Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 2 Maine

CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 2 Maine

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 208502 * ACADIA FAMILY HEALTH CENTER 460 MAIN STREET SUITE 104 MADAWASKA, ME 04756 (207)728-6359 Aroostook 208523 * ARNOLD MEMORIAL MEDICAL 70 SNARE CREEK ROAD JONESPORT, ME 04649 (207)255-3356 Washington CENTER 203983 * ARTHUR JEWELL COMMUNITY 55 REYNOLDS RD BROOKS, ME 04921 (207)338-2500 Waldo HEALTH CENTER 208509 * CALAIS REGIONAL MEDICAL 37 PALMER STREET, SUITE 3 CALAIS, ME 04619 (207)454-8195 Washington SERVICES 208522 * CORINTH MEDICAL ASSOCIATES 492 MAIN STREET CORINTH, ME 04427 (207)285-3312 Penobscot 203835 * DEXTER FAMILY HEALTH 51 HIGH STREET SUITE A DEXTER, ME 04930 (207)924-7349 Penobscot 203992 * DEXTER INTERNAL MEDICINE 41 HIGH ST DEXTER, ME 04930 (207)924-5226 Penobscot 203993 * DOVER-FOXCROFT FAMILY 891 W MAIN ST DOVER FOXCROFT, ME 04426 (207)924-3424 Piscataquis PRACTICE 203988 * ELSEMORE-DIXFIELD FAMILY 146 WELD STREET DIXFIELD, ME 04224 (207)562-4226 Oxford MEDICINE 203881 * FAMILY MEDICINE 6 FACTORY RD EAST MACHIAS, ME 04630 (207)255-3338 Washington 203890 * FAMILY PLANNING ASSOCIATION OF 147 WALDO AVE BELFAST, ME 04915 (207)338-3736 Waldo MAINE INC 203889 * FULL CIRCLE HEALTH CARE, LLC 1063 ALLAGASH RD ALLAGASH, ME 04774 (207)398-1022 Aroostook 203994 * GUILFORD MEDICAL ASSOCIATES 3 PARK ST GUILFORD, ME 04443 (207)876-3547 Piscataquis 208501 * HOULTON FAMILY PRACTICE 20 HARTFORD ST HOULTON, ME 04730 (207)532-3289 Aroostook 208504 * INLAND FAMILY CARE - UNITY 80 MAIN ST UNITY, ME 04988 (207)984-2100 Waldo 203825 * ISLESBORO HEALTH CENTER 150 MAIN ROAD ISLESBORO, ME 04848 (207)734-2213 Waldo 203975 * LMP FAMILY CARE CENTER 19 ST ANDREWS LANE BOOTHBAY HARBOR, ME (207)633-7820 Lincoln 04538 208510 * LMP FAMILY MEDICINE 79 SCHOONER STREET DAMARISCOTTA, ME 04543 (207)563-4321 Lincoln DAMARISCOTTA 208511 * LMP FAMILY MEDICINE WALDOBORO 592 WEST MAIN STREET WALDOBORO, ME 04572 (207)832-6394 Lincoln

208507 * MILBRIDGE MEDICAL CENTER (RHC) 5 SCHOOL ST MILBRIDGE, ME 04658 (207)546-2391 Washington 208521 * MILLINOCKET FAMILY MEDICINE 200 SOMERSET STREET, SUITE 3 MILLINOCKET, ME 04462 (207)723-5161 Penobscot RHC 208520 * MILLINOCKET PRIMARY CARE RHC 200 SOMERSET STREET MILLINOCKET, ME 04462 (207)723-5173 Penobscot 203991 * MILO FAMILY PRACTICE 135 PARK STREET - PO BOX 7 MILO, ME 04463 (207)943-7752 Piscataquis 208513 * N M M C MEDICAL OFFICE BUILDING 194 E. MAIN ST. FORT KENT, ME 04743 (207)834-3155 Aroostook 208505 * NEW HORIZONS HEALTHCARE 167 MAIN STREET NORTH ANSON, ME 04958 (207)635-2330 Somerset * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 2 Maine

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 208506 * NEW HORIZONS HEALTHCARE 344 LAKEWOOD ROAD MADISON, ME 04950 (207)474-2994 Somerset 203857 * NEWPORT FAMILY PRACTICE 26 MAIN STREET, SUITE 2, PO BOX J NEWPORT, ME 04953 (207)368-5747 Penobscot 203987 * NORTHWOODS HEALTHCARE PRITHAM AVE GREENVILLE, ME 04441 (207)695-2084 Piscataquis 208517 * OXFORD HILLS FAMILY PRACTICE 34 WINTER ST NORWAY, ME 04268 (207)743-8031 Oxford 208516 * PENOBSCOT VALLEY PRIMARY 252 ENFIELD RD SUITE 2 LINCOLN, ME 04457 (207)794-3321 Penobscot CARE 208515 * RIVER VALLEY INTERNAL MEDICINE 431 FRANKLIN STREET RUMFORD, ME 04276 (207)269-1032 Oxford 203839 * SEAPORT FAMILY PRACTICE, P A 41 WIGHT ST BELFAST, ME 04915 (207)338-6900 Waldo 208514 * SEBASTICOOK VALLEY HEALTH 470 SOMERSET AVE PITTSFIELD, ME 04967 (207)487-5141 Somerset 208508 * SIGRID E TOMPKINS HEALTH 20 HARTFORD STREET HOULTON, ME 04730 (207)532-2234 Aroostook CENTER 208512 * STATION HILL MEDICAL OFFICE 104 EAST MAIN STREET FORT KENT, ME 04743 (207)834-3101 Aroostook BUILDING 203985 * STOCKTON SPRINGS REGIONAL MILL ROAD PO BOX 309 STOCKTON SPRINGS, ME (207)567-4000 Waldo HEALTH CENTER 04981 203989 * SWIFT RIVER HEALTH CARE 430 FRANKLIN ST RUMFORD, ME 04276 (207)369-0146 Oxford 208503 * VALLEY MEDICAL ASSOCIATION 194 E MAIN ST FORT KENT, ME 04743 (207)834-5877 Aroostook 208518 * WESTERN MAINE FAMILY PRACTICE 193 MAIN STREET NORWAY, ME 04268 (207)743-9292 Oxford 208519 * WESTERN MAINE PEDIATRICS 193 MAIN STREET NORWAY, ME 04268 (207)743-8766 Oxford Total Providers for this State = 40

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Massachusetts

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 223800 * ISLAND HEALTH INC 245 VINEYARD HAVEN ROAD EDGARTOWN, MA 02539 (508)693-5090 Dukes Total Providers for this State = 1

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 New Hampshire

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 303992 * ANTRIM MEDICAL GROUP 12 ELM ST ANTRIM, NH 03440 (603)588-4200 Hillsboro 303989 * COTTAGE HOSPITAL INTERNAL 79 SWIFTWATER RD, SUITE 2 WOODSVILLE, NH 03785 (603)747-2900 Grafton MEDICINE 303816 * DARTMOUTH HITCHCOCK 71 HIGHLAND STREET PLYMOUTH, NH 03264 (603)536-3700 Grafton PLYMOUTH 303984 * NEWFOUND FAMILY PRACTICE 5 SCHOOL STREET BRISTOL, NH 03222 (603)744-5441 Grafton 303978 * NEWPORT HEALTH CENTER 11 JOHN STARK HIGHWAY NEWPORT, NH 03773 (603)863-4100 Sullivan 303988 * NORTH COUNTRY PRIMARY CARE 580 ST JOHNSBURY RD LITTLETON, NH 03561 (603)444-7070 Grafton 303990 * PLYMOUTH OB/GYN 16 HOSPITAL RD PLYMOUTH, NH 03264 (603)536-1104 Grafton 303814 * SACO RIVER MEDICAL GROUP 7 GREENWOOD AVENUE CONWAY, NH 03818 (603)447-3500 Carroll 303987 * SPEARE PRIMARY CARE 103 BOULDER POINTE DR PLYMOUTH, NH 03264 (603)536-6355 Grafton 303991 * WEEKS MEDICAL CENTER 43 MAIN STREET NORTH STRATFORD, NH (603)922-5039 Coos 03590 303977 * WEEKS MEDICAL CENTER - 47 CHURCH STREET GROVETON, NH 03582 (603)788-2521 Coos GROVETON 303975 * WEEKS MEDICAL CENTER - 170 MIDDLE STREET LANCASTER, NH 03584 (603)788-2521 Coos LANCASTER 303976 * WEEKS MEDICAL CENTER 8 CLOVER LANE WHITEFIELD, NH 03598 (603)837-9005 Coos WHITEFIELD 303980 * WESTSIDE HEALTH CARE 15 AIKEN AVE FRANKLIN, NH 03235 (603)934-4259 Merrimack Total Providers for this State = 14

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Vermont

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 473824 * COLD HOLLOW FAMILY PRACTICE 84 WATER TOWER ROAD ENOSBURG FALLS, VT 05450 (802)933-6664 Franklin 473981 * GRACE COTTAGE FAMILY HEALTH 185 GRAFTON RD, PO BOX 216 TOWNSHEND, VT 05353 (802)365-4331 Windham 473982 * NORTH COUNTRY OB/GYN 81 MEDICAL VILLAGE DRIVE SUITE 2 NEWPORT, VT 05855 (802)334-4110 Orleans SERVICES 473814 * NORTH COUNTRY PEDIATRICS 121 MEDICAL VILLAGE DRIVE NEWPORT, VT 05855 (802)334-5929 Orleans 473979 * NORTH COUNTRY PRIMARY CARE 186 MEDICAL VILLAGE DRIVE NEWPORT, VT 05855 (802)334-3522 Orleans NEWPORT 473988 * NVRH CORNER MEDICAL 195 INDUSTRIAL PARKWAY LYNDONVILLE, VT 05851 (802)748-9501 Caledonia 473991 None NVRH KINGDOM INTERNAL 714 BREEZY HILL ROAD SAINT JOHNSBURY, VT 05819 (802)748-7500 Caledonia MEDICINE 473989 * NVRH ST JOHNSBURY PEDIATRICS 97 SHERMAN DRIVE SAINT JOHNSBURY, VT 05819 (802)748-5131 Caledonia 473992 None NVRH-WOMENS WELLNESS CENTER 1315 HOSPITAL DRIVE SAINT JOHNSBURY, VT 05819 (802)748-7520 Caledonia 473827 * RYDER BROOK PEDIATRICS PO BOX 608 MORRISVILLE, VT 05661 (802)888-2448 Lamoille 473987 * THE BARTON HEALTH CLINIC 488 ELM STREET BARTON, VT 05822 (802)525-3539 Orleans Total Providers for this State = 11

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 New York

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 333805 * COMMUNITY HEALTH CENTER 2 MAIN STREET CHERRY VALLEY, NY 13320 (607)264-3036 Otsego 333835 * FAMILY HEALTH CENTER OF CMH - 164 BROAD STREET HAMILTON, NY 13346 (315)824-8447 Madison HAMILTON 333834 * FAMILY HEALTH CENTER OF CMH - 3460 SOUTH STREET MORRISVILLE, NY 13408 (315)684-9848 Madison MORRISVILLE 333833 * FAMILY HEALTH CENTER OF CMH - 117 WEST MAIN STREET WATERVILLE, NY 13480 (315)841-4566 Oneida WATERVILLE 333831 * GREENVILLE FAMILY HEALTH CARE 20 BRYANT'S COUNTRY SQUARE, GREENVILLE, NY 12083 (518)966-8786 Greene CENTER ROUTE 32 333803 * TRI-COUNTY FAMILY COHOCTON PARK AVENUE COHOCTON, NY 14826 (518)384-5310 Steuben 333829 * TRI-COUNTY FAMILY MEDICINE 60 RED JACKET STREET DANSVILLE, NY 14437 (585)335-6041 Livingston 333830 * TRI-COUNTY FAMILY MEDICINE 200 NORTH MAIN STREET WAYLAND, NY 14572 (585)728-5131 Steuben PROGRAM 333808 * TRI-COUNTY FAMILY NUNDA 61 NORTH STATE STREET NUNDA, NY 14517 (585)468-2528 Livingston Total Providers for this State = 9

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 Pennsylvania

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 393899 * AC VALLEY MEDICAL CENTER 855 ROUTE 58 SUITE 1 PARKER, PA 16049 (724)659-5601 Armstrong 393414 * ALLEGHENY HEALTH CENTER 22 INDUSTRIAL PARK ROAD BROOKVILLE, PA 15825 (814)849-0990 Jefferson 393977 * ARMSTRONG PRIMARY CARE 116 MAIN STREET LEECHBURG, PA 15656 (724)354-5258 Armstrong CENTER 393428 * ARMSTRONG PRIMARY CARE 260 SOUTH JEFFERSON STREET KITTANNING, PA 16201 (724)543-5919 Armstrong CENTER - KITTANING 393415 * ARMSTRONG PRIMARY CARE 10261 STATE ROUTE 85 KITTANNING, PA 16201 (412)783-7124 Armstrong CENTER - RURAL VALLEY 393894 * ARMSTRONG PRIMARY CARE 102 SOUTH STREET NEW BETHLEHEM, PA 16242 (814)275-2264 Clarion CENTER SOUTH BETHLEHEM 393416 * BOWMAN HEALTH CENTER 83 SOUTH MARVIN STREET SMETHPORT, PA 16749 (814)887-5395 McKean 393422 * BRMC FAMILY PRACTICE 116 INTERSTATE PARKWAY, SUITE 41 BRADFORD, PA 16701 (814)363-9484 McKean 393421 * BRMC RURAL HEALTH CLINIC 406 FRANKLIN STREET SMETHPORT, PA 16749 (717)999-9999 McKean SMETHPORT FAMILY MEDICINE 393420 * BRMC RURAL HLTH CLINIC 116 INTERESTATE PARKWAY 42 BRADFORD, PA 16701 (717)999-9999 McKean PEDIATRIC ASSOC OF BRADFORD 393433 * CAMBRIDGE SPRINGS HEALTH 118 RAILROAD STREET CAMBRIDGE SPRINGS, PA (814)398-4313 Crawford CENTER 16403 393921 * CARING HEALTHCARE NETWORK 601 NORTH FRONT STREET PHILIPSBURG, PA 16866 (814)342-2333 Centre 393418 * CENTRAL POTTER HEALTH CENTER 71 ELK STREET COUDERSPORT, PA 16915 (814)274-5577 Potter 393855 * COMMUNITY HEALTH CARE RURAL 550 W WALNUT STREET SHAMOKIN, PA 17872 (717)644-2222 Northumberland HEALTH CLINIC 393922 * CONEMAUGH HEALTH INITIATIVES 1611 W PITT STREET JENNERSTOWN, PA 15547 (717)999-9999 Somerset RURAL HEALTH CLINIC 393923 * CONEMAUGH HEALTH INITIATIVES 207 WOODSTOWN HIGHWAY HOLLSOPPLE, PA 15935 (814)479-4034 Somerset RURAL HEALTH CLINIC 393431 * CONNEAUT LAKE HEALTH CENTER 10926 ST HWY 18 CONNEAUT LAKE, PA 16316 (814)382-0446 Crawford 393432 * CONNEAUT VALLEY HEALTH 906 WASHINGTON STREET CONNEAUTVILLE, PA 16406 (814)373-2276 Crawford CENTER 393920 * CORNERSTONE COORDINATED 40 WEST FRACK STREET FRACKVILLE, PA 17931 (570)794-6123 Schuylkill HEALTH CARE LLC 393435 None CORRY MEMORIAL HOSPITAL 300 YORK STREET CORRY, PA 16407 (814)664-3979 Erie RURAL HEALTH CLINIC 393989 * COUDERSPORT FAMILY MEDICINE 1001 EAST SECOND STREET SUITE S COUDERSPORT, PA 16915 (814)274-9198 Potter 393910 * CRESSON FAMILY PRACTICE RHC 225 KEYSTONE AVENUE CRESSON, PA 16630 (814)886-4635 Cambria 393992 * ELDERTON PRIMARY CARE CENTER 116 MAIN STREET BOX 148 ELDERTON, PA 15736 (412)354-5258 Armstrong * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 Pennsylvania

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 393978 * ELDRED HEALTH CENTER 139 MAIN STREET ELDRED, PA 16731 (814)225-4241 McKean 393975 * EMPORIUM HEALTH CENTER 288 SIZERVILLE ROAD EMPORIUM, PA 15834 (814)486-0810 Cameron 393918 * FAMILY HEALTH CARE CENTER OF 83 HILLCREST DRIVE, SUITE 200 PUNXSUTAWNEY, PA 15767 (814)938-3550 Jefferson PUNXSUTAWNEY INC 393410 * FAMILY HEALTH CARE MEYERSDALE 7160 MASON DIXON HIGHWAY MEYERSDALE, PA 15552 (814)634-5935 Somerset RHC 393409 * FAMILY HEALTH CARE SALISBURY 231 ORD STREET SALISBURY, PA 15558 (814)662-2755 Somerset RHC 393413 * FAMILY HEALTH CLINIC OF BARNES 137 DELAWARE STREET NEW MILFORD, PA 18834 (570)465-7330 Susquehanna KASSON HOSPITAL 393419 * FAMILY HEALTH CLINIC OF BARNES- 2872 TURNPIKE STREET SUSQUEHANNA, PA 18847 (717)999-9999 Susquehanna KASSON 393407 * FAMILY HEALTH CLINIC OF BARNES- 401 BROAD AVENUE SUSQUEHANNA, PA 18847 (570)853-3995 Susquehanna KASSON HOSPITAL 393994 * GALETON HEALTH CENTER 30 RIVER STREET GALETON, PA 16922 (814)435-2942 Potter 393429 * HAVEN CENTER FOR WOMEN'S 24 CREE DRIVE THIRD FLOOR LOCK HAVEN, PA 17745 (570)893-5043 Clinton HEALTH 393423 * HAVEN MEDICAL CENTER 208 E CHURCH STREET LOCK HAVEN, PA 17745 (717)999-9999 Clinton 393902 * HIGHLANDS FAMILY MEDICINE 4324 GLADES PIKE SOMERSET, PA 15501 (814)445-4585 Somerset RURAL HEALTH CLINIC 393893 * HUNTINGDON HEALTHCARE INC 814 WASHINGTON STREET HUNTINGDON, PA 16652 (814)643-4415 Huntingdon 393873 * JOHN E BALMER D O CANADOHTA 35255 BROWN HILL ROAD UNION CITY, PA 16438 (814)694-2339 Erie 393884 * JUNIATA VALLEY MEDICAL CENTER PO BOX 355 846 MEDICAL CENTER ALEXANDRIA, PA 16611 (814)669-4444 Huntingdon INC 393434 * MEADVILLE COMMUNITY HEALTH 747 TERRACE STREET MEADVILLE, PA 16335 (814)373-2976 Crawford CENTER 393820 * MEDICAL ASSOCIATES OF BOSWELL 430 STONYCREEK STREET BOSWELL, PA 15531 (814)629-5612 Somerset 393821 * MEDICAL ASSOCIATES OF BOSWELL 136 PINE STREET BOX 340 STOYSTOWN, PA 15563 (814)893-5568 Somerset 393986 * MERCER FAMILY MEDICINE CENTER 551 GREENVILLE ROAD MERCER, PA 16137 (412)662-4155 Mercer 393857 * MILLER DONMOYER FAMILY HEALTH 255 WEST SPRUCE STREET SHAMOKIN, PA 17872 (717)644-5050 Northumberland CENTER 393886 * MOUNT UNION AREA MEDICAL 100 SOUTH PARK STREET MT UNION, PA 17066 (814)542-8627 Huntingdon CENTE 393426 * NATHAN THOMAS PRACTICE 312 INDUSTRIAL PARK ROAD MEYERSDALE, PA 15552 (814)634-5954 Somerset 393901 * NEW PARIS RURAL HEALTH CLINIC 4186 CORTLAND AVENUE NEW PARIS, PA 15554 (814)839-4108 Bedford

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 Pennsylvania

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 393983 * NORTHERN POTTER HEALTH 511 ACADEMY STREET ULYSSES, PA 16948 (814)848-7555 Potter CENTER 393906 * PEDIATRIC PRACTICES OF NEPA 27-B WOODLAND DRIVE WAYMART, PA 18472 (570)488-9550 Wayne 393887 * PEDIATRIC PRACTICES OF 1837 FAIR AVENUE HONESDALE, PA 18431 (570)253-5838 Wayne NORTHEASTERN PENNSYLVANIA 393888 * PEDIATRIC PRACTICES OF 62 INDUSTRIAL PARK ROAD LAKE ARIEL, PA 18436 (570)689-7565 Wayne NORTHEASTERN PENNSYLVANIA 393430 * PENN HIGHLANDS BROOKVILLE 271 RAILROAD STREET PHILIPSBURG, PA 16866 (717)999-9999 Centre 393424 * PENN HIGHLANDS BROOKVILLE 1323 BROOKVILLE STREET FAIRMOUNT CITY, PA 16224 (814)275-3320 Clarion FAMILY PRACTICE NEW BETH 393412 * PENN HIGHLANDS BROOKVILLE 125 CHESTNUT STREET PO BOX 463 MARIENVILLE, PA 16239 (814)927-5609 Forest MARIENVILLE FAMILY PRACT 393895 * PINNACLE HEALTH PARTNERS INC 132 MANLY ROAD TAFTON, PA 18464 (570)226-2151 Pike 393988 * PORT ALLEGANY HEALTH CENTER 45 PINE STREET PORT ALLEGANY, PA 16743 (814)642-7205 McKean 393909 * PORTAGE HEALTH CENTER RHC 3670 PORTAGE STREET SUITE 105 PORTAGE, PA 15946 (814)736-9614 Cambria 393876 * RIMERSBURG MEDICAL CENTER 57 EAST BROAD STREET RIMERSBURG, PA 16248 (814)473-3191 Clarion 393907 * SAINT BENEDICT RURAL HEALTH 564 THEATRE ROAD CARROLLTOWN, PA 15722 (814)344-8480 Cambria CENTER 393889 * SAINT VINCENT MEDICAL GROUP 315 YORK STREET CORRY, PA 16407 (814)664-8686 Erie 393984 * SHINGLEHOUSE HEALTH CENTER 129 NORTH PURITAN STREET SHINGLEHOUSE, PA 16748 (814)260-9352 Potter 393877 * SHORE FAMILY HEALTH CARE 82 TOWN RUN ROAD FAIRMOUNT CITY, PA 16224 (814)275-1600 Clarion RURAL 393824 * SOUTHERN HUNTINGDON COUNTY PO BOX 40 ORBISONIA, PA 17243 (814)447-5556 Huntingdon MED 393851 * SPARTANSBURG MEDICAL CENTER 132 MECHANIC ST SPARTENSBURG SPARTANSBURG, PA 16434 (814)654-7334 Crawford MEDICAL CT 393408 * ST LUKE'S MINERS HEALTH CENTER 108 WEST CATAWISSA STREET NESQUEHONING, PA 18240 (570)669-9787 Carbon 393411 * ST LUKE'S MINERS HEALTH CENTER 34 S RAILROAD STREET TAMAQUA, PA 18252 (570)668-6111 Schuylkill -HOMETOWN 393427 * TYRONE HOSPITAL RURAL HEALTH 120 SPRING STREET HOUTZDALE, PA 16651 (814)497-4297 Clearfield CARE - HOUTZDALE 393425 * TYRONE HOSPITAL RURAL HEALTH 221 HOSPITAL DRIVE SUITE 6 TYRONE, PA 16686 (814)684-2501 Blair CLINIC 393437 * UPMC HUNTINGDON HEALTHCARE 814 WASHINGTON STREET HUNTINGDON, PA 16652 (814)643-4415 Huntingdon 393436 * UPMC HUNTINGDON HEALTHCARE 846 MEDICAL CENTER DRIVE ALEXANDRIA, PA 16611 (814)669-4444 Huntingdon

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 Pennsylvania

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 393849 * UPPER ALLEGHENY MEDICAL 1 WILLOW STREET PORT ALLEGANY, PA 16743 (814)642-9531 McKean CENTER 393897 * WASHINGTON PHYSICIAN SERVICES 343 EAST ROY FURMAN HIGHWAY WAYNESBURG, PA 15370 (724)627-8080 Greene SUITE 105 393982 * WESTFIELD HEALTH CENTER 222 CHURCH STREET WESTFIELD, PA 16950 (814)367-5971 Tioga Total Providers for this State = 72

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 2 Virginia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 493840 * ABINGDON FAMILY HEALTH CARE 445 PORTERFIELD HIGHWAY SUITE A ABINGDON, VA 24210 (276)628-3144 Washington 493422 * ARH PENNINGTON GAP CLINIC 121 STACY DRIVE PENNINGTON GAP, VA 24277 (276)546-1182 Lee 493412 * BATH COMMUNITY PHYSICIANS 106 PARK DRIVE, SUITE C HOT SPRINGS, VA 24445 (540)839-7197 Bath GROUP 498915 * BLUEFIELD FAMILY MEDICINE 106 HUFFARD DRIVE BLUEFIELD, VA 24605 (276)322-5732 Tazewell 498914 * BLUEFIELD INTERNAL MEDICINE 2111 COLLEGE AVENUE BLUEFIELD, VA 24605 (276)322-4661 Tazewell 493418 * CARILION CLINIC FAMILY MEDICINE 430 BOXWOOD LANE PEARISBURG, VA 24134 (540)921-3636 Giles 493420 * CARILION CLINIC FAMILY MEDICINE 108 HOUSTON STREET SUITE C LEXINGTON, VA 24450 (540)463-2181 Lexington City 493419 * CARILION CLINIC INTERNAL 108 HOUSTON STREET, SUITE A LEXINGTON, VA 24450 (540)463-2181 Lexington City MEDICINE 498906 * CHASE CITY PRIMARY CARE CLINIC 200 EAST FIFTH STREET CHASE CITY, VA 23924 (434)372-0900 Mecklenburg 493820 * CLINCH VALLEY PHYSICIANS 1 CLINIC DRIVE, CLAYPOOL HILL RICHLANDS, VA 24641 (540)964-1267 Tazewell 493857 * COMMUNITY HEALTH CLINIC P C 5705 REDBUD HWY HONAKER, VA 24260 (540)873-6300 Russell 493836 * FAMILY HEALTH CARE CENTER - 107 HENRY STREET GRETNA, VA 24557 (804)656-2224 Pittsylvania GRETNA 493421 * FAMILY MEDICINE WASHINGTON 12699 LEE HIGHWAY WASHINGTON, VA 22747 (540)536-1867 Rappahannock 498918 * FRIES COMMUNITY HEALTH CARE 109 CARROLL DRIVE FRIES, VA 24330 (276)744-3660 Grayson INC 493843 * GREEVER RURAL HEALTH CLINIC 403 CHILHOWIE STREET PO BOX 346 CHILHOWIE, VA 24319 (276)646-3241 Smyth 498917 * MARTINSVILLE PEDIATRICS 1109 BROOKDALE STREET, SUITE C MARTINSVILLE, VA 24112 (276)666-7545 Martinsville City 493866 * MERIT MEDICAL RURAL HEALTH CORNER OF ROUTE 460 AND 624 OAKWOOD, VA 24631 (276)498-3135 Buchanan CLINIC - OAKWOOD 493844 * MERIT MEDICAL RURAL HEALTH 6719 GOVERNOR GC PEERY HWY RICHLANDS, VA 24641 (276)964-9102 Tazewell CLINIC - RICHLANDS SUITE 3100 493981 * MSMG FP GLDE 636 SOUTH MONTE VISTA DRIVE GLADE SPRING, VA 24340 (276)429-5163 Washington 493978 * MSMG FP ST PA 16431 WISE STREET SAINT PAUL, VA 24283 (703)762-2300 Wise 493825 * OLDE TOWNE MEDICAL CENTER 5249 OLDE TOWNE ROAD WILLIAMSBURG, VA 23188 (757)259-3258 James City 493830 * PATRICK COUNTY FAMILY 18877 JEB STUART HIGHWAY, PO BOX STUART, VA 24171 (276)694-4466 Patrick PRACTICE - STUART 1019 493415 * PIONEER FAMILY MEDICAL PO BOX 912 835 WOODLAND DRIVE STUART, VA 24171 (276)694-6677 Patrick 498901 * REGIONAL HEALTH RESOURCES INC 373 CECIL D QUILLEN DRIVE, SUITE 101 DUFFIELD, VA 24244 (276)431-1638 Scott

493829 * TRI-STATE CLINIC INC 1520 SLATE CREEK ROAD GRUNDY, VA 24614 (276)935-6055 Buchanan 493977 * V H PAGE MEM HOSP FAMILY & 135 MEMORIAL DRIVE LURAY, VA 22835 (540)743-2887 Page INTERNAL MEDICINE * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 2 Virginia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 493416 * V H PAGE MEM HOSP FAMILY 250 MEMORIAL DRIVE, SUITE C LURAY, VA 22835 (540)843-4624 Page MEDICINE/LURAY 493411 * V H PAGE MEM HOSP FAMILY 505 WILLIAMS AVENUE SHENANDOAH, VA 22849 (540)652-9100 Page MEDICINE/SHENANDOAH 493987 * V H PAGE MEM HOSP FAMILY 235 MEDICAL DRIVE STANLEY, VA 22851 (540)778-4259 Page MEDICINE/STANLEY 493834 * VIRGINIA PRIMARY CARE ASSOCIAT 121 COURTHOUSE LANE BOWLING GREEN, VA 22427 (804)633-5840 Caroline Total Providers for this State = 30

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 West Virginia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 513995 * ATHENS MEDICAL CENTER 401 VERMILLION STREET ATHENS, WV 24712 (304)487-7451 Mercer 513917 * BLUEWELL FAMILY CLINIC 154 MAJESTIC PLACE BLUEFIELD, WV 24701 (304)589-4377 Mercer 513992 * BOONE MEMORIAL HOSPITAL, INC - 173 STATE STREET MADISON, WV 25130 (304)369-1230 Boone RURAL HEALTH CLINIC 513411 * BOONE MEMORIAL HOSPITAL, INC 660A SOUTH MAIN STREET MADISON, WV 25130 (304)369-4250 Boone RURAL HEALTH CLINIC 513889 * BRADSHAW MEDICAL RHC BOX 240 MAIN STREET BRADSHAW, WV 24817 (304)967-5034 McDowell 513400 * BRAXTON COMMUNITY HEALTH 100 HOYLMAN DRIVE GASSAWAY, WV 26624 (304)364-1093 Braxton CENTER RHC 513884 * BRAXTON PRIMARY HEALTH CARE 110 MUNICIPAL STREET BURNSVILLE, WV 26335 (304)853-2278 Braxton 513981 * ELK GARDEN CLINIC 48 OAK STREET ELK GARDEN, WV 26717 (304)788-3141 Mineral 513843 * FAMILY CARE CLINIC 197 PLEASANT STREET HINTON, WV 25951 (304)466-2501 Summers 513848 * FAMILY HEALTH CARE ASSOCIATES 113 MAIN AVENUE PINEVILLE, WV 24874 (304)732-6611 Wyoming 513905 * FAMILY HEALTHCARE ASSOCIATES 113 3RD AVENUE GILBERT, WV 25621 (304)732-6735 Mingo 513900 * FAMILY HEALTHCARE ASSOCIATES 114 MAIN STREET MAN, WV 25635 (304)583-0020 Logan 513849 * FAMILY HEALTHCARE ASSOCIATES COOK PARKWAY OCEANA, WV 24870 (304)682-8238 Wyoming 513850 * FAMILY HEALTHCARE ASSOCIATES 205 HOWARD AVENUE MULLENS, WV 25882 (304)294-4880 Wyoming 513918 * FAMILY HEALTHCARE ASSOCIATES - 19771 COAL HERITAGE ROAD WELCH, WV 24801 (304)436-6650 McDowell WELCH 513988 * HAMPSHIRE RURAL HEALTH CLINIC 329 SUNRISE BLVD ROMNEY, WV 26757 (304)822-5817 Hampshire 513859 * HARDY COUNTY MEDICAL 422 SOUTH MAIN STREET MOOREFIELD, WV 26836 (304)538-2331 Hardy SERVICES 513897 * HARPERS FERRY FAMILY MEDICINE 171 TAYLOR STREET HARPERS FERRY, WV 25425 (304)535-6343 Jefferson CENTER 513891 * JANA PETERS DO 365 COURTHOUSE ROAD PRINCETON, WV 24740 (304)425-3922 Mercer 513804 * LOVE MEMORIAL CLINIC 112 KUYKENDALL LANE MOOREFIELD, WV 26836 (304)530-7755 Hardy 513865 * MANCHIN CLINIC MAIN STREET FARMINGTON, WV 26571 (304)825-6554 Marion 513902 * MANNINGTON PRIMARY CARE OF 800 EAST MAIN STREET MANNINGTON, WV 26582 (304)986-2996 Marion MON GENERAL HOSPITAL 513997 * MIDDLE ISLAND HEALTH CLINIC 200 FAIR STREET MIDDLEBOURNE, WV 26149 (304)758-5100 Tyler 513914 * MILLER FAMILY PRACTICE 3921 SENECA TRAIL SOUTH PETERSTOWN, WV 24963 (304)753-9100 Monroe 513998 * MINNIE HAMILTON HLTH. CARE CTR 186 HOSPITAL DRIVE GRANTSVILLE, WV 26147 (304)354-9244 Calhoun 513410 * MORAD/HUGHES HEALTH CLINIC 122 PINNELL STREET RIPLEY, WV 25271 (304)372-2731 Jackson 513912 * MOUNTAINEER HEALTHCARE PLLC 1500 TERRACE STREET HINTON, WV 25951 (304)466-2933 Summers

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 West Virginia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 513873 * MYERS CLINIC (THE) #3 HEALTH CARE DRIVE PHILIPPI, WV 26416 (304)457-2800 Barbour 513987 * NEW MARTINSVILLE HEALTH 150 PADUCAH DRIVE NEW MARTINSVILLE, WV (304)455-8190 Wetzel CENTER 26155 513879 * NORTH MARION MEDICAL 118 MARKET STREET MANNINGTON, WV 26582 (304)986-1750 Marion ASSOCIATES, PLLC 513989 * PINE GROVE HEALTH CARE RHC 12960 SHORT LINE HIGHWAY PINE GROVE, WV 26419 (304)889-3344 Wetzel 513415 * POCAHONTAS MEMORIAL HOSPITAL RR2 BOX 52W BUCKEYE, WV 24924 (304)799-7400 Pocahontas RURAL HEALTH CLINIC 513414 * RIVERSIDE CLINIC 122 ASHFIELD STREET PIEDMONT, WV 26750 (304)355-2323 Mineral 513408 * ROANE GENERAL MEDICAL 300 HOSPITAL DRIVE SPENCER, WV 25276 (304)927-6203 Roane ASSOCIATES 513990 * ROANE GENERAL MEDICAL CENTER 200 HOSPITAL DRIVE SPENCER, WV 25276 (304)927-6822 Roane 513852 * ROMNEY MEDICAL ASSOCIATES 22347 NORTHWESTERN PIKE ROMNEY, WV 26757 (304)822-3838 Hampshire 513911 * S K SHAMMAA MD INC 623 TEMPLE STREET HINTON, WV 25951 (304)466-1243 Summers 513412 None SISTERSVILLE GENERAL HOSPITAL 305 CLAY ST SISTERSVILLE, WV 26175 (304)447-2030 Tyler RURAL HEALTH CLINIC 513413 None SISTERSVILLE GENERAL MEDICAL 100 FAIR STREET MIDDLEBOURNE, WV 26149 (304)447-2038 Tyler CENTER 513409 * SOUTHERN ROANE MEDICAL CLINIC ONE LIBRARY LANE SUITE 2 LEFT HAND, WV 25251 (304)565-3151 Roane 513991 * SUMMERS COUNTY ARH CLINIC TERRACE STREET HINTON, WV 25951 (304)466-2905 Summers 513418 * SUMMERS COUNTY ARH FAMILY 197 PLEASANT STREET HINTON, WV 25951 (304)466-2501 Summers CARE CLINIC 513893 * SUMMERSVILLE PEDIATRIC, INC 400 FAIRVIEW HEIGHTS ROAD SUMMERSVILLE, WV 26651 (304)872-7063 Nicholas 513416 * SUMMERSVILLE REGIONAL MEDICAL 74 AVENUE B RICHWOOD, WV 26261 (304)846-4980 Nicholas CENTER-RICHWOOD FAMI 513402 * SUMMERSVILLE RURAL HEALTH 400 FAIRVIEW HEIGHTS ROAD SUMMERSVILLE, WV 26651 (304)872-5124 Nicholas CLINIC 513978 * TYGART VALLEY TOTAL CARE 500 MARKET STREET GRAFTON, WV 26354 (304)265-6416 Taylor CENTER 513405 * TYGART VALLEY TOTAL CARE EMS BUILDING ROUTE 76 FLEMINGTON, WV 26347 (304)739-4867 Taylor FLEMINGTON 513417 * WALTON MEDICAL CLINIC 94 SCHOOL DRIVE WALTON, WV 25286 (304)577-6815 Roane 513880 * WARDENSVILLE MEDICAL SERVICES ROUTE 259, 55 MAIN STREET WARDENSVILLE, WV 26851 (304)874-4012 Hardy 513407 * WEBSTER COUNTY MEMORIAL 324 MILLER MOUNTAIN DRIVE WEBSTER SPRINGS, WV (304)847-5682 Webster HOSPITAL RHC 26288 513979 * WELCH COMMUNITY HOSPITAL RHC 454 MCDOWELL STREET WELCH, WV 24801 (304)436-8461 McDowell * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 West Virginia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 513919 * WEST VIRGINIA PRIMARY CARE 705 WASHINGTON STREET RAVENSWOOD, WV 26164 (304)868-6000 Jackson SPECIALISTS 513907 * YUKON MEDICAL CLINIC HC 32 BOX 78-A WAR, WV 24892 (304)875-2302 McDowell Total Providers for this State = 53

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 5 Alabama

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 013444 * ACH FAMILY PHYSICIANS 611 LAUREL STREET ATMORE, AL 36502 (251)368-8001 Escambia 013446 * ACH MED PLUS 406 MEDICAL PARK DRIVE ATMORE, AL 36502 (251)368-6384 Escambia 013445 * ACH PRIMARY CARE 402 MEDICAL PARK DRIVE ATMORE, AL 36502 (251)368-7974 Escambia 013947 * ARAB FAMILY HEALTHCARE LLC 121 GOLFVIEW DRIVE N E ARAB, AL 35016 (256)931-3531 Marshall 013463 * ATHENS LIMESTONE PEDIATRIC 101 FITNESS WAY, SUITE 2100 ATHENS, AL 35611 (256)216-9730 Limestone CLINIC 013888 * BAPTIST HEALTH CENTER BLOUNT 180 MEDICAL ST SNEAD, AL 35952 (205)466-7114 Etowah & ETOWAH 013848 * BAPTIST HEALTH CENTER 320 EAST COOSA STREET TALLADEGA, AL 35160 (256)362-3636 Talladega TALLADEG 013811 * BBH PCN MUNFORD 48 NORTH CEDARS ROAD MUNFORD, AL 36268 (256)358-4553 Talladega 013873 * BHC BLOUNT AND ETOWAH 150 GILBREATH DRIVE, SUITE 201 ONEONTA, AL 35121 (205)274-8198 Blount 018918 * BHC JEMISON 25420 US HIGHWAY 31 NORTH JEMISON, AL 35085 (205)668-1616 Chilton 013855 * BHC LINCOLN 47344 U S HIGHWAY 78 LINCOLN, AL 35096 (205)763-7848 Talladega 013961 * BHC TALLADEGA FAMILY MEDICINE 101 STEPHEN J WHITE MEMORIAL BLVD TALLADEGA, AL 35160 (256)362-4000 Talladega 013943 * BHC TALLADEGA PEDIATRICS 722 STONE AVENUE TALLADEGA, AL 35160 (256)362-1725 Talladega 018912 * BHC-TALLADEGA OB/GYN 724 STONE AVENUE TALLADEGA, AL 35160 (256)362-1410 Talladega 013976 * BIBB MEDICAL ASSOCIATES 405 BELCHER STREET CENTREVILLE, AL 35042 (205)926-4694 Bibb 013457 * BUTLER PRIMARY CARE 138 JONES STREET GEORGIANA, AL 36033 (334)376-0078 Butler 013454 * CARROLLTON PRIMARY CARE 289 WILLIAM E HILL DRIVE CARROLLTON, AL 35447 (205)375-6251 Pickens 013465 * CASTLEBERRY MEDICAL CLINIC 1674 CLEVELAND AVE CASTLEBERRY, AL 36432 (251)966-4600 Conecuh 013958 * CENTRAL PEDIATRICS, INC 101 FITNESS WAY, SUITE 1100 ATHENS, AL 35611 (256)233-0712 Limestone 013923 * CHATOM PRIMARY CARE, PC 653 ST STEPHENS AVENUE CHATOM, AL 36518 (251)847-6262 Washington 013886 * CHEROKEE CLINIC 395 NORTHWOOD DRIVE CENTRE, AL 35960 (256)927-4900 Cherokee 013422 * CHOCTAW URGENT CARE CENTER 1404 E PUSHMATAHA STREET BUTLER, AL 36904 (205)459-4488 Choctaw 013429 * COFFEEVILLE MEDICAL CLINIC 101 PARK CIRCLE COFFEEVILLE, AL 36524 (334)275-3191 Clarke 013458 * COMPLETE FAMILY CARE 94 MEDICAL CIRCLE MOULTON, AL 35650 (256)974-9216 Lawrence 018919 * COVINGTON HEALTHCARE, LLC 1608A GILMER AVE TALLASSEE, AL 36078 (334)283-2291 Elmore 013884 * COVINGTON PEDIATRICS RURAL 614 WEST BYPASS ANDALUSIA, AL 36420 (334)222-0119 Covington HEALTH CLINIC 013967 * CRENSHAW FAMILY CARE CENTER 58 ROY BEALL DRIVE LUVERNE, AL 36049 (334)335-1212 Crenshaw 013846 * CULLMAN INTERNAL MEDICINE PC 1890 ALABAMA HIGHWAY 157 SUITE 300 CULLMAN, AL 35058 (256)734-9370 Cullman 013856 * DEKALB CLINIC 415 MEDICAL CENTER DRIVE SW FORT PAYNE, AL 35968 (256)997-2820 DeKalb

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 5 Alabama

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 013971 * EPEDIATRICS AND FAMILY CARE 299 PRAIRIE STREET NORTH UNION SPRINGS, AL 36089 (334)738-7337 Bullock CLINIC 013450 * EVERGREEN PRIMARY CARE 98 CRESTVIEW AVENUE EVERGREEN, AL 36401 (251)578-0278 Conecuh 018905 * FALKVILLE MEDICAL CLINIC 434 EAST PIKE ROAD FALKVILLE, AL 35622 (256)784-2200 Morgan 013456 * FAMILY CARE CLINIC 826 WEST WASHINGTON STREET EUFAULA, AL 36027 (334)688-7410 Barbour 018914 * FAMILY CARE FIRST, INC 1023 HWY 13 HALEYVILLE, AL 35565 (205)486-5050 Winston 018913 * FAMILY CARE FIRST, INC 11809 AL HWY 157 SUITE E MOULTON, AL 35650 (256)905-0340 Lawrence 013959 * FAMILY HEALTH CLINIC OF UNION 309 N PRAIRIE NORTH UNION SPRINGS, AL 36089 (334)738-2146 Bullock SPRINGS 013926 * FAMILY MEDICAL CLINIC OF 227 HOSPITAL DRIVE JACKSON, AL 36545 (251)246-4446 Clarke JACKSON 013440 * FLOMATON MEDICAL CENTER 174 HIGHWAY 113 FLOMATON, AL 36441 (251)296-2456 Escambia 013467 None FMC MEDICAL CLINIC MILLPORT 13530 HIGHWAY 96 MILLPORT, AL 35576 (205)662-3207 Lamar 013962 * FORT MITCHELL CLINIC PC 2 GILMORE RD FORT MITCHELL, AL 36856 (334)664-1960 Russell 018917 * FORT PAYNE PEDIATRICS - 1359 OLD WATERWORKS ROAD SW FORT PAYNE, AL 35968 (256)997-5900 DeKalb WATERWORKS 013954 * FULTON FAMILY MEDICAL 218 MAIN STREET FULTON, AL 36446 (334)636-4823 Clarke 013911 * GRANT FAMILY PRACTICE CLINIC 5447 MAIN STREET GRANT, AL 35747 (256)498-5770 Marshall 013449 * GREENE COUNTY HOSPITAL 607 WILSON AVE EUTAW, AL 35462 (205)372-1260 Greene PHYSICIANS' CLINIC 013905 * GREENVILLE PEDIATRICS 84 LV STABLER DRIVE GREENVILLE, AL 36037 (334)382-9760 Butler 013438 * GROVE HILL HEALTH CARE 295-B SOUTH JACKSON STREET GROVE HILL, AL 36451 (251)275-3173 Clarke 013894 * GUNTERSVILLE FAMILY PRACTICE 1241 BLOUNT AVENUE GUNTERSVILLE, AL 35976 (205)582-6377 Marshall CLINIC 013447 * HALE COUNTY HOSPITAL CLINIC 508 GREENE STREET GREENSBORO, AL 36744 (334)624-4442 Hale 013464 * HEALTH PARTNERS OF 1229 S MAIN STREET GOODWATER, AL 35072 (256)743-1300 Coosa GOODWATER 013430 * HILL HOSPITAL PHYSICIANS CLINIC 724 DERBY DRIVE YORK, AL 36925 (205)392-5263 Sumter 013878 * HMC RURAL HEALTH CLINIC 2201 NORTH AIRPORT ROAD JASPER, AL 35502 (205)221-9351 Walker 018902 None HORIZON HEALTHCARE, LLC 205 GRAND AVENUE NW, SUITE A FORT PAYNE, AL 35967 (256)635-6600 DeKalb 018900 None HORIZON MEDICAL CLINIC, LLC 2343 2ND AVE E ONEONTA, AL 35121 (256)796-3083 Blount 013424 * IVY CREEK CLINIC 125 CHURCH STREET GEORGIANA, AL 36033 (334)376-2291 Butler 013461 * J PAUL JONES HOSPITAL PINE HILL 3945 BROAD STREET PINE HILL, AL 36769 (334)963-2113 Wilcox RURAL HEALTH CLINI

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 5 Alabama

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 013452 * J PAUL JONES HOSPITAL RURAL 319 MCWILLIAMS AVE CAMDEN, AL 36726 (334)682-4224 Wilcox HEALTH CLINIC 018915 * KEVIN G KELLY, MD 13150 HWY 43, SUITE 10 RUSSELLVILLE, AL 35653 (256)332-5901 Franklin 013420 * LAKE MARTIN FAMILY MEDICINE 301 MARIARDEN RD SUITE D DADEVILLE, AL 36853 (205)825-7871 Tallapoosa 013955 * LAKESHORE PEDIATRIC RURAL 603 GANDY STREET NE RUSSELLVILLE, AL 35653 (256)331-5055 Franklin HEALTH CLINIC 013994 * LAWRENCE RHC, 10939 ALABAMA HIGHWAY 157 MOULTON, AL 35650 (205)974-3390 Lawrence MOULTON/LAWRENCE URGENT CARE CENTER 013401 * LAWRENCE RURAL HEALTH CLINIC- 350 TENNESSEE STREET P O BOX 320 COURTLAND, AL 35618 (205)637-8033 Lawrence COURTLAND 013917 * MAINSTREET MEDICAL CLINIC, LLC 1508 COGSWELL AVENUE PELL CITY, AL 35125 (205)814-1598 St. Clair 013982 * MARION CLINIC 1768 SO WASHINGTON STREET, HWY MARION, AL 36756 (334)683-9085 Perry 45 SOUTH 013448 * MCB FAMILY CLINIC 31 RAILROAD STREET LOUISVILLE, AL 36048 (334)266-5110 Barbour 013908 * MED - ASSIST 3442 US HWY 431 ALBERTVILLE, AL 35950 (256)593-1234 Marshall 013459 * MED EXPRESS LITTLEVILLE 1369A GEORGE WALLACE HWY RUSSELLVILLE, AL 35654 (256)331-9700 Franklin 013460 * MED EXPRESS RED BAY, LLC 221 HOSPITAL ROAD RED BAY, AL 35582 (256)356-8907 Franklin 013455 * MEDEXPRESS FORD CITY 14490 COUNTY LINE ROAD, SUITE A MUSCLE SHOALS, AL 35661 (256)661-2078 Colbert 013965 * MEDICAL EAST OF DECATUR 2941 POINT MALLARD PARKWAY DECATUR, AL 35603 (256)432-2822 Morgan 018901 None MIDWAY MEDICAL CLINIC, LLC 111 BROOKLYN ROAD HOLLY POND, AL 35083 (256)796-3084 Cullman 013936 * MILLPORT FAMILY PRACTICE 13530 HIGHWAY 96 MILLPORT, AL 35576 (205)662-5784 Lamar CLINIC, LLC 013963 * MILLRY PEDIATRIC CLINIC, LLC 75 FIFTH AVENUE MILLRY, AL 36558 (251)846-3233 Washington 013851 * MORROW CLINICS INC 34867 US HIGHWAY 43 HACKLEBURG, AL 35564 (205)935-3744 Marion 013466 * MOULTON PRIMARY CARE CLINIC 40 MEDICAL CIRCLE MOULTON, AL 35650 (256)974-2131 Lawrence 013468 * MOUNDVILLE MEDICAL ASSOCIATES 40870 AL HWY 69 STE A MOUNDVILLE, AL 35474 (205)371-4444 Hale 018924 * MOUNDVILLE MEDICAL ASSOCIATES 40870 AL HWY 69 STE A MOUNDVILLE, AL 35474 (205)371-4444 Hale 013415 * MOUNTAIN VIEW FAMILY MEDICINE 5995 HIGHWAY 72 EAST GURLEY, AL 35748 (256)776-2094 Madison 013969 * NC HEALTH CARE CLINIC, LLC 68 MARCO DRIVE DECATUR, AL 35603 (256)274-4524 Morgan 013462 None NORTH MISS MEDICAL CTR 1256 MILITARY STREET SOUTH HAMILTON, AL 35570 (205)921-6200 Marion HAMILTON'S PRIMARY CARE CTR 018920 * OPELIKA PEDIATRICS & FAMILY 5809 HWY 280E OPELIKA, AL 36804 (334)275-3059 Lee CLINIC PC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 5 Alabama

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 018903 * PEDIATRIC CARE CENTER OF 200 EAST BATTLE STREET, SUITE B TALLADEGA, AL 35160 (256)368-9800 Talladega NORTHEAST ALABAMA TALLADE 013433 * PERFECT KIDS AND FAMILY CARE 111 WEST CONECUH STREET UNION SPRINGS, AL 36089 (334)738-1500 Bullock 013904 * PHIL CAMPBELL MEDICAL CLINIC 2930 HIGHWAY 237 PHIL CAMPBELL, AL 35581 (205)993-5642 Franklin 013973 * PHYSICIANS CARE OF SWEET 31431 ALABAMA HIGHWAY 10 SWEET WATER, AL 36782 (334)994-6300 Marengo WATER, LLC 013864 * PISGAH MEDICAL CLINIC 6110 COUNTY ROAD 88 PISGAH, AL 35765 (205)451-1250 Jackson 013902 * PREFERRED FAMILY HEALTHCARE, 312 SAND MOUNTAIN DRIVE, SE ALBERTVILLE, AL 35950 (256)878-1053 Marshall LLC 018921 * PREMIER FAMILY CARE ARAB LLC 20 SOUTH MAIN STREET ARAB, AL 35016 (256)586-2324 Marshall 013957 * PREMIER FAMILY CARE, LLC 2017 OBRIG AVENUE GUNTERSVILLE, AL 35976 (256)582-2324 Marshall 018906 None PREMIER MEDICAL CLINIC, LLC 506 HARLEY STREET SCOTTSBORO, AL 35768 (256)259-0685 Jackson 018922 * PRIMARY CARE CENTER OF 1075 DREWRY ROAD MONROEVILLE, AL 36460 (251)575-5988 Monroe MONROEVILLE 013434 * RIVER REGION FAMILY MEDICINE 41 CAMBRIDGE COURT WETUMPKA, AL 36093 (334)567-3309 Elmore 013964 * ROANOKE RURAL HEALTH CLINIC 1950 MAIN STREET ROANOKE, AL 36274 (334)863-2311 Randolph 018916 * RURAL PRIMARY CARE SOUTH, INC 143 WHITE OAK TRAIL, SUITE 2 WARRIOR, AL 35180 (205)543-6668 Jefferson 013989 * RUSH MEDICAL GROUP - 1221 WASHINGTON STREET LIVINGSTON, AL 35470 (205)652-9575 Sumter LIVINGSTON 018927 * SOMERVILLE FAMILY MEDICINE 4166 HIGHWAY 36 E SOMERVILLE, AL 35670 (256)432-2811 Morgan 013966 * SOUTH ALABAMA MEDICAL CLINIC, 10075 GRAND BAY WILMER ROAD GRAND BAY, AL 36541 (251)865-1852 Mobile LLC 013854 * SOUTH DEKALB FAMILY MEDICAL 15239 AL HIGHWAY 68 W CROSSVILLE, AL 35962 (256)528-7173 DeKalb CENTER 018926 * SOUTHEAST PEDIATRICS, PC 804 CRAWFORD STREET TUSKEGEE, AL 36083 (334)724-0550 Macon 013915 * SOUTHERN FAMILY HEALTH, LLC 201 OLD HWY 25 EAST COLUMBIANA, AL 35051 (205)669-4884 Shelby 018907 None SOUTHVIEW MEDICAL CLINIC, LLC 222 ARKADELPHIA ROAD, NE HANCEVILLE, AL 35077 (256)352-4767 Cullman 013970 * SULLIGENT MEDICAL CLINIC 1390 WALNUT STREET SULLIGENT, AL 35586 (205)698-7111 Lamar 013847 * SYLACAUGA PEDIATRIC CLINIC LLC 115 WEST CLAY STREET SYLACAUGA, AL 35150 (256)245-3267 Talladega 018908 * TANNER MEDICAL CLINIC 20104 SWANNER BLVD, SUITE C TANNER, AL 35671 (256)686-3334 Limestone 018904 * TANNER PRIMARY CARE OF 1030 MAIN STREET SOUTH WEDOWEE, AL 36278 (256)357-2188 Randolph WEDOWEE, INC 013876 * THREE NOTCH RURAL HEALTH INC 835 THREE NOTCH STREET ANDALUSIA, AL 36420 (334)222-8421 Covington 013956 * VALLEY HEAD CLINIC, LLC 205 GRAND AVENUE NW STE B FORT PAYNE, AL 35967 (256)635-6600 DeKalb

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 5 Alabama

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 013960 * WETUMPKA FAMILY RURAL HEALTH 815 JACKSON TRACE ROAD WETUMPKA, AL 36092 (334)567-2882 Elmore CLINIC 018923 * WILMER MEDICAL CLINIC LLC 6353 2ND STREET WILMER, AL 36587 (251)410-7425 Mobile 013953 * WOODLAND FAMILY HEALTHCARE 76 COUNTY RD 64, SUITE 3 WOODLAND, AL 36280 (256)449-2001 Randolph Total Providers for this State = 109

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 683800 * A WOMAN'S PLACE INC 1415 NW 23RD AVENUE CHIEFLAND, FL 32626 (352)493-9393 Levy 103911 * ACORN CLINIC 23320 NORTH STATE ROAD 235 BROOKER, FL 32622 (904)485-1133 Bradford 108997 * ACUTE CARE PEDIATRICS OF PALM 397 SW PALM COAST PKWY PALM COAST, FL 32137 (386)447-7337 Flagler COAST PA 108985 * ACUTE CARE PEDIATRICS, PA 1301 REID ST PALATKA, FL 32177 (386)328-5437 Putnam 103918 * AHMAD TARIQ ISMAIL 110 EAST BYRD STREET BONIFAY, FL 32425 (904)547-4799 Holmes 683819 * ALACHUA PEDIATRICS AND 14900 NW 140TH ST ALACHUA, FL 32615 (386)418-0004 Alachua PRIMARY CARE 683802 * ARCHER FAMILY HEATH CARE 16939 SW 134TH AVE ARCHER, FL 32618 (352)495-2550 Alachua 103905 * AVON MEDICAL CENTER 2398 HARTFORD DR AVON PARK, FL 33825 (813)453-2500 Highlands 103814 * AVON PARK PEDIATRICS INC 1571 US HWY 27 N AVON PARK, FL 33825 (863)453-7337 Highlands 103453 * BAKER RURAL HEALTH CLINIC 159 NORTH 3RD STREET MACCLENNY, FL 32063 (904)259-3279 Baker 103864 * BAPTIST MEDICAL GROUP - 8401 N CENTURY BLVD. CENTURY, FL 32535 (904)256-5314 Escambia CENTURY 103944 * BELLAM MEDICAL CLINIC 20021 SW 111TH PL DUNNELLON, FL 34432 (352)465-1199 Marion 103941 * BEVERLY HILLS MEDICAL CLINIC 3737 N LECANTO HWY BEVERLY HILLS, FL 34465 (352)746-1515 Citrus 108922 * BIRTH & BEYOND 1326 SR 100 GRANDIN, FL 32138 (904)659-2104 Putnam 103920 * BUSHNELL FAMILY PRACTICE 117 W BELT AVE BUSHNELL, FL 33513 (904)568-1988 Sumter 103451 * CALHOUN LIBERTY PRIMARY CARE 20370 NE BURNS AVE BLOUNTSTOWN, FL 32424 (850)237-3000 Calhoun CLINIC 103446 * CAMPBELLTON-GRACEVILLE 5429 COLLEGE DR GRACEVILLE, FL 32440 (850)263-9350 Jackson HOSPITAL PHYSICIANS OFFICE 103954 * CHARLES S LI MD 7647 W GULF TO LAKE HWY CRYSTAL RIVER, FL 34429 (352)795-1718 Citrus 103932 * CHIEFLAND MEDICAL CENTER LLC 1113 NW 23RD AVE CHIEFLAND, FL 32644 (904)463-2348 Levy 108932 * CHILDREN'S MEDICAL CENTER 1419 S 6TH ST MACCLENNY, FL 32063 (904)755-2588 Baker 103840 * CHILDREN'S MEDICAL CENTER 798 W DUVAL ST LAKE CITY, FL 32055 (904)364-8050 Columbia 108940 * CHILDREN'S MEDICAL CENTER 6704 E MT VERNON STREET GLEN SAINT MARY, FL 32040 (904)299-7420 Baker 108960 * CHILDREN'S MEDICAL CENTER - 14861 NW HWY 441 ALACHUA, FL 32615 (386)462-1911 Alachua ALACHUA 103868 * CHILDREN'S MEDICAL CENTER LIVE 1002 11TH ST SW LIVE OAK, FL 32064 (386)364-8050 Suwannee OAK 103902 * CHILDRENS CLINIC 1100 N MAIN ST BELLE GLADE, FL 33430 (407)996-8505 Palm Beach 108943 * CHIPLEY MEDICAL GROUP 1376 BRICKYARD RD CHIPLEY, FL 32428 (904)638-7910 Washington 103966 * CITRA FAMILY HEALTH 17805 US HWY 301 N CITRA, FL 32113 (352)595-7777 Marion

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 103957 * CITRUS SPRINGS RURAL HEALTH 10489 N FLORIDA AVE CITRUS SPRINGS, FL 34434 (352)489-2486 Citrus CLINIC 108972 * CLARK CLINIC INC 212 S FLORIDA ST BUSHNELL, FL 33513 (352)793-2441 Sumter 108973 * CLARK CLINIC, INC 107 W CENTRAL AVE HOWEY IN THE HILLS, FL (352)324-0504 Lake 34737 103897 * COMMUNITY MEDICAL CENTER OF 810 COMMED BLVD ORANGE CITY, FL 32763 (386)774-1155 Volusia WEST VOLUSIA PA 103869 * COMMUNITY MEDICAL CENTER OF 1190 N STONE ST DELAND, FL 32724 (904)738-1792 Volusia WEST VOLUSIA PA 683814 * COMPREHENSIVE PRIMARY CARE 4363 S SUNCOAST BLVD HOMOSASSA, FL 34446 (352)503-2011 Citrus 103819 * COPELAND CLINIC 10820 MARVIN E JONES BLVD LIVE OAK, FL 32060 (904)658-5300 Suwannee 103417 * DESOTO MEMORIAL CENTER FOR 888 N ROBERT AVE ARCADIA, FL 34266 (941)494-8401 DeSoto FAMILY HEALTH 103922 * DEVEN MEDICAL CENTER 11707 N WILLIAMS ST STE 2 DUNNELLON, FL 34432 (352)465-1199 Marion 108987 * DFS WALK-IN CLINIC 9 W ORANGE AVE DEFUNIAK SPRINGS, FL (850)951-1800 Walton 32435 683823 * DIVAKER PEDIATRICS LLC 6551 NORTH ORANGE BLOSSOM TRL MOUNT DORA, FL 32757 (407)615-5005 Lake 108941 * DOCTORS MEDICAL CENTER OF 21 W MAIN AVE DEFUNIAK SPRINGS, FL (850)892-2888 Walton WALTON COUNTY PA 32435 103440 * DOCTORS MEMORIAL FAMILY 117 SW VIRGINIA CIRCLE MAYO, FL 32066 (904)294-2475 Lafayette MEDICINE 103441 * DOCTORS MEMORIAL FAMILY 555 N BYRON BUTLER PARKWAY PERRY, FL 32347 (850)838-2141 Taylor PRACTICE 103422 * DR JAMES D FORBES FAMILY CARE 500 W SAGAMORE AVE CLEWISTON, FL 33440 (941)983-3434 Hendry 683809 * DYNAMIC HEALTH CENTERS INC 155 SE 6TH PL LAKE BUTLER, FL 32054 (352)505-5346 Union 103964 * DYNAMIC HEALTH CENTERS INC 2806 W HWY 90 LAKE CITY, FL 32055 (386)438-8391 Columbia 108981 * EXCEL PEDIATRICS 265 CITRUS TOWER BLVD, SUITE 102 CLERMONT, FL 34711 (352)394-3929 Lake 103951 * EXPRESS CARE OF BELLEVIEW 10762 S US HWY 441 BELLEVIEW, FL 34420 (352)245-1087 Marion 108991 * EXPRESS CARE OF LEESBURG 2500 CITRUS BLVD LEESBURG, FL 34748 (352)347-5225 Lake 683821 * FAMILY AND AFTER HOURS CARE 1413 NW 23RD AVENUE CHIEFLAND, FL 32626 (352)493-9393 Levy LLC 103884 * FAMILY MEDICAL GROUP PA 3420 US 27 N SEBRING, FL 33870 (813)385-7077 Highlands 103857 * FAMILY MEDICAL GROUP PA 105 TOMOKA BLVD. SOUTH LAKE PLACID, FL 33852 (813)465-7010 Highlands 103879 * FAMILY MEDICAL GROUP PA 225 US 27 S LAKE PLACID, FL 33852 (813)699-9977 Highlands

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 683815 * FIRST COAST OBSTETRICS & 6100 ST JOHNS AVE PALATKA, FL 32177 (386)325-5699 Putnam GYNECOLOGY PA 103449 * FL HOSP HEARTLAND MED CTR 1006 W PLEASANT ST AVON PARK, FL 33825 (863)453-3121 Highlands FAMILY PRACTICE CENTER 103448 * FLORIDA HOSPITAL WAUCHULA 515 CARLTON ST WAUCHULA, FL 33873 (813)773-6606 Hardee PIONEER MEDICAL CENTER 103921 * FOREST FAMILY HEALTH 15932 E HWY 40 SILVER SPRINGS, FL 34488 (904)694-4445 Marion 108975 * GARCIA MEDICAL CLINIC LLC 411 E NELSON AVE DEFUNIAK SPRINGS, FL (850)892-4791 Walton 32433 103999 * GATEWAY MEDICAL CLINIC - 127 E REDSTONE AVE CRESTVIEW, FL 32539 (615)377-4522 Okaloosa CRESTVIEW 103411 * GATEWAY MEDICAL CLINIC DFS 1045 US HWY 331 S DEFUNIAK SPRINGS, FL (904)892-2366 Walton 32435 103903 * GRACE HEALTHCARE SOLUTIONS 7368 STATE RD 15, US 441 PAHOKEE, FL 33476 (561)958-3484 Palm Beach INC 683810 * GRACE PEDIATRICS PL 4196 W US HWY 90 LAKE CITY, FL 32055 (386)243-8474 Columbia 103980 * HEALTHMARK OF WALTON RURAL 4413 US HWY 331 S DEFUNIAK SPRINGS, FL (904)892-1019 Walton HEALTH CLINIC INC 32435 103856 * HEARTLAND PEDIATRIC 7215 US HIGHWAY 27 N SEBRING, FL 33870 (813)452-1818 Highlands ASSOCIATES 103851 * HEARTLAND PEDIATRIC 120 HEARTLAND WAY WAUCHULA, FL 33873 (813)767-1414 Hardee ASSOCIATION OF WAUCHULA 108907 * HEARTLAND PEDIATRICS OF LAKE P 344 E ROYAL PALM ST LAKE PLACID, FL 33852 (941)699-1414 Highlands 103968 * HEARTLAND PEDIATRICS OF LAKE 1354 STATE ROAD 60 E LAKE WALES, FL 33853 (941)679-8888 Polk WALES LLC 103445 * HENDRY REGIONAL CONVENIENT 450 S MAIN ST LABELLE, FL 33935 (863)675-2356 Hendry CARE CENTER 103969 * HERNANDO MEDICAL CENTER 2669 N FLORIDA AVE HERNANDO, FL 34442 (352)637-2550 Citrus 103889 * HIGH SPRINGS PEDIATRICS LLC 210 NW 1ST AVE HIGH SPRINGS, FL 32643 (386)454-1156 Alachua 103866 * INTERNAL MEDICINE ASSOCIATES 4318 FIFTH AVENUE MARIANNA, FL 32446 (904)526-5300 Jackson OF JACKSON HOSPITAL 103848 * IRA FIALKO DO, PA 6171 W GULF TO LAKE HWY CRYSTAL RIVER, FL 34429 (352)429-2679 Citrus 103846 * JACK M MATHENY II MD 205 ZEAGLER DRIVE PALATKA, FL 32177 (904)328-6746 Putnam 103858 * JAY MEDICAL CENTER 14088 ALABAMA STREET JAY, FL 32565 (904)675-4546 Santa Rosa 103908 * KIDS CARE PEDIATRICS PA 6910 OLD WOLF BAY RD PALATKA, FL 32177 (904)328-7337 Putnam 103933 * KIDS HEALTH ALLIANCE PA 2650 NW 2ND ST OCALA, FL 34475 (352)237-5400 Marion * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 103424 * LAKE BUTLER FAMILY & PEDIATRIC 575 SE 3RD AVE LAKE BUTLER, FL 32054 (904)496-2323 Union CLINIC 108915 * LAKE PEDIATRICS P A 4880 N HWY 19A MOUNT DORA, FL 32757 (352)383-8111 Alachua 103808 * LITTLE PINE PEDIATRICS PLLC 1702 S JEFFERSON ST PERRY, FL 32348 (850)973-4195 Taylor 103901 * LOUIS J RADNOTHY DO PA 390 S CENTRAL AVE UMATILLA, FL 32784 (904)669-3175 Lake 103934 * MEENA NATHAN MEDICAL CLINIC 840 S BEA AVE INVERNESS, FL 34453 (352)637-6300 Citrus 103916 * MILLA PEDIATRICS RURAL HEALTH 426 SW COMMERCE DR LAKE CITY, FL 32025 (904)755-2240 Columbia CLINIC 103882 * MOHAMMAD YUNGUS MD RURAL 404 EAST HIGHWAY 90 BONIFAY, FL 32425 (904)547-4284 Holmes HEALTH CARE 103942 * NATURE COAST FAMILY HEALTH 3400 N LECANTO HWY BEVERLY HILLS, FL 34465 (352)746-2227 Citrus CLINIC 103421 * NATURE COAST FAMILY HEALTH 125 SW 7TH STREET WILLISTON, FL 32696 (352)529-0300 Levy SERVICES 108905 * NATURE COAST FAMILY MEDICAL 405 N CENTRAL AVE INVERNESS, FL 34453 (352)341-2400 Citrus CENTER 683803 * NATURE COAST MEDICAL GROUP 130 SW 7TH ST WILLISTON, FL 32696 (618)664-9818 Levy PA 108906 * NORTH FLORIDA PEDIATRICS 1117 US HWY 41 NW JASPER, FL 32052 (904)758-0003 Hamilton 103931 * NORTH FLORIDA PEDIATRICS PA 1859 SW NEWLAND WAY LAKE CITY, FL 32025 (904)758-0003 Columbia 683817 None NORTH FLORIDA PEDIATRICS PA 1101 S OHIO AVE LIVE OAK, FL 32064 (386)339-1060 Suwannee 683822 * NORTH FLORIDA PEDIATRICS PA 149 NE 241ST STREET CROSS CITY, FL 32628 (352)498-3337 Dixie 103875 * NORTH FLORIDA PEDIATRICS RHC 4316 5TH AVE MARIANNA, FL 32446 (904)526-5437 Jackson 108925 * OAK HILL MEDICAL 185 A US #1, NORTH OAK HILL, FL 32759 (904)345-0003 Volusia 683805 * OB & GYN OF NE FL, PA 700 ZEIGLER DR PALATKA, FL 32177 (386)530-2380 Putnam 683811 * ORIGINS FAMILY MEDICAL & 194 SW WALL TERRACE LAKE CITY, FL 32025 (386)719-9227 Columbia WEIGHT LOSS CLINIC INC 103972 * PALM GLADES RURAL HEALTH 217 W AVE A BELLE GLADE, FL 33430 (561)753-5563 Palm Beach ASSOCIATES INC 683801 * PANHANDLE FAMILY MEDICINE LLC 310 EAST BYRD AVE STE B BONIFAY, FL 32425 (314)968-0076 Holmes 108984 * PANHANDLE FAMILY MEDICINE PA 877 3RD ST CHIPLEY, FL 32428 (850)638-4555 Washington 103863 * PEDIATRIC AND INTERNAL 1990 N PROSPECT AVE LECANTO, FL 34461 (352)527-6888 Citrus MEDICINE SPECIALISTS PA 108964 * PEDIATRIC ASSOCIATES OF 2140 E EDGEWOOD DR LAKELAND, FL 33803 (863)669-1212 Polk LAKELAND

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 108966 * PEDIATRIC PARTNERS OF WINTER 550 POPE AVE NW WINTER HAVEN, FL 33880 (863)293-2144 Polk HAVEN 108969 * PEDIATRICS IN BREVARD 134 S WOODS DR ROCKLEDGE, FL 32955 (321)636-3066 Brevard 108968 * PEDIATRICS IN BREVARD 1755 W HIBISCUS BLVD MELBOURNE, FL 32901 (321)724-5437 Brevard MELBOURNE 108970 * PEDIATRICS IN BREVARD PA 699 W COCOA BEACH CSWY COCOA BEACH, FL 32931 (321)784-5437 Brevard 108944 * PHILIP COLAIZZO MD PA 170 S BARFIELD HWY PAHOKEE, FL 33476 (561)924-5155 Palm Beach 103818 * POSITIVE HEALTHCARE MOBILE 4300 BAYOU BLVD PENSACOLA, FL 32503 (850)470-8071 Escambia CLINIC 103801 * PREMIER MEDICAL PEDIATRICS 315 E ASH ST PERRY, FL 32347 (850)838-2121 Taylor CLINIC INC 683812 * PREMIER PEDIATRICS 11223 N WILLIAMS DUNNELLON, FL 34432 (352)671-6741 Marion 683818 * PREMIER PEDIATRICS FOREST 14141 E HWY 40, UNIT B SILVER SPRINGS, FL 34488 (352)512-0466 Marion 103881 * PREMIER PEDIATRICS, LLC 7960 SW 60TH AVE OCALA, FL 34476 (352)671-6741 Marion 103904 * PRIMARY CARE CENTER OF LIVE 1500 OHIO AVE N LIVE OAK, FL 32064 (386)330-0100 Suwannee OAK 103924 * PROFESSIONAL PEDIATRICS 1050 US HWY 27 N CLERMONT, FL 34714 (352)404-8944 Lake 108949 * PUTNAM OBSTETRICS AND 6061 ST JOHNS AVE PALATKA, FL 32177 (386)325-0826 Putnam GYNECOLOGY 103429 * QUINCY MEDICAL GROUP 178 LASALLE LEFALL DR QUINCY, FL 32351 (904)875-3600 Gadsden 103854 * RAYPAR, INC DBA TRINITY MEDICAL 1064 N BROADWAY AVE BARTOW, FL 33830 (863)519-9797 Polk CENTER 103804 * RIDGE MANOR MEDICAL CLINIC 34498 CORTEZ BLVD RIDGE MANOR, FL 33523 (352)583-4520 Hernando 103883 * ROMULO J CAMOGLIANO MD PA 1400 US HWY 441 N THE VILLAGES, FL 32159 (352)259-3435 Lake 103452 * SACRED HEART MEDICAL GROUP 55 AVENUE E APALACHICOLA, FL 32320 (850)370-1000 Franklin ON THE GULF 103914 * SEBRING PEDIATRICS LLC 3201 MEDICAL WAY, SUITE #101 SEBRING, FL 33870 (941)382-0770 Highlands 103435 * SHANDS LIVE OAK MEDICAL GROUP 1426 CANYON AVE NE LIVE OAK, FL 32064 (904)362-1809 Suwannee 103998 * SHANDS MEDICAL GROUP OF 1550 S WATER ST STARKE, FL 32091 (904)368-2480 Bradford STARKE 103887 * SHORELINE MEDICAL GROUP 419 BALTZELL AVENUE PORT SAINT JOE, FL 32456 (904)670-8585 Gulf 103952 * SONNIS PEDIATRICS INC 1125 S 6TH AVE WACHULA, FL 33873 (863)767-1616 Hardee 108947 * SOUTHERN FAMILY HEALTHCARE 877 3RD ST CHIPLEY, FL 32428 (850)638-4383 Washington PA 683804 * SOUTHERN HEALTH CLINIC 2910 HOSPITAL DRIVE BONIFAY, FL 32425 (850)547-8158 Holmes * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 108971 * ST FRANCIS PRIMARY CARE CLINIC 720 N BAY ST EUSTIS, FL 32726 (352)357-3129 Lake 108909 * ST VINCENTS PRIMARY CARE 3772 W 3RD ST HILLIARD, FL 32046 (904)845-3574 Nassau 103430 * STEINHATCHEE FAMILY CENTER 1209 1ST AVE S STEINHATCHEE, FL 32359 (352)498-5888 Taylor 683806 * SUMTER MEDICAL CENTER 411 N WEST ST BUSHNELL, FL 33513 (352)508-1125 Sumter 108950 * SUN N LAKE MEDICAL GROUP - 4958 SUN N LAKE BLVD SEBRING, FL 33872 (863)386-4711 Highlands SEBRING 108999 * SUN N LAKE MEDICAL GROUP PA 511 W INTERLAKE BLVD LAKE PLACID, FL 33852 (863)699-1220 Highlands 103855 * SUNCOAST PRIMARY CARE 7991 S SUNCOAST BLVD HOMOSASSA, FL 34446 (352)489-2486 Citrus SPECIALISTS 108954 * SUNCOAST PRIMARY CARE 3733 E GULF TO LAKE HWY INVERNESS, FL 34450 (352)746-1588 Citrus SPECIALISTS 108961 * SUNRISE PRIMARY CARE 811 N SUMMIT ST CRESCENT CITY, FL 32112 (386)698-2279 Putnam 108995 * SUNRISE PRIMARY CARE INC 219 N PALM AVENUE PALATKA, FL 32177 (386)325-8002 Putnam 103973 * SUNSHINE PEDIATRICS OF OCALA 1900 SW 20TH PL OCALA, FL 34471 (352)840-5437 Marion PA 103409 * TALLAHASSEE MEMORIAL FAMILY 1549 S JEFFERSON ST MONTICELLO, FL 32344 (904)997-0707 Jefferson MEDICINE MONTICELLO 103928 * TAVARES PEDIATRICS, INC. 2523 DORA AVENUE TAVARES, FL 32778 (352)394-3929 Lake 103847 * THE HEALTH CLINIC LLC 1351 SOUTH BLVD CHIPLEY, FL 32428 (904)638-1230 Washington 108963 * THE MEDICAL CENTER AT 20454 NE FINLEY AVE BLOUNTSTOWN, FL 32424 (850)674-2221 Calhoun BLOUNTSTOWN 683824 * THE PEDIATRIC CENTER 927 SOUTHEAST 1ST STREET BELLE GLADE, FL 33430 (561)996-5252 Palm Beach 108978 * THREE RIVERS MEDICAL INC 208 NW SUWANNEE AVE BRANFORD, FL 32008 (386)935-1607 Suwannee 103997 * TMH PHYSICIAN PARTNERS 17808 NE CHARLEY JOHNS ST BLOUNTSTOWN, FL 32424 (904)674-8450 Calhoun BLOUNTSTOWN 103428 * TMH PHYSICIAN PARTNERS 15 COUNCIL MOORE RD CRAWFORDVILLE, FL 32327 (850)926-7105 Wakulla WAKULLA 108998 * TRI COUNTY PRIMARY CARE INC 306 NE HWY 351 CROSS CITY, FL 32628 (352)498-3372 Dixie 103949 * URGENT AND CONVENIENT CARE 700 SOUTH MAIN ST LA BELLE, FL 33935 (239)325-1310 Hendry CENTER 103450 * VERNON CLINIC 3250 MAIN ST VERNON, FL 32462 (850)638-1610 Washington 108989 * VERNON FAMILY HEALTH CENTER 3027 MAIN ST VERNON, FL 32462 (850)535-0703 Washington 103815 * WAKULLA URGENT CARE AND 41 FELI WAY CRAWFORDVILLE, FL 32327 (850)926-3140 Wakulla DIAGNOSTIC CENTER PLC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 7 Florida

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 108934 * WEIRSDALE FAMILY HEALTH 16400 SOUTH HIGHWAY 25 WEIRSDALE, FL 32195 (352)821-9797 Marion CENTER 103834 * WEST FLORIDA MEDICAL 213 S PINE AVE INVERNESS, FL 34452 (352)344-5511 Citrus ASSOCIATES PA 108923 * WEST FLORIDA MEDICAL 41 N INGLIS AVE INGLIS, FL 34449 (352)447-3031 Levy ASSOCIATES PA 103893 * WEST FLORIDA MEDICAL 3775 N LECANTO HWY BEVERLY HILLS, FL 34465 (352)746-0600 Citrus ASSOCIATES, PA 108939 * WILLISTON PEDIATRICS PA 223 N MAIN ST WILLISTON, FL 32696 (352)529-0477 Levy 103974 * WILLISTON RURAL HEALTH AND 300 NW 1ST AVE WILLISTON, FL 32696 (352)528-3561 Levy WELLNESS CLINIC 103923 * WIMAUMA FAMILY HEALTH CENTER 5121 STATE RD 674 WIMAUMA, FL 33598 (813)633-8489 Hillsborough 683813 * WOMEN'S CENTER OF FLORIDA 1546 S WATER ST STARKE, FL 32091 (904)964-4777 Bradford Total Providers for this State = 155

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 Georgia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 118520 * APPLING MEDICAL GROUP 755 SOUTH MAIN STREET BAXLEY, GA 31513 (912)367-9841 Appling 113400 * ARABI HEALTH CARE CLINIC 4110 BEDGOOD AVE ARABI, GA 31712 (229)273-0116 Crisp 118544 * ARCHBOLD PELHAM PRIMARY CARE 250 BLANTON STREET NE PELHAM, GA 31779 (229)294-2437 Mitchell CLINIC 113408 * BACON COUNTY COMMUNITY CARE 204 EAST 15TH STREET ALMA, GA 31510 (912)632-2952 Bacon CENTER 118516 * BLUE MOUNTAIN FAMILY PRACTICE 178 A HOSPITAL ROAD BLAIRSVILLE, GA 30512 (706)745-4191 Union 118501 * BROOKS MEDICAL ASSOCIATES 907 NORTH COURT STREET QUITMAN, GA 31643 (229)263-4531 Brooks 118549 * BUCHANAN MEDICAL CLINIC 30 BUCHANAN BYPASS BUCHANAN, GA 30113 (770)646-8281 Haralson 118556 * BURKE MEDICAL CENTER HEALTH 311 FOURTH STREET WAYNESBORO, GA 30830 (706)554-5908 Burke CLINIC 113474 * CAMILLA PEDIATRIC CENTER 25 PERRY STREET CAMILLA, GA 31730 (229)336-7472 Mitchell 118538 * CANDLER COUNTY HOSPITAL 380 CEDAR STREET METTER, GA 30439 (912)685-5073 Candler FAMILY MEDICAL CLINIC 113825 * CARROLL COUNTY PRIMARY 4248 MT. ZION ROAD MOUNT ZION, GA 30150 (770)836-0103 Carroll HEALTH CARE CLINIC 113835 * CARROLL COUNTY PRIMARY 41 WELLINGTON MILL ROAD WHITESBURG, GA 30185 (770)836-0504 Carroll HEALTH CARE CLINIC 118535 * CLINIC AT WALMART, THE 2630 HIGHWAY 515 BLAIRSVILLE, GA 30512 (706)493-6860 Union 113460 * COFFEE REGIONAL FIRST CARE 205 SHIRLEY AVE DOUGLAS, GA 31533 (912)384-1900 Coffee 113422 * COLQUITT REG MEDICAL CENTER 6 HOSPITAL PARK MOULTRIE, GA 31768 (229)985-3320 Colquitt PRIMARY CARE CLINIC 118533 * COMMUNITY MEDICAL ASSOCIATES 116 MAIN STREET LINCOLNTON, GA 30817 (706)359-4215 Lincoln OF LINCOLNTON 118536 * COMMUNITY MEDICAL ASSOCIATES 212 HOSPITAL DRIVE WASHINGTON, GA 30673 (706)678-5982 Wilkes OF WASHINGTON 118534 * COOK FAMILY WELLNESS CENTER 103 E JAMES STREET ADEL, GA 31620 (229)896-3424 Cook 118528 * COOK PRIMARY CARE 308 N PARRISH AVE ADEL, GA 31620 (229)896-8134 Cook 118555 * CRISP REGIONAL CONVENIENT 216 HOSPITAL DRIVE CORDELE, GA 31015 (229)276-2000 Crisp CARE 118529 * DAHLONEGA FAMILY PRACTICE 59 TIPTON DRIVE DAHLONEGA, GA 30533 (706)864-4012 Lumpkin 118910 * DAHLONEGA PEDIATRICS 1055 NORTH GROVE STREET DAHLONEGA, GA 30533 (706)864-6700 Lumpkin 118530 * DAWSON FAMILY PHYSICIANS 1078 LUMPKIN CAMPGROUND RD DAWSONVILLE, GA 30534 (706)265-8439 Dawson SOUTH STE 100 113466 * DMC INTERNAL MEDICINE AND 118 NORMAN DORMINY DRIVE FITZGERALD, GA 31750 (229)424-7263 Ben Hill FAMILY HEALTH CLINIC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 Georgia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 118911 * DOERUN FAMILY MEDICINE 128 WEST BROAD AVENUE DOERUN, GA 31744 (229)782-7589 Colquitt 118542 * EFFINGHAM FAMILY MEDICINE AT 100 GOSHEN ROAD RINCON, GA 31326 (912)754-6451 Effingham GOSHEN 118541 * EFFINGHAM FAMILY MEDICINE AT 3 HIDDEN CREEK DRIVE GUYTON, GA 31312 (912)754-6451 Effingham GUYTON 118557 * EFFINGHAM FAMILY MEDICINE AT 800 TOWNE PARK DRIVE SUITE 100 RINCON, GA 31326 (912)544-0426 Effingham RINCON 118540 * EFFINGHAM FAMILY MEDICINE AT 1451 HIGHWAY 21 SOUTH SPRINGFIELD, GA 31329 (912)754-1035 Effingham TWENTY ONE 113403 * ELLAVILLE PRIMARY MEDICINE 72 SOUTH BROAD STREET ELLAVILLE, GA 31806 (229)937-2602 Schley CENTER 118546 * EMANUEL MEDICAL CENTER 114 S. JEFFERSON STREET SWAINSBORO, GA 30401 (478)237-7517 Emanuel 118554 * EMANUEL PEDIATRIC ASSOCIATES 115 S RACETRACK ST SWAINSBORO, GA 30401 (478)419-1206 Emanuel 118532 * EVANS FAMILY CENTERED 501 EAST LONG STREET CLAXTON, GA 30417 (912)739-8001 Evans HEALTHCARE 113863 * FAMILY PRACTICE & SURGERY 120 SPARTA HIGHWAY EATONTON, GA 31024 (706)444-6521 Putnam 113862 * FAMILY PRACTICE & SURGERY 446 SPRING STREET SPARTA, GA 31087 (706)444-6521 Hancock CENTER 118525 * FAMILY PRACTICE CLINIC 2383 NORTH THIRD STREET FOLKSTON, GA 31537 (912)496-4839 Charlton 113954 * FIROZ PATKA, MD 809 PEACHTREE STREET LOUISVILLE, GA 30434 (478)625-3743 Jefferson 113431 * FLINT RIVER RURAL HEALTH CLINIC 502 SUMTER STREET MONTEZUMA, GA 31063 (478)472-8178 Dooly 113404 * FLINT RIVER- RHC 509 SUMTER ST MONTEZUMA, GA 31063 (478)472-3100 Dooly 113851 * FRANKLIN PRIMARY HEALTH CARE 1236 FRANKLIN PARKWAY FRANKLIN, GA 30217 (706)675-8669 Heard CLINIC 118902 * HABIGAILE CRIBE, MD LLC 911 PLAZA AVE STE B EASTMAN, GA 31023 (478)374-5582 Dodge 113952 * HIAWASSEE FAMILY PRACTICE, PC 56 HOSPITAL STREET HIAWASSEE, GA 30546 (706)896-2289 Towns 113965 * HINESVILLE FAMILY CARE CENTER 502 EAST GENERAL STEWART WAYS HINESVILLE, GA 31313 (912)368-4169 Liberty STE A 113968 * KIRK CLINIC, THE 8 LAUREL COURT MOULTRIE, GA 31768 (229)891-9016 Colquitt 118537 * LOWER OCONEE RURAL HEALTH 280 WILLOW CREEK LANE MC RAE, GA 31055 (229)868-4122 Telfair CLINIC AT MCRAE 113808 * MEDICAL ACCESS CLINIC 808 PROFESSIONAL BLVD. DALTON, GA 30720 (706)226-5446 Whitfield 113886 * MEDICAL ASSOCIATES 305 JONES AVENUE WAYNESBORO, GA 30830 (706)554-5147 Burke 113958 * MEDICAL CENTER OF ELBERTON, 109 COLLEGE AVENUE ELBERTON, GA 30635 (706)283-3315 Elbert LLP, THE

