From: Lydia Shen To: Foster, Tillman Cc: User, OHCA; Davis, Rachel; Roberts, Karen; Capone, Claudio Subject: RE: Annual Group Practice Filing Date: Thursday, March 29, 2018 8:53:48 AM Attachments: image003.png image004.png image005.png Annual Saint Francis Medical Groups Filing - 2017.xlsm Annual Saint Francis Medical Groups Filing - 2017.pdf
Good morning,
Please find attached the 2017 annual group practice filing for the Saint Francis Medical Groups.
If you have any questions about the filings, please let us know.
Thank you, Lydia
Lydia Shen, MHA Strategic Planner Trinity Health Of New England [email protected] W 860-714-6579 1000 Asylum Avenue Hartford, CT 06105
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From: Foster, Tillman [mailto:[email protected]] Sent: Tuesday, March 27, 2018 11:37 AM To: Lydia Shen
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Ms. Shen-
I am emailing you in regards to the CY 2017 Saint Francis Medical Groups (SFMG) annual group practice filing, which OHCA has not received but was due on January 15.
Attached is the report submitted SFMG from last year.
If you have any other questions please do not hesitate to call or email me.
Tillman Foster Associate Health Care Analyst Department of Public Health Office of Health Care Access 410 Capitol Avenue MS #13HCA, P.O. Box 340308 Hartford, CT 06134 Phone: (860) 418-7031 Fax: (860) 418-7053 Email: [email protected]
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Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
(1) (2) (3) (4) Is the Group Practice reported owned Description of the nature of the relationship of the Name of Group Practice being reported or affiliated by the Hospital or Hospital or Hospital System to the Group Practice Line Hospital System? 1 Saint Francis Behavioral Health Group (SFBHG) Professional group practice Owned by the Hospital 2 Saint Francis Emergency Medical Group (SFEMG) Hospital Affiliated 3 Saint Francis Medical Group (SFMG) Professional group practice Owned by the Hospital 4 Saint Francis Care Medical Group (SFCMG) Hospital Affiliated 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Group Practice Reporting Page 2 of 20 Medical Practice Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Behavioral Health Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 1 Chu, Anita Psychiatry 2 Cohen, Eric Psychiatry 3 Dove, Laura Psychiatry 4 Enciso Chaves, Carlos Psychiatry 5 Frenkel, Yana Psychiatry 6 Gill, Neelu Psychiatry 7 Gonzalez, Alberto Psychiatry 8 Gonzalez, Luis Psychiatry 9 Gonzalez-Restrepo, Alejandro Psychiatry 10 Greenberg, Jonathan Psychiatry 11 Hamdheydari, Ladan Psychiatry 12 Jermin, Ernest Psychiatry 13 Malik, Nayyara Psychiatry 14 Munawar, Muhammad Psychiatry 15 Mushtaq, Yaser Psychiatry 16 Raza, Mahreen Psychiatry 17 Rothschild, Bruce Psychiatry 18 Shamsi, Mohammad Psychiatry 19 Taylor, Laine Psychiatry 20 Yelunina, Larisa Psychiatry 21 Yotova, Malina Psychiatry 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Group Practice Reporting Page 3 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Behavioral Health Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
Group Practice Reporting Page 4 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Emergency Medical Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 1 Abbatiello, Carol Emergency medicine 2 Apollon, Rebecca Emergency medicine 3 Bankwalla, Arnaz Emergency medicine 4 Bernard, Hannah Emergency medicine 5 Brancato, Raphael Emergency medicine 6 Brody, Richard Emergency medicine 7 Brunell, Thomas Emergency medicine 8 Carolan, Beverly Emergency medicine 9 Casey, Zoe Emergency medicine 10 Curran, Gerard Emergency medicine 11 Dansky, Perry Emergency