2013 Provider/Pharmacy Directory

632 Pages·2011·2.42 MB·English

2013 Provider/Pharmacy Directory
(PPO)
January 1, 2013 – December 31, 2013
BlueCross BlueShield of South Carolina contracts with the federal government.
Contract # h4209
h4209_ppo2013ppd Accepted 12925m-2013
TABLE OF CONTENTS
PROVIDER DIRECTORY
SECTION 1 - INTRODUCTION ii
SECTION 2 - LIST OF PLAN PROVIDERS
PRIMARY CARE PHYSICIANS 1
SPECIALISTS 137
HOSPITALS 387
SKILLED NURSING FACILITIES 391
OUTPATIENT MENTAL HEALTH PROVIDERS 398
CHIROPRACTORS 434
ANCILLARY PROVIDERS 453
AMBULANCE SERVICE 453
AMBULATORY SURGICAL CENTER 455
CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) 458
DIABETIC EDUCATOR 458
DIALYSIS CENTERS 459
DURABLE MEDICAL SUPPLY COMPANY 463
FREESTANDING IMAGING FACILITY 472
HOME HEALTH INSTITUTION 472
INDEPENDENT LABORATORY 475
INDEPENDENT PHYSIOLOGICAL LABORATORY 476
INFUSION THERAPY 476
MED SUPPLY CO WITH CERT PROSTHETIST/ORTHOTIST 477
MINUTE CLINIC 479
NURSE PRACTITIONER 481
OCCUPATIONAL THERAPY GROUPS 481
PHARMACY & DME SUPPLIERS 482
PHYSICAL THERAPIST GROUPS 483
REHABILITATION 495
URGENT CARE 497
HOSPITAL IDENTIFIER CODES 500
ROUTINE VISION SERVICE PROVIDERS V i
PHARMACY DIRECTORY
SECTION 1 - INTRODUCTION PH ii
SECTION 2 - NETWORK PHARMACIES PH 1
TABLE OF CONTENTS
CHAIN PHARMACIES PH 1
RETAIL PHARMACIES PH 2
LONG TERM CARE PHARMACIES PH 23
MAIL ORDER PHARMACIES PH 26
HOME INFUSION PHARMACIES PH 27
INDIAN HEALTH SERVICE/TRIBAL/URBAN INDIAN HEALTH PROGRAM PHARMACIES PH 29
NETWORK PHARMACIES OUTSIDE SOUTH CAROLINA PH 30
PROVIDER INDEX I 1
Medicare Blue
SM
PPO Plan

Provider Directory

This directory provides a list of Medicare BlueSM (PPO)’s network providers.

This directory is for the state of South Carolina.

This directory is current as of July 2012. Some network providers may have been added
or removed from our network after this directory was printed. We do not guarantee that
each provider is still accepting new members. To get the most up-to-date information
about Medicare Blue’s network providers in your area, you can visit
www.scbluesmedadvantage.com/mb13 or call our Customer Service Department at
1-888-645-6025. Hours are 8 a.m. to 8 p.m. Eastern Time, Monday through Friday; from
October 1, 2012 to February 14, 2013, 8 a.m. to 8 p.m., seven days a week. Beginning
February 15, 2013, our automated telephone system handles calls received after 8 p.m.
and on Saturdays, Sundays and holidays. TTY/TDD users should call 1-888-645-6023.

Medicare Blue is a PPO plan with a Medicare contract.

This document is available in alternate formats. To get this information in other formats,
please call 1-888-645-6025. TTY/TDD users should call 1-888-645-6023.

H4209_PPO2013PPD ACCEPTED 12925M-2013

BlueCross BlueShield of South Carolina is an independent
licensee of the Blue Cross and Blue Shield Association.
Section 1 – Introduction

This directory provides a list of Medicare Blue’s network providers. To get detailed information
about your health care coverage, please see your Evidence of Coverage.