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 Georgia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 118519 * MEDICAL GROUP OF MITCHELL 259 US HIGHWAY 19 NORTH CAMILLA, GA 31730 (229)336-1949 Mitchell COUNTY 118545 * MIDDLE GEORGIA PEDIATRICS AT 222 PERRY HIGHWAY BUILDING A HAWKINSVILLE, GA 31036 (478)783-4080 Pulaski HAWKINSVILLE SUITE 101 113997 * MILLER COUNTY MEDICAL CENTER 208 N. CUTHBERT STREET COLQUITT, GA 39837 (229)758-3304 Miller 113869 * MOUNTAIN VALLEY MEDICAL 92 BETTY'S CREEK ROAD DILLARD, GA 30537 (706)746-6571 Rabun CENTER 118912 * NORMAN PARK FAMILY MEDICINE 139 E BROAD NORMAN PARK, GA 31771 (229)769-3500 Colquitt CLINIC 113882 * NORTH JEFFERSON MEDICAL 406 E. BROAD STREET WRENS, GA 30833 (706)547-7008 Jefferson CENTER 118548 * OPTIM PRIMARY CARE - DARIEN 1101 NORTH WAY DARIEN, GA 31305 (423)243-6185 McIntosh 118512 * OPTIM PRIMARY CARE- COBBTOWN 36671 HIGHWAY 23 COBBTOWN, GA 30420 (912)684-3692 Tattnall 118511 * OPTIM PRIMARY CARE- GLENNVILLE 1000B NORTH VETERANS BLVD GLENNVILLE, GA 30427 (912)654-1080 Long 118513 * OPTIM PRIMARY CARE- MILLEN 961 E WINTHROPE AVENUE MILLEN, GA 30442 (478)982-9081 Jenkins 118508 * OPTIM PRIMARY CARE- REIDSVILLE 125 MEMORIAL DRIVE REIDSVILLE, GA 30453 (912)557-1000 Tattnall 118547 * OPTIM PRIMARY CARE- SYLVANIA 213 MIMS ROAD SYLVANIA, GA 30467 (912)564-7426 Screven 113477 * PHOEBE WORTH FAMILY MEDICINE 1014 WEST FRANKLIN ST SYLVESTER, GA 31791 (229)776-2965 Worth 113420 * PHYSICIANS' HEALTH GROUP 1067 PEACHTREE STREET LOUISVILLE, GA 30434 (478)625-8471 Jefferson 113453 * PHYSICIANS' HEALTH GROUP- 162 NORTH MAIN STREET WADLEY, GA 30477 (478)252-8900 Jefferson WADLEY 118543 * PIONEER FAMILY CARE 11168 COLUMBIA STREET BLAKELY, GA 39823 (229)723-8300 Early 118509 * PIONEER FAMILY MEDICAL OF 11045 COLUMBIA STREET BLAKELY, GA 39823 (229)723-4313 Early EARLY COUNTY, LLC 118552 * PORTER FAMILY MEDICAL CLINIC 124 VICTORY DRIVE SWAINSBORO, GA 30401 (478)237-5506 Emanuel 118904 * R T STANLEY HEALTH CENTER 110 R.T. STANLEY, SR. PLACE LYONS, GA 30436 (912)526-9355 Toombs 113429 * RANDOLPH MEDICAL ASSOCIATES 125 MCDONALD AVE CUTHBERT, GA 39840 (229)732-2181 Randolph 118510 * RANDOLPH MEDICAL ASSOCIATES 107 PARK STREET SHELLMAN, GA 39886 (229)679-5579 Randolph 118526 * RAY MEDICAL CLINIC 401 WEST MAIN STREET SWAINSBORO, GA 30401 (478)289-1150 Emanuel 113885 * REDDY MEDICAL GROUP- FRANKLIN 132 FRANKLIN SPRINGS STREET ROYSTON, GA 30662 (706)245-7371 Franklin SPRINGS STREET 113856 * REDDY MEDICAL GROUP- GENERAL 280 GENERAL DANIEL AVENUE DANIELSVILLE, GA 30633 (706)795-2211 Madison DANIEL AVENUE 118909 * REDDY URGENT CARE- HARTWELL, 138 GIBSON STREET HARTWELL, GA 30643 (706)247-5450 Hart LLC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 Georgia

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 113858 * RIVERSTONE MD, PC 101 RIVERSTONE VISTA SUITE 205 BLUE RIDGE, GA 30513 (706)632-4400 Fannin 113497 * ROBERT E. JENNINGS MEDICAL 103 R.E. JENNINGS AVENUE, ARLINGTON, GA 39813 (229)725-4251 Calhoun CLINIC 118550 * SCREVEN COUNTY FAMILY HEALTH 105 ROCKY FORD RD SYLVANIA, GA 30467 (912)564-7133 Screven CENTER 118906 * SJC MEDICAL GROUP INC 10 DOCTORS STREET METTER, GA 30439 (912)685-5715 Candler 118522 * SOUTH GEORGIA MEDICAL 105 EAST TOLLISON STREET, STE B BAXLEY, GA 31515 (912)367-9841 Appling ASSOCIATES 113948 * SOUTHCARE MEDICAL CENTER 2514 C TOBACCO ROAD HEPHZIBAH, GA 30815 (706)790-0311 Richmond 113841 * ST. JOSEPH'S/CANDLER MEDICAL 159 WEST RAILROAD ST PEMBROKE, GA 31321 (912)653-2897 Bryan GROUP 118551 * SWAINSBORO INTERNAL MED 119 VICTORY DR SUITE A SWAINSBORO, GA 30401 (478)237-8342 Emanuel CLINIC 118504 * TALLAPOOSA FAMILY HEALTHCARE 25 WEST LYONS STREET TALLAPOOSA, GA 30176 (770)824-2800 Haralson 118900 * TANNER FAMILY HEALTHCARE OF 2906 FRANKLIN PARKWAY FRANKLIN, GA 30217 (706)675-6949 Heard FRANKLIN 113960 * THOMSON PEDIATRICS & INTERNAL 306 MOUNT PLEASANT ROAD THOMSON, GA 30824 (706)595-0090 McDuffie MEDICINE 118505 * TMC HARALSON FAMILY 204 ALLEN MEMORIAL DR, STE 201 BREMEN, GA 30110 (770)537-6500 Haralson HEALTHCARE CENTER 118553 * TWIN CITY FAMILY MEDICAL CLINIC 115 GILLIKIN ST TWIN CITY, GA 30471 (478)763-3036 Emanuel 118539 * VALLEY MEDICAL CENTER 701 BLUE BIRD BLVD FORT VALLEY, GA 31030 (478)825-7000 Crawford 113998 * WARWICK HEALTH CARE CLINIC 135 DOGWOOD STREET WARWICK, GA 31796 (229)535-4170 Worth 113890 * WEST CARROLL FAMILY HEALTH 1125 EAST HIGHWAY 166 BOWDON, GA 30108 (770)836-9388 Carroll CARE CTR 113498 * WRENS PHYSICIANS' HEALTH 400 CANTERBURY DRIVE WRENS, GA 30833 (478)625-7000 Jefferson GROUP Total Providers for this State = 90

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183821 * AARON K JONAN MEMORIAL CLINIC 832 HIGHWAY 15 NORTH JACKSON, KY 41339 (606)666-5142 Breathitt 183972 * ACCESS FAMILY HEALTH CENTER 315 HOSPITAL DRIVE, SUITE 2 BARBOURVILLE, KY 40906 (606)546-4060 Knox 183941 * ALBAREE HEALTH SERVICES, LLC 906 EAST MOUNTAIN PARKWAY, ROUTE SALYERSVILLE, KY 41465 (606)349-8100 Magoffin 114 183955 * ANNVILLE MEDICAL CLINIC 78 STATE ROAD 3444 ANNVILLE, KY 40402 (606)364-5162 Jackson 183893 * APPALACHIA HEALTH SERVICES 3080 US HIGHWAY 25W, NORTH WILLIAMSBURG, KY 40769 (606)549-9107 Whitley 183932 * APPALACHIAN CLINIC-WOOTON 21154 HWY 421, SUITE A HYDEN, KY 41749 (606)672-1144 Leslie 183924 * APPALACHIAN PHYSICIANS, PSC 48 DANIEL BOONE PLAZA HAZARD, KY 41701 (606)487-9999 Perry 183886 * ARH DANIEL BOONE CLINIC - 37 BALL PARK ROAD HARLAN, KY 40831 (606)573-4520 Harlan HARLAN 183452 * ARH MCDOWELL CLINIC 9879 KY ROUTE 122 MC DOWELL, KY 41647 (606)377-3401 Floyd 183451 * ARH MORGAN COUNTY CLINIC 476 LIBERTY ROAD WEST LIBERTY, KY 41472 (606)743-3198 Morgan 183867 * ARH TRI-CITY MEDICAL CENTER 18880 NORTH US HIGHWAY 119 CUMBERLAND, KY 40823 (606)589-0130 Harlan 183888 * ARH TUG VALLEY MEDICAL 306 HOSPITAL DRIVE SOUTH WILLIAMSON, KY (606)237-1757 Pike ASSOCIATES 41503 183868 * ARH WHITESBURG CLINIC 214 HOSPITAL ROAD WHITESBURG, KY 41858 (606)633-3632 Letcher 183877 * ASSOCIATES IN PHYSICIAN 1573 HIGHWAY 259 NORTH BROWNSVILLE, KY 42210 (270)597-2168 Edmonson SERVICES 183933 * ATIENZA-ACOB MEDICAL CLINIC 110 ROY KIDD AVENUE CORBIN, KY 40701 (606)528-7400 Knox 188929 * AUBURN COMMUNITY HEALTH 128 SUGAR MAPLE DRIVE AUBURN, KY 42206 (270)542-5500 Logan CLINIC 183447 * B F TAYLOR MEDICAL ARTS CLINIC 299-A GLASGOW ROAD BURKESVILLE, KY 42717 (270)864-2555 Cumberland 188935 * BAPTIST PRIMARY CARE OF 602 KNOX STREET BARBOURVILLE, KY 40906 (606)546-6027 Knox BARBOURVILLE 183950 * BAPTIST PRIMARY CARE OF 1010 MEDICAL CENTER DRIVE POWDERLY, KY 42367 (270)377-1600 Muhlenberg POWDERLY 188940 * BAPTIST PRIMARY CARE OF 403 SYCAMORE STREET WILLIAMSBURG, KY 40769 (606)549-8244 Whitley WILLIAMSBURG 183916 * BARBOURVILLE FAMILY HEALTH 215 NORTH ALLISON AVENUE BARBOURVILLE, KY 40906 (606)546-9287 Knox CENTER 183945 * BATES, MILLER, AND SIMS, PLLC 100 JAY STREET STANFORD, KY 40484 (606)365-1547 Lincoln 183480 * BEATTYVILLE FAMILY MEDICAL 1027 HIGHWAY 11 NORTH BEATTYVILLE, KY 41311 (606)464-0061 Lee CLINIC 183485 * BEDFORD FAMILY PRACTICE 470 HIGHWAY 421 NORTH BEDFORD, KY 40006 (502)225-7732 Trimble 183470 * BEECH FORK ARH CLINIC 805 MIDDLE FORK ROAD ASHER, KY 40803 (606)374-3393 Leslie * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183859 * BELL CLINIC, PLLC 105 ELK FORK ROAD ELKTON, KY 42220 (270)265-2574 Todd 188955 * BEREA WALK-IN CLINIC 245 PRINCE ROYAL DRIVE, SUITE A BEREA, KY 40403 (859)986-0375 Madison 183421 * BETSY LAYNE CLINIC 9350 US HIGHWAY 23 S, SUITE 3 STANVILLE, KY 41659 (606)478-3636 Floyd 183471 * BIG CREEK ARH CLINIC 17644 SOUTH HIGHWAY 421 BIG CREEK, KY 40914 (606)598-6196 Clay 188931 * BLOUNT RURAL HEALTH CENTER 810 SOUTH MAIN STREET ELKTON, KY 42220 (270)265-6504 Todd 183956 * BLUEGRASS CLINIC LIBERTY, PLLC 19 ABES PLAZA LIBERTY, KY 42539 (606)787-0014 Casey 183939 * BLUEGRASS CLINIC STANFORD, 107 METKER TRAIL, SUITE A STANFORD, KY 40484 (606)365-8338 Lincoln PLLC 188949 * BLUEGRASS FAMILY MEDICINE & 67 PUBLIC SQUARE LANCASTER, KY 40444 (859)792-1420 Garrard PEDIATRICS, PLLC 188946 * BRYANT FAMILY MEDICINE 2932 NORTH HIGHWAY 25W WILLIAMSBURG, KY 40769 (606)549-8088 Whitley 183831 * BURKHART RURAL HEALTH CLINIC 117 EAST MAIN STREET, BOX 6 SALEM, KY 42078 (270)988-3839 Livingston 183967 * BURNING SPRINGS MEDICAL CLINIC 11901 NORTH HIGHWAY 421 MANCHESTER, KY 40962 (606)598-2706 Clay 183489 * BUTLER COUNTY FAMILY CARE 210 NORTH MAIN STREET MORGANTOWN, KY 42261 (270)526-3137 Butler 188948 * CAREPLUS RURAL HEALTH CLINIC, 998 SOUTH HIGHWAY 25 WEST, SUITE 1 WILLIAMSBURG, KY 40769 (606)549-0071 Whitley LLC 183922 * CARLISLE CLINIC 107 SOUTH BROADWAY STREET CARLISLE, KY 40311 (859)289-4124 Nicholas 183985 * CARROLL COUNTY RURAL HEALTH 309 11TH STREET CARROLLTON, KY 41008 (502)732-3272 Carroll CLINIC 188912 * CASA SAN PIO 638 EAST COLLEGE AVENUE, SUITE B STANTON, KY 40380 (606)318-3500 Powell 183466 * CASEY COUNTY FAMILY PRACTICE 112 LIBERTY SQUARE SHOPPING LIBERTY, KY 42539 (606)787-5044 Casey CENTER 183428 * CASEY COUNTY PRIMARY CARE 187 WOLFORD AVENUE LIBERTY, KY 42539 (606)787-8348 Casey RURAL HEALTH CLINIC 183464 * CAVERNA PRIMARY CARE CLINIC 1495 SOUTH DIXIE STREET HORSE CAVE, KY 42749 (270)786-2372 Hart 183827 * CHILDREN'S CLINIC 223 RIVER DRIVE IRVINE, KY 40336 (606)723-5142 Estill 183849 * CHILDREN'S CLINIC ANNEX 62 MERCY COURT IRVINE, KY 40336 (606)723-5142 Estill 183919 * CLARK CLINIC PRIMARY CARE 225 HOSPITAL DRIVE WINCHESTER, KY 40391 (859)744-5757 Clark 183931 * CLARK FAMILY CARE 174 PEDRO WAY WINCHESTER, KY 40391 (859)745-4469 Clark 188927 * CLAY CITY PEDIATRICS AND 98 RIVER STREET CLAY CITY, KY 40312 (606)663-7788 Powell PRIMARY CARE 183823 * CLOVER FORK OUTPATIENT 101 CHAD STREET EVARTS, KY 40828 (606)837-2108 Harlan MEDICAL PROJECT 183412 * CLOVERPORT HEALTH CLINIC 209 ELM STREET CLOVERPORT, KY 40111 (270)778-3000 Breckinridge

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 188928 * COMMUNITY FAMILY CLINIC, PLLC 17 MILLER DRIVE OWINGSVILLE, KY 40360 (606)674-3033 Bath 183949 * COMMUNITY FAMILY CLINIC, PLLC 784 HIGHWAY 36 FRENCHBURG, KY 40322 (606)768-9190 Menifee 183917 * CORBIN FAMILY HEALTH CENTER 140 BRYAN BOULEVARD CORBIN, KY 40701 (606)523-2005 Knox 183929 * CORBIN PEDIATRIC ASSOCIATES, 57 SUMMIT DRIVE CORBIN, KY 40701 (606)528-9700 Whitley PSC 183965 * CORBIN RURAL HEALTH CENTER, 1013 MASTER STREET CORBIN, KY 40701 (606)280-7772 Knox PLLC 188925 * CRAB ORCHARD PRIMARY CARE 207 MAIN STREET CRAB ORCHARD, KY 40419 (606)355-7800 Garrard 188930 * CUMBERLAND FAMILY CLINIC, PLLC 57 HOGUE ROAD PINE KNOT, KY 42635 (606)354-9444 McCreary 183957 * DANIEL BOONE FAMILY 215 TREUHAFT BOULEVARD, SUITE 3B BARBOURVILLE, KY 40906 (606)545-0400 Knox HEALTHCARE, PLLC 188944 * EAST KENTUCKY HEALTHCARE 566 HWY 899 HINDMAN, KY 41822 (606)785-3164 Knott SERVICES CENTER, INC 183914 * EASTERN KY TENDER CARE 4851 KY ROUTE 321 PRESTONSBURG, KY 41653 (606)886-1173 Floyd PEDIATRICS 188939 * EASTERN PULASKI RURAL HEALTH 31 MARK SHOPVILLE ROAD SOMERSET, KY 42503 (606)485-4553 Pulaski CLINIC, PLLC 183481 * EDDYVILLE FAMILY MEDICAL 209 WEST MAIN STREET EDDYVILLE, KY 42038 (270)388-0620 Lyon 188908 * ELKTON CLINIC, PSC 713 WEST MAIN STREET ELKTON, KY 42220 (270)265-5353 Todd 188910 * EPHRAIM MCDOWELL GARRARD 405 DANVILLE STREET LANCASTER, KY 40444 (859)792-2124 Garrard CLINIC 183905 * EPHRAIM MCDOWELL SPRINGFIELD 280 LINCOLN DRIVE SPRINGFIELD, KY 40069 (859)336-9801 Washington FAMILY MEDICAL CENTER 183952 * ERTEL MEDICINE & PEDIATRICS 68 EAST ELKINS STREET STANTON, KY 40380 (606)663-2511 Powell STANTON 183892 * ERTEL MEDICINE & PEDIATRICS 1520 BOONESBORO ROAD WINCHESTER, KY 40391 (859)744-0067 Clark WINCHESTER 188903 * ESTILL MEDICAL CLINIC 275 NORTH COURT STREET IRVINE, KY 40336 (606)723-2167 Estill 183826 * FAMILY & INTERNAL MEDICINE 325 WALNUT STREET, SUITE 600 LEBANON, KY 40033 (270)699-9500 Marion ASSOCIATES PLLC 183902 * FAMILY CARE CLINIC MT STERLING 129 STONE TRACE MOUNT STERLING, KY 40353 (859)498-6006 Montgomery 188926 * FAMILY FIRST HEALTH CARE, PLLC 363 OFFICE PARK DRIVE COLUMBIA, KY 42728 (270)384-3939 Adair 183899 * FAMILY HEALTH CARE ASSOCIATES 1927 S HWY 25 E BARBOURVILLE, KY 40906 (606)546-7777 Knox 183936 * FAMILY HEALTH CARE CLINIC, PSC 1012 CENTER DRIVE RICHMOND, KY 40475 (859)626-9696 Madison 183884 * FAMILY MEDICAL CENTER 1463 CAMPBELLSVILLE ROAD COLUMBIA, KY 42728 (270)384-9934 Adair

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183897 * FAMILY MEDICAL CENTER OF HART 117 WEST SOUTH STREET MUNFORDVILLE, KY 42765 (270)524-7231 Hart COUNTY 183488 * FAMILY PRACTICE ASSOCIATES 124 DOWELL ROAD RUSSELL SPRINGS, KY 42642 (270)866-2440 Russell 183898 * FAMILY PRACTICE CLINIC OF 200 MULBERRY STREET, SUITE A BOONEVILLE, KY 41314 (606)593-6023 Owsley BOONEVILLE 183963 * FAMILY PRACTICE CLINIC, PSC 518 WEST GUM STREET MARION, KY 42064 (270)965-5238 Crittenden 188923 * FIRST YOU MEDICAL CENTER, PLLC 151 EAST BROADWAY EMINENCE, KY 40019 (502)845-6288 Henry 188922 * FIRST YOU MEDICAL CENTER, PLLC 18 ALEXANDER AVENUE, UNIT 1 BEDFORD, KY 40006 (502)255-0222 Trimble 183896 * FLAT LICK MEDICAL CLINIC 34 MARY ALICE LANE FLAT LICK, KY 40935 (606)542-5900 Knox 183974 * FLOWERS RURAL HEALTH CARE 333 KEEN STREET BURKESVILLE, KY 42717 (270)864-3371 Cumberland 183408 * FORDSVILLE AREA MEDICAL CLINIC 44 WEST MAIN STREET FORDSVILLE, KY 42343 (270)276-9953 Ohio 183432 * FOUNTAIN RUN RURAL HEALTH 47 AKERSVILLE ROAD FOUNTAIN RUN, KY 42133 (270)434-4857 Monroe CLINIC 183940 * FREDERICK MEDICAL CLINIC 430 LIBERTY ROAD WEST LIBERTY, KY 41472 (606)743-3114 Morgan 183964 * FREEMAN FAMILY PRACTICE 10755 NORTH US HIGHWAY 25 E GRAY, KY 40734 (606)258-8050 Knox 183958 * GEORGE HAYDEN CAUDILL, PSC 1893 RED FOX ROAD REDFOX, KY 41847 (606)642-3250 Knott 183448 * GRAND LAKES CLINIC 1860 J H O'BRYAN AVENUE GRAND RIVERS, KY 42045 (270)362-8246 Livingston 183455 * GREEN COUNTY PRIMARY CARE 310 INDUSTRIAL PARK ROAD GREENSBURG, KY 42743 (270)299-2247 Green 183477 * HAROLD PRIMARY CARE 24 LEFT PENHOOK ROAD HAROLD, KY 41635 (606)478-8787 Floyd 183906 * HARRODSBURG FAMILY MEDICAL 1509 LOUISVILLE ROAD HARRODSBURG, KY 40330 (859)734-5770 Mercer CENTER 183449 * HICKMAN-FULTON CO MED CLINIC 2003 SOUTH 7TH STREET HICKMAN, KY 42050 (270)236-3202 Fulton 183490 * HIGHLANDS PRIMARY CARE 100 BRIANNA BOULEVARD, SUITE 100 SALYERSVILLE, KY 41465 (606)349-6500 Magoffin 183943 * HILLTOP PRIMARY CARE, INC 7617 UPPER JOHNS CREEK ROAD PHELPS, KY 41553 (606)835-9333 Pike 183928 * HO PHYSICIANS SERVICES 841 US HWY 25W SOUTH, SUITE 5 WILLIAMSBURG, KY 40769 (606)549-0123 Whitley CORPORATION 183930 * HOMETOWN CLINIC 96 HIGHWAY 80 HYDEN, KY 41749 (606)672-4878 Leslie 183909 * HOSKINS MEDICAL CENTER 1120 REUBEN STREET LONDON, KY 40743 (606)862-7000 Laurel 183472 * HYDEN ARH CLINIC 130 KATE IRELAND DRIVE HYDEN, KY 41749 (606)672-2901 Leslie 188911 * IMMEDIATE CARE OF EASTERN 1238 MIDDLE FORK ROAD INEZ, KY 41224 (606)298-4000 Martin KENTUCKY 188937 * JACKSON PURCHASE PRIMARY 1111 MEDICAL CENTER CIRCLE MAYFIELD, KY 42066 (270)251-4055 Graves CARE MAYFIELD CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183891 * KENTUCKYONE HEALTH PRIMARY 417 RIVER DRIVE IRVINE, KY 40336 (606)723-0399 Estill CARE ASSOCIATES 183838 * KENTUCKYONE PRIMARY CARE 534 HILLCREST DRIVE BRANDENBURG, KY 40108 (270)422-5000 Meade 183495 * KIDS KARE PEDIATRICS 420 LORETTO ROAD, SUITE 200 LEBANON, KY 40033 (270)699-4638 Marion 188934 * KNOTT COUNTY CENTER FOR 3470 HIGHWAY 80W EMMALENA, KY 41740 (606)785-9377 Knott FAMILY HEALTH, LLC 183901 * KNOTT COUNTY FAMILY 70 HOLLY HILLS MALL ROAD HINDMAN, KY 41822 (606)785-9440 Knott HEALTHCARE 183405 * LAKE CUMBERLAND MEDICAL 350 HOSPITAL WAY, SUITE 100 SOMERSET, KY 42501 (606)451-2619 Pulaski ASSOCIATES 188954 * LANCASTER RURAL HEALTH CLINIC 230 LEXINGTON STREET, SUITE D LANCASTER, KY 40444 (606)272-3574 Garrard 183430 * LIBERTY FAMILY MEDICAL CENTER 511 MIDDLEBURG STREET LIBERTY, KY 42539 (606)787-5963 Casey 188913 * LIVING WELL HEALTHCARE, LLC 200 NORTH CRAWFORD STREET, SUITE TOMPKINSVILLE, KY 42167 (270)407-5052 Monroe 3 183959 * LON E LAFFERTY, MD, PSC 2160 BLACKLOG ROAD, SUITE 120 INEZ, KY 41224 (606)298-7405 Martin 183435 * LONDON PEDIATRIC AND 378 THOMPSON POYNTER ROAD LONDON, KY 40741 (606)877-3990 Laurel ADOLESCENT MEDICINE 183926 * LONDON WOMEN'S CARE, PLLC 803 MEYERS-BAKER ROAD, SUITE 200 LONDON, KY 40741 (606)878-3240 Laurel 183935 * MADISON FAMILY CLINIC 2161 LEXINGTON ROAD, 1ST FLOOR, RICHMOND, KY 40475 (859)626-7794 Madison SUITE 5 188914 * MADISON PRIMARY CARE, LLC 210 ST GEORGE STREET, SUITE 110 RICHMOND, KY 40475 (859)626-9766 Madison 183960 * MARION PHYSICIANS CLINIC 308 SOUTH MAIN STREET MARION, KY 42064 (270)965-4377 Crittenden 183492 * MARSHALL COUNTY SURGICAL & 619 OLD SYMSONIA ROAD BENTON, KY 42025 (570)527-2411 Marshall MEDICAL GROUP 183442 * MARTIN CLINIC 12579 MAIN STREET, SUITE 101 MARTIN, KY 41649 (606)285-0681 Floyd 188941 * MARTIN COUNTY RURAL HEALTH 64 KIRK PLAZA INEZ, KY 41224 (606)886-1173 Martin CLINIC, PLLC 188924 * MCCREARY PRIMARY CARE 65 CENTER AVENUE WHITLEY CITY, KY 42653 (606)376-2224 McCreary CENTER, INC 183487 * MCDANIELS FAMILY CARE 9798 SOUTH HIGHWAY 259 MCDANIELS, KY 40152 (270)902-4411 Breckinridge 183923 * MCKEE MEDICAL CLINIC 25 HWY 290, CAMPBELL DRUG BLDG MC KEE, KY 40447 (606)287-5162 Jackson 188900 * MEDICAL ASSOCIATES OF 515 MEMORIAL DRIVE, SUITE 3 MANCHESTER, KY 40962 (606)599-0169 Clay SOUTHEAST KENTUCKY 183484 * MEMORIAL HOSPITAL RED BIRD 53 QUEENDALE CENTER BEVERLY, KY 40913 (606)599-2525 Bell CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183479 * MERCY MEDICAL CLINIC OF LEE 1025 GRAND AVENUE BEATTYVILLE, KY 41311 (606)464-8806 Lee COUNTY 183475 * MERCY MEDICAL CLINIC OF POWELL 749 IRVINE ROAD CLAY CITY, KY 40312 (606)663-2153 Powell COUNTY 183462 * MERCY PRIMARY CARE - IRVINE 1100 RICHMOND ROAD IRVINE, KY 40336 (606)723-7771 Estill 183951 * METHODIST FAMILY MEDICINE OF 9064 US HIGHWAY 60 WEST STURGIS, KY 42459 (270)333-4349 Union STURGIS 183459 * METHODIST FAMILY PRACTICE 1284 US HWY 60 W MORGANFIELD, KY 42437 (270)389-2323 Union 183833 * MONTICELLO MEDICAL ASSOCIATES ONE SOUTH CREEK DRIVE, SUITE 102 MONTICELLO, KY 42633 (606)348-3365 Wayne 183491 * MORGAN COUNTY ARH FAMILY 1084 HIGHWAY 7, SUITE 2 WEST LIBERTY, KY 41472 (606)743-3186 Morgan HEALTH 183857 * MOUNTAIN AFTER-HOURS CLINIC 1908 NORTH MAIN STREET, SUITE 120 HAZARD, KY 41701 (606)439-2662 Perry 188933 * MOUNTAIN FAMILY PRACTICE 90 GARRARD SQUARE GARRARD, KY 40941 (606)658-6333 Clay CLINIC OF MANCHESTER, INC 183465 * MUNFORDVILLE PRIMARY CARE 1134 MAIN STREET MUNFORDVILLE, KY 42765 (270)524-3641 Hart CLINIC 183450 * NEW HORIZONS FAMILY PRACTICE 330 ROLAND AVENUE OWENTON, KY 40359 (502)484-4656 Owen 188950 * NEWBORN & KIDS HEALTH CENTER, 215 TREUHAFT BOULEVARD, SUITE 8 BARBOURVILLE, KY 40906 (606)277-0173 Knox INC 183861 * NORTH GARRARD CENTER 510 NORTH CAMP DICK ROAD LANCASTER, KY 40444 (859)548-8000 Garrard 188918 * ONE HEALTH OHIO COUNTY 1213 NORTH MAIN STREET BEAVER DAM, KY 42320 (270)274-4771 Ohio 183478 * OWENSBORO HEALTH 101 LEGION DRIVE CENTRAL CITY, KY 42330 (270)754-5400 Muhlenberg MUHLENBERG COMMUNITY HOSPITAL FAM 183907 * PEDIATRIC ASSOCIATES OF 474 VILLAGE LANE, HAZARD VILLAGE HAZARD, KY 41701 (606)487-8300 Perry HAZARD, LLC SHOPPING CENTER 183880 * PEDIATRIC ASSOCIATES OF 156 ISLAND CREEK ROAD PIKEVILLE, KY 41502 (606)432-3221 Pike PIKEVILLE 183468 * PHYSICIAN SERVICES OF MEMORIAL 94 MARIE LANGDON DRIVE, SUITE 4 MANCHESTER, KY 40962 (606)598-7900 Clay HOSPITAL 188952 * PINE MOUNTAIN CLINIC, PSC 850 RIVERVIEW PINEVILLE, KY 40977 (606)337-6047 Bell 183469 * POWELL COUNTY CLINIC 68 ELKINS STREET STANTON, KY 40380 (606)663-8000 Powell 188936 * PREFERRED HEALTHCARE, INC 686 SOUTH HIGHWAY 25W WILLIAMSBURG, KY 40769 (606)549-5052 Whitley 183942 * PRIMARY CARE CENTERS OF 10897 S KY HIGHWAY 15 SCUDDY, KY 41760 (606)476-2274 Perry EASTERN KENTUCKY

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183953 * PRIMARY CARE CENTERS OF 21992 MAIN STREET HYDEN, KY 41749 (606)672-5200 Leslie EASTERN KENTUCKY - HYDEN 183918 * PRIMARY CARE CENTERS OF 145 CITIZENS LANE, SUITE B HAZARD, KY 41701 (606)439-1300 Perry EASTERN KY - HAZARD 183947 * PRIMARY CARE CENTERS OF 58 WEST HIGHWAY 80, SUITE 2 HINDMAN, KY 41822 (606)785-1300 Knott EASTERN KY - HINDMAN 183871 * QUANTUM HEALTHCARE 210 BLACK GOLD BOULEVARD, SUITE HAZARD, KY 41701 (606)436-0711 Perry 106 188920 * QUANTUM HEALTHCARE 103 KINGDOM COME DRIVE CUMBERLAND, KY 40823 (606)589-5514 Harlan ASSOCIATES OF CUMBERLAND 183934 * RED RIVER PEDIATRICS 321-C EAST COLLEGE AVENUE STANTON, KY 40380 (606)663-9797 Powell 183476 * ROCKCASTLE FAMILY CARE 160 EAST MAIN STREET MOUNT VERNON, KY 40456 (606)256-7761 Rockcastle 183467 * ROCKCASTLE FAMILY WELLNESS 140 NEWCOMB AVENUE MOUNT VERNON, KY 40456 (606)256-7761 Rockcastle 183483 * ROCKCASTLE PEDIATRICS & 140 NEWCOMB AVENUE, SUITE C & D MOUNT VERNON, KY 40456 (606)256-4148 Rockcastle ADOLESCENTS 188942 * ROYAL TREATMENT HEALTHCARE, 4671 SOUTH US HIGHWAY 25 EAST BIMBLE, KY 40915 (606)546-2598 Knox INC 183473 * SAINT JOSEPH BEREA FAMILY 305 ESTILL STREET BEREA, KY 40403 (859)986-2343 Madison MEDICINE 183961 * SALEM MEDICAL CLINIC 141 HOSPITAL DRIVE SALEM, KY 42078 (270)988-3298 Livingston 183878 * SALYERSVILLE MEDICAL CENTER 601 EAST MAPLE STREET SALYERSVILLE, KY 41465 (606)349-5300 Magoffin 188907 * SANDY HOOK FAMILY CARE CENTER 1908 NORTH KENTUCKY 7 SANDY HOOK, KY 41171 (606)738-9339 Elliott

183440 * SETON FAMILY HEALTH CENTER 11087 MAIN STREET MARTIN, KY 41649 (606)285-3690 Floyd 183948 * SHEPHERDSVILLE FAMILY HEALTH 130 WEST JOE B HALL AVENUE SHEPHERDSVILLE, KY 40165 (502)921-1231 Bullitt CLINIC, PSC 183962 * SMITHLAND MEDICAL CLINIC 205 EAST ADAIR STREET SMITHLAND, KY 42081 (270)928-2146 Livingston 183920 * SOUTH FORK MEDICAL CLINIC, PLLC 71 MEDICAL LANE WHITLEY CITY, KY 42653 (606)376-7212 McCreary 183474 * SPRING VIEW CLINIC 79 BOB O LINK DRIVE SPRINGFIELD, KY 40069 (859)336-0771 Washington 183418 * ST CLAIRE REGIONAL FAMILY 732 HIGHWAY 36 FRENCHBURG, KY 40322 (606)768-2191 Menifee MEDICINE-FRENCHBURG 183417 * ST CLAIRE REGIONAL FAMILY 155 BRICKLAYER STREET OLIVE HILL, KY 41164 (606)286-4152 Carter MEDICINE-OLIVE HILL 183416 * ST CLAIRE REGIONAL FAMILY 632 SLATE AVENUE OWINGSVILLE, KY 40360 (606)674-6386 Bath MEDICINE-OWINGSVILLE

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 8 of 8 Kentucky

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 183415 * ST CLAIRE REGIONAL FAMILY 390 KY HIGHWAY 7 SOUTH SANDY HOOK, KY 41171 (606)738-5155 Elliott MEDICINE-SANDY HOOK 183904 * STANFORD MEDICAL PARK 110 METKER TRAIL STANFORD, KY 40484 (606)365-3360 Lincoln IMMEDIATE CARE 183493 * T J HEALTH CAVE CITY 440 EAST HAPPY VALLEY STREET CAVE CITY, KY 42127 (270)773-2111 Barren 183970 * T J HEALTH COLUMBIA CLINIC 902 WESTLAKE DRIVE, SUITE 101 COLUMBIA, KY 42728 (270)384-0451 Adair 183998 * T J HEALTH COLUMBIA PRIMARY 810 JAMESTOWN STREET COLUMBIA, KY 42728 (270)384-4764 Adair CARE 183994 * T J HEALTH EDMONTON 1704 WEST STOCKTON STREET EDMONTON, KY 42129 (270)432-4800 Metcalfe 183446 * T J HEALTH RUSSELL SPRINGS 2465 LAKEWAY DRIVE RUSSELL SPRINGS, KY 42642 (270)858-3636 Russell 188915 * T J SAMSON TOMPKINSVILLE CLINIC 800 NORTH MAIN STREET TOMPKINSVILLE, KY 42167 (270)487-0720 Monroe 183829 * TAYLOR RURAL HEALTH, LLC 805 BURKESVILLE STREET COLUMBIA, KY 42728 (270)384-1110 Adair 183458 * THE MEDICAL CENTER AT 466 BURNLEY ROAD SCOTTSVILLE, KY 42164 (270)618-3700 Allen SCOTTSVILLE 188943 * THREE RIVERS IMMEDIATE CARE - 94 BOARD WALK INEZ, KY 41224 (606)298-2660 Martin INEZ 188945 * TOTAL CARE RURAL HEALTH CLINIC 121 VIRGINA AVE PINEVILLE, KY 40977 (606)337-2381 Bell 183406 * TRIGG COUNTY PRIMARY CARE 214 MAIN STREET CADIZ, KY 42211 (270)522-0898 Trigg CENTER 183874 * UNITED CLINICS OF KENTUCKY 219 MOUNTAIN PARKWAY SPUR CAMPTON, KY 41301 (606)668-6932 Wolfe 188909 * UNITED CLINICS OF KENTUCKY 1060 GRAND AVENUE BEATTYVILLE, KY 41311 (606)464-0108 Lee BEATTYVILLE 183486 * WARSAW FAMILY PRACTICE 202 FRANKLIN STREET WARSAW, KY 41095 (859)567-2754 Gallatin 183427 * WAYNE COUNTY HOSPITAL RURAL 166 HOSPITAL STREET MONTICELLO, KY 42633 (606)348-9343 Wayne HEALTH CLINIC 183954 * WAYNESBURG CLINIC, PLLC 14098 US HIGHWAY 27 SOUTH WAYNESBURG, KY 40489 (606)379-6646 Lincoln 183437 * WHEELWRIGHT FAMILY HEALTH 1403 KY ROUTE 306, SUITE 102 WHEELWRIGHT, KY 41669 (606)452-2300 Floyd CENTER 183858 * WILLIAM COLLINS MD 109 EAST MAIN STREET WHITESBURG, KY 41858 (606)633-4488 Letcher 183832 * WILLIAMSBURG FAMILY MEDICINE 475 NORTH HWY 25 W, SUITE 100 WILLIAMSBURG, KY 40769 (606)549-2930 Whitley CENTER 183903 * WINCHESTER FAMILY PRACTICE, PS 4 NORTH HIGHLAND STREET, SUITE A WINCHESTER, KY 40391 (859)744-1445 Clark 183937 * WINCHESTER, PATTON & BURGESS, 19 MEDICAL LOOP WHITLEY CITY, KY 42653 (606)376-5391 McCreary PSC Total Providers for this State = 191

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 253938 * ABERDEEN HEALTH CLINIC 501 CHESTNUT STREET ABERDEEN, MS 39730 (662)369-6131 Monroe 258587 * AIRPARK FAMILY MEDICAL CLINIC 1056 HOLLAND AVENUE PHILADELPHIA, MS 39350 (601)656-8545 Neshoba 253871 * ALL CARE MISSISSIPPI, LLC 301 WEST JACKSON OXFORD, MS 38655 (662)234-6464 Lafayette 258514 * ALLIANCE-LAIRD CLINIC 25155 HWY 15 UNION, MS 39365 (601)774-1513 Neshoba 253821 * ANAZIA MEDICAL, INC 120 5TH AVENUE MC COMB, MS 39648 (601)789-0390 Pike 258584 * ANDERSON CHILDREN'S MEDICAL 1400 20TH AVENUE, SUITE D MERIDIAN, MS 39301 (601)703-8370 Lauderdale CLINIC 258995 * ANDREW GEORGE, MD 25 SOUTH 4TH STREET ROLLING FORK, MS 39159 (662)873-0477 Sharkey 258598 None ARRINGTON MEDICAL CLINIC 14415 MAIN STREET COFFEEVILLE, MS 38922 (662)473-5901 Yalobusha 258509 * ARTHUR E WOOD MEDICAL CLINIC 920 MATTHEW DRIVE WAYNESBORO, MS 39367 (601)735-7101 Wayne 258536 * BAPTIST LEAKE MEDICAL CLINIC- 110 PARK STREET WALNUT GROVE, MS 39189 (601)253-0173 Leake WALNUT GROVE 258508 * BAPTIST LEAKE PRIMARY CARE 1100 HIGHWAY 16 EAST CARTHAGE, MS 39051 (601)267-1470 Leake CENTER 258589 * BAPTIST LEAKE WOMEN'S HEALTH 303 WEST FRANKLIN STREET CARTHAGE, MS 39051 (601)267-9658 Leake CLINIC 258614 None BAPTIST MEDICAL CLINIC 220 HIGHWAY 12 WEST KOSCIUSKO, MS 39090 (662)290-3150 Attala KOSCIUSKO 253885 * BAY SPRNGS AFTER HRS & FAM HLT 31 EAST 5TH AVENUE BAY SPRINGS, MS 39422 (601)764-2143 Jasper 253891 * BOLTON FAMILY CLINIC 115 WEST MADISON STREET BOLTON, MS 39041 (601)866-7723 Hinds 258541 * BROOKSVILLE PRIMARY CARE 139 NORTH OLIVER STREET/ P O BOX BROOKSVILLE, MS 39739 (662)738-4424 Noxubee CLINIC 348 253896 * CAMPBELL FAMILY CLINIC 580 FRIAR'S POINT CLARKSDALE, MS 38614 (662)624-4316 Coahoma 258936 * CANTON PRIMARY CARE CLINIC 1883 HIGHWAY 43 SOUTH, STE D / P O CANTON, MS 39046 (601)667-3492 Madison BOX 819 258501 * CATCHINGS CLINIC 451 BANK STREET/ PO BOX 876 WOODVILLE, MS 39669 (601)888-3421 Wilkinson 253986 * CENTRAL MS FAMILY HEALTH 905-C SOUTH FRONTAGE ROAD MERIDIAN, MS 39301 (601)486-4210 Lauderdale CLINIC 258502 * CENTREVILLE CLINIC 178 HIGHWAY 24, SUITE A CENTREVILLE, MS 39631 (601)645-5361 Wilkinson 253421 * CHARLESTON CLINIC 401 CHURCH ST / PO BOX 27 CHARLESTON, MS 38921 (662)647-5816 Tallahatchie 258975 * CHESTNUT MEDICAL CLINIC 502 JACKSON STREET, SUITE 6 ABERDEEN, MS 39730 (662)369-9525 Monroe 258925 * CHILDREN'S CLINIC OXFORD 2888 SOUTH LAMAR OXFORD, MS 38655 (662)234-8286 Lafayette 253928 None CHILDREN'S INTERNATIONAL 801 WILLIAMS AVENUE PICAYUNE, MS 39466 (601)798-5558 Pearl River MEDICAL GROUP

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 253930 None CHILDRENS INTERNATIONAL 3016 HIGHWAY 80 MORTON, MS 39117 (601)732-2382 Scott MEDICAL GROUP-MORTON 258599 None CHOCTAW MEDICAL CLINIC OF WEIR 780 MAIN STREET WEIR, MS 39772 (662)547-9407 Choctaw

258609 None CHOCTAW REGIONAL MEDICAL 8613 MS HIGHWAY 12 ACKERMAN, MS 39735 (662)285-4400 Choctaw CLINIC-ACKERMAN 258577 * CLARK MEDICAL CLINIC 321 HIGHWAY 13 SOUTH MORTON, MS 39117 (601)732-8612 Scott 258578 * COFFEEVILLE MEDICAL CLINIC 14430 MAIN STREET COFFEEVILLE, MS 38922 (662)675-2500 Yalobusha 258504 * COMMUNITY HEALTH CLINIC 1123 HWY 35 SOUTH FOREST, MS 39074 (601)469-4771 Scott 253988 * COMMUNITY MEDICAL CENTER 92 WEST RATLIFF STREET LUCEDALE, MS 39452 (601)947-8181 George 258973 * COTTON PLANT FAMILY CLINIC 1755 CR81 BLUE MOUNTAIN, MS 38610 (662)538-4111 Tippah 258505 * DECATUR FAMILY MEDICAL 14884 HIGWAY 15 DECATUR, MS 39327 (601)635-2258 Newton 258586 None DELTA PRIMARY CARE RURAL 110 BAKER STREET, SUITE B INDIANOLA, MS 38751 (662)887-7339 Sunflower HEALTH CLINIC 253461 * DELTA REGIONAL HEALTH CLINIC 344 ARNOLD AVENUE GREENVILLE, MS 38701 (662)344-9100 Washington 253927 * E C -HEALTHNET FAMILY HEALTH 2514 67TH AVENUE LOOP, SUITE 112 MERIDIAN, MS 39307 (601)482-4955 Lauderdale CENTER 258543 * EAST CENTRAL MEDICAL CENTER- 7001 HIGHWAY 614/ MAIL - P.O. BOX 850 HURLEY, MS 39555 (228)588-6622 Jackson RHC 253808 * EAST MISSISSIPPI MEDICAL CLINIC 9425 EASTSIDE DRIVE, EXTENSION, NEWTON, MS 39345 (601)635-3333 Newton SUITE A 253841 * EAST MISSISSIPPI MEDICAL CLINIC- 4711 POPLAR SPRINGS DRIVE MERIDIAN, MS 39305 (601)485-7777 Lauderdale RHC 258600 None ECRU MEDICAL CLINIC 202 MAIN STREET ECRU, MS 38841 (662)488-7670 Pontotoc 253901 * EMS CLINIC 1509 STRONG AVENUE GREENWOOD, MS 38930 (662)455-4411 Leflore 258588 * ENTERPRISE FAMILY MEDICAL 83-A OLD MILL CREEK ROAD ENTERPRISE, MS 39330 (601)704-1020 Clarke CENTER 258596 None EUPORA FAMILY MEDICAL CLINIC 1301 VETERAN'S MEMORIAL BLVD EUROPA, MS 39744 (662)258-7200 Webster 258580 * EUPORA PEDIATRIC CLINIC 15 MEDICAL PLAZA EUROPA, MS 39744 (662)258-4701 Webster 258605 None EUPORA PRIMARY CARE CLINIC 70 MEDICAL PLAZA EUPORA, MS 39744 (662)258-6221 Webster 253845 * EVERGREEN FAMILY MEDICAL 4929 HIGHWAY 371 SOUTH NETTLETON, MS 38858 (662)963-9154 Itawamba CLINIC 258531 * FAIRCHILD-CLEARMAN MEDICAL 1122 EAST MAIN STREET, SUITE 4 PHILADELPHIA, MS 39350 (601)656-1001 Neshoba ASSOCIATES RHC 258562 * FAMILY CARE EXPRESS 3275 HIGHWAY 49 SUITE E COLLINS, MS 39428 (601)765-6292 Covington

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 258996 * FAMILY CARE MEDICAL CLINIC 109 PARKGATE EXT TUPELO, MS 38801 (662)840-4175 Lee 258954 * FAMILY CLINIC OF NEW ALBANY 474 WEST BANKHEAD STREET NEW ALBANY, MS 38652 (662)534-7777 Union 253426 * FAMILY CLINIC OF RIENZI,THE 82 MAIN STREET BOX 194 RIENZI, MS 38865 (662)462-8600 Alcorn 258994 * FAMILY MEDICAL 101, INC 101 MIMOSA STREET BOONEVILLE, MS 38829 (662)720-4919 Prentiss 253497 * FAMILY MEDICAL ASSOCIATES 701 HOLLY AVENUE COLLINS, MS 39428 (601)765-3180 Covington 258575 * FAMILY MEDICAL CLINIC 1500 HIGHWAY 19 N MERIDIAN, MS 39307 (601)703-1480 Lauderdale 253422 * FAMILY MEDICAL CLINIC OF 105 HILLCREST DRIVE HOUSTON, MS 38851 (662)456-5008 Chickasaw HOUSTON 258542 * FAMILY MEDICAL CLINIC OF 521 WEST DRIVE OKOLONA, MS 38860 (662)447-1405 Chickasaw OKOLONA 253417 * FAMILY MEDICAL CLINIC OF VARDA 310 WEST SWEET POTATO STREET VARDAMAN, MS 38878 (662)682-7555 Calhoun 258616 None FAMILY MEDICAL GROUP OF BUDE 136 MAIN STREET, N BUDE, MS 39630 (301)384-2394 Franklin 253995 * FAMILY MEDICAL GROUP OF PO BOX 636 MEADVILLE, MS 39653 (601)384-3199 Franklin MEADVILLE 253495 * FAMILY MEDICAL GROUP OF UNION 24345 HIGHWAY 15 UNION, MS 39365 (601)774-8211 Neshoba 253435 * FAMILY PRACTICE CLINIC MCCOMB 1506 HARRISON AVENUE MCCOMB, MS 39648 (601)249-2142 Pike 258953 * FLORENCE FAMILY CLINIC 218 EAST MAIN STREET FLORENCE, MS 39073 (601)845-6602 Rankin 258610 None FMCH LIBERTY CLINIC 1410 MAIN STREET EAST LIBERTY, MS 39645 (601)657-8820 Amite 253923 * FOREST FAMILY PRACTICE CLINIC #1 MEDICAL LANE FOREST, MS 39074 (601)469-4861 Scott 258552 * G L H - MAGNOLIA MEDICAL CLINIC 1413 STRONG AVENUE GREENWOOD, MS 38930 (662)459-1207 Leflore 253904 * G S V CARE MEDICAL CLINC 400 THIRD AVENUE, HWY 32 WEST HOULKA, MS 38850 (662)568-2013 Chickasaw 253946 * GLENDORA CLINIC CORNER OF GIPSON AVE AND GLENDORA, MS 38928 (662)375-8878 Tallahatchie WESTBROOK ST 258503 * GLOSTER CLINIC 434 N CAPTAIN GLOSTER DRIVE GLOSTER, MS 39638 (601)225-4711 Amite 253824 * GOLDEN AGE CLINIC 2901 HIGHWAY 82 EAST GREENWOOD, MS 38930 (662)374-2185 Leflore 258981 * GOLDEN TRIANGLE RURAL FAMILY 1237 HIGHWAY 182 EAST CLAYTON STARKVILLE, MS 39759 (662)320-7001 Oktibbeha HEALTH CENTER VILLAGE 253800 * GORTON RURAL HEALTH CLINIC, 107 CHURCH STREET BELZONI, MS 39038 (662)247-2105 Humphreys LLC 253911 * GREEN TREE FAMILY MEDICAL 603 MAIN STREET MOUNT OLIVE, MS 39119 (601)797-3405 Covington CENT 258544 * GREENE COUNTY FAMILY MEDICAL 1017 JACKSON AVENUE LEAKESVILLE, MS 39451 (601)394-2820 Greene CLINIC 253894 * GREENVILLE PRIMARY CARE CLINIC 2363 HIGHWAY 1 SOUTH GREENVILLE, MS 38701 (662)334-1253 Washington

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 258555 * GREENWOOD LEFLORE HOSPITAL 1601 STRONG AVENUE GREENWOOD, MS 38930 (662)451-7565 Leflore AFTER HOURS CLINIC 258566 * GREENWOOD LEFLORE WALK IN 706 HIGHWAY 82 W, SUITE B / PO BOX GREENWOOD, MS 38930 (662)459-2181 Leflore CLINIC 1410 38935-1410 258500 * HANCOCK MEDICAL SERVICES 3068 PORT AND HARBOUR DRIVE BAY SAINT LOUIS, MS 39520 (228)533-9000 Hancock 258535 * HARRISVILLE MEDICAL CLINIC 1652 SIMPSON HIGHWAY 469 / P.O. BOX HARRISVILLE, MS 39082 (601)847-7784 Simpson 279 258987 * HEALTH 1ST FAMILY MEDICAL 131 HIGHWAY 309 SOUTH BYHALIA, MS 38611 (662)838-5565 Marshall CLINIC 258601 None HOLCOMB CLINIC 195 HIGHWAY 35 SOUTH HOLCOMB, MS 38940 (662)229-9787 Grenada 253940 * HOLLANDALE FAMILY CARE PC 1257 HIGHWAY 61 SOUTH HOLLANDALE, MS 38748 (662)827-2214 Washington 253812 * HOLMES COUNTY MEDICAL CLINIC- 18295 EMORY ROAD WEST, MS 39192 (662)967-2462 Holmes WEST 253813 * HOLMES FAMILY MEDICAL CLINIC 239 BOWLING GREEN ROAD LEXINGTON, MS 39095 (662)834-5339 Holmes 258547 * IMMEDIATE CARE FAMILY CLINIC 1710 14TH STREET MERIDIAN, MS 39301 (601)482-9211 Lauderdale 258525 * INDIANOLA FAMILY MEDICAL GROUP 122 EAST BAKER STREET INDIANOLA, MS 38751 (662)887-2212 Sunflower 258902 * INTERNAL MEDICINE CLINIC OF CO 914 SUMRALL ROAD COLUMBIA, MS 39429 (601)731-1470 Marion 253958 * INTERNAL MEDICINE RHC OF NEW A 300 OXFORD ROAD NEW ALBANY, MS 38652 (662)534-8166 Union 253418 * ITTA BENA CLINIC 103 BASKET STREET ITTA BENA, MS 38941 (662)254-7717 Leflore 253949 * JACKSON CLINIC 29 SOUTH FOURTH STREET ROLLING FORK, MS 39159 (662)873-4361 Sharkey 258523 * JEFFERSON DAVIS RURAL HEALTH 1014 ROSE STREET, SUITE A PRENTISS, MS 39474 (601)792-2200 Jefferson Davis CLINIC 258591 * K D H PRIMARY CARE CLINIC 823 GRAND AVENUE YAZOO CITY, MS 39194 (662)751-8188 Yazoo 258615 None KILMICHAEL FAMILY MEDICAL 301 LAMAR STREET KILMICHAEL, MS 39747 (662)258-6221 Montgomery CLINIC 253814 * L C TENNIN, JR, MD, PA 122 EAST ACADEMY STREET CANTON, MS 39046 (601)859-8992 Madison 258608 * LACKEY PEDIATRIC CLINIC 1129 HIGHWAY 35 SOUTH, SUITE 1 FOREST, MS 39074 (601)469-3320 Scott 258510 * LAUREL PEDIATRIC & ADOLESCENT 234 SOUTH 12TH AVENUE LAUREL, MS 39440 (601)649-3520 Jones 258526 * LAWRENCE COUNTY FAMILY 1135 EAST BROAD STREET MONTICELLO, MS 39654 (601)249-2701 Lawrence PRACTICE 258962 * LELAND MEDICAL CLINIC 201 BAKER BLVD LELAND, MS 38756 (662)686-4121 Washington 253490 * LEXINGTON PRIMARY CARE CLINIC 110 TCHULA STREET LEXINGTON, MS 39095 (662)834-1855 Holmes 253889 * LIFECORE HEALTH GROUP 499 GLOSTER CREEK VILLAGE, SUITE TUPELO, MS 38801 (662)844-1717 Lee A-3 258904 * LOUISVILLE MEDICAL ASSOCIATES 564 EAST MAIN STREET LOUISVILLE, MS 39339 (662)773-7500 Winston * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 258602 None LOUISVILLE MEDICAL CLINIC 320 HIGHWAY 15 NORTH LOUISVILLE, MS 39339 (662)773-7500 Winston 258978 * LOWER CROSSING MEDICAL CLINIC 670 HIGHWAY 178- SUITES 2&3 SHERMAN, MS 38869 (662)844-7999 Pontotoc 253481 * LUCEDALE OB/GYN CENTER 92 WEST RATLIFF STREET SUITE B LUCEDALE, MS 39452 (601)947-6000 George 253487 * MACON PRIMARY CLINIC 606 NORTH JEFFERSON STREET MACON, MS 39341 (662)726-4231 Noxubee 258999 * MADISON CANTON MEDICAL CLINIC 1171 HART ST CANTON, MS 39046 (601)859-9888 Madison 258970 * MAGEE AFTER HOURS CLINIC 376-A SIMPSON HWY 49 MAGEE, MS 39111 (601)849-5321 Simpson 258570 * MAIN STREET MEDICAL CLINIC OF 347 SOUTH 4TH STREET MORTON, MS 39117 (601)732-1524 Scott MORTON 258612 None MARION GENERAL RURAL HEALTH 1560 SUMRALL ROAD COLUMBIA, MS 39429 (601)261-2940 Marion CLINIC 258565 * MARION PRIMARY CARE CENTER 5334 DALE DRIVE MARION, MS 39342 (601)703-0130 Lauderdale 253403 * MEDI STAT CLINIC 703 ALCORN DRIVE, SUITE 109 CORINTH, MS 38834 (662)286-1499 Alcorn 258540 * MEDICAL GROUP OF QUITMAN,THE 603 SOUTH ARCHUSA AVENUE QUITMAN, MS 39355 (601)776-2123 Clarke 253903 * MINOR MEDICAL CARE RAYMOND 120 WEST MAIN ST/P O BOX 1223 RAYMOND, MS 39154 (601)857-2341 Hinds 258559 * NESHOBA INTERNAL MEDICINE 921 WEST BEACON STREET PHILADELPHIA, MS 39350 (601)656-6116 Neshoba ASSOCIATES 258560 * NESHOBA URGENT CARE CLINIC 1120 EAST MAIN STREET, SUITE 1 PHILADELPHIA, MS 39350 (601)663-1360 Neshoba 258603 None NEW ALBANY MEDICAL CLINIC 400 DOCTORS DRIVE NEW ALBANY, MS 38652 (662)534-5036 Union 258617 * NEWTON FAMILY AND PEDIATRIC 9427 EASTSIDE DRIVE EXT SUITE A NEWTON, MS 39345 (601)683-0330 Newton CLINIC 253474 * NEWTON FAMILY MEDICAL 252 NORTHSIDE DRIVE NEWTON, MS 39345 (601)683-3117 Newton ASSOCIATES 258537 * NINA JURNEY'S FAMILY MEDICAL 502 JACKSON STREET, SUITE 4 ABERDEEN, MS 39730 (662)369-9945 Monroe PRACTICE 253471 * NORTH HILLS FAMILY MEDICAL 4331 HIGHWAY 39 NORTH MERIDIAN, MS 39305 (601)484-6180 Lauderdale CLINIC 258972 * NURSE MED I I, INC 1031 NORTHRIDGE ROAD BALDWYN, MS 38824 (662)365-9305 Lee 253865 * NURSE MED INC 716 SOUTH MAIN STREET RIPLEY, MS 38663 (662)837-1534 Tippah 258585 * OAKLAND MEDICAL CLINIC 14101 HICKORY STREET OAKLAND, MS 38948 (662)623-7319 Yalobusha 258538 * ODOM RURAL HEALTH CLINIC 604 SOUTH MAIN STREET WATER VALLEY, MS 38965 (662)473-1311 Yalobusha 258556 * PEARL RIVER FAMILY CLINIC 302 HIGHWAY 11 SOUTH POPLARVILLE, MS 39470 (601)403-8284 Pearl River 258948 * PEDIATRIC AND ADOLESCENT CLINI 308 HIGHLAND BOULEVARD NATCHEZ, MS 39120 (601)442-7676 Adams 253970 * PICAYUNE HEALTH SERVICES 2274 HIGHWAY 43 SOUTH PICAYUNE, MS 39466 (601)798-3964 Pearl River 258968 * PINNACLE MEDICAL CLINIC 7900 MS HWY 570 WEST SUMMIT, MS 39666 (601)684-7771 Pike

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 258515 * PIONEER FAMILY MEDICAL 502 JACKSON STREET, SUITE 4 ABERDEEN, MS 39730 (662)369-9500 Monroe 258521 * PIONEER FAMILY MEDICAL OF 40128 HAMILTON ROAD HAMILTON, MS 39746 (662)343-5129 Monroe HAMILTON 258604 None PONTOTOC MEDICAL CLINIC 345 HIGHWAY 15 NORTH PONTOTOC, MS 38863 (662)488-7670 Pontotoc 258530 * POPLARVILLE FAMILY MEDICAL 1222 SOUTH MAIN STREET POPLARVILLE, MS 39470 (601)795-9320 Pearl River CLINIC 258567 * PREMIER MEDICAL CLINIC 300 RAWLS DRIVE, SUITE 600 MC COMB, MS 39648 (601)249-4415 Pike 258574 * PRIMARY HEALTH CARE 1080 HIGHWAY 35 SOUTH FOREST, MS 39074 (601)469-3555 Scott 258606 None PUCKETT MEDICAL CLINIC 6455 HIGHWAY 18 BRANDON, MS 39042 (601)824-9490 Rankin 253861 * RANKIN RURAL MEDICAL CLINIC 129 CENTER STREET, SUITE B RICHLAND, MS 39218 (769)233-7141 Rankin 253850 * REGION I I I PRIMARY CARE 2434 SOUTH EASON BLVD TUPELO, MS 38804 (662)844-1717 Lee 253816 * RIVER REGION RURAL HEALTH- 2100 HIGHWAY 61 NORTH VICKSBURG, MS 39183 (601)883-5000 Warren MOB1 253817 * RIVER REGION RURAL HEALTH- S C 2200 HIGHWAY 61 NORTH VICKSBURG, MS 39180 (601)883-5000 Warren 258922 * RUNNELSTOWN CLINIC 5034 HWY 29 PETAL, MS 39465 (601)583-1553 Forrest 258576 * RUSH FAMILY PRACTICE-LAKE 24489 HIGHWAY 80 LAKE, MS 39092 (601)775-3264 Scott 258564 * RUSH MEDICAL CLINC-DEKALB 14365 HIGHWAY 16 WEST DE KALB, MS 39328 (601)743-4626 Kemper 258579 * RUSH MEDICAL CLINIC 1106 CENTRAL DRIVE PHILADELPHIA, MS 39350 (601)656-6921 Neshoba PHILADELPHIA 258554 * RUSH MEDICAL CLINIC- 9097 COLLINSVILLE ROAD COLLINSVILLE, MS 39325 (601)626-8374 Lauderdale COLLINSVILLE 258607 * RUSH MEDICAL GROUP PRIMARY 1800 12TH STREET MERIDIAN, MS 39301 (601)703-9265 Lauderdale CARE 253801 * SARDIS FAMILY MEDICAL CLINIC, 124 SOUTH MAIN STREET SARDIS, MS 38666 (662)487-1064 Panola INC 258906 * SHANNON FAMILY MEDICAL CLINIC 219 BROAD STREET SHANNON, MS 38868 (662)995-2201 Lee LLC 253437 * SOUTH CENTRAL ELLISVILLE MED C 1203 AVENUE B ELLISVILLE, MS 39437 (601)477-8553 Jones 258581 * SOUTH CENTRAL URGENT CARE 1430 JEFFERSON STREET LAUREL, MS 39441 (601)425-2273 Jones 253479 * SOUTHWEST FAMILY MEDICINE 421 MARION AVENUE MCCOMB, MS 39648 (601)684-6891 Pike 258519 * STONE COUNTY FAMILY MEDICAL 144 EAST CENTRAL AVENUE WIGGINS, MS 39577 (601)928-6700 Stone CENTER 253408 * SUMNER CLINIC 100 N COURT SQUARE SUMNER, MS 38957 (662)375-9989 Tallahatchie 253400 * SUNFLOWER RURAL HEALTH CLINIC 840 NORTH OAK AVENUE RULEVILLE, MS 38771 (662)756-2711 Sunflower 253452 * THE DOCTORS CLINIC 210 BAY AVENUE WEST RICHTON, MS 39476 (601)788-9222 Perry * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 7 Mississippi

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 258977 * THE WOMAN'S CLINIC 2000 NORTH STATE STREET CLARKSDALE, MS 38614 (662)627-7361 Coahoma 253820 * TOCCOPOLA FAMILY MEDICAL 7908 HWY 334 P O BOX 389 TOCCOPOLA, MS 38874 (662)488-0270 Lafayette CLINIC 258518 * TRACE FAMILY HEALTH & INTERNAL 1002 EAST MADISON HOUSTON, MS 38851 (662)456-2800 Chickasaw MEDICINE 258516 * TRI LAKES PEDIATRIC CLINIC 435 HWY 6 EAST BATESVILLE, MS 38606 (662)563-7873 Panola 258517 * TRI LAKES WOMEN'S CLINIC 225 MEDICAL CENTER DRIVE, SUITE B BATESVILLE, MS 38606 (662)563-7873 Panola 253964 * TRI STATE RURAL HEALTH CLINIC 502 ALCORN DRIVE CORINTH, MS 38835 (662)287-5216 Alcorn 253847 * TRINITY HEALTH CLINIC 321 SOUTH SHARPE AVENUE CLEVELAND, MS 38732 (662)284-3870 Bolivar 258568 * TYLERTOWN FAMILY CLINIC 200 HOSPITAL DR TYLERTOWN, MS 39667 (601)876-5303 Walthall 258590 * UMMC-GRENADA PRIMARY CARE 965 AVENT DRIVE, SUITE 107 GRENADA, MS 38901 (662)227-7575 Grenada CLINIC 258613 * VANCLEAVE MEDICAL CENTER 11700 HIGHWAY 57 VAN CLEAVE, MS 39565 (228)826-1482 Jackson 258546 * WAYNESBORO FAMILY MEDICINE 951 MATTHEW DRIVE, SUITE A WAYNESBORO, MS 39367 (601)735-2401 Wayne AND OBSTETRICS 258527 * WIGGINS PRIMARY CARE 975 HALL STREET WIGGINS, MS 39577 (601)528-9119 Stone 258528 * WILLIAMS MEDICAL CLINIC 1938 CRESCENT MEADOW DRIVE HOLLY SPRINGS, MS 38634 (662)252-1599 Marshall 258529 * WILLIAMS MEDICAL CLINIC OF POT 39 CENTER ST BOX 40 POTTS CAMP, MS 38659 (662)333-6933 Marshall 258593 * WINSTON MEDICAL CLINIC 923 CHURCH STREET LOUISVILLE, MS 39339 (662)773-3503 Winston 258594 * WINSTON MEDICAL CLINIC ( 90 EAST MAIN STREET NOXAPATER, MS 39346 (662)733-3503 Winston NOXAPATER) 253884 * WOMEN'S HEALTH CLINIC OF 1401 OAK STREET GRENADA, MS 38901 (662)226-4010 Grenada GRENADA 253945 None WOMEN'S PAVILION 551 EAGLE DAY AVENUE COLUMBIA, MS 39429 (601)736-6137 Marion 253929 None WOMEN'S PAVILION OF SOUTH MS ( 5003 HARDY STREET, SUITE 350 HATTIESBURG, MS 39402 (601)261-5835 Forrest HATTIESBURG) 253878 None WOMEN'S PAVILION OF SOUTH MS, 1242 HIGHWAY 29 NORTH ELLISVILLE, MS 39437 (601)719-0003 Jones PLLC 258937 * WOODLAND CLINIC 120 MARKET STREET PO BOX 186 WOODLAND, MS 39776 (662)456-0111 Chickasaw 253855 * YAZOO FAMILY CLINIC 1435 GRAND AVENUE YAZOO CITY, MS 39194 (662)746-3555 Yazoo 258969 * YAZOO FAMILY HEALTHCARE PLLC 307 EAST 15TH STREET YAZOO CITY, MS 39194 (662)746-2113 Yazoo Total Providers for this State = 177

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 North Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 343411 * ANGEL URGENT CARE CENTER 195 FRANKLIN PLAZA FRANKLIN, NC 28744 (828)369-4427 Macon 343931 * BENSON AREA MEDICAL CENTER 3333 NC HWY 242N PO BOX 399 BENSON, NC 27504 (919)894-2011 Johnston INC 343905 * BLACK RIVER FAMILY PRACTICE 301 SOUTH CAMPBELL STREET BURGAW, NC 28425 (910)259-5721 Pender 343867 * BLACK RIVER HEALTH SERVICES 109 W CHURCH STREET ATKINSON, NC 28421 (910)283-5011 Pender 343427 * BLUE RIDGE MEDICAL CENTER - 800 MEDICAL CAMPUS DRIVE BURNSVILLE, NC 28714 (828)682-0200 Yancey YANCEY CAMPUS 343449 * CAPE FEAR VALLEY BLADEN 107 DUNHAM STREET ELIZABETHTOWN, NC 28337 (910)862-2122 Bladen MEDICAL ASSOC EXPRESSCARE 343444 * CAPE FEAR VALLEY- BLADEN 16 3RD STREET DUBLIN, NC 28332 (910)862-3528 Bladen MEDICAL ASSOCIATES 343445 * CAPE FEAR VALLEY-BLADEN 300A EAST MCKAY STREET ELIZABETHTOWN, NC 28337 (910)862-6308 Bladen MEDICAL ASSOCIATES 343446 * CAPE FEAR VALLEY-BLADEN 1106 W SEABOARD STREET BLADENBORO, NC 28320 (919)863-3138 Bladen MEDICAL ASSOCIATES 343918 * CHADBOURN FAMILY PRACTICE P A 104 SEVENTH AVENUE CHADBOURN, NC 28431 (910)654-3143 Columbus 343970 * CLECO MEDICAL CENTER OF 808 SCHENCK STREET SHELBY, NC 28150 (704)480-9344 Cleveland SHELBY 348906 * COLUMBUS CO COMMUNITY 15 HILL PLAZA, SUITE A WHITEVILLE, NC 28472 (910)641-0202 Columbus HEALTH CENTER 343443 * COMMUNITY MEDICINE OLD FORT 32 E MAIN STREET OLD FORT, NC 28762 (828)659-5741 McDowell 343453 * DOSHER MEDCIAL BOLIVIA 3875 BUSINESS 17 E BOLIVIA, NC 28422 (910)253-7990 Brunswick 343454 * DOSHER MEDICAL HOLDEN BEACH 2930 HOLDEN BEACH ROAD SW SUPPLY, NC 28462 (910)842-5991 Brunswick 343450 * DOSHER MEDICAL LONG BEACH 4222 LONG BEACH ROAD SE SOUTHPORT, NC 28461 (910)454-1197 Brunswick ROAD 343452 * DOSHER MEDICAL-SMITHVILLE 1513 N HOWE STREET SOUTHPORT, NC 28461 (910)457-9127 Brunswick CROSSING 343448 * DOSHER MEDICAL/OAK ISLAND 4700 EAST OAK ISLAND OAK ISLAND, NC 28465 (910)278-6414 Brunswick 348959 * DR ARTHUR J ROBINSON MEDICAL C 800 MARTIN LUTHER KING DRIVE LUMBERTON, NC 28359 (910)738-3957 Robeson

348939 * EASTERN CAROLINA GERIATRIC 105 COMMERCE STREET POWELLSVILLE, NC 27967 (252)332-6484 Bertie ASSOC & FAM CARE CTR PL 348957 * FAIRMONT MEDICAL CLINIC 101 N WALNUT STREET FAIRMONT, NC 28340 (910)628-0655 Robeson 348932 * FAMILY CARE CENTER 1668 NC HWY 16 SOUTH TAYLORSVILLE, NC 28681 (828)632-9736 Alexander 343440 * FAMILY MEDICINE-GLENWOOD 5623 US 221 SOUTH MARION, NC 28752 (828)659-9000 McDowell 343441 * FAMILY MEDICINE-NEBO 339 NEBO SCHOOL ROAD NEBO, NC 28761 (828)652-6326 McDowell * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 North Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 343431 * FIRSTHEALTH MONTGOMERY 522 ALLEN STREET TROY, NC 27371 (910)571-5510 Montgomery MEMORIAL HOSPITAL-FAMILY CA 343437 * GRANVILLE INTERNAL MEDICINE & 1032 COLLEGE STREET OXFORD, NC 27565 (919)693-6541 Granville GERIATRICS 343919 * HARMONY MEDICAL CARE PA 3210 HARMONY HWY HARMONY, NC 28634 (704)546-7587 Iredell 343414 * HEALTH PLUS OF THE MCDOWELL 472 RANKIN DRIVE MARION, NC 28752 (828)652-1400 McDowell HOSP 348944 * HIGHLAND MEDICAL ASSOCIATES 165 COOLRIDGE STREET HENDERSONVILLE, NC 28792 (828)694-3939 Henderson 343422 * HOKE FAMILY MEDICAL CENTER 405 S MAIN STREET RAEFORD, NC 28376 (910)875-5101 Hoke 343963 * KINGS MOUNTAIN MEDICAL CENTER 812 W KING STREET KINGS MOUNTAIN, NC 28086 (704)739-5456 Cleveland 343964 * LAUREL HILL MEDICAL CLINIC 18901 IDA MILL ROAD LAUREL HILL, NC 28351 (910)462-2707 Scotland 343447 * LIFEBRITE FAMILY MEDICAL OF 1020 HOSPICE DRIVE DANBURY, NC 27016 (336)593-8281 Stokes DANBURY 343904 * MAPLE HILL MEDICAL CENTER 4811 NC HWY 53 MAPLE HILL, NC 28454 (910)259-6444 Pender 343987 * MAXTON FAMILY PRACTICE CENTER 1001 W DR MARTIN LUTHER KING DR MAXTON, NC 28364 (910)844-4077 Robeson 343439 * MCDOWELL OB/GYN MCDOWELL 1633 SUGAR HILL ROAD MARION, NC 28752 (828)659-3621 McDowell INTERNAL MEDICINE 343438 * MCDOWELL PEDIATRICS 387 US 70 W MARION, NC 28752 (828)652-6328 McDowell 343972 * MED FIRST IMMEDIATE CARE AND 718 CORBETT AVENUE SWANSBORO, NC 28584 (910)326-5588 Onslow FAMILY PRACTICE, PA 348951 * MID CAROLINA FAMILY MEDICINE, 1038 ALBEMARLE ROAD TROY, NC 27371 (910)572-1785 Montgomery PA 343457 * MISSION COMMUNITY OBSTETRICS 125 HOSPITAL DRIVE SPRUCE PINE, NC 28777 (828)766-3001 Mitchell AND GYNECOLOGY SPECIA 343426 * MISSION COMMUNITY PRIMARY 11728 SOUTH HIGHWAY SPRUCE PINE, NC 28777 (828)765-5672 Mitchell CARE 343462 * MISSION COMMUNITY PRIMARY 360 HOSPITAL DRIVE CLYDE, NC 28721 (828)456-9006 Haywood CARE-HAYWOOD 343410 * MISSION HEALTH MAUZY-PHILLIPS 189 HOSPITAL DRIVE SPRUCE PINE, NC 28777 (828)765-0170 Mitchell CENTER 343455 * MISSION WOMEN'S CARE SYLVA 111 CENTRAL STREET SYLVA, NC 28779 (828)349-6804 Jackson 343425 * MOUNTAIN FAMILY CARE CENTER 310 HOSPITAL AVENUE JEFFERSON, NC 28640 (336)846-6322 Ashe 343459 * MURPHY GROUP FAMILY PRACTICE 183B LEDFORD STREET MURPHY, NC 28906 (828)837-4712 Cherokee 343460 * MURPHY GROUP PRACTICE 2076 HIGHWAY 69 SOUTH HAYESVILLE, NC 28904 (828)389-3608 Clay HAYESVILLE 343458 * MURPHY GROUP PRACTICE OB/GYN 75 MEDICAL PARK LANE, SUITE D MURPHY, NC 28906 (828)837-1332 Cherokee * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 North Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 343461 * MURPHY MEDICAL CENTER URGENT 183 A LEDFORD STREET MURPHY, NC 28906 (828)837-4712 Cherokee CARE 343858 * NEWPORT FAMILY PRACTICE 338 HOWARD BLVD NEWPORT, NC 28570 (252)223-5054 Carteret 343982 * PEMBROKE FAMILY PRACTICE 208 RUTH DIAL ST PEMBROKE, NC 28372 (910)521-4462 Robeson 343803 * PENSLOW HEALTH CLINIC INC 206 NORTH DYSON STREET HOLLY RIDGE, NC 28445 (910)329-7591 Onslow 343430 * PLYMOUTH PRIMARY CARE 1006 US HIGHWAY 64 EAST PLYMOUTH, NC 27962 (252)793-7701 Washington 343911 * RIEGELWOOD MEDICAL CLINIC REIGELWOOD SHOPPING CTR HWY 87 RIEGELWOOD, NC 28456 (910)655-0021 Columbus 348938 * RIVERQUEST MEDICAL CARE 258 LOWE ROAD LUMBERTON, NC 28360 (910)735-1234 Robeson 348941 * ROANOKE CLINIC 1385 MEDICAL CENTER DRIVE ROANOKE RAPIDS, NC 27870 (252)537-9176 Halifax 343914 * ROSE HILL MEDICAL CENTER 600 S SYCAMORE STREET ROSE HILL, NC 28458 (910)289-3027 Duplin 343988 * SCOTLAND URGENT CARE CENTER 205 LAUCHWOOD DRIVE LAURINBURG, NC 28352 (910)277-8300 Scotland 343962 * SEAGROVE MEDICAL CLINIC 614 NORTH BROAD STREET SEAGROVE, NC 27341 (336)873-7248 Randolph 343436 * SOUTH GRANVILLE PRIMARY CARE 1614 HWY 56 CREEDMOOR, NC 27522 (919)575-6103 Granville 348961 * SOUTHEASTERN MEDICAL CLINIC 302 S MAIN STREET BLADENBORO, NC 28320 (910)863-2400 Bladen BLADENBORO 348952 * SOUTHEASTERN MEDICAL CLINIC 9928 N W R LATHAN STREET CLARKTON, NC 28433 (910)647-1503 Bladen CLARKTON 348954 * SOUTHEASTERN MEDICAL CLINIC 22401 ANDREW JACKSON HIGHWAY MAXTON, NC 28364 (910)844-2004 Robeson MAXTON 348964 * SOUTHEASTERN MEDICAL CLINIC 302 MT TABOR ROAD RED SPRINGS, NC 28377 (910)843-9991 Hoke RED SPRINGS 348960 * SOUTHEASTERN MEDICAL CLINIC 102 NORTH BOND STREET ROWLAND, NC 28383 (910)422-3350 Robeson ROWLAND 348953 * SOUTHEASTERN RED SPRINGS 229 S MAIN STREET RED SPRINGS, NC 28377 (910)843-9991 Robeson FAMILY MEDICINE 348958 * ST PAULS MEDICAL CLINIC 128 EAST BROAD STREET SAINT PAULS, NC 28384 (910)865-5955 Robeson 343923 * THE COLUMBIA MEDICAL CENTER 208 NORTH BROAD STREET BOX 189 COLUMBIA, NC 27925 (252)796-0689 Tyrrell 343955 * UPPER CLEVELAND MEDICAL 5009 FALLSTON ROAD LAWNDALE, NC 28090 (704)538-8532 Cleveland CENTER 343951 * VANCE FAMILY MEDICINE 381 RUIN CREEK RD HENDERSON, NC 27536 (252)430-0666 Vance 343400 * VIDANT FAMILY MEDICINE 1473 NC HIGHWAY 42-43 WEST PINETOPS, NC 27864 (252)827-5231 Edgecombe PINETOPS 343423 * VIDANT FAMILY MEDICINE- 1403 SOUTH KING STREET WINDSOR, NC 27983 (252)794-6775 Bertie WINDSOR, A DEPARTMENT OF VI 343828 * YANCEY COUNTY PRIMARY CARE 202 MEDICAL CAMPUS DRIVE BURNSVILLE, NC 28714 (828)682-6118 Yancey * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 North Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name

