2021 Primary Care Clinic Listing with clinic ID numbers

EssentiaCare (PPO)

This document contains a listing of the primary You may change your primary care clinic at any care clinics in our network for: time, for any reason, by logging into your member account at ucare.org or by calling EssentiaCare l Customer Service at the number on your member identification card. The change will You can see all of the providers (including become effective the first of the following month specialists) at any of our network clinics without a referral. after we receive your request. The network providers on this chart have agreed The Provider and Pharmacy Directory is a to provide you with your health care coverage. complete listing of all providers available in the network. You can ask for a copy by calling You may go to any of our network providers. You can get all covered services on your own, without 1-855-432-7027, TTY users call 1-800-688-2534, a referral. Still more, if your Essentia Health 8 am – 5 pm, Monday-Friday. You can also see the Provider and Pharmacy Directory at physician decides you need an even higher level ucare.org/for-members. of specialized care for rare or complex health issues, your physician will coordinate your care EssentiaCare with Mayo Clinic in Rochester at in-network cost share levels. Members enrolling in EssentiaCare must choose a Primary Care Clinic (PCC) from the chart Note: If you choose to enroll online at starting on page 2. PCCs are listed in alphabetical ucare.org, you will search for the clinic by order on this chart. name and location only, and will not need the clinic ID#. You will need to know your PCC identification number when completing your enrollment EssentiaCare is a PPO plan with a Medicare application. Please record the name of the clinic contract. Enrollment in EssentiaCare depends on and the six-digit clinic ID # from the chart on contract renewal. your EssentiaCare Enrollment Application.

Y0120_6411_09022020_C U6411 (09/20) EssentiaCare Primary Care Clinic Listing

Primary Care Clinic Clinic Address City Clinic ID# Iowa Winneshiek Medical Center 901 Montgomery St Decorah 116497 Altru Clinic - Crookston 400 S Minnesota St Crookston 121752 Altru Clinic - Erskine 23076 347th St SE Erskine 167273 Altru Clinic - Fertile Main and Mill Fertile 167274 Altru Clinic - Red Lake Falls 312 International Dr Red Lake Falls 167275 Altru Clinic - Roseau 711 Delmore Dr Roseau 122406 Altru Clinic - Thief River Falls 1845 Hwy 59 S Thief River Falls 203145 Altru Clinic - Warroad 412 N Main Ave Warroad 167277 - East Grand Forks Clinic 607 DeMers Ave East Grand Forks 199061 CentraCare Clinic - River Campus 1200 6th Ave N Saint Cloud 110890 Clearwater Medical Clinic 615 Nelson Dr Clearwater 186976 Cold Spring Medical Clinic 402 N River Ave Cold Spring 186975 Duluth Family Medicine Clinic 330 8th Ave NE Duluth 112027 Essentia Health - Ada Clinic 201 9th St W Ada 116036 Essentia Health - Babbitt Clinic 71 South Dr Babbitt 150135 Essentia Health - Bagley Clinic 121 W Central St Bagley 113713 Essentia Health - Brainerd Specialty Clinic 2024 6th St S Brainerd 115044 Essentia Health - Chisholm Clinic 400 1st St NW Chisholm 150136 Essentia Health - Deer River Clinic 115 10th Ave NE Deer River 150137 Essentia Health - Duluth Clinic 400 E Third St Duluth 103181 Essentia Health - Ely Clinic 300 W Conan St Ely 226747 Essentia Health - Fosston Clinic 900 Hilligoss Blvd SE Fosston 167649 Essentia Health - Graceville Clinic 115 2nd St W Graceville 115873 Essentia Health - Grand Rapids Clinic 1542 Golf Course Rd Grand Rapids 186186 Essentia Health - Hackensack Clinic 110 3rd St S Hackensack 186660 Essentia Health - Hermantown Clinic 4855 W Arrowhead Rd Hermantown 150141 Essentia Health - Hibbing Clinic 730 E 34th St Hibbing 120270 Essentia Health - Lakeside Clinic 4621 East Superior St Duluth 150143 Essentia Health - Lakewalk Clinic 1502 London Rd Duluth 150735

