Blue Medicare Advantage PPO Contracted Providers

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Appendix D Blue Medicare Advantage PPO Contracted Providers Ambulatory Surgicenters... 2 Durable Medical Equipment... 3 Hearing Aid 5 Home Health Care.. 6 Home Infusion 8 Hospice... 9 Inpatient Metro Hospitals 10 Mental Health 12 Orthotic & Prosthetic. 13 Hospital Based Outpatient Surgery 15 Renal Dialysis 17 Skilled Nursing Facilities.. 22 Rev. 09/20/16 Division of Healthcare Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP SURGICENTER 05/01/16 APOLLO SURGICAL CENTER LLC 2750 S RIVER RD DES PLAINES IL 60018-4103 (847) 385-0700 A 6/1/2016 SURGICENTER 04/01/15 DUPAGE EYE SURGERY CENTER LLC 2015 N MAIN ST WHEATON IL 60187-3152 (630) 665-3690 SURGICENTER 02/01/16 ELMHURST OUTPATIENT SURGERY CTR 1200 S YORK RD ELMHURST IL 60126-5626 (630) 758-8800 SURGICENTER 06/01/16 FULLERTON SURGERY CENTER 4849 W FULLERTON AVE CHICAGO IL 60639-2503 (773) 237-2900 A 6/1/2016 SURGICENTER 05/01/15 GLEN ENDOSCOPY CENTER LLC 2551 COMPASS RD GLENVIEW IL 60026-8042 (800) 590-2713 SURGICENTER 10/01/15 GOLF SURGICAL CENTER 8901 GOLF RD DES PLAINES IL 60016-6850 (847) 299-2273 SURGICENTER 05/01/15 HOFFMAN ESTATES SURGERY CNTR LLC 1555 BARRINGTON RD HOFFMAN IL 60169-1019 (847) 519-1600 SURGICENTER 07/01/15 MIDWEST CENTER FOR DAY SURGERY 3811 HIGHLAND AVE DOWNERS IL 60515-1555 (630) 852-9300 SURGICENTER 07/01/15 NAPERVILLE SURGICAL CENTRE LLC 1263 RICKERT DR NAPERVILLE IL 60540-0954 (630) 305-3300 SURGICENTER 01/01/15 NORTHWEST COMM DAY SURG CTR II 675 W KIRCHHOFF RD ARLINGTON IL 60005-2371 (847) 618-7060 SURGICENTER 05/01/15 OAK LAWN ENDOSCOPY 9921 SOUTHWEST HIGHWAY OAK LAWN IL 60453-3754 (708) 499-5678 SURGICENTER 07/01/15 PALOS HILLS SURGERY CENTER LLC 10330 S ROBERTS RD PALOS HILLS IL 60465-1999 (708) 237-7290 SURGICENTER 10/01/15 PALOS SURGI CENTER LLC 7340 COLLEGE DR PALOS HEIGHTS IL 60463-1159 (708) 361-3233 SURGICENTER 05/01/15 THE LAKE BLUFF IL ENDOSCOPY ASC 101 S WAUKEGAN RD LAKE BLUFF IL 60044-3013 (847) 604-8700 SURGICENTER 07/01/15 TINLEY WOODS SURGERY CENTER 18200 S LAGRANGE RD TINLEY PARK IL 60487-7721 (708) 570-2490 SURGICENTER 08/01/15 TRI CITIES SURGERY CENTER LLC 345 DELNOR DR GENEVA IL 60134-4220 (630) 262-8100 SURGICENTER 05/01/16 UNITED SHOCKWAVE SERVICES LTD 120 N LAGRANGE RD LAGRANGE IL 60525-2040 (708) 352-6666 A 8/1/2016 SURGICENTER 08/01/16 VALLEY AMBULATORY SURGERY CENTER 2210 DEAN ST ST CHARLES IL 60175-1066 (630) 584-9800 A 9/1/2016 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 2

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP DME 03/01/16 APRIA HEALTHCARE INC 1015 W DEITWEILLER DR PEORIA IL 61615-2064 (309) 691-1012 DME 08/01/15 ARMOR MED SUPPLY LLC CHCAGO SOUTH 16643 S KEDZIE MARKHAM IL 60428-5512 (708) 331-7111 DME 09/01/15 BASINGERS PHARMACY 2130 W JEFFERSON ST JOLIET IL 60435-6622 (815) 725-1102 DME 01/01/14 BYRAM HEALTHCARE INC 3010 WOODCREEK DR DOWNERS IL 60515-5415 (800) 681-1395 DME 05/01/16 COMPLIANT SLEEP SOLUTIONS CONVERG 7501 LEMONT RD WOODRIDGE IL 60517-2681 (630) 324-5370 A 6/1/2016 DME 02/01/16 DJ O LLC 599 CARDIGAN RD SAINT PAUL MN 55126-3965 (800) 328-2536 DME 01/01/14 DOUBEK MEDICAL SUPPLY INC 11350 S CICERO AVE ALSIP IL 60803-2830 (708) 293-1122 DME 08/01/15 EMPI INC 599 CARDIGAN RD SAINT PAUL MN 55126-3965 (800) 328-2536 DME 08/01/15 FITZSIMMONS SURGICAL SUPPLY 8000 W 186TH ST TINLEY PARK IL 60487-9215 (708) 532-1199 DME 09/01/15 HEALTH TECHNOLOGY RESOURCES 1400 E LAKE COOK RD BUFFALO IL 60089-8219 (847) 947-8044 DME 01/01/15 HOVEROUND CORPORATION 241 S FRONTAGE RD BURR RIDGE IL 60527-4400 (800) 701-5781 DME 09/01/15 ILLINOIS SLEEP PROVIDER 8736 W OGDEN AVE LYONS IL 60534-1060 (708) 442-9800 DME 03/01/16 LEHAN DRUG INC 1407 S 4TH ST DEKALB IL 60115-4605 (815) 758-0911 DME 01/01/14 LINCARE INC 1701 HOWARD ST ELK GROVE IL 60007-2483 (847) 806-8080 DME 01/01/14 LINCARE INC 700 N HENERIETTA ST EFFINGHAM IL 62401-1720 (217) 347-7002 DME 01/01/14 MARK DRUG 548A W DUNDEE RD WHEELING IL 60090-2608 (847) 537-8500 DME 08/01/15 MCKESSON PATIENT CARE SOLUTIONS 140 EX BLVD GLENDALE IL 60139-2089 (856) 273-9900 DME 05/01/16 MEDLINE INDUSTRIES INC 1 MEDLINE PL MUNDELEIN IL 60060-4485 (866) 356-4997 A 8/1/2016 DME 08/01/15 MERIT SLEEP TECHNOLOGIES INC 1300 S MAIN ST LOMBARD IL 60148-4526 (630) 652-7900 DME 05/01/15 MINI MED DIST CORP 3725 25TH AVE SCHILLER PARK IL 60176-2147 (800) 341-3849 DME 01/01/15 MOBILITY SYSTEMS SOLUTIONS INC 9755 S 78TH AVE HICKORY HILLS IL 60457-2301 (708) 599-3500 DME 02/01/15 NATIONAL SEATING AND MOBILITY INC 85 EISENHOWER LN SOUTH LOMBARD IL 60148-5409 (630) 495-3751 DME 02/01/15 NATIONAL SEATING AND MOBILITY INC 3808 W SPRINGFIELD AVE CHAMPAIGN IL 61822-8806 (217) 355-1399 DME 02/01/15 NATIONAL SEATING AND MOBILITY INC 4209 PFIEFFER RD BARTONVILLE IL 61607-2812 (866) 740-3252 DME 02/01/15 NATIONAL SEATING AND MOBILITY INC 11551 S RIDGELAND AVE ALSIP IL 60803-2409 (708) 361-7060 DME 08/01/16 OPTION HEALTH LTD 985 AVE OF THE CITIES SILVIS IL 61282-7001 (309) 792-7200 A 9/1/2016 DME 01/01/16 ORBIT MED OF NAPERVILLE INC 1701 QUINCY AVE NAPERVILLE IL 60540-3955 (630) 544-5381 DME 01/01/16 ORBIT MEDICAL OF CHICAGO INC 1419 W CARROLL AVE CHICAGO IL 60607-1105 (866) 565-2375 DME 12/01/15 ORTHOFIX INC 875 N MICHIGAN AVE CHICAGO IL 60611-1962 (800) 527-0404 DME 06/01/16 PACIFIC PULMONARY SERVICES 4511 N KEDZIE AVE CHICAGO IL 60625-4510 (773) 477-8802 A 8/1/2016 DME 06/01/16 PACIFIC PULMONARY SERVICES 1521 WRIGHT BLVD SCHAUMBURG IL 60193-4509 (847) 895-4834 A 8/1/2016 DME 06/01/16 PACIFIC PULMONARY SERVICES 1551 E 91ST DR MERRILLVILLE IN 46410-7177 (219) 736-5828 A 8/1/2016 DME 06/01/16 PACIFIC PULMONARY SERVICES 2201 W TOWNLINE RD PEORIA IL 61615-1565 (309) 693-0375 A 8/1/2016 DME 06/01/16 PACIFIC PULMONARY SERVICES 9935 S 76TH AVE BRIDGEVIEW IL 60455-2452 (708) 599-7339 A 8/1/2016 DME 06/01/16 PACIFIC PULMONARY SERVICES 3384 N PUBLISHERS ROCKFORD IL 61109-6334 (815) 874-1314 A 8/1/2016 DME 02/01/15 PATIENTS CHOICE 625 W UNIVERSITY DR ARLINGTON IL 60004-1826 (847) 818-9088 DME 01/01/16 PREMIER MEDICAL PRODUCTS INC 1701 QUINCY AVE NAPERVILLE IL 60540-6689 (630) 420-0308 DME 01/01/14 REHABTECH SUPPLY CORPORATION 655 W GRAND AVE ELMHURST IL 60126-1061 (888) 800-9445 DME 01/01/14 RGH ENTERPRISES INC DBA EDGEPARK 1360 MADELINE LN ELGIN IL 60124-8835 (800) 307-5930 DME 05/01/16 SIONA HEALTH CARE PRODUCTS INC 5011 N LINCOLN AVE CHICAGO IL 60625-2611 (773) 907-0680 A 6/1/2016 DME 01/01/15 SLEEP RX LLC 7536 N ST LOUIS SKOKIE IL 60076-4034 (847) 676-4138 DME 08/01/15 SLEEPMED THERAPIES INC 2357 HASSELL ROAD HOFFMAN IL 60169-2172 (847) 490-9309 3

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP DME 05/01/15 THH ACQUISITION LLC I 780 S MCLEAN BLVD ELGIN IL 60123-6710 (847) 931-9300 DME 01/01/14 UNITED SEATING AND MOBILITY LLC 335 EISENHOWER LN S LOMBARD IL 60148-5406 (630) 424-0330 DME 01/01/15 WALGREEN MEDICAL SUPPLY LLC 18861 90TH AVE MOKENA IL 60448-8036 (888) 410-5779 DME 01/01/15 WALGREENS HOME CARE INC 4721 135TH ST CRESTWOOD IL 60445-1404 (800) 323-2828 DME 09/01/15 WOUND CARE SOLUTIONS INC 2003 W FULTON ST CHICAGO IL 60612-2345 (312) 738-2330 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 4

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP HEARING AID SUPPLIER 01/01/15 TRU HEARING INC 5 REVERE DR NORTHBROOK IL 00006-0662 (773) 870-6763 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 5