The “network providers” listed in this directory have agreed to provide you with your health care
and vision coverage. You may go to any of our network providers listed in this directory. If you
have been going to one network provider, you are not required to continue going to that same
provider. In some cases, you may get covered services from non-network providers.

Emergency care can always be obtained in or out of the service area from the nearest available
provider. When in the service area, you must use plan providers for urgent care. When out of the
service area, urgent care may be obtained from the first available provider. In addition, when out
of the service area, you can obtain dialysis treatment from any qualified dialysis provider. If you
obtain routine care from out-of-network providers, neither Medicare nor Medicare Blue will be
responsible for the costs.

A “medical emergency,” when you believe that your health is in serious danger, includes severe
pain, a bad injury, a sudden illness, or a medical condition that is quickly getting much worse. If
you have a medical emergency, get medical help as quickly as possible. Call 911 for help or go
to the nearest emergency room, hospital, or urgent care center. You do not need to get approval
or a referral first from your doctor or other network provider. You may get covered emergency
medical care whenever you need it, anywhere in the United States. As soon as possible, make
sure that we know about your emergency; call your doctor’s regular office number.

While you are a member of our Plan, you may use either network providers or out-of-network
providers. However, your out-of-pocket costs may be higher if you use out-of-network providers,
except for emergency care or out-of-area dialysis services. You do not need to get a referral or
prior authorization when you get care from out-of-network providers; however, before getting
services from out-of-network providers, you may want to confirm with us that the services you
are getting are covered by us and are medically necessary.

If an out-of-network provider sends you a bill that you think we should pay, please contact
Customer Service or send the bill to us for payment. We will pay your doctor for our share of the
bill and will let you know what, if anything, you must pay. You will not have to pay an out-of-
network provider any more than what he or she would have gotten if you had been covered with
the Original Medicare Plan. It is best to ask an out-of-network provider to bill us first; but if you
have already paid for the covered services, we will reimburse you for our share of the cost.
(Please note that we can not pay a provider who has opted out of the Medicare program. Check
with your provider before receiving services to confirm that they have not opted out of
Medicare.) If we later determine that the services are not covered or were not medically
necessary, we may deny coverage and you will be responsible for the entire cost.

ii
What is the service area for Medicare Blue?
Our service area is the state of South Carolina.

How do you find Medicare Blue providers in your area?

This directory lists our Plan’s primary care physicians, specialists, hospitals, skilled nursing
facilities, and outpatient mental health providers in the state of South Carolina. To select a
physician from this directory, find the county you live in or a county that is convenient for you.
Under the counties are cities; under the cities are the physicians and types of practice (such as
Family Medicine, Internal Medicine or Surgery), with their addresses and telephone numbers.
The counties, cities and physicians are arranged alphabetically. If the physician you choose
belongs to a group practice, the name of the group practice will also appear under his or her
name. Typically, your primary care doctor will provide most of your health care; but you may
also see any specialist without a referral. This directory lists primary care doctors and specialists.

To provide quality service to our members, we have asked our plan physicians to identify foreign
languages they or their office staffs speak in addition to English. The additional languages a
doctor or his/her office staff speaks are noted under the office location in the Primary Care and
Specialists sections of this directory. We have also asked our Plan physicians to identify
hospitals where they have admitting privileges. The hospital identifier codes are listed under the
provider’s name throughout the Primary Care and Specialists sections. The key for hospital
identifiers is located at the end of the Provider Directory. Medicaid-participating providers are
identified with an asterisk and an accompanying explanatory footnote.

