-877-615-4022, Daily between the hours of 8 a.m. to
8 p.m. The hearing impaired may call TRS Relay 711.
The above programs are utilized as components of the FHCP Chronic Care Improvement Program (CCIP), and Quality Improvement
Programs (QIP).
47
10/01/16
DURABLE MEDICAL EQUIPMENT
Taffi Medical
2381 Mason Ave., Ste. 140, Daytona Beach, FL 32117
386 / 255-3785
Fax: 386 / 238-1065
Mattress Gel Overlays
Alternating Pressure Pumps and Pads
Mattress Replacement Systems
Please follow the below Referral Instructions for Mattress Gel Overlays, and Alternating Pressure Pumps, Pads and Mattresses.
Additional DME information on the following page.
48
10/01/16
DURABLE MEDICAL EQUIPMENT (continued)
FOR ALL OTHER MEDICAL EQUIPMENT NOT LISTED ABOVE
Apria Healthcare, Inc. #011216
771 Fentress Blvd., Ste. 1F, Daytona Beach, FL 32114
Wheelchairs
Walkers
Mastectomy Bras
Please send order and clinicals
Customer Care Center
1-855-613-8303
Fax: 1-855-550-2845
The patient (regardless of group type) must meet STRINGENT evidence based medical criteria guidelines for the specific equipment/supplies
requested. The requesting provider’s office should call this office directly to order covered equipment and supplies. You must then forward or fax
your supporting documentation directly to Apria Healthcare for the order to be filled.
OXYGEN ORDERS - To request oxygen for a FHCP member, please supply one of the following: an arterial blood gas study performed within 30
days of the order, if not conducted prior to a hospital discharge, an arterial oxygen saturation, 6 minute walk results, or O2 saturation on Room air
must be below 88. If the O2 order is only for night, an overnight oximetry is all that will be required. The order must indicate the liter flow and
indicate frequency (i.e. at night only, 24 hours per day).
If patient does not meet evidence based medical criteria guidelines, Apria Healthcare will refer the case to the FHCP Referral Department for review.
ALL DME REFERRALS MUST INCLUDE A PHYSICIAN SIGNATURE AND A LENGTH OF NEED.
NEBULIZERS DO NOT REQUIRE A LENGTH OF NEED.
•
Vacuum assisted closure devices
•
Bone growth stimulators
•
Neuro muscular stimulators
•
Splinting Systems
Additional DME information on the following page.
49
10/01/16
DURABLE MEDICAL EQUIPMENT (continued)
Apria Healthcare, Inc. #011216
771 Fentress Blvd., Ste. 1F, Daytona Bach, FL 32114
Power Operated Vehicles
Electric Wheelchairs
Customer Care Center
1-855-613-8303
Fax: 1-855-550-2845
The patient (regardless of group type) must meet STRINGENT evidence based medical criteria guidelines for the specific equipment/supplies
requested. The requesting provider’s office should call this office directly to order covered equipment and supplies. You must then forward or fax
your supporting documentation directly to Apria Healthcare for the order to be filled
POV’S / ELECTRIC WHEELCHAIR ORDERS - FHCP follows evidence based medical criteria guidelines for the eligibility of Power Operated
Vehicles (POV’s) and Electric Wheelchairs for all members (Medicare and Commercial). Therefore, prior to submitting a referral to Apria
Healthcare, the member must have had a Physical Therapy Evaluation specific to the need for and use of the equipment.
Ability Health Services, Palm Coast Sports Medicine & Rehabilitation Center, and Professional Physical Therapy – Edgewater provides outpatient
Physical Therapy for FHCP members. They will evaluate the patient for the appropriateness of the specified equipment. They will do an objective
assessment of the patient’s functional ability. This evaluation must be submitted to Apria along with the referral request for the POV or Electric
Wheelchair.
Outpatient Rehabilitation Instructions and Locations can be found in this directory.
If patient does not meet evidence based medical criteria guidelines, Apria Healthcare will refer the case to the FHCP Referral Department for review.
EAR LAVAGE
FHCP Center
FHCP Center - Edgewater
FHCP Center
FHCP Center
BY APPOINTMENT ONLY – Thursday, 8:30 AM – 3:30 PM
239 N. Ridgewood Avenue, Edgewater, FL 32132
BY APPOINTMENT ONLY
BY APPOINTMENT ONLY – Wednesday, 2:00 PM – 4:00 PM
309 Palm Coast Parkway, Palm Coast, FL 32137
BY APPOINTMENT ONLY
386 / 238-3200, Ext. 3297
Fax: 386 / 238-3274
386 / 427-4868
Fax: 386 / 427-6350
386 / 774-2550 Ext. 6832
Fax: 386 / 774-0788
386 / 445-7073
Fax: 386 / 447-7092
INSTRUCTIONS: The requesting provider may call the above facility for information and instructions. Patient must have a written order from the
physician.
50
10/01/16
EAR, NOSE AND THROAT (ENT)
Robert P. Collette, M.D. #003831
766 N. Sun Dr., Ste. 1060, Lake Mary, FL 32746
Perrin C. Clark, M.D. 054814
James Craven, M.D. 011985
Joseph P. Mirante, M.D. #001948
Michael Munier, M.D. #000024
Anthony Tucker, M.D. #044370
Infant and older
Coastal Ear, Nose, & Throat, P.A.
1185 Dunlawton Avenue, Suite 102, Port Orange, FL 32127
3 Pine Cone Dr., Ste. 106, Palm Coast, FL 32137
Atlantic Ear, Nose & Throat, P.A.
963 Town Center Dr., Suite 100, Orange City, FL 32763
Daniel Rothbaum, M.D. #011652
Devang Shah, M.D. #006370
All ages
1431 Orange Camp Rd., Ste. 112, DeLand, FL 32724
Videostroboscopy and Voice Therapy
Evaluations available with this provider. 1301 S. International Pkwy., Suite 2011, Lake Mary, FL 32746
Please see Outpatient Rehabilitation for
Fax Number 386 / 774-2898 to be used for all offices
guidelines.
386 / 775-4467
Fax: 386 / 775-8679
407 / 444-0573
Fax: 386 / 775-8679
386 / 677-8808
Fax: 855 / 811-9591
386 / 760-6601
Fax: 386 / 767-5567
386 / 597-5839
Fax: 386 / 597-5844
386 / 774-9880
386 / 774-9880
407 / 444-5225
Fax: 386 / 774-2898
For hearing loss, vertigo and tinnitus, an Audiogram must be done before you schedule the appointment. For sinusitis, a CT Sinus – Limited
without contrast, must be ordered prior to appointment. See Diagnostic Testing for instructions.
51
10/01/16
ECHOCARDIOGRAMS
Ultrasound Department
FHCP Center
800 / 321-1227 Ext. 3303
FHCP Center
386 / 238-3270
Fax: 386 / 238-3256
FHCP Center
239 N. Ridgewood Avenue, Edgewater, FL 32132
Bhupendra Patel, M.D. #000015 (N)
925 N. Stone Street, DeLand, FL 32720
Central Florida Regional Hospital #00Y009 1401 West Seminole Blvd., Sanford, FL 32771
(H)
Cyrus Diagnostic Imaging, Inc. #109138 (N) 165 Waymont Court, Lake Mary, FL 32746
Florida Hospital - Fish Memorial #00YG34 1055 Saxon Blvd., Orange City, FL 32763
(H)
386 / 734-6007
Fax: 386 / 734-6008
407 / 321-4500
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 860-9336
Fax: 386 / 860-2225
52
10/01/16
EEG TESTING
Halifax Health #00Y007 (H)
Central Florida Regional Hospital #00Y009 1401 West Seminole Blvd., Sanford, FL 32771
(H)
Florida Hospital - Fish Memorial #00YG34 1055 Saxon Blvd., Orange City, FL 32763
(H)
Florida Hospital – Ormond #00Y004 (H)
301 Memorial Medical Pkwy., Daytona Beach, FL 32117
Coastal Diagnostic Group, LLC #037343 927 Beville Road, Suite 106, South Daytona, FL 32119
(N)
Neurology Associates of Ormond Beach Neurology Associates of Ormond Beach
8 Mirror Lake Dr., Ormond Beach, FL 32174
(N)
870 Dunlawton Ave., Ste. 109, Port Orange, FL 32127
Brain & Spine Institute of Port Orange (N)
Brain & Spine Institute of Port Orange
386 / 238-2251
Fax: 386 / 238-2252
407 / 321-4500
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 671-5055
Fax: 386 / 677-8196
386 / 672-3340
Fax: 386 / 672-3341
386 / 673-2500
Fax: 386 / 673-3204
386 / 427-3700
Fax: 386 / 673-3204
386 / 304-0111
Fax: 386 / 304-1099
53
10/01/16
EEG TESTING – AMBULATORY
Comprehensive
#10J125 (N)
Sleep
Disorder
Center 851 Douglas Avenue, Suite 101, Altamonte Springs, FL 32714
Neurology Associates of Ormond Beach, P.A. 8 Mirror Lake Dr., Ormond Beach, FL 32174
(N)
Brain & Spine Institute of Port Orange (N)
Brain & Spine Institute of Port Orange
407 / 834-1023
Fax: 407 / 834-6515
386 / 673-2500
Fax: 386 / 673-3204
386 / 427-3700
Fax: 386 / 673-3204
386 / 304-0111
Fax: 386 / 304-1099
Services for 24-72 ambulatory EEG video monitoring shall be rendered in the Physician’s office or the Member’s place of residence.
EEG TESTING – MOBILE SERVICES
Coastal Diagnostic Group, LLC #037343
927 Beville Road, Suite 106, South Daytona, FL 32119
386 / 672-3340
Fax: 386 / 672-3341
Services shall be rendered in the Member’s place of residence and are limited to EEG recording and interpretation.
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ELECTROCARDIOGRAMS (EKG’S)
FHCP Center – Daytona Beach
Cardiology Department
FHCP Center - DeLand
FHCP Center - Edgewater
FHCP Center – Orange City
FHCP Center – Ormond Beach
FHCP Center – Palm Coast
FHCP Center – Port Orange
FHCP Center – Holly Hill
937 N. Spring Garden Ave., DeLand, FL 32720
BY APPOINTMENT ONLY
BY APPOINTMENT ONLY
BY APPOINTMENT ONLY
481 S. Nova Road, Ormond Beach, FL 32174
BY APPOINTMENT ONLY
BY APPOINTMENT ONLY
BY APPOINTMENT ONLY
1340 Ridgewood Ave., Holly Hill, FL 32117
386 / 238-3289
Fax: 386 / 238-3296
386 / 736-1948
Fax: 386 / 736-2784
386 / 427-4868
Fax: 386 / 427-6350
386 / 774-2550, Ext. 6832
Fax: 386 / 775-0176
386 / 671-4337
Fax: 386 / 671-7242
386 / 447-9685
Fax: 386 / 446-3222
386 / 763-1000
Fax : 386 / 763-0507
386 / 676-7136
Fax: 386 / 676-7181
BY APPOINTMENT ONLY
Write the order for the EKG on a prescription pad and give to the member to take with them when they have their test. Please include ICD-10
(Diagnosis Code).
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EMERGENCY FACILITIES
407 / 321-4500
Daytona Beach Facility – Pediatric
admissions available
386 / 254-4303
Fax: 386 / 254-4113
386 / 322-4700
386 / 424-5000
Fax: 386 / 424-5007
386 / 943-4522
386 / 851-5000
Florida Hospital Memorial Medical Center
#00Y004
Putnam Community Medical Center #102234
South Seminole Hospital #00Y120
555 W. State Rd. 434, Longwood, FL 32750
386 / 437-2211
Fax: 386 / 586-4627
386 / 231-3034
Fax: 386 / 676-6077
386 / 328-5711
Fax: 386 / 325-8178
321 / 842-2000
Highway 20, West, Palatka, FL 32177
Emergency Department Admissions or 23 hour Observation Cases:
Identify the member’s assigned FHCP PCP and contact that PCP to discuss the case. After 5:00 pm or on weekends or holidays, contact FHCP’s
After Hours Call office at 386 / 226-4542 or Fax 386 / 258-4858.
FHCP contracts with the above hospitals for inpatient, outpatient and twenty-four (24) hour emergency services: however, Pediatric admissions are
only available at Halifax Health – Daytona Beach.
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EMG TESTING
FHCP Center
Mulki Bhat, M.D. #00001X
Send records prior to scheduling
Office will schedule and confirm with
patient
FHCP Center
Kenneth Derbenwick, M.D. #000694
DMA-Central Florida Neurologic Consultants, P.A.
Stephanie Carinci, M.D. #10A885
Hendrik Dinkla, M.D. #004435
Patients newborn and older
Volusia Neurology, P.A.
Jeffrey Corak, M.D. #003022
Neurology Associates of Ormond Beach
Olimpio Cunha, M.D. #003779
Dalia Fulop, M.D. #133180
Mandeep Garewal, M.D. #011986
David McDonald, M.D. #002373
James A. Scott, M.D. #005198
patient
Amol K. Gupta, M.D. #10F317
Gupta Sports & Spine Center
345 Clyde Morris Blvd., Ste. 390, Ormond Beach, FL 32174
Additional EMG information on the following page.
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386 / 445-7073
Fax: 386 / 447-7092
386 / 238-3244
Fax: 386 / 238-3269
386 / 943-3190
Fax: 386 / 738-7629
386 / 774-0220
Fax: 386 / 774-0961
386 / 673-2500
Fax: 386 / 673-3204
386 / 427-3700
Fax: Same as Ormond
386 / 673-0075
Fax: 386 / 673-0049
EMG TESTING (continued)
Grimes Neurology and Concussion Center, P.A.
Jeremy Grimes, M.D. 10T549
patient
Seminole Neurology Associates, P.A.
Bhupinder Mangat, M.D. #003464
386 / 679-3270
Fax: 386 / 256-2518
407 / 324-5500
Fax: 407 / 324-5584
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ENDOCRINOLOGY
Kent J. Lyon, M.D. #046548
Patients 18 years of age and older
Gerald Miceli, M.D. #005608
Maha Ansara, M.D. #000836
patient
Christina Rho, M.D. #00007N
Patients 16 and 17 years of age evaluated
On a case by case basis.
Sheila Gupta, M.D. #00007L
Lee Metchick, M.D. #011145
Under 18 – case by case basis
FHCP Center
FHCP Center
FHCP Center
Regency Endocrinology & Diabetes
752 Stirling Center Place, Suite 1008, Lake Mary, FL 32746
Established Patients Only
Gupta Medical Specialists
Not accepting new diabetic patients
Endocrinology of Central Florida, P.A.
109 W. Knapp Ave., Edgewater, FL 32132
210 Rinehart Rd., Ste. 1000, Lake Mary, FL 32746
Additional Endocrinology information on the following page.
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386 / 238- 3200 Ext. 3434
Fax: 386 / 238-3216
386 / 445-7073
Fax: 386 / 246-3859
386 / 774-2550, Ext. 6891
Fax: 386 / 774-5140
407 / 333-1212
Fax: 407 / 333-1213
386 / 322-6111
Fax: 386 / 322-3777
386 / 673-0075
Fax: 386 / 673-0049
386 / 427-4544
Fax: 386 / 427-8688
407 / 691-3200
Fax: 386 / 427-8688
ENDOCRINOLOGY (continued)
Benigno Digon, M.D. #011038
PROVIDERS
Digon Diabetes and Endocrinology, P.A.
311 N. Clyde Morris Blvd., Suite 440, Daytona Beach, FL 32114
386 / 265-1908
Fax: 386 / 872-4910
EVENT MONITOR
FHCP Center
EKG Technician
FHCP Center
EKG Technician
FHCP Center
EKG Technician
386 / 238-3200, Ext. 3352
Fax: 386 / 238-3210
386 / 774-2550, Ext. 6832
Fax: 386 / 775-0176
386 / 447-9685
Fax: 386 / 446-3222
Additional cardiac monitors can be found under Cardiac Monitoring in this document
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EXTENDED HOUR PRIMARY CARE
FHCP After Hours Walk-in Clinic
FHCP After Hours Walk-in Clinic
Pediatric Unscheduled Care Walk-in Clinic
Anita Mathur, M.D.
FHCP Center
Monday and Wednesday 5 :00 PM to 7 :15 PM
FHCP Center
Monday thru Thursday 5 :00 PM to 7 :30 PM
Monday and Wednesday – Ages 12 years and older
Tuesday and Thursday – Ages 1 year and older
999 S. Volusia Ave., Suite B, Orange City, FL 32763
Wednesday until 6 :00 PM
Please call to verify availability prior to your visit
386 / 774-2550
386 / 445-7073
Fax: 386 / 447-7092
386 / 774-7337
Fax: 386 / 774-7445
INSTRUCTIONS: Members will be charged the appropriate co-payment as listed in the co-payment section of the FHCP Member Handbook.
Halifax Health Primary Care Clinics
HECN PROVIDER
Halifax Health Primary Care
2090 Saxon Blvd., Suite B, Deltona, FL 32725
Halifax Health Primary Care – Ormond
1688 W. Granada Blvd., Suite 2A, Ormond Beach, FL 32174
386 / 425-3300
Fax: 386 / 425-3301
386 / 425-4460
Fax: 386 / 425-4461
FOR ADDITIONAL AFTER HOURS SERVICES SEE URGENT CARE SERVICES
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PROVIDERS OR FACILITIES NOT LISTED IN FHCP DIRECTORIES
This would include all providers and hospitals that are out of the FHCP network. It also includes supplemental providers not listed in FHCP Provider
Directories.
Referrals to Providers who do not participate in FHCP’s HMO Network or certain providers and facilities that supplement FHCP’s Network require
prior authorization by FHCP. Referral to a non-participating or supplemental provider may be considered for approval under the following
circumstances:
1.
2.
3.
A particular skill or service is not available from FHCP Network Providers
A Network Provider is not available or accessible within established availability time frames
The Network Provider is not geographically accessible to the member
Please include the requested provider’s complete name and telephone number if available.
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FLIGHT PHYSICALS
FAA FLIGHT PHYSICALS
Elizabeth Le, M.D. #10G373
All FHCP members
386 / 238-3204
Fax: 238-3235
Ryan Rees, M.D. #011254
Commercial FHCP members only
386 / 258-4836
Fax: 386 / 255-0140
Charles Schildecker, M.D. #001828
All FHCP members
401 Downing St., New Smyrna Beach, FL, 32168
386 / 428-3243
Fax: 386 / 428-9929
GASTROENTEROLOGY
Beatrice Bratu, M.D. #005470
Ammar Hemaidan, M.D. #000104
Issam R. Nasr, M.D. #10S757
Saud El-Sayed Suleiman, M.D. #001166
Hassan Zulfiqar, M.D. #009959
Patients 18 years and older*
Advanced GI
239 N. Ridgewood Avenue, Ste. 3, Edgewater, FL 32132
315 Palm Coast Pkwy., Palm Coast, FL 32137
1240 E. Normandy Blvd., Ste. 100, Deltona, FL 32725
All appointment scheduling will be through the Port Orange office
Additional Gastroenterology information on the following page.
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386 / 763-4920
Fax: 386 / 481-5429
GASTROENTEROLOGY (continued)
Antonio DeCarli, M.D. #10D185
Maria Soriano Co, M.D. #043830
Bharat C. Patel, M.D. #000451
Martin Gino F. Prado, M.D. #007629
Kalyani Gaddipati, M.D. #003542
Raul J. Badillo, M.D. #049415
Christina Covelli, M.D. #038577
Vishal Gupta, M.D. #143207
Mari Rivera, M.D. #057319
Bryan Heath, M.D. #004974
Lenkala Mallaiah, M.D. #005629
AJD Medical, LLC
Digestive Health Specialists
1070 N. Stone Street, Suite D, DeLand, FL 32720
Felix A. Navarro, Jr., M.D. #001881
Gastroenterology of Greater Orlando, P.A.
2728 Enterprise Road, Ste. 100, Orange City, FL 32763
Mid-Florida Gastroenterology Group, P.A.
1565 Saxon Blvd., Suite 102, Deltona, FL 32725
Gastroenterology & Liver Consultants, P.A.
Additional Gastroenterology information on the following page.
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10/01/16
386 / 943-3270
Fax: 386 / 822-9112
FHCP members have to either reside in or be assigned to a PCP in
West Volusia County to be referred to this group.
311 Mangoustine Ave., Sanford, FL 32771
Mark Nagrani, M.D. #004740
386 / 427-0390
Fax: 386 / 427- 0394
407 / 936-2444
Fax: 407 / 936-2448
386 / 668-2221
Fax: 386 / 668-2228
Phone & Fax the same as
above
386 / 957-3891
Fax: 386 / 957-3887
386 / 789-5400
Fax: 386 / 532-0889
407 / 321-4570
Fax: 407 / 321-7690
386 / 423-5500
Fax: 386 / 409-9762
407 / 322-9530
Fax: 407/ 322-9534
GASTROENTEROLOGY (continued)
Safwan Shams, M.D. #004175
61 Memorial Medical Parkway, Suite 1-800A, Palm Coast, FL
32164
386 / 586-1810
Fax: 386 / 586-1811
Please send EKG if done within the past year.
*For patients under 16 years of age, forward a FHCP Referral form, with the attached documentation, to Central Referrals in the Holly Hill
Facility for approval and scheduling.
GENETIC TESTING
All Genetic Testing for FHCP members must have prior authorization from FHCP’s Central Referrals in Holly Hill. Please do not send a FHCP
member directly to a lab.
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / 2383253) or courier, to FHCP’s Central Referrals in the Holly Hill facility. The Referral Department will review the request and notify you of their
BRCA TESTING
Prior to submitting a referral for BRCA testing, the patient must be referred for Genetic Counseling.
The Counselor must be a healthcare professional with specialized education and training in medical genetics.
No prior authorization is required for Genetic Counseling.
The following counselors are available if needed:
Caren Wilkie, M.D.–201 N. Clyde Morris Blvd. Daytona Beach, FL- 386 / 238-3295
LabCorp Genetic Counseling - 855 / 422-2557
Once the genetic counseling report has been received, attach the report to the FHCP Referral form and follow the above instructions.
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GLUCOMETERS
BLOOD GLUCOSE METER TRAINING
FHCP’s Call Center, located at Halifax Health, has meters available ONLY for FHCP members being discharged.