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP HOME HEALTH CARE 09/01/15 A 2 Z HEALTHCARE SERVICE LLC 15347 70TH CT ORLAND PARK IL 60462-5156 (708) 332-9070 HOME HEALTH CARE 03/01/15 ABCOR HOME HEALTH INC 3201 N WILKE RD ARLINGTON IL 60004-1437 (847) 670-8424 HOME HEALTH CARE 04/01/16 ACE HEALTH CARE SERVICES LLC 4731 W MIDLOTHIAN TURNPIKE CRESTWOOD IL 60445-1990 (708) 926-9137 HOME HEALTH CARE 04/01/16 ADDUS HEALTHCARE 20280 GOVERNORS HWY OLYMPIA IL 60461-1076 (708) 283-4240 HOME HEALTH CARE 07/01/16 ADVANTAGE HOME HEALTH CARE INC 425 E US ROUTE 6 MORRIS IL 60450-9042 (815) 467-1905 A 8/1/2016 HOME HEALTH CARE 03/01/16 ALC HOME HEALTH CARE INC 477 E BUTTERFIELD RD LOMBARD IL 60148-4881 (630) 368-1102 A 6/1/2016 HOME HEALTH CARE 03/01/15 ALEXIAN BROTHERS HOME HEALTH AGE 1515 E LAKE ST HANOVER PARK IL 60133-7152 (847) 437-5500 HOME HEALTH CARE 02/01/16 ALL FAMILY HEALTH CARE INC 6413 N KINZUA AVE CHICAGO IL 60646-2853 (773) 775-2588 HOME HEALTH CARE 01/01/15 ALL QUALITY HOME HEALTH CARE LLC 395 E DUNDEE RD WHEELING IL 60090-7017 (224) 676-1470 HOME HEALTH CARE 03/01/15 AMEDISYS HOME HEALTH 765 ELA RD LAKE ZURICH IL 60047-2339 (847) 643-8480 HOME HEALTH CARE 03/01/15 AMEDISYS ILLINOIS OF TINLEY PARK 18450 CROSSING DR TINLEY PARK IL 60487-9279 (708) 532-3324 HOME HEALTH CARE 02/01/16 AMERICHOICE HEALTH CARE INC 950 SKOKIE BLVD NORTHBROOK IL 60062-4018 (847) 714-9787 HOME HEALTH CARE 05/01/15 ANGEL HEALTH CARE LLC 2625 BUTTERFIELD RD OAK BROOK IL 60523-1275 (847) 510-5905 HOME HEALTH CARE 08/01/16 ANREX HEALTHCARE INC 6200 N HIAWATHA CHICAGO IL 60646-4314 (773) 285-1000 A 9/1/2016 HOME HEALTH CARE 03/01/16 AT HOME HEALTH INC 3344 W PETERSON AVE CHICAGO IL 60659-3533 (773) 279-9244 HOME HEALTH CARE 03/01/15 ATNT HOME HEALTH CARE INC 10719 WINTERSET DR ORLAND PARK IL 60467-1106 (708) 364-7298 HOME HEALTH CARE 02/01/16 AUXILIUM HEALTHCARE SERVICES 129 FAIRFIELD WAY BLOOMINGDAL IL 60108-1557 (224) 765-0100 HOME HEALTH CARE 09/01/15 AWESOME HOME HEALTH CARE 10540 S WESTERN AVE CHICAGO IL 60643-2540 (773) 840-3386 HOME HEALTH CARE 03/01/16 BETTER CHOICE HOME HEALTH INC 7250 N CICERO AVE LINCOLNWOOD IL 60712-1643 (847) 677-7000 HOME HEALTH CARE 04/01/16 BG HOME HEALTH PROVIDERS LLC 133 W RAND ROAD ARLINGTON IL 60004-3142 (847) 656-5035 HOME HEALTH CARE 06/01/16 CARELINK HOME HEALTH LLC 33 W HIGGINS RD SOUTH IL 60010-9121 (847) 426-0300 A 6/1/2016 HOME HEALTH CARE 07/01/16 CARESS HOME HEALTH CARE INC 3917 HOWARD STREET SKOKIE IL 60076-3778 (847) 674-7102 A 9/1/2016 HOME HEALTH CARE 05/01/16 CHICAGOLAND HOME HLTH PROV INC 2604 DEMPSTER ST PARK RIDGE IL 60068-8429 (847) 296-3950 A 6/1/2016 HOME HEALTH CARE 08/01/15 CHOICECARE HOME HEALTH INC 6400 W COLLEGE DR PALOS HTS IL 60463-1789 (708) 489-0123 HOME HEALTH CARE 03/01/15 COMPLETE HOME HEALTH SERVICES INC 16234 PRINCE DR SOUTH IL 60473-3233 (708) 333-1700 HOME HEALTH CARE 06/01/15 DIRECT HOME HEALTHCARE INC 4001 W DEVON AVE CHICAGO IL 60646-4538 (773) 777-9271 HOME HEALTH CARE 03/01/15 DIVINE INTERVENTION HLTHCARE INC 4747 LINCOLN MALL DR MATTESON IL 60443-3817 (708) 248-7662 HOME HEALTH CARE 06/01/16 EVERGREEN HOME HEALTHCARE 6069 DEMPSTER ST MORTON IL 60053-2943 (847) 583-8998 A 8/1/2016 HOME HEALTH CARE 04/01/15 FAMILY HOME HEALTH SERVICES INC 2171 EXECUTIVE DR ADDISON IL 60101-5610 (630) 317-3300 HOME HEALTH CARE 08/01/15 FIRST HOME HEALTH CARE SERVICES 14730 KILBOURN MIDLOTHIAN IL 60445-3392 (708) 535-8609 HOME HEALTH CARE 11/01/15 GENTLE PRO HOME HEALTH CARE INC 2060 E ALGONQUIN RD SCHAUMBURG IL 60173-4162 (847) 593-3750 HOME HEALTH CARE 11/01/15 GOVVAS HEALTHCARE SERVICES INC 670 N 1ST BANK DR PALATINE IL 60067-8112 (847) 496-4715 HOME HEALTH CARE 02/01/15 GUARDIAN HOME HEALTH CARE LLC 181 WAUKEGAN RD NORTHFIELD IL 60093-2700 (847) 441-5020 HOME HEALTH CARE 05/01/15 HANDS OF WELLNESS INC 1062 SIBLEY BLVD CALUMET CITY IL 60409-2413 (708) 832-2228 HOME HEALTH CARE 06/01/15 HEALTHTRENDS LTD 200 E HOWARD AVE DES PLAINES IL 60018-5909 (847) 803-0774 HOME HEALTH CARE 09/01/15 HOME CARE LIT CO OF MARY HOSP 2800 W 95TH ST EVERGREEN IL 60805-2701 (708) 229-4663 HOME HEALTH CARE 07/01/16 HOME HEALTH CHOICE INC 8308 N LINCOLN AVE SKOKIE IL 60077-2436 (847) 568-0900 A 8/1/2016 HOME HEALTH CARE 02/01/16 INTEGRATED HOME HEALTHCARE SRVCS 900 TECHNOLOGY WAY LIBERTYVILLE IL 00006-0048 (847) 549-0588 HOME HEALTH CARE 01/01/14 INTERIM HEALTHCARE 10735 S CICERO OAK LAWN IL 60453-6210 (708) 422-2934 HOME HEALTH CARE 02/01/15 KINDRED AT HOME CHICAGO HOME HLTH 7101 N CICERO AVE LINCOLNWOOD IL 60712-2112 (847) 972-1590 HOME HEALTH CARE 01/01/15 LEXINGTON HOME HEALTH CARE INC 1300 S MAIN STREET LOMBARD IL 60148-4526 (630) 748-3700 HOME HEALTH CARE 06/01/15 LIFECARE HOME HLTH SERVICES INC 3400 DUNDEE RD NORTHBROOK IL 60062-2365 (847) 205-4444 6

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP HOME HEALTH CARE 10/01/15 MIRANDA HOME HEALTHCARE 19150 S KEDZIE AVE FLOSSMOOR IL 00006-0422 (708) 922-3710 HOME HEALTH CARE 01/01/15 NORTHWEST COMM HOSP HOME CARE 3060 SALT CREEK LANE ARLINGTON IL 60005-5027 (847) 618-1000 HOME HEALTH CARE 04/01/16 NORTHWESTERN ILLINOIS HOME HEALTH 151 TENNEY ST KEWANEE IL 61443-3447 (309) 623-4022 HOME HEALTH CARE 01/01/14 NORTHWESTERN MED HOME HLTH HOSPIC 690 E NORTH AVE CAROL STREAM IL 60188-2172 (630) 665-7000 HOME HEALTH CARE 01/01/15 O AND P HOME HEALTH CARE INC 4950 MAIN ST SKOKIE IL 60077-5205 (847) 329-7050 HOME HEALTH CARE 10/01/15 PALOS COMMUNITY HOSP HOME HEALTH 15295 E 127TH ST LEMONT IL 60439-8410 (630) 257-1111 HOME HEALTH CARE 01/01/15 PEAK HOME HLTHC DBA NEWSOME HOME 920 ESSINGTON RD JOLIET IL 60435-2859 (815) 744-4770 HOME HEALTH CARE 09/01/15 PHOENIX HOME CARE LLC 200 S FRONTAGE RD BURR RIDGE IL 60527-6953 (630) 321-9400 HOME HEALTH CARE 09/01/15 PREMIER POINT HOME HEALTH NFP 4701 N SHERIDAN RD CHICAGO IL 60640-5021 (773) 275-8390 HOME HEALTH CARE 01/01/14 PRIVATE HOME CARE UNLIMITED 5517 N CUMBERLAND CHICAGO IL 60656-4740 (773) 467-6000 HOME HEALTH CARE 06/01/16 PRUDENT CHOICE HOME HLTH CARE COR 1699 E WOODFIELD RD SCHAUMBURG IL 60173-4958 (847) 972-1028 A 8/1/2016 HOME HEALTH CARE 08/01/16 RESILIENCE HOME HEALTH CORP 31 KENDALL POINT DR OSWEGO IL 00006-0543 (630) 236-8800 A 9/1/2016 HOME HEALTH CARE 07/01/16 SERENITY HOME HEALTHCARE 6677 N LINCOLN AVE LINCOLNWOOD IL 60712-3634 (773) 588-4000 A 8/1/2016 HOME HEALTH CARE 06/01/15 SHAY HEALTHCARE SERVICES 5730 W 159TH ST OAK FOREST IL 60452-3163 (708) 535-4300 HOME HEALTH CARE 01/01/15 SILVER CROSS HOME HEALTH 1900 SILVER CROSS BLVD NEW LENOX IL 60451-9509 (815) 300-1100 HOME HEALTH CARE 03/01/16 SOLARIS HOME HEALTHCARE INC 3330 DUNDEE RD NORTHBROOK IL 60062-2329 (847) 701-2243 HOME HEALTH CARE 05/01/15 STAR HOME HEALTH SERVICES INC 8130 1/2 SOUTH KEDZIE CHICAGO IL 60652-2605 (773) 498-8943 HOME HEALTH CARE 05/01/15 TOTAL HOME HEALTHCARE 4001 WEST DEVON CHICAGO IL 60646-4540 (773) 853-2641 HOME HEALTH CARE 01/01/15 URBAN HEALTH LLC 224 S MILWAUKEE AVE WHEELING IL 60090-5006 (312) 292-6397 HOME HEALTH CARE 01/01/15 VANGUARD HEALTH AND WELLNESS 1585 ELLINWOOD AVE DES PLAINES IL 60016-4510 (855) 438-2431 HOME HEALTH CARE 07/01/15 WHOLE LIFE HOME HEALTH 7501 N MILWAUKEE AVE NILES IL 60714-3610 (847) 588-2111 HOME HEALTH CARE 03/01/16 WOUND AND REHAB HM HLTH CARE INC 700 BUSSE HIGHWAY PARK RIDGE IL 60068-2402 (847) 692-6000 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 7

