Rural Health Clinic - CMS.gov [PDF]

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Maine CCN

Key Provider Name

208502 208523

*

203983

*

208509

*

208522 203835 203992 203993

*

203988

*

203881 203890

*

203889 203994 208501 208504 203825 203975

*

208510

*

208511

*

208507 208521

*

208520 203991 208513 208505

*

*

* * *

*

* * * * *

*

* * *

* = Non-Deemed

ACADIA FAMILY HEALTH CENTER ARNOLD MEMORIAL MEDICAL CENTER ARTHUR JEWELL COMMUNITY HEALTH CENTER CALAIS REGIONAL MEDICAL SERVICES

CORINTH MEDICAL ASSOCIATES DEXTER FAMILY HEALTH DEXTER INTERNAL MEDICINE DOVER-FOXCROFT FAMILY PRACTICE ELSEMORE-DIXFIELD FAMILY MEDICINE FAMILY MEDICINE FAMILY PLANNING ASSOCIATION OF MAINE INC FULL CIRCLE HEALTH CARE, LLC GUILFORD MEDICAL ASSOCIATES HOULTON FAMILY PRACTICE INLAND FAMILY CARE - UNITY ISLESBORO HEALTH CENTER LMP FAMILY CARE CENTER

Page 1 of 2

Address

City, State and ZIP

Telephone # County Name

460 MAIN STREET SUITE 104 70 SNARE CREEK ROAD

MADAWASKA, ME 04756 JONESPORT, ME 04649

(207)728-6359 Aroostook (207)255-3356 Washington

55 REYNOLDS RD

BROOKS, ME 04921

(207)338-2500 Waldo

37 PALMER STREET, SUITE 3

CALAIS, ME 04619

(207)454-8195 Washington

492 MAIN STREET 51 HIGH STREET SUITE A 41 HIGH ST 891 W MAIN ST

CORINTH, ME 04427 (207)285-3312 Penobscot DEXTER, ME 04930 (207)924-7349 Penobscot DEXTER, ME 04930 (207)924-5226 Penobscot DOVER FOXCROFT, ME 04426 (207)924-3424 Piscataquis

146 WELD STREET

DIXFIELD, ME 04224

(207)562-4226 Oxford

6 FACTORY RD 147 WALDO AVE

EAST MACHIAS, ME 04630 BELFAST, ME 04915

(207)255-3338 Washington (207)338-3736 Waldo

1063 ALLAGASH RD 3 PARK ST 20 HARTFORD ST 80 MAIN ST 150 MAIN ROAD 19 ST ANDREWS LANE

ALLAGASH, ME 04774 GUILFORD, ME 04443 HOULTON, ME 04730 UNITY, ME 04988 ISLESBORO, ME 04848 BOOTHBAY HARBOR, ME 04538 DAMARISCOTTA, ME 04543

(207)398-1022 Aroostook (207)876-3547 Piscataquis (207)532-3289 Aroostook (207)984-2100 Waldo (207)734-2213 Waldo (207)633-7820 Lincoln

WALDOBORO, ME 04572

(207)832-6394 Lincoln

5 SCHOOL ST 200 SOMERSET STREET, SUITE 3

MILBRIDGE, ME 04658 MILLINOCKET, ME 04462

(207)546-2391 Washington (207)723-5161 Penobscot

200 SOMERSET STREET 135 PARK STREET - PO BOX 7 194 E. MAIN ST. 167 MAIN STREET

MILLINOCKET, ME 04462 MILO, ME 04463 FORT KENT, ME 04743 NORTH ANSON, ME 04958

(207)723-5173 Penobscot (207)943-7752 Piscataquis (207)834-3155 Aroostook (207)635-2330 Somerset

LMP FAMILY MEDICINE 79 SCHOONER STREET DAMARISCOTTA LMP FAMILY MEDICINE WALDOBORO 592 WEST MAIN STREET MILBRIDGE MEDICAL CENTER (RHC) MILLINOCKET FAMILY MEDICINE RHC

MILLINOCKET PRIMARY CARE RHC MILO FAMILY PRACTICE N M M C MEDICAL OFFICE BUILDING NEW HORIZONS HEALTHCARE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

(207)563-4321 Lincoln

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Maine CCN

Key Provider Name *

NEW HORIZONS HEALTHCARE NEWPORT FAMILY PRACTICE * NORTHWOODS HEALTHCARE * OXFORD HILLS FAMILY PRACTICE * PENOBSCOT VALLEY PRIMARY CARE * 208515 RIVER VALLEY INTERNAL MEDICINE * 203839 SEAPORT FAMILY PRACTICE, P A * 208514 SEBASTICOOK VALLEY HEALTH * 208508 SIGRID E TOMPKINS HEALTH CENTER * 208512 STATION HILL MEDICAL OFFICE BUILDING * 203985 STOCKTON SPRINGS REGIONAL HEALTH CENTER * 203989 SWIFT RIVER HEALTH CARE * 208503 VALLEY MEDICAL ASSOCIATION * 208518 WESTERN MAINE FAMILY PRACTICE * 208519 WESTERN MAINE PEDIATRICS Total Providers for this State = 40

208506 203857 203987 208517 208516

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 2

Address

City, State and ZIP

Telephone # County Name

344 LAKEWOOD ROAD 26 MAIN STREET, SUITE 2, PO BOX J PRITHAM AVE 34 WINTER ST 252 ENFIELD RD SUITE 2

MADISON, ME 04950 NEWPORT, ME 04953 GREENVILLE, ME 04441 NORWAY, ME 04268 LINCOLN, ME 04457

(207)474-2994 Somerset (207)368-5747 Penobscot (207)695-2084 Piscataquis (207)743-8031 Oxford (207)794-3321 Penobscot

431 FRANKLIN STREET 41 WIGHT ST 470 SOMERSET AVE 20 HARTFORD STREET

RUMFORD, ME 04276 BELFAST, ME 04915 PITTSFIELD, ME 04967 HOULTON, ME 04730

(207)269-1032 Oxford (207)338-6900 Waldo (207)487-5141 Somerset (207)532-2234 Aroostook

104 EAST MAIN STREET

FORT KENT, ME 04743

(207)834-3101 Aroostook

MILL ROAD PO BOX 309

STOCKTON SPRINGS, ME 04981 RUMFORD, ME 04276 FORT KENT, ME 04743 NORWAY, ME 04268 NORWAY, ME 04268

(207)567-4000 Waldo

430 FRANKLIN ST 194 E MAIN ST 193 MAIN STREET 193 MAIN STREET

(207)369-0146 Oxford (207)834-5877 Aroostook (207)743-9292 Oxford (207)743-8766 Oxford

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Massachusetts CCN

Key Provider Name

* ISLAND HEALTH INC 223800 Total Providers for this State = 1

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

Address

City, State and ZIP

Telephone # County Name

245 VINEYARD HAVEN ROAD

EDGARTOWN, MA 02539

(508)693-5090 Dukes

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey New Hampshire CCN

Key Provider Name

303992 303989

*

303816

*

303984 303978 303988 303990 303814 303987 303991

*

303977

*

*

* * * * * *

ANTRIM MEDICAL GROUP COTTAGE HOSPITAL INTERNAL MEDICINE DARTMOUTH HITCHCOCK PLYMOUTH NEWFOUND FAMILY PRACTICE NEWPORT HEALTH CENTER NORTH COUNTRY PRIMARY CARE PLYMOUTH OB/GYN SACO RIVER MEDICAL GROUP SPEARE PRIMARY CARE WEEKS MEDICAL CENTER

WEEKS MEDICAL CENTER GROVETON * 303975 WEEKS MEDICAL CENTER LANCASTER * 303976 WEEKS MEDICAL CENTER WHITEFIELD * 303980 WESTSIDE HEALTH CARE Total Providers for this State = 14

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

Address

City, State and ZIP

Telephone # County Name

12 ELM ST 79 SWIFTWATER RD, SUITE 2

ANTRIM, NH 03440 WOODSVILLE, NH 03785

(603)588-4200 Hillsboro (603)747-2900 Grafton

71 HIGHLAND STREET

PLYMOUTH, NH 03264

(603)536-3700 Grafton

5 SCHOOL STREET 11 JOHN STARK HIGHWAY 580 ST JOHNSBURY RD 16 HOSPITAL RD 7 GREENWOOD AVENUE 103 BOULDER POINTE DR 43 MAIN STREET

(603)744-5441 Grafton (603)863-4100 Sullivan (603)444-7070 Grafton (603)536-1104 Grafton (603)447-3500 Carroll (603)536-6355 Grafton (603)922-5039 Coos

47 CHURCH STREET

BRISTOL, NH 03222 NEWPORT, NH 03773 LITTLETON, NH 03561 PLYMOUTH, NH 03264 CONWAY, NH 03818 PLYMOUTH, NH 03264 NORTH STRATFORD, NH 03590 GROVETON, NH 03582

170 MIDDLE STREET

LANCASTER, NH 03584

(603)788-2521 Coos

8 CLOVER LANE

WHITEFIELD, NH 03598

(603)837-9005 Coos

15 AIKEN AVE

FRANKLIN, NH 03235

(603)934-4259 Merrimack

(603)788-2521 Coos

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Vermont CCN

Key Provider Name *

COLD HOLLOW FAMILY PRACTICE GRACE COTTAGE FAMILY HEALTH * NORTH COUNTRY OB/GYN SERVICES * 473814 NORTH COUNTRY PEDIATRICS * 473979 NORTH COUNTRY PRIMARY CARE NEWPORT * 473988 NVRH CORNER MEDICAL None 473991 NVRH KINGDOM INTERNAL MEDICINE * 473989 NVRH ST JOHNSBURY PEDIATRICS None NVRH-WOMENS WELLNESS CENTER 473992 * 473827 RYDER BROOK PEDIATRICS * 473987 THE BARTON HEALTH CLINIC Total Providers for this State = 11

473824 473981 473982

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

Address

City, State and ZIP

Telephone # County Name

84 WATER TOWER ROAD 185 GRAFTON RD, PO BOX 216 81 MEDICAL VILLAGE DRIVE SUITE 2

ENOSBURG FALLS, VT 05450 (802)933-6664 Franklin TOWNSHEND, VT 05353 (802)365-4331 Windham NEWPORT, VT 05855 (802)334-4110 Orleans

121 MEDICAL VILLAGE DRIVE 186 MEDICAL VILLAGE DRIVE

NEWPORT, VT 05855 NEWPORT, VT 05855

195 INDUSTRIAL PARKWAY 714 BREEZY HILL ROAD

LYNDONVILLE, VT 05851 (802)748-9501 Caledonia SAINT JOHNSBURY, VT 05819 (802)748-7500 Caledonia

97 SHERMAN DRIVE 1315 HOSPITAL DRIVE PO BOX 608 488 ELM STREET

SAINT JOHNSBURY, VT 05819 SAINT JOHNSBURY, VT 05819 MORRISVILLE, VT 05661 BARTON, VT 05822

(802)334-5929 Orleans (802)334-3522 Orleans

(802)748-5131 Caledonia (802)748-7520 Caledonia (802)888-2448 Lamoille (802)525-3539 Orleans

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey New York CCN

Key Provider Name *

COMMUNITY HEALTH CENTER FAMILY HEALTH CENTER OF CMH HAMILTON * 333834 FAMILY HEALTH CENTER OF CMH MORRISVILLE * 333833 FAMILY HEALTH CENTER OF CMH WATERVILLE

*

333831 GREENVILLE FAMILY HEALTH CARE CENTER * 333803 TRI-COUNTY FAMILY COHOCTON * 333829 TRI-COUNTY FAMILY MEDICINE * 333830 TRI-COUNTY FAMILY MEDICINE PROGRAM * 333808 TRI-COUNTY FAMILY NUNDA Total Providers for this State = 9

333805 333835

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

Address

City, State and ZIP

Telephone # County Name

2 MAIN STREET 164 BROAD STREET

CHERRY VALLEY, NY 13320 HAMILTON, NY 13346

(607)264-3036 Otsego (315)824-8447 Madison

3460 SOUTH STREET

MORRISVILLE, NY 13408

(315)684-9848 Madison

117 WEST MAIN STREET

WATERVILLE, NY 13480

(315)841-4566 Oneida

20 BRYANT'S COUNTRY SQUARE, ROUTE 32 PARK AVENUE 60 RED JACKET STREET 200 NORTH MAIN STREET

GREENVILLE, NY 12083

(518)966-8786 Greene

COHOCTON, NY 14826 DANSVILLE, NY 14437 WAYLAND, NY 14572

(518)384-5310 Steuben (585)335-6041 Livingston (585)728-5131 Steuben

61 NORTH STATE STREET

NUNDA, NY 14517

(585)468-2528 Livingston

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Pennsylvania CCN 393899 393414 393977 393428 393415 393894 393416 393422 393421 393420 393433 393921 393418 393855 393922 393923 393431 393432 393920 393435 393989 393910 393992

Key Provider Name *

AC VALLEY MEDICAL CENTER ALLEGHENY HEALTH CENTER * ARMSTRONG PRIMARY CARE CENTER * ARMSTRONG PRIMARY CARE CENTER - KITTANING * ARMSTRONG PRIMARY CARE CENTER - RURAL VALLEY * ARMSTRONG PRIMARY CARE CENTER SOUTH BETHLEHEM * BOWMAN HEALTH CENTER * BRMC FAMILY PRACTICE * BRMC RURAL HEALTH CLINIC SMETHPORT FAMILY MEDICINE * BRMC RURAL HLTH CLINIC PEDIATRIC ASSOC OF BRADFORD * CAMBRIDGE SPRINGS HEALTH CENTER * CARING HEALTHCARE NETWORK * CENTRAL POTTER HEALTH CENTER * COMMUNITY HEALTH CARE RURAL HEALTH CLINIC * CONEMAUGH HEALTH INITIATIVES RURAL HEALTH CLINIC * CONEMAUGH HEALTH INITIATIVES RURAL HEALTH CLINIC