Total Providers for this State = 73

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 South Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 423442 * ABBEVILLE INTERNAL MEDICINE 901 W GREENWOOD STREET, SUITE 6 ABBEVILLE, SC 29620 (864)366-9938 Abbeville 428956 * ADVANCED MEDICAL ASSOCIATES 511 SOUTH MAIN STREET MULLINS, SC 29574 (843)464-8244 Marion 423970 * ANDREWS MEDICAL CENTER 701 SOUTH MORGAN AVENUE ANDREWS, SC 29510 (843)264-5253 Georgetown 428975 * ANGEL OAK FAMILY MEDICINE, LLC 1816 BOHICKET RD, SUITE F JOHNS ISLAND, SC 29455 (843)559-1938 Charleston 423806 * AYNOR FAMILY PRACTICE 1213 ELM STREET AYNOR, SC 29511 (843)358-5806 Horry 423820 * BEAUFORT MEMORIAL HARRISON 1000 PINE STREET W VARNVILLE, SC 29944 (803)943-5228 Hampton PEEPLES HEALTHCARE CTR 428981 * BEAUFORT PEDIATRICS 964 RIBAUT ROAD BEAUFORT, SC 29902 (843)524-5437 Beaufort 423449 * BLUE GRANITE MEDICAL CENTER 880 WEST MOULTRIE STREET, SUITE WINNSBORO, SC 29180 (803)635-0288 Fairfield 102 428933 * BLUE RIDGE PEDIATRICS, LLC 457 B HIGHWAY 123 BYPASS P O BOX SENECA, SC 29678 (864)888-4464 Oconee 947 428990 * BLYTHEWOOD MEDICAL 428 - 2 MCNULTY ROAD BLYTHEWOOD, SC 29016 (803)754-8941 Richland ASSOCIATES 423457 * CANNON FAMILY PRACTICE 111 WEST ROPER ROAD EASLEY, SC 29640 (864)898-1377 Pickens EASTSIDE 423428 * CAROLINA MEDICAL ASSOCIATES 1787 ALLENDALE FAIRFAX HWY FAIRFAX, SC 29827 (803)632-3421 Allendale 428980 * CAROLINA PEDIATRIC ASSOCIATES 301 WEST PINE STREET BLACKSBURG, SC 29702 (864)839-4325 Cherokee 428979 * CAROLINA PEDIATRIC ASSOCIATES 1610 B N LIMESTONE STREET GAFFNEY, SC 29340 (864)839-4325 Cherokee 423877 * CAROLINAS HEALTH ASSOCIATES - 801 WEST MAIN STREET UNION, SC 29379 (864)429-8029 Union FAMILY MEDICINE 428973 * CHA - UPSTATE PEDIATRICS 407 WEST SOUTH STREET UNION, SC 29379 (864)429-8846 Union 428992 * CHA FAMILY PRACTICE ASSOCIATES 429 E MAIN STREET UNION, SC 29379 (864)427-9045 Union

428948 * CHEROKEE CHILDREN'S CLINIC, PA 1307 N LOGAN STREET GAFFNEY, SC 29341 (864)488-1333 Cherokee 423444 * COASTAL CAROLINA MEDICAL 1010 MEDICAL CENTER DR SUITE 240 HARDEEVILLE, SC 29927 (843)784-8293 Jasper ASSOCIATES 423450 * COASTAL MEDICAL ASSOCIATES 10911 N JACOB SMART BOULEVARD, D RIDGELAND, SC 29936 (843)645-1635 Beaufort 423432 * COASTAL PLAINS PRIMARY CARE 595 WCAROLINA AVENUE VARNVILLE, SC 29944 (803)943-1221 Hampton 423865 * CONWAY PEDIATRICS 907 BELL STREET CONWAY, SC 29526 (843)248-2727 Horry 423875 * CPG FAMILY MEDICINE 51 11TH AVE AYNOR, SC 29511 (843)358-3700 Horry 423453 * DUE WEST FAMILY MEDICINE 6 COLLEGE STREET DUE WEST, SC 29639 (864)379-2345 Abbeville 423968 * EASTERN CAROLINA PEDIATRIC 105 INDUSTRIAL WAY DARLINGTON, SC 29532 (843)395-0015 Darlington ASSOCIATES 428998 * EDGEFIELD MEDICAL CLINIC, PA 200 RIDGE MEDICAL PLAZA EDGEFIELD, SC 29824 (803)637-3146 Edgefield * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 South Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 423838 * F MARION DWIGHT MD PA 450 NORTH STREET BAMBERG, SC 29003 (803)245-5168 Bamberg 423840 * FAIRFIELD MEDICAL ASSOCIATES 880 WEST MOULTRIE STEET, SUITE 200 WINNSBORO, SC 29180 (803)635-6461 Fairfield 423872 * FAMILY HEALTHCARE NEWBERRY 2605 KINARD STREET SUITE 200 NEWBERRY, SC 29108 (803)405-1900 Newberry 423451 * FAMILY MEDICINE ASSOCIATES 901 W GREENWOOD ST STE 9 ABBEVILLE, SC 29620 (864)366-9681 Abbeville 423888 * FAMILY MEDICINE ASSOCIATES, LLC 505 THURGOOD MARSHALL BLVD KINGSTREE, SC 29556 (843)355-8380 Williamsburg 423455 * GHS CLEMSON-SENECA PEDS- 208-1 FRONTAGE ROAD CLEMSON, SC 29631 (864)654-6034 Pickens CLEMSON 423456 * GHS CLEMSON-SENECA PEDS- 109 OMNI DRIVE, SUITE B SENECA, SC 29672 (864)888-4222 Oconee SENECA 423452 * GHS LAURENS FAMILY MED-MAIN 106 PARKVIEW DRIVE LAURENS, SC 29360 (864)984-0571 Laurens 423454 * GHS LAURENS FAMILY MEDICINE- 9100 HWY 14 GRAY COURT, SC 29645 (864)876-4888 Laurens GRAY COURT 423803 * HEALTHWISE FAMILY PRACTICE, 154 WREN STREET BARNWELL, SC 29812 (803)259-3399 Barnwell LLC 428969 * JOHN A MARTIN PRIMARY HEALTH 56 HWY 321 BYPASS NORTH WINNSBORO, SC 29180 (803)635-6099 Fairfield CARE 423420 * KERSHAWHEALTH HEALTHCARE 103 SOUTH MAIN STREET BETHUNE, SC 29009 (803)334-6557 Kershaw PLACE AT BETHUNE 423424 * LAFFITTE & WARREN MEDICAL 623 NORTH MEMORIAL AVENUE ALLENDALE, SC 29810 (803)584-2128 Allendale CENTER 428988 * LAKE CITY FAMILY MEDICINE, LLC 901 N MATTHEWS ROAD LAKE CITY, SC 29560 (843)394-8380 Florence 428995 * LANDRUM FAMILY HEALTH CARE 108 W RUTHERFORD STREET LANDRUM, SC 29356 (864)457-2363 Spartanburg LLC 428945 * LEXINGTON MEDICAL CENTER 338 EAST COLUMBIA AVE BATESBURG-LEESVILLE, SC (803)604-0066 Lexington BATESBURG-LEESVILLE 29070 428943 * LEXINGTON MEDICAL CENTER 935 WEST SECOND STREET SWANSEA, SC 29160 (803)568-2000 Lexington SWANSEA 423852 * MARION MEDICAL GROUP, INC 1205 N MAIN STREET MARION, SC 29571 (843)423-0760 Marion 423889 * MARION PEDIATRICS 2845 E HWY 76 , SUITE 4 MULLINS, SC 29574 (843)431-2720 Marion 428989 * MCLEOD FAMILY MEDICINE - 355 SOUTH GEORGETOWN HIGHWAY JOHNSONVILLE, SC 29555 (843)380-2000 Florence JOHNSONVILLE 423416 * MCLEOD FAMILY MEDICINE CTR- 701 CASHUA FERRY ROAD DARLINGTON, SC 29532 (803)398-8500 Darlington WILSON 423857 * MCLEOD FAMILY MEDICINE 512 NELSON BOULEVARD SUITE 200 KINGSTREE, SC 29556 (843)355-5459 Williamsburg KINGSTREE

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 South Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 873801 * MCLEOD FAMILY MEDICINE- DR 200 E HOSPITAL STREET MANNING, SC 29102 (803)433-0439 Clarendon EAGERTON JR 428927 * MCLEOD FAMILY MEDICINE-MARION 3032 EAST HIGHWAY 76 MULLINS, SC 29574 (803)464-7111 Marion COUNTY 428962 * MCLEOD FAMILY PRACTICE 755 EAST SMITH STREET TIMMONSVILLE, SC 29161 (843)346-3900 Florence TIMMONSVILLE 428934 * MCLEOD PEDIATRICS-DILLON 705 NORTH 8TH AVENUE SUITE 3A DILLON, SC 29536 (843)774-6091 Dillon 423859 * MEDICAL BUILDING PA #2 456 NORTH MAIN STREET HEMINGWAY, SC 29554 (803)558-9319 Williamsburg 428986 * MEDICAL CENTER OF SANTEE 500 BASS DRIVE PO BOX 1190 SANTEE, SC 29142 (803)854-3805 Orangeburg 423808 * MONCKS CORNER PEDIATRICS 5000 EPSON PLANTATION DRIVE SUITE MONCKS CORNER, SC 29461 (843)761-2000 Berkeley B 428919 * OCONEE PEDIATRICS 15579 WELLS HIGHWAY SENECA, SC 29678 (864)882-7800 Oconee 423846 * PAGELAND FAMILY MEDICINE 301 N VAN LINGLE MUNGO BLVD PAGELAND, SC 29728 (843)672-6127 Chesterfield 423878 * PALMETTO MEDICAL CARE, LLC 1002 S MAIN STREET MULLINS, SC 29574 (843)245-0613 Marion 423431 * PALMETTO PRIMARY CARE 334 MERCY STREET LAKE CITY, SC 29560 (843)374-9355 Florence 423817 * PATE MEDICAL ASSOCIATES 116 HOSPITAL SQUARE BISHOPVILLE, SC 29010 (803)484-9424 Lee 423443 * PEACH TREE MEDICAL CENTER 906 WEST MAIN STREET RIDGE SPRING, SC 29129 (803)685-7355 Saluda 423436 * PEACH TREE MEDICAL CENTER - 100 RIDGE MEDICAL PLAZA EDGEFIELD, SC 29824 (803)637-3630 Edgefield EDGEFIELD 873800 * PEDIATRIC ASSOCIATES PA 40 PINNACLE PARKWAY, SUITE 206 ELGIN, SC 29045 (803)438-3311 Kershaw 423429 * PEE DEE FAMILY PRACTICE 625 SOUTH GEORGETOWN HWY PO JOHNSONVILLE, SC 29555 (803)386-3106 Florence JOHNSONVILLE BOX 180 423430 * PEE DEE FAMILY PRACTICE LAKE 276 NORTH RON MCNAIR BOULEVARD LAKE CITY, SC 29560 (843)394-5471 Florence CITY 428928 * PEE DEE PEDIATRICS 2845 E HIGHWAY 76, SUITE 5 MULLINS, SC 29574 (803)431-2650 Marion 428976 * PIEDMONT PEDIATRICS 996 MEDICAL RIDGE ROAD CLINTON, SC 29325 (864)833-5654 Laurens 423828 * R DALE PADGETT MD PA 526 NORTH STREET BAMBERG, SC 29003 (803)245-2433 Bamberg 428926 * R DALE PADGETT MD RHC 1499 JOHN C CALHOUN DRIVE ORANGEBURG, SC 29115 (803)533-0007 Orangeburg 423826 * RILEY FAMILY PRACTICE 595 NEWBERRY HWY SALUDA, SC 29138 (864)445-2500 Saluda ASSOCIATES, PA 423868 * RMC OBSTETRICS AND 1175 COOK ROAD, SUITE 145 ORANGEBURG, SC 29118 (803)531-2300 Orangeburg GYNECOLOGY 428966 * RMC PRIMARY CARE 1750 VILLAGE PARK DRIVE ORANGEBURG, SC 29118 (803)534-4254 Orangeburg 423818 * RMC PRIMARY CARE BAMBERG 498 NORTH STREET BAMBERG, SC 29003 (803)245-5144 Bamberg 423856 * RMC PRIMARY CARE BRANCHVILLE 215 DORANGE ROAD PO BOX 247 BRANCHVILLE, SC 29432 (803)274-8400 Orangeburg * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 South Carolina

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 423883 * RMC PRIMARY CARE CAROLINA AVE 1619 CAROLINA AVE ORANGEBURG, SC 29115 (803)531-7474 Orangeburg 423821 * RMC PRIMARY CARE HOLLY HILL 187 BUNCH FORD RD HOLLY HILL, SC 29059 (803)496-3312 Orangeburg 428907 * RMC PRIMARY CARE ST MATTHEWS 725 HARRY C RAYSOR DRIVE SOUTH SAINT MATTHEWS, SC 29135 (803)874-3902 Calhoun 428978 * SALUDA FAMILY MEDICINE, PA 102 R L SAWYER, MD DRIVE SALUDA, SC 29138 (864)445-2173 Saluda 428964 * SINGLETON HEALTH CENTER 1773 VILLAGE PARK DRIVE ORANGEBURG, SC 29118 (803)535-3600 Orangeburg 423891 * ST PAUL'S MEDICAL GROUP, INC 7610 HWY 164 HOLLYWOOD, SC 29449 (843)889-8018 Charleston 423871 * SYCAMORE HEALTH CARE LLC 7205 BUFORD'S BRIDGE HIGHWAY SYCAMORE, SC 29846 (803)632-3900 Allendale 428987 * TRI-COUNTY PEDIATRICS, LLC 815 EAST LIBERTY STREET YORK, SC 29745 (803)628-2728 York 423870 * WACCAMAW FAMILY MEDICINE 9699 OCEAN HWY PAWLEYS IS, SC 29585 (843)237-4296 Georgetown 428958 * WACCAMAW MEDICAL CENTER 1075 NORTH FRASER STREET GEORGETOWN, SC 29440 (843)527-4442 Georgetown 423804 * WALTERBORO ADULT & PEDIATRIC 447 SPRUCE STREET WALTERBORO, SC 29488 (843)549-6331 Colleton MEDICINE, LLC 428915 * WALTERBORO FAMILY PRACTICE 107 CHURCH ST WALTERBORO, SC 29488 (803)549-1558 Colleton ASSOCIATES, PA 423448 * WILLIAMSBURG REGIONAL HEALTH 500 THURGOOD MARSHALL HWY KINGSTREE, SC 29556 (843)933-2494 Williamsburg CENTER Total Providers for this State = 87

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 5 Tennessee

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 448968 * ACCESS MEDICAL CARE OF 4233 HIGHWAY 411 N MADISONVILLE, TN 37354 (423)253-4707 Monroe MONROE COUNTY, PC 448955 * ADVANCED HEALTH & WELLNESS 8 LEXINGTON DRIVE LEXINGTON, TN 38351 (731)968-2233 Henderson FAMILY CLINIC 448903 * ALLCARE MEDICAL PLLC 313 CLEVELAND STREET RIPLEY, TN 38063 (731)677-3000 Lauderdale 443931 * APPALACHIA HEALTH SERVICES LLC 292 NORTH MAIN STREET JELLICO, TN 37762 (423)784-3600 Campbell 448956 * ARISTORENAS HEALTH CLINIC 135 WEST MAIN ADAMSVILLE, TN 38310 (731)632-3373 McNairy 448938 * ATHENS FAMILY PRACTICE 711 COOK DRIVE SUITE 100 ATHENS, TN 37303 (615)516-3283 McMinn 448925 * ATHENS PEDIATRICS PLLC 111 EPPERSON ST ATHENS, TN 37303 (423)745-5955 McMinn 448951 * ATHENS WOMENS CLINIC, PC 817 COOK DRIVE ATHENS, TN 37303 (423)745-3394 McMinn 443435 * BAPTIST HICKMAN MEDICAL CLINIC 150 EAST SWAN STREET CENTERVILLE, TN 37033 (931)729-3091 Hickman 443937 * BEDFORD URGENT CARE 1612 NORTH MAIN STREET, SUITE A SHELBYVILLE, TN 37160 (615)555-5555 Bedford 448957 * BROWNSVILLE FAMILY MEDICINE PA 2290 N WASHINGTON AVENUE BROWNSVILLE, TN 38012 (111)222-3333 Haywood 448946 * CELEBRATION FAMILY CARE PLLC 529 WEST COMMERCE STREET LEWISBURG, TN 37091 (931)270-9729 Marshall 443450 * CENTER FOR FAMILY MEDICINE 1615 MCMINNVILLE HWY, SUITE B MANCHESTER, TN 37355 (931)728-6205 Coffee 443925 * CHARLES H WILKENS MD PC 131 HOSPITAL LANE, PO BOX 447 JELLICO, TN 37762 (423)784-7269 Campbell 448906 * CHRISTIAN FAMILY MEDICINE 2017 SOUTH COLLEGE STREET, SUITE TRENTON, TN 38382 (731)749-7444 Gibson C 448942 * CHRISTIAN FAMILY MEDICINE OF 622 W MARKET STREET BOLIVAR, TN 38008 (731)635-8189 Hardeman BOLIVAR 448936 * CHRISTIAN FAMILY MEDICINE OF 105 HIGHWAY 431 MARTIN, TN 38237 (731)281-4760 Weakley WEAKLEY COUNTY 443951 * CHRISTIAN FAMILY MEDICINE, INC 79 HIGHWAY 51 SOUTH RIPLEY, TN 38063 (731)635-8189 Lauderdale 443956 * COMMUNITY MEDICAL CENTER OF 926 WEST MAIN STREET, PO BOX 1148 MONTEAGLE, TN 37356 (931)924-6006 Grundy MONTEAGLE 448971 * COMPLETE HEALTHCARE MEDICAL 3170 APPALACHIAN HIGHWAY SUITE 5 JACKSBORO, TN 37757 (423)566-4748 Campbell CENTER 448904 * COOKEVILLE MEDICAL CLINIC 402 EAST GORE AVENUE GAINESBORO, TN 38562 (931)268-6899 Jackson GAINESBORO RHC 443916 * COOKEVILLE MEDICAL CLINIC RHC 225 NORTH WILLOW AVENUE COOKEVILLE, TN 38501 (615)528-8089 Putnam 448926 * COVENANT PEDIATRICS 421 OLD RICEVILLE ROAD SUITE 2 ATHENS, TN 37303 (423)744-8755 McMinn 448934 * CROCKETT MEDICAL CLINIC 58 SOUTH BELLS STREET ALAMO, TN 38001 (731)696-5401 Crockett 443957 * CUMBERLAND FAMILY CARE OF 817 COLLEGE STREET SPENCER, TN 38585 (931)946-2113 Van Buren VANBUREN

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 5 Tennessee

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 443448 * CUMBERLAND RIVER MEDICAL 102 OLD JEFFERSON STREET CELINA, TN 38551 (931)243-3576 Clay CLINIC 448914 * DOVER MEDICAL CLINIC 133 DR ROBERT H LEE DRIVE DOVER, TN 37058 (931)232-5141 Stewart 448961 None DRESDEN FAMILY CLINIC LLC 130 E LOCUST ST DRESDEN, TN 38225 (731)364-3196 Weakley 443971 * DYERSBURG FAMILY WALK-IN 2017 SAINT JOHN AVENUE, SUITE B DYERSBURG, TN 38024 (731)285-6110 Dyer CLINIC, PC 443845 * EAGLEVILLE MEDICAL GROUP 341 SOUTH MAIN STREET EAGLEVILLE, TN 37060 (615)274-6207 Rutherford 443918 * EAST JACKSON FAMILY MEDICAL CE 655 LEXINGTON AVENUE JACKSON, TN 38301 (731)425-7900 Madison 443442 * ERLANGER BLEDSOE - INTERNAL 136 WHEELERTOWN AVANUE PIKEVILLE, TN 37367 (423)447-3524 Bledsoe MEDICINE & PEDIATRICS 448941 * FAMILY CARE CLINIC LLC 231 NORTHGATE DR 102 MC MINNVILLE, TN 37110 (931)474-4700 Warren 443955 * FAMILY CLINIC OF HENDERSON 236 NORTH AVENUE HENDERSON, TN 38340 (731)989-5180 Chester 448905 * FAMILY FIRST MEDICAL CENTER 899 HIGHWAY 51 SOUTH COVINGTON, TN 38019 (901)476-8886 Tipton 443930 * FAMILY HEALTH CENTER OF 342 FREY STREET ASHLAND CITY, TN 37015 (615)792-1199 Cheatham ASHLAND CITY 448935 * FAMILY HEALTHCARE CLINIC LLC 7065 KNOXVILLE HIGHWAY OLIVER SPRINGS, TN 37840 (865)435-3918 Morgan 448923 * FAMILY HEALTHCARE OF CAMDEN, 350 HOSPITAL DRIVE CAMDEN, TN 38320 (731)584-3330 Benton INC 448952 * FAMILY MEDICINE WEST OF 1236 KNOXVILLE HIGHWAY, SUITE 500 WARTBURG, TN 37887 (423)346-5566 Morgan WARTBURG 448909 * FAMILY WALK-IN CLINIC 42 DOOLEY STREET CROSSVILLE, TN 38555 (931)707-7117 Cumberland 448921 * FAMILY WALK-IN CLINIC OF SPARTA 287 W TURNTABLE RD SPARTA, TN 38583 (931)337-1035 White 448920 * GREENFIELD FAMILY CARE 801 S MERIDIAN GREENFIELD, TN 38230 (731)235-0555 Weakley 448973 None HALL MEDICAL CLINIC 107 JV MANGUBAT DRIVE WAYNESBORO, TN 38485 (931)722-2800 Wayne 448976 * HCMC PARIS PEDIATRICS 243 JIM ADAMS DRIVE PARIS, TN 38242 (731)644-2747 Henry 443447 * HENDERSON COUNTY MEDICAL 250 BOSWELL ST LEXINGTON, TN 38351 (731)968-2006 Henderson GROUP RHC 448962 * HIGH FOREST HEALTH GROUP 120 KITTRELL STREET HOHENWALD, TN 38462 (931)796-1818 Lewis 448950 * HOHENWALD MEDICAL CENTER 20 S PARK STREET HOHENWALD, TN 38462 (931)796-7960 Lewis 448967 * J HOWARD RUPARD MD 883 UNION STREET SHELBYVILLE, TN 37160 (931)685-1145 Bedford 443913 * JENNINGS FAMILY MEDICAL CLINIC 364 TENNESSEE AVENUE SOUTH PARSONS, TN 38363 (901)847-6396 Decatur 443438 * JOHNSON COUNTY MEDICAL 1901 S SHADY STREET MOUNTAIN CITY, TN 37683 (423)727-1133 Johnson GROUP 448977 None JUST 4 KIDS PEDIATRICS, LLC 326 N LOCUST SUITE A LAWRENCEBURG, TN 38464 (931)762-5437 Lawrence

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 5 Tennessee

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 448948 * JUST 4 KIDS PEDIATRICS, LLC 910 WEST COLLEGE STREET PULASKI, TN 38478 (931)363-0077 Giles 448945 * KIDS ARE SPECIAL 880 COLLOREDO BLVD SHELBYVILLE, TN 37160 (931)685-8111 Bedford 443973 * KIDZCARE PEDIATRICS 119 EPPERSON STREET ATHENS, TN 37303 (423)745-7500 McMinn 448958 * KING FAMILY MEDICAL 215B HOLLY LANE WAVERLY, TN 37185 (111)222-3333 Humphreys 443961 * KINGSTON FAMILY PRACTICE, PC 820 WEST RACE STREET KINGSTON, TN 37763 (865)376-3406 Roane 448908 * LENTZ PEDIATRICS PLC 10777 HWY 412 WEST LEXINGTON, TN 38351 (731)968-5558 Henderson 448924 * LEXINGTON FAMILY PRACTICE 524 S BROAD ST LEXINGTON, TN 38351 (731)651-0300 Henderson 443974 * LIBERTY MEDICAL CLINIC 4944 COLLEGE STREET BELLS, TN 38006 (731)663-3530 Crockett 448964 None LORETTO FAMILY CARE 722 NORTH MILITARY STREET LORETTO, TN 38469 (111)222-3333 Lawrence 443932 * LYNETTE M ADAMS, MD 1612 NORTH MAIN, SUITE 13 SHELBYVILLE, TN 37160 (931)685-2022 Bedford 448919 * MADISON STREET FAMILY CLINIC 1401 MADISON STREET SHELBYVILLE, TN 37160 (931)685-2022 Bedford 443441 * MANCHESTER RURAL HEALTH 482 INTERSTATE DRIVE, SUITE A MANCHESTER, TN 37355 (931)728-4718 Coffee CLINIC 448910 * MARTIN CHILDREN'S CLINIC LLC 130 COMMONS DR MARTIN, TN 38237 (731)681-1577 Weakley 448972 * MEDINA FAMILY PRACTICE 605 HWY 45 E S MEDINA, TN 38355 (731)783-1234 Gibson 448918 * MEDSOUTH MEDICAL CENTER, 1700 WOODLAWN AVE DYERSBURG, TN 38024 (731)287-4500 Dyer DYERSBURG 448932 * MICHIE MEDICAL CLINIC INC 6659 MICHIE PEBBLE HILL RD MICHIE, TN 38357 (731)632-1783 McNairy 448966 * MID-SOUTH CONVENIENT CARE, 521 HIGHWAY 51 NORTH RIPLEY, TN 38063 (731)635-2000 Lauderdale PLLC 448969 * MOORE MEDICAL CLINIC LLC 600 MAIN STREET FRIENDSHIP, TN 38034 (731)677-3400 Crockett 443868 * MOUNTAIN CITY EXTENDED HOURS JOHNSON CO HLTH CTR, 1901 S SHADY MOUNTAIN CITY, TN 37683 (423)727-1150 Johnson H ST 448931 * ONE STOP MEDICAL LLC 325 GERI STREET LAWRENCEBURG, TN 38464 (931)762-9797 Lawrence 448930 * ONE STOP MEDICAL, LLC 912 WEST COLLEGE STREET PULASKI, TN 38478 (931)424-9797 Giles 443933 * PAUL E SCATES FAMILY MEDICINE 12995 HWY 64, PO BOX 399 SOMERVILLE, TN 38068 (901)466-0250 Fayette 448944 * PAULA VASSAR INC 1720 E REELFOOT AVE STE 103 UNION CITY, TN 38261 (731)885-6600 Obion 448900 * PEDIATRIC ASSOCIATES OF WEST 1501 BRAYTON AVENUE DYERSBURG, TN 38024 (731)285-4111 Dyer TENNESSEE PLLC 448933 * PIKEVILLE CLINIC LLC 3062 MAIN STREET PIKEVILLE, TN 37367 (423)447-2955 Bledsoe 448960 * PIKEVILLE URGENT CARE, PLLC 344 CHURCH STREET PIKEVILLE, TN 37367 (423)618-3696 Bledsoe 443967 * PIONEER PEDIATRICS PLLC 236 E MAIN ST MC MINNVILLE, TN 37110 (931)815-5457 Warren 443966 * PLATEAU PEDIATRICS PLC 3234 MILLER AVENUE CROSSVILLE, TN 38555 (931)707-8700 Cumberland

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 5 Tennessee

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 443935 * R SHANE ROBERTS, MD 398 N MAIN STREET DECATUR, TN 37322 (423)334-2222 Meigs 448965 * RAINBOW PEDIATRIC PC 1636 E MAIN STREET HUMBOLDT, TN 38343 (731)784-7833 Gibson 448947 * RAY MEDICAL 2409 HIGHWAY 70 E DICKSON, TN 37055 (615)740-7322 Dickson 448913 * REELFOOT FAMILY WALK- IN CLINIC 1509 EAST REELFOOT AVENUE UNION CITY, TN 38261 (731)442-9306 Obion 448940 * REELFOOT FAMILY WALK-IN CLINIC 130 E LOCUST STREET DRESDEN, TN 38225 (731)364-3196 Weakley 448937 * REELFOOT FAMILY WALK-IN CLINIC 708 EAST COURT STREET DYERSBURG, TN 38024 (731)555-5555 Dyer 443451 * RHEA MEDICAL CENTER PHYSICIAN 22576 RHEA COUNTY HIGHWAY SPRING CITY, TN 37381 (111)222-3456 Rhea GROUP 448922 * ROBERSON RIKE CLINIC 768 EVERETT STREET TIPTONVILLE, TN 38079 (731)253-3760 Lake 443948 * RURAL HEALTH CLINICS OF WEST 1716 PARR AVENUE SUITE A DYERSBURG, TN 38024 (731)253-3683 Dyer TN, PLLC 443949 * RURAL HEALTH CLINICS OF WEST 326 ASBURY AVENUE, SUITE 101 RIPLEY, TN 38063 (731)635-2755 Lauderdale TN, PLLC 443950 * RURAL HEALTH CLINICS OF WEST 115 WEST TIGRETT STREET HALLS, TN 38040 (731)836-7700 Lauderdale TN, PLLC 448953 * SDG PRIMARY AND IMMEDIATE 201 SOUTH FRONT STREET HALLS, TN 38040 (731)836-5617 Lauderdale CARE LLC 448912 * SOUTHERN TENNESSEE PRIMARY 21 1ST STREET MONTEAGLE, TN 37356 (931)924-9000 Grundy CARE-MOUNTAIN MEDICAL C 443943 * SPRING CITY WALK IN MEDICAL 126 LAVENDER STREET SPRING CITY, TN 37381 (423)452-9984 Rhea CENTER 443970 * SPRINGER MEDICAL ASSOCIATES 16615 HIGHWAY 104 N SUITE B LEXINGTON, TN 38351 (731)968-0660 Henderson 443997 * TENNOVA LAFOLLETTE MEDICAL 905 E CENTRAL AVE LAFOLLETTE, TN 37766 (423)907-1600 Campbell CENTER CLINIC 443440 * TENNOVA LAFOLLETTE MEDICAL 2145 JACKSBORO PIKE LA FOLLETTE, TN 37766 (423)907-1700 Campbell CENTER CLINIC-SOUTH 443449 None TENNOVA PRIMARY CARE-HILLVIEW 1203 INDUSTRIAL PARK RD SOUTH FULTON, TN 38257 (731)479-2606 Obion SOUTH 448916 * TERRELL CLINIC LLC 701 EAST REELFOOT AVE SUITE 100 UNION CITY, TN 38261 (731)885-9687 Obion 448963 None THE FAMILY CLINIC 545 PICKWICK STREET SAVANNAH, TN 38372 (731)925-3354 Hardin 443968 * THE GROVE PRIMARY CARE CLINIC 541 WEST PARK PLACE SUITE C HENDERSON, TN 38340 (731)983-0499 Chester 448929 * THE GROVE PRIMARY CARE CLINIC 702 S MAIN STREET MIDDLETON, TN 38052 (731)376-1311 Hardeman LLC 448954 * THE GROVE PRIMARY CARE CLINIC, 9458 HIGHWAY 100 SCOTTS HILL, TN 38374 (231)924-0244 Decatur LLC 443960 * THE RICKARD CLINIC 557 WEST PARK PLACE HENDERSON, TN 38340 (731)989-1007 Chester * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 5 Tennessee

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 448928 * TRINITY MEDICAL CLINIC, LLC 828 MULERRY AVE SELMER, TN 38375 (731)434-0200 McNairy 443936 * UNIONVILLE FAMILY PRACTICE 3335 HIGHWAY 41A NORTH UNIONVILLE, TN 37180 (931)685-2022 Bedford 448975 * UPPER CUMBERLAND MEDICAL 225 N WILLOW AVENUE COOKEVILLE, TN 38501 (931)528-8899 Putnam ASSOCIATES PLLC 443965 * UT PRIMARY CARE HEARTLAND 309 N BROAD STREET NEW TAZEWELL, TN 37825 (423)626-7297 Claiborne 448927 * WALK-IN MEDICAL CLINIC OF 847 SQUIRREL HOLLOW DR LINDEN, TN 37096 (931)589-2600 Perry LINDEN PLLC 443969 * WARTRACE FAMILY PRACTICE 507 WEST BLACKMAN BLVD WARTRACE, TN 37183 (931)389-0600 Bedford 448974 * WEST FAMILY CARE CLINIC 108 EAST DRIVE NEWBERN, TN 38059 (731)627-3553 Dyer 448970 * WOMEN'S CENTER OF EAST 135 N MEADOWS DRIVE, SUITE B ATHENS, TN 37303 (423)507-8067 McMinn TENNESSEE 443947 * WOMEN'S WELLNESS & MATERNITY 3459 HWY 68 MADISONVILLE, TN 37354 (423)442-6624 Monroe CENTER, INC Total Providers for this State = 112

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148985 * AHEARN ASSOCIATES MEDICAL 513 ELLIOTT STREET SUITE 4 KEWANEE, IL 61443 (309)853-2442 Henry CENTER INC 143438 * ATWOOD RURAL HEALTH CLINIC 108 S MAIN STREET ATWOOD, IL 61913 (217)578-3814 Douglas 783821 * BENTON COMMUNITY HEALTHCARE 203 BAILEY LANE SUITE 1 BENTON, IL 62812 (618)438-5670 Franklin 143456 * BOWEN FAMILY PRACTICE 209 EAST 5TH STREET BOWEN, IL 62316 (217)842-5211 Hancock 143474 * BOYD-FILLAGER CLINIC 712 COLLEGE STREET GREENFIELD, IL 62044 (217)368-3051 Greene 143917 * BRIAN W DOSSETT MD LTD 1029 N 8TH STREET VANDALIA, IL 62471 (618)283-4469 Fayette 148522 * BUSHNELL FAMILY PRACTICE, S C 1150 N COLE ST BUSHNELL, IL 61422 (309)772-9444 McDonough 148921 * C C MEDICAL CLINIC 1141 N CHENEY STREET TAYLORVILLE, IL 62568 (217)287-7477 Christian 148533 * CARLE AT TUSCOLA 301 E SOUTHLINE ROAD TUSCOLA, IL 61953 (217)253-5231 Douglas 148521 * CARLE AT WATSEKA 1490 E WALNUT STREET, SUITE C WATSEKA, IL 60970 (815)432-8200 Iroquois 148531 * CARLE DANVILLE ON FAIRCHILD 311 WEST FAIRCHILD STREET DANVILLE, IL 61832 (217)431-7600 Vermilion 148544 None CARLE MATTON ON HURST 2512 HURST DR SUITE 130 MATTOON, IL 61938 (217)258-5900 Coles 148530 None CARLINVILLE FAMILY HEALTH CARE 20613 NORTH BROAD STREET CARLINVILLE, IL 62626 (217)854-3881 Macoupin 148926 * CARLINVILLE FAMILY PRACTICE 15574 ROUTE 108 CARLINVILLE, IL 62626 (217)854-4319 Macoupin 143937 * CARLINVILLE MEDICAL CLINIC 604 N BROAD ST CARLINVILLE, IL 62626 (217)854-9411 Macoupin 148978 * CARLINVILLE MEDICAL CLINIC INC 125 SOUTH 2ND STREET, PO BOX 25 GIRARD, IL 62640 (217)627-3350 Macoupin 148529 None CARMI FAMILY CLINIC 110A E MAIN STREET NORRIS CITY, IL 62869 (618)378-2067 White 143978 * CASEY CLINIC 412 NW 3RD, PO BOX 40 CASEY, IL 62420 (217)932-4061 Clark 143458 * CCH MEDICAL CLINIC 929 STABY BURK DRIVE, PO BOX 40 FLORA, IL 62839 (618)662-2191 Clay 143880 * CENTER FOR FAMILY HEALTH - 21193 MALTA RD MALTA, IL 60150 (815)753-9010 DeKalb MALTA 143821 * CENTER FOR MEDICAL ARTS RURAL 2601 W MAIN STREET CARBONDALE, IL 62901 (618)549-5361 Jackson HEALTH 783803 * CENTRALIA FAMILY HEALTH 1441 WEST BROADWAY CENTRALIA, IL 62801 (618)532-9050 Marion CENTER 148566 None CERRO GORDO RURAL HEALTH 407 S JACKSON ST SUITE A CERRO GORDO, IL 61818 (217)763-6010 Piatt CLINIC 143485 * CISSNA PARK MEDICAL CLINIC 141 WEST GARFIELD AVENUE CISSNA PARK, IL 60924 (815)457-2146 Iroquois 148569 None CLAY COUNTY HOSPITAL CISNE 413 PARK STREET CISNE, IL 62823 (618)662-2131 Wayne MEDICAL CLINIC 148558 None CLAY COUNTY HOSPITAL CLAY CITY 800 KELLY DRIVE SW CLAY CITY, IL 62824 (618)662-2131 Clay CLINIC 148503 * CLINTON COUNTY RURAL HEALTH 9401 HOLY CROSS LANE BREESE, IL 62230 (618)526-7271 Clinton

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148570 * CLINTON COUNTY RURAL HEALTH - 1110 MULLIKIN STREET CARLYLE, IL 62231 (618)526-5900 Clinton CARLYLE 148502 * CLINTON COUNTY RURAL HEALTH 205 MUNSTER STREET GERMANTOWN, IL 62245 (618)523-4541 Clinton GERMANTOWN 148553 None CLINTON COUNTY RURAL HEALTH 211 E HANOVER ST NEW BADEN, IL 62265 (618)588-2900 Clinton NEW BADEN 148554 None CLINTON COUNTY RURAL HEALTH- 14509 STATE ROUTE 127 CARLYLE, IL 62231 (618)594-8924 Clinton CARYLE 148552 None CLINTON COUNTY RURAL HEALTH- 409 E BROADWAY TRENTON, IL 62293 (618)224-7366 Clinton TRENTON 143488 * CMH OBLONG RURAL HEALTH 1366 EAST 1050TH AVENUE OBLONG, IL 62449 (618)592-3119 Crawford 143486 * CMH PALESTINE RURAL HEALTH 209 EAST GRAND PRAIRIE PALESTINE, IL 62451 (618)586-2153 Crawford 143429 * CMH RURAL HEALTH CLINIC 1101 NORTH ALLEN STREET ROBINSON, IL 62454 (618)544-3699 Crawford 143484 * COMMUNITY MEDICAL CLINIC 135 W BROADWAY ASTORIA, IL 61501 (309)329-2926 Fulton 148508 * COMMUNITY MEDICAL CLINIC OF 101 EAST 9TH STREET, SUITE 105 PANA, IL 62557 (217)562-2544 Christian PANA 143948 * COMPREHENSIVE HEALTH CENTER 1238 COMMERICAL PARK ROAD METROPOLIS, IL 62960 (618)524-2284 Massac 148545 None CONVENIENT CARE 1345 S RTE 127 GREENVILLE, IL 62246 (618)665-9390 Bond 143975 * CONVENIENT CARE CLINIC 517 N MAIN STREET ANNA, IL 62906 (618)833-2295 Union 148987 * CORK MEDICAL CENTER 408 N 2ND STREET MARSHALL, IL 62441 (217)826-2361 Clark 143465 * COULTERVILLE MEDICAL CLINIC 203 E GRANT COULTERVILLE, IL 62237 (618)758-2331 Randolph 148993 * COWDEN MEDICAL CLINIC LLC 209 EAST ELM STREET, PO BOX 154 COWDEN, IL 62422 (217)783-6565 Shelby 148924 * CRAIG W FURRY, MD 20 N WASHINGTON, SUITE 2 DU QUOIN, IL 62832 (618)542-2129 Perry 148524 None CROSSROADS FAMILY MEDICINE OF 209 CROSSROADS PLACE, SUITE 120 MOUNT VERNON, IL 62864 (618)242-3465 Jefferson MT VERNON 148523 None CROSSROADS FAMILY MEDICINE OF 1209 ROBINSON ST WAYNE CITY, IL 62895 (618)895-2050 Wayne WAYNE CITY 143878 * DANVILLE PEDIATRIC CENTER 405 SHERIDAN STREET DANVILLE, IL 61832 (217)446-3259 Vermilion 783801 * DIETERICH COMMUNITY MEDICAL 203 S MAIN STREET PO BOX 182 DIETERICH, IL 62424 (217)925-5730 Effingham CENTER 143877 * DOCTORS CLINIC, THE 402 S PLUM CARMI, IL 62821 (618)384-2226 White 148556 * DOWNTOWN FAMILY CLINIC 208 S WASHINGTON STREET MC LEANSBORO, IL 62859 (618)643-2361 Hamilton 143404 * DR JOHN WARNER HOSP RURAL 422 WEST WHITE STREET CLINTON, IL 61727 (217)935-9571 De Witt HLTH

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 143422 * EAST ADAMS COUNTY RURAL 102 PRAIRIE MILLS ROAD GOLDEN, IL 62339 (217)696-4446 Adams HEALTH 783818 * EFFINGHAM OBSTETRICS & 912 N HENRIETTA PO BOX 784 EFFINGHAM, IL 62401 (217)342-3337 Effingham GYNECOLOGY ASSOCIATES LLC 148507 * ELDORADO FAMILY MEDICINE 1407 LOCUST STREET ELDORADO, IL 62930 (618)273-2100 Saline CLINIC 143473 * ELDORADO PRIMARY CARE 1007 U S ROUTE 45 ELDORADO, IL 62930 (618)273-7723 Saline 143483 * ELMER HUGH TAYLOR CLINIC 100 W 15TH STREET BEARDSTOWN, IL 62618 (217)322-4321 Cass 148518 * EQUALITY FAMILY PRACTICE 183 WEST LANE STREET EQUALITY, IL 62934 (618)276-5196 Gallatin 783815 * FAMILY CARE ASSOCIATES OF 1106 NORTH MERCHANT STREET, PO EFFINGHAM, IL 62401 (217)342-7000 Effingham EFFINGHAM, SC BOX 665 143466 * FAMILY HEALTH CENTER 207 SOUTH BURNS AVENUE SPARTA, IL 62286 (618)443-3084 Randolph 148517 * FAMILY HEALTHCARE OF FARMER 1230 GEORGE ROCK DRIVE FARMER CITY, IL 61842 (309)928-9192 De Witt CITY 148516 * FAMILY HEALTHCARE OF GIBSON 7 DOCTORS PARK GIBSON CITY, IL 60936 (217)784-5500 Ford CITY 148515 * FAMILY HEALTHCARE OF 705 S DIXIE HWY HOOPESTON, IL 60942 (217)728-3553 Vermilion HOOPESTON 143431 * FAMILY MEDICAL CENTER 104 E BUENA VISTA KANSAS, IL 61933 (217)465-8411 Edgar 143989 * FAMILY MEDICAL CENTER 112 WEST MADISON AVENUE CHRISMAN, IL 61924 (217)269-2394 Edgar 143412 * FAMILY MEDICAL CENTER 5383 STATE ROUTE 154 PINCKNEYVILLE, IL 62274 (618)357-2131 Perry 143987 * FAMILY MEDICAL CENTER 727 E COURT PARIS, IL 61944 (217)465-8411 Edgar 148956 * FAMILY PRACTICE MEDICAL 511 W FAIRCHILD STREET DANVILLE, IL 61832 (217)431-2025 Vermilion CENTER 148935 * FAMILY PRACTICE MEDICAL 508 N MAIN STREET GEORGETOWN, IL 61846 (217)662-2282 Vermilion CENTER, LTD 148534 * FAMILY RURAL HEALTH OF 501 EAST MAIN STREET LA HARPE, IL 61450 (217)659-3844 Hancock LAHARPE 148528 * FCH RURAL HEALTH ST ELMO 515 N MAIN STREET SAINT ELMO, IL 62458 (618)829-9200 Fayette 148527 * FCH RURAL HEALTH VANDALIA 1442 N 8TH SUITE C VANDALIA, IL 62471 (618)283-0266 Fayette 148506 * FERRELL HOSPITAL FAMILY 1306 MAPLE STREET ELDORADO, IL 62930 (618)297-9665 Saline PRACTICE 143469 * FRANKLIN HOSPITAL - FRANKLIN 201 BAILEY LANE BENTON, IL 62812 (618)439-3161 Franklin HEALTHCARE CLINIC 148560 None GALATIA PRIMARY CARE 124 E MAIN ST PO BOX 69 GALATIA, IL 62935 (618)268-4083 Saline

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148986 * GALLATIN COUNTY WELLNESS 5150 HIGHWAY 13 JUNCTION, IL 62954 (618)272-7132 Gallatin CENTER 148918 * GENESIS HEALTH GROUP 530 12TH STREET ERIE, IL 61250 (309)659-2215 Whiteside 143453 * GENESIS HEALTH GROUP, ALEDO 1007 NW 3RD ST ALEDO, IL 61231 (309)582-5301 Mercer 148546 * GIBSON AREA HOSPITAL AND 8 DOCTOR'S PARK GIBSON CITY, IL 60936 (217)784-8580 Ford HEALTH SERVICES 148559 * GIBSON CITY CLINIC SC 222 NORTH SANGAMON AVENUE GIBSON CITY, IL 60936 (217)784-8148 Ford 143859 * GILLESPIE FAMILY PRACTICE 715 W BROADWAY GILLESPIE, IL 62033 (217)839-4491 Macoupin 143424 * GILMAN CLINIC 508 E CRESCENT ST GILMAN, IL 60938 (815)265-8889 Iroquois 148532 None GIRARD FAMILY HEALTH CARE 205 SOUTH THIRD STREET GIRARD, IL 62640 (217)627-2222 Macoupin 143493 * GRAHAM MEDICAL GROUP - 2001 NORTH MAIN ST LEWISTOWN, IL 61542 (309)547-9700 Fulton LEWISTON 143497 * GRAHAM MEDICAL GROUP-CUBA 114 SOUTH 4TH STREET CUBA, IL 61427 (309)785-5156 Fulton 143494 * GRAHAM MEDICAL GROUP- 601 E FORT ST FARMINGTON, IL 61531 (309)245-2428 Fulton FARMINGTON 143492 * GRAHAM SERVICE DBA COLEMAN 175 SOUTH MAIN STREET CANTON, IL 61520 (309)647-0201 Fulton CLINIC RHC 143403 * GREENE COUNTY RURAL HEALTH 116 N MAIN ST WHITE HALL, IL 62092 (217)374-2188 Greene CLI 143491 * GREENVILLE FAMILY WELLNESS 150 HEALTHCARE DRIVE GREENVILLE, IL 62246 (618)664-9830 Bond CENTER 148513 * GREENVILLE MEDICAL ASSOCIATES 101 HEALTHCARE DRIVE GREENVILLE, IL 62246 (618)664-2531 Bond 143477 * HAMILTON MEMORIAL FAMILY 611 SOUTH MARSHALL AVENUE, PO MCLEANSBORO, IL 62859 (618)642-2988 Hamilton CLINIC BOX 429 148957 * HAMILTON-WARSAW CLINIC 1102 N COUNTY RD 700 WARSAW, IL 62379 (217)256-4100 Hancock 143479 * HARDIN COUNTY GENERAL PO BOX 2467, FERRELL ROAD ROSICLARE, IL 62982 (618)285-2800 Hardin HOSPITAL CLINIC 143457 * HAVANA MEDICAL ASSOCIATES 615 PROMENADE ST HAVANA, IL 62644 (309)543-6600 Mason 148966 * HEARTLAND PEDIATRICS 805 WEST DEYOUNG STREET, SUITE B MARION, IL 62959 (618)993-5274 Williamson 783830 None HEARTLAND WOMEN'S 3130 VETERNAS MEMORIAL DRIVE MOUNT VERNON, IL 62864 (314)968-0076 Jefferson HEALTHCARE 148999 * HEARTLAND WOMEN'S 430 NORTH PLEASANT CENTRALIA, IL 62801 (618)436-8350 Marion HEALTHCARE, LTD 783816 * HEARTLAND WOMEN'S 3408 OFFICE PARK DRIVE MARION, IL 62959 (618)997-5266 Williamson HEALTHCARE, LTD 783827 * HENNEPIN MEDICAL CLINIC 220 E HIGH ST SUITE 101 HENNEPIN, IL 61327 (815)925-7032 Putnam * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 783813 * HIGHLAND PRIORITY CARE 12860 TROXLER AVENUE HIGHLAND, IL 62249 (618)651-2810 Madison 143448 * HOOPESTON MEDICAL CENTER 801 EAST ORANGE STREET HOOPESTON, IL 60942 (217)283-5644 Vermilion 148500 * HORIZON HEALTHCARE RHC 213 NW 10TH STREET, SUITE A FAIRFIELD, IL 62837 (618)842-4617 Wayne 143446 * HSHS GOOD SHEPHERD FAMILY 200 SOUTH CEDAR STREET SHELBYVILLE, IL 62565 (217)774-9640 Shelby HEALTH 148520 * HSHS HOLY FAMILY HEALTH 507 W STATE, BOX 450 POCAHONTAS, IL 62275 (618)669-2270 Bond CENTER 148519 * HSHS HOLY FAMILY HEALTH 201 HEALTH CARE DR GREENVILLE, IL 62246 (618)664-1380 Bond CENTER 148917 * HSHS MEDICAL GROUP FAMILY 400 ROUNTREE ST HILLSBORO, IL 62049 (217)532-9471 Montgomery MEDICINE HILLSBORO 148972 * HSHS MEDICAL GROUP FAMILY 130 N BROADWAY TABLE GROVE, IL 61482 (309)758-5070 Fulton MEDICINE- TABLE GROVE 143905 * HSHS MEDICAL GROUP FAMILY 108 RODEWALD DRIVE RUSHVILLE, IL 62681 (217)322-3529 Schuyler MEDICINE-RUSHVILLE 148977 * HYGIENIC INSTITUTE FOR LASALLE, 2970 CHARTRES STREET LA SALLE, IL 61301 (815)223-0196 LaSalle PERU & OGLESBY 143482 * ILLINI COMMUNITY HOSPITAL RURAL 640 W WASHINGTON ST PITTSFIELD, IL 62363 (217)223-8400 Pike HEALTH CLINIC 143425 * IMH MILFORD CLINIC 34 EAST JONES STREET MILFORD, IL 60953 (815)889-4241 Iroquois 148551 None IMH MULTI-SPECIALITY PHYSICIANS 200 E FAIRMAN AVENUE WATSEKA, IL 60970 (815)432-5411 Iroquois CLINIC 148996 * IRVINGTON RURAL HEALTH CENTER 205 HURON ST IRVINGTON, IL 62848 (618)249-6203 Washington 148564 None IVCH MEDICAL CLINIC WOMEN'S 920 WEST ST BLDG B PERU, IL 61354 (815)223-2944 LaSalle HEALTH CARE CENTER 148565 None IVCH MEDICAL GROUP LASALLE 128 BUCKLIN STREET LA SALLE, IL 61301 (815)220-7170 LaSalle MEDICAL CLINIC 148561 None IVCH MEDICAL GROUP OGLESBY 520 W WALNUT STREET OGLESBY, IL 61348 (815)883-3588 LaSalle MEDICAL CLINIC 148562 None IVCH MEDICAL GROUP PERU 710 PEORIA STREET PERU, IL 61354 (815)223-3500 LaSalle MEDICAL CLINIC 148563 None IVCH MEDICAL GROUP PERU 920 WEST ST SUITE 311 PERU, IL 61354 (815)223-9214 LaSalle PRIMARY CLINIC 148537 * JCH MEDICAL GROUP CAROLLTON 523 S MAIN CARROLLTON, IL 62016 (217)942-3326 Greene 148539 * JCH MEDICAL GROUP HARDIN 106 WATER STREET HARDIN, IL 62047 (618)576-9407 Calhoun 148550 * JCH MEDICAL GROUP JERSEYVILLE 270 MAPLE SUMMIT RD JERSEYVILLE, IL 62052 (618)498-7108 Jersey

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148538 * JCH MEDICAL GROUP JERSEYVILLE 390 MAPLE SUMMIT ROAD PO BOX 279 JERSEYVILLE, IL 62052 (618)498-2101 Jersey 148540 * JCH MEDICAL GROUP ROODHOUSE 205 S MORSE STREET ROODHOUSE, IL 62082 (217)589-4383 Greene 143495 * KIRBY MEDICAL GROUP 1000 MEDICAL CENTER DRIVE MONTICELLO, IL 61856 (217)762-6241 Piatt 143951 * LAWRENCE COUNTY HEALTH DEPT 11362 COUNTRY CLUB ROAD LAWRENCEVILLE, IL 62439 (618)943-3302 Lawrence RH 143499 * LAWRENCE COUNTY MEMORIAL 2111 LEXINGTON AVENUE LAWRENCEVILLE, IL 62439 (618)943-7216 Lawrence HOSPITAL PRIMARY CARE CLI 148950 * LAWRENCE P JENNINGS MD, MSC 1430 COLLEGE DRIVE-SUITE A MOUNT CARMEL, IL 62863 (618)262-5113 Wabash 143925 * LINCOLN RURAL HEALTH 100 STAHLNUT DRIVE LINCOLN, IL 62656 (217)735-9955 Logan 143822 * LITCHFIELD FAMILY PRACTICE CTR 1285 FRANCISCAN DRIVE LITCHFIELD, IL 62056 (217)324-6127 Montgomery 143870 * LOGAN PRIMARY CARE 405 RUSHING DRIVE HERRIN, IL 62948 (618)942-4640 Williamson 148969 * LOGAN PRIMARY CARE SERVICES 502 WEST ST LOUIS STREET WEST FRANKFORT, IL 62896 (618)937-3400 Franklin 143487 * LOUISIVILLE MEDICAL CLINIC 935 BRYANT STREET LOUISVILLE, IL 62858 (618)665-4500 Clay 783825 * MARION DIAGNOSTIC CENTER, LLC 3003 CIVIC CIRCLE BLVD STE 200 MARION, IL 62959 (618)993-1400 Williamson 143490 * MARISSA MEDICAL CLINIC 521 NORTH BORDERS MARISSA, IL 62257 (618)295-1591 St. Clair 148504 * MARSHALL BROWING HOSPITAL 900 NORTH WASHINGTON DU QUOIN, IL 62832 (618)542-8958 Perry ASSOCIATION 143462 * MASON CITY MEDICAL ASSOCIATES 122 E ELM STREET MASON CITY, IL 62664 (309)543-8542 Mason 143478 * MASSAC MEMORIAL MEDICAL 1204 W 10TH STREET METROPOLIS, IL 62960 (618)524-2176 Massac CLINIC 143871 * MEDICAL ARTS CLINIC 19 E SHAWNEE DRIVE, SUITE 2 MURPHYSBORO, IL 62966 (618)684-2172 Jackson 783833 None MEDICAL SERVICES UNLIMITED 1404 N 5TH ST VANDALIA, IL 62471 (618)283-2000 Fayette 148542 * MEMORIAL HOSPITAL 602 WEST SHAWNEETOWN TRAIL STEELEVILLE, IL 62288 (618)826-2388 Randolph 148543 * MEMORIAL HOSPITAL 2319 OLD PLANK ROAD CHESTER, IL 62233 (618)826-4581 Randolph 148547 None MEMORIAL MEDICAL NAUVOO 1370 MULHOLLAND ST POC BOX 367 NAUVOO, IL 62354 (217)453-6802 Hancock CLINIC 143936 * MEMORIAL PHYSICANS SERVICES 1 CENTRE DRIVE PETERSBURG, IL 62675 (217)632-7761 Menard 148905 * MEMORIAL PHYSICIAN SERVICES 800 W STATE STREET JACKSONVILLE, IL 62650 (217)243-9471 Morgan 143895 * MEMORIAL PHYSICIANS SERVICES 515 N COLLEGE LINCOLN, IL 62656 (217)732-9681 Logan 148958 * MICHAEL W ELLIOTT, MD RURAL 807 WEST CRAFT STREET ROBINSON, IL 62454 (618)546-5052 Crawford HEALTH CLINIC 148962 * MID IL MEDICAL CARE ASSOC 206 NORTH PEARL TEUTOPOLIS, IL 62467 (217)857-6481 Effingham 148960 * MID ILLINOIS MEDICAL CARE ASSOC 512 N MAPLE ST EFFINGHAM, IL 62401 (217)347-7030 Effingham

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148955 * MID ILLINOIS MEDICAL CARE 8 NORTH 3RD STREET ALTAMONT, IL 62411 (217)347-2707 Effingham ASSOCIATES 148959 * MID-IL MEDICAL CARE ASSOC D/B/A 900 W TEMPLE AVENUE, STE 205 PO EFFINGHAM, IL 62401 (217)347-0458 Effingham DR EUGENE DUST BOX 1209 148511 * MIDWEST HEALTH CLINIC ONE MEDICAL CENTER DRIVE GALENA, IL 61036 (815)776-7381 Jo Daviess 148557 None MIDWEST HEALTH CLINIC OF 117 N MAIN STREET ELIZABETH, IL 61028 (815)858-2238 Jo Daviess ELIZABETH 148526 None MILFORD MEDICAL CLINIC 322 CHICAGO STREET MILFORD, IL 60953 (815)889-4011 Iroquois 783807 * MMG AT LACON 1112 FIFTH STREET LACON, IL 61540 (309)246-2676 Marshall 783806 * MMG AT PRINCEVILLE 223 MAIN STREET PRINCEVILLE, IL 61559 (309)385-4371 Stark 783804 * MMG-CHILLICOTHE 525 SWEETBRIAR DRIVE CHILLICOTHE, IL 61523 (309)274-2102 Peoria 143981 * MORRISON COMM HOSP FAMILY 303 N JACKSON ST MORRISON, IL 61270 (815)772-4003 Whiteside CARE 143863 * MT OLIVE FAMILY PRACTICE CENTE 115 N POPLAR MOUNT OLIVE, IL 62069 (217)999-4157 Macoupin 143886 * MT STERLING RURAL HEALTH CLINI 521 E MAIN P O BOX 264 MOUNT STERLING, IL 62353 (217)773-3963 Brown 143855 * MURPHYSBORO FAMILY MEDICINE 628 N 14TH ST MURPHYSBORO, IL 62966 (618)687-2353 Jackson CL 143435 * NEOGA CLINIC 650 OAK AVE NEOGA, IL 62447 (217)895-2222 Cumberland 783814 * NOKOMIS RURAL HEALTH CLINIC 105 EAST STATE STREET NOKOMIS, IL 62075 (217)563-2882 Montgomery 148968 * NORRIS CITY HEALTHCARE CLINIC 110 A EAST MAIN STREET NORRIS CITY, IL 62869 (618)378-3440 White 148514 * OLDER ADULT HEALTH CENTER 325 SPRING STREET RED BUD, IL 62278 (618)282-7373 Randolph 143440 * ONARGA CLINIC, THE 912 W SEMINARY AVENUE ONARGA, IL 60955 (815)268-4843 Iroquois 143461 * OSF HOLY FAMILY CLINICS 1000 WEST HARLEM AVENUE MONMOUTH, IL 61462 (309)734-1400 Warren 148567 None OSF MEDICAL GROUP WASHINGTON 1404 WASHINGTON STREET MENDOTA, IL 61342 (815)538-1825 LaSalle STREET 143445 * OSF MEDICAL GROUP-KEWANEE 1051 W SOUTH STREET KEWANEE, IL 61443 (309)852-7700 Henry 148535 None OSF MEDICAL GROUP/OSF SAINT 1405 EAST 12TH STREET MENDOTA, IL 61342 (815)538-7200 LaSalle PAUL MEDICAL CENTER 143408 * PAXTON CLINIC,THE 227 N MARKET PAXTON, IL 60957 (217)379-4864 Ford 783817 * PEDIATRIC GROUP 3412 OFFICE PARK DRIVE MARION, IL 62959 (618)993-0404 Williamson 783835 None PEDIATRIC GROUP LLC 28 VETERAN'S DRIVE HARRISBURG, IL 62946 (618)993-0404 Saline 783834 None PEDIATRIC GROUP LLC 310 WEST ST LOUIS STREET WEST FRANKFORT, IL 62896 (618)993-0404 Franklin 143976 * PEMBROKE COMMUNITY HEALTH 3400 S MAIN STREET HOPKINS PARK, IL 60944 (815)944-5545 Kankakee CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 8 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148549 None PERRY MEMORIAL FAMILY HEALTH 530 PARK AVENUE EAST PRINCETON, IL 61356 (815)876-4531 Bureau CLINIC 143949 * PHYSICIANS RURAL HEALTH CLINIC 3307 BROADWAY SUITE 130 MOUNT VERNON, IL 62864 (618)244-2560 Jefferson 143885 * PITTSFIELD RURAL HEALTH AFFILI 320 NORTH MADISON PITTSFIELD, IL 62363 (217)285-9601 Pike 148505 * PRAIRIE FAMILY MEDICINE & 122 EAST WABASH FORREST, IL 61741 (815)657-8707 Livingston OBSTETRICS 143883 * PRIMARY CARE GROUP 117 EAST CLARK HARRISBURG, IL 62946 (618)252-8625 Saline 148919 * QUINCY MEDICAL GROUP 231 W CHERRY ST WINCHESTER, IL 62694 (217)742-3117 Scott 148923 * QUINCY MEDICAL GROUP 405 E STATE STREET PLEASANT HILL, IL 62366 (217)734-2545 Pike 783819 * QUINCY MEDICAL GROUP 1025 MAINE STREET QUINCY, IL 62301 (217)222-6550 Adams 148900 * QUINCY MEDICAL GROUP BARRY 868 MORTIMER ST BARRY, IL 62312 (217)335-2343 Pike RURAL HEALTH AFFILIATE 783829 None RAYMOND RURAL HEALTH 801 N OBANNON ST RAYMOND, IL 62560 (217)229-3711 Montgomery 148964 * REGIONAL HEALTH PARTNERS LLC 1258 W SOUTH STREET SUITE 2 KEWANEE, IL 61443 (309)853-3677 Henry 148963 * REGIONAL HEALTH PARTNERS LLC 101 SOUTH GALENA STREET WYOMING, IL 61491 (309)695-6448 Stark 143496 * ROSSVILLE MEDICAL CLINIC 619 N CHICAGO STREET ROSSVILLE, IL 60963 (217)748-4141 Vermilion 143476 * RURAL HEALTH CENTER OF 132 WEST LORTON ROODHOUSE, IL 62082 (217)589-4629 Greene ROODHOUSE 143847 * RURAL HEALTH CLINIC OF 2 WEST ADMAS SULLIVAN, IL 61951 (217)728-8329 Moultrie MOULTRIE COUNTY LLC 148970 * S B JANI MD, PC 1106 OAK STREET MOUNT CARMEL, IL 62863 (618)263-6575 Wabash 148931 * SABEEHA HAQUE ALI MD LLC 102 N LOGAN STREET DANVILLE, IL 61832 (217)442-5863 Vermilion 143413 * SALEM TOWNSHIP HOSPITAL 1201 RICKER ROAD SALEM, IL 62881 (618)548-3194 Marion 148541 * SARAH BUSH LINCOLN HEALTH 910 SOUTH VAN BUREN STREET NEWTON, IL 62448 (618)783-3800 Jasper CENTER 148555 * SBL MARTINSVILLE CLINIC 890 RIDGELAWN ROAD MARTINSVILLE, IL 62442 (217)382-4191 Clark 148995 * SIU CARE-A-VAN 305 WEST JACKSON STREET, SUITE 200 CARBONDALE, IL 62901 (618)536-6621 Jackson

143958 * SLOAN MEDICAL CLINIC 7211 US HWY 45 SOUTH CARRIER MILLS, IL 62917 (618)252-8625 Saline 143862 * SOUTHERN IL UNIVERSITY FMLY PR 305 WEST JACKSON CARBONDALE, IL 62901 (618)536-6621 Jackson 783824 * SOUTHERN OB/GYN 9447 HOLY CROSS LANE BREESE, IL 62230 (618)526-2209 Clinton 783823 * SOUTHERN OB/GYN - HIGHLAND 100 WOODCREST DRIVE HIGHLAND, IL 62249 (618)654-4836 Madison 143464 * SPARTA COMMUNITY HOSPITAL, 1300 NORTH MARKET SPARTA, IL 62286 (618)443-4138 Randolph NORTH CAMPUS

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 9 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 143489 * SPARTA MEDICAL OFFICE 215 SOUTH BURNS AVENUE, PO BOX SPARTA, IL 62286 (618)443-2297 Randolph 378 783822 * SPRINGFIELD CLINIC JACKSONVILLE 610 N WESTGATE JACKSONVILLE, IL 62650 (217)245-9931 Morgan RURAL HEALTH 143907 * SPRINGFIELD CLINIC LLC DBA BRIAN 1280 EAST TREMONT HILLSBORO, IL 62049 (217)532-2320 Montgomery J CADY 148947 * SPRINGFIELD CLINIC LLP, DBA 20613 N BROAD STREET CARLINVILLE, IL 62626 (217)854-5099 Macoupin CARLINVILLE RURAL HLTH 148938 * SPRINGFIELD CLINIC RURAL 3 DO IT DRIVE ALTAMONT, IL 62411 (618)483-6131 Effingham HEALTH ALTAMONT 148997 * SPRINGFIELD CLINIC RURAL 300 NORTH MAPLE EFFINGHAM, IL 62401 (217)342-4151 Effingham HEALTH EFFINGHAM 783812 * SPRINGFIELD CLINIC RURAL 223 EAST SIXTH STREET NEOGA, IL 62447 (217)895-2320 Cumberland HEALTH NEOGA 783800 * SPRINGFIELD CLINIC RURAL 507 WEST WASHINGTON NEWTON, IL 62448 (618)783-5094 Jasper HEALTH NEWTON 143850 * SPRINGFIELD CLINIC TAYLORVILLE 1025 S 6TH STREET SPRINGFIELD, IL 62703 (217)824-8191 Sangamon 143887 * SPRINGFIELD CLINIC- HILLSBORO 1250 E TREMONT ST HILLSBORO, IL 62049 (217)532-6911 Montgomery 148928 * SPRINGFILED CLINC RURAL HEALTH 134 SOUTH CHURCH STREET LOUISVILLE, IL 62858 (618)665-4612 Clay LOUISVILLE 783802 * ST MARY'S GOOD SAMITAN FAMILY #8 CUSUMANO PLAZA MOUNT VERNON, IL 62864 (618)242-7819 Jefferson HEALTH CENTER 148974 * STAUNTON CLINIC, LLC 444 NORTH EDWARDSVILLE STREET STAUNTON, IL 62088 (618)635-3800 Macoupin 143467 * STEELVILLE CLINIC #9 STEELVILLE CLINIC STEELEVILLE, IL 62288 (618)965-3466 Randolph 143998 * SULLIVAN CLINIC 7 HAWTHORNE LANE SULLIVAN, IL 61951 (217)728-8441 Moultrie 143475 * THOMAS H BOYD RURAL HEALTH 800 SCHOOL STREET CARROLLTON, IL 62016 (217)942-3600 Greene CLINIC 148501 * WABASH GENERAL CONVENIENT 1418 COLLEGE DRIVE MOUNT CARMEL, IL 62863 (618)263-6331 Wabash CARE 148568 * WABASH PRIMARY CARE 1123 CHESTNUT STREET MOUNT CARMEL, IL 62863 (618)263-4376 Wabash ASSOCIATES 143472 * WASHINGTON COUNTY HEALTH 70 SOUTH GRAND AVENUE NASHVILLE, IL 62263 (618)327-2200 Washington CENTER 148510 * WEST FRANKFORT FAMILY 309 W ST LOUIS STREET WEST FRANKFORT, IL 62896 (618)932-2200 Franklin HEALTHCARE CLINIC 143454 * WEST FRANKFORT FAMILY 2553 KEN GRAY BLVD WEST FRANKFORT, IL 62896 (618)932-3937 Franklin PRACTICE * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 10 of 10 Illinois

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 148548 * WEST SALEM MEDICAL CENTER 100 SOUTH MAIN P O BOX 306 WEST SALEM, IL 62476 (618)456-3727 Edwards 143405 * WOMEN & FAMILY MEDICAL CENTER 630 LOCUS STREET CARTHAGE, IL 62321 (217)357-0617 Hancock 783826 * WOMENS HEALTH CENTER OF 505 E GRANT STREET SUITE 102 MACOMB, IL 61455 (309)833-5959 McDonough MACOMB Total Providers for this State = 223

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 Indiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 153907 None ACUTE MEDICAL CARE PC 1145 INDIANAPOLIS ROAD GREENCASTLE, IN 46135 (765)653-8453 Putnam 153869 * BRAZIL FAMILY MEDICINE 115 S MURPHY AVENUE, STE A BRAZIL, IN 47834 (812)442-2100 Clay 153896 * CAMBRIDGE CITY FAMILY MEDICINE 1 E CHURCH ST CAMBRIDGE CITY, IN 47327 (765)478-6108 Wayne 158519 None CANNELTON CLINIC 510 WASHINGTON STREET CANNELTON, IN 47520 (812)547-4176 Perry 153906 * CARLISLE MEDICAL CLINIC 8685 OLD HW 41 S CARLISLE, IN 47838 (812)398-5202 Sullivan 153804 * CLAY CITY CENTER FOR FAMILY 315 LANKFORD ST CLAY CITY, IN 47841 (812)939-2126 Clay MEDICINE 153891 * COMPREHENSIVE HEALTH CARE 420 W LONGEST ST PO BOX 270 PAOLI, IN 47454 (812)723-3944 Orange 153871 * COUNTRY HEALTH CENTER 5066 N 900 E MONTGOMERY, IN 47558 (812)486-3396 Daviess 153825 * CRAWFORD COUNTY FAMILY 5604 EAST WHITE OAK LANE MARENGO, IN 47140 (812)365-3221 Crawford HEALTHCARE CENTER 153903 * CRAWFORD COUNTY FAMILY 6402 EAST INDUSTRIAL LANE LEAVENWORTH, IN 47137 (877)291-6488 Crawford MEDICINE 153911 None CULLEN MEDICAL PROFESSIONALS 2005 STATE STREET, SUITE A WASHINGTON, IN 47501 (812)254-4650 Daviess 153859 * DALE FAMILY MEDICINE 4 W VINE ST PO BOX 599 DALE, IN 47523 (812)937-7140 Spencer 158506 * DAVIESS MARTIN MEDICAL CLINIC 12546 E US HWY 50 LOOGOOTEE, IN 47553 (812)295-5095 Martin 158501 * DCH HEALTH PAVILION QUICK CARE 1805 S STATE RD 57 WASHINGTON, IN 47501 (812)254-7845 Daviess CLINIC 158500 * DCH MEDICAL CLINIC 1402 GRAND AVE WASHINGTON, IN 47501 (812)254-6696 Daviess 153843 * DEACONESS CLINIC INC 106 W PIKE AVE PETERSBURG, IN 47567 (812)354-1052 Pike 153829 * DR ROBERT E JUDGE MD 1521 W MAIN ST BERNE, IN 46711 (260)589-2312 Adams 158513 None FAMILY MEDICINE OF CLOVERDALE 51 E MARKET STREET CLOVERDALE, IN 46120 (765)795-4242 Putnam 153868 * FAMILY PRACTICE ASSOCIATES OF 2229 MARY SHERMAN DR SULLIVAN, IN 47882 (812)268-3318 Sullivan SULLIVAN COUNTY 153883 * FOUNDATIONS FAMILY MEDICINE PC 25 W MAIN STREET AUSTIN, IN 47102 (812)794-8100 Scott

158502 * FRANCISCAN BROOK HEALTH 420 E MAIN ST PO BOX 118 BROOK, IN 47922 (219)275-2521 Newton CENTER 153990 * FRANCISCAN WHEATFIELD HEALTH 492 S BIERMA ST WHEATFIELD, IN 46392 (219)956-2110 Jasper CENTER 158507 * FRENCH LICK FAMILY MEDICINE 679 STATE HIGHWAY 145 FRENCH LICK, IN 47432 (812)936-6400 Orange 153904 * GOOD SAMARITAN HOSPITAL 611 EAST MAIN STREET, STE 110 PETERSBURG, IN 47567 (812)354-8426 Pike PHYSICIAN SERVICES INC 158503 * GRAND AVENUE PEDIATRICS 1402 GRAND AVE WASHINGTON, IN 47501 (812)257-0383 Daviess

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 Indiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 153886 * GREENE COUNTY GENERAL 1210 NORTH 1000 WEST LINTON, IN 47441 (812)847-7005 Greene HOSPITAL LLC 153837 * GREENE COUNTY HEALTH - 102 E MAIN ST WORTHINGTON, IN 47471 (812)875-2000 Greene WORTHINGTON 153821 * JOANNE GUTTMAN MD 11137 US HWY 52 STE B BROOKVILLE, IN 47012 (765)647-3547 Franklin 153870 * JOHN A EGLI MD PC 315 LEHMAN AVE TOPEKA, IN 46571 (260)593-2902 LaGrange 153864 * KENNETH D WATKINS MD 108 HOSPITAL DR WINCHESTER, IN 47394 (765)584-1639 Randolph 153979 * KENTLAND CLINIC 303 N 7TH KENTLAND, IN 47951 (219)474-5464 Newton 153987 * KNIGHTSTOWN FAMILY HEALTH 224 W MAIN ST KNIGHTSTOWN, IN 46148 (765)345-5572 Henry CARE 153809 * KNOX FAMILY PRACTICE 1520 S HEATON ST KNOX, IN 46534 (574)772-2188 Starke 153857 * LAPORTE CLINIC COMPANY LLC 104 CULVER ROAD, SUITE 102 KNOX, IN 46534 (574)772-7918 Starke 158508 * LOOGOOTEE FAMILY MEDICINE 105 COOPER STREET LOOGOOTEE, IN 47553 (812)295-2812 Martin 153860 * MARTIN COUNTY HEALTH CENTER 229 HIGH ST SHOALS, IN 47581 (812)247-2733 Martin 153912 None MCV PEDIATRICS 528 N 1ST STREET VINCENNES, IN 47591 (812)882-4434 Knox 153890 * MONTGOMERY MEDICAL 542 N 3RD ST MONTGOMERY, IN 47558 (812)486-2842 Daviess ASSOCIATES LLC 153828 * MONTICELLO MEDICAL CENTER 826 N SIXTH ST MONTICELLO, IN 47960 (574)585-3333 White 153908 None NEW CASTLE FAMILY AND INTERNAL 2200 FOREST RIDGE PKWY NEW CASTLE, IN 47362 (765)599-3400 Henry MEDICINE 153863 * NEW CASTLE PEDIATRICS 1000 N 16TH ST STE G-10 NEW CASTLE, IN 47362 (765)521-0901 Henry 153999 * NORTH DAVIESS MEDICAL CLINIC 202 N WEST ST ODON, IN 47562 (812)636-7300 Daviess 158514 None NORTH PUTNAM FAMILY 440 EAST PAT RADY WAY BAINBRIDGE, IN 46105 (765)522-2556 Putnam HEALTHCARE 158511 * OSGOOD PRIMARY CARE 112 N BUCKEYE STREET OSGOOD, IN 47037 (812)689-3424 Ripley 153850 * PATOKA FAMILY HEALTH CARE 307 S INDIANA AVE ENGLISH, IN 47118 (812)338-2924 Crawford CENTER 158517 None PERRY COUNTY FAMILY PRACTICE 18485 STATE ROAD 37 LEOPOLD, IN 47551 (812)843-3038 Perry 153872 * PETERSBURG FAMILY MEDICINE 1003 E ILLINOIS ST PETERSBURG, IN 47567 (812)354-3458 Pike 153816 * PREMIER HEALTHCARE LLC 1043 N 1000 W LINTON, IN 47441 (812)847-4481 Greene 153913 None PRIMARY CARE CLINIC 429 S 6TH STREET VINCENNES, IN 47591 (812)885-3703 Knox 158512 None PULASKI MEMORIAL HOSPITAL 540 HOSPITAL DRIVE WINAMAC, IN 46996 (574)946-2194 Pulaski MEDICAL AND SURGICAL GRO 158515 None PUTNAM PEDIATRICS AND 1542 S BLOOMINGTON STREET GREENCASTLE, IN 46135 (765)658-2700 Putnam INTERNAL MEDICINE * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 Indiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 153823 * REDI-CARE INC PC 2120 N DETROIT ST LAGRANGE, IN 46761 (260)463-2468 LaGrange 153914 None SCOTTSBURG FAMILY PRACTICE 1465 NORTH GARDNER STREET SCOTTSBURG, IN 47170 (812)752-0001 Scott 153882 * ST LUKE'S MEDICAL MINISTRY PC 1441 N GARDNER SCOTTSBURG, IN 47170 (812)752-4055 Scott 153887 * ST VINCENT MEDICAL GROUP INC 301 N HENRY ST NORTH VERNON, IN 47265 (812)352-4300 Jennings 153897 * ST VINCENT MEDICAL GROUP INC 301 HENRY ST BLDG B NORTH VERNON, IN 47265 (812)352-4300 Jennings 153879 * ST VINCENT MEDICAL GROUP INC 330 WEST DEERFIELD ROAD UNION CITY, IN 47390 (317)964-6200 Randolph 153881 * ST VINCENT MEDICAL GROUP, INC 409 GREENVILLE AVE WINCHESTER, IN 47394 (765)584-0480 Randolph 153993 * ST VINCENT NORTH CLINIC 1731 RINGER LN WILLIAMSPORT, IN 47993 (765)762-4170 Warren 153994 * ST VINCENT SOUTH CLINIC 440 W SONGER LN VEEDERSBURG, IN 47987 (765)762-4180 Fountain 153905 * STROUD MEDICAL 1401 MEMORIAL AVENUE, SUITE C WASHINGTON, IN 47501 (812)254-4399 Daviess 153862 * SWITZERLAND COUNTY NURSE 727 US HWY 56 STE 300 VEVAY, IN 47043 (812)427-4038 Switzerland MANAGED CLINIC 158516 None TELL CITY CLINIC 109 EAST US HIGHWAY 66 TELL CITY, IN 47586 (812)547-3447 Perry 153853 * THOMAS L MILLER MD 1500 W MAUMEE ANGOLA, IN 46703 (260)665-8494 Steuben 158518 None TROY CLINIC 315 MAIN STREET TROY, IN 47588 (812)547-9552 Spencer 153909 * UNION COUNTY HEALTH 6 WEST SOUTH STREET SUITE 2 LIBERTY, IN 47353 (765)458-5393 Union DEPARTMENT 153902 * VALLEY HEALTH 9529 WEST STATE ROAD 56 FRENCH LICK, IN 47432 (812)936-2425 Orange Total Providers for this State = 67

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 233823 * ALLEGAN MEDICAL CLINIC PC 551 LINN ST ALLEGAN, MI 49010 (616)673-8402 Allegan 238637 * ALMA INTERNAL MEDICINE 200 E WARWICK DRIVE ALMA, MI 48801 (989)463-5876 Gratiot 233900 * ALPENA MEDICAL ARTS PC 211 LONG RAPIDS RD ALPENA, MI 49707 (989)354-2142 Alpena 238680 None ASPIRUS CRYSTAL FALLS CLINIC 1328 US HIGHWAY 2 CRYSTAL FALLS, MI 49920 (906)875-4486 Iron 238661 None ASPIRUS GRAND VIEW CLINIC N10565 GRAND VIEW LN IRONWOOD, MI 49938 (906)932-1500 Gogebic 238617 * ASPIRUS HOUGHTON CLINIC 1000 CEDAR ST HOUGHTON, MI 49931 (906)487-1710 Houghton 238552 * ASPIRUS KEWEENAW LAKE LINDEN 110 CALUMET ST LAKE LINDEN, MI 49945 (906)337-5040 Houghton CLINIC 238653 None ASPIRUS KEWEENAW LAURIUM 300 HECLA ST LAURIUM, MI 49913 (906)337-9355 Houghton WELLNESS 238598 * ASPIRUS ONTONAGON FAMILY 601 SOUTH SEVENTH STREET ONTONAGON, MI 49953 (906)884-4134 Ontonagon PRACTICE CLINIC 238650 None BAY CARE MEDICAL CENTER 1500 SAND POINT RD MUNISING, MI 49862 (906)387-4338 Alger 238646 * BCMH PHYSICIAN GROUP 18341 US HIGHWAY 41 L' ANSE, MI 49946 (906)524-6118 Baraga 233813 * BEAVER ISLAND RURAL HEALTH 37304 KINGS HIGHWAY BEAVER ISLAND, MI 49782 (231)448-2275 Charlevoix CENTER 238901 * BOARDMAN FAMILY PRACTICE 4713 PINE STREET SOUTH BOARDMAN, MI 49680 (231)369-2656 Kalkaska 238595 * BORGESS FAMILY MEDICINE 345 NAOMI STREET PLAINWELL, MI 49080 (616)692-6661 Allegan 238544 * BORGESS LEE MEDICAL GROUP 520 MAIN STREET SUITE A DOWAGIAC, MI 49047 (269)783-3052 Cass 238580 * BORGESS LEE MEDICAL GROUP 520 MAIN STREET SUITE C DOWAGIAC, MI 49047 (269)783-2080 Cass 238578 * BORGESS LEE MEDICAL GROUP 117 SOUTH BROADWAY STREET CASSOPOLIS, MI 49031 (269)445-0771 Cass 238626 * BORGESS LEE MEDICAL GROUP 400 W DIVISION ST DOWAGIAC, MI 49047 (269)782-2111 Cass DIVISION STREET CLINIC 233870 * BORGESS WOMEN'S HEALTH 671 ALLEGAN PLAINWELL, MI 49080 (616)685-1777 Allegan 238665 None BOYNE AREA MEDICAL CENTER 223 N PARK ST BOYNE CITY, MI 49712 (231)582-5314 Charlevoix 238546 * BRONSON LAKEVIEW FAMILY CARE - 319 W DELAWARE ST DECATUR, MI 49045 (616)423-7028 Van Buren DECATUR 238613 * BRONSON LAKEVIEW FAMILY CARE - 52375 N MAIN STREET MATTAWAN, MI 49071 (269)657-0243 Van Buren MATTAWAN 238601 * BRONSON LAKEVIEW FAMILY CARE - 451 HEALTH PARKWAY PAW PAW, MI 49079 (269)657-2550 Van Buren PAW PAW 238635 * CADILLAC PRIMARY CARE & OB/GYN 7985 MACKINAW TRAIL CADILLAC, MI 49601 (231)876-6100 Wexford 238932 None CARO HEALTH PLAZA 1525 W CARO ROAD CARO, MI 48723 (989)672-2100 Tuscola 238669 None CASS CITY FAMILY PRACTICE 4675 HILL STREET CASS CITY, MI 48726 (989)872-8303 Tuscola