medicine 12 Fialkovich, John Emergency medicine 13 Fojtik, John Emergency medicine 14 Gelin, Joan Emergency medicine 15 Gilmore, Thomas Emergency medicine 16 Guerrieri, Justus Emergency medicine 17 Hubbard, Natalie Emergency medicine 18 Ibrahim, Danyal Emergency medicine 19 LaPolla, Gary Emergency medicine 20 Leavens, John Emergency medicine 21 Markuszka, Karl Emergency medicine 22 Martin, Jennifer Emergency medicine 23 McAdoo, Douglas Emergency medicine 24 Neulander, Matthew Emergency medicine 25 Parekh, Sachin Emergency medicine 26 Pettini, John Emergency medicine 27 Quinby, Peter Emergency medicine 28 Ryan, Emily Emergency medicine 29 Sanders, William Emergency medicine 30 Schiller, Elizabeth Emergency medicine 31 Smith, Jillian Emergency medicine 32 Spear, Jeffrey Emergency medicine 33 Thomassin, Cassis Emergency medicine 34 Turbiak, Thomas Emergency medicine 35 Ward, Che Emergency medicine 36 Wolf, Charles Emergency medicine 37 Young, Neil Emergency medicine 38 Zucker, Amanda Emergency medicine 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Group Practice Reporting Page 5 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Emergency Medical Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
Group Practice Reporting Page 6 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Medical Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 1 Abbott, Kathleen Physical Medicine and Rehabilitation 2 Acharya, Sampada Rheumatology 3 Afshani, Mansour Neurology 4 Ali, Syed Internal Medicine 5 Al-Mezrakchi, Yahya Internal Medicine - Hospitalist 6 Alvi, Sama Family Medicine 7 Anthony, Paul Infectious Diseases 8 Arias-Camison, Jose Neonatology 9 Arora, Sabeena Cardiology 10 Atar, Laura Family Medicine 2 Atubra, Mary Pediatrics 3 Bagdasarian, Kristofer Vascular Surgery 4 Bailey, Mary Neurology 5 Balawi, Fadel Neonatology 6 Balloch, Rachel Podiatric Surgery 7 Bansal, Sudeep Internal Medicine 8 Bayona, Gerald Internal Medicine 9 Bilgrami, Syed Hematology and Oncology 10 Bona, Robert Hematology and Oncology 11 Boruchov, Adam Hematology and Oncology 3 Bosco, Peter Urology 4 Brar, Navkiran Internal Medicine - Hospitalist 5 Brown, Jeffrey Family Medicine 6 Buonocore, Samuel Plastic Surgery 7 Butto, Danielle Podiatric Surgery 8 Cabuslay, Ray Victor Internal Medicine - Hospitalist 9 Cagna, Richard Internal Medicine 10 Caprio, Kimberly Surgery 11 Chagnon, Raymond Rehabilitation Medicine 12 Chawla, Surendra Thoracic Surgery 4 Chirayath, Lilyan Internal Medicine - Hospitalist 5 Chittoori, Shatya Geriatrics 6 Ciccarelli, Carmine Orthopedics 7 Clark, Bernard Cardiology 8 Collins, Courtney Surgery 9 Comey, Christopher Neurological Surgery 10 Conte, Harry Infectious Diseases 11 Cordoba Vargas, Sandra Internal Medicine 12 Costello, Victoria Geriatrics 13 Dankwah-Quansah, Maame Neurology 5 Dermesropian, Racha Endocrinology Diabetes and Metabolism 6 Dewanjee, Jessie Internal Medicine 7 Dhamija, Asha Internal Medicine - Hospitalist 8 Diez-Morales, Luis Internal Medicine 9 Diver, Daniel Cardiology 10 Donadio, Alessia Oncology 11 Dudek, Robert Orthopedics 12 Dulipsingh, Latha Endocrinology Diabetes and Metabolism 13 Dyquiangco, Rachelle Internal Medicine 14 Edwards, Richard Hematology and Oncology 6 Emott, Molly Endocrinology 7 Fecteau, Scott Vascular Surgery 8 Figueroa, Reinaldo Maternal Fetal Medicine 9 Flaherty, James Surgery Oncology