Meters (both new and replacement meters) are available for all other FHCP members at their FHCP PCP office or one of the Extended Hours Care
Centers listed below. If member has an outside PCP and needs a new or replacement meter those meters are available in the EHCC clinics. All
other requests or issues should default to Health/Diabetes Education and they will assist member. Please call 386 / 676-7133 or 1 / 877-229-4518;
Fax: 386 / 238-3228.
Fee for Service clients must have a prescription and obtain their meter from wherever their insurance plan directs them. Volusia Health Network
patients should call Karen Aalbregtse at VHN, 386 / 239-2322, to obtain their meters.
A member or his/her representative may pick up a meter if they already know how to use it. Meter training must be provided for all newly
diagnosed members and American Diabetes Association (ADA) Recognized Diabetes Education Classes offered.
Meters (both new and replacement meters) are available for FHCP members at their FHCP PCP office or one of the Extended Hours Care
Centers listed below. The below EHCC locations will also be available for FHCP members who have an outside PCP and needs a new or
replacement meter.
Designated EHCC Clinics
FHCP Center
320 North Clyde Morris Blvd., Ste. D
386 / 238-3204
FHCP Center-Edgewater
239 N. Ridgewood Ave.
Edgewater, FL 32132
386 / 427-4868
FHCP Center
461 S. Nova Road
Ormond Bach, FL 32174
386 / 671-4337
FHCP Center
2777 Enterprise Road
Orange City, FL 32763
386 / 774-2550
FHCP Center
937 North Spring Garden Ave.
DeLand, FL 32720
386 / 736-1948
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GYNECOLOGY AND WELL WOMAN’S ASSESSMENTS
The following offices will need the patient’s Social Security Number.
Megan M. Bagwell, M.D. #042577
Meetesh Desai, #112690
Ted E. Robertson, M.D. #10Q518
Cecille Tapia-Santiago, M.D. #000793
All ages
Cynthia Baldwin, M.D. #011160
Marjorie Bhogal, M.D. #042174
Pamela Carbiener, M.D. #000170
Steven Cortez, M.D. #000090
Patricia C. Esquivel, M.D. #049161
Thomas Stavoy, M.D. #001860
George Besong, M.D. #011209
Jeffrey Brooks, M.D. #043476
Steven J. Brown, M.D. #000075
All ages
Laura Bell, A.R.N.P. #000112
Susan Chappuis, A.R.N.P. #037449
Shelley S. Jones, A.R.N.P. #043427
Volusia OB/GYN
Halifax OB/GYN Associates
Women’s Health Resource Center
2728 Enterprise Rd., Ste. 200, Orange City, FL 32763
Florida Hospital DeLand OB/GYN
1431 Orange Camp Road, Ste. 118 & 119, DeLand, FL 32724
Palm Coast Women’s Center
Halifax Health Care for Women
Additional Gynecology and Well Women’s information on the following page.
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386 / 252-5858
Fax: 386 / 252-4477
386 / 252-4701
Fax: 386 / 253-9410
386 / 774-0109
Fax: 386 / 774-1203
386 / 740-4054
Fax: 386 / 822-5487
386 / 437-5959
Fax: 386 / 437-5390
386 / 425-4450
Fax: 386 / 425-4451
GYNECOLOGY AND WELL WOMAN’S ASSESSMENTS (continued)
Christine DaSilva, M.D. #107457
Tedra Gilmore, M.D. #10B391
John Meyers, M.D. #006366
All ages
Paula Foust, M.D. # 011771
All ages
Ricardo J. Larrain, M.D. #001855
All ages
OB/GYN Health Center
Port Orange Gynecology
900 N. Swallowtail Dr., Ste. 102, Port Orange, FL 32129
Ricardo J. Larrain, M.D., P.A.
Heather Metchick, M.D. #011105
Patricia Modad, M.D. #10T904
Carhine Pierre-Lambert, M.D. #040777
Hussain Esmail-Rawji, M.D. #045908
Established Patients Only
Jacob Rouse, M.D. #001831
All ages
Edgewater Gynecology, P.A.
433 N. Causeway, New Smyrna Beach, FL 32169
Palm Coast OB/GYN
50 Leanni Way, Suites A3 & A4, Palm Coast, FL 32137
Obstetrics & Gynecology of Port Orange
Orange City OB/GYN
932 Saxon Blvd., Ste. B, Orange City, FL 32763
Dr. Rawji MD OB/GYN, L.L.C.
New Smyrna Beach Gynecology
603 South Orange Street, New Smyrna Beach, FL 32168
Additional Gynecology and Well Women’s information on the following page.
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10/01/16
386 / 258-0123
Fax: 386 / 258-6464
386 / 492-6929
Fax: 386 / 492-6930
386 / 673-7503
Fax: 386 / 673-7340
386 / 736-1404
Fax: 386 / 736-1423
386 / 427-4441
Fax: 386 / 427-4494
386 / 447-6831
Fax: 386 / 447-6834
386 / 767-1660
Fax: 386 / 447-6834
386 / 775-0839
Fax: 386 / 775-1029
386 / 337-3190
Fax: 386 / 279-0268
386 / 423-0333
Fax: 386 / 423-0042
GYNECOLOGY AND WELL WOMAN’S ASSESSMENTS (continued)
The Gynecology Center
Whitney Shoemaker, D.O. #043950
598 Sterthaus Dr., Ormond Beach, FL 32174
All ages
Charles Stein, M.D. #005416
All ages
Shakeela Tawwab, M.D., P.A.
Shakeela Tawwab, M.D. #005161
780 Deltona Blvd., Ste. 104, Deltona, FL 32725
Daytona Beach Women’s Center, Inc.
R. John Vagovic, M.D. #005314
All ages
John White, M.D. #005158
HECN PROVIDER
533 N. Clyde Morris Blvd., Ste. A, Daytona Beach, FL 32114
386 / 256-2565
Fax: 386 / 256-2567
386 / 586-5344
Fax: 386 / 586-5356
386 / 574-5565
Fax: 386 / 574-8567
386 / 274-1005
Fax: 386 / 274-5779
386 / 255-0901
Fax: 386 / 255-4454
WELL WOMAN ASSESSMENT: Routine Well Woman Assessments may be provided by either the GYN provider or the member’s PCP. All
female FHCP members 16 years of age and older may call directly and schedule themselves for an annual Well Woman Assessment with any of the
Providers listed above. An order for this service is not required.
GYN APPOINTMENTS: Member can self refer to this specialty and will be able to call and schedule an appointment without an order from
a physician.
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HAND THERAPY SERVICES
Daytona Beach Hand Clinic
3635 S. Clyde Morris Blvd., Ste. 300, Port Orange, FL 32129
386 / 258-8080
Fax: 386 / 258-8177
Brooks Rehab Center
Flagler County Residents Only
9 Pine Cone Trail, Suite 104B, Palm Coast, FL 32137
386 / 446-9716
Fax: 386 / 446-0046
Hand Therapy services must be ordered by a hand surgeon.
Prior authorization from the FHCP Central Referrals is not needed. The requesting provider will call or send an order to the specialist.
Appointments can be made by the physician’s office or the member can call after the order has been received by the specialty office. The specialty
office will advise you of their scheduling protocol.
HEARING / AUDIOLOGY SERVICES
Timko Hearing Care
First Coast Hearing Clinic
386 / 756-8225
Fax: 386 / 767-0742
386 / 677-2366
Fax: 386 / 671-0342
100 E. New York Ave., Ste. 103, DeLand, FL 32724
All ages
386 / 736-7192
Fax: 386 / 736-8520
50 Cypress Point Pkwy., Ste. B3, Palm Coast, FL 32164
386 / 447-7364
Fax: 386 / 447-8742
If a physician is requesting hearing testing for a FHCP member, the order can be placed on a prescription pad and given directly to the patient.
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HEARING / AUDIOLOGY SERVICES
Easter Seals Society of Volusia & Flagler
Counties #10J850
1219 Dunn Ave., Daytona Beach, FL 32114
386 / 255-4568
156 McGregor Road, Deland, FL 32720
386 / 873-3658
Fax: 738-1160
HEPATITIS C
Daniel A. Warner, M.D. #008293
Consultive Medicine
1435 Dunn Ave., Ste. 101, Daytona Beach, FL 32114
386 / 274-7651
Fax: 386 / 274-7650
FHCP is currently managing curative treatment of chronically infected HCV patients through our HCV Clinic with Dr. Daniel Warner. Commercial
and Exchange members are currently eligible for treatment with Direct Acting Antivirals (DAAs) if they have a Metavir score of F3-F4. Medicare
members are eligible for treatment regardless of Metavir score.
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / 2383253) or courier, to FHCP’s Central Referrals at the Holly Hill facility. Please include recent labs and notes as well as support documentation for
Metavir score (Either through liver biopsy or Fibrosure), as well as genotype, viral load, and treatment history.
The Referral Department will review the request and notify you of their decision.
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HIV
Daniel A. Warner, M.D. #008293
Godson Oguchi, M.D. #011100
Consultive Medicine
1435 Dunn Ave., Ste. 101, Daytona Beach, FL 32114
Santa Rosa De Lima Medical, P.A.
955 Town Center Drive, Suite 100, Orange City, FL 32763
665 Peachwood Dr., DeLand, FL 32720
386 / 274-7651
Fax: 386 / 274-7650
386 / 228-0661
Fax: 386 / 228-0662
386 / 822-4191
Fax: 386 / 822-4192
HOLTER MONITOR
FHCP Center
EKG Technician
FHCP Center
EKG Technician
386 / 238-3200, Ext. 3352
Fax: 386 / 238-3210
386 / 774-2550, Ext. 6832
Fax: 386 / 775-0176
Additional cardiac monitors can be found under Cardiac Monitoring in this document
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HOME HEALTH CARE
Doctors’ Choice Home Health #011810
Doctors’ Choice Home Health
1801 South Nova Road, Suite 110, South Daytona, FL 32119
For FHCP members residing in Volusia and
Flagler Counties
Conficare Home Health Solutions, LLC
Conficare Home Health Solutions, LLC
1425 State Road 434, Suite 101, Longwood, FL 32750
For FHCP members residing in Seminole
County
Interim Healthcare of Greater Orlando
Interim Healthcare of Greater Orlando
1890 State Road 436, Suite 355, Winter Park, FL 32792
For FHCP members residing in Seminole
County
386 / 872-4700
Fax: 386 / 304-5393
407 / 834-0020
Fax: 407 / 834-0080
407 / 740-5284
Fax: 407 / 539-1463
INSTRUCTIONS: The requesting provider may call the home health agency directly and make arrangements for necessary home health services.
When HHC obtains referral they call FHCP Case Management Dept. for authorization – 386 / 676-7187
HOME INFUSION PHARMACIES
Holly Hill Pharmacy
1702 Ridgewood Ave., Holly Hill, FL 32117
386 / 677-7377
INSTRUCTIONS: All Home Infusion Services must have PRIOR AUTHORIZATION from FHCP.
Contact FHCP Case Management Department at 386 / 676-7187. Toll Free Number 1 / 866 / 676-7187
After Hours and Holidays – Call the FHCP Call Center at 386 / 226-4542
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HOSPICE
Halifax Health - Hospice
Florida Hospital Hospice Care
Care Center Locations
386 / 425-8950
1625 Veterans Memorial Pkwy., Orange City, FL 32763
386 / 851-7600
235 Booth Road, Ormond Beach, FL 32174
386 / 425-7900
3800 Woodbriar Trail, Port Orange, FL 32129
386 / 322-4752
Office Locations
3800 Woodbriar Trail, Port Orange, FL 32129
386 / 322-4701
386 / 425-7900
1250 South S.R. 15-A, Ste. 5, DeLand, FL 32720
386 / 822-4848
110 Flagler Plaza Drive, Palm Coast, FL 32137
386 / 446-0300
770 West Granada Blvd., Suite 304, Ormond Beach, FL 32174
386 / 671-2138
Fax: 386 / 672-0314
The above listings are to be used for FHCP commercial members. Commercial members require prior authorization. Contact FHCP Case
Management Utilization Review Department at 386 / 676-7187 or 800 / 352-9824, Ext. 7187
The FHCP Medicare members can be referred to any Medicare certified hospice of their choice.
Office locations can be called for information and evaluations.
INSTRUCTIONS FOR MEDICARE PATIENTS:
request a hospice evaluation.
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The requesting provider, member or other concerned party may call hospice directly and
HOSPITAL ADMISSIONS
407 / 321-4500
386 / 254-4303
Fax: 386 / 254-4113
386 / 322-4700
386 / 424-5000
Fax: 386 / 424-5007
386 / 943-4522
386 / 851-5000
#00Y004
South Seminole Hospital #00Y120
555 W. State Rd. 434, Longwood, FL 32750
386 / 437-2211
Fax: 386 / 586-4627
386 / 231-3034
Fax: 386 / 676-6077
386 / 328-5711
Fax: 386 / 325-8178
321 / 842-2000
INSTRUCTIONS: Direct Admissions:
Providers with admitting privileges should contact FHCP’s Admission Coordinator at 386 / 676-7187, Monday – Friday, 8am – 5pm for preadmission evaluations/verification on direct admissions from the provider’s office. After 5:00 pm, on weekends or holidays, please call FHCP’s
If admitting physician does not have admission privileges at facility, the requesting physician needs to contact FHCP contracted hospitalist
group assigned to that facility for coverage.
Emergency Department Admissions or 23 hour Observation Cases:
Identify the member’s assigned FHCP PCP and contact that PCP to discuss the case. After 5:00 pm or on weekends or holidays, contact FHCP’s
FHCP contracts with the above hospitals for inpatient, outpatient and twenty-four (24) hour emergency services: however, Pediatric admissions are
only available at Halifax Health – Daytona Beach.
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LTACH ADMISSIONS – LONG TERM ACUTE CARE HOSPITALS
Kindred Hospital Melbourne #045272
All ages
765 W. Nasa Blvd., Melbourne, FL 32901
321 / 733-5725
Fax: 321 / 733-5799
Kindred Hospital North Florida #00YP41
All ages
Kindred Hospital Ocala #00Y729
All ages
Select Specialty Hospital – Daytona Beach
#049209
18 years and older
Select Specialty Hospital – North Campus
#135829
18 years and older
Select Specialty Hospital – South Campus
#135829
18 years and older
801 Oak Ave., Green Cove Springs, FL 32043
1500 SW 1st. Ave., Ocala, FL 34474
904 / 284-9230
Fax: 904 / 284-6612
352 / 369-0513
301 Memorial Medical Pkwy., 11th. Floor, Daytona Beach, FL
32117
386 / 231-3436
Fax: 386 / 231-5210
2250 Bedford Rd., Orlando, FL 32803
407 / 303-7869
5579 S. Orange Ave., Edgewood, FL 32809
407 / 241-4800
INSTRUCTIONS: All admissions for long term acute care hospitals must have PRIOR AUTHORIZATION from FHCP.
Contact FHCP Case Management Department at 386 / 676-7187. Toll Free Number 1 / 866 / 676-7187
After Hours and Holidays – Call the FHCP Call Center at 386 / 226-4542
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HOSPITALIST
FHCP Hospitalist Program
Richard L. Braithwaite, M.D.–Program Director
Susan P. Mathew, M.D., Ph.D.
Edward Schwartz, D.O.
FHCP Physicians – Hospitalist Services
Mario Cucchiarella, M.D.
Wesley Driggers, M.D.
Carmen Serrano-Lopez, M.D.
Donald White, M.D.
Halifax Pediatric Hospitalists
Lindsey Johnson, M.D.
Muhammad Yousuf Hassan, M.D.
FHCP Physicians – Hospitalist Services
George L. Ehringer, M.D.
Erika Faile, M.D.
Jason Harmon, M.D.
Susan P. Mathew, M.D., Ph.D.
Alfonza McCollum, M.D.
FHCP Hospitalist Program
Staci Appleton, M.D.
Elizabeth Eads, D.O.
Christopher Mai, M.D.
Thomas W. Ownby, Jr., M.D.
Charles Schildecker, M.D
Jeffrey True, M.D.
Halifax Health
Halifax Health
Halifax Health
386 / 226-4542
Fax: 386 / 258-4858
386 / 226-4542
Fax: 386 / 258-4858
386 / 226-4542
Fax: 386 / 258-4858
386 / 226-4542
Fax: 386 / 258-4858
386 / 226-4542
Fax: 386 / 258-4858
Physicians provide medical care to FHCP members and to non-FHCP patients of FHCP PCP’s who choose not to perform inpatient services.
INSTRUCTIONS: If admitting physician does not have admitting privileges at a facility, please contact the appropriate hospitalist group to
facilitate coverage for the patient.
Additional Hospitalist information on the following page.
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HOSPITALIST (continued)
Inpatient Consultants of Florida, Inc. (IPC)
Florida Hospital-Deland
701 W. Plymouth Ave., Deland, FL 32720
386 / 304-3888
Florida Hospital Fish Memorial
Greater Orlando Hospitalists, P.A.
Central Florida Regional
1401 W. Seminole Blvd., Sanford, FL 32771
Florida Hospital – Altamonte
601 East Altamonte Drive, Altamonte Springs, FL 32701
407 / 303-2200
Physicians provide medical care to FHCP members and to non-FHCP patients of FHCP PCP’s who choose not to perform inpatient services.
INSTRUCTIONS: If admitting physician does not have admitting privileges at a facility, please contact the appropriate hospitalist group to
facilitate coverage for the patient.
HYPERBARIC OXYGEN THERAPY (HBO)
Guidelines listed under Wound Care
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INFECTIOUS DISEASES
Levonne Mitchell-Samon, M.D. #10AK97
Outpatient services only
Reba K. Isaac, M.D. #011046
Ukonu Ejie, M.D. #133136
Godson Oguchi, M.D. #011100
FHCP Center
386 / 238-3293
Fax: 386 / 238-3223
Infectious Diseases of Mid-Florida, P.A.
104 La Costa Lane, Suite 120, Daytona Beach, FL 32114
Santa Rosa De Lima Medical, P.A.
955 Town Center Drive, Suite 100, Orange City, FL 32763
386 / 410-4981
Fax: 386 / 410-4982
386 / 274-1966
Fax: 386 / 274-1964
386 / 228-0661
Fax: 386 / 228-0662
386 / 822-4191
Fax: 386 / 822-4192
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INFECTIOUS DISEASES - PEDIATRICS
INFUSION CLINICS
FHCP Center – Daytona Beach
386 / 238-3297
Fax: 386 / 238-3274
FHCP Center – Orange City
386 / 774-2550, Ext. 6832
Fax: 386 / 774-5667
FHCP Center – Palm Coast
386 / 445-7073
Fax: 386 / 445-7464
INSTRUCTIONS: The requesting provider may call the above facility for information and instructions. Patient must have a written order from the
physician.
SCHEDULING BY APPOINTMENT ONLY
The Infusion Therapy Physician Order form needed for the above services is available at www.fhcp.com–Providers, under Forms
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INFUSION SERVICES (WEST VOLUSIA & SEMINOLE COUNTY)
Infusion services for the FHCP members of West Volusia and Seminole County will be available at Mid-Florida Hematology & Oncology.
Please follow the listed instructions for infusion services for FHCP members:
●
Some infusion medications require Prior Authorization. Please refer to the list of Prior Authorization medications located on the
FHCP website at http://www.fhcp.com/providers/forms/Prior-Authorization-Medication.pdf. Please follow the specific instructions for the
medication and use the form indicated. The FHCP Central Referral Department will review your request and forward on for administration or notify
you if request is denied.
●
If the medication does not require prior authorization, the order must be sent to Mid-Florida Hematology. Please send the completed
form to:
Mid-Florida Hematology & Oncology
Contact Person – Kristy
Phone: 386 / 774 -1223
Fax: 386 / 774 – 1314
●
For Infusion services starting on a weekend, the ordering provider must contact a FHCP contracted Home Health agency to start the
process. A listing of the contracted Home Health agencies are located in the Provider Referral Guides for Volusia/Flagler and Seminole Counties.
The guidelines are located on the FHCP website at http://www.fhcp.com/providers/services/referral-guidance.
All orders must have Patient Demographics and a recent History & Physical along with the required Physician Order.
The Infusion Therapy Physician Order form needed for the above services is available at www.fhcp.com–Providers, under Forms
INFUSION SERVICES (INFUSION PUMPS FOR CHEMOTHERAPY)
InfuSystem, Inc.
Walter Schytte-Representative
407 / 488-3491
InfuSystem will supply ambulatory infusion pumps and supplies related to chemotherapy/oncology patients.
Prior authorization from the FHCP Central Referrals is not needed. The Oncology office should contact the local representative, Walter Schytte at
407 / 488-3491 to order the supplies for the FHCP member.
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INJECTION CLINIC
FHCP Center
FHCP Center
Mon – Fri, 8:30 AM – 1:00 PM, 2:00 PM – 3:00 PM.
Routine injections will be scheduled Wed., 1:00 PM – 4:00 PM
FHCP Center
INSTRUCTIONS: The requesting provider may call the above facility for information and instructions.
SCHEDULING BY APPOINTMENT ONLY
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386 / 238-3297
Fax: 386 / 238-3274
386 / 774-2550
Ext. 6832 or Ext. 6833
Fax: 386 / 774-5667
386 / 445-7073
Fax: 386 / 447-7092
INSULIN PUMPS
It is the policy of Florida Health Care Plans to follow Centers for Medicare and Medicaid and Milliman Care Guidelines for approval of an Insulin
Pump for Florida health Care Plans members.
PROCEDURE
All orders for the Insulin Pump will be processed through the Central Referrals Department. Attach the following documentation and laboratory
values to the Referral.
Criteria A:
• Diagnosis of Diabetes Mellitus Type 1 that is obvious or that is documented by a fasting C-peptide level that is less than or equal to 110
percent of the lower limit of normal of the laboratory’s measurement method, or positive GAD or insulin auto-antibodies; or
• Diagnosis of Diabetes Mellitus Type 2 manifested by wide fluctuations in blood sugars, or severe insulin resistance with inadequate glycemic
control (i.e. HgbA1C > 7.0% despite multiple insulin injections with > 50 units per day + or – oral agents); and
• Completion of a comprehensive Diabetes Education Program (10 hour ADA Recognized Self Management Class or equivalent) within the
past three years, to include carbohydrate counting by RD CDE. Once Diabetes Education and Carbohydrate counting has been completed,
the appropriate educator will notify physician of completion via email or dictation within 72 hours of completion; and
• Documentation of an average of four (4) per day self glucose testing during the two (2) months prior to ordering pump; and
• Appointment with RN Diabetes Educator for evaluation and introduction to Pump
• Documentation of frequent adjustments of insulin dose for three (3) months prior to order.