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 238649 None CASS CITY MEDICAL PRACTICE 4675 HILL STREET CASS CITY, MI 48726 (989)872-8202 Tuscola 238688 None CENTER FOR OBSTETRICS & 315 E WARWICK DR STE D ALMA, MI 48801 (989)466-5486 Gratiot GYNECOLOGY 238917 * CHARLES R BARKER JR DO FAMILY 1320 W STATE ST, 3A BELDING, MI 48809 (616)794-1810 Ionia PRACTICE PC 238603 * COLOMA MEDICAL CENTER 6701 PAW PAW AVENUE COLOMA, MI 49038 (269)468-0015 Berrien 238672 None COLON MEDICAL CLINIC 111 SAINT JOSEPH STREET COLON, MI 49040 (269)432-3221 St. Joseph 238541 * COMMUNITY CARE CLINIC 509 OSBORNE BLVD SAULT SAINTE MARIE, MI (906)635-4401 Chippewa 49783 238615 * COMMUNITY HEALTH CENTER 358 EAST CHICAGO STREET, SUITE 202 COLDWATER, MI 49036 (517)279-5252 Branch PEDIATRIC & ADOLESCENT CTR 238605 * COMMUNITY MEDICAL CENTER 400 MEDICAL PARK DRIVE WATERVLIET, MI 49098 (269)463-3600 Berrien 238540 * DCHS AFTER HOURS CLINIC 1721 S STEPHENSON AVE IRON MOUNTAIN, MI 49801 (906)776-5660 Dickinson 238666 None DECKERVILLE HEALTHCARE 2433 BLACK RIVER ST DECKERVILLE, MI 48427 (810)376-2835 Sanilac SERVICES INC 238687 * DECKERVILLE MAIN STREET CLINIC 3532 MAIN STREET DECKERVILLE, MI 48427 (810)376-3100 Sanilac 238643 * DICKINSON FAMILY AND GERIATRIC 500 MAIN ST NORWAY, MI 49870 (906)563-9255 Dickinson CLINIC 238559 * DICKINSON FAMILY PRACTICE 844 PYLE DR KINGSFORD, MI 49801 (906)774-6383 Dickinson CENTER 238654 None DICKINSON FAMILY PRACTICE N1667 US HIGHWAY 8 NORWAY, MI 49870 (906)776-5648 Dickinson CENTER-NORWAY 238656 None DICKINSON INTERNAL 1711 SOUTH STEPHENSON AVE IRON MOUNTAIN, MI 49801 (906)776-5648 Dickinson MEDICINE/NEPHROLOGY CLINIC 238690 None DICKINSON OB/GYN CLINIC 1001 S HEMLOCK ST IRON MOUNTAIN, MI 49801 (906)776-5982 Dickinson 238634 * DICKINSON PEDIATRIC CLINIC 1711 S STEPHENSON AVE SUITE 210 IRON MOUNTAIN, MI 49801 (906)776-5800 Dickinson 233869 * EASTSIDE FAMILY MEDICAL 8540 105TH AVENUE STANWOOD, MI 49346 (231)972-2710 Mecosta 238633 * EATON RAPIDS MEDICAL CENTER 1500 S MAIN ST EATON RAPIDS, MI 48827 (517)857-4500 Eaton FAMILY PRACTICE 238906 * FAIRVIEW CLINIC, PLC 1910 E MILLER RD FAIRVIEW, MI 48621 (989)848-5644 Oscoda 233944 * FAMILY HEALTH & WELLNESS 129 W BROWN STREET BEAVERTON, MI 48612 (989)435-2937 Gladwin 238577 * FAMILY HEALTHCARE OF BROWN 4472 MAIN STREET BROWN CITY, MI 48416 (810)346-2751 Sanilac CITY 238671 None FAMILY HEALTHCARE OF CASS CITY 6230 HOSPITAL DRIVE CASS CITY, MI 48726 (989)872-2410 Tuscola 238521 * FAMILY MEDICAL CARE - 302 W CHESTNUT BRECKENRIDGE, MI 48615 (989)842-3118 Gratiot BRECKENRIDGE * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 238618 * FAMILY MEDICAL CARE ITHACA 121 N PINE RIVER STREET ITHACA, MI 48847 (989)875-5111 Gratiot 238545 * FAMILY MEDICINE CENTER 370 EAST CHICAGO STREET COLDWATER, MI 49036 (517)279-5378 Branch 233981 * GIBSON FAMILY HEALTH CENTER 502 W HARRIE ST NEWBERRY, MI 49868 (906)293-9233 Luce 238561 * GRAYLING COMMUNITY HEALTH 1250 E MICHIGAN AVE GRAYLING, MI 49738 (989)348-1212 Crawford CENTER 238538 * HALE ST JOSEPH FAMILY CLINIC 116 S CHURCH HALE, MI 48739 (989)728-4334 Iosco 233903 * HEALTH SPECIALISTS OF LENAWEE 6869 OCCIDENTAL HWY TECUMSEH, MI 49286 (517)423-4777 Lenawee 233845 * HILLSDALE MEDICAL ASSOCIATES 1456 HUDSON RD HILLSDALE, MI 49242 (517)439-0200 Hillsdale 233967 * HONOR FAMILY PRACTICE 10524 MAIN STREET HONOR, MI 49640 (231)325-2277 Benzie 238584 * INTERNAL MEDICINE SERVICES 740 SOUTH MAIN STREET CHEBOYGAN, MI 49721 (231)627-7118 Cheboygan 233882 * IONIA FAMILY PRACTICE 330 LOVELL IONIA, MI 48846 (616)527-5732 Ionia 238927 None JONESVILLE HEALTHCARE 216 OLDS STREET JONESVILLE, MI 49250 (517)849-7100 Hillsdale 233975 * KALKASKA MEMORIAL HEALTH 419 S CORAL KALKASKA, MI 49646 (616)258-7500 Kalkaska CENTER 238551 * KEWEENAW MEMORIAL LAURIUM 205 OSCEOLA STREET LAURIUM, MI 49913 (906)337-6560 Houghton CLINIC 238582 * KINGSTON FAMILY HEALTHCARE 5988 STATE ST KINGSTON, MI 48741 (989)683-2221 Tuscola 238670 None KINGSTON FAMILY PRACTICE 5854 STATE STREET KINGSTON, MI 48741 (989)683-8065 Tuscola 238624 * LAKESHORE MEDICAL CENTER- 71 BEVIER ST SHELBY, MI 49455 (231)861-2187 Oceana SHELBY 238639 * LONG RAPIDS FAMILY CARE 393 LONG RAPIDS ROAD ALPENA, MI 49707 (989)356-0504 Alpena 233979 * MACKINAC STRAITS RURAL HEALTH 1140 NORTH STATE STREET SAINT IGNACE, MI 49781 (906)643-7999 Mackinac CLINIC 238651 None MACKINAW CITY MEDICAL CLINIC 420 S NICOLET ST MACKINAW CITY, MI 49701 (231)436-9900 Cheboygan 233940 * MACKINAW TRAIL PEDIATRICS 7917 MACKINAW TRAIL CADILLAC, MI 49601 (231)779-9700 Wexford 233811 * MANCELONA FAMILY PRACTICE 419 W STATE ST MANCELONA, MI 49659 (231)587-9181 Antrim 238610 * MANISTIQUE LAKES FAMILY CLINIC W 17530 CO RD 4-42 CURTIS, MI 49820 (906)586-3300 Mackinac 238689 None MARLETTE FAMILY HEALTHCARE 2750 MAIN STREET, SUITE #2 MARLETTE, MI 48453 (989)635-4614 Sanilac 233837 * MARQUETTE GENERAL HOSPITAL E 2995 STATE HWY M67 TRENARY, MI 49891 (906)446-3336 Alger FAMILY MEDICINE TRENARY 233885 * MARQUTTE GENERAL HOSPITAL 800 EAST BOULEVARD KINGSFORD, MI 49801 (906)774-4000 Dickinson KINGSFORD CLINIC 238575 * MAYVILLE FAMILY HEALTHCARE 2180 OHMER ROAD MAYVILLE, MI 48744 (989)843-5135 Tuscola 238537 * MCKENZIE RURAL HEALTH CLINIC 75 DAWSON STREET SANDUSKY, MI 48471 (810)648-6160 Sanilac

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 233846 * MCLAREN NORTHERN MICHIGAN 124 AMES ELK RAPIDS, MI 49629 (231)264-8282 Antrim ELK RAPIDS FAMILY MEDICI 233852 * MEDICS PC 220 N ENSLEY HOWARD CITY, MI 49329 (231)937-6226 Montcalm 233850 * MEDICS PC 1131 E M-46 EDMORE, MI 48829 (989)427-5070 Montcalm 238921 * MEMORIAL HEALTHCARE 1975 W M 21, ST 104 OWOSSO, MI 48867 (989)725-8171 Shiawassee 238918 * MEMORIAL HEALTHCARE 9099 E LANSING ROAD DURAND, MI 48429 (989)288-2651 Shiawassee 233861 * MENOMINEE MEDICAL CLINIC 1100 TENTH ST MENOMINEE, MI 49858 (906)863-7897 Menominee 238623 * MERCY HEALTH PHYSICIAN 905 E COLBY ST WHITEHALL, MI 49461 (231)728-5910 Muskegon PARTNERS LAKESHORE MEDICAL 238627 * MERCY HEALTH PHYSICIAN 611 EAST MAIN STREET HART, MI 49420 (231)873-5675 Oceana PARTNERS-HART FAMILY MEDICA 238678 None MERCY HEALTH PHYSICIANS 5656 US HIGHWAY 10 LUDINGTON, MI 49431 (231)843-2543 Mason PARTNERS-SABLE POINT FAMIL 233872 * MI-WI FAMILY PRACTICE 1711 S STEPHENSON AVE SUITE 300 IRON MOUNTAIN, MI 49801 (906)774-1633 Dickinson ASSOCIATES PC 238645 * MIDMICHIGAN HEALTH PARK - MT 4851 E PICKARD ST MOUNT PLEASANT, MI 48858 (989)775-1610 Isabella PLEASANT 238681 None MIDMICHIGAN HEALTH PARK - WEST 640 COURT STREET WEST BRANCH, MI 48661 (989)345-8120 Ogemaw BRANCH 238640 * MIDMICHIGAN MEDICAL CLINIC 815 N CLARE AVE HARRISON, MI 48625 (989)539-2114 Clare HARRISON 238644 * MIDMICHIGAN MEDICAL OFFICE 2812 W CADILLAC DR FARWELL, MI 48622 (989)802-5050 Clare FARWELL 238642 * MIDMICHIGAN MEDICAL OFFICE- 602 BEECH STREET CLARE, MI 48617 (989)802-8730 Clare CLARE 238659 None MIDMICHIGAN MEDICAL OFFICES 212 W 6TH STREET CLARE, MI 48617 (989)802-8445 Clare SIXTH/MAPLE 238641 * MIDMICHIGAN MEDICAL OFFICES- 609 QUARTER STREET GLADWIN, MI 48624 (989)246-6490 Gladwin GLADWIN 238625 * MIDMICHIGAN URGENT CARE - 700 WEST 5TH STREET CLARE, MI 48617 (989)386-9911 Clare CLARE 238522 * MIDMICHIGAN URGENT CARE ALMA 321 WARWICK DRIVE ALMA, MI 48801 (989)466-3348 Gratiot 238558 * NORDIC MEDICAL CENTER 4243 WEST M-69, BOX 139 FELCH, MI 49831 (906)246-3800 Dickinson 233935 * NORTH REACH HEALTHCARE - 106 S SCHOOL RD, BOX 37 DAGGETT, MI 49821 (906)753-2155 Menominee DAGGETT MEDICAL CLINIC 233937 * NORTHERN PINES HEALTH CENTER 11293 NORTH M37, SUITE A BUCKLEY, MI 49620 (231)269-4185 Wexford

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 233974 * OAKLAWN MEDICAL GROUP HOMER 420 SOUTH HILLSDALE HOMER, MI 49245 (616)789-8814 Calhoun 238620 * OMH MEDICAL GROUP LEWISTON 3040 BOURN STREET LEWISTON, MI 49756 (989)786-4877 Montmorency RHC 238662 None OMH MEDICAL GROUP-BOYNE 2572 N US HIGHWAY 131 ELMIRA, MI 49730 (989)731-7700 Otsego VALLEY RHC 238660 None OMH MEDICAL GROUP-INDIAN 3860 S STRAITS HIGHWAY INDIAN RIVER, MI 49749 (231)238-0581 Cheboygan RIVER RHC 238590 * OSF MEDICAL GROUP - ESCANABA 3409 LUDINGTON ST ESCANABA, MI 49829 (906)789-4040 Delta 238589 * OSF MEDICAL GROUP - GLADSTONE 128 MICHIGAN AVE GLADSTONE, MI 49837 (906)428-3273 Delta 238616 * OSF ST FRANCIS HOSPITAL N 15995 MAIN STREET POWERS, MI 49874 (906)497-4360 Menominee MEDICAL GROUP-POWERS CLINI 238606 * OTSEGO MEMORIAL HOSPITAL 1996 WALDEN DRIVE GAYLORD, MI 49735 (989)731-4111 Otsego MEDCARE RURAL HEALTH CLIN 238607 * OTSEGO MEMORIAL HOSPITAL 825 NORTH CENTER AVENUE GAYLORD, MI 49735 (989)731-7708 Otsego RURAL HEALTH CLINIC 233997 * PEDIATRIC & ADOLESCENT 245 S SECOND ST CARSON CITY, MI 48811 (989)584-3981 Montcalm SPECIALISTS 233932 * PEDIATRIC CENTER OF ADRIAN 770 RIVERSIDE AVE, SUITE 17 ADRIAN, MI 49221 (517)265-8134 Lenawee 233939 * PERRY FAMILY PRACTICE 3337 W BRITTON RD PERRY, MI 48872 (517)625-3004 Shiawassee 233873 * PRESCOTT CLINIC PC 125 WASHINGTON STREET PRESCOTT, MI 48756 (989)873-3352 Ogemaw 233928 * PRIMARY CARE 5170 RIFLE RIVER TRAIL ALGER, MI 48610 (989)873-5323 Ogemaw 233821 * PRIMARY CARE 2990 CAMPBELL ROAD ROSE CITY, MI 48654 (989)685-6969 Ogemaw 238916 * PRIMARY CARE ASSOCIATES OF 100 E CHICAGO STREET JONESVILLE, MI 49250 (517)849-9090 Hillsdale JONESVILLE LLC 238902 * PRIMARY CARE INC 558 LOCKWOOD LANE MIO, MI 48647 (989)826-3271 Oscoda 233842 * PRIMARY CARE, INC 2331 PROGRESS, SUITE D, PO BOX 340 WEST BRANCH, MI 48661 (989)345-1184 Ogemaw 233820 * PRIMARY CARE, INC 1360 NORTH ST HELEN ROAD SAINT HELEN, MI 48656 (989)389-4944 Roscommon 233954 * PRIMARY HEALTH SERVICES, PC 505 W LUDINGTON AVENUE LUDINGTON, MI 49431 (231)843-8452 Mason 238562 * PRUDENVILLE COMMUNITY HEALTH 2585 W HOUGHTON LAKE DR PRUDENVILLE, MI 48651 (517)422-2400 Roscommon CENTER 233956 * RANDALL STREET MEDICAL, PC 675 WEST RANDALL STREET COOPERSVILLE, MI 49404 (616)837-9777 Ottawa 238699 * READING HEALTH CLINIC 143 SOUTH MAIN STREET READING, MI 49274 (517)283-1772 Hillsdale 233864 * RIVERSIDE MEDICAL ASSOCIATES 560 OSBORN BLVD SAULT SAINTE MARIE, MI (906)632-1800 Chippewa PC 49783

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 238573 * ROSCOMMON COMMUNITY HEALTH 234 LAKE ST ROSCOMMON, MI 48653 (989)348-0448 Roscommon CENTER 233998 * SAINT MARY'S STANDISH 441 WEST CEDAR STANDISH, MI 48658 (989)846-4521 Arenac COMMUNITY HOSP RHC 233977 * SCHEURER FAMILY MEDICAL 168 N CASEVILLE RD PIGEON, MI 48755 (989)453-2141 Huron CENTER 238588 * SCHOOLCRAFT MEMORIAL 7870 W US HIGHWAY 2 MANISTIQUE, MI 49854 (906)341-2153 Schoolcraft HOSPITAL RURAL HEALTH CLINIC 238565 * SHERIDAN CARE CLINIC 303 CONGRESS STREET, SUITE B SHERIDAN, MI 48884 (517)291-5077 Montcalm 238682 None SMG MUIR 1044 HAYDEN RD MUIR, MI 48860 (989)855-2755 Ionia 238631 * SMG PORTLAND 9751 EAST GRAND RIVER AVENUE, PORTLAND, MI 48875 (517)641-7672 Ionia SUITE 1 238591 * SMG PRACTICE 1717 EAST CHICAGO ROAD, SUITE 2 STURGIS, MI 49091 (269)651-1471 St. Joseph 238698 None SMG SARANAC 107 N BRIDGE ST SARANAC, MI 48881 (616)642-9408 Ionia 238533 * SOUTH HAVEN COMMUNITY 520 RAILROAD ST BANGOR, MI 49013 (269)427-5811 Van Buren HOSPITAL COOPER MEDICAL CLIN 233987 * SOUTH HAVEN COMMUNITY 965 S BAILEY AVE SOUTH HAVEN, MI 49090 (269)639-2810 Van Buren HOSPITAL RHC 238664 * SOUTHWESTERN MEDICAL CLINIC 2002 SOUTH ELEVENTH STREET NILES, MI 49120 (269)687-0200 Berrien 238550 * SPARROW IONIA HOSPITAL 550 EAST WASHINGTON STREET SUITE IONIA, MI 48846 (616)527-4290 Ionia 101 233996 * SPARROW MEDICAL GROUP - 1014 E WASHINGTON ST GREENVILLE, MI 48838 (616)754-7145 Montcalm GREENVILLE 238673 None SPARROW MEDICAL GROUP LYONS 505 E BRIDGE STREET LYONS, MI 48851 (989)855-3345 Ionia 238518 * SPARROW MEDICAL GROUP- 320 S STERLING ST ASHLEY, MI 48806 (989)847-2621 Gratiot ASHLEY 233994 * SPARROW MEDICAL GROUP- 102 S THIRD, SUITE 100 CARSON CITY, MI 48811 (989)584-1308 Montcalm CARSON 238517 * SPARROW MEDICAL GROUP- 114 N MAIN ST ITHACA, MI 48847 (989)875-4166 Gratiot ITHACA 238667 None SPECTRUM HEALTH BIG RAPIDS 8354 100TH AVE, STE 1 STANWOOD, MI 49346 (231)972-6000 Mecosta HOSPITAL FAMILY MEDICIN 238652 * SPECTRUM HEALTH BIG RAPIDS 650 LINDEN STREET, SUITE 1 BIG RAPIDS, MI 49307 (231)796-3200 Mecosta HOSPITAL FAMILY MEDICIN 238677 None SPECTRUM HEALTH BIG RAPIDS 722 LOCUST STREET BIG RAPIDS, MI 49307 (231)592-4200 Mecosta HOSPITAL OBSTETRICS AND

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 238686 None SPECTRUM HEALTH FAMILY 500 N HANCOCK STREET PENTWATER, MI 49449 (231)869-7051 Oceana MEDICINE-PENTWATER 238685 None SPECTRUM HEALTH GERBER 211 W PINE LAKE DRIVE NEWAYGO, MI 49337 (231)652-1631 Newaygo MEMORIAL FAMILY MEDICINE 238632 * SPECTRUM HEALTH GERBER 204 W MAIN STREET FREMONT, MI 49412 (231)924-1800 Newaygo MEMORIAL FAMILY MEDICINE-FR 238572 * SPECTRUM HEALTH GERBER 230 S MAPLE ST GRANT, MI 49327 (231)834-5995 Newaygo MEMORIAL FAMILY MEDICINE-GR 233990 * SPECTRUM HEALTH GERBER 78 N DIVISION HESPERIA, MI 49421 (616)854-6415 Oceana MEMORIAL FAMILY MEDICINE-HE 238684 None SPECTRUM HEALTH GERBER 230 W OAK STREET FREMONT, MI 49412 (231)942-4200 Newaygo MEMORIAL MULTISPECIALITY 238636 * SPECTRUM HEALTH GERBER 212 S SULLIVAN AVE FREMONT, MI 49412 (231)924-1212 Newaygo MEMORIAL OBSTETRICS AND GYN 238683 None SPECTRUM HEALTH LUDINGTON 922 LAWNDALE ST LUDINGTON, MI 49431 (231)845-2251 Mason HOSPITAL FAMILY AND INTE 238676 None SPECTRUM HEALTH LUDINGTON 2481 N 72ND AVENUE HART, MI 49420 (231)873-2163 Oceana HOSPITAL FAMILY MEDICINE 238696 None SPECTRUM HEALTH LUDINGTON 5 N ATKINSON DR, SUITE 207 LUDINGTON, MI 49431 (231)843-3600 Mason HOSPITAL INTERNAL MEDICI 238695 None SPECTRUM HEALTH LUDINGTON 250 N NELSON RD LUDINGTON, MI 49431 (231)843-6767 Mason HOSPITAL OBSTETRICS & GY 238701 None SPECTRUM HEALTH PENNOCK 12851 W M-179 HIGHWAY WAYLAND, MI 49348 (877)377-7322 Allegan FAMILY MEDICINE-GUN LAKE 238679 None SPECTRUM HEALTH PENNOCK 2776 S STATE RD IONIA, MI 48846 (616)775-7500 Ionia FAMILY MEDICINE-IONIA 238675 None SPECTRUM HEALTH PENNOCK 4294 LAUREL DRIVE LAKE ODESSA, MI 48849 (616)374-7660 Ionia FAMILY MEDICINE-LAKE ODESS 238700 None SPECTRUM HEALTH PENNOCK 1108 WEST GREEN STREET, SUITE 3 HASTINGS, MI 49058 (269)945-0922 Barry FAMILY, INTERNAL & PEDIATR 238697 None SPECTRUM HEALTH PENNOCK 1005 W GREEN STREET, SUITE 301 HASTINGS, MI 49058 (269)945-8080 Barry OBSTETRICS & GYNECOLOGY-HA 238594 * SPECTRUM HEALTH REED CITY 5991 S 95TH AVENUE EVART, MI 49631 (616)734-5561 Osceola CAMPUS 238504 * SPECTRUM HEALTH REED CITY 300 N PATTERSON ROAD REED CITY, MI 49677 (616)832-3271 Osceola HOSPITAL 238621 * SPECTRUM HEALTH REED CITY 111 EAST CHURCH STREET TUSTIN, MI 49688 (231)829-3423 Osceola HOSPITAL TUSTIN FAMILY P * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 8 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 238668 None SPECTRUM HEALTH UNITED 1227 W STATE ST BELDING, MI 48809 (616)794-0940 Ionia HOSPITAL BELDING FAMILY MED 238648 * SPECTRUM HEALTH UNITED 1202 WEST OAK STREET GREENVILLE, MI 48838 (616)754-2944 Montcalm HOSPITAL FAMILY MEDICINE 238691 None SPECTRUM HEALTH UNITED 707 S GREENVILLE WEST DR GREENVILLE, MI 48838 (231)832-8509 Montcalm HOSPITAL INTERNAL MEDICINE 238647 None SPECTRUM HEALTH UNITED 418 WASHINGTON ST LAKEVIEW, MI 48850 (989)352-6474 Montcalm HOSPITAL LAKEVIEW FAMILY ME 238614 * SPRINGPORT MEDICAL CLINIC 400 EAST MAIN STREET SUITE 200 SPRINGPORT, MI 49284 (517)857-4500 Jackson 233985 * ST JOESPH HEALTH SYSTEMS 5935 N HURON ROAD - OSCODA OSCODA, MI 48750 (989)739-1441 Iosco OSCODA HEALHT PARK & AFTE HEALTH PARK 238570 * ST JOSEPH HEALTH SYSTEM 3210 E HURON RD AU GRES, MI 48703 (989)876-7104 Arenac AUGRES FAMILY CLINIC 233986 * ST JOSEPH HEALTH SYSTEM 295 MAPLE ST TAWAS CITY, MI 48763 (989)362-6108 Iosco INTERNAL MEDICINE CLINIC 238534 * ST JOSEPH HEALTH SYSTEM 25 E M-55 TAWAS CITY, MI 48763 (989)362-2540 Iosco WOMENS CLINIC 233991 * ST JOSEPH HURON FAMILY 700 EAST GERMAN STREET TAWAS CITY, MI 48763 (989)362-4470 Iosco MEDICINE CLINIC 238911 * ST JOSEPH PEDIATRICS 325 M-55 TAWAS CITY, MI 48763 (989)984-3770 Iosco 238608 * ST LOUIS FAMILY CLINIC 224 N MILL ST SAINT LOUIS, MI 48880 (989)681-3524 Gratiot 238604 * STAGG MEDICAL CENTER 525 SOUTH CENTER STREET HARTFORD, MI 49057 (269)621-4063 Van Buren 238566 * STANTON 1ST CARE 620 W MAIN STREET STANTON, MI 48888 (517)831-7200 Montcalm 238574 * STANTON FAMILY CARE CENTER 545 N STATE ST STANTON, MI 48888 (517)831-8301 Montcalm 238597 * STURGIS PEDIATRIC AND WOMENS 1555 E CHICAGO RD STURGIS, MI 49091 (269)651-7114 St. Joseph CENTER 233906 * SUPERIOR FAMILY MEDICAL ASSOC 550 OSBORN BLVD SAULT SAINTE MARIE, MI (906)632-0370 Chippewa 49783 233835 * TAWAS BAY FAMILY PRACTICE 541 LAKE ST TAWAS CITY, MI 48764 (989)362-3447 Iosco 238599 * THREE RIVERS HEALTH FAMILY 721 SIXTH AVE, SUITE A THREE RIVERS, MI 49093 (269)273-9749 St. Joseph CARE THREE RIVER 238506 * THREE RIVERS HEALTH FAMILY 601 E CHICAGO RD WHITE PIGEON, MI 49099 (269)483-7624 St. Joseph CARE WHITE PIGEON 238655 None THREE RIVERS HEALTH FAMILY, 711 S HEALTH PARKWAY, SUITE 1 THREE RIVERS, MI 49093 (269)273-8557 St. Joseph INTERNAL MEDICINE AND 238602 * THUMB PEDIATRICS 6190 HOSPITAL DRIVE CASS CITY, MI 48726 (989)872-8503 Tuscola

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 9 of 9 Michigan

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 238586 * UBLY FAMILY PRACTICE/WALK-IN 2269 MAIN STREET UBLY, MI 48475 (989)658-2159 Huron CLINIC 238593 * UNION CITY MEDICAL CENTER 624 WEST M 60 UNION CITY, MI 49094 (517)741-7989 Branch 233919 * WELLSTON MEDICAL CENTER 17081 CABERFAE HWY WELLSTON, MI 49689 (616)848-4777 Manistee 238611 * WEST MACKINAC HEALTH CLINIC W 14034 MELVILLE ROAD ENGADINE, MI 49827 (906)477-6066 Mackinac 238663 None WEST SHORE MEDICAL CENTER 1400 E PARKDALE AVE MANISTEE, MI 49660 (231)398-1840 Manistee PHYSICIAN SERVICES 238692 None WEST SHORE MEDICAL CENTER- 1391 E PARKDALE AVE MANISTEE, MI 49660 (231)398-1771 Manistee PHYSICIAN SERVICES 238693 None WEST SHORE MEDICAL CENTER- 1293 E PARKDALE AVE, SUITE 1200A MANISTEE, MI 49660 (231)398-1550 Manistee PHYSICIAN SERVICES 233808 * WHITE PINE FAMILY MEDICINE 261 NORTH MAIN STREET CEDAR SPRINGS, MI 49319 (616)696-2020 Kent 238658 * WMH COMMUNITY CARE-KINROSS 16523 S WATERTOWER DRIVE KINCHELOE, MI 49788 (906)495-1344 Chippewa 238583 * WOMEN'S AND CHILDREN'S HEALTH 722 SOUTH MAIN STREET CHEBOYGAN, MI 49721 (231)627-1493 Cheboygan Total Providers for this State = 195

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 Minnesota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 243467 * APPLETON MUNICIPAL HOSPITAL & 30 SOUTH BEHL STREET APPLETON, MN 56208 (320)289-1580 Swift NH 243470 * AVERA MEDICAL GROUP LAKE 109 EAST BENTON STREET LAKE BENTON, MN 56149 (507)368-4323 Lincoln BENTON 243413 * AVERA MEDICAL GROUP TYLER 240 WILLOW STREET TYLER, MN 56178 (507)247-5921 Lincoln 243456 * BROOTEN MEDICAL CENTER 111 PLEASANT AVENUE PO BOX 69 BROOTEN, MN 56316 (320)346-2272 Stearns 243465 * CENTRACARE CLINIC- SAUK 433 ELM STREET NORTH SAUK CENTRE, MN 56378 (320)952-6591 Stearns CENTRE 243454 * CENTRACARE HEALTH SYSTEM - 525 WEST MAIN STREET MELROSE, MN 56352 (320)256-4228 Stearns MELROSE 243451 * CENTRACARE HEALTH SYSTEM 24 9TH STREET SE LONG PRAIRIE, MN 56347 (320)732-2131 Todd LONG PRAIRIE 243477 None COTEAU DES PRAIRIES HC SYSTEM 404 WEST BROADWAY BROWNS VALLEY, MN 56219 (320)695-2526 Traverse BROWNS VALLEY CLINI 243466 * CRMC-LONGVILLE 180 JORDAN LANE LONGVILLE, MN 56655 (218)363-3300 Cass 243996 * DASSEL MEDICAL CENTER 460 FIFTH STREET NORTH BOX 367 DASSEL, MN 55325 (320)275-3358 Meeker 243979 * DAWSON CLINIC 1272 WALNUT STREET DAWSON, MN 56232 (320)769-4393 Lac qui Parle 243416 * ESSENTIA HEALTH - ADA CLINIC 201 9TH STREET WEST ADA, MN 56510 (218)784-2727 Norman 243461 * ESSENTIA HEALTH BAGLEY CLINIC 121 CENTRAL STREET WEST BAGLEY, MN 56621 (218)694-6281 Clearwater 243405 * ESSENTIA HEALTH CHOKIO CLINIC 101 MAIN STREET CHOKIO, MN 56221 (320)748-7223 Stevens 243997 * ESSENTIA HEALTH GRACEVILLE 115 WEST SECOND STREET GRACEVILLE, MN 56240 (320)324-7500 Big Stone CLINIC 243475 * ESSENTIA HEALTH MENAHGA 212 ASPEN AVENUE NORTH EAST MENAHGA, MN 56464 (218)564-4131 Wadena CLINIC 243464 * ESSENTIA HEALTH OKLEE CLINIC GOVERNOR STREET & THIRD AVENUE OKLEE, MN 56742 (218)796-4525 Red Lake 243471 * ESSENTIA HEALTH PARK RAPIDS 705 PLEASANT AVENUE PARK RAPIDS, MN 56470 (218)732-2800 Hubbard CLINIC 243474 * ESSENTIA HEALTH WALKER CLINIC 110 D MICHIGAN AVENUE NORTHWEST WALKER, MN 56484 (218)547-6900 Cass 243472 * ESSENTIA PELICAN RAPIDS CLINIC 301 NORTH BROADWAY PELICAN RAPIDS, MN 56572 (218)863-2000 Otter Tail 243468 * ESSENTIA ST MARYS MAHNOMEN 117 NORTH MAIN STREET MAHNOMEN, MN 56557 (218)936-5616 Mahnomen CLINIC 243449 * FAMILY MEDICAL CENTER 200 SOUTH FIRST AVENUE PIERZ, MN 56364 (320)468-2536 Morrison 243463 * FIRSTLIGHT HINCKLEY 620 SANDY LANE ROAD HINCKLEY, MN 55037 (320)629-7505 Pine 243462 * FIRSTLIGHT PINE CITY 1425 MAIN STREET NORTH PINE CITY, MN 55063 (320)629-7505 Pine 243859 * GATEWAY FAMILY CLINIC 204 LUNDORFF DRIVE SANDSTONE, MN 55072 (320)245-2250 Pine * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 Minnesota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 243861 * GATEWAY FAMILY HEALTH CLINIC 45 LADY LUCK DRIVE, PO BOX 309 HINCKLEY, MN 55037 (320)384-6618 Pine 243437 * GLENWOOD MEDICAL CENTER 417 SOUTH FRANKLIN GLENWOOD, MN 56334 (320)634-5157 Pope 243856 * HEALTH CARE TODAY/AVERA 1444 WEST HIGHWAY #30 SLAYTON, MN 56172 (507)836-8538 Murray HEALTH 243455 * HENDRICKS CLINIC 501 EAST LINCOLN STREET HENDRICKS, MN 56136 (507)275-3134 Lincoln 243457 * IVANHOE MEDICAL CENTER 366 EAST GEORGE STREET IVANHOE, MN 56142 (507)694-1100 Lincoln 243426 * JOHNSON MEMORIAL BOYD CLINIC 115 3RD STREET BOYD, MN 56218 (320)769-4323 Lac qui Parle 243977 * KITTSON MEMORIAL CLINIC 1010 SOUTH BIRCH, BOX 700 HALLOCK, MN 56728 (218)843-3612 Kittson 243427 * KITTSON MEMORIAL CLINIC OF 205 ROOSEVELT AVENUE WEST, PO KARLSTAD, MN 56732 (218)843-3612 Kittson KARLSTAD BOX 199 243990 * LAC QUI PARLE CLINIC MADISON 900 SECOND AVE MADISON, MN 56256 (320)598-7551 Lac qui Parle 243423 * LAKEWOOD CLINIC BROWERVILLE 30535 241ST AVENUE BROWERVILLE, MN 56438 (320)594-2231 Todd 243421 * LAKEWOOD CLINIC EAGLE BEND 815 HIGHWAY 71 EAGLE BEND, MN 56446 (218)738-2804 Todd 243431 * LAKEWOOD CLINIC MOTLEY 1233 HIGHWAY 10 MOTLEY, MN 56466 (218)352-6911 Morrison 243436 * LAKEWOOD CLINIC PILLAGER 653 PILLSBURY STREET NORTH PILLAGER, MN 56473 (218)746-4550 Cass 243422 * LAKEWOOD CLINIC STAPLES 49725 COUNTY 83 STAPLES, MN 56479 (218)894-1033 Todd 243450 * LAKEWOOD HEALTH CENTER CLINIC 600 MAIN AVENUE SOUTH BAUDETTE, MN 56623 (218)634-2120 Lake of the 243445 * LONG PRAIRIE MEM HOSPITAL - 815 HIGHWAY 71 SOUTH EAGLE BEND, MN 56446 (218)738-2804 Todd EAGLE VALLEY CLIN 243434 * MILLE LACS FAMILY CLINIC 26362 370TH AVENUE HILLMAN, MN 56338 (320)277-3682 Morrison 243975 * MILLE LACS FAMILY CLINIC ISLE 375 WEST ISIE STREET ISLE, MN 56342 (320)676-3661 Mille Lacs 243976 * MILLE LACS FAMILY CLNC ONAMIA 200 NORTH ELM STREET, PO BOX A ONAMIA, MN 56359 (320)532-3154 Mille Lacs 243417 * MURRAY COUNTY CLINIC 2040 JUNIPER AVENUE SLAYTON, MN 56172 (507)836-6153 Murray 243446 * MURRAY COUNTY CLINIC FULDA 119 NORTH ST PAUL AVENUE FULDA, MN 56131 (507)425-2300 Murray 243409 * NORTH VALLEY HLTH CTR CLINIC 300 WEST GOOD SAMARITAN DRIVE WARREN, MN 56762 (218)745-4211 Marshall 243987 * RAINY LAKE MEDICAL CENTER 912 MAIN STREET LITTLEFORK, MN 56653 (218)278-6634 Koochiching 243469 * RAINY LAKE MEDICAL CENTER RHC 1400 HIGHWAY 71 INTERNATIONAL FALLS, MN (218)283-4481 Koochiching 56649 243447 * RANDALL LAKES AREA CLINIC 250 WHITE OAK DRIVE RANDALL, MN 56475 (320)749-2877 Morrison 243443 * RENVILLE COUNTY HOSPITAL & 131 BIRCH AVENUE WEST HECTOR, MN 55342 (320)848-6294 Renville CLINIC - HECTOR CLINIC 243444 * RENVILLE COUNTY HOSPITAL & 420 NORTH MAIN STREET RENVILLE, MN 56284 (320)329-8395 Renville CLINICS RENVILLE CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 Minnesota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 243442 * RENVILLE COUNTY HOSPITAL AND 100 HEALTHY WAY OLIVIA, MN 56277 (320)523-1460 Renville CLINICS - OLIVIA CLIN 243428 * RIDGEVIEW ARLINGTON CLINIC 607 WEST CHANDLER ARLINGTON, MN 55307 (507)964-2285 Sibley 243429 * RIDGEVIEW GAYLORD CLINIC 315 4TH STREET GAYLORD, MN 55334 (507)237-5523 Sibley 243438 * RIDGEVIEW HENDERSON CLINIC 505 MAIN STREET HENDERSON, MN 56044 (507)248-3433 Sibley 243430 * RIDGEVIEW WINTHROP CLINIC 223 NORTH CARVER WINTHROP, MN 55396 (507)647-5318 Sibley 243458 * RIVERVIEW CLINIC 323 SOUTH MINNESOTA STREET CROOKSTON, MN 56716 (218)281-9200 Polk 243459 * RIVERVIEW CLINIC 306 NORTH MILL STREET FERTILE, MN 56540 (218)945-6695 Polk 243460 * RIVERVIEW CLINIC 105 INTERNATIONAL DRIVE SUITE 25 RED LAKE FALLS, MN 56750 (218)253-4606 Red Lake 243406 * RIVERWOOD CLINIC AITKIN 200 BUNKER HILL DRIVE AITKIN, MN 56431 (218)927-2157 Aitkin 243441 * RIVERWOOD HLTH CC GARRISON 27278 STATE HIGHWAY 18 GARRISON, MN 56450 (320)525-3400 Crow Wing 243407 * RIVERWOOD MCGREGOR CLINIC 2 EAST CENTER AVE PO BOX 340 MCGREGOR, MN 55760 (218)768-4011 Aitkin 243419 * SANFORD BAGLEY CLEARBROOK 22 ELM STREET CLEARBROOK, MN 56634 (218)776-3124 Clearwater CLINIC 243418 * SANFORD BAGLEY CLINIC 1656 CENTRAL STREET WEST BAGLEY, MN 56621 (218)694-2384 Clearwater 243420 * SANFORD CLINIC BALATON HIGHWAY 14E BALATON, MN 56115 (507)629-3200 Lyon 243411 * SANFORD CLINIC CANBY 112 ST OLAF AVENUE CANBY, MN 56220 (507)223-7221 Yellow Medicine 243403 * SANFORD CLINIC LAKEFIELD 209 MAIN STREET PO BOX 546 LAKEFIELD, MN 56150 (507)662-6611 Jackson 243831 * SANFORD CLINIC MOUNTAIN LAKE 308 EIGHTH STREET MOUNTAIN LAKE, MN 56159 (507)427-3332 Cottonwood 243414 * SANFORD CLINIC TRACY 251 FIFTH STREET EAST TRACY, MN 56175 (507)629-3520 Lyon 243415 * SANFORD CLINIC WESTBROOK 920 BELL AVENUE WESTBROOK, MN 56183 (507)274-6121 Cottonwood 243857 * SANFORD CLINIC WINDOM 591 2ND AVENUE NORTH WINDOM, MN 56101 (507)831-2223 Cottonwood 243476 * SANFORD HEALTH HALSTAD CLINIC 445 1ST STREET EAST HALSTAD, MN 56548 (218)456-2158 Norman 243850 * SANFORD HEALTH MAHNOMEN 414 WEST JEFFERSON, PO BOX 396 MAHNOMEN, MN 56557 (218)935-2514 Mahnomen CLINIC 243862 * SANFORD HEALTH PELICAN RAPIDS 211 EAST MILL STREET PELICAN RAPIDS, MN 56572 (701)234-6207 Otter Tail CLINIC 243846 * SANFORD HEALTH TWIN VALLEY 501 2ND STREET NORTHWEST TWIN VALLEY, MN 56584 (218)584-5142 Norman CLINIC 243847 * SANFORD HEALTH ULEN CLINIC 108 VIKING AVENUE WEST ULEN, MN 56585 (218)494-3404 Clay 243848 * SANFORD HEALTH WALKER CLINIC 614 MICHIGAN AVENUE WALKER, MN 56484 (218)547-3938 Cass 243985 * SANFORD JACKSON CLINIC 1430 NORTH HIGHWAY JACKSON, MN 56143 (507)847-2200 Jackson 243433 * SANFORD TRACY WALNUT GROVE 830 EIGHTH STREET WALNUT GROVE, MN 56180 (507)859-2157 Redwood CLINIC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 Minnesota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 243435 * SANFORD WHEATON 401 12TH STREET NORTH WHEATON, MN 56296 (320)563-8226 Traverse 243439 * SLEEPY EYE MEDICAL CENTER 400 4TH AVENUE NORTHWEST SLEEPY EYE, MN 56085 (507)794-3571 Brown 243478 None SWIFT COUNTY-BENSON HEALTH 1810 MCKINNEY AVENUE BENSON, MN 56215 (320)843-2030 Swift SERVICES 243988 * TRI COUNTY HEALTH CARE 401 DOUGLAS AVENUE HENNING, MN 56551 (218)583-2953 Otter Tail HENNING CLINIC 243452 * TRI COUNTY HEALTH CARE 232 HIGHWAY 78 NORTH PO BOX 129 OTTERTAIL, MN 56571 (218)367-6262 Otter Tail OTTERTAIL CLINIC 243453 * TRI COUNTY HEALTH CARE 4 NORTHWEST DEERWOOD AVENUE WADENA, MN 56482 (218)631-1100 Wadena WADENA CLINIC 243978 * TRI COUNTY HEALTH CARE, BERTHA PO BOX 67, FIRST STREET NORTH BERTHA, MN 56437 (218)924-2250 Todd CLINIC 243986 * TRI COUNTY HEALTHCARE SEBEKA 106 MINNESOTA AVENUE EAST SEBEKA, MN 56477 (218)837-5333 Wadena CLINIC 243473 * TRI COUNTY HOSP VERNDALE 102 FARWELL STREET SOUTH VERNDALE, MN 56481 (218)445-5990 Wadena CLINIC Total Providers for this State = 89

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 Ohio

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 363851 * AMJAD RASS, INC 61353 SOUTHGATE PARKWAY CAMBRIDGE, OH 43725 (740)435-8585 Guernsey 363868 None ANTWERP FAMILY HEALTH CENTER 422 WEST RIVER STREET ANTWERP, OH 45813 (419)542-5672 Paulding 363405 None AULTMAN ORVILLE DUNLAP FAMILY 49 MAPLE STREET APPLE CREEK, OH 44606 (330)684-5470 Wayne PHYSICIANS 363404 None AULTMAN ORVILLE DUNLAP FAMILY 830 SOUTH MAIN STREET ORRVILLE, OH 44667 (330)684-2015 Wayne PHYSICIANS 363406 None AULTMAN ORVILLE DUNLAP FAMILY 129 WENGER ROAD N DALTON, OH 44618 (330)684-5480 Wayne PHYSICIANS 363400 None CEDARVILLE FAMILY PRACTICE 29 KYLE DRIVE CEDARVILLE, OH 45314 (937)766-2611 Greene 363836 * CHANDRA SHAKER, MD 120 STURGES AVENUE, SUITE 1 MANSFIELD, OH 44903 (419)522-5454 Richland 363803 * CLERMONT PEDIATRIC CENTER 3003 HOSPITAL DRIVE BATAVIA, OH 45103 (513)732-2277 Clermont 363401 None COMMUNITY PHYSICIANS OF 888 DAYTON STREET, SUITE 200 YELLOW SPRINGS, OH 45387 (937)767-7291 Greene YELLOW SPRINGS 363867 None EDGERTON FAMILY HEALTH 104 SOUTH WEST STREET EDGERTON, OH 43517 (419)542-5672 Williams CENTER 363982 * FAYETTE CTY MEMORIAL HOSP 1450 COLUMBUS AVENUE, SUITE 103 WASHINGTON CH, OH 43160 (740)333-2236 Fayette MEDICAL & SURGICAL ASSOC 363983 * FCMH MEDICAL AND SURGICAL 1510 COLUMBUS AVENUE, SUITE 230 WASHINGTON CH, OH 43160 (740)333-3333 Fayette ASSOCIATES 363865 None FPG COUNSELING AND RECOVERY 1925 HAYES AVENUE SANDUSKY, OH 44870 (419)557-5177 Erie PLUS 363863 None FPG COUNSELING AND RECOVERY 675 BARTSON ROAD FREMONT, OH 43420 (419)332-5524 Sandusky SERVICE 363864 None FPG COUNSELING AND RECOVERY 292 BENEDICT AVENUE NORWALK, OH 44857 (419)663-3737 Huron SERVICE 363403 None GALION OB/GYN 1200 STATE ROUTE 598 GALION, OH 44833 (419)468-0111 Crawford 363995 None GCH PHYSICIAN PRACTICE - EAST 130 HILL STREET BUCYRUS, OH 44820 (419)562-3264 Crawford HILL STREET 363862 None GCH PHYSICIAN PRACTICE - GAIUS 139 GAIUS STREET BUCYRUS, OH 44820 (419)562-4677 Crawford STREET 363992 None GCH PHYSICIAN PRACTICE- 330 NORTH STELZER STREET CRESTLINE, OH 44827 (419)689-3200 Crawford CRESTLINE 363991 None GCH PHYSICIAN PRACTICE- MAPLE 1323 EAST MANSFIELD STREET BUCYRUS, OH 44820 (419)563-0300 Crawford CREEK MEDICAL CENTER 363987 * GCH PHYSICIAN PRACTICES 955 BUCYRUS ROAD GALION, OH 44833 (419)468-0503 Crawford BUCYRUS ROAD CAMPUS

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 Ohio

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 363994 None GCH PHYSICIAN PRACTICES NEW 120 WEST MAIN STREET NEW WASHINGTON, OH (419)492-2200 Crawford WASHINGTON CAMPUS 44854 363993 None GCH PHYSICIAN PRACTICES, BCH 629 NORTH SANDUSKY AVENUE BUCYRUS, OH 44820 (419)563-9865 Crawford PRIMARY CARE 363985 * GCH PHYSICIAN PRACTICES, 269 PORTLAND WAY SOUTH GALION, OH 44833 (419)468-0503 Crawford HOSPITAL CAMPUS 363984 * GCH PHYSICIAN PRACTICES, 270 PORTLAND WAY SOUTH GALION, OH 44833 (419)468-0503 Crawford PORTLAND WAY CAMPUS 363986 * GCH PHYSICIAN PRACTICES, 385 NORTH SELTZER CRESTLINE, OH 44827 (419)468-0503 Crawford SELTZER STATION CAMPUS 363850 * GENESIS MEDICAL GROUP 401 LINCOLN PARK DRIVE NEW LEXINGTON, OH 43764 (740)342-5107 Perry 363844 * GREENFIELD MEDICAL SERVICES 1092 WEST JEFFERSON STREET GREENFIELD, OH 45123 (937)981-1121 Highland 363408 None HICKSVILLE FAMILY HEALTH 208 NORTH COLUMBUS STREET HICKSVILLE, OH 43526 (419)542-5672 Defiance CENTER 363843 * HIGHLAND FAMILY HEALTHCARE 1402 NORTH HIGH STREET HILLSBORO, OH 45133 (937)393-4899 Highland 363853 * KINGS DAUGHTERS MED CTR 14365 STATE ROUTE 93 JACKSON, OH 45640 (740)288-7681 Jackson JACKSON MED SPECIALTIES 363999 None MCH PRIMARY CARE CARDINAL 73 SPORTMAN DRIVE MARENGO, OH 43334 (419)949-3030 Morrow CENTER 363402 None MCH PRIMARY CARE MOUNT 900 MEADOW DRIVE MOUNT GILEAD, OH 43338 (419)947-8001 Morrow GILEAD 363998 None MCH PRIMARY CARE NORTHFIELD 6519 US HIGHWAY 42 MOUNT GILEAD, OH 43338 (419)362-6033 Morrow 363989 * MERCY ALLEN RURAL HEALTH 105 OPPORTUNITY WAY LAGRANGE, OH 44050 (440)355-4206 Lorain CLINIC LAGRANGE 363988 * MERCY ALLEN RURAL HEALTH 508 DICKSON STREET, SUITE 2 WELLINGTON, OH 44090 (440)647-2225 Lorain CLINIC WELLINGTON 363861 None ONTARIO PHYSICIAN PRACTICES 2981 WEST 4TH STREET MANSFIELD, OH 44906 (419)462-4561 Richland 363829 * PERRY COUNTY FAMILY PRACTICE 1625 AIRPORT ROAD NEW LEXINGTON, OH 43764 (740)342-5158 Perry 363852 * POMERENE EXPRESS CARE 4900 OAK STREET BERLIN, OH 44610 (330)893-1318 Holmes 363855 * PROSPECT FAMILY MEDICINE 102 EAST WATER STREET PROSPECT, OH 43342 (740)494-2624 Marion RURAL HEALTH CLINIC 363857 None SHAWNEE FAMILY HEALTH CENTER 901 WASHINGTON STREET PORTSMOUTH, OH 45662 (740)354-7770 Scioto 363858 None SHAWNEE FAMILY HEALTH CENTER 192 CHESTNUT RIDGE ROAD WEST UNION, OH 45693 (937)544-5581 Adams 363981 * SOUTHWEST REGIONAL MEDICAL 210 NORTH UNION STREET BETHEL, OH 45106 (513)734-9050 Clermont CENTER BETHEL RHC 363996 None TRINITY MEDICAL GROUP 819 NORTH FIRST STREET DENNISON, OH 44621 (740)922-8042 Tuscarawas * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 Ohio

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 363997 None TRINITY MEDICAL GROUP 110 NORTH WALNUT STREET GNADENHUTTEN, OH 44629 (740)254-9443 Tuscarawas 363859 None TRUSTED HEALTH CARE INC 128 EAST MAIN STREET BAINBRIDGE, OH 45612 (740)634-2013 Ross 363860 None TURJOMAN PEDIATRICS 8930 OHIO RIVER ROAD WHEELERSBURG, OH 45694 (740)574-1903 Scioto 363800 * TUSCARAWAS COUNTY GENERAL 897 EAST IRON AVENUE DOVER, OH 44622 (330)343-4928 Tuscarawas HEALTH DISTRICT Total Providers for this State = 48

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 Wisconsin

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 528569 None ASPIRUS BIRNAMWOOD CLINIC 400 RAILROAD ST BIRNAMWOOD, WI 54414 (715)449-2539 Marathon 528570 None ASPIRUS ELCHO CLINIC W10618 CLINIC ST ELCHO, WI 54428 (715)275-4011 Langlade 528535 * ASPIRUS GILMAN CLINIC 320 EAST MAIN ST GILMAN, WI 54433 (715)447-8293 Taylor 528560 None ASPIRUS GRAND VIEW CLINIC 501 GRANITE ST HURLEY, WI 54534 (715)561-2255 Iron 528559 None ASPIRUS MEDFORD CLINIC 143 S GIBSON ST MEDFORD, WI 54451 (715)748-2121 Taylor 528537 * ASPIRUS PHILLIPS CLINIC 625 PETERSON AVE PHILLIPS, WI 54555 (715)339-4035 Price 528536 * ASPIRUS PRENTICE CLINIC 1511 RAILROAD AVE PRENTICE, WI 54556 (715)428-2521 Price 528538 * ASPIRUS RIB LAKE CLINIC 1121 HIGHWAY 102 RIB LAKE, WI 54470 (715)427-5701 Taylor 523810 * AURORA NOR DOOR CLINIC 2521 S BAY SHORE DR SISTER BAY, WI 54234 (920)854-2347 Door 528554 * BELLIN HEALTH OCONTO CLINIC 820 ARBITUS AVE OCONTO, WI 54153 (920)834-8833 Oconto 528501 * BLAND CLINIC VERNON MEMORIAL 100 MELBY ST WESTBY, WI 54667 (608)634-3126 Vernon HOSPITAL 528517 * BURNETT MEDICAL CTR CLINIC 257 W ST GEORGE AVE GRANTSBURG, WI 54840 (715)463-5317 Burnett 528562 None CLEAR LAKE CLINIC 357 THIRD AVE CLEAR LAKE, WI 54005 (715)263-3100 Polk 528563 None CUMBERLAND HC MEDICAL CLINIC 1110 7TH AVE CUMBERLAND, WI 54829 (715)822-2741 Barron 528571 None CUMBERLAND HC TURTLE LAKE 632 US HIGHWAY 8 CUMBERLAND, WI 54829 (715)822-2741 Barron CENTER 528573 * DURAND CLINIC SOUTH 1250 3RD AVE WEST DURAND, WI 54736 (715)672-5233 Pepin 523984 * ELROY FAMILY MEDICAL CENTER 1515 ACADEMY ST ELROY, WI 53929 (608)462-8466 Juneau 523991 * FLORENCE MEDICAL CTR 1010 OLIVE AVE FLORENCE, WI 54121 (715)528-4775 Florence 523865 * FMC ALGOMA 831 PARKER ST ALGOMA, WI 54201 (920)487-3676 Kewaunee 523864 * FMC KEWAUNEE 575 4TH ST KEWAUNEE, WI 54216 (920)388-4640 Kewaunee 523866 * FMC OCONTO FALLS 107 E HIGHLAND DR OCONTO FALLS, WI 54154 (920)846-3092 Oconto 528555 None FREDERIC CLINIC 205 OAK ST WEST FREDERIC, WI 54837 (715)327-5700 Polk 528572 None GRANT REGIONAL COMMUNITY 507 S MONROE ST LANCASTER, WI 53813 (608)723-3202 Grant CLINIC 528523 * GUNDERSEN BOSCOBEL AREA 208 PARKER ST BOSCOBEL, WI 53805 (608)375-2424 Grant HOSPITAL AND CLINICS 528534 * GUNDERSEN BOSCOBEL AREA 220 LINCOLN AVE FENNIMORE, WI 53809 (608)822-3737 Grant HSPTL & CLINICS FENNIMORE 528533 * GUNDERSEN BOSCOBEL AREA 525 N WISCONSIN AVE MUSCODA, WI 53573 (608)739-3138 Grant HSPTL AND CLINICS MUSCODA 528540 * GUNDERSEN ST JOSEPHS HSPTL 400 WATER AVE HILLSBORO, WI 54634 (608)489-8280 Vernon AND CLINICS HILLSBORO * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 Wisconsin

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 528551 * GUNDERSEN TRI COUNTY HSPTL & 35791 OSSEO RD INDEPENDENCE, WI 54747 (715)985-2351 Trempealeau CLINICS INDEPENDENCE 528552 * GUNDERSEN TRI COUNTY HSPTL 420 S PETERSON AVE BLAIR, WI 54616 (608)989-2505 Trempealeau AND CLINICS BLAIR 528553 * GUNDERSEN TRI COUNTY HSPTL 18606 ERVIN ST WHITEHALL, WI 54773 (715)538-4355 Trempealeau AND CLINICS WHITEHALL 523996 * HIRSCH CLINIC 407 S MAIN ST STE 400 VIROQUA, WI 54665 (608)637-3174 Vernon 528556 None INGALLS CLINIC 7456 MAIN ST WEBSTER, WI 54893 (715)866-4271 Burnett 523999 * KICKAPOO VALLEY MEDICAL CLINIC 102 SUNSET BLVD SOLDIERS GROVE, WI 54655 (608)624-5203 Crawford 528526 * LAFARGE MEDICAL CLINIC 206 N MILL ST LA FARGE, WI 54639 (608)625-2494 Vernon 528516 * LUCK CLINIC 137 1ST AVE LUCK, WI 54853 (715)472-2177 Polk 523998 * MAYO CLINIC HS FRANCISCAN 310 W MAIN ST SPARTA, WI 54656 (608)269-2132 Monroe HEALTHCARE 523981 * MEMORIAL MEDICAL CTR 201 S MAIN ST GREENWOOD, WI 54437 (715)267-3399 Clark GREENWOOD 523979 * MEMORIAL MEDICAL CTR LOYAL 502 E ELM ST LOYAL, WI 54446 (715)255-8551 Clark 523980 * MEMORIAL MEDICAL CTR 216 SUNSET PLACE NEILLSVILLE, WI 54456 (715)743-3101 Clark NEILSVILLE 523828 * MILE BLUFF CLINIC 1040 DIVISION ST MAUSTON, WI 53948 (608)847-5000 Juneau 528541 * MINISTRY MEDICAL GROUP 400 W GLEN ST CRANDON, WI 54520 (715)478-3318 Forest CRANDON 528543 * MINISTRY MEDICAL GROUP LAONA 4876 MILL ST LAONA, WI 54541 (715)674-5233 Forest 528518 * MINISTRY MEDICAL GROUP OWEN 6 JOHNSON ST OWEN, WI 54460 (715)229-2177 Clark 528521 * MINISTRY MEDICAL GROUP 1120 PINE ST STANLEY, WI 54768 (715)644-5530 Chippewa STANLEY 528519 * MINISTRY MEDICAL GROUP THORP 704 S CLARK ST THORP, WI 54771 (715)669-7279 Clark 528520 * MOUNDVIEW MEMORIAL CLINIC 402 W LAKE ST FRIENDSHIP, WI 53934 (608)339-6350 Adams 528513 * MUSCODA HEALTH CENTER 1075 N WISCONSIN AVE MUSCODA, WI 53573 (608)739-3113 Grant 523990 * NECEDAH FAMILY MEDICAL CTR 1408 WHEELIHAN AVE NECEDAH, WI 54646 (608)565-2000 Juneau 523829 * NEW LISBON FAMILY MEDICAL CTR 901 W BRIDGE ST NEW LISBON, WI 53950 (608)562-3111 Juneau 528530 * NORTH SHORE MED CLINIC 815 JEFFERSON ST ALGOMA, WI 54201 (920)487-3496 Kewaunee ALGOMA 528532 * NORTH SHORE MED CLINIC FISH 3711 HIGHWAY 42 FISH CREEK, WI 54212 (920)868-3511 Door CREEK

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 Wisconsin

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 528531 * NORTH SHORE MED CLINIC 323 SOUTH 18TH AVE STURGEON BAY, WI 54235 (920)746-0510 Door STURGEON BAY 528515 * NORTH SHORE MED CLINIC 910 MAIN RD WASHINGTON ISLAND, WI (920)847-2424 Door WASHINGTON ISLAND 54246 523860 * NORTHREACH HEALTHCARE 218 S US HWY 141 CRIVITZ, WI 54114 (715)854-7477 Marinette CRIVITZ 523862 * NORTHREACH HEALTHCARE FAMILY 3123 SHORE DR SUITE 202 MARINETTE, WI 54143 (715)732-4120 Marinette CARE 523863 * PESHTIGO FAMILY MEDICINE CLINIC 441 FRENCH ST PESHTIGO, WI 54157 (715)582-9949 Marinette 528524 * PLAIN MEDICAL CLINIC 825 MAIN ST PLAIN, WI 53577 (608)546-4211 Sauk 528525 * RIVER VALLEY MEDICAL CLINIC 436 SUNRISE DR SPRING GREEN, WI 53588 (608)588-2502 Sauk 528567 None RUSK COUNTY MEMORIAL 900 COLLEGE AVENUE W LADYSMITH, WI 54848 (715)532-5561 Rusk HOSPITAL CLINIC 528565 None SOUTHWEST HEALTH CUBA CITY 207 E SKELLY ST CUBA CITY, WI 53807 (608)744-2767 Grant CLINIC 528564 None SOUTHWEST HEALTH PLATTEVILLE 1450 EAST SIDE ROAD PLATTEVILLE, WI 53818 (608)348-4330 Grant CLINIC 528514 * SPRING GREEN MEDICAL CENTER 150 E JEFFERSON ST SPRING GREEN, WI 53588 (608)588-7413 Sauk 528542 None ST CLARE MEM HOSPITAL GILLETT 340 N GREEN BAY AVE GILLETT, WI 54124 (920)855-2823 Oconto HEALTH CENTER 528544 None ST CLARE MEM HOSPITAL LENA 200 S ROSERA ST LENA, WI 54139 (920)829-6400 Oconto HEALTH CENTER 528545 None ST CLARE MEM HOSPITAL 14353 HIGHWAY 32 / 64 MOUNTAIN, WI 54149 (715)276-1600 Oconto MOUNTAIN HEALTH CENTER 528546 None ST CLARE MEM HOSPITAL OCONTO 835 S MAIN ST OCONTO FALLS, WI 54154 (920)846-8187 Oconto FALLS HEALTH CENTER 528547 None ST CLARE MEM HOSPITAL SURING 913 E MAIN ST SURING, WI 54174 (920)842-1147 Oconto HEALTH CENTER 528568 None ST JOSEPHS HEALTH SERVICES 1705 OMAHA ST ELROY, WI 53929 (608)462-4116 Juneau ELROY 528539 * ST JOSEPHS HEALTH SVCS 301 RAILROAD ST WONEWOC, WI 53968 (608)464-3575 Juneau WONEWOC CLINIC 528528 * STONE LAKE MEDICAL CLINIC 16887 SECOND ST SOUTH STONE LAKE, WI 54876 (715)865-6510 Sawyer 528561 None TURTLE LAKE CLINIC 550 MARTIN AVE TURTLE LAKE, WI 54889 (715)986-4101 Barron 528557 None UPLAND HILLS HEALTH CLINIC 551 N MAIN ST HIGHLAND, WI 53543 (608)929-4518 Iowa HIGHLAND

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 Wisconsin

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 528558 None UPLAND HILLS HEALTH CLINIC 202 HIGHWAY 18 WEST MONTFORT, WI 53569 (608)943-6308 Grant MONTFORT 528566 None UPLAND HILLS HEALTH CLINIC 156 W JEFFERSON ST SPRING GREEN, WI 53588 (608)588-2600 Sauk SPRING GREEN 523989 * WAUSAUKEE HEALTH CENTER 536 KENNY DR WAUSAUKEE, WI 54177 (715)856-6983 Marinette 528504 * WESTERN WISCONSIN HEALTH 1100 BERGSLIEN ST BALDWIN, WI 54002 (715)684-3311 St. Croix Total Providers for this State = 76

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 Arkansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 043877 None ACCESS MEDICAL CLINIC 3519 HIGHWAY 63 BLACK ROCK, AR 72415 (870)994-7301 Lawrence 043886 None ACCESS MEDICAL CLINIC CALICO 2161 AR 56 HIGHWAY CALICO ROCK, AR 72519 (870)916-2000 Izard ROCK 043887 None ACCESS MEDICAL CLINIC HARDY 101 WEST MAIN STREET HARDY, AR 72542 (870)994-7301 Sharp 043879 None ACCESS MEDICAL CLINIC MARKED 202 NEWSOME DRIVE MARKED TREE, AR 72365 (870)358-4355 Poinsett TREE 043885 None ACCESS MEDICAL CLINIC WEINER 106 NORTH VAN BUREN STREET WEINER, AR 72479 (870)358-4355 Poinsett 043432 * AHRENS CLINIC 400 NORTH FIRST STREET YELLVILLE, AR 72687 (870)449-4221 Marion 043490 * ASHLEY HEALTH SERVICES 1003 FRED LAGRONE DRIVE CROSSETT, AR 71635 (870)364-9519 Ashley 043853 * BANISTER LIEBLONG CLINIC 2425 DAVE WARD DRIVE, #401 CONWAY, AR 72032 (501)329-3824 Faulkner 043457 * BAPTIST HEALTH - FAMILY CLINIC 110 NORTH NEW YORK STREET BRINKLEY, AR 72021 (870)734-4405 Monroe BRINKLEY 043492 * BAPTIST HEALTH - FAMILY CLINIC 1703 SOUTH WHITEHEAD DRIVE DE WITT, AR 72042 (870)673-3511 Arkansas DEWITT 043489 * BAPTIST HEALTH - FAMILY CLINIC 102 WEST FRONT STREET HAZEN, AR 72064 (870)673-3511 Prairie HAZEN 043480 * BAPTIST HEALTH - STUTTGART 1609 NORTH MEDICAL DRIVE STUTTGART, AR 72160 (870)673-7211 Arkansas MEDICAL CLINIC 043990 * BAPTIST HEALTH CENTER GREERS 8544 EDGEMOUNT RD GREERS FERRY, AR 72067 (501)825-6283 Cleburne FERRY 048505 * BAPTIST HEALTH FAMILY CLINIC - 221 NE 2ND STREET ENGLAND, AR 72046 (501)842-3819 Lonoke ENGLAND BHMCS 048504 None BAPTIST HEALTH FAMILY CLINIC - 200 EAST WALNUT STREET GURDON, AR 71743 (870)353-2800 Clark GURDON 048508 None BAPTIST HEALTH FAMILY CLINIC- 6679 HIGHWAY 7 BISMARCK, AR 71929 (501)865-2755 Hot Spring BISMARCK 048507 None BAPTIST HEALTH FAMILY CLINIC- 10 MONTGOMERY DRIVE CADDO VALLEY, AR 71923 (870)245-2198 Clark CADDO VALLEY 048510 None BAPTIST HEALTH FAMILY CLINIC- 110 VILLAGE PLACE 2B FAIRFIELD BAY, AR 72088 (501)887-3212 Van Buren FAIRFIELD BAY 048506 * BAPTIST HEALTH FAMILY CLINIC- 106 SOUTH SEVENTH STREET HEBER SPRINGS, AR 72543 (501)362-7538 Cleburne HEBER SPRINGS 048512 None BAPTIST HEALTH FAMILY CLINIC- 304 MAIN STREET PANGBURN, AR 72121 (501)728-4535 White PANGBURN 048511 None BAPTIST HEALTH FAMILY CLINIC- 1484 WEST FIRST STREET NORTH, #2 PRESCOTT, AR 71857 (870)887-0155 Nevada PRESCOTT

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 Arkansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 043456 * BAPTIST HEALTH-FAMILY CLINIC 198 SOUTH MAIN STREET CLARENDON, AR 72029 (870)747-3349 Monroe CLARENDON 043829 * BELL-WINSTON CLINIC, PA 626 POPLAR STREET HELENA, AR 72342 (870)338-8163 Phillips 043982 * CAVE CITY MEDICAL CLINIC 301 SOUTH MAIN STREET CAVE CITY, AR 72521 (870)283-5353 Sharp 043868 * CHI ST VINCENT MEDICAL GROUP 234 EAST BROADWAY GLENWOOD, AR 71943 (870)356-4821 Pike HOT SPRINGS 043869 * CHI ST VINCENT MEDICAL GROUP 319 EAST 13TH STREET MURFREESBORO, AR 71958 (870)285-3118 Pike HOT SPRINGS 043870 * CHI ST VINCENT MEDICAL GROUP 320 LUZERNE MT IDA, AR 71957 (870)867-2175 Montgomery HOT SPRINGS 048513 None CHICOT MEMORIAL MEDICAL CTR 2729 SOUTH HIGHWAY 65 & 82 LAKE VILLAGE, AR 71653 (870)265-9365 Chicot FAMILY MEDICAL CLINIC 043424 * CLAUDE PARRISH COMMUNITY 131 EAST HIGHWAY 14 LEAD HILL, AR 72644 (870)436-5271 Boone HEALTH CLINIC 043851 * CLINTON MEDICAL CLINIC 2526 HWY 65 S, SUITE 203 CLINTON, AR 72031 (501)745-4914 Van Buren 043497 * COMMUNITY MEDICAL CENTER 61 GRASSE STREET CALICO ROCK, AR 72519 (870)297-3726 Izard CLINIC OF CALICO ROCK 043831 * COOPER CLINIC PA 303 SOUTH 5TH STREET PARIS, AR 72855 (479)963-2132 Logan 043494 * DALLAS COUNTY MEDICAL CENTER 201 NORTH CLIFTON STREET FORDYCE, AR 71742 (870)352-6363 Dallas FAMILY CLINIC 043808 * DE PAUL HEALTH CENTER 145 WEST WATERMAN STREET DUMAS, AR 71639 (870)382-4878 Desha 043812 * DECATUR MEDI-CLINIC 346 NORTH MAIN DECATUR, AR 72722 (479)752-3233 Benton 043495 * DELTA HEALTH SERVICES 803 HIGHWAY 65 SOUTH DUMAS, AR 71639 (870)382-4303 Desha 043455 * DRASCO MEDICAL CLINIC 60 GREERS FERRY ROAD DRASCO, AR 72530 (870)668-3200 Cleburne 043867 * EARLE FAMILY MEDICAL CLINIC 1605 SECOND STREET EARLE, AR 72331 (870)792-8825 Crittenden 043463 * EUDORA MEDICAL CLINIC 200 SOUTH MAIN STREET EUDORA, AR 71640 (870)355-2300 Chicot 043448 * FAMILY CARE CLINIC OF RECTOR 715 EAST NINTH STREET RECTOR, AR 72461 (870)595-3596 Clay 043864 * FAMILY HEALTH CARE, LLC 350 SOUTH MAIN, SUITE 4 MAMMOTH SPRING, AR 72554 (870)625-3111 Fulton 043479 * FAMILY MEDICAL CENTER 1309 WEST MAIN WALNUT RIDGE, AR 72476 (870)886-3211 Lawrence 043486 * FERGUSON RURAL HEALTH CLINIC 1641 SOUTH WHITEHEAD DRIVE DE WITT, AR 72042 (870)946-3637 Arkansas 043875 * FORE FAMILY PRACTICE LLC 307 NORTH MAIN STREET CAVE CITY, AR 72521 (870)283-5550 Sharp 043872 * GREENBRIER CHILDREN'S CLINIC 10 LOIS LANE GREENBRIER, AR 72058 (501)679-6796 Faulkner 043854 * GREENBRIER FAMILY MEDICINE 110 NORTH BROADVIEW GREENBRIER, AR 72058 (501)679-3551 Faulkner 048501 * HAMBURG HEALTH CLINIC 319 WEST PARKER STREET HAMBURG, AR 71646 (870)853-8271 Ashley

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 Arkansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 043832 * HOPE MEDICAL CLINIC, INC 145 SHAKERAG ROAD CLINTON, AR 72031 (501)745-7161 Van Buren 043838 * LAKE VILLAGE CLINIC, PA 2918 LOUIS SESSIONS STREET LAKE VILLAGE, AR 71653 (870)265-5343 Chicot 043839 * LAWRENCE COUNTY FAMILY CLINIC, 1210 WEST MAIN WALNUT RIDGE, AR 72476 (870)886-3543 Lawrence PA 043976 * MAMMOTH SPRING MEDICAL CLINIC 236 SOUTH MAIN STREET MAMMOTH SPRING, AR 72554 (870)625-3228 Fulton 043414 * MARSHALL FAMILY PRACTICE 211 AIRPORT ROAD MARSHALL, AR 72650 (870)448-3327 Searcy CLINIC 043852 * MAYFLOWER MEDICAL CLINIC 587 HIGHWAY 365 MAYFLOWER, AR 72106 (501)470-7413 Faulkner 043844 * MCCRORY FAMILY CLINIC, P A 908 NORTH EDMONDS AVENUE MCCRORY, AR 72101 (870)731-1100 Woodruff 048509 * MCGEHEE FAMILY CLINIC 601 HOLLY ST MC GEHEE, AR 71654 (870)222-6131 Desha 043997 * MELBOURNE MEDICAL CLINIC 1526 EAST MAIN STREET MELBOURNE, AR 72556 (870)368-4344 Izard 043491 * MERCY CLINIC PRIMARY CARE - 128 DANIEL AVENUE BOONEVILLE, AR 72927 (479)675-2800 Logan BOONEVILLE 048502 None MERCY HOSPITAL BOONEVILLE 351 B EAST PRIDDY STREET MAGAZINE, AR 72943 (479)969-8640 Logan PRIMARY CARE-MAGAZINE 043488 * MERCY HOSPITAL SCOTT CO RURAL 1341 WEST 6TH STREET WALDRON, AR 72958 (479)637-2136 Scott HEALTH CLINIC 043493 * MERCY HOSPITAL WALDRON- 100 NORTH WALNUT STREET, SUITE A MANSFIELD, AR 72944 (479)928-4404 Scott MANSFIELD FAMILY MEDICINE 043981 * MIDWAY MEDICAL CLINIC 195 HOSPITAL DRIVE A CHEROKEE VILLAGE, AR (870)257-6000 Sharp 72529 043878 * MORRILTON MEDICAL CLINIC PA 10 HOSPITAL DRIVE MORRILTON, AR 72110 (501)354-0052 Conway 043423 * NEWTON COUNTY FAMILY 502 WEST COURT STREET JASPER, AR 72641 (870)446-2203 Newton PRACTICE CLINIC 043876 * NUTT-WALLEY CLINIC 110 NORTH CLIFTON STREET FORDYCE, AR 71742 (870)352-3525 Dallas 043871 * OZARK MEDICAL CLINIC 2526 HIGHWAY 65 SOUTH, SUITE 201 CLINTON, AR 72031 (501)745-3388 Van Buren 043883 None OZARK MEDICAL CLINIC - FAIRFIELD 383 DAVE CREEK PARKWAY FAIRFIELD BAY, AR 72088 (501)884-6900 Van Buren BAY 043822 * PARAGOULD DOCTORS CLINIC 4000 LINWOOD DRIVE, SUITE A PARAGOULD, AR 72450 (870)239-8503 Greene 043834 * PIGGOTT FAMILY MEDICAL CENTER 425 WEST JACKSON PIGGOTT, AR 72454 (870)598-2236 Clay 043866 * PILLOW CLINIC AT MARVELL 1008 MAIN STREET MARVELL, AR 72366 (870)829-2521 Phillips 043861 * PILLOW CLINIC, PLLC 101 SHIRLEY HICKS DRIVE HELENA, AR 72342 (870)572-5996 Phillips 043422 * PLEASANT PLAINS MEDICAL CLINIC 6200 BATESVILLE BOULEVARD PLEASANT PLAINS, AR 72568 (501)345-2182 Independence 043873 * POTTSVILLE PRIMARY CARE 5395 WEST ASH STREET, SUITE 2 POTTSVILLE, AR 72858 (479)880-1118 Pope 043882 None PREMIER CENTRAL PEDIATRICS 900 SOUTH MAIN STREET HOPE, AR 71801 (870)722-6567 Hempstead * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 Arkansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 043826 * RECTOR MEDICAL CLINIC 807 EAST 9TH STREET RECTOR, AR 72461 (870)595-3527 Clay 048500 * RIVER VALLEY MEDICINE 515 HOLLY STREET MC GEHEE, AR 71654 (870)222-9301 Desha 043975 * SALEM 1ST CARE 172 HIGHWAY 62 EAST, SUITE 1 SALEM, AR 72576 (870)895-1911 Fulton 043802 * ST ELIZABETH HEALTH CENTER 407 SOUTH GOULD AVENUE GOULD, AR 71643 (870)263-4317 Lincoln 043477 * ST VINCENT MEDICAL CLINIC 4 HOSPITAL DRIVE MORRILTON, AR 72110 (501)354-4637 Conway MORRILTON 043460 * STEPHENS COMMUNITY CLINIC 113 WEST RUBY STEPHENS, AR 71764 (870)786-9114 Ouachita 043884 None STONE COUNTY PRIMARY CARE 2202 EAST MAIN STREET MOUNTAIN VIEW, AR 72560 (870)269-6495 Stone CLINIC 043467 * STRAWBERRY MEDICAL CLINIC 58 EAST RIVER DRIVE STRAWBERRY, AR 72469 (870)528-4081 Lawrence 043874 * UAMS FAMILY MEDICAL CLINIC- 1617 NORTH WASHINGTON MAGNOLIA, AR 71753 (870)562-2588 Columbia MAGNOLIA 043402 * VALLEY HEALTH SERVICES OF 11720 SR 27 HECTOR, AR 72843 (479)284-5001 Pope HECTOR 048503 None WADLEY RURAL HEALTH CLINIC AT 302 BILL CLINTON DRIVE HOPE, AR 71801 (870)777-8115 Hempstead HOPE 043856 * WAGNER MEDICAL CLINIC 434 HWY 18 BYPASS MANILA, AR 72442 (870)561-3300 Mississippi 043863 * WEBBER FAMILY PRACTICE 504 PECAN STREET HELENA, AR 72342 (870)338-9244 Phillips 043865 * WEBBER FAMILY PRACTICE 207 WEST CHESTNUT STREET MARIANNA, AR 72360 (870)295-2367 Lee 043859 * WK BRADLEY HEALTH CLINIC 409 WOODRUFF STREET BRADLEY, AR 71826 (870)894-3366 Lafayette Total Providers for this State = 88

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 6 Louisiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 193465 * ABBEVILLE GENERAL HOSPITAL 2419 ALONZO STREET ABBEVILLE, LA 70510 (337)893-2302 Vermilion CLINIC 193889 * ACADIA FAMILY CLINIC 1325 WRIGHT AVE SUITE E CROWLEY, LA 70526 (337)788-1081 Acadia 193830 * ACADIANA FAMILY PRACTICE 1501 BETHIA STREET FRANKLIN, LA 70538 (337)828-3507 St. Mary ASSOCIATES, L L P 193470 * ALLEN PARISH HOSPITAL RURAL 204 6TH AVENUE KINDER, LA 70648 (337)738-9494 Allen MEDICAL CENTER 193985 * AMITE RURAL HEALTH CLINIC 409 NW CENTRAL AVE AMITE, LA 70422 (985)748-7141 Tangipahoa 193426 * ASSUMPTION COMMUNITY 143 HWY 402 NAPOLEONVILLE, LA 70390 (985)369-3600 Assumption HOSPITAL RURAL HEALTH CLINIC 193902 * AVOYELLES PEDIATRICS 338 MOREAU STREET, SUITE E MARKSVILLE, LA 71351 (318)253-7022 Avoyelles 193484 * BASTROP OUTPATIENT RURAL 510 S WASHINGTON STREET BASTROP, LA 71220 (318)665-9950 Morehouse HEALTH CLINIC 193845 * BIENVILLE FAMILY CLINIC 1175 PINE STREET ARCADIA, LA 71001 (318)263-7970 Bienville 193460 * BUNKIE GENERAL HOSPITAL FAMILY 510 S COTTONWOOD STREET BUNKIE, LA 71322 (318)346-3339 Avoyelles CARE CLINIC 193987 * BUNKIE GENERAL HOSPITAL RURAL 109 NORTH LEXINGTON BUNKIE, LA 71322 (318)346-7283 Avoyelles HEALTH CLINIC 193808 * BUTLER ABSHIRE MEDICAL CLINIC 926 FRANCES DRIVE HAYNESVILLE, LA 71038 (318)624-0554 Claiborne APMC 193873 * CHADHA MEDICAL CLINIC 140 WEST FOURTH STREET DEQUINCY, LA 70633 (337)786-5007 Calcasieu 193483 * CHATHAM MEDICAL CLINIC 804 CHATHAM AVENUE CHATHAM, LA 71226 (318)249-3200 Jackson 193489 None CHATHAM RURAL HEALTH CLINIC 6619 HWY 34 CHATHAM, LA 71226 (318)649-2743 Jackson 193921 None CHENEVERT FAMILY CARE CLINIC 501 FRONT STREET CHENEYVILLE, LA 71325 (318)279-2300 Rapides 193881 * CHILDREN FIRST KIDMED 1828 WEST THOMAS HAMMOND, LA 70401 (985)419-2250 Tangipahoa 193918 None CHILDREN'S INTERNATIONAL 2401 WASHINGTON ST FRANKLINTON, LA 70438 (985)795-2228 Washington MEDICAL GROUP 193919 None CHILDREN'S INTERNATIONAL 106 MIMOSA ST AMITE, LA 70422 (985)247-2411 Tangipahoa MEDICAL GROUP 193447 * CHRISTUS COUSHATTA RINGGOLD 3342 BIENVILLE ROAD RINGGOLD, LA 71068 (318)894-9611 Bienville RURAL HEALTH CLINIC 193445 * CHRISTUS COUSHATTA RURAL 1633 MARVEL STREET COUSHATTA, LA 71019 (318)932-2222 Red River HEALTH CLINIC 193820 * CHRISTUS MEDICAL GROUP 5541 HWY 1 MARKSVILLE, LA 71351 (318)253-6583 Avoyelles MARKSVILLE FAMILY CARE CENT 193446 * CITIZENS RURAL CLINIC 484 COLLINS ROAD COLUMBIA, LA 71418 (318)649-5300 Caldwell * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 6 Louisiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 193409 * COMMUNITY MEDICAL CLINIC 712 SETTOON STREET OAK GROVE, LA 71263 (318)428-3237 West Carroll 193869 * COTTONPORT FAMILY CLINIC 1007 SYCAMORE STREET SUITE B COTTONPORT, LA 71327 (318)876-3696 Avoyelles 193488 None CROWVILLE HEALTH CENTER 5745 HIGHWAY 17 WINNSBORO, LA 71295 (318)435-9411 Franklin 193920 None D C S FAMILY HEALTH CLINIC 19100 DR JOHN LAMBERT DRIVE HAMMOND, LA 70403 (985)247-4567 Tangipahoa 193895 * D GREGORY BELL, MD AND WILLIS- 1633 MARVEL STREET (POD B) COUSHATTA, LA 71019 (318)932-2176 Red River KNIGHTON MEDICAL CTR 193417 * DELHI RURAL HEALTH CLINIC 508 BROADWAY STREET DELHI, LA 71232 (318)878-3739 Richland 193901 None DESOTO HEALTHCARE CENTER INC 7356 HIGHWAY 509 MANSFIELD, LA 71052 (318)871-1633 De Soto 193448 * DESOTO REGIONAL FAMILY 808 MAIN STREET LOGANSPORT, LA 71049 (318)697-2273 De Soto MEDICINE - LOGANSPORT 193480 * DESOTO REGIONAL FAMILY 130 JEFFERSON STREET MANSFIELD, LA 71052 (318)872-2700 De Soto MEDICINE - MANSFIELD 193908 None DUSON FAMILY HEALTHCARE 9023 CAMERON STREET DUSON, LA 70529 (337)873-8244 Lafayette 193467 * ELIZABETH FAMILY HEALTH CLINIC 504 WEST MAIN STREET ELIZABETH, LA 70638 (318)634-5475 Allen 193977 * ELTON RURAL HEALTH CLINIC 907 MAIN STREET ELTON, LA 70532 (337)584-2237 Jefferson Davis 193490 * ERATH DELCAMBRE COMMUNITY 220 NORTH ROAD ERATH, LA 70533 (337)937-5944 Vermilion CARE CLINIC 193905 None FAMILY CARE CLINIC 107 LELA STREET MANGHAM, LA 71259 (318)248-4100 Richland 193864 * FAMILY FIRST MEDICINE, APMC 902 S VIENNA STREET RUSTON, LA 71273 (318)513-1950 Lincoln 193464 * FAMILY MEDICAL CLINIC 300 SCARBOROUGH STREET LAKE PROVIDENCE, LA 71254 (318)559-2814 East Carroll 193890 * FAMILY MEDICINE ASSOCIATES OF 1111 HOMER ROAD MINDEN, LA 71055 (318)377-7500 Webster MINDEN LLC 193866 * FAMILY MEDICINE CENTER OF 147 CENTRAL AVENUE RESERVE, LA 70084 (985)536-8388 St. John the RESERVE 193495 None FAMILY MEDICINE CLINIC OF 1322 ELTON ROAD, SUITE F JENNINGS, LA 70546 (337)824-8868 Jefferson Davis JENNINGS AMERICAN LEGION 193916 None FLEUR-DE-LIS COMMUNITY HEALTH 711 SOUTH BROADWAY CHURCH POINT, LA 70525 (337)684-0127 Acadia IN CHURCH POINT 193862 * FLEUR-DE-LIS COMMUNITY HEALTH, 376 MAIN STREET CANKTON, LA 70584 (337)984-2623 St. Landry INC 193461 * FRANKLIN MEDICAL CENTER R H C - 448 NEWTON STREET ST JOSEPH, LA 71366 (318)766-8506 Tensas ST JOSEPH 193442 * FRANKLIN MEDICAL CENTER R H C - 104 VERONA STREET NEWELLTON, LA 71357 (137)467-9949 Tensas TENSAS 193459 * FRANKLIN MEDICAL CENTER R H C - 2104-C LOOP ROAD WINNSBORO, LA 71295 (318)435-4571 Franklin WINNSBORO * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 6 Louisiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 193863 * GARDINER CENTER HEALTH CLINIC 710 5TH STREET GUEYDAN, LA 70542 (337)536-9263 Vermilion 193997 * HACKBERRY RURAL HEALTH CLINIC 1020 MAIN STREET HACKBERRY, LA 70645 (337)762-3762 Cameron 193493 None HARDTNER FAMILY CLINIC 1136-A NORTH PINE ROAD OLLA, LA 71465 (318)495-3131 LaSalle 193456 * HARDTNER MEDICAL CLINIC 1049 -A NORTH PINE ROAD OLLA, LA 71465 (318)495-3229 LaSalle 193891 * HEALTH CARE FIRST MEDICAL 18015 WILLOW STREET GROSSE TETE, LA 70740 (225)648-3433 Iberville CLINIC L L C 193887 * HEALTHY STEPS PEDIATRICS 192 STILLY ROAD PINEVILLE, LA 71360 (318)484-3401 Rapides 193907 None HOPE'S CHILDREN & FAMILY CARE 338 MOREAU STREET, SUITE B MARKSVILLE, LA 71351 (318)253-2299 Avoyelles CLINIC LLC 193888 * HUSAM SUKEREK M D 210 HIGHLAND DRIVE MANY, LA 71449 (318)256-5722 Sabine 193911 None IOTA FAMILY HEALTHCARE,LLC 119 S 5TH STREET IOTA, LA 70543 (337)779-6000 Acadia 193408 * IOWA HEALTH CENTER OF LAKE 203 E MILLER IOWA, LA 70647 (337)582-7632 Calcasieu CHARLES MEMORIAL HOSPIT 193494 None J A L H PHYSICIAN CLINICS 805 N STATE STREET JENNINGS, LA 70546 (337)824-6150 Jefferson Davis 193457 * JACKSON PARISH HOSPITAL FAMILY 107 WATTS JONESBORO, LA 71251 (318)395-2121 Jackson CARE CLINIC 193404 * JEANERETTE RURAL HEALTH CLINIC 217 BOURG STREET JEANERETTE, LA 70544 (337)276-7002 Iberia 193479 * JOHNSON BAYOU RURAL HEALTH 6240 GULF BEACH HWY CAMERON, LA 70631 (337)569-2245 Cameron CLINIC 193463 * JONESBORO FAMILY CARE CLINIC 121 WATTS STREET SUITES A, B, E, & F JONESBORO, LA 71251 (318)395-0521 Jackson 193451 * LADY OF THE SEA MEDICAL CLINIC - 144 WEST 134TH PLACE CUT OFF, LA 70345 (985)632-6233 Lafourche CUT OFF 193453 * LADY OF THE SEA MEDICAL CLINIC - 13030 HWY 308 LAROSE, LA 70373 (985)798-7021 Lafourche LAROSE 193496 None LAKE ARTHUR CLINIC OF J A L H 328 KELLOGG STREET LAKE ARTHUR, LA 70549 (337)774-0100 Jefferson Davis 193999 * LAKE PROVIDENCE MEDICAL CLINIC 319 NORTH HOOD STREET LAKE PROVIDENCE, LA 71254 (318)428-3237 East Carroll 193481 * LASALLE FAMILY MEDICINE CLINIC 155-A NINTH STREET JENA, LA 71342 (318)992-4275 LaSalle 193823 * LEONARD P NEUMANN JR MD, APMC 800 JOHNSON STREET TALLULAH, LA 71284 (318)574-4731 Madison 193906 None LOUISIANA QUICK CARE, L L C 12805 HIGHWAY 28 EAST, SUITE B PINEVILLE, LA 71360 (318)466-5151 Rapides 193477 * MADISON PARISH HOSPITAL RURAL 808 JOHNSON STREET TALLULAH, LA 71282 (318)574-8584 Madison HEALTH CLINIC 193904 * MALINDA'S PATIENT CARE 19115 FLORIDA BLVD, SUITE A ALBANY, LA 70711 (225)567-7150 Livingston 193880 * MANSURA FAMILY CLINIC 2104 CLECO STREET MANSURA, LA 71350 (318)964-2551 Avoyelles 193472 * MAURICE COMMUNITY CARE CLINIC 207 MILTON ROAD MAURICE, LA 70555 (337)893-5466 Vermilion

