2015 Plan Provider Directory 2015 Plan Provider 2015 Plan Provider Directory P.O. Box 21420 El Sobrante, CA 94820 www.uhcamedicare.org H2986_PD_033 Accepted 2015 University Health Care Advantage HMO Plan Provider Directory This directory provides a list of University Health Care Advantage (HMO)'s network providers. This directory is for the County of Santa Clara, California. This directory is current as of September, 2014. 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 University Health Care Advantage’s network providers in your area, you can visit www.UHCAmedicare.org or call our Member Services Department at 1- 855-996-8422, 8:00 a.m. to 8:00 p.m., Pacific Standard Time, 7 days a week. TTY users should call 711. University Health Care Advantage is an HMO plan with a Medicare contract. Enrollment in University Health Care Advantage depends on contract renewal. This document is available in other formats such as Braille and large print. This information is available for free in other languages. Please call our Member Services number at 1-855- 996-8422, 8:00 a.m. to 8:00 p.m., Pacific Standard Time, 7 days a week. TTY users call 711. Esta información está disponible gratuitamente en otros idiomas. Llame a nuestro número de servicio al cliente 1-855-996-8422, 8:00 a.m. a 8:00 p.m., hora estándar del pacífico, siete días a la semana. Los usuarios de TTY deben llamar al 711. 7K{QJWLQQj\FyVˏQPL˟QSKtEˋQJFiFQJ{QQJ̉NKiF;LQYXLOzQJJ˧L'˥FK9˿+˳L9LrQF́DFK~QJW{LWʻL V˫ViQJÿ˙QFKL˛XJL˷&KX˃Q7KiL%uQK'ʦʤQJQJj\P˳WWXˁQ1Jʦ˷LGQJ 77<J˧LV˫ Ⲵᴳ଑ᴽउ㲏⻬ 1-855ف䋷䀺ⲴަԆ䃎䀰⡸ᵜਟݽ䋫⦢ਆDŽ䃻൘䙡а㠣䙡ᰕкॸ8唎㠣ᲊк8唎ѻ䯃㠤䴫ᡁ↔ ᱲ䯃⛪ཚᒣ⌻⁉Ⓠᱲ䯃DŽTTY ֯⭘㘵䃻᫕ᢃ 711DŽˈ-996-8422 H2986_PD_033 Accepted 2015 Section 1 - Introduction This directory provides a list of University Health Care Advantage’s network providers. To get detailed information about your health care coverage, please see your Evidence Of Coverage. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP). The term "PCP" will be used throughout this directory. Generally, you must get your health care coverage from you PCP. There are several types of physicians who may serve as your PCP, these include: Family Practice, General Practice and Internal Medicine. Also, a woman may self-refer to one of our women's health specialists (i.e., OB-GYN/GYN) listed in this directory for routine women's health services such as a Pap smear, pelvic examination and breast examination annually. Your Primary Care Physician’s (PCP) Role Your PCP is a physician who meets state requirements and is trained to provide you basic preventive and routine medical care. You will receive routine and preventive medical care from your PCP as well as referrals when it is necessary for you to see a specialist for specialized diagnosis, treatment, and care. Your PCP will help you arrange or coordinate covered services such as X-rays, laboratory tests, therapies, hospital admissions, and follow-up care you receive. Your PCP and any of our plan specialists to whom you are referred by your PCP will also obtain pre-authorization with the plan on your behalf. Certain tests, procedures and services require pre-authorization in order to coordinate medical care and to help ensure that the treatment you receive is the most suitable treatment for your condition according to nationally recognized standards of medical care. Since your PCP will provide and coordinate your medical care, you should have all of your medical records sent to your PCP’s office. The “network providers” listed in this directory have agreed to provide your health care/ vision/dental 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. Instructions for Non-Network Provider Bills You Receive University Health Care Advantage will cover some health care services that you may receive from non- network providers. These services include care for medical emergencies, urgently needed care, renal dialysis that you receive when you are traveling outside the plan’s service area, care that has been approved in advance by University Health Care Advantage or decided to be covered through an appeal process. If a non-network provider gives you a bill for services in these situations, please contact our Member Services Department at 1-855-996-8422, or by dialing 711 for TTY services, 8:00 a.m. to 8:00 p.m., Pacific Standard Time, 7 days a week. In cases where a non-network provider submits a bill directly to you, you should not pay the bill, but should submit it to the plan for processing and