And meets one or more of the following:
•
•
•
•
•
•
Glycosylated hemoglobin level (HbA1c) >7.0 percent.
History of recurring hypoglycemia and/or hypoglycemic unawareness.
Wide fluctuation in blood glucose before mealtime.
Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl.
History of severe glycemic excursions.
Pregnancy.
Additional Insulin Pump information on the following page.
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INSULIN PUMPS (continued)
Criteria B:
•
•
The patient with Diabetes has been on a pump prior to enrollment with Florida Health
Care Plans; and
Has documented frequency of glucose self-testing an average of at least four (4) times
per day during the month prior to enrollment;
And the patient has been evaluated by an Endocrinologist who recommends continuation of the insulin pump within the last 3 months.
Member should be seen and evaluated by the treating Endocrinologist* at least every three (3) months.
*Insulin pumps may be ordered and managed only by a treating Florida Health Care Plans Endocrinologist or contracted Pediatric
Endocrinologist.
All pediatric insulin pump patients under the age of 18 must be treated and managed by a Pediatric Endocrinologist.
INSTRUCTIONS: Complete the FHCP Referral Form or Task in EHR. Attach pertinent documentation to substantiate the request and forward by
fax (386 / 238-3253), mail, or courier, to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and
notify you of their decision.
The form needed for the above services is available at – For Providers, under Related Documents
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INTERPRETER SERVICES
1.
Deaf and Hard of Hearing Services – Sign Language
Provider Relations Coordinator
FHCP Center
386 / 615-4001
Fax: 386 / 676-7167
INSTRUCTIONS: Deaf and Hard of Hearing Interpreter services are available to all FHCP members. The requesting provider must call the FHCP
Provider Relations Coordinator to request a Sign Language Interpreter at least 24 hours prior to the member’s visit to their office.
2.
Deaf and Hard of Hearing Services – Telecommunication Relay Services
FHCP uses the national Telecommunication Relay Services (TRS) System. TRS is a telephone service that allows persons with hearing or speech
disabilities to place and receive telephone calls. Please call TRS RELAY directly at 711.
3.
Language Interpreters – Language Line
FHCP contracts with Language Line to assist FHCP staff and providers to better communicate with members whose primary language is other than
English.
Language Line Instructions for FHCP Contracted Providers:
Contact FHCP at 1-800-352-9824 or 1-386-238-3200 for your 6-digit Client ID Number. This will be needed for your
call. You must call and request the FHCP 6-digit Client ID Number. This will insure FHCP is financially responsible
for the service. You will then be able to proceed with the call.
All FHCP Staff Providers will have the 6-deigit Client ID Number made available to them in their offices.
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INTERPRETER SERVICES (continued)
INSTRUCTIONS:
Call comes in requesting a specific Language or patient is in the office
1. Use Conference Hold to place the limited English speaker on hold or have the patient present
2. Dial: 866 – 874 – 3972
3. Enter on your telephone keypad or provide the call Agent:
• 6-digit Client ID ( Number obtained when calling FHCP or available at FHCP Staff offices)
• Press 1 for Spanish
• Press 2 for all other languages and speak the name of the language you need at the prompt.
An Interpreter will be connected to the call.
4. Brief the Interpreter. Give your name and phone number and advise the interpreter that in the event you are dropped off the call to
conference you back in. Summarize what you wish to accomplish and give any special instructions.
5. Add the limited-English Speaker to the line.
6. Say “End of Call” to the Interpreter when the call is completed.
To hear a recorded demonstration of over-the-phone interpretation, call the demonstration line at 1-800-996-8808 or visit the website at
www.LanguageLine.com.
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LABORATORY SERVICES – ROUTINE
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
Halifax Health-Professional Bldg.
Countryside Professional Center
Twin Lakes Medical Center
Halifax Health-Ormond Beach
Laboratory Hours: Monday-Friday 7:00 am – 5:00 pm
927 North Spring Garden Ave., Ste. 927-B, DeLand, FL 32720
Laboratory Hours: Monday - Friday 7:30 am – 3:00 pm
1340 Ridgewood Avenue, Holly Hill, FL 32117
461 South Nova Road, Ormond Beach, FL 32174
Laboratory Hours: Monday – Friday 7:00 am – 3:30 pm
Drug Screens: 8:00 am – 2:00 pm
602 W. Indian River Blvd., Suite 1&2, Edgewater, FL 32132
No Drug Screens
3510 S. Nova Road, Suite 109 & 110, Port Orange FL, 32129
No Drug Screens
Laboratory Hours: Monday-Thursday 6:30 am – 3:45 pm
Friday 6:30 am to noon
1890 LPGA Blvd., Ste. 200, Daytona Beach, FL 32117
Laboratory Hours: Mon-Fri 7:00 am to 11:30 am, and 12:30 pm
to 3:15 pm (Closed for lunch)
Monday –Friday 7:00 am to noon
HECN PROVIDERS
Additional Laboratory Services information on the following page.
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386 / 238-3285
Fax: 386 / 238-3282
386 / 736-1948
Fax: 386 / 736-2784
386 / 676-7136
Fax: 386 / 676-7181
386 / 671-4337
Fax: 386 / 481-6185
386 / 774-2550
Fax: 386 / 775-0176
386 / 447-9685
Fax: 386 / 446-3222
386 / 763-1000 Ext. 6312
Fax: 386 / 481-6386
386 / 822-9000
Fax: 386 / 740-1075
386 / 424-7346
Fax: 386 / 424-0705
386 / 788-5004
Fax: 386 / 788-1997
386 / 254-4128
Fax: 386 / 254-6833
386 / 947-4655
Fax: 386 / 947-4658
386 / 274-1830
Fax: 386 / 274-2955
386 / 615-4405
Fax: 386 / 676-1391
LABORATORY SERVICES – ROUTINE (continued)
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
393 Center Point Cir., Ste. 1457, Altamonte Springs, FL 32701 407 / 834-0804
Fax: 407 / 834-8233
Drug Screens: Monday – Friday: 7:00 am – 2:00 pm
Sat: 8:00 am – 12:00 pm No Drug Screens
1706 E. Semoran Blvd., Ste. 114, Apopka, FL 32703
407 / 814-0281
Fax: 407 / 814-0397
Lunch 12:00 pm – 1:00 pm
1239 SR 436, Walmart 101, Casselberry, FL 32707
407 / 678-0169
Fax: 407 / 678-0364
Sat.: 7:00 am to 5:00 pm Sun.: 9:00 am to 5:00 pm
Drug Screens: Monday – Friday: 7:00 am – 6:00 pm &
Sat: 7:00 am – 4:00 pm
2500 W. Lake Mary Blvd., Ste. 112, Lake Mary, FL 32746
407 / 268-4253
Fax: 407 / 268-4486
Lunch: 12:00 pm – 1:00 pm
No Drug Screens
705 W. State Rd. 434, Ste. J K, Longwood, FL 32750
407 / 331-0182
Fax: 407 / 331-4314
Drug Screens: 8:00 am - 11:00 am & 1:00 pm - 2:30 pm
1000 W. Broadway St., Ste. 204, Oviedo, FL 32765
407 / 359-2132
Fax: 407 / 359-2176
Lunch: 12:30 pm – 1:30 pm
No Drug Screens
910 Lexington Green Ln., Sanford, FL 32771
407 / 330-0300
Fax: 407 / 330-3892
Lunch 12:00 pm – 1:00 pm
No appointment necessary for the locations noted above.
Genetic Lab Testing Instructions see Genetic Testing
LABCORP DRAW STATIONS:
Appointments are not necessary but wait time will be longer without an appointment. Online appointment scheduling available at
www.LabCorp.com or by phone at 1 / 800 / 877-3818, Option 3. Appointments should be made at least one day in advance.
INSTRUCTIONS: Complete the LabCorp Request form and give to the member to take to one of the Draw Stations noted in this section.
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LABORATORY SERVICES – STAT
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
FHCP Center
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
Halifax Health-Professional Bldg.
Countryside Professional Center
Twin Lakes Medical Center
Halifax Health-Ormond Beach
1340 Ridgewood Avenue, Holly Hill, FL 32117
Drug Screens: 8:00 am – 2:30 pm
No Drug Screens
3510 S. Nova Road, Suite 109 & 110, Port Orange FL, 32129
No Drug Screens
Laboratory Hours: Monday-Thursday 6:30 am – 3:45 pm
Friday 6:30 am to noon
Laboratory Hours: Mon-Fri 7:00 am to 11:30 am, and 12:30 pm
to 3:15 pm (Closed for lunch)
Monday –Friday 7:00 am to noon
HECN PROVIDERS
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386 / 238-3285
Fax: 386 / 238-3282
386 / 736-1948
Fax: 386 / 736-2784
386 / 676-7136
Fax: 386 / 676-7181
386 / 671-4337
Fax: 386 / 481-6185
386 / 774-2550
Fax: 386 / 775-0176
386 / 447-9685
Fax: 386 / 446-3222
386 / 763-1000 Ext. 6312
Fax: 386 / 481-6386
386 / 822-9000
Fax: 386 / 740-1075
386 / 424-7335
Fax: 386 / 424-0705
386 / 788-5004
Fax: 386 / 788-1997
386 / 254-4128
Fax: 386 / 254-6833
386 / 947-4655
Fax: 386 / 947-4658
386 / 274-1830
Fax: 386 / 274-2955
386 / 615-4405
Fax: 386 / 676-1391
LABORATORY SERVICES – STAT (continued)
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
LabCorp
Draw Station
393 Center Point Cir., Ste. 1457, Altamonte Springs, FL 32701
Sat: 8:00 am – 12:00 pm No Drug Screens
1706 E. Semoran Blvd., Ste. 114, Apopka, FL 32703
Lunch 12:00 pm – 1:00 pm
1239 SR 436, Walmart 101, Casselberry, FL 32707
Sat.: 7:00 am to 5:00 pm Sun.: 9:00 am to 5:00 pm
Drug Screens: Monday – Friday: 7:00 am – 6:00 pm &
Sat: 7:00 am – 4:00 pm
2500 W. Lake Mary Blvd., Ste. 112, Lake Mary, FL 32746
Lunch: 12:00 pm – 1:00 pm
No Drug Screens
705 W. State Rd. 434, Ste. J K, Longwood, FL 32750
1000 W. Broadway St., Ste. 204, Oviedo, FL 32765
Lunch: 12:30 pm – 1:30 pm
No Drug Screens
910 Lexington Green Ln., Sanford, FL 32771
Lunch 12:00 pm – 1:00 pm
407 / 834-0804
Fax: 407 / 834-8233
407 / 814-0281
Fax: 407 / 814-0397
407 / 678-0169
Fax: 407 / 678-0364
407 / 268-4253
Fax: 407 / 268-4486
407 / 331-0182
Fax: 407 / 331-4314
407 / 359-2132
Fax: 407 / 359-2176
407 / 330-0300
Fax: 407 / 330-3892
No appointment necessary for the locations noted above.
Genetic Lab Testing Instructions see Genetic Testing
INSTRUCTIONS: Complete the LabCorp Request form and give to the member to take to one of the Draw Stations noted in this section.
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LABORATORY SERVICES – STAT (continued)
IF STAT LABS ARE NEEDED FOR A FHCP MEMBER, AND ALL DRAW STATIONS ARE CLOSED, PLEASE SEND THE PATIENT
TO THE CLOSEST CONTRACTED HOSPITAL WITH THE ORDER
407 / 321-4500
386 / 254-4303
Fax: 386 / 254-4113
386 / 322-4700
386 / 424-5000
Fax: 386 / 424-5007
386 / 943-4522
386 / 851-5000
#00Y004
386 / 437-2211
Fax: 386 / 586-4627
386 / 231-3034
Fax: 386 / 676-6077
386 / 328-5711
Fax: 386 / 325-8178
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LABORATORY SERVICES-HOME
Independent
#042041
Phlebotomy
Services,
Inc. 977 Gardenia Drive, Daytona Beach, FL 32117
386 / 677-8338
Fax: 386 / 673-5729
Independent Phlebotomy Services, Inc. will be providing home phlebotomy/laboratory draw services to FHCP members residing in Volusia, Flagler
and Seminole Counties. This service is for patients that have homebound status or documentation of a taxing physical effort to receive services at an
outpatient lab draw station.
LITHOLINK SERVICES
Litholink assists in preventing recurrent stone formation in patients.
consultation services.
They provide laboratory services, educational materials and physician
All services for Litholink will require prior authorization from the FHCP Central Referral Department in Holly Hill. The FHCP Guidelines for
Litholink services are as follows:
●
●
●
All children 18 years of age and younger will be eligible
Patients over the age of 18 must have 2 documented episodes of Nephrolithiasis in 5 years
FHCP Primary Care Physicians, Urologists and Nephrologists can request Litholink services
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / 2383253) or courier, to FHCP’s Central Referrals at the FHCP Holly Hill Facility. This must include documentation of the 2 episodes of
Nephrolithiasis in 5 years. The Referral Department will review the request and notify you of their decision.
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LACTATION SERVICES/BREASTFEEDING CLASSES
Better Breastfeeding
Florida Hospital Deland
701 West Plymouth Avenue, Deland, FL 32720
(386) 943-4560
Breastfeeding Class
Halifax Medical Center
(386) 425-4000
LYMPHEDEMA CLINIC
201 N. Clyde Morris Blvd., 3rd. Floor, Daytona Beach, FL 32114
386 / 258-4969
Fax: 386 / 947-4645
Ability Health Services-Progressive Physical
Therapy
290 Clyde Morris Blvd., Suite B2, Ormond Beach, FL 32174
386 / 898-0443
Fax: 386 / 898-0459
Ability Health Services - Palm Coast Sports
Medicine & Rehab Center, Inc. #005429
35 Old Kings Rd., North, Palm Coast, FL 32137
386 / 445-5555
Fax: 386 / 445-9800
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MAMMOGRAMS (DIAGNOSTIC OR SCREENING)
#00Y010 (H)
1555 Saxon Blvd., Ste. 401, Deltona, FL 32725
Victoria Medical Park/DeLand Women’s Center 151Victoria Commons Blvd., DeLand, FL 32724
#00YG80 (H)
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-3012
Fax: 407 / 321-9006
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 860-9336
Fax: 386 / 860-2225
386 / 446-5200
Fax: 386 / 446-1866
386 / 322-1616
Fax: 386 / 322-5330
386 / 446-5200
Fax: 386 / 446-1866
386 / 274-5454
Fax: 386 / 274-5440
386 / 943-4610
Fax: 386 / 734-4781
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MEDICATIONS (REQUIRING PRIOR AUTHORIZATIONS)
Following is a list of medications that either require prior authorization in order to be covered or are not covered under the FHCP’s prescription
drug benefit. Specific guidelines for the prior authorization medications can be found in FHCP Policy/Procedure MCG004. This policy is available
on the FHCP Website. The policy is also available on PAI (Provider Access Inquiry) in the FHCP Provider Handbook. For additional information,
please contact Carol Cooper, LPN / Provider Relations Coordinator at 386 / 615-4001.
**Biologic, Specialty, or Enzyme therapies not specifically listed must
receive approval through the FHCP Central Referral Department prior to
administration for reimbursement**.
Drug Name
Abatacept (Orencia)
Abraxane
Actemra
Adagen
Adcetris
Aldurazyme
ALGLUCOSIDASE ALFA
Aloxi
Alprostadil
Alprostadil,Caverject,Edex
Amevive
Antizol
Aralast
Aralast NP
Arixtra
Dosage
10 MG
1mg
1 MG
25 IU
1 mg
0.1 MG
10 MG
25 MCG
1.25 MCG
1.25 MCG
0.5 MG
15 MG
10 MG
10 MG
0.5 MG
J code
J0129
J9264
J3262
J2504
J9042
J1931
J0220
J2469
J0270
J0270
J0215
J1451
J0256
J0256
J1652
Short Description
Abatacept injection
Paclitaxel Protein-bound
Tocilizumab
Pegademase bovine, 25 iu
Brentuximab
Laronidase injection
Alglucosidase alfa injection
Palonosetron hcl
Alprostadil for injection
Alefacept
Fomepizole, 15 mg
Alpha 1 proteinase inhibitor
Fondaparinux sodium
Avastin
Benlysta
Botox
Bravelle
Carimune Nf
Carimune/Gammagard Polygam Classic
Caverject
Caverject Impulse
10 MG
10MG
1 UNIT
75 IU
500 MG
500 MG
1.25 MCG
1.25 MCG
J9035
Q2044
J0585
J3355
J1566
J1566
J0270
J0270
Anti-VEGF monoclonal antibody
Belimumab
Injection,onabotulinumtoxinA
Urofollitropin, 75 iu
Immune globulin, powder
95
10/01/16
Status
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Not Covered
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
(For non-ophthalmic use)
Not Covered
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Not Covered
Not Covered
Ceredase
10 UNITS
J0205
Alglucerase injection
Prior Auth Required
Cerezyme
Chorionic Gonadotropin
Cimzia
Cubicin
Cyramza
Denosomab/ Xgeva or Prolia
Edex
Elitek
EMEND FOR INJECTION
Enbrel (Etanercept)
Epoprostenol
Epoprostenol/Flolan
EUFLEXXA
Eylea
Fabrazyme
Flebogamma
Feraheme
Flolan
Fomepizole
Fomepizole/Antizol
Fusilev
GamaSTAN 10ML 532 PACK LF 13MM
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
1 UNIT
1000 UNITS
1 MG
1 MG
J1785
J0725
J0718
J0878
J3490 TEMP
J0897
J0270
J2783
J1453
J1438
J1325
J1325
J7323
J0178
J0180
J1572
Q0138
J1325
J1451
J1451
J0641
J1480
J1490
J1500
J1510
J1540
J1550
J1460
J1470
J1560
J1520
J1530
J1470
J1520
J1530
J1460
J1550
Injection imiglucerase /unit
Chorionic gonadotropin/1000u
Certolizumab pegol inj
Daptomycin injection
Ramucirumab
Denosomab
Rasburicase
Fosaprepitant injection
Etanercept injection
Epoprostenol injection
Euflexxa inj per dose
Afilbercept
Agalsidase beta injection
Flebogamma injection
Ferumoxytol
Fomepizole, 15 mg
Fomepizole, 15 mg
Levoleucovorin/Fusilev
Gamma globulin 3 CC inj
Gamma globulin > 10 CC inj
Prior Auth Required
Not Covered
Not Covered
Prior Auth Required
Prior Auth Required
Prolia Not Cov/ XGEVA PA
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
96
10/01/16
1mg
1.25 MCG
0.5 MG
1 MG
25 MG
0.5 MG
0.5 MG
PER DOSE
1mg
1 MG
500 MG
500 MG
0.5 MG
15 MG
15 MG
0.5mg
3CC
4 CC
5 CC
6 CC
9 CC
10 CC
1 CC
2 CC
10 CC
7 CC
8 CC
2 CC
7 CC
8 CC
1 CC
10 CC
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
GAMASTAN S/D
GAMMAGARD LIQUID
Gammagard S/D
Gamunex
Ganite
Humira
Ibandronate sodium
Idursulfase
Immune Globulin (Human)
Injectafer
Levulan Kerastick
Lucentis
Kadcyla
Macugen
Keytruda
Marinol
Marinol
Marinol
Muse
Myobloc
Naglazyme
Naltrexone
Novarel
97
10/01/16
10 CC
3CC
4 CC
5 CC
6 CC
9 CC
500 MG
500 MG
500 MG
1 MG
20 MG
1 MG
1 MG
4 CC
8 CC
2 CC
3CC
5 CC
6 CC
7 CC
9 CC
1 CC
10 CC
10 CC
500
354 MG
0.1 MG
1 MG
0.3 MG
2.5 MG
5 MG
5 MG
125 MCG
100 UNITS
1 MG
1 MG
1000 UNITS
J1560
J1480
J1490
J1500
J1510
J1540
J1569
J1566
J1561
J1457
J0135
J1740
J1743
J1490
J1530
J1470
J1480
J1500
J1510
J1520
J1540
J1460
J1560
J1550
J1439
J7308
J2778
J9354
J2503
J3490 TEMP
Q0167
Q0167
Q0168
J0275
J0587
J1458
J2315
J0725
Gammagard liquid injection
Gamunex injection
Gallium nitrate injection
Adalimumab injection
Ibandronate sodium injection
Idursulfase injection
Ferric carboxymaltose
Aminolevulinic acid hcl top
Ranibizumab injection
Ado-trastuzumab
Pegaptanib sodium injection
Pembrolizumab
Dronabinol 2.5mg oral
Dronabinol 2.5mg oral
Dronabinol 5mg oral
Alprostadil urethral suppos
Inj, rimabotulinumtoxinB
Galsulfase injection
Naltrexone, depot form
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Prior Auth Required
Not Covered
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Not Covered
Not Covered
Drug Name
Nplate
Nulojix
Octagam
Dosage
10 MCG
J code
J2796
J1568
Short Description
Romiplostim injection
Belatacept
Octagam injection
Status
Not Covered
Prior Auth Required
Prior Auth Required
500 MG
Octagam 5%, 1 g in 20 ml
500 MG
J1568
Octagam injection
Prior Auth Required
Octagam 5%, 2.5 g in 50 ml
Octagam 5%, 25 g in 500 ml
500 MG
500 MG
J1568
J1568
Octagam injection
Octagam injection
Prior Auth Required
Prior Auth Required
Opdivo
Orthovisc
Panglobulin Nf
Perjeta
Polygam S/D
Pregnyl
Pregnyl, Novarel, HCG
Prialt
Privigen
Prolia 1mg (denosumab)
Prolastin/Zemaira/Aralast
Prostin Vr
Provenge
Pulmozyme
Reclast
Remicade
Remodulin
Rituxan
Soliris
Sporanox
Stelara
Supartz
Synvisc
SynviscOne
TOBI
Tysarbi
Testapel
PER DOSE
500 MG
1 MG
500 MG
1000 UNITS
1000 UNITS
1 MCG
500 MG
1mg
10 MG
1.25 MCG
50 million units
1 MG
1 MG
10 MG
1 MG
100 MG
10 MG
50 MG
1mg
PER DOSE
1 MG
1 MG
300 MG
1 MG
75mg
J3490 TEMP
J7324
J1566
J9306
J1566
J0725
J0725
J2278
J1459
J0897
J0256
J0270
Q2043
J7639
J3488
J1745
J3285
J9310
J1300
J1835
J3357
J7321
J7325
J7325
J7682
J2323
S0189
Nivolumab
Orthovisc inj per dose
Pertuzumab
Ziconotide injection
Inj IVIG privigen 500 mg
Denosomab
Sipuleucel-T auto CD54+
Dornase alfa non-comp unit
Reclast Injection
Infliximab injection
Treprostinil injection
Rituximab
Eculizumab injection
Itraconazole injection
Ustekinumab
Hyalgan/supartz inj per dose
Synvisc or Synvisc-One
Synvisc or Synvisc-One
Tobramycin non-comp unit
Natalizumab injection
Testosterone Pellet
Prior auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Not Covered
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Not Covered
Prior Auth Required
FHCP infusion clinic NO PA
Prior Auth Required
Not Covered
Prior Auth Required
Not Covered
Prior Auth Required
Not Covered
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Not Covered
Not Covered
98
10/01/16
Visudyne
Vivaglobin
Vivaglobulin
Vivitrol
Xgeva(denosumab)
Xolair
Yervoy
Zaltrap
Zemaira
Zyvox
99
10/01/16
0.1 MG
100 MG
100 MG
1 MG
1mg
5 MG
1 MG
1mg
10 MG
200 MG
J3396
J1562
J1562
J2315
J0897
J2357
J9228
J9400
J0256
J2020
Verteporfin injection
Vivaglobin, inj
Vivaglobin, inj
Naltrexone, depot form
Denosomab
Omalizumab injection
Ipilimumab
Ziv-Afilbercept
Linezolid injection
Prior Auth Required
Not Covered
Not Covered
Not Covered
Prior auth
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
Prior Auth Required
MRI’S
#00Y010 (H)
CT’s & MRI’s - Breast MRI’s not available
Open MRI of Daytona #000297 (N)
201 Bill France Blvd., Daytona Beach, FL 32114
386 / 774-7226
Fax: 386 / 774-7227
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 860-9336
Fax: 386 / 860-2225
386 / 426-1900
Fax: 386 / 426-5939
386 / 254-6800
Fax: 386 / 254-6995
386 / 446-5200
Fax: 386 / 446-1866
386 / 322-1616
Fax: 386 / 322-5330
386 / 446-5200
Fax: 386 / 446-1866
Additional MRI information on the following page.
