CCN Network Provider Listing - Proposal …new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/Resources/...CCN Network Provider Listing - Proposal Submission ... 501 Doctor Michael

CCN Network Provider Listing - Proposal Submission SpreadsheetCCN Name: Coventry Health Care of Louisiana, Inc.

Provider/Practice Name Last Name First Name Middle Initial Title 1st Line of Address

Highland Clinic, APMC Johnson Lori R. MD 1455 E Bert Kouns Industrial LooHighland Clinic, APMC Washburne Willard F. MD 1455 E Bert Kouns Industrial LooHighland Clinic, APMC Whited Steven C. MD 1455 E Bert Kouns Industrial LooThe Allergy & Asthma Clinic Zambie Michael F. MD 909 North Third St.Parish Anesthesia of Monroe 309 JACKSON ST SMSO Anesthesia, LLC 312 Grammont St.Highland Clinic, APMC Waguespack Glen 1455 E Bert KounsArk‐LA‐Tex Cardiology, APMC Brown Thomas A. MD 2727 Hearne AveThe Heart Clinic Caskey David M. MD 102 Thomas RdP. Thomas Causey, jr.,MD, AMC Causey P. Thomas, MD 102 Thomas RdChristus Schumpert Group Practice CardioloDavis Jonathan M. MD 1801 Fairfield AveArk‐LA‐Tex Cardiology, APMC Davis Paul C. MD 1800 E 70th St

Freedman Memorial Cardiology, LLC Eubanks Beth S. NP 3311 Prescott Rd

Imperial Calcasieu Medical Group, LLP Fastabend Carl P. MD 501 Doctor Michael Debakey DrArk‐LA‐Tex Cardiology, APMC Fileccia Jr. Russell S. MD 2727 Hearne Ave

Freedman Memorial Cardiology, LLC Freedman Robert J. MD 3311 Prescott Rd

Imperial Calcasieu Medical Group, LLP Gilmore Richard M. MD 501 Doctor Michael Debakey DrCardiovascular Diagnostic Cener Gonzales Virginia MD 402 McMillan RdCardiovascular Diagnostic Center, APMC Gonzalez Virginia Y. MD 402 McMillan Rd.

Freedman Memorial Cardiology, LLC Hanley Henry G. MD 3311 Prescott Rd

Practitioner Name

Ark‐La‐Tex Cardiology, APMC Hewitt Donna R. FNP‐BC 1800 E 70th St.Monroe Cardiovascular Associates Islam Rezaul MD 3100 Forsythe Ave.Monroe Cardiovascular Associates Islam Rezaul MD 606 East Water StAlexandria Cardiology Clinic Jaffrani Naseem A. MD 501 Medical Center DrArk‐La‐Tex Cardiology, APMC Johnson Betty C. FNP‐BC 2727 Hearne Ave.Alexandria Cardiology Clinic Kaimal Parameswara K. MD 501 Medical Cener DrThe Heart Clinic Koepke Ronald P. MD 102 Thomas RdNorthern Louisiana Family Care Langiulli Michael MD 3057 Highway 80 WRuston Cardiology Associates Langiulli Michael MD 411 E Vaughn AveJonesboro Internal Medicine Langiulli Michael MD 4633 Quitman HwyRuston Clinic Company, LLC Langiulli Michael MD 601 W Lafayette StAlexandria Cardiology Clinic Leyser Larry J. MD 501 Medical Center DrLA Cardiovascular & Thoracic Manzer Craig W. NP 3311 Prescott Rd.Ark‐LA‐Tex Cardiology, APMC Martin Robert T. MD 1800 E 70th StLeesville Heart Center, PMC Meadaa Reymond MD 1106 Port Arthur TerMedical Association of Northeast LouisianaMouhaffel Assad H. MD 102 Thomas Rd

Sheikh‐Khalil Mahmoud MD 501 Durham St.Sheikh‐Khalil Mahmoud MD 3424 Medical Park Dr

Ark‐LA‐Tex Cardiology, APMC Singh Iqbal MD 1800 E 70th StArk‐LA‐Tex Cardiology, APMC Smith James F. MD 2727 Hearne AveArk‐LA‐Tex Cardiology, APMC Smith Ray D. MD 2727 Hearne AveArk‐LA‐Tex Cardiology, APMC Stafford Paul R. MD 1800 E 70th St

Freedman Memorial Cardiology, LLC Stowe Deann NP 3311 Prescott RdArk‐LA‐Tex Cardiology, APMC Walton Michael G. MD 2400 Hospital DrArk‐LA‐Tex Cardiology, APMC Wiggins Sherman S. MD 2727 Hearne AveArk‐La‐Tex Cardiology, APMC Willis Elizabeth R. FNP‐BC 2400 Hospital Dr.

Freedman Memorial Cardiology Younes Alaa H. MD 3311 Prescott RdArk‐La‐Tex Cardiology, APMC Craig Pamela B. FNP‐BC 1800 E 70TH ST Ruston Cardiology Associates DiStante Brian T. MD 411 E Vaughn AveArk‐LA‐Tex Cardiology, APMC Holt Jeffrey W. MD 2400 Hospital DrAlexandria Cardiology Clinic Kaimal Parameswara K. MD 1605 7th StArk‐La‐Tex Cardiology, APMC Reeves Eric R. MD 2727 Hearn AveArk‐La‐Tex Cardiology, APMC Wilson Kayci D. FNP‐BC 2400 Hospital Dr.

Alexandria Chiropractic Clinic Boisvert Robert A. DC 5501 COLISEUM BLVD Clauss Chafbond DC 2804 N. First St.

Deese Chiropractic Clinic Deese Charles J. DC 217 W Plaquemine StCalcasieu Spinal Care, Inc. Duhon David M. DC 2118 E Prien Lake Rd

Faircloth Kelly B. DC 3620 Bayou Rapides RdGreenacres Chiropractic Clinic Hamer Jennifer G. DC 925 Benton Rd

Optimum Health Chiropractic Rider Shaine E. DC 4451 Nelson RdGreenacres Chiropractic Clinic Rougeau Robert A. DC 925 Benton RdMarksville Chiropractic Clinic Vermaelen Devin R. DC 503 N Main StBossier Chiropractic Center Wiseman James A. DC 3018 Old Minden RdTrinity Chiropractic Clinic, Inc. Zeagler Jon E. DC 366 South DrHighland Clinic, APMC Cooksey David MD 1455 E Bert Kouns Industrial Loo

Imperial Calcasieu Medical Group, LLP Olivier Maureen A. MD 501 Doctor Michael Debakey DrLaSalle General Hospital Gallaspy John W. MD 187 Ninth St.LaSalle General Hospital Godley Clifford MD 187 Ninth St.LaSalle General Hospital Rohr Gabriela MD 187 Ninth St.St. Francis ER Physicians 309 Jackson St.Highland Clinic, APMC Chico Michelle A. MD 1455 E Bert Kouns Industrial Loo

Imperial Calcasieu Medical Group, LLP Gilbert Timothy R. MD 501 Doctor Michael Debakey Dr

Miguel P. Rivera,MD, APMC Rivera Miguel P. MD 3020 Kingman StHighland Clinic, APMC Rushing Donna J. MD 1455 E Bert Kouns Industrial LooHighland Clinic, APMC Barnes Jon C. NP 1455 E. Bert Kouns

Imperial Calcasieu Medical Group, LLP Byrd Gerald W. MD 501 Doctor Michael Debakey DrRuston Clinic Company, LLC dba Ruston Ga Lacayo Leonel MD 411 E Vaughn AveJonesboro Internal Medicine Lacayo Leonel MD 4633 Quitman HwyRuston Clinic Company, LLC Lacayo Leonel MD 601 W Lafayette St

Gastrointestinal Consultants McHugh J. B. MD 102 Thomas Rd

Alexandria Gastrointestinal Specialists, LLC Morrison Maury K. MD 3311 Prescott Rd

Imperial Calcasieu Medical Group, LLP Nichols III Paul H. MD 501 Doctor Michael Debakey Dr

Hemant Pande,MD Pande Hemant MD 1015 W Fertitta Blvd

MID LOUISIANA SURGICAL SPECIA Aguilar Darryl J. MD 3311 PRESCOTT RD

MID LOUISIANA SURGICAL SPECIA Bledsoe Samuel E. MD 3311 PRESCOTT RD

MID LOUISIANA SURGICAL SPECIA Conerly James MD 3311 PRESCOTT RDThe Medical Office at Regency Ferguson William MD 102 Thomas RdGuru Ghanta,MD Ghanta Guru P. MD 1015 W Fertitta BlvdRon C. Gregg,MD Gregg Ron C. MD 206 Serio Blvd

Minor Claude B., MD 2806 Mark Dr

MID LOUISIANA SURGICAL SPECIA Parrish James N., MD 3311 PRESCOTT RDRayburn Surgical Clinic Rayburn Dave M. MD 390 Griffith St.Morehouse Hyperbaric Medicine ProvidersReynolds Joseph B. MD 323 W WALNUT ST

Mid Louisiana Surgical Specialties Watkins Wayne L. MD 3311 PRESCOTT RDSabbaghian Bahman MD 1322 Elton Rd

Springhill Medical Services Inc dba SMC/ DoTorrence Leamon G. MD 401 11th St NECHRISTUS Medical Group Rembert Paula E. MD 1455 E Bert Kouns Industrial LooWomen's Healthcare Smith Tina M NP 410 Wood St.

