FLORIDA HEALTH CARE PLANS PROVIDER GUIDELINES CHECK OUT OUR WEBSITE!!!

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1 FLORIDA HEALTH CARE PLANS PROVIDER GUIDELINES CHECK OUT OUR WEBSITE!!! FHCP Referral Department 386 / or 800 / Fax: 386 / Manager of Referrals and Call Center Services / Sue Karparis, L.P.N. 386 / Referral Department Supervisor / Susan Dreggors, L.P.N. 386 / Provider Relations Coordinator / Carol Cooper, L.P.N. 386 / Indicates pre-authorization needed by the FHCP Referral Department. If an urgent appointment (not later than 72 hours) is needed for a service that requires pre-authorization, the requesting provider/staff MUST contact the FHCP Referral Department at 386 / 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 Guidelines for assistance in referring your patients for services. 1

2 TABLE OF CONTENTS ACUTE LOW BACK & NECK PROGRAM... 7 FLORIDA HEALTH CARE PLANS... 8 OUTPATIENT REHABILITATION LOCATIONS... 8 AFTER HOURS PRIMARY CARE... 9 ALLERGY ARTERIAL BLOOD GASES (ABG S) BONE DENSITY STUDIES BRACES / ORTHOTICS / PROSTETICS DIABETIC SHOE PROVIDERS DIABETIC SHOE PROVIDERS (CONTINUED) CARDIAC CATHETERIZATION CARDIAC REHABILITATION CARDIOLOGY CARDIOLOGY (CONTINUED) CASE MANAGEMENT DEPARTMENT CHIROPRACTIC COLONOSCOPY / SCREENING CT SCANS CT SCANS (CONTINUED) DENTAL SERVICES DENTAL SERVICES (CONTINUED) DERMATOLOGY DIABETES EDUCATION DIAGNOSTIC TESTING DIAGNOSTIC TESTING (CONTINUED) DIALYSIS SERVICES DISEASE MANAGEMENT PROGRAMS DISEASE MANAGEMENT PROGRAMS (CONTINUED) DISEASE MANAGEMENT PROGRAMS (CONTINUED) DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT DURABLE MEDICAL EQUIPMENT (CONTINUED)

3 EAR LAVAGE EAR, NOSE AND THROAT (ENT) ECHOCARDIOGRAMS EEG TESTING ELECTROCARDIOGRAMS (EKG S) EMG TESTING ENDOCRINOLOGY EVENT MONITOR GASTROENTEROLOGY GASTROENTEROLOGY (CONTINUED) GENETIC TESTING GYNECOLOGY AND WELL WOMAN S ASSESSMENTS GYNECOLOGY AND WELL WOMAN S ASSESSMENTS (CONTINUED) HEARING / AUDIOLOGY SERVICES HEPATITIS C HIV HOLTER MONITOR HOME HEALTH CARE HOSPICE HOSPITAL ADMISSIONS HOSPITALIST HOSPITAL SURGERY INFECTIOUS DISEASES INFECTIOUS DISEASES PEDIATRICS INFUSION CLINIC INJECTION CLINIC LABORATORY SERVICES ROUTINE LABORATORY SERVICES STAT LYMPHEDEMA CLINIC MAMMOGRAMS (DIAGNOSTIC OR SCREENING) MEDICATIONS (REQUIRING PRIOR AUTHORIZATIONS) MRI S MRI S (CONTINUED) NEPHROLOGY NEUROLOGY NEUROLOGY (CONTINUED)