*

CONNEAUT LAKE HEALTH CENTER * CONNEAUT VALLEY HEALTH CENTER * CORNERSTONE COORDINATED HEALTH CARE LLC None CORRY MEMORIAL HOSPITAL RURAL HEALTH CLINIC * COUDERSPORT FAMILY MEDICINE * CRESSON FAMILY PRACTICE RHC * ELDERTON PRIMARY CARE CENTER *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

855 ROUTE 58 SUITE 1 22 INDUSTRIAL PARK ROAD 116 MAIN STREET

PARKER, PA 16049 BROOKVILLE, PA 15825 LEECHBURG, PA 15656

(724)659-5601 Armstrong (814)849-0990 Jefferson (724)354-5258 Armstrong

260 SOUTH JEFFERSON STREET

KITTANNING, PA 16201

(724)543-5919 Armstrong

10261 STATE ROUTE 85

KITTANNING, PA 16201

(412)783-7124 Armstrong

102 SOUTH STREET

NEW BETHLEHEM, PA 16242 (814)275-2264 Clarion

83 SOUTH MARVIN STREET 116 INTERSTATE PARKWAY, SUITE 41 406 FRANKLIN STREET

SMETHPORT, PA 16749 BRADFORD, PA 16701 SMETHPORT, PA 16749

(814)887-5395 McKean (814)363-9484 McKean (717)999-9999 McKean

116 INTERESTATE PARKWAY 42

BRADFORD, PA 16701

(717)999-9999 McKean

118 RAILROAD STREET

(814)398-4313 Crawford

601 NORTH FRONT STREET 71 ELK STREET 550 W WALNUT STREET

CAMBRIDGE SPRINGS, PA 16403 PHILIPSBURG, PA 16866 COUDERSPORT, PA 16915 SHAMOKIN, PA 17872

1611 W PITT STREET

JENNERSTOWN, PA 15547

(717)999-9999 Somerset

207 WOODSTOWN HIGHWAY

HOLLSOPPLE, PA 15935

(814)479-4034 Somerset

10926 ST HWY 18 906 WASHINGTON STREET

CONNEAUT LAKE, PA 16316 CONNEAUTVILLE, PA 16406

(814)382-0446 Crawford (814)373-2276 Crawford

40 WEST FRACK STREET

FRACKVILLE, PA 17931

(570)794-6123 Schuylkill

300 YORK STREET

CORRY, PA 16407

(814)664-3979 Erie

1001 EAST SECOND STREET SUITE S 225 KEYSTONE AVENUE 116 MAIN STREET BOX 148

COUDERSPORT, PA 16915 CRESSON, PA 16630 ELDERTON, PA 15736

(814)274-9198 Potter (814)886-4635 Cambria (412)354-5258 Armstrong

(814)342-2333 Centre (814)274-5577 Potter (717)644-2222 Northumberland

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Pennsylvania CCN

Key Provider Name

393978 393975 393918

*

393410

*

393409

*

393413

*

393419

*

393407

*

393994 393429

*

393423 393902

*

393893 393873 393884

*

393434

*

393820 393821 393986 393857

*

393886

*

393426 393901

*

* *

*

*

* *

* * *

*

* = Non-Deemed

Address

ELDRED HEALTH CENTER 139 MAIN STREET EMPORIUM HEALTH CENTER 288 SIZERVILLE ROAD FAMILY HEALTH CARE CENTER OF 83 HILLCREST DRIVE, SUITE 200 PUNXSUTAWNEY INC FAMILY HEALTH CARE MEYERSDALE 7160 MASON DIXON HIGHWAY RHC

FAMILY HEALTH CARE SALISBURY 231 ORD STREET RHC FAMILY HEALTH CLINIC OF BARNES 137 DELAWARE STREET KASSON HOSPITAL FAMILY HEALTH CLINIC OF BARNES- 2872 TURNPIKE STREET KASSON

FAMILY HEALTH CLINIC OF BARNES- 401 BROAD AVENUE KASSON HOSPITAL GALETON HEALTH CENTER 30 RIVER STREET HAVEN CENTER FOR WOMEN'S 24 CREE DRIVE THIRD FLOOR HEALTH HAVEN MEDICAL CENTER 208 E CHURCH STREET HIGHLANDS FAMILY MEDICINE 4324 GLADES PIKE RURAL HEALTH CLINIC

HUNTINGDON HEALTHCARE INC 814 WASHINGTON STREET JOHN E BALMER D O CANADOHTA 35255 BROWN HILL ROAD JUNIATA VALLEY MEDICAL CENTER PO BOX 355 846 MEDICAL CENTER INC MEADVILLE COMMUNITY HEALTH 747 TERRACE STREET CENTER MEDICAL ASSOCIATES OF BOSWELL 430 STONYCREEK STREET MEDICAL ASSOCIATES OF BOSWELL 136 PINE STREET BOX 340 MERCER FAMILY MEDICINE CENTER 551 GREENVILLE ROAD MILLER DONMOYER FAMILY HEALTH 255 WEST SPRUCE STREET CENTER MOUNT UNION AREA MEDICAL 100 SOUTH PARK STREET CENTE NATHAN THOMAS PRACTICE 312 INDUSTRIAL PARK ROAD NEW PARIS RURAL HEALTH CLINIC 4186 CORTLAND AVENUE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 4

City, State and ZIP

Telephone # County Name

ELDRED, PA 16731 EMPORIUM, PA 15834 PUNXSUTAWNEY, PA 15767

(814)225-4241 McKean (814)486-0810 Cameron (814)938-3550 Jefferson

MEYERSDALE, PA 15552

(814)634-5935 Somerset

SALISBURY, PA 15558

(814)662-2755 Somerset

NEW MILFORD, PA 18834

(570)465-7330 Susquehanna

SUSQUEHANNA, PA 18847

(717)999-9999 Susquehanna

SUSQUEHANNA, PA 18847

(570)853-3995 Susquehanna

GALETON, PA 16922 LOCK HAVEN, PA 17745

(814)435-2942 Potter (570)893-5043 Clinton

LOCK HAVEN, PA 17745 SOMERSET, PA 15501

(717)999-9999 Clinton (814)445-4585 Somerset

HUNTINGDON, PA 16652 UNION CITY, PA 16438 ALEXANDRIA, PA 16611

(814)643-4415 Huntingdon (814)694-2339 Erie (814)669-4444 Huntingdon

MEADVILLE, PA 16335

(814)373-2976 Crawford

BOSWELL, PA 15531 STOYSTOWN, PA 15563 MERCER, PA 16137 SHAMOKIN, PA 17872

(814)629-5612 Somerset (814)893-5568 Somerset (412)662-4155 Mercer (717)644-5050 Northumberland

MT UNION, PA 17066

(814)542-8627 Huntingdon

MEYERSDALE, PA 15552 NEW PARIS, PA 15554

(814)634-5954 Somerset (814)839-4108 Bedford

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Pennsylvania CCN

Key Provider Name

393983

*

393906 393887

*

393888

*

393430 393424

*

393412

*

393895 393988 393909 393876 393907

*

393889 393984 393877

*

393824

*

393851

*

393408 393411

*

393427

*

393425

*

393437 393436

*

*

*

* * * *

* *

*

*

* = Non-Deemed

NORTHERN POTTER HEALTH CENTER

PEDIATRIC PRACTICES OF NEPA PEDIATRIC PRACTICES OF NORTHEASTERN PENNSYLVANIA PEDIATRIC PRACTICES OF NORTHEASTERN PENNSYLVANIA

PENN HIGHLANDS BROOKVILLE PENN HIGHLANDS BROOKVILLE FAMILY PRACTICE NEW BETH PENN HIGHLANDS BROOKVILLE MARIENVILLE FAMILY PRACT

PINNACLE HEALTH PARTNERS INC PORT ALLEGANY HEALTH CENTER PORTAGE HEALTH CENTER RHC RIMERSBURG MEDICAL CENTER SAINT BENEDICT RURAL HEALTH CENTER SAINT VINCENT MEDICAL GROUP SHINGLEHOUSE HEALTH CENTER SHORE FAMILY HEALTH CARE RURAL SOUTHERN HUNTINGDON COUNTY MED

SPARTANSBURG MEDICAL CENTER

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

Address

City, State and ZIP

Telephone # County Name

511 ACADEMY STREET

ULYSSES, PA 16948

(814)848-7555 Potter

27-B WOODLAND DRIVE 1837 FAIR AVENUE

WAYMART, PA 18472 HONESDALE, PA 18431

(570)488-9550 Wayne (570)253-5838 Wayne

62 INDUSTRIAL PARK ROAD

LAKE ARIEL, PA 18436

(570)689-7565 Wayne

271 RAILROAD STREET 1323 BROOKVILLE STREET

PHILIPSBURG, PA 16866 FAIRMOUNT CITY, PA 16224

(717)999-9999 Centre (814)275-3320 Clarion

125 CHESTNUT STREET PO BOX 463

MARIENVILLE, PA 16239

(814)927-5609 Forest

132 MANLY ROAD 45 PINE STREET 3670 PORTAGE STREET SUITE 105 57 EAST BROAD STREET 564 THEATRE ROAD

TAFTON, PA 18464 PORT ALLEGANY, PA 16743 PORTAGE, PA 15946 RIMERSBURG, PA 16248 CARROLLTOWN, PA 15722

(570)226-2151 Pike (814)642-7205 McKean (814)736-9614 Cambria (814)473-3191 Clarion (814)344-8480 Cambria

315 YORK STREET 129 NORTH PURITAN STREET 82 TOWN RUN ROAD

CORRY, PA 16407 SHINGLEHOUSE, PA 16748 FAIRMOUNT CITY, PA 16224

(814)664-8686 Erie (814)260-9352 Potter (814)275-1600 Clarion

PO BOX 40

ORBISONIA, PA 17243

(814)447-5556 Huntingdon

SPARTANSBURG, PA 16434

(814)654-7334 Crawford

NESQUEHONING, PA 18240 TAMAQUA, PA 18252

(570)669-9787 Carbon (570)668-6111 Schuylkill

HOUTZDALE, PA 16651

(814)497-4297 Clearfield

TYRONE, PA 16686

(814)684-2501 Blair

HUNTINGDON, PA 16652 ALEXANDRIA, PA 16611

(814)643-4415 Huntingdon (814)669-4444 Huntingdon

132 MECHANIC ST SPARTENSBURG MEDICAL CT ST LUKE'S MINERS HEALTH CENTER 108 WEST CATAWISSA STREET ST LUKE'S MINERS HEALTH CENTER 34 S RAILROAD STREET -HOMETOWN

TYRONE HOSPITAL RURAL HEALTH 120 SPRING STREET CARE - HOUTZDALE TYRONE HOSPITAL RURAL HEALTH 221 HOSPITAL DRIVE SUITE 6 CLINIC UPMC HUNTINGDON HEALTHCARE 814 WASHINGTON STREET UPMC HUNTINGDON HEALTHCARE 846 MEDICAL CENTER DRIVE

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Pennsylvania CCN

Key Provider Name *

Address

UPPER ALLEGHENY MEDICAL 1 WILLOW STREET CENTER * 393897 WASHINGTON PHYSICIAN SERVICES 343 EAST ROY FURMAN HIGHWAY SUITE 105 * 393982 WESTFIELD HEALTH CENTER 222 CHURCH STREET Total Providers for this State = 72

393849

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

City, State and ZIP

Telephone # County Name

PORT ALLEGANY, PA 16743

(814)642-9531 McKean

WAYNESBURG, PA 15370

(724)627-8080 Greene

WESTFIELD, PA 16950

(814)367-5971 Tioga

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Virginia CCN

Key Provider Name

493840 493422 493412

*

498915 498914 493418 493420 493419

*

498906 493820 493857 493836

*

493421 498918

*

493843 498917 493866

*

493844

*

493981 493978 493825 493830

*

493415 498901

*

493829 493977

*

* *

* * * *

* * *

*

* *

* * *

*

*

* = Non-Deemed

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 2

City, State and ZIP

Telephone # County Name

ABINGDON FAMILY HEALTH CARE 445 PORTERFIELD HIGHWAY SUITE A ARH PENNINGTON GAP CLINIC 121 STACY DRIVE BATH COMMUNITY PHYSICIANS 106 PARK DRIVE, SUITE C GROUP

BLUEFIELD FAMILY MEDICINE 106 HUFFARD DRIVE BLUEFIELD INTERNAL MEDICINE 2111 COLLEGE AVENUE CARILION CLINIC FAMILY MEDICINE 430 BOXWOOD LANE CARILION CLINIC FAMILY MEDICINE 108 HOUSTON STREET SUITE C CARILION CLINIC INTERNAL 108 HOUSTON STREET, SUITE A MEDICINE CHASE CITY PRIMARY CARE CLINIC 200 EAST FIFTH STREET CLINCH VALLEY PHYSICIANS 1 CLINIC DRIVE, CLAYPOOL HILL COMMUNITY HEALTH CLINIC P C 5705 REDBUD HWY FAMILY HEALTH CARE CENTER 107 HENRY STREET GRETNA FAMILY MEDICINE WASHINGTON 12699 LEE HIGHWAY FRIES COMMUNITY HEALTH CARE 109 CARROLL DRIVE INC GREEVER RURAL HEALTH CLINIC 403 CHILHOWIE STREET PO BOX 346 MARTINSVILLE PEDIATRICS 1109 BROOKDALE STREET, SUITE C MERIT MEDICAL RURAL HEALTH CORNER OF ROUTE 460 AND 624 CLINIC - OAKWOOD MERIT MEDICAL RURAL HEALTH 6719 GOVERNOR GC PEERY HWY CLINIC - RICHLANDS SUITE 3100 MSMG FP GLDE 636 SOUTH MONTE VISTA DRIVE MSMG FP ST PA 16431 WISE STREET OLDE TOWNE MEDICAL CENTER 5249 OLDE TOWNE ROAD PATRICK COUNTY FAMILY 18877 JEB STUART HIGHWAY, PO BOX PRACTICE - STUART 1019 PIONEER FAMILY MEDICAL PO BOX 912 835 WOODLAND DRIVE REGIONAL HEALTH RESOURCES INC 373 CECIL D QUILLEN DRIVE, SUITE 101