CHRISTUS ST FRANCES CABRINI Al‐halawani Hafez MD 3330 MASONIC DR CH Wilkinson Physician Network Khan Mohammad Y. MD 1611 Foster St.

CHRISTUS ST FRANCES CABRINI Saccaro Steven J. MD 3330 Masonic Dr

CHRISTUS Cabrini Cancer Center Ule Ulla J. MD 3330 Masonic DrHighland Clinic, APMC Walker Donna A. MD 2001 Doctor DrHighland Clinic, APMC Walker Donna A. MD 620 E. College StHighland Clinic, APMC Walker Donna A. MD 301 Bert KounsHighland Clinic, APMC Walker Donna A. MD 1512 Doctors Dr.West LA Family Practice Bhattarai Yubaraja MD 18570 Johnny b HallCH Wilkinson Physician Network Fontil Valy MD 3330 Masonic Dr.CH Wilkinson Physician Network Foret Gerald L., MD 3330 Masonic Dr.West LA Hospitalists Ghetia Ditina K. MD 1020 Fertitta blvd.The Intensivist Group, LLC Lambert Ronald S. MD 2525 Viking Dr.CH Wilkinson Physician Network Mai Minh MD 3330 Masonic Dr.CH Wilkinson Physician Network Mensah‐Armoo Elsie J. MD 3330 MASONIC DR CH Wilkinson Physician Network Olatinwo Omotayo MD 3330 Masonic Dr.West LA Hospitalists Saidan Mohammad M. MD 1020 Fertitta blvd.CH Wilkinson Physician Group Smith George MD 3330 Masonic Dr.CH Wilkinson Physician Network Wadyal Crystal J. MD 1801 Fairfield AveLake Area Physician Services, LLC Diket Albert MD 4150 Nelson RdLake Area Physician Services, LLC Newman Mark G. MD 4150 Nelson RdLake Area Physician Services, LLC St. Amant Marshall MD 4150 Nelson RdLake Area Physician Services, LLC Stedman Charles M. MD 4150 Nelson RdLake Area Physician Services, LLC Veillon Edward W. MD 4150 Nelson RdHighland Clinic, APMC Dhawan Manish MD 301 Bert Kouns Industrial Loop

Imperial Calcasieu Medical Group, LLP Goolsby III Henry J. MD 501 Doctor Michael Debakey DrHighland Clinic, APMC Reddy Shantan G. MD 211 Medical DrAllstar Pediatrics Beg Mirza Ashhab MD 935 Verone TerraceThe Kidney Clinic, LLC Abushamat Abdel‐Raouf F. MD 1700 Engleside St

Cenla Heart Specialty From Kendall T., MD 1337 CENTRE COURT Nephrology Consultants, LLC Kilpatrick John S. MD 745 Olive StNephrology Consultants, LLC White Randall G. MD 745 Olive St

Cenla Heart Specialty Wilson Mark M. MD 1337 CENTRE COURT

Alexandria Neurosurgical Clinic Dowd Gregory C. MD 3704 North Blvd

Alexandria Neurosurgical Clinic Drerup Michael L. MD 3704 North BlvdOuachita Neurosurgery Center, AMC McHugh Bernie MD 312 Grammon St.

Alexandria Neurosurgical Clinic Vaughn Troy M. MD 3704 North Blvd

ALEXANDRIA NEUROSURGICAL CLINIC Culbertson Howard S. MD 3704 NORTH BLVDHighland Clinic, APMC Harris Meghan MD 1455 E Bert Kouns Industrial Loo

NeuroMedical Clinic of CenLa, LLC Hidalgo Gonzalo MD 3311 Prescott RdNeurology and Headache Center Kumar Suresh MD 3555 Youree DrHighland Clinic, APMC Scaltsas‐Persson Irene MD 1455 E Bert Kouns Industrial Loo

Imperial Calcasieu Medical Group, LLP Sconzert Alan C. MD 501 Doctor Michael Debakey DrNeurology and Sleep Center, LLC Zeibo Mohammad MD 301 4th StCHRISTUS St. Frances Cabrini Hospital Zeibo Mohammad MD 3330 Masonic DrSterlington Rural Health Clinic Fletcher Kimberly NP 10374 Hwy 165Martin Aviles,MD Aviles Martin MD 627 Bienville CirThe Woman's Clinic Belsom William B. MD 301 McMillan RdThe Woman's Clinic Belsom William B. MD 931 North Trenton StHaissam N. Bouz,MD Bouz Haissam N. MD 3311 Prescott RdThe Woman's Clinic Bryan David G. MD 301 McMillan RdThe Woman's Clinic Bryan David G. MD 931 North Trenton StMichael J. Caire,MD Caire Michael J. MD 410 Wood StThe Woman's Clinic Clark Dellie H. MD 931 North Trenton StThe Woman's Clinic Clarke Dellie H. MD 301 McMillan RdCH Wilkinson Physician Network Coleman Stephen C. DO 1534 Elizabeth St.Morehouse General Hospital's Women's HeGuoth Janos MD 316 W. Walnut Ave.The Woman's Clinic Hall Peyton R. MD 301 McMillan RdThe Woman's Clinic Hall Peyton R. MD 931 North Trenton StCH Wilkinson Physician Network Ingalls Amanda L. MD One St. Mary PlaceThe Woman's Clinic Jackson Gwenn V. MD 301 McMillan

The Woman's Clinic Jackson Gwenn V. MD 931 North Trenton StCH Wilkinson Physician Network Jones J. Stephen MD 1534 Elizbeth St.The Woman's Clinic Jopling Annie G NP 931 North Trenton StThe Woman's Clinic Klug Sara J. NP 931 North Trenton StThe Woman's Clinic Klug Sara NP 301 McMillan RdRuston Clinic Company, LLC dva OB/GYN AsLarson Cynthia E. DO 411 E Vaughn AveThe Woman's Clinic LeBleu‐Vaszily Laurie R. MD 312 GRAMMONT STThe Woman's Clinic LeBleu‐Vaszily Laurie R. MD 931 North Trenton StThe Woman's Clinic Lee Won S. MD 301 McMillan RdThe Woman's Clinic Lee Won S. MD 931 North Trenton St

Oommen Jacob MD 502 RUE DE SANTE #201 The Woman's Clinic Pennebaker Dawn W. MD 301 McMillan RdThe Woman's Clinic Pennebaker Dawn W. MD 931 North Trenton StThe Woman's Clinic Peveto Sherry S. NP 301 McMillan RdThe Woman's Clinic Peveto Sherry S. NP 931 North Trenton StHighland Clinic, APMC Popwell Benny M. MD 1455 E Bert Kouns Industrial LooMinerva Ramirez,MD Ramirez Minerva MD 1110 Port Arthur TerCHRISTUS Medical Group Runnels Lauren H. MD 1801 Fairfield AveThe Woman's Clinic Salas Amber M. MD 301 McMillan RdThe Woman's Clinic Salas Amber M. MD 931 North Trenton St

Sarfraz Mohammad MD 1112 PORT ARTHUR TERRACE Susan Shattuck,MD Shattuck Susan M. MD 8001 Youree DrThe Woman's Clinic Sheppard Tonya H. MD 301 McMillan RdThe Woman's Clinic Sheppard Tonya H. MD 931 North Trenton StRuston Womens Specialty Center Smith Landon c. MD 411 E. Vaughn Ave.Highland Clinic, APMC Stokes Brooke B NP 1455 E Bert KounsCH Wilkinson Physician Network Talukder Saimah MD 1 SAINT MARY PL The Woman's Clinic Tugwell Terence MD 301 McMillan RdThe Woman's Clinic Tugwell Terence R. MD 931 North Trenton StHighland Clinic, APMC Tynes Kerry W. MD 1455 E Bert Kouns Industrial LooCatherine F. Vanderloos,MD, AMC Vanderloos Catherine F. MD 2508 Bert Kouns Industrial Loop

Obstetrical & Gynecological Associates, Inc. Vincent III Vincent MD 3335 Prescott RdThe Woman's Clinic Walters Christie J. NP 301 McMillan Rd

The Woman's Clinic Walters Christie J. NP 931 North Trenton StCHRISTUS Medical Group Whitaker Racheal MD 1801 Fairfield AveThe Woman's Clinic Williams Adrienne M. MD 301 McMillan RdThe Woman's Clinic Willliams Adrienne M. MD 931 North Trenton StThe Woman's Clinic Wilson Jason B. MD 312 GRAMMONT STThe Woman's Clinic Wilson Jason B. MD 931 North Trenton St

Iowa Therapy Group Arabie Marilyn PT 702 E. Miller Ave.