determination of your financial liability, if any. H2986_PD_033 Accepted 2015 Instructions for Emergency Care and Urgently Needed Care When Traveling Outside Our Service Area You can always receive emergency care in or out of the University Health Care Advantage service area from the nearest available provider. In the event of a life-threatening illness or injury, call 911 right away. If you need care when you are traveling outside the University Health Care Advantage service area, your health care coverage is limited. Covered services include emergency care (including maintenance and hospital care until your condition is stabilized and you can be discharged safely from the hospital or transferred to a network hospital), urgently needed care, renal (kidney) dialysis, and care that University Health Care Advantage or a plan provider has approved in advance. If you are not sure whether your symptoms require urgent or emergent medical care, we recommend you contact your PCP and discuss your condition and follow your doctor’s advice on treatment. You may also contact our Nurse Line service, which is staffed by trained nurses 24 hours a day, 7 days a week. The Nurse Line number is printed on the back of your identification card. If you are planning a trip out of our service area and need renal (kidney) dialysis services, we suggest you call us for assistance in identifying renal dialysis providers located where you are traveling. 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 University Health Care Advantage will be responsible for the costs. For questions about seeing a non-UHCA provider, including when you travel, please contact Member Care Services at 1-855-996-8422, or by dialing 711 for TTY services. What is the service area for University Health Care Advantage (HMO)? The county in our service area is listed below. County of Santa Clara, California: all zip codes How do you find University Health Care Advantage providers in your area? The providers in this directory are organized alphabetically by the cities where they reside, and further listed in alphabetical order by last name. Following the listing of Primary Care Physicians, the specialists are organized alphabetically by their specialty type and further listed in alphabetical order by last name. Providers identified by an asterisk (*) are Stanford Health Care Providers. If you have questions about the University Health Care Advantage or require assistance in selecting a PCP, please call our Member Services Department at 1-855-996-8422, 8:00 a.m. to 8:00 p.m., Pacific Standard Time, 7 days a week. TTY users should call 711. Or, visit, www.UHCAmedicare.org. H2986_PD_033 Accepted 2015 Section 2 - List of Network Providers Primary Care Physicians - By City Alameda David Belk, MD * Ayanna Bennett, MD Prabha Bhatnagar, MD #0013218 #0015309 #0006083 Internal Medicine General Pediatrics Family Practice 2070 Clinton Avenue 1332 Park Street 2151 Santa Clara Avenue Suite 5E Suite 202 Suite 225 Alameda, CA 94501 Alameda, CA 94501 Alameda, CA 94501 (510) 769-7078 (510) 523-3417 (510) 865-1244 Jenna Brimmer, MD * John Carper, MD * Edward Chan, MD #0019327 #0006094 #0016866 Internal Medicine Family Practice Family Practice 501 S Shore Center West 2433 Central Avenue 2433 Central Avenue Suite 103F Suite A Suite A Alameda, CA 94501 Alameda, CA 94501 Alameda, CA 94501 (510) 814-4630 (510) 521-2300 (510) 521-2300 Robert Deutsch, MD * Mary Fisher, MD * Penny Harris, MD #0006097 #0014964 #0006102 Internal Medicine Family Practice General Pediatrics 2070 Clinton Avenue 2433 Central Avenue 1332 Park Street Suite 3336 Suite A Suite 202 Alameda, CA 94501 Alameda, CA 94501 Alameda, CA 94501 (510) 814-4089 (510) 521-2300 (510) 523-3417 * Bhoomika Kamath, MD Jagmohan Khaira, MD William Lowery, MD #0021926 #0013015 #0006098 Family Practice Internal Medicine Internal Medicine 2433 Central Avenue 1050 Marina Village Parkway 2070 Clinton Avenue Suite A Suite 101 Suite 3336 Alameda, CA 94501 Alameda, CA 94501-1033 Alameda, CA 94501 (510) 521-2300 (510) 227-5540 (510) 814-4089 * Vijay Mirmira, MD * Barbara Parker, MD * William Sellman, MD #0025462 #0006104 #0013540 Family Practice General Pediatrics Family Practice 2433 Central Avenue 1332 Park Street 2433 Central Avenue Suite A Suite 202 Suite A Alameda, CA 94501 Alameda, CA 94501 Alameda, CA 94501 (510) 521-2300 (510) 523-3417 (510) 521-2300 4 | University Health Care Advantage | Provider Directory * - Stanford Health