ABINGDON, VA 24210 (276)628-3144 Washington PENNINGTON GAP, VA 24277 (276)546-1182 Lee HOT SPRINGS, VA 24445 (540)839-7197 Bath

TRI-STATE CLINIC INC V H PAGE MEM HOSP FAMILY & INTERNAL MEDICINE

1520 SLATE CREEK ROAD 135 MEMORIAL DRIVE

BLUEFIELD, VA 24605 BLUEFIELD, VA 24605 PEARISBURG, VA 24134 LEXINGTON, VA 24450 LEXINGTON, VA 24450

(276)322-5732 Tazewell (276)322-4661 Tazewell (540)921-3636 Giles (540)463-2181 Lexington City (540)463-2181 Lexington City

CHASE CITY, VA 23924 RICHLANDS, VA 24641 HONAKER, VA 24260 GRETNA, VA 24557

(434)372-0900 Mecklenburg (540)964-1267 Tazewell (540)873-6300 Russell (804)656-2224 Pittsylvania

WASHINGTON, VA 22747 FRIES, VA 24330

(540)536-1867 Rappahannock (276)744-3660 Grayson

CHILHOWIE, VA 24319 MARTINSVILLE, VA 24112 OAKWOOD, VA 24631

(276)646-3241 Smyth (276)666-7545 Martinsville City (276)498-3135 Buchanan

RICHLANDS, VA 24641

(276)964-9102 Tazewell

GLADE SPRING, VA 24340 SAINT PAUL, VA 24283 WILLIAMSBURG, VA 23188 STUART, VA 24171

(276)429-5163 Washington (703)762-2300 Wise (757)259-3258 James City (276)694-4466 Patrick

STUART, VA 24171 DUFFIELD, VA 24244

(276)694-6677 Patrick (276)431-1638 Scott

GRUNDY, VA 24614 LURAY, VA 22835

(276)935-6055 Buchanan (540)743-2887 Page

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Virginia CCN 493416

Key Provider Name *

V H PAGE MEM HOSP FAMILY MEDICINE/LURAY * 493411 V H PAGE MEM HOSP FAMILY MEDICINE/SHENANDOAH * 493987 V H PAGE MEM HOSP FAMILY MEDICINE/STANLEY * 493834 VIRGINIA PRIMARY CARE ASSOCIAT Total Providers for this State = 30

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 2

Address

City, State and ZIP

Telephone # County Name

250 MEMORIAL DRIVE, SUITE C

LURAY, VA 22835

(540)843-4624 Page

505 WILLIAMS AVENUE

SHENANDOAH, VA 22849

(540)652-9100 Page

235 MEDICAL DRIVE

STANLEY, VA 22851

(540)778-4259 Page

121 COURTHOUSE LANE

BOWLING GREEN, VA 22427

(804)633-5840 Caroline

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey West Virginia CCN

Key Provider Name

513995 513917 513992

*

513411

*

513889 513400

*

513884 513981 513843 513848 513905 513900 513849 513850 513918

*

513988 513859

*

513897

*

513891 513804 513865 513902

*

513997 513914 513998 513410 513912

*

* *

*

* * * * * * * *

*

* * *

* * * *

* = Non-Deemed

ATHENS MEDICAL CENTER BLUEWELL FAMILY CLINIC BOONE MEMORIAL HOSPITAL, INC RURAL HEALTH CLINIC

BOONE MEMORIAL HOSPITAL, INC RURAL HEALTH CLINIC BRADSHAW MEDICAL RHC BRAXTON COMMUNITY HEALTH CENTER RHC

BRAXTON PRIMARY HEALTH CARE ELK GARDEN CLINIC FAMILY CARE CLINIC FAMILY HEALTH CARE ASSOCIATES FAMILY HEALTHCARE ASSOCIATES FAMILY HEALTHCARE ASSOCIATES FAMILY HEALTHCARE ASSOCIATES FAMILY HEALTHCARE ASSOCIATES FAMILY HEALTHCARE ASSOCIATES WELCH HAMPSHIRE RURAL HEALTH CLINIC HARDY COUNTY MEDICAL SERVICES HARPERS FERRY FAMILY MEDICINE CENTER JANA PETERS DO LOVE MEMORIAL CLINIC MANCHIN CLINIC MANNINGTON PRIMARY CARE OF MON GENERAL HOSPITAL MIDDLE ISLAND HEALTH CLINIC MILLER FAMILY PRACTICE MINNIE HAMILTON HLTH. CARE CTR MORAD/HUGHES HEALTH CLINIC MOUNTAINEER HEALTHCARE PLLC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

Address

City, State and ZIP

Telephone # County Name

401 VERMILLION STREET 154 MAJESTIC PLACE 173 STATE STREET

ATHENS, WV 24712 BLUEFIELD, WV 24701 MADISON, WV 25130

(304)487-7451 Mercer (304)589-4377 Mercer (304)369-1230 Boone

660A SOUTH MAIN STREET

MADISON, WV 25130

(304)369-4250 Boone

BOX 240 MAIN STREET 100 HOYLMAN DRIVE

BRADSHAW, WV 24817 GASSAWAY, WV 26624

(304)967-5034 McDowell (304)364-1093 Braxton

110 MUNICIPAL STREET 48 OAK STREET 197 PLEASANT STREET 113 MAIN AVENUE 113 3RD AVENUE 114 MAIN STREET COOK PARKWAY 205 HOWARD AVENUE 19771 COAL HERITAGE ROAD

BURNSVILLE, WV 26335 ELK GARDEN, WV 26717 HINTON, WV 25951 PINEVILLE, WV 24874 GILBERT, WV 25621 MAN, WV 25635 OCEANA, WV 24870 MULLENS, WV 25882 WELCH, WV 24801

(304)853-2278 Braxton (304)788-3141 Mineral (304)466-2501 Summers (304)732-6611 Wyoming (304)732-6735 Mingo (304)583-0020 Logan (304)682-8238 Wyoming (304)294-4880 Wyoming (304)436-6650 McDowell

329 SUNRISE BLVD 422 SOUTH MAIN STREET

ROMNEY, WV 26757 MOOREFIELD, WV 26836

(304)822-5817 Hampshire (304)538-2331 Hardy

171 TAYLOR STREET

HARPERS FERRY, WV 25425 (304)535-6343 Jefferson

365 COURTHOUSE ROAD 112 KUYKENDALL LANE MAIN STREET 800 EAST MAIN STREET

PRINCETON, WV 24740 MOOREFIELD, WV 26836 FARMINGTON, WV 26571 MANNINGTON, WV 26582

(304)425-3922 Mercer (304)530-7755 Hardy (304)825-6554 Marion (304)986-2996 Marion

200 FAIR STREET 3921 SENECA TRAIL SOUTH 186 HOSPITAL DRIVE 122 PINNELL STREET 1500 TERRACE STREET

MIDDLEBOURNE, WV 26149 PETERSTOWN, WV 24963 GRANTSVILLE, WV 26147 RIPLEY, WV 25271 HINTON, WV 25951

(304)758-5100 Tyler (304)753-9100 Monroe (304)354-9244 Calhoun (304)372-2731 Jackson (304)466-2933 Summers

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey West Virginia CCN

Key Provider Name *

Address

MYERS CLINIC (THE) #3 HEALTH CARE DRIVE NEW MARTINSVILLE HEALTH 150 PADUCAH DRIVE CENTER * 513879 NORTH MARION MEDICAL 118 MARKET STREET ASSOCIATES, PLLC * 513989 PINE GROVE HEALTH CARE RHC 12960 SHORT LINE HIGHWAY * 513415 POCAHONTAS MEMORIAL HOSPITAL RR2 BOX 52W RURAL HEALTH CLINIC * 513414 RIVERSIDE CLINIC 122 ASHFIELD STREET * 513408 ROANE GENERAL MEDICAL 300 HOSPITAL DRIVE ASSOCIATES * 513990 ROANE GENERAL MEDICAL CENTER 200 HOSPITAL DRIVE * 513852 ROMNEY MEDICAL ASSOCIATES 22347 NORTHWESTERN PIKE * 513911 S K SHAMMAA MD INC 623 TEMPLE STREET None SISTERSVILLE GENERAL HOSPITAL 305 CLAY ST 513412 RURAL HEALTH CLINIC None SISTERSVILLE GENERAL MEDICAL 513413 100 FAIR STREET CENTER * 513409 SOUTHERN ROANE MEDICAL CLINIC ONE LIBRARY LANE SUITE 2 * 513991 SUMMERS COUNTY ARH CLINIC TERRACE STREET * 513418 SUMMERS COUNTY ARH FAMILY 197 PLEASANT STREET CARE CLINIC * 513893 SUMMERSVILLE PEDIATRIC, INC 400 FAIRVIEW HEIGHTS ROAD * 513416 SUMMERSVILLE REGIONAL MEDICAL 74 AVENUE B CENTER-RICHWOOD FAMI * 513402 SUMMERSVILLE RURAL HEALTH 400 FAIRVIEW HEIGHTS ROAD CLINIC * 513978 TYGART VALLEY TOTAL CARE 500 MARKET STREET CENTER * 513405 TYGART VALLEY TOTAL CARE EMS BUILDING ROUTE 76 FLEMINGTON * 513417 WALTON MEDICAL CLINIC 94 SCHOOL DRIVE * 513880 WARDENSVILLE MEDICAL SERVICES ROUTE 259, 55 MAIN STREET * 513407 WEBSTER COUNTY MEMORIAL 324 MILLER MOUNTAIN DRIVE HOSPITAL RHC * 513979 WELCH COMMUNITY HOSPITAL RHC 454 MCDOWELL STREET * = Non-Deemed

513873 513987

*

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

City, State and ZIP

Telephone # County Name

PHILIPPI, WV 26416 NEW MARTINSVILLE, WV 26155 MANNINGTON, WV 26582

(304)457-2800 Barbour (304)455-8190 Wetzel

PINE GROVE, WV 26419 BUCKEYE, WV 24924

(304)889-3344 Wetzel (304)799-7400 Pocahontas

PIEDMONT, WV 26750 SPENCER, WV 25276

(304)355-2323 Mineral (304)927-6203 Roane

SPENCER, WV 25276 ROMNEY, WV 26757 HINTON, WV 25951 SISTERSVILLE, WV 26175

(304)927-6822 Roane (304)822-3838 Hampshire (304)466-1243 Summers (304)447-2030 Tyler

MIDDLEBOURNE, WV 26149

(304)447-2038 Tyler

LEFT HAND, WV 25251 HINTON, WV 25951 HINTON, WV 25951

(304)565-3151 Roane (304)466-2905 Summers (304)466-2501 Summers

SUMMERSVILLE, WV 26651 RICHWOOD, WV 26261

(304)872-7063 Nicholas (304)846-4980 Nicholas

SUMMERSVILLE, WV 26651

(304)872-5124 Nicholas

GRAFTON, WV 26354

(304)265-6416 Taylor

FLEMINGTON, WV 26347

(304)739-4867 Taylor

WALTON, WV 25286 WARDENSVILLE, WV 26851 WEBSTER SPRINGS, WV 26288 WELCH, WV 24801

(304)577-6815 Roane (304)874-4012 Hardy (304)847-5682 Webster

(304)986-1750 Marion

(304)436-8461 McDowell

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey West Virginia CCN

Key Provider Name *

WEST VIRGINIA PRIMARY CARE SPECIALISTS * 513907 YUKON MEDICAL CLINIC Total Providers for this State = 53

513919

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

705 WASHINGTON STREET

RAVENSWOOD, WV 26164

(304)868-6000 Jackson

HC 32 BOX 78-A

WAR, WV 24892

(304)875-2302 McDowell

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Alabama CCN

Key Provider Name

013444 013446 013445 013947 013463

*

013888

*

013848

*

013811 013873 018918 013855 013961 013943 018912 013976 013457 013454 013465 013958 013923 013886 013422 013429 013458 018919 013884

*

013967 013846 013856

*

* * * *

* * * * * * * * * * * * * * * * * *

* *

* = Non-Deemed

ACH FAMILY PHYSICIANS ACH MED PLUS ACH PRIMARY CARE ARAB FAMILY HEALTHCARE LLC ATHENS LIMESTONE PEDIATRIC CLINIC BAPTIST HEALTH CENTER BLOUNT & ETOWAH BAPTIST HEALTH CENTER TALLADEG BBH PCN MUNFORD BHC BLOUNT AND ETOWAH BHC JEMISON BHC LINCOLN BHC TALLADEGA FAMILY MEDICINE BHC TALLADEGA PEDIATRICS BHC-TALLADEGA OB/GYN BIBB MEDICAL ASSOCIATES BUTLER PRIMARY CARE CARROLLTON PRIMARY CARE CASTLEBERRY MEDICAL CLINIC CENTRAL PEDIATRICS, INC CHATOM PRIMARY CARE, PC CHEROKEE CLINIC CHOCTAW URGENT CARE CENTER COFFEEVILLE MEDICAL CLINIC COMPLETE FAMILY CARE COVINGTON HEALTHCARE, LLC COVINGTON PEDIATRICS RURAL HEALTH CLINIC CRENSHAW FAMILY CARE CENTER CULLMAN INTERNAL MEDICINE PC DEKALB CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 5

Address

City, State and ZIP

Telephone # County Name

611 LAUREL STREET 406 MEDICAL PARK DRIVE 402 MEDICAL PARK DRIVE 121 GOLFVIEW DRIVE N E 101 FITNESS WAY, SUITE 2100

ATMORE, AL 36502 ATMORE, AL 36502 ATMORE, AL 36502 ARAB, AL 35016 ATHENS, AL 35611

(251)368-8001 Escambia (251)368-6384 Escambia (251)368-7974 Escambia (256)931-3531 Marshall (256)216-9730 Limestone