Dan Wood PT, Inc. Barnes Leslye PT 3867 Bayou Acres Dr.

Dan Wood PT, Inc. Freeland William PT 3867 Bayou Acres Dr.

Dan Wood PT, Inc. Martin Adam OT 3867 Bayou Acres Dr.

Iowa Therapy Group Meche Scott OT 702 E. Miller Ave.

Southwest LA Sports & Rehab Meche Scott OT 646 McNeese St.

Broussard Physical Therapy Clinic Patton Melissa OT 295 Highland Dr

Dan Wood PT, Inc. Richardson Anita OT 3867 Bayou Acres Dr.

Iowa Therapy Group Stewart Anne OT 702 E. Miller Ave.Wilson Baber,MD, LLC Baber Wilson B. MD 734 N Ashley Ridge LoopHighland Clinic, APMC Berg Mary E. MD 471 Ashley RidgeEyecare Specialists of Louisiana, LLC Carmody John B. MD 1801 Fairfield AveHighland Clinic, APMC Cooper Stephan K. MD 471 Ashley Ridge BlvdHighland Clinic, APMC Garrett Geoffrey W. MD 471 Ashley Ridge BlvdWilson Baber,MD, LLC Gosslee Jeffrey M. MD 734 N Ashley Ridge LoopHighland Clinic, APMC Henderson Bruce C. MD 471 Ashley Ridge BlvdEYE CARE AND SURGICAL ASSOC Luke Celeste C. MD 108 MEDIC AVE Northern Louisiana Eye Associates Meyer Jo Ann H. MD 411 E Vaughn AveRegional Retina Ren David H. MD 7330 Fern AveBryan Vekovius,MD, APMC Vekovius Bryan J. MD 450 Ashley Ridge Blvd

Zaffater Eye Center, LLC Zaffater Jr. Norman MD 2300 Hospital Dr

ALEXANDRIA ORAL SURGERY ASSOC Carlton David M., DDS 1403 PETERMAN DR

ALEXANDRIA ORAL SURGERY ASSOC Marks Ronald B. DDS 1403 PETERMAN DR West LA Orthopedics Park H. John MD 700 S. 6th St.Highland Clinic, APMC Anglin Edward L. MD 1455 E Bert Kouns Industrial LooHighland Clinic, APMC Auer Powell B. MD 1455 E Bert Kouns Industrial LooRuston Orthopaedics Blair Major E. MD 411 E. Vaughn Ave.Ruston Orthopaedics Blair Major E. MD 601 W. Lafayette St.

Mid State Orthopaedic and Sports Medicine Brunet Michael E. MD 1135 Expressway Dr

Imperial Calcasieu Medical Group, LLP Collins Geoffrey J. MD 1747 Imperial Blvd

Mid State Orthopaedic and Sports Medicine Crenshaw William D. MD 3351 Masonic Dr

Mid State Orthopaedic and Sports Medicine Dodson Mark A. MD 1135 Expressway Dr

Mid State Orthopaedic and Sports Medicine Drury Benjamin T. MD 3351 Masonic DrRuston Orthopaedics Finley James S. MD 920 Oliver rd.Lake Area Orthopaedics Ford Thomas B. MD 4150 Nelson Rd

Mid State Orthopaedic and Sports Medicine Foster W. Stanley MD 3351 Masonic Dr

Mid State Orthopaedic and Sports Medicine Galante Gaeton PA 3351 Masonic DrHighland Clinic, APMC Goodman Carl G. MD 1455 E Bert Kouns Industrial Loo

Mid State Orthopaedic and Sports Medicine Goudeau Dustin PA 3351 Masonic Dr

West State Orthopedics and Sports Medicine Clinic Granger Shawn P. MD 506 S 6th StHighland Clinic, APMC Green M. Ragan MD 1455 E Bert Kouns Industrial Loo

Imperial Calcasieu Medical Group, LLP Hale Steven S. MD 1747 Imperial Blvd

Imperial Calcasieu Medical Group, LLP Hale Steven S. MD 250 Beglis PkwyHighland Clinic, APMC Houtz Carlton G. MD 1455 E Bert KounsHighland Clinic, APMC Mead Gordon M. MD 1455 E Bert Kouns Industrial Loo

Imperial Calcasieu Medical Group, LLP Noble Jr. John W. MD 1747 Imperial BlvdWest LA Orthopedics Park H. John MD 255 Highland Dr.

Mid State Orthopaedic and Sports Medicine Perdue Louis D. MD 3351 Masonic Dr

Imperial Calcasieu Medical Group, LLP Perry James D. MD 1747 Imperial Blvd

Pontchartrain Bone & Joint Clinic Ploger Wilmot F. MD 3939 Houma Blvd

Mid State Orthopaedic and Sports Medicine Rich Christopher J. MD 134 E 5th St

Mid State Orthopaedic and Sports Medicine Sadler Graham MD 3351 Masonic DrHighland Clinic, APMC Springmeyer Craig R. MD 1455 E Bert Kouns Industrial Loo

Mid State Orthopaedic and Sports Medicine Texada Charles T. MD 3351 Masonic Dr

Imperial Calcasieu Medical Group, LLP Trappey IV George J. MD 1747 Imperial Blvd

Joseph A. Badeaux, III,MD, APMC Badeaux III Joseph A. MD 2108 Texas Ave

Imperial Calcasieu Medical Group, LLP Chan Raphael K. MD 501 Doctor Michael Debakey DrDanna Lawrence J. MD 108 Contempo Ave.

West LA Ear, Nose & Throat Gozaine Teofilo C. MD 240 Highland Dr.

Imperial Calcasieu Medical Group, LLP Louviere Eugene M. MD 501 Doctor Michael Debakey DrHighland Clinic, APMC Parker J. William MD 1455 E Bert Kouns Industrial Loo

3James T. Pate,MD Pate James T. MD 4124 Jackson Street ExtHighland Clinic, APMC Rice Clifford, H., MD 1455 E. Bert KounsHighland Clinic, APMC Robinson James R. MD 1455 E Bert Kouns Industrial LooThe Head & Neck Clinic White John A. MD 107 Fron StByrd Medical ClinicWest LA Ear, Nose & Th Gozaine Teofilo C. MD 506 S 6th St

Alexandria Neurosurgical Clinic Felder Kathryn PA‐C 3704 North Blvd

Alexandria Neurosurgical Clinic Harvey Robert PA‐C 3704 North Blvd

Alexandria Neurosurgical Clinic Murphy Kevin PA‐C 3704 North BlvdHighland Clinic, APMC Betzing Kenneth PA 1455 E Bert KounsArk‐La‐Tex Cardiology, APMC Eason Kent W. PA‐C 2727 Hearne AveArk‐La‐Tex Cardiology, APMC Hamic Mia F. PA‐C 2727 Hearne Ave.Ark‐La‐Tex Cardiology. APMC Hanna Angela C. PA‐C 2727 Hearne AveArk‐La‐Tex Cardiology, APMC Neal Kelli M. PA‐C 2727 Hearne Ave.Ark‐La‐Tex Cardiology, APMC Savoie Amanda M. PA‐C 2727 Hearne Ave.