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP HOME INFUSION 01/01/14 CENTRAL DUPAGE SPECIAL HLTH ASSOC 690 E NORTH AVE CAROL STREAM IL 60188-2172 (630) 933-7777 HOME INFUSION 06/01/16 IV SOLUTIONS LLC 420 LAKE COOK RD DEERFIELD IL 60015-4914 (847) 945-4444 A 6/1/2016 HOME INFUSION 01/01/14 METRO INFECTIOUS DISEASE CONSULTS 901 MCCLINTOCK DR BURR RIDGE IL 60527-0872 (630) 654-4201 HOME INFUSION 01/01/15 OPTION CARE ENTERPRISES 2050 S FINLEY RD LOMBARD IL 60148-4837 (630) 495-2777 HOME INFUSION 08/01/16 OPTION HEALTH LTD 321 W LAKE ST ELMHURST IL 60126-1539 (630) 617-0034 A 9/1/2016 HOME INFUSION 06/01/15 OPTION HEALTH LTD 985 AVE OF THE CITIES SILVIS IL 61282-7001 (309) 792-7200 HOME INFUSION 08/01/15 RUSH UNIVERSITY MED CNTR 1725 W HARRISON ST CHICAGO IL 60612-3841 (312) 563-2093 HOME INFUSION 01/01/16 RX CONSULT INC DBA HEALTH OPTIONS 110 S MARKET ST SPARTA IL 62286-2062 (618) 443-1155 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 8

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP HOSPICE 04/01/16 ACCORD HOSPICE INC 1247 LYNN TERRACE HIGHLAND IL 60035-1030 (847) 780-4594 HOSPICE 03/01/15 ALEXIAN BROTHERS HOSPICE 1515 E LAKE ST HANOVER PARK IL 60133-7152 (630) 233-5100 HOSPICE 01/01/15 CNS HOME HEALTH 690 E NORTH AVE CAROL STREAM IL 60188-2172 (630) 665-7000 HOSPICE 09/01/14 COVENANT HOME SERVICES 3755 E MAIN ST ST CHARLES IL 60174-2409 (630) 845-0680 HOSPICE 04/01/15 FAMILY CENTERED HOSPICE 2171 EXECUTIVE DR ADDISON IL 60101-5610 (630) 317-3300 HOSPICE 07/01/15 HOSPICE ADVANTAGE 16W485 S FRONTAGE BURR RIDGE IL 60527-7155 (708) 499-3400 HOSPICE 03/01/16 HOSPICE OF GREATER CHICAGO LLC 1727 S INDIANA AVE CHICAGO IL 60616-1345 (630) 226-1306 HOSPICE 02/01/16 INTEGRATED PALLIATIVE HOSPICE LLC 900 TECHNOLOGY WAY LIBERTYVILLE IL 60048-5364 (847) 549-0588 HOSPICE 01/01/15 LEXINGTON HOSPICE SERVICES LLC 1300 S MAIN STREET LOMBARD IL 60148-4526 (630) 652-7900 HOSPICE 09/01/15 LITTLE COMPANY OF MARY HOSPICE 9800 SOUTHWEST HWY OAK LAWN IL 60453-3617 (708) 422-6200 HOSPICE 10/01/15 PALOS COMMUNITY HOSPITAL HOSPICE 15295 E 127TH ST LEMONT IL 60439-8410 (630) 257-1111 HOSPICE 01/01/14 RAINBOW HOSPICE AND PALLIATIVE 1550 BISHOP CT MOUNT IL 60056-6039 (847) 685-9900 HOSPICE 08/01/15 RESIDENTIAL HOSPICE ILLINOIS 1431 OPUS PLACE DOWNERS IL 60515-1391 (855) 902-5100 HOSPICE 01/01/14 VITAS INNOVATVE HOSPICE CARE CHGO 1340 S DAMEN AVE CHICAGO IL 60608-1170 (312) 997-7200 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 9

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP INPATIENT - METRO 01/01/14 ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440-4906 (630) 312-5000 INPATIENT - METRO 01/01/14 ADVENTIST GLEN OAKS HOSPITAL 701 WINTHROP AVE GLENDALE IL 60139-1405 (630) 545-8000 INPATIENT - METRO 01/01/14 ADVENTIST HINSDALE HOSPITAL 120 N OAK ST HINSDALE IL 60521-3829 (630) 856-9000 INPATIENT - METRO 01/01/14 ADVENTIST LAGRANGE MEMORIAL HOSP 5101 S WILLOW SPRINGS RD LA GRANGE IL 60525-2600 (708) 245-9000 INPATIENT - METRO 01/01/16 ADVOCATE BROMENN MEDICAL CTR 1304 FRANKLIN AVE NORMAL IL 61761-3558 (309) 454-1400 INPATIENT - METRO 01/01/14 ADVOCATE CHRIST HOSP MED CNTR 4440 W 95TH ST OAK LAWN IL 60453-2600 (708) 684-8000 INPATIENT - METRO 01/01/14 ADVOCATE CONDELL MEDICAL CENTER 801 S MILWAUKEE AVE LIBERTYVILLE IL 60048-3204 (847) 362-2900 INPATIENT - METRO 01/01/14 ADVOCATE GOOD SAMARITAN HOSPITAL 3815 HIGHLAND AVE DOWNERS IL 60515-1500 (630) 275-5900 INPATIENT - METRO 01/01/14 ADVOCATE GOOD SHEPHERD HOSPITAL 450 W HIGHWAY 22 BARRINGTON IL 60010-7509 (847) 381-9600 INPATIENT - METRO 01/01/14 ADVOCATE ILLINOIS MASONIC MED CNT 836 W WELLINGTON AVE CHICAGO IL 60657-5147 (773) 975-1600 INPATIENT - METRO 01/01/14 ADVOCATE LUTHERAN GENERAL HOSP 1775 DEMPSTER ST PARK RIDGE IL 60068-1143 (847) 723-2210 INPATIENT - METRO 01/01/14 ADVOCATE SHERMAN HOSPITAL 1425 N RANDALL RD ELGIN IL 00006-0123 (847) 742-9800 INPATIENT - METRO 01/01/14 ADVOCATE SOUTH SUBURBAN HOSPITAL 17800 S KEDZIE AVE HAZEL CREST IL 60429-2029 (708) 799-8000 INPATIENT - METRO 01/01/14 ADVOCATE TRINITY HOSPITAL 2320 E 93RD ST CHICAGO IL 60617-3983 (773) 967-2000 INPATIENT - METRO 01/01/14 ALEXIAN BROTHERS BEHAVIORAL HLTH 1650 MOON LAKE BLVD HOFFMAN IL 60194-1010 (847) 882-1600 INPATIENT - METRO 01/01/14 ALEXIAN BROTHERS MEDICAL CENTER 800 BIESTERFIELD RD ELK GROVE IL 60007-3361 (847) 437-5500 INPATIENT - METRO 01/01/14 CENTRAL DUPAGE HOSPITAL 25 N WINFIELD RD WINFIELD IL 60190-1295 (630) 933-1600 INPATIENT - METRO 11/01/15 CHICAGO BEHAVIORAL HOSPITAL 555 WILSON RD DES PLAINES IL 60016-4729 (847) 768-5430 INPATIENT - METRO 01/01/15 COMMUNITY FIRST MEDICAL CENTER 5645 W ADDISON ST CHICAGO IL 60634-4403 (773) 282-7000 INPATIENT - METRO 01/01/14 COPLEY MEMORIAL HOSPITAL 2000 OGDEN AVE AURORA IL 60504-7222 (630) 978-6200 INPATIENT - METRO 01/01/14 DELNOR COMMUNITY HOSPITAL 300 RANDALL RD GENEVA IL 60134-4200 (630) 208-3000 INPATIENT - METRO 01/01/14 EDWARD HOSPITAL 801 S WASHINGTON ST NAPERVILLE IL 60540-7430 (630) 355-0450 INPATIENT - METRO 01/01/14 ELMHURST MEM HOSPITAL MAIN CAMPUS 155 E BRUSH HILL RD ELMHURST IL 60126-5658 (331) 221-1000 INPATIENT - METRO 01/01/14 HOLY CROSS HOSPITAL 2701 W 68TH ST CHICAGO IL 60629-1813 (773) 884-9000 INPATIENT - METRO 01/01/15 INGALLS MEMORIAL HOSPITAL 1 INGALLS DR HARVEY IL 60426-3558 (708) 333-2300 INPATIENT - METRO 11/01/15 KINDRED CHGO CENTRAL HOSPITAL 4058 W MELROSE ST CHICAGO IL 60641-4799 (773) 736-7000 INPATIENT - METRO 11/01/15 KINDRED HOSP NORTHLAKE 365 E NORTH AVE NORTHLAKE IL 60164-2628 (708) 345-8100 INPATIENT - METRO 11/01/15 KINDRED HOSPITAL SYCAMORE 225 EDWARD ST SYCAMORE IL 60178-2137 (815) 895-2144 INPATIENT - METRO 01/01/14 KISHWAUKEE COMMUNITY HOSPITAL 1 KISH HOSPITAL DR DEKALB IL 00006-0115 (815) 756-1521 INPATIENT - METRO 01/01/14 LINDEN OAKS HOSPITAL 852 WEST ST NAPERVILLE IL 60540-6400 (630) 305-5500 INPATIENT - METRO 01/01/14 LITTLE COMPANY OF MARY HOSP 2800 W 95TH ST EVERGREEN IL 60805-2701 (708) 422-6200 INPATIENT - METRO 01/01/14 MACNEAL HOSPITAL 3249 S OAK PARK AVE BERWYN IL 60402-3429 (708) 783-9100 INPATIENT - METRO 01/01/14 MARIANJOY REHABILITATION HOSPITAL 26 W 171 ROOSEVELT RD WHEATON IL 60187-6078 (630) 909-8000 INPATIENT - METRO 01/01/14 MOUNT SINAI HOSPITAL 1500 S. CALIFORNIA CHICAGO IL 60608-1704 (773) 542-2000 INPATIENT - METRO 01/01/14 NORTHSHORE EVANSTON HOSPITAL 2650 RIDGE AVE EVANSTON IL 60201-1718 (847) 570-2000 INPATIENT - METRO 01/01/14 NORTHSHORE GLENBROOK HOSPITAL 2100 PFINGSTEN RD GLENVIEW IL 60026-1301 (847) 657-5800 INPATIENT - METRO 01/01/14 NORTHSHORE HIGHLAND PARK HOSPITAL 777 PARK AVE WEST HIGHLAND IL 60035-2433 (847) 432-8000 INPATIENT - METRO 01/01/14 NORTHSHORE SKOKIE HOSPITAL 9600 GROSS POINT RD SKOKIE IL 60076-1214 (847) 677-9600 INPATIENT - METRO 01/01/14 NORTHWEST COMMUNITY HOSPITAL 800 W CENTRAL RD ARLINGTON IL 60005-2349 (847) 618-1000 INPATIENT - METRO 01/01/14 PALOS COMMUNITY HOSPITAL 12251 S 80TH AVE PALOS HEIGHTS IL 60463-1256 (708) 923-4000 INPATIENT - METRO 01/01/14 PRESENCE COVENANT MEDICAL CENTER 1400 W PARK ST URBANA IL 61801-2334 (217) 337-2000 INPATIENT - METRO 01/01/14 PRESENCE HOLY FAMILY MEDICAL CTR 100 N RIVER RD DES PLAINES IL 60016-1209 (847) 297-1800 10