100
10/01/16
MRI’S (continued)
386 / 274-5454
Fax: 386 / 274-5440
•
Breast MRI’s
•
•
•
•
•
Pill Cam
•
Genetic Testing
•
Hida Scans
•
•
101
10/01/16
NEONATAL & PERINATAL HIGH RISK PREGNANCY & INFANT CASE MANAGEMENT
FHCP is now offering the Rosebud Program to eligible FHCP Members who meet Rosebud’s perinatal and/or neonatal case management risk
criteria. Services are available at no charge to the recipient of care; however, prior authorization is required to refer the Member to Rosebud’s
program and services. A nurse that specializes in high risk pregnancy or high risk infant care will contact the Member to discuss the pregnancy or
the infant care upon approved referral. The Rosebud Referral Form is available on our website at http://www.fhcp.com/providers/announcements in
the “Related Documents” section as well at http://www.fhcp.com/providers/forms/ Please complete this form and forward to the FHCP Central
Referral Department via fax to either of the numbers listed below for processing.
Fax (386) 238-3253 or (877) 659-3427
NEPHROLOGY
Anil Mandal, M.D. #120190
Shiram Marathe, M.D. #006368
J. Peter Singh, M.D. #001889
MEDICARE MEMBERS ONLY
Jacksonville Clinic
206 Dr. Carter Blvd. (S. Lemon), Bunnell, FL, 32110
East Coast Nephrology Associates, LLC
385 Palm Coast Parkway S.W., Ste. 2, Palm Coast, FL 32137
Rohan Desai, M.D. #011664
Harjas Moorjani, M.D. #000022
Alfredo Pegoraro, M.D. #005634
Florida Kidney and Hypertension Specialists, P.A.
2877 Wellness Avenue, Orange City, FL 32763
999 N. Stone St., Ste. B, DeLand, FL 32720
Additional Nephrology information on the following page.
102
10/01/16
386 / 445-2003
Fax: 904 / 823-1284
386 / 672-4001
Fax: 386 / 672-4006
386 / 767-8815
Fax: 386 / 672-4006
386 / 445-9205
Fax: 386 / 672-4006
386 / 668-4650
Fax: 386 / 668-4649
NEPHROLOGY (continued)
Abdul Jumani, M.D. #011821
Jaideep Hoskote, M.D. #037825
Jaideep Hoskote, M.D. #101719
Vinod Patel, M.D. #000151
Daniel V. Patel, M.D. #10M826
Sajid Latif, M.D.
Office will schedule and confirm with patient
Helder De Paiva, M.D., #041910
Christopher Mai, M.D. #010475
Vinayak V. Purandare, M.D. #000778
Prathap Simhadri, M.D. #049827
Volusia Renal Consultants
120 Cypress Edge Dr., Ste. 201, Palm Coast, FL 32164
Nephrology Consultants, P.A.
544 Health Blvd. Daytona Beach, FL 32114
Renal Care Consultants, P.L.
Helder De Paiva, M.D., LLC
21 Hospital Dr., #250, Palm Coast, FL 32164
Christopher Mai, M.D., P.A.
386 / 295-6601
Fax: 386 / 492-1174
386 / 586-4460
Fax: 386 / 586-4461
386 / 258-6522
Fax: 386 / 254-8803
386 / 322-6340
Fax: 386 / 322-6212
904 / 829-0400
Fax: 904 / 829-0411
386 / 427-3767
Fax: 386 / 423-2516
Vinayak V. Purandare, M.D., P.L.
305 Memorial Medical Pkwy., Ste. 507, Daytona Beach, FL 386 / 672-8595
32117
Fax: 386 / 677-4987
103
10/01/16
NEUROLOGY
Mulki Bhat, M.D. #00001X
Mary J. Derbenwick, M.D. #000693
Alyn Benezette, D.O. #003692
All ages
Stephanie Carinci, M.D. #10A885
Hendrik Dinkla, M.D. #004435
Patients newborn and older
Jeffrey Corak, M.D. #003022
FHCP Center
FHCP Center
Coastal Neurology
801 Beville Road, South Daytona, FL 32119
DMA-Central Florida Neurologic Consultants, P.A.
Volusia Neurology, P.A.
Additional Neurology information on the following page.
104
10/01/16
386 / 445-7073
Fax: 386 / 447-7092
386 / 238-3244
Fax: 386 / 238-3269
386 / 788-2300
Fax: 386 / 756-1697
386 / 943-3190
Fax: 386 / 738-7629
386 / 774-0220
Fax: 386 / 774-0961
NEUROLOGY (continued)
Olimpio Cunha, M.D. #003779
Dalia Fulop, M.D. #133180
Mandeep Garewal, M.D. #011986
David McDonald, M.D. #002373
James A. Scott, M.D. #005198
Elias M. Gizaw, M.D. #003223
Ramit Panara, M.D. #037613
Sampathkumar Shanmugham, M.D. #006807
Nitesh Shekhadia, M.D. #010451
Bhupinder Mangat, M.D. #003464
Jeremy Grimes, M.D. #10T549
Deepak Tikku, M.D. #011898
Neurology Associates of Ormond Beach
SCHEDULING FAX NUMBER
Florida Neurology, P.A.
755 Stirling Center Place, Lake Mary, FL 32746
Seminole Neurology Associates, P.A.
Grimes Neurology and Concussion Center, P.A.
Neurology Center of Florida
2808 Enterprise Rd., Ste. 104, Debary, FL 32713
Additional Neurology information on the following page.
105
10/01/16
386 / 673-2500
Fax: 386 / 673-3204
386 / 427-3700
Fax: Same as Ormond
386 / 676-6348
407 / 333-1718
Fax: 407 / 333-1633
407 / 324-5500
Fax: 407 / 324-5584
386 / 679-3270
Fax: 386 / 256-2518
386 / 624-6900
Fax: 386 / 624-6993
NEUROLOGY (continued)
Vicente Trapani, M.D. #038366
Maria L. Vivino, M.D. #008774
Timothy Wierzbicki, M.D. #036851
NDC of Volusia
1055 N. Dixie Freeway, Ste. 1, New Smyrna Beach, FL 32168
South East Volusia Medical Services, Inc.
501 Live Oak Street, New Smyrna Beach, FL 32168
Brain & Spine Institute of Port Orange, LLC
386 / 423-0505
Fax: 386 / 423-0515
386 / 322-6111
Fax: 386 / 322-3777
386 / 424-3860
Fax: 386 / 424-3861
386 / 304-0111
Fax: 386 / 304-1099
106
10/01/16
NUTRITIONAL ASSESSMENT AND COUNSELING
Melissa Baumann, MS, RD, CDE
All ages
FHCP Center
330 N. Clyde Morris Blvd., Daytona Bach, FL 32114 – Main Office
Classes available at various locations or on an individual basis
386 / 676-7133 or
1 / 877 / 229-4518
Fax: 386 / 238-3228
Prior authorization from the FHCP Central Referrals is not needed. The requesting provider will send a Task through EHR or complete a referral for
Diabetes Education or Nutritional Counseling (Form # 17-105/1/09RX 06-606-04/Rev. 10-10-11) to the Department. Appointments can be made by
the physician’s office or the member can call after the order has been received by the specialty office. The Department will advise you of their
scheduling protocol. Always document ICD-10 code for service requested.
Services provided include, but not limited to:
Eating Disorders; anorexia, bulemia, obesity
Hyperlipidemia
Chronic Kidney Disease
Peg Tube Feedings
Carbohydrate Counting
Diabetes Education
107
10/01/16
OBSTETRICS
Agape Birth & Wellness Center
*Complete outpatient obstetrical services,
including vaginal delivery at the Center, to
members age 15 years and older for
Volusia OB/GYN
Megan M. Bagwell, M.D. #042577
Meetesh Desai, #112690
Ted E. Robertson, M.D. #10Q518
Cecille Tapia-Santiago, M.D. #000793
All ages
Halifax OB/GYN Associates
Cynthia Baldwin, M.D. #011160
Marjorie Bhogal, M.D. #042174
Pamela Carbiener, M.D. #000170
Stephen Cortez, M.D. #000090
Thomas Stavoy, M.D. #001860
Patricia C. Esquivel, M.D. #049161
Women’s Health Resource Center
George Besong, M.D. #011209
Jeffrey Brooks, M.D. #043476
Jacinta Feldman, C.N.M. #001949
Florida Hospital DeLand OB/GYN
1431 Orange Camp Road, Ste. 118 & 119, DeLand, FL 32724
386 / 258--5400
Fax: 386 / 258-5005
386 / 252-5858
Fax: 386 / 252-4477
386 / 252-4701
Fax: 386 / 253-9410
386 / 774-0109
Fax: 386 / 774-1203
386 / 740-4054
Fax: 386 / 822-5487
INSTRUCTIONS: Member can self- refer to this specialty and will be able to call and schedule an appointment without an order from a physician.
Additional Obstetrics information on the following page.
108
10/01/16
OBSTETRICS (continued)
Christine DaSilva, M.D. #107457
Tedra Gilmore, M.D. #10B391
John Meyers, M.D. #006366
All ages
OB/GYN Health Center
Heart2Heart Birth Center, LLC
1110 Lexinton Green Ln., Sanford, FL 32771
*Complete outpatient obstetrical services,
including vaginal delivery at the Center, to
members age 16 years and older for
Palm Coast OB/GYN
Patricia Modad, M.D. #10T904
50 Leanni Way, Suites A3 & A4, Palm Coast, FL 32137
Obstetrics & Gynecology of Port Orange
Patients15 years and older
R. John Vagovic, M.D. #005314
All ages
Ricardo J. Larrain, M.D. #001855
All ages
Dr. Rawji MD OB/GYN, L.L.C.
Daytona Beach Women’s Center, Inc.
Ricardo J. Larrain, M.D., P.A.
John White, M.D. #005158
HECN PROVIDER
533 N. Clyde Morris Blvd., Ste. A, Daytona Beach, FL 32114
386 / 258-0123
Fax: 386 / 258-6464
407 / 322-9944
Fax: 407 / 878-5858
386 / 447-6831
Fax: 386 / 447-6834
386 / 767-1660
Fax: 386 / 447-6834
386 / 337-3190
Fax: 386 / 279-0268
386 / 274-1005
Fax: 386 / 274-5779
386 / 736-1404
Fax: 386 / 736-1423
386 / 673-7503
Fax: 386 / 673-7340
386 / 255-0901
Fax: 386 / 255-4454
109
10/01/16
OCULAR PROSTHETICS LAB
Ocular Prosthetics Lab, Inc.
Ocular Prosthetics Lab, Inc.
575 W. Granada Blvd., Suite H, Ormond Beach, FL 32174
Toll Free:
1 / 888 / 578-4788
Fax: 407 / 246-0222
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (877 / 6593427) to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and notify you of their decision.
Services include:
1. Evaluation for Ocular Prostheses/Artificial Eye
2. Fabrication and Fitting of Ocular Prostheses
3. Polishing/Resurfacing of Ocular Prosthesis. FHCP will not require prior authorization for the Polishing and Resurfacing as long as the
Medicare Guidelines are met. Any services above the standard number of units per year will require prior authorization.
110
10/01/16
ONCOLOGY–MEDICAL/HEMATOLOGY
Christopher Alexander, D.O. #002456
Kathleen Doughney, M.D. #003384
Paul Dodd III, M.D. #002284
Karin Bigman, M.D. #002309
Eric M. Harris, D.O. #043960
Mudussara Khan, M.D. #037471
Rene Cabeza, M.D. #002283
Seema Harichand-Herdt, M.D. #10S812
Giselle M. Mery, M.D. #044784
Santosh Nair, M.D. #011306
Gregory Ortega, M.D. #003181
Roderick Paras, M.D. #051693
Neeraj Sharma, M.D. #009958
Dipali Trivedi, M.D. #052859
Bhanu Visvalingam, M.D. #011770
Florida Cancer Specialists, P.L.
386 / 672-3933
Fax: 386 / 672-3911
224 Memorial Medical Pkwy., Ste. 300, Daytona Beach, FL 386 / 231-4060
32117
Fax: 386 / 615-9119
125 Florida Memorial Pkwy., Ste. 2200, New Smyrna Beach, FL 386 / 409-6836
32168
Fax: 386 / 409-6909
Mid-Florida Hematology & Oncology Ctr., P.A.
386 / 774-1223
Fax: 386 / 774-4658
1070 N. Stone Street, Suite C, DeLand, FL 32720
386 / 734-1013
Fax: 386 / 734-1028
2100 West 1st Street, Sanford, FL 32771
407 / 323-2250
Fax: 407 / 321-5550
Referral Fax: Fax: 386 / 774-1314
Additional Oncology information on the following page.
111
10/01/16
386 / 673-2442
Fax: 386 / 673-4884
386 / 767-6977
Fax: 386 / 767-6786
ONCOLOGY–MEDICAL/HEMATOLOGY (continued)
Medical Oncology Associates
Boon Y. Chew, M.D. #011075
Halifax Health – Daytona Beach
Ruby Anne Deveras, M.D. #011371
Walter Durkin, M.D. #003875
Gregory Favis, M.D. #003927
Halifax Health Center for Oncology - Ormond
Awais M. Khan, M.D. #052402
Zafar Latif, M.D. #10X841
Abdul Sorathia, M.D. #002958
Richard Weiss, M.D. #003903
Kelly Molpus, M.D. #011164 (Medical and Florida Hospital – New Smyrna
Gynecologic only)
Rasha N. Beg, M.D. #053816
765 Image Way, Orange City, FL 32763
Kottapurath K. Kunjumoideen, M.D. #10Q733
Victor W. Melgen, M.D. #006583
Shemin Saferali, M.D. #038068
Lynn Van Ummersen, M.D. #10J831
810 N. Spring Garden, Ave., Ste. 100, Deland, FL 32720
Philip Ndum, M.D. #118327
61 Memorial Medical Pkwy., Suite 2818, Palm Coast, FL 32164
Padmaja Sai, M.D. #011934
61 Memorial Medical Pkwy, Suite 2812, Palm Coast, FL 32164
386 / 254-4212
Office Fax: 386 / 254-4214
Referral Fax: 386 / 425-7531
386 / 425-4400
Fax: 386 / 425-4416
386 / 425-4750
Fax: 386 / 322-4751
386 / 424-5038
Fax: 386 / 424-5081
386 / 774-7411
Fax: 386 / 774-7412
407 / 804-6133
Fax: 321 / 283-4332
386 / 943-9446
Fax: 386 / 943-9385
386 / 586-2889
Fax: 386 / 586-2890
386 / 586-1860
Fax: 386 / 586-1861
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ONCOLOGY- RADIATION
Joyce Battle, M.D. #005481
Brad Factor, M.D. #011613
Ronald J. Krochak, M.D. #048160
Halifax Health
Halifax Health Center for Oncology - Ormond
Twin Lakes
1890 LPGA Blvd., Ste.70, Daytona Beach, FL 32117
Gary Graham, M.D. #011581
Thomas Scheer, M.D. #10W302
Mid-Florida Hematology & Oncology Centers
386 / 254-4210
Office Fax: 386 / 254-4383
Referral Fax: 386 / 254-4038
386 / 425-4400
Fax: 386 / 425-4416
386 / 424-5038
Fax: 386 / 424-5081
386 / 425-7310
Fax 386 / 425-7530
386 / 774-1223
Fax: 386 / 774-4658
ONCOLOGY - RADIATION THERAPY
Radiation oncology services on or after May 1, 2016 will require pre-authorization. Authorization requests should be directed to AIM Specialty
Health by telephone at (844) 423-0881 or through their secure web portal located at www.providerportal.com
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OPHTHALMOLOGY
Annemarie N. Etienne, M.D.
Todd Geis, M.D. #000091
F. Harold Kushner, M.D. #000007
Joseph Zobian, M.D. #008480
All ages
Kevin Barber, M.D. #10A214
Robert Cordero, M.D. #003829
Ryan Scruggs, M.D. #041904
Infants and older
Kevin Barber, M.D. #10A214
Eric Cohn, D.O. #002496
Mathew K. George, M.D. #038402
Douglas Lieb, M.D. #111727
Huberto Perez, M.D. #10B846
Howard Sakowitz, M.D. #002412
Daniel F. Miller, M.D. #003882
Orest Krajnyk, M.D. #053146
Robert Routh, M.D. #038022
Ages: Case by case basis
FHCP Center
FHCP Center
Palm Coast and Daytona Beach appointments to be made through
the Daytona Beach office.
Central Florida Eye Specialists
1592 S. SR 15-A, Deland, FL 32720
2715 Rebecca Lane, Orange City, FL 32763
Central Florida Eye Specialists
524 Canal Street, New Smyrna Beach, FL 32168
Sakowitz Eye Center
313 N. Mangoustine Avenue, Sanford, FL 32771
2850 Wellness Ave., Orange City, FL 32763
Volusia Eye Associates, LLC
2568 S. Ridgewood Ave., Ste. 4, Edgewater, FL 32141
Additional Ophthalmology information on the following page.
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386 / 676-7103
Fax: 386 / 676-7186
386 / 676-7103
Fax: 386 / 447-7536
386 / 734-2931
Fax: 386 / 734-2939
386 / 917-0404
Fax: 386 / 917-0584
386 / 428-6811
Fax: 386 / 734-2939
386 / 574-0700
Fax: 386 / 574-1139
386 / 574-0700
Fax: 386 / 574-1139
386 / 427-4143
Fax: 386 / 427-0711
386 / 424-1422
Fax: 386 / 424-1401
OPHTHALMOLOGY (continued)
Nishita Patel, M.D. #049665
HECN PROVIDER
Donald Cardone, M.D. #004093
HECN PROVIDER
Halifax Health Center for Ophthalmology
Halifax Health Center for Ophthalmology
311 N. Clyde Morris Blvd., Ste. 500 C, Daytona Beach, FL 32114
386 / 425-0393
Fax: 386 / 253-3484
386 / 425-0393
Fax: 386 / 239-2381
OPHTHALMOLOGY-RETINAL SERVICES ONLY
Thomas Barnard, M.D. #003338
Mathew A. Cunningham, M.D. #036832
William J. Dunn, M.D. #000489
Samuel K. Houston, M.D. #047789
Elias Mavrofrides, M.D. #011037
Raul J. Moreno, M.D. #000145
James A. Staman, M.D. #000490
Jonathan A. Staman, M.D. #037523
All ages accepted
Florida Retina Institute, Inc.
412 Tremonte Dr., Orange City, FL 32763
50 Leanni Way., Ste. E5, Palm Coast, FL 32137
1025 Primera Blvd., Lake Mary, FL 32748
386 / 258-5777
Fax: 386 / 239-8984
386 / 775-9909
Fax: 386 / 775-7344
386 / 447-1847
Fax: 386 / 447-1848
407 / 333-1570
Fax: 407 / 333-1381
Prior authorization from the FHCP Central Referrals is not needed. The requesting Ophthalmologist will send an order to the specialist.
Referrals for Retinal Services can only be made by an Ophthalmologist
Additional Ophthalmology information on the following page.
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OPHTHALMOLOGY-CORNEAL SERVICES ONLY
Tomoka Eye Associates, P.A.
Rory Myer, M.D. #040158
Patients 18 months and older
790 Dunlawton Ave., Ste. A, Port Orange, FL 32127
21 Hospital Dr., Ste. 160, Palm Coast, FL 32164
Michael Lugo, M.D. #003444
661 E. Altamonte Dr., Ste. 223, Altamonte Springs, FL 32701
386 / 767-0053
Fax: 386 / 767-3490
386 / 672-4244
Fax: 386 / 672-0603
386 / 586-3711
Fax: 386 / 586-3788
407 / 260-2255
Fax: 407 / 260-2831
564 Health Blvd., Daytona Beach, FL 32114 (Limited Hours)
Prior authorization from the FHCP Central Referrals is not needed. The requesting Ophthalmologist will send an order to the specialist.
