-Listing of s- CORAL GABLES SPECIALTY PHYSICIANS "UHZ" SPORTS MEDICINE PRACTICE Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San Completed- -In Process Incomplete / Non- # 63-1071721 63-1071721 63-1071721 63-1071721 Group # 26-0886056 26-0886056 26-0886056 26-0886056 26-0886056 MEDICAL LICENSE EFFECTIVE / EXPIRATION DATE BOARD CERTIFICATION CAQH STATUS 02/03/1978 Exp. 01/31/2012 10/27/2011 10/25/1984 Exp. 01/31/2012 12/25/09 06/14/1989 Exp. 1/31/2012 12/02/09 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 # 7800053 5/20/11 #225842 #225848 #225845 #262298 #321273 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 #47139 5/21/09 with CGSP # 65006 9/1/11 7/1/11 # 7009326 Medica Commercial HMO 12/1/10 12/1/10 12/1/10 1/1/11 Credentialing Eff 10/31/2011
-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 # 60079 #63526 #31098 # United HealthCare of Florida Coventry Health Care of Florida (formerly Vista Health Plan HMO) #445336 Negotiation #1139456 Negotiation #1139483 Negotiation 1/26/10 #2010724 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 # 7800053 12/3/10 5/20/11 #225842 #225848 #225845 #262298 #321273 AvMed Select Plus #225842 #225848 #225845 #262298 #321273 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) # 607570 #75023 # 607571 # 1470309 under under under #47139 # 65006 9/1/11 2
-Listing of s- Blue Cross Blue Options (a/k/a Network Blue) Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San under under under under # 65006 9/1/11 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 #1035588 4/16/09 4/20/09 4/23/09 5/21/09 7/1/11 # 7009326 Dimension Health Network 3/31/09 3/31/09 2/28/09 3/31/09 #12021 5/31/11 First Health Humana PPO/EPO/POS 5/1/09 #1035588 Multiplan credentialing 1/1/10 6/4/11 Tricare Standard 1/26/10 10/11/11 3
-Listing of s- Dr. Uribe Dr. Hechtman Dr. Zvijac Dr. San United HealthCare of Florida 7/21/11 #445336 #1139456 #1139483 #2010724 # MEDICARE AvMed (HMO and PPO) #225842 #225848 #225845 #262298 #321273 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 # 65006 9/1/11 credentialing 01/1/11 Eff 10/31/2011 Non- Non- Non- Non- Non- Non- Non- Beechstreet # 607570 # 75023 4 # 607571 # 1470309 Non-
Coventry/First health Heritage Summit 10/1/2007 06-01-2009 02-28-2009 06-01-2009 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, 2011 5/31/11 5