Ark‐La‐Tex Cardiology, APMC Spaw Shannon P. PA‐C 2727 Hearne Ave.Ark‐La‐Tex Cardiology, APMC Stovall Mathew W. PA‐C 2400 Hospital DrArk‐La‐Tex Cardiology, APMC Stringer Daniel B. PA‐C 1800 E 70th StArk‐La‐Tex Cardiology, APMC Troyer Rachel L. PA‐C 1800 E 70th St.Ark‐La‐Tex Cardiology, APMC Warren‐White Amy D. PA‐C 2727 Hearne Ave.NCMC Medical Surgical Clinic Messier John PA 1003 S Spruce StHighland Clinic, APMC Scheffy Lauren P. PA 301 Bert KounsHighland Clinic, APMC Green Alexis K. PA 1455 E. Bert KounsLouisiana Pain Care Forte Vincent MD 210 Layton Ave.Louisiana Pain Cae Gordon James H. MD 210 Layton Ave.Louisiana Pain Care Ledbetter John MD 210 Layton Ave.Bayou Pathology 109 CIRCLE DR The Delta Pathology Group, LLC 211 Fourth St.The Delta Pathology Group, LLC 2915 MissouriThe Delta Pathology Group, LLC 309 Jackson StThe Delta Pathology Group, LLC 211 Fourth St

La Allergy Asthma Close Benjamin B. MD 201 Pecan Park AvePediatric Cardiology of Southwest LouisianaGugol Rubee MD 2005 SOUTHWOOD DR Pediatric Cardiology of Southwest LouisianaKattash Mudar M. MD 2005 SOUTHWOOD DR CH Wilkinson Physician Network Edelman Samuel B. DO One St. Mary Place

Khateeb Naila Imran MD 1022 PORT ARTHUR TERRACECHRISTUS Medical Group Young Martin C. MD 3311 Prescott RdSabine Medical Associates, Inc Sukerek Husam H. MD 210 HIGHLAND DR LSU Health Science Center Morales Jaime MD 1000 Walters St.CH Wilkinson Physician Network Kampert Amanda L. MD One St. Mary PlaceChildren's Clinic of SW Louisiana Nadell Joseph MD 2903 First Ave.Highland Clinic, APMC Hinrichsen John D. MD 1400 E Bert KounsHighland Clinic, APMC Richards Alan B. MD 1400 E Bert KounsChristus Schumpert Hospital Physicians GroBrown Mark F. MD 1 Saint Mary PlNorthwest Louisiana Physical Medicine Courtney III Jenness D. MD 1801 Fairfield AveHighland Clinic, APMC Henderson Leigh MD 1455 E Bert Kouns Industrial Loo

Imperial Calcasieu Medical Group, LLP Lowry Jr. William J. MD 1747 Imperial Blvd

Imperial Calcasieu Medical Group, LLP Morton Craig G. MD 1747 Imperial BlvdTaylor Robert M. MD 3311 PRESCOTT RD

Brewer Physical Therapy Brewer Amanda T. PT 2015 FAIRFIELD AVE

Iowa Therapy Group Albro Daryl PT 702 E. Miller Ave.

Southwest LA Sports & Rehab Albro Daryl PT 646 McNeese St.

Thibodeaux, Albro & touchet Therapy Albro Daryl PT 1322 Elton Rd.

Thibodeaux, Albro & touchet Therapy Arabie Marilyn PT 1322 Elton Rd.

Ouachita Physical Therapy Boardman Brent PT 1910 Stubbs Ave.

Brewer Physical Therapy Brewer Keith PT 2015 Fairfield

Broussard Physical Therapy Clinic Broussard Keith PT 295 Highland Dr

Dan Wood PT, Inc. Butler Nicholas PT 3867 Bayou Acres Dr.

Thibodeaux, Albro & touchet Therapy Campbell Antoinette PT 1322 Elton Rd.

Tri‐State Physical Therapy Caradonna Lindsay PT 2820 Hearne Ave.

Thibodeaux, Albro & touchet Therapy Daigle Brad PT 1322 Elton Rd.

The Therapy Center of Avoyelles, LLC Ebersohn George PT 5435 Highway 1

Thibodeaux, Albro & touchet Therapy Elter Doug PT 1322 Elton Rd.

Iowa Therapy Group Elter Douglas PT 702 E. Miller Ave.

Ouachita Physical Therapy Enlow Brian PT 1910 Stubbs Ave.

Guidroz Physical Therapy Guidroz Richard PT 132 E 5th St

Ouachita Physical Therapy Guilbeau Glenn PT 1910 Stubbs Ave.

Tri‐State Physical Therapy Hart Timothy PT 2820 Hearne Ave.

Helping Hands Physical Therapy Johnson Bradley PT 385 Bert Kouns Industrial Loop

Helping Hands Physical Therapy Johnson Chere PT 385 Bert Kouns Industrial Loop

Guidroz Physical Therapy Jones Jerry PT 132 E 5th St

Lake Physical Therapy Lamkin Kerry PT 1709 W Prien Lake Rd

Iowa Therapy Group Meche Sarah PT 702 E. Miller Ave.

Southwest LA Sports & Rehab Meche Sarah PT 646 McNeese St.

Thibodeaux, Albro & touchet Therapy Meche Scott PT 1322 Elton Rd.

Guidroz Physical Therapy Miller Mary PT 132 E 5th St

Miller Physical Therapy Miller Wilvan PT 3912 Parliament Dr.

Alexandria Neurosurgical Clinic Noel Eugene PT 3704 North Blvd

Guidroz Physical Therapy Parker Jason PT 132 E 5th St

Iowa Therapy Group Prince Raymond PT 702 E. Miller Ave.

Southwest LA Sports & Rehab Prince Raymond PT 646 McNeese St.

Qualls & Co. Qualls David PT 702 1st Ave.

Ouachita Physical Therapy Richardson Jon PT 1910 Stubbs Ave.Shreveport Physical Therapy PT 1453 E Bert Kouns

Avoyelles Physical Therapy Clinic Singletary John PT 510 S. Cottonwood St.

Avoyelles Physical Therapy Clinic Singletary Pamela PT 510 S. Cottonwood St.

Thibodeaux, Albro & touchet Therapy Stewart Anne PT 1322 Elton Rd.

Iowa Therapy Group Thibodeaux Chris PT 702 E. Miller Ave.

Southwest LA Sports & Rehab Thibodeaux Christopher PT 646 McNeese St.

Thibodeaux, Albro & touchet Therapy Thibodeaux Christopher PT 1322 Elton Rd.

Iowa Therapy Group Touchet Kevin PT 702 E. Miller Ave.

Thibodeaux, Albro & touchet Therapy Touchet Kevin PT 1322 Elton Rd.

Dan Wood PT, Inc. Wood Dan PT 3867 Bayou Acres Dr.

Tri‐State Physical Therapy Zytkoskee Tracy PT 2906 Plantation DrCH Wilkinson Physician Network Aaron Casey PA 1455 East Bert Kouns Loop

LA Cardiovascular & Thoracic Riley Ashley N. PA 3311 Prescott Rd.Highland Clinic, APMC Knight Daniel R. MD 1455 E Bert Kouns Industrial Loo

John S. McCabe,MD, Inc, APC McCabe John S. MD 301 4th St

Dr. Geoffrey Bergman Bergman Geoffrey DPM 1406 Peterman DrWest LA Foot & Ankle Cohen Benjamin DPM 506 S. 6th St.West LA Foot & Ankle Cohen Benjamin DPM 220 B Highland Dr.West LA Foot & Ankle Eleyae Oghale E. DPM 325 W 8TH ST

Imperial Calcasieu Medical Group, LLP Green Tyson E. DPM 1747 Imperial BlvdSouthside Foot Clinic Havens Richard T. DPM 9308 Mansfield RdSouthside Foot Clinic Havens Richard T. DPM 1521 Doctors DrMobile Foot Specialist, Inc. Hudson Cassell DPM 2855 Long Lake DrFamily Foot and Ankle Clinic Okereke Edozie C. DPM 3626 Youree Dr

Mid State Orthopaedic and Sports Medicine Saucier Maria N. DPM 3351 Masonic Dr

Mid State Orthopaedic and Sports Medicine Sunderhaus Paul T. DPM 134 E 5th St

Mid State Orthopaedic and Sports Medicine Sunderhaus Paul T. DPM 3351 Masonic DrA Complete Foot Center, LLC Vang Charlotte D. DPM 212 W McNeese StMobile X‐RAY Services 9376 MANSFIELD RD

Imperial Calcasieu Medical Group, LLP Belenchia Johnny M. MD 501 Doctor Michael Debakey Dr

Imperial Calcasieu Medical Group, LLP Chinn Albert J. MD 501 Doctor Michael Debakey DrRuston Pulmonology Murray Howard N. MD 411 E Vaughn AveRuston Pulmonology Murray Howard N. MD 620 E College St

Imperial Calcasieu Medical Group, LLP Williams Luke M. MD 501 Doctor Michael Debakey DrYounes Maan MD 3311 PRESCOTT RD

Regional Cancer Center‐SPH Hauskins Larry A. MD 524 Doctor Michael Debakey Dr

DELAND CORPORATION Deland Mary M. MD 211 MEDICAL DR Radiology Consultants Atchison James W. MD 503 McMillan Rd.Radiology Consultants Atchison James W. MD 401 E. Vaughn St.Radiology Consultants Braud John A. MD 503 McMillan Rd.Radiology Consultants Braud John A. MD 401 E. Vaughn St.Radiology Consultants Broyles Michael O. MD 503 McMillan Rd.Radiology Consultants Broyles Michael O. MD 401 E. Vaughn St.