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 6 Louisiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 193486 * MER ROUGE OUTPATIENT RURAL 220 W DAVENPORT MER ROUGE, LA 71261 (318)647-3720 Morehouse HEALTH CLINIC 193811 * MINDEN FAMILY CARE CENTER 208 MORRIS DRIVE MINDEN, LA 71055 (318)377-8260 Webster 193909 None MONTGOMERY FAMILY CLINIC 641 ROWENA STREET MONTGOMERY, LA 71454 (318)646-3000 Grant 193487 * MOREHOUSE GENERAL HOSPITAL 420 GUNBY AVE BASTROP, LA 71220 (318)283-3601 Morehouse RURAL HEALTH CLINIC 193476 * NCMC MEDICAL AND SURGICAL 715 S PINE STREET VIVIAN, LA 71082 (318)375-3239 Caddo CLINIC 193485 * NCMC PLAIN DEALING MEDICAL 112 FOREST STREET PLAIN DEALING, LA 71064 (318)326-7282 Bossier CLINIC 193917 None NEWMAN FAMILY CLINIC 502 HOSPITAL DRIVE OAKDALE, LA 71463 (318)335-2000 Allen 193478 * NORTH NATCHITOCHES MEDICAL 3194 HWY 71 CAMPTI, LA 71411 (318)476-3991 Natchitoches CLINIC 193810 * NORTH OAKS OB/GYN RURAL 15778 MEDICAL ARTS PLAZA HAMMOND, LA 70403 (985)542-0663 Tangipahoa HEALTH CLINIC 193482 * NORTH WEBSTER MEDICAL CLINIC 106 TRI-STATE DRIVE SAREPTA, LA 71071 (318)539-1000 Webster 193412 * NORTHEAST LOUISIANA HEALTH 256 HIGHWAY 3048 RAYVILLE, LA 71269 (318)728-2046 Richland CENTER 193984 * OAK GROVE MEDICAL CLINIC 708 EAST MAIN OAK GROVE, LA 71263 (318)428-3200 West Carroll 193876 None OUR LADY OF THE LAKE PHYSICIAN 18740 HWY 22 MAUREPAS, LA 70449 (225)698-3435 Livingston GROUP - RIVERSIDE 193856 * OUR LADY OF THE LAKE PHYSICIAN 310 DUREL DRIVE NEW ROADS, LA 70760 (225)713-2400 Pointe Coupee GROUP NEW ROADS 193883 * PEDIATRIC & ADOLESCENT CLINIC 1806 CARTER STREET VIDALIA, LA 71373 (318)336-7172 Concordia 193912 None PELICAN PEDIATRICS, L L C 911 WEST MAIN STREET SUITE C HOMER, LA 71040 (318)927-3255 Claiborne 193886 * RAYMOND F SCHNEIDER MEMORIAL 1302 ED BROUSSARD RD NEW IBERIA, LA 70563 (337)229-7929 Iberia CLINIC, LLC 193900 * RAYVILLE FAMILY CLINIC 1962 JULIA STREET RAYVILLE, LA 71269 (318)728-8833 Richland 193836 * REDDY FAMILY MEDICAL CENTER 32985 BOWIE STREET WHITE CASTLE, LA 70788 (225)545-3631 Iberville WHITE CASTLE 193813 * REDDY FAMILY MEDICAL CLINIC 217 RAIL ROAD AVENUE DONALDSONVILLE, LA 70346 (225)473-3931 Ascension DONALDSONVILLE 193832 * REDDY FAMILY MEDICAL CLINIC 3407 HWY 70 PIERRE PART, LA 70339 (985)252-1000 Assumption PIERRE PART 193838 * REDDY FAMILY MEDICAL CLINIC 58725 BELLEVIEW STREET PLAQUEMINE, LA 70764 (225)687-6200 Iberville PLAQUEMINE

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 6 Louisiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 193850 * REDDY FAMILY MEDICAL OF 154 HWY 1008 NAPOLEONVILLE, LA 70390 (980)369-9191 Assumption NAPOLEONVILLE 193416 * REEVES MEMORIAL MEDICAL 402 SECOND STREET BERNICE, LA 71222 (318)285-9069 Union CENTER - RHC 193858 * RIVERPARK MEDICAL CLINIC- 800 AUDUBON DRIVE JONESVILLE, LA 71343 (318)339-6388 Catahoula JONESVILLE 193441 * RIVERSIDE FAMILY CARE CLINIC 2004 J MARVIN MAGEE DRIVE FRANKLINTON, LA 70438 (985)839-3555 Washington 193833 * RURAL HEALTH CLINIC OF 411 SOUTH MAIN STREET LOREAUVILLE, LA 70552 (337)229-8288 Iberia LOREAUVILLE 193466 * S M C DOCTORS CLINIC 401 11TH N E SPRINGHILL, LA 71075 (318)539-1700 Webster 193474 * SABINE MEDICAL CENTER RURAL 395 S CAPITOL STREET MANY, LA 71449 (318)256-1136 Sabine HEALTH CLINIC #1 193475 * SABINE MEDICAL CENTER RURAL 1015 OBRIE STREET ZWOLLE, LA 71486 (318)256-2000 Sabine HEALTH CLINIC #2 193401 * SAVOY FAMILY CARE 102 SOUTH 2ND STREET EUNICE, LA 70535 (337)457-3135 St. Landry 193851 * SHIRLEY MEDICAL CLINIC 711 NORTH MAIN ST JENNINGS, LA 70546 (337)824-2002 Jefferson Davis 193871 * SIMMESPORT FAMILY CLINIC 417 NORTH MARTIN LUTHER KING SIMMESPORT, LA 71369 (318)941-2336 Avoyelles DRIVE 193915 None SOUTHCARE MEDICAL, LLC 1305 NORTH STATE STREET ABBEVILLE, LA 70510 (337)422-6240 Vermilion 193870 * ST JAMES PRIMARY CARE 827 PINE STREET GRAMERCY, LA 70052 (225)869-9200 St. James 193875 * ST JAMES PRIMARY CARE 502 RUE DE SANTE LA PLACE, LA 70068 (985)652-5475 St. John the 193860 * ST JOSEPH MEDICAL CLINIC AMC 22080 LA HWY 20 W VACHERIE, LA 70090 (225)265-3061 St. James 193923 None ST LANDRY FAMILY HEALTHCARE L 6633 HIGHWAY 10 WASHINGTON, LA 70589 (337)826-7702 St. Landry L C 193885 * ST MARTINVILLE MATERNAL-CHILD 1119 N MAIN STREET SAINT MARTINVILLE, LA (337)394-7774 St. Martin CLINIC 70582 193492 * START COMMUNITY CLINIC 5975 FEDERAL HWY 80 RAYVILLE, LA 71269 (318)728-4368 Richland 193473 * STERLINGTON OUTPATIENT RURAL 10374 HIGHWAY 165 STERLINGTON, LA 71280 (318)665-4543 Ouachita HEALTH CLINIC 193896 * STEWART FAMILY MEDICINE & 29565 FROST RD SUITE C LIVINGSTON, LA 70754 (225)686-1114 Livingston AFTER HOURS 193431 * THE FAMILY PRACTICE CLINIC 320 NORTH HOOD STREET LAKE PROVIDENCE, LA 71254 (318)559-2404 East Carroll 193879 * THE WOMEN'S CLINIC 427 HOMER ROAD MINDEN, LA 71055 (318)377-8855 Webster 193897 * THIBODAUX MEDICAL CLINIC 931 NORTH CANAL BLVD THIBODAUX, LA 70301 (985)446-6381 Lafourche 193913 None TOTAL FAMILY MEDICAL LLC 22601 HWY 190 ROBERT, LA 70455 (985)542-2466 Tangipahoa

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 6 Louisiana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 193444 * UNION GENERAL RURAL HEALTH 1025 MARION HWY FARMERVILLE, LA 71241 (318)368-9745 Union CLINIC 193914 None VILLE PLATTE PEDIATRICS, PA 504 JACK MILLER ROAD SUITE 3 VILLE PLATTE, LA 70586 (337)363-3560 Evangeline 193458 * VINTON MEDICAL CLINIC 1611 HAMPTON STREET VINTON, LA 70668 (337)589-5951 Calcasieu 193843 * W K CLAIBORNE REGIONAL HEALTH 104 MORRIS CIRCLE HOMER, LA 71040 (318)927-1110 Claiborne 193992 * WEST CARROLL MEDICAL CLINIC 502 ROSS STREET OAK GROVE, LA 71263 (318)428-3237 West Carroll 193436 * WINTERS CLINIC 412 MAIN STREET COLUMBIA, LA 71418 (318)649-6157 Caldwell 193471 * WISNER RURAL HEALTH CLINIC 3286 OAK STREET WISNER, LA 71378 (318)649-6111 Franklin 193878 * WOMEN'S CLINIC 2602 NORTH DRIVE ABBEVILLE, LA 70510 (337)893-1101 Vermilion 193898 * WOMEN'S CLINIC OF OAKDALE LLC 119 N HOSPITAL DRIVE OAKDALE, LA 71463 (318)335-0260 Allen 193449 * ZWOLLE RURAL CLINIC 2026 OBRIE STREET ZWOLLE, LA 71486 (318)871-1081 Sabine Total Providers for this State = 129

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 New Mexico

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 323831 * CARRIZOZO HEALTH CENTER 710 AVENUE E CARRIZOZO, NM 88301 (575)648-2317 Lincoln 323855 * CORONA HEALTH CLINIC HIGHWAY 54-MAIN STREET CORONA, NM 88318 (575)849-1561 Lincoln 323405 None FAMILY HEALTH CENTER OF LEA 515 EAST MAIN HOBBS, NM 88240 (575)396-6611 Lea COUNTY 323404 None HOBBS MEDICAL CLINIC 1923 NORTH DAL PASO HOBBS, NM 88240 (575)396-6611 Lea 323403 None LOVELACE HEALTH CARE CENTER- 1112 NORTH MAIN STREET ROSWELL, NM 88201 (575)627-7000 Chaves RURAL HEALTH CLINIC 323400 * LOVINGTON CLINIC 1600 NORTH MAIN AVE LOVINGTON, NM 88260 (575)396-6611 Lea 323401 * MEMORIAL FAMILY PRACTICE AT 702 NORTH 13TH ARTESIA, NM 88210 (575)746-3119 Eddy ARTESIA GENERAL HOSP 323402 * RGH CLINIC - PORTALES 42121 US HWY 70 PORTALES, NM 88130 (575)356-6652 Roosevelt 323999 * SIERRA VISTA COMMUNITY HEALTH 800 EAST 9TH AVENUE T OR C, NM 87901 (575)743-1202 Sierra CENTER 323984 * TATUM CLINIC 204 NORTH MAIN TATUM, NM 88267 (575)396-6611 Lea 323988 * VALLEY HEALTH CLINIC OF 116 EAST SECOND STREET DEXTER, NM 88230 (575)734-5817 Chaves EASTERN NM Total Providers for this State = 11

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 Oklahoma

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 373862 * A B C MEDICAL CLINIC, PLLC 1510 SOUTH VIRGINIA ATOKA, OK 74525 (580)889-3355 Atoka 373490 None ALLIANCEHEALTH WOODWARD 623 AVENUE C BEAVER, OK 73932 (580)625-2273 Beaver CLINICS 373473 None ALLIANCEHEALTH WOODWARD 908 19TH STREET WOODWARD, OK 73801 (580)256-1789 Woodward CLINICS 373482 None ALLIANCEHEALTH WOODWARD 417 SW 7TH ST MOORELAND, OK 73852 (918)994-2180 Woodward CLINICS 373999 * BUSTER RURAL HEALTH CLINIC 101 F K BUSTER AVENUE CHEYENNE, OK 73628 (580)497-3333 Roger Mills 373875 * CHEROKEE FAMILY CLINIC 221 SOUTH GRAND CHEROKEE, OK 73728 (580)596-3516 Alfalfa 373459 * CIMARRON MEMORIAL RURAL 102 SOUTH ELLIS BOISE CITY, OK 73933 (580)544-3008 Cimarron HEALTH CLINIC 373868 * CLINICO, L L C 103 EAST MAIN BEGGS, OK 74421 (918)267-7000 Okmulgee 373422 * COMANCHE COUNTY HOSPITAL 624 SOUTH COBB LAKE APACHE, OK 73006 (580)588-3257 Caddo AUTHORITY 373402 * COMMUNITY CLINIC OF BEAVER 718 AVENUE A BEAVER, OK 73932 (580)625-3477 Beaver 373408 * COMMUNITY CLINIC OF TURPIN 104 NORTH HIBBS TURPIN, OK 73950 (580)778-3966 Beaver 373828 * DOCTORS CLINIC OF DURANT, INC 1400 BRYAN DRIVE, SUITE 300 DURANT, OK 74701 (580)924-1700 Bryan 373464 * DRUMRIGHT RURAL HEALTH CLINIC 610 WEST BYPASS DRUMRIGHT, OK 74030 (918)382-2300 Creek 373468 * FAIRFAX RURAL HEALTH CLINIC 40 HOSPITAL ROAD FAIRFAX, OK 74637 (918)642-3291 Osage 373400 * FAIRVIEW FAMILY CLINIC 519 EAST STATE ROAD FAIRVIEW, OK 73837 (580)227-2585 Major 373819 * FAMILY CLINIC OF WELEETKA 315 WEST 9TH WELEETKA, OK 74880 (405)786-2248 Okfuskee 373479 None FAMILY MEDICAL CLINIC 104 WALL STREET POTEAU, OK 74953 (918)647-8635 Le Flore 373478 None FIVE OAKS FAMILY MEDICAL CLINIC 2100 W IOWA AVENUE, SUITE A CHICKASHA, OK 73018 (405)224-2100 Grady 373465 * GRAND LAKE MEDICAL PARK 26300 SOUTH HWY 125 AFTON, OK 74331 (918)257-8585 Ottawa 373860 * GREEN COUNTRY MEDICAL CLINIC 238 WILLOW STREET SOUTH COFFEYVILLE, OK (918)255-6000 Nowata 74072 373480 None HEAVENER MEDICAL CLINIC 304 HWY 59 NORTH HEAVENER, OK 74937 (918)647-8161 Le Flore 373823 * HELTON RURAL HEALTH CLINIC 108 WEST OHIO COALGATE, OK 74538 (580)927-2334 Coal 373489 None HOLDENVILLE GENERAL HOSPITAL 202 W BROADWAY ALLEN, OK 74825 (580)857-2400 Pontotoc ALLEN HEALTH CLINIC 373488 None HOLDENVILLE GENERAL HOSPITAL 100 MCDOUGAL DRIVE HOLDENVILLE, OK 74848 (405)379-4202 Hughes PHYSICIAN HEALTH CLIN 373994 * HOLDENVILLE GENERAL HOSPITAL 100 MCDOUGAL DRIVE HOLDENVILLE, OK 74848 (405)379-6631 Hughes RURAL HEALTH CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 Oklahoma

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 373477 * HOLDENVILLE GENERAL HOSPITAL 1401 WEST 1ST STREET WEWOKA, OK 74884 (405)257-3396 Seminole WEWOKA HEALTH CLINIC 373833 * HUGO RURAL HEALTH CLINIC 1201 EAST JACKSON HUGO, OK 74743 (580)326-6423 Choctaw 373876 * HUSSAINS FAMILY PRACTICE 139 EAST MAIN STREET WILBURTON, OK 74578 (918)465-5727 Latimer 373870 * INTEGRIS KINGSTON MEDICAL 701 EAST HIGHWAY 70 KINGSTON, OK 73439 (580)564-4944 Marshall CLINIC 373484 None JCMH FAMILYCARE MEDICAL CLINIC 114 S LOUIS TITTLE MANGUM, OK 73554 (580)782-3393 Greer OF MANGUM 373486 None JCMH MEDICAL CLINIC 205 S PARK LANE ALTUS, OK 73521 (580)379-6650 Jackson 373485 None JCMH PEDIATRIC CLINIC 101 S PARK LANE, SUITE 100 ALTUS, OK 73521 (580)379-6100 Jackson 373483 None JCMH WOMEN'S HEALTH 101 S PARK LANE, SUITE 200 ALTUS, OK 73521 (580)379-6140 Jackson ASSOCIATES 373878 * LAKESIDE RURAL HEALTH CLINIC 113653 OLD HWY 69 CHECOTAH, OK 74426 (918)618-4766 McIntosh 373873 * MEDFORD FAMILY CLINIC 158-B SUNSET DRIVE MEDFORD, OK 73759 (580)395-2319 Grant 373429 * MERCY HEALTH LOVE COUNTY 301 WANDA MARIETTA, OK 73448 (580)276-2400 Love RURAL HEALTH CLINIC 373472 None MERCY HOSPITAL HEALDTON - 3472 HOSPITAL ROAD HEALDTON, OK 73438 (580)229-0701 Carter PRIMARY CARE 373993 * MERCY HOSPITAL LOGAN COUNTY - 2919 SOUTH DIVISION STREET GUTHRIE, OK 73044 (405)282-6301 Logan GUTHRIE DIVISION 373990 * MERCY HOSPITAL LOGAN COUNTY- 400 SOUTH GRAND CRESCENT, OK 73028 (405)969-2818 Logan CRESCENT PRIMARY CARE 373830 * NOWATA COUNTY RURAL HEALTH 712 EAST OSAGE NOWATA, OK 74048 (918)273-0140 Nowata CLINIC 373462 * PRAGUE FAMILY CLINIC 1322 KLABZUBA AVENUE PRAGUE, OK 74864 (405)567-4922 Lincoln 373481 None QUARTZ MOUNTAIN MEDICAL 3000 N MAIN STREET ALTUS, OK 73521 (580)471-7019 Jackson CENTER 373463 * QUARTZ MOUNTAIN MEDICAL CLINIC 118 LOUIS TITTLE AVE MANGUM, OK 73554 (580)782-2113 Greer MANGUM 373442 * RINGLING FAMILY CARE 108 S 5TH STREET RINGLING, OK 73456 (580)662-2316 Jefferson 373487 None ROBISON CLINIC 1415 WATTS ST, SUITE 100 SAYRE, OK 73662 (580)928-2044 Beckham 373449 * RUSH SPRINGS FAMILY MEDICAL 113 SOUTH RUSH RUSH SPRINGS, OK 73082 (580)476-2527 Grady CLINIC 373979 * RYAN HEALTH CLINIC 1104 SOUTH 6TH STREET RYAN, OK 73565 (580)757-2451 Jefferson 373834 * RYAN MEDICAL CLINIC, L L C 514 WASHINGTON STREET RYAN, OK 73565 (580)757-2224 Jefferson 373470 None SMHA RHC US HIGHWAY 60 NORTHEAST SEILING, OK 73663 (580)922-7361 Dewey * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 Oklahoma

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 373443 * SNYDER MEDICAL CLINIC 823 'D' STREET SNYDER, OK 73566 (580)569-2373 Kiowa 373824 * ST JOHN CLINIC 112 NORTH 5TH STREET BARNSDALL, OK 74002 (918)331-1090 Osage 373471 None THE PAWNEE CLINIC 535 6TH STREET PAWNEE, OK 74058 (918)762-3972 Pawnee 373469 * VICI RURAL HEALTH CLINIC 104 WEST BROADWAY STREET VICI, OK 73859 (580)995-3004 Dewey 373854 * WATONGA FAMILY CARE 407 NORTH CLARENCE NASH WATONGA, OK 73772 (580)623-4954 Blaine BOULEVARD 373872 * WAYNOKA FAMILY CLINIC 503 SOUTH NICKERSON WAYNOKA, OK 73860 (580)824-2291 Woods 373476 None WOODWARD CLINIC 1818 KANSAS AVENUE WOODWARD, OK 73801 (580)254-3396 Woodward 373474 None WOODWARD CLINIC 1810 KANSAS AVENUE WOODWARD, OK 73801 (580)254-3174 Woodward 373475 None WOODWARD CLINIC 1101 HILLCREST DRIVE WOODWARD, OK 73801 (580)256-3608 Woodward Total Providers for this State = 58

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 673916 * ALFONSO H LUEVANO, MD PA 302 S 5TH STREET CARRIZO SPRINGS, TX 78834 (830)876-9458 Dimmit 453956 * ALICE PEDIATRIC CLINIC 305 EAST THIRD ST ALICE, TX 78332 (361)664-5291 Jim Wells 453955 * ALPINE MEDICAL CENTER 202 NORTH 2ND ST ALPINE, TX 79830 (432)837-5505 Brewster 453934 * ALVORD MEDICAL CLINIC 115 E BYPASS 287 ALVORD, TX 76225 (940)427-2858 Wise 458655 * ANDREWS FAMILY MEDICINE 700 HOSPITAL DRIVE ANDREWS, TX 79714 (915)523-6624 Andrews 673989 * ANSON FAMILY WELLNESS CLINIC 215 N AVE J ANSON, TX 79501 (325)823-3209 Jones 673413 None ARCHER CITY RHC 404 E CHESTNUT ARCHER CITY, TX 76351 (940)564-5521 Archer 673927 None AUSTIN OBGYN 301 HIGHWAY 71 W, SUITE 111 BASTROP, TX 78602 (512)304-0318 Bastrop 458813 * AUSTWELL TIVOLI MEDICAL CLINIC 106 W WILSON TIVOLI, TX 77990 (361)286-0115 Refugio 458867 * BALLINGER HOSPITAL CLINIC 2001 HUTCHINS AVE, SUITE C BALLINGER, TX 76821 (325)365-2531 Runnels 673835 * BEEVILLE FAMILY PRACTICE LLP 302 S HILLSIDE DRIVE BEEVILLE, TX 78102 (361)358-9912 Bee 458572 * BOGATA MEDICAL CLINIC 600 PARIS RD BOGATA, TX 75417 (903)632-5632 Red River 673821 * BORGER MEDICAL CLINIC 104 NORTH BRYAN BORGER, TX 79007 (806)274-2986 Hutchinson 458828 * BRADY MEDICAL CLINIC 2010 NINE ROAD BRADY, TX 76825 (325)597-2114 McCulloch 458881 * BRECKENRIDGE MEDICAL CENTER 101 S HARTFORD BRECKENRIDGE, TX 76424 (254)559-3363 Stephens 453828 * BRENHAM CLINIC 600 N PARK BRENHAM, TX 77833 (979)836-6153 Washington 673862 * BRENHAM CLINIC-BELLVILLE 235 WEST PALM SUITE 106 BELLVILLE, TX 77418 (979)865-9391 Austin 458821 * BROWNFIELD REGIONAL MEDICAL 703 EAST FELT STREET BROWNFIELD, TX 79316 (806)637-1955 Terry CENTER 673926 None BSZ MEDICAL PA 256 MEDICAL DR JOURDANTON, TX 78026 (830)769-9900 Atascosa 673844 * BUNA MEDICAL CLINIC 35607 HWY 96 SOUTH BUNA, TX 77612 (409)994-9323 Jasper 458940 * CADENHEAD RURAL HEALTH CLINIC 1417 NORTH 1ST SUITE A HASKELL, TX 79521 (940)864-2636 Haskell 673902 * CAMPBELL CLINIC 1517 TEXAS DRIVE WEATHERFORD, TX 76086 (817)458-3300 Parker 458906 * CENTER RURAL HEALTH CLINIC 620 TENAHA CENTER, TX 75935 (936)598-2716 Shelby 673908 * CHILDREN'S CLINIC OF DIMMIT AND 1313 VETERANS BLVD, SUITE C CRYSTAL CITY, TX 78839 (830)374-3118 Zavala ZAVALA PA 673855 * CHILDRENS CLINIC OF DIMMIT AND 403 SOUTH 7TH STREET CARRIZO SPRINGS, TX 78834 (830)876-9870 Dimmit 453426 * CHRISTUS FAMILY PRACTICE 205 E LAVIELLE KIRBYVILLE, TX 75956 (409)423-2217 Jasper CENTER - KIRBYVILLE 453480 * CHRISTUS FAMILY PRACTICE 1276 SOUTH PEACHTREE STREET JASPER, TX 75951 (409)384-5701 Jasper CENTER JASPER 458514 * CHRISTUS FAMILY PRACTICE 2427 W RECREATIONAL RD 255 BROOKELAND, TX 75931 (409)698-9600 Sabine CENTER SAM RAYBURN

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 458612 * CHRISTUS SPOHN FAMILY HEALTH 1038 TEXAS YES BLVD ROBSTOWN, TX 78380 (361)767-1200 Nueces CENTER ROBSTOWN 458855 * CHRISTUS SPOHN FAMILY HEALTH 111 RILEY STREET FREER, TX 78357 (361)394-7311 Duval FREER 458771 * CHRISTUS SPOHN HOSPITAL 1602 EAST HOUSTON STREET, SUITE A BEEVILLE, TX 78102 (361)358-6249 Bee MEDICAL CLINIC-BEEVILLE 673810 * CLARENDON FAMILY MEDICAL ONE MEDICAL CENTER DR POD K CLARENDON, TX 79226 (806)874-3531 Donley CENTER 673819 * CLAUDE FAMILY MEDICAL CLINIC 201 PARKS STREET CLAUDE, TX 79019 (806)226-5611 Armstrong LLC 458779 * CLEARFORK HEALTH CENTER 774 STATE HWY 70N, PO DRAWER L ROTAN, TX 79546 (325)735-2256 Fisher 673995 * CLIFTON MEDICAL CLINIC 201 S AVE T CLIFTON, TX 76634 (254)675-8621 Bosque 673897 * CLINIC FOR FAMILY WELLNESS, 1645 N 18TH STREET MEMPHIS, TX 79245 (806)259-1058 Hall PLLC 453928 * COASTAL BEND PEDIATRIC CTR 160 S 13TH ST ARANSAS PASS, TX 78336 (361)758-1984 San Patricio 673904 * COASTAL MEDICAL CLINIC 1704 JENKINS STREET ROCKPORT, TX 78382 (361)790-9047 Aransas 458838 * COGDELL CLINIC 320 NORTH MAIN LOCKNEY, TX 79241 (806)652-3373 Floyd 458875 * COGDELL CLINIC BRISCOE COUNTY 701 COMMERCE STREET SILVERTON, TX 79257 (806)823-2449 Briscoe 458827 * COGDELL FAMILY CLINIC 1700 COGDELL BLVD SNYDER, TX 79549 (432)574-7166 Scurry 673402 * COLEMAN MEDICAL ASSOCIATES 310 SOUTH PECOS 2ND FLOOR COLEMAN, TX 76834 (915)625-3533 Coleman 458842 * COLLINGSWORTH FAMILY MEDICINE 1014 15TH STREET WELLINGTON, TX 79095 (806)447-5311 Collingsworth 458608 * COLUMBUS MEDICAL CLINIC 2122 HIGHWAY 71 SOUTH COLUMBUS, TX 78934 (979)732-2318 Colorado 458832 * COMMUNITY CARE CENTER 400 SOUTHWEST 25TH AVENUE MINERAL WELLS, TX 76067 (940)325-7891 Palo Pinto 458653 * COMMUNITY CARE CENTER 202 SW 25TH AVE, SUITE 300 MINERAL WELLS, TX 76067 (940)328-7500 Palo Pinto 453862 * COMMUNITY HEALTH CLINIC LLP 160 RIVER NORTH BLVD STEPHENVILLE, TX 76401 (254)965-2500 Erath 458910 * COMPLETE HEALTHCARE SERVICE 315 WEST HOUSTON JASPER, TX 75951 (409)384-3430 Jasper PA 673440 * CONNALLY MEMORIAL MEDICAL 6511 US HIGHHWAY 181 N FLORESVILLE, TX 78114 (830)393-1747 Wilson CENTER 673442 None CONNALLY MEMORIAL MEDICAL 117 DILWORTH PLAZA POTH, TX 78147 (830)393-1770 Wilson CENTER 673441 None CONNALLY MEMORIAL MEDICAL 497 10TH STREET STE 101 FLORESVILLE, TX 78114 (830)393-1630 Wilson CENTER 458896 * COOKE COUNTY MEDICAL CENTER 801 N GRAND AVENUE STE 1 GAINESVILLE, TX 76240 (940)668-7231 Cooke

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 673910 * COVENANT FAMILY HEALTHCARE 409 8TH ST ABERNATHY, TX 79311 (806)298-5884 Hale CENTER 673992 * COVENANT HEALTHCARE CENTER 2222 W 24TH ST SUITE 6 PLAINVIEW, TX 79072 (806)293-5113 Hale PLAINVIEW 458830 * COVENANT PLAINVIEW MEDICAL 917 GOBER, PO DRAWER A PADUCAH, TX 79248 (806)492-3581 Cottle CLINIC 453423 * CRANE COUNTY RURAL HEALTH 1310 SOUTH ALFORD STREET CRANE, TX 79731 (432)558-3758 Crane CLINIC 673889 * CRANE MEDICAL CLINIC PA 102 S GASTON ST CRANE, TX 79731 (432)558-2223 Crane 458829 * CROSBYTON CLINIC HOSPITAL 710 WEST MAIN CROSBYTON, TX 79322 (806)675-7382 Crosby RURAL HEALTH CLINIC 673432 * CUERO MEDICAL CLINIC 2500 N ESPLANADE STREET SUITE 102 CUERO, TX 77954 (361)275-3466 DeWitt 458816 * DALHART FAMILY MEDICINE CLINIC 206 EAST 16TH STREET DALHART, TX 79022 (806)249-5668 Dallam 673876 * DEWEYVILLE RURAL HEALTH CLINIC 2493 HWY 12 E DEWEYVILLE, TX 77614 (409)746-7000 Newton 458562 * DOCTORS MEDICAL CENTER 10201 HWY 16N COMANCHE, TX 76442 (254)879-4910 Comanche 673830 * DUBLIN FAMILY MEDICINE 305 N PATRICK STREET DUBLIN, TX 76446 (254)445-4900 Erath 453944 * DUMAS FAMILY PRACTICE 120 BEARD AVENUE DUMAS, TX 79029 (806)935-9005 Moore 453819 * EAGLE PASS PEDIATRIC HLTH CLIN 2198 EAST GARRISON STREET EAGLE PASS, TX 78852 (830)773-1103 Maverick 458846 * EAST TEXAS MED CNTR CARTHAGE 409 COTTAGE ROAD SUITE A CARTHAGE, TX 75633 (903)693-6626 Panola HEALTH CTR 458714 * EAST TEXAS MEDICAL CENTER 300 WILSON STREET 2E HENDERSON, TX 75652 (903)655-6536 Rusk HENDERSON FAMILY HEALTH 458763 * EAST TEXAS PEDIATRICS 618 S GROVE STE 100 MARSHALL, TX 75670 (903)935-5242 Harrison 453832 * EDUARDO MORENO M D RHC 210 S AVE C CRYSTAL CITY, TX 78839 (830)374-2952 Zavala 458782 * ETMC COMMUNITY HEALTH CLINIC 315 PROSPECT DR TRINITY, TX 75862 (936)594-3595 Trinity 458854 * ETMC FIRST PHYSICIANS CLINIC 702 DAVIS ST CARTHAGE, TX 75633 (903)694-2213 Panola 458852 * ETMC FIRST PHYSICIANS CLINIC - 108 PARKER ST STE 100 QUITMAN, TX 75783 (903)763-6322 Wood QUITMAN 673410 None ETMC FIRST PHYSICIANS CLINIC 2000 SOUTH PALESTINE ATHENS, TX 75751 (903)676-1134 Henderson ATHENS 458892 * ETMC FIRST PHYSICIANS CLINIC 1743 SOUTHVIEW CIRCLE CENTER, TX 75935 (936)591-8888 Shelby CENTER II 673408 None ETMC FIRST PHYSICIANS CLINIC 233 HURST STREET CENTER, TX 75935 (903)590-4035 Shelby CENTER III 458888 * ETMC FIRST PHYSICIANS CLINIC 580 N FRANKSTON HWY FRANKSTON, TX 75763 (903)876-5888 Anderson FRANKSTON * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 673444 None ETMC FIRST PHYSICIANS CLINIC 801 N WALDRIP ST GRAND SALINE, TX 75140 (903)962-7551 Van Zandt GRAND SALINE 673400 None ETMC FIRST PHYSICIANS CLINIC 203 NACOGDOCHES ST, STE 280 JACKSONVILLE, TX 75766 (903)541-5378 Cherokee JACKSONVILLE 453447 * ETMC FIRST PHYSICIANS CLINIC 1220 NORTH PACIFIC STREET MINEOLA, TX 75773 (903)569-6124 Wood MINEOLA 458891 * ETMC FIRST PHYSICIANS CLINIC 1325 N DICKINSON DR RUSK, TX 75785 (903)683-3600 Cherokee RUSK 458850 * ETMC FIRST PHYSICIANS HEALTH 2701 US HWY 271 PITTSBURG, TX 75686 (903)856-4242 Camp CLINIC 453977 * FALLS COMMUNITY CLINIC 307 LIVE OAK ST MARLIN, TX 76661 (254)803-3561 Falls 673403 None FAMILY CARE CENTER 1700 BRAZOS STREET STE A&B ROCKDALE, TX 76567 (512)446-4535 Milam 458547 * FAMILY CARE CENTER 387 WEST IH 10, STE 1 FORT STOCKTON, TX 79735 (432)336-2058 Pecos 453863 * FAMILY CARE CLINIC 119 EAST ACADEMY DEL RIO, TX 78840 (830)774-4094 Val Verde 458617 * FAMILY CARE CLINIC 1010 SOUTH MAIN SHAMROCK, TX 79079 (806)256-5148 Wheeler 453812 * FAMILY HEALTH CENTER L L P 2768 PHARMACY ROAD RIO GRANDE CITY, TX 78582 (956)487-5621 Starr 673841 * FAMILY HEALTH CENTER OF OZONA 104 NORTH AVENUE H OZONA, TX 76943 (325)392-3788 Crockett 673416 None FAMILY HEALTH CLINIC OF SANTO 13965 SOUTH FM 4 SANTO, TX 76472 (940)769-2303 Palo Pinto 673913 * FAMILY HEALTHCARE- WOODVILLE 920 N MAGNOLIA WOODVILLE, TX 75979 (409)283-5556 Tyler 673880 * FAMILY HEALTHCARE-KIRBYVILLE 1905 N MARGARET AVE KIRBYVILLE, TX 75956 (409)420-0816 Jasper 453849 * FAMILY MEDICAL & SPECIALTY 2790 PHARMACY ROAD RIO GRANDE CITY, TX 78582 (956)487-5621 Starr CLINIC 453403 * FAMILY MEDICAL ASSOCIATES 997 WEST I 20 COLORADO CITY, TX 79512 (325)728-2693 Mitchell 458707 * FAMILY MEDICAL CLINIC OF 705 WEST 7TH SPEARMAN, TX 79081 (806)659-2846 Hansford HANSFORD 453984 * FAMILY MEDICINE CENTER 701 MCCLINTIC DRIVE GROESBECK, TX 76642 (254)729-3411 Limestone 673920 * FAMILY MEDICINE CLINIC 2401 WALKER PLACE BLVD COPPERAS COVE, TX 76522 (254)547-5516 Coryell 458605 * FAMILY MEDICINE OF LEVELLAND 116 JOHN DUPRE DRIVE LEVELLAND, TX 79336 (806)894-7900 Hockley 458905 * FAMILY MEDICINE RURAL HEALTH 207 WEST AVENUE E LAMPASAS, TX 76550 (512)556-3621 Lampasas CLINIC, PA 453818 * FAMILY PRACTICE CENTER OF 126 W NOPAL UVALDE, TX 78801 (830)278-7101 Uvalde UVALDE 458895 * FAMILY PRACTICE CLINIC OF MILLS 1501 W FRONT STREET GOLDTHWAITE, TX 76844 (325)648-2850 Mills COUNTY 458540 * FAMILY PRACTICE RURAL HEALTH C 400 N BROWN STREET HAMILTON, TX 76531 (254)386-3102 Hamilton * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 458527 * FCHC BREMOND CLINIC 201 SOUTH MAIN BREMOND, TX 76629 (254)746-7264 Robertson 458870 * FCHC ROSEBUD MEDICAL CLINIC 312 NORTH STALLWORTH ROSEBUD, TX 76570 (254)803-3561 Falls 673414 * FIRST IN PEDIATRICS 304 UNIVERSITY SUITE 207 MARSHALL, TX 75670 (903)935-9441 Harrison 453405 * FLATONIA COMMUNITY CLINIC 113 W SOUTH MAIN STREET FLATONIA, TX 78941 (512)865-3561 Fayette 673853 * FLORESVILLE FAMILY MEDICAL 921 10TH STREET SUITE 111 FLORESVILLE, TX 78114 (830)216-7979 Wilson CENTER 458848 * FOARD COUNTY MEDICAL CLINIC 200 NORTH FIRST STREET CROWELL, TX 79227 (940)684-1515 Foard 453415 * FOUR OAKS MEDICAL CLINIC 109 SHULT DR COLUMBUS, TX 78934 (979)732-5794 Colorado 453996 * FOX RURAL HEALTH CLINIC 1001 HWY 83 N CHILDRESS, TX 79201 (940)937-3636 Childress 673899 * FRED HEALTH CARE PLLC 20290 S FM 92 FRED, TX 77616 (409)429-9494 Tyler 458502 * FREESTONE HEALTH CLINIC 734 WEST COMMERCE FAIRFIELD, TX 75840 (903)389-2181 Freestone 673418 * FRIONA RHC 1307 CLEVELAND FRIONA, TX 79035 (806)250-2781 Parmer 458778 * FRITCH MEDICAL CLINIC 700 WEST BROADWAY FRITCH, TX 79036 (806)857-2311 Hutchinson 673888 * GARFIELD MEDICAL CLINIC 205 N COMMERCE STREET DILLEY, TX 78017 (830)965-4466 Frio 673909 * GARFIELD MEDICAL CLINIC 404 E SAN MARCOS ST PEARSALL, TX 78061 (830)334-3336 Frio 458927 * GARFIELD MEDICAL CLINIC 408 N GIRAUD COTULLA, TX 78014 (830)879-2279 La Salle 453936 * GARNER FIELD FAMILY MEDICINE, 524 E NOPAL ST UVALDE, TX 78801 (830)278-4588 Uvalde PA 458894 * GEORGE RURAL HEALTH CLINIC 511 NORTH MAIN FORT STOCKTON, TX 79735 (432)336-2291 Pecos 673924 * GOLDEN PLAINS RURAL HEALTH 100 S MCGEE BORGER, TX 79007 (806)273-5131 Hutchinson CLINIC 673433 * GOLIAD FAMILY PRACTICE 139 WEST FRANKLIN STREET GOLIAD, TX 77963 (361)645-8235 Goliad 458883 * GOOD SHEPHERD GLENN GARRETT 402 N KAUFMAN LINDEN, TX 75563 (903)756-5581 Cass CLINIC LINDEN 458916 * GRACE AND MERCY HEALTH CLINIC 100 S E 4TH STREET KERENS, TX 75144 (903)396-7217 Navarro 673854 * GROVETON FAMILY MEDICAL CLINIC 110 MAGEE ST GROVETON, TX 75845 (936)642-0841 Trinity 673424 None HAMLIN MEDICAL CLINIC 350 NORTHWEST AVENUE F HAMLIN, TX 79520 (325)597-3611 Jones 458893 * HARDEMAN COUNTY CLINIC 404 MERCER STREET QUANAH, TX 79252 (940)663-6651 Hardeman 673932 None HEALTH HORIZONS OF EAST TEXAS, 1407 EAST MAIN STREET NACOGDOCHES, TX 75961 (936)715-0027 Nacogdoches INC 673931 None HEALTH TEXAS PROVIDER 6257 FM 2642 ROYSE CITY, TX 75189 (972)635-9480 Rockwall NETWORK 458831 * HEREFORD HEALTH CLINIC 540 W 15TH ST HEREFORD, TX 79045 (806)364-7512 Deaf Smith 673438 None HICKMAN RURAL HEALTH CLINIC 1300 N MAIN AVENUE BIG LAKE, TX 76932 (325)884-2561 Reagan * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 458878 * HICO CLINIC 104 WALNUT STREET HICO, TX 76457 (254)796-4224 Hamilton 673409 * HIGH COUNTRY COMMUNITY RURAL 201 TEXAS BLVD DALHART, TX 79022 (806)249-8324 Dallam HEALTH CLINIC 453859 * HOOD MEDICAL CLINIC 207 TILDEN STREET COTULLA, TX 78014 (830)879-2358 La Salle 453860 * HOOD MEDICAL CLINIC OF DILLEY 111 E MILLER DILLEY, TX 78017 (830)965-1684 Frio 458978 * HOOD MEDICAL CLINICS-PEARSALL 325 N CHERRY STR PEARSALL, TX 78061 (830)334-8703 Frio 458973 * HUNT REGIONAL MEDICAL 1607 E QUINLAN PARKWAY QUINLAN, TX 75474 (903)356-2144 Hunt PARTNERS 673930 None HUNT REGIONAL MEDICAL 886 E LENNON, SUITE 100 EMORY, TX 75440 (903)473-2060 Rains PARTNERS 673976 * HUNTSVILLE MEMORIAL HOSPITAL 125 MEDICAL PARK LANE, SUITE C HUNTSVILLE, TX 77340 (936)291-3219 Walker 673445 None HUNTSVILLE MEMORIAL HOSPITAL 3638 HIGHWAY 19 HUNTSVILLE, TX 77320 (936)291-4514 Walker 458899 None HUNTSVILLE MEMORIAL HOSPITAL 1613 EAST MAIN STREET MADISONVILLE, TX 77864 (936)349-0359 Madison 673447 None HUNTSVILLE MEMORIAL HOSPITAL 110 HILL AVENUE COLDSPRING, TX 77331 (936)291-4514 San Jacinto 453888 * INTERNAL MEDICINE CLINIC OF 1042 GARNER FIELD ROAD UVALDE, TX 78801 (830)278-6681 Uvalde UVALDE 673425 None IOWA PARK CLINIC 405 SE ACCESS ROAD IOWA PARK, TX 76367 (940)495-3981 Wichita 673404 * JACK COUNTY MEDICAL CLINIC 717 MAGNOLIA ST JACKSBORO, TX 76458 (940)567-6633 Jack 458736 * JACKSON COUNTY MEDICAL CLINIC 1013 A SOUTH WELLS STREET EDNA, TX 77957 (361)782-7820 Jackson OF EDNA 673923 None JASPER FAMILY HEALTH & 492 SPRINGHILL STREET, SUITE B JASPER, TX 75951 (409)381-5751 Jasper WELLNESS RURAL CLINIC 458965 * JOURDANTON FAMILY HEALTH 1540 WEST GOODWIN PLEASANTON, TX 78064 (830)569-6340 Atascosa CENTE 458531 * JUNCTION MEDICAL CLINIC 399 REID ROAD JUNCTION, TX 76849 (325)446-3305 Kimble 673452 None KENEDY FAMILY PRACTICE 113 W MAIN ST KENEDY, TX 78119 (830)583-0612 Karnes 458833 * KNOX COUNTY HOSPITAL CLINIC 712 SOUTH 5TH STREET KNOX CITY, TX 79529 (940)657-3535 Knox 673436 None LAKE WHITNEY MEDICAL CLINIC 202E JEFFERSON AVENUE WHITNEY, TX 76692 (254)694-2221 Hill 673994 * LAVACA FAMILY HEALTH CLINIC 1406 N TEXANA STREET HALLETTSVILLE, TX 77964 (361)798-1200 Lavaca 453825 * LAVERNIA FAMILY MEDICAL CENTER 402 W CHIHUAHUA STREET LA VERNIA, TX 78121 (830)779-3800 Wilson 673988 * LEVELLAND CLINIC 1804 SOUTH COLLEGE AVENUE LEVELLAND, TX 79336 (806)894-3141 Hockley 458815 * LEVELLAND CLINIC NORTH 103 JOHN DUPREE LEVELLAND, TX 79336 (806)894-2465 Hockley 458836 * LHC FAMILY MEDICINE 1600 SOUTH SUNSET LITTLEFIELD, TX 79339 (806)385-6424 Lamb 673428 None LIBERTY DAYTON MEDICAL CLINIC 1353 NORTH TRAVIS LIBERTY, TX 77575 (936)336-7316 Liberty

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 453892 * LIBERTY MEDICAL RHC 720 TRAVIS ST LIBERTY, TX 77575 (936)336-6439 Liberty 458889 * LITTLE RIVER HEALTHCARE 708 N CROCKETT CAMERON, TX 76520 (254)697-6554 Milam CAMERON CLINIC 458590 * LITTLE RIVER HEALTHCARE 602 NORTH MAIN ROCKDALE, TX 76567 (512)446-4555 Milam ROCKDALE CLINIC 453918 * LIVE OAK PROFESSIONAL CENTER 1705 LIVE OAK COMMERCE, TX 75428 (903)886-8818 Hunt 458934 * LOS FRESNOS MEDICINE 725 OCEAN STREET LOS FRESNOS, TX 78566 (956)233-3443 Cameron 458863 * LOVETT MEREDITH RURAL HEALTH 306 WEST MAIN STREET OLNEY, TX 76374 (940)564-3546 Young CLINIC 673421 None LYNN COUNTY HOSPITAL DISTRIC 1809 LOCKWOOD ST TAHOKA, TX 79373 (806)998-4533 Lynn FAMILY WELLNESS RURAL 673808 * MARATHON HEALTH CENTER 101 SOUTH FIRST MARATHON, TX 79842 (432)386-4316 Brewster 673412 None MARATHON RURAL HEALTH CENTER 101 SOUTH POST ROAD MARATHON, TX 79842 (432)336-4200 Brewster

453496 * MARSHALL HEALTH CLINIC 805 LINDSEY MARSHALL, TX 75670 (903)927-6140 Harrison 458824 * MARSHALL PEDIATRIC CLINIC 707 S GROVE ST MARSHALL, TX 75670 (903)927-6620 Harrison 458868 * MARTIN COUNTY FAMILY CLINIC 207 N LAMESA HWY STANTON, TX 79782 (432)756-3345 Martin 458681 * MCCAMEY HOSPITAL RURAL 2500 HWY 305 SOUTH MCCAMEY, TX 79752 (432)652-8626 Upton HEALTH 453466 * MEDICAL ARTS CLINIC 2202 N BRYAN AVENUE LAMESA, TX 79331 (806)872-7494 Dawson 458679 * MEDICAL CENTER OF DIMMITT 300 W HALSELL DIMMITT, TX 79027 (806)647-2194 Castro 458872 * MEDICAL CLINIC OF CASTROVILLE 8406 FM 471 SOUTH CASTROVILLE, TX 78009 (830)538-3035 Medina 453982 * MEDICAL CLINIC OF DEVINE 1250 STATE HIGHWAY 173 NORTH DEVINE, TX 78016 (830)665-2876 Medina 453981 * MEDICAL CLINIC OF HONDO 3200 AVENUE E HONDO, TX 78861 (830)426-7444 Medina 673430 None MEDICAL CLINIC OF MULESHOE 610 SOUTH FIRST ST MULESHOE, TX 79347 (806)272-7544 Bailey 453963 * MEMORIAL CLINIC 105 MEDICAL PLAZA SULPHUR SPRINGS, TX 75482 (903)885-3181 Hopkins 673811 * MEMORIAL CLINIC 650 E LENNON EMORY, TX 75440 (903)473-7234 Rains 458611 * MEMORIAL HEALTH CLINIC 1303 MABEE DRIVE STAMFORD, TX 79553 (915)773-5733 Jones 673435 None MEMORIAL HOSPITAL CLINIC SOUTH 311 NORTHWEST 8TH STREET SEMINOLE, TX 79360 (432)758-5811 Gaines 673422 None MEMORIAL MEDICAL CLINIC 815 N VIRGINIA STREET PORT LAVACA, TX 77979 (361)552-0325 Calhoun 453463 * MID COAST MEDICAL CLINIC 305 SANDY CORNER ROAD, SUITE 120 EL CAMPO, TX 77437 (409)543-5510 Wharton 458530 * MILLS COUNTY MEDICAL CLINIC 1510 HANNAH VALLEY ROAD GOLDTHWAITE, TX 76844 (325)648-2263 Mills 458784 * MMH FAMILY HEALTH CLINIC 509 N MAPLE ST MUENSTER, TX 76252 (940)759-2226 Cooke 673411 * MOORE COUNTY FAMILY CLINIC 110 SOUTH BLISS AVE DUMAS, TX 79029 (806)935-6599 Moore * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 8 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 458809 * MORTON RURAL HEALTH CLINIC 210 EAST GRANT MORTON, TX 79346 (806)266-5565 Cochran 458897 * MOTHER FRANCES HOSPITAL 719 W COKE RD MOB 4 WINNSBORO, TX 75494 (903)342-0407 Wood WINNSBORO RHC 458898 * MOTLEY COUNTY CLINIC 1224 MAIN STREET, PO BOX 136 MATADOR, TX 79244 (806)347-2641 Motley 458968 * MOULTON CLINIC 100 SOUTH PECAN MOULTON, TX 77975 (361)596-4675 Lavaca 458652 * MULESHOE FAMILY CLINIC 701 SOUTH 1ST STREET MULESHOE, TX 79347 (806)272-4524 Bailey 458835 * MUNDAY CLINIC 120 EAST D STREET MUNDAY, TX 76371 (940)422-5271 Knox 458970 * NEW BRAUNFELS PEDIATRIC 1535 E COMMON NEW BRAUNFELS, TX 78130 (830)625-9153 Comal ASSOCI 673918 * NEWTON FAMILY RURAL HEALTH 561 STATE STREET JASPER, TX 75951 (409)384-8990 Jasper CLINIC AT JASPER 453876 * NOCONA MEDICAL CLINIC PA 90 PARK RD NOCONA, TX 76255 (940)825-3333 Montague 453460 * NORTHEAST TEXAS RURAL HEALTH 108 SIXTH ST WINFIELD, TX 75493 (903)524-4700 Titus CLINIC 458865 * NRH CLINIC 7571 STATE HWY 153 / PO BOX 185 WINTERS, TX 79567 (325)754-4553 Runnels 673405 * NTMC PEDIATRICS 801 N GRAND AVE STE 4 GAINESVILLE, TX 76240 (940)665-0683 Cooke 673443 None OLTON RURAL HEALTH CLINIC 524 8TH STREET OLTON, TX 79064 (806)285-3312 Lamb 673895 * ONE SOURCE HEALTH CENTER, 2005 HWY 183 N EARLY, TX 76802 (915)646-8541 Brown EARL 673900 * ONE SOURCE HEALTH CENTER-SAN 403 WEST WALLACE SAN SABA, TX 76877 (915)372-5701 San Saba SABA 673826 * P I MEDICAL DAY AND NIGHT CLIN 1506 HIGHWAY 100, SUITE A PORT ISABEL, TX 78578 (956)943-6675 Cameron 458820 * PALACIOS MEDICAL CLINIC 1519 4TH STREET PALACIOS, TX 77465 (361)972-2511 Matagorda 673834 * PALMER MEDICAL CLINIC 110 NORTH MAIN STREET PALMER, TX 75152 (972)449-3555 Ellis 458548 * PALO PINTO RHC 118 S MAIN GORDON, TX 76453 (254)693-5211 Palo Pinto 458639 * PARIS HEALTH CLINIC 2224 BONHAM PARIS, TX 75460 (903)139-2299 Lamar 673423 * PARKSIDE FAMILY CLINIC 1109 E BROADWAY CUERO, TX 77954 (361)275-2800 DeWitt 673434 None PARKVIEW MEDICAL CLINIC OF 101 ANTHONY DR TEAGUE, TX 75860 (254)739-5655 Freestone TEAGUE 673999 * PARKVIEW REGIONAL HEALTH CLINI 514 S BONHAM STE G H MEXIA, TX 76667 (254)562-9699 Limestone 673427 None PARKVIEW RURAL HEALTH CLINIC 307 E 9TH STREET WHEELER, TX 79096 (806)826-5581 Wheeler 673802 * PCA GUN BARREL CITY 801 WEST MAIN STREET GUN BARREL CITY, TX 75147 (903)877-6252 Anderson 453870 * PCA GREENVILLE 4211 JOE RAMSEY BLVD, SUITE 100 GREENVILLE, TX 75401 (903)408-7700 Hunt

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 9 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 453871 * PCA GREENVILLE INTERNAL 4803 WESLEY STREET GREENVILLE, TX 75401 (903)454-2246 Hunt MEDICINE 458946 * PCA QUINLAN 734 E QUINLAN PARKWAY QUINLAN, TX 75474 (903)408-4848 Hunt 458972 * PCA- PARIS 3150 CLARKSVILLE SUITE 100 PARIS, TX 75460 (903)782-9206 Lamar 453883 * PCA-LEONARD 700 E HWY 78 LEONARD, TX 75452 (903)587-3331 Fannin 458579 * PECOS VALLEY RURAL HEALTH CLIN 2323 TEXAS STREET PECOS, TX 79772 (432)447-3551 Reeves

673915 * PEDIATRIC PRACTICE ASSOCIATION 1609 US HWY 83 ZAPATA, TX 78076 (956)765-0770 Zapata 673891 * PEDIATRIC PRACTICE ASSOCIATION 201 EAST 2ND ST RIO GRANDE CITY, TX 78582 (956)488-1200 Starr -RIO GRANDE CITY 673893 * PEDIATRIC PRACTICE ASSOCIATION 1408 GRANT STREET ROMA, TX 78584 (956)849-4700 Starr -ROMA 458750 * PERRYTON HEALTH CENTER 3101 GARRETT DR PERRYTON, TX 79070 (806)435-7224 Ochiltree 458810 * PLAINS CLINIC 602 HWY 214 PLAINS, TX 79355 (806)456-6365 Yoakum 458956 * PLAINVIEW CHILDREN'S RURAL 2202 EDGEMERE PLAINVIEW, TX 79072 (806)293-1555 Hale HEALTH 458923 * PORT ISABEL HEALTH CLINIC 202 2ND STREET PORT ISABEL, TX 78578 (956)943-1774 Cameron 453957 * PORT LAVACA CLINIC ASSOCIATES 1200 N VIRGINIA PORT LAVACA, TX 77979 (361)552-6721 Calhoun 673912 * PRESIDIO MEDICAL CENTER 101 NORTH ERMA PRESIDIO, TX 79845 (432)229-4246 Presidio 458913 * PROVIDENCE FAMILY HEALTH 1323 E FRANKLIN STREET STE 105 HILLSBORO, TX 76645 (254)582-7481 Hill CLINIC-HILLSBORO 673919 * PUCKETT FAMILY CLINIC, PC 1301 EAST MAIN STREET HONEY GROVE, TX 75446 (903)378-3444 Fannin 673420 None QUICK CARE CLINIC 1411 N MAIN ST ANDREWS, TX 79714 (432)646-2586 Andrews 453441 * REFUGIO RHC 107 SWIFT ST REFUGIO, TX 78377 (361)526-2321 Refugio 458804 * RICE MEDICAL ASSOCIATES 610 SOUTH AUSTIN ROAD EAGLE LAKE, TX 77434 (409)234-2551 Colorado 453962 * RIO HONDO HEALTH CLINIC 29099 HWY 106 RIO HONDO, TX 78583 (956)748-2381 Cameron 673857 * ROBSTOWN HEALTH CENTER 327 W AVE J ROBSTOWN, TX 78380 (361)387-9233 Nueces 458780 * ROBY RURAL HEALTH CLINIC 117 NORTH 1ST NORTH CONCHO ROBY, TX 79543 (325)776-2500 Fisher BOX 66 673439 None ROLLING PLAINS MEMORIAL 201 E ARIZONA AVE SWEETWATER, TX 79556 (325)235-8641 Nolan HOSPITAL RURAL HEALTH CLIN 458812 * ROMA FAMILY HEALTH CLINIC 128 N FM 3167 ROMA, TX 78584 (956)849-0674 Starr 458862 * ROSEBUD RURAL HEALTH CLINIC 320 E AVENUE I ROSEBUD, TX 76570 (254)583-0331 Falls 673865 * RURAL FAMILY HEALTHCARE 1304 WEST COURT STREET NEWTON, TX 75966 (409)379-2177 Newton

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 10 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 673448 None SABINAL HEALTH CLINIC 517 NORTH CENTER STREET SABINAL, TX 78881 (830)988-2582 Uvalde 458885 * SABINE FAMILY MEDICAL CENTER 1111 WORTH ST HEMPHILL, TX 75948 (409)787-1707 Sabine 673801 * SAINT JO HEALTHCARE CENTER 108 E BOGGESS SAINT JO, TX 76265 (940)995-2410 Montague 673406 None SANDERSON RURAL HEALTH 213 PERSIMMONS STREET SANDERSON, TX 79848 (432)345-2508 Terrell CENTER 458684 * SANDHILLS FAMILY CLINIC 813 E 4TH STREET MONAHANS, TX 79756 (432)943-2068 Ward 458823 * SCHLEICHER COUNTY FAMILY 100 NORTH US HIGHWAY 277 ELDORADO, TX 76936 (325)853-2507 Schleicher CLINIC 673417 None SCOTT & WHITE CLINIC - JOHNSON 208 HALEY RD JOHNSON CITY, TX 78636 (830)868-4033 Blanco CITY 673419 None SCOTT & WHITE CLINIC BURNET 101 E JACKSON ST BURNET, TX 78611 (830)201-7100 Burnet 458839 * SCOTT & WHITE CLINIC- 100 PECAN CROSSING HORSESHOE BAY, TX 78657 (830)598-4405 Burnet HORSESHOE BAY 458686 * SCOTT & WHITE CLINIC-KINGSLAND 105 FM 2342 KINGSLAND, TX 78639 (325)388-3515 Llano 458693 * SCOTT & WHITE CLINIC-MARBLE 706 AVENUE G MARBLE FALLS, TX 78654 (830)593-8234 Burnet FALLS 458799 * SCOTT & WHITE CLINIC-SAN SABA 2005 W WALLACE SUITE 200 SAN SABA, TX 76877 (325)372-5163 San Saba 458738 * SCOTT & WHITE FAMILY PRACTICE- 539 MEDICAL PARKWAY BRENHAM, TX 77833 (979)836-1883 Washington BRENHAM 453413 * SCOTT & WHITE HOERSTER CLINIC- 102 E YOUNG LLANO, TX 78643 (325)247-4131 Llano LLANO 453922 * SEARS MEDICAL ASSOCIATES 836 E CALIFORNIA ST GAINESVILLE, TX 76240 (940)665-5566 Cooke 458845 * SEBD CHILDREN'S CARE-A-VAN 300 S COLORADO LOCKHART, TX 78644 (512)376-9690 Caldwell 458876 * SETON BERTRAM HEALTHCARE 160 NORTH LAMPASAS ST BERTRAM, TX 78605 (512)355-2678 Burnet CENTER 458825 * SETON BURNET HEALTHCARE 200 COUNTY RD 340 A SUITE 2 BURNET, TX 78611 (512)715-3009 Burnet CENTER 458843 * SETON HIGHLAND LAKES MARBLE 700 HIGHWAY 281 MARBLE FALLS, TX 78654 (830)693-2500 Burnet FALLS HEALTH CENTER 673450 None SETON KINGSLAND HEALTHCARE 525 RANCH ROAD 2900 KINGSLAND, TX 78639 (325)388-6912 Llano CENTER 458887 * SETON LAMPASAS HEALTHCARE 1205 CENTRAL TEXAS EXPRESSWAY LAMPASAS, TX 76550 (512)556-5362 Lampasas CENTER 458819 * SETON LOCKHART FAMILY HEALTH 300 SOUTH COLORADO SUITE A&D LOCKHART, TX 78644 (830)875-7000 Caldwell CENTER

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 11 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 673449 None SETON LULING FAMILY MEDICINE 130 HAYS STREET, STE B LULING, TX 78648 (830)675-7078 Caldwell CLINIC 458573 * SEYMOUR HOSPITAL RHC 201 STADIUM DRIVE SEYMOUR, TX 76380 (940)889-5572 Baylor 458844 * SHL CARE-A-VAN 3201 S WATER STREET BURNET, TX 78611 (830)693-2600 Burnet 453456 * SIEVERS MEDICAL CLINIC 1110 N SARAH DEWITT DRIVE GONZALES, TX 78629 (830)672-8502 Gonzales 453953 * SINTON PEDIATRIC CENTER 301 S SAN PATRICIO SINTON, TX 78387 (361)364-3355 San Patricio 673911 * SLATON FAMILY MEDICAL CLINIC 235 W GARZA SLATON, TX 79364 (806)828-1600 Lubbock 458877 * SONORA MEDICAL CLINIC 301 HUDSPETH SUITE B SONORA, TX 76950 (325)387-7911 Sutton 458986 * SOUTH PADRE ISLAND PEDS CNTR 220E ST MARY STREET MATHIS, TX 78368 (361)547-5700 San Patricio M 673426 * SPUR CLINIC 907 E HILL ST SPUR, TX 79370 (806)271-3306 Dickens 458713 * STARR COUNTY MEMORIAL 128 N FARM ROAD 3167 RIO GRANDE CITY, TX 78582 (210)487-5561 Starr HOSPITAL RURAL HEALTH CLINIC 673887 * STEVE AHMED, MD, PA 1700 W FM 700 BIG SPRING, TX 79720 (432)264-1900 Howard 673446 None STINNETT MEDICAL CLINIC 711 S STEWART AVENUE STINNETT, TX 79083 (806)878-2271 Hutchinson 453826 * STOCKDALE FAMILY MEDICAL 601 PERSON ST STOCKDALE, TX 78160 (830)996-3701 Wilson CENTER 458789 * STONEWALL MEMORIAL HOSPITAL 1447 MAIN STREET JAYTON, TX 79528 (806)237-3405 Kent 453986 * STONEWALL RURAL HEALTH CLINIC 821 N BROADWAY ST ASPERMONT, TX 79502 (940)989-2875 Stonewall 673858 * TAFT HEALTH CENTER 1210 GREGORY SUITE 2 TAFT, TX 78390 (361)528-2595 San Patricio 458705 * TCH FAMILY MEDICAL CLINIC 104 N BEECH STREET WOODVILLE, TX 75979 (409)283-2822 Tyler 458974 * TEARE MEMORIAL CLINIC 146 PIONEER DRIVE BOOKER, TX 79005 (806)658-4531 Lipscomb 673429 None TEXLINE HEALTH CLINIC 100 N THIRD ST TEXLINE, TX 79087 (231)924-0244 Dallam 673922 None THE PEDIATRIC CARE CENTER 4857 W HWY 83 ROMA, TX 78584 (956)849-0104 Starr 673929 None THE PEDIATRIC CARE CENTER 1804 N US HWY 83 ZAPATA, TX 78076 (956)265-9040 Zapata 458683 * THROCKMORTON RURAL HEALTH 802 NORTH MINTER AVE, SUITE B THROCKMORTON, TX 76483 (940)849-2471 Throckmorton CLINIC 453411 * TIMBERLANDS CLINIC 1050 LOOP 304 EAST CROCKETT, TX 75835 (936)544-7856 Houston 673401 None TOLEDO BEND FAMILY MEDICINE 2421 WORTH ST HEMPHILL, TX 75948 (409)787-1416 Sabine 673822 * TRINITY CLINIC - CANTON 18780 INTERSTATE 20 CANTON, TX 75103 (903)567-4841 Van Zandt 673823 * TRINITY CLINIC - QUITMAN 502 EGOODE ST, STE 1E QUITMAN, TX 75783 (903)763-5402 Wood 673883 * TRINITY CLINIC HENDERSON 511 N HIGH HENDERSON, TX 75652 (903)657-7583 Rusk 673886 * TRINITY CLINIC HOLLY LAKE 5321 FM 14/2869 HAWKINS, TX 75765 (903)769-2990 Wood

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 12 of 12 Texas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 673825 * TRINITY CLINIC MINEOLA 1302 NORTH PACIFIC MINEOLA, TX 75773 (903)531-4965 Wood 458694 * TULIA RURAL HEALTH CLINIC 105 HOSPITAL AVE TULIA, TX 79088 (806)995-4122 Swisher 453929 * UNITED CLINICS OF NORTH TEXAS 1010 NORTH MILL STREET BOWIE, TX 76230 (940)872-1121 Montague 458619 * UNIVERSITY MEDICAL CENTER- 101 POTASIO, PO BOX 3940 FABENS, TX 79838 (915)764-5000 El Paso FABENS 453835 * UVALDE FAMILY PRACTICE ASSN 1800 GARNER FIELD ROAD UVALDE, TX 78801 (830)278-4453 Uvalde 673437 None UVALDE MEDICAL AND SURGICAL 1195 GARNER FIELD ROAD BUILDING B UVALDE, TX 78801 (830)278-3086 Uvalde ASSOCIATES SUITE 500 673431 None VAL VERDE HOSPITAL 1801 N BEDELL AVENUE DEL RIO, TX 78840 (830)768-9200 Val Verde CORPORATION 453462 * VAN HORN RHC FM 2185 & EISENHOWER ROAD VAN HORN, TX 79855 (432)283-2760 Culberson 458932 * VIDOR COMMUNITY HEALTH CLINIC 1290 HWY 12 VIDOR, TX 77662 (409)769-7795 Orange 453481 * WAELDER MEDICAL CLINIC 401 NORTH AVENUE G# APT9 WAELDER, TX 78959 (830)788-7280 Gonzales 458912 * WAGNER MEDICAL CLINIC, LLP 124 E WOLTERS/2ND STREET SHINER, TX 77984 (361)594-3824 Lavaca 458811 * WEST TEXAS MEDICAL CENTER 415 NORTH AVENUE F DENVER CITY, TX 79323 (806)592-9501 Yoakum 673933 None WHITNEY FAMILY MEDICINE 1314 N BRAZOS STREET WHITNEY, TX 76692 (254)694-3621 Hill 458557 * WINKLER COUNTY RURAL HEALTH 828 MYER LANE KERMIT, TX 79745 (432)586-2040 Winkler CLINIC 458874 * WINNIE COMMUNITY CLINIC 538 BROADWAY WINNIE, TX 77665 (409)296-6337 Chambers 673982 * WOODSBORO MEDICAL CLINIC 120 WOOD AVE WOODSBORO, TX 78393 (361)543-5414 Refugio 458987 * YELED SHALOM PEDIATRIC CLINIC 1975 VETERANS BLVD SUITE 5 EAGLE PASS, TX 78852 (830)773-9449 Maverick 673451 None YORKTOWN MEDICAL CLINIC 508 N RIEDEL ST YORKTOWN, TX 78164 (361)564-9230 DeWitt 458851 * YOUNG COUNTY FAMILY CLINIC 820 MONTGOMERY ROAD SUITE 202 GRAHAM, TX 76450 (940)549-7741 Young Total Providers for this State = 305

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 168576 None ADAIR COUNTY MEDICAL CLINIC 303 SW 7TH STREET, SUITE B STUART, IA 50250 (515)523-2513 Adair STUART 168500 * ADAIR COUNTY MEDICAL CLINIC- 609 SOUTHEAST KENT GREENFIELD, IA 50849 (641)743-6189 Adair GREENFIELD 163830 * AKRON FAMILY PRACTICE CLINIC 321 MILL STREET AKRON, IA 51001 (712)568-2411 Plymouth 168526 * ANITA MEDICAL CENTER 720 MAIN ANITA, IA 50020 (712)762-4462 Cass 168945 * ANTHON MERCY MEDICAL CLINIC 307 MAIN STREET ANTHON, IA 51004 (712)373-5711 Woodbury 168556 None ATKINS FAMILY MEDICAL CLINIC 401 CARDINAL AVENUE ATKINS, IA 52206 (319)446-7800 Benton 168523 * ATLANTIC MEDICAL CENTER 1501 EAST 10TH, PO BOX 429 ATLANTIC, IA 50022 (712)243-2850 Cass 168546 * AUDUBON FAMILY HEALTH CARE 515 PACIFIC STREET, SUITE 2 AUDUBON, IA 50025 (712)563-4611 Audubon 163853 * AUDUBON MEDICAL CLINIC 222 BROADWAY AUDUBON, IA 50026 (712)563-4206 Audubon 168557 None BELMOND CLINIC 403 FIRST STREET SE BELMOND, IA 50421 (641)444-3500 Wright 163997 * BIRMINGHAM MEDICAL CLINIC 735 N HIGHWAY 1 BIRMINGHAM, IA 52535 (319)498-4370 Van Buren 163451 * BONAPARTE MEDICAL CLINIC 624 FIRST STREET BONAPARTE, IA 52620 (319)592-3168 Van Buren 168575 None BOONE COUNTY FAMILY MEDICINE 320 W WALNUT STREET OGDEN, IA 50212 (515)275-2417 Boone OGDEN 168577 None BURGESS CLINIC WHITING 153 BLAIR STREET WHITING, IA 51063 (712)455-2431 Monona 163470 * BURGESS FAMILY CLINC - DUNLAP 612 IOWA AVENUE DUNLAP, IA 51529 (712)643-5880 Harrison 168538 * BURGESS FAMILY CLINIC - MAPLE 513 SOUTH MUCKEY STREET MAPLETON, IA 51034 (712)882-2234 Monona VALLEY 163483 * BURGESS FAMILY CLINIC - SLOAN 409 EVANS SLOAN, IA 51055 (712)428-4100 Woodbury 168535 None C C M H MEDICAL CLINIC 100 MEDICAL PARKWAY, SUITE A DENISON, IA 51442 (712)265-2700 Crawford 168587 None CCMH MEDICAL CLINIC - CITY 115 N 14TH STREET DENISON, IA 51442 (712)263-5071 Crawford CENTER 163487 * CHEROKEE REGIONAL CLINIC 300 SIOUX VALLEY DRIVE CHEROKEE, IA 51012 (712)225-6265 Cherokee 163441 * CHEROKEE REGIONAL CLINIC- 112 NORTH KIEL STREET HOLSTEIN, IA 51025 (712)368-4730 Ida HOLSTEIN 163479 * CHI HEALTH CLINIC BEDFORD 1502 MADISON STREET BEDFORD, IA 50833 (712)523-2196 Taylor 163480 * CHI HEALTH CLINIC CORNING 601 ROSARY DRIVE CORNING, IA 50841 (641)322-3121 Adams 163476 * CHI HEALTH CLINIC DUNLAP 704 IOWA AVENUE DUNLAP, IA 51529 (712)643-2298 Harrison 163478 * CHI HEALTH CLINIC LENOX 210 SOUTH MAIN LENOX, IA 50851 (641)333-2266 Taylor 163431 * CHI HEALTH CLINIC LOGAN 122 WEST EIGHTH STREET LOGAN, IA 51546 (712)642-3612 Harrison 163433 * CHI HEALTH CLINIC MISSOURI 809 EAST ELM STREET MISSOURI VALLEY, IA 51555 (712)642-2794 Harrison VALLEY * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 163477 * CHI HEALTH CLINIC WOODBINE 518 LINCOLN WAY WOODBINE, IA 51579 (712)647-2566 Harrison 168539 * CHRISTOPHEL CLINIC 312 9TH STREET SW, SUITE 2300 WAVERLY, IA 50677 (319)483-1390 Bremer 168579 None CIH CONRAD CLINIC 105 N CHURCH STREET CONRAD, IA 50621 (641)366-2123 Grundy 168578 None CIH MARSHALLTOWN CLINIC 405 E MAIN STREET, FIRST FLOOR MARSHALLTOWN, IA 50158 (641)753-2752 Marshall 168580 None CIH STATE CENTER CLINIC 503 3RD AVENUE SW STATE CENTER, IA 50247 (641)844-2970 Marshall 168581 None CIH TAMA TOLEDO CLINIC 1307 S BROADWAY STREET, UPPER TOLEDO, IA 52342 (641)484-5445 Tama LEVEL 163495 * CLARION CLINIC 215 13TH AVENUE SW CLARION, IA 50525 (515)532-2836 Wright 168550 * CORNERSTONE FAMILY PRACTICE 101 E WATSON ST GARNAVILLO, IA 52049 (563)964-2608 Clayton 168552 * CORNERSTONE FAMILY PRACTICE 200 MAIN STREET GUTTENBERG, IA 52052 (563)252-2141 Clayton 168553 * CORNERSTONE FAMILY PRACTICE 101 SOUTH WASHINGTON EDGEWOOD, IA 52042 (563)928-6435 Delaware 168934 * CORRECTIONVILLE MERCY 1120 EAST HIGHWAY 20 CORRECTIONVILLE, IA 51016 (712)372-4145 Woodbury MEDICAL CLINIC 163438 * COVENANT CLINIC - ARLINGTON 751 MAIN STREET ARLINGTON, IA 50606 (563)633-6965 Fayette 163493 * CRESCO MEDICAL CLINIC 321 EIGHTH AVENUE WEST CRESCO, IA 52136 (563)547-2022 Howard 163878 * DALLAS CENTER MEDICAL 507 14TH STREET DALLAS CENTER, IA 50063 (515)992-3711 Dallas ASSOCIATES 168566 None DAVIS COUNTY MEDICAL 509 N MADISON STREET, SUITE 100 BLOOMFIELD, IA 52537 (641)664-3832 Davis ASSOCIATES 163998 * DOUDS MEDICAL CLINIC 14204 HIGHWAY 98 DOUDS, IA 52551 (641)936-7107 Van Buren 163486 * EARLHAM MEDICAL CLINIC 125 WEST FIRST STREET EARLHAM, IA 50072 (515)758-2907 Madison 168534 * EXIRA MEDICAL CLINIC 107 SOUTH JEFFERSON STREET EXIRA, IA 50076 (712)268-5348 Audubon 163890 * FAMILY HEALTH CARE OF 410 MAIN STREET MOVILLE, IA 51039 (712)873-5225 Woodbury SIOUXLAND 163464 * FAMILY HEALTH CENTER 309 SOUTH FIFTH AVENUE VILLISCA, IA 50864 (712)826-3003 Montgomery 163831 * FAMILY MEDICINE CLINIC 1614 DIAMOND STREET PLACE ONAWA, IA 51040 (712)423-1525 Monona 163482 * FAMILY PRACTICE CLINIC 3201 FIRST STREET EMMETSBURG, IA 50536 (712)852-5555 Palo Alto EMMETSBURG 163472 * FAMILY PRACTICE CLINIC 109 WEST ROBBINS STREET GRAETTINGER, IA 51342 (712)859-3131 Palo Alto GRAETTINGER 163417 * FAMILY PRACTICE CLINIC WEST 107 DIVISION STREET WEST BEND, IA 50597 (515)887-7881 Palo Alto BEND 163452 * FARMINGTON MEDICAL CLINIC 206 SOUTH FOURTH STREET FARMINGTON, IA 52626 (319)878-4232 Van Buren 163498 * FLOYD COUNTY AREA FAMILY 1501 SOUTH MAIN STREET, SUITE 6 CHARLES CITY, IA 50616 (641)257-1184 Floyd PRACTICE CENTER * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 163996 * FOX RIVER MEDICAL CLINIC 14983 275TH STREET CANTRIL, IA 52542 (319)397-2300 Van Buren 168913 * FRANCISCAN HEALTHCARE - 105 EAST MAIN STREET WAUKON, IA 52172 (563)568-3449 Allamakee WAUKON 163987 * FRANKLIN MEDICAL CENTER-DOWS 103 EAST ELLSWORTH STREET DOWS, IA 50071 (515)852-4113 Wright 163979 * FRANKLIN MEDICAL CENTER- 606 SOUTH SECOND STREET DUMONT, IA 50625 (641)857-6696 Butler DUMONT 163420 * FRANKLIN MEDICAL CENTER- 1720 CENTRAL AVENUE EAST HAMPTON, IA 50441 (641)456-5050 Franklin HAMPTON 163463 * FRANKLIN MEDICAL CENTER- 109 SOUTH AKIR STREET LATIMER, IA 50452 (641)579-6340 Franklin LATIMER 163849 * GREAT RIVER CLINIC AT WAPELLO 220 MULBERRY, SUITE A WAPELLO, IA 52653 (319)523-3421 Louisa 168525 * GRISWOLD MEDICAL CENTER 1109 MORNINGSIDE DRIVE GRISWOLD, IA 51535 (712)778-5140 Cass 163892 * GUNDERSEN LANSING CLINIC 50 NORTH 4TH STREET LANSING, IA 52151 (563)538-4874 Allamakee 168583 * GUNDERSEN PALMER LUTHERAN 111 SOUTH REYNOLDS POSTVILLE, IA 52162 (563)864-7512 Allamakee HOSP & CLIN - POSTVILLE 168582 * GUNDERSEN PALMER LUTHERAN 110 JEFFERSON STREET WEST UNION, IA 52175 (563)422-3817 Fayette HOSP & CLIN-WEST UNION 168584 * GUNDERSEN PALMER LUTHERAN 110 KING STREET FAYETTE, IA 52142 (563)425-3381 Fayette HOSP & CLINICS-FAYETTE 168559 None HAMPTON CLINIC 700 SECOND STREET SE HAMPTON, IA 50441 (641)444-3223 Franklin 163456 * HARDIN MEDICAL CLINIC 400 SOUTH DODGE STREET BEDFORD, IA 50833 (712)523-2738 Taylor 163492 * HARTLEY MERCY MEDICAL CLINIC 231 NORTH EIGHTH AVENUE WEST HARTLEY, IA 51346 (712)728-2820 O'Brien 168503 * HAWARDEN REGIONAL 1122 AVENUE L HAWARDEN, IA 51023 (712)551-2522 Sioux HEALTHCARE CLINICS, LLC 163410 * HEALTH TRUST PHYSICIANS CLINIC 300 WEST HUTCHINS STREET WINTERSET, IA 50273 (515)462-2950 Madison 168537 * HORN PHYSICIANS CLINIC 700 EAST 2ND STREET, SUITE 2 IDA GROVE, IA 51445 (712)364-2514 Ida 168558 None HORN PHYSICIANS CLINIC 520 MAIN STREET MAPLETON, IA 51034 (712)881-4676 Monona MAPLETON 168565 None HORN PHYSICIANS CLINIC ODEBOLT 300 S MAPLE STREET ODEBOLT, IA 51458 (712)668-2232 Sac 168548 None HUMESTON FAMILY MEDICAL CLINIC 109 BROAD STREET HUMESTON, IA 50123 (641)877-6108 Wayne 168572 None JCHC RURAL HEALTH CLINIC 2000B SOUTH MAIN STREET FAIRFIELD, IA 52556 (641)472-4156 Jefferson 168585 None KEOKUK COUNTY MEDICAL CLINIC 1314 SOUTH STUART STREET, SUITE B SIGOURNEY, IA 52591 (641)622-1170 Keokuk 163453 * KEOSAUQUA MEDICAL CLINIC 304 FRANKLIN ST KEOSAUQUA, IA 52565 (319)293-3171 Van Buren 163846 * KINGSLEY MERCY MEDICAL CLINIC 111 MAIN STREET KINGSLEY, IA 51028 (712)378-2921 Plymouth 163437 * KOSSUTH FAMILY HEALTH CENTER 1519 SOUTH PHILLIPS STREET ALGONA, IA 50511 (515)295-2451 Kossuth * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 163976 * KOSSUTH REGIONAL HEALTH 122 WEST RAMSEY STREET BANCROFT, IA 50517 (515)885-2336 Kossuth CENTER 163469 * LENOX MEDICAL CLINIC 100 S MAIN STREET LENOX, IA 50851 (641)333-4545 Taylor 163494 * LIME SPRINGS MEDICAL CLINIC 101 WEST MAIN STREET LIME SPRINGS, IA 52155 (563)566-2243 Howard 163435 * LINEVILLE MEDICAL CLINIC 101 MAIN STREET LINEVILLE, IA 50147 (641)876-2070 Wayne 168560 None LUCAS COUNTY HEALTH CENTER 1200 N 7TH STREET CHARITON, IA 50049 (641)774-3000 Lucas MEDICAL CLINIC 168574 None MADRID FAMILY PRACTICE CLINIC 623 W NORTH STREET MADRID, IA 50156 (515)795-4300 Boone 168563 None MARENGO FAMILY MEDICAL CLINIC 255 W LUCAS STREET MARENGO, IA 52301 (319)741-6789 Iowa 168524 * MASSENA MEDICAL CENTER 92 SOUTH MAIN STREET MASSENA, IA 50853 (712)779-3626 Cass 168516 * MCCRARY ROST CLINIC 1160 3RD STREET LAKE VIEW, IA 51450 (712)657-8555 Sac 163475 * MCCRARY ROST CLINIC 1800 MAIN STREET GOWRIE, IA 50543 (515)352-3891 Webster 168545 * MCCRARY-ROST CLINIC 505 EAST LAKE STREET ROCKWELL CITY, IA 50579 (712)297-8989 Calhoun 168522 * MCCRARY-ROST CLINIC 1351 WEST MAIN STREET LAKE CITY, IA 51449 (712)464-3194 Calhoun 168951 * MEDIAPOLIS MEDICAL CLINIC 401 N ORCHARD MEDIAPOLIS, IA 52637 (319)394-3177 Des Moines 163834 * MEDICAL CLINIC 1219 MAIN STREET HAMBURG, IA 51640 (712)382-2626 Fremont 163833 * MEDICAL CLINIC 313 MAIN STREET SIDNEY, IA 51652 (712)374-2649 Fremont 163836 * MEDICAL CLINIC 710 CENTER STREET TABOR, IA 51653 (712)629-2975 Fremont 168950 * MERCY CARE MONTICELLO 619 SOUTH MAIN STREET MONTICELLO, IA 52310 (319)465-5937 Jones 168949 * MERCY CARE TAMA 402 SIEGAL STREET TAMA, IA 52339 (641)484-3333 Tama 168948 * MERCY FAMILY CLINIC 115 NORTH MAIN STREET BUFFALO CENTER, IA 50424 (641)562-2424 Winnebago 168964 None MERCY FAMILY MEDICINE OF 56 CEDAR STREET TIPTON, IA 52772 (563)886-2195 Cedar TIPTON 168963 None MERCY FAMILY MEDICINE OF WEST 206 COOKSON DRIVE WEST BRANCH, IA 52358 (319)643-2516 Cedar BRANCH 168533 * MERCY MEDICAL CLINIC 19876 ST JOSEPH'S DRIVE CENTERVILLE, IA 52544 (641)856-8684 Appanoose 163462 * MILL CREEK FAMILY PRACTICE 5616 460TH STREET PAULLINA, IA 51046 (712)448-2000 O'Brien 168536 * MONROE COUNTY HOSPITAL CLINIC 6580 165TH STREET ALBIA, IA 52531 (641)932-2134 Monroe 163449 * MONROE FAMILY HEALTH CENTER 100 E SHERMAN MONROE, IA 50170 (641)259-2155 Jasper 168570 None MOUNT AYR MEDICAL CLINIC 504 N CLEVELAND STREET, SUITE M MOUNT AYR, IA 50854 (641)464-4470 Ringgold 168517 * MYRTUE MEDICAL CENTER - AVOCA 510 NORTH ELM STREET AVOCA, IA 51521 (712)343-6455 Pottawattamie CLINIC 168518 * MYRTUE MEDICAL CENTER - G E 4022 MAIN STREET ELK HORN, IA 51531 (712)764-4642 Shelby LARSON ELK HORN/KIMBAL * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 168509 * MYRTUE MEDICAL CENTER - 1220 CHATBURN AVENUE HARLAN, IA 51537 (712)755-5130 Shelby HARLAN CLINIC 168519 * MYRTUE MEDICAL CENTER - 105 EAST STREET SHELBY, IA 51570 (712)544-2511 Shelby SHELBY CLINIC 168571 None MYRTUE MEDICAL CENTER- 100 INDUSTRIAL DRIVE SUITE 101 EARLING, IA 51530 (712)747-5700 Shelby EARLING CLINIC 168527 * NASHUA CLINIC 80 AMHEARST BLVD, SUITE 400 NASHUA, IA 50658 (641)435-4133 Chickasaw 163454 * OSAGE CLINIC 620 NORTH EIGHTH STREET OSAGE, IA 50461 (641)732-6100 Mitchell 168562 None OTTUMWA MEDICAL CLINIC 920 N QUINCY AVENUE OTTUMWA, IA 52501 (641)455-5200 Wapello 163488 * PAULLINA MERCY MEDICAL CLINIC 108 EAST GROESBECK AVENUE PAULLINA, IA 51046 (712)448-2126 O'Brien 163490 * PRIMGHAR MERCY MEDICAL CLINIC 240 NORTH RERICK AVENUE PRIMGHAR, IA 51245 (712)957-2310 O'Brien 163827 * REDFIELD MEDICAL CLINIC 1013 FIRST STREET REDFIELD, IA 50233 (515)833-2301 Dallas 168530 * REGIONAL FAMILY HEALTH - 709 WEST MAIN STREET MANCHESTER, IA 52057 (563)927-3232 Delaware MANCHESTER 168554 * REGIONAL FAMILY HEALTH 345 1ST STREET SOUTH WINTHROP, IA 50682 (319)935-3343 Buchanan WINTHROP 168531 * REGIONAL FAMILY HEALTH, 702 WEST UNION STREET EDGEWOOD, IA 52042 (563)928-7191 Clayton EDGEWOOD 168529 * REGIONAL FAMILY HEALTH, 122 FIRST STREET SW HOPKINTON, IA 52237 (563)926-2922 Delaware HOPKINTON 168528 * REGIONAL FAMILY HEALTH, 111 EAST MISSION STREET STRAWBERRY POINT, IA (563)933-6277 Clayton STRAWBERRY POINT 52076 163497 * RICEVILLE CLINIC 109 WESTWARD DRIVE RICEVILLE, IA 50466 (641)985-2122 Howard 168508 * SANFORD CLINIC LAKE PARK 204 MARKET STREET LAKE PARK, IA 51347 (712)382-9559 Dickinson 168507 * SANFORD CLINIC ROCK RAPIDS 803 SOUTH GREEN STREET ROCK RAPIDS, IA 51246 (712)472-3716 Lyon 168505 * SANFORD CLINIC SANBORN 321 MAIN STREET SANBORN, IA 51248 (712)729-3545 O'Brien 168506 * SANFORD CLINIC SHELDON 800 OAK STREET, PO BOX 10 SHELDON, IA 51201 (712)324-5356 O'Brien 168561 * SANFORD ROCK RAPIDS GEORGE 101 N MAIN STREET GEORGE, IA 51237 (712)475-3393 Lyon CLINIC 168541 None SEYMOUR MEDICAL CLINIC 515 W WALL SEYMOUR, IA 52590 (641)898-2898 Wayne 168555 None SHELL ROCK CLINIC 1001 MASON WAY SHELL ROCK, IA 50670 (319)885-6530 Butler 168549 None SHENANDOAH PHYSICIANS CLINIC 1 JACK FOSTER DRIVE SHENANDOAH, IA 51601 (712)246-7240 Page 168569 None SHENANDOAH PHYSICIANS CLINIC - 802 ILLINOIS STREET SIDNEY, IA 51652 (712)374-6005 Fremont SIDNEY