If you have questions about Medicare Blue, please call our Customer Service Department at
1-888-645-6025. Hours are 8 a.m. to 8 p.m. Eastern Time, Monday through Friday; from
October 1, 2012 to February 14, 2013, 8 a.m. to 8 p.m., seven days a week. Beginning February
15, 2013, our automated telephone system handles calls received after 8 p.m. and on Saturdays,
Sundays and holidays. TTY/TDD users should call 1-888-645-6023. Or visit
www.scbluesmedadvantage.com/mb13.

iii
Primary Care Physicians
ABBEVILLE - ABBEVILLE AIKEN - AIKEN
ABBEVILLE Rodillo Heidi E MD Gordineer Dale R MD*
ABBEVILLE Internal Medicine Family Medicine
Adams Steven D MD Hospital Identifier(s):1 Hospital Identifier(s):23
Abbeville Internal Medicine Doctors Care
Family Medicine
901 W Greenwood St Ste 5 1029 York St Ne
Family Medicine Associates
Abbeville,SC 29620 Aiken,SC 29801
901 W Greenwood St Ste 9
[phone] [phone]
Abbeville,SC 29620
[phone] AIKEN Hashmi Asif A MD
Gonzalez Evangeline G MD AIKEN Internal Medicine
Asif A Hashmi MD
Internal Medicine Besson William T III MD
60 Physician Dr Ste 200
Hospital Identifier(s):1
Internal Medicine Aiken,SC 29801
Abbeville Internal Medicine
Hospital Identifier(s):2 [phone]
901 W Greenwood St Ste 5
Aiken Internal Medicine Assoc
Abbeville,SC 29620 Hesse Raymond D MD
410 University Pkwy Ste 2500
[phone] Internal Medicine
Aiken,SC 29801
Scdr Lang: PHILIPPINE Hospital Identifier(s):2
[phone]
Johnston Bruce S MD* Aiken Internal Medicine Assoc
Bryan Gasnel E MD*
410 University Pkwy Ste 2500
Family Medicine
Obstetrics & Gynecology Aiken,SC 29801
Hospital Identifier(s):1
Hospital Identifier(s):2 [phone]
Family Medicine Associates
Gasnel E Bryan MD Scdr Speciality: Geriatrics
901 W Greenwood St Ste 9
209 Abbeville AveNW
Abbeville,SC 29620 Keisler David S Jr MD
Aiken,SC 29801
[phone] Internal Medicine
[phone]
Kolb Charles A MD* Hospital Identifier(s):2
Daniels Brandon L MD
Aiken Internal Medicine Assoc
Family Medicine
Obstetrics & Gynecology 410 University Pkwy Ste 2500
Hospital Identifier(s):1
Hospital Identifier(s):2 Aiken,SC 29801
Family Medicine Associates
Brandon L Daniels MD LLC [phone]
901 W Greenwood St Ste 9
953 Dougherty Rd Unit A Scdr Speciality: Gastroenterology
Abbeville,SC 29620
Aiken,SC 29803
[phone] Kinsey Timothy R MD
[phone]
Oxendine Christopher L MD Pediatrics
Goldberg Susan M MD
Hospital Identifier(s):2
Family Medicine
Pediatrics Palmetto Pediatrics
Family Medicine Associates
Hospital Identifier(s):2 60 Physician Dr
901 W Greenwood St Ste 9
Palmetto Pediatrics Aiken,SC 29801
Abbeville,SC 29620
60 Physician Dr [phone]
[phone]
Aiken,SC 29801
[phone]
* Providers identified with an asterisk also accept Medicaid
1
Primary Care Physicians
AIKEN - AIKEN AIKEN - AIKEN
Kobleur Jessica A MD Meyer Theodore M MD* Roberts Mark A MD*
Pediatrics Internal Medicine Family Medicine
Hospital Identifier(s):2 Hospital Identifier(s):2 Aiken Center for Family Health
Palmetto Pediatrics Aiken Internal Medicine Assoc 415 Barnwell AveNW
60 Physician Dr 410 University Pkwy Ste 2500 Aiken,SC 29801
Aiken,SC 29801 Aiken,SC 29801 [phone]