4 NON-PARTICIPATING PROVIDER OR HOSPITAL NUTRITIONAL EDUCATION OBSTETRICS ONCOLOGY MEDICAL/HEMATOLOGY ONCOLOGY MEDICAL/HEMATOLOGY (CONTINUED) ONCOLOGY-RADIATION OPHTHALMOLOGY OPTOMETRY ORTHOPAEDICS ORTHOPAEDICS (CONTINUED) ORTHOPAEDICS (CONTINUED) ORTHOPAEDICS - SPORTS MEDICINE (NON-OPERATIVE ORTHOPAEDICS AND PRIMARY CARE SPORTS MEDICINE) OSTOMY SERVICES OUTPATIENT REHABILITATION PHYSICAL THERAPY OCCUPATIONAL THERAPY SPEECH THERAPY FLORIDA HEALTH CARE PLANS OUTPATIENT REHABILITATION LOCATIONS BALANCE & VESTIBULAR THERAPY PAIN MANAGEMENT PAIN MANAGEMENT (CONTINUED) PEDIATRICS PEDIATRICS (CONTINUED) PHARMACY PHARMACY (CONTINUED) PHYSICAL MEDICINE AND REHABILITATION SERVICES PODIATRY PRIMARY CARE PRIMARY CARE (CONTINUED) PRIMARY CARE (CONTINUED) PRIMARY CARE (CONTINUED) PRIMARY CARE (CONTINUED) PRIMARY CARE (CONTINUED)

5 PSYCHIATRY / BEHAVIORAL HEALTH PSYCHIATRY / BEHAVIORAL HEALTH (CONTINUED) SUBSTANCE ABUSE, DETOXIFICATION AND SUBSTANCE ABUSE COUNSELING INPATIENT CARE SUBSTANCE ABUSE COUNSELING OUTPATIENT CARE PULMONARY FUNCTION TESTS (PFTS) / SPIROMETRY PULMONARY FUNCTION TESTS (PFTS) WITH DLCO PULMONARY REHABILITATION PULMONOLOGY PULMONOLOGY PULMONOLOGY (CONTINUED) RABIES VACCINE SERIES RHEUMATOLOGY RHEUMATOLOGY - PEDIATRICS SKILLED NURSING FACILITY SLEEP DISORDER PROVIDERS SLEEP DISORDER PROVIDERS (CONTINUED) SLEEP DISORDER PROVIDERS (CONTINUED) SLEEP DISORDER PROVIDERS (CONTINUED) SMOKING CESSATION PROGRAM SPORTS MEDICINE (NON-OPERATIVE ORTHOPAEDICS AND PRIMARY CARE SPORTS MEDICINE) SURGERY-CARDIOVASCULAR SURGERY-COLON & RECTAL SURGERY-GENERAL SURGERY-GENERAL (CONTINUED) MINOR SURGICAL CLINIC SURGERY - NEURO SURGERY - ORAL SURGERY - PLASTIC SURGERY VASCULAR SURGERY VASCULAR (CONTINUED) SUTURE AND STAPLE REMOVAL ULTRASOUND URGENT CARE SERVICES

6 UROLOGY UROLOGY (CONTINUED) UROLOGY (CONTINUED) VARICOSE VEIN TREATMENT VNG TESTING WEIGHT MANAGEMENT PROGRAM WOUND CARE CLINIC X-RAYS (PLAIN FILMS) X-RAYS (UNABLE TO BE DONE AT FHCP)

7 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: 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. Member: 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. 7

8 8 FLORIDA HEALTH CARE PLANS OUTPATIENT REHABILITATION LOCATIONS Selection of facility is by residence location. Please call to schedule your initial appointment within one week of the date of the request. VOLUSIA COUNTY RESIDENTS ONLY Ability Health Services Deltona Ability Health Services - Titusville Ability Health Services - Daytona Beach 1565 Saxon Blvd., Suite S. Washington Ave., Suite Venture Blvd., Suite C Deltona, FL Titusville, FL South Daytona, FL Phone: (386) Phone: (321) Phone: (386) Fax: (386) Fax: (321) Fax: (386) Ability Health Services Longwood Ability Health Services Ormond Beach Ability Health Services Lake Mary 851 E. SR 434, Suite Clyde Morris Blvd., Suite S. International Pkwy., Suite 1321 Longwood, FL Ormond Beach, FL Lake Mary, FL Phone: (407) Phone: (386) Phone: (407) Fax: (407) Fax: (386) Fax: (407) Ability Health Services Sanford Ability Health Services Oviedo Professional Physical Therapy 1200 Lexington Green Lane 7400 Red Bug Lake Road Edgewater Sanford, FL Oviedo, FL S. Ridgewood Ave., Suite 1 Phone: (407) Phone: (407) Edgewater, FL Fax: (407) Fax: (407) Phone: (386) Fax: (386) ************************************************ Ability Health Services Altamonte Springs FLAGLER COUNTY RESIDENTS ONLY 652 Palm Springs Drive Palm Coast Sports Medicine and Rehabilitation Center Altamonte Springs, FL Old Kings Road, North Phone: (407) Palm Coast, Fl Fax: (407) Phone: (386) Fax: (386) ************************************************ /07-08RX