Referrals for Corneal Services can only be made by an Ophthalmologist
OCULARIST, OCULOPLASTICS, NEURO OPHTHALMOLOGY AND ANY PROVIDER NOT LISTED IN THE
PROVIDER REFERRAL GUIDE WILL REQUIRE PRIOR AUTHORIZATION FROM THE FHCP REFERRAL
DEPARTMENT.
INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / 2383253) to FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and notify you of their decision.
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OPTOMETRY
Michael Cady, O.D.
Andreea Chih, O.D.
Nicola Gough, O.D.
Charles Heacock, O.D.
Phillip L. Stephens, O.D.
Jeffrey Ryan Timko, O.D.
Jeffery Timko, O.D.
Jeffrey Ryan Timko, O.D.
Dustin H. Ramey, O.D.
Elizabeth Ramey, O.D.
Michael Cady, O.D.
Philip Stephens, O.D.
Nicola Gough, O.D.
Kirsten Wilgers, O.D.
Florida Eye Clinic – Ormond Beach
Total Vision New Smyrna Beach
524 Canal Street, New Smyrna Beach, FL 32168
Total Vision Deland
840 N. Stone Street, Deland, FL 32720
Total Vision Debary
2836 Enterprise Road, Debary, FL 32713
Total Vision Palm Coast
15 Cypress Branch Way, Suite 206, Palm Coast, FL 32137
Total Vision Port Orange
5820 S. Williamson Blvd., Unit 106, Port Orange, FL 32128
386 / 676-1300
Fax: 386 / 672-5073
386 / 423-5190
Fax: 386 / 423-1490
386 / 734-1766
Fax: 386 / 740-7866
386 / 668-8885
Fax: 386 / 668-3301
386 / 445-1880
Fax: 386 / 445-8796
386 / 767-4449
Fax: 386 / 767-1980
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OPTOMETRY – LOW VISION
Christopher Choat, O.D. #10F236
Darshna Salh, O.D. #10Y761
Low Vision Center
Seibert Eye Clinic – Halifax Professional Center
407 / 895-4400
Fax: 407 / 264-8671
Optometry – Low Vision services can only be ordered by an Optometrist or Ophthalmologist
ORAL SLEEP APNEA APPLIANCES
John Whitsitt, D.D.S. #002016
Elsa Wittbold, D.D.S. #10Y759
Atlantic Coast Prosthodontists, Inc.
Florida Snoring and Apnea Solutions, LLC
555 W. Granada Blvd., Ste. C-2, Ormond Beach, FL 32174
386 / 239-7600
Fax: 1(866) 262-0851
386 / 675-6769
Fax: 386 / 675-6770
Patient must have a Sleep Apnea evaluation with Sleep Studies prior to submitting your request.
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ORTHOPAEDICS – SPORTS MEDICINE- NON-SURGICAL TREATMENT
Orthopaedics/Sports Medicine involves non-surgical treatment of conditions or injuries of bones, joints, ligaments, tendons and muscles. Services
can include evaluation and management, splinting, casting, therapy or injections. These providers also have additional training in sports medicine
and provide medical care to active people to prevent or treat sports related injuries.
Tyler Jay Staley, M.D. #10X029
John Shelton, M.D., Program Director
All ages
FHCP Center
Halifax Health Center for Family & Sports Medicine
386 / 238-3290
Fax: 386 / 238-3278
386 / 254-4165
Fax: 386 / 425-7545
Do not refer patients with traumatic fractures, orthopaedic
evaluations when surgery is considered, pre-ops when surgery is
needed and patients desiring an orthopaedic opinion.
Brent Fulton, M.D.
Michael Fulton, M.D.
PROVIDERS
3127 W. International Speedway Blvd., Daytona Beach, FL 386 / 258-9502
32124
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OUTPATIENT REHABILITATION
Halifax Outpatient Rehabilitation
Physical Therapy
Occupational Therapy
Speech Therapy
12 years and older
201 N. Clyde Morris Blvd., 3rd. Floor, Daytona Beach, FL 32114 386 / 254-4001
Fax: 386 / 947-4645
4701 City Center Parkway, YMCA Bldg., Port Orange, FL 386 / 304-7660
32119
Fax: 386 / 304-7662
AVAILABLE TO HECN MEMBERS ONLY
Physical Therapy
Occupational Therapy
Speech Therapy
INSTRUCTIONS: Complete the Rehabilitation Services Request form and give the order to the member. The member must call and schedule their
appointment directly with this provider and is responsible for bringing the Rehabilitation order form to the initial appointment. Please indicate if
therapy requested is a result of a motor vehicle accident.
The following page is a listing of all locations which can be printed or ordered for the convenience of your office.
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Please call to schedule your initial appointment
within one week of the date of the request.
Ability Health Services – Deltona
1565 Saxon Blvd., Suite 301
Deltona, FL 32725
Phone: (386) 851-0901
Fax: (386) 851-2426
Stetson/FH Hospital Deland
141 East Pennsylvania Ave.
Deland, FL 32724
Phone: (386) 822-5649
Fax: (386) 822-7809
Ability Health Services – South Daytona
401 Venture Blvd., Suite C
South Daytona, FL 32119
Phone: (386) 763-0084
Fax: (386) 763-0085
Ability Health Services – Altamonte Springs
801 Douglas Ave., Suite 103
Altamonte Springs, FL 32714
Phone: (407) 865-7153
Fax:
(407) 865-7159
Ability Health Services - Daytona Beach
614 N. Peninsula Drive
Phone: (386) 258-6212
Fax:
(386) 676-7572
Ability Health Services – Lake Mary
1337 S. International Pkwy., Suite 1321
Lake Mary, FL 32746
Phone: (407) 833-0802
Fax:
(407) 833-8931
Ability Health Services – Sanford
1200 Lexington Green Lane
Sanford, FL 32771
Phone: (407) 322-3442
.
Fax:
(407) 322-8404
Ability Health Services – Oviedo
7400 Red Bug Lake Road
Oviedo, FL 32765
Phone: (407) 971-2774
Fax:
(407) 971-2776
Professional Physical Therapy –
Edgewater
1316 S. Ridgewood Ave., Suite 1
Edgewater, FL 32132
Phone: (386) 423-0100
Fax:
(386) 428-8631
Progressive Physical Therapy-Ormond Beach
290 Clyde Morris Blvd., Ste. B2
Ormond Beach, FL 32174
Phone: (386) 898-0443
Fax: (386) 898-0459
Additional locations on the following page.
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Blue Water Therapy-New Smyrna Beach
916 North Dixie Freeway
Phone: (386) 426-7885
Fax:
(866) 239-9013
Palm Coast Sports Medicine and Rehabilitation Center
35 Old Kings Road
Palm Coast, FL 32137
Phone: (386) 445-5555
Fax:
(386) 445-9800
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BALANCE & VESTIBULAR THERAPY
Ability Health Services
Professional Physical Therapy – Edgewater
Palm Coast Sports Medicine and Rehabilitation
Center
INSTRUCTIONS: Complete the Rehabilitation Services Request form and give to the member. Retain the Yellow copy for your records. The
member must call and schedule their appointment directly with this provider and is responsible for bringing the Rehabilitation form to the initial
appointment. Please indicate if therapy requested is a result of a motor vehicle accident.
Please refer to the previous page for a list of locations that provide Balance & Vestibular Therapy.
BALANCE & VESTIBULAR THERAPY
James Corwin, P.T. #011262
University Rehabilitation
733 Dunlawton Ave., Suite 103 & 104, Port Orange, FL 32127
386 / 756-0077
Fax: 386 / 756-6811
Varsity Rehab & Wellness
1 N. Old Kings Road, Ormond Beach, FL 32174
All scheduling will be done through the Port Orange office
386 / 424-5000
Additional Outpatient Rehabilitation information on the following page.
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HAND THERAPY SERVICES
Daytona Beach Hand Clinic
386 / 258-8080
Fax: 386 / 258-8177
Brooks Rehab Center
Flagler County Residents Only
9 Pine Cone Trail, Suite 104B, Palm Coast, FL 32137
386 / 446-9716
Fax: 386 / 446-0046
Hand Therapy services must be ordered by a hand surgeon.
Prior authorization from the FHCP Central Referrals is not needed. The requesting provider will call or send an order to the specialist.
VIDEOSTROBOSCOPY AND VOICE THERAPY EVALUATION
All ages
●
●
●
●
●
963 Town Center Dr., Suite 100, Orange City, FL 32763
386 / 774-9880
Fax: 386 / 774-2898
Laryngoscopy with a stroboscopy
Evaluation of speech, language, voice and communication
Laryngeal function studies (i.e., aerodynamic and acoustic testing)
Patient then sent to Ability for prescribed therapy program
Further evaluation will be made depending on the need of the patient
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PAIN MEDICINE
ESTABLISHED PATIENTS MAY CONTINUE SEEING THEIR CURRENT PAIN MEDICINE PROVIDERS
NEW PATIENTS - FHCP HMO MEMBERS HAVING A PCP IN THE EAST VOLUSIA AREA ARE PRE-APPROVED TO BE
TREATED BY THIS PROVIDER
Carmen Dominguez, M.D. #00014D
Pervez Tirandaz Iranpur, M.D. #001799
FHCP Center
350 N. Clyde Morris Blvd., 2nd. Floor, Daytona Beach, FL 386 / 238-3226
32114
Fax: 386 / 238-3260
For HMO members assigned to PCP’s in the East Volusia County who are requesting to see any other Pain Medicine provider, a FHCP
Referral form must be completed. Attach pertinent documentation to substantiate the request and forward by fax (386 / 238-3253) or courier, to
FHCP’s Central Referrals at the Holly Hill facility. The Referral Department will review the request and notify you of their decision. If approved,
FHCP will schedule the member’s appointment and also confirm the appointment with the patient.
************************************************************************************************************************
PAIN MEDICINE
FHCP HMO MEMBERS ASSIGNED TO PCP’S IN THE SOUTHEAST, WEST VOLUSIA AND FLAGLER COUNTIES ARE PREAPPROVED TO BE TREATED BY THE BELOW PROVIDERS
Carmen Dominguez, M.D. #00014D
Pervez Tirandaz Iranpur, M.D. #001799
FHCP Center
350 N. Clyde Morris Blvd., 2nd. Floor, Daytona Beach, FL 386 / 238-3226
32114
Fax: 386 / 238-3260
Additional Pain Medicine information on the following page.
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PAIN MEDICINE (continued)
Rabinder S. Bhatti, D.O. #049566
Youssef Guergues, M.D. #000448
Arun G. Joseph, M.D. #042425
Rathi Joseph, D.O. #044330
Tse Lee, M.D. #101175
Vinod K. Malik, M.D. #102405
Jessica Olsen, M.D. #050188
Nader Sawiris, M.D. #044119
Kavita Sharma, D.O. #10G271
Jason Song, M.D. #050052
Pain Management & Rehabilitation Associates
1671 N. Clyde Morris Blvd., Suite 100, Daytona Beach, FL 386 / 274-2977
32117
Fax: 386 / 274-2362
386 / 760-0815
Fax: 386 / 274-4354
740 ½ W. Plymouth Ave., DeLand, FL 32720
386 / 740-1123
Fax: 386 / 274-4835
2720 Rebecca Lane, Suite 104, Orange City, FL 32763
386 / 456-1160
Fax: 386 / 274-2923
21 Hospital Dr., Ste. 170, Palm Coast, FL 32137
386 / 586-2280
Fax: 386 / 274-3682
501 S. Orange St., New Smyrna Beach, FL 32168
386 / 410-4926
Fax: 386 / 275-1767
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PATHOLOGY – OUT-PATIENT/AMBULATORY
Pathology services done as an out-patient, must be done at one of the following locations for FHCP members.
AmeriPath Florida, LLC d/b/a Bay Area
Dermatopathology
Surgical Pathology
AmeriPath Florida, LLC d/b/a/ AmeriPath
South Florida
Surgical Pathology
AmeriPath Florida, LLC d/b/a/ AmeriPath
Central Florida
Surgical Pathology
Atlantic Medical Services, LLC
GI Pathology
Central Florida Pathology Group, P.A.
Surgical Pathology
LabCorp / Dianon Systems, Inc.
Surgical Pathology
LabCorp / Dianon Systems, Inc
Surgical Pathology
Mark & Kambour M.D., P.A. #001869
f/k/a Global Pathology Laboratory
Derm Pathology
Palm Beach Pathology
Thyroid Specimens & Dermatopathology
Services
Progressive Medical Lab
Surgical Pathology
Surgical Pathology Laboratories, P.A.
Mobile Surgical Pathology
10500 University Center Dr., Tampa, FL 33612
800 / 929-6694
895 SW 30th. Ave., Ste. 101, Pompano Beach, FL 33069
866 / 450-7030
8150 Chancellor Dr., Ste. 110, Orlando, FL 32809
800 / 395-7284
386 / 481-6626
1000 Waterman Way, Tavares, FL 32778
352 / 589-4434
5610 W. LaSalle St., Tampa, FL 33607
800 / 877-5227
1 Forest Pkwy., Shelton, CT 06484
800 / 328-2666
16250 N.W. 59th. Ave., Ste. 201, Miami Lakes, FL 33014
866 / 825-4422
2013 Ponce de Leon Ave., West Palm Beach, FL 33407
800 / 659-6595
345 Beville Rd., Ste. 101, South Daytona, FL 32119
386 / 788-8000
8455 66th. St. North, Pinellas Park, FL 33781
800 / 304-1066
Additional Pathology information on the following page.
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PATHOLOGY – OUT-PATIENT/AMBULATORY (continued)
Mid-Florida Pathology, LLC
Dermatopathology, Surgical Pathology,
Frozen sections & Mobile services.
Miraca Life Sciences, Inc.
Dermatology & Gastroenterology.
120 E. North Boulevard, Leesburg, FL 34748
352 / 460-0292
6655 North MacArthur Blvd., Irving, TX 75039
(866) 588-3280
Prior authorization from the FHCP Central Referrals is not needed. The specimen of the FHCP member can be sent to one of the contracted
providers listed above.
All Pathology services done while patient is in a hospital will be covered.
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PEDIATRICS
Participating Pediatricions can be found on our website at https://providersearch.fhcp.com/.
PEDIATRIC SUB-SPECIALTIES
PEG TUBE FEEDING ASSESSMENT
Melissa Baumann, MS, RD, CDE
All ages
FHCP Center
386 / 676-7133
Fax: 386 / 238-3228
INSTRUCTIONS: Send Task through EHR or complete one page sheet titled FHCP Referral for Diabetes Education or Nutritional Counseling
(Form # 17-105/1/09RX 06-606-04/Rev. 10-10-11). Follow the instructions on the bottom of the Form. If assessment is prior to PEG tube insertion,
state scheduled date of procedure.
• Nutritional Assessment and recommendation will be sent to physician who will send an order for feeding to Apria Healthcare, Inc., Fax # 386 /
673-4403.
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PELVIC HEALTH PROGRAM
This program is designed to help with urinary incontinence and pelvic pain for both male and female FHCP members 18 years of age and older. The
program includes up to six (6) visits for pelvic floor strengthening and muscle training including biofeedback. This will be considered a “Direct
Access/Self-Referral program by FHCP. FHCP members can either be referred by their physician or call directly themselves for scheduling.
Ability – Orlando
11543 Lake Underhill Rd.
Orlando, FL 32825
407 / 380-0357-Both Females & Males
Should a member require more than six (6) visits, such additional visits will need
to be pre-authorized through the FHCP Central Referral Department
Blue Water TherapyNew Smyrna Beach
916 N. Dixie Freeway
(386) 426-7885
PERINATAL & NEONATAL HIGH RISK PREGNANCY & INFANT CASE MANAGEMENT
FHCP is now offering the Rosebud Program to eligible FHCP Members who meet Rosebud’s perinatal and/or neonatal case management risk
criteria. Services are available at no charge to the recipient of care; however, prior authorization is required to refer the Member to Rosebud’s
program and services. A nurse that specializes in high risk pregnancy or high risk infant care will contact the Member to discuss the pregnancy or
the infant care upon approved referral. The Rosebud Referral Form is available on our website at http://www.fhcp.com/providers/announcements in
the “Related Documents” section as well at http://www.fhcp.com/providers/forms/ Please complete this form and forward to the FHCP Central
Referral Department via fax to either of the numbers listed below for processing.
Fax (386) 238-3253 or (877) 659-3427
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PERINATOLOGY
Joann Acuna, M.D. #10AG04
Ramon Castillo, M.D. #002650
Gerardo Del Valle, M.D. #009720
Francisco Gaudier, M.D. #132173
Walter Morales, M.D. #039607
Edgard Ramos-Santos, M.D. #039607
Kathryn Villano, M.D. #10M260
Lama Tolaymat, M.D. #049429
Regional Obstetric Consultants, PA
303 N. Clyde Morris Blvd., Perinatal Unit-HMC,
Sunshine Perinatology Specialists, M.D., P.A.
1893 Clyde Morris Blvd., Ste. 100, Daytona Beach, FL 32117
7421 Conroy Windermere Road, Orlando, FL 32835
386 / 239-5007
Fax: 386 / 239-5010
386 / 872-7509
Fax: 386 / 256-4881
407 / 378-5970
Fax: 407 / 757-0999
Perinatology services can only be ordered by an OB provider
Prior authorization from the FHCP Central Referrals is not needed. The requesting OB provider will send an order to the specialist. Appointments
can be made by the physician’s office or the member can call after the order has been received by the specialty office. The specialty office will
advise you of their scheduling protocol.
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PERIPHERAL VASCULAR INTERVENTION
Utpal S. Desai, M.D. #009810
FHCP Center
FHCP Center
Utpal Desai, M.D. FHMMC-Healthcare Partners
305 Memorial Medical Pkwy., Ste. 307, Daytona Beach, FL
32117
386 / 238-3289
Fax: 386 / 238-3296
386 / 231-3600
Fax: 386 / 231-3602
John B. Holt, M.D. #000426
William Johnson, M.D. #000018
Requires records prior to scheduling
Atlantic Cardiovascular & Thoracic Surgeons, LLC
588 Sterthaus Ave., Ormond Beach, FL 32174
386 / 672-9503
Fax: 386 / 672-0386
Send pertinent dictation and appropriate test results (done within 90 days) and fax to the specialist’s office. The specialist’s office will review,
schedule and notify the patient of their appointment. Upon completion, the specialist’s office will notify the requesting provider of the appointment
date and time.
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PHARMACY-PREFERRED RETAIL PHARMACY
PREFERRED MEANS LOWER COST FOR MEMBERS
FHCP Pharmacy
FHCP Pharmacy
FHCP Pharmacy
FHCP Pharmacy
FHCP Pharmacy
FHCP Pharmacy
FHCP Pharmacy
FHCP Pharmacy
FHCP Mail Order Pharmacy
NOT OPEN TO PUBLIC
350 N. Clyde Morris Blvd., Daytona Beach, FL
Monday – Friday 8:30 am – 6:00 pm
939 N. Spring Garden Ave., DeLand, FL
Monday – Friday 8:30 am – 6:00 pm Sat. 9:00 am – 1:00 pm
239 N. Ridgewood Ave., Edgewater, FL
1340 Ridgewood Ave., Holly Hill, FL
2777 Enterprise Road, Orange City, FL
4932 W. State Road 46, Suite 1000, Sanford, FL 32771
P.O. Box 11696, Daytona Beach, FL 32120
Additional Pharmacy information on the following page.
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386 / 248-0832
Fax: 386 / 238-3263
386 / 736-7318
Fax: 386 / 943-8123
386 / 423-4212
Fax: 386 / 428-9713
386 / 676-7120
Fax: 386 / 676-7128
386 / 774-5961
Fax: 386 / 774-7592
386 / 446-9447
Fax: 386 / 446-6983
386 / 767-0563
Fax: 386 / 761-7095
407 / 732-7950
Fax: 407 / 732-7956
386 / 676-7126
800 / 232-0216
Fax: 386 / 676-7165
PHARMACY-STANDARD RETAIL PHARMACY
THE FOLLOWING PHARMACIES CAN FILL FHCP PRESCRIPTIONS ALL DAY – DURING BUSINESS HOURS
Walgreen Pharmacy
Walgreen Pharmacy
Walgreen Pharmacy
3010 S. Ridgewood Ave., Edgewater, FL
Sat. 9:00 am – 6:00 pm Sun. 9:00 am – 5:00 pm
7815 Highway 17-92, Fern Park
Sat. & Sun. 9:00 am – 5:00 pm
205 East Granada Blvd.., Ormond Beach, FL
Sat. 9:00 am – 6:00 pm Sun. 9:00 am – 5:00 pm
386 / 427-5208
Fax: 386 / 427-9840
407 / 331-0968
Fax: 407 / 331-7904
386 / 677-8849
Fax: 386 / 673-7661
THE FOLLOWING FHCP CONTRACT PHARMACIES CAN FILL FHCP PRESCRIPTIONS AFTER HOURS AND FOR
EMERGENCY PRESCRIPTIONS ONLY.
Walgreen Pharmacy
Walgreen Pharmacy
Walgreen Pharmacy
Walgreen Pharmacy
Walgreen Pharmacy
Walgreen Pharmacy
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1420 Beville Road, Daytona Beach, FL
Sat. 9:00 am – 6:00 pm Sun. 9:00 am – 5:00 pm
100 E. International Spdwy., DeLand, FL
Open Monday – Sunday 7:00 am – 12:00 am
897 Saxon Blvd., Orange City, FL
Open Monday – Sunday 7:00 am – 11:00 pm
790 W. Granada Ave., Ormond Beach, FL
1109 Palm Coast Pkwy., Palm Coast, FL
Open 24 hours
1650 Dunlawton Ave., Port Orange, FL
386 / 257-5773
Fax: 386 / 254-7895
386 / 738-4371
Fax: 386 / 734-0371
386 / 775-5336
Fax: 386 / 775-8956
386 / 672-7107
Fax: 386 / 673-2892
386 / 445-7041
Fax: 386 / 446-8088
386 / 322-3267
Fax: 386 / 322-9321
PHYSICAL MEDICINE AND REHABILITATION SERVICES
Physical Medicine and Rehabilitation Providers specialize in the non-operative physical medicine services specific to
musculoskeletal conditions.