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 168547 None SOUTH CENTRAL IOWA MEDICAL 417 S EAST STREET, SUITE 100 CORYDON, IA 50060 (641)872-2063 Wayne CLINIC 163445 * ST ANSGAR CLINIC 140 WEST FOURTH STREET, SUITE 1 SAINT ANSGAR, IA 50472 (641)736-4401 Mitchell 163460 * STORY MEDICAL CLINIC - ZEARING 112 WEST MAIN STREET ZEARING, IA 50278 (641)487-7779 Story 168943 * STUART MEDICAL CLINIC 106 NE SECOND STREET STUART, IA 50250 (515)523-2283 Adair 163455 * SULLY FAMILY HEALTH CENTER 704 THIRD STREET SULLY, IA 50251 (641)594-3150 Jasper 163489 * SUTHERLAND MERCY MEDICAL 108 WEST SECOND STREET SUTHERLAND, IA 51058 (712)446-2567 O'Brien CLINIC 168960 None UNITY POINT CLINIC FAMILY 800 KENYON ROAD, SUITE S FORT DODGE, IA 50501 (515)574-6800 Webster MEDICINE KENYON ROAD 168955 * UNITYPOINT CLINC FAMILY 312 9TH STREET SW, SUITE 1200 WAVERLY, IA 50677 (319)352-4340 Bremer MEDICINE ROHLF MEMORIAL 168905 * UNITYPOINT CLINIC FAMILY 502 LOCUST STREET ALLISON, IA 50602 (319)267-2759 Butler MEDICINE ALLISON 168952 * UNITYPOINT CLINIC FAMILY 105 9TH AVENUE BELLE PLAINE, IA 52208 (319)444-2840 Benton MEDICINE BELLE PLAINE 163898 * UNITYPOINT CLINIC FAMILY 411 FIRST AVENUE CLARENCE, IA 52216 (563)452-3211 Cedar MEDICINE CLARENCE 168907 * UNITYPOINT CLINIC FAMILY 111 TOWER STREET DENVER, IA 50622 (319)984-5645 Bremer MEDICINE DENVER 168916 * UNITYPOINT CLINIC FAMILY 115 SOUTH PARK EAGLE GROVE, IA 50533 (515)448-5185 Wright MEDICINE EAGLE GROVE 168944 * UNITYPOINT CLINIC FAMILY 101 N MAIN FONDA, IA 50540 (712)288-4426 Pocahontas MEDICINE FONDA 168953 * UNITYPOINT CLINIC FAMILY 101 EAST J AVENUE, SUITE 120 GRUNDY CENTER, IA 50638 (319)824-6945 Grundy MEDICINE GRUNDY CENTER 168917 * UNITYPOINT CLINIC FAMILY 1010 NORTH 15TH STREET HUMBOLDT, IA 50548 (515)332-2015 Humboldt MEDICINE HUMBOLDT 168919 * UNITYPOINT CLINIC FAMILY 208 MAIN STREET LAKE VIEW, IA 51450 (712)657-8513 Sac MEDICINE LAKE VIEW 168926 * UNITYPOINT CLINIC FAMILY 307 WEST HIGHWAY 10 LAURENS, IA 50554 (712)841-4516 Pocahontas MEDICINE LAURENS 168947 * UNITYPOINT CLINIC FAMILY 1303 11TH AVENUE MANSON, IA 50563 (712)469-3307 Calhoun MEDICINE MANSON 168904 * UNITYPOINT CLINIC FAMILY 124 1ST AVENUE SE OELWEIN, IA 50662 (563)283-2651 Fayette MEDICINE OELWEIN

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 7 Iowa

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 168903 * UNITYPOINT CLINIC FAMILY 502 THIRD STREET PARKERSBURG, IA 50665 (319)346-2331 Butler MEDICINE PARKERSBURG 168925 * UNITYPOINT CLINIC FAMILY 608 NW SEVENTH STREET POCAHONTAS, IA 50574 (712)335-5632 Pocahontas MEDICINE POCAHONTAS 168918 * UNITYPOINT CLINIC FAMILY 301 HIGHLAND AVENUE SAC CITY, IA 50583 (712)662-7119 Sac MEDICINE SAC CITY 168962 None UNITYPOINT CLINIC FAMILY 1428 2ND AVENUE NORTH FORT DODGE, IA 50501 (515)574-6110 Webster MEDICINE SECOND AVE NORTH 168900 * UNITYPOINT CLINIC FAMILY 1412 CEDAR STREET TIPTON, IA 52772 (563)886-2182 Cedar MEDICINE TIPTON 163896 * UNITYPOINT CLINIC FAMILY 1803 C AVENUE VINTON, IA 52349 (319)472-2304 Benton MEDICINE VINTON 168961 None UNITYPOINT CLINIC PEDIATRICS 804 KENYON ROAD, SUITE D FORT DODGE, IA 50501 (515)574-6855 Webster FORT DODGE 168588 None UNITYPOINT HEALTH JONES 740 E OAK STREET MONTICELLO, IA 52310 (319)465-6702 Jones REGIONAL MEDICAL CENTER 168586 * UNITYPOINT HLTH JONES REG MED 1791 HIGHWAY 64 EAST ANAMOSA, IA 52205 (563)462-3571 Jones CTR ANAMOSA CLINIC 163485 * URBANA FAMILY MEDICAL CLINIC 1002 WEST MAIN STREET URBANA, IA 52345 (319)472-6318 Benton 163468 * VAN HORNE FAMILY MEDICAL 205 MAIN STREET VAN HORNE, IA 52346 (319)228-8240 Benton CLINIC 168510 * VICTOR HEALTH CENTER 709 2ND STREET VICTOR, IA 52347 (319)647-7511 Iowa 163461 * VINTON FAMILY MEDICAL CLINIC 504 NORTH NINTH AVENUE VINTON, IA 52349 (319)472-6300 Benton 163400 * WALL LAKE MEDICAL CLINIC 311 WEST FIRST STREET WALL LAKE, IA 51466 (712)664-2800 Sac 168568 None WASHINGTON CO HOSP AND 444 EAST POLK STREET WASHINGTON, IA 52353 (319)653-6601 Washington CLINICS FAMILY MEDICINE 168567 None WASHINGTON CO HOSP AND 1230 SOUTH IOWA AVENUE, BOX 909 WASHINGTON, IA 52353 (319)653-7291 Washington CLINICS FAMILY MEDICINE 168573 None WASHINGTON COUNTY HOSPITAL & 207 FIRST STREET, SUITE4 KALONA, IA 52247 (319)656-3700 Washington CLINICS KALONA CLINIC 168564 None WILLIAMSBURG FAMILY MEDICAL 498 N HIGHLAND STREET WILLIAMSBURG, IA 52361 (319)668-6789 Iowa CLINIC 168540 * WOMEN'S CLINIC 312 9TH STREET SW, SUITE 2200 WAVERLY, IA 50677 (319)483-4074 Bremer Total Providers for this State = 170

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178578 * ALLEN COUNTY REGIONAL CLINIC 401 SOUTH WASHINGTON IOLA, KS 66749 (620)365-6933 Allen 178598 None ALTAMONT COMMUNITY CLINIC 401 S WABASH ALTAMONT, KS 67330 (620)784-5784 Labette 173438 * ANDERSON CO HOSP FAM CARE 536 W FOURTH PO BOX 309 GARNETT, KS 66032 (785)448-2674 Anderson CTR 173403 * ANTHONY PRIMARY CARE CENTER 1101 E SPRING ST ANTHONY, KS 67003 (620)842-5144 Harper 178913 * ARK CITY CLINIC PA 510 WEST RADIO LANE ARKANSAS CITY, KS 67005 (620)442-2100 Cowley 173476 * ASHLAND HEALTH CENTER 529 W 7TH ASHLAND, KS 67831 (620)635-2222 Clark 178923 * ASHLEY CLINIC 505 S PLUMMER CHANUTE, KS 66720 (620)431-2500 Neosho 178997 * ASSOCIATES IN FAMILY CARE, 100 EAST MAIN STREET OSAWATOMIE, KS 66064 (913)755-3044 Miami OSAWATOMIE 178994 * ASSOCIATES IN FAMILY CARE- 2102 BAPTISTE DRIVE STE A PAOLA, KS 66071 (913)557-5678 Miami PAOLA 178521 * ATCHISON INTERNAL MEDICINE & 810 RAVEN HILL DRIVE ATCHISON, KS 66002 (913)367-7300 Atchison FAMILY PRACTICE 178533 * ATTICA RURAL HEALTH CLINIC 302 N BOTKIN ATTICA, KS 67009 (620)254-7272 Harper 703805 None AUGUSTA FAMILY PRACTICE 1230 E 6TH SUITE 2C WINFIELD, KS 67156 (620)402-6699 Cowley 178951 * AUGUSTA FAMILY PRACTICE 1306 STATE STREET AUGUSTA, KS 67010 (316)775-9191 Butler 173416 * BLUE RAPIDS MEDICAL CLINIC 607 LINCOLN ST BLUE RAPIDS, KS 66411 (785)363-7202 Marshall 178537 * BUCKLIN COMMUNITY CLINIC 101 N FORD AVENUE, BOX 625 BUCKLIN, KS 67834 (620)826-3266 Ford 178973 * CALDWELL FAMILY CLINIC 415 S OSAGE CALDWELL, KS 67022 (620)845-2516 Sumner 173414 * CEDAR VALE RURAL HEALTH CLINIC 508 WASHINGTON STREET CEDAR VALE, KS 67024 (620)758-2221 Chautauqua 178576 * CENTRAL KANSAS FAMILY 1309 POLK STREET GREAT BEND, KS 67530 (620)792-5341 Barton PRACTICE 173483 * CENTRALIA MEDICAL CLINIC 606 FIRST STREET CENTRALIA, KS 66415 (785)857-3334 Nemaha 178585 * CHASE COUNTY FAMILY HEALTH 411 WALNUT COTTONWOOD FALLS, KS (620)273-6131 Chase CTR 66845 178593 * CHERRYVALE FAMILY MEDICINE 203 WEST MAIN STREET CHERRYVALE, KS 67335 (620)336-2131 Montgomery 178566 * CHETOPA COMMUNITY CLINIC 429 MAPLE CHETOPA, KS 67336 (620)236-7351 Labette 173478 * CHEYENNE COUNTY CLINIC 221 W 4TH STREET BIRD CITY, KS 67731 (785)734-2306 Cheyenne 173477 * CHEYENNE COUNTY CLINIC-ST 221 W FIRST STREET SAINT FRANCIS, KS 67756 (785)332-2682 Cheyenne FRANCIS 178591 None CLARA BARTON MEDICAL CLINIC- 1031 JACKSON STREET GREAT BEND, KS 67530 (620)793-6990 Barton GREAT BEND 173466 * CLARA BARTON RURAL HEALTH 252 W 9TH HOISINGTON, KS 67544 (620)653-2386 Barton CLINIC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178596 * CLAY CENTER FAMILY PHYSICIANS 609 LIBERTY CLAY CENTER, KS 67432 (785)632-2181 Clay 173856 * CLYDE FAMILY PHYSICIANS 815 W CAMPBELL LINN, KS 66953 (785)446-2226 Washington 178595 * CLYDE FAMILY PHYSICIANS 815 W CAMPBELL CLYDE, KS 66938 (785)446-2226 Cloud 173982 * COFFEY COUNTY MEDICAL CLINIC 309 SANDERS ST BURLINGTON, KS 66839 (620)364-5395 Coffey 173404 * COMMUNITY PHYSICIANS CLINIC 1902 MAY STREET MARYSVILLE, KS 66508 (785)562-3942 Marshall 178549 * CONWAY SPRINGS RHC 111 W SPRING AVENUE CONWAY SPRINGS, KS 67031 (620)456-2411 Sumner 178603 None CRMC MEDICAL GROUP 1400 WEST 4TH STREET STE 100 COFFEYVILLE, KS 67337 (620)688-6566 Montgomery 178587 None CUNNINGHAM CLINIC 112 N MAIN CUNNINGHAM, KS 67035 (620)298-2397 Kingman 178968 * DANIEL J SANCHEZ MD PA 1210 N WASHINGTON PLAINVILLE, KS 67663 (785)434-2622 Rooks 178564 * DECATUR HEALTH SYSTEMS FAMILY 902 W COLUMBIA OBERLIN, KS 67749 (785)475-2015 Decatur PRACTICE CLINIC 173433 * DEXTER COMMUNITY RHC 204 N MAIN DEXTER, KS 67038 (620)876-5863 Cowley 178958 * DONLEY MEMORIAL CLINIC LLC 437 NORTH CEDAR STREET KINGMAN, KS 67068 (620)532-3101 Kingman 173485 * DOWNTOWN MEDICAL CLINIC 112 E 2ND STREET FRANKFORT, KS 66427 (785)292-4451 Marshall 178999 * DRS MORRIS & HILL MEDICAL CLINIC 1525 MADISON ST SUITE 2 FREDONIA, KS 66736 (620)378-2068 Wilson LLC 173498 * ECMC RURAL HEALTH CLINIC - 216 S MAIN LUCAS, KS 67648 (785)525-7788 Russell LUCAS 178925 * EL DORADO CLINIC PA 700 W CENTRAL SUITE 205 EL DORADO, KS 67042 (316)321-2010 Butler 173402 * ELLINWOOD HOSPITAL CLINIC 611 N MAIN ELLINWOOD, KS 67526 (620)564-2548 Barton 178538 * ELLIS FAMILY CARE CENTER 1000 WASHINGTON STREET ELLIS, KS 67637 (785)726-4956 Ellis 173497 * ELLSWORTH MEDICAL CLINIC 1602 AYLWARD ELLSWORTH, KS 67439 (785)810-1177 Ellsworth 178544 * EUREKA CLINIC 100 WEST 16TH EUREKA, KS 67045 (620)583-5274 Greenwood 178917 * F ALLEN MOORHEAD JR MD 709 MAIN STREET NEODESHA, KS 66757 (620)325-2200 Wilson 173469 * FAMILY CARE CENTER 1100 HIGHLAND DRIVE CONCORDIA, KS 66901 (785)243-4272 Cloud 178586 None FAMILY CARE CENTER SOUTH 309 N PINE COLONY, KS 66015 (620)852-3600 Anderson 178508 * FAMILY CENTER FOR HEALTH CARE 310 E COLLEGE DRIVE COLBY, KS 67701 (785)462-6184 Thomas 178580 None FAMILY HEALTH CENTER 506 THORPE ST LAKIN, KS 67860 (620)355-7550 Kearny 178579 None FAMILY HEALTH CENTER 521 MAIN DEERFIELD, KS 67838 (620)426-2990 Kearny 178594 None FAMILY MEDICINE OF WASHINGTON 302 E 2ND STREET WASHINGTON, KS 66968 (785)519-6111 Washington COUNTY 178966 * FAMILY PRAC ASSOC OF WSTRN KS 120 WEST ROSS BLVD DODGE CITY, KS 67801 (620)225-1650 Ford 178511 * FAMILY PRACTICE ASSOCIATES 1100 COLUMBINE DRIVE HOLTON, KS 66436 (785)364-2126 Jackson

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178575 * FAMILY PRACTICE ASSOCIATES 323 SECOND STREET WETMORE, KS 66550 (785)364-2116 Nemaha (WETMORE) 178523 * FAMILY PRACTICE ASSOCIATES 117 WEST 3RD STREET HOYT, KS 66440 (785)986-6630 Jackson HOYT 178513 * FARMER CLINIC 802 W BROADWAY STAFFORD, KS 67578 (620)234-6826 Stafford 178536 * FOWLER COMMUNITY CLINIC 404 MAIN ST PO BOX 462 FOWLER, KS 67844 (620)646-5446 Meade 173452 * GCH RURAL HEALTH CLINIC 1110 SAINT MARY'S RD JUNCTION CITY, KS 66441 (785)762-3388 Geary 178520 * GIRARD MEDICAL CENTER OF 120 NW HIGHWAY 400 CHEROKEE, KS 66724 (620)457-8100 Crawford CHEROKEE 178532 * GIRARD MEDICAL CENTER OF 1011 N 69 HWY FRONTENAC, KS 66763 (620)235-1377 Crawford FRONTENAC 178552 * GIRARD RURAL HEALTH CLINIC 307 N HOSPITAL DRIVE STE 1, 4, 5 GIRARD, KS 66743 (620)724-4659 Crawford 178569 * GOAD MEDICAL CLINIC 431 W NEW HAMPSHIRE OSBORNE, KS 67473 (785)346-2510 Osborne 178515 * GOODLAND FAMILY HEALTH 106 WILLOW STREET GOODLAND, KS 67735 (785)890-6075 Sherman CENTER 178550 * GRAHAM COUNTY HOSPITAL CLINIC 114 E WALNUT ST HILL CITY, KS 67642 (785)421-2191 Graham 173805 * GREAT BEND CHILDREN'S CLINIC PA 1021 EISENHOWER GREAT BEND, KS 67530 (620)792-5437 Barton 178522 * GREELEY CO FAMILY PRACTICE 321 E HARPER TRIBUNE, KS 67879 (620)376-4251 Greeley CLINIC 173494 * GREENSBURG FAMILY PRACTICE 721 W KANSAS GREENSBURG, KS 67054 (620)723-2127 Kiowa 173480 * GRISELL MEMORIAL HOSPITAL RHC 206 S VERMONT AVE RANSOM, KS 67572 (785)731-2295 Ness 173481 * GRISELL MEMORIAL HOSPITAL 114 E MAIN NESS CITY, KS 67560 (785)798-2955 Ness SATELLITE RHC 178547 * HAMILTON COUNTY FAMILY 700 N HUSER SYRACUSE, KS 67878 (620)384-7350 Hamilton PRACTICE CLINIC 173407 * HARPER HOSP MED CLINIC 700 W 13TH STREET HARPER, KS 67058 (620)896-7306 Harper 178540 * HAVILAND CLINIC 106 N MAIN HAVILAND, KS 67059 (620)862-5431 Kiowa 173464 * HCH FAMILY PRACTICE 300 UTAH 2ND FLOOR HIAWATHA, KS 66434 (785)742-2161 Brown 173491 * HCH HIGHLAND CLINIC 415 WEST MAIN HIGHLAND, KS 66035 (785)442-3213 Doniphan 178574 * HEALTH PROFESSIONALS OF 1230 E 6TH AVE STE 1B WINFIELD, KS 67156 (620)221-4000 Cowley WINFIELD 178563 * HEARTLAND HEALTH CARE CENTER 511 NE 10TH ABILENE, KS 67410 (785)263-4131 Dickinson 178557 * HEARTLAND REGIONAL HEALTH 514 CLEVELAND STREET GREAT BEND, KS 67530 (620)793-7520 Barton CLINIC 178517 * HERINGTON AREA HEALTH CLINIC 1005 NORTH B STREET HERINGTON, KS 67449 (785)258-5130 Dickinson * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178567 * HILLSBORO CLINIC 101 INDUSTRIAL ROAD HILLSBORO, KS 67063 (620)947-1421 Marion 173458 * HMC PEDIATRIC CENTER 2214 CANTERBURY DRIVE SUITE 204 HAYS, KS 67601 (785)623-2360 Ellis 173482 * HOLTON FAMILY HEALTH CLINIC 1603 W 4TH STREET HOLTON, KS 66436 (785)364-3205 Jackson 173499 * HOLYROOD MEDICAL CLINIC 101 S MAIN HOLYROOD, KS 67450 (785)252-3565 Ellsworth 173489 * HORTON RURAL HEALTH CLINIC 1903 EUCLID AVE HORTON, KS 66439 (785)486-2998 Brown 178542 * HOWARD CLINIC 118 S WABASH HOWARD, KS 67349 (620)374-2650 Elk 178908 * HUTCHINSON CLINIC 2101 N WALDRON HUTCHINSON, KS 67502 (620)669-2500 Reno 173882 * HUTCHINSON CLINIC PA INC 1100 N MAIN HUTCHINSON, KS 67501 (620)669-6690 Reno 703804 None HUTCHINSON CLINIC WALK-IN CARE 24 SOUTH MAIN STREET SOUTH HUTCHINSON, KS (620)669-2500 Reno 67505 178582 * INDEPENDENCE FAMILY MEDICINE 1415 N PENN AVENUE INDEPENDENCE, KS 67301 (620)331-2400 Montgomery 178589 None INTERNAL MEDICINE ASSOCIATES 1428 SOUTH MAIN, SUITE 4 OTTAWA, KS 66067 (785)229-8309 Franklin OF OTTAWA 173479 * JEWELL COUNTY RURAL HEALTH 102 S CENTER MANKATO, KS 66956 (785)378-3511 Jewell CLINIC 173449 * KINSLEY RURAL HEALTH CLINIC 807 E 4TH KINSLEY, KS 67547 (620)659-3639 Edwards 178506 * KIOWA DISTRICT HOSP - CLINIC 1002 S 4TH STREET KIOWA, KS 67070 (620)825-4121 Barber 178995 * LA CYGNE FAMILY CARE 1017 E MARKET STREET LA CYGNE, KS 66040 (913)757-4575 Linn 178570 * LABETTE HEALTH CHERRYVALE 116 N MAPLE CHERRYVALE, KS 67335 (620)336-3255 Montgomery CLINIC 178571 * LABETTE HEALTH FAMILY PRACTICE 1902 S HWY 59 BLDG E STE 101 PARSONS, KS 67357 (620)820-5800 Labette CLINIC 178600 None LABETTE HEALTH INDEPENDENCE 209 E LAUREL ST INDEPENDENCE, KS 67301 (620)577-4310 Montgomery CLINIC 173475 * LANE COUNTY MEDICAL CLINIC 444 W LONG DIGHTON, KS 67839 (620)397-5316 Lane 173984 * LEROY MEDICAL CLINIC 538 S C ST PO BOX 212 LE ROY, KS 66857 (620)964-2264 Coffey 173405 * LINCOLN COUNTY MEDICAL CLINIC 313 E FRANKLIN LINCOLN, KS 67455 (785)524-4474 Lincoln 178597 * LINN FAMILY PHYSICIANS 706 W 3RD ST LINN, KS 66953 (785)348-5503 Washington 178996 * LOUISBURG FAMILY CARE 102 WEST CRESTVIEW CIRCLE SUITE LOUISBURG, KS 66053 (913)837-4299 Miami 200 178568 * LYONS MEDICAL CENTER 1221 W NOBLE LYONS, KS 67554 (620)257-5124 Rice 178529 * MEADE RURAL HEALTH CLINIC 119 N HART MEADE, KS 67864 (620)873-2112 Meade 178545 * MEDICINE LODGE MEMORIAL 710 NORTH WALNUT STREET MEDICINE LODGE, KS 67104 (620)930-3704 Barber HOSPITAL PHYSICIANS CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178982 * MERCY CLINIC - COLUMBUS FAMILY 101 W SYCAMORE COLUMBUS, KS 66725 (620)429-3636 Cherokee MEDICINE 173422 * MERCY HOSPITAL FORT SCOTT - 601 E WASHINGTON ARMA, KS 66712 (620)347-4033 Crawford ARMA FAMILY MEDICINE 173420 * MERCY HOSPITAL FORT SCOTT- 11155 TUCKER ROAD PLEASANTON, KS 66075 (913)352-8379 Linn LINN COUNTY FAMILY MEDIC 173495 * MIDWAY CLINIC 604 W 8TH KINSLEY, KS 67547 (620)659-2732 Edwards 178535 * MINNEOLA COMMUNITY CLINIC 222 MAIN ST PO BOX 127 MINNEOLA, KS 67865 (620)885-4202 Clark 173425 * MOLINE COMM RURAL HEALTH 200 N PLUM ST MOLINE, KS 67353 (620)647-8109 Elk CLINIC 178601 None MORTON COUNTY MEDICAL CLINIC 411 SUNSET STREET ELKHART, KS 67950 (620)697-2175 Morton 178998 * MOUND CITY FAMILY CARE 302 N 1ST STREET MOUND CITY, KS 66056 (913)795-2203 Linn 703808 None MUDDY CREEK FAMILY CLINIC LLC 200 WHITE WAY STREET NETAWAKA, KS 66516 (785)933-2000 Jackson 173822 * MULVANE FAMILY CARE CENTER 102 E MAIN MULVANE, KS 67110 (316)777-0106 Sumner 178560 * NESS CITY MEDICAL CLINIC 316 CUSTER ST NESS CITY, KS 67560 (785)798-2233 Ness 178562 * NEW FRONTIERS HEALTH SERVICES 212 MAPLE AVE OAKLEY, KS 67748 (785)672-3261 Logan 178584 None NMRMC ERIE FAMILY CARE CLINIC 13920 HIGHWAY 59 ERIE, KS 66733 (620)244-5105 Neosho 178592 * NMRMC FAMILY MEDICINE 1501 W 7TH STREET CHANUTE, KS 66720 (620)432-5588 Neosho 178518 * NORTON MEDICAL CLINIC 807 N STATE STREET NORTON, KS 67654 (785)877-3305 Norton 173992 * O'SHEA MEMORIAL CLINIC 810 WEST BRAMLEY JETMORE, KS 67854 (620)357-8354 Hodgeman 173486 * ONAGA CLINIC 114 W 8TH STREET ONAGA, KS 66521 (785)889-4241 Pottawatomie 178561 * OSWEGO COMMUNITY CLINIC 800 BARKER DRIVE SUITE B OSWEGO, KS 67356 (620)795-2921 Labette 173876 * OTTAWA FAMILY PHYSICIANS, 1418 S MAIN SUITE 5 OTTAWA, KS 66067 (785)242-1620 Franklin CHARTERED 178581 * PAWNEE VALLEY MEDICAL 713 W 11TH LARNED, KS 67550 (620)804-6007 Pawnee ASSOCIATES 178502 * PHILLIPS COUNTY MEDICAL CLINIC 1719 HIGHWAY 183 PHILLIPSBURG, KS 67661 (785)543-5211 Phillips 178528 * PLAINS RURAL HEALTH CLINIC 402 GRAND AVE PLAINS, KS 67869 (620)563-9313 Meade 178987 * PRATT FAMILY PRACTICE 203 WATSON SUITE 200 PRATT, KS 67124 (620)672-7422 Pratt 178583 * PRATT INTERNAL MEDICINE GROUP 420 COUNTRY CLUB RD PRATT, KS 67124 (620)672-7415 Pratt 173487 * RAWLINS CLINIC/ATWOOD 707 GRANT ST ATWOOD, KS 67730 (785)626-3241 Rawlins 178602 None ROLLA MEDICAL CLINIC 415 WASHINGTON ROLLA, KS 67954 (620)593-4242 Morton 178504 * RRH PHYSICIAN'S CLINIC 222 S MAIN RUSSELL, KS 67665 (785)483-3333 Russell 178541 * RUSH COUNTY MEDICAL CLINIC 801 LOCUST STREET LA CROSSE, KS 67548 (785)222-2564 Rush * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178519 * RUSSELL FAMILY MEDICAL CLINIC 410 N MAIN ST RUSSELL, KS 67665 (785)483-3811 Russell 173455 * SATANTA HOSP CLINIC-SATANTA 410 S CHEYENNE ST PO BOX 9 SATANTA, KS 67870 (620)649-2771 Haskell BRANCH 173454 * SATANTA HOSP CLINIC-SUBLETTE 301 SOUTH DERBY SUBLETTE, KS 67877 (620)675-2686 Haskell BRANCH 173492 * SCOTT CITY CLINIC 201 ALBERT AVENUE SCOTT CITY, KS 67871 (620)872-2187 Scott 173843 * SENECA FAMILY PACTICE PA 201 NORTH SIXTH SENECA, KS 66538 (785)336-6107 Nemaha 178507 * SENECA FAMILY PRACTICE PA 1600 COMMUNITY DRIVE SENECA, KS 66538 (785)336-6107 Nemaha 178505 * SMITH COUNTY FAMILY PRACTICE 119 E PARLIAMENT SMITH CENTER, KS 66967 (785)282-6834 Smith 178599 None SOUTH CENTRAL KANSAS CLINIC 515 NORTH SUMMIT STREET ARKANSAS CITY, KS 67005 (620)442-4850 Cowley LLC 178539 * SPEARVILLE MEDICAL CLINIC 205 HALL STREET SPEARVILLE, KS 67876 (620)385-2963 Ford 703806 None SPRING RIVER MEDICAL CLINIC 6524 SE QUAKERVALE RD RIVERTON, KS 66770 (620)848-2380 Cherokee 178512 * ST JOHN CLINIC 609 E FIRST AVE SAINT JOHN, KS 67576 (620)549-3251 Stafford 178934 * ST JOHN CLINIC 1505 W 11TH, SUITE C COFFEYVILLE, KS 67337 (620)251-5400 Montgomery 173893 * ST JOHN CLINIC (CANEY) 218 WEST 4TH STREET CANEY, KS 67333 (620)879-2182 Montgomery 178983 * ST JOHN'S CLINIC-OSWEGO-FAMILY 805 BARKER DRIVE OSWEGO, KS 67356 (620)795-2525 Labette MEDICINE 178551 * ST LUKE MEDICAL CLINIC 537 S FREEBORN STREET MARION, KS 66861 (620)382-2033 Marion 173484 * ST MARYS CLINIC 206 GRAND AVENUE SAINT MARYS, KS 66536 (785)437-3734 Pottawatomie 173432 * ST PAUL RURAL HEALTH CLINIC 200 CARROLL SAINT PAUL, KS 66771 (620)449-2582 Neosho 178572 None STANTON COUNTY FAMILY 404 N CHESTNUT STREET JOHNSON, KS 67855 (620)492-1400 Stanton PRACTICE 178565 * STERLING MEDICAL CENTER 239 N BROADWAY STERLING, KS 67579 (620)278-2123 Rice 173446 * STEVENS COUNTY RURAL HEALTH 1006 S JACKSON PO BOX 10 HUGOTON, KS 67951 (620)544-8563 Stevens CLINIC 173819 * SUMNER COUNTY FAMILY CARE 507 E 16TH STREET SUITE 1 WELLINGTON, KS 67152 (620)326-3301 Sumner CENTER 173408 * SYLVAN MEDICAL CLINIC 219 N MAIN STREET SYLVAN GROVE, KS 67481 (785)526-7474 Lincoln 178526 * SYLVIA HEALTH CARE CLINIC 200 S MAIN ST SYLVIA, KS 67581 (620)486-2985 Reno 173423 * TALLGRASS RURAL HEALTH CLINIC 300 NORTH STREET SEDAN, KS 67361 (620)725-3818 Chautauqua 178969 * THE FAMILY PHYSICIANS 1408 EAST STREET IOLA, KS 66749 (620)365-3115 Allen 173991 * TROY MEDICAL CLINIC 311 WEST LOCUST TROY, KS 66087 (785)985-3504 Doniphan 173465 * ULYSSES FAMILY PHYSICIANS 505 N MAIN STREET ULYSSES, KS 67880 (620)356-1261 Grant

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 7 Kansas

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 178530 * WAKEENEY FAMILY CARE CENTER 333 N 14TH STREET WA KEENEY, KS 67672 (785)743-2124 Trego 178525 * WALLACE CO FAMILY PRACTICE 504 EAST 6TH STREET SHARON SPGS, KS 67758 (785)852-4230 Wallace CLINIC 178510 * WAMEGO FAMILY CLINIC 711 GENN DRIVE WAMEGO, KS 66547 (785)458-7420 Pottawatomie 173983 * WAVERLY MEDICAL CLINIC 302 PEARSON PO BOX 65 WAVERLY, KS 66871 (785)733-2667 Coffey 178590 None WELLSVILLE FAMILY MEDICAL 424 MAIN STREET WELLSVILLE, KS 66092 (785)883-4863 Franklin CLINIC 173488 * WICHITA COUNTY HEALTH CENTER 211 E EARL LEOTI, KS 67861 (620)375-2222 Wichita CLINIC 178500 * WILSON MEDICAL CLINIC 2509 N AVE E WILSON, KS 67490 (785)658-3688 Ellsworth 178964 * WINFIELD MEDICAL ARTS PA 3625 QUAIL RIDGE DRIVE WINFIELD, KS 67156 (620)221-6100 Cowley 178559 * YATES CENTER MEDICAL CENTER 1004 E MADISON YATES CENTER, KS 66783 (620)625-2312 Woodson RURAL HEALTH CLINIC Total Providers for this State = 170

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268593 * A C RURAL HEALTH CLINIC 408 E 7TH, PO BOX 97 APPLETON CITY, MO 64724 (660)476-2121 St. Clair 268921 * A PLUS FAMILY CLINIC 203 EAST 3RD STREET PORTAGEVILLE, MO 63873 (573)379-2100 New Madrid 268671 * AKEMAN MCBURNEY HEALTH CLINIC 420 WEST FRONT STREET SLATER, MO 65349 (660)529-2251 Saline

268945 * APOLLO HEALTHCARE, LLC 1031 E KARSCH FARMINGTON, MO 63640 (573)756-7880 St. Francois 268622 * APPLE-KIDS PEDIATRICS 590 PINE STREET SAINTE GENEVIEVE, MO (573)883-4455 Ste. Genevieve 63670 268669 * APPLEGATE MEDICAL GROUP 125 E LOCKLING BROOKFIELD, MO 64628 (660)258-8237 Linn 268572 * ARCADIA VALLEY FAMILY CLINIC 200 ST MARY, BOX 523 PILOT KNOB, MO 63663 (573)546-7000 Iron 268522 * ARCHIE MEDICAL CLINIC 709 E PINE ST, PO BOX 48 ARCHIE, MO 64725 (816)430-5777 Cass 263471 * ASH GROVE FAMILY MEDICAL 500 NORTH MEDICAL DRIVE ASH GROVE, MO 65604 (417)672-2794 Greene CENTER 263449 * ASSOCIATED MEDICAL ARTS 504 NORTH STURGEON ST MONTGOMERY CITY, MO (314)564-2486 Montgomery 63361 268505 * AUSTIN PLAZA PRIMARY CARE 108 FRIZZELL STREET, SUITE 5 POTOSI, MO 63664 (573)438-8500 Washington 268740 None BENTON COMMUNITY CARE 6468 STATE HIGHWAY 77 BENTON, MO 63736 (573)545-3700 Scott CENTER 793825 * BEST MEDICAL LLC 112 UNION STREET LEADINGTON, MO 63601 (573)431-2253 St. Francois 268649 * BETHANY MEDICAL CLINIC 3202 MILLER ST BETHANY, MO 64424 (660)425-3154 Harrison 268942 * BEYER MEDICAL GROUP 735 WEST MAIN STREET FREDERICKTOWN, MO 63645 (573)783-8875 Madison 263486 * BLOOMFIELD MEDICAL CLINIC 101 SOUTH PRAIRIE BLOOMFIELD, MO 63825 (573)568-3838 Stoddard 268647 * BLOOMSDALE FAMILY HEALTH 255 BODERMAN LANE BLOOMSDALE, MO 63627 (573)483-9492 Ste. Genevieve CENTER 268694 * BOLIVAR FAMILY CARE CENTER, 1240 N BUTTERFIELD RD BOLIVAR, MO 65613 (417)326-6012 Polk LLC 268681 * BONNE TERRE MEDICAL GROUP 527 BENHAM STREET BONNE TERRE, MO 63628 (573)358-5577 St. Francois 793809 * BOOTHEEL COUNSELING SERVICES 760 PLANTATION BLVD SIKESTON, MO 63801 (573)471-0800 New Madrid 268626 * BOOTHEEL PRIMARY CARE CLINIC 1502 WARD AVE CARUTHERSVILLE, MO 63830 (573)333-4244 Pemiscot CARUTHERSVILLE 268627 * BOOTHEEL PRIMARY CARE CLINIC 310 E MAIN STREET HAYTI, MO 63851 (573)359-2019 Pemiscot HAYTI 263488 * BOOTHEEL PRIMARY CARE CLINIC 900 STATE ROUTE VV KENNETT, MO 63857 (573)888-8828 Dunklin KENNETT 268628 * BOOTHEEL PRIMARY CARE CLINIC- 213 SOUTH WALNUT STREET STEELE, MO 63877 (573)575-4416 Pemiscot STEELE

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268598 * BOTHWELL HEALTH CENTER - 1765 COMMERCIAL STREET WARSAW, MO 65355 (660)438-6800 Benton TRUMAN LAKE 268527 * BOURBON MEDICAL CLINIC 240 COLLEGE ROAD, PO BOX 100 BOURBON, MO 65441 (573)732-5140 Crawford 263925 * BRIDGES MEDICAL SERVICES PC PO BOX 1240 FORSYTH, MO 65653 (417)546-4200 Taney 268917 * BRIDGES MEDICAL SERVICES- 1440 STATE HIGHWAY 248, STE O BRANSON, MO 65616 (417)239-0706 Taney BRANSON 268904 * BURTON CREEK MEDICAL CLINIC 805 KENTUCKY AVE WEST PLAINS, MO 65775 (417)256-2111 Howell 268553 * BUTTERFIELD PARK MEDICAL 1300 N OAKLAND AVENUE STE A BOLIVAR, MO 65613 (417)326-7676 Polk CENTER 268554 * BUTTERFIELD PARK PEDIATRICS 1195 NORTH OAKLAND AVENUE, SUITE BOLIVAR, MO 65613 (417)777-2121 Polk 2 268937 * BYRNES MILL MEDICAL CENTER - 10649 STATE HIGHWAY A, PO BOX 280 RICHWOODS, MO 63071 (573)678-2444 Washington RICHWOODS 793830 * C&S FAMILY MEDICAL 65 COUNTY ROAD 527 POPLAR BLUFF, MO 63901 (573)785-4600 Butler 263405 * CAMPBELL MEDICAL CLINIC 413 WEST GRAND CAMPBELL, MO 63933 (314)246-3220 Dunklin 263984 * CANTON-LAGRANGE FAMILY 1802 ELM STREET CANTON, MO 63435 (573)288-5360 Lewis PRACTICE 263972 * CAPE FAMILY MEDICAL CLINIC, LLC 24 N SPRIGG ST SUITE 1 CAPE GIRARDEAU, MO 63701 (573)332-7992 Cape Girardeau 263862 * CAPE GIRARDEAU COUNTY RURAL 1121 LINDEN STREET CAPE GIRARDEAU, MO 63703 (573)335-7846 Cape Girardeau HEALTH CLINIC 793800 * CARUTHERSVILLE CLINIC 108 WEST 15TH STREET CARUTHERSVILLE, MO 63830 (573)333-0033 Pemiscot 268510 * CASSVILLE MEDICAL CARE 75 SMITHSON DR, SUITE A, PO BOX 568 CASSVILLE, MO 65625 (417)269-2414 Barry ASSOCIATES 263474 * CCMH MEDICAL MALL CLINIC 1317 SOUTH 32 HIGHWAY EL DORADO SPRINGS, MO (417)876-3333 Cedar 64744 268983 * CENTRALIA FAMILY HEALTH CLINIC 1021 E HWY 22 CENTRALIA, MO 65240 (573)682-5588 Boone 268715 * CHARITON VALLEY FAMILY 413 W 2ND STREET SALISBURY, MO 65281 (660)388-7084 Chariton MEDICINE 268927 * CHARLESTON FAMILY CARE 400 SOUTH MAIN ST CHARLESTON, MO 63834 (573)331-5510 Mississippi 268727 None CMH OSCEOLA MEDICAL CENTER 855 ARDUSER DRIVE OSCEOLA, MO 64776 (417)646-5075 St. Clair 268640 * CMH WALK-IN-CLINIC 2230 S SPRINGFIELD AVE STE H-J BOLIVAR, MO 65613 (417)326-6000 Polk 268977 * COMMUNITY HEALTH PARTNERS 510 E GAY STREET, SUITE A WARRENSBURG, MO 64093 (660)747-1111 Johnson LLP 268563 * COMMUNITY MEDICAL ASSOCIATES 130 EAST LOCKLING BROOKFIELD, MO 64628 (660)258-8237 Linn 793824 * COMPASS HEALTH WELLNESS 530 ARDUSER DR OSCEOLA, MO 64776 (417)646-8157 St. Clair

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 793837 None COMPLETE FAMILY MEDICINE - LA 29934 JULY ROAD LA PLATA, MO 63549 (660)332-7576 Macon PLATA 793838 None COMPLETE FAMILY MEDICINE LLC 1611 S BALTIMORE STREET KIRKSVILLE, MO 63501 (660)665-7575 Adair 263857 * COMPLETE FAMILY MEDICINE LLC - 1000 W WASHINGTON STREET LANCASTER, MO 63548 (660)665-9038 Schuyler LANCASTER 268980 * COMPREHENSIVE FAMILY HEALTH 142 SOUTH WINCHESTER, PO BOX 650 BENTON, MO 63736 (573)545-4484 Scott CARE LLC 263874 * CONWAY FAMILY CLINIC 301 SOUTH NEWPORT AVE, PO BOX 9 CONWAY, MO 65632 (417)589-2050 Laclede 263470 * COOPER CO RURAL HEALTH CLINIC 17601 HIGHWAY B, PO BOX 88 BOONVILLE, MO 65233 (660)882-7461 Cooper 268732 * COX FAMILY MEDICINE OF MONETT 307 WEST BENTON MONETT, MO 65708 (417)236-2410 Barry 268565 * COX HEALTH CENTER - AURORA 106 COMMERCE, PO BOX 71 AURORA, MO 65605 (417)269-2400 Lawrence 268531 * COX HEALTH CENTER BUFFALO 119 NORTH ASH BUFFALO, MO 65622 (417)345-2231 Dallas 263962 * COX HEALTH CENTER LEBANON 510 E HIGHWAY 32 LEBANON, MO 65536 (417)532-8700 Laclede 263472 * COX HEALTH CENTER MARSHFIELD 941 HUBBLE DR, PO BOX 589 MARSHFIELD, MO 65706 (417)859-2339 Webster 268617 * COX HEALTH CENTER MT VERNON 10763 HIGHWAY 39, SUITE 200 MOUNT VERNON, MO 65712 (417)269-2460 Lawrence 268564 * COX HEALTH CENTER 151 JOHNSTOWN DRIVE ROGERSVILLE, MO 65742 (417)269-2252 Webster ROGERSVILLE 268733 * COX HEALTH CENTER SHELL KNOB 25376 STATE HWY 39, SUITE 301 SHELL KNOB, MO 65747 (417)858-6845 Barry 268692 * COXHEALTH CENTER BRANSON 890 HWY 248 BRANSON, MO 65616 (417)269-3721 Taney 263480 * COXHEALTH CENTER BRANSON 18452 BUSINESS 13 BRANSON WEST, MO 65737 (417)272-8911 Stone WEST 268543 * COXHEALTH CENTER CRANE 102 CORTNEY LANE CRANE, MO 65633 (417)723-8537 Stone 268501 * COXHEALTH CENTER KIMBERLING 2 KIMBERLING BVLD KIMBERLING CITY, MO 65686 (417)739-2520 Stone CITY 268571 * COXHEALTH CENTER MOUNTAIN 1602 A NORTH MAIN ST MOUNTAIN GROVE, MO 65711 (417)926-5572 Wright GROVE 268684 * COXHEALTH CENTER REPUBLIC 820 SOUTH ILLINOIS REPUBLIC, MO 65738 (417)269-1910 Greene 263451 * COXHEALTH CENTER SEYMOUR 202 N COMMERCIAL ST SEYMOUR, MO 65746 (417)935-2213 Webster 263496 * COXHEALTH FAMILY MEDICINE & 545 N BRANSON LANDING BLVD, SUITE BRANSON, MO 65616 (417)335-7540 Taney OBSTETRICS 508 268595 * COXHEALTH FAMILY MEDICINE 1150 STATE HWY 248, STE 202 BRANSON, MO 65616 (417)348-8964 Taney BRANSON HWY 248 263407 * CUBA MEDICAL OFFICE 102 OZARK STREET, SUITE B CUBA, MO 65453 (573)885-3499 Crawford 263411 * DADE COUNTY FAMILY MEDICAL PO BOX 367 GREENFIELD, MO 65661 (417)637-5133 Dade CENTER * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 263482 * DALLAS CO COMM MEDICAL CEN 102 N ASH ST, PO BOX 1730 BUFFALO, MO 65662 (417)345-6100 Dallas 263824 * DENT MEDICAL CLINIC 1010 E SCENIC RIVERS BLVD SALEM, MO 65560 (573)729-5533 Dent 263849 * DESOTO FAMILY PRACTICE 12 JEFFERSON SQUARE DE SOTO, MO 63020 (636)586-6685 Jefferson 268739 None DEXTER COMMUNITY CARE CENTER 1523 W BUSINESS US HIGHWAY 60 STE DEXTER, MO 63841 (573)614-5762 Stoddard 1 263440 * DEXTER MEDICAL CENTER 610 NORTH ONE MILE ROAD, PO BOX DEXTER, MO 63841 (314)624-3600 Stoddard 399 263875 * DIXON FAMILY PRACTICE AND 206 WEST SECOND, PO BOX 235 DIXON, MO 65459 (573)759-3030 Pulaski INTERNAL MEDICINE LLC 268537 * DOCTOR'S CLINIC 106 WEST 12TH STREET CARUTHERSVILLE, MO 63830 (573)333-1782 Pemiscot 268700 * EAGLEVILLE MEDICAL CLINIC 12050 12TH STREET EAGLEVILLE, MO 64442 (816)632-2101 Harrison 263460 * EASTERN MO HEALTH SERVICES 2305 WEST GEORGIA STREET LOUISIANA, MO 63353 (314)754-4584 Pike 263468 * EASTERN MO HEALTH SERVICES 1015 WEST ADAMS STREET BOWLING GREEN, MO 63334 (314)324-5300 Pike 793834 * FAMILIES 1ST OF DESOTO LLC 127 W PRATT DE SOTO, MO 63020 (636)337-7800 Jefferson 268734 * FAMILY AND OCCUPATIONAL 2200 E CLEVELAND AVE MONETT, MO 65708 (417)236-2600 Barry MEDICINE OF MONETT 268606 * FAMILY CARE CLINIC - NURSERY 617 W NURSERY ST BUTLER, MO 64730 (660)200-2004 Bates STREET 268667 * FAMILY CARE CLINIC ADRIAN 102 E MAIN STREET ADRIAN, MO 64720 (816)297-2640 Bates 268646 * FAMILY CARE CLINIC HIGH STREET 706 SOUTH HIGH BUTLER, MO 64730 (660)679-3118 Bates 268749 None FAMILY CARE CLINIC RICH HILL 225 N 14TH STREET RICH HILL, MO 64779 (660)200-0700 Bates 268580 * FAMILY HEALTH CARE - POINTE 753 POINTE BASSE DR SAINTE GENEVIEVE, MO (314)883-2782 Ste. Genevieve BASSE 63670 263418 * FAMILY HEALTH CENTER OF EDINA 205 SOUTH FIFTH ST, PO BOX 8 EDINA, MO 63537 (816)397-2400 Knox 793802 * FAMILY MEDICAL CENTER OF 1632 MISSOURI AVENUE CARTHAGE, MO 64836 (417)358-1500 Jasper CARTHAGE 268735 * FAMILY PRACTICE & OBSTETRICS 813 NORTH LINCOLN, SUITE B MONETT, MO 65708 (417)354-1500 Barry OF MONETT 268743 * FAMILY PRACTICE OF CENTRAL 513 BURKARTH RD WARRENSBURG, MO 64093 (660)747-7751 Johnson MISSOURI 268742 * FAMILY PRACTICE OF CENTRAL 1200 WEST 22ND STREET HIGGINSVILLE, MO 64037 (660)584-7751 Lafayette MISSOURI 268944 * FAMILY PREFERENCE HEALTH CARE 201 W MAIN MATTHEWS, MO 63867 (573)471-1514 New Madrid CLINIC 263939 * FAMILY WALK IN CLINIC OF 205 W 3RD, SUITE 3 MOUNTAIN GROVE, MO 65711 (417)926-7625 Wright MOUNTAIN GROVE, INC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268933 * FERGUSON MEDICAL GROUP 100 EAST OUTER ROAD SCOTT CITY, MO 63780 (573)264-2211 Scott 263931 * FERGUSON MEDICAL GROUP 1012 NORTH MAIN SIKESTON, MO 63801 (573)471-0330 New Madrid 263830 * FERGUSON MEDICAL GROUP 112 W COMMERCIAL STREET CHARLESTON, MO 63834 (573)683-4010 Mississippi 263930 * FERGUSON MEDICAL GROUP 320 NORTH LINCOLN STREET EAST PRAIRIE, MO 63845 (573)649-3026 Mississippi 268978 * FERGUSON MEDICAL GROUP 1516 W BUSINESS HWY 60 DEXTER, MO 63841 (573)614-5007 Stoddard 268731 None FITZGIBBON FAMILY HEALTH 600 W MORRISON STREET, SUITE 5 FAYETTE, MO 65248 (660)248-2900 Howard 268577 * FITZGIBBON PROFESSIONAL 2305 S HIGHWAY 65 BUILDING A MARSHALL, MO 65340 (660)886-7800 Saline BUILDING 263904 * FOREST CITY FAMILY PRACTICE 1000 NORTH JEFFERSON SAINT JAMES, MO 65559 (573)265-8840 Phelps 268722 * FREEMAN NEOSHO PHYSICIAN 336 S JEFFERSON STREET NEOSHO, MO 64850 (417)455-4200 Newton GROUP 268532 * FULTON MEDICAL CLINIC 850 WEST HOSPITAL DRIVE, SUITE F FULTON, MO 65251 (573)642-5338 Callaway 263981 * GAINESVILLE CLINIC 404 W STATE HWY 160, PO BOX 426 GAINESVILLE, MO 65655 (417)679-4613 Ozark 268632 * GALLATIN FAMILY MEDICINE 502 SOUTH MAIN GALLATIN, MO 64640 (660)663-3751 Daviess 263458 * GARDEN CITY FAMILY CLINIC 101 OLD HWY 7, PO BOX 46 GARDEN CITY, MO 64747 (816)862-6203 Cass 268958 * GIDEON MEDICAL CLINIC 100 MAIN STREET GIDEON, MO 63848 (573)448-3165 New Madrid 268691 * GILMAN CITY MEDICAL CLINIC 427 MAIN ST GILMAN CITY, MO 64642 (660)876-5533 Daviess 263974 * GLENNON CARE PEDIATRICS 511 ASHLAND, SUITE A WARRENTON, MO 63383 (636)456-0543 Warren 268625 * GOLDEN CITY CLINIC 407 MAIN STREET GOLDEN CITY, MO 64748 (417)537-4311 Barton 268584 * GOLDEN VALLEY MEDICAL - 1602 N 2ND STREET CLINTON, MO 64735 (660)885-8171 Henry CLINTON 268725 None GOLDEN VALLEY MEDICAL - 675 3RD STREET OSCEOLA, MO 64776 (417)646-2231 St. Clair OSCEOLA 268588 * GOLDEN VALLEY MEDICAL - 1771 COMMERCIAL WARSAW, MO 65355 (660)438-5193 Benton WARSAW 268583 * GOLDEN VALLEY MEDICAL - 100 S TEBO WINDSOR, MO 65360 (660)647-2147 Henry WINDSOR 263498 * GRAND RIVER MEDICAL CLINIC 815 EAST BROADWAY BRUNSWICK, MO 65236 (660)548-3161 Chariton 268991 * HALLSVILLE AREA FAMILY CLINIC 501 N ROUTE B HALLSVILLE, MO 65255 (573)696-0500 Boone 263404 * HAMILTON FAMILY HEALTH CENTER 103 NORTH DAVIS HAMILTON, MO 64644 (816)583-7839 Caldwell 263852 * HANNIBAL CLINIC 100 MEDICAL DRIVE HANNIBAL, MO 63401 (573)221-5250 Ralls 793804 * HANNIBAL CLINIC AT PALMYRA 1811 S MAIN STREET PALMYRA, MO 63461 (573)769-2231 Marion 793815 * HANNIBAL CLINIC BOWLING GREEN 710 BUSINESS 61 SOUTH BOWLING GREEN, MO 63334 (573)324-2063 Pike

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268696 * HARRISON COUNTY FAMILY HEALTH 2703 MILLER ST, PO BOX 233 BETHANY, MO 64424 (660)425-7443 Harrison CENTER 268515 * HARRISONVILLE MEDICAL CLINIC 2820 E ROCK HAVEN ROAD, STE 210 HARRISONVILLE, MO 64701 (816)884-3244 Cass 263869 * HARTVILLE MEDICAL CLINIC 275 SOUTH SCHOOL AVENUE HARTVILLE, MO 65667 (417)741-7484 Wright 268934 * HAVEN HEALTH CARE MEDICAL 502 WEST STURDIVANT, PO BOX 137 ADVANCE, MO 63730 (573)722-9191 Stoddard CLINIC 263410 * HEALTH WAY PRIMARY CARE 200 HEALTH WAY POTOSI, MO 63664 (573)438-2240 Washington 268539 * HEDRICK MEDICAL CENTER 2791 NORTH WASHINGTON STREET CHILLICOTHE, MO 64601 (660)646-2682 Livingston 268947 * HERITAGE MEDICAL CLINIC 101-1 MAIN STREET CASSVILLE, MO 65625 (417)846-2277 Barry 268602 * HERMANN MEDICAL ARTS 134 WEST SIXTH STREET HERMANN, MO 65041 (573)486-5711 Gasconade 268548 * HIGGINSVILLE MEDICAL CLINIC 3401 PINE STREET HIGGINSVILLE, MO 64037 (660)584-2192 Lafayette 793811 * HOLDEN FAMILY CARE, LLC 612 E 10TH STREET HOLDEN, MO 64040 (816)732-6010 Johnson 263976 * HUMANSVILLE FAMILY CARE 201 SOUTH ARTHUR HUMANSVILLE, MO 65674 (417)754-2223 Polk CENTER 268599 * I-70 MEDICAL CLINIC 105 HOSPITAL DRIVE, BUILDING B SWEET SPRINGS, MO 65351 (660)335-4700 Saline 263897 * IMMEDIATE CONVENIENT CARE 1702 NORTH KINGSHIGHWAY CAPE GIRARDEAU, MO 63701 (573)339-2000 Cape Girardeau 268642 * IRON COUNTY HOSPITAL FAMILY 600 NORTH MAIN PILOT KNOB, MO 63663 (573)546-0184 Iron CARE CLINIC 263912 * JACKSON FAMILY CARE 545 BROADRIDGE DRIVE SUITE 200 JACKSON, MO 63755 (573)243-8408 Cape Girardeau 263914 * JACKSON PHYSICIAN ASSOCIATES 2130 E JACKSON BLVD JACKSON, MO 63755 (573)243-2154 Cape Girardeau 793807 * JACKSON PRIMARY CARE, LLC 2685 EAST MAIN STREET, SUITE A JACKSON, MO 63755 (573)204-1400 Cape Girardeau 263988 * JAMESPORT OUTREACH CLINIC 409 W AUBERRY GROVE JAMESPORT, MO 64648 (816)684-6252 Daviess 268666 * JEFFERSON MEDICAL GROUP 1502 N JEFFERSON STREET CARROLLTON, MO 64633 (660)542-9998 Carroll 268665 * JEFFERSON MEDICAL GROUP HALE 221 ELM STREET HALE, MO 64643 (660)565-2602 Carroll CLINIC 268664 * JEFFERSON MEDICAL GROUP 105 E 2ND STREET NORBORNE, MO 64668 (660)593-3623 Carroll NORBORNE CLINIC 263895 * JOSEPH E PEHLMAN FAMILY CLINIC, 1207 NORTH DOUGLAS MALDEN, MO 63863 (573)276-3884 Dunklin LLC 268918 * JOSEPH WILLIAM STAFFORD, JR 312 KENTUCKY AVE WEST PLAINS, MO 65775 (417)757-7076 Howell 263960 * KENNETT PEDIATRICS AND 211 TEACO ROAD PO BOX 908 KENNETT, MO 63857 (583)888-0001 Dunklin ADOLESC 268659 * KINGSVILLE MEDICAL CLINIC 305 EAST PACIFIC STREET KINGSVILLE, MO 64061 (816)597-3500 Johnson 263935 * KNEIBERT CLINIC 686 LESTER STREET POPLAR BLUFF, MO 63901 (573)778-7210 Butler

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268615 * LAKE AREA PRIMARY CARE CLINIC HWY 54 EAST, PO BOX 38 WHEATLAND, MO 65779 (417)282-5882 Hickory 268705 * LAKE REGIONAL - ELDON 304-A EAST 4TH ST ELDON, MO 65026 (573)392-5654 Miller 268707 * LAKE REGIONAL CLINIC - 1930 N BUSINESS ROUTE 5, UNIT 1A CAMDENTON, MO 65020 (573)346-5624 Camden CAMDENTON 268710 * LAKE REGIONAL CLINIC - IBERIA 2333 HIGHWAY 17 IBERIA, MO 65486 (573)793-6900 Miller 268711 * LAKE REGIONAL CLINIC - LAKE 1870 BAGNELL DAM BLVD LAKE OZARK, MO 65049 (573)365-2318 Camden OZARK 268706 * LAKE REGIONAL CLINIC - MACKS 14298 W US HIGHWAY 54 MACKS CREEK, MO 65786 (573)363-5304 Camden CREEK 268709 * LAKE REGIONAL CLINIC - OSAGE 1057 MEDICAL PARK DRIVE, STE A OSAGE BEACH, MO 65065 (573)302-3100 Camden BEACH 268708 * LAKE REGIONAL CLINIC-LAURIE 156 MISSOURI BLVD, SUITE B LAURIE, MO 65038 (573)374-5263 Morgan 268530 * LANCASTER MEDICAL SERVICES HWY 63 NORTH LANCASTER, MO 63548 (660)457-3655 Schuyler 263831 * LEBANON INTERNAL 120 HOSPITAL DRIVE, SUITE 300 LEBANON, MO 65536 (417)533-6746 Laclede MEDICINE/PEDS 263833 * LEWISTOWN RURAL HEALTH CLINIC 105 EAST QUINCY STREET, PO BOX 98 LEWISTOWN, MO 63452 (573)215-2715 Lewis 268551 * LEXINGTON MEDICAL CLINIC 1026 STATE STREET LEXINGTON, MO 64067 (660)259-2216 Lafayette 268568 * MADISON MEDICAL CENTER RHC 611 WEST MAIN PO BOX 431 FREDERICKTOWN, MO 63645 (573)783-3341 Madison 263996 * MALDEN MEDICAL CENTER 806 NORTH DOUGLAS MALDEN, MO 63863 (314)276-3873 Dunklin 268965 * MANAGED CARE, INC 808 HUNTER, SUITE 4 SIKESTON, MO 63801 (557)347-5911 Scott 263940 * MANSFIELD CLINIC 304 WEST COMMERICAL MANSFIELD, MO 65704 (417)924-3066 Wright 268961 * MANSFIELD CLINIC DBA PRIME 120 SW 2ND AVE AVA, MO 65608 (417)683-6790 Douglas CARE OF AVA 793835 * MARBLE HILL MEDICAL CLINIC, LLC 307 BROADWAY STREET MARBLE HILL, MO 63764 (573)238-0038 Bollinger 268908 * MARIES MEDICAL CLINIC 606 HIGHWAY 63 SOUTH VIENNA, MO 65582 (573)422-3636 Maries 268738 None MAYSVILLE FAMILY HEALTH CLINIC 1007 S POLK STREET MAYSVILLE, MO 64469 (816)449-2123 DeKalb 268682 * MEADVILLE MEDICAL CLINIC 101 E HAYWARD MEADVILLE, MO 64659 (660)258-1041 Linn 263947 * MEDICAL ARTS CLINIC 1103 WEST LIBERTY FARMINGTON, MO 63640 (573)756-6751 St. Francois 268536 * MEDICAL CLINIC OF OWENSVILLE 708 EAST HWY 28 OWENSVILLE, MO 65066 (573)437-4481 Gasconade 263967 * MEDICAL CLINIC OF WILLOW 816 E MAIN WILLOW SPRINGS, MO 65793 (417)469-3116 Howell SPRINGS 268648 * MEDICAL ONE CLINIC 29 NW 1ST LANE LAMAR, MO 64759 (417)681-5284 Barton 263889 * MEDSTOP ONE 3065 WILLIAMS STREET, SUITE 209 CAPE GIRARDEAU, MO 63703 (573)335-4100 Cape Girardeau 268518 * MEMPHIS MEDICAL SERVICES 450 E SIGLER AVE SUITE A MEMPHIS, MO 63555 (660)465-2828 Scotland

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 8 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268689 * MERCY CARTHAGE PEDIATRICS 1911 BUENA VISTA AVENUE CARTHAGE, MO 64836 (417)358-8121 Jasper 263900 * MERCY CLINIC - EL DORADO 309 EAST HOSPITAL ROAD EL DORADO SPRINGS, MO (417)876-5851 Cedar SPRINGS 64744 263839 * MERCY CLINIC - HOUSTON 1422 SOUTH SAM HOUSTON BLVD HOUSTON, MO 65483 (417)967-4445 Texas 263870 * MERCY CLINIC - SALEM 404 W ROLLA ROAD SALEM, MO 65560 (573)729-6225 Dent 268979 * MERCY CLINIC EAST COMMUNITIES 1326 S SERVICE RD W STE. 200 SULLIVAN, MO 63080 (573)468-3555 Crawford 268984 * MERCY CLINIC EAST COMMUNITIES- 125 N OLD HWY 66 BOURBON, MO 65441 (573)679-2006 Crawford BOURBON 268986 * MERCY CLINIC EAST COMMUNITIES- 301 THERESA STREET CUBA, MO 65453 (573)677-2006 Crawford CUBA 263809 * MERCY CLINIC FAMILY MEDICINE - 114 DOWNEY PLACE CUBA, MO 65453 (573)885-3358 Crawford CUBA 263945 * MERCY CLINIC FAMILY MEDICINE - 331 HOSPITAL DR STE C LEBANON, MO 65536 (417)533-6500 Laclede LEBANON 263921 * MERCY CLINIC FAMILY MEDICINE- 118 W DALLAS BUFFALO, MO 65622 (417)345-6101 Dallas BUFFALO 263814 * MERCY CLINIC FAMILY MEDICINE- 120 HOSPITAL DRIVE, SUITE 100 LEBANON, MO 65536 (417)533-6751 Laclede LEBANON 263806 * MERCY CLINIC FAMILY MEDICINE- STATE HIGHWAY 99 & OBANION BIRCH TREE, MO 65438 (573)292-3214 Shannon BIRCH TREE STREET, PO BOX 229 263909 * MERCY CLINIC FAMILY MEDICINE- 92 MAIN STREET CASSVILLE, MO 65625 (417)847-5225 Barry CASSVILLE 263840 * MERCY CLINIC FAMILY MEDICINE- 120 W 16TH STREET MOUNTAIN GROVE, MO 65711 (417)926-6111 Wright MOUNTAIN GROVE 263819 * MERCY CLINIC FAMILY MEDICINE- 104 E HIGHWAY 60 MOUNTAIN VIEW, MO 65548 (417)934-2251 Howell MOUNTAIN VIEW 263946 * MERCY CLINIC FAMILY MEDICINE- 332 S MAIN AVENUE REPUBLIC, MO 65738 (417)732-5050 Greene REPUBLIC 263813 * MERCY CLINIC FAMILY MEDICINE-ST 608 CITY ROUTE 66, PO BOX 914 ST ROBERT, MO 65584 (573)336-5100 Pulaski ROBERT 263920 * MERCY CLINIC FAMILY MEDICINE- 149 ROGERS AVENUE SUMMERSVILLE, MO 65571 (417)932-4119 Texas SUMMERSVILLE 268990 * MERCY CLINIC FAMILY MEDICINE- 1202 EAST MAIN WILLOW SPRINGS, MO 65793 (417)469-1820 Howell WILLOW SPRINGS 268924 * MERCY CLINIC OB/GYN- LEBANON 120 HOSPITAL DRIVE, SUITE 225 LEBANON, MO 65536 (417)533-6710 Laclede 268935 * MERCY CLINIC PEDIATRICS-ROLLA 1605 MARTIN SPRINGS DRIVE, STE 250 ROLLA, MO 65401 (573)341-9163 Phelps 263934 * MERCY CLINIC RICHLAND 904 SOUTH PINE STREET RICHLAND, MO 65556 (573)765-2956 Pulaski * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 9 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 263918 * MERCY CLINIC-BRANSON WEST 18598 STATE HIGHWAY 13, PO BOX BRANSON WEST, MO 65737 (417)272-8497 Stone 2067 263850 * MERCY CLINIC-STEELVILLE 518 PINE STREET STEELVILLE, MO 65565 (573)775-5838 Crawford 263457 * MERCY HOSP LINCOLN FAMILY 900 EAST CHERRY ST TROY, MO 63379 (636)528-8585 Lincoln MEDICINE AND PSYCHIATRY 268506 * MERCY HOSPITAL JOPLIN NEOSHO 2550 LUSK DR NEOSHO, MO 64850 (417)451-2060 Newton 268663 * MERCY HOSPITAL LINCOLN FAMILY 106 BROADWAY, SUITE 3C ELSBERRY, MO 63343 (573)898-9100 Lincoln MEDICINE ELSBERRY 263479 * MERCY HOSPITAL LINCOLN FAMILY 1003 E CHERRY ST TROY, MO 63379 (636)528-6755 Lincoln MEDICINE TROY 268701 * MERCY HOSPITAL LINCOLN FAMILY 35 WINFIELD PLAZA WINFIELD, MO 63389 (636)668-6824 Lincoln MEDICINE WINFIELD 268687 * MERCY HOSPITAL LINCOLN-FAMILY 1165 EAST CHERRY STREET TROY, MO 63379 (636)528-7745 Lincoln MEDICINE 268545 * MERCY MCAULEY CLINIC 851 E 5TH STREET SUITE 200 WASHINGTON, MO 63090 (636)239-8585 Franklin 268688 * MERCY PHYSICIANS FOR WOMEN'S 1515 HAZEL ST, SUITE 101 CARTHAGE, MO 64836 (417)358-8121 Jasper HEALTH 268690 * MERCY PRIMARY CARE 1515 HAZEL ST CARTHAGE, MO 64836 (417)358-8121 Jasper 793812 * MERCY URGENT CARE-BRANSON 1065 STATE HIGHWAY 248, STE 200 BRANSON, MO 65616 (417)337-5000 Taney 793842 None MERITAS HEALTH RICHMOND 902 WOLLARD BOULEVARD RICHMOND, MO 64085 (816)776-2201 Ray 793829 * MIDWEST FAMILY CARE 404 S HOPE JACKSON, MO 63755 (573)204-3900 Cape Girardeau 793823 * MIDWEST FAMILY CARE 36 DOCTORS PARK CAPE GIRARDEAU, MO 63703 (573)803-1771 Cape Girardeau 263487 * MISSOURI BAPTIST SULLIVAN 965 MATTOX DR SULLIVAN, MO 63080 (573)860-6000 Crawford MEDICAL OFFICE 268591 * MISSOURI DELTA EXPRESS CLINIC 1008 NORTH MAIN SIKESTON, MO 63801 (573)471-1600 New Madrid 268660 * MISSOURI DELTA PRIMARY CARE 135 PLAZA DRIVE, STE 102 SIKESTON, MO 63801 (573)472-6010 Scott 268528 * MO BAPTIST-STEELVILLE OFFICE 510 WEST MAIN, PO BOX AH STEELVILLE, MO 65565 (573)775-4600 Crawford 263492 * MO DELTA MED CTR COMM CARE 1200 EAST MARSHALL CHARLESTON, MO 63834 (573)683-2191 Mississippi CTR 268611 * MOBERLY RHC 1501 UNION AVENUE, SUITE A & B MOBERLY, MO 65270 (660)263-9095 Randolph 268513 * MONROE CITY FAMILY PRACTICE 821 BUSINESS HIGHWAY 24 & 36, PO MONROE CITY, MO 63456 (573)735-2506 Monroe BOX 305 793813 * MORTON VAN ZANTEN CLINIC 101 GIESLER DRIVE OSCEOLA, MO 64776 (417)646-8123 St. Clair 793840 None MOUNTAIN GROVE MEDICAL AND 601 N BUSCH AVENUE MOUNTAIN GROVE, MO 65711 (417)926-6643 Wright LASER CENTER PC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 10 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268579 * MOUNTAIN GROVE MEDICAL 500 N 19TH ST STE A MOUNTAIN GROVE, MO 65711 (417)926-6955 Wright COMPLEX 268946 * MT VERNON CLINIC 1011 SOUTH EAST ST MOUNT VERNON, MO 65712 (417)466-7191 Lawrence 263901 * NEVADA MEDICAL CLINIC 900 SOUTH ADAMS NEVADA, MO 64772 (417)667-6015 Vernon 268737 None NEVADA REGIONAL PRIMARY CARE 627 S ASH STREET SUITE B NEVADA, MO 64772 (417)667-6800 Vernon CENTER 268699 * NEW MADRID COMMUNITY CARE 615 N MAIN STREET NEW MADRID, MO 63869 (573)748-2546 New Madrid CENTER 263911 * NIXA FAMILY MEDICAL WALK IN CL 103 OLD WOLDERNESS ROAD NIXA, MO 65714 (417)724-0308 Christian 268702 * NMC - NEW HAMPTON RURAL 304 E LINCOLN WAY NEW HAMPTON, MO 64471 (660)439-2060 Harrison HEALTH CLINIC 263420 * NMC - STANBERRY RURAL HEALTH 202 EAST MAIN PO BOX 99 STANBERRY, MO 64489 (816)783-2192 Gentry CLINIC 268730 None NMC GRANT CITY CLINIC 16 W 4TH STREET, PO BOX 187 GRANT CITY, MO 64456 (660)564-3322 Worth 268714 * NORTH HARRISON MEDICAL CLINIC 16027 LOCUST STREET EAGLEVILLE, MO 64442 (660)867-5111 Harrison 268675 * NORTHEAST REGIONAL MEDICAL 1607 S BALTIMORE KIRKSVILLE, MO 63501 (660)785-1122 Adair GROUP 268645 * NRMC NOWCARE CLINIC 345 S BARRETT LANE, STE 2 NEVADA, MO 64772 (417)448-2439 Vernon 268533 * OB/GYN SPECIALTY SERVICES 415-A BURKARTH ROAD WARRENSBURG, MO 64093 (660)429-2992 Johnson 268747 * OCH ANDERSON RURAL HEALTH 104 EAST MAIN, PO BOX 750 ANDERSON, MO 64831 (417)845-6984 McDonald CLINIC 268745 * OCH GOODMAN FAMILY CLINIC 125 E MAIN STREET, PO BOX 97 GOODMAN, MO 64843 (417)364-8300 McDonald 268728 None OCH JASPER COUNTY CLINIC 327 EAST AIRPORT DRIVE CARTHAGE, MO 64836 (417)237-0604 Jasper CARTHAGE CAMPUS 268597 * OCH LAWRENCE COUNTY CLINIC 108 S HICKORY MOUNT VERNON, MO 65712 (417)466-4110 Lawrence 268695 None OCH MCDONALD COUNTY CLINIC 125 MAIN ST NOEL, MO 64854 (417)837-4004 McDonald 268748 * OCH PINEVILLE MEDICAL CLINIC 412 US HIGHWAY 71, SUITE J, PO BOX PINEVILLE, MO 64856 (417)223-4290 McDonald 265 268697 None OCH POLK COUNTY CLINIC 910 E SAN MARTIN ST, BOLIVAR, MO BOLIVAR, MO 65613 (417)777-4749 Polk 65613-2893 268746 * OCH SOUTHWEST CITY COMM 109 NORTH BROADWAY, PO BOX 160 SOUTH WEST CITY, MO 64863 (417)762-3287 McDonald CLINIC 268726 * OCH SPARTA CLINIC 155 VILLAGE DRIVE, PO BOX 183 SPARTA, MO 65753 (417)634-4203 Christian 268609 * OCH WEBSTER COUNTY CLINIC 101 S MAIN ROGERSVILLE, MO 65742 (417)753-9404 Greene 268672 * OCH WELLPOINTE FAMILY MEDICAL 543 WEST HUBBLE DRIVE MARSHFIELD, MO 65706 (417)859-7746 Webster CLINIC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 11 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268550 * ODESSA MEDICAL GROUP 1280 WEST OLD HWY 40 ODESSA, MO 64076 (660)633-5774 Lafayette 263484 * OMC URGENT CARE CLINIC 181 KENTUCKY AVE, SUITE 100 WEST PLAINS, MO 65775 (417)257-5911 Howell 268523 * OZARKS MED CLINIC OF ALTON 100 MEDICAL DRIVE, PO BOX 468 ALTON, MO 65606 (417)778-7227 Oregon 268616 * OZARKS MEDICAL CENTER 220 N ELM STREET MOUNTAIN VIEW, MO 65548 (417)111-1111 Howell MOUNTAIN VIEW 263979 * OZARKS MEDICAL CENTER WINONA 1008 HWY 19 NORTH PO BOX 28 WINONA, MO 65588 (314)325-4711 Shannon 268902 * PALMYRA CLINIC 6996 COUNTY ROAD 326 PALMYRA, MO 63461 (573)769-3710 Marion 268910 * PARIS FAMILY MEDICAL CLINIC 102 E MARION PARIS, MO 65275 (660)327-4911 Monroe 263402 * PATTONSBURG MED CLINIC 110 N CENTRAL AVE PATTONSBURG, MO 64670 (660)367-4304 Daviess 268741 None PCMH CLINIC 425 N GALLOWAY ROAD VANDALIA, MO 63382 (573)594-2111 Audrain 263495 * PCMH RURAL HEALTH CLINIC 1926 OAK STREET, PO BOX 389 UNIONVILLE, MO 63565 (660)947-7373 Putnam 268987 * PCRMC MEDICAL GROUP INC 1050 WEST TENTH STREET ROLLA, MO 65401 (573)458-3510 Phelps 263434 * PEMISCOT PRIMARY CARE CLINIC 907 EAST REED AVE HAYTI, MO 63851 (573)359-3660 Pemiscot 268614 * PERRY COUNTY PHYSICIANS 206 HOSPITAL LANE, SUITE 201 PERRYVILLE, MO 63775 (573)547-4899 Perry SERVICES 268909 * PERRY KIDS PEDIATRICS 210 HOSPITAL LN, SUITE 202 PERRYVILLE, MO 63775 (573)517-0999 Perry 268592 * PERRYVILLE FAMILY CARE CLINIC 212 HOSPITAL LANE, SUITE 101 PERRYVILLE, MO 63775 (314)547-7888 Perry 268717 * PFCC WEST 1508 EDGEMONT BLVD PERRYVILLE, MO 63775 (573)339-2000 Perry 263968 * PHYSICIANS PARK PRIMARY CARE 225 PHYSICIANS PARK DRIVE, SUITE POPLAR BLUFF, MO 63901 (573)727-5500 Butler 400 263435 * PIEDMONT FAMILY CLINIC #1 HAL'S PLAZA PIEDMONT, MO 63957 (573)223-4800 Wayne 263933 * PIEDMONT PHYSICIAN ASSOCIATES CANYON RD & HWY 34, RT 4 BOX 4515 PIEDMONT, MO 63957 (573)223-4233 Wayne 268723 * PIKE MEDICAL CLINIC INC 211 SOUTH THIRD ST LOUISIANA, MO 63353 (573)754-5555 Pike 268724 * PIKE MEDICAL CLINIC INC 905 HWY 161 BOWLING GREEN, MO 63334 (573)324-2241 Pike 268939 * PILOT GROVE RURAL HEALTH 212 COLLEGE STREET PILOT GROVE, MO 65276 (660)834-5100 Cooper CLINIC 268586 * PLATTSBURG FAMILY MEDICINE 214 N MAIN PLATTSBURG, MO 64477 (816)930-2041 Clinton 263929 * PLATTSBURG MEDICAL CLINIC 214 N MAIN PLATTSBURG, MO 64477 (816)539-2117 Clinton 263485 * PLEASANT HILL MEDICAL CENTER 1601 N HIGHWAY 7 PLEASANT HILL, MO 64080 (816)540-2111 Cass 268552 * PLEASANT HOPE FAMILY MED CTR 209 SOUTH MAIN STREET PLEASANT HOPE, MO 65725 (417)267-2001 Polk 268581 * PMHS CONVENIENT CARE CLINIC 946 E REED STREET HAYTI, MO 63851 (573)359-6162 Pemiscot 263446 * POLO FAMILY HEALTH CTR 198 N MAIN STREET POLO, MO 64671 (660)354-2550 Caldwell 268676 * POPLAR BLUFF MEDICAL CLINIC 2588 N WESTWOOD POPLAR BLUFF, MO 63901 (573)778-1277 Butler