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP INPATIENT - METRO 01/01/14 PRESENCE MERCY MEDICAL CENTER 1325 N HIGHLAND AVE AURORA IL 60506-1449 (630) 859-2222 INPATIENT - METRO 01/01/14 PRESENCE RESURRECTION MED CTR 7435 W TALCOTT AVE CHICAGO IL 60631-3707 (773) 774-8000 INPATIENT - METRO 01/01/14 PRESENCE ST FRANCIS HOSPITAL 355 RIDGE AVE EVANSTON IL 60202-3328 (847) 316-4000 INPATIENT - METRO 01/01/14 PRESENCE ST JOSEPH HOSP CHICAGO 2900 N LAKE SHORE DR CHICAGO IL 60657-5640 (773) 665-3000 INPATIENT - METRO 01/01/14 PRESENCE ST JOSEPH HOSP ELGIN 77 N AIRLITE ST ELGIN IL 60123-4912 (847) 695-3200 INPATIENT - METRO 01/01/14 PRESENCE ST JOSEPH MEDICAL CTR 333 N MADISON ST JOLIET IL 60435-8200 (815) 725-7133 INPATIENT - METRO 01/01/14 PRESENCE ST MARY ELIZABETH MDCT 2233 W DIVISION ST CHICAGO IL 60622-3043 (312) 770-2000 INPATIENT - METRO 01/01/14 PRESENCE ST MARYS HOSPITAL 500 W COURT ST KANKAKEE IL 60901-3661 (815) 937-2490 INPATIENT - METRO 01/01/14 PRESENCE UNITED SAMARITANS MED CT 812 N LOGAN AVE DANVILLE IL 61832-3752 (217) 443-5000 INPATIENT - METRO 01/01/14 RML SPECIALTY HOSPITAL 5601 S COUNTY LINE RD HINSDALE IL 60521-4875 (630) 286-4223 INPATIENT - METRO 07/01/15 SAINT ANTHONY HOSPITAL 2875 W 19TH ST CHICAGO IL 60623-3501 (773) 484-1000 INPATIENT - METRO 01/01/14 SCHWAB REHABILITATION HOSPITAL 1401 S CALIFORNIA AVE CHICAGO IL 60608-1858 (773) 522-2010 INPATIENT - METRO 01/01/14 SILVER CROSS HOSPITAL 1900 SILVER CROSS BLVD NEW LENOX IL 60451-9508 (815) 300-1100 INPATIENT - METRO 01/01/14 ST ALEXIUS MEDICAL CENTER 1555 BARRINGTON RD HOFFMAN IL 60169-1019 (847) 843-2000 INPATIENT - METRO 01/01/14 ST BERNARD HOSPITAL 326 W 64TH ST CHICAGO IL 60621-3114 (773) 962-3900 INPATIENT - METRO 01/01/14 ST JAMES HOSPITAL AND HLTH CNTRS 1423 CHICAGO RD CHICAGO IL 60411-3400 (708) 756-1000 INPATIENT - METRO 01/01/14 SWEDISH COVENANT HOSPITAL 5145 N CALIFORNIA AVE CHICAGO IL 60625-3661 (773) 878-8200 INPATIENT - METRO 03/01/16 THOREK MEMORIAL HOSPITAL 850 W IRVING PARK RD CHICAGO IL 60613-3077 (773) 525-6780 INPATIENT - METRO 01/01/14 UNIVERSITY OF CHICAGO MEDICAL CEN 5841 S MARYLAND AVE CHICAGO IL 60637-1447 (773) 702-1000 INPATIENT - METRO 01/01/14 VALLEY WEST COMMUNITY HOSPITAL 11 E PLEASANT AVE SANDWICH IL 60548-1100 (815) 786-8484 INPATIENT - METRO 01/01/14 WEISS MEMORIAL HOSPITAL 4646 N MARINE DR CHICAGO IL 60640-5759 (773) 878-8700 INPATIENT - METRO 01/01/14 WEST SUBURBAN MEDICAL CENTER 3 ERIE COURT OAK PARK IL 60302-2519 (708) 383-6200 INPATIENT - METRO 01/01/14 WESTLAKE HOSPITAL INC 1225 W LAKE ST MELROSE PARK IL 60160-4039 (708) 681-3000 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 11

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP MENTAL HEALTH 11/01/15 CHICAGO BEHAVIORAL HOSPITAL 555 WILSON RD DES PLAINES IL 60016-4729 (847) 768-5430 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 12

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP ORTHOTIC & PROSTHETIC 02/01/16 BALLERT ORTHOPEDIC OF CHICAGO 139 141 FRONT ST WOOD DALE IL 60191-1509 (630) 694-9305 ORTHOTIC & PROSTHETIC 03/01/15 BALLERT ORTHOPEDIC OF CHICAGO 2434 W PETERSON AVE CHICAGO IL 60659-4113 (773) 878-2445 ORTHOTIC & PROSTHETIC 02/01/16 BALLERT ORTHOPEDIC OF CHICAGO 1250 N MILL ST NAPERVILLE IL 60563-6305 (630) 637-9540 ORTHOTIC & PROSTHETIC 02/01/16 BALLERT ORTHOPEDIC OF CHICAGO 233 E ERIE ST CHICAGO IL 60611-5938 (312) 787-4400 ORTHOTIC & PROSTHETIC 03/01/16 HANGER PROSTHETICS & ORTHOTIC INC 1910 S MT ZION RD DECATUR IL 62521-8425 (217) 429-6656 ORTHOTIC & PROSTHETIC 03/01/16 HANGER PROSTHETICS AND ORTHOTICS 3691 COUGAR DR PERU IL 61354-9302 (815) 220-1382 ORTHOTIC & PROSTHETIC 08/01/15 HANGER PROSTHETICS AND ORTHOTICS 311 W ROMEO B GARRETT AVE PEORIA IL 61605-2504 (309) 682-1382 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHO EAST 100 TOWER DR BURR RIDGE IL 60527-5778 (630) 986-0007 ORTHOTIC & PROSTHETIC 03/01/16 HANGER PROSTHETICS ORTHOTICS 719 N WILLIAM KUMPF BLVD PEORIA IL 61605-2531 (309) 637-6581 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 4525 W LINCOLN HWY MATTESON IL 60443-2318 (708) 679-1006 ORTHOTIC & PROSTHETIC 03/01/16 HANGER PROSTHETICS ORTHOTICS 7 BRONZE POINTE SOUTH BELLEVILLE IL 62226-8308 (618) 222-7032 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 694 ESSINGTON RD JOLIET IL 60435-4902 (815) 744-9944 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 75 MARKET ST ELGIN IL 60123-5093 (847) 695-6955 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 4255 WESTBROOK DR AURORA IL 60504-8125 (630) 820-5656 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 35 TOWER CT GURNEE IL 60031-5712 (847) 623-6080 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 1123 EMERSON ST EVANSTON IL 60201-3100 (847) 864-7711 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 10719 W 160TH ST ORLAND PARK IL 60467-5541 (708) 364-1570 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 10837 S CICERO AVE OAK LAWN IL 60453-5403 (708) 371-9999 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 11231 W CERMAK RD WESTCHESTER IL 60154-5706 (708) 447-9860 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 4801 W PETERSON AVE CHICAGO IL 60646-5728 (773) 777-9494 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 17530 S KEDZIE AVE HAZEL CREST IL 60429-2004 (708) 957-0240 ORTHOTIC & PROSTHETIC 01/01/14 HANGER PROSTHETICS ORTHOTICS 1 S 224 SUMMIT AVE OAKBROOK IL 60181-3938 (630) 620-5333 ORTHOTIC & PROSTHETIC 08/01/16 HANGER PROSTHETICS ORTHOTICS 4255 WESTBROOK DR AURORA IL 60504-8125 (630) 820-5656 A 9/1/2016 ORTHOTIC & PROSTHETIC 07/01/15 NATURALLY YOURS INC 7219 KINGERY HWY WILLOWBROOK IL 60527-7561 (630) 570-5004 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 401 HARRISON ST OAK PARK IL 60304-1427 (708) 383-2257 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 5202 OLD ORCHARD RD SKOKIE IL 60077-4407 (847) 475-7080 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 1S376 SUMMIT AVE OAK BROOK IL 60181-3985 (630) 424-0392 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 10 N FAIRLANE DR JOLIET IL 60435-5894 (847) 382-3222 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 1551 BOND ST NAPERVILLE IL 60563-0150 (630) 637-4638 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 1725 W HARRISON ST CHICAGO IL 60612-3841 (312) 942-2011 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 1740 W TAYLOR ST CHICAGO IL 60612-7232 (312) 996-6450 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 2835 N SHEFFIELD CHICAGO IL 60657-5084 (773) 472-3663 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 617 E GOLF RD ARLINGTON IL 60005-4069 (847) 437-3929 ORTHOTIC & PROSTHETIC 01/01/14 SCHECK AND SIRESS PROSTHETICS INC 8641 W 95TH ST HICKORY HILLS IL 60457-1730 (708) 599-8336 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate 13