9 AFTER HOURS PRIMARY CARE FHCP Pediatric After Hours Walk-in Clinic Any member under the age of 19, regardless of PCP, may utilize the services of the walk-in clinic. FHCP After Hours Walk-in Clinic FHCP Adult After Hours Walk-in Clinic FHCP Pediatric After Hours Walk-in Clinic Pediatric Unscheduled Care Walk-in Clinic Anita Mathur, M.D. Preferred Medical Center- Holly Hill 1340 Ridgewood Ave., Holly Hill, FL Monday and Thursday 5 :00 PM TO 7 :00 PM Preferred Medical Center Port Orange 740 Dunlawton Avenue, Port Orange, FL Monday Thursday 5 :00 PM 7 :30 PM Preferred Medical Center Orange City 2777 Enterprise Rd., Orange City, FL Monday and Wednesday 5 :00 PM to 7 :00 PM Preferred Medical Center Orange City 2777 Enterprise Rd., Orange City, FL Monday Friday 5 :00 PM to 7 :00 PM 999 S. Volusia Ave., Suite B, Orange City, FL Wednesday until 6 :00 PM Please call to verify availability prior to your visit Twilight Pediatrics After Hours Walk-in Clinic 1688 W. Granada Blvd., Suite 1A, Ormond Beach, FL Monday Friday 5 :00 PM 9 :00 PM Saturday and Sunday 10:00 AM 3:00 PM CLOSED HOLIDAYS Twilight Pediatrics at Bert Fish Medical Center Under 17 years of age 386 / Fax: 386 / / / , Ext / , Ext / / Fax: 386 / Palmetto Street, New Smyrna Beach, FL / Fax: 386 / INSTRUCTIONS: Members will be charged the appropriate co-payment as listed in the co-payment section of the FHCP Member Handbook. FOR ADDITIONAL AFTER HOURS SERVICES SEE URGENT CARE SERVICES 9

10 ALLERGY FHCP HMO MEMBERS ASSIGNED TO PCP S IN EAST AND SOUTHEAST VOLUSIA COUNTY ARE PRE-APPROVED TO BE TREATED BY THIS PROVIDER Robert DiNicolo, M.D. # Infants and older Requires records prior to scheduling 353 N. Clyde Morris Blvd., Daytona Beach, FL / The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. For HMO members assigned to PCP s in the East and Southeast Volusia County who are requesting to see any other Allergy provider, a FHCP Referral form must be completed. Attach pertinent documentation to substantiate the request and forward by fax (386 / ) or courier, to FHCP s Central Referrals at the Daytona Beach 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. ALLERGY FHCP HMO MEMBERS ASSIGNED TO PCP S IN WEST VOLUSIA AND FLAGLER COUNTIES ARE PRE-APPROVED TO BE TREATED BY THIS PROVIDER Asthma & Allergy Specialists 890 N. Boundary Avenue, Suite 101, DeLand, FL Juan C. Mas, M.D. # Edward McLaughlin, M.D. # Shayna Zimmer, P.A.-C Patients 2 years and older 9 Pine Cone Drive, Ste. 105, Palm Coast, FL / Fax: 386 / / Fax: 386 / The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. For HMO members assigned to PCP s in the West Volusia and Flagler Counties who are requesting to see any other Allergy provider, a FHCP Referral form must be completed. Attach pertinent documentation to substantiate the request and forward by fax (386 / ) or courier, to FHCP s Central Referrals at the Daytona Beach 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. 10