180 MEDICAL ST

SNEAD, AL 35952

(205)466-7114 Etowah

320 EAST COOSA STREET

TALLADEGA, AL 35160

(256)362-3636 Talladega

48 NORTH CEDARS ROAD 150 GILBREATH DRIVE, SUITE 201 25420 US HIGHWAY 31 NORTH 47344 U S HIGHWAY 78 101 STEPHEN J WHITE MEMORIAL BLVD 722 STONE AVENUE 724 STONE AVENUE 405 BELCHER STREET 138 JONES STREET 289 WILLIAM E HILL DRIVE 1674 CLEVELAND AVE 101 FITNESS WAY, SUITE 1100 653 ST STEPHENS AVENUE 395 NORTHWOOD DRIVE 1404 E PUSHMATAHA STREET 101 PARK CIRCLE 94 MEDICAL CIRCLE 1608A GILMER AVE 614 WEST BYPASS

MUNFORD, AL 36268 ONEONTA, AL 35121 JEMISON, AL 35085 LINCOLN, AL 35096 TALLADEGA, AL 35160 TALLADEGA, AL 35160 TALLADEGA, AL 35160 CENTREVILLE, AL 35042 GEORGIANA, AL 36033 CARROLLTON, AL 35447 CASTLEBERRY, AL 36432 ATHENS, AL 35611 CHATOM, AL 36518 CENTRE, AL 35960 BUTLER, AL 36904 COFFEEVILLE, AL 36524 MOULTON, AL 35650 TALLASSEE, AL 36078 ANDALUSIA, AL 36420

(256)358-4553 Talladega (205)274-8198 Blount (205)668-1616 Chilton (205)763-7848 Talladega (256)362-4000 Talladega (256)362-1725 Talladega (256)362-1410 Talladega (205)926-4694 Bibb (334)376-0078 Butler (205)375-6251 Pickens (251)966-4600 Conecuh (256)233-0712 Limestone (251)847-6262 Washington (256)927-4900 Cherokee (205)459-4488 Choctaw (334)275-3191 Clarke (256)974-9216 Lawrence (334)283-2291 Elmore (334)222-0119 Covington

58 ROY BEALL DRIVE LUVERNE, AL 36049 1890 ALABAMA HIGHWAY 157 SUITE 300 CULLMAN, AL 35058 415 MEDICAL CENTER DRIVE SW FORT PAYNE, AL 35968

(334)335-1212 Crenshaw (256)734-9370 Cullman (256)997-2820 DeKalb

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Alabama CCN 013971 013450 018905 013456 018914 018913 013959 013926 013440 013467 013962 018917 013954 013911 013449 013905 013438 013894 013447 013464 013430 013878 018902 018900 013424 013461

Key Provider Name *

EPEDIATRICS AND FAMILY CARE CLINIC * EVERGREEN PRIMARY CARE * FALKVILLE MEDICAL CLINIC * FAMILY CARE CLINIC * FAMILY CARE FIRST, INC * FAMILY CARE FIRST, INC * FAMILY HEALTH CLINIC OF UNION SPRINGS * FAMILY MEDICAL CLINIC OF JACKSON * FLOMATON MEDICAL CENTER None FMC MEDICAL CLINIC MILLPORT * FORT MITCHELL CLINIC PC * FORT PAYNE PEDIATRICS WATERWORKS * FULTON FAMILY MEDICAL * GRANT FAMILY PRACTICE CLINIC * GREENE COUNTY HOSPITAL PHYSICIANS' CLINIC * GREENVILLE PEDIATRICS * GROVE HILL HEALTH CARE * GUNTERSVILLE FAMILY PRACTICE CLINIC * HALE COUNTY HOSPITAL CLINIC * HEALTH PARTNERS OF GOODWATER * HILL HOSPITAL PHYSICIANS CLINIC * HMC RURAL HEALTH CLINIC None HORIZON HEALTHCARE, LLC None HORIZON MEDICAL CLINIC, LLC * IVY CREEK CLINIC * J PAUL JONES HOSPITAL PINE HILL RURAL HEALTH CLINI

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 5

Address

City, State and ZIP

Telephone # County Name

299 PRAIRIE STREET NORTH

UNION SPRINGS, AL 36089

(334)738-7337 Bullock

98 CRESTVIEW AVENUE 434 EAST PIKE ROAD 826 WEST WASHINGTON STREET 1023 HWY 13 11809 AL HWY 157 SUITE E 309 N PRAIRIE NORTH

EVERGREEN, AL 36401 FALKVILLE, AL 35622 EUFAULA, AL 36027 HALEYVILLE, AL 35565 MOULTON, AL 35650 UNION SPRINGS, AL 36089

(251)578-0278 Conecuh (256)784-2200 Morgan (334)688-7410 Barbour (205)486-5050 Winston (256)905-0340 Lawrence (334)738-2146 Bullock

227 HOSPITAL DRIVE

JACKSON, AL 36545

(251)246-4446 Clarke

174 HIGHWAY 113 13530 HIGHWAY 96 2 GILMORE RD 1359 OLD WATERWORKS ROAD SW

FLOMATON, AL 36441 MILLPORT, AL 35576 FORT MITCHELL, AL 36856 FORT PAYNE, AL 35968

(251)296-2456 Escambia (205)662-3207 Lamar (334)664-1960 Russell (256)997-5900 DeKalb

218 MAIN STREET 5447 MAIN STREET 607 WILSON AVE

FULTON, AL 36446 GRANT, AL 35747 EUTAW, AL 35462

(334)636-4823 Clarke (256)498-5770 Marshall (205)372-1260 Greene

84 LV STABLER DRIVE 295-B SOUTH JACKSON STREET 1241 BLOUNT AVENUE

GREENVILLE, AL 36037 GROVE HILL, AL 36451 GUNTERSVILLE, AL 35976

(334)382-9760 Butler (251)275-3173 Clarke (205)582-6377 Marshall

508 GREENE STREET 1229 S MAIN STREET

GREENSBORO, AL 36744 GOODWATER, AL 35072

(334)624-4442 Hale (256)743-1300 Coosa

724 DERBY DRIVE 2201 NORTH AIRPORT ROAD 205 GRAND AVENUE NW, SUITE A 2343 2ND AVE E 125 CHURCH STREET 3945 BROAD STREET

YORK, AL 36925 JASPER, AL 35502 FORT PAYNE, AL 35967 ONEONTA, AL 35121 GEORGIANA, AL 36033 PINE HILL, AL 36769

(205)392-5263 Sumter (205)221-9351 Walker (256)635-6600 DeKalb (256)796-3083 Blount (334)376-2291 Butler (334)963-2113 Wilcox

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Alabama CCN

Key Provider Name

013452

*

018915 013420 013955

*

013994

*

013401

*

013917 013982

*

013448 013908 013459 013460 013455 013965 018901 013936

*

013963 013851 013466 013468 018924 013415 013969 013462 018920

* *

*

J PAUL JONES HOSPITAL RURAL HEALTH CLINIC KEVIN G KELLY, MD LAKE MARTIN FAMILY MEDICINE LAKESHORE PEDIATRIC RURAL HEALTH CLINIC LAWRENCE RHC, MOULTON/LAWRENCE URGENT CARE CENTER LAWRENCE RURAL HEALTH CLINICCOURTLAND MAINSTREET MEDICAL CLINIC, LLC MARION CLINIC

MCB FAMILY CLINIC MED - ASSIST * MED EXPRESS LITTLEVILLE * MED EXPRESS RED BAY, LLC * MEDEXPRESS FORD CITY * MEDICAL EAST OF DECATUR None MIDWAY MEDICAL CLINIC, LLC * MILLPORT FAMILY PRACTICE CLINIC, LLC

*

MILLRY PEDIATRIC CLINIC, LLC * MORROW CLINICS INC * MOULTON PRIMARY CARE CLINIC * MOUNDVILLE MEDICAL ASSOCIATES * MOUNDVILLE MEDICAL ASSOCIATES * MOUNTAIN VIEW FAMILY MEDICINE * NC HEALTH CARE CLINIC, LLC None NORTH MISS MEDICAL CTR HAMILTON'S PRIMARY CARE CTR * OPELIKA PEDIATRICS & FAMILY CLINIC PC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 5

Address

City, State and ZIP

Telephone # County Name

319 MCWILLIAMS AVE

CAMDEN, AL 36726

(334)682-4224 Wilcox

13150 HWY 43, SUITE 10 301 MARIARDEN RD SUITE D 603 GANDY STREET NE

RUSSELLVILLE, AL 35653 DADEVILLE, AL 36853 RUSSELLVILLE, AL 35653

(256)332-5901 Franklin (205)825-7871 Tallapoosa (256)331-5055 Franklin

10939 ALABAMA HIGHWAY 157

MOULTON, AL 35650

(205)974-3390 Lawrence

350 TENNESSEE STREET P O BOX 320

COURTLAND, AL 35618

(205)637-8033 Lawrence

1508 COGSWELL AVENUE 1768 SO WASHINGTON STREET, HWY 45 SOUTH 31 RAILROAD STREET 3442 US HWY 431 1369A GEORGE WALLACE HWY 221 HOSPITAL ROAD 14490 COUNTY LINE ROAD, SUITE A 2941 POINT MALLARD PARKWAY 111 BROOKLYN ROAD 13530 HIGHWAY 96

PELL CITY, AL 35125 MARION, AL 36756

(205)814-1598 St. Clair (334)683-9085 Perry

LOUISVILLE, AL 36048 ALBERTVILLE, AL 35950 RUSSELLVILLE, AL 35654 RED BAY, AL 35582 MUSCLE SHOALS, AL 35661 DECATUR, AL 35603 HOLLY POND, AL 35083 MILLPORT, AL 35576

(334)266-5110 Barbour (256)593-1234 Marshall (256)331-9700 Franklin (256)356-8907 Franklin (256)661-2078 Colbert (256)432-2822 Morgan (256)796-3084 Cullman (205)662-5784 Lamar

75 FIFTH AVENUE 34867 US HIGHWAY 43 40 MEDICAL CIRCLE 40870 AL HWY 69 STE A 40870 AL HWY 69 STE A 5995 HIGHWAY 72 EAST 68 MARCO DRIVE 1256 MILITARY STREET SOUTH

MILLRY, AL 36558 HACKLEBURG, AL 35564 MOULTON, AL 35650 MOUNDVILLE, AL 35474 MOUNDVILLE, AL 35474 GURLEY, AL 35748 DECATUR, AL 35603 HAMILTON, AL 35570

(251)846-3233 Washington (205)935-3744 Marion (256)974-2131 Lawrence (205)371-4444 Hale (205)371-4444 Hale (256)776-2094 Madison (256)274-4524 Morgan (205)921-6200 Marion

5809 HWY 280E

OPELIKA, AL 36804

(334)275-3059 Lee

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Alabama CCN 018903 013433 013904 013973 013864 013902 018921 013957 018906 018922 013434 013964 018916 013989 018927 013966 013854 018926 013915 018907 013970 013847 018908 018904 013876 013956

Key Provider Name *

PEDIATRIC CARE CENTER OF NORTHEAST ALABAMA TALLADE * PERFECT KIDS AND FAMILY CARE * PHIL CAMPBELL MEDICAL CLINIC * PHYSICIANS CARE OF SWEET WATER, LLC * PISGAH MEDICAL CLINIC * PREFERRED FAMILY HEALTHCARE, LLC * PREMIER FAMILY CARE ARAB LLC * PREMIER FAMILY CARE, LLC None PREMIER MEDICAL CLINIC, LLC * PRIMARY CARE CENTER OF MONROEVILLE * RIVER REGION FAMILY MEDICINE * ROANOKE RURAL HEALTH CLINIC * RURAL PRIMARY CARE SOUTH, INC * RUSH MEDICAL GROUP LIVINGSTON * SOMERVILLE FAMILY MEDICINE * SOUTH ALABAMA MEDICAL CLINIC, LLC * SOUTH DEKALB FAMILY MEDICAL CENTER * SOUTHEAST PEDIATRICS, PC * SOUTHERN FAMILY HEALTH, LLC None SOUTHVIEW MEDICAL CLINIC, LLC * SULLIGENT MEDICAL CLINIC * SYLACAUGA PEDIATRIC CLINIC LLC * TANNER MEDICAL CLINIC * TANNER PRIMARY CARE OF WEDOWEE, INC * THREE NOTCH RURAL HEALTH INC * VALLEY HEAD CLINIC, LLC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 5

Address

City, State and ZIP

Telephone # County Name

200 EAST BATTLE STREET, SUITE B

TALLADEGA, AL 35160

(256)368-9800 Talladega

111 WEST CONECUH STREET 2930 HIGHWAY 237 31431 ALABAMA HIGHWAY 10

UNION SPRINGS, AL 36089 PHIL CAMPBELL, AL 35581 SWEET WATER, AL 36782

(334)738-1500 Bullock (205)993-5642 Franklin (334)994-6300 Marengo

6110 COUNTY ROAD 88 312 SAND MOUNTAIN DRIVE, SE

PISGAH, AL 35765 ALBERTVILLE, AL 35950

(205)451-1250 Jackson (256)878-1053 Marshall

20 SOUTH MAIN STREET 2017 OBRIG AVENUE 506 HARLEY STREET 1075 DREWRY ROAD

ARAB, AL 35016 GUNTERSVILLE, AL 35976 SCOTTSBORO, AL 35768 MONROEVILLE, AL 36460

(256)586-2324 Marshall (256)582-2324 Marshall (256)259-0685 Jackson (251)575-5988 Monroe

41 CAMBRIDGE COURT 1950 MAIN STREET 143 WHITE OAK TRAIL, SUITE 2 1221 WASHINGTON STREET

WETUMPKA, AL 36093 ROANOKE, AL 36274 WARRIOR, AL 35180 LIVINGSTON, AL 35470

(334)567-3309 Elmore (334)863-2311 Randolph (205)543-6668 Jefferson (205)652-9575 Sumter

