From: Lydia Shen To: Foster, Tillman Cc: User, OHCA; Davis, Rachel; Roberts, Karen; Capone, Claudio Subject: RE: Annual Group Practice Filing Date: Thursday, March 29, 2018 8:53:48 AM Attachments: image003.png image004.png image005.png Annual Saint Francis Medical Groups Filing - 2017.xlsm Annual Saint Francis Medical Groups Filing - 2017.pdf Good morning, Please find attached the 2017 annual group practice filing for the Saint Francis Medical Groups. If you have any questions about the filings, please let us know. Thank you, Lydia Lydia Shen, MHA Strategic Planner Trinity Health Of New England [email protected] W 860-714-6579 1000 Asylum Avenue Hartford, CT 06105 TrinityHealthOfNE.org | Facebook | Twitter | Instagram From: Foster, Tillman [mailto:[email protected]] Sent: Tuesday, March 27, 2018 11:37 AM To: Lydia Shen <[email protected]> Cc: User, OHCA <[email protected]>; Davis, Rachel <[email protected]>; Roberts, Karen <[email protected]> Subject: [EXTERNAL] Annual Group Practice Filing Warning: This email originated from the Internet! DO NOT CLICK links if the sender is unknown, and NEVER provide your Password. Ms. Shen- I am emailing you in regards to the CY 2017 Saint Francis Medical Groups (SFMG) annual group practice filing, which OHCA has not received but was due on January 15. Attached is the report submitted SFMG from last year. If you have any other questions please do not hesitate to call or email me. Tillman Foster Associate Health Care Analyst Department of Public Health Office of Health Care Access 410 Capitol Avenue MS #13HCA, P.O. Box 340308 Hartford, CT 06134 Phone: (860) 418-7031 Fax: (860) 418-7053 Email: [email protected] NOTICE: This email and/or attachments may contain confidential or proprietary information which may be legally privileged. It is intended only for the named recipient(s). If an addressing or transmission error has misdirected this email, please notify the author by replying to this message. If you are not the named recipient, you are not authorized to use, disclose, distribute, make copies or print this email, and should immediately delete it from your computer system. Saint Francis Hospital and Medical Center has scanned this email and its attachments for malicious content. However, the recipient should check this email and any attachments for the presence of viruses. Saint Francis Hospital and Medical Center and its affiliated entities accepts no liability for any damage caused by any virus transmitted by this email. Medical Practice Data Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report due by December 31st annually Date of Filing --------------------------------------------------------------> Full Legal Name of Entity Reporting ------------------------------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) -------------> Hospital (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 Saint Francis Behavioral Health Group (SFBHG) Professional group practice Owned by the Hospital 2 Saint Francis Emergency Medical Group (SFEMG) Hospital Affiliated 3 Saint Francis Medical Group (SFMG) Professional group practice Owned by the Hospital 4 Saint Francis Care Medical Group (SFCMG) Hospital Affiliated 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 2 of 20 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 -----------------------------------------------------------------> Full Legal Name of Entity Reporting ----------------------------------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) -----------------> Hospital (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 -------------------------------------> Saint Francis Behavioral Health Group (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 Chu, Anita Psychiatry 2 Cohen, Eric Psychiatry 3 Dove, Laura Psychiatry 4 Enciso Chaves, Carlos Psychiatry 5 Frenkel, Yana Psychiatry 6 Gill, Neelu Psychiatry 7 Gonzalez, Alberto Psychiatry 8 Gonzalez, Luis Psychiatry 9 Gonzalez-Restrepo, Alejandro Psychiatry 10 Greenberg, Jonathan Psychiatry 11 Hamdheydari, Ladan Psychiatry 12 Jermin, Ernest Psychiatry 13 Malik, Nayyara Psychiatry 14 Munawar, Muhammad Psychiatry 15 Mushtaq, Yaser Psychiatry 16 Raza, Mahreen Psychiatry 17 Rothschild, Bruce Psychiatry 18 Shamsi, Mohammad Psychiatry 19 Taylor, Laine Psychiatry 20 Yelunina, Larisa Psychiatry 21 Yotova, Malina Psychiatry 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 51 52 53 54 Group Practice Reporting Page 3 of 20 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 -----------------------------------------------------------------> Full Legal Name of Entity Reporting ----------------------------------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) -----------------> Hospital (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 -------------------------------------> Saint Francis Behavioral Health Group (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. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 Group Practice Reporting Page 4 of 20 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 -----------------------------------------------------------------> Full Legal Name of Entity Reporting ----------------------------------> Saint Francis Hospital and Medical Center Type of Provider Reporting (see options below) -----------------> Hospital (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 -------------------------------------> Saint Francis Emergency Medical Group (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 Abbatiello, Carol Emergency medicine 2 Apollon, Rebecca Emergency medicine 3 Bankwalla, Arnaz Emergency medicine 4 Bernard, Hannah Emergency medicine 5 Brancato, Raphael Emergency medicine 6 Brody, Richard Emergency medicine 7 Brunell, Thomas Emergency medicine 8 Carolan, Beverly Emergency medicine 9 Casey, Zoe Emergency medicine 10 Curran, Gerard Emergency medicine 11 Dansky, Perry Emergency medicine 12 Fialkovich, John Emergency medicine 13 Fojtik, John Emergency medicine 14 Gelin, Joan Emergency medicine 15 Gilmore, Thomas Emergency medicine 16 Guerrieri, Justus Emergency medicine 17 Hubbard, Natalie Emergency medicine 18 Ibrahim, Danyal Emergency medicine 19 LaPolla, Gary Emergency medicine 20 Leavens, John Emergency medicine 21 Markuszka, Karl Emergency medicine 22 Martin, Jennifer Emergency medicine 23 McAdoo, Douglas Emergency medicine 24 Neulander, Matthew Emergency medicine 25 Parekh, Sachin Emergency medicine 26 Pettini, John Emergency medicine 27 Quinby, Peter Emergency medicine 28 Ryan, Emily Emergency medicine 29 Sanders, William Emergency medicine 30 Schiller, Elizabeth Emergency medicine 31 Smith, Jillian Emergency medicine 32 Spear, Jeffrey Emergency medicine 33 Thomassin, Cassis Emergency medicine 34 Turbiak, Thomas Emergency medicine 35 Ward, Che Emergency medicine 36 Wolf, Charles Emergency medicine 37 Young, Neil Emergency medicine 38 Zucker, Amanda Emergency medicine 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Group Practice Reporting Page 5 of 20 Physician Name Data Physician Name Data Hospitals, Hospital Systems, and Group Practices with 30 or more physicians Written Report