Clear Spring Health HMO Plan Provider Directory
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Clear Spring Health HMO Plan Provider Directory This directory is current as of August 13, 2019. This directory provides a list of Clear Spring Health’s current network providers. This directory is for the Illinois Service Area: Boone, Clinton, Cook, Du Page, Kane, Kankakee, La Salle, Macoupin, Madison, Mc Henry, Ogle, St. Clair, Stephenson, Will and Winnebago county. To access Clear Spring Health’s online provider directory, you can visit www.clearspringhealthcare.com. For any questions about the information contained in this directory, please call our Member Service Department at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. Out-of-network/non-contracted providers are under no obligation to treat Clear Spring Health members, except in emergency situations. Please call our Member Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of- network services. Our plan has people and free interpreter services available to answer questions from disabled and non-English speaking members. We can also give you information in Braille, in large print, or other alternate formats at no cost if you need it. We are required to give you information about the plan’s benefits in a format that is accessible and appropriate for you. To get information from us in a way that works for you, please call Member Services or contact Office for Civil Rights. H5454_0149_M Clear Spring Health has a contract with Medicare to offer HMO and PPO plans. Enrollment in Clear Spring Health depends on contract renewal. 1 Table of Contents Section 1 – Introduction ...............................................................................................................3 What is the service area for Clear Spring Health? ....................................................................5 How do you find Clear Spring Health providers in your area? ...............................................5 Section 2 – List of Network Providers .........................................................................................6 Primary Care Providers (PCPs) ................................................................................................6 Specialists ...............................................................................................................................58 Hospitals ...............................................................................................................................182 Skilled Nursing Facilities (SNFs) ........................................................................................185 Outpatient Mental Health Providers .....................................................................................188 Other Ancillary and Facility Providers ................................................................................189 2 Section 1 – Introduction This directory provides a list of Clear Spring Health’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). You may choose a PCP by selecting a PCP from within the plan Provider Directory and calling Member Services to inform them of the change. The Provider Directory may be downloaded from the plan website at www.clearspringhealthcare.com, or requested from Member Services. Member Services may also check to see if a specific Provider you are requesting is within the network. Please call member Services at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. A PCP should be your first point of contact for undiagnosed health concerns or health problems and routine health care needs. In addition to providing you care, your PCP will help arrange or coordinate the covered services you get as a plan member. This includes your x-rays, laboratory tests, therapies, care from doctors who are specialists, hospital admissions, and follow-up care. Referrals are not required with Clear Spring Health HMO plans, but your PCP should be your primary resource to use when seeking specialist and hospital care and coordination of your medical services. The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory. In cases where out-of-network providers submit a bill directly to you, you should not pay the bill but should submit it to Clear Spring Health for processing and determination of your liability, if any. Please send the bill to the following address: Clear Spring Health: P.O. Box 4048 Scranton, PA 18505 You may get covered emergency medical care whenever you need it from the nearest hospital or provider. You don’t need to get approval first from Clear Spring Health or your doctor. If you have an emergency, Clear Spring Health will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. 3 After the emergency is over, you are entitled to follow-up care to be sure your condition continues to be stable. Your follow up care will be covered by our plan. You must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Clear Spring Health will be responsible for the costs. 4 What is the service area for Clear Spring Health? The counties in our service area are listed below. Illinois Service Area: Boone, Clinton, Cook, Du Page, Kane, Kankakee, La Salle, Macoupin, Madison, Mc Henry, Ogle, St Clair, Stephenson, Will and Winnebago county. How do you find Clear Spring Health providers in your area? The Clear Spring Health Provider Directory contains participating providers within our service area. There are provider sections in the directory, such as participating hospitals and specialists, where we list facilities and providers within our service area to provide you with comprehensive network information. There is also an alphabetical index of our network providers in the back of the directory for your convenience. If you have questions about Clear Spring Health or require assistance in selecting a PCP, please call our Member Service Department at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. You can also visit www.clearspringhealthcare.com. 5 Primary Care Providers Boone Cook (PCPs) Belvidere Alsip Illinois Phoenix MD, James Dalal MD, Ankita Family Nurse Practitioner 1747 Henry Luckow Lane 12246 S Pulaski Road Belvidere, IL 61008 Alsip, IL 60803 Winnebago 815-971-3030 708-385-5601 Rockford Ulmer DO, Meredith Khan MD, Humaira Bosennebagoo NP, Andrea 1747 Henry Luckow Lane 12246 S Pulaski Road Belvidere, IL 61008 Alsip, IL 60803 2300 N Rockton Avenue 815-971-3030 708-385-5601 Rockford, IL 61103 815-971-2000 Belvidier Townsend-Scott MD, Kimberly 12246 S Pulaski Road Dinges NP, Jennifer Giamalva MD, Andrea Alsip, IL 60803 2300 N Rockton Avenue 1700 Henry Luckow Lane 708-385-5601 Rockford, IL 61103 Belvidier, IL 61008 815-971-2000 779-696-8650 Arlington Heights Thompson NP, Beth Simmons MD, Mary Edwards MD, Elena 2300 N Rockton Avenue 1700 Henry Luckow Lane 3295 N Arlington Heights Road Rockford, IL 61103 Belvidier, IL 61008 Arlington Heights, IL 60004 815-971-3200 779-696-8650 847-392-7400 Family Nurse Practitioner Clinton Matsumoto MD, Kojiro 2101 S Arlington Heights Road Winnebago Breese Arlington Heights, IL 60005 Rockford Beaty MD, Timothy 847-952-8910 9401 Holy Cross Lane Barr NP, Jessica Bellwood Breese, IL 62230 2300 N Rockton Avenue 618-526-7271 Erlikh MD, Edward Rockford, IL 61103 456 25th Avenue 815-971-2000 Klostermann MD, Brian Bellwood, IL 60104 9401 Holy Cross Lane Cosennebagoo NP, Donna 708-467-7254 Breese, IL 62230 2300 N Rockton Avenue 618-651-2810 Berwyn Rockford, IL 61103 815-971-2000 McCleary MD, Marc Acosta MD, Yanet 9401 Holy Cross Lane 3100 S Oak Park Avenue Sternhagen NP, DeeAnn Breese, IL 62230 Berwyn, IL 60402 2300 N Rockton Avenue 618-526-7271 708-317-4422 Rockford, IL 61103 815-971-2000 Osborn MD, Jonathan Augustin MD, Joel 9401 Holy Cross Lane 7000 W Cermak Road Family Practice Breese, IL 62230 Berwyn, IL 60402 Bond 618-526-7271 708-484-8090 Greenville St. Clair Baldoceda MD, Blanca 3231 S Euclid Avenue McCleary MD, Marc Dawdy MD, John Berwyn, IL 60402 201 Healthcare Drive 5 Ludwig Drive 708-783-2000 Greenville, IL 62246 St. Clair , IL 62208 618-664-1380 618-397-9000 Barragan MD, Lorena 6447 W Cermak Road Hall DO, Tracy Trenton Berwyn, IL 60402 201 Healthcare Drive Garcia MD, Arnel 773-254-1400 Greenville, IL 62246 409 E Broadway Bass MD, Danielle 618-669-2270 Trenton, IL 62293 3231 S Euclid Avenue 618-224-7366 McCracken MD, Boyd Berwyn, IL 60402 201 Healthcare Drive 708-783-2000 Greenville, IL 62246 618-669-2270 6 Berndt MD, Sheila Janakiram MD, Mithila 7000 W Cermak Road 6840 Windsor Avenue 3249 S Oak Park Avenue