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Hospitals, Hospital Systems, and Group Practices with 30 Or More Physicians Written Report Due by December 31St Annually

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Hospitals, Hospital Systems, and Group Practices with 30 Or More Physicians Written Report Due by December 31St Annually Medical Practice Data Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually Date of Filing --------------------------------------------------------------> Dec. 21, 2015 Full Legal Name of Entity Reporting ------------------------------> Stamford Health Integrated Practices, Inc. Type of Provider Reporting (see options below) -------------> Group Practice (Hospital, Hospital System, Group Practice) (1) (2) (3) (4) Is the Group Practice reported owned Description of the nature of the relationship of the Name of Group Practice being reported or affiliated by the Hospital or Hospital or Hospital System to the Group Practice Line Hospital System? 1 Stamford Health Integrated Practices, Inc. Group Practice is a subsidiary of Stamford Hospital Owned by Stamford Hospital 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Group Practice Reporting Page 1 of 8 Medical Practice Data Physician Name Data Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually Date of Filing -----------------------------------------------------------------> Dec. 21, 2015 Full Legal Name of Entity Reporting ----------------------------------> Stamford Health Integrated Practices, Inc. Type of Provider Reporting (see options below) -----------------> Group Practice (Hospital, Hospital System, Group Practice) If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK" Name of Group Practice -------------------------------------> Stamford Health Integrated Practices, Inc. (1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s) When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 1 Dr. Acosta,Rodrigo Family practice 2 Dr. Alleva,Anthony Internal medicine 3 Dr. Aronow,Elisabeth Obstetrics/gynecology 4 Dr. Asnis,Maria Cecilia C Endocrinology 5 Dr. Babayev, Revekka Nephrology 6 Dr. Barbadimos,Arghiris Physical medicine and rehabilitation 7 Dr. Bendl,Jennifer Family practice 8 Dr. Beger, Eric Rheumatology 9 Dr. Bishop,Jennifer General surgery 10 Dr. Boside, Neil N. Internal medicine 11 Dr. Brown,Eric Y. Nephrology 12 Dr. Caragol,William Radiation oncology 13 Dr. Carbonaro,Salvatore Cardiovascular disease (cardiology) 14 Dr. Chan,Brenda S. Nephrology 15 Dr. Chaudhary,Neeta D General surgery 16 Dr. Cheng,Zandra General surgery 17 Dr. Choi,Joonun Cardiovascular disease (cardiology) 18 Dr. Cipriani,Ralph J. Internal medicine 19 Dr. Ciulla, Melindy Obstetrics/gynecology 20 Dr. Collins,Susan M Internal medicine 21 Dr. Collins-Baine,Amanda C Internal medicine 22 Dr. Costanzo,Joseph Internal medicine 23 Dr. Couture,Carolyn M. Family practice 24 Dr. Cusack,Evelyn Cardiovascular disease (cardiology) 25 Dr. Daunt,Debra A. Internal medicine 26 Dr. De Freese,Marissa A General surgery 27 Dr. Dhruvakumar,Sandhya Cardiac electrophysiology 28 Dr. Di Giovanni,Maria Internal medicine 29 Dr. Dong,Xiang General surgery 30 Dr. D'Onofrio,Gregory Cardiovascular disease (cardiology) 31 Dr. Dorr, James Internal medicine 32 Dr. Douglas, Andrea Neurosurgery 33 Dr. Dowdle,John Orthopedic surgery 34 Dr. Dreyer,Neil P. Internal medicine 35 Dr. Dwyer,Kevin General surgery 36 Dr. Ebright, Deena Family practice 37 Dr. Ebright, Michael Thoracic surgery 38 Dr. Feliciano,Edward Orthopedic surgery 39 Dr. Fennell,Gail Internal medicine 40 Dr. Forman Rose,Robin Internal medicine 41 Dr. Freitas,Marilee Colorectal surgery (proctology) 42 Dr. Fucigna,Carol Obstetrics/gynecology 43 Dr. Gallop,Vernetta D. Internal medicine 44 Dr. Gallousis,Stephen Obstetrics/gynecology 45 Dr. Goldstein,Melissa K Endocrinology 46 Dr. Gordon,Laurie A. Internal medicine 47 Dr. Green,Jeffrey Cardiovascular disease (cardiology) 48 Dr. Gruen,David Radiation oncology 49 Dr. Herbert,Joshua B Internal medicine 50 Dr. Hines,Brian J. Urology 51 Dr. Hines,William H. Nephrology Group Practice Reporting Page 2 of 8 Physician Name Data Physician Name Data Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually Date of Filing -----------------------------------------------------------------> Dec. 21, 2015 Full Legal Name of Entity Reporting ----------------------------------> Stamford Health Integrated Practices, Inc. Type of Provider Reporting (see options