Central LA Imaging Dozier Timothy J. MD 3704 NORTH BLVD Radiology Consultants Green Warren J. MD 503 McMillan Rd.Radiology Consultants Green Warren J. MD 401 E. Vaughn St.

Hindelang III Floyd M., MD 107 E SHANKLAND AVE Radiology Consultants Hindelang III Henry G., MD 503 McMillan Rd.Radiology Consultants Hindelang III Henry G., MD 401 E. Vaughn St.

Central LA Imaging Larson Paul C. MD 1410 JACKSON ST

CENTRAL LOUISIANA IMAGING Long William D. MD 1410 JACKSON ST

CENTRAL LOUISIANA IMAGING CTR Mansour Alfred A., MD 1410 JACKSON ST Radiology Consultants Pate Steven W. MD 503 McMillan Rd.Radiology Consultants Pate Steven W. MD 401 E. Vaughn St.

MINIMALLY INVASIVE IMAGE GUID Sachasinh Rachadip S. MD 3704 NORTH BLVD

IMPERIAL CALCASIEU MEDICAL GR Tomek Barbara C. MD 501 Dr. Michael DeBakey Dr.Menache Lawrence MD 211 Medical Dr

Cenla Heart Specialty Garcia‐Carol Miguel A. MD 1337 CENTRE COURT

Highland Clinic, APMC Kampert Kurt W. MD 1455 E Bert Kouns

Mohammad I. Shbeeb,MD Shbeeb Mohammad I. MD 3349 Masonic Dr

Imperial Calcasieu Medical Group, LLP Varela Raul E. MD 501 Doctor Michael Debakey DrChadha Medical Clinic 140 W FOURTH ST Delhi Rural Health Clinic 508 Broadway StNCMC Plain Dealing Clinic 108 N LOUISIANA ST Union Clinc of Marion 3150 TAYLOR ST Union General Rural Health Clinic 1025 MARION HWYCommunity Health Institute 907 POLK ST

Speech Therapy Unlimited Halelujah, LLC King Barbara MS CCC‐S 4646 Hilry Huckaby Ave.

Dan Wood PT, Inc. Laird Pamela ST 3867 Bayou Acres Dr.

Nelson Margaret ST 805 AUBURN AVE

Miller Physical Therapy Warner Brian 3912 Parliament Dr.

Mid State Orthopaedic and Sports Medicine Leddy III Michael J. MD 3351 Masonic DrSpringhill Medical Center Bozeman Martin C. MD 2001 Doctors Dr.Norwood Surgical Specialists, LLC Burke James B. MD 2751 Albert L Bicknell DrHighland Clinic, APMC Dockendorf Brian L. MD 1455 E Bert Kouns Industrial LooPredrag M. Gagic,MD, APMC Gagic Predrag M. MD 313 Center StWest LA Surgical Associates Ghorab Khaled MD 255 Highland Dr.Lincoln Surgical Associates Jones Cynthia M. MD 411 E Vaughn AveHighland Clinic, APMC Knight Charles D. MD 1455 E Bert Kouns Industrial LooSulphur Surgical Clinic Ledet Jr. Walter P. MD 914 Cypress StLincoln Surgical Associates Meyer Kevin M. MD 411 E Vaughn AveLincoln Surgical Associates Meyer Kevin M. MD 620 E College StNorwood Surgical Specialists, LLC Norwood William L. MD 2751 Albert L Bicknell DrCommunity Health Institute Sawyer Douglas C. MD 907 Polk St.

Imperial Calcasieu Medical Group, LLP Shimer Richard T. MD 501 Doctor Michael Debakey DrCH Wilkinson Physician Network Sorrells Donald L. MD 1 Saint Mary Pl

Mid Louisiana Surgical Specialties Suter James MD 3311 Prescott Rd.Michael J. Torma,MD Torma Michael J. MD 2530 Bert Kouns Industrial Loop

Mid Louisiana Surgical Specialties Wallace Jamie PA 3311 Prescott Rd.

Mid Louisiana Surgical Specialties Watson Erin PA 3311 Prescott Rd.Louisiana Cardiovascular & Thoracic Institute, LLC Dewitt R. Chance MD 3311 Prescott RdLouisiana Cardiovascular & Thoracic Institute, LLC Jones Gary P. MD 3311 Prescott RdSterlington Clinic Lipka John M. MD 115 LA HWY 2 CH Wilkinson Physician Network Mousset Xavier R. MD 1605 Foster StNORTH LA SURGERY CENTER Sasaki Larry S. MD 1512 DOCTORS DR Sulphur Surgical Clinic Seale Arnold K. MD 914 Cypress StWest LA Urology Fraser Francis A. MD 1201 Fertitta Blvd.Ruston Urology Associates Rutland Edward H. MD 411 E. Vaughn Ave.Highland Clinic, APMC White Stephen C. MD 1455 E Bert Kouns Industrial Loo

t (G.1)Geocoding

2nd Line of Address City State Postal Code Latitude

Suite 101 SHREVEPORT LA 71105 20 03 1 1 32426160SHREVEPORT LA 71105 20 03 1 1 32426160SHREVEPORT LA 71105 20 03 1 1 32426160Monroe LA 71220 20 03 1 1 32509145MONROE LA 71201 20 05 1 1 32499761

Suite 101 MONROE LA 71201 20 05 1 1 32500779Suite 206 Shreveport LA 71105 34 64 1 1 32426160Suite 300 SHREVEPORT LA 71103 20 06 1 1 32485950

Monroe LA 71291 20 06 1 1 32516899Suite 201 WEST MONROE LA 71291 20 06 1 1 32516899Suite 210 SHREVEPORT LA 71101 20 06 1 1 32494871

SHREVEPORT LA 71105 20 06 1 1 32443263

Suite 112 Alexandria LA 71301 78 06 1 2 31284063

LAKE CHARLES LA 70601 20 06 1 1 30224634Suite 300 SHREVEPORT LA 71103 20 06 1 1 32485950

Suite 112 ALEXANDRIA LA 71301 20 06 1 1 31284063

LAKE CHARLES LA 70601 20 06 1 1 30224634West Monroe LA 71291 20 06 1 1 32514698West Monroe LA 71291 20 06 1 1 32514698


Contract STP*PCP

Linkages

Business Location AddressNew

Patient LOIProvider Type

Specialty Code

Age Restriction

Shreveport LA 71105 78 06 1 2 32443263Monroe La 71201 20 06 1 1 32540768Farmerville LA 71241 20 06 1 1 32773900

Suite 250 ALEXANDRIA LA 71301 20 06 1 1 31313604Suite 300 SHREVEPORT LA 71103 78 06 1 2 32485950Suite 250 ALEXANDRIA LA 71301 20 06 1 1 31313604

Monroe LA 71291 20 06 1 1 32516899CALHOUN LA 71225 20 06 1 1 32512567

Suite 105 RUSTON LA 71270 20 06 1 1 32515402HODGE LA 71247 20 06 1 1 32269047WINNFIELD LA 71483 20 06 1 1 31924811

Suite 250 ALEXANDRIA LA 71301 20 06 1 1 31313604Suite 202 Alexandria LA 71301 78 06 1 2 31284063

SHREVEPORT LA 71105 20 06 1 1 32443263Suite A LEESVILLE LA 71446 20 06 1 1 31137737Suite 103 West Monroe LA 71291 20 06 1 1 32516899

Bastrop LA 71220 20 06 1 1 32773439Suite 6 Monroe LA 71203 20 06 1 1 32577984

SHREVEPORT LA 71105 20 06 1 1 32443263Suite 300 SHREVEPORT LA 71103 20 06 1 1 32485950Suite 300 SHREVEPORT LA 71103 20 06 1 1 32485950

SHREVEPORT LA 71105 20 06 1 1 32443263

Suite 112 Alexandria LA 71301 78 06 1 2 31284063Suite 490 BOSSIER CITY LA 71111 20 06 1 1 32556430Suite 300 SHREVEPORT LA 71103 20 06 1 1 32485950Suite 490 BOSSIER CITY LA 71111 78 06 1 2 32556430

