Overview -Listing of Provider Agreements-
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1 -Listing of s- CORAL GABLES SPECIALTY PHYSICIANS "UHZ" SPORTS MEDICINE PRACTICE Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San Completed- -In Process Incomplete / Non- # Group # MEDICAL LICENSE EFFECTIVE / EXPIRATION DATE BOARD CERTIFICATION CAQH STATUS 02/03/1978 Exp. 01/31/ /27/ /25/1984 Exp. 01/31/ /25/09 06/14/1989 Exp. 1/31/ /02/09 04/02/1999 Exp. 01/31/2013 3/28/11 04/03/08 Exp. 01/31/12 3/21/11 HMO Plans Aetna 10/1/10 10/1/10 10/1/10 12/3/10 12/3/10 AvMed Health Plan # /20/11 # # # # # Blue Care HMO (formerly Health Options) Cigna Healthcare Humana HMO under 4/16/09 with CGSP under 4/20/09 with CGSP under 4/23/09 with CGSP # /21/09 with CGSP # /1/11 7/1/11 # Medica Commercial HMO 12/1/10 12/1/10 12/1/10 1/1/11 Credentialing Eff 10/31/2011
2 -Listing of s- Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San Neighborhood Health tnership (an affiliate of United HealthCare) 7/21/11 Tricare Prime #25121 # #63526 #31098 # United HealthCare of Florida Coventry Health Care of Florida (formerly Vista Health Plan HMO) # Negotiation # Negotiation # Negotiation 1/26/10 # Negotiation 10/11/11 7/21/11 # Negotiation Coventry Health Plan of Florida (formerly Vista South Florida HMO) PPO/POS Plans Negotiation Negotiation Negotiation Negotiation Negotiation Aetna AvMed Classic Plus 10/1/10 10/1/10 10/1/10 12/3/10 # /3/10 5/20/11 # # # # # AvMed Select Plus # # # # # Beech Street 10/1/07 06/01/09 02/28/09 06/01/09 Non-contracted Blue Cross/Blue Shield of Florida (PPC and Traditional) # #75023 # # under under under #47139 # /1/11 2
3 -Listing of s- Blue Cross Blue Options (a/k/a Network Blue) Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San under under under under # /1/11 Coventry One f/k/a Vista Health Plan PPO 5/1/09 Coventry Healthcare of Florida f/k/a Vista Health Plan 5/1/09 CIGNA Health Care # /16/09 4/20/09 4/23/09 5/21/09 7/1/11 # Dimension Health Network 3/31/09 3/31/09 2/28/09 3/31/09 # /31/11 First Health Humana PPO/EPO/POS 5/1/09 # Multiplan credentialing 1/1/10 6/4/11 Tricare Standard 1/26/10 10/11/11 3
4 -Listing of s- Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San United HealthCare of Florida 7/21/11 # # # # # MEDICARE AvMed (HMO and PPO) # # # # # Blue Medicare HMO (HMO Only) Humana Gold Plus (HMO Only) Medicare Medica Medicare HMO Coventry Healthcare f/k/a Vista South Florida Medicare HMO Coventry Healthcare f/k/a Vista Medicare HMO Worker s Comp CorVel Dimension under 12/1/10 under 12/1/10 under Group PTAN 12/1/10 under 01/1/11 # /1/11 credentialing 01/1/11 Eff 10/31/2011 Non- Non- Non- Non- Non- Non- Non- Beechstreet # # # # Non-
5 Coventry/First health Heritage Summit 10/1/ Non- Non- Non- Non- Non- Non- Non- Non- Non- International CMN 6/15/10 6/15/10 6/15/10 6/15/10 6/15/10 Dimension International HAA QHM Updated November 2, /31/11 5
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