below) -----------------> Group Practice (Hospital, Hospital System, Group Practice) If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK" Name of Group Practice -------------------------------------> Stamford Health Integrated Practices, Inc. (1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s) When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 52 Dr. Hsi, David Cardiovascular disease (cardiology) 53 Dr. Israel,Shara P. Internal medicine 54 Dr. Jamrozik, Anna Family practice 55 Dr. Juriga, Matthew Podiatry 56 Dr. Kane-Brook,Mary M. Internal medicine 57 Dr. Kernagis,Lily Y. Radiation oncology 58 Dr. King, Valencia Radiation oncology 59 Dr. Kung,Eric Neurology 60 Dr. Kurian,Lisa Internal medicine 61 Dr. Latimer,Clarke Family practice 62 Dr. Leibowitz,Lawrence Family practice 63 Dr. Lindberg,Robert A. Internal medicine 64 Dr. Littlejohn,Charles E. Colorectal surgery (proctology) 65 Dr. Mallozzi,Angelo Family practice 66 Dr. McCalley,Stuart Pulmonary disease 67 Dr. Mehta,Shikha Rheumatology 68 Dr. Miller,Kevin General surgery 69 Dr. Miller,Wayne Cardiovascular disease (cardiology) 70 Dr. Miner,Charles Internal medicine 71 Dr. Misra, Bismruta Endocrinology 72 Dr. Morris,Lynn J. Internal medicine 73 Dr. Mulukutla, Sarah Neurosurgery 74 Dr. Neeson,Francis J Cardiovascular disease (cardiology) 75 Dr. Negus,Philip Internal medicine 76 Dr. Olin,Craig Internal medicine 77 Dr. Ostroff,Allison Geriatric medicine 78 Dr. Papa,Joey General surgery 79 Dr. Parnes,Allyson Radiation oncology, Rheumatology 80 Dr. Pass,Helen A. General surgery 81 Dr. Plansky,Robert L. Internal medicine 82 Dr. Popot,Janine Obstetrics/gynecology 83 Dr. Resor,Louise Neurology 84 Dr. Rose, Kamilah Family practice 85 Dr. Rosenberg,Remi Internal medicine 86 Dr. Rosenstein,Charles C. Neurosurgery 87 Dr. Sandhu, Katherine Urology 88 Dr. Schuster,Edward Cardiovascular disease (cardiology) 89 Dr. Shah,Asha K. Infectious disease 90 Dr. Siegel, Brianna Internal medicine 91 Dr. Slutsky,Richard M. Internal medicine 92 Dr. Sparks, Maura Family practice 93 Dr. Stoneburg-Coca,Sara Obstetrics/gynecology 94 Dr. Streett,Linda S. Infectious disease 95 Dr. Troy,Cathrine L. Internal medicine 96 Dr. Tuluca,Inga Internal medicine 97 Dr. Turk,Russell Obstetrics/gynecology 98 Dr. Vadel,Shira B. Internal medicine 99 Dr. VanBeek,Corinne Orthopedic surgery 100 Dr. Vietorisz,Tomas J. Internal medicine 101 Dr. Vinnick,Leonard Internal medicine 102 Dr. Williams, Ann Family practice Group Practice Reporting Page 3 of 8 Physician Name Data Physician Name Data Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually Date of Filing -----------------------------------------------------------------> Dec. 21, 2015 Full Legal Name of Entity Reporting ----------------------------------> Stamford Health Integrated Practices, Inc. Type of Provider Reporting (see options below) -----------------> Group Practice (Hospital, Hospital System, Group Practice) If more than one Group Practice is being reported, please follow the instructions below to add additional tabs. 1 Right click on the the "PhysicianName" tab below 2 Click the "Move or Copy" option 3 Under the heading "Before Sheet:," click on "Business Entity" 4 Click inside the "create a copy" box 5 Click "OK" Name of Group Practice -------------------------------------> Stamford Health Integrated Practices, Inc. (1) (2) (3) Line Physician Name (Last, First) Physician Specialty(s) When user clicks into a cell below, a dropdown box appears allowing the user to enter multiple services. Users must select one service at a time when entering services. 103 Dr. Wong,Andrew C Internal medicine 104 Dr. Xistris,Evangelos Neurology 105 Dr. Yu,Lu Family practice 106 Dr. Zafar,Shahzad Colorectal surgery (proctology) 107 Dr. Zucker,Michael D. Internal medicine 108 Dr. Engel, Murray Neurology, Pediatric medicine 109 Dr. Fryer, Robert Neurology, Pediatric medicine 110 Dr. Stone, Michael General surgery 111 Dr. Madhoun, Maher Internal medicine 112 Dr. Parry, Michael Infectious disease 113 Dr. Corvaya, Nicola Cardiovascular disease (cardiology) Group Practice Reporting Page 4 of 8 Physician Name Data Business Entity Data Hospitals, Hospital Systems and Group Practices with 30 or more physicians Written Report due by December 31st annually Date of Filing ------------------------------------------------------------------------------------------------------------------------>
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