2 - For more information, go to ucare.org or call 1-855-432-7027 (TTY 1-800-688-2534), from 8 am – 5 pm, Monday-Friday. Primary Care Clinic Clinic Address City Clinic ID# Essentia Health - Menahga Clinic 212 Aspen Ave NE Menahga 115702 Essentia Health - Moorhead Clinic 801 Belsly Blvd Moorhead 126102 Essentia Health - Oklee Clinic 400 Governor St Oklee 173004 Essentia Health - Park Rapids Clinic 705 Pleasant Ave Park Rapids 112107 Essentia Health - Proctor Clinic 211 S Boundary Ave Proctor 186933 Essentia Health - Remer Clinic 9 Birch St NE Remer 150145 Essentia Health - St Joseph's Baxter Clinic 13060 Isle Dr Baxter 190025 Essentia Health - Virginia Clinic 1101 9th St N Virginia 184063 Essentia Health - Walker Clinic 110 Michigan Ave NW Walker 170504 Essentia Health - West Duluth Clinic 4212 Grand Ave Duluth 125264 Essentia Health International Falls Clinic 2501 Keenan Dr International 221337 Falls Essentia Health Northern Pines Clinic 5211 Hwy 110 Aurora 224070 Essentia Health St Joseph's - Brainerd Clinic 2024 S 6th St Brainerd 187676 Essentia Health St Joseph's - Crosslake Clinic 35205 Cty Rd 3 Crosslake 128317 Essentia Health St Joseph's - Pequot Lakes Clinic 4317 Woodman St W Pequot Lakes 127171 Essentia Health St Joseph's - Pierz Clinic 138 Main St S Pierz 150994 Essentia Health St Joseph's - Pine River Clinic 415 Barclay Ave Pine River 124635 Essentia Health St Joseph's Pillager Clinic 680 Pillsbury St N Pillager 164250 Essentia Health St Mary's - Detroit Lakes Clinic 1027 Washington Ave Detroit Lakes 187054 Essentia Health St Mary's - Frazee Clinic 300 Main Ave E Frazee 195558 Essentia Health St Mary's - Lake Park Clinic 1005 1st St Lake Park 187055 Essentia Health St Mary's - Mahnomen Clinic 117 Main St N Mahnomen 187053 Essentia Health St Mary's - Pelican Rapids Clinic 301 Broadway N Pelican Rapids 156042 Essentia Health St. Joseph's Emily Clinic 20918 County Rd 1 Emily 203241 Essentia Health Virginia Medical Arts Clinic 901 9th St N Virginia 106080 Fond du Lac Reservation - Min No Aya Win Clinic 927 Trettel Ln Cloquet 122990 Scenic Rivers Health Services - Big Falls 410 2nd St NW Big Falls 110058 Scenic Rivers Health Services - Bigfork 135 Pinetree Dr Bigfork 110061 Scenic Rivers Health Services - Cook 20 5th St SE Cook 110054 Scenic Rivers Health Services - Floodwood 810 Poplar St Floodwood 167785 Scenic Rivers Health Services - Northome 12052 Main St Northome 110062 Scenic Rivers Health Services - Tower 415 N 2nd St Tower 197507 St. Cloud Medical Group - South Campus 1301 33rd St S Saint Cloud 186974

3 - For more information, go to ucare.org or call 1-855-432-7027 (TTY 1-800-688-2534), from 8 am – 5 pm, Monday-Friday. Primary Care Clinic Clinic Address City Clinic ID# Altru Clinic - Devils Lake 1001 7th St NE Devils Lake 221342 Altru Clinic - Drayton 1003 N Main Drayton 167286 Altru Family Medicine Center 1380 Columbia Rd S Grand Forks 221161 Altru Family Medicine Residency 725 Hamline St Grand Forks 167282 Altru Professional Center 4440 S Washington St Grand Forks 235555 Altru Speciality Care (Cavalier) 301 Mountain St E Cavalier 235554 Essentia Health - Wahpeton Clinic 275 11th St S Wahpeton 108643 Essentia Health - 32nd Avenue Clinic 3000 32nd Ave S Fargo 170507 Essentia Health - Casselton Clinic 5 9th Ave N Casselton 170499 Essentia Health - Hankinson Clinic 501 Main Ave S Hankinson 169338 Essentia Health - Jamestown Clinic 2430 20th St SW Jamestown 170500 Essentia Health - Lisbon Clinic 819 Main St Lisbon 170501 Essentia Health - Valley City Clinic 132 4th Ave NE Valley City 170503 Essentia Health - West Acres Clinic 3902 13th Ave S Fargo 170505 Essentia Health - West Fargo Clinic 1401 13th Ave E West Fargo 170506 Essentia Health South University Clinic 1702 University Dr S Fargo 103180 Amery Regional Medical Center 265 Griffin St E Amery 128438 Amery Regional Medical Center - Clear Lake 357 3rd Ave Clear Lake 185925 Essentia Health - Ashland Clinic 1615 Maple Ln Ashland 150134 Essentia Health - Hayward Clinic 11134 State Rd 77 N Hayward 150140 Essentia Health - Spooner Clinic 1180 Chandler Dr Spooner 150147 Essentia Health St Mary's - Superior Clinic 3500 Tower Ave Superior 160410 Luck Medical Center 2547 State road 35 Luck 185927 Turtle Lake Medical Associates 550 Martin Ave Turtle Lake 185926

4 - For more information, go to ucare.org or call 1-855-432-7027 (TTY 1-800-688-2534), from 8 am – 5 pm, Monday-Friday. Notice of Nondiscrimination UCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. UCare does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. We provide aids and services at no charge to people with disabilities to communicate effectively with us, such as TTY line, or written information in other formats, such as large print. If you need these services, contact us at 612-676-3200 (voice) or toll free at 1-800-203-7225 (voice), 612-676-6810 (TTY), or 1-800-688-2534 (TTY). We provide language services at no charge to people whose primary language is not English, such as qualified interpreters or information written in other languages. If you need these services, contact us at the number on the back of your membership card or 612-676-3200 or toll free at 1-800-203-7225 (voice); 612-676-6810 or toll free at 1-800-688-2534 (TTY). If you believe that UCare has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file an oral or written grievance. Oral grievance If you are a current UCare member, please call the number on the back of your membership card. Otherwise please call 612-676-3200 or toll free at 1-800-203-7225 (voice); 612-676-6810 or toll free at 1-800-688-2534 (TTY). You can also use these numbers if you need assistance filing a grievance. Written grievance Mailing Address UCare Attn: Appeals and Grievances PO Box 52 Minneapolis, MN 55440-0052 Email: [email protected] Fax: 612-884-2021 You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 1-800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.