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 14

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP OUTPATIENT SURGERY 01/01/14 ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440-4906 (630) 312-5000 OUTPATIENT SURGERY 01/01/14 ADVENTIST GLEN OAKS HOSPITAL 701 WINTHROP AVE GLENDALE IL 60139-1405 (630) 545-8000 OUTPATIENT SURGERY 01/01/14 ADVENTIST HINSDALE HOSPITAL 120 N OAK ST HINSDALE IL 60521-3829 (630) 856-9000 OUTPATIENT SURGERY 01/01/14 ADVENTIST LAGRANGE MEMORIAL HOSP 5101 S WILLOW SPRINGS RD LA GRANGE IL 60525-2600 (708) 245-9000 OUTPATIENT SURGERY 01/01/16 ADVOCATE BROMENN MEDICAL CTR 1304 FRANKLIN AVE NORMAL IL 61761-3558 (309) 454-1400 OUTPATIENT SURGERY 01/01/14 ADVOCATE CHRIST HOSP MED CNTR 4440 W 95TH ST OAK LAWN IL 60453-2600 (708) 684-8000 OUTPATIENT SURGERY 01/01/14 ADVOCATE CONDELL MEDICAL CENTER 801 S MILWAUKEE AVE LIBERTYVILLE IL 60048-3204 (847) 362-2900 OUTPATIENT SURGERY 01/01/14 ADVOCATE GOOD SAMARITAN HOSPITAL 3815 HIGHLAND AVE DOWNERS IL 60515-1500 (630) 275-5900 OUTPATIENT SURGERY 01/01/14 ADVOCATE GOOD SHEPHERD HOSPITAL 450 W HIGHWAY 22 BARRINGTON IL 60010-7509 (847) 381-9600 OUTPATIENT SURGERY 01/01/14 ADVOCATE ILLINOIS MASONIC MED CNT 836 W WELLINGTON AVE CHICAGO IL 60657-5147 (773) 975-1600 OUTPATIENT SURGERY 01/01/14 ADVOCATE LUTHERAN GENERAL HOSP 1775 DEMPSTER ST PARK RIDGE IL 60068-1143 (847) 723-2210 OUTPATIENT SURGERY 01/01/14 ADVOCATE SHERMAN HOSPITAL 1425 N RANDALL RD ELGIN IL 00006-0123 (847) 742-9800 OUTPATIENT SURGERY 01/01/14 ADVOCATE SOUTH SUBURBAN HOSPITAL 17800 S KEDZIE AVE HAZEL CREST IL 60429-2029 (708) 799-8000 OUTPATIENT SURGERY 01/01/14 ADVOCATE TRINITY HOSPITAL 2320 E 93RD ST CHICAGO IL 60617-3983 (773) 967-2000 OUTPATIENT SURGERY 01/01/14 ALEXIAN BROTHERS BEHAVIORAL HLTH 1650 MOON LAKE BLVD HOFFMAN IL 60194-1010 (847) 882-1600 OUTPATIENT SURGERY 01/01/14 ALEXIAN BROTHERS MEDICAL CENTER 800 BIESTERFIELD RD ELK GROVE IL 60007-3361 (847) 437-5500 OUTPATIENT SURGERY 01/01/14 CENTRAL DUPAGE HOSPITAL 25 N WINFIELD RD WINFIELD IL 60190-1295 (630) 933-1600 OUTPATIENT SURGERY 11/01/15 CHICAGO BEHAVIORAL HOSPITAL 555 WILSON RD DES PLAINES IL 60016-4729 (847) 768-5430 OUTPATIENT SURGERY 01/01/15 COMMUNITY FIRST MEDICAL CENTER 5645 W ADDISON ST CHICAGO IL 60634-4403 (773) 282-7000 OUTPATIENT SURGERY 01/01/14 COPLEY MEMORIAL HOSPITAL 2000 OGDEN AVE AURORA IL 60504-7222 (630) 978-6200 OUTPATIENT SURGERY 01/01/14 DELNOR COMMUNITY HOSPITAL 300 RANDALL RD GENEVA IL 60134-4200 (630) 208-3000 OUTPATIENT SURGERY 01/01/14 EDWARD HOSPITAL 801 S WASHINGTON ST NAPERVILLE IL 60540-7430 (630) 355-0450 OUTPATIENT SURGERY 01/01/14 ELMHURST MEM HOSPITAL MAIN CAMPUS 155 E BRUSH HILL RD ELMHURST IL 60126-5658 (331) 221-1000 OUTPATIENT SURGERY 01/01/14 HOLY CROSS HOSPITAL 2701 W 68TH ST CHICAGO IL 60629-1813 (773) 884-9000 OUTPATIENT SURGERY 01/01/15 INGALLS MEMORIAL HOSPITAL 1 INGALLS DR HARVEY IL 60426-3558 (708) 333-2300 OUTPATIENT SURGERY 11/01/15 KINDRED CHGO CENTRAL HOSPITAL 4058 W MELROSE ST CHICAGO IL 60641-4799 (773) 736-7000 OUTPATIENT SURGERY 11/01/15 KINDRED HOSP NORTHLAKE 365 E NORTH AVE NORTHLAKE IL 60164-2628 (708) 345-8100 OUTPATIENT SURGERY 11/01/15 KINDRED HOSPITAL SYCAMORE 225 EDWARD ST SYCAMORE IL 60178-2137 (815) 895-2144 OUTPATIENT SURGERY 01/01/14 KISHWAUKEE COMMUNITY HOSPITAL 1 KISH HOSPITAL DR DEKALB IL 00006-0115 (815) 756-1521 OUTPATIENT SURGERY 01/01/14 LINDEN OAKS HOSPITAL 852 WEST ST NAPERVILLE IL 60540-6400 (630) 305-5500 OUTPATIENT SURGERY 01/01/14 LITTLE COMPANY OF MARY HOSP 2800 W 95TH ST EVERGREEN IL 60805-2701 (708) 422-6200 OUTPATIENT SURGERY 01/01/14 MACNEAL HOSPITAL 3249 S OAK PARK AVE BERWYN IL 60402-3429 (708) 783-9100 OUTPATIENT SURGERY 01/01/14 MARIANJOY REHABILITATION HOSPITAL 26 W 171 ROOSEVELT RD WHEATON IL 60187-6078 (630) 909-8000 OUTPATIENT SURGERY 01/01/14 MOUNT SINAI HOSPITAL 1500 S. CALIFORNIA CHICAGO IL 60608-1704 (773) 542-2000 OUTPATIENT SURGERY 01/01/14 NORTHSHORE EVANSTON HOSPITAL 2650 RIDGE AVE EVANSTON IL 60201-1718 (847) 570-2000 OUTPATIENT SURGERY 01/01/14 NORTHSHORE GLENBROOK HOSPITAL 2100 PFINGSTEN RD GLENVIEW IL 60026-1301 (847) 657-5800 OUTPATIENT SURGERY 01/01/14 NORTHSHORE HIGHLAND PARK HOSPITAL 777 PARK AVE WEST HIGHLAND IL 60035-2433 (847) 432-8000 OUTPATIENT SURGERY 01/01/14 NORTHSHORE SKOKIE HOSPITAL 9600 GROSS POINT RD SKOKIE IL 60076-1214 (847) 677-9600 OUTPATIENT SURGERY 01/01/14 NORTHWEST COMMUNITY HOSPITAL 800 W CENTRAL RD ARLINGTON IL 60005-2349 (847) 618-1000 OUTPATIENT SURGERY 01/01/14 PALOS COMMUNITY HOSPITAL 12251 S 80TH AVE PALOS HEIGHTS IL 60463-1256 (708) 923-4000 OUTPATIENT SURGERY 01/01/14 PRESENCE COVENANT MEDICAL CENTER 1400 W PARK ST URBANA IL 61801-2334 (217) 337-2000 OUTPATIENT SURGERY 01/01/14 PRESENCE HOLY FAMILY MEDICAL CTR 100 N RIVER RD DES PLAINES IL 60016-1209 (847) 297-1800 15

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP OUTPATIENT SURGERY 01/01/14 PRESENCE MERCY MEDICAL CENTER 1325 N HIGHLAND AVE AURORA IL 60506-1449 (630) 859-2222 OUTPATIENT SURGERY 01/01/14 PRESENCE RESURRECTION MED CTR 7435 W TALCOTT AVE CHICAGO IL 60631-3707 (773) 774-8000 OUTPATIENT SURGERY 01/01/14 PRESENCE ST FRANCIS HOSPITAL 355 RIDGE AVE EVANSTON IL 60202-3328 (847) 316-4000 OUTPATIENT SURGERY 01/01/14 PRESENCE ST JOSEPH HOSP CHICAGO 2900 N LAKE SHORE DR CHICAGO IL 60657-5640 (773) 665-3000 OUTPATIENT SURGERY 01/01/14 PRESENCE ST JOSEPH HOSP ELGIN 77 N AIRLITE ST ELGIN IL 60123-4912 (847) 695-3200 OUTPATIENT SURGERY 01/01/14 PRESENCE ST JOSEPH MEDICAL CTR 333 N MADISON ST JOLIET IL 60435-8200 (815) 725-7133 OUTPATIENT SURGERY 01/01/14 PRESENCE ST MARY ELIZABETH MDCT 2233 W DIVISION ST CHICAGO IL 60622-3043 (312) 770-2000 OUTPATIENT SURGERY 01/01/14 PRESENCE ST MARYS HOSPITAL 500 W COURT ST KANKAKEE IL 60901-3661 (815) 937-2490 OUTPATIENT SURGERY 01/01/14 PRESENCE UNITED SAMARITANS MED CT 812 N LOGAN AVE DANVILLE IL 61832-3752 (217) 443-5000 OUTPATIENT SURGERY 01/01/14 RML SPECIALTY HOSPITAL 5601 S COUNTY LINE RD HINSDALE IL 60521-4875 (630) 286-4223 OUTPATIENT SURGERY 07/01/15 SAINT ANTHONY HOSPITAL 2875 W 19TH ST CHICAGO IL 60623-3501 (773) 484-1000 OUTPATIENT SURGERY 01/01/14 SCHWAB REHABILITATION HOSPITAL 1401 S CALIFORNIA AVE CHICAGO IL 60608-1858 (773) 522-2010 OUTPATIENT SURGERY 01/01/14 SILVER CROSS HOSPITAL 1900 SILVER CROSS BLVD NEW LENOX IL 60451-9508 (815) 300-1100 OUTPATIENT SURGERY 01/01/14 ST ALEXIUS MEDICAL CENTER 1555 BARRINGTON RD HOFFMAN IL 60169-1019 (847) 843-2000 OUTPATIENT SURGERY 01/01/14 ST BERNARD HOSPITAL 326 W 64TH ST CHICAGO IL 60621-3114 (773) 962-3900 OUTPATIENT SURGERY 01/01/14 ST JAMES HOSPITAL AND HLTH CNTRS 1423 CHICAGO RD CHICAGO IL 60411-3400 (708) 756-1000 OUTPATIENT SURGERY 01/01/14 SWEDISH COVENANT HOSPITAL 5145 N CALIFORNIA AVE CHICAGO IL 60625-3661 (773) 878-8200 OUTPATIENT SURGERY 03/01/16 THOREK MEMORIAL HOSPITAL 850 W IRVING PARK RD CHICAGO IL 60613-3077 (773) 525-6780 OUTPATIENT SURGERY 01/01/14 UNIVERSITY OF CHICAGO MEDICAL CEN 5841 S MARYLAND AVE CHICAGO IL 60637-1447 (773) 702-1000 OUTPATIENT SURGERY 01/01/14 VALLEY WEST COMMUNITY HOSPITAL 11 E PLEASANT AVE SANDWICH IL 60548-1100 (815) 786-8484 OUTPATIENT SURGERY 01/01/14 WEISS MEMORIAL HOSPITAL 4646 N MARINE DR CHICAGO IL 60640-5759 (773) 878-8700 OUTPATIENT SURGERY 01/01/14 WEST SUBURBAN MEDICAL CENTER 3 ERIE COURT OAK PARK IL 60302-2519 (708) 383-6200 OUTPATIENT SURGERY 01/01/14 WESTLAKE HOSPITAL INC 1225 W LAKE ST MELROSE PARK IL 60160-4039 (708) 681-3000 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 16

MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP RENAL DIALYSIS 01/01/15 AFFILIATED DIALYSIS LLC 715 LAKE ST OAK PARK IL 60301-1412 (309) 698-1800 RENAL DIALYSIS 01/01/15 AFFILIATED DIALYSIS OF GLEN ELLYN 800 ROOSEVELT GLEN ELLYN IL 60137-5849 (309) 698-1800 RENAL DIALYSIS 01/01/15 AFFILIATED HOME DIALYSIS LLC 2462 WASHINGTON RD WASHINGTON IL 00006-1571 (309) 698-1800 RENAL DIALYSIS 01/01/15 AFFILIATED HOME DIALYSIS LLC 1014 BONAVENTURE DR ELK GROVE IL 60007-3277 (309) 698-1800 RENAL DIALYSIS 01/01/14 ALTON DIALYSIS 309 HOMER ADAMS PKWAY ALTON IL 62002-5929 (618) 462-0186 RENAL DIALYSIS 01/01/14 ARLINGTON HEIGHTS PD 17 W GOLF RD ARLINGTON IL 60005-3905 (847) 437-2188 RENAL DIALYSIS 01/01/14 AURORA DIALYSIS CENTER 455 MERCY LN AURORA IL 60506-2462 (630) 892-7445 RENAL DIALYSIS 01/01/14 AUSTIN COMMUNITY KIDNEY CENTER 4800 W CHICAGO AVE CHICAGO IL 60651-3223 (773) 287-0680 RENAL DIALYSIS 04/01/16 AVANTUS HOME TH-CHAMPAIGN URB 901 W UNIVERSITY AVE CHAMPAIGN IL 61821-3319 (217) 328-4100 A 6/1/2016 RENAL DIALYSIS 01/01/14 BARRINGTON CREEK DIALYSIS 28160 W NORTHWEST HWY LAKE IL 60010-2324 (847) 381-1325 RENAL DIALYSIS 01/01/14 BENTON DIALYSIS 1151 RTE 14 WEST BENTON IL 62812-1500 (618) 435-4850 RENAL DIALYSIS 01/01/14 BEVERLY DIALYSIS 8109 SOUTH WESTERN AVE CHICAGO IL 60620-5939 (773) 238-5200 RENAL DIALYSIS 01/01/14 BIG OAKS DIALYSIS 5623 W TOUHY AVE NILES IL 60714-4019 (847) 647-3140 RENAL DIALYSIS 01/01/14 BLUE ISLAND DIALYSIS CENTER 12200 S WESTERN AVE BLUE ISLAND IL 60406-1398 (708) 597-9933 RENAL DIALYSIS 11/01/14 CENTER FOR RENAL REPLACEMENT LLC 7301 N LINCOLN LINCOLNWOOD IL 60712-1735 (847) 675-5555 RENAL DIALYSIS 01/01/14 CENTRALIA DIALYSIS 1231 STATE ROUTE 161 EAST CENTRALIA IL 62801-6739 (618) 533-2535 RENAL DIALYSIS 01/01/14 CHAMPAIGN URBANA 1405 W PARK ST URBANA IL 61801-2344 (217) 328-4100 RENAL DIALYSIS 01/01/14 CHICAGO DIALYSIS CENTER 1806 W HUBBARD ST CHICAGO IL 00006-0622 (312) 243-1139 RENAL DIALYSIS 01/01/14 CHICAGO HEIGHTS DIALYSIS 177 B JOE ORR RD CHICAGO IL 60411-1733 (630) 851-4812 RENAL DIALYSIS 01/01/14 CHICAGO WESTSIDE DIALYSIS 1340 S DAMEN CHICAGO IL 60608-1190 (312) 738-2587 RENAL DIALYSIS 01/01/14 CHURCHVIEW DIALYSIS 417 WARE AVE ROCKFORD IL 61107-6413 (815) 397-4123 RENAL DIALYSIS 01/01/14 COBBLESTONE DIALYSIS 836 DUNDEE AVE ELGIN IL 60120-3068 (847) 888-9386 RENAL DIALYSIS 01/01/14 COUNTRY HILLS DIALYSIS 4215 W 167TH ST COUNTRY CLUB IL 60478-2017 (708) 206-1845 RENAL DIALYSIS 10/01/15 CRYSTAL SPRINGS DIALYSIS 720 COG CIR CRYSTAL LAKE IL 60014-7301 (815) 459-4945 RENAL DIALYSIS 01/01/14 DECATUR EASTWOOD DIALYSIS 794 E WOOD ST DECATUR IL 62523-1155 (217) 425-6403 RENAL DIALYSIS 01/01/14 DIALYSIS CENTER OF AMERICA 5401 S WENTWORTH AVE CHICAGO IL 60609-6300 (773) 548-5714 RENAL DIALYSIS 01/01/14 DIALYSIS CENTER OF AMERICA 2277 W HOWARD ST CHICAGO IL 60645-1922 (773) 262-7147 RENAL DIALYSIS 01/01/14 DIALYSIS CENTER OF AMERICA 4861-73 CAL SAG RD CRESTWOOD IL 60445-4415 (708) 385-1400 RENAL DIALYSIS 01/01/14 DIALYSIS CENTER OF AMERICA 9160 W 159TH ST ORLAND PARK IL 60462-5648 (708) 403-2790 RENAL DIALYSIS 01/01/14 DIALYSIS SERVICES CONGRESS PKWY 3410 W VAN BUREN ST CHICAGO IL 60624-3358 (773) 722-4245 RENAL DIALYSIS 01/01/14 DIALYSIS SERVICES OF ALSIP 12250 S CICERO AVE ALSIP IL 60803-2946 (708) 389-0955 RENAL DIALYSIS 01/01/14 DIALYSIS SERVICES OF WILLOWBROOK 6300 KINGERY HWY WILLOWBROOK IL 60527-2248 (630) 325-0309 RENAL DIALYSIS 01/01/14 DIXON KIDNEY CENTER 1131 N GALENA AVE DIXON IL 61021-1015 (815) 284-0595 RENAL DIALYSIS 01/01/14 DOWNERS GROVE DIALYSIS CENTER 3825 HIGHLAND AVE DOWNERS IL 60515-1560 (630) 964-2605 RENAL DIALYSIS 01/01/14 DSI RENAL ARLINGTON HEIGHTS 17 W GOLF RD ARLINGTON IL 60005-3905 (847) 437-2188 RENAL DIALYSIS 01/01/14 DSI RENAL BUFFALO GROVE 1291 W DUNDEE RD BUFFALO IL 60089-4009 (800) 424-6589 RENAL DIALYSIS 01/01/14 DSI RENAL SCHAUMBURG 1156 S ROSELLE RD SCHAUMBURG IL 60193-4072 (847) 524-4310 RENAL DIALYSIS 01/01/14 DVA RENAL HEALTHCARE IND 932 N RUTLEDGE ST SPRINGFIELD IL 62702-3721 (217) 788-3688 RENAL DIALYSIS 04/01/16 EAST CHICAGO DIALYSIS CENTER 1207 E CHICAGO AVE EAST CHICAGO IN 46312-6517 (219) 397-7751 A 9/1/2016 RENAL DIALYSIS 01/01/14 EDWARDSVILLE DIALYSIS 235 S BUCHANAN ST EDWARDSVILLE IL 62025-2108 (618) 692-9217 RENAL DIALYSIS 01/01/14 EFFINGHAM DIALYSIS 904 MEDICAL PARK DR EFFINGHAM IL 62401-2193 (217) 342-9558 RENAL DIALYSIS 01/01/14 ELK GROVE DIALYSIS CENTER 901 BIESTERFIELD RD ELK GROVE IL 60007-7331 (847) 437-0824 17

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP RENAL DIALYSIS 01/01/14 ELK GROVE HOME DIALYSIS CENTER 901 BIESTERFIELD RD ELK GROVE IL 60007-7331 (847) 952-9890 RENAL DIALYSIS 01/01/14 EMERALD KIDNEY CENTER 710 W 43RD ST CHICAGO IL 60609-3435 (773) 843-5668 RENAL DIALYSIS 01/01/14 EVANSTON RENAL CENTER 1922 DEMPSTER ST EVANSTON IL 60202-1016 (847) 869-5336 RENAL DIALYSIS 01/01/14 FMC DIALYSIS SVC OF WESTCHESTER 2400 WOLF RD WESTCHESTER IL 60154-5635 (708) 409-7780 RENAL DIALYSIS 04/01/16 FMC DUPAGE HOME DIALYSIS 501 WEST LAKE ST ELMHURST IL 60126-2701 (630) 758-2490 AD 6/1/2016 RENAL DIALYSIS 04/01/16 FMC OF CARBONDALE 1425 E MAIN ST CARBONDALE IL 62901-3141 (618) 351-8031 A 6/1/2016 RENAL DIALYSIS 01/01/14 FMC OF SOUTHSIDE DIALYSIS CNTR 3134 W 76TH ST CHICAGO IL 60652-1968 (773) 471-0400 RENAL DIALYSIS 01/01/14 FMC ROSS DIALYSIS ENGLEWOOD 6333 S GREEN ST CHICAGO IL 60621-1943 (773) 873-0271 RENAL DIALYSIS 01/01/14 FMC WILLIAMSON COUNTY 900 SKYLINE DR MARION IL 62959-4974 (618) 993-1625 RENAL DIALYSIS 01/01/14 FREEPORT DIALYSIS 1028 KONKLE BLVD FREEPORT IL 61032-6914 (815) 232-2477 RENAL DIALYSIS 01/01/14 FRESENIUS DUPAGE WEST DIALYSIS 450 E ROOSEVELT WEST CHICAGO IL 60185-3905 (630) 293-6356 RENAL DIALYSIS 01/01/14 FRESENIUS MED CARE BOLINGBROOK 329 REMINGTON BLVD BOLINGBROOK IL 60440-5894 (630) 759-1395 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE DES PLAINES 1625 OAKTON PL DES PLAINES IL 60018-2002 (847) 795-0014 A 6/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE HAZEL CREST 17524 CARRIAGE WAY HAZEL CREST IL 60429-2187 (708) 798-2899 A 6/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE HOFFMAN ESTATE 3150 W HIGGINS ROAD HOFFMAN IL 60169-7237 (847) 310-0074 A 6/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE LOGAN SQUARE 2721 N SPAULDING CHICAGO IL 60647-1338 (773) 292-2971 A 6/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE MELROSE PARK 1111 SUPERIOR STREET MELROSE PARK IL 60160-4156 (708) 338-1780 A 6/1/2016 RENAL DIALYSIS 01/01/14 FRESENIUS MED CARE OF NAPERVILLE 516 W 5TH ST NAPERVILLE IL 60563-2901 (630) 753-9295 RENAL DIALYSIS 01/01/14 FRESENIUS MED CARE RIVER FOREST 103 FOREST AVE RIVER FOREST IL 60305-2003 (708) 488-9258 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE ROLLING MEADOW 4180 WINNETKA AVE ROLLING IL 60008-1375 (847) 394-6250 A 6/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE SOUTH CHICAGO 9200 S CHICAGO CHICAGO IL 60617-4512 (773) 734-7433 A 8/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE SOUTH SHORE 2420 E 79TH ST CHICAGO IL 60649-5112 (773) 374-9002 A 6/1/2016 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE SOUTHWESTERN 7 EASTGATE PLZ EAST ALTON IL 62024-1057 (618) 254-1117 A 8/1/2016 RENAL DIALYSIS 01/01/14 FRESENIUS MED CARE WAUKEGAN HARBO 101 N WEST STREET WAUKEGAN IL 00006-0085 (847) 599-1346 RENAL DIALYSIS 01/01/14 FRESENIUS MED CARE WEST BATAVIA 2580 WEST FABYAN PARKWAY BATAVIA IL 60510-1572 (630) 406-1690 RENAL DIALYSIS 04/01/16 FRESENIUS MED CARE WEST BELMONT 4943 WEST BELMONT CHICAGO IL 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MEDICARE ADVANTAGE PPO APPENDIX D PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP SKILLED NURSING 01/01/14 ALDEN DES PLAINES 1221 E GOLF RD DES PLAINES IL 60016-1213 (847) 768-1300 SKILLED NURSING 01/01/14 ALDEN ESTATES OF BARRINGTON 1420 S BARRINGTON RD BARRINGTON IL 60010-5206 (847) 382-6664 SKILLED NURSING 01/01/14 ALDEN ESTATES OF SHOREWOOD 710 BLACK ROAD SHOREWOOD IL 60404-8400 (815) 230-8700 SKILLED NURSING 01/01/14 ALDEN ESTATES OF SKOKIE INC 4326 OLD ORCHARD ROAD SKOKIE IL 60076-1009 (847) 676-4800 SKILLED NURSING 01/01/14 ALDEN HEATHER REHAB HLTHCARE CNTR 15600 HONORE AVE HARVEY IL 60426-4102 (708) 333-9550 SKILLED NURSING 01/01/14 ALDEN NORTHMOOR REHAB HLTH CARE 5831 N NORTHWEST HWY CHICAGO IL 60631-2642 (773) 775-8080 SKILLED NURSING 01/01/14 ALDEN NORTHSHORE REHAB AND HLTH 5050 TOUHY AVE SKOKIE IL 60077-3542 (847) 679-6100 SKILLED NURSING 01/01/14 ALDEN NURSING CENTER EVANSTON 2520 GROSS POINT RD EVANSTON IL 60201-4929 (847) 328-6000 SKILLED NURSING 01/01/14 ALDEN NURSING CENTER LAKELAND 820 W LAWRENCE AVE CHICAGO IL 60640-4213 (773) 769-2570 SKILLED NURSING 01/01/14 ALDEN NURSING CENTER LONG GROVE BOX 2308 RFD OLD HICKS RD LONG GROVE IL 60047-0000 (847) 438-8275 SKILLED NURSING 01/01/14 ALDEN NURSING CENTER VALLEY RIDGE 275 ARMY TRAIL ROAD BLOOMINGDAL IL 60108-2135 (630) 893-9616 SKILLED NURSING 01/01/14 ALDEN NURSING CTR NAPERVILLE 1525 OXFORD LN NAPERVILLE IL 60565-1511 (630) 983-0300 SKILLED NURSING 01/01/14 ALDEN NURSING CTR POPLAR CREEK 1545 BARRINGTON RD HOFFMAN IL 60194-1018 (847) 884-0011 SKILLED NURSING 01/01/14 ALDEN OF WATERFORD 2021 RANDI DR AURORA IL 60504-4758 (630) 851-7266 SKILLED NURSING 01/01/14 ALDEN ORLAND PARK REHAB HLTHCARE 16450 S 97TH AVE ORLAND PARK IL 60467-5587 (708) 403-6500 SKILLED NURSING 11/01/15 APERION CARE FOREST PARK 8200 W ROOSEVELT RD FOREST PARK IL 60130-2528 (708) 488-9850 SKILLED NURSING 11/01/15 APERION CARE HIGHWOOD 50 PLEASANT AVE HIGHWOOD IL 60040-1813 (847) 432-9142 SKILLED NURSING 11/01/15 APERION CARE INTERNATIONAL 4815 S WESTERN BLVD CHICAGO IL 60609-4067 (708) 389-3141 SKILLED NURSING 11/01/15 APERION CARE OAK LAWN 9401 S RIDGELAND AVE OAK LAWN IL 60453-2221 (847) 673-6767 SKILLED NURSING 11/01/15 ARIA POST ACUTE CARE 4600 N FRONTAGE RD HILLSIDE IL 60162-1761 (847) 933-2600 SKILLED NURSING 04/01/16 ASTORIA PLACE LIVING & REHAB 6300 N CALIFORNIA AVE CHICAGO IL 60659-1702 (773) 973-1900 A 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 ASTORIA PLACE LIVING AND REHAB CE 6300 N CALIFORNIA CHICAGO IL 60659-1702 (773) 973-1900 C 6/1/2016 SKILLED NURSING 08/01/15 AVANTARA LONG GROVE 1666 RID CHECKER RD LONG GROVE IL 00006-0047 (847) 419-1111 SKILLED NURSING 11/01/15 AVANTARA PARK RIDGE LLC 1601 N WESTERN AVE PARK RIDGE IL 60068-1233 (847) 825-5531 SKILLED NURSING 01/01/16 BALLARD RESPIRATORY AND REHAB CTR 9300 BALLARD RD DES PLAINES IL 60016-4904 (847) 674-5454 SKILLED NURSING 08/01/15 BELLA TERRA MORTON GROVE 8425 N WAUKEGAN RD MORTON IL 60053-2202 (847) 965-8100 SKILLED NURSING 10/01/15 BRANDEL HEALTH AND REHAB 2155 PFINGSTEN RD NORTHBROOK IL 60062-6427 (847) 480-6350 SKILLED NURSING 07/01/14 BRAVO CARE OF NORTHBROOK 4101 LAKE COOK RD NORTHBROOK IL 60062-1112 (847) 562-1770 SKILLED NURSING 01/01/16 BRENTWOOD NORTH HLTHCARE & REHAB 3705 DEERFIELD RD RIVERWOODS IL 60015-3540 (847) 947-9000 SKILLED NURSING 03/01/16 BRIDGEVIEW HEALTHCARE CENTER LTD 8100 S HARLEM AVE BRIDGEVIEW IL 60455-1690 (708) 594-5440 SKILLED NURSING 04/01/15 BURGESS SQUARE HEALTHCARE 5801 S CASS AVE WESTMONT IL 60559-2300 (630) 971-2645 SKILLED NURSING 10/01/15 CARLTON AT THE LAKE 725 W MONTROSE AVE CHICAGO IL 60613-1515 (773) 929-1700 SKILLED NURSING 06/01/16 CARLTON SKILLED NURSING FACILITY 725 W MONTROSE AVE CHICAGO IL 60613-1515 (773) 929-1700 A 9/1/2016 SKILLED NURSING 04/01/16 CHALET LIVING AND REHAB 7350 N SHERIDAN RD CHICAGO IL 60626-2017 (773) 274-1000 A 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 CHALET LIVING AND REHAB CTR LLC 7350 N SHERIDAN RD CHICAGO IL 60626-2017 (773) 274-1000 C 6/1/2016 SKILLED NURSING 01/05/16 CITADEL CARE CENTER 900 W RIVER PL KANKAKEE IL 60901-2932 (815) 933-1711 SKILLED NURSING 01/05/16 CITADEL CARE CENTER ELGIN 180 S STATE ST ELGIN IL 60123-6429 (847) 742-3310 SKILLED NURSING 01/05/16 CITADEL CARE CENTER WILMETTE 432 POPLAR DR WILMETTE IL 60091-2731 (847) 256-5000 SKILLED NURSING 01/01/15 COMMUNITY FIRST MEDICAL CENTER SN 5645 W ADDISON ST CHICAGO IL 60634-4403 (773) 282-7000 SKILLED NURSING 01/01/15 COMMUNITY NURSING AND REHAB CTR 1136 N MILL ST NAPERVILLE IL 60563-2519 (630) 355-3300 SKILLED NURSING 11/01/15 COUNTRYSIDE CARE CENTRE 2330 W GALENA BLVD AURORA IL 60506-4246 (630) 896-4686 SKILLED NURSING 04/01/16 ELMBROOK HEALTHCARE & REHAB CTR 127 W DIVERSEY AVE ELMHURST IL 60126-1101 (630) 530-5225 A 6/1/2016 22