4166 HIGHWAY 36 E 10075 GRAND BAY WILMER ROAD

SOMERVILLE, AL 35670 GRAND BAY, AL 36541

(256)432-2811 Morgan (251)865-1852 Mobile

15239 AL HIGHWAY 68 W

CROSSVILLE, AL 35962

(256)528-7173 DeKalb

804 CRAWFORD STREET 201 OLD HWY 25 EAST 222 ARKADELPHIA ROAD, NE 1390 WALNUT STREET 115 WEST CLAY STREET 20104 SWANNER BLVD, SUITE C 1030 MAIN STREET SOUTH

TUSKEGEE, AL 36083 COLUMBIANA, AL 35051 HANCEVILLE, AL 35077 SULLIGENT, AL 35586 SYLACAUGA, AL 35150 TANNER, AL 35671 WEDOWEE, AL 36278

(334)724-0550 Macon (205)669-4884 Shelby (256)352-4767 Cullman (205)698-7111 Lamar (256)245-3267 Talladega (256)686-3334 Limestone (256)357-2188 Randolph

835 THREE NOTCH STREET 205 GRAND AVENUE NW STE B

ANDALUSIA, AL 36420 FORT PAYNE, AL 35967

(334)222-8421 Covington (256)635-6600 DeKalb

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Alabama CCN 013960

Key Provider Name *

Address

WETUMPKA FAMILY RURAL HEALTH 815 JACKSON TRACE ROAD CLINIC *

018923 WILMER MEDICAL CLINIC LLC 6353 2ND STREET * 013953 WOODLAND FAMILY HEALTHCARE 76 COUNTY RD 64, SUITE 3 Total Providers for this State = 109

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 5

City, State and ZIP

Telephone # County Name

WETUMPKA, AL 36092

(334)567-2882 Elmore

WILMER, AL 36587 WOODLAND, AL 36280

(251)410-7425 Mobile (256)449-2001 Randolph

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN

Key Provider Name

683800 103911 108997

*

108985 103918 683819

*

683802 103905 103814 103453 103864

*

103944 103941 108922 103920 103451

*

103446

*

103954 103932 108932 103840 108940 108960

*

103868

*

103902 108943 103966

*

* *

* *

* * * *

* * * *

* * * * *

* *

* = Non-Deemed

A WOMAN'S PLACE INC ACORN CLINIC ACUTE CARE PEDIATRICS OF PALM COAST PA ACUTE CARE PEDIATRICS, PA AHMAD TARIQ ISMAIL ALACHUA PEDIATRICS AND PRIMARY CARE ARCHER FAMILY HEATH CARE AVON MEDICAL CENTER AVON PARK PEDIATRICS INC BAKER RURAL HEALTH CLINIC BAPTIST MEDICAL GROUP CENTURY BELLAM MEDICAL CLINIC BEVERLY HILLS MEDICAL CLINIC BIRTH & BEYOND BUSHNELL FAMILY PRACTICE CALHOUN LIBERTY PRIMARY CARE CLINIC CAMPBELLTON-GRACEVILLE HOSPITAL PHYSICIANS OFFICE CHARLES S LI MD CHIEFLAND MEDICAL CENTER LLC CHILDREN'S MEDICAL CENTER CHILDREN'S MEDICAL CENTER CHILDREN'S MEDICAL CENTER CHILDREN'S MEDICAL CENTER ALACHUA CHILDREN'S MEDICAL CENTER LIVE OAK CHILDRENS CLINIC CHIPLEY MEDICAL GROUP CITRA FAMILY HEALTH

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 7

Address

City, State and ZIP

Telephone # County Name

1415 NW 23RD AVENUE 23320 NORTH STATE ROAD 235 397 SW PALM COAST PKWY

CHIEFLAND, FL 32626 BROOKER, FL 32622 PALM COAST, FL 32137

(352)493-9393 Levy (904)485-1133 Bradford (386)447-7337 Flagler

1301 REID ST 110 EAST BYRD STREET 14900 NW 140TH ST

PALATKA, FL 32177 BONIFAY, FL 32425 ALACHUA, FL 32615

(386)328-5437 Putnam (904)547-4799 Holmes (386)418-0004 Alachua

16939 SW 134TH AVE 2398 HARTFORD DR 1571 US HWY 27 N 159 NORTH 3RD STREET 8401 N CENTURY BLVD.

ARCHER, FL 32618 AVON PARK, FL 33825 AVON PARK, FL 33825 MACCLENNY, FL 32063 CENTURY, FL 32535

(352)495-2550 Alachua (813)453-2500 Highlands (863)453-7337 Highlands (904)259-3279 Baker (904)256-5314 Escambia

20021 SW 111TH PL 3737 N LECANTO HWY 1326 SR 100 117 W BELT AVE 20370 NE BURNS AVE

DUNNELLON, FL 34432 BEVERLY HILLS, FL 34465 GRANDIN, FL 32138 BUSHNELL, FL 33513 BLOUNTSTOWN, FL 32424

(352)465-1199 Marion (352)746-1515 Citrus (904)659-2104 Putnam (904)568-1988 Sumter (850)237-3000 Calhoun

5429 COLLEGE DR

GRACEVILLE, FL 32440

(850)263-9350 Jackson

7647 W GULF TO LAKE HWY 1113 NW 23RD AVE 1419 S 6TH ST 798 W DUVAL ST 6704 E MT VERNON STREET 14861 NW HWY 441

CRYSTAL RIVER, FL 34429 CHIEFLAND, FL 32644 MACCLENNY, FL 32063 LAKE CITY, FL 32055 GLEN SAINT MARY, FL 32040 ALACHUA, FL 32615

(352)795-1718 Citrus (904)463-2348 Levy (904)755-2588 Baker (904)364-8050 Columbia (904)299-7420 Baker (386)462-1911 Alachua

1002 11TH ST SW

LIVE OAK, FL 32064

(386)364-8050 Suwannee

1100 N MAIN ST 1376 BRICKYARD RD 17805 US HWY 301 N

BELLE GLADE, FL 33430 CHIPLEY, FL 32428 CITRA, FL 32113

(407)996-8505 Palm Beach (904)638-7910 Washington (352)595-7777 Marion

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN

Key Provider Name

103957

*

108972 108973

*

103897

*

103869

*

683814 103819 103417

*

103922 108987

*

683823 108941

*

103440

*

103441

*

103422 683809 103964 108981 103951 108991 683821

*

103884 103857 103879

*

*

* *

*

*

* * * * * *

* *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 7

Address

City, State and ZIP

Telephone # County Name

CITRUS SPRINGS RURAL HEALTH CLINIC CLARK CLINIC INC CLARK CLINIC, INC

10489 N FLORIDA AVE

CITRUS SPRINGS, FL 34434

(352)489-2486 Citrus

212 S FLORIDA ST 107 W CENTRAL AVE

(352)793-2441 Sumter (352)324-0504 Lake

COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA COMPREHENSIVE PRIMARY CARE COPELAND CLINIC DESOTO MEMORIAL CENTER FOR FAMILY HEALTH DEVEN MEDICAL CENTER DFS WALK-IN CLINIC

810 COMMED BLVD

BUSHNELL, FL 33513 HOWEY IN THE HILLS, FL 34737 ORANGE CITY, FL 32763

1190 N STONE ST

DELAND, FL 32724

(904)738-1792 Volusia

4363 S SUNCOAST BLVD 10820 MARVIN E JONES BLVD 888 N ROBERT AVE

HOMOSASSA, FL 34446 LIVE OAK, FL 32060 ARCADIA, FL 34266

(352)503-2011 Citrus (904)658-5300 Suwannee (941)494-8401 DeSoto

11707 N WILLIAMS ST STE 2 9 W ORANGE AVE

(352)465-1199 Marion (850)951-1800 Walton

DIVAKER PEDIATRICS LLC DOCTORS MEDICAL CENTER OF WALTON COUNTY PA DOCTORS MEMORIAL FAMILY MEDICINE DOCTORS MEMORIAL FAMILY PRACTICE DR JAMES D FORBES FAMILY CARE DYNAMIC HEALTH CENTERS INC DYNAMIC HEALTH CENTERS INC EXCEL PEDIATRICS EXPRESS CARE OF BELLEVIEW EXPRESS CARE OF LEESBURG FAMILY AND AFTER HOURS CARE LLC FAMILY MEDICAL GROUP PA FAMILY MEDICAL GROUP PA FAMILY MEDICAL GROUP PA

6551 NORTH ORANGE BLOSSOM TRL 21 W MAIN AVE 117 SW VIRGINIA CIRCLE

DUNNELLON, FL 34432 DEFUNIAK SPRINGS, FL 32435 MOUNT DORA, FL 32757 DEFUNIAK SPRINGS, FL 32435 MAYO, FL 32066

555 N BYRON BUTLER PARKWAY

PERRY, FL 32347

(850)838-2141 Taylor

500 W SAGAMORE AVE 155 SE 6TH PL 2806 W HWY 90 265 CITRUS TOWER BLVD, SUITE 102 10762 S US HWY 441 2500 CITRUS BLVD 1413 NW 23RD AVENUE

CLEWISTON, FL 33440 LAKE BUTLER, FL 32054 LAKE CITY, FL 32055 CLERMONT, FL 34711 BELLEVIEW, FL 34420 LEESBURG, FL 34748 CHIEFLAND, FL 32626

(941)983-3434 Hendry (352)505-5346 Union (386)438-8391 Columbia (352)394-3929 Lake (352)245-1087 Marion (352)347-5225 Lake (352)493-9393 Levy

3420 US 27 N 105 TOMOKA BLVD. SOUTH 225 US 27 S

SEBRING, FL 33870 LAKE PLACID, FL 33852 LAKE PLACID, FL 33852

(813)385-7077 Highlands (813)465-7010 Highlands (813)699-9977 Highlands

(386)774-1155 Volusia

(407)615-5005 Lake (850)892-2888 Walton (904)294-2475 Lafayette

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN

Key Provider Name

683815

*

103449

*

103448

*

103921 108975

*

103999

*

103411

*

103903

*

683810 103980

*

103856

*

103851

*

108907 103968

*

103445

*

103969 103889 103866

*

103848 103846 103858 103908 103933

*

*

*

*

* *

* * * *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 7

Address

City, State and ZIP

Telephone # County Name

FIRST COAST OBSTETRICS & GYNECOLOGY PA FL HOSP HEARTLAND MED CTR FAMILY PRACTICE CENTER FLORIDA HOSPITAL WAUCHULA PIONEER MEDICAL CENTER FOREST FAMILY HEALTH GARCIA MEDICAL CLINIC LLC

6100 ST JOHNS AVE

PALATKA, FL 32177

(386)325-5699 Putnam

1006 W PLEASANT ST

AVON PARK, FL 33825

(863)453-3121 Highlands

515 CARLTON ST

WAUCHULA, FL 33873

(813)773-6606 Hardee

15932 E HWY 40 411 E NELSON AVE

(904)694-4445 Marion (850)892-4791 Walton

GATEWAY MEDICAL CLINIC CRESTVIEW GATEWAY MEDICAL CLINIC DFS

127 E REDSTONE AVE

SILVER SPRINGS, FL 34488 DEFUNIAK SPRINGS, FL 32433 CRESTVIEW, FL 32539

(904)892-2366 Walton

GRACE HEALTHCARE SOLUTIONS INC GRACE PEDIATRICS PL HEALTHMARK OF WALTON RURAL HEALTH CLINIC INC HEARTLAND PEDIATRIC ASSOCIATES HEARTLAND PEDIATRIC ASSOCIATION OF WAUCHULA HEARTLAND PEDIATRICS OF LAKE P HEARTLAND PEDIATRICS OF LAKE WALES LLC HENDRY REGIONAL CONVENIENT CARE CENTER HERNANDO MEDICAL CENTER HIGH SPRINGS PEDIATRICS LLC INTERNAL MEDICINE ASSOCIATES OF JACKSON HOSPITAL IRA FIALKO DO, PA JACK M MATHENY II MD JAY MEDICAL CENTER KIDS CARE PEDIATRICS PA KIDS HEALTH ALLIANCE PA

7368 STATE RD 15, US 441

DEFUNIAK SPRINGS, FL 32435 PAHOKEE, FL 33476

(386)243-8474 Columbia (904)892-1019 Walton

7215 US HIGHWAY 27 N

LAKE CITY, FL 32055 DEFUNIAK SPRINGS, FL 32435 SEBRING, FL 33870

120 HEARTLAND WAY

WAUCHULA, FL 33873

(813)767-1414 Hardee

344 E ROYAL PALM ST 1354 STATE ROAD 60 E

LAKE PLACID, FL 33852 LAKE WALES, FL 33853

(941)699-1414 Highlands (941)679-8888 Polk

450 S MAIN ST

LABELLE, FL 33935

(863)675-2356 Hendry

2669 N FLORIDA AVE 210 NW 1ST AVE 4318 FIFTH AVENUE

HERNANDO, FL 34442 HIGH SPRINGS, FL 32643 MARIANNA, FL 32446

(352)637-2550 Citrus (386)454-1156 Alachua (904)526-5300 Jackson

6171 W GULF TO LAKE HWY 205 ZEAGLER DRIVE 14088 ALABAMA STREET 6910 OLD WOLF BAY RD 2650 NW 2ND ST

CRYSTAL RIVER, FL 34429 PALATKA, FL 32177 JAY, FL 32565 PALATKA, FL 32177 OCALA, FL 34475

(352)429-2679 Citrus (904)328-6746 Putnam (904)675-4546 Santa Rosa (904)328-7337 Putnam (352)237-5400 Marion

1045 US HWY 331 S

4196 W US HWY 90 4413 US HWY 331 S

(615)377-4522 Okaloosa

(561)958-3484 Palm Beach

(813)452-1818 Highlands

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN 103424 108915 103808 103901 103934 103916 103882 103942 103421 108905 683803 108906 103931 683817 683822 103875 108925 683805 683811 103972 683801 108984 103863 108964

