Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 1 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts Tulsa Tulsa, OK74132-1823 [email protected] Excl. Body Parts/Svcs: Contact: Jan None Phone: (918) 513-3226 Fax: (918) 447-9308 American Board of Anesthesiology T Anesthesiology Emad Attallah-Wasif, M.D. 2811 E 15th Street Suite 102 pain management Tulsa Tulsa, OK74104 Contact: Christina Phone: (918) 935-3240 Fax: ( ) - American Board of Anesthesiology T Anesthesiology Blake Christensen, D.O. 14100 Parkway Commons Dr Suite 100 All, intervential pain management Oklahoma City Oklahoma City, OK73134 Excl. Body Parts/Svcs: Contact: Jeniffer Heart, Kidneys, Liver, Lungs, GI Phone: (405) 286-9820 Fax: ( ) - Certification Unknown T R MITF Anesthesiology David P. Ellis, M.D. 701 NE 10 Street pain management/interventional pain Oklahoma City Oklahoma City, OK73104 medicine/spinal cord stimulators [email protected] Contact: Betty Excl. Body Parts/Svcs: Phone: (405) 232-8003 Fax: (405) 232-8008 headache American Board of Anesthesiology - Pain Medicine T R MITF * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 2 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology Frank J. Hackl, M.D. 9709 E 79th Street South Pain Management Tulsa Tulsa, OK74133 Contact: Angie Phone: (918) 994-4068 Fax: (918) 994-4095 American Board of Anesthesiology - Pain Medicine T Anesthesiology Gerald R. Hale, D.O. 2448 E 81 Ste 363 pain management Tulsa Tulsa, OK74137 Excl. Body Parts/Svcs: Contact: Brenda all except pain management cases Phone: (918) 477-5943 Fax: ( ) - American Osteopathic Board of Anesthesiology & Pain Management T Anesthesiology Daniel G. Morris, D.O.* 4110 S 100th East Ave Suite 201 Pain Management Only Tulsa Tulsa, OK74146 [email protected] Contact: scheduling Phone: (918) 857-7246 Fax: (918) 359-5828 American Osteopathic Board of Anesthesiology-Pain Management T * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 3 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology John W. Nelson, M.D. 3535 NW 58 Street Ste 950E all pain management Oklahoma City Oklahoma City, OK73112 [email protected] Excl. Body Parts/Svcs: Contact: Stephanie none Phone: (405) 702-8623 Fax: (405) 702-8628 American Board of Anesthesiology/Internal Med. T Anesthesiology Michael Chad Owens, D.O. 427 E Cherokee Interventional Pain Management Enid Enid, OK73701 (total body) [email protected] Contact: Barbara Excl. Body Parts/Svcs: Phone: (580) 234-7246 Fax: ( ) - none American Board of Anesthesiology T Anesthesiology Jayen H. Patel, M.D. 2811 E 15 Street Ste 102 pain management, neck, back, Tulsa Tulsa, OK 7410-4 extremities, nervous system, [email protected] headache, joints, fractures Contact: appt desk Phone: (918) 935-3240 Fax: (918) 935-3241 Excl. Body Parts/Svcs: PTSD, psychological trauma American Board of Anesthesiology T R MITF * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 4 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology Terrell R. Phillips, D.O. 401 SW 80 Street Ste 200 Pain Management Oklahoma City Oklahoma City, OK73139 [email protected] Excl. Body Parts/Svcs: Contact: Tammy none within specialty Phone: (405) 601-4227 Fax: (405) 601-4237 American Osteopathic Board of Anesthesiology T R MITF Anesthesiology Justin Porter, M.D. 3601 NW 138 Street Ste 200 Pain Management - head, neck,back Oklahoma City Oklahoma City, OK73134 [email protected] Excl. Body Parts/Svcs: Contact: Neile pelvic pain, vaginal pain, rectal Phone: (405) 242-4100 Fax: (405) 775-9356 pain Certification Unknown T Anesthesiology Andreas "Andrew" Revelis, M.D. 2000 S Wheeling Ave Ste 600 pain management Tulsa Tulsa, OK74104 [email protected] Excl. Body Parts/Svcs: Contact: Pat None Phone: (918) 742-7030 Fax: (918) 742-9958 Certification Unknown T * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 5 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology Hugo S. Salguero, M.D. 9320 South Mingo Road Anesthesia/pain management Tulsa Tulsa, OK74133 asalguero@advanced paintulsa.com Excl. Body Parts/Svcs: Contact: scheduling none Phone: (918) 879-1700 Fax: (918) 879-1701 Am Board of Anesthesiology - Pain Management T Anesthesiology Adam J. Wallace, M.D. 6802 S Olympia Ave Ste 