medicare hmo network provider directory

820 Pages·2015·5.94 MB·English

Medicare HMO
netwOrk prOvider
directOrY
Queens

EMBLEMHEALTH
MEDICARE HMO PLAN
PROVIDER DIRECTORY
This directory provides a list of EmblemHealth Medicare HMO’s network providers.
This directory is for Queens County.
This directory is current as of August 2015. 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 EmblemHealth Medicare HMO’s network providers in your area, you
can visit www.emblemhealth.com/medicare or call our Customer Service Department at
1-877-344-7364, Monday to Sunday, 8:00 am to 8:00 pm. TTY users should call 711.
HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract.
Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.
This information is available for free in other languages. Please contact our Customer
Service number at 1-877-344-7364, Monday to Sunday, 8:00 am to 8:00 pm. TTY users
should call 711.
Esta información está disponible gratis en otros idiomas. Comuníquese con nuestro
departamento se Servicio al cliente al 1-877-344-7364 para obtener mas informacion.
(Los usuarios de TTY deben llamar al 711).
This document may be available in alternate formats such as large print.
Formulary, pharmacy network, and/or provider network may change at any time.
You will receive notice when necessary.
Y0026_126002 Accepted 08/26/2015
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EMBLEMHEALTH MEDICARE HMO NETWORK
PROVIDER DIRECTORY
Section 1 – Introduction
This directory provides a list of our plan’s network providers. To get detailed information
about your health care coverage, please see your Evidence of Coverage (EOC).
You will have to choose one of our network providers who are listed in this directory to
be your Primary Care Provider (PCP). The term “PCP” will be used throughout this
directory. Generally, you must get your health care coverage from your PCP. Your PCP is
your primary care provider who can provide and coordinate all of your care, including
specialist visits, hospital admissions and more.
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. However, some services may require a referral. 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. Please check your EOC
for more details on specific referral requirements and more details about your plan
benefits.
There may be times when you get a bill from a provider for the full cost of medical care
you have received. In many cases, you should send this bill to us instead of paying it.
We will look at the bill and decide whether the services should be covered. If we decide
they should be covered, we will pay the provider directly.
You may get services from out-of-area providers when providers of specialized services are
not available in the service area, including kidney dialysis services for End Stage Renal
Disease enrollees who have traveled outside the plan’s service area or cannot access
qualified dialysis providers within the service area
You may also get services from out-of-area providers in situations where emergency or
urgently needed care is needed. Our plan covers emergency and urgently needed care
anywhere in the world. If you experience a medical emergency, call for help or go to the
nearest emergency room or hospital. Call for an ambulance if you need it. You do not
need to get approval or a referral first. After the emergency is over, you are entitled to
follow-up care to be sure your condition continues to be stable. Your follow-up care will
be covered by our plan. If your emergency care is provided by out-of-network providers,
we will try to arrange for network providers to take over your care as soon as your medical
condition and the circumstances allow.
You must use plan providers except in emergency or urgent care situations or for out-
of-area renal dialysis or other services. If you obtain routine care from out-of-network
providers neither Medicare nor our plan will be responsible for the costs.
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EMBLEMHEALTH MEDICARE HMO NETWORK
PROVIDER DIRECTORY
What is the service area for EmblemHealth
Medicare HMO?
The counties in our service area are listed below:
Bronx, Kings, New York, Queens, Richmond, Nassau, Suffolk and Westchester
How do you find EmblemHealth Medicare HMO providers
in your area?
You can find a network provider by looking in this directory or going online at
www.emblemhealth.com/medicare. We do everything possible to keep our directories
current, but participation status can change from time to time. Before selecting your
provider, you may want to confirm that he or she is still participating in the plan’s
network and with the product you are covered by, and if he or she is accepting new
patients. You can do this by contacting the provider at the phone number listed in the
directory.
If you have questions about our plan or require assistance in selecting a PCP, please call
our Customer Service Department at 1-877-344-7364, Monday to Sunday, 8:00 am to
8:00 pm. TTY users should call 711. Or visit www.emblemhealth.com/medicare.
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EMBLEMHEALTH
VENDORS
The vendors listed below are partners with EmblemHealth and provide certain services
on our behalf.
ValueOptions
The names of the providers listed and the information about them are furnished and
managed by ValueOptions, which has a contract with EmblemHealth. This allows you to
find a ValueOptions provider as part of your in-network benefit. The accuracy of these
listings is confirmed annually by ValueOptions.
Comprehensive Professional Systems, General
Vision Services and Eyecare Advantage
The names of the providers listed and the information about them are furnished and
managed by Comprehensive Professional Systems, General Vision Services and Eyecare
Advantage, which have contracts with EmblemHealth. This allows you to find
Comprehensive Professional Systems, General Vision Services and Eyecare Advantage
provider services as part of your in-network benefit. The accuracy of these listings is
confirmed annually by Comprehensive Professional Systems, General Vision Services and
Eyecare Advantage.
Express Scripts, Inc. (ESI)
The names of the providers listed and the information about them are furnished and
managed by ESI, which has a contract with EmblemHealth. This allows you to find an
ESI provider as part of your in-network benefit. The accuracy of these listings is
confirmed annually by ESI.
Y0026_ 24657 Accepted 09/01/2014
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EMBLEMHEALTH MEDICARE HMO PROVIDER
DIRECTORY - QUEENS

ADVANTAGECARE PHYSICIANS ............................................................................ 1
HOSPITAL ABBREVIATION KEY .......................................................................... 23
PRIMARY CARE PHYSICIANS ................................................................................ 27
Queens ......................................................................................................................... 29
SPECIALTY CARE PHYSICIANS ............................................................................ 121
Queens ........................................................................................................................123
EMBLEM BEHAVIORAL HEALTH SERVICES PROGRAM ...................... 633
Behavioral Health Facilities ............................................................................ 635
Outpatient Behavioral Health Specialists ................................................ 660
SKILLED NURSING FACILITIES .......................................................................... 697
HOSPITALS ................................................................................................................... 703
IMMEDIATE AND URGENT CARE CENTERS ................................................. 715
OPTICAL PROVIDERS ............................................................................................... 721
Queens ...................................................................................................................... 723
DESIGNATED AIDS CENTERS (DACs) AND EXPERIENCED AIDS
PROVIDERS .................................................................................................................... 731
COMMUNITY HEALTH CARE CENTERS ........................................................ 739
QUEST DIAGNOSTICS LABS ............................................................................... 747
ANCILLARY PROVIDERS ........................................................................................ 751
INDEX OF HOSPITALS ............................................................................................ 763
INDEX BY LAST NAME ........................................................................................... 767