Key Provider Name *

LAKE BUTLER FAMILY & PEDIATRIC CLINIC * LAKE PEDIATRICS P A * LITTLE PINE PEDIATRICS PLLC * LOUIS J RADNOTHY DO PA * MEENA NATHAN MEDICAL CLINIC * MILLA PEDIATRICS RURAL HEALTH CLINIC * MOHAMMAD YUNGUS MD RURAL HEALTH CARE * NATURE COAST FAMILY HEALTH CLINIC * NATURE COAST FAMILY HEALTH SERVICES * NATURE COAST FAMILY MEDICAL CENTER * NATURE COAST MEDICAL GROUP PA * NORTH FLORIDA PEDIATRICS * NORTH FLORIDA PEDIATRICS PA None NORTH FLORIDA PEDIATRICS PA * NORTH FLORIDA PEDIATRICS PA * NORTH FLORIDA PEDIATRICS RHC * OAK HILL MEDICAL * OB & GYN OF NE FL, PA * ORIGINS FAMILY MEDICAL & WEIGHT LOSS CLINIC INC * PALM GLADES RURAL HEALTH ASSOCIATES INC * PANHANDLE FAMILY MEDICINE LLC * PANHANDLE FAMILY MEDICINE PA * PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS PA * PEDIATRIC ASSOCIATES OF LAKELAND

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 7

Address

City, State and ZIP

Telephone # County Name

575 SE 3RD AVE

LAKE BUTLER, FL 32054

(904)496-2323 Union

4880 N HWY 19A 1702 S JEFFERSON ST 390 S CENTRAL AVE 840 S BEA AVE 426 SW COMMERCE DR

MOUNT DORA, FL 32757 PERRY, FL 32348 UMATILLA, FL 32784 INVERNESS, FL 34453 LAKE CITY, FL 32025

(352)383-8111 Alachua (850)973-4195 Taylor (904)669-3175 Lake (352)637-6300 Citrus (904)755-2240 Columbia

404 EAST HIGHWAY 90

BONIFAY, FL 32425

(904)547-4284 Holmes

3400 N LECANTO HWY

BEVERLY HILLS, FL 34465

(352)746-2227 Citrus

125 SW 7TH STREET

WILLISTON, FL 32696

(352)529-0300 Levy

405 N CENTRAL AVE

INVERNESS, FL 34453

(352)341-2400 Citrus

130 SW 7TH ST

WILLISTON, FL 32696

(618)664-9818 Levy

1117 US HWY 41 NW 1859 SW NEWLAND WAY 1101 S OHIO AVE 149 NE 241ST STREET 4316 5TH AVE 185 A US #1, NORTH 700 ZEIGLER DR 194 SW WALL TERRACE

JASPER, FL 32052 LAKE CITY, FL 32025 LIVE OAK, FL 32064 CROSS CITY, FL 32628 MARIANNA, FL 32446 OAK HILL, FL 32759 PALATKA, FL 32177 LAKE CITY, FL 32025

(904)758-0003 Hamilton (904)758-0003 Columbia (386)339-1060 Suwannee (352)498-3337 Dixie (904)526-5437 Jackson (904)345-0003 Volusia (386)530-2380 Putnam (386)719-9227 Columbia

217 W AVE A

BELLE GLADE, FL 33430

(561)753-5563 Palm Beach

310 EAST BYRD AVE STE B 877 3RD ST 1990 N PROSPECT AVE

BONIFAY, FL 32425 CHIPLEY, FL 32428 LECANTO, FL 34461

(314)968-0076 Holmes (850)638-4555 Washington (352)527-6888 Citrus

2140 E EDGEWOOD DR

LAKELAND, FL 33803

(863)669-1212 Polk

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN

Key Provider Name

108966

*

108969 108968

*

108970 108944 103818

*

103801

*

683812 683818 103881 103904

*

103924 108949

*

103429 103854

*

103804 103883 103452

*

103914 103435 103998

*

103887 103952 108947

*

683804

*

*

* *

* * *

*

*

* *

* *

* *

* = Non-Deemed

PEDIATRIC PARTNERS OF WINTER HAVEN PEDIATRICS IN BREVARD PEDIATRICS IN BREVARD MELBOURNE PEDIATRICS IN BREVARD PA PHILIP COLAIZZO MD PA POSITIVE HEALTHCARE MOBILE CLINIC PREMIER MEDICAL PEDIATRICS CLINIC INC PREMIER PEDIATRICS PREMIER PEDIATRICS FOREST PREMIER PEDIATRICS, LLC PRIMARY CARE CENTER OF LIVE OAK PROFESSIONAL PEDIATRICS PUTNAM OBSTETRICS AND GYNECOLOGY QUINCY MEDICAL GROUP RAYPAR, INC DBA TRINITY MEDICAL CENTER RIDGE MANOR MEDICAL CLINIC ROMULO J CAMOGLIANO MD PA SACRED HEART MEDICAL GROUP ON THE GULF SEBRING PEDIATRICS LLC SHANDS LIVE OAK MEDICAL GROUP SHANDS MEDICAL GROUP OF STARKE SHORELINE MEDICAL GROUP SONNIS PEDIATRICS INC SOUTHERN FAMILY HEALTHCARE PA SOUTHERN HEALTH CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 7

Address

City, State and ZIP

Telephone # County Name

550 POPE AVE NW

WINTER HAVEN, FL 33880

(863)293-2144 Polk

134 S WOODS DR 1755 W HIBISCUS BLVD

ROCKLEDGE, FL 32955 MELBOURNE, FL 32901

(321)636-3066 Brevard (321)724-5437 Brevard

699 W COCOA BEACH CSWY 170 S BARFIELD HWY 4300 BAYOU BLVD

COCOA BEACH, FL 32931 PAHOKEE, FL 33476 PENSACOLA, FL 32503

(321)784-5437 Brevard (561)924-5155 Palm Beach (850)470-8071 Escambia

315 E ASH ST

PERRY, FL 32347

(850)838-2121 Taylor

11223 N WILLIAMS 14141 E HWY 40, UNIT B 7960 SW 60TH AVE 1500 OHIO AVE N

DUNNELLON, FL 34432 SILVER SPRINGS, FL 34488 OCALA, FL 34476 LIVE OAK, FL 32064

(352)671-6741 Marion (352)512-0466 Marion (352)671-6741 Marion (386)330-0100 Suwannee

1050 US HWY 27 N 6061 ST JOHNS AVE

CLERMONT, FL 34714 PALATKA, FL 32177

(352)404-8944 Lake (386)325-0826 Putnam

178 LASALLE LEFALL DR 1064 N BROADWAY AVE

QUINCY, FL 32351 BARTOW, FL 33830

(904)875-3600 Gadsden (863)519-9797 Polk

34498 CORTEZ BLVD 1400 US HWY 441 N 55 AVENUE E

RIDGE MANOR, FL 33523 THE VILLAGES, FL 32159 APALACHICOLA, FL 32320

(352)583-4520 Hernando (352)259-3435 Lake (850)370-1000 Franklin

3201 MEDICAL WAY, SUITE #101 1426 CANYON AVE NE 1550 S WATER ST

SEBRING, FL 33870 LIVE OAK, FL 32064 STARKE, FL 32091

(941)382-0770 Highlands (904)362-1809 Suwannee (904)368-2480 Bradford

419 BALTZELL AVENUE 1125 S 6TH AVE 877 3RD ST

PORT SAINT JOE, FL 32456 WACHULA, FL 33873 CHIPLEY, FL 32428

(904)670-8585 Gulf (863)767-1616 Hardee (850)638-4383 Washington

2910 HOSPITAL DRIVE

BONIFAY, FL 32425

(850)547-8158 Holmes

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN

Key Provider Name

108971 108909 103430 683806 108950

*

108999 103855

*

108954

*

108961 108995 103973

*

103409

*

103928 103847 108963

*

683824 108978 103997

*

103428

*

108998 103949

*

103450 108989 103815

*

* * * *

*

* *

* *

* *

*

* *

* = Non-Deemed

ST FRANCIS PRIMARY CARE CLINIC ST VINCENTS PRIMARY CARE STEINHATCHEE FAMILY CENTER SUMTER MEDICAL CENTER SUN N LAKE MEDICAL GROUP SEBRING SUN N LAKE MEDICAL GROUP PA SUNCOAST PRIMARY CARE SPECIALISTS SUNCOAST PRIMARY CARE SPECIALISTS SUNRISE PRIMARY CARE SUNRISE PRIMARY CARE INC SUNSHINE PEDIATRICS OF OCALA PA TALLAHASSEE MEMORIAL FAMILY MEDICINE MONTICELLO TAVARES PEDIATRICS, INC. THE HEALTH CLINIC LLC THE MEDICAL CENTER AT BLOUNTSTOWN THE PEDIATRIC CENTER THREE RIVERS MEDICAL INC TMH PHYSICIAN PARTNERS BLOUNTSTOWN TMH PHYSICIAN PARTNERS WAKULLA TRI COUNTY PRIMARY CARE INC URGENT AND CONVENIENT CARE CENTER VERNON CLINIC VERNON FAMILY HEALTH CENTER WAKULLA URGENT CARE AND DIAGNOSTIC CENTER PLC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 7

Address

City, State and ZIP

Telephone # County Name

720 N BAY ST 3772 W 3RD ST 1209 1ST AVE S 411 N WEST ST 4958 SUN N LAKE BLVD

EUSTIS, FL 32726 HILLIARD, FL 32046 STEINHATCHEE, FL 32359 BUSHNELL, FL 33513 SEBRING, FL 33872

(352)357-3129 Lake (904)845-3574 Nassau (352)498-5888 Taylor (352)508-1125 Sumter (863)386-4711 Highlands

511 W INTERLAKE BLVD 7991 S SUNCOAST BLVD

LAKE PLACID, FL 33852 HOMOSASSA, FL 34446

(863)699-1220 Highlands (352)489-2486 Citrus

3733 E GULF TO LAKE HWY

INVERNESS, FL 34450

(352)746-1588 Citrus

811 N SUMMIT ST 219 N PALM AVENUE 1900 SW 20TH PL

CRESCENT CITY, FL 32112 PALATKA, FL 32177 OCALA, FL 34471

(386)698-2279 Putnam (386)325-8002 Putnam (352)840-5437 Marion

1549 S JEFFERSON ST

MONTICELLO, FL 32344

(904)997-0707 Jefferson

2523 DORA AVENUE 1351 SOUTH BLVD 20454 NE FINLEY AVE

TAVARES, FL 32778 CHIPLEY, FL 32428 BLOUNTSTOWN, FL 32424

(352)394-3929 Lake (904)638-1230 Washington (850)674-2221 Calhoun

927 SOUTHEAST 1ST STREET 208 NW SUWANNEE AVE 17808 NE CHARLEY JOHNS ST

BELLE GLADE, FL 33430 BRANFORD, FL 32008 BLOUNTSTOWN, FL 32424

(561)996-5252 Palm Beach (386)935-1607 Suwannee (904)674-8450 Calhoun

15 COUNCIL MOORE RD

CRAWFORDVILLE, FL 32327

(850)926-7105 Wakulla

306 NE HWY 351 700 SOUTH MAIN ST

CROSS CITY, FL 32628 LA BELLE, FL 33935

(352)498-3372 Dixie (239)325-1310 Hendry

3250 MAIN ST 3027 MAIN ST 41 FELI WAY

VERNON, FL 32462 VERNON, FL 32462 CRAWFORDVILLE, FL 32327

(850)638-1610 Washington (850)535-0703 Washington (850)926-3140 Wakulla

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Florida CCN

Key Provider Name *

WEIRSDALE FAMILY HEALTH CENTER * 103834 WEST FLORIDA MEDICAL ASSOCIATES PA * 108923 WEST FLORIDA MEDICAL ASSOCIATES PA * 103893 WEST FLORIDA MEDICAL ASSOCIATES, PA * 108939 WILLISTON PEDIATRICS PA * 103974 WILLISTON RURAL HEALTH AND WELLNESS CLINIC *

103923 WIMAUMA FAMILY HEALTH CENTER * 683813 WOMEN'S CENTER OF FLORIDA Total Providers for this State = 155 108934

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 7

Address

City, State and ZIP

Telephone # County Name

16400 SOUTH HIGHWAY 25

WEIRSDALE, FL 32195

(352)821-9797 Marion

213 S PINE AVE

INVERNESS, FL 34452

(352)344-5511 Citrus

41 N INGLIS AVE

INGLIS, FL 34449

(352)447-3031 Levy

3775 N LECANTO HWY

BEVERLY HILLS, FL 34465

(352)746-0600 Citrus

223 N MAIN ST 300 NW 1ST AVE

WILLISTON, FL 32696 WILLISTON, FL 32696

(352)529-0477 Levy (352)528-3561 Levy

5121 STATE RD 674 1546 S WATER ST

WIMAUMA, FL 33598 STARKE, FL 32091

(813)633-8489 Hillsborough (904)964-4777 Bradford

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Georgia CCN

Key Provider Name

118520 113400 118544

*

113408

*

118516 118501 118549 118556

*

113474 118538

*

113825

*

113835

*

118535 113460 113422

*

118533

*

118536

*

118534 118528 118555

*

118529 118910 118530

*

113466

*

* *

* * *

*

* *

* *

* *

* = Non-Deemed

APPLING MEDICAL GROUP ARABI HEALTH CARE CLINIC ARCHBOLD PELHAM PRIMARY CARE CLINIC BACON COUNTY COMMUNITY CARE CENTER

BLUE MOUNTAIN FAMILY PRACTICE BROOKS MEDICAL ASSOCIATES BUCHANAN MEDICAL CLINIC BURKE MEDICAL CENTER HEALTH CLINIC CAMILLA PEDIATRIC CENTER CANDLER COUNTY HOSPITAL FAMILY MEDICAL CLINIC CARROLL COUNTY PRIMARY HEALTH CARE CLINIC CARROLL COUNTY PRIMARY HEALTH CARE CLINIC CLINIC AT WALMART, THE COFFEE REGIONAL FIRST CARE COLQUITT REG MEDICAL CENTER PRIMARY CARE CLINIC COMMUNITY MEDICAL ASSOCIATES OF LINCOLNTON