Tyler Jay Staley, M.D. #10X029
FHCP Center
FHCP Center
Amol K. Gupta, M.D. #10F317
Jonathan Waldbaum, M.D. #011866
Specializes in treatment of neck and back pain
Gupta Sports & Spine Center
386 / 238-3290
Fax: 386 / 238-3278
386 / 445-7073
Fax: 386 / 447-7092
386 / 673-0075
Fax: 386 / 673-0049
Florida Orthopaedic Associates
740 West Plymouth Avenue, DeLand, FL 32720
386 / 734-9122
Fax: 386 / 736-4348
386 / 774-2500
Fax: 386 / 774-2545
1337 International Parkway South, Suite 1341, Lake Mary, FL 407 / 333-4507
Fax: 407 / 323- 4576
32746
32168
Fax: 386 / 774-9041
Additional Physical Medicine and Rehabilitation Services information on the following page.
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PHYSICAL MEDICINE AND REHABILITATION SERVICES
Carolyn Geis, M.D. #000114
Jorge Perez-Lopez, M.D. #038579
Halifax Health Brooks Rehabilitation
Physician Group
386 / 425-4641
Fax: 386 / 947-4647
PODIATRY
790 Dunlawton Avenue, Suite C, Port Orange, FL 32127
Zachery P. Barnett, D.P.M. #056978
Andrew Green, D.P.M. #005587
Hilaree B. Milliron, D.P.M. #043201
Dennis McBroom, D.P.M. #10F763
Sona Ramdath Jr., D.P.M. #10T330
James Rust, III, D.P.M. #000031
Laura M. Walton, D.P.M. #042420
Infants and older
Pamela E. Kirby, D.P.M. #006082
PROVIDERS
Eric Goldenberg, D.P.M. #048484
HECN
4606 S. Clyde Morris Blvd., Ste. 1J, Port Orange, FL 32119
Halifax Health Center for Foot & Ankle
311 N. Clyde Morris Blvd., Ste. 500 B, Daytona Beach, FL 32114
386 / 788-6333
Fax: 386 / 788-3993
386 / 274-3336
Fax: 386 / 274-3660
386 / 775-2281
Fax: 386 / 775-2482
386 / 586-7373
Fax: 386 / 586-7346
386 / 957-4818
Fax: 386 / 788-3993
386 / 788-4111
Fax: 386 / 788-4113
386 / 425-9656
Fax: 386 / 239-2381
INSTRUCTIONS: Member can call and schedule an appointment with this provider directly without any paperwork being completed.
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PRIMARY CARE
Participating Primary Care Physicians can be found on our website at https://providersearch.fhcp.com/.
PROVIDERS OR FACILITIES NOT LISTED IN FHCP DIRECTORIES
This would include all providers and hospitals that are out of the FHCP network. It also includes supplemental providers not listed in FHCP Provider
Directories.
Referrals to Providers who do not participate in FHCP’s HMO Network or certain providers and facilities that supplement FHCP’s Network require
prior authorization by FHCP. Referral to a non-participating or supplemental provider may be considered for approval under the following
circumstances:
1.
2.
3.
A particular skill or service is not available from FHCP Network Providers
A Network Provider is not available or accessible within established availability time frames
The Network Provider is not geographically accessible to the member
Please include the requested provider’s complete name, address and telephone number.
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PSYCHIATRY / BEHAVIORAL HEALTH
Prior authorization is NOT REQUIRED by the FHCP Central Referral Department for these services:
CBT- Cognitive screening/Behavioral therapy
CISM – Critical Incident Stress Management counseling/treatment
EMDR – Eye Movement Desensitization and reprocessing
PTSD – Post Traumatic Stress Syndromes counseling/treatment
Prior authorization IS REQUIRED by the FHCP Central Referral Department for these services:
NLP – Neuro-linguistic programming
Neuropsychological evaluation
Rapid Trauma Resolution
decision.
Additional Psychiatry information on the following page.
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PSYCHIATRY / BEHAVIORAL HEALTH (continued)
Willis (Bill) Blower, LCSW #055245
Sheila Cook, LCSW #00004F
Newborn and older
James T. Moore, M.D. #043530
Jared Ritter, M.D. #041010
Newborn and older
Monique L. Upton, M.D. #10W539
Mary Flynn Boener, LCSW #038717
Upon approved referral only
Shannon B. Howard, LMFT #038046
Patients 1 year and older
Julia D. Howe, LCSW #138254
Mary Kathleen (Kathy) Lichenwalter, M.S.,
LMHC, #10S109
Susan Mounteer, LMFT #007654
Lisa Dante, LMHC #10W148
FHCP Center
FHCP Center
FHCP Center
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386 / 676-7175
Fax: 386 / 676-7134
386 / 445-7073
Fax: 386 / 246-3839
386 / 774-2550
Fax: 386 / 774-5667
Rafael Parlade, Ph.D. #000456
Heather Pepe, LCSW #042370
Upon approved referral only
Linda Rodgers, LMHC #00007W
FHCP Center
FHCP Center
FHCP Center
386 / 676-7175
Fax: 386 / 676-7134
386 / 445-7073
Fax: 386 / 246-3839
386 / 774-2550
Fax: 386 / 774-5667
MUST HAVE PSYCHIATRIC HISTORY, DICTATION, RECENT LABS AND LIST OF MEDICATIONS
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Bret Althafer, LMHC #041907
Amparo Benitez-Broome, D.O. #043158
Edda Casanova, M.D. #041672
Karen Hadley, M.D. #045038
Judith Hewes, LCSW #042745
Lynval Parke, ARNP #10B824
Santosh Pillai, D.O. #057511
Katharine Usher, LMHC #042803
Hilda Vega-Vazquez, M.D. #10F568
Robert L. Barringer, LMHC #039089
Elisa Carter, LMHC #047178
Non-Medicare Members
Robert Kennerly, Ph.D #011237
Shane Porter, LMHC #010963
Timothy Shaw, Ph.D. #004693
All ages
T. Richard Saunders, Ph.D. #10Y124
Kim Carter Winokur, LMHC #055222
Saafe Behavioral Services, LLC
201 W. Plymouth Ave., Deland FL 32720
3993 West First St., Sanford, FL 32771
Counseling Center of New Smyrna Beach
265 North Causeway, New Smyrna Beach, FL 32169
386 / 873-2963
Fax: 386 / 873-2786
407 / 732-4272
Fax: 407 / 732-4579
386 / 423-9161
Fax: 386 / 423-3094
Additional Psychiatry information on the following page
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Anthony Capozzi, M.D. #10R246
Salvador Cevallos, M.D. #10V006
Jerry Oestmann, Ph.D. #047257
Patricia A. Blakeslee, LMFT
All ages
Cynthia Parkes, LMHC #052971
Patients newborn to 16 years
Shane Porter, LMHC #010963
Kim Carter Winokur, LMHC #055222
Peter Poulos, M.D. #044948
Nancy Russo, LMHC #042751
Donna Rethemeyer, LCSW #042750
Chhaya Johnson, LMHC #042747
Wallace (Scott) Shearon, LMFT #001947
All ages
Center for Behavioral Medicine
386 / 957-3905
Fax: 386 / 402-8992
Flagler Mental Health Center, P.A.
2729 E. Moody Blvd., Ste. 105, Bunnell, FL 32110
386 / 313-1989
Fax: 386 / 206-1057
800 S. Nova Rd., Ormond Beach, FL 32174
386 / 313-1989
Fax: 386 / 206-1057
3424 St. Johns Ave., Palatka, FL 32177
386 / 313-1989
Fax: 386 / 206-1057
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Margaret Aldridge, LCSW #011355
261 North Causeway, New Smyrna Beach, FL 32169
Trevon Clow, Ph.D. #011023
All ages
221 N. Causeway, Suite B, New Smyrna Beach, FL 32169
Cristen Coker, LMHC #052988
Pamela Derr, LMHC #133293
Not accepting new patients at this time
Autumn French, LMFT #041745
Gary Frick, M.D. #039522
David L. Johns, L.M.H.C. #057539
Sara Keen, LMHC #040804
Asad Khan, M.D. #045159
Better Day Therapy
328 N. Ridgewood Ave., Ste. 1, Edgewater, FL 32132
210 Moody Blvd., Flagler Beach, FL 32136
Autumn French, LLC
1025 W. New York Ave., Ste. 3, DeLand, FL 32720
Northeast Florida Psychiatric Association, Inc.
465 Summerhaven Dr., Ste. A., DeBary, FL
Keen counseling, LLC
315 Palm Coast Pkwy., NE, Palm Coast, FL 32137
Medical & Psychiatric Institute of FL, Inc.
927 Beville Rd., Ste. 7, South Daytona, FL 32119
386 / 957-4807
Fax: 386 / 957-4807
386 / 428-4564
Fax: 386 / 428-4539
386 / 663-4495
Fax: 386 / 269-6121
386 / 503-9674
Fax: 386 / 868-4567
386 / 214-5143
Fax: 386 / 873-7565
386 / 767-8584
Fax: 386 / 767-8536
32713 407 / 970-8814
Fax: 888 / 386-7036
386 / 871-9632
Fax: 386 / 200-4410
386 / 269-9009
Fax: 386 / 269-9004
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Travis McBride, LMHC #10P589
Rebecca Spigener, LMHC #049716
Patrick Nave, LMHC, CAP
Julie Parker, Psy.D. #10F433
Sara Riley, LMHC #011510
Kimberly Rust, LCSW #10AC36
Stacy Savage, L.M.H.C. #10Q548
Elizabeth Shoemaker, LMFT #039542
Cynthia Streifer, LMFT #042753
Central Florida Mental Health Associates
Family4Today
1349 International Pkwy. S., Ste. 2421, Lake Mary, FL 32746
960 E. Normandy Blvd., Deltona, FL 32725
397 SW Palm Coast Pkwy., #5, Palm Coast, FL 32137
118 ½ N. Woodland Blvd., Ste. 4, DeLand, FL 32720
386 / 736-9165
Fax: 386 / 736-9181
407 / 952-8444
Fax: 321 / 249-0222
386 / 423-0442
Fax: 386 / 423-0402
386 / 986-2222
Fax: 386 / 986-2200
386 / 232-8623
Fax: 386 / 742-1509
Solutions Counseling and Consulting
381 SW Palm Coast Pkwy., Ste. 1, Palm Coast, FL 32137
386 / 597-2904
Fax: 386 / 597-2903
Behavioral Health Center of Ormond Beach
533 N. Nova Rd., Ste. 203, Ormond Beach, FL 32174
386 / 589-5610
Fax: 386 / 672-0771
386 / 957-3905
Fax: 386 / 402-8992
Behavioral Health Center of Ormond Beach
533 N. Nova Rd., Ste. 203, Ormond Beach, FL 32174
386 / 265-3920
Fax: 386 / 672-0771
386 / 957-3905
Fax: 386 / 402-8992
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Edward Lee Somers, LMHC #10V167
Sunita Tikku, M.D. 10N259
Adly Thebaud, M.D. #104459
Josette Romain, M.D. #011590
Sara Ely, LMHC
All ages
Josephine H. Underhill, LMHC #044953
Kathleen Vacchelli, ARNP #142680
Jennifer Warmka, LCSW #057543
101 N. Woodland Blvd, Ste. 203, DeLand, FL 32720
Southwest Volusia Medical Associates
1061 Medical Center Dr., Orange City, FL 32763
Family Psychiatric Services
2725 Rebecca Lane, Orange City, FL 32763
All appointments will be made through the Sanford office
101 N. Woodland Blvd., Ste. 207, DeLand, FL 32720
Commercial members only
Atlas Behavioral Health
50 Leanni Way, Ste. B-3, Palm Coast, FL 32137
Journey to Wellness
300 Palm Coast Pkwy., NE, Palm Coast, FL 32137
321 / 277-7714
Fax: 321 / 445-5223
386 / 917-7610
Fax: 386 / 917-7615
407 / 322-3096
Fax: 407 / 321-5655
386 / 747-7148
Fax: 386 / 873-4311
386 / 283-2929
Fax: 386 / 264-6254
386 / 530-6796
Fax: 386 / 530-6797
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PSYCHIATRY / BEHAVIORAL HEALTH
Halifax Health Behavioral Services
Child & Adolescent
Halifax Health Behavioral Health
841 Jimmy Ann Drive, Daytona Beach, FL 32117
Lisa Merilson, Psy.D. #011043
Volusia Neuropsychology & Behavioral Health
SMA Behavioral Health Services, Inc
Mental Health Counseling and Medication Management
1220 Willis Avenue, Daytona Beach, FL
105 West Calvin Street, Deland, FL
311 North Orange Street, New Smyrna Beach, FL
386 / 425-3900
Fax: 386 / 274-6646
386 / 423-0442
Fax: 386 / 423-0402
800 / 539-4228
Fax: 386 / 236-3161
Kathryn Fraser, Ph.D.
HECN PROVIDER
201 N. Clyde Morris Blvd., Suite 200, Daytona Beach, FL 32114 386 / 254-4165
Fax: 386 / 254-4339
Substance Abuse Information can be found under the heading SUBSTANCE ABUSE.
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PSYCHIATRY / BEHAVIORAL HEALTH – CHILD & ADOLESCENT
Monique L. Upton, M.D. #10W539
FHCP Center
386 / 676-7175
Fax: 386 / 676-7134
FHCP Center
386 / 445-7073
Fax: 386 / 246-3839
SEND RECENT H&P, RECENT LABS, LAST DICTATON AND LIST OF MEDICATIONS
Substance Abuse Information can be found under the heading SUBSTANCE ABUSE.
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PULMONARY FUNCTION TESTS (PFTs) / SPIROMETRY
●
●
●
FHCP Center
386 / 238-3200 Ext. 3352
Fax: 386 / 238-3210
FHCP Center
386 / 774-2550 Ext. 92
Fax: 386 / 775-0176
FHCP Center
386 / 445-7073 Ext. 1114
Fax: 386 / 447-7092
FHCP Center
386 / 763-1000
Fax: 386 / 756-6127
FHCP Center
386 / 428-4531 Ext. 6216
Fax: 386 / 427-9935
Fax: 386 / 427-1544
The FHCP member or requesting provider may call the specialist to schedule an appointment.
An order or written prescription is needed.
The office can fax the order or the member can bring it with them to their appointment.
A basic Spirometry test will include the flow volume loop (FVL) and measure the FEV1 & FVC. If you need pre & post bronchodilation, add that to
your order/Rx. Patient to bring inhaler with them if having pre & post bronchodilation.
NO INHALERS OR NEBULIZER TREATMENTS 4 HOURS PRIOR TO APPOINTMENT
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PULMONARY FUNCTION TESTS (PFTs) with DLCO)
Florida Hospital – Fish Memorial #00YG34
Outpatient Laboratory
Florida Hospital – Oceanside #001366
264 S. Atlantic Ave., Ormond Beach, FL 32176
386 / 238-2251
Fax: 386 / 238-2252
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-4500
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 671-5055
Fax: 386 / 677-8196
NO INHALERS OR NEBULIZER TREATMENTS 4 HOURS PRIOR TO APPOINTMENT
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PULMONARY REHABILITATION
201 N. Clyde Morris Blvd., 3rd. Floor, Daytona Beach, FL 32114
60 Memorial Parkway, Room 2803, Palm Coast, FL 32164
386 / 947-4644
Fax: 386 / 258-4803
407 / 321-4500
386 / 424-5091
Fax: 386 / 424-5079
386 / 851-5125
Fax: 386 / 917-5167
386 / 586-4480
Fax: 386 / 586-4644
386 / 943-4610
Fax: 386 / 943-4461
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PULMONOLOGY
PROVIDER IS AVAILABLE TO ALL FHCP HMO/HECN MEMBERS INCLUDING THOSE ASSIGNED TO PCP’S IN EAST VOLUSIA
Suresh D. Desai, M.D. #000506
570 Memorial Circle, Ormond Beach, FL 32174
386 / 677-3662
Fax: 386 / 677-3491
Arjun D. Aneja, M.D. #010390
All appointments, faxes and correspondence will go through the
Ormond Beach office.
Arjun D. Aneja, M.D., LLC
386 / 672-6356
Fax: 386 / 672-6366
790 Dunlawton Ave., Ste. D, Port Orange, FL 32127
PLEASE SEND FILMS OR HAVE PATIENT BRING FILMS TO APPOINTMENT
************************************************************************************************************************
Additional Pulmonology information on the following page.
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PULMONOLOGY(continued)
FHCP HMO MEMBERS ASSIGNED TO PCP’S IN THE SOUTHEAST, WEST VOLUSIA AND FLAGLER COUNTIES ARE
PRE-APPROVED TO BE TREATED BY THE BELOW PROVIDERS
THERE ARE NO GEOGRAPHIC PCP ASSIGNMENT LIMITATIONS FOR HECN MEMBERS
Suresh D. Desai, M.D. #000506
570 Memorial Circle, Ormond Beach, FL 32174
386 / 677-3662
Fax: 386 / 677-3491
Karuna Ahuja, M.D. #111202
Patient to bring films
All appointments, faxes and correspondence will go through the
Ormond Beach office.
Central Florida Cardio Pulmonary Center
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386 / 456-0300
Fax: 386 / 456-0303
407 / 268-3660
Fax: Same as Orange City
Rajesh K. Ailani, M.D. #108513
Christopher DiBello, M.D. #10W190
Nelson Medina Villanueva, M.D. #042749
Theodossis Zacharis, M.D. #011605
PCCC of Volusia, LLC
575 N. Clyde Morris Blvd., Ste. B, Daytona Beach, FL 32114
Arjun D. Aneja, M.D. #010390
Arjun D. Aneja, M.D., LLC
386 / 423-0505
Fax: 386 / 423-0515
386 / 322-6111
Fax: 386 / 322-3777
386 / 671-6333
Fax: 386 / 615-1713
386 / 279-0006
Fax: 386 / 279-0007
386 / 672-6356
Fax: 386 / 672-6366
Bernard Borbely, M.D. #117588
Martin Kubiet, M.D. #003148
Ramzi Shaqareq, M.D. #10J052
Patient 18 years and older
Kurt Bowman, M.D. 10T025
Kristal Carthan, M.D. # 046536
Edward K. Scanlon, M.D. #004629
P. Travis Smith, M.D. #005345
Radhika Verma, M.D. #117360
Albert Razzetti, M.D. #005177
First Coast Pulmonary Associates, P.A.
3 Pine Cone Drive., Suite 106, Palm Coast, FL 32137
100 Whetstone Place, Suite 208, St. Augustine, FL 32086
Pulmonary Practice Associates
1075 Town Center Drive, Orange City, FL 32763
West Volusia Medical Associates
1070 North Stone Street, DeLand, FL 32720
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386 / 986-1422
Fax: 386 / 986-1415
904 / 819-6800
Fax: 904 / 819-6700
407 / 321-8230
Fax: 407 / 321-0388
386 / 917-0333
Fax: 386 / 917-0335
386 / 917-0333
Fax: 386 / 917-0335
386 / 943-7100
Fax: 386 / 943-8909
PROVIDER IS AVAILABLE TO HECN MEMBERS ONLY
Wahba Wahba, M.D. # 003854
810 Wildwood St., Ste. 1, Daytona Beach, FL 32117
386 / 258-7100
Fax: 386 / 253-1843
HECN PROVIDERS
3949 Nova Road, Port Orange, FL 32127
4869 Palm Coast Parkway NW Unit 4, Palm Coast, FL 32137
All correspondence / phone calls will be
handled through the Daytona Beach office.
PLEASE SEND FILMS
PULMONOLOGY - PEDIATRIC
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REPORTABLE DISEASES/CONDITIONS
HIV/AIDS – VOLUSIA COUNTY
Phone: 386 / 274-0634
Fax: 386 / 274-0641
STD – VOLUSIA COUNTY
Phone: 386 / 274-0643
Fax: 386 / 274-0641
TB – VOLUSIA COUNTY
Phone: 386 / 274-0654
Fax: 386 / 274-0641
Fax form to:
Fax: 386 / 641-0641
Volusia County Health Department #00P421
East Side 8:00 am TO 5:00 pm
Phone: 386 / 274-0633
Fax: 386 / 274-0641
Volusia County Health Department #00P421
West Side 8:00 am TO 5:00 pm
Phone: 386 / 274-0588
Fax: 386 / 274-0641
Phone: 386 / 316-5030
No Fax
ANIMAL BITES/RABIESVOLUSIA COUNTY
ALL OTHER REPORTABLE
DISEASES/CONDITIONS –
VOLUSIA COUNTY
Volusia County Health Department
After Hours/Weekends
FLAGLER
#00PV15
COUNTY
Health
After 5:00 pm and before 8:00 am
Holidays and Weekends
Department All Flagler County Services are available at this phone and fax 386 / 437-7350, Ext. 2240
number
Fax: 386 / 437-7353
The Animal Incident Reporting Form should be filled out by the reporter (staff member) and not the victim.
An animal bite report must be submitted before the rabies series can be started. The report form needed for this is located on www.fhcp.com,
PROVIDERS-FORMS.
Prior authorization from the FHCP Central Referrals is not needed.
For a list of Reportable Diseases/Conditions in Florida visit:
http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-andmanagement/_documents/reportable_diseases/_documents/Reportable_Diseases_List_Practitioners.pdf
Additional Reportable Diseases/Conditions information on the following page.
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REPORTABLE DISEASES/CONDITIONS (continued)
Forms needed for reporting diseases and conditions to the State of Florida can be found on www.fhcp.com, PROVIDERS-FORMS
ADDITIONAL INFORMATION ON REPORTABLRE DISEASES IS PROVIDED IN CHAPTER 10 OF THE FHCP PROVIDER HANDBOOK
.
http://www.fhcp.com/providers/services/provider-handbook
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RHEUMATOLOGY
Sanjiv Kapil, M.D. #010533
Florida Arthritis Center
147 Parliament Loop, #1005, Lake Mary, Fl. 32746
407 / 688-9446
Fax: 407 / 688-9448
70 Fox Ridge Court, Suite B, DeBary, FL 32713
All appointments will be made through the Lake Mary office
Michael D. Kohen, M.D. #004099
386 / 252-1632
Fax: 386 / 257-5526
1545 Hand Ave., Ste. 2, Ormond Beach, FL 32174
Howard L. Offenberg, M.D. #002521
Howard L. Offenberg, M.D., P.L.