Ste 112 ALEXANDRIA LA 71301 20 06 1 1 31284063SHREVEPORT LA 71105 78 06 1 2 32443263

Suite 105 RUSTON LA 71270 20 06 1 1 32515402Suite 490 BOSSIER CITY LA 71111 20 06 1 1 32556430

Mamou LA 70554 20 06 1 1 30627200Suite 300 SHREVEPORT LA 71103 20 06 1 1 32485950Suite 490 BOSSIER CITY LA 71111 78 06 1 2 32556430

ALEXANDRIA LA 71303 30 35 1 2 31294963JENA LA 71342 30 35 1 2 31687600JENNINGS LA 70546 30 35 1 2 30222463LAKE CHARLES LA 70601 30 35 1 2 30198063Alexandria LA 71303 30 35 1 2 31303924BOSSIER CITY LA 71111 30 35 1 2 32528729

LAKE CHARLES LA 70605 30 35 1 2 30176686BOSSIER CITY LA 71111 30 35 1 2 32528729MARKSVILLE LA 71351 30 35 1 2 31130000

Suite 1203 BOSSIER CITY LA 71112 30 35 1 2 32521644NATCHITOCHES LA 71457 30 35 1 2 31743200

Suite 308 SHREVEPORT LA 71105 20 07 1 1 32426160

LAKE CHARLES LA 70601 20 07 1 1 30224634Jena LA 71342 20 1T 1 1 31681100Jena LA 71342 20 1T 1 1 31681100Jena LA 71342 20 1T 1 1 31681100Monroe LA 71201 20 1T 1 2 32499761

3rd Floor SHREVEPORT LA 71105 20 2E 1 1 32426160

LAKE CHARLES LA 70601 20 2E 1 1 30224634

Ste B METAIRIE LA 70006 20 2E 1 1 30002237SHREVEPORT LA 71105 20 2E 1 1 32426160

Suite 210 Shreveport LA 71105 78 79 1 2 32426160

LAKE CHARLES LA 70601 20 10 1 1 30224634Suite 205 RUSTON LA 71270 20 10 1 1 32515402

HODGE LA 71247 20 10 1 1 32269047WINNFIELD LA 71483 20 10 1 1 31924811

Suite 506 West Monroe LA 71291 20 10 1 1 32516899


LAKE CHARLES LA 70601 20 10 1 1 30224634

LEESVILLE LA 71446 20 10 1 1 31137163



Suite 201 ALEXANDRIA LA 71301 20 02 1 1 31284063Suite 205 Monroe LA 71291 20 02 1 1 32516899

LEESVILLE LA 71446 20 02 1 1 31137163FERRIDAY LA 71334 20 02 1 1 31649800Monroe LA 71201 20 02 1 1 32527567

Suite 201 ALEXANDRIA LA 71301 20 02 1 1 31284063PINEVILLE LA 71360 20 02 1 1 31332944BASTROP LA 71220 20 02 1 1 32775163

Suite 201 ALEXANDRIA LA 71301 20 02 1 1 31284063Ste H Jennings LA 70546 20 02 1 1 30233838

SPRINGHILL LA 71075 20 38 1 1 330079452nd Floor SHREVEPORT LA 71105 20 16 1 1 32426160

Monroe LA 71201 78 16 1 2 32500353

ALEXANDRIA LA 71301 20 2H 1 1 31282579Lake Charles LA 70601 20 2H 1 1 30216355

Alexandria LA 71301 20 2H 1 1 31282579

ALEXANDRIA LA 71301 20 2H 1 1 31282579Springhill LA 71075 20 2H 1 1 33011146

Suite D Homer LA 71040 20 2H 1 1 32794052Shreveport LA 71106 20 2H 1 1 32398068Bossier City LA 71112 20 2H 1 1 32533599Rosepine LA 70659 20 87 1 1 30920391Alexandria LA 71301 20 87 1 1 31282579ALEXANDRIA LA 71301 20 87 1 1 31282579Leesville LA 71446 20 87 1 1 31137521Bossier City LA 71111 20 87 1 1 32554416Alexandria LA 71301 20 87 1 1 31282579ALEXANDRIA LA 71301 20 87 1 1 31282579Alexandria LA 72301 20 87 1 1 31282579Leesville LA 71446 20 87 1 1 31137521Alexandria LA 71301 20 87 1 1 31282579

Suite 401 Shreveport LA 71101 20 87 1 1 32494871Building G Suite 6 LAKE CHARLES LA 70605 20 3C 1 1 30181964Building G Suite 6 LAKE CHARLES LA 70605 20 3C 1 1 30181964Building G Suite 6 LAKE CHARLES LA 70605 20 3C 1 1 30181964Building G Suite 6 LAKE CHARLES LA 70605 20 3C 1 1 30181964Building G Suite 6 LAKE CHARLES LA 70605 20 3C 1 1 30181964

SHREVEPORT LA 71106 20 2J 1 1 32398068

LAKE CHARLES LA 70601 20 2J 1 1 30224634Natchitoches LA 71457 20 2J 1 1 31757402Leesville LA 71446 20 1C 1 1 31140284LAKE CHARLES LA 70601 20 2K 1 1 30216063

ALEXANDRIA LA 71301 20 2K 1 1 31280662Suite 200 SHREVEPORT LA 71104 20 2K 1 1 32492563Suite 200 SHREVEPORT LA 71104 20 2K 1 1 32492563

ALEXANDRIA LA 71301 20 2K 1 1 31280662

Suite C ALEXANDRIA LA 71301 20 14 1 1 31274671

Suite C ALEXANDRIA LA 71301 20 14 1 1 31274671Suite 404 Monroe LA 71201 20 14 1 1 32500779

Suite C ALEXANDRIA LA 71301 20 14 1 1 31274671

Suite C ALEXANDRIA LA 71301 20 13 1 1 31274671Suite 109 SHREVEPORT LA 71105 20 13 1 1 32426160

Suite 216 ALEXANDRIA LA 71301 20 13 1 1 31284063SHREVEPORT LA 71105 20 13 1 1 32475467SHREVEPORT LA 71105 20 13 1 1 32426160

LAKE CHARLES LA 70601 20 13 1 1 30224634Suite F ALEXANDRIA LA 71301 20 13 1 1 31314299

ALEXANDRIA LA 71301 20 13 1 1 31282579Suite B STERLINGTON LA 71280 78 79 1 2 32699248

NATCHITOCHES LA 71457 20 16 1 1 31752638West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213

Suite 314 ALEXANDRIA LA 71301 20 16 1 1 31284063West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213Monroe LA 71201 20 16 1 1 32500353West Monroe LA 71291 20 16 1 1 32507213West Monroe 71291 20 16 1 1 32515525

Suite 204 Shreveport LA 71101 19 16 1 1 32497734Bastrop LA 71220 20 16 1 1 32775383West Monroe LA 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213Shreveport LA 71101 20 16 1 1 32505824West Monroe LA 71291 20 16 1 1 32515525

West Monroe LA 71291 20 16 1 1 32507213Suite 204 SHREVEPORT LA 71101 20 16 1 1 32497734

West Monroe LA 71291 78 16 1 2 32507213West Monroe LA 71291 78 16 1 2 32507213West Monroe 71291 89 16 1 2 32515525

Suite 202 RUSTON LA 71270 19 16 1 1 32515402Suite 300 MONROE LA 71201 20 16 1 1 32500779

West Monroe LA 71291 20 16 1 1 32507213West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213LAPLACE LA 70068 20 16 1 1 30074500West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213West Monroe 71291 78 16 1 2 32515525West Monroe LA 71291 78 16 1 2 32507213

Suite 305 SHREVEPORT LA 71105 20 16 1 1 32426160LEESVILLE LA 71446 20 16 1 1 31137737

Suite 403 SHREVEPORT LA 71101 20 16 1 1 32494871West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213LEESVILLE LA 71446 20 16 1 1 31137737

Suite 350 SHREVEPORT LA 71115 20 16 1 1 32431738West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213

Suite 103 RUSTON LA 71270 20 16 1 1 32515402Suite 306 Shreveport LA 71105 78 16 1 2 32426160

SHREVEPORT LA 71101 20 16 1 1 32494068West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213SHREVEPORT LA 71105 20 16 1 1 32426160

Suite 400 SHREVEPORT LA 71118 20 16 1 1 32402100

ALEXANDRIA LA 71301 20 16 1 1 31283091West Monroe LA 71291 78 16 1 2 32515525

West Monroe LA 71291 78 16 1 2 32507213Suite 403 SHREVEPORT LA 71101 20 16 1 1 32494871