[phone] [phone]
Royal Howard G Jr MD
Kule Bernard J MD* Milot Sheila I MD
Family Medicine
Family Medicine Internal Medicine Hospital Identifier(s):2
East Aiken Health Center LLC Doctors Care Center for Primary Care
1847 Hatchaway Bridge Rd 1029 York St Ne 410 Hitchcock Pkwy
Aiken,SC 29805 Aiken,SC 29801 Aiken,SC 29801
[phone] [phone] [phone]
Scdr Lang: SPANISH
Muniz Leopold M MD Saavedra Roland I MD
Manhiani Rajwinder S MD
Family Medicine Family Medicine
Internal Medicine Hospital Identifier(s):2 Aiken Professional Association
Aiken Professional Association Leopoldo M Muniz LLC LLC
LLC 101 Summerwood Way 191 Centre South Blvd
302 University Pkwy Aiken,SC 29803 Aiken,SC 29803
Aiken,SC 29801 [phone] [phone]
[phone] Scdr Lang: SPANISH
Naseem Kashif MD*
Scdr Lang: URDU
Tam Henry W MD*
Internal Medicine
McCullough Thomas E MD
Aiken Professional Association Family Medicine
Internal Medicine LLC Aiken Emergency Physicians PA
Aiken Internal Medicine Assoc 302 University Pkwy 216 Edgefield AveNW
410 University Pkwy Ste 2500 Aiken,SC 29801 Aiken,SC 29801
Aiken,SC 29801 [phone] [phone]
[phone] Scdr Lang: CHINESE
Naseem Kashif MD*
McNeeley Lacey P MD Tam Henry W MD*
Internal Medicine
Internal Medicine Aiken Professional Association Family Medicine
Aiken Professional Association 137 Miracle Dr Aiken Emergency Physicians PA
LLC Aiken,SC 29801 2678 Whiskey Rd
302 University Pkwy [phone] Aiken,SC 29803
Aiken,SC 29801 [phone]
Rhoades Sidney F MD*
[phone] Scdr Lang: CHINESE
Internal Medicine
To Phuong N DO
Aiken Regional Medical Centers
302 University Pkwy Pediatrics
Aiken,SC 29801 Hospital Identifier(s):2
[phone] Palmetto Pediatrics
60 Physician Dr
Aiken,SC 29801
[phone]
* Providers identified with an asterisk also accept Medicaid
2
Primary Care Physicians
AIKEN - AIKEN ANDERSON - ANDERSON
Udogu Chioma V MD* GRANITEVILLE Rivell William A MD
Internal Medicine Englee Mae J MD* General Practice
Aiken Regional Medical Centers Family Medicine Doctors Care North Augusta
302 University Pkwy Hospital Identifier(s):2 1520 Knox Ave
Aiken,SC 29801 Graniteville Family Medical Ct North Augusta,SC 29841
[phone] 1 Hickman St [phone]
Watson Randy D MD Graniteville,SC 29829 Suykerbuyk Robert A MD
[phone]
Internal Medicine Family Medicine
Scdr Lang: SPANISH
Hospital Identifier(s):2 Center for Primary Care PC
Aiken Regional Med Ctrs Phys NORTH AUGUSTA 105 E Hugh St
302 University Pkwy North Augusta,SC 29841
Barefield Tracy R MD
Aiken,SC 29801 [phone]
Family Medicine
[phone]
Center for Primary Care PC ALLENDALE
Watson Randy D MD
105 E Hugh St ALLENDALE
Internal Medicine North Augusta,SC 29841
Nunn Roger E MD
Hospital Identifier(s):2 [phone]
Randy Watson MD General Practice
Broder Jeffrey N MD
944 Dougherty Rd Laffitte and Warren Medical
Family Medicine
Aiken,SC 29803 Center
Jeffrey N Broder MD PC
[phone] Allendale County Hospital
1201 West Ave
623 Memorial Ave N
Zimmerman David W MD
North Augusta,SC 29841
Allendale,SC 29810
Family Medicine [phone]
[phone]
Center for Primary Care
Fallaw Robyn F MD
Warren Thomas B Jr MD*
410 Hitchcock Pkwy