11 ARTERIAL BLOOD GASES (ABG s) Halifax Health #00Y N. Clyde Morris Blvd., Daytona Beach, FL NO APPOINTMENT NECESSARY 386 / Fax: 386 / Bert Fish Medical Center #00Y Palmetto Street, New Smyrna Beach, FL / Fax: 386 / Florida Hospital DeLand #00YG W. Plymouth Ave., DeLand, FL / Fax: 386 / Florida Hospital Fish Memorial #00YG Saxon Blvd., Orange City, FL / Fax: 386 / Florida Hospital Flagler #00Y015 Outpatient Laboratory 60 Memorial Medical Parkway, Palm Coast, FL / Fax: 386 / The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. 11

12 BONE DENSITY STUDIES Florida Health Care Plans CENTRAL DEXA Patients 350 lbs. & under Preferred Medical Center Daytona Beach 350 N. Clyde Morris Blvd., Daytona Beach, FL / Ext Fax: 386 / The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. FHCP will cover this testing once every 24 months. BRACES / ORTHOTICS / PROSTETICS American Ortho Tech # Mason Avenue, Daytona Beach, FL Medical Center Dr., Ste., 101, Orange City, FL / Fax: 386 / / Fax: 386 / Dynasplint Systems 770 Ritchie Hwy., Suite #W21, Severna Park, MD / Hanger Prosthetics & Orthotics, Inc. Orthotic Spinal Devices Only 1400 Mason Ave., Suite C, Daytona Beach, FL A Enterprise Rd., Orange City, FL Fax: 866 / / Fax: 376 / / East 1st. Street, Sanford, FL Underwood Street, Orlando, FL San Marco Blvd., Jacksonville, FL S. 3 rd. Street, Jacksonville 407 / / / / INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / ) or courier, to FHCP s Central Referrals at the Daytona Beach 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. 12

13 DIABETIC SHOE PROVIDERS Atlantic Podiatry Associates All ages 790 Dunlawton Avenue, Suite C, Port Orange, FL LPGA Blvd., Suite 230, Daytona Beach, FL N. Stone St., DeLand, FL / Fax: 386 / / Fax: 386 / / Memorial Medical Parkway, Suite 3806, Palm Coast, FL 32164, FL Hanger Prosthetics & Orthotics, Inc Mason Ave., Suite C, Daytona Beach, FL A Enterprise Rd., Orange City, FL East 1st. Street, Sanford, FL Underwood Street, Orlando, FL San Marco Blvd., Jacksonville, FL S. 3 rd. Street, Jacksonville 386 / / Fax: 376 / / / / / / JSC Pedorthics, Inc. All ages 100 S. State Street, Suite D, Bunnell, FL / Fax: 386 / SuperMed, Inc. 525 Shadow Lakes Blvd., Ormond Beach, FL / Fax: 386 / Vienna Medical # Enterprise Rd., Suite 5, DeBary, FL / Fax: 386 / Additional Diabetic Shoe Provider information on the following page. 13

14 DIABETIC SHOE PROVIDERS (continued) 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-9-CM diagnosis codes ); 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. 14

15 CARDIAC CATHETERIZATION Halifax Health #00Y007 Out-patient Cardiac Cath. Lab 303 N. Clyde Morris Blvd., Daytona Beach, FL / Fax: 386 / Bert Fish Medical Center #00Y Palmetto Street, New Smyrna Beach, FL / Fax:: 386 / Central Florida Regional Hospital #Y West Seminole Blvd., Sanford, FL / Ext Florida Hospital - DeLand #00YG W. Plymouth Avenue, DeLand, FL / Fax: 386 / Florida Hospital - Fish Memorial #00YG Saxon Blvd., Orange City, FL / Fax: 386 / Florida Hospital Flagler #00Y Memorial Medical Parkway, Palm Coast, FL / Fax: 386 / Florida Hospital Ormond #00Y004 Out-patient Cardiac Cath. Lab 875 Sterthaus Drive, Ormond Beach, FL / Fax: 386 / 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 Pre-Admission/Pre-Operative Checklist Form. Fax the form to the FHCP s Central Referrals at the Daytona Beach facility 386 / Retain the Pink copy for your files. The Referral Department will review the request. The Cardiologist will be notified only if the procedure is not approved. 15