West Monroe 71291 20 16 1 1 32515525West Monroe LA 71291 20 16 1 1 32507213

Suite 300 MONROE LA 71201 20 16 1 1 32500779West Monroe LA 71291 20 16 1 1 32507213

Iowa LA 70647 35 74 1 2 30246000

Bastrop LA 71220 35 74 1 2 32762753

Bastrop LA 71220 35 74 1 2 32762753

Bastrop LA 71220 37 74 1 2 32762753

Iowa LA 70647 37 74 1 2 30246000

Lake Charles LA 70605 37 74 1 2 30176313

Many LA 71449 37 74 1 2 31560161

Bastrop LA 71220 37 74 1 2 32762753

Iowa LA 70647 37 74 1 2 30246000SHREVEPORT LA 71106 20 17 1 1 32416358SHREVEPORT LA 71106 20 17 1 1 32418343

Suite 103 SHREVEPORT LA 71101 20 17 1 1 32494871SHREVEPORT LA 71106 20 17 1 1 32418343SHREVEPORT LA 71106 20 17 1 1 32418343SHREVEPORT LA 71106 20 17 1 1 32416358SHREVEPORT LA 71106 20 17 1 1 32418343MARKSVILLE LA 71351 20 17 1 1 31122600

Suite 206 RUSTON LA 71270 20 17 1 1 32515402Suite 702 SHREVEPORT LA 71105 20 17 1 1 32434989

SHREVEPORT LA 71106 20 17 1 1 32418094

Suite 300 BOSSIER CITY LA 71111 20 17 1 1 32557800

ALEXANDRIA LA 71301 27 67 1 2 31275036

ALEXANDRIA LA 71301 27 67 1 2 31275036LEESVILLE LA 71446 20 20 1 1 31137922

Suite 210 SHREVEPORT LA 71105 20 20 1 1 32426160Suite 210 SHREVEPORT LA 71105 20 20 1 1 32426160Suite 201 Ruston LA 71207 20 20 1 1 32515402

Winnfield LA 71483 20 20 1 1 31924811

Suite 100A PINEVILLE LA 71360 20 20 1 1 31320797

LAKE CHARLES LA 70605 20 20 1 1 30168574

ALEXANDRIA LA 71301 20 20 1 1 31281766

Suite 100A PINEVILLE LA 71360 20 20 1 1 31320797

ALEXANDRIA LA 71301 20 20 1 1 31281766suite 1475 Monroe LA 71203 20 20 1 1 32520036Bldg. G, Suite 1 LAKE CHARLES LA 70605 20 20 1 1 30181964

ALEXANDRIA LA 71301 20 20 1 1 31281766

ALEXANDRIA LA 71301 94 20 1 2 31281766Suite 210 SHREVEPORT LA 71105 20 20 1 1 32426160

ALEXANDRIA LA 71301 94 20 1 2 31281766

Suite B LEESVILLE LA 71446 20 20 1 1 31140313Suite 210 SHREVEPORT LA 71105 20 20 1 1 32426160

LAKE CHARLES LA 70605 20 20 1 1 30168574

Suite 1 SULPHUR LA 70663 20 20 1 1 30235700Suite 210 Shreveport LA 71105 20 20 1 1 32426160Suite 210 SHREVEPORT LA 71105 20 20 1 1 32426160

LAKE CHARLES LA 70605 20 20 1 1 30168574Many LA 71446 20 20 1 1 31560836

ALEXANDRIA LA 71301 20 20 1 1 31281766

LAKE CHARLES LA 70605 20 20 1 1 30168574

Suite 21 Doctors Row METAIRIE LA 70006 20 20 1 1 30010929

NATCHITOCHES LA 71457 20 20 1 1 31752362

ALEXANDRIA LA 71301 20 20 1 1 31281766SHREVEPORT LA 71105 20 20 1 1 32426160

ALEXANDRIA LA 71301 20 20 1 1 31281766

LAKE CHARLES LA 70605 20 20 1 1 30168574


LAKE CHARLES LA 70601 20 04 1 1 30224634West Monore LA 71291 20 04 1 1 32514879Many LA 71449 20 04 1 1 31560935

LAKE CHARLES LA 70601 20 04 1 1 30224634SHREVEPORT LA 71105 20 04 1 1 32426160

ALEXANDRIA LA 71303 20 04 1 1 31280910Suite 206 Shreveport LA 71105 20 04 1 1 32426160Suite 206 SHREVEPORT LA 71105 20 04 1 1 32426160

VIDALIA LA 71373 20 04 1 1 31564600Suite B LEESVILLE LA 71446 20 04 1 1 31140313

Suite C Alexandria LA 71301 94 2R 1 2 31274671

Suite C Alexandria LA 71301 94 2R 1 2 31274671

Suite C Alexandria LA 71301 94 2R 1 2 31274671Suite 101 Shreveport LA 71105 94 2R 1 2 32426160Suite 300 Shreveport LA 71103 94 2R 1 2 32485950Suite 300 Shreveport LA 71103 94 2R 1 2 32485950Suite 300 Shreveport LA 71103 94 2R 1 2 32485950Suite 300 Shreveport LA 71103 94 2R 1 2 32485950Suite 300 Shreveport LA 71103 94 2R 1 2 32485950

Suite 300 Shreveport LA 71103 94 2R 1 2 32485950Suite 490 Bossier City LA 71111 94 2R 1 2 32556430

Shreveport LA 71105 94 2R 1 2 32443263Shreveport LA 71105 94 2R 1 2 32443263

Suite 300 Shreveport LA 71103 94 2R 1 2 32485950Vivian LA 71082 94 2R 1 2 32863644Shreveport LA 71106 94 2R 1 2 32398068

Suite 210 Shreverport LA 71105 94 2R 1 2 32426160Monroe LA 71201 20 87 1 1 32497099Monroe LA 71201 20 87 1 1 32497099Monroe LA 71201 20 87 1 1 32497099WEST MONROE LA 71291 20 22 1 2 32516710Alexandria LA 71301 20 22 1 2 31314842Shreveport LA 71109 20 22 1 2 32484252Monroe LA 71201 20 22 1 2 32499761Alexandria LA 71301 20 22 1 2 31314842

ALEXANDRIA LA 71303 20 03 1 1 31293800LAKE CHARLES LA 70605 20 1D 1 1 30178572LAKE CHARLES LA 70605 20 1D 1 1 30178572SHREVEPORT LA 71101 19 1E 1 1 32505824Leesville LA 71446 20 1G 1 1 31137401

Suite 210 ALEXANDRIA LA 71301 20 1G 1 1 31284063MANY LA 71449 20 1H 1 1 31561441Lake Charles LA 70607 20 1I 1 1 30183363Shreveport LA 71101 20 87 1 1 32505824Lake Charles LA 70601 20 1P 1 1 30203227

Suite 103 Shreveport LA 71105 20 18 1 1 32423700Suite 103 Shreveport LA 71105 20 18 1 1 32423700

SHREVEPORT LA 71101 20 1P 1 1 32494068Suite 411 SHREVEPORT LA 71101 20 25 1 1 32494871

SHREVEPORT LA 71105 20 25 1 1 32426160

LAKE CHARLES LA 70605 20 25 1 1 30168574

LAKE CHARLES LA 70605 20 25 1 1 30168574Suite 203 ALEXANDRIA LA 71301 20 25 1 1 31284063

Suite 2B SHREVEPORT LA 71104 35 25 1 2 32492663

Iowa LA 70647 35 25 1 2 30246000

Lake Charles LA 70605 35 25 1 2 30176313

Suite 1 Jennings LA 70546 35 25 1 2 30233838


Monroe LA 71201 35 25 1 2 32520241

Suite 2B Shreveport LA 71104 35 25 1 2 32492663

Many LA 71449 35 25 1 2 31560161

Bastrop LA 71220 35 25 1 2 32762753


Shreveport LA 71103 35 25 1 2 32485214


Marksville, LA 71351 35 25 1 2 31142959


Iowa LA 70647 35 25 1 2 30246000

Monroe LA 71201 35 25 1 2 32520241

Natchitoches LA 71457 35 25 1 2 31752331

Monroe LA 71201 35 25 1 2 32520241

Shreveport LA 71103 35 25 1 2 32485214



Natchitoches LA 71457 35 25 1 2 31752331

Suite B Lake Charles LA 70601 35 25 1 2 30197837

Iowa LA 70647 35 25 1 2 30246000

Lake Charles LA 70605 35 25 1 2 30176313


Natchitoches LA 71457 35 25 1 2 31752331

Alexandria LA 71303 35 25 1 2 31283406

Suite C Alexandria LA 71301 35 25 1 2 31274671

Natchitoches LA 71457 35 25 1 2 31752331

Iowa LA 70647 35 25 1 2 30246000

Lake Charles LA 70605 35 25 1 2 30176313

Sulphur LA 70663 35 25 1 2 30231247

Monroe LA 71201 35 25 1 2 32520241Shreveport LA 71105 35 25 1 2 32426160

Bunkie LA 71322 35 25 1 2 30954056

Bunkie LA 71322 35 25 1 2 30954056


Iowa LA 70647 35 25 1 2 30246000

Lake Charles LA 70605 35 25 1 2 30176313


Iowa LA 70647 35 25 1 2 30246000


Bastrop LA 71220 35 25 1 2 32762753

Bossier City LA 71111 35 25 1 2 325398152nd Floor Shreveport LA 75284 94 2R 1 2 32426160