Family Medicine
Aiken,SC 29801 Family Medicine
Center for Primary Care PC
[phone] Laffitte and Warren Medical
105 E Hugh St
Center
Zotovic Danijela S MD
North Augusta,SC 29841
Allendale County Hospital
Internal Medicine [phone]
623 Memorial Ave N
Hospital Identifier(s):2
Jester David M MD Allendale,SC 29810
Aiken Internal Medicine Assoc
[phone]
Family Medicine
410 University Pkwy Ste 2500
Center for Primary Care PC ANDERSON
Aiken,SC 29801
105 E Hugh St
[phone] ANDERSON
North Augusta,SC 29841
Scdr Lang: ITALIAN
[phone] Abercrombie Stoney A MD*
Lambert Jerry A MD Family Medicine
Hospital Identifier(s):4
Family Medicine
AnMed Health Family Medicine
Center for Primary Care PC
Center
105 E Hugh St
2000 E Greenville St Ste 3700
North Augusta,SC 29841
Anderson,SC 29621
[phone]
[phone]
* Providers identified with an asterisk also accept Medicaid
3
Primary Care Physicians
ANDERSON - ANDERSON ANDERSON - ANDERSON
Abraham Joseph M MD Bledsoe Shannon H MD* Byrd Larry N MD
Family Medicine Obstetrics & Gynecology Pediatrics
Anderson Family Care PA Hospital Identifier(s):4 Hospital Identifier(s):4
605 E Greenville St AnMed Health Carolina OB/GYN AnMed Health
Anderson,SC 29621 160 Perpetual Sq 800 N Fant St
[phone] Anderson,SC 29621 Anderson,SC 29621
Scdr Lang: ARABIC [phone] [phone]
Akhter Shabana MD* Boggs Chris MD* Cayelli Maria A MD*
Pediatrics Family Medicine Family Medicine
AnMed Health Child Health Hospital Identifier(s):4 Hospital Identifier(s):4
Center AnMed Health Westside Comm AnMed Health Anderson Family
500 N Fant St Ste C Hlth Cntr Med
Anderson,SC 29621 1100 W Franklin St 2000 E Greenville St Ste 2000
[phone] Anderson,SC 29624 Anderson,SC 29621
Scdr Lang: URDU [phone] [phone]
Alikhail Mohammad B MD* Boyer Elizabeth MD Charowski Artur A MD*
Internal Medicine Family Medicine Pediatrics
Hospital Identifier(s):4 AnMed Health-Lakeside Family AnMed Health Child Health Center
Mohammad B Alikhail MD Medicine 500 N Fant St Ste C
819 N Fant St 4120 Highway 24 Anderson,SC 29621
Anderson,SC 29621 Anderson,SC 29626 [phone]
[phone] [phone] Scdr Lang: POLISH
Alikhail Mohammad B MD* Bradford Nathan F Sr MD* Cianciolo Amy MD*
Internal Medicine Internal Medicine Family Medicine
Hospital Identifier(s):4 Hospital Identifier(s):4 Hospital Identifier(s):4
AnMed Health AnMed Health Child Health AnMed Health Family Medicine
800 N Fant St Center Center
Anderson,SC 29621 500 N Fant St Ste C 2000 E Greenville St Ste 3700
[phone] Anderson,SC 29621 Anderson,SC 29621
Bailey-Dorton Chasse M [phone] [phone]
MD* Britenburg James E MD Clark Andrew D MD
Family Medicine Family Medicine Obstetrics & Gynecology
Hospital Identifier(s):4 Hospital Identifier(s):4 AnMed Health Family Medicine
AnMed Health Anderson Family AnMed Health Center
Med 800 N Fant St 2000 E Greenville St Ste 3700
2000 E Greenville St Ste 2000 Anderson,SC 29621 Anderson,SC 29621
Anderson,SC 29621 [phone] [phone]
[phone] Bryant C D MD
Family Medicine
Hospital Identifier(s):4
Don Bryant MD
4144 Clemson Blvd
Anderson,SC 29621
[phone]
* Providers identified with an asterisk also accept Medicaid
4