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 12 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268919 * POPLAR BLUFF PEDIATRIC 2210 BARRON ROAD, STE, 120 POPLAR BLUFF, MO 63901 (573)785-2002 Butler ASSOCIATES, LLC 268685 * POPLAR BLUFF PRIMARY CARE 2360 KATY LANE POPLAR BLUFF, MO 63901 (573)712-2546 Butler 268698 * PORTAGEVILLE COMMUNITY CARE 204 E 3RD STREET PORTAGEVILLE, MO 63873 (573)379-5467 New Madrid CENTER 263421 * PORTAGEVILLE PRIMARY CARE 314 E MAIN STREET PORTAGEVILLE, MO 63873 (314)379-3777 New Madrid 793836 None POTOSI PAIN SOLUTIONS 24 SOUTHTOWNE DRIVE POTOSI, MO 63664 (573)438-3733 Washington 268651 * POTOSI RURAL HEALTH CLINIC #1 KWAN PLAZA POTOSI, MO 63664 (573)438-1899 Washington 268996 * PROFESSIONAL CLINICS DBA 624 OLD ST MARYS RD, SUITE A PERRYVILLE, MO 63775 (573)547-3232 Perry CONVENIENT HEALTHCARE 263826 * PULASKI MEDICAL CLINIC 1000 GW LANE WAYNESVILLE, MO 65583 (573)774-2715 Pulaski 263473 * PUXICO CLINIC 130 E HARBIN PO BOX 7 PUXICO, MO 63960 (573)222-3556 Stoddard 268995 * QUINCY MEDICAL GR, LABELLE 1000 CENTRAL STREET LA BELLE, MO 63447 (660)462-3266 Lewis RURAL HEALTH AFFILIATE 263836 * QUINCY MEDICAL GROUP - CANTON 1100 EAST OUTER ROAD SOUTH CANTON, MO 63435 (573)288-5949 Lewis 268959 * RANDOLPH COUNTY HEALTH 1319 E HIGHWAY 24 MOBERLY, MO 65270 (660)263-6643 Randolph DEPARTMENT 268670 * REID MEDICAL CLINIC 1401 N JEFFERSON ST CARROLLTON, MO 64633 (660)542-3900 Carroll 268941 * REPUBLIC FAMILY MEDICAL WALK- 281 US HWY 60 WEST REPUBLIC, MO 65738 (417)732-6277 Greene IN CLINIC 263425 * RICH HILL FAMILY MED CLINIC 320 NORTH 14TH ST RICH HILL, MO 64779 (417)395-2150 Bates 263892 * RIVER CITY HLTH CLINIC INC 224 NORTH FREDERICK ST CAPE GIRARDEAU, MO 63701 (573)332-0121 Cape Girardeau 268956 * ROLLA FAMILY CLINIC 1060 SOUTH BISHOP AVENUE ROLLA, MO 65401 (573)647-1869 Phelps 268556 * SAC-OSAGE HOSPITAL TRI-COUNTY 855 ARDUSER DRIVE OSCEOLA, MO 64776 (417)646-8153 St. Clair CLINIC 793839 None SAINT FRANCIS OUTPATIENT CLINIC 1212 SAINT FRANCIS DRIVE DEXTER, MO 63841 (573)614-3600 Stoddard 268713 * SAINT LUKE'S MERCER COUNTY 400 N FULLERTON STREET PRINCETON, MO 64673 (660)748-4040 Mercer CLINIC 268960 * SCHEIDLER RURAL HEALTH CLINIC 301 SOUTH BYP KENNETT, MO 63857 (573)888-0900 Dunklin 263942 * SCOTT CITY MEDICAL CLINIC 2102 MAIN STREET SCOTT CITY, MO 63780 (573)264-0087 Scott 263450 * SE HEALTH CENTER OF RIPLEY 109 LEROUX DR DONIPHAN, MO 63935 (573)996-2136 Ripley COUNTY RURAL HEALTH 268512 * SHELBINA FAMILY PRACTICE 400 SOUTH CENTER SHELBINA, MO 63468 (573)588-4131 Shelby 268538 * SHELDON FAMILY MEDICAL CLINIC 810 W MAIN STREET SHELDON, MO 64784 (417)884-5006 Vernon

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 13 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268634 * SMDH FAMILY MEDICINE 35629 HWY 72, PHYSICIANS OFFICE SALEM, MO 65560 (573)729-6626 Dent BLDG 3 268635 * SMITH STREET MEDICAL CLINIC 117 SMITH AVE SIKESTON, MO 63801 (573)471-0200 New Madrid 268683 * SOUTHEAST HEALTH BERNIE CLINIC 810 N WALNUT BERNIE, MO 63822 (573)283-5336 Stoddard 268587 * SOUTHEAST HEALTH BLOOMFIELD 1003 HIGHWAY 25 NORTH BLOOMFIELD, MO 63825 (573)568-3686 Stoddard CLINIC 268721 * SOUTHEAST HEALTH FAMILY 1 HOSPITAL DRIVE DONIPHAN, MO 63935 (573)996-7148 Ripley MEDICINE OF DONIPHAN 268661 * SOUTHEAST HEALTH MALDEN 500 N DOUGLAS MALDEN, MO 63863 (573)276-2221 Dunklin CLINIC 268674 * SOUTHEAST PEDIATRICS 25 DOCTORS PARK CAPE GIRARDEAU, MO 63703 (573)519-4600 Cape Girardeau 268657 * SOUTHEAST PRIMARY CARE-MT 817 S MT AUBURN, SUITE 100 CAPE GIRARDEAU, MO 63703 (573)519-4500 Cape Girardeau AUBURN 268570 * SOUTHEASTHEALTH FAMILY 1200 N ONE MILE RD DEXTER MO DEXTER, MO 63841 (573)624-7575 Stoddard MEDICINE OF DEXTER 63841-1000 268736 None SOUTHEASTHEALTH FAMILY 2002 KANELL BLVD POPLAR BLUFF, MO 63901 (573)727-9129 Butler MEDICINE OF POPLAR BLUFF 268668 * SOUTHSIDE MEDICAL CENTER 1120 SOUTH SPRINGFIELD AVENUE BOLIVAR, MO 65613 (417)328-6653 Polk 268590 * SOUTHWEST MEDICAL ASSOCIATES 1714 WEIN STREET HERMANN, MO 65041 (573)486-2118 Gasconade 263886 * SPARTA HEALTH CLINIC 515 HUGH AVENUE, PO BOX 449 SPARTA, MO 65753 (417)634-3000 Christian 263906 * SSM GLENNON CARE PEDIATRICS- 164 PROFESSIONAL PARKWAY TROY, MO 63379 (636)462-5437 Lincoln TROY 268750 None SSM HEALTH MEDICAL GROUP 350 COUNTRY MEADOW LANE FULTON, MO 65251 (573)642-4500 Callaway 268680 * SSM HEALTH MEDICAL GROUP 2265 BADNELL DAM BLVD SUITE 103 LAKE OZARK, MO 65049 (573)964-5599 Camden 268559 * SSM HEALTH MEDICAL GROUP - 240 PICKERING STREET MONTGOMERY CITY, MO (573)564-2101 Montgomery FAMILY MEDICINE 63361 268677 * SSM HEALTH MEDICAL GROUP 221 N MAIN STREET PARIS, MO 65275 (660)327-4000 Monroe FAMILY MEDICINE 268557 * SSM HEALTH MEDICAL GROUP 111 W BATES STREET WELLSVILLE, MO 63384 (573)684-2208 Montgomery FAMILY MEDICINE 268716 * SSM HEALTH MEDICAL GROUP 201 S MAIN STREET AUXVASSE, MO 65231 (573)386-5959 Callaway FAMILY MEDICINE 268631 * SSM HEALTH MEDICAL GROUP 809 MEDICAL PARK DRIVE, STE 101 MEXICO, MO 65265 (573)581-8590 Audrain FAMILY MEDICINE 268678 * SSM HEALTH MEDICAL GROUP 100 HIGHWAY 28 W BELLE, MO 65013 (573)859-3775 Maries FAMILY MEDICINE

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 14 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268703 * SSM HEALTH MEDICAL GROUP 875 STATE ROUTE 5 TIPTON, MO 65081 (660)433-5541 Moniteau FAMILY MEDICINE 268562 * SSM HEALTH MEDICAL GROUP 204 WEST WASHINGTON STREET VANDALIA, MO 63382 (573)594-3800 Audrain FAMILY MEDICINE 268686 * SSM HEALTH MEDICAL GROUP 801 KIDWELL DR VERSAILLES, MO 65084 (573)378-5454 Morgan FAMILY MEDICINE 268558 * SSM HEALTH MEDICAL GROUP 1223 MAIN STREET PERRY, MO 63462 (573)565-2213 Ralls FAMILY MEDICINE 268560 * SSM HEALTH MEDICAL GROUP 626 E SUMMIT STREET, SUITE L MEXICO, MO 65265 (573)581-6266 Audrain FAMILY MEDICINE 268555 * SSM HEALTH MEDICAL GROUP 600 MEDICAL PARK DRIVE MEXICO, MO 65265 (573)581-1040 Audrain INTERNAL MEDICINE 268589 * SSM HEALTH MEDICAL GROUP 3626 S CLARK STREET, STE A MEXICO, MO 65265 (573)581-5011 Audrain PEDIATRICS 268540 * SSM HEALTH ST FRANCIS HOSPITAL 2016 SOUTH MAIN MARYVILLE, MO 64468 (660)562-2525 Nodaway MEDICAL GROUP 268542 * SSM HEALTH ST FRANCIS HOSPITAL 114 E SOUTH HILLS DRIVE MARYVILLE, MO 64468 (660)562-2525 Nodaway MEDICAL GROUP 268693 * SSM HEALTH ST FRANCIS HOSPITAL 301 E PRICE AVE STE A SAVANNAH, MO 64485 (816)432-0006 Andrew MEDICAL GROUP 263915 * ST JOHN'S CLINIC - ROLLA FAMILY 1605 MARTIN SPRINGS DRIVE, STE 230 ROLLA, MO 65401 (573)458-6739 Phelps MEDICINE 263943 * ST JOHN'S CLINIC - ST JAMES 107 W ELDON ST SAINT JAMES, MO 65559 (573)265-1818 Phelps 263851 * ST LUKE'S GREEN HILLS MEDICAL 3300 E 10TH ST TRENTON, MO 64683 (660)359-3939 Grundy CLINIC 263439 * STE GENEVIEVE FAMILY HEALTH 930 PARK DRIVE SAINTE GENEVIEVE, MO (573)883-2782 Ste. Genevieve CLINIC 63670 263896 * STEELE FAMILY RURAL HEALTH 216 WEST MAIN STREET, SUITE A STEELE, MO 63877 (573)695-2181 Pemiscot CLINIC, LLC 263983 * STEWARTSVILLE MED CLINIC 106 E FOURTH STEWARTSVILLE, MO 64490 (816)669-3225 DeKalb 263977 * STOCKTON FAMILY MEDICAL 810 SOUTH ST STOCKTON, MO 65785 (417)276-5131 Cedar CENTER 793843 None STOCKTON LAKE WALKIN MEDICAL 913 SOUTH STREET STOCKTON, MO 65785 (417)809-8620 Cedar 268520 * SULLIVAN CO MEM HOSP PHYS CLIN 630 WEST THIRD ST MILAN, MO 63556 (660)265-5204 Sullivan 268718 * SULLIVAN COUNTY MEMORIAL 18 WEST 3RD STREET GREEN CITY, MO 63545 (660)874-5887 Sullivan HOSP GREEN CITY CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 15 of 15 Missouri

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 268729 * SULLIVAN COUNTY MEMORIAL 210 N MARKET STREET MILAN, MO 63556 (660)265-4456 Sullivan HOSP MILAN FAM PRACT CLIN 268603 * TCMH - CABOOL MEDICAL CLINIC 500 MAIN STREET, PO BOX 380 CABOOL, MO 65689 (417)962-3121 Texas 268630 * TCMH FAMILY CLINIC-LICKING 233 S MAIN LICKING, MO 65542 (573)674-3011 Texas 268535 * TCMH INTERNAL MEDICINE ASSOC 1337 S SAM HOUSTON BLVD HOUSTON, MO 65483 (417)967-3311 Texas 268653 * TCMH MOUNTAIN GROVE CLINIC 1905 WEST 19TH STREET MOUNTAIN GROVE, MO 65711 (417)926-1770 Wright 263438 * THAYER MEDICAL CLINIC HWY 63 & EASTWOOD CTR THAYER, MO 65791 (417)257-6752 Oregon 268658 * THE CLINIC AT WALMART 2025 W BUSINESS HIGHWAY 60 DEXTER, MO 63841 (573)614-4600 Stoddard OPERATED BY SOUTHEASTHEALTH 268930 * THE MEDICAL CENTER RURAL 902 WOLLARD BLVD RICHMOND, MO 64085 (816)776-2201 Ray HEALTH CLINIC 793833 * THEODOSIA FAMILY MEDICAL 4900 ST HWY 160 STE 2 THEODOSIA, MO 65761 (417)273-2300 Ozark CLINIC LLC 263970 * TINSLEY MEDICAL CLINIC 2400 LUCY LEE PARKWAY SUITE A POPLAR BLUFF, MO 63901 (573)686-1144 Butler 268567 * TOTAL FAMILY HEALTH CARE 1201 NORTH RUTHERFORD MACON, MO 63552 (660)385-5880 Macon 268644 * TWIN RIVERS WOMEN'S CENTER 509 SOUTH BYP KENNETT, MO 63857 (573)888-0444 Dunklin 263871 * VALLEY MEDICAL CLINIC 308 SOUTH HARRIS WILLOW SPRINGS, MO 65793 (417)469-3175 Howell 268650 * WCMH URGENT CARE 300 HEALTHWAY POTOSI, MO 63664 (573)438-0751 Washington 263414 * WESTWOOD RURAL HLTH CLINIC 2642 STATE ROUTE 76 WILLOW SPRINGS, MO 65793 (417)469-5124 Howell 263969 * WILBERS FAMILY CARE CLINIC 111 EAST FIRST ST MONTGOMERY CITY, MO (573)564-3214 Montgomery 63361 268652 * WOMEN'S CARE CENTER 1013 NORTH MAIN STREET, STE 101 SIKESTON, MO 63801 (573)472-7535 Scott 268744 None WOMEN'S WELLNESS AT THE PLAZA 120 PLAZA DRIVE SAINTE GENEVIEVE, MO (573)883-1199 Ste. Genevieve 63670 268623 * WOMENS HEALTH CENTER 800 STE GENEVIEVE DRIVE SAINTE GENEVIEVE, MO (573)883-5715 Ste. Genevieve 63670 793827 * WOMENS HEALTH SPECIALISTS, PC 2340 KATY LANE POPLAR BLUFF, MO 63901 (573)776-7393 Butler 263926 * WOODS MEDICAL CLINIC LLC 250 SOUTH HICKMAN PUXICO, MO 63960 (573)222-2292 Stoddard 268643 * WRIGHT MEMORIAL JAMESPORT 103 2ND STREET JAMESPORT, MO 64648 (660)684-6244 Daviess CLINIC 268637 * WRIGHT MEMORIAL PHYSICIANS 189 IOWA BLVD TRENTON, MO 64683 (660)359-3899 Grundy GROUP 268519 * WYACONDA MEDICAL SERVICES 124 WEST JEFFERSON WYACONDA, MO 63474 (660)479-5553 Clark Total Providers for this State = 367

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 6 Nebraska

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 283499 * ADAMS PRIMARY CARE PO BOX 963, 620 MAIN STREET, SUITE A ADAMS, NE 68301 (402)988-2188 Gage 288520 * AINSWORTH FAMILY CLINIC 913 EAST ZERO STREET AINSWORTH, NE 69210 (402)387-1900 Brown 283473 * AMH CLEARWATER CLINIC 308 NEVADA STREET CLEARWATER, NE 68726 (402)485-2277 Antelope 283472 * AMH ELGIN CLINIC 101 WEST CEDAR STREET ELGIN, NE 68636 (402)843-5444 Antelope 283438 * AMH FAMILY PRACTICE P O BOX 109, 109 WEST 11TH NELIGH, NE 68756 (402)887-5440 Antelope 283474 * AMH-TILDEN CLINIC 104 SOUTH CENTER TILDEN, NE 68781 (402)368-5520 Antelope 283976 * ARAPAHOE MEDICAL CLINIC P.O. BOX 389, 305 NEBRASKA AVENUE ARAPAHOE, NE 68922 (308)962-8495 Furnas 283475 * ARNOLD MEDICAL CLINIC 104 NORTH BROADWAY STREET ARNOLD, NE 69120 (308)848-3259 Custer 288539 * ASHLAND FAMILY CLINIC 705 N 17TH AVENUE ASHLAND, NE 68003 (402)944-2201 Saunders 283814 * AVERA MEDICAL GROUP BUTTE 730 WILSON BUTTE, NE 68722 (402)775-2508 Boyd 283427 * AVERA MEDICAL GROUP CROFTON 203 WEST MAIN STREET CROFTON, NE 68730 (402)388-2343 Knox 283428 * AVERA MEDICAL GROUP 405 WEST DARLENE STREET HARTINGTON, NE 68739 (402)254-3935 Cedar HARTINGTON 288521 * AVERA MEDICAL GROUP LAFLAN 804 CHASE AVENUE CREIGHTON, NE 68729 (402)358-5335 Knox 283460 * AVERA MEDICAL GROUP NIOBRARA 254-10 PARK AVE APT E, PO BOX 254 NIOBRARA, NE 68760 (402)857-3398 Knox 288507 * AVERA MEDICAL GROUP O'NEILL 300 NORTH 2ND STREET O' NEILL, NE 68763 (402)336-2900 Holt 288509 * AVERA MEDICAL GROUP PIERCE 503 N 6TH STREET PIERCE, NE 68767 (402)329-6780 Pierce 283466 * AVERA MEDICAL GROUP VERDIGRE 401 JAMES STREET VERDIGRE, NE 68783 (402)668-2216 Knox 288528 * BANCROFT MEDICAL CLINIC 219 MAIN STREET BANCROFT, NE 68004 (402)648-7606 Cuming 288524 * BEATRICE INTERNAL MEDICINE 4800 HOSPITAL PARKWAY BEATRICE, NE 68310 (402)228-3545 Gage 288523 * BEATRICE MEDICAL CENTER 805 WEST COURT BEATRICE, NE 68310 (402)228-3366 Gage 288527 * BEEMER MEDICAL CLINIC 212 MAIN STREET BEEMER, NE 68716 (402)528-3288 Cuming 283498 * BLUE HILL MEDICAL CLINIC 102 NORTH PINE BLUE HILL, NE 68930 (402)756-2141 Webster 283480 * BOONE COUNTY MEDICAL CLINIC 1019 SOUTH 8TH STREET ALBION, NE 68620 (402)395-5013 Boone 283832 * BRADY RURAL HEALTH CLINIC 114 NORTH MAIN STREET BRADY, NE 69123 (308)584-3770 Lincoln 288538 None BURGESS FAMILY CLINIC-DECATUR 823 S BROADWAY, SUITE 120 DECATUR, NE 68020 (402)349-5592 Burt 283836 * BURWELL FAMILY PRACTICE CLINIC 410 SOUTH 8TH AVENUE, PO BOX 906 BURWELL, NE 68823 (308)346-5544 Garfield 283476 * CALLAWAY MEDICAL CLINIC 213 EAST KIMBALL STREET CALLAWAY, NE 68825 (308)836-2294 Custer 283977 * CAMBRIDGE MEDICAL CENTER P.O. BOX 488, 1305 WEST HIGHWAY CAMBRIDGE, NE 69022 (308)697-3317 Furnas 6/34 283864 * CEDAR RAPIDS MEDICAL CLINIC 106 S 3RD STREET CEDAR RAPIDS, NE 68627 (308)358-0615 Boone 283489 * CHASE COUNTY CLINIC 308 NORTH TECUMSEH STREET WAUNETA, NE 69045 (308)394-5593 Chase 283490 * CHASE COUNTY CLINIC 600 WEST 12TH STREET IMPERIAL, NE 69033 (308)882-7299 Chase * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 6 Nebraska

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 283477 * CHERRY COUNTY CLINIC 512 NORTH GREEN STREET VALENTINE, NE 69201 (402)376-3770 Cherry 283435 * CHESTER MEDICAL CLINIC 116 HURON STREET CHESTER, NE 68327 (402)324-7101 Thayer 283461 * CHI HEALTH CLINIC CLARKSON 322 PINE STREET CLARKSON, NE 68629 (402)892-3466 Colfax 283403 * CHI HEALTH CLINIC HOWELLS P O BOX 98, 121 S 6TH STREET HOWELLS, NE 68641 (402)986-1115 Colfax 283402 * CHI HEALTH CLINIC PLAINVIEW 704 NORTH 3RD STREET, BOX 490 PLAINVIEW, NE 68769 (402)582-4245 Pierce 283418 * CHI HEALTH CLINIC SCHUYLER 1721 COLFAX STREET SCHUYLER, NE 68661 (402)352-3745 Colfax 283997 * CHIMNEY ROCK MEDICAL CENTER 320 MAIN BAYARD, NE 69334 (308)586-1717 Morrill 283426 * COMMUNITY PHYSICIAN'S CLINIC 100 NORTH 7TH WYMORE, NE 68466 (402)645-3733 Gage 283404 * COTTONWOOD RURAL HEALTH 120 S. 9TH ST. TEKAMAH, NE 68061 (402)374-1585 Burt CLINIC 288512 * COZAD COMMUNITY MEDICAL P O BOX 86, 1803 PAPIO LANE COZAD, NE 69130 (308)784-3039 Dawson CLINIC 283468 * CRETE AREA MEDICAL CENTER 2910 BETTEN DRIVE CRETE, NE 68333 (402)826-2102 Saline 283980 * CURTIS MEDICAL CENTER 302 EAST 6TH STREET CURTIS, NE 69025 (308)367-4162 Frontier 283436 * DAVENPORT MEDICAL CLINIC 102 NORTH A STREET DAVENPORT, NE 68335 (402)364-2105 Thayer 283482 * DINKLAGE MEDICAL CLINIC 500 EAST DECATUR WEST POINT, NE 68788 (402)372-2477 Cuming 283496 * EDGAR MEDICAL CLINIC 315 NORTH C STREET, BOX 406 EDGAR, NE 68935 (402)224-3344 Clay 283879 None ELKHORN VALLEY FAMILY MEDICINE 304 E DOUGLAS STREET O' NEILL, NE 68763 (402)336-4222 Holt PC 288525 * EMERSON MEDICAL CLINIC 1012 S MAIN ST EMERSON, NE 68733 (402)695-2453 Dakota 283449 * FAMILY MEDICINE 3307 N BARADA STREET FALLS CITY, NE 68355 (402)245-4475 Richardson 288540 None FAMILY MEDICINE SPECIALISTS 1105 N ERIE STREET LEXINGTON, NE 68850 (308)324-8308 Dawson 283400 * FCMH CAMPBELL MEDICAL CLINIC 148 SOUTH TAYLOR CAMPBELL, NE 68932 (402)756-8080 Franklin 283998 * FCMH HILDRETH MEDICAL CLINIC 511 HUBBARD HILDRETH, NE 68947 (308)938-4885 Franklin 283999 * FCMH POOL MEDICAL CLINIC 121 15TH AVE FRANKLIN, NE 68939 (308)425-6249 Franklin 283844 * FILLMORE COUNTY MEDICAL 1840 F STREET GENEVA, NE 68361 (402)759-4485 Fillmore CENTER, PC 288506 * FORT CALHOUN CLINIC 4929 COUNTY ROAD P43 FORT CALHOUN, NE 68023 (402)468-4655 Washington 283846 * FRIEND MEDICAL CLINIC 1210 SECOND STREET FRIEND, NE 68359 (402)947-2021 Saline 288518 * GAGE COUNTY MEDICAL CLINIC 1101 NORTH 10TH STREET BEATRICE, NE 68310 (402)228-3436 Gage 283448 * GORDON CLINIC 807 N ASH GORDON, NE 69343 (308)282-1442 Sheridan 288536 None GOTHENBURG CLINIC 918 20TH STREET GOTHENBURG, NE 69138 (308)537-4066 Dawson

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 6 Nebraska

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 283876 * GOTHENBURG MEDICAL ARTS 619 10TH STREET, P O BOX 389 GOTHENBURG, NE 69138 (308)537-3673 Dawson RURAL HEALTH CLINIC 283989 * GRANT MEDICAL CLINIC 912 CENTRAL AVENUE GRANT, NE 69140 (308)352-7100 Perkins 288502 * GREATER NEBRASKA MEDICAL & 2091 BOX BUTTE AVENUE, SUITE 200 & ALLIANCE, NE 69301 (308)762-4300 Box Butte SURGICAL SERV-ALLIANCE SUITE 700 283454 * GREATER NEBRASKA MEDICAL & 812 LARAMIE AVENUE HEMINGFORD, NE 69348 (308)487-3322 Box Butte SURGICAL SERV-HEMINGFOR 283467 * GREATER NEBRASKA MEDICAL & 111 NORTH MAIN STREET HYANNIS, NE 69350 (308)458-2436 Grant SURGICAL SERV-HYANNIS 283866 * GREATER SANDHILLS FAMILY P O BOX 146, 101 E SOUTH STREET BASSETT, NE 68714 (402)684-2285 Rock HEALTHCARE PC 283867 * GREATER SANDHILLS FAMILY 418 E 5TH STREET ATKINSON, NE 68713 (402)925-2994 Holt HEALTHCARE PC 283865 * GREATER SANDHILLS FAMILY 110 W 2ND STREET STUART, NE 68780 (402)924-3777 Holt HEALTHCARE PC 288511 * GREELEY MEDICAL CLINIC 109 WEST OCONNOR AVENUE GREELEY, NE 68842 (308)428-3018 Greeley 288515 * HEARTLAND FAMILY MEDICINE 811 HOWELL STREET OXFORD, NE 68967 (308)824-3288 Furnas 288516 * HEARTLAND FAMILY MEDICINE 715 BROWN STREET ALMA, NE 68920 (308)928-2103 Harlan 283421 * HENDERSON FAMILY CARE 1621 FRONT STREET HENDERSON, NE 68371 (402)723-4512 York 288537 None HOOPER MEDICAL CLINIC 600 E FULTON STREET, SUITE A HOOPER, NE 68031 (402)654-2221 Dodge 283455 * HOWARD COUNTY MEDICAL CLINIC 1113 SHERMAN STREET ST PAUL, NE 68873 (308)754-5447 Howard 283483 * HOWELLS FAMILY PRACTICE 119 SOUTH 3RD STREET HOWELLS, NE 68641 (402)986-0830 Colfax 283493 * HUMBOLDT FAMILY MEDICINE 1120 GRAND AVENUE HUMBOLDT, NE 68376 (402)862-3280 Richardson 288519 * HUMPHREY MEDICAL CLINIC 303 MAIN STREET HUMPHREY, NE 68642 (402)923-0412 Platte 283985 * INDIANOLA MEDICAL CLINIC 119 SOUTH FOURTH INDIANOLA, NE 69034 (308)364-9290 Red Willow 283416 * KEARNEY COUNTY HEALTH 727 EAST FIRST STREET MINDEN, NE 68959 (308)832-1440 Kearney SERVICES 288532 None KHS POTTER CLINIC 922 1/2 SHERMAN STREET POTTER, NE 69156 (308)879-0155 Cheyenne 283437 * KIMBALL COUNTY HOSPITAL CLINIC 505 SOUTH BURG STREET KIMBALL, NE 69145 (308)235-1966 Kimball 283405 * LEGEND BUTTES HEALTH P.O. BOX 272, 11 PADDOCK ST. CRAWFORD, NE 69339 (308)665-1770 Dawes SERVICES- 288544 None LEXINGTON REGIONAL HEALTH 202 SMITH AVENUE ELWOOD, NE 68937 (402)324-5651 Gosper CENTER ELWOOD CLINIC 288531 * LONE TREE MEDICAL CLINIC 2510 18TH AVENUE CENTRAL CITY, NE 68826 (308)946-3845 Merrick 288530 * LONE TREE MEDICAL CLINIC 901 BROADWAY STREET FULLERTON, NE 68638 (308)536-2458 Nance * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 6 Nebraska

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 283401 * LYONS MERCY MEDICAL CLINIC 220 MAIN, BOX 229 LYONS, NE 68038 (402)687-2171 Burt 283813 * MAIN STREET MEDICAL CLINIC 313 NORTH WEBSTER, P O BOX 467 RED CLOUD, NE 68970 (402)746-2282 Webster 283462 * MCH PHYSICIANS BLAIR CLINIC 812 NORTH 22ND STREET BLAIR, NE 68008 (402)426-4611 Washington 283994 * MEMORIAL CLINIC-UTICA 100 4TH STREET UTICA, NE 68456 (402)534-2081 Seward 283432 * MILFORD FAMILY MEDICAL CENTER 119 SOUTH C STREET MILFORD, NE 68405 (402)761-3307 Seward 283430 * MORRILL COUNTY HOSPITAL CLINIC 1320 S STREET BRIDGEPORT, NE 69336 (308)262-1755 Morrill 283458 * NANCE COUNTY MEDICAL CLINIC 405 BROADWAY STREET FULLERTON, NE 68638 (308)536-2446 Nance 288522 * NEBRASKA CITY MEDICAL CLINIC 1301 GRUNDEMAN BLVD, SUITE A NEBRASKA CITY, NE 68410 (402)873-4242 Otoe 288542 None NEWMAN GROVE MEDICAL CLINIC 104 NORTH 1ST STREET NEWMAN GROVE, NE 68758 (402)447-6214 Madison 283485 * OAKLAND FAMILY PRACTICE 100 WEST 9TH STREET OAKLAND, NE 68045 (402)685-5120 Burt 283456 * OAKLAND MERCY MEDICAL CLINIC 211 NORTH ENGDAHL OAKLAND, NE 68045 (402)685-5116 Burt 283471 * ORCHARD MEDICAL CLINIC 103 WASHINGTON STREET ORCHARD, NE 68764 (402)893-5155 Antelope 283878 * PARK STREET MEDICAL CLINIC PC 505 SOUTH PARK STREET GENOA, NE 68640 (402)993-2206 Nance 283984 * PAWNEE COUNTY RURAL HEALTH 600 I STREET, P O BOX 433 PAWNEE CITY, NE 68420 (402)852-2311 Pawnee CLINIC 288526 * PENDER MEDICAL CLINIC 100 VALLEY VIEW DRIVE, SUITE 1 PENDER, NE 68047 (402)385-3033 Thurston 288543 None PHELPS MEDICAL GROUP 1315 TIBBALS STREET HOLDREGE, NE 68949 (308)995-6111 Phelps 283870 * PONCA MERCY MEDICAL CLINIC 111 2ND STREET PONCA, NE 68770 (402)755-2231 Dixon 283442 * QUALITY HEALTHCARE SERVICES 1313 N. CHEYENNE - P O BOX 710 BENKELMAN, NE 69021 (308)423-2151 Dundy MEDICAL CLINIC 283441 * QUALITY HEALTHCARE SERVICES 903 BAILEY STREET STRATTON, NE 69043 (308)276-2411 Hitchcock MEDICAL CLINIC 288533 None RANDOLPH FAMILY PRACTICE 106 E WAYNE STREET RANDOLPH, NE 68771 (402)337-0200 Cedar CLINIC 283440 * REGIONAL WEST GARDEN COUNTY 1100 WEST 2ND STREET OSHKOSH, NE 69154 (308)772-3283 Garden CLINIC 283821 * REGIONAL WEST PHYSICIANS 302 CENTER AVENUE MORRILL, NE 69358 (308)247-3475 Scotts Bluff CLINIC 283443 * ROCK COUNTY CLINIC 801 S STATE STREET BASSETT, NE 68714 (402)684-2906 Rock 283451 * RUSHVILLE CLINIC 307 CONRAD STREET RUSHVILLE, NE 69360 (308)327-2757 Sheridan 283857 * SALINE MEDICAL SPECIALTIES 969 EAST HIGHWAY 33 CRETE, NE 68333 (402)826-3222 Saline 283990 * SAUNDERS MEDICAL CENTER - 1760 COUNTY ROAD J WAHOO, NE 68066 (402)443-4191 Saunders CLINIC 283486 * SCRIBNER MEDICAL CLINIC 429 MAIN STREET SCRIBNER, NE 68057 (402)664-3414 Dodge

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 6 Nebraska

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 283409 * SEWARD FAMILY MEDICAL CENTER 250 NORTH COLUMBIA SEWARD, NE 68434 (402)643-4800 Seward 288513 * SIDNEY REG MEDICAL CTR 562 VINCENT AVENUE CHAPPELL, NE 69129 (308)874-2255 Deuel PHYSICIANS CLINIC-CHAPPELL 288514 * SIDNEY REGIONAL MEDICAL 1000 POLE CREEK XING SIDNEY, NE 69162 (308)254-5544 Cheyenne CENTER PHYSICIANS CLINIC 283481 * SPALDING MEDICAL CLINIC 151 NORTH CHESTNUT SPALDING, NE 68665 (308)497-2485 Greeley 283863 * ST EDWARD MEDICAL CLINIC 1102 WATER STREET SAINT EDWARD, NE 68660 (402)678-2232 Boone 283478 * SUPERIOR FAMILY MEDICAL PO BOX 407, 525 EAST 11TH STREET SUPERIOR, NE 68978 (402)879-4781 Nuckolls CENTER 283479 * SUPERIOR FAMILY MEDICAL 76 WEST 8TH STREET NELSON, NE 68961 (402)225-2375 Nuckolls CENTER 283494 * SUTTON FAMILY PRACTICE 208 NORTH FRENCH AVENUE SUTTON, NE 68979 (402)773-2130 Clay 283470 * SYRACUSE MEDICAL CENTER 277 EAST 17TH STREET SYRACUSE, NE 68446 (402)269-2411 Otoe 283433 * TCHS BRUNING MEDICAL CLINIC 108 SOUTH FILLMORE BRUNING, NE 68322 (402)353-2055 Thayer 283996 * TECUMSEH FAMILY HEALTH 202 HIGH STREET, SUITE 100 TECUMSEH, NE 68450 (402)335-2811 Johnson 288501 * TEKAMAH MERCY MEDICAL CLINIC 1121 SOUTH 13TH STREET TEKAMAH, NE 68061 (402)685-7590 Burt 283446 * THAYER CO HLTH SVS DESHLER 615 4TH STREET DESHLER, NE 68340 (402)365-7604 Thayer MED 283434 * THAYER COUNTY HEALTH 120 PARK AVENUE HEBRON, NE 68370 (402)768-7203 Thayer SERVICES HEBRON MEDICAL CLINI 288504 * THE BEATRICE WOMEN'S AND 4800 HOSPITAL PARKWAY, SUITE 202 BEATRICE, NE 68310 (402)228-3117 Gage CHILDREN'S CLINIC 288541 * THE FAIRBURY CLINIC 825 22ND ST FAIRBURY, NE 68352 (402)729-3361 Jefferson 288500 * TRENTON REGIONAL MEDICAL 406 EAST 1ST STREET TRENTON, NE 69044 (308)334-5155 Hitchcock CENTER 283872 * VALENTINE MEDICAL CLINIC, LLC 502 N CHERRY STREET VALENTINE, NE 69201 (402)376-2200 Cherry 283424 * VALLEY MEDICAL CLINIC OF BIG PO BOX 299, 100 WEST 3RD BIG SPRINGS, NE 69122 (308)889-3376 Deuel SPRINGS 283463 * VCHS MEDICAL CLINIC 150 NORTH 9TH AVENUE, SUITE B BURWELL, NE 68823 (308)346-5442 Garfield 288529 * VCHS MEDICAL CLINIC 130 NORTH 6TH STREET, SUITE B LOUP CITY, NE 68853 (308)745-0324 Sherman 283465 * VCHS MEDICAL CLINIC 2707 L STREET, SUITE 1 ORD, NE 68862 (308)728-4200 Valley 288534 None WAUSA MEDICAL CLINIC 100 N LINCOLN STREET WAUSA, NE 68786 (402)586-2244 Knox 283408 * WEBSTER COUNTY CLINIC P O BOX 465, 6TH & FRANKLIN STS RED CLOUD, NE 68970 (402)746-5614 Webster 288503 * WEEPING WATER MEDICAL CENTER 204 NORTH RANDOLPH STREET WEEPING WATER, NE 68463 (402)267-5330 Cass 283488 * WEST HOLT MEDICAL CLINIC 405 WEST PEARL STREET ATKINSON, NE 68713 (402)925-2811 Holt * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 6 Nebraska

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 283469 * WILBER MEDICAL CLINIC 203 WEST 4TH STREET WILBER, NE 68465 (402)821-3293 Saline 283484 * WISNER FAMILY PRACTICE 2100 21ST CIRCLE SUITE A WISNER, NE 68791 (402)529-6516 Cuming 283868 * WITTER FAMILY MEDICINE 358 S 10TH, P O BOX 110 DAVID CITY, NE 68632 (402)367-3322 Butler 283415 * WYMORE MEDICAL CLINIC 116 EAST H STREET WYMORE, NE 68466 (402)645-3310 Gage Total Providers for this State = 141

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 Colorado

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 068507 * AKRON CLINIC 82 MAIN AKRON, CO 80720 (970)345-6336 Washington 063873 * ARKANSAS VALLEY FAMILY 2317 SAN JUAN AVE LA JUNTA, CO 81050 (719)383-2325 Otero PRACTICE LLC 063405 None BANNER HEALTH CENTER 102 HAYS AVE STERLING, CO 80751 (970)521-3223 Logan STERLING 063876 * BASIN CLINIC 421 WEST ADAMS ROAD NATURITA, CO 81422 (970)865-2665 Montrose 063979 * BRUSH FAMILY CLINIC 2400 W EDISON BRUSH, CO 80723 (970)842-6740 Morgan 063986 * BUENA VISTA HEALTH CENTER 28374 COUNTY ROAD 317 BUENA VISTA, CO 81211 (719)395-9048 Chaffee 063866 * BUTTON FAMILY PRACTICE 715 SOUTH 9TH STREET CANON CITY, CO 81212 (719)269-8820 Fremont 063829 * CENTENNIAL FAMILY HEALTH 319 MAIN STREET ORDWAY, CO 81063 (719)267-3503 Crowley CENTER 063864 * COLORADO PLAINS CLINIC - 226 MAIN STREET WIGGINS, CO 80654 (970)483-7283 Morgan WIGGINS 068510 * CONVENIENT CARE CLINIC 403 KENDELL DRIVE LAMAR, CO 81052 (719)336-6767 Prowers 068519 * CORTEZ PRIMARY CARE CLINIC 118 NORTH CHESTNUT CORTEZ, CO 81321 (970)564-9777 Montezuma 068503 * CREEDE FAMILY PRACTICE OF RIO 802 RIO GRANDE AVENUE CREEDE, CO 81130 (719)658-0929 Mineral GRANDE HOSPITAL 063804 * CUSTER COUNTY MEDICAL CENTER 704 EDWARDS WESTCLIFFE, CO 81252 (719)783-2380 Custer 068501 * EADS MEDICAL CLINIC 1211 LUTHER STREET EADS, CO 81036 (719)438-2251 Kiowa 063858 * EASTERN PLAINS MEDICAL CLINIC 560 CRYSTOLA STREET CALHAN, CO 80808 (719)347-0100 El Paso OF CALHAN 068500 * FAMILY CARE CLINIC 615 FAIRHURST STERLING, CO 80751 (970)521-3223 Logan 063400 * FAMILY PRACTICE OF HOLYOKE 1001 EAST JOHNSON STREET HOLYOKE, CO 80734 (970)854-2500 Phillips 063851 * FLORENCE MEDICAL CENTER 501 W 5TH ST FLORENCE, CO 81226 (719)784-4816 Fremont 063872 * FORT MORGAN PEDIATRIC CLINIC, 1000 LINCOLN STREET, STE 202 FORT MORGAN, CO 80701 (970)542-9187 Morgan PC 063996 * GRAND RIVER HEALTH CLINIC WEST 201 SIPPERELLE DRIVE PARACHUTE, CO 81635 (970)285-7046 Garfield 063980 * GRAND RIVER PRIMARY CARE 501 AIRPORT ROAD RIFLE, CO 81650 (970)625-1100 Garfield 063854 * HAVENS FAMILY CLINIC 109 LATIGO LANE, STE C CANON CITY, CO 81212 (719)276-3211 Fremont 063999 * KIT CARSON CLINIC 102 EAST 2ND AVENUE KIT CARSON, CO 80825 (719)962-3501 Cheyenne 063810 * LAKE CITY AREA MEDICAL CENTER 700 N HENSON STREET LAKE CITY, CO 81235 (970)944-2331 Hinsdale 068512 * LAMAR MEDICAL CLINIC 403 KENDALL DRIVE LAMAR, CO 81052 (719)336-6767 Prowers 068521 * MANCOS VALLEY HEALTH CENTER 111 RAILROAD AVE MANCOS, CO 81328 (970)564-2104 Montezuma

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 Colorado

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 063869 * MEADOWS FAMILY MEDICAL 115 15TH AVE, PO BOX 3243 IDAHO SPRINGS, CO 80452 (303)567-2668 Clear Creek CENTER 063403 * MEEKER FAMILY HEALTH CENTER 345 CLEVELAND STREET MEEKER, CO 81641 (970)878-4014 Rio Blanco 063407 None MONTE VISTA RHC OF RIO GRANDE 1033 2ND AVENUE MONTE VISTA, CO 81144 (719)852-8827 Rio Grande HOSPITAL 063404 * MT SAN RAFAEL HOSPITAL HEALTH 400 BENEDICTA STE A TRINIDAD, CO 81082 (719)846-2206 Las Animas CLINIC 068518 * NORTH PARK MEDICAL CENTER - 350 MCKINLEY STREET WALDEN, CO 80480 (970)723-4255 Jackson WALDEN 068509 * PAGOSA MOUNTAIN CLINIC 95 SOUTH PAGOSA BLVD PAGOSA SPRINGS, CO 81147 (970)731-3700 Archuleta 063997 * PARKE HEALTH CLINIC 182 16TH ST BURLINGTON, CO 80807 (719)346-9481 Kit Carson 063834 * PEDIATRIC ASSOCIATION OF CANON 1335 PHAY AVENUE, SUITE A CANON CITY, CO 81212 (719)269-1727 Fremont CITY 063985 * PRAIRIE VIEW RURAL HEALTH 615 WEST 5TH NORTH CHEYENNE WELLS, CO 80810 (719)767-5669 Cheyenne CLINIC 068504 * RIO GRANDE HOSPITAL CLINIC 0310C COUNTY RD 14 DEL NORTE, CO 81132 (719)657-2418 Rio Grande 063837 * ROCKY FORD FAMILY HEALTH 1014 ELM AVENUE ROCKY FORD, CO 81067 (719)254-7421 Otero CENTER 063870 * SABATINI PEDIATRICS PC 612 YALE PLACE CANON CITY, CO 81212 (719)275-3442 Fremont 063992 * SAN LUIS VALLEY HEALTH 115 MAIN STREET ANTONITO, CO 81120 (719)376-2308 Conejos ANTONITO CLINIC 068513 * SAN LUIS VALLEY LA JARA MEDICAL 509 MAIN STREET LA JARA, CO 81140 (719)274-5000 Conejos CLINIC 068523 None SLV HEALTH MONTE VISTA 103 CHICO CT MONTE VISTA, CO 81144 (719)589-8194 Rio Grande COMMUNITY CLINIC 063998 * SOUTHEAST COLORADO 900 CHURCH STREET SPRINGFIELD, CO 81073 (719)523-6628 Baca PHYSICIANS CLINIC 068506 * SOUTHWEST MEMORIAL PRIMARY 33 NORTH ELM STREET CORTEZ, CO 81321 (970)565-8556 Montezuma CARE 063406 None SOUTHWEST SCHOOL-BASED 418 S SLIGO STREET CORTEZ, CO 81321 (970)564-2104 Montezuma HEALTH CENTER 068520 * SOUTHWEST WALK-IN CARE 2095 NORTH DOLORES ROAD, STE C CORTEZ, CO 81321 (970)564-1037 Montezuma 068517 * SPANISH PEAKS FAMILY CLINIC 23400 US HIGHWAY 160 WALSENBURG, CO 81089 (719)738-4591 Huerfano 063401 * STRATTON MEDICAL CLINIC 500 NEBRASKA AVENUE STRATTON, CO 80836 (719)348-4650 Kit Carson 063831 * SURFACE CREEK FAMILY PRACTICE 255 SW 8TH AVE CEDAREDGE, CO 81413 (970)856-3146 Delta 063840 * TMC - PRIMARY CARE 500 W PACIFIC AVENUE TELLURIDE, CO 81435 (970)728-3848 San Miguel * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 Colorado

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 063995 * VALLEY MEDICAL CLINIC 116 E NINTH STREET JULESBURG, CO 80737 (970)474-3376 Sedgwick 063874 * WALSH MEDICAL CLINIC 137 KANSAS STREET WALSH, CO 81090 (719)324-5253 Baca 063868 * WASHINGTON COUNTY CLINIC 482 ADAMS AVENUE AKRON, CO 80720 (970)345-2262 Washington 063994 * YUMA CLINIC 1000 W 8TH AVENUE YUMA, CO 80759 (970)848-4792 Yuma Total Providers for this State = 53

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 Montana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 273975 * BAIR MEDICAL CLINIC 16 W MAIN WHITE SULPHUR SPRING, MT (406)547-3321 Meagher 59645 273986 * BAIR MEMORIAL CLINIC 530 3RD ST NW HARLOWTON, MT 59036 (406)632-4351 Wheatland 273818 * BASIN MEDICAL CENTER 76 CENTRAL AVE STANFORD, MT 59479 (406)566-2773 Judith Basin 273414 * BENEFIS TETON RURAL HEALTH 915 4TH ST NW CHOTEAU, MT 59422 (406)466-5763 Teton CLINIC 273985 * BENTON MEDICAL CENTER 1203 15TH ST FORT BENTON, MT 59442 (406)622-5485 Chouteau 273989 * BIG SANDY MEDICAL CENTER RHC 166 MONTANA AVE E BIG SANDY, MT 59520 (406)378-2189 Chouteau 273419 * BITTERROOT PHYSICIANS CLINIC 1200 WESTWOOD DR HAMILTON, MT 59840 (406)363-1100 Ravalli 273817 * BOULDER MEDICAL CLINIC INC 214 S MAIN BOULDER, MT 59632 (406)225-4201 Jefferson 273981 * COMMUNITY CLINIC OF FALLON CO 202 S 4TH WEST ST BAKER, MT 59313 (406)778-2833 Fallon 273420 * CONVENIENT CARE CLINIC 1200 WESTWOOD DR STE H HAMILTON, MT 59840 (406)363-0597 Ravalli 273418 * CORVALLIS FAMILY MEDICINE 1037 MAIN ST CORVALLIS, MT 59828 (406)961-4661 Ravalli 273976 * DAHL MEMORIAL CLINIC 215 SANDY ST EKALAKA, MT 59324 (406)775-8739 Carter 273998 * DANIELS MEMORIAL MEDICAL 105 5TH AVE E SCOBEY, MT 59263 (406)487-2296 Daniels CLINIC 273991 * DEER LODGE MEDICAL CENTER 1100 HOLLENBECK LN DEER LODGE, MT 59722 (406)846-1722 Powell 273423 * EUREKA HEALTHCARE PRIMARY 304 OSLOSKI RD EUREKA, MT 59917 (406)297-2438 Lincoln CARE 273411 * GABERT CLINIC 107 DILWORTH GLENDIVE, MT 59330 (406)345-8900 Dawson 273406 * GLASGOW CLINIC, INC 221 5TH AVE S GLASGOW, MT 59230 (406)228-3400 Valley 273400 * GRANITE COUNTY CLINIC 310 SANSOME PHILIPSBURG, MT 59858 (406)859-3271 Granite 273412 * HARRISON CLINIC 7558 US HWY 287 HARRISON, MT 59735 (406)685-3250 Madison 273425 * HOLY ROSARY HEALTHCARE RHC 2600 WILSON ST MILES CITY, MT 59301 (406)233-2600 Custer 273980 * HOT SPRINGS MEDICAL CLINIC 209 MAIN ST HOT SPRINGS, MT 59845 (406)741-3602 Sanders 273830 None JACK LINCOLN MEMORIAL CLINIC 341 MONTANA HIGHWAY 135 SAINT REGIS, MT 59866 (406)649-7307 Mineral 273826 * LIBBY CLINIC 211 E 2ND ST LIBBY, MT 59923 (406)293-8711 Lincoln 273992 * LISTERUD RURAL HEALTH CLINIC 301 KNAPP ST WOLF POINT, MT 59201 (406)653-6501 Roosevelt 273995 * LIVINGSTON HEALTHCARE 320 ALPENGLOW LANE LIVINGSTON, MT 59047 (406)222-0800 Park 273427 * LIVINGSTON HEALTHCARE SHIELDS 309 ELLIOTT ST N WILSALL, MT 59086 (406)578-2580 Park VALLEY CLINIC 273402 * MADISON VALLEY CLINIC 305 N MAIN ENNIS, MT 59729 (406)682-4223 Madison 273828 * MAIN STREET MEDICAL 907 MAIN ST THOMPSON FALLS, MT 59873 (406)827-4307 Sanders

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 Montana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 273404 * MARGO BOWERS HEALTH CENTER 26 E BROAD ST DRUMMOND, MT 59832 (406)288-3627 Granite 273978 * MONDAK FAMILY CLINIC 304 S ELLERY AVE FAIRVIEW, MT 59221 (406)742-5261 Richland 273982 * MUSSELSHELL CO MEDICAL 1202 THIRD ST W ROUNDUP, MT 59072 (406)323-2301 Musselshell CENTER 273424 * NORTH VALLEY PROFESSIONAL 2165 9TH ST W COLUMBIA FALLS, MT 59912 (406)892-3208 Flathead CENTER 273408 * NORTHERN MONTANA FAMILY 1410 1ST AVE HAVRE, MT 59501 (406)265-5408 Hill MEDICAL CENTER 273990 * NORTHERN MONTANA SPECIALTY 20 13TH ST W HAVRE, MT 59501 (406)265-7831 Hill MEDICAL CENTER 273984 * NORTHERN ROCKIES MEDICAL 226 9TH AVE SE CUT BANK, MT 59427 (406)873-5507 Glacier CLINIC 273987 * PHILLIPS COUNTY FAMILY HEALTH 311 S 8TH AVE E MALTA, MT 59538 (406)654-1800 Phillips CLINIC 273421 * PHYSICIAN'S CLINIC 1170 WESTWOOD DR STE B HAMILTON, MT 59840 (406)363-5101 Ravalli 273407 * PIONEER MEDICAL CENTER 701 STOCK ST BIG TIMBER, MT 59011 (406)932-4199 Sweet Grass 273997 * PLAINS MEDICAL CLINIC 10 KRUGER RD PLAINS, MT 59859 (406)826-4800 Sanders 273996 * PONDERA MEDICAL CENTER CLINIC 809 SUNSET BLVD CONRAD, MT 59425 (406)271-3231 Pondera 273410 * PRAIRIE COUNTY RURAL HEALTH 409 BOWEN TERRY, MT 59349 (406)635-5863 Prairie CLINIC 273415 * PROVIDENCE ST JOSEPH MEDICAL 6 13TH AVE E POLSON, MT 59860 (406)883-5680 Lake CENTER POLSON 273416 * PROVIDENCE ST JOSEPH MEDICAL 63351 U S HWY 93 S RONAN, MT 59864 (406)676-5680 Lake CENTER RONAN 273829 * RAVALLI FAMILY MEDICINE 411 W MAIN ST HAMILTON, MT 59840 (406)363-5104 Ravalli 273993 * RIVERSIDE FAMILY CLINIC, INC 209 1/2 H ST E POPLAR, MT 59255 (406)768-5171 Roosevelt 273977 * ROOSEVELT MEDICAL CLINIC 818 2ND AVE E CULBERTSON, MT 59218 (406)787-6400 Roosevelt 273413 * ROSEBUD HEALTH CARE CLINIC 281 N 17TH AVE FORSYTH, MT 59327 (406)346-2916 Rosebud 273405 * RUBY VALLEY MEDICAL CLINIC 210 E CROFOOT ST SHERIDAN, MT 59749 (406)842-5056 Madison 273417 * SHERIDAN MEMORIAL CLINIC 440 W LAUREL AVE PLENTYWOOD, MT 59254 (406)765-3700 Sheridan 273988 * ST LUKE COMMUNITY CLINIC ST 330 SIX TRACT LN SAINT IGNATIUS, MT 59865 (406)745-2781 Lake IGNATIUS 273426 * STILLWATER BILLINGS CLINIC 710 N 11TH ST COLUMBUS, MT 59019 (406)322-5316 Stillwater 273403 * TAMARACK MEDICAL CLINIC 1208 6TH AVE E SUPERIOR, MT 59872 (406)822-4278 Mineral 273979 * THOMPSON FALLS CLINIC 120 POND ST THOMPSON FALLS, MT 59873 (406)827-4442 Sanders * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 Montana

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 273824 * THREE RIVERS CLINIC, LLC 16 RAILWAY AVE THREE FORKS, MT 59752 (406)285-3251 Gallatin 273994 * TRIANGLE HEALTH CARE 418 W MONROE CHESTER, MT 59522 (406)759-5194 Liberty 273409 * TWIN BRIDGES MEDICAL CLINIC 104 S MADISON ST TWIN BRIDGES, MT 59754 (406)684-5546 Madison Total Providers for this State = 56

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 North Dakota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 353423 * AMC CLINIC 612 CENTER AVE N ASHLEY, ND 58413 (701)288-3448 McIntosh 353419 * AMC ZEELAND CLINIC 203 MAIN STREET ZEELAND, ND 58581 (701)423-5403 McIntosh 353837 * AVERA CLINIC OF ELLENDALE 240 MAIN ELLENDALE, ND 58436 (701)349-3666 Dickey 353437 * CAVALIER COUNTY MEMORIAL 901 2ND ST LANGDON, ND 58249 (701)256-6120 Cavalier HOSPITAL CLINIC 353434 * CHI ST ALEXIUS HEALTH CLINIC 1177 BORDER LANE WASHBURN, ND 58577 (701)462-3396 McLean 353985 * CHI ST ALEXIUS HEALTH DICKINSON 95 2ND ST NW BEACH, ND 58621 (701)872-3777 Golden Valley FAMILY CLINIC 353428 * CLINICARE 301 MOUNTAIN ST E STE 2 CAVALIER, ND 58220 (701)265-6307 Pembina 353979 * COOPERSTOWN MEDICAL CENTER 1200 ROBERTS AVE NE COOPERSTOWN, ND 58425 (701)797-2128 Griggs 353413 * CROSBY CLINIC 702 1ST ST SW CROSBY, ND 58730 (701)965-6349 Divide 353852 * FAMILY MEDICAL CLINIC 10 9TH AVENUE EAST LISBON, ND 58054 (701)683-4711 Ransom 353405 * FIRST CARE HEALTH CENTER 115 VIVIAN ST PARK RIVER, ND 58270 (701)284-7555 Walsh 353995 * FOSTER COUNTY MED CTR 820 N 5TH ST CARRINGTON, ND 58421 (701)652-2515 Foster 353412 * GARRISON FAMILY CLINIC 407 3RD AVE SE GARRISON, ND 58540 (701)463-2245 McLean 353449 * GLEN ULLIN FAMILY MEDICAL CLINIC 602 ASH AVE GLEN ULLIN, ND 58631 (701)348-9175 Morton

353450 * HEART OF AMERICA JOHNSON 800 S MAIN AVE RUGBY, ND 58368 (701)776-5235 Pierce CLINIC 353451 * HEART OF AMERICA JOHNSON 215 MAIN ST SE DUNSEITH, ND 58329 (701)224-5694 Rolette CLINIC - DUNSEITH 353452 * HEART OF AMERICA JOHNSON 301 ROOSEVELT AVE MADDOCK, ND 58348 (701)438-2555 Benson CLINIC - MADDOCK 353442 * JACOBSON MEMORIAL HOSPITAL 603 EAST STREET NORTH ELGIN, ND 58533 (701)584-3338 Grant COMMUNITY CLINIC 353415 * LINTON MEDICAL CENTER 511 ELM ST LINTON, ND 58552 (701)254-4531 Emmons 353438 * MCKENZIE COUNTY HEALTHCARE 525 N MAIN ST WATFORD CITY, ND 58854 (701)842-3771 McKenzie SYSTEMS CLINIC 353402 * MILNOR CLINIC 401 MAIN MILNOR, ND 58060 (701)427-5300 Sargent 353407 * MOUNTRAIL COUNTY MEDICAL 615 6TH ST SE STANLEY, ND 58784 (701)638-2505 Mountrail CENTER RHC 353977 * NELSON COUNTY HEALTH SYSTEM - 108 N MAIN ST MCVILLE, ND 58254 (701)322-4347 Nelson MCVILLE CLINIC 353997 * NEW ROCKFORD COMMUNITY 118 1ST ST S NEW ROCKFORD, ND 58356 (701)947-2021 Eddy CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 North Dakota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 353456 * NORTHWOOD DEACONESS HEALTH 611 TOWNER AVE LARIMORE, ND 58251 (701)587-6060 Grand Forks CENTER 353459 * NORTHWOOD DEACONESS HEALTH 308 WHINERY ST BINFORD, ND 58416 (701)676-2528 Griggs CENTER 353455 * NORTHWOOD DEACONESS HEALTH 4 N PARK ST NORTHWOOD, ND 58267 (701)587-6060 Grand Forks CENTER NORTHWOOD CLINIC 353454 * OAKES COMMUNITY CLINIC 1200 N 7TH ST OAKES, ND 58474 (701)742-3600 Dickey 358506 * PRESENTATION CLINIC 213 2ND AVE NE ROLLA, ND 58367 (701)477-3161 Rolette 353899 * RICHARDTON HEALTH CENTER - 215 3RD AVE W RICHARDTON, ND 58652 (701)974-3372 Stark RICHARDTON CLINIC 353443 * RURAL HEALTH GACKLE 321 MAIN STREET GACKLE, ND 58442 (701)485-3611 Logan 353411 * RURAL HEALTH KULM 4 1ST AVE SE KULM, ND 58456 (701)647-2345 LaMoure 353989 * RURAL HEALTH NAPOLEON 420 MAIN NAPOLEON, ND 58561 (701)754-2323 Logan 353408 * RURAL HEALTH WISHEK PO BOX 647 WISHEK, ND 58495 (701)452-2364 McIntosh 353445 * SAKAKAWEA BEULAH CLINIC 1101 3RD AVE NW BEULAH, ND 58523 (701)873-4242 Mercer 353848 * SANFORD HEALTH ELLENDALE 141 MAIN ST ELLENDALE, ND 58436 (701)349-3331 Dickey CLINIC 353822 * SANFORD HEALTH ENDERLIN CLINIC 201 4TH AVE, SUITE 1 ENDERLIN, ND 58027 (701)437-3320 Ransom

353847 * SANFORD HEALTH FORMAN CLINIC 336 MAIN ST FORMAN, ND 58032 (701)724-3221 Sargent 353844 * SANFORD HEALTH LAMOURE CLINIC 100 1ST AVE SW LAMOURE, ND 58458 (701)883-5048 LaMoure 353406 * SOUTHWEST MEDICAL CLINIC 14 6TH AVE SW BOWMAN, ND 58623 (701)523-3226 Bowman 353851 * ST ANDREW'S BOTTINEAU CLINIC 314 OHMER ST BOTTINEAU, ND 58318 (701)228-9400 Bottineau LLC 353987 * TIOGA MEDICAL CENTER - POWERS 117 MAIN ST POWERS LAKE, ND 58773 (701)464-5668 Burke LAKE RHC 353986 * TIOGA MEDICAL CENTER TIOGA 810 N WELO ST TIOGA, ND 58852 (701)664-3368 Williams RHC 353988 * TIOGA MEDICAL CENTER-RAY RHC RAY MALL RAY, ND 58849 (701)585-3624 Williams 353404 * TOWNER COUNTY MEDICAL HIGHWAY 281 NORTH CANDO, ND 58324 (701)968-4411 Towner CENTER 353992 * TRINITY COMMUNITY CLINIC - 307 1ST AVE NW KENMARE, ND 58746 (701)385-4283 Ward KENMARE 353978 * UNITY MEDICAL CENTER/GRAFTON 155 W 14TH ST GRAFTON, ND 58237 (701)352-2000 Walsh FAMILY CLINIC 353458 * WALHALLA CLINIC 301 5TH ST WALHALLA, ND 58282 (701)549-2711 Pembina * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 North Dakota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 353983 * WEST RIVER HEALTH CLINIC - 211 MAIN ST SCRANTON, ND 58653 (701)275-6336 Bowman SCRANTON 353982 * WEST RIVER HEALTH SERVICES 608 HWY 12 WEST BOWMAN, ND 58623 (701)523-3271 Bowman BOWMAN CLINIC 353980 * WEST RIVER HEALTH SERVICES 420 PACIFIC AVE MOTT, ND 58646 (701)824-2391 Hettinger MOTT CLINIC 353981 * WEST RIVER HEALTH SERVICES 820 2ND AVE W NEW ENGLAND, ND 58647 (701)579-4507 Hettinger NEW ENGLAND CLINIC Total Providers for this State = 52

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 3 South Dakota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 433859 * AVERA MEDICAL GROUP CORSICA 265 MAIN STREET CORSICA, SD 57328 (605)946-5411 Douglas 433840 * AVERA MEDICAL GROUP HOWARD 213 S MAIN POST OFFICE BOX 370 HOWARD, SD 57349 (605)772-4426 Miner 433435 * AVERA MEDICAL GROUP MILBANK 803 EAST MILBANK AVE MILBANK, SD 57252 (605)432-4587 Grant 433413 * AVERA MEDICAL GROUP REVILLO 103 EAST 3RD STREET PO BOX 6 REVILLO, SD 57259 (605)623-4695 Grant 433883 * AVERA MEDICAL GROUP SALEM 741 S HILL STREET SALEM, SD 57058 (605)425-3038 McCook 433886 * AVERA MEDICAL GROUP WAUBAY 80 N MAIN STREET PO BOX 215 WAUBAY, SD 57273 (605)947-3422 Day 433876 * AVERA MEDICAL GROUP WILMOT 409 4TH STREET WILMOT, SD 57279 (605)938-4351 Roberts 433447 None AVERA MEDICAL GROUP WINNER 660 WEST 2ND STREET PO BOX 705 WINNER, SD 57580 (605)842-2443 Tripp 433408 * AVERA ST BENEDICT CRHC/LAKE 756 E LAKE PO BOX 279 LAKE ANDES, SD 57356 (605)487-7878 Charles Mix ANDES 433409 * AVERA ST BENEDICT 401 WEST GLYNN DRIVE PARKSTON, SD 57366 (605)928-7961 Hutchinson CRHC/PARKSTON 433410 * AVERA ST BENEDICT CRHC/TRIPP 306 SOUTH MAIN STREET TRIPP, SD 57376 (605)935-7211 Hutchinson 433440 * BELLE FOURCHE REGIONAL 2200 13TH AVENUE BELLE FOURCHE, SD 57717 (605)723-8970 Butte MEDICAL CLINIC 433442 * BENNETT COUNTY RURAL HEALTH 102 MAJOR ALLEN MARTIN, SD 57551 (605)685-1660 Bennett CLINIC 433890 * BLACK HILLS FAMILY HEALTH 1100 HWY 71 S SUITE 101 HOT SPRINGS, SD 57747 (605)745-5188 Fall River CLINIC, PC 433418 * BON HOMME FAMILY PRACTICE- 130 N MAIN STREET PO BOX 164 AVON, SD 57315 (605)286-3888 Bon Homme AVON 433416 * BON HOMME FAMILY PRACTICE- 410 WEST 16TH STREET TYNDALL, SD 57066 (605)589-3322 Bon Homme TYNDALL 433422 * BONESTEEL MEDICAL CLINIC 314 MELLETTE BONESTEEL, SD 57317 (605)654-9021 Gregory 433419 * BOWDLE CLINIC 8001 WEST 5TH STREET POST OFFICE BOWDLE, SD 57428 (605)285-6832 Edmunds BOX 556 433433 * BROOKINGS HEALTH SYSTEM 104 W BIRCH POST OFFICE BOX 291 ARLINGTON, SD 57212 (605)983-3283 Kingsbury ARLINGTON CLINIC 433438 * BROOKINGS HEALTH SYSTEM 210 KASAN AVENUE VOLGA, SD 57071 (605)627-5701 Brookings VOLGA MEDICAL CLINIC 433436 * BROOKINGS HEALTH SYSTEM 302 EAST 5TH STREET WHITE, SD 57276 (605)629-3333 Brookings WHITE MEDICAL CLINIC 433407 * BURKE MEDICAL CLINIC 814 JACKSON ST POST OFFICE BOX 358 BURKE, SD 57523 (605)775-2294 Gregory

433989 * CAMPBELL COUNTY CLINIC- 208 MAIN STREET N POST OFFICE HERREID, SD 57632 (605)437-2304 Campbell HERREID BOX 158 * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 3 South Dakota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 433428 * CENTERVILLE MEDICAL CLINIC 512 BROADWAY POST OFFICE BOX 70 CENTERVILLE, SD 57014 (605)563-2411 Turner 433446 None COTEAU DES PRAIRIES HEALTH 116 W MAIN STREET ROSHOLT, SD 57260 (605)537-4244 Roberts CARE SYS-ROSHOLT CLINIC 433420 * COTEAU DES PRAIRIES HOSPITAL - 205 ORCHARD DRIVE SISSETON, SD 57262 (605)698-7681 Roberts SISSETON CLINIC 433423 * FALL RIVER CLINIC 1201 HIGHWAY 71 SOUTH HOT SPRINGS, SD 57747 (605)745-5491 Fall River 433401 * FAULKTON AREA MEDICAL CENTER 1300 OAK STREET POST OFFICE BOX FAULKTON, SD 57438 (606)598-6239 Faulk 100 433429 * FLANDREAU MEDICAL CLINIC / 212 N PRAIRIE AVENUE FLANDREAU, SD 57028 (605)997-2471 Moody AVERA HEALTH 433414 * GEDDES MEDICAL CLINIC 322 MAIN GEDDES, SD 57342 (605)337-3197 Charles Mix 433437 * HILL CITY CLINIC 238 ELM ST POST OFFICE BOX 639 HILL CITY, SD 57745 (605)574-4470 Pennington 433424 * KADOKA CLINIC 601 CHESTNUT STREET POST OFFICE KADOKA, SD 57543 (605)837-2257 Jackson BOX 460 433441 * MARSHAL COUNTY MEDICAL CLINIC 415 9TH ST BRITTON, SD 57430 (605)448-5953 Marshall 433878 * MCGREEVY CLINIC SALEM 740 SOUTH HILL SALEM, SD 57058 (605)425-2855 McCook 438500 * MOBRIDGE MEDICAL CLINIC 1309 10TH AVENUE WEST PO BOX 580 MOBRIDGE, SD 57601 (605)845-8225 Walworth 433427 * PARKER MEDICAL CLINIC 100 EAST SANBORN, SUITE #1 PARKER, SD 57053 (605)297-3888 Turner 433411 * PHILIP CLINIC 503 W PINE PO BOX 550 PHILIP, SD 57567 (605)859-2566 Haakon 433415 * PLATTE MEDICAL CLINIC 612 E 7TH PO BOX 818 PLATTE, SD 57369 (605)337-2633 Charles Mix 433402 * PRAIRIE HEALTH CLINIC - ARMOUR 708 8TH STREET ARMOUR, SD 57313 (605)724-2151 Douglas 433426 * PRAIRIE HEALTH CLINIC - CORSICA 230 MAIN STREET CORSICA, SD 57328 (605)946-5959 Douglas 433425 * PRAIRIE HEALTH CLINIC - STICKNEY 301 MAIN STREET STICKNEY, SD 57375 (605)732-4508 Aurora 433404 * REDFIELD CLINIC 1010 W 1ST PO BOX 590 REDFIELD, SD 57469 (605)472-0510 Spink 433445 * RURAL MEDICAL CLINICS 307 EAST STATE STREET POST OFFICE MARION, SD 57043 (605)648-3559 Turner BOX 9 433444 * RURAL MEDICAL CLINICS 301 S HIGH ST POST OFFICE BOX 307 MENNO, SD 57045 (605)387-5435 Hutchinson 433443 * RURAL MEDICAL CLINICS - 208 S MAIN POST OFFICE BOX 17 BRIDGEWATER, SD 57319 (605)729-2421 McCook BRIDGEWATER 433828 * SANFORD BERESFORD CLINIC 600 W CEDAR STREET BERESFORD, SD 57004 (605)763-3700 Union 433403 * SANFORD CLEAR LAKE CLINIC 701 3RD AVENUE S CLEAR LAKE, SD 57226 (605)874-2141 Deuel 433857 * SANFORD CLINIC CLARK 211 N COMMERCIAL ST CLARK, SD 57225 (605)532-3676 Clark 433858 * SANFORD CLINIC ESTELLINE 305 HOSPITAL DRIVE ESTELLINE, SD 57234 (605)873-2222 Hamlin 433874 * SANFORD CLINIC IPSWICH 110 5TH AVENUE IPSWICH, SD 57451 (605)426-6040 Edmunds

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 3 South Dakota

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 433836 * SANFORD CLINIC LAKE NORDEN 512 MAIN STREET POST OFFICE BOX 79 LAKE NORDEN, SD 57248 (605)785-3633 Hamlin 433827 * SANFORD CLINIC LENNOX 108 S MAIN POST OFFICE BOX 662 LENNOX, SD 57039 (605)647-2841 Lincoln 433412 * SANFORD CLINIC WEBSTER 101 PEABODY DRIVE PO BOX 381 WEBSTER, SD 57274 (605)345-4141 Day 433993 * VIBORG MEDICAL CLINIC 103 PIONEER PO BOX 337 VIBORG, SD 57070 (605)326-5201 Turner 433802 * WALL REGIONAL MEDICAL CLINIC 112 7TH AVENUE WALL, SD 57790 (605)279-2149 Pennington 433995 * WEST DAKOTA HEALTH CENTER 906 MAIN STREET PO BOX 206 TIMBER LAKE, SD 57656 (605)865-3258 Dewey 433430 * WEST RIVER HEALTH CLINIC 103 1ST AVE EAST POST OFFICE BOX MC LAUGHLIN, SD 57642 (605)823-4253 Corson 520 433987 * WEST RIVER HEALTH CLINIC - 401 6TH AVENUE W LEMMON, SD 57638 (605)374-3773 Perkins LEMMON 433439 * WHITE LAKE MEDICAL CLINIC AVERA 306 SOUTH JOHNSTON STREET WHITE LAKE, SD 57383 (605)337-1529 Aurora

438501 * WINNER REGIONAL CLINIC 825 EAST 8TH STREET SUITE 100 WINNER, SD 57580 (605)842-2626 Tripp Total Providers for this State = 60

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Utah

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 463810 * BEAVER MEDICAL CLINIC 1059 NORTH 100 WEST BEAVER, UT 84713 (435)438-7280 Beaver 463991 * BEAVER/ MILFORD MEDICAL CLINIC 850 NORTH MAIN MILFORD, UT 84751 (435)438-7280 Beaver 463989 * BLANDING MEDICAL CLINIC 804 NORTH 400 WEST BLANDING, UT 84511 (435)678-2254 San Juan 463981 * BRYCE VALLEY CLINIC 25 SOUTH REDROCK DRIVE CANNONVILLE, UT 84718 (435)679-8545 Garfield 463980 * CIRCLEVILLE CLINIC 110 SOUTH 100 EAST CIRCLEVILLE, UT 84723 (435)577-2958 Piute 463816 * COALVILLE HEALTH CENTER 142 SOUTH 50 EAST COALVILLE, UT 84017 (435)336-4403 Summit 463979 * DUCHESNE VALLEY MEDICAL CLINIC 50 EAST 200 SOUTH DUCHESNE, UT 84021 (435)738-2426 Duchesne 463985 * EMERY MEDICAL CENTER 90 WEST MAIN STREET CASTLE DALE, UT 84513 (435)381-2305 Emery 463984 * GARFIELD MEMORIAL CLINIC 200 NORTH 400 EAST PANGUITCH, UT 84759 (435)676-8842 Garfield 463815 * KAMAS HEALTH CENTER 228 WEST 200 SOUTH KAMAS, UT 84036 (435)783-4385 Summit 463818 * MONUMENT VALLEY HEALTH 4 ROCK CANYON ROAD MONUMENT VALLEY, UT (435)727-3242 San Juan CENTER 84536 463813 * MOUNTAIN UTAH FAMILY MEDICINE 879 NORTH MAIN RICHFIELD, UT 84701 (435)896-9561 Sevier 463820 * PAROWAN MEDICAL CLINIC 450 EAST CLINIC WAY PAROWAN, UT 84761 (435)477-3344 Iron 463993 * SAN JUAN CLINIC 380 WEST 100 NORTH, SUITE A MONTICELLO, UT 84535 (435)587-5054 San Juan Total Providers for this State = 14

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Wyoming

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 533985 * BIG HORN CLINIC 156 N 6TH STREET BASIN, WY 82410 (307)568-2499 Big Horn 533809 * CASTLE ROCK HOSPITAL DISTRICT PO BOX 219 GREEN RIVER, WY 82935 (307)872-4500 Sweetwater 533819 * GLENROCK HEALTH CENTER 925 W BIRCH, PO BOX 786 GLENROCK, WY 82637 (307)436-9206 Converse 533978 * HULETT CLINIC PO BOX 65 HULETT, WY 82720 (307)467-5281 Crook 533803 * MEDICINE BOW HEALTH CENTER PO BOX 37 MEDICINE BOW, WY 82329 (307)379-2222 Carbon 533981 * MIDWAY CLINIC 388 HIGHWAY 20 SOUTH BASIN, WY 82410 (307)568-3311 Big Horn 533977 * MOORCROFT CLINIC PO BOX 187 MOORCROFT, WY 82721 (307)756-3414 Crook 533806 * NEWCASTLE REGIONAL MEDICAL 1121 WASHINGTON BLVD NEWCASTLE, WY 82701 (307)746-3582 Weston CLINIC 533984 * NORTH BIG HORN HOSPITAL CLINIC 1115 LANE 12 LOVELL, WY 82431 (307)548-5201 Big Horn 533987 * OREGON TRAILS PO BOX 1648 GLENROCK, WY 82637 (307)436-8838 Converse 533986 * RAWHIDE RURAL HEALTH CLINIC 921 BALLANCEE AVE LUSK, WY 82225 (307)334-4000 Niobrara 533811 * RED ROCK FAMILY PRACTICE 120 NORTH C AVE THERMOPOLIS, WY 82443 (307)864-5534 Hot Springs 533820 * RED ROCK FAMILY PRACTICE- 1125 CHARLES AVENUE WORLAND, WY 82401 (307)347-2449 Washakie WORLAND 533989 * REGISTER CLIFF RURAL HEALTH 650 W WHALEN ST GUERNSEY, WY 82214 (307)836-3009 Platte CLINIC 533976 * SUNDANCE CLINIC 713 OAK STREET SUNDANCE, WY 82729 (307)283-2476 Crook 533807 * UPTON REGIONAL MEDICAL CLINIC PO BOX 676 UPTON, WY 82730 (307)468-2302 Weston Total Providers for this State = 16

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Arizona

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 033999 * BOUSE MEDICAL CLINIC 44031 EAST PLUMOSA ROAD, BOX 866 BOUSE, AZ 85325 (928)851-2177 La Paz 033998 * COMMUNITY HOSPITAL CLINIC - 523 ROSE LANE WICKENBURG, AZ 85390 (928)668-1833 Maricopa WICKENBURG 038502 * COMMUNITY HOSPITAL CLINIC- 26750 B SOUTH SANTA FE ROAD CONGRESS, AZ 85332 (928)684-5421 Yavapai CONGRESS 038503 * COPPER MOUNTAIN CLINIC 2250 WEST 16TH STREET SAFFORD, AZ 85546 (928)348-4006 Graham 033830 * COPPER QUEEN MEDICAL 101 COLE AVENUE BISBEE, AZ 85603 (520)432-2042 Cochise ASSOCIATES-BISBEE 033829 * COPPER QUEEN MEDICAL 100 EAST 5TH STREET DOUGLAS, AZ 85607 (520)364-7650 Cochise ASSOCIATES-DOUGLAS 033985 * GREASEWOOD CLINIC PO BOX 457, HIGHWAY 264 GANADO, AZ 86505 (928)654-3208 Apache 033997 * KEARNY CLINIC 100 TILBURY DRIVE KEARNY, AZ 85237 (520)363-5573 Pinal 038504 * LA PAZ HEALTHCARE PARKER 601 RIVERSIDE DRIVE, SUITES 3 AND 4 PARKER, AZ 85344 (928)669-5550 La Paz CLINIC 033987 * LA PAZ MEDICAL SERVICES 150 EAST TYSON ROAD QUARTZSITE, AZ 85359 (928)927-8747 La Paz QUARTZSITE 033996 * PALOMINAS / HEREFORD RURAL 10524 EAST HIGHWAY 92 PALOMINAS, AZ 85615 (520)366-0300 Cochise HEALTH CLINIC 038505 * PARKER FAMILY PRACTICE 1713 SOUTH KOFA AVENUE, #A PARKER, AZ 85344 (928)669-6299 La Paz 033836 * PARKER MEDICAL CENTER, LTD 905 SOUTH FIESTA AVENUE PARKER, AZ 85344 (928)669-2225 La Paz 038500 * PLEASANT VALLEY COMM MEDICAL 124 NORTH TEWKSBURY BOULEVARD YOUNG, AZ 85554 (928)462-3435 Gila CENTER 033984 * SAGE OUTPATIENT CLINIC PO BOX 457, HIGHWAY 264 GANADO, AZ 86505 (928)755-3411 Apache 033831 * SAN LUIS WALK-IN CLINIC - FAMILY & 1896 EAST BABBIT LANE SAN LUIS, AZ 85349 (928)722-6112 Yuma ADULT CENTER 033835 * SAN LUIS WALK-IN CLINIC URGENT 214 WEST MAIN STREET SOMERTON, AZ 85350 (928)627-1120 Yuma CARE & FAMILY CENTE 033834 * SONORAN FAMILY PRACTICE 171 WEST CENTRAL AVENUE COOLIDGE, AZ 85128 (520)723-7726 Pinal 033992 * SULPHUR SPRINGS MEDICAL 900 WEST SCOTT WILLCOX, AZ 85643 (520)384-4421 Cochise CENTER 038501 * SUMMIT HEALTHCARE FAMILY 2352 QUARTER HORSE TRAIL OVERGAARD, AZ 85933 (928)535-3616 Navajo MEDICINE AT BISON RANCH 033989 * SUNSITES MEDICAL CLINIC 223 NORTH FRONTAGE ROAD PEARCE, AZ 85625 (520)826-1089 Cochise 033993 * SUPERIOR CLINIC 1134 WEST US HIGHWAY 60 SUPERIOR, AZ 85173 (520)689-2423 Pinal 033994 * TRI-VALLEY MEDICAL CENTER 39726 HARQUAHALA ROAD SALOME, AZ 85348 (928)859-3460 La Paz