Group Practice Reporting Page 7 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Medical Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 10 Flynn, Kelly Obstetrics & Gynecology 11 Fusco, Joseph Internal Medicine - Hospitalist 12 Gerardi, Daniel Pulmonary/Critical Care 13 Gjertson, Carl Urology 14 Gordon, Barry Neurology 15 Goundrey, Timothy Surgery 7 Green, Robert Orthopedics 8 Grewal, Serena Internal Medicine - Hospitalist 9 Grey, Michael Internal Medicine 10 Grover, Prashant Pulmonary/Critical Care 11 Gupta, Hemant Internal Medicine 12 Gupta, Sandeep Surgery 13 Hanna, John Internal Medicine 14 Hansen, Karyn Obstetrics & Gynecology 15 Hartenstein, Theodore Internal Medicine 16 Henretta, Melissa Obstetrics & Gynecology 8 Hom, Kenrick Internal Medicine - Hospitalist
Group Practice Reporting Page 8 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Care Medical Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 1 Bauer, Frank Pathology 2 Chapman, Christopher Pathology 3 Curran, Matthew Pathology 4 Jovanovic, Anna Pathology 5 Kowalczyk, Pamela Pathology 6 Mesologites, Thalia Pathology 7 Ong-Bacay, Aileen Pathology 8 Scholes, John Pathology 9 Tang, Jihong Pathology 10 Yu, Gengsheng Pathology 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Group Practice Reporting Page 9 of 20 Physician Name Data Physician Name Data
Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK"
Name of Group Practice ------> Saint Francis Care Medical Group
(1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s)
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
Group Practice Reporting Page 10 of 20 Physician Name Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Primary Service Area as defined in Section 1(11) Name and address of each Business Entity that Line Name and address of Group Practice Location of PA 14-168 provides services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
06106; 06105; 06095; 06108; 06117; 06118; 06066; Saint Francis Behavioral Health Group Hartford, CT 06040; 06112; 06110; 06082; 06051; 06109; 06114; 114 Woodland Street, 7th Floor 1 06120; 06001; 06002; Hartford, CT 06105 Psychiatry 06105; 06112; 06106; 06120; 06095; 06002; 06082; 06040; 06114; 06118; 06108; 06109; 06066; 06119; Saint Francis Behavioral Health Group Hartford, CT 06096; 06117; 06033; 06111; 06110; 06010; 06107; 675 Tower Avenue, Suite 301 2 06042; 06074; Hartford, CT 06112 Psychiatry 06106; 06105; 06112; 06114; 06002; 06108; 06095; 1000 Asylum Avenue 1st Floor (Suite 1026) Saint Francis Behavioral Health Group Hartford, CT 3 06117; 06040; 06119; Hartford, CT 06105 Psychiatry 06070; 06001; 06035; 06081; 06019; 06092; 06026; 30 Dorset Crossing, Suite 400 Saint Francis Behavioral Health Group Simsbury, CT 4 06089; 06096; 06078; 06095; 06082; 06057; 06002; Simsbury, CT 06105 Psychiatry 06033; 06109; 06118; 06040; 06067; 06248; 06111; 06108; 06066; 06457; 06010; 06073; 06074; 06447; Saint Francis Behavioral Health Group Glastonbury, CT 06095; 06042; 06415; 06416; 06450; 06110; 06480; 5 06238; 06084; 06231; 27 Sycamore Street #400, Glastonbury, CT 06033 Psychiatry 6 Saint Francis Behavioral Health Group Vernon, CT 06029; 06074; 06066; 428 Hartford Turnpike, Suite 209, Vernon, CT 06066 Psychiatry 06120; 06002; 06076; 06109; 06112; 06106; 06108; Saint Francis Behavioral Health Group Hartford, CT 7 06114; 06033; 06040; 06095; 500 Blue Hills Avenue, Hartford, CT 06112 Psychiatry 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
Group Practice Reporting Page 11 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Primary Service Area as defined in Section 1(11) Name and address of each Business Entity that Line Name and address of Group Practice Location of PA 14-168 provides services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Group Practice Reporting Page 12 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Primary Service Area as defined in Section 1(11) Name and address of each Business Entity that Line Name and address of Group Practice Location of PA 14-168 provides services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