COMMUNITY MEDICAL ASSOCIATES OF WASHINGTON COOK FAMILY WELLNESS CENTER COOK PRIMARY CARE CRISP REGIONAL CONVENIENT CARE DAHLONEGA FAMILY PRACTICE DAHLONEGA PEDIATRICS DAWSON FAMILY PHYSICIANS DMC INTERNAL MEDICINE AND FAMILY HEALTH CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

755 SOUTH MAIN STREET 4110 BEDGOOD AVE 250 BLANTON STREET NE

BAXLEY, GA 31513 ARABI, GA 31712 PELHAM, GA 31779

(912)367-9841 Appling (229)273-0116 Crisp (229)294-2437 Mitchell

204 EAST 15TH STREET

ALMA, GA 31510

(912)632-2952 Bacon

178 A HOSPITAL ROAD 907 NORTH COURT STREET 30 BUCHANAN BYPASS 311 FOURTH STREET

BLAIRSVILLE, GA 30512 QUITMAN, GA 31643 BUCHANAN, GA 30113 WAYNESBORO, GA 30830

(706)745-4191 Union (229)263-4531 Brooks (770)646-8281 Haralson (706)554-5908 Burke

25 PERRY STREET 380 CEDAR STREET

CAMILLA, GA 31730 METTER, GA 30439

(229)336-7472 Mitchell (912)685-5073 Candler

4248 MT. ZION ROAD

MOUNT ZION, GA 30150

(770)836-0103 Carroll

41 WELLINGTON MILL ROAD

WHITESBURG, GA 30185

(770)836-0504 Carroll

2630 HIGHWAY 515 205 SHIRLEY AVE 6 HOSPITAL PARK

BLAIRSVILLE, GA 30512 DOUGLAS, GA 31533 MOULTRIE, GA 31768

(706)493-6860 Union (912)384-1900 Coffee (229)985-3320 Colquitt

116 MAIN STREET

LINCOLNTON, GA 30817

(706)359-4215 Lincoln

212 HOSPITAL DRIVE

WASHINGTON, GA 30673

(706)678-5982 Wilkes

103 E JAMES STREET 308 N PARRISH AVE 216 HOSPITAL DRIVE

ADEL, GA 31620 ADEL, GA 31620 CORDELE, GA 31015

(229)896-3424 Cook (229)896-8134 Cook (229)276-2000 Crisp

59 TIPTON DRIVE 1055 NORTH GROVE STREET 1078 LUMPKIN CAMPGROUND RD SOUTH STE 100 118 NORMAN DORMINY DRIVE

DAHLONEGA, GA 30533 DAHLONEGA, GA 30533 DAWSONVILLE, GA 30534

(706)864-4012 Lumpkin (706)864-6700 Lumpkin (706)265-8439 Dawson

FITZGERALD, GA 31750

(229)424-7263 Ben Hill

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Georgia CCN

Key Provider Name

118911 118542

*

118541

*

118557

*

118540

*

113403

*

118546 118554 118532

*

113863 113862

*

118525 113954 113431 113404 113851

*

118902 113952 113965

*

113968 118537

*

113808 113886 113958

*

*

* *

*

* * * *

* *

*

* *

* = Non-Deemed

DOERUN FAMILY MEDICINE EFFINGHAM FAMILY MEDICINE AT GOSHEN EFFINGHAM FAMILY MEDICINE AT GUYTON EFFINGHAM FAMILY MEDICINE AT RINCON

EFFINGHAM FAMILY MEDICINE AT TWENTY ONE ELLAVILLE PRIMARY MEDICINE CENTER EMANUEL MEDICAL CENTER EMANUEL PEDIATRIC ASSOCIATES EVANS FAMILY CENTERED HEALTHCARE FAMILY PRACTICE & SURGERY FAMILY PRACTICE & SURGERY CENTER FAMILY PRACTICE CLINIC FIROZ PATKA, MD FLINT RIVER RURAL HEALTH CLINIC FLINT RIVER- RHC FRANKLIN PRIMARY HEALTH CARE CLINIC HABIGAILE CRIBE, MD LLC HIAWASSEE FAMILY PRACTICE, PC HINESVILLE FAMILY CARE CENTER KIRK CLINIC, THE LOWER OCONEE RURAL HEALTH CLINIC AT MCRAE MEDICAL ACCESS CLINIC MEDICAL ASSOCIATES MEDICAL CENTER OF ELBERTON, LLP, THE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 4

Address

City, State and ZIP

Telephone # County Name

128 WEST BROAD AVENUE 100 GOSHEN ROAD

DOERUN, GA 31744 RINCON, GA 31326

(229)782-7589 Colquitt (912)754-6451 Effingham

3 HIDDEN CREEK DRIVE

GUYTON, GA 31312

(912)754-6451 Effingham

800 TOWNE PARK DRIVE SUITE 100

RINCON, GA 31326

(912)544-0426 Effingham

1451 HIGHWAY 21 SOUTH

SPRINGFIELD, GA 31329

(912)754-1035 Effingham

72 SOUTH BROAD STREET

ELLAVILLE, GA 31806

(229)937-2602 Schley

114 S. JEFFERSON STREET 115 S RACETRACK ST 501 EAST LONG STREET

SWAINSBORO, GA 30401 SWAINSBORO, GA 30401 CLAXTON, GA 30417

(478)237-7517 Emanuel (478)419-1206 Emanuel (912)739-8001 Evans

120 SPARTA HIGHWAY 446 SPRING STREET

EATONTON, GA 31024 SPARTA, GA 31087

(706)444-6521 Putnam (706)444-6521 Hancock

2383 NORTH THIRD STREET 809 PEACHTREE STREET 502 SUMTER STREET 509 SUMTER ST 1236 FRANKLIN PARKWAY

FOLKSTON, GA 31537 LOUISVILLE, GA 30434 MONTEZUMA, GA 31063 MONTEZUMA, GA 31063 FRANKLIN, GA 30217

(912)496-4839 Charlton (478)625-3743 Jefferson (478)472-8178 Dooly (478)472-3100 Dooly (706)675-8669 Heard

911 PLAZA AVE STE B 56 HOSPITAL STREET 502 EAST GENERAL STEWART WAYS STE A 8 LAUREL COURT 280 WILLOW CREEK LANE

EASTMAN, GA 31023 HIAWASSEE, GA 30546 HINESVILLE, GA 31313

(478)374-5582 Dodge (706)896-2289 Towns (912)368-4169 Liberty

MOULTRIE, GA 31768 MC RAE, GA 31055

(229)891-9016 Colquitt (229)868-4122 Telfair

808 PROFESSIONAL BLVD. 305 JONES AVENUE 109 COLLEGE AVENUE

DALTON, GA 30720 WAYNESBORO, GA 30830 ELBERTON, GA 30635

(706)226-5446 Whitfield (706)554-5147 Burke (706)283-3315 Elbert

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Georgia CCN

Key Provider Name

118519

*

118545

*

113997 113869

*

118912

*

113882

*

118548 118512 118511 118513 118508 118547 113477 113420 113453

*

118543 118509

*

118552 118904 113429 118510 118526 113885

*

113856

*

118909

*

*

* * * * * * * *

*

* * * * *

* = Non-Deemed

MEDICAL GROUP OF MITCHELL COUNTY

MIDDLE GEORGIA PEDIATRICS AT HAWKINSVILLE MILLER COUNTY MEDICAL CENTER MOUNTAIN VALLEY MEDICAL CENTER

NORMAN PARK FAMILY MEDICINE CLINIC NORTH JEFFERSON MEDICAL CENTER OPTIM PRIMARY CARE - DARIEN OPTIM PRIMARY CARE- COBBTOWN OPTIM PRIMARY CARE- GLENNVILLE OPTIM PRIMARY CARE- MILLEN OPTIM PRIMARY CARE- REIDSVILLE OPTIM PRIMARY CARE- SYLVANIA PHOEBE WORTH FAMILY MEDICINE PHYSICIANS' HEALTH GROUP PHYSICIANS' HEALTH GROUPWADLEY PIONEER FAMILY CARE PIONEER FAMILY MEDICAL OF EARLY COUNTY, LLC PORTER FAMILY MEDICAL CLINIC R T STANLEY HEALTH CENTER RANDOLPH MEDICAL ASSOCIATES RANDOLPH MEDICAL ASSOCIATES RAY MEDICAL CLINIC REDDY MEDICAL GROUP- FRANKLIN SPRINGS STREET REDDY MEDICAL GROUP- GENERAL DANIEL AVENUE REDDY URGENT CARE- HARTWELL, LLC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

Address

City, State and ZIP

Telephone # County Name

259 US HIGHWAY 19 NORTH

CAMILLA, GA 31730

(229)336-1949 Mitchell

222 PERRY HIGHWAY BUILDING A SUITE 101 208 N. CUTHBERT STREET 92 BETTY'S CREEK ROAD

HAWKINSVILLE, GA 31036

(478)783-4080 Pulaski

COLQUITT, GA 39837 DILLARD, GA 30537

(229)758-3304 Miller (706)746-6571 Rabun

139 E BROAD

NORMAN PARK, GA 31771

(229)769-3500 Colquitt

406 E. BROAD STREET

WRENS, GA 30833

(706)547-7008 Jefferson

1101 NORTH WAY 36671 HIGHWAY 23 1000B NORTH VETERANS BLVD 961 E WINTHROPE AVENUE 125 MEMORIAL DRIVE 213 MIMS ROAD 1014 WEST FRANKLIN ST 1067 PEACHTREE STREET 162 NORTH MAIN STREET

DARIEN, GA 31305 COBBTOWN, GA 30420 GLENNVILLE, GA 30427 MILLEN, GA 30442 REIDSVILLE, GA 30453 SYLVANIA, GA 30467 SYLVESTER, GA 31791 LOUISVILLE, GA 30434 WADLEY, GA 30477

(423)243-6185 McIntosh (912)684-3692 Tattnall (912)654-1080 Long (478)982-9081 Jenkins (912)557-1000 Tattnall (912)564-7426 Screven (229)776-2965 Worth (478)625-8471 Jefferson (478)252-8900 Jefferson

11168 COLUMBIA STREET 11045 COLUMBIA STREET

BLAKELY, GA 39823 BLAKELY, GA 39823

(229)723-8300 Early (229)723-4313 Early

124 VICTORY DRIVE 110 R.T. STANLEY, SR. PLACE 125 MCDONALD AVE 107 PARK STREET 401 WEST MAIN STREET 132 FRANKLIN SPRINGS STREET

SWAINSBORO, GA 30401 LYONS, GA 30436 CUTHBERT, GA 39840 SHELLMAN, GA 39886 SWAINSBORO, GA 30401 ROYSTON, GA 30662

(478)237-5506 Emanuel (912)526-9355 Toombs (229)732-2181 Randolph (229)679-5579 Randolph (478)289-1150 Emanuel (706)245-7371 Franklin

280 GENERAL DANIEL AVENUE

DANIELSVILLE, GA 30633

(706)795-2211 Madison

138 GIBSON STREET

HARTWELL, GA 30643

(706)247-5450 Hart

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Georgia CCN

Key Provider Name *

RIVERSTONE MD, PC ROBERT E. JENNINGS MEDICAL CLINIC * 118550 SCREVEN COUNTY FAMILY HEALTH CENTER * 118906 SJC MEDICAL GROUP INC * 118522 SOUTH GEORGIA MEDICAL ASSOCIATES * 113948 SOUTHCARE MEDICAL CENTER * 113841 ST. JOSEPH'S/CANDLER MEDICAL GROUP * 118551 SWAINSBORO INTERNAL MED CLINIC * 118504 TALLAPOOSA FAMILY HEALTHCARE * 118900 TANNER FAMILY HEALTHCARE OF FRANKLIN

*

113960 THOMSON PEDIATRICS & INTERNAL MEDICINE * 118505 TMC HARALSON FAMILY HEALTHCARE CENTER * 118553 TWIN CITY FAMILY MEDICAL CLINIC * 118539 VALLEY MEDICAL CENTER * 113998 WARWICK HEALTH CARE CLINIC * 113890 WEST CARROLL FAMILY HEALTH CARE CTR

*

113498 WRENS PHYSICIANS' HEALTH GROUP Total Providers for this State = 90

113858 113497

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

Address

City, State and ZIP

Telephone # County Name

101 RIVERSTONE VISTA SUITE 205 103 R.E. JENNINGS AVENUE,

BLUE RIDGE, GA 30513 ARLINGTON, GA 39813

(706)632-4400 Fannin (229)725-4251 Calhoun

105 ROCKY FORD RD

SYLVANIA, GA 30467

(912)564-7133 Screven

10 DOCTORS STREET 105 EAST TOLLISON STREET, STE B

METTER, GA 30439 BAXLEY, GA 31515

(912)685-5715 Candler (912)367-9841 Appling

2514 C TOBACCO ROAD 159 WEST RAILROAD ST

HEPHZIBAH, GA 30815 PEMBROKE, GA 31321

(706)790-0311 Richmond (912)653-2897 Bryan

119 VICTORY DR SUITE A

SWAINSBORO, GA 30401

(478)237-8342 Emanuel

25 WEST LYONS STREET 2906 FRANKLIN PARKWAY

TALLAPOOSA, GA 30176 FRANKLIN, GA 30217

(770)824-2800 Haralson (706)675-6949 Heard

306 MOUNT PLEASANT ROAD

THOMSON, GA 30824

(706)595-0090 McDuffie

204 ALLEN MEMORIAL DR, STE 201

BREMEN, GA 30110

(770)537-6500 Haralson

115 GILLIKIN ST 701 BLUE BIRD BLVD 135 DOGWOOD STREET 1125 EAST HIGHWAY 166

TWIN CITY, GA 30471 FORT VALLEY, GA 31030 WARWICK, GA 31796 BOWDON, GA 30108

(478)763-3036 Emanuel (478)825-7000 Crawford (229)535-4170 Worth (770)836-9388 Carroll