386 / 673-7227
Fax: 386 / 673-9940
Not accepting fibromyalgia patients
Yong Tsai, M.D. #004441
Paients 3 years and older
Maria Vintimilla, M.D. #10Q341
1893 N. Clyde Morris Blvd., Ste. 110, Daytona Beach, FL 32117 386 / 676-0307
Fax: 386 / 677-7842
RDC of Volusia, LLC
1055 N. Dixie Freeway, Ste. 1, New Smyrna Beach, FL 32168
386 / 423-0505
Fax: 386 / 423-0515
386 / 322-6111
Fax: 386 / 322-3777
386 / 671-6333
Fax: 386 / 615-1713
386 / 279-0006
Fax: 386 / 279-0007
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RHEUMATOLOGY - PEDIATRICS
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SKILLED NURSING FACILITY
Alliance Community Nursing Center #00K040
138 W. Armstrong, DeLand, FL 32720
Avante at Ormond Beach, Inc. #105530
170 N. Kings Road, Ormond Beach, FL 32174
Flagler Health and Rehabilitation Center
#000814
Florida Lutheran Retirement Center #00K072
(Available only to residents of Nursing Home)
Grand Oaks Health & Rehabilitation Center
#122441
Healthcare and Rehab of Sanford #037061
300 Dr. Carter Blvd., Bunnell, FL 32110
Indigo Manor #00K027
595 Williamson Blvd., Daytona Beach, FL 32114
John Knox Village #00K002
Majestic Oaks
Longwood Health Care Center #037062
901 Veteran’s Memorial Parkway, Orange City, FL 32763
450 N. McDonald Ave., DeLand, FL 32724
3001 Palm Coast Parkway, SE, Palm Coast, FL 32137
950 Mellonville Ave., Sanford, FL 32771
1520 South Grant Street, Longwood, FL 32750
Seaside Health and Rehabilitation Center 324 Wilder Boulevard, Daytona Beach, FL 32114
#00K022
Parkside Health and Rehabilitation Center 451 South Amelia Avenue, DeLand, FL 32724
#00K041
Ocean View Nursing and Rehabilitation Center 2810 S. Atlantic Avenue, New Smyrna Beach, FL 32169
Signature Healthcare of Ormond #00K079
103 North Clyde Morris Blvd., Ormond Beach, FL 32174
Ridgecrest Nursing & Rehabilitation Center 1200 North Stone Street, DeLand, FL 32720
#00K018
Additional Skilled Nursing Facility information on the following page.
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10/01/16
386 / 734-6401
Fax: 386 / 734-9168
386 / 677-7955
Fax: 386 / 676-9573
386 / 437-4168
Fax: 386 / 437-7740
386 / 736-5800
Fax: 386 / 736-5858
386 / 446-6060
Fax: 386 / 446-6033
407 / 322-8566
Fax: 407 / 322-0121
386 / 257-4400
Fax: 386 / 252-9797
386 / 775-2008
Fax: 386 / 775-0655
407 / 339-9200
Fax: 407 / 339-5032
386 / 252-2600
Fax: 386 / 252-2660
386 / 734-8614
Fax: 386 / 738-2616
386 / 428-6424
Fax: 386 / 428-7132
386 / 673-0450
Fax: 386 / 677-6715
386 / 734-4334
Fax: 386 / 736-2118
SKILLED NURSING FACILITY (continued)
Villa Health & Rehab Center #0474537
120 Chipola Ave., DeLand, FL 32720
386 / 738-3433
Fax: 386 / 822-9296
INSTRUCTIONS: Hospital in-patient will be placed through Florida Health Care Plan Case Management Department at 386 / 676-7187. Florida
Health Care Plans offers no custodial coverage. Any questions regarding member being placed from home or clarification of skilled vs. custodial,
please contact Case Management Department at 386 / 676-7187.
Admissions to skilled level of care require prior authorization through the FHCP Case Management Dept. at
386 / 676-7187 or 800 / 352-9824, Ext. 7187
SLEEP DISORDER PROVIDERS
PROVIDER IS AVAILABLE TO ALL FHCP HMO/HECN MEMBERS
Wahba W. Wahba, M.D. #003854
386 / 258-7100
Fax: 386 / 253-1843
3949 S. Nova Road, Port Orange, FL 32127
4869 Palm Coast Parkway Unit 4, Palm Coast, FL 32137
All correspondence, appointments and phone
calls will be handled through the Daytona Beach
office.
Additional Sleep Disorder information on the following page.
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SLEEP DISORDER PROVIDERS (continued)
FHCP HMO MEMBERS ASSIGNED TO PCP’S IN EAST VOLUSIA COUNTY ARE
PRE-APPROVED TO BE TREATED BY THESE PROVIDERS
386 / 258-7100
Fax: 386 / 253-1843
calls will be handled through the Daytona Beach 263 N. Causeway, New Smyrna Beach, FL 32169
office.
PCCC of Port Orange and Ormond, LLC
Rajesh K. Ailani, M.D. #10A996
Theodossis Zacharis, M.D. #10A997
386 / 322-6111
Fax: 386 / 322-3777
386 / 671-6333
Fax: 386 / 615-1713
For HMO members assigned to PCP’s in the East Volusia County who are requesting to see any other Sleep Disorder Provider, a FHCP
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FHCP HMO MEMBERS ASSIGNED TO PCP’S IN SOUTHEAST VOLUSIA COUNTY ARE
386 / 258-7100
Fax: 386 / 253-1843
office.
PCC of Volusia, L.L.C.
386 / 423-0505
Fax: 386 / 423-0515
386 / 322-6111
Fax: 386 / 322-3777
386 / 671-6333
Fax: 386 / 615-1713
3876 / 279-0006
Fax: 386 / 279-0007
For HMO members assigned to PCP’s in the Southeast Volusia County who are requesting to see any other Sleep Disorder Provider, a FHCP
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FHCP HMO MEMBERS ASSIGNED TO PCP’S IN WEST VOLUSIA COUNTY ARE
386 / 258-7100
Fax: 386 / 253-1843
office.
Sleep Center - Patients 4 years and older
386 / 943-4777
Fax: 386 / 943-4896
Florida Hospital – Fish Memorial
Sleep Center - All ages
1061 Medical Center Dr., Suite 301, Orange City, FL 32763
386 / 917-7600
Fax: 386 / 917-7602
Karuna Ahuja, M.D. #111202
1319 S. International Parkway, Ste. 1171, Lake Mary, FL 32746
407 / 268-3660
Fax: 407 / 936-1601
Kurt Bowman, M.D. #10T025
Kristal Carthan, M.D. #046536
Kevin Scanlon, M.D. #004629
P. Travis Smith, M.D. #005345
Radhika Verma, M.D. #117360
Pulmonary Practice Associates
407 / 321-8230
Fax: 407 / 321-0388
386 / 917-0333
Fax: 386 / 917-0335
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SLEEP DISORDER PROVIDERS (continued
PCC of Volusia, L.L.C.
386 / 423-0505
Fax: 386 / 423-0515
386 / 322-6111
Fax: 386 / 322-3777
386 / 671-6333
Fax: 386 / 615-1713
3876 / 279-0006
Fax: 386 / 279-0007
For HMO members assigned to PCP’s in the West Volusia County who are requesting to see any other Sleep Disorder Provider, a FHCP
FHCP HMO MEMBERS ASSIGNED TO PCP’S IN FLAGLER COUNTY ARE
office.
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386 / 258-7100
Fax: 386 / 253-1843
Bernard Borbely, M.D. #117588
Martin Kubiet, M.D. #003148
Ramzi Shaqareq, M.D. #10J052
Flagler Diagnostic and Sleep Disorders Center
First Coast Pulmonary Associates, P.A.
3 Pine Cone Drive, Suite 106, Palm Coast, FL 32137
4721 East Moody Blvd., Bldg. 1, Suite 104, Bunnell, FL 32110
386 / 986-1422
Fax: 386 / 986-1415
386 / 586-6229
Fax: 386 / 263-2975
For HMO members assigned to PCP’s in Flagler County who are requesting to see any other Sleep Disorder Provider, a FHCP Referral form
must be completed. Attach pertinent documentation to substantiate the request and forward by fax (386 / 238-3253) or courier, to FHCP’s Central
Referrals at the Holly Hill facility. The Referral Department will review the request and notify you of their decision. If approved, FHCP will
schedule the member’s appointment and also confirm the appointment with the patient.
SLEEP DISORDER PROVIDER – HOME STUDIES
386 / 258-7100
Fax: 386 / 253-1843
office.
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SLEEP DISORDER PROVIDER – PEDIATRIC
SUBSTANCE ABUSE / DETOXIFICATION & INPATIENT CARE
SMA Behavioral Health Services, Inc.
Crisis Stabilization/23 Hour Observation
Pinegrove, 1150 Red John Road, Daytona Beach, FL
800 / 539-4228
Fax: 386 / 236-3161
Adult Detox
1200 Red John Road, Daytona Beach, FL
Florida Hospital – DeLand
Florida Hospital – DeLand
701 W. Plymouth Ave., DeLand, FL
The Darryl Strawberry Revocery Center
Non-medicare patients only
The Darryl Strawberry Recovery Center
2775 Big John Dr., Deland, FL
386 / 943-4522
386 / 337-7957
Fax: 386 / 337-7968
INSTRUCTIONS: The requesting provider should instruct the member to present themselves to one of the above facilities for screening.
Pre-authorization from the FHCP Referral Department is not needed for the initial 24 hour detox admission. However, the admitting facility must
notify FHCP’s Case Management Department within 1 business day of the admission and provide clinical information for the authorization of
continued inpatient care. FHCP Case Management Department – 386 / 676-7187.
Additional Substance Abuse information on the following page.
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SUBSTANCE ABUSE / RESIDENTIAL
Adult Residential Substance Abuse
1200 Red John Road, Daytona Beach, FL
800 / 539-4228
Fax: 386 / 236-3161
Adolescent Residential Substance Abuse
3875 Tiger Bay Road, Daytona Beach, FL
SUBSTANCE ABUSE – OUTPATIENT CARE / INTENSIVE OUTPATIENT PROGRAMS
FHCP Center
Mary Kathleen (Kathy) Lichenwalter, M.S., 1340 N. Ridgewood Ave., Holly Hill, FL 32117
LMHC, #10S109
Susan Mounteer, LMFT #007654
386 / 676-7175
Fax: 386 / 676-7134
INTENSIVE OUTPATIENT PROGRAMS (IOP’s) are one of the highest levels of care in an outpatient setting.
SEND RECENT H&P, RECENT LABS, LAST DICTATON AND LIST OF MEDICATIONS
Additional Substance Abuse information on the following page.
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SUBSTANCE ABUSE – OUTPATIENT CARE / INTENSIVE OUTPATIENT PROGRAMS
Substance Abuse Counseling
702 South Ridgewood Avenue, Daytona Beach, FL
356 Englenook Drive, Debary, FL - Court Orders Only
800 / 539-4228
Fax: 386 / 236-3161
INTENSIVE OUTPATIENT PROGRAMS (IOP’s) are one of the highest levels of care in an outpatient setting.
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SURGERY-CARDIOVASCULAR
386 / 672-9503
Fax: 386 / 672-0386
date and time.
Bradley Litke, M.D. #001876
Sohit K. Khanna, M.D. #048751
Ryan Messiner, D.O. #057553
Cary H. Meyers, M.D. #048752
Cardiovascular Surgeons, P.A.
4106 West Lake Mary Blvd., Suite 201, Lake Mary, FL 32746
32117
UF Health Heart & Vascular Surgery at Halifax
407/ 425-1566
Fax: 407 / 422-0166
386 / 231-3600
Fax: 386 / 231-3602
386 / 226-2662
Fax: 386 / 226-2593
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SURGERY-COLON & RECTAL
David Meese, M.D. #004013
Andrew Ritter, M.D. #003473
John Tolland, M.D. #006725
Kathleen Williams, M.D. #009804
All ages
Colon & Rectal Surgery Associates
550 Memorial Circle, Suite H, Ormond Beach, FL 32174
386 / 672-0017
Fax: 386 / 676-0506
386 / 756-7066
Fax: 386 / 756-8012
170
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SURGERY-GENERAL
Harry H. Black, M.D. #001852
Jonathan Dean, M.D. #038770
All ages
Joel Sebastien, M.D. #006578
Caren Wilkie, M.D. #00002E
Steven Bower, M.D. #010391
386 / 238-3295
Fax: 386 / 238-3273
2777 Enterprise Rd., Suite 5, Orange City, FL 32763
All appointment scheduling will be through the Daytona Beach
office
Memorial Hospital Flagler
61 Memorial Medical Parkway, Ste.3807, Palm Coast, FL 32164
386 / 586-1780
Fax: 386 / 586-1781
John J. Cascone, M.D. #049876
61 Memorial Medical Parkway, Ste.3805, Palm Coast, FL 32164
386 / 586-1605
Fax: 386 / 586-1607
Eric D. Pinnar, M.D. #047064
61 Memorial Medical Parkway, Ste. 2815, Palm Coast, FL 32164
386 / 586-1850
Fax: 386 / 586-1851
Rene Capulong, M.D. #004196
Infants and older
Franklin D. Clontz, M.D. #005310
Walter Schratt, M.D. #038338
Thomas Corbyons, M.D. #004024
Michael Donohoe, M.D. #003724
All ages
Rene Capulong, M.D., P.A.
2511 Junior Street, Orange City, FL 32763
Osceola Surgical Associates, LLC
305 N. Mangoustine Ave., Ste. 100, Sanford, FL 32771
932 Saxon Blvd., Ste. B, Orange City, FL 32763
Corbyons & Donohoe Surgical Assoc.
North Orlando Surgical Group, Inc.
Dennis Diaz, M.D. #10Q154
Joan Iacobelli, M.D. #10S540
Jeremy Steinbaum, M.D. #006391
All ages
Additional General Surgery information on the following page.
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386 / 736-7600
Fax: 386 / 738-4649
407 / 322-7841
Fax: 407 / 322-7845
386 / 738-5300
Fax: 386 / 738-9537
386 / 775-0333
Fax: 386 / 775-0427
407 / 790-9800
Fax: 386 / 775-0427
SURGERY-GENERAL (continued)
Kimberly Clayton, M.D. #10L018
Frank Toub, M.D. #005494
Michael P. Harrington, M.D. #009096
James T. Sutton, M.D. #009105
All ages
Surgical Associates of Volusia
386 / 428-8326
Fax: 386 / 428-2493
386 / 274-0250
Fax: 386 / 274-0269
HECN, DAYTONA STATE COLLEGE & BETHUNECOOKMAN COLLEGE PROVIDERS
SURGEON MUST HAVE RECORDS PRIOR TO APPOINTMENT.
MINOR SURGICAL CLINIC
Harry H. Black, M.D. #001852
Vijay Moradia, M.D. #003038
Joel Sebastien, M.D. #006578
Caren Wilkie, M.D. #00002E
386 / 238-3295
Fax: 386 / 238-3273
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SURGERY-HAND
Louis Blaum, III, M.D. #132457
Laurence Brenner, M.D. #10H501
Jeffrey DeMercurio, M.D. #10K656
All ages
Juan Castaneda, D.O. #011373
Hand & Upper Extremity Surgery of Daytona Beach
1241 S. Ridgewood Ave., Daytona Beach, FL 32114
Tamara R. Clancy, M.D. #006794
All ages
Tamara R. Clancy, M.D. #006794
Srikanth Eathiraju, M.D. #038612
Sarah Henry, M.D. #048405
All ages
Sarah Henry, M.D. #038612
Srikanth Eathiraju, M.D. #038612
Volusia Hand Surgery Clinic
315 Palm Coast Parkway N.E., Suite. 4, Palm Coast, FL 32137
Fax number listed is for Dr. Clancy’s Port Orange Office
Fax number listed is for Dr. Henry’s Port Orange Office
2777 Enterprise Road, Suite 1, Orange City, FL 32763
Fax number listed is for Dr. Eathiraju’s Port Orange Office
386 / 238-2244
Fax: 386 / 239-2381
386 / 322-6882
Fax: 386 / 322-6848
386 / 322-6882
Fax: 386 / 322-6848
386 / 246-3063
Fax: 386 / 788-0679
386 / 788-4263
Fax: 386 / 788-0679
386 / 410-4972
Fax: 386 / 788-0679
386 / 218-4920
Fax: 386 / 788-0679
173
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SURGERY-NEURO
Rohit Khanna, M.D. #006424````
386 / 257-5055
Fax: 386 / 257-5058
Yannick Grenier, M.D. #057875
William Kuhn, M.D. #003731
386 / 255-8582
Fax: 386 / 252-1776
Federico Vinas, M.D. #009198
386 / 253-7644
Fax: 386 / 238-2224
Send listed information to the specialist office listed above. Please include: Patient Demographics, Insurance Information (copies of cards
preferred), Referral, Diagnostic Studies (MRI, CT, X-rays, EMG’s). You will be notified if the patient is going to be seen or not. Patient to bring
MRI and / or CT disks with them to their appointment.
Christopher Kent, M.D. #10T171
Robert Martin, M.D. #10A067
Dennis Mark Murphy, M.D. #143848
Gregory Velat, M.D. #056531
Dennis Mark Murphy, M.D. # 143848
FHMMC Brain & Spine Surgery Associates
32117
Palm Coast Brain & Spine Surgical Associates
120 Cypress Edge Dr., Ste. 208, Palm Coast, FL 32164
386 / 231-3540
Fax: 386 / 231-3544
386 / 586-1658
Fax: 386 / 586-1680
For Urgent NeuroSurgery Referrals, the requesting provider should call and speak directly to the physician of choice
Additional Neurosurgery information on the following page.
174
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SURGERY-NEURO (continued)
Raul A. Rodas, D. O. #139691
The NeuroHealth Center, LLC
407 / 878-3704
Fax: 407 / 878-3705
Per the request of Dr. Rodas, you may call his cell phone at 386 /
334-2524 to schedule an appointment. If needed, Dr. Rodas will
evaluate the needs of the patient.
SURGERY-ORAL
For accidental dental injury services, call FHCP’s Dental Department in the Daytona Beach Facility at 386 / 238-3280 and describe the presenting
problem. They will advise if FHCP covers the problem and who you should contact within the FHCP’s Provider Network to arrange for treatment of
the member.
175
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SURGERY-ORTHOPAEDICS
NON-SURGICAL ORTHOPAEDICS – SEE ORTHOPAEDICS-SPORTS MEDICINE
Dennis Alter, M.D. #005138
David Gay, M.D. #10N313
Jeffrey Keen, M.D. #10U001
Sonia Millan-Pinzon, M.D. #053337
Corey Rosenbaum, D.O. #051951
All ages
Ronald Bathaw, M.D. #003959
All ages
Requires records prior to scheduling.
Patient to bring films.
James Bryan, M.D. #006073
Richard K. Gaines, M.D. #10AB03
Antony Denard Jr., M.D. #054447
Albert Gillespy, M.D. #004452
Mark Gillespy, M.D. #004501
Malcolm Gottlich, M.D. #006876
Jeffrey Martin, M.D. #107390
Todd McCall, M.D. #10B922
Brian Hatten, M.D. #125572
All ages
Flagler Orthopedics and Sports Medicine
Palm Harbor Orthopaedics
80 Pinnacles Drive, Suite 700, Palm Coast, FL 32164
10/01/16
386 / 586-2234
Fax: 386 / 586-2885
Orthopaedic Clinic Of Daytona Beach, P.A.
17 Old Kings Rd., N., Suite K, Palm Coast, FL 32137
This Orthopedic group prefers to order their own imaging so
it is not required to order imaging just for the referral.
However, if any imaging is available, please send with the
patient.
All offices use the same phone number
386 / 255-4596
Fax number for all referral and appointment information
Fax: 386 / 323-9814
Additional Surgery-Orthopaedic information on the following page.
176
386 / 586-1910
Fax: 386 / 586-1912
SURGERY-ORTHOPAEDICS (continued)
Thomas Brodrick, M.D. #004328
Mark Hollman, M.D. #000050
Royce Hood, M.D. #000039
Stephane Lavoie, M.D. #000132
Stephen M. Reed, M.D. #001954
Brandon M. Steen, M.D. #043372
Benjamin G. Thomasson, D.O. #048347
Nathan J. Turnbull, M.D. #049624
All ages *Under age 14-case by case *
Florida Orthopaedic Associates, P.A.
386 / 734-9122
Fax: 386 / 736-4348
386 / 774-2500
Fax: 386 / 774-2545
1337 International Parkway S., Suite 1341, Lake Mary, FL 32746
407 / 333-4507
Fax: 407 / 333-4576
32168
Fax: 386 / 774-9041
Charles Kollmer. M.D. #006651
All ages
Richard Rhodes, M.D. #008855
Srinivasa Sridhar, M.D. #008858
All ages
John M. Russell, M.D. #002854
All ages
Patient to bring films.
Gregory White, M.D. #10AF78
New Smyrna Beach Orthopedics
812 W. Indian River Blvd., Edgewater, FL 32132
Atlantic Orthopaedic Associates, P.A.
1400 Dunlawton Avenue, Ste. 1-A, Port Orange, FL 32127
ACL Repairs not available at this office
Russell Orthopaedic Clinic
315 Palm Coast Pkwy, NE, Palm Coast, FL 32137
Additional Surgery-Orthopaedic information on the following page.
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10/01/16
386 / 426-1411
Fax: 386 / 426-0457
386 / 760-5008
Fax: 386 / 760-0084
386 / 447-4440
Fax: 386 / 447-4446
386 / 424-3846
Fax: 386 / 424-3847
SURGERY-ORTHOPAEDICS (continued)
Kenneth Hawthorne, Jr., M.D. #004499
PROVIDERS
Norman Seltzer, M.D. #003476
PROVIDERS
106 N. Old Kings Rd., Ste. E, Ormond Beach, FL 32174
Halifax Orthopaedic Clinic
614 N. Peninsula Dr., Daytona Beach, FL 32118
386 / 671-0115
Fax: 386 / 671-0844
386 / 788-4949
Fax: 386 / 671-0844
386 / 257-2602
Fax: 386 / 257-2329
Charles B. Williamson, M.D. #003397
PROVIDERS
386 / 760-2888
Fax: 386 / 760-8866
Michael Fulton, M.D.