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 2 Arizona

CCN Key Provider Name Address City, State and ZIP Telephone # County Name

Total Providers for this State = 23

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058635 * ADVENTIST HEALTH COMMUNITY 216 E FRESNO STREET AVENAL, CA 93204 (559)386-5364 Kings CARE - AVENAL 058568 * ADVENTIST HEALTH COMMUNITY 250 W EL MONTE AVENUE DINUBA, CA 93618 (559)638-8155 Tulare CARE - DINUBA WEST 058690 None ADVENTIST HEALTH COMMUNITY 11976 ROAD 37 MADERA, CA 93636 (559)645-4191 Fresno CARE - MADERA RANCHOS 058689 None ADVENTIST HEALTH COMMUNITY 49063 ROAD 426, STE C & D OAKHURST, CA 93644 (559)642-1500 Madera CARE - OAKHURST EAST 058589 * ADVENTIST HEALTH COMMUNITY 372 W CYPRESS AVE REEDLEY, CA 93654 (559)643-8083 Fresno CARE - REEDLEY CYPRESS 058685 None ADVENTIST HEALTH COMMUNITY 501 6TH STREET TAFT, CA 93268 (661)763-5131 Kern CARE - TAFT 553977 * ADVENTIST HEALTH COMMUNITY 105 WEST E STREET TEHACHAPI, CA 93561 (661)823-7070 Kern CARE - TEHACHAPI 058672 None ADVENTIST HEALTH COMMUNITY 444 W EL MONTE WAY DINUBA, CA 93618 (559)591-4166 Tulare CARE -DINUBA PLAZA 058540 * ADVENTIST HEALTH COMMUNITY 1433 N ACACIA REEDLEY, CA 93654 (209)638-8155 Fresno CARE REEDLEY CHILDREN'S 058610 * ADVENTIST HEALTH COMMUNITY 2141 HIGH STREET SELMA, CA 93662 (559)891-8940 Fresno CARE- SELMA CENTRAL 058665 None ADVENTIST HEALTH COMMUNITY 337 E KINGS STREET AVENAL, CA 93204 (559)638-8155 Kings CARE-AVENAL WEST 058592 * ADVENTIST HEALTH COMMUNITY 2440 WEST TAHOE CARUTHERS, CA 93609 (559)864-3212 Fresno CARE-CARUTHERS 058669 None ADVENTIST HEALTH COMMUNITY 2357 W TAHOE CARUTHERS, CA 93609 (559)864-5200 Fresno CARE-CARUTHERS EAST 058596 * ADVENTIST HEALTH COMMUNITY 155 S 5TH STREET COALINGA, CA 93210 (559)935-4282 Fresno CARE-COALINGA 058552 * ADVENTIST HEALTH COMMUNITY 1212 HANNA STREET CORCORAN, CA 93212 (559)992-2800 Kings CARE-CORCORAN 058666 None ADVENTIST HEALTH COMMUNITY 1310 HANNA AVENUE, SUITE 1 AND CORCORAN, CA 93212 (559)638-8155 Kings CARE-CORCORAN EAST SUITE 3 058613 * ADVENTIST HEALTH COMMUNITY 1451 E EL MONTE WAY DINUBA, CA 93618 (559)591-3342 Tulare CARE-DINUBA 058595 * ADVENTIST HEALTH COMMUNITY 119 SOUTH SIXTH STREET FOWLER, CA 93625 (559)834-1614 Fresno CARE-FOWLER 553983 * ADVENTIST HEALTH COMMUNITY 1025 N DOUTY ST HANFORD, CA 93230 (559)583-2254 Kings CARE-HANFORD * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058630 * ADVENTIST HEALTH COMMUNITY 11899 SHAW PLACE HANFORD, CA 93230 (559)585-3437 Kings CARE-HOME GARDEN 058611 * ADVENTIST HEALTH COMMUNITY 16916 5TH STREET HURON, CA 93234 (559)945-9090 Fresno CARE-HURON 058599 * ADVENTIST HEALTH COMMUNITY 1000 SOUTH MADERA AVENUE KERMAN, CA 93630 (559)846-9370 Fresno CARE-KERMAN 058668 None ADVENTIST HEALTH COMMUNITY 275 S MADERA AVENUE, STE 201 KERMAN, CA 93630 (559)846-5240 Fresno CARE-KERMAN CENTRAL 058653 * ADVENTIST HEALTH COMMUNITY 1251 DRAPER STREET KINGSBURG, CA 93631 (559)897-6610 Fresno CARE-KINGSBURG 058600 * ADVENTIST HEALTH COMMUNITY 810 E 'D' STREET LEMOORE, CA 93245 (559)583-2271 Kings CARE-LEMOORE 058675 None ADVENTIST HEALTH COMMUNITY 48677 VICTORIA LANE OAKHURST, CA 93644 (559)683-2711 Madera CARE-OAKHURST 058621 * ADVENTIST HEALTH COMMUNITY 1455 PARK BLVD ORANGE COVE, CA 93646 (559)638-8155 Fresno CARE-ORANGE COVE 058673 None ADVENTIST HEALTH COMMUNITY 41696 ROAD 128 EAST OROSI, CA 93647 (559)528-6966 Tulare CARE-OROSI 058569 * ADVENTIST HEALTH COMMUNITY 155 S NEWMARK PARLIER, CA 93648 (559)964-6120 Fresno CARE-PARLIER NEWMARK 058638 * ADVENTIST HEALTH COMMUNITY 811 11TH STREET REEDLEY, CA 93654 (559)638-3227 Fresno CARE-REEDLEY 058664 None ADVENTIST HEALTH COMMUNITY 1150 E WASHINGTON AVENUE REEDLEY, CA 93654 (559)638-2154 Fresno CARE-REEDLEY JEFFERSON 058985 None ADVENTIST HEALTH COMMUNITY 550 W CYPRESS AVE REEDLEY, CA 93654 (559)637-2455 Fresno CARE-REEDLEY WOMEN'S HE 058667 * ADVENTIST HEALTH COMMUNITY 3567 MT WHITNEY AVENUE RIVERDALE, CA 93656 (559)567-7200 Fresno CARE-RIVERDALE 058644 * ADVENTIST HEALTH COMMUNITY 1939 ACADEMY AVENUE SANGER, CA 93657 (559)875-6900 Fresno CARE-SANGER 058617 * ADVENTIST HEALTH COMMUNITY 1041 ROSE AVENUE SELMA, CA 93662 (559)891-6345 Fresno CARE-SELMA 553885 * AMERICAN DESERT MEDICAL 6186 ADOBE ROAD 29 PALMS, CA 92277 (760)361-8525 San Bernardino CLINICS 553832 * ANDERSON MEDICAL ASSOCIATES 2830 EAST STREET ANDERSON, CA 96007 (530)365-2545 Shasta 553862 * ANDERSON WALK-IN MEDICAL 3082 MCMURRAY DRIVE ANDERSON, CA 96007 (530)365-4412 Shasta CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058908 * APEX MEDICAL GROUP, INC 311 WEST I STREET LOS BANOS, CA 93635 (209)826-2222 Merced 058963 * ARVIN MEDICAL CLINIC 146 NORTH HILL STREET ARVIN, CA 93203 (661)855-4468 Kern 058930 * AURORA GRACE E HWANG, MD RHC 835 NORTH SEQUOIA AVENUE LINDSAY, CA 93247 (559)562-5177 Tulare 058921 * AVENAL MEDICAL CLINIC 148 EAST KINGS AVENAL, CA 93204 (559)386-9000 Kings 058950 * BAART CARTWRIGHT CLINIC 3103 EAST CARTWRIGHT AVENUE FRESNO, CA 93725 (559)498-7100 Fresno 053968 * BAECHTEL CREEK MEDICAL CLINIC 1245 SOUTH MAIN STREET WILLITS, CA 95490 (707)459-6861 Mendocino 058580 * BARTON COMMUNITY HEALTH 2201 SOUTH AVENUE SOUTH LAKE TAHOE, CA (530)543-5620 El Dorado CENTER 96150 553933 * BAUTISTA RURAL MEDICAL CLINICS, 2570 JENSEN AVENUE, SUITE 106 SANGER, CA 93657 (559)875-3428 Fresno INC 058614 * BEAR VALLEY RURAL HEALTH 1028 W BIG BEAR BLVD BIG BEAR CITY, CA 92314 (909)878-8277 San Bernardino CLINIC 058991 None BIG SUR HEALTH CENTER 46896 HIGHWAY 1 BIG SUR, CA 93920 (831)667-2580 Monterey 058949 * BISHOP FAMILY AND MATERNITY 153-A PIONEER LANE BISHOP, CA 93514 (760)872-7059 Inyo CARE MEDICAL CLINIC 553894 * CAL CITY CLINIC 9300 NORTH LOOP BOULEVARD, SUITE CALIF CITY, CA 93505 (760)373-1256 Kern A 058902 * CAL FAMILY HEALTH, INC 1415 N ACACIA, SUITE 101 REEDLEY, CA 93654 (559)638-8187 Fresno 058607 * CALEXICO HEALTH CENTER 450 EAST BIRCH STREET CALEXICO, CA 92231 (760)768-6262 Imperial 058536 * CALEXICO OUTPATIENT CENTER 495 BIRCH STREET, SUITE A CALEXICO, CA 92231 (760)357-0508 Imperial 553952 * CAMPUS FAMILY HEALTH MEDICAL 355 CAMPUS DRIVE, SUITE E HANFORD, CA 93230 (559)584-2721 Kings CENTER 053888 * CANBY FAMILY PRACTICE CLINIC 670 COUNTY ROAD 83 CANBY, CA 96015 (530)233-4641 Modoc 553891 * CASTLE FAMILY HEALTH CENTER AT 1251 GROVE STREET ATWATER, CA 95301 (209)358-8201 Merced BLOSS 053917 * CEDAR FAMILY PRACTICE 12700 WELCH STREET WATERFORD, CA 95386 (209)874-2345 Stanislaus 058603 * CHARLIE MITCHELL RURAL HEALTH 41169 GOODWIN WAY, RM 100 MADERA, CA 93638 (559)353-6425 Madera CLINIC 058912 * CHILDREN'S CLINIC 348 MARKET STREET, SUITE B COLUSA, CA 95932 (530)458-2300 Colusa 553925 * CHOWCHILLA FAMILY CLINIC 1020 VENTURA BLVD CHOWCHILLA, CA 93610 (559)665-0275 Madera 058639 * CHOWCHILLA MEDICAL CENTER 285 HOSPITAL DRIVE CHOWCHILLA, CA 93610 (559)665-3781 Madera 553931 * CHUK NDULUE MEDICAL OFFICE 135 SPRUCE STREET GRIDLEY, CA 95948 (530)846-1400 Butte 058989 None CLINICA EL LAGO, INC 101 NORTH PALM WOODLAKE, CA 93286 (559)564-8616 Tulare 058608 * CMH CENTER FOR FAMILY HEALTH - 852 VENTURA ST FILLMORE, CA 93015 (805)524-2672 Ventura FILLMORE * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058609 * CMH CENTER FOR FAMILY HEALTH - 242 E HARVARD BLVD STE C SANTA PAULA, CA 93060 (805)652-5490 Ventura SANTA PAULA 058654 * COALINGA REGIONAL MEDICAL 1165 PHELPS AVENUE, STE 105 COALINGA, CA 93210 (559)935-6537 Fresno CENTER RURAL HEALTH CLIN 553916 * COALINGA VALLEY HEALTH CLINICS 1145 PHELPS AVENUE, STE B COALINGA, CA 93210 (559)935-4374 Fresno INC-COALINGA 553927 * COALINGA VALLEY HEALTH CLINICS, 36617 CENTRAL AVENUE, HURON, CA 93234 (559)945-9251 Fresno INC-HURON 058504 * COMMUNITY MEDICAL CENTER 48677 VICTORIA LANE OAKHURST, CA 93644 (209)683-2992 Madera OAKHURST 058591 * CORCORAN DISTRICT HOSPITAL 1310 HANNA AVENUE, SUITE 3 CORCORAN, CA 93212 (559)992-5051 Kings HEALTH CENTER 058676 None CORNING RURAL HEALTH CLINIC 155 SOLANO ST CORNING, CA 96021 (530)824-4663 Tehama 553866 * DE ANZA CLINIC 1001 BLAIR STREET CALEXICO, CA 92231 (760)357-7867 Imperial 058901 * DEL PUERTO HEALTH CENTER 1700 KEYSTONE PACIFIC PARKWAY PATTERSON, CA 95363 (209)892-9100 Stanislaus UNIT B 553869 * DELANO DISTRICT MEDICAL 1004 14TH AVENUE DELANO, CA 93215 (661)725-5676 Kern CENTER 058539 * DELANO REGIONAL MEDICAL 2300 7TH STREET WASCO, CA 93280 (661)758-4184 Kern CENTER RURAL HEALTH CLINIC 058588 * DELANO WOMEN'S MEDICAL CLINIC 1201 JEFFERSON STREET DELANO, CA 93215 (661)721-0737 Kern 053965 * DELHI MEDICAL CLINIC 9696 STEPHENS ST DELHI, CA 95315 (209)667-0702 Merced 058693 None DIGNITY HEALTH SOLANO STREET 2126 SOLANO STREET CORNING, CA 96021 (530)824-4002 Tehama MEDICAL CLINIC 553817 * DINUBA MEDICAL CENTER 247 NORTH L STREET DINUBA, CA 93618 (559)591-1820 Tulare 053940 * DINUBA MEDICAL CLINIC 271 N L ST DINUBA, CA 93618 (559)591-1820 Tulare 553898 * DINUBA RURAL HEALTH MEDICAL 420 EAST EL MONTE WAY DINUBA, CA 93618 (559)595-9500 Tulare CENTER 058514 * DIVIDE WELLNESS CENTER 6065 HIGHWAY 193 GEORGETOWN, CA 95634 (916)333-2548 El Dorado 058947 * DON PEDRO FAMILY PRACTICE 3191 EL PRADO STREET, SUITE D LA GRANGE, CA 95329 (209)852-2764 Stanislaus 058598 * DOS PALOS MEMORIAL RURAL 2118 MARGUERITE STREET DOS PALOS, CA 93620 (209)392-6121 Merced HEALTH CLINIC 553928 * DR NDULUE MEDICAL PRACTICE 620 E STREET MARYSVILLE, CA 95901 (530)741-2600 Yuba 058929 * DR OCHOA FAMILY CLINIC 3275 MCCALL AVENUE, STE 102 SELMA, CA 93662 (559)896-3808 Fresno 553808 * DR'S PHILIP OLKIN & C RAY JONES, 3302 RENNER DRIVE FORTUNA, CA 95540 (707)725-3318 Humboldt MD'S * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058967 * EARLIMART SCHOOL BASED 398 SOUTH CHURCH STREET EARLIMART, CA 93219 (559)366-1150 Tulare COMMUNITY HEALTHCARE CENTER 058597 * EASTERN PLUMAS HOSPITAL - 725 THIRD STREET LOYALTON, CA 96118 (530)993-1231 Sierra LOYALTON MEDICAL CLINIC 058926 * EEL VALLEY RURAL HEALTH CLINIC 129 WILDWOOD SUITE E RIO DELL, CA 95562 (707)764-3139 Humboldt 058518 * EL CENTRO REGIONAL MEDICAL 385 WEST MAIN STREET EL CENTRO, CA 92243 (760)482-9100 Imperial CTR OUTPATIENT CLINIC 058663 * EMANUEL FAMILY PRACTICE 1010 W LAS PALMAS AVE PATTERSON, CA 95363 (209)895-7100 Stanislaus 058606 * ESCALON COMMUNITY HEALTH 2080 MCHENRY AVENUE #200 ESCALON, CA 95320 (209)847-3011 San Joaquin CLINIC 053955 * EUREKA PEDIATRICS 2800 HARRIS ST EUREKA, CA 95501 (707)445-8416 Humboldt 553849 * EUREKA PEDIATRICS MCKINLEYVILL 2192 CENTRAL AVENUE SUITE A MCKINLEYVILLE, CA 95521 (209)777-7777 Humboldt 058634 * FAIRCHILD MEDICAL CLINIC 475 BRUCE ST YREKA, CA 96097 (530)842-3507 Siskiyou 053975 * FAMILY CARE 315 EAST 13TH STREET MERCED, CA 95340 (209)385-7060 Merced 058941 * FAMILY HEALTH CENTER OF 63532 TWENTY NINE PALMS HWY, JOSHUA TREE, CA 92252 (760)366-7555 San Bernardino JOSHUA TREE SUITE C 058564 * FAMILY HEALTH CENTER RHC 41820 GARSTIN DRIVE BIG BEAR LAKE, CA 92315 (909)878-8246 San Bernardino 058951 * FAMILY HEALTH MEDICAL CENTER 1045 5TH STREET LOS BANOS, CA 93635 (559)665-0275 Merced 053990 * FAMILY HEALTH SERVICES ANNEX 1210 E ALMOND MADERA, CA 93637 (209)673-5101 Madera 058574 * FAMILY MEDICAL CENTER - ANGELS 222 SOUTH MAIN STREET ANGELS CAMP, CA 95222 (209)736-0813 Calaveras CAMP 058573 * FAMILY MEDICAL CENTER - ARNOLD 2182 HIGHWAY 4, SUITE A100 ARNOLD, CA 95223 (209)795-4193 Calaveras 058548 * FAMILY MEDICAL CENTER - 3505 SPRANGLER LANE, SUITE 400 COPPEROPOLIS, CA 95228 (209)785-7000 Calaveras COPPEROPOLIS 058940 * FAMILY MEDICAL CENTER - SAN 704 MOUNTAIN RANCH ROAD, SUITE SAN ANDREAS, CA 95249 (209)754-4564 Calaveras ANDREAS 103 - 104 058571 * FAMILY MEDICAL CENTER - VALLEY 1919 VISTA DEL LAGO DRIVE VALLEY SPRINGS, CA 95252 (209)772-9538 Calaveras SPRINGS 058656 * FAMILY MEDICINE PRACTICE 2721 OLIVE HWY SUITE 9 OROVILLE, CA 95966 (530)538-3020 Butte 058585 * FAMILY PRACTICE ASSOCIATES 2721 OLIVE HWY, SUITE 4 OROVILLE, CA 95966 (530)532-6588 Butte 058604 * FEATHER RIVER HOSPITAL - 5125 SKYWAY PARADISE, CA 95969 (530)872-2000 Butte FEATHER RIVER HEALTH CENT 058594 * FEATHER RIVER HOSPITAL CANYON 5734 CANYON VIEW DRIVE PARADISE, CA 95969 (530)876-7179 Butte VIEW CLINIC 058587 * FEATHER RIVER HOSPITAL FAMILY 5730 CANYON VIEW DRIVE PARADISE, CA 95969 (530)876-7162 Butte HEALTH * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 6 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 053930 * FIREBAUGH FAMILY HEALTH CLINIC 944 O STREET FIREBAUGH, CA 93622 (209)659-3011 Fresno 058922 * FIRST CARE MEDICAL ASSOCIATES, 750 EAST WALKER STREET SUITE A ORLAND, CA 95963 (530)865-4400 Glenn INC 553887 * FIRST VALLEY MEDICAL GROUP 1535 NORTH CHINA LAKE BLVD SUITE A RIDGECREST, CA 93555 (760)446-1691 Kern 053991 * FOREST ROAD HEALTH AND 193 FAIRVIEW LANE SONORA, CA 95370 (209)536-5100 Tuolumne WELLNESS CENTER 058684 * FORT BRAGG RURAL HEALTH 850 SEQUOIA CIRCLE FORT BRAGG, CA 95437 (707)964-0259 Mendocino CENTER 053936 * FORTUNA FAMILY MEDICAL GROUP 874 MAIN ST FORTUNA, CA 95540 (707)725-3334 Humboldt 053951 * FOWLER MEDICAL CENTER INC 210 E MERCED FOWLER, CA 93625 (209)834-5341 Fresno 553909 * FRONTIER VILLAGE FAMILY HEALTH 645 ANTELOPE BLVD, SUITE 24 RED BLUFF, CA 96080 (530)528-7650 Tehama CENTER, INC 058546 * GALT MEDICAL SERVICES 387 CIVIC DRIVE GALT, CA 95632 (209)745-8080 Sacramento 058572 * GLENN FAMILY MEDICAL GROUP 130 NORTH ENRIGHT AVE WILLOWS, CA 95988 (530)934-4681 Glenn 053981 * GLENN MEDICAL CENTER FAMILY 1133 W SYCAMORE STREET WILLOWS, CA 95988 (530)934-8822 Glenn MEDICAL CENTER 058970 * GLORIA NELSON CENTER FOR 1500 6TH AVENUE DELANO, CA 93215 (661)725-1010 Kern WOMEN AND CHILDREN 553884 * GONZALES MEDICAL GROUP INC 133 FOURTH STREET GONZALES, CA 93926 (831)675-3601 Monterey 553852 * GOOSE LAKE MEDICAL SERVICES 535 S MAIN ST ALTURAS, CA 96101 (530)233-2288 Modoc 553985 * GRAEAGLE MEDICAL CLINIC RHC 7597 HIGHWAY 89 GRAEAGLE, CA 96103 (530)836-1122 Plumas 058964 * GREEN VALLEY MEDICAL CLINIC 41689 ROAD 128 OROSI, CA 93647 (559)528-1777 Tulare 553954 * HAROLD S BUDHRAM MD INC 5145 SHASTA DAM BLVD SHASTA LAKE, CA 96019 (530)275-5421 Shasta 058646 * HAYFORK COMMUNITY HEALTH 6961 HIGHWAY 3 HAYFORK, CA 96041 (530)628-5517 Trinity CLINIC 058590 * HAZEL HAWKINS HEALTH CLINIC 301 THE ALAMEDA, SUITE B3 SAN JUAN BAUTISTA, CA (831)623-4615 San Benito 95045 553846 * HEALTH VALLEY MEDICAL GROUP 812 EAST D STREET LEMOORE, CA 93245 (209)925-1000 Kings INC 553845 * HIGH DESERT FAMILY MEDICAL 7350 CHURCH STREET YUCCA VALLEY, CA 92284 (760)369-3069 San Bernardino CLINIC 058974 * HILMAR FAMILY MEDICAL CENTER 19901 1ST STREET HILMAR, CA 95324 (209)658-8701 Merced 058965 * HORISONS UNLIMITED 101 FRONT STREET CHOWCHILLA, CA 93610 (209)201-2099 Madera 058978 None HORISONS UNLIMITED 5320 STATE HIGHWAY 49 N MARIPOSA, CA 95338 (209)383-5200 Mariposa 058945 * HORISONS UNLIMITED 1120 WEST I STREET, SUITE B LOS BANOS, CA 93635 (209)826-1900 Merced * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 7 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058911 * HORISONS UNLIMITED HEALTH 2275 F STREET, SUITE 1 & 2 LIVINGSTON, CA 95334 (209)394-8854 Merced CARE 058900 * HORISONS UNLIMITED HEALTH 554 5TH STREET GUSTINE, CA 95322 (209)854-3854 Merced CARE-GUSTINE 058505 * HUMBOLDT FAMILY CARE 1733 CENTRAL AVE MCKINLEYVILLE, CA 95521 (707)839-4852 Humboldt 553802 * IMMEDIATE HEALTH CARE, RHC 1850 WHITSON AVE SELMA, CA 93662 (209)896-6666 Fresno 058984 None IMPERIAL VALLEY FAMILY CARE 608 G STREET BRAWLEY, CA 92227 (760)351-1011 Imperial MEDICAL GROUP 058636 * INDIAN VALLEY MEDICAL CLINIC 176 HOT SPRINGS ROAD GREENVILLE, CA 95947 (530)284-6116 Plumas 553964 * JAMES CORONA, MD 203 WALKER STREET, SUITE 2 ORLAND, CA 95963 (530)865-6430 Glenn 553900 * JAMES OOI, MD 320 SOLANO STREET CORNING, CA 96021 (530)824-3283 Tehama 058938 * JAVIER AMU, MD, PROFESSIONAL 1121 F STREET REEDLEY, CA 93654 (559)743-7340 Fresno CORPORATION 058937 * JOANNE E REID MD INC 263 N VILLA AVE WILLOWS, CA 95988 (530)934-8700 Glenn 058637 * JOHN C FREMONT HEALTHCARE 6386 GREELEY HILL ROAD COULTERVILLE, CA 95311 (209)878-0155 Mariposa DISTRICT NORTHSIDE 058605 * JOHN C FREMONT HEALTHCARE 5186 HOSPITAL ROAD MARIPOSA, CA 95338 (209)966-3631 Mariposa DISTRICT-RHC II 053992 * JOHN C FREMONT MEDICAL CLINIC 5189 HOSPITAL ROAD MARIPOSA, CA 95338 (209)966-3631 Mariposa 058677 * KAWEAH DELTA DINUBA HEALTH 355 MONTE VISTA DRIVE, SUITE A DINUBA, CA 93618 (559)624-2000 Tulare CLINIC 058508 * KAWEAH DELTA EXETER HEALTH 1014 SAN JUAN AVENUE EXETER, CA 93221 (559)592-7300 Tulare CLINIC 058649 * KAWEAH DELTA LINDSAY HEALTH 839 N SEQUOIA AVENUE LINDSAY, CA 93247 (559)562-1546 Tulare CLINIC 058659 * KAWEAH DELTA WOODLAKE 180 EAST ANTELOPE AVENUE WOODLAKE, CA 93286 (559)564-1800 Tulare HEALTH CLINIC 058561 * KERN VALLEY HEALTHCARE DIST 4300 BIRCH STREET LAKE ISABELLA, CA 93240 (760)379-1791 Kern RHC 553912 * KHUSAL MEHTA, MD RHC 430 VERMONT AVENUE DINUBA, CA 93618 (559)591-1060 Tulare 053995 * KINGSBURG RURAL HEALTH CLINIC 1200 SMITH ST KINGSBURG, CA 93631 (209)897-5841 Fresno 553829 * KRISHNAMOORTHI MD INC, A 324 F STREET WATERFORD, CA 95386 (209)874-2321 Stanislaus PROFESSIONAL MEDICAL CORP 553830 * KRISHNAMOORTHI MD INC, A 850 WEST CALIFORNIA STREET ESCALON, CA 95320 (209)838-2278 San Joaquin PROFESSIONAL MEDICAL CORP

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 8 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058918 * LINDSAY FAMILY AND PEDIATRIC 825 NORTH SEQUOIA AVENUE LINDSAY, CA 93247 (559)562-1960 Tulare CLINIC 553967 * LUCERNE COMMUNITY CLINIC 6300 E HIGHWAY 20 LUCERNE, CA 95458 (707)274-9299 Lake 058660 * MABIE FIRST STREET HEALTHCARE 321 FIRST STREET HOLLISTER, CA 95023 (831)638-1652 San Benito CENTER 058641 * MABIE SAN JUAN ROAD 991 FOURTH STREET HOLLISTER, CA 95023 (831)636-3277 San Benito HEALTHCARE CENTER 553965 * MAGALIA-PINES FAMILY PRACTICE 14662 SKYWAY MAGALIA, CA 95954 (530)873-1676 Butte MEDICAL CLINIC 058523 * MAMMOTH HOSPITAL RURAL 85 SIERRA PARK ROAD MAMMOTH LAKES, CA 93546 (760)934-3311 Mono HEALTH 058640 * MAMMOTH HOSPITAL RURAL 221 TWIN LAKES ROAD BRIDGEPORT, CA 93517 (760)932-7012 Mono HEALTH CLINIC - BRIDGEPORT 553871 * MARIPOSA FAMILY MEDICINE 5300 HWY 49N PO BOX 155 MARIPOSA, CA 95338 (209)966-3672 Mariposa ASSOCIATES 058682 None MARSHALL PEDIATRIC CLINIC 4341 GOLDEN CENTER DRIVE, PLACERVILLE, CA 95667 (530)626-1144 El Dorado BUILDING A 058958 * MARTIN ROCHA MD INC 251 NORTH HIGHWAY 173 SUITE 6 LAKE ARROWHEAD, CA 92352 (909)336-3670 San Bernardino 058960 * MARYSVILLE CLINIC 527 E STREET MARYSVILLE, CA 95901 (530)674-2100 Yuba 058962 * MCFARLAND SINGH MEDICAL CLINIC 733 3RD STREET MC FARLAND, CA 93250 (661)792-3097 Kern INC 058535 * MCH MEDICAL CLINIC 29099 HOSPITAL ROAD LAKE ARROWHEAD, CA 92352 (909)336-3651 San Bernardino 058558 * MEE MEMORIAL HOSPITAL MEDICAL 467 EL CAMINO ROAD GREENFIELD, CA 93927 (831)674-0112 Monterey CLINIC 058562 * MEE MEMORIAL HOSPITAL MEDICAL 210 CANAL STREET KING CITY, CA 93930 (831)385-6000 Monterey CLINIC 553998 * MEMORIAL HOSP LOS BANOS 1253 WEST I STREET LOS BANOS, CA 93635 (209)710-6333 Merced RURAL 053914 * MENDOTA FAMILY HEALTH CENTER 507 OLLER STREET MENDOTA, CA 93640 (209)655-4211 Fresno 058662 * MERCY LAKE SHASTINA 16337 EVERHART DRIVE WEED, CA 96094 (530)938-2297 Siskiyou COMMUNITY CLINIC 058650 * MERCY MT SHASTA COMMUNITY 912 PINE ST MOUNT SHASTA, CA 96067 (530)926-5105 Siskiyou CLINIC 058975 * MICHAEL KOMIN, MD, MEDICAL 1150 EAST LERDO HIGHWAY SHAFTER, CA 93263 (661)630-5890 Kern CORPORATION 053988 * MODOC MED CTR - FAMILY PRACTIC 229 W MCDOWELL AVE ALTURAS, CA 96101 (916)233-5176 Modoc 553949 * MOUNTAIN VIEW MEDICAL CLINIC 468 VERMONT AVENUE DINUBA, CA 93618 (559)591-6200 Tulare * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 9 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058935 * NEWMAN MEDICAL CLINIC 1349 MAIN STREET NEWMAN, CA 95360 (209)862-3604 Stanislaus 058629 * NORTH COAST FAMILY HEALTH 721 RIVER DRIVE, SUITE A & B & C FORT BRAGG, CA 95437 (707)964-7241 Mendocino CENTER 058952 * NORTH VALLEY FAMILY PHYSICIANS 173 EAST WEBSTER ST COLUSA, CA 95932 (530)458-8050 Colusa MEDICAL GROUP 058953 * NORTH VALLEY FAMILY PHYSICIANS 501 E ST SUITE C WILLIAMS, CA 95987 (530)473-5255 Colusa MEDICAL GROUP 058578 * NORTHERN INYO HOSPITAL RURAL 150 PIONEER LANE BISHOP, CA 93514 (760)873-2849 Inyo HEALTH CLINIC 058553 * OAK VIEW FAMILY PRACTICE 655 N VENTURA AVE OAK VIEW, CA 93022 (805)649-3750 Ventura 553978 * OAKDALE COMMUNITY HEALTH 1420 WEST H STREET OAKDALE, CA 95361 (209)848-1743 Stanislaus CENTER 553982 * ORCHARD HOSPITAL MEDICAL 284 SPRUCE ST GRIDLEY, CA 95948 (530)846-5671 Butte SPECIALTY CENTER 058942 * ORCHARD MEDICAL CENTER 555 SIXTH STREET ORANGE COVE, CA 93646 (559)626-7118 Fresno 058936 * ORLAND CHILDREN'S CENTER 203 WALKER ST SUITE 3 ORLAND, CA 95963 (530)865-5400 Glenn 553911 * OROSI FAMILY MEDICAL CARE 12683 AVENUE 416 OROSI, CA 93647 (559)528-4717 Tulare 553935 * OROSI RURAL HEALTH CLINIC 12572 AVENUE 416, SUITE B OROSI, CA 93647 (559)528-4779 Tulare 058581 * OROVILLE FAMILY PRACTICE 2809 OLIVE HWY, SUITE 380 OROVILLE, CA 95966 (530)532-8687 Butte 058601 * OROVILLE HOSPITAL - MEDICAL 2767 OLIVE HIGHWAY, ANNEX BUILDING OROVILLE, CA 95966 (530)532-8544 Butte CLINIC 058686 None OROVILLE HOSPITAL PRIMARY 2721 OLIVE HWY, SUITE 12A, 12B & 10 OROVILLE, CA 95966 (530)538-3171 Butte CARE PRACTICE 058582 * OROVILLE PEDIATRIC PRACTICE 2809 OLIVE HIGHWAY, #270 OROVILLE, CA 95966 (530)533-4422 Butte 058661 * OROVILLE WOMEN'S HEALTH 2809 OLIVE HIGHWAY SUITES 260 & 310 OROVILLE, CA 95966 (530)532-8636 Butte 053971 * PATHWAY HEALTHCARE 190 SOUTH OAK AVENUE, BLDG 2, OAKDALE, CA 95361 (209)848-8410 Stanislaus SUITE 1 058583 * PEDIATRIC PRACTICE ASSOCIATES 2809 OLIVE HIGHWAY, SUITE 330 OROVILLE, CA 95966 (530)533-0774 Butte 058986 None PINE MOUNTAIN HEALTH CENTER 16233 ASKIN DRIVE, SUITE A FRAZIER PARK, CA 93222 (661)242-2592 Kern 058674 None PINE STREET CLINIC 408 PINE ST MOUNT SHASTA, CA 96067 (530)926-7196 Siskiyou 058678 None PIONEERS HEALTH CENTER 751 WEST LEGION ROAD, SUITE 103 BRAWLEY, CA 92227 (760)351-4400 Imperial 053845 * PIT RIVER HEALTH SERVICE, INC 36977 PARK AVENUE, PO BOX 2720 BURNEY, CA 96013 (530)335-3651 Shasta 553825 * PIXLEY MEDICAL GROUP 205 EAST DAVIS STREET, DRAWER Y PIXLEY, CA 93256 (559)757-2000 Tulare 553810 * PLACER COUNTY MEDICAL CLINIC 11583 C AVENUE AUBURN, CA 95603 (916)889-7215 Placer 553867 * PLACER MEDICAL CLINIC - TAHOE PO BOX 1785/8665 SALMON STREET KINGS BEACH, CA 96143 (916)546-6356 Placer * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 10 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 053989 * PLUMAS RURAL HEALTH CENTERS 1065 BUCKS LAKE RD QUINCY, CA 95971 (530)283-2121 Plumas 058522 * PORTOLA MEDICAL/DENTAL CLINIC 480 FIRST AVENUE PORTOLA, CA 96122 (916)832-4211 Plumas 058990 None PRATHER MEDICAL CLINIC 29424 AUBERRY ROAD PRATHER, CA 93651 (559)855-6550 Fresno 058584 * PREMIER HEALTH CENTER 900 ORO DAM BOULEVARD OROVILLE, CA 95966 (530)532-8824 Butte 058983 * RAN HEALTH SERVICES INC 489 5TH ST GUSTINE, CA 95322 (209)854-3728 Merced 553943 * RANCHOS FAMILY HEALTH 11976 ROAD 37, AVENUE 12 MADERA, CA 93637 (559)645-4191 Madera SERVICES 058680 None REDWOOD MEDICAL CLINIC 3 MARCELA DR WILLITS, CA 95490 (707)459-6115 Mendocino 553836 * REDWOOD PEDIATRIC MEDICAL 3305 RENNER DRIVE FORTUNA, CA 95540 (707)725-9355 Humboldt GROUP 058957 * REDWOOD WOMEN'S CENTER P C 3309 RENNER DRIVE FORTUNA, CA 95540 (707)725-6108 Humboldt 553879 * REDWOODS RURAL HEALTH 321 5TH STREET ALDERPOINT, CA 95511 (707)926-1070 Humboldt CENTER 058655 * RIDGECREST REGIONAL HOSPITAL 1111 NORTH CHINA LAKE BOULEVARD, RIDGECREST, CA 93555 (760)446-3551 Kern RURAL HEALTH CLINIC SUITE 190 058913 * RIGOBERTO O GUTIERREZ, MD 2809 OLIVE HWY #370 OROVILLE, CA 95966 (530)538-9410 Butte 058528 * RIVERBANK COMMUNITY HEALTH 2603 PATTERSON ROAD, SUITE 3 RIVERBANK, CA 95367 (209)869-8102 Stanislaus CENTER 553859 * RIVERBANK PRIMARY CARE 3227 STANISLAUS ST SUITE A RIVERBANK, CA 95367 (209)869-0131 Stanislaus MEDICAL CLINIC, INC 053969 * ROBERT RUSHTON, MD RHC 844 S DORA ST UKIAH, CA 95482 (707)462-8603 Mendocino 058632 * RUNNING SPRINGS RURAL HEALTH 31900 HILLTOP BOULEVARD RUNNING SPRINGS, CA 92382 (909)336-9715 San Bernardino CLINIC 058934 * SALAS MEDICAL CLINIC, INC 973 NORTH SEQUOIA AVENUE LINDSAY, CA 93247 (559)562-7799 Tulare 058946 * SAMUEL DIXON FAMILY HEALTH 30257 SAN MARTINEZ ROAD VAL VERDE, CA 91384 (661)257-4008 Los Angeles CENTER, INC 058512 * SAN BENITO COMMUNITY HEALTH 930 SUNSET DRIVE BUILDING #3 HOLLISTER, CA 95023 (831)637-5711 San Benito CLINIC 553939 * SAN JOAQUIN PRIME CARE MEDICAL 682 EAST VISALIA ROAD FARMERSVILLE, CA 93223 (559)594-4564 Tulare

553822 * SAN JOAQUIN PRIME CARE MEDICAL 330 EAST PINE STREET EXETER, CA 93221 (559)592-2134 Tulare

058928 * SAN JOAQUIN PRIME CARE MEDICAL 30924 E KINGS CANYON ROAD SQUAW VALLEY, CA 93675 (559)332-9399 Fresno CORPORATION 553947 * SAN JOAQUIN PRIME CARE MEDICAL 826 EAST MANNING AVENUE REEDLEY, CA 93654 (559)592-2134 Fresno CORP * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 11 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 553882 * SANTA ROSA DEL VALLE MEDICAL 1293 SIXTH STREET COACHELLA, CA 92236 (760)391-5151 Riverside GROUP, INC 058517 * SCOTT VALLEY RURAL HEALTH CLIN 155 DIGGLES STREET ETNA, CA 96027 (530)467-5393 Siskiyou 553886 * SEAN R THOMAS, MD, INC 55585 29 PALMS HIGHWAY YUCCA VALLEY, CA 92284 (760)228-3366 San Bernardino 553946 * SELMA RURAL HEALTH CENTER 2057 HIGH STREET SELMA, CA 93662 (559)891-9100 Fresno 058593 * SENECA HEALTHCARE DISTRICT 199 REYNOLDS ROAD CHESTER, CA 96020 (530)258-2866 Plumas LAKE ALMANOR CLINIC 553820 * SEQUOIA FAMILY MEDICAL CENTER 590 W PUTNAM AVE PORTERVILLE, CA 93257 (559)781-4100 Tulare 058944 * SESPE MEDICAL INC 552 SESPE AVE FILLMORE, CA 93015 (805)524-2559 Ventura 553819 * SHAFTER RURAL HEALTH CARE 565 KERN STREET SHAFTER, CA 93263 (661)746-4937 Kern CLINIC 058966 * SHASTA FAMILY CARE 725 PINE ST MOUNT SHASTA, CA 96067 (530)926-4556 Siskiyou 553951 * SHYAM BHASKAR MD INC 1001 VAN DORSTEN AVENUE CORCORAN, CA 93212 (559)992-2337 Kings 058982 * SHYAM BHASKAR MD, INC 1425 MAIN STREET DELANO, CA 93215 (661)778-0920 Kern 553881 * SISKIYOU MEDICAL GROUP DR LA 824 PINE STREET MOUNT SHASTA, CA 96067 (530)926-4528 Siskiyou GRO 553938 * SOLEDAD MEDICAL CLINIC 600 MAIN STREET SOLEDAD, CA 93960 (831)678-2462 Monterey 553991 * SOUTHERN HUMBOLDT COMMUNITY 509 ELM ST GARBERVILLE, CA 95542 (707)923-3925 Humboldt CL 058511 * SOUTHERN INYO HOSP DIST CLINIC 510 E LOCUST LONE PINE, CA 93545 (760)876-1146 Inyo 058988 * SPECIALTY HEALTH CLINIC 57402 29 PALMS HWY SUITE 1 YUCCA VALLEY, CA 92284 (760)228-1800 San Bernardino 553995 * ST HELENA FAMILY HEALTH 5290 STATE STREET KELSEYVILLE, CA 95451 (707)279-8813 Lake CENTER - KELSEYVILLE 058533 * ST HELENA FAMILY HEALTH 15230 LAKESHORE DRIVE CLEARLAKE, CA 95422 (707)994-0407 Lake CENTER - CLEARLAKE 058586 * ST HELENA FAMILY HEALTH 21337 BUSH STREET MIDDLETOWN, CA 95461 (707)987-3311 Lake CENTER - MIDDLETOWN 058681 None ST HELENA KONOCTI WELLNESS 9430 - C LAKE STREET LOWER LAKE, CA 95457 (707)995-5630 Lake CENTER 058687 None ST HELENA MEDICAL CARE 18990 COYOTE VALLEY ROAD, SUITE 8, MIDDLETOWN, CA 95461 (707)987-8344 Lake 9, & 10 053983 * SURPRISE VALLEY MEDICAL CLINIC 745 MAIN STREET CEDARVILLE, CA 96104 (916)279-6115 Modoc 058519 * SUTTER COAST HEALTH CENTER 785 EAST WASHINGTON BLVD SUITE 10 CRESCENT CITY, CA 95531 (707)464-8511 Del Norte 553994 * SUTTER LAKESIDE FAMILY 5176 HILL ROAD EAST LAKEPORT, CA 95453 (707)262-5088 Lake MEDICINE CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 12 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058969 * SUTTER MEDICAL FOUNDATION 9279 LOCUST STREET PLYMOUTH, CA 95669 (209)245-6968 Amador PLYMOUTH HEALTH CENTER 553950 * SUTTER NORTH BROWNSVILLE 16911 WILLOW GLEN ROAD BROWNSVILLE, CA 95919 (530)675-2457 Yuba FAMILY PRACTICE CTR 058688 None TAYLOR FARMS FAMILY HEALTH 850 FIFTH STREET GONZALES, CA 93926 (831)675-3601 Monterey AND WELLNESS CENTER 553979 * TEHACHAPI FAMILY HEALTH 2041 BELSHAW STREET MOJAVE, CA 93501 (661)824-4511 Kern CENTER - MOJAVE 058620 * TEHACHAPI FAMILY HEALTH 9350 NORTH LOOP BOULEVARD CALIF CITY, CA 93505 (760)373-1785 Kern CENTER-CALIFORNIA CITY 058910 * TEHAMA COUNTY HEALTH CENTER 1850 WALNUT ST RED BLUFF, CA 96080 (530)527-0350 Tehama CL 553969 * TIPTON MEDICAL CLINIC 575 NORTH THOMPSON ROAD TIPTON, CA 93272 (559)762-4147 Tulare 058618 * TRINITY COMMUNITY HEALTH 31 EASTER AVENUE WEAVERVILLE, CA 96093 (530)623-5541 Trinity CLINIC 058670 * TRONA RURAL HEALTH CLINIC 82820 TRONA ROAD TRONA, CA 93562 (760)499-3902 San Bernardino 058648 * TULARE HOSPITAL AND CLINICS 1062 SOUTH K STREET TULARE, CA 93274 (559)684-4530 Tulare HILLMAN CENTER 058624 * UKIAH VALLEY PRIMARY CARE / 260 HOSPITAL DRIVE, STE UKIAH, CA 95482 (707)468-0491 Mendocino ADVENTIST 102,103,107,201,204 & 209 058622 * UKIAH VALLEY PRIMARY CARE / 1165 SOUTH DORA STREET, SUITE B1 UKIAH, CA 95482 (707)462-1201 Mendocino ADVENTIST HEALTH 058625 * UKIAH VALLEY PRIMARY CARE / 487 S MAIN ST LAKEPORT, CA 95453 (707)263-4631 Lake ADVENTIST HEALTH 058623 * UKIAH VALLEY PRIMARY CARE / 1165 SOUTH DORA STREET, SUITE E1 & UKIAH, CA 95482 (707)463-8000 Mendocino ADVENTIST HEALTH E2 058626 * UKIAH VALLEY PRIMARY CARE / 1050 NORTH STATE STREET UKIAH, CA 95482 (707)468-1471 Mendocino ADVENTIST HEALTH 058939 * UNIVERSAL MEDICAL CENTER, INC 1472 B STREET STE A LIVINGSTON, CA 95334 (209)394-7614 Merced 058977 * WAHID MEDICAL CORPORATION 1108 WARD AVE PATTERSON, CA 95363 (209)892-1300 Stanislaus 058679 None WATERFORD COMMUNITY HEALTH 12146 YOSEMITE BLVD WATERFORD, CA 95386 (209)874-9254 Stanislaus CENTER 058987 None WEIMAR FAMILY CARE 20601 WEST PAOLI LANE WEIMAR, CA 95736 (530)296-4417 Placer 058992 None WEST SIDE FAMILY HEALTH CARE 100 EAST NORTH STREET TAFT, CA 93268 (661)765-1935 Kern 058909 * WESTERN SIERRA MEDICAL 3070 CAMINO HEIGHTS DRIVE, SUITE B CAMINO, CA 95709 (530)647-9762 El Dorado CENTER 553929 * WESTSIDE MEDICAL GROUP 1107 O STREET FIREBAUGH, CA 93622 (559)569-9000 Fresno * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 13 of 13 California

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 058916 * WESTSIDE MEDICAL GROUP OF 450 OLLER STREET, STE 101 MENDOTA, CA 93640 (559)655-1000 Fresno MENDOTA, INC 553988 * WILLIAMS URGENT CARE AND 501 E STREET SUITE B WILLIAMS, CA 95987 (530)473-5641 Colusa MEDICAL CENTER 058961 * WILLOWS FIRSTCARE INC 460 W SYCAMORE ST WILLOWS, CA 95988 (530)934-3385 Glenn 553937 * WOMENS AND CHILDREN 57463 TWENTYNINE PALMS HWY, SUITE YUCCA VALLEY, CA 92284 (760)365-0808 San Bernardino HEALTHCARE 202 058976 * YUCCA FAMILY MEDICAL CARE INC 57675 29 PALMS HWY SUITE 111 YUCCA VALLEY, CA 92284 (760)365-8500 San Bernardino Total Providers for this State = 280

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Hawaii

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 123976 * KAU HOSPITAL RURAL HEALTH CLIN 1 KAMANI STREET PAHALA, HI 96777 (808)928-2050 Hawaii 123977 * MOLOKAI GENERAL HOSPITAL 280 HOME OLU PLACE KAUNAKAKAI, HI 96748 (808)553-5331 Maui Total Providers for this State = 2

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 1 Nevada

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 293984 * BATTLE MOUNTAIN CLINIC 535 SOUTH HUMBOLDT STREET, STE A BATTE MTN, NV 89820 (775)635-2424 Lander 293961 * HUMBOLDT GENERAL HOSPITAL 118 E HASKELL STREET WINNEMUCCA, NV 89445 (775)623-5222 Humboldt RHC 293982 * LINCOLN COUNTY HOSPITAL 700 NORTH SPRING STREET CALIENTE, NV 89008 (775)726-3171 Lincoln DISTRICT 293811 * MINDEN FAMILY MEDICINE AND 1649 LUCERNE ST UNIT A & B MINDEN, NV 89423 (775)782-1603 Douglas COMPLETE CARE 293975 * MOUNT GRANT MEDICAL BUILDING 1ST & A STREETS/PO BOX 1510 HAWTHORNE, NV 89415 (775)945-2461 Mineral 293981 * PERSHING GENERAL HOSP & 850 SIXTH STREET/PO BOX 661 LOVELOCK, NV 89419 (775)273-2621 Pershing NURSING HOME PHYSICIAN CTR 293962 * SILVER SPRINGS RURAL HEALTH 3595 HWY 50 WEST SILVER SPRINGS, NV 89429 (775)982-6508 Lyon CENTERS 293978 * SMITH VALLEY PHYSICIANS CLINIC 445 STATE HWY 338 WELLINGTON, NV 89444 (775)465-2587 Lyon 293979 * SOUTH LYON MEDICAL CENTER- 213 S WHITACRE STREET YERINGTON, NV 89447 (775)463-2301 Lyon BARNETT CLINIC 293980 * SOUTH LYON PHYSICIANS CLINIC 311 SURPRISE STREET YERINGTON, NV 89447 (775)463-2301 Lyon 293985 * TOPAZ RANCH MEDICAL CLINIC 3919 CARTER DR WELLINGTON, NV 89444 (775)783-3096 Lyon 293977 * WILLIAM BEE RIRIE HOSPITAL-RHC 6 STEPTOE CIRCLE ELY, NV 89301 (775)289-3001 White Pine Total Providers for this State = 12

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 2 Idaho

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 133838 * ASSOCIATES IN FAMILY PRACTICE 425 IDAHO STREET GOODING, ID 83330 (208)934-5900 Gooding GOODING 133845 * ASSOCIATES IN FAMILY PRACTICE 640 FROGS LANDING HAGERMAN, ID 83332 (208)837-6161 Gooding HAGERMAN 133850 * ASSOCIATES IN FAMILY PRACTICE 410 NORTH IDAHO STREET WENDELL, ID 83355 (208)536-5900 Gooding WENDELL 138514 * BEAR LAKE FAMILY CARE & OB/GYN 465 WASHINGTON STREET MONTPELIER, ID 83254 (208)847-1630 Bear Lake 138505 * BEAR LAKE INTERNAL MEDICINE 166 SOUTH 5TH STREET MONTPELIER, ID 83254 (208)847-1110 Bear Lake 133831 * BLACKFOOT MEDICAL CENTER 1441 PARKWAY DRIVE BLACKFOOT, ID 83221 (208)785-2600 Bingham 133859 * BONNERS FERRY FAMILY MEDICINE 6488 CHINOOK ST BONNERS FERRY, ID 83805 (208)267-8779 Boundary 138521 None BOUNDARY COMMUNITY CLINICS 6641 KANIKSU STREET BONNERS FERRY, ID 83805 (208)267-3141 Boundary 133993 * CASCADE FAMILY PRACTICE 402 LAKE CASCADE PKWY CASCADE, ID 83611 (208)382-4285 Valley 133832 * CHALLIS AREA HEALTH CENTER 611 CLINIC ROAD CHALLIS, ID 83226 (208)879-4351 Custer 133851 * CLAY I CAMPBELL 166 SOUTH 5TH STREET MONTPELIER, ID 83254 (208)847-3847 Bear Lake 138511 * DRIGGS MEDICAL CLINIC 283 NORTH 1ST EAST DRIGGS, ID 83422 (208)354-2302 Teton 133833 * EMMETT MEDICAL CENTER 1102 EAST LOCUST EMMETT, ID 83617 (208)365-6004 Gem 138515 None FIRST CHOICE URGENT CARE & 1350 PARKWAY DRIVE BLACKFOOT, ID 83221 (208)782-2410 Bingham MEDICAL CLINIC 133861 None FOUR PEAKS CLINIC 852 VALLEY CENTRE DRIVE DRIGGS, ID 83422 (208)354-4757 Teton 138520 * GOODING FAMILY PHYSICIANS 267 N CANYON DR GOODING, ID 83330 (208)934-4446 Gooding 138502 * IDAHO PHYSICIANS CLINIC 98 POPLAR STREET BLACKFOOT, ID 83221 (208)785-3800 Bingham 133997 * KENDRICK CLINIC 606 EAST MAIN STREET KENDRICK, ID 83537 (208)289-3841 Latah 138506 * LAKEVIEW MEDICAL CLINIC 300 SOUTH THIRD WEST SODA SPRINGS, ID 83276 (208)547-3118 Caribou 133981 * LOST RIVERS RURAL HEALTH 551 HIGHLAND DRIVE ARCO, ID 83213 (208)527-8206 Butte CLINIC 133990 * MACKAY CLINIC 313 EAST CUSTER STREET MACKAY, ID 83251 (208)588-2993 Custer 138507 * MINIDOKA MEDICAL CENTER 1308 8TH STREET, SUITE 1 RUPERT, ID 83350 (208)436-4322 Minidoka 133858 * MOSCOW MEDICAL, P A 213 N MAIN STREET MOSCOW, ID 83843 (208)882-7565 Latah 138509 * ONEIDA COUNTY CLINIC 220 BANNOCK STREET MALAD, ID 83252 (208)766-2600 Oneida 133860 None PALOUSE PEDIATRICS-MOSCOW 1420 S BLAINE ST STE 5 MOSCOW, ID 83843 (509)322-2605 Latah 138512 * PHYSICIANS & SURGEONS CLINIC 275 W LOCUST STREET SHELLEY, ID 83274 (208)357-3960 Bingham OF SHELLEY 133989 * PIONEER MEDICAL CLINIC 105 CARLE STREET PIERCE, ID 83546 (208)464-2578 Clearwater 133995 * POTLATCH CLINIC 156 6TH ST POTLATCH, ID 83855 (208)875-2380 Latah * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 2 Idaho

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 138500 * POWER COUNTY FAMILY CLINIC 502 TYHEE ST AMERICAN FALLS, ID 83211 (208)226-1057 Power 133808 * SALMON RIVER CLINIC 1 NIECE AVENUE STANLEY, ID 83278 (208)774-3565 Custer 133839 * SHELLEY FAMILY MEDICAL CENTER 210 SOUTH EMERSON SHELLEY, ID 83274 (208)357-7405 Bingham 133826 * ST ALPHONSUS MEDICAL GROUP - 315 EAST ELM STREET CALDWELL, ID 83605 (208)459-7415 Canyon ELM 133835 * ST ALPHONSUS MEDICAL GROUP - 1200 GARRITY BOULEVARD NAMPA, ID 83687 (208)466-9092 Canyon GARRITY 133825 * ST ALPHONSUS MEDICAL GROUP - 211 WEST IOWA AVENUE NAMPA, ID 83686 (208)465-7377 Canyon IOWA 138524 None ST ALPHONSUS MEDICAL GROUP 910 NW 16TH STREET SUITE 101 FRUITLAND, ID 83619 (208)452-6851 Payette FRUITLAND HEALTH PLAZA 138516 * ST LUKE'S CLINIC - SALMON RIVER 214 N MAIN STREET RIGGINS, ID 83549 (208)628-3666 Idaho MEDICAL 133992 * ST LUKE'S CLINIC JEROME FAMILY 132 5TH AVENUE WEST JEROME, ID 83338 (208)324-5286 Jerome MEDICINE 133999 * ST LUKE'S TRINITY MOUNTAIN 465 MCKENNA DRIVE MOUNTAIN HOME, ID 83647 (208)587-9703 Elmore 138503 * ST MARIES FAMILY MEDICINE 229 8TH STREET ST MARIES, ID 83861 (208)245-2591 Benewah 133996 * STEELE MEMORIAL CLINIC 805 MAIN STREET SALMON, ID 83467 (208)756-6212 Lemhi 138518 None SYRINGA KOOSKIA CLINIC 022 N MAIN ST KOOSKIA, ID 83539 (208)926-4776 Idaho 138517 None SYRINGA PRIMARY CARE CLINIC 722 W NORTH ST GRANGEVILLE, ID 83530 (208)983-8590 Idaho 133836 * TWO RIVERS MEDICAL CLINIC, P A 683 EAST THIRD STREET WEISER, ID 83672 (208)549-0211 Washington 133856 * UPPER VALLEY FAMILY MEDICINE 711 RIGBY LAKE DRIVE RIGBY, ID 83442 (208)745-5021 Jefferson 138510 * VICTOR HEALTH CLINIC 252 SOUTH MAIN STREET VICTOR, ID 83455 (208)787-9898 Teton 138523 None WEISER MEMORIAL HOSPITAL 360 E LIBERTY WEISER, ID 83672 (208)549-4424 Washington FAMILY MEDICAL PRACTICE 138522 None WILLOW VALLEY MEDICAL CENTER 47 NORTH 1ST EAST PRESTON, ID 83263 (208)852-2900 Franklin Total Providers for this State = 47

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 4 Oregon

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 388516 * ADVENTIST HEALTH BAYSHORE 1105 SOUTHWEST JETTY AVENUE LINCOLN CITY, OR 97367 (541)614-0482 Lincoln MEDICAL LINCOLN CITY SUITE C 388514 * ADVENTIST HEALTH BAYSHORE 38505 BROOTEN RD PACIFIC CITY, OR 97135 (503)965-6555 Tillamook MEDICAL PACIFIC CITY 388504 * ADVENTIST HEALTH TILLAMOOK 1100 THIRD STREET TILLAMOOK, OR 97141 (503)815-2260 Tillamook MEDICAL GROUP 388507 * ADVENTIST HEALTH TILLAMOOK 1011 THIRD STREET TILLAMOOK, OR 97141 (503)815-2260 Tillamook MEDICAL GROUP BAY OCEAN 388510 * ADVENTIST HEALTH TILLAMOOK 10445 NEAHKAHNIE CREEK ROAD MANZANITA, OR 97130 (503)368-6244 Tillamook MEDICAL GROUP MANZANITA 383807 * ALSEA RURAL HEALTH CARE, INC 201 NORTH 4TH ALSEA, OR 97324 (541)487-7116 Benton 383887 * APPLEGATE VALLEY FAMILY 8600 NEW HOPE ROAD GRANTS PASS, OR 97527 (541)862-2836 Josephine MEDICINE LLC 388520 * AUMSVILLE MEDICAL CLINIC 205 MAIN STREET AUMSVILLE, OR 97325 (503)749-4734 Marion 383866 * C SCOTT GRAHAM, DO, PC 620 SOUTH J STREET LAKEVIEW, OR 97630 (541)947-2331 Lake 383883 * CANBY HEALTH CARE CLINIC LLC 703 SE 1ST AVE CANBY, OR 97013 (503)266-7687 Clackamas 383886 * CASCADE DIRECT CARE 750 NW 4TH STREET PRINEVILLE, OR 97754 (541)362-8688 Crook 388522 * CASCADE MEDICAL CLINIC 1375 N 10TH AVENUE SUITE B STAYTON, OR 97383 (503)769-7546 Linn 383873 * CENTER FOR WOMEN & THE FAMILY 17 SW FRAZER, SUITE 282 PENDLETON, OR 97801 (541)278-3377 Umatilla 388502 * CHI ST ANTHONY HOSPITAL FAMILY 3001 ST ANTHONY WAY, SUITE 120 PENDLETON, OR 97801 (541)278-8183 Umatilla CLINIC 388515 * CMH PRIMARY CLINIC 1639 SE ENSIGN LANE #B 103 WARRENTON, OR 97146 (503)338-4500 Clatsop 383836 * COASTAL HEALTH PRACTITIONERS 3015 WEST DEVILS LAKE ROAD LINCOLN CITY, OR 97367 (541)994-5591 Lincoln 383882 * COLUMBIA GORGE FAMILY 1750 12TH STREET HOOD RIVER, OR 97031 (541)386-5070 Hood River MEDICINE 383895 * COLUMBIA RIVER WOMEN'S 1810 EAST 19TH STREET, SUITE 209 THE DALLES, OR 97058 (541)296-5657 Wasco CENTER 383990 * CURRY FAMILY MEDICAL 525 MADRONA STREET PORT ORFORD, OR 97465 (541)332-3861 Curry 388513 * DUNES FAMILY HEALTH CARE 620 RANCH ROAD REEDSPORT, OR 97467 (541)271-2163 Douglas 383880 * EVERGREEN FAMILY MEDICINE PC 2570 NW EDENBOWER BLVD STE 100 ROSEBURG, OR 97471 (541)677-7200 Douglas 383891 * EVERGREEN FAMILY MEDICINE 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541)863-3146 Douglas SOUTH 383884 * FAMILY HEALTH ASSOCIATES 600 NW 11TH, SUITE E-15 HERMISTON, OR 97838 (541)567-6434 Umatilla 383856 * GIFFORD MEDICAL 1050 W ELM AVENUE, SUITE 110 HERMISTON, OR 97838 (541)567-2995 Umatilla 383985 * GOOD SHEPHERD MEDICAL GROUP 600 NW 11TH STREET HERMISTON, OR 97838 (541)567-5305 Umatilla * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 4 Oregon

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 388524 * GRANDE RONDE HOSPITAL ELGIN 580 S 8TH STREET ELGIN, OR 97827 (541)437-2273 Union CLINIC 388527 * GRANDE RONDE HOSPITAL 506 4TH STREET LA GRANDE, OR 97850 (541)663-3138 Union REGIONAL MEDICAL CLINIC 388526 * GRANDE RONDE HOSPITAL UNION 142 EAST DEARBORN UNION, OR 97883 (541)963-1842 Union CLINIC 388525 * GRANDE RONDE HOSPITAL 710 SUNSET DRIVE, SUITE E LA GRANDE, OR 97850 (541)633-3150 Union WOMEN'S & CHILDREN'S CLINIC 383848 * GRANT COUNTY HEALTH 528 EAST MAIN, SUITE E JOHN DAY, OR 97845 (541)575-0429 Grant DEPARTMENT 388512 * HARNEY DISTRICT HOSPITAL 559 W WASHINGTON ST BURNS, OR 97720 (541)573-2074 Harney FAMILY CARE 383858 * HERMISTON FAMILY PRACTICE AND 236 E NEWPORT AVENUE HERMISTON, OR 97838 (541)567-1137 Umatilla URGENT CARE 388518 * IONE COMMUNITY CLINIC 365 W 3RD STREET IONE, OR 97843 (541)422-7128 Morrow 383987 * IRRIGON MEDICAL CLINIC 220 NORTH MAIN STREET IRRIGON, OR 97844 (541)922-5880 Morrow 388517 * LAKE HEALTH DISTRICT 700 SOUTH J STREET LAKEVIEW, OR 97630 (541)947-2114 Lake 383867 * LEGACY CLINIC ST HELENS 500 N COLUMBIA RIVER HIGHWAY, ST HELENS, OR 97051 (503)397-0471 Columbia SUITE 6 383881 * LEGACY MEDICAL GROUP - 36860 INDUSTRIAL WAY SANDY, OR 97055 (503)826-0206 Clackamas FIRWOOD 388501 * LEGACY MEDICAL GROUP - 693 GLATT CIRCLE WOODBURN, OR 97071 (503)982-0403 Marion SILVERTON INTERNAL MEDICINE 383999 * LEGACY MEDICAL GROUP – MT. 250 W MARQUIM ST MOUNT ANGEL, OR 97362 (503)845-2000 Marion ANGEL 388500 * LEGACY MEDICAL GROUP – 1475 MOUNT HOOD AVE WOODBURN, OR 97071 (503)982-2174 Marion WOODBURN HEALTH CENTER 383862 * LISA CALLAHAN, CPNP 1465 B NE 7TH STREET GRANTS PASS, OR 97526 (541)471-0100 Josephine 383859 * MADRAS MEDICAL GROUP 76 NE 12TH STREET MADRAS, OR 97741 (541)475-3874 Jefferson 383817 * MALHEUR MEMORIAL HEALTH 410 MAIN STREET NYSSA, OR 97913 (541)372-2211 Malheur CENTER 383802 * MCKENZIE RIVER CLINIC 51730 DEXTER STREET BLUE RIVER, OR 97413 (503)822-3341 Lane 383996 * MCMC FAMILY MEDICINE 1620 E 12TH STREET THE DALLES, OR 97058 (541)296-9151 Wasco 388506 * MCMC PEDIATRICS 1935 E 19TH STREET, SUITE 100 THE DALLES, OR 97058 (541)296-7677 Wasco 383863 * MILTON-FREEWATER CLINIC 10 NE 5TH MILTON FREEWATER, OR (541)938-3314 Umatilla 97862

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 4 Oregon

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 388528 None MOUNTAIN VIEW MEDICAL 603 MEDICAL PARKWAY ENTERPRISE, OR 97828 (541)426-7900 Wallowa ENTERPRISE 383876 * NORTH BEND MEDICAL CENTER 110 E TENTH STREET BANDON, OR 97411 (541)347-5191 Coos BANDON 383853 * NORTH BEND MEDICAL CENTER 94180 SECOND STREET GOLD BEACH, OR 97444 (541)247-7047 Curry GOLD BEACH 383893 * NORTH BEND MEDICAL CENTER, INC 1900 WOODLAND DRIVE COOS BAY, OR 97420 (541)267-5151 Coos IMMEDIATE CARE 383839 * OAK STREET HEALTH CARE CENTER 446 OAK STREET BROOKINGS, OR 97415 (541)412-8898 Curry

383849 * OHSU FAMILY MEDICINE AT 51377 OLD PORTLAND ROAD SUITE C SCAPPOOSE, OR 97056 (503)418-4222 Columbia SCAPPOOSE 383890 * ORCHID HEALTH 47815 HWY 58 OAKRIDGE, OR 97463 (541)782-8304 Lane 383894 * ORCHID HEALTH WADE CREEK 535 NE 6TH AVENUE ESTACADA, OR 97023 (503)630-8550 Clackamas CLINIC 383808 * PEACEHEALTH MEDICAL GROUP - 38843 DEXTER ROAD DEXTER, OR 97431 (541)937-2134 Lane DEXTER 383874 * PEDIATRIC SPECIALISTS OF 2461 SW PERKINS AVE PENDLETON, OR 97801 (541)276-0250 Umatilla PENDLETON, L L C 383869 * PINE EAGLE CLINIC 218 N PINE STREET HALFWAY, OR 97834 (541)742-5023 Baker 383984 * PIONEER MEMORIAL CLINIC 130 THOMPSON AVENUE HEPPNER, OR 97836 (541)676-9133 Morrow 383981 * PROVIDENCE NORTH COAST CLINIC 727 SOUTH WAHANNA ROAD SEASIDE, OR 97138 (503)717-7000 Clatsop 383993 * RIVER VIEW CLINIC 1825 E 19TH STREET THE DALLES, OR 97058 (541)296-1151 Wasco 383991 * SAMARITAN COASTAL CLINIC 825 NW HIGHWAY 101, SUITE A LINCOLN CITY, OR 97367 (541)994-3661 Lincoln 388509 * SAMARITAN LINCOLN CITY MEDICAL 2870 WEST DEVILS LAKE ROAD LINCOLN CITY, OR 97367 (541)557-6490 Lincoln CENTER 388519 * SAMARITAN WALDPORT CLINIC 920 SW RANGE DR WALDPORT, OR 97394 (541)563-3197 Lincoln 388521 * SANTIAM MEDICAL CLINIC 280 S FIRST STREET MILL CITY, OR 97360 (503)897-4100 Linn 383825 * SHADY COVE CLINIC 21990 HIGHWAY 62 SHADY COVE, OR 97539 (541)878-2022 Jackson 383820 * SHERMAN COUNTY MEDICAL CLINIC 110 MAIN STREET MORO, OR 97039 (541)565-3325 Sherman 383843 * SISKIYOU PEDIATRIC CLINIC LLP 700 SW RAMSEY, SUITE 204 GRANTS PASS, OR 97527 (541)955-5683 Josephine 383892 * SNAKE RIVER PEDIATRICS 1050 SW 3RD AVE, SUITE 3200 ONTARIO, OR 97914 (541)881-2380 Malheur 383805 * SOUTH GILLIAM HEALTH CENTER 422 NORTH MAIN CONDON, OR 97823 (541)384-2061 Gilliam 388511 * ST ALPHONSUS MEDICAL CENTER 3820 17TH STREET BAKER CITY, OR 97814 (541)523-4465 Baker VALLEY MEDICAL CLINIC

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 4 Oregon

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 388508 * ST ALPHONSUS MEDICAL GROUP- 3175 POCAHONTAS ROAD BAKER CITY, OR 97814 (541)523-4415 Baker BAKER CLINIC 388505 * ST CHARLES FAMILY CARE - 384 SE COMBS FLAT ROAD, SUITE 1200 PRINEVILLE, OR 97754 (541)447-6263 Crook PRINEVILLE 383852 * ST LUKE'S CLINIC-EASTERN 3950 17TH STREET, SUITE A BAKER CITY, OR 97814 (541)523-1001 Baker OREGON MEDICAL ASSOCIATES 383998 * STRAWBERRY WILDERNESS 180 FORD ROAD JOHN DAY, OR 97845 (541)575-0404 Grant COMMUNITY CLINIC 388523 * SUBLIMITY MEDICAL CLINIC 114 SE CHURCH STREET SUBLIMITY, OR 97385 (503)769-2259 Marion 383868 * TREASURE VALLEY PEDIATRIC 1219 SW 4TH AVENUE, SUITE 1 ONTARIO, OR 97914 (541)889-2668 Malheur CLINIC P C 383872 * UMPQUA REGIONAL MEDICAL 1813 W HARVARD SUITE 201 ROSEBURG, OR 97471 (541)459-3500 Douglas CENTER, LLC 383878 * URGENTCARE NW-ASTORIA, PC 2120 EXCHANGE ST, SUITE 111 ASTORIA, OR 97103 (503)666-5050 Clatsop 383885 * VERNONIA HEALTH CENTER 1005 COUGAR STREET VERNONIA, OR 97064 (503)429-0622 Columbia 383994 * WATER'S EDGE MEDICAL CLINIC 551 LONE PINE BLVD THE DALLES, OR 97058 (541)296-2353 Wasco 383864 * WINDING WATERS CLINIC P C - 603 MEDICAL PARKWAY ENTERPRISE, OR 97828 (541)426-4502 Wallowa ENTERPRISE 383889 * WOODBURN PEDIATRIC CLINIC LLP 2050 PROGRESS WAY WOODBURN, OR 97071 (503)981-5348 Marion Total Providers for this State = 83

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 1 of 5 Washington

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 508550 * ADVENTIST HEALTH MEDICAL 1111 S 2ND AVENUE WALLA WALLA, WA 99362 (509)522-0100 Walla Walla GROUP 508505 * ANACORTES FAMILY MEDICINE 2511 M AVENUE, SUITE B ANACORTES, WA 98221 (360)293-5102 Skagit 508554 * BENTON CITY CLINIC 701 DALE AVE BENTON CITY, WA 99320 (800)356-1011 Benton 503905 * BIRCH BAY FAMILY MEDICINE 8097 HARBORVIEW RD BLAINE, WA 98230 (360)371-5855 Whatcom 508539 * BIRCH STREET MEDICAL CENTER 222 EAST 2ND STREET GRANDVIEW, WA 98930 (509)882-3500 Yakima 503872 * BLUE MOUNTAIN MEDICAL GROUP 1111 S 2ND AVE WALLA WALLA, WA 99362 (509)522-0100 Walla Walla 508520 * BOGACHIEL CLINIC 390 FOUNDERS WAY FORKS, WA 98331 (360)374-6998 Clallam 508502 * CAMANO COMMUNITY HEALTH 127 N EAST CAMANO DR CAMANO CITY, WA 98292 (360)387-5398 Snohomish CLINIC 503992 * CASCADE MEDICAL CENTER 817 COMMERCIAL STREET LEAVENWORTH, WA 98826 (509)548-5815 Chelan 508509 * CASCADE VALLEY DARRINGTON 1190 RIDDLE ST DARRINGTON, WA 98241 (360)436-1055 Snohomish CLINIC 503900 * CENTRALIA SPECIALTY CENTER 1707 COOKS HILL ROAD CENTRALIA, WA 98531 (360)740-4001 Lewis 503897 * CHEHALIS CHILDRENS CLINIC 370 S MARKET BLVD CHEHALIS, WA 98532 (360)748-6693 Lewis 503868 * CHEWELAH ASSOCIATED 410 EAST KING STREET CHEWELAH, WA 99109 (509)935-8711 Stevens PHYSICIANS 503975 * CLALLAM BAY MEDICAL CLINIC 6TH & BOGACHIEL CLALLAM BAY, WA 98326 (206)963-2202 Clallam 508541 * CLE ELUM FAMILY MEDICINE CTR 201 ALPHA WAY CLE ELUM, WA 98922 (509)674-5331 Kittitas 503985 * COLUMBIA BASIN FAMILY MEDICINE 200 NAT WASHINGTON WAY EPHRATA, WA 98823 (509)754-4631 Grant 503977 * COLUMBIA FAMILY CLINIC 1012 SOUTH 3RD STREET DAYTON, WA 99328 (509)382-2531 Columbia 503920 * CONFLUENCE HEALTH BREWSTER 418 W MAIN ST BREWSTER, WA 98812 (509)663-8711 Okanogan 508523 * CONFLUENCE HEALTH CASHMERE 303 COTTAGE AVENUE CASHMERE, WA 98815 (509)782-1541 Chelan 508515 * CONFLUENCE HEALTH EAST 100 HIGHLINE DRIVE EAST WENATCHEE, WA 98802(509)884-0614 Douglas WENATCHEE 508516 * CONFLUENCE HEALTH MOSES LAKE 840 EAST HILL DRIVE MOSES LAKE, WA 98837 (509)765-0216 Grant 508512 * CONFLUENCE HEALTH OMAK 916 KOALA AVENUE OMAK, WA 98841 (509)826-1800 Okanogan 508513 * CONFLUENCE HEALTH OROVILLE 1617 MAIN STREET OROVILLE, WA 98844 (509)476-3631 Okanogan 503854 * CONFLUENCE HEALTH ROYAL CITY 101 CAMELIA NW ROYAL CITY, WA 99357 (509)346-1447 Grant 508517 * CONFLUENCE HEALTH TONASKET 17 SOUTH WESTERN AVENUE TONASKET, WA 98855 (509)486-2174 Okanogan 508568 * CONFLUENCE HEALTH WATERVILLE 117 S CHELAN AVE DOUGLAS, WA 98858 (509)663-8711 Douglas 508514 * CONFLUENCE HEALTH WENATCHEE 820 NORTH CHELAN AVENUE WENATCHEE, WA 98801 (509)663-8711 Chelan 508535 * COULEE CITY CLINIC 130 N ADAMS STREET COULEE CITY, WA 99115 (509)632-5701 Grant

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 2 of 5 Washington

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 503981 * COULEE FAMILY MEDICINE 411 FORTUYN ROAD GRAND COULEE, WA 99133 (509)633-1911 Grant 508533 * CURLEW MEDICAL CLINIC 9 KETTLE RIVER ROAD CURLEW, WA 99118 (509)779-4049 Ferry 508529 * DAVENPORT CLINIC 100 THIRD STREET DAVENPORT, WA 99122 (509)725-7501 Lincoln 503885 * DEER PARK FAMILY CARE CLINIC 905 EAST D STREET DEER PARK, WA 99006 (509)276-5005 Spokane 503919 * EAST CAMPUS INTERNAL MEDICINE 1006 N H STREET ABERDEEN, WA 98520 (360)537-6496 Grays Harbor 503881 * ELLENSBURG PEDIATRICS 611 S CHESTNUT, SUITE E ELLENSBURG, WA 98926 (509)962-5437 Kittitas 508556 * ELMA FAMILY MEDICINE 575 E MAIN STREET BLDG 2 ELMA, WA 98541 (360)482-3711 Grays Harbor 503904 * EVERSON FAMILY MEDICINE 407 E MAIN ST EVERSON, WA 98247 (360)966-3441 Whatcom 503863 * FAMILY CARE NETWORK ISLAND 2511 M AVENUE STE A ANACORTES, WA 98221 (360)293-9813 Skagit FAMILY PHYSICIANS 503886 * FAMILY HEALTH CARE OF 107 E MOUNTAIN VIEW AVENUE, SUITE ELLENSBURG, WA 98926 (509)962-6348 Kittitas ELLENSBURG #1 508500 * FAMILY HEALTH CENTER NEWPORT 714 W PINE STREET BLDG C NEWPORT, WA 99156 (509)447-2441 Pend Oreille 508518 * FAMILY MEDICINE NEWPORT SOUTH 100 SCOTT AVENUE NEWPORT, WA 99156 (509)447-3139 Pend Oreille 503873 * FAMILY MEDICINE OF PORT ANGEL 240 WEST FRONT STREET, SUITE A PORT ANGELES, WA 98362 (360)425-7891 Clallam 508519 * FAMILY PRACTICE CLINIC 711 EAST COLLINS DR GOLDENDALE, WA 98620 (509)773-4017 Klickitat 503903 * FERNDALE FAMILY MEDICAL 5580 NORDIC WAY FERNDALE, WA 98248 (360)384-1511 Whatcom CENTER 508548 * FIDALGO MEDICAL ASSOCIATES AT 1213 24TH STREET, SUITE 100 ANACORTES, WA 98221 (360)293-4655 Skagit ISLAND HOSPITAL 508540 * GRANDVIEW MEDICAL CENTER 208 N EUCLID ROAD GRANDVIEW, WA 98930 (509)882-1855 Yakima 503824 * HARRISON HEALTH PARTNERS 461 G STREET SW FORKS, WA 98331 (360)374-6224 Clallam FAMILY MEDICAL CENTER 503917 * HIGHLANDS PEDIATRICS 615 NORTH F STREET ABERDEEN, WA 98520 (360)533-4599 Grays Harbor 508526 * JEFFERSON GENERAL MEDICAL 915 SHERIDAN AVENUE, SUITE B103 PT TOWNSEND, WA 98368 (360)385-4848 Jefferson GROUP 508525 * JEFFERSON HEALTHCARE FAMILY 1010 SHERIDAN AVE SUITE 1 PT TOWNSEND, WA 98368 (360)379-8631 Jefferson MEDICINE 508524 * JEFFERSON HEALTHCARE 934 SHERIDAN AVENUE PT TOWNSEND, WA 98368 (360)385-6200 Jefferson INTERNAL MEDICINE 508569 * JOHN HUGHES STUDENT HEALTH 1801 E EDISON AVE SUNNYSIDE, WA 98944 (509)837-1650 Yakima CENTER 508553 * KITTITAS VALLEY HEALTHCARE 716 EAST MANITOBA AVENUE ELLENSBURG, WA 98926 (509)925-3151 Kittitas FAMILY MEDICINE-ELLENSB

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 3 of 5 Washington

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 508545 * KITTITAS VALLEY HEALTHCARE 716 E MANITOBA AVENUE ELLENSBURG, WA 98926 (509)925-6100 Kittitas INTERNAL MEDICINE 503894 * L KEITH HANSON PLLC 520 W INDIAN AVENUE # A BREWSTER, WA 98812 (509)689-2525 Okanogan 508567 * LAKE CHELAN CLINIC, PC 219 EAST JOHNSON CHELAN, WA 98816 (509)682-2511 Chelan 508538 * LINCOLN AVENUE FAMILY MEDICINE 803 E LINCOLN AVENUE SUNNYSIDE, WA 98944 (509)837-6911 Yakima 503995 * LOPEZ ISLAND MEDICAL CLINIC 103 WASHBURN LOPEZ ISLAND, WA 98261 (360)468-2245 San Juan 503902 * LYNDEN FAMILY MEDICINE 1610 GROVER ST #D-1 LYNDEN, WA 98264 (360)354-1333 Whatcom 503998 * MARK REED HEALTHCARE DISTRICT 157 S HOWARD ST #405 SPOKANE, WA 99201 (360)495-3244 Spokane 503898 * MARY'S CORNER MEDICAL CLINIC 4254 JACKSON HIGHWAY CHEHALIS, WA 98532 (360)262-3966 Lewis 508551 * MASON GEN HOSP MOUNTAIN VIEW 2300 KATI COURT, SUITE A SHELTON, WA 98584 (360)426-0955 Mason WOMEN'S HEALTH CENTER 508565 * MASON GENERAL HOSP OLYMPIC 221 PROFESSIONAL WAY SHELTON, WA 98584 (360)426-2500 Mason PHYSICIANS, P L L C 508566 * MASON GENERAL HOSPITAL N 24261 US HWY 101 HOODSPORT, WA 98548 (360)877-0372 Mason HOODSPORT FAMILY CLINIC PS 508527 * MASON GENERAL HOSPITAL 247 PROFFESSIONAL WAY BUILDING SHELTON, WA 98584 (360)426-3102 Mason OAKLAND BAY PEDIATRICS 508564 * MASON GENERAL HOSPITAL 237 PROFESSIONAL WAY SHELTON, WA 98584 (360)426-2500 Mason OLYMPIC PHYSICIANS 508549 * MASON GENERAL HOSPITAL 939 MOUNTAIN VIEW DRIVE, SUITE 100 SHELTON, WA 98584 (360)426-2653 Mason SHELTON FAMILY MEDICINE 508571 * MGH FAMILY HEALTH ANKLE AND 1812 N 13TH LOOP RD SHELTON, WA 98584 (360)426-3662 Mason FOOT 503907 * MID-VALLEY COMMUNITY CLINIC 700 S 11TH ST SUNNYSIDE, WA 98944 (509)839-6822 Yakima PLLC 503858 * MID-VALLEY MEDICAL GROUP 529 JASMINE STREET OMAK, WA 98841 (509)826-1600 Okanogan 503877 * MORTON MEDICAL CENTER PLLC 531 ADAMS STREET MORTON, WA 98356 (360)496-5145 Lewis 503850 * MOUNTAIN VIEW WOMEN'S HEALTH 2300 KATI COURT, SUITE A SHELTON, WA 98584 (360)426-0955 Mason C 503984 * NASELLE CLINIC NORTH VALLEY ROAD NASELLE, WA 98638 (206)484-7161 Pacific 503835 * NORTHSHORE MEDICAL GROUP 212 SKYLINE DRIVE WHITE SALMON, WA 98672 (509)493-2133 Klickitat 503836 * NORTHSHORE MEDICAL GROUP 875 SW ROCK CREEK DRIVE STEVENSON, WA 98648 (509)427-4212 Skamania 503915 * NORTHWEST PEDIATRIC CENTER 18313 PAULSON STREET SW ROCHESTER, WA 98579 (360)273-1150 Thurston 503899 * NORTHWEST PEDIATRIC CENTER 193 S MARKET BLVD CHEHALIS, WA 98532 (360)748-3366 Lewis INC PS

* = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 4 of 5 Washington

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 503888 * NW PEDIATRIC CENTER INC PS 1911 COOKS HILL ROAD CENTRALIA, WA 98531 (360)736-6778 Lewis 508555 * OCEAN BEACH HOSPITAL & CLINICS 167 1ST AVENUE NORTH, PO BOX N ILWACO, WA 98624 (360)642-6300 Pacific WOMENS HEALTH CTR 503988 * OCEAN BEACH MEDICAL CLINIC 176 FIRST AVENUE NORTH, PO BOX N ILWACO, WA 98624 (360)642-3747 Pacific 508501 * ODESSA MEMORIAL HEALTHCARE 510 E AMENDE DRIVE ODESSA, WA 99159 (509)982-2611 Lincoln CENTER 503906 * ORCAS FAMILY HEALTH CENTER 1286 MT BAKER ROAD #B 102 EASTSOUND, WA 98245 (360)376-7778 San Juan 508558 * ORCAS MEDICAL CENTER PLLC 7 DEYE LANE EASTSOUND, WA 98245 (360)376-2561 San Juan 508562 * PACIFIC FAMILY HEALTH CENTER 826 ALDER STREET SOUTH BEND, WA 98586 (360)875-5579 Pacific 503883 * PALOUSE HEALTH CENTER 235 E MAIN STREET PALOUSE, WA 99161 (509)878-8000 Whitman 503922 * PALOUSE PEDIATRICS, PULLMAN 1205 SE PROFESSIONAL MALL BLVD PULLMAN, WA 99163 (509)332-2605 Whitman 503837 * PE ELL HEALTH CLINIC 402 NORTH MAIN STREET PE ELL, WA 98572 (360)291-3232 Lewis 503924 * PEDIATRIC ASSOICATES OF 275 SE CABOT DRIVE OAK HARBOR, WA 98277 (360)675-5555 Island WHIDBEY ISLAND 503876 * PENINSULA CHILDRENS CLINIC INC 902 E CAROLINE PORT ANGELES, WA 98362 (360)457-8578 Clallam 503982 * POMEROY MEDICAL CLINIC 446 PATAHA POMEROY, WA 99347 (509)843-1491 Garfield 503860 * PROVIDENCE NORTHEAST 840 S MEYERS STREET KETTLE FALLS, WA 99141 (509)685-7848 Stevens WASHINGTON MEDICAL GROUP 503865 * PROVIDENCE NORTHEAST 1200 EAST COLUMBIA COLVILLE, WA 99114 (509)684-3701 Stevens WASHINGTON MEDICAL GROUP 503976 * QUINCY VALLEY CLINIC 908 TENTH AVENUE SW QUINCY, WA 98848 (509)787-3531 Grant 508511 * RANDLE CLINIC 108 KINDLE ROAD RANDLE, WA 98377 (360)497-3333 Lewis 508528 * REARDAN HEALTH CLINIC E 550 E BROADWAY REARDAN, WA 99029 (509)796-2737 Spokane 508522 * REPUBLIC MEDICAL CLINIC 10 ROS CIRCLE REPUBLIC, WA 99166 (509)775-3153 Ferry 508557 * RIFFE MEDICAL CENTER 745 WILLIAMS STREET MOSSYROCK, WA 98564 (360)983-8990 Lewis 503983 * RITZVILLE MEDICAL CLINIC 903 SOUTH ADAMS RITZVILLE, WA 99169 (509)659-1200 Adams 503839 * ROCHESTER FAMILY MED CLINIC 18313 PAULSON SW ROCHESTER, WA 98579 (360)273-8818 Thurston 508536 * SAMARITAN CLINIC 1550 S PIONEER WAY MOSES LAKE, WA 98837 (509)766-4185 Grant 508559 * SAMARITAN PARKVIEW PEDIATRICS 615 SOUTH DIVISION MOSES LAKE, WA 98837 (509)766-9450 Grant 503909 * SAN JUAN HEALTHCARE 689 AIRPORT CENTER STE B FRIDAY HARBOR, WA 98250 (360)378-1338 San Juan 503997 * SOUTH COUNTY MEDICAL CLINIC 294843 HIGHWAY 101 QUILCENE, WA 98376 (360)765-3111 Jefferson 503901 * STECK MEDICAL CENTER 1299 BISHOP ROAD CHEHALIS, WA 98532 (360)748-0211 Lewis 508570 * SUNNYSIDE COMMUNITY HOSPITAL 355 CHARDONNAY AVE PROSSER, WA 99350 (509)781-6366 Benton AND CLINIC * = Non-Deemed CASPER Report 0006D Run Date: 05/24/2017 Name and Address Listing Job # 57880641 For Rural Health Clinic Last Update: 05/23/2017 Based on Current Survey Page 5 of 5 Washington

CCN Key Provider Name Address City, State and ZIP Telephone # County Name 508547 * SUNNYSIDE PEDIATRICS 812 MILLER AVENUE, SUITE C SUNNYSIDE, WA 98944 (509)837-7551 Yakima 503908 * SWOFFORD & HALMA CLINIC INC PS 2303 REITH WAY SUNNYSIDE, WA 98944 (509)837-3933 Yakima 503857 * TENINO FAMILY PRACTICE 273 EAST SUSSEX TENINO, WA 98589 (360)264-5665 Thurston 503921 * THE HOQUIAM CLINIC 815 K STREET HOQUIAM, WA 98550 (360)553-2734 Grays Harbor 503809 * TULALIP HEALTH CLINIC 7520 TOTEM BEACH ROAD TULALIP, WA 98271 (360)651-4511 Snohomish 508546 * VALLEY INTERNAL MEDICINE 2925 ALLEN RD SUNNYSIDE, WA 98944 (509)837-4949 Yakima 508563 * VALLEY REGIONAL RHC V 2705 E LINCOLN AVE SUNNYSIDE, WA 98944 (509)836-4848 Yakima 503978 * WAITSBURG CLINIC 111 PRESTON AVENUE WAITSBURG, WA 99361 (509)337-6311 Walla Walla 503846 * WALLA WALLA CLINIC 55 WEST TIETAN WALLA WALLA, WA 99362 (509)525-3720 Walla Walla 508542 * WASHTUCNA MEDICAL CLINIC 545 SE CHURCH ST WASHTUCNA, WA 99371 (509)646-3290 Adams 503923 * WEAVER FAMILY MEDICINE 2935 ALLEN RD SUNNYSIDE, WA 98944 (509)837-0070 Yakima 508506 * WHIDBEYHEALTH PRIMARY CARE- 11245 STATE ROUTE 525 CLINTON, WA 98236 (360)341-5252 Island CLINTON 503996 * WHIDBEYHEALTH PRIMARY CARE- 1300 NE GOLDIE STREET OAK HARBOR, WA 98277 (360)679-5590 Island GOLDIE ST 508530 * WILBUR CLINIC 109 MAIN STREET WILBUR, WA 99185 (509)647-5321 Lincoln Total Providers for this State = 118

* = Non-Deemed