06105; 06112; 06106; 06120; 06002; 06095; 06108; St Francis Emergency Medical Group Hartford, CT 114 Woodland Street, Hartford, CT 1 06114; 06118; 06082; 06040; 06117; 06096; Emergency medicine 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
Group Practice Reporting Page 13 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Primary Service Area as defined in Section 1(11) Name and address of each Business Entity that Line Name and address of Group Practice Location of PA 14-168 provides services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
43 44 45 46 47 48 49 50
Group Practice Reporting Page 14 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Name and address of each Business Entity that provides Line Name and address of Group Practice Location Primary Service Area as defined in Section 1(11) of PA 14-168 services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
06002; 06095; 06112; 06106; 06105; 06082; 06118; 06108; Cardiovascular disease (cardiology), Endocrinology, Family practice, Geriatric medicine, 06120; 06117; 06040; 06111; 06109; 06001; 06114; 06096; Gynecological oncology, Hematology/oncology, Internal medicine, Infectious disease, Saint Francis Medical Group Hartford, CT 06070; 06074; 06107; 06066; 06042; 06033; 06010; 06119; 114 Woodland Street, Hartford, CT 06105 Registered Dietitian / Nutrition Professional, Neurology, Neurosurgery, 06110; 06790; 06032; 06029; 06026; 06035; 06078; 06084; Obstetrics/gynecology, Orthopedic surgery, Pediatric medicine, Pulmonary disease, 1 06067; Critical care medicine (intensivists) 06105; 06082; 06106; 06112; 06040; 06010; 06118; 06111; 06095; 06037; 06109; 06002; 06117; 06053; 06114; 06119; 06033; 06066; 06074; 06107; 06108; 06120; 06067; 06489; Saint Francis Medical Group Hartford, CT 06042; 06096; 06051; 06029; 06110; 06001; 06062; 06032; 06238; 06016; 06450; 06084; 06790; 06088; 06035; 06071; 2 06019; 06092; 06416; 06415; 06078; 06234; 06457; 1000 Asylum Avenue, Suite 3207, Hartford, CT 06105 Plastic and reconstructive surgery 06105; 06106; 06112; 06002; 06082; 06118; 06108; 06117; 06095; 06040; 06114; 06109; 06120; 06119; 06070; 06074; Saint Francis Medical Group Hartford, CT 06032; 06010; 06042; 06107; 06037; 06111; 06033; 06110; 3 06066; 06001; 06029; 06076; 06457; 06096; 06067; 1000 Asylum Avenue, Suite 2112, Hartford, CT 06105 Geriatric medicine, Infectious disease, Internal medicine 06105; 06112; 06095; 06106; 06002; 06114; 06118; 06108; Saint Francis Medical Group Hartford, CT 06120; 06040; 06042; 06119; 06107; 06066; 06110; 06053; 4 06109; 06067; 06117; 06070; 06033; 06111; 06074; 1000 Asylum Avenue, Suite 1026, Hartford, CT 06105 Obstetrics/gynecology 06107; 06108; 06070; 06110; 06002; 06040; 06111; 06001; Saint Francis Medical Group Hartford, CT 06033; 06078; 06095; 06066; 06082; 06112; 06117; 06114; 5 06118; 06042; 06119; 06026; 06035; 06013; 1000 Asylum Avenue, Suite 2107, Hartford, CT 06105 Surgical oncology 06082; 06002; 06095; 06112; 06118; 06109; 06040; 06066; 06108; 06106; 06105; 06074; 06111; 06042; 06010; 06096; Saint Francis Medical Group Hartford, CT 06117; 06001; 06078; 06119; 06107; 06033; 06120; 06114; 06035; 06084; 06032; 06070; 06029; 06110; 06076; 06053; 6 06019; 06026; 06088; 06790; 06098; 06051; 1000 Asylum Avenue, Suite 2110, Hartford, CT 06105 General surgery 06106; 06112; 06002; 06105; 06118; 06095; 06114; 06120; Saint Francis Medical Group Hartford, CT 06108; 06082; 06040; 06109; 06066; 06074; 06033; 06096; 7 06111; 06042; 06110; 06117; 06067; 06084; 1000 Asylum Avenue, Suite 2115, Hartford, CT 06105 Rheumatology 06112; 06105; 06002; 06082; 06095; 06106; 06108; 06066; 06010; 06109; 06120; 06118; 