100 pain management Tulsa Tulsa, OK74132 [email protected] Excl. Body Parts/Svcs: Contact: Angelia, Julie none Phone: (918) 447-9300 Fax: (918) 447-9308 Certification Unknown T Anesthesiology Kalvin L. White, D.O. 6802 S Olympia Avenue Ste 100 Pain Management Only Tulsa Tulsa, OK74132-1823 [email protected] Contact: Angelia Phone: (918) 513-3231 Fax: (918) 447-9308 Am Board of Anesiology T Anesthesiology Traci L. White, M.D. 6802 S Olympia Avenue Ste 100 Pain Management Only Tulsa Tulsa, OK73132-1923 Contact: Buffy Phone: (918) 513-3225 Fax: (918) 447-9308 American Board of Anesthesiology/Pain Medicine T * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 6 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Chiropractic Michael A. Chiaffitelli, D.C. 10001 S Penn Bldg P Ste 170 all chiropractics - spine Oklahoma City Oklahoma City, OK73159 Excl. Body Parts/Svcs: Contact: Alisha all but spine Phone: (405) 681-2273 Fax: (405) 681-2274 Certification Unknown T R Chiropractic Seyoung Kim, D.C. 5583 NW Expressway spine (neck, back), hand Oklahoma City Oklahoma City, OK73132 Excl. Body Parts/Svcs: Contact: Jennifer None Phone: (405) 773-3131 Fax: (405) 773-4267 Certification Unknown T Chiropractic Hugh G. McClure, D.C. 401 Vandament Ave Ste 102 whole body Yukon Yukon, OK73099 [email protected] Excl. Body Parts/Svcs: Contact: Amy None Phone: (405) 350-7283 Fax: (405) 354-7802 Certification Unknown R MITF Chiropractic C. Keith Muse, D.C. 6825 S Western Ave neuromusculoskeletal Oklahoma City Oklahoma City, OK73139 Excl. Body Parts/Svcs: Contact: Peggy None Phone: (405) 634-1127 Fax: (405) 634-1177 Certification Unknown T R MITF * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 7 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Chiropractic Jim R. Muse, D.C. 6825 S Western Full Body Oklahoma City Oklahoma City, OK73139 Contact: Ann, Peggy Phone: (405) 634-1127 Fax: (405) 634-1177 Certification Unknown T R MITF Chiropractic James Daniel Post, D.C. 4141 NW Expressway Ste 180 all chiropractics-spine Oklahoma City Oklahoma City, OK73116 [email protected] Contact: Rhonda, Cathy Phone: (405) 840-8900 Fax: (405) 840-8990 Certification Unknown T Chiropractic Keith G. Ryan, D.C. 3319 E 46 St Ste 101 back and extremities Tulsa Tulsa, OK74135-2903 [email protected] Excl. Body Parts/Svcs: Contact: Dr. Ryan None Phone: (918) 742-6262 Fax: (918) 742-7152 Certification Unknown T R Chiropractic Troy A. Sturgill, D.C. PO Box 335 musculoskeletal Woodward Woodward, OK73802 Excl. Body Parts/Svcs: Contact: self brain, heart, lungs, vision Phone: (580) 256-1555 Fax: (580) 256-3370 Certification Unknown T R MITF * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 8 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Chiropractic Steve Sweeney, D.C. 211 S. Sooner Rd. Spine, upper and lower extremities Midwest City Midwest City, OK73110 [email protected] Excl. Body Parts/Svcs: Contact: Misty Cardiovascular, Pulmonary, Phone: (405) 672-4800 Fax: ( ) - Digestive Hematopoietic Certification Unknown T R Chiropractic Ronald B. Tripp, D.C. 2400 Tee Circle neck and back Norman Norman, OK73069 [email protected] Excl. Body Parts/Svcs: Contact: Sherri internal medicine Phone: (405) 321-8530 Fax: (405) 321-1478 Certification Unknown T R MITF Chiropractic David B. Waggoner, D.C. 7000 NW Expressway Ste H chiropractic Oklahoma City Oklahoma City, OK73132 [email protected] Excl. Body Parts/Svcs: Contact: Meaghan non-musculoskeletal Phone: (405) 773-1113 Fax: ( ) - Certification Unknown T Dentistry Melvin Burnitt Baker, Jr., D.D.S. 7405 NW 23 St general dentistry Bethany Bethany, OK73008 [email protected] Excl. Body Parts/Svcs: Contact: Stacey None Phone: (405) 787-5266 Fax: (405) 495-5060 Certification Unknown * Physician has multiple specialties. Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 15:52 (Alphabetical by Specialty) Page: 9 As of July 1, 2015 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Dentistry Larry S. Baker, D.D.S. 2616 W I-44 Service Rd mouth: teeth, temporomandibular Oklahoma City Oklahoma City, OK73112 joints Contact: Mary Excl. Body Parts/Svcs: Phone: (405) 943-3575 Fax: ( ) - anything not dentally related Certification Unknown T R MITF Dentistry Steven W.