Suite 202 Alexandria LA 71301 94 2R 1 2 31284063Suite 106 SHREVEPORT LA 71105 20 24 1 1 32426160

Box 30150 ALEXANDRIA LA 71301 20 24 1 1 31314299

ALEXANDRIA LA 71301 32 48 1 2 31274765Leesville LA 71446 32 48 1 2 31140313Many LA 71449 32 48 1 2 31516751DERIDDER LA 70634 32 48 1 2 30839637

LAKE CHARLES LA 70605 32 48 1 2 30168574Suite 100 SHREVEPORT LA 71118 32 48 1 2 32397544

Bossier City LA 71111 32 48 1 2 32533873SHREVEPORT LA 71106 32 48 1 2 32358706SHREVEPORT LA 71105 32 48 1 2 32473580

ALEXANDRIA LA 71301 32 48 1 2 31281766

NATCHITOCHES LA 71457 32 48 1 2 31752362

ALEXANDRIA LA 71301 32 48 1 2 31281766LAKE CHARLES LA 70605 32 48 1 2 30176337SHREVEPORT LA 71134 25 63 1 2 32396442

LAKE CHARLES LA 70601 20 21 1 1 30224634

LAKE CHARLES LA 70601 20 21 1 1 30224634Suite 101 RUSTON LA 71270 20 21 1 1 32515402

HOMER LA 71040 20 21 1 1 32794052

LAKE CHARLES LA 70601 20 21 1 1 30224634Suite 318 ALEXANDRIA LA 71301 20 21 1 1 31284063

LAKE CHARLES LA 70601 20 30 1 1 30224634

NATCHITOCHES LA 71457 20 30 1 1 31757402West Monroe LA 71291 20 30 1 1 32514387Ruston LA 71270 20 30 1 1 32515383West Monroe LA 71291 20 30 1 1 32514387Ruston LA 71270 20 30 1 1 32515383West Monroe LA 71291 20 30 1 1 32514387Ruston LA 71270 20 30 1 1 32515383

ALEXANDRIA LA 71301 20 30 1 1 31274671West Monroe LA 71291 20 30 1 1 32514387Ruston LA 71270 20 30 1 1 32515383JENNINGS LA 70546 20 30 1 1 30231463West Monroe LA 71291 20 30 1 1 32514387Ruston LA 71270 20 30 1 1 32515383

ALEXANDRIA LA 71301 20 30 1 1 31306255

ALEXANDRIA LA 71301 20 30 1 1 31306255

ALEXANDRIA LA 71301 20 30 1 1 31306255West Monroe LA 71291 20 30 1 1 32514387Ruston LA 71270 20 30 1 1 32515383

ALEXANDRIA LA 71301 20 30 1 1 31274671

LAKE CHARLES LA 70601 20 30 1 1 30224634Natchitoches LA 71457 20 30 1 1 31757402

ALEXANDRIA LA 71301 20 2M 1 1 31280662

Suite 210 Shreveport LA 71105 20 2M 1 1 32426160

ALEXANDRIA LA 71301 20 2M 1 1 31281826

LAKE CHARLES LA 70601 20 2M 1 1 30224634DEQUINCY LA 70633 20 94 1 2 30446803Delhi LA 71232 87 94 1 2 32452069PLAIN DEALING LA 71064 87 94 1 2 32907200MARION LA 71260 87 94 1 2 32902400FARMERVILLE LA 71241 87 94 1 2 32785846Mansfield LA 71052 87 94 1 2 32037737

Suite III SHREVEPORT LA 71107 37 71 1 2 32567229

Bastrop LA 71220 37 71 1 2 32762753

MONROE LA 71201 37 71 1 2 32516214

Alexandria LA 71303 37 71 1 2 31283406

ALEXANDRIA LA 71301 20 87 1 1 31281766Springhill LA 71075 20 02 1 1 33011146

Suite 3A SHREVEPORT LA 71103 20 02 1 1 32485043Suite 203 SHREVEPORT LA 71105 20 02 1 1 32426160

MARKSVILLE LA 71351 20 02 1 1 31125455MANY LA 71449 20 02 1 1 31560836

Suite 200 RUSTON LA 71270 20 02 1 1 32515402Suite 203 SHREVEPORT LA 71105 20 02 1 1 32426160

SULPHUR LA 70663 20 02 1 1 30231237Suite 200 RUSTON LA 71270 20 02 1 1 32515402

HOMER LA 71040 20 02 1 1 32794052Suite 3A SHREVEPORT LA 71103 20 02 1 1 32485043

MANSFIELD LA 71052 20 02 1 1 32037737

LAKE CHARLES LA 70601 20 02 1 1 30224634SHREVEPORT LA 71101 20 02 1 1 32494068

Suite 201 Alexandria LA 71301 20 02 1 1 31284063Suite 138 SHREVEPORT LA 71118 20 02 1 1 32402100




Suite 202 ALEXANDRIA LA 71301 20 33 1 1 31284063STERLINGTON LA 71280 20 33 1 1 32700500LAKE CHARLES LA 70601 20 33 1 1 30216381BOSSIER CITY LA 71111 20 33 1 1 32533599SULPHUR LA 70663 20 33 1 1 30231237Leesville LA 71446 20 34 1 1 31137100

Suite 100 Ruston LA 71207 20 34 1 1 32515402SHREVEPORT LA 71105 20 2P 1 1 32426160

1 2

g

Longitude Legend:93718525 1. Provider/Practice Name ‐ Indicate the name of the provider. For practitioners indicate the professional 93718525 association/group name, if applicable.93718525 2. Practitioner Name ‐ Only complete for practitioners. Specify the practitioner’s name and title.92121054 Last Name ‐ Specify the last name of the practitioner.92114361 First Name ‐ Specify the first name of the practitioner.92114762 Title ‐ Specify the practitioner's title such asMD, NP (Nurse Practitioner), PA (Physician Assistant), etc.93718525 1st line of address, 2nd line of address, City, State, and Postal Code. Do not include P.O. Box in the address.93780036 4. Provider Type ‐ Specify the two digit Medicaid provider type code.92156878 5. Specialty Code ‐ Specify the two digit Medicaid specialty type code.92156878 6. New Patient ‐ Indicate whether or not the provider is accepting new patients. If accepting new patients specify "1" 93752236 if Yes or "2" if No.93717885 7. Age Restriction ‐ Indicate any age restrictions for the provider’s practice. For instance, if a physician only sees

92462875 patients up to age 19, indicate "< 19"; if a physician only sees patients age 13 or above, indicate "≥13".

93204849 8. PCP Linkages ‐ If PCP ‐ specify the number of potential linkages.93780036 9. LOI ‐ Letter of Intent ‐ If a Letter of Intent has been executed specify "1" if Yes or "2" if No.

92462875 10. Contract ‐ If a Contract has been executed specify "1" if Yes or "2" if No.

93204849 11. STP* ‐ If network provider meets the definition of Significant Traditional Provider, specify "1" if Yes or "2" if No..92150710 12. Geocoding ‐ Specify the latitude and longitude in decimal (dd) format. (ie. 32.7834 ‐91.12345)92150710

92462875

93717885 *STP Report is available on the MakingMedicaidBetter.com website.920976729239800092450284937800369245028492156878923591479263326092724297926465599245028492462875937178859327251692156878919178369207155493717885937800369378003693717885

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93204849

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92156878

92462875

93204849

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92462875

92462875

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Documents

CCN Network Provider Listing - Proposal …new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/Resources/...CCN Network Provider Listing - Proposal Submission ... 501 Doctor Michael