16 CARDIAC REHABILITATION Halifax Health #00Y N. Clyde Morris Blvd., 3 rd. Floor, Daytona Beach, FL / Fax: 386 / Bert Fish Medical Center #00Y Palmetto Street, New Smyrna Beach, FL / Fax: 386 / Central Florida Regional Hospital #Y West Seminole Blvd., Sanford, FL / Ext Florida Hospital - DeLand #00YG W. Plymouth Avenue, DeLand, FL / Fax: 386 / Florida Hospital - Fish Memorial #00YG Saxon Blvd., Orange City, FL / Fax: 386 / Florida Hospital Flagler #00Y Memorial Medical Parkway, Palm Coast, FL / Fax: 386 / Florida Hospital - Ormond #00Y Sterthaus Drive, Ormond Beach, FL / Fax: 386 / INSTRUCTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / ) or courier, to FHCP s Central Referrals at the Daytona Beach 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. 16

17 CARDIOLOGY Maria I. Lopez, M.D. #00003M Patrick McLaughlin, M.D. #00003V David Williams, M.D. # Richard Miller, A.R.N.P. #00005R Jimmy Wyatt, P.A. #00002G Patients 18 years and older Jacob K. Agamasu, M.D. # Patients 18 years and older Ratan Ahuja, M.D. # Robert Bianco, M.D. # Patients 18 years and older Chad Broome-Webster, M.D. # Marielle Lazard, M.D. #10A228 Francis A. Reed, Jr., M.D. # Oscar D. West, M.D. # Patients 18 years and older Chad Broome-Webster, M.D. # Marielle Lazard, M.D. #10A228 Oscar D. West, M.D. # Patients 18 years and older Mubeen Chida, M.D. # Tulio Sulbaran, M.D. # Patients 18 years and older Preferred Medical Center Daytona Beach Cardiology Department 350 N. Clyde Morris Blvd., Daytona Beach, FL / Fax: 386 / S. International Parkway, Suite 1481, Lake Mary, FL / Fax: 407 / Central Florida Cardiovascular Consultants 759 Harley Strickland Blvd., Orange City, FL S. International Parkway, Suite 1171, Lake Mary, FL / Fax: 386 / / Fax: Same as Orange City Consultative Cardiology 14 Office Park Drive, Ste. 1, Palm Coast, FL / Fax: 386 / Cardiology Consultants, P.A N. Stone Street, Suite B, DeLand, FL / Fax: 386 / Cardiology Consultants, P.A. 938 Saxon Blvd., Suite 101-C, Orange City, FL / Fax: 386 / Cardiovascular Specialists, P.A. 305 Mangoustine Ave., Suite 200, Sanford, FL Medical Center Drive, Suite 201, Orange City, FL / Fax: 407 / Additional Cardiology information on the following page. 17

18 CARDIOLOGY (continued) Ashraf Elsakr, M.D. # Sheryl Heath, A.R.N.P. # Nicole Wells, A.R.N.P.-C #10F775 Patients 18 years and older Gary D. Hecht, M.D. # Patients 18 years and older Rajendra Hippalgoankar, M.D. # Robert Rosemond, M.D. # Patients 18 years and older Eric Lo, M.D. # Patients 18 years and older Ravi Rao, M.D. #10E081 Surya Rao, M.D. #10E082 Patients 18 years and older Yogesh Shah, M.D. # Patients 18 years and older Advanced Cardiology 840 Dunlawton Avenue, Suite A, Port Orange, FL / Fax: 386 / Cardiology Associates of West Volusia, P.A W. New York Avenue, DeLand, FL / Central Florida Heart Associates, PA 932 Saxon Blvd., Suite A, Orange City, FL Medical Plaza Drive, Suite 106, Sanford, FL Live Oak Street, Suite C, New Smyrna Beach, FL Fax: 386 / / Fax: 386 / / Fax: 386 / / Fax: 386 / S. Ridgewood Ave., Pelican Plaza, Edgewater, FL Heartcare Center of Florida 600 Palmetto Street, Suite 1, New Smyrna Beach, FL / Fax : 386 / Live Oak Street, Suite A, New Smyrna Beach, FL S. Clyde Morris Blvd., Suite 1, Port Orange, FL / Fax: 386 / / Fax: 386 / PLEASE SEND RECENT EKG AND LABS. The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. 18

