Palm Springs

2020

PROVIDER AND PHARMACY
DIRECTORY

Riverside County

Golden State Medicare Health Plan HMO Plan

Provider Directory

This directory is current as of 1/16/2020. This directory provides a list of Golden State Medicare Health Plan’s current network providers. This directory is for Riverside County. To access Golden State Medicare Health Plan’s online provider directory, you can visit www.GSMHP.com. For any questions about the information contained in this directory, please call our Member Service Department at 877-541-4111, 8am to 8pm Monday through Friday TTY/TDD users should call 711.

Golden State Medicare Health Plan is an HMO with a Medicare contract. Enrollment in Golden State Medicare Health Plan depends on contract renewal. The Provider and Pharmacy Network may change at any time. You will receive notice when necessary. This document may be available in an alternate format such as Braille, large print, or audio.

We strongly suggest that you review our current Provider/Pharmacy Directory to see if your pharmacy is still in our network.

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2020 PROVIDER AND PHARMACY DIRECTORY - Riverside County

Table of Contents

131 – Introduction...................................................................................................................5

What is the service area for Golden State Medicare Health Plan?.......................................................... 7 How do you find Golden State Medicare Health Plan providers in your area?.................................. 8

131 – List of Network Providers........................................................................................... 10 AFFILIATED DOCTORS OF ORANGE COUNTY

Primary Care Providers (PCPs)........................................................................................................................... 11 Specialists................................................................................................................................................................. 12 Ancillary Services................................................................................................................................................... 14

AFFILIATED PARTNERS IPA

Primary Care Providers (PCPs)........................................................................................................................... 15 Specialists................................................................................................................................................................. 16 Ancillary Services................................................................................................................................................... 18

ALAMITOS IPA

Ancillary Services................................................................................................................................................... 19

ALPHA CARE MEDICAL GROUP

Primary Care Providers (PCPs)........................................................................................................................... 20 Specialists................................................................................................................................................................. 21

BROOKSHIRE IPA

CHOICE MEDICAL GROUP

Specialists................................................................................................................................................................. 23 Hospitals....................................................................................................................................................................26 Outpatient Mental Health Providers...............................................................................................................27 Ancillary Services................................................................................................................................................... 28

COASTAL COMMUNITIES PHYSICIAN NETWORK

Primary Care Providers (PCPs)........................................................................................................................... 29 Outpatient Mental Health Providers...............................................................................................................30 Ancillary Services................................................................................................................................................... 31

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DESERT OASIS HEALTHCARE

Primary Care Providers (PCPs)........................................................................................................................... 32 Specialists................................................................................................................................................................. 35 Hospitals....................................................................................................................................................................48 Skilled Nursing Facilities (SNFs)........................................................................................................................ 49 Outpatient Mental Health Providers...............................................................................................................50 Ancillary Services................................................................................................................................................... 52

DOCTORS CHOICE MEDICAL GROUP

Specialists................................................................................................................................................................. 54

HERITAGE VICTOR VALLEY MEDICAL GROUP

Primary Care Providers (PCPs)........................................................................................................................... 55 Specialists................................................................................................................................................................. 56 Hospitals....................................................................................................................................................................59 Outpatient Mental Health Providers...............................................................................................................60 Ancillary Services................................................................................................................................................... 61

HIGH DESERT MEDICAL GROUP

Specialists................................................................................................................................................................. 62 Ancillary Services................................................................................................................................................... 63

LAKESIDE MEDICAL GROUP

Primary Care Providers (PCPs)........................................................................................................................... 64 Specialists................................................................................................................................................................. 68 Hospitals....................................................................................................................................................................79 Skilled Nursing Facilities (SNFs)........................................................................................................................ 80 Outpatient Mental Health Providers...............................................................................................................81 Ancillary Services................................................................................................................................................... 82

LAKEWOOD IPA

REGAL MEDICAL GROUP

Primary Care Providers (PCPs)........................................................................................................................... 87 Specialists................................................................................................................................................................. 94 Hospitals................................................................................................................................................................. 112 Skilled Nursing Facilities (SNFs)......................................................................................................................113 Outpatient Mental Health Providers.............................................................................................................114 Ancillary Services.................................................................................................................................................115