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP SKILLED NURSING 11/01/15 04/01/16 ELMBROOK NURSING LLC 127 DIVERSY RD ELMHURST IL 60126-1101 (630) 530-5225 C 6/1/2016 SKILLED NURSING 01/01/15 ELMHURST EXTENDED CARE CENTER 200 E LAKE ST ELMHURST IL 60126-2013 (630) 516-5000 SKILLED NURSING 06/01/16 FAIRMONT CARE CENTRE 5061 N PULASKI RD CHICAGO IL 60630-2706 (773) 604-8112 A 9/1/2016 SKILLED NURSING 11/01/15 FOREST VILLA NURSING REHAB CNTR 6840 W TOUHY AVE NILES IL 60714-4520 (847) 647-6400 SKILLED NURSING 05/01/16 FRIENDSHIP VILLAGE OF SCHAUMBURG 350 W SCHAUMBURG RD SCHAUMBURG IL 60194-3464 (847) 884-5000 A 8/1/2016 SKILLED NURSING 01/01/16 GLEN ELSTON NURSING REHAB CENTRE 4340 N KEYSTONE AVE CHICAGO IL 60641-2121 (773) 545-8700 SKILLED NURSING 01/01/16 GLEN OAKS NURSING CENTER 270 SKOKIE BLVD NORTHBROOK IL 60062-1612 (847) 498-9320 SKILLED NURSING 01/01/16 GLEN SAINT ANDREW LIVING COMM LLC 7000 N NEWARK NILES IL 60714-4577 (847) 674-5454 SKILLED NURSING 01/01/16 GLENBRIDGE NURSING AND REHAB 8333 W GOLF RD NILES IL 60714-1113 (847) 966-9190 SKILLED NURSING 01/01/16 GLENCREST NURSING AND REHAB 2451 W TOUHY AVE CHICAGO IL 60645-3309 (773) 338-6800 SKILLED NURSING 01/01/16 GLENLAKE TERRACE NURSING AND REHA 2222 W 14TH ST WAUKEGAN IL 60085-7708 (847) 249-2400 SKILLED NURSING 01/01/16 GLENSHIRE NURSING & REHAB CENTERE 22660 CICERO AVE RICHTON PARK IL 60471-1700 (708) 747-6120 SKILLED NURSING 10/01/15 GLENVIEW TERRACE NURSING CENTER 1511 GREENWOOD RD GLENVIEW IL 60026-1513 (847) 729-9090 SKILLED NURSING 05/01/16 GREEN FIELDS OF GENEVA 0N801 FRIENDSHIP WAY GENEVA IL 60134-6206 (847) 843-4259 A 8/1/2016 SKILLED NURSING 11/01/15 04/01/16 GROVE AT LINCOLN PRK LIVING REHAB 2732 N HAMPDEN CT CHICAGO IL 60614-1612 (773) 248-6000 C 6/1/2016 SKILLED NURSING 04/01/16 GROVE AT THE LAKE 2534 ELM AVE ZION IL 60099-2661 (847) 746-8435 A 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 GROVE AT THE LAKE NURSING AND LIV 2534 ELM AVE ZION IL 60099-2661 (847) 746-8435 C 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 GROVE OF EVANSTON 500 ASHBURY ST EVANSTON IL 00006-0202 (847) 316-3320 C 6/1/2016 SKILLED NURSING 04/01/16 GROVE OF EVANSTON LIVING AND RHB 500 ASBURY AVE EVANSTON IL 60202-2724 (847) 316-3320 A 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 GROVE OF LA GRANGE PARK 701 N LA GRANGE RD LA GRANGE IL 60526-1520 (708) 354-7300 C 6/1/2016 SKILLED NURSING 04/01/16 GROVE OF SKOKIE 9000 N LAVERGNE AVE SKOKIE IL 60077-1618 (847) 679-2322 A 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 GROVE OF SKOKIE LIVING & REHAB CT 9000 LAVERGNE AVE SKOKIE IL 60077-1618 (847) 679-2322 C 6/1/2016 SKILLED NURSING 10/01/15 HARMONY NURSING AND REHAB CENTER 3919 W FOSTER AVE CHICAGO IL 60625-6056 (773) 588-9500 SKILLED NURSING 03/01/15 HELIA HEALTHCARE OF YORKVILLE 1308 GAME FARM RD YORKVILLE IL 60560-2110 (630) 553-5811 SKILLED NURSING 11/01/15 JACKSON SQUARE SKILLED NURSING 5130 W JACKSON BLVD CHICAGO IL 60644-4332 (773) 921-8000 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE CHGO RIDGE 10300 SOUTHWEST HWY CHICAGO RIDGE IL 60415-1426 (708) 425-1100 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE ELMHURST 420 W BUTTERFIELD RD ELMHURST IL 60126-4980 (630) 832-2300 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE LAGRANGE 4735 WILLOW SPRINGS RD LA GRANGE IL 60525-6130 (708) 352-6900 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE LAKE ZURICH 900 S RAND RD LAKE ZURICH IL 60047-2450 (847) 726-1200 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE LOMBARD 2100 S FINLEY RD LOMBARD IL 60148-4830 (630) 495-4000 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE ORLAND PARK 14601 S JOHN HUMPHREY DR ORLAND PARK IL 60462-2641 (708) 349-8300 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE SCHAUMBURG 675 S ROSELLE RD SCHAUMBURG IL 60193-3100 (847) 352-5500 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE STREAMWOOD 815 E IRVING PK RD STREAMWOOD IL 60107-3073 (630) 837-5300 SKILLED NURSING 09/01/15 LEXINGTON HEALTH CARE WHEELING 730 W HINTZ RD WHEELING IL 60090-5501 (847) 537-7474 SKILLED NURSING 09/01/15 LEXINGTON HLTH CARE BLOOMINGDALE 165 S BLOOMINGDALE RD BLOOMINGDAL IL 60108-1434 (630) 980-8700 SKILLED NURSING 01/01/14 MANOR CARE AT ARLINGTON HEIGHTS 715 W CENTRAL RD ARLINGTON IL 60005-2348 (847) 392-2020 SKILLED NURSING 01/01/14 MANOR CARE AT NAPERVILLE 200 MARTIN AVE NAPERVILLE IL 60540-6516 (630) 355-4111 SKILLED NURSING 01/01/14 MANOR CARE AT SOUTH HOLLAND 2145 E 170TH ST SOUTH IL 60473-3788 (708) 895-3255 SKILLED NURSING 01/01/14 MANOR CARE HEALTH SRVC NORTHBROOK 3300 MILWAUKEE AVE NORTHBROOK IL 60062-7126 (847) 795-9700 SKILLED NURSING 01/01/14 MANOR CARE HEALTH SRVCS HINSDALE 600 W OGDEN AVE HINSDALE IL 60521-3158 (630) 325-9630 SKILLED NURSING 01/01/14 MANOR CARE HEALTH SRVS WESTMONT 512 E OGDEN AVE WESTMONT IL 60559-1228 (630) 323-4400 SKILLED NURSING 01/01/14 MANOR CARE HLTH SERV OAK LAWN WES 6300 W 95TH ST OAK LAWN IL 60453-2256 (708) 599-8800 SKILLED NURSING 01/01/14 MANOR CARE HLTH SERV ROLLING MEAD 4225 KIRCHOFF RD ROLLING IL 60008-2005 (847) 397-2400 SKILLED NURSING 01/01/14 MANOR CARE HLTH SRVS ELK GROVE VI 1920 NERGE RD ELK GROVE IL 60007-2972 (847) 301-0550 SKILLED NURSING 01/01/14 MANOR CARE HLTH SRVS LIBERTYVILLE 1500 S MILWAUKEE AVE LIBERTYVILLE IL 60048-3723 (847) 816-3200 SKILLED NURSING 01/01/14 MANOR CARE HLTH SRVS PALOS HTS E 7850 W COLLEGE DR PALOS HEIGHTS IL 60463-1010 (708) 361-6990 SKILLED NURSING 01/01/14 MANOR CARE HLTH SVCS OAK LAWN EAS 9401 S KOSTNER AVE OAK LAWN IL 60453-2697 (708) 423-7882 SKILLED NURSING 01/01/14 MANOR CARE HLTH SVCS PALOS HTS W 11860 SOUTHWEST HWY PALOS HEIGHTS IL 60463-1036 (708) 361-4555 23