19 CARDIOLOGY - PEDIATRIC Robert S. Appleton, M.D. # Thomas P. Carson, M.D. # Patients newborn to 18 years Jorge Garcia, M.D. # Agustin Ramos, M.D. # Patients newborn to 18 years Thomas McLoughlin, M.D. # Patients newborn to 16 years Carson & Appleton, M.D. 311 N. Clyde Morris Blvd., Suite 320, Daytona Beach, FL / 800 / Fax: 407 / Pediatric Cardiology Consultants, P.A. 311 N. Clyde Morris Blvd., Suite 335, Daytona Beach, FL / 800 / Fax: 407 / N. Clyde Morris Blvd., Daytona Beach, FL / Fax: 386 / PLEASE SEND RECENT EKG AND LABS. The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. CASE MANAGEMENT DEPARTMENT The FHCP Case Management Department is a multidisciplinary team comprised of several members with a variety of foci. Office Coordinator Screens incoming calls and coordinates our initial departmental needs Admissions Coordinator Manages authorizations for members admitted to hospital and nursing homes Data Coordinator Assists both office and admission coordinators, maintains forms, correspondence and manage reporting data Case Management Nurses Review inpatient related clinical information and coordinate discharges as needed, both locally and out of area HHC Coordinator Reviews and monitors related clinical information as pertinent to Skilled HHC needs Complex Case Managers Coordinates resources for members with complex health needs including the CHF telescale and MTM programs Skilled Nursing Facility (SNF) Coordinator - Coordinates care and reviews clinical information for members during skilled stays in nursing facilities Outpatient Social Services Provider Coordinates outpatient member social service needs To access this department, please call the FHCP Holly Hill Facility at 386 / or by fax at 386 / For contact to assist with after hours needs, please call the FHCP Call Center at 386 /

20 CHIROPRACTIC Rebecca Bruno, D.C. # Linda Lombardo, D.C. # Lorra Nuzum, D.C. # Roy Carlisi, D.C. # Michelle Gingras, D.C. # Infants and older James Jeremy Hether, D.C All ages Matt R. Nirschl, D.C. # Blaine O Neal, D.C. # Lawrence Petker, D.C. # Vivian I. Solivan, D.C. #10A363 All ages Lombardo Chiropractic Clinic, PA 1400 Hand Ave., Suite S, Ormond Beach, FL / Fax: 386 / Carlisi Chiropractic Center 1400 E. Moody Blvd., State Road 100, Bunnell, FL / Fax: 386 / Third Avenue, New Smyrna Beach, FL / Fax: Same as phone 2719 S. Woodland Blvd., DeLand, FL / Fax: 386 / N. Clyde Morris Blvd., Daytona Beach, FL / Fax: 386 / Patrick Reed, D.C. # All ages Patrick Reed, D.C., P.A East Highway 100, Suite G4, Bunnell, FL / Fax: Same as phone Edward Siarkowicz, D.C. # Old Kings Road, N., Suite 30A, Palm Coast, FL / Fax: Same as phone Trudi Vogel, D.C. # All ages 1780 S. Nova Road, Suite 4, South Daytona, FL / Fax: 386 / INSTRUCTIONS: Member can call and schedule an appointment with this provider directly without any paperwork being completed. 20