06114; 06074; 06040; 06033; Saint Francis Medical Group Hartford, CT 06117; 06067; 06790; 06119; 06111; 06076; 06070; 06001; 06078; 06238; 06042; 06110; 06016; 06053; 06107; 06360; 8 06084; 06035; 1000 Asylum Avenue, Suite 2120, Hartford, CT 06105 Vascular surgery 06082; 06010; 06040; 06066; 06105; 06042; 06095; 06074; 06002; 06108; 06118; 06109; 06033; 06238; 06111; 06076; 06112; 06001; 06117; 06078; 06029; 06096; 06084; 06106; Saint Francis Medical Group Hartford, CT 06088; 06070; 06107; 06026; 06416; 06071; 06098; 06013; 06120; 06032; 06489; 06019; 06790; 06110; 06415; 06241; 9 06237; 06067; 06119; 1000 Asylum Avenue, Suite 3201A, Hartford, CT 06105 Cardiothoracic Surgery
Group Practice Reporting Page 15 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Name and address of each Business Entity that provides Line Name and address of Group Practice Location Primary Service Area as defined in Section 1(11) of PA 14-168 services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
06082; 06106; 06010; 06105; 06112; 06095; 06108; 06120; 06114; 06066; 06040; 06118; 06111; 06002; 06074; 06096; Saint Francis Medical Group Hartford, CT 06071; 06078; 06088; 06051; 06033; 06119; 06457; 06053; 06098; 06109; 06790; 06110; 06016; 06786; 06084; 06117; 10 06416; 06489; 06019; 06226; 06042; 06001; 06035; 1000 Asylum Avenue, Suite 3215, Hartford, CT 06105 Neurosurgery 06112; 06105; 06106; 06120; 06095; 06002; 06118; 06082; Saint Francis Medical Group Hartford, CT 06108; 06040; 06114; 06096; 06119; 06111; 06053; 06010; 11 06107; 06109; 06033; 06070; 06042; 06066; 06117; 06001; 1000 Asylum Avenue Suite 4302 Hartford CT 06105 General surgery 06002; 06112; 06117; 06105; 06095; 06106; 06010; 06120; 06118; 06111; 06082; 06040; 06107; 06108; 06096; 06078; Saint Francis Medical Group Hartford, CT 06033; 06001; 06070; 06119; 06076; 06074; 06110; 06035; 12 06066; 06067; 1000 Asylum Avenue, Suite 4307, Hartford, CT 06105 Orthopedic surgery 06002; 06095; 06082; 06112; 06105; 06106; 06118; 06108; 06109; 06040; 06074; 06111; 06107; 06114; 06001; 06096; Saint Francis Medical Group Hartford, CT 06119; 06066; 06033; 06117; 06067; 06070; 06042; 06110; 06120; 06010; 06019; 06078; 06032; 06076; 06029; 06238; 13 06088; 1000 Asylum Avenue, Suite 4304, Hartford, CT 06105 Neurology 14 Saint Francis Medical Group Hartford, CT 06105; 06112; 06106; 06120; 06114; 06108; 06095; 1075 Asylum Avenue Hartford, CT 06105 Obstetrics/gynecology 15 Saint Francis Medical Group Enfield, CT 06082; 06076; 06071; 06078; 06096; 140 Hazard Avenue Suite 101 , Enfield, CT 06082 Orthopedic surgery 16 Saint Francis Medical Group Enfield, CT 06082; 06076; 06071; 06029; 06096; 146Hazard Avenue, Enfield, CT 06082 Hematology/oncology 06095; 06002; 06082; 06106; 06105; 06112; 06107; 06111; 06109; 06108; 06118; 06117; 06067; 06114; 06119; 06074; Saint Francis Medical Group Hartford, CT 06001; 06070; 06040; 06096; 06033; 06066; 06110; 06010; 17 06035; 06120; 06076; 06078; 19 Woodland Street, Hartford, CT 06105 Urology 06106; 06114; 06110; 06118; 06108; 06105; 06119; 06117; Saint Francis Medical Group West Hartford, CT 18 06095; 06109; 06111; 06002; 06112; 06051; 06001; 06053; 345 North Main Street, West Hartford, CT 06117 Family practice 06001; 06070; 06019; 06095; 06002; 06117; 06082; 06013; 06107; 06790; 06035; 06106; 06105; 06074; 06111; 06109; Saint Francis Medical Group Avon, CT 06057; 06032; 06092; 06085; 06120; 06118; 06033; 06119; 19 06096; 06010; 06112; 06089; 06040; 06489; 06084; 06026; 35 Nod Road, Suite, 205 Avon, CT 06001 Podiatry 06001; 06070; 06019; 06035; 06790; 06095; 06002; 06092; Saint Francis Medical Group Avon, CT 06096; 06107; 06117; 06078; 06026; 06057; 06032; 06060; 20 06098; 06791; 06013; 35 Nod