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SIERRA MEDICAL GROUP

Specialists...............................................................................................................................................................119 Outpatient Mental Health Providers.............................................................................................................120 Ancillary Services.................................................................................................................................................121

ST. MARY IPA

Ancillary Services.................................................................................................................................................122

XIMED & HEALTH EXCEL IPA

Specialists...............................................................................................................................................................123

2020 Pharmacy Directory....................................................................................................124

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Section

1

–

Introduction

Section 1

Introduction

This directory provides a list of Golden State Medicare Health 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 listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. Your PCP is a physician who meets state requirements and is trained to give you basic medical care. Your PCP will also coordinate the rest of the covered services you get as a member of our Plan. For example, in most situations, your PCP must give you approval in advance before you can use other providers in the plan’s network, such as specialists, hospitals, skilled nursing facilities, or home health care agencies. This is called giving you a “referral.” Your PCP will provide most of your care and will help you arrange or coordinate the rest of the covered services you get as a member of our Plan. Selection of a PCP also determines your selection of specialists, hospitals, and facilities. When a PCP is in more than one Independent Physician Association (IPA) or Medical Group, you must also select which IPA/ Medical group you would like.

The network providers listed in this directory have agreed to provide you with your health care services. 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 to go to that same provider. In some cases, you may get covered services from non-network providers. Other providers are available in our network.

We cover certain health care services that you get from non-contracted providers. These include: care for a medical emergency, urgently needed care, renal dialysis that you get when you are outside the plan’s service area, care that has been approved in advance by Golden State Medicare Health Plan, and any services which were covered through the appeals process. If a non-contracted provider asks you to pay for covered services, contact us at:

Golden State Medicare Health Plan c/o Claims Department P.O. Box 10729 Newport Beach, CA 92658

You should never pay any non-contracted providers more than what the plan is allowed by Medicare. The provider has a right to get his/her fees but does not have a right to get them from you. Ask the non-contracted provider to bill us first. If you have already paid for the covered services, we will reimburse you for our share of the cost if you get a bill for services, you can send the bill to us for payment (address listed above). We will pay your non-contracted provider for our share of the bill and will let you know what, if anything you must pay.

A “medical emergency” is when you, or any other prudent layperson with an average knowledge of health and medicine, believe that you have a medical symptom that requires immediate medical

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attention to prevent loss of life, loss of limb, or loss of function of a limb. The medical symptoms may be an illness, injury, sever pain, or a medical condition that is quickly getting worse.

If you have a medical emergency:

··

Get help as quickly as possible. Call 911 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 from your PCP.

We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. You should also have someone call your PCP at the number listed on your membership card as soon as reasonably possible.

After the emergency is over you are entitled to post stabilization care to be sure your condition continues to be stable. 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 network 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 Golden State Medicare Health Plan will be responsible for the costs.

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What is the service area for Golden State Medicare Health Plan?

Golden State Medicare Health Plan service area is comprised of the counties below.

Los Angeles County Orange County Riverside County San Bernardino County San Diego County San Francisco County San Joaquin County San Luis Obispo County Stanislaus County

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How do you find Golden State Medicare Health Plan providers in your area?

How do you find Golden State Medicare Health Plan providers in your area?

To find a Primary Care Physician (PCP) refer to the following list of Primary Care Physicians listed alphabetically by city. Followed by Specialists, listed by specialty type in alphabetical order.

If you have questions about Golden State Medicare Health Plan or require assistance in selecting a PCP, please call our Member Service Department at 877-541-4111, 8am to 8pm Monday through Friday and daily during the enrollment periods. TTY/TDD users should call 711. You can also visit

www.GSMHP.com.

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List of Providers in English

Allergy & Immunology Audiology Cardiovascular Disease Chiropractor Dermatology Endocrinology Family Practice Gastroenterology General Practice General Surgery Geriatrics Gynecology Hand Surgery Hematology & Oncology Infectious Diseases Internal Medicine Nephrology Neurology Neurological Surgery OB/GYN Oncology Ophthalmology Optometry Orthopedic Surgery Otolaryngology Pain Management Physical and Rehabilitative Medicine Plastic Surgery Podiatry Pulmonary Disease Radiation Oncology Rheumatology Speech Therapy Thoracic Surgery Urology

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Section 2

List of Network Providers

Providers marked with an asterisk (*) are closed to new members.