PROVIDER
3127 W. International Speedway Blvd., Daytona Beach, FL 386 / 258-9502
32124
NON-SURGICAL CARE ONLY
PLEASE SEND DICTATION, CURRENT X-RAY OF THE AREA AND PHYSICAL THERAPY NOTES
SEE PHYSICAL MEDICINE AND REHABILITATION SERVICES FOR ADDITIONAL BACK PAIN PROVIDERS
178
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SURGERY-PLASTIC
Vijay Moradia, M.D. #003038
201 N. Clyde Morris Blvd., Suite 100, Daytona Beach, FL
32114
386 / 238-3295
Fax: 386 / 238-3273
Richard V. Cashio Jr., M.D. #10B744
61 Memorial Medical Pkwy., Ste. 2802, Palm Coast, FL 32164
386 / 313-1982
Fax: 386 / 313-1985
Jeffrey DeMercurio, M.D. #10K656
311 N. Clyde Morris Blvd., Suite 500, Daytona Beach, FL
32114
386 / 238-2244
Fax: 386 / 239-2381
Carl Lentz, III, M.D. #004080
All ages
386 / 252-8051
Fax: 386 / 252-1173
James T. Shoukas, M.D. #10N064
934 Williston Park Point, Ste. 1028, Lake Mary, FL 32746
407 / 333-2518
Fax: 407 / 333-2521
Michel Samson, M.D. #10AF66
C. Lawrence Slade, M.D. #004047
Patients 1 year of age and older
Sergio Zamora, M.D. # 006299
All ages
Michael C. Samson, M.D. FACCS, PLLC
3635 Clyde Morris Blvd., Suite 400, Port Orange, FL 32129
Sergio M. Zamora, M.D., P.L.C.
386 / 756-9400
Fax: 386 / 756-4338
386 / 274-5557
Fax: 386 / 274-5527
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SURGERY-THORACIC
386 / 672-9503
Fax: 386 / 672-0386
date and time
All ages
All ages
32117
Additional Thoracic Surgery information on the following page.
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386 / 738-5300
Fax: 386 / 738-9537
386 / 231-3600
Fax: 386 / 231-3602
386 / 226-2662
Fax: 386 / 226-2593
386 / 775-0333
Fax: 386 / 775-0427
407 / 790-9800
Fax: 386 / 775-0427
SURGERY–THORACIC (continued)
Bradley Litke, M.D. #001876
John A. Walsh, M.D. #011584
Cardiovascular Surgeons, P.A.
4106 West Lake Mary Blvd., Suite 201, Lake Mary, FL 32746
John A. Walsh, M.D., P.A.
14 Office Park Dr., Ste. 7, Palm Coast, FL 32137
407 / 425-1566
Fax: 407 / 422-0166
386 / 302-5064
Fax: 386 / 302-5093
SURGERY–VASCULAR
PERIPHERAL VASCULAR INTERVENTION
FHCP Center
FHCP Center
Additional Vascular Surgery information on the following page.
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10/01/16
386 / 238-3289
Fax: 386 / 238-3296
SURGERY–VASCULAR (continued)
William H. Johnson, M.D. #000018
386 / 672-9503
Fax: 386 / 672-0386
date and time.
All ages
Michael P. Harrington, M.D. #003484
James T. Sutton, M.D. #004179
All ages
Joan Iacobelli, M.D. #10S540
All ages
32117
Surgical Associates
Additional Vascular Surgery information on the following page.
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386 / 738-5300
Fax: 386 / 738-9537
386 / 231-3600
Fax: 386 / 231-3602
386 / 274-0250
Fax: 386 / 274-0269
386 / 775-0333
Fax: 386 / 775-0427
407 / 790-9800
Fax: 386 / 775-0427
386 / 226-2662
Fax: 386 / 226-2593
SURGERY–VASCULAR (continued)
Frank Toub, M.D. #006635
John A. Walsh, M.D. #011584
The Vein & Vascular Center of North Orlando
1061 Medical Center Dr., Ste. 102, Orange City, FL 32763
600 Palmetto St, New Smyrna Beach, FL 32168
John A. Walsh, M.D., P.A.
14 Office Park Dr., Ste. 7, Palm Coast, FL 32137
386 / 917-7315
Fax: 386 / 917-7334
386 / 428-8326
Fax: 386 / 428-2493
386 / 302-5064
Fax: 386 / 302-5093
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SURGICAL FACILITIES
FHCP ASC #048538
386 / 481-6282
Fax: 386 / 481-6885
Scheduling Number 386 / 481-6282
407 / 708-5383
Fax: 407 / 708-5390
386 / 248-8221
Fax: 386 / 248-8226
407 / 321-4500
386 / 254-4000
Halifax Health–Atlantic Campus #00Y007
386 / 239-5000
Alliance Surgical Center, LLC #10P538
Atlantic Surgery Center, Inc. #00YH63
Halifax Health Twin Lakes Surgery Center 1890 LPGA Blvd., Daytona Beach, FL 32117
#00Y007
Florida Hospital - DeLand # 00YG80
386 / 274-1665
Fax: 386 / 274-2070
386 / 424-5000
Fax: 386 / 424-5054
386 / 878-8080
Fax: 386 / 878-8081
Scheduling Number 386 / 878-8080, Ext. 107
386 / 943-4522
386 / 851-5000
386 / 437-2211
Blue Springs Surgery Center #10G603
#00Y004
Lake Mary Surgery Center, LLC #037262
460 St. Charles Court, Lake Mary, FL 32746
386 / 676-6000
407 / 585-0263
Fax: 407 / 585-0264
Surgery Center of Volusia, LLC #118394
3635 Clyde Morris Blvd., Suite 500, Port Orange, FL 32129
386 / 760-8151
Fax: 386 / 760-8185
Additional Surgical Facilities information on the following page.
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10/01/16
SURGICAL FACILITIES (continued)
INSTRUCTIONS: You should schedule the surgery with the hospital/surgery center, make arrangements for pre-op as needed and notify the
member. The requesting surgeon should then complete the FHCP Surgical & Special Procedure Form. Fax the form to the FHCP’s Central Referrals
at the Holly Hill facility at 386 / 238-3253. The Referral Department will review the request. The surgeon will be notified only if the surgery is not
approved.
If available, patients may have their pre-op testing (Labs, Chest x-ray & EKG) at the facility where the surgery is scheduled.
The form needed for the above services is available at – For Providers, under Related Documents
185
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SUTURE AND STAPLE REMOVAL
FHCP Center
386 / 427-4868
Workforce Wellness Center
FHCP Center
320 N. Clyde Morris Blvd., Suite D, Daytona Beach, FL 32114
386 / 238-3204
FHCP Center - DeLand
937 N. Spring Garden Ave., DeLand, FL 32720
386 / 736-1948
Workforce Wellness
FHCP Center
386 / 774-2550, Ext. 6832
FHCP Center – Ormond Bach
386 / 671-4337
TERTIARY CARE CENTERS
186
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TRANSPLANTS
INSTRUCTIONS: All Transplants, as well as a second transplant opinion, require prior authorization by FHCP. Complete a FHCP Referral Form;
fax the form along with all clinical documentation to the FHCP Central Referral Department at 386 / 238-3253 or 877 / 659-3427. The Referral
Department will review the request and notify you of their decision. Requests for Bone Marrow Transplants should indicate if the request is for an
Allogenic or an Autologous transplant. You will be notified of the plans decision.
** Please do not make any arrangements for this service without prior authorization**
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ULTRASOUND TESTING
Ultrasound Department
FHCP Center
General, GYN, Cardiac and Vascular
Ultrasound services available.
FHCP Center
OB Ultrasounds not available at FHCP
FHCP Center
386 / 238-3270
Fax: 386 / 238-3256
800 / 321-1227 Ext. 3303
FHCP Center
INSTRUCTIONS:
1) Call the Ultrasound Department directly at FHCP’s Daytona Beach Facility at 386 / 238-3270 to schedule the appointment. Confirm the
appointment date and time with the member. Send the order, via courier, to the Ultrasound Department, Daytona Beach Facility, or fax to 386 /
238-3256. OR
2) Send the Ultrasound order to the Ultrasound Department, Daytona Beach Facility, via courier, or fax to 386 / 238-3256. The FHCP Ultrasound
Department will contact the member with their appointment.
ALL BREAST ULTRASOUNDS, REQUESTED AFTER A MAMMOGRAM, ARE TO BE DONE AT THE FACILITY
WHERE THE MAMMOGRAM WAS PERFORMED.
407 / 321-3012
Fax: 407 / 321-9006
188
10/01/16
URGENT CARE SERVICES
MediQuick Urgent Care Center
New Smyrna Beach Urgent Care, LLC
Advanced Urgent Care
PrimeCare at Twin Lakes
All ages
6 Office Park Drive, Palm Coast, FL 32137
After hours care only - Mon. – Fri. 8:00 AM to 8:00 PM
Saturday 8:00 AM to 6:00 PM
Sundays and Holidays 10:00 AM to 5:00 PM
386 / 447-6615
Fax: 386 / 447-1266
140 Pinnacles Drive, Palm Coast, FL 32164
After hours care only – Mon – Fri 8:00 AM to 8:00 PM
Saturday 8:00 AM to 6:00 PM
Sundays and Holidays 10:00 AM to 5:00 PM
New Smyrna Beach Urgent Care
1860 Renzulli Road, New Smyrna Beach, FL 32168
386 / 597-2829
Fax: 386 / 313-1923
Ormond Beach Urgent Care
435 S. Yonge Street, Unit 1, Ormond Beach, FL 32174
Hours for both locations :
After hours care only – Mon. – Fri. 8:00 AM to 6:00 PM
Saturday, Sunday and Holidays 9:00 AM to 3:00 PM
Sat. and Sun. 9:00 AM to 7:00 PM
Holidays : 9 :00 AM to 6 :00 PM Closed on Thanksgivng Day
and Christmas Day
1240 E. Normandy Blvd., Suite 100, Deltona, FL 32725
Sat. and Sun. 9:00 AM to 3:00 PM
Holidays : 9 :00 AM to 3 :00 PM Closed on Thanksgiving Day
and Christmas Day
After hours care only - Mon. - Fri. 8:00 AM to 7:30 PM
Sat., Sun. & Holidays 10:00 AM to 4:30 PM
Additional Urgent Care Services information on the following page.
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10/01/16
386 / 663-3061
Fax: 386 / 663-3066
386 / 673-9949
Fax: 386 / 673-9952
386 / 271-2273
Fax: 386 / 271-2274
386 / 860-5051
Fax: 386 / 860-5053
386 / 274-2212
Fax: 386 / 274-1508
386 / 767-2402
Fax: 386 / 274-1508
URGENT CARE SERVICES (continued)
Heathrow Urgent Care
1125 Town Park Ave., Suite 1011, Lake Mary, FL 32746
PrimeCare at Port Orange
Sat., Sun. 9:00 AM to 3 :00 PM
Prompt Care of Central Florida, LLC
Twilight Pediatrics After Hours Walk-in Clinic
Urgent Care of Longwood
Sat.and Sun. 9:00 AM to 5:00 PM
Closed on Christmas Day & New Year’s Day
1688 W. Granada Blvd., Suite 1A, Ormond Beach, FL 32174
After hours care only-Monday thru Friday 5:00 PM –
10:00 PM
Sat.and Sun. 10:00 AM –4:00 PM
Closed Holidays
450 West State Road 434, Longwood, FL 32750
After hours care only-Monday thru Friday 8:30 AM – 7:00 PM
Sat. 9:00 AM –2:00 PM Sun. 12 :00 PM – 5 :00 PM
407 / 804-9494
Fax: 407 / 804-9443
386 / 767-2402
Fax: 386 / 274-1508
386 / 878-4137
Fax: 386 / 878-4293
386 / 425-4414
Fax: 386 / 615-8466
407 / 212-3000
Fax: 407 / 212-3001
FHCP urgent care facilities can be used after hours and when the member’s primary care physician is unavailable for those medical services
required to prevent a serious deterioration of a member’s health that results from an unforeseen illness or injury.
FOR ADDITIONAL AFTER HOURS SERVICES SEE AFTER HOURS PRIMARY CARE
190
10/01/16
UROGYNECOLOGY/RECONSTRUCTIVE PELVIC SURGERY SERVICES
Christopher Stanley, M.D. #001206
Jason R. Thompson, M.D. #13826
Halifax Health Urology Center
Florida Urogynecology & Reconstructive Surgery, PA
84 Pinnacles Dr., Ste. 500, Palm Coast, FL 32164
386 / 254-4199
Fax: 386 / 947-4680
904 / 652-0373
Fax: 904 / 652-0378
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10/01/16
UROLOGY
Anthony Cantwell, M.D. #000599
Jeffrey Dann, M.D. #010952
Martin Dineen, M.D. #003540
Evan M. Fynes, M.D. #043681
Michael Grable, M.D. #001811
Samuel Lawindy, M.D. #057351
John J. McGetrick, M.D. #051576
Mathew Merrell, M.D. #009320
Terrance Regan, M.D. #001842
Stephen Weiss, M.D. #000126
Robert Youngman, M.D. #000347
Arash Rafiei, M.D. #049271
John E. Greene, M.D. #000625
Bennett Scaglia, M.D. #10K206
Shawn W. Thomas, D.O. #040021
18 years of age and older
Adolescents are accepted on a case by case basis
Atlantic Urology – A Division of Advanced Urology Institute
685 Peachwood Drive, Suite 1, DeLand, FL 32720
1620 Mason Ave., Ste. E, Daytona Beach, FL 32117
Greene Urological Center
386 / 239-8500
Fax: 386 / 239-8530
386 / 427-9554
Fax: 386 / 427-2157
386 / 736-3463
Fax: 386 / 736-3492
386 / 774-2121
Fax: 386 / 774-5505
386 / 445-8530
Fax: 386 / 446-5087
386 / 506-5117
Fax: 386 / 506-5120
386 / 756-1945
Fax: 386 / 239-8530
386 / 426-2565
Fax: 386 / 426-8983
Halifax Health Urology Center
32114
Fax: 386 / 947-4680
Patient must bring any pertinent radiology films with them to their appointment.
Halifax Health Center for Urology has a dedicated fax for surgical labs, pre-op orders, EKG’s, insurance pre-authorizations, or surgery
scheduling information – 386 / 238-2220.
192
10/01/16
VACUUM ASSISTED CLOSURE DEVICES
Guidelines listed under Wound Care
VARICOSE VEIN TREATMENT
All ages
William H. Johnson, M.D. #000018
Sukhender Singireddy, M.D. #010488
All ages
Charles Stein, M.D. #005416
All ages
32117
Suncoast Vein & Vascular Clinic
Vein Treatment Center
386 / 738-5300
Fax: 386 / 738-9537
386 / 231-3600
Fax: 386 / 231-3602
386 / 672-9501
Fax: 386 / 673-0308
386 / 304-3404
Fax: 386 / 304-3135
386 / 586-5344
Fax: 386 / 586-5356
193
10/01/16
VNG TESTING
Robert P. Collette, M.D. #003831
18 years of age and older
386 / 775-4467
Fax: 386 / 775-8679
First Coast Hearing Clinic, Inc.
50 Cypress Point Pkwy., B-3, Palm Coast, FL 32164
386 / 447-7364
Fax: 386 / 447-8742
386 / 774-9880
Fax: 386 / 774-2898
An Audiological Evaluation is normally performed prior to a VNG. Please refer to Hearing/Audiology Services in this document for instructions on
how to obtain these services for a FHCP member.
194
10/01/16
WEIGHT MANAGEMENT PROGRAMS
Eat Right Move Right Adult Weight
Management Program
FHCP Center
Classes available at various locations or on an individual basis
386 / 676-7133 or
1 / 877 / 229-4518
Fax: 386 / 238-3228
BMI of 27 or higher – No Charge
FHCP contracted providers can complete a Referral for Diabetes Education or Nutritional Counseling and send by courier to FHCP Health Education
Department in Daytona Beach or fax to 386 / 238-3228/
FHCP members may call directly to the Diabetes/Health Education Department in Daytona Beach to reserve their seating. Please call 386 / 676-7133
or 877 / 229-4518, Monday through Friday between 9:00 am – 5:00 pm.
FHCP staff physicians can generate an order in the EHR system.
Halifax Fitness Center
386 / 254-4031
Fax: 386 / 947-2982
Program is open to FHCP members 18 years and older with a BMI of 30 or above who has been a member for at least 6 months. The Member may
self-refer or the Provider can direct them to the Halifax Fitness Center by calling the number listed above and asking to speak with a dietician.
For information on the Bariatric Program, call 386 / 254-4223.
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WOUND CARE
All ages
FHCP Center
386 / 238-3295
Fax: 386 / 238-3273
Prior authorization from the FHCP Central Referrals is not needed for Wound Care. The requesting provider will send an order to the specialist.
WOUND CARE
407 / 302-7399
Fax: 407/ 321-4353
Halifax Wound Care
All ages
HECN PROVIDER
32114
Fax: 386 / 947-4004
HYPERBARIC OXYGEN THERAPY (HBO) AND VACUUM ASSISTED CLOSURE DEVICES
196
10/01/16
X-RAYS (PLAIN FILMS)
STAT READINGS AVAILABLE
Florida Health Care Plan (N)
FHCP Center
350 N. Clyde Morris Blvd. Daytona Beach, FL 32114
FHCP Center
APPOINTMENTS PREFERRED
WALK-INS ACCEPTED WHEN SCHEDULE PERMITS
FHCP Center
FHCP Center
FHCP Center
FHCP Center
Additional x-ray information on the following page
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10/01/16
386 / 238-3200 Ext. 3339
Fax: 386 / 238-3292
386 / 671-4337
Fax: 386 / 481-6185
386 / 774-2550 Ext. 6823
Fax: 386 / 774-4705
386 / 446-0561
Fax: 386 / 446-0324
386 / 763-4910
Fax: 386 / 481-6399
386 / 427-4868
Fax: 386 / 481-6593
407 / 321-3012
Fax: 407 / 321-9006
X-RAYS (PLAIN FILMS) (continued)
New Smyrna Imaging, LLC #135587 (N)
386 / 426-1900
Fax: 386 / 426-5939
INSTRUCTIONS: Prior authorization from the FHCP Central Referrals is not needed. The requesting provider will send an order to the
specialist. Appointments can be made by the physician’s office or the member can call after the order has been received by the specialty office. The
specialty office will advise you of their scheduling protocol.
Mastoid Films, Panorex Films, Pediatric Head / Skull Series, Mandible X-rays, TMJ X-rays, patients above stated weight limits and patients
with limited mobility can not be done at the above FHCP Centers. For patients needing these films and STAT readings, please follow
instructions in the next sections.
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X-RAYS (STAT READINGS)
Florida Health Care Plan (N)
FHCP Center
350 N. Clyde Morris Blvd. Daytona Beach, FL 32114
FHCP Center
FHCP Center
FHCP Center
FHCP Center
FHCP Center
H) – Outpatient Hospital Department/Facility
199
10/01/16
386 / 238-3200 Ext. 3339
Fax: 386 / 238-3292
386 / 671-4337
Fax: 386 / 481-6185
386 / 774-2550 Ext. 6823
Fax: 386 / 774-4705
386 / 446-0561
Fax: 386 / 446-0324
386 / 763-4910
Fax: 386 / 481-6399
386 / 427-4868
Fax: 386 / 481-6593
X-RAYS (STAT READINGS) (continued)
Florida Hospital – DeLand #00YG80 (H)
Florida Hospital – Fish Memorial #00YG34 (H) 1055 Saxon Blvd., Orange City, FL 32763
New Smyrna Imaging, LLC #135587 (N)
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 860-9336
Fax: 386 / 860-2225
386 / 426-1900
Fax: 386 / 426-5939
INSTRUCTIONS: The requesting Provider should call the listed facility directly to schedule an appointment. Prior authorization from the FHCP
Central Referrals is not needed. The requesting provider will send an order to the specialist. Appointments can be made by the physician’s office
or the member can call after the order has been received by the specialty office. The specialty office will advise you of their scheduling protocol.
For patients needing Mastoid Films, Panorex Films, Pediatric Head / Skull Series, Mandible X-rays, TMJ X-rays, higher weight limits or
need help with their mobility problems, please follow instructions in the next section.
200
10/01/16
X-RAYS (UNABLE TO BE DONE AT FHCP)
For patients needing Mastoid Films, Panorex Films, Pediatric Head / Skull Series, Mandible X-rays, TMJ X-rays, higher weight limits or
need help with their mobility problems, please follow instructions in this section.
Florida Hospital – DeLand #00YG80 (H)
Florida Hospital – Fish Memorial #00YG34 (H) 1055 Saxon Blvd., Orange City, FL 32763
190 Southpark Blvd., Suite 101, St. Augustine, FL 32086
St. Augustine Imaging Center #F00003 (N)
Additional x-ray information on the following page.
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386 / 774-7226
Fax: 386 / 774-7227
386 / 424-5044
Fax: 386 / 424-5048
407 / 321-3012
Fax: 407 / 321-9006
386 / 943-4610
Fax: 386 / 943-4461
386 / 917-5428
Fax: 386 / 917-5576
386 / 917-5428
Fax: 386 / 917-5576
386 / 586-4402
Fax: 386 / 586-4767
386 / 860-9336
Fax: 386 / 860-2225
386 / 446-5200
Fax: 386 / 446-1866
386 / 322-1616
Fax: 386 / 322-5330
904 / 827-9191
Fax: 904 / 827-9171
386 / 446-5200
Fax: 386 / 446-1866
X-RAYS (UNABLE TO BE DONE AT FHCP) (continued)
Twin Lakes Imaging Center # F00001 (N)
St. Augustine Imaging Center #F00003 (N)
Twin Lakes Imaging Center # F00001 (N)
190 Southpark Blvd., Suite 101, St. Augustine, FL 32086
386 / 274-5454
Fax: 386 / 274-5440
386 / 322-1616
Fax: 386 / 322-5330
904 / 827-9191
Fax: 904 / 827-9171
386 / 446-5200
Fax: 386 / 446-1866
386 / 274-5454
Fax: 386 / 274-5440
INSTRUCTIONS: The requesting Provider should call the listed facility directly to schedule an appointment. Prior authorization from the FHCP
Central Referrals is not needed. The requesting provider will send an order to the specialist. Appointments can be made by the physician’s office
or the member can call after the order has been received by the specialty office. The specialty office will advise you of their scheduling protocol.
202
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provider referral guide – volusia/flagler counties

Transcription

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