21 COLONOSCOPY / SCREENING Beatrice Bratu, M.D. # Ammar Hemaidan, M.D. # Saud El-Sayed Suleiman, M.D. # Ahmed Shobassy, M.D. #00008A Hassan Zulfiqar, M.D. # David F. Elijah, M.D. # Paul B. Goldberg, M.D. # Bharat C. Patel, M.D. #00451 Martin Gino F. Prado, M.D. # Advanced GI 1690 Dunlawton Ave., Suite 210, Port Orange, FL Twin Lakes Medical Center 1890 LPGA Blvd., Suite 270, Daytona Beach, FL / Fax: 386 / All appointment scheduling will be through the Port Orange office Digestive Health Specialists, P.A N. Stone Street, Suite D, DeLand, FL / Fax: 386 / Kalyani Gaddipati, M.D. # Rinehart Road, Suite 2051, Lake Mary, FL Junior Street, Orange City, FL / Fax: 407 / Vishal Gupta, M.D. # Lenkala Mallaiah, M.D. # Felix A. Navarrro, Jr., M.D. # Nitin Parikh, M.D. # All appointment scheduling through the Lake Mary office. 793 Healthcare Drive, Orange City, FL Suite 102, Orange City, FL Mid-Florida Gastroenterology Group, P.A Saxon Blvd., Suite 203, Deltona, FL N. Mangoustine Ave., Sanford, FL / Fax: 386 / / Fax: 386 / / Fax: 407 / Gastroenterology & Liver Consultants, P.A Medical Plaza Dr., Suite 206, Sanford, FL / Fax: 407 / Central Florida Gastroenterology, P.A Medical Center Dr., Suite 251, Orange City, FL / Fax: 386 / INSTRUCTIONS: Member can call and schedule an appointment with this provider directly without any paperwork being completed. A Screening Colonoscopy is recommended every 10 years starting at the age of fifty. 21

22 CT SCANS Bert Fish Medical Center #00Y Palmetto Street, New Smyrna Beach, FL / Fax: 386 / Central Florida Regional Hospital Y West Seminole Blvd., Sanford, FL / Florida Hospital - DeLand #00YG W. Plymouth Avenue, DeLand, FL / Fax: 386 / Florida Hospital Fish Imaging #00YG Medical Center Drive, Suite 151, Orange City, FL Centralized scheduling 386 / / Fax: 386 / Florida Hospital - Fish Memorial #00YG Saxon Blvd., Orange City, FL Centralized scheduling 386 / / Fax: 386 / Florida Hospital Flagler #00Y Memorial Medical Parkway, Palm Coast, FL / Fax: 386 / Florida Hospital Imaging, LLC # Clyde Morris Blvd., Ormond Beach, FL / Fax: 386 / LAD Imaging, LLC # Saxon Blvd., Bldg. 4, Suite 401, Deltona, FL S. Woodland Blvd., DeLand, FL / Fax: 386 / / Fax: 386 / Palm Coast Imaging Center # Pine Cone Drive, Ste. 101, Palm Coast, FL / Fax: 386 / Port Orange Imaging Center #F00002 Open MRI Unit also available 1195 Dunlawton Avenue, Port Orange, FL / Fax: 386 / St. Augustine Imaging Center #F Southpark Blvd., Suite 101, St. Augustine, FL / Fax: 904 / Suncoast Imaging of Port Orange # MRI s, MRA s and CTA s Only 1680 Dunlawton Ave., Port Orange, FL / Fax: 386 / Town Center Imaging #F Hospital Drive, Palm Coast, FL / Fax: 386 / The FHCP member or requesting provider may call the specialist to schedule an appointment. The specialty office will advise you of their scheduling protocol. Additional CT Scan information on the following page. 22

23 CT SCANS (continued) Twin Lakes Imaging Center #F00001 Stand-up MRI Unit also available 1890 LPGA Blvd., Suite 110, Daytona Beach, FL / Fax: 386 / Ultrasound Unlimited, Inc. #00SA97 14 Office Park Drive, Ste. 5, Palm Coast, FL / Fax: 386 / 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 Stereotactic Breast Biopsy Sestamibi Scan Ultrasound Guided Needle Breast Biopsy CT Colonography (Virtual Colonoscopy) Pill Cam Genetic Testing PET SCAN (PCP s ordering PET SCANS must have prior authorization) INSTRUCTIONS FOR EXCEPTIONS: Complete the FHCP Referral Form. Attach pertinent documentation to substantiate the request and forward by fax (386 / ) or courier, to FHCP s Central Referrals at the Daytona Beach 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. 23

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