Road, Suite 105, Avon, CT 06001 Rheumatology 06066; 06029; 06084; 06040; 06042; 06074; 06076; 06238; Saint Francis Medical Group Vernon, CT 21 06279; 06108; 06082; 428 Hartford Turnpike, Vernon, CT 06066 Obstetrics/gynecology 06082; 06112; 06106; 06095; 06002; 06105; 06040; 06108; 06074; 06118; 06120; 06066; 06070; 06010; 06001; 06114; Saint Francis Medical Group Hartford, CT 06096; 06109; 06107; 06037; 06042; 06067; 06119; 06238; 06117; 06033; 06111; 06088; 06457; 06110; 06029; 06078; 22 06053; 06019; 06035; 06226; 06051; 490/500 Blue Hills Avenue, Hartford, CT 06112 Physical medicine and rehabilitation 06067; 06109; 06095; 06118; 06416; 06111; 06112; 06002; 06033; 06457; 06106; 06040; 06114; 06108; 06066; 06074; Saint Francis Medical Group Rocky Hill, CT 06096; 06450; 06051; 06042; 06438; 06110; 06415; 06010; 23 06441; 06279; 06037; 06105; 06053; 546 Cromwell Avenue Suite 100 , Rocky Hill, CT 06067 Obstetrics/gynecology
Group Practice Reporting Page 16 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Name and address of each Business Entity that provides Line Name and address of Group Practice Location Primary Service Area as defined in Section 1(11) of PA 14-168 services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
06082; 06096; 06078; 06071; 06076; 06029; 06095; 06066; Saint Francis Medical Group Enfield, CT 24 06016; 06074; 7 Elm Street Enfield CT 06082 Primary care 06002; 06095; 06112; 06117; 06096; 06074; 06082; 06108; Saint Francis Medical Group Bloomfield, CT 06118; 06070; 06105; 06042; 06066; 06106; 06035; 06107; 25 06067; 06120; 06001; 06109; 06114; 06033; 06040; 421 Cottage Grove Road Suite C , Bloomfield, CT 06002 Urology 06082; 06066; 06002; 06074; 06095; 06118; 06042; 06040; 06108; 06033; 06029; 06112; 06106; 06114; 06071; 06067; Saint Francis Medical Group Bloomfield, CT 06016; 06105; 06119; 06088; 06096; 06078; 06117; 06076; 26 06070; 06120; 06111; 06109; 580 Cottage Grove Road, Bloomfield, CT 06002 Urogynecology 06095; 06002; 06096; 06016; 06074; 06001; 06082; 06112; Saint Francis Medical Group Bloomfield, CT 06078; 06070; 06118; 06035; 06066; 06026; 06090; 06040; 27 06117; 06088; 06108; 06109; 06032; 06106; 421 Cottage Grove Road Suite B, Bloomfield, CT 06002 General surgery 06082; 06095; 06074; 06002; 06106; 06096; 06112; 06114; 06117; 06040; 06070; 06066; 06118; 06001; 06010; 06105; Saint Francis Medical Group Bloomfield, CT 06108; 06109; 06026; 06078; 06088; 06107; 06110; 06120; 28 06119; 06071; 06035; 1 Northwestern Drive, Suite 302, Bloomfield, CT 06002 Vascular surgery 29 Saint Francis Medical Group Hartford, CT 06112; 06120; 06106; 06114; 06002; 06105; 131 Coventry Street, Hartford, CT 06112 Obstetrics/gynecology 30 Saint Francis Medical Group Enfield, CT 06082; 06071; 06096; 06078; 06076; 06016; 06095; 146 Hazard Avenue, Enfield, CT 06082 Urology 06010; 06111; 06001; 06095; 06002; 06107; 06109; 06070; 06032; 06117; 06108; 06110; 06106; 06082; 06066; 06019; Saint Francis Medical Group Farmington, CT 06040; 06119; 06118; 06067; 06051; 06112; 06013; 06033; 06053; 06114; 06085; 06062; 06074; 06489; 06057; 06037; 31 06035; 06096; 06790; 06105; 11 South Road, Farmington, CT 06032 Rheumatology, Urology, Vascular surgery 06106; 06105; 06112; 06040; 06108; 06114; 06002; 06120; Saint Francis Medical Group Farmington, CT 06118; 06095; 06051; 06082; 06053; 06790; 06010; 06066; 32 06042; 06096; 06226; 06457; 06110; 06111; 06074; 06076; 220 Farmington Avenue, Farmington, CT 06032 Surgical oncology 06033; 06108; 06040; 06118; 06074; 06042; 06109; 06114; Saint Francis Medical Group Glastonbury, CT 06067; 06416; 06111; 06095; 06066; 06106; 06002; 06001; 33 06238; 06084; 06120; 06107; 06073; 06415; 31 Sycamore Street, Glastonbury, CT 