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP SKILLED NURSING 01/01/14 MANOR CARE HLTHCARE SRVS HOMEWOOD 940 MAPLE RD HOMEWOOD IL 60430-2061 (708) 799-0244 SKILLED NURSING 01/01/14 MARIANJOY AT PROV DOWNERS GROVE 3450 SARATOGA AVE DOWNERS IL 60515-1141 (630) 969-9360 SKILLED NURSING 01/01/14 MARIANJOY AT PROV PALOS HEIGHTS 13259 S CENTRAL AVE PALOS HEIGHTS IL 60463-2601 (708) 239-6060 SKILLED NURSING 01/01/14 MARIANJOY REHABILITATION HOSPITAL 26 W 171 ROOSEVELT RD WHEATON IL 60187-6078 (630) 909-8000 SKILLED NURSING 03/01/16 MAYFIELD CARE CENTER 5905 W WASHINGTON BLVD CHICAGO IL 60644-2845 (773) 261-7074 SKILLED NURSING 04/01/16 MEADOWBROOK MANOR 431 REMINGTON BLVD BOLINGBROOK IL 60440-4918 (630) 759-1112 SKILLED NURSING 04/01/16 MEADOWBROOK MANOR NAPERVILLE 720 RAYMOND DR NAPERVILLE IL 60563-9758 (630) 355-0220 SKILLED NURSING 04/01/16 MEADOWBROOK MANOR OF LAGRANGE 339 S 9TH AVE LA GRANGE IL 60525-6429 (630) 759-1112 SKILLED NURSING 10/01/15 MICHEALSEN HEALTH CENTER 831 N BATAVIA AVE BATAVIA IL 60510-2198 (630) 879-4300 SKILLED NURSING 06/01/16 OAK BROOK HEALTHCARE CENTRE LTD 2013 MIDWEST RD OAK BROOK IL 60523-1312 (630) 495-0220 A 8/1/2016 SKILLED NURSING 07/01/16 07/01/16 PALOS HILLS HEALTHCARE LLC 10426 S ROBERTS RD PALOS HILLS IL 60456-1932 (708) 598-3460 C 8/1/2016 SKILLED NURSING 01/01/15 PARK PLACE CHRISTIAN COMMUNITY 1150 S EUCLID AVE ELMHURST IL 60126-5178 (630) 909-7370 SKILLED NURSING 11/01/15 PARK VILLA NURSING AND REHAB CTR 12550 S RIDGELAND PALOS HEIGHTS IL 60463-1859 (708) 597-9300 SKILLED NURSING 11/01/15 PETERSON PARK HEALTHCARE CENTER 6141 N PULASKI RD CHICAGO IL 60646-5215 (773) 478-2000 SKILLED NURSING 10/01/15 RENAISSANCE AT 87TH STREET 2940 W 87TH ST CHICAGO IL 60652-3832 (773) 434-8787 SKILLED NURSING 01/01/14 ROSEWOOD CARE CENTER OF ELGIN 2355 ROYAL BLVD ELGIN IL 60123-4716 (847) 888-9585 SKILLED NURSING 01/01/14 ROSEWOOD CARE CENTER OF JOLIET 3401 HENNEPIN DR JOLIET IL 60431-1080 (815) 436-5900 SKILLED NURSING 01/01/14 ROSEWOOD CARE CENTER ST CHARLES 850 DUNHAM RD ST CHARLES IL 60174-1494 (630) 443-4400 SKILLED NURSING 01/01/14 ROSEWOOD CARE CNTR INC INVERNESS 1800 W COLONIAL PKWY INVERNESS IL 60067-1216 (847) 776-4700 SKILLED NURSING 01/01/14 SALEM VILL NURSING AND REHAB CTR 1314 ROWELL AVE JOLIET IL 60433-2866 (815) 727-5451 SKILLED NURSING 03/01/16 STERLING PAVILION LTD 105 E 23RD ST STERLING IL 61081-1212 (815) 626-4264 SKILLED NURSING 08/01/15 SYMPHONY EVANSTON HEALTHCARE 820 FOSTER AVE EVANSTON IL 60201-3212 (847) 492-7700 SKILLED NURSING 11/01/15 SYMPHONY MORGAN PARK 10935 S HALSTED ST CHICAGO IL 60628-3127 (773) 928-2000 N 9/1/2016 SKILLED NURSING 11/01/15 SYMPHONY OF BEVERLY 2940 W 87TH ST CHICAGO IL 60652-3832 (773) 434-8787 SKILLED NURSING 11/01/15 SYMPHONY OF BRONZEVILLE PARK 3400 S INDIANA AVE CHICAGO IL 60616-3841 (312) 842-5000 SKILLED NURSING 11/01/15 SYMPHONY OF BUFFALO GROVE 150 WEILAND RD BUFFALO IL 60089-7047 (847) 465-0200 SKILLED NURSING 11/01/15 SYMPHONY OF CRESTWOOD 14255 S CICERO AVE CRESTWOOD IL 60445-2154 (708) 371-0400 SKILLED NURSING 04/29/16 SYMPHONY OF HANOVER PARK 2000 W LAKE ST HANOVER PARK IL 60133-4302 (630) 556-2000 SKILLED NURSING 11/01/15 SYMPHONY OF JOLIET 306 N LARKIN AVE JOLIET IL 60435-6698 (815) 744-5560 SKILLED NURSING 11/01/15 SYMPHONY OF LINCOLN 2202 N KICKAPOO ST LINCOLN IL 62656-1306 (217) 735-1538 SKILLED NURSING 11/01/15 SYMPHONY OF MIDWAY LLC 4437 S CICERO AVE CHICAGO IL 60632-4333 (773) 884-0484 SKILLED NURSING 11/01/15 SYMPHONY OF SOUTH SHORE 2425 E 71ST ST CHICAGO IL 60649-2612 (773) 720-5000 SKILLED NURSING 02/01/16 SYMPHONY OSWEGO LLC 4390 ROUTE 71 OSWEGO IL 60543-9866 (630) 554-1001 SKILLED NURSING 07/01/14 TABOR HILLS HEALTHCARE 1347 CRYSTAL CT NAPERVILLE IL 60563-0149 (630) 305-5400 SKILLED NURSING 04/01/16 THE GROVE AT LINCOLN PARK 2732 N HAMPDEN CT CHICAGO IL 60614-1612 (773) 248-6000 A 6/1/2016 SKILLED NURSING 11/01/15 THE GROVE OF FOX VALLEY 1601 FARNSWORTH AVE AURORA IL 60505-1509 (847) 679-9797 SKILLED NURSING 04/01/16 THE GROVE OF LAGRANGE PARK LIVING 701 N LAGRANGE RD LA GRANGE IL 60526-1520 (708) 354-7300 A 6/1/2016 SKILLED NURSING 11/01/15 04/01/16 THE GROVE OF NORTHBROOK 263 SKOKIE BLVD NORTHBROOK IL 60062-1611 (847) 564-0505 C 6/1/2016 SKILLED NURSING 04/01/16 THE GROVE OF NORTHBROOK 263 SKOKIE BLVD NORTHBROOK IL 60062-1611 (847) 564-0505 A 6/1/2016 SKILLED NURSING 03/01/16 THE HEIGHTS HLTHCARE & REHAB CTRE 1629 GARDNER LN PEORIA IL 61616-3613 (309) 685-1545 SKILLED NURSING 11/01/15 THE IMPERIAL OF LINCOLN PARK 1366 W FULLERTON AVE CHICAGO IL 60614-2129 (773) 248-9300 SKILLED NURSING 11/01/15 THE VILLA AT EVERGREEN PARK 10124 S KEDZIE EVERGREEN IL 60805-3738 (708) 907-7000 SKILLED NURSING 11/01/15 THE VILLA AT SOUTH HOLLAND LLC 16300 WAUSAU AVE SOUTH IL 60473-2158 (708) 596-5500 SKILLED NURSING 04/01/16 TRANSITIONAL CARE CTR ARLINGTON 1200 N ARLINGTON HEIGHTS RD ARLINGTON IL 60004-4741 (847) 392-9000 A 6/1/2016 SKILLED NURSING 10/01/15 TRI STATE NURSING AND REHAB CTR 2500 E 175TH ST LANSING IL 60438-1801 (708) 474-7330 SKILLED NURSING 09/01/15 WARREN BARR LINCOLNSHIRE 150 JAMESTOWN LN LINCOLNSHIRE IL 60069-2119 (224) 543-7100 SKILLED NURSING 11/01/15 WARREN BARR LIVING AND REHAB 66 W OAK ST CHICAGO IL 60610-7325 (312) 705-5100 SKILLED NURSING 09/01/15 WARREN BARR NORTH SHORE LLC 2773 SKOKIE VALLEY ROAD HIGHLAND IL 60035-1042 (847) 266-9266 24

PROVIDER TYPE ORGANIZATION NAME OFFICE ADDRESS 1 CITY STATE ZIP SKILLED NURSING 11/01/15 WARREN BARR SOUTH LOOP 1725 S WABASH CHICAGO IL 00006-0616 (312) 922-2777 SKILLED NURSING 03/01/16 WARREN PARK HEALTH AND LIVING CTR 6700 N DAMEN AVE CHICAGO IL 60645-4902 (773) 465-5000 SKILLED NURSING 03/01/16 WATER FRONT TERRACE 7750 S SOUTH SHORE DR CHICAGO IL 60649-4434 (773) 731-4200 SKILLED NURSING 06/01/16 WAUCONDA HLTH AND REHAB CNTR 176 THOMAS CT WAUCONDA IL 60084-2451 (847) 526-5551 A 9/1/2016 SKILLED NURSING 10/01/15 WHITEHALL OF DEERFIELD 300 WAUKEGAN RD DEERFIELD IL 60015-4908 (847) 945-4600 SKILLED NURSING 03/01/16 WINDMILL NURSING PAVILION 16000 S WABASH AVE SOUTH IL 60473-1464 (708) 339-0600 SKILLED NURSING 10/01/15 WINDSOR PARK MANOR 110 WINDSOR PARK DR CAROL STREAM IL 60188-1986 (630) 682-4491 Change Codes: A: New C: Cancel N: Prov. Name P: Prov. Number R: Reinstate AC: Accreditation Cancel AD: Address CP: Cancel prov # changed PN: Name and Number TE: Telephone Number TI: Transfer into a class TO: Transfer out of a class 25

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