Section

2

–

List of Network Providers

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AFFILIATED DOCTORS OF ORANGE COUNTY

Primary Care Providers (PCPs)

AFFILIATED DOCTORS OF ORANGE COUNTY PHYSICIAN NETWORK

Lake Elsinore

Oliveira, Thomas DO 506 W Graham Ave Ste 107 Lake Elsinore, CA 92530 (951) 471-5116

Palm Springs

Mazzei, Laurie DO 340 S Farrell Dr Ste A112 Palm Springs, CA 92262 (760) 969-6533

Temecula

Wong Simmons, Pamela DO 28780 Single Oak Dr Ste 160 Temecula, CA 92590 (951) 676-4193

* Closed Panel Provider. This list is subject to change.

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Specialists

AFFILIATED DOCTORS OF ORANGE COUNTY PHYSICIAN NETWORK

Dermatology

Shiell, Ronald DO 340 S Farrell Dr Ste A205 Palm Springs, CA 92262 (760) 325-5588

Ophthalmology

Optometrist

Quach, Phuc DO 47474 Washington St La Quinta, CA 92253 (760) 564-2500
Grant-Acquah, Kweku DO 47474 Washington St La Quinta, CA 92253 (760) 564-2500

Shiell, Ronald DO

Grant-Acquah, Kweku DO

44139 MONTEREY AVE STE A PALM DESERT, CA 92260 (760) 469-5195
Quach, Phuc DO
72785 FRANK SINATRA DR STE 101 RANCHO MIRAGE, CA 92270 (760) 969-5900
44139 MONTEREY AVE STE A PALM DESERT, CA 92260 (760) 469-5195

Roshdieh, Babak DO* 72785 Frank Sinatra Dr Ste 101 Rancho Mirage, CA 92270 (760) 969-5900
Culotta, Anthony DO 29950 Haun Rd Ste 202 Menifee, CA 92586 (951) 679-1800
Mathur, Varsha DO 29826 Haun Rd Ste 100 Menifee, CA 92586 (951) 301-8888

Culotta, Anthony DO 40690 CALIFORNIA OAKS RD STE B MURRIETA, CA 92562 (951) 677-0099
Mathur, Varsha DO

Gastroenterology

41637 MARGARITA RD STE 100 TEMECULA, CA 92591 (951) 296-9300
Jamal, M. Mazen DO* 2097 Compton Ave Ste 103 Corona, CA 92881

Chang, Tom DO

Quach, Phuc DO

1801 E Tahquitz Canyon Way Ste 200 Palm Springs, CA 92262 (760) 327-2700
(951) 934-0505
44139 Monterey Ave Ste A

Palm Desert, CA 92260 (760) 469-5195
Boules, Fady DO* 817 S Main St Ste D Corona, CA 92882 (951) 339-8459
Chang, Tom DO 1801 E TAHQUITZ CANYON WAY STE 200 PALM SPRINGS, CA 92262 (760) 327-2700
Quach, Phuc DO 58471 29 PALMS HIGHWAY STE 203 YUCCA VALLEY, CA 92284 (760) 853-3005
Hassanein, Tarek DO* 6216 Brockton Ave Ste 212 Riverside, CA 92506 (619) 522-0399
Davis, Michael DO

44139 Monterey Ave Ste A Palm Desert, CA 92260 (760) 469-5195

Pain Management
General Surgery

Bustos, Jerrold DO* 69780 Stellar Dr St A Rancho Mirage, CA 92270 (760) 424-3380
Moore, Patrick DO* 28078 Baxter Rd Ste 420 Murrieta, CA 92563 (951) 566-9370
Davis, Michael DO 1801 E TAHQUITZ CANYON WAY STE 200 PALM SPRINGS, CA 92262 (760) 327-2700