06033 Podiatry 06118; 06033; 06067; 06109; 06108; 06074; 06040; 06111; Saint Francis Medical Group Glastonbury, CT 06248; 06415; 06231; 06066; 06073; 06043; 06416; 06042; 34 06447; 300 Hebron Avenue, Suite 207, Glastonbury, CT 06033 Urology 06360; 06351; 06118; 06040; 06374; 06066; 06042; 06108; Saint Francis Medical Group Manchester, CT 06450; 06074; 06331; 06238; 06084; 06268; 06071; 06281; 35 06249; 06078; 06067; 06033; 06001; 06423; 06239; 515 West Middle Turnpike, Manchester, CT 06040 Vascular surgery 36 Saint Francis Medical Group Suffield, CT 06078; 06096; 06082; 06093; 06095; 162 Mountain Road, Suffield, CT 06078 Urology 06001; 06019; 06070; 06092; 06057; 06063; 06032; 06035; Saint Francis Medical Group Avon, CT 37 06089; 8-D Canal Court, Avon, CT 06001 Surgical oncology 06053; 06051; 06489; 06111; 06010; 06037; 06062; 06052; Saint Francis Medical Group New Britain, CT 38 06479; 06032; 06109; 1 Liberty Square, New Britain, CT 06051 Surgical oncology 06118; 06108; 06033; 06095; 06082; 06040; 06109; 06074; Saint Francis Medical Group East Hartford, CT 06002; 06106; 06096; 06119; 06042; 06111; 06001; 06067; 39 06114; 06066; 06107; 06073; 06053; 06051; 06112; 893 Main Street, East Hartford, CT 06108 General surgery 40 Saint Francis Medical Group Windsor Locks, CT 06096; 06082; 06088; 06016; 06095; 06078; 2 Concord Way, Windsor Locks, CT 06096 Internal medicine, General surgery
Group Practice Reporting Page 17 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Name and address of each Business Entity that provides Line Name and address of Group Practice Location Primary Service Area as defined in Section 1(11) of PA 14-168 services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
45 46 47 48 49 50
Group Practice Reporting Page 18 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Primary Service Area as defined in Section 1(11) Name and address of each Business Entity that Line Name and address of Group Practice Location of PA 14-168 provides services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
1 Saint Francis Care Medical Group Bloomfield, CT 06112 421 Cottage Grove Road, Bloomfield CT 06002 Emergency medicine 2 Saint Francis Care Medical Group Glastonbury, CT 06033; 06118; 06073; 06614; 06249; 55 Oak Street, Glastonbury CT 06033 Internal medicine 3 Saint Francis Care Medical Group Manchester, CT 06040; 06042; 06118; 06108; 318 West Middle Tpke, Manchester CT 06040 Emergency medicine 4 Saint Francis Care Medical Group Simsbury, CT 06092; 06001; 06070; 06019; 06089; 06063; 498 Bushy Hill Road, Simsbury, CT 06070 Emergency medicine 5 Saint Francis Care Medical Group Stafford Springs, CT 06076 87 West Stafford Road Rt 190, Stafford Springs, CT 06076 Emergency medicine 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Group Practice Reporting Page 19 of 20 Business Entity Data Business Entity Data
Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually
Date of Filing ------> Full Legal Name of Entity Reporting ------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) ------> Hospital (Hospital, Hospital System, Group Practice)
If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "BusinessEntity" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "(move to end)" 4 Click inside the "create a copy" box 5 Click "OK"
(1) (2) (3) (4) (5) (6) Primary Service Area as defined in Section 1(11) Name and address of each Business Entity that Line Name and address of Group Practice Location of PA 14-168 provides services as part of the Group Practice Description of services at this location
When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services.
44 45 46 47 48
Group Practice Reporting Page 20 of 20 Business Entity Data