400 CANTERBURY DRIVE

WRENS, GA 30833

(478)625-7000 Jefferson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

183821 183972 183941

*

183955 183893 183932 183924 183886

*

183452 183451 183867 183888

*

183868 183877

*

183933 188929

*

183447 188935

*

183950

*

188940

*

183916

*

183945 183480

*

183485 183470

*

* *

* * * *

* * *

*

*

*

*

*

* = Non-Deemed

Address

AARON K JONAN MEMORIAL CLINIC 832 HIGHWAY 15 NORTH ACCESS FAMILY HEALTH CENTER 315 HOSPITAL DRIVE, SUITE 2 ALBAREE HEALTH SERVICES, LLC 906 EAST MOUNTAIN PARKWAY, ROUTE 114 ANNVILLE MEDICAL CLINIC 78 STATE ROAD 3444 APPALACHIA HEALTH SERVICES 3080 US HIGHWAY 25W, NORTH APPALACHIAN CLINIC-WOOTON 21154 HWY 421, SUITE A APPALACHIAN PHYSICIANS, PSC 48 DANIEL BOONE PLAZA ARH DANIEL BOONE CLINIC 37 BALL PARK ROAD HARLAN ARH MCDOWELL CLINIC 9879 KY ROUTE 122 ARH MORGAN COUNTY CLINIC 476 LIBERTY ROAD ARH TRI-CITY MEDICAL CENTER 18880 NORTH US HIGHWAY 119 ARH TUG VALLEY MEDICAL 306 HOSPITAL DRIVE ASSOCIATES ARH WHITESBURG CLINIC 214 HOSPITAL ROAD ASSOCIATES IN PHYSICIAN 1573 HIGHWAY 259 NORTH SERVICES ATIENZA-ACOB MEDICAL CLINIC 110 ROY KIDD AVENUE AUBURN COMMUNITY HEALTH 128 SUGAR MAPLE DRIVE CLINIC

B F TAYLOR MEDICAL ARTS CLINIC 299-A GLASGOW ROAD BAPTIST PRIMARY CARE OF 602 KNOX STREET BARBOURVILLE BAPTIST PRIMARY CARE OF 1010 MEDICAL CENTER DRIVE POWDERLY BAPTIST PRIMARY CARE OF 403 SYCAMORE STREET WILLIAMSBURG BARBOURVILLE FAMILY HEALTH 215 NORTH ALLISON AVENUE CENTER BATES, MILLER, AND SIMS, PLLC 100 JAY STREET BEATTYVILLE FAMILY MEDICAL 1027 HIGHWAY 11 NORTH CLINIC BEDFORD FAMILY PRACTICE 470 HIGHWAY 421 NORTH BEECH FORK ARH CLINIC 805 MIDDLE FORK ROAD

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 8

City, State and ZIP

Telephone # County Name

JACKSON, KY 41339 BARBOURVILLE, KY 40906 SALYERSVILLE, KY 41465

(606)666-5142 Breathitt (606)546-4060 Knox (606)349-8100 Magoffin

ANNVILLE, KY 40402 WILLIAMSBURG, KY 40769 HYDEN, KY 41749 HAZARD, KY 41701 HARLAN, KY 40831

(606)364-5162 Jackson (606)549-9107 Whitley (606)672-1144 Leslie (606)487-9999 Perry (606)573-4520 Harlan

MC DOWELL, KY 41647 WEST LIBERTY, KY 41472 CUMBERLAND, KY 40823 SOUTH WILLIAMSON, KY 41503 WHITESBURG, KY 41858 BROWNSVILLE, KY 42210

(606)377-3401 Floyd (606)743-3198 Morgan (606)589-0130 Harlan (606)237-1757 Pike

CORBIN, KY 40701 AUBURN, KY 42206

(606)528-7400 Knox (270)542-5500 Logan

BURKESVILLE, KY 42717 BARBOURVILLE, KY 40906

(270)864-2555 Cumberland (606)546-6027 Knox

POWDERLY, KY 42367

(270)377-1600 Muhlenberg

WILLIAMSBURG, KY 40769

(606)549-8244 Whitley

BARBOURVILLE, KY 40906

(606)546-9287 Knox

STANFORD, KY 40484 BEATTYVILLE, KY 41311

(606)365-1547 Lincoln (606)464-0061 Lee

BEDFORD, KY 40006 ASHER, KY 40803

(502)225-7732 Trimble (606)374-3393 Leslie

(606)633-3632 Letcher (270)597-2168 Edmonson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

183859 188955 183421 183471 188931 183956 183939

*

188949

*

188946 183831 183967 183489 188948

*

183922 183985

*

188912 183466

*

183428

*

183464 183827 183849 183919 183931 188927

*

183823

*

183412

*

* * * * * *

* * * *

*

*

* * * * *

* = Non-Deemed

BELL CLINIC, PLLC BEREA WALK-IN CLINIC BETSY LAYNE CLINIC BIG CREEK ARH CLINIC BLOUNT RURAL HEALTH CENTER BLUEGRASS CLINIC LIBERTY, PLLC BLUEGRASS CLINIC STANFORD, PLLC

BLUEGRASS FAMILY MEDICINE & PEDIATRICS, PLLC BRYANT FAMILY MEDICINE BURKHART RURAL HEALTH CLINIC BURNING SPRINGS MEDICAL CLINIC BUTLER COUNTY FAMILY CARE CAREPLUS RURAL HEALTH CLINIC, LLC CARLISLE CLINIC CARROLL COUNTY RURAL HEALTH CLINIC CASA SAN PIO CASEY COUNTY FAMILY PRACTICE CASEY COUNTY PRIMARY CARE RURAL HEALTH CLINIC CAVERNA PRIMARY CARE CLINIC CHILDREN'S CLINIC CHILDREN'S CLINIC ANNEX CLARK CLINIC PRIMARY CARE CLARK FAMILY CARE CLAY CITY PEDIATRICS AND PRIMARY CARE

CLOVER FORK OUTPATIENT MEDICAL PROJECT CLOVERPORT HEALTH CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 8

Address

City, State and ZIP

Telephone # County Name

105 ELK FORK ROAD 245 PRINCE ROYAL DRIVE, SUITE A 9350 US HIGHWAY 23 S, SUITE 3 17644 SOUTH HIGHWAY 421 810 SOUTH MAIN STREET 19 ABES PLAZA 107 METKER TRAIL, SUITE A

ELKTON, KY 42220 BEREA, KY 40403 STANVILLE, KY 41659 BIG CREEK, KY 40914 ELKTON, KY 42220 LIBERTY, KY 42539 STANFORD, KY 40484

(270)265-2574 Todd (859)986-0375 Madison (606)478-3636 Floyd (606)598-6196 Clay (270)265-6504 Todd (606)787-0014 Casey (606)365-8338 Lincoln

67 PUBLIC SQUARE

LANCASTER, KY 40444

(859)792-1420 Garrard

2932 NORTH HIGHWAY 25W 117 EAST MAIN STREET, BOX 6 11901 NORTH HIGHWAY 421 210 NORTH MAIN STREET 998 SOUTH HIGHWAY 25 WEST, SUITE 1

WILLIAMSBURG, KY 40769 SALEM, KY 42078 MANCHESTER, KY 40962 MORGANTOWN, KY 42261 WILLIAMSBURG, KY 40769

(606)549-8088 Whitley (270)988-3839 Livingston (606)598-2706 Clay (270)526-3137 Butler (606)549-0071 Whitley

107 SOUTH BROADWAY STREET 309 11TH STREET

CARLISLE, KY 40311 CARROLLTON, KY 41008

(859)289-4124 Nicholas (502)732-3272 Carroll

638 EAST COLLEGE AVENUE, SUITE B 112 LIBERTY SQUARE SHOPPING CENTER 187 WOLFORD AVENUE

STANTON, KY 40380 LIBERTY, KY 42539

(606)318-3500 Powell (606)787-5044 Casey

LIBERTY, KY 42539

(606)787-8348 Casey

1495 SOUTH DIXIE STREET 223 RIVER DRIVE 62 MERCY COURT 225 HOSPITAL DRIVE 174 PEDRO WAY 98 RIVER STREET

HORSE CAVE, KY 42749 IRVINE, KY 40336 IRVINE, KY 40336 WINCHESTER, KY 40391 WINCHESTER, KY 40391 CLAY CITY, KY 40312

(270)786-2372 Hart (606)723-5142 Estill (606)723-5142 Estill (859)744-5757 Clark (859)745-4469 Clark (606)663-7788 Powell

101 CHAD STREET

EVARTS, KY 40828

(606)837-2108 Harlan

209 ELM STREET

CLOVERPORT, KY 40111

(270)778-3000 Breckinridge

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

188928 183949 183917 183929

*

183965

*

188925 188930 183957

*

188944

*

183914

*

188939

*

183481 188908 188910

*

183905

*

183952

*

183892

*

188903 183826

*

183902 188926 183899 183936 183884

*

* * *

* *

* *

*

* * * *

* = Non-Deemed

COMMUNITY FAMILY CLINIC, PLLC COMMUNITY FAMILY CLINIC, PLLC CORBIN FAMILY HEALTH CENTER CORBIN PEDIATRIC ASSOCIATES, PSC

CORBIN RURAL HEALTH CENTER, PLLC CRAB ORCHARD PRIMARY CARE CUMBERLAND FAMILY CLINIC, PLLC DANIEL BOONE FAMILY HEALTHCARE, PLLC EAST KENTUCKY HEALTHCARE SERVICES CENTER, INC EASTERN KY TENDER CARE PEDIATRICS

EASTERN PULASKI RURAL HEALTH CLINIC, PLLC EDDYVILLE FAMILY MEDICAL ELKTON CLINIC, PSC EPHRAIM MCDOWELL GARRARD CLINIC EPHRAIM MCDOWELL SPRINGFIELD FAMILY MEDICAL CENTER ERTEL MEDICINE & PEDIATRICS STANTON

ERTEL MEDICINE & PEDIATRICS WINCHESTER ESTILL MEDICAL CLINIC FAMILY & INTERNAL MEDICINE ASSOCIATES PLLC FAMILY CARE CLINIC MT STERLING FAMILY FIRST HEALTH CARE, PLLC FAMILY HEALTH CARE ASSOCIATES FAMILY HEALTH CARE CLINIC, PSC FAMILY MEDICAL CENTER

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 8

Address

City, State and ZIP

Telephone # County Name

17 MILLER DRIVE 784 HIGHWAY 36 140 BRYAN BOULEVARD 57 SUMMIT DRIVE

OWINGSVILLE, KY 40360 FRENCHBURG, KY 40322 CORBIN, KY 40701 CORBIN, KY 40701

(606)674-3033 Bath (606)768-9190 Menifee (606)523-2005 Knox (606)528-9700 Whitley

1013 MASTER STREET

CORBIN, KY 40701

(606)280-7772 Knox

207 MAIN STREET 57 HOGUE ROAD 215 TREUHAFT BOULEVARD, SUITE 3B

CRAB ORCHARD, KY 40419 PINE KNOT, KY 42635 BARBOURVILLE, KY 40906

(606)355-7800 Garrard (606)354-9444 McCreary (606)545-0400 Knox

566 HWY 899

HINDMAN, KY 41822

(606)785-3164 Knott

4851 KY ROUTE 321

PRESTONSBURG, KY 41653

(606)886-1173 Floyd

31 MARK SHOPVILLE ROAD

SOMERSET, KY 42503

(606)485-4553 Pulaski

209 WEST MAIN STREET 713 WEST MAIN STREET 405 DANVILLE STREET

EDDYVILLE, KY 42038 ELKTON, KY 42220 LANCASTER, KY 40444

(270)388-0620 Lyon (270)265-5353 Todd (859)792-2124 Garrard

280 LINCOLN DRIVE

SPRINGFIELD, KY 40069

(859)336-9801 Washington

68 EAST ELKINS STREET

STANTON, KY 40380

(606)663-2511 Powell

1520 BOONESBORO ROAD

WINCHESTER, KY 40391

(859)744-0067 Clark

275 NORTH COURT STREET 325 WALNUT STREET, SUITE 600

IRVINE, KY 40336 LEBANON, KY 40033

(606)723-2167 Estill (270)699-9500 Marion

129 STONE TRACE 363 OFFICE PARK DRIVE 1927 S HWY 25 E 1012 CENTER DRIVE 1463 CAMPBELLSVILLE ROAD

MOUNT STERLING, KY 40353 COLUMBIA, KY 42728 BARBOURVILLE, KY 40906 RICHMOND, KY 40475 COLUMBIA, KY 42728

(859)498-6006 Montgomery (270)384-3939 Adair (606)546-7777 Knox (859)626-9696 Madison (270)384-9934 Adair

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

183897

*

183488 183898

*

183963 188923 188922 183896 183974 183408 183432

*

183940 183964 183958 183448 183455 183477 183906

*

183449 183490 183943 183928

*

183930 183909 183472 188911

*

188937

*

*

* * * * * *

* * * * * *

* * *

* * *

* = Non-Deemed

FAMILY MEDICAL CENTER OF HART COUNTY FAMILY PRACTICE ASSOCIATES FAMILY PRACTICE CLINIC OF BOONEVILLE

FAMILY PRACTICE CLINIC, PSC FIRST YOU MEDICAL CENTER, PLLC FIRST YOU MEDICAL CENTER, PLLC FLAT LICK MEDICAL CLINIC FLOWERS RURAL HEALTH CARE FORDSVILLE AREA MEDICAL CLINIC FOUNTAIN RUN RURAL HEALTH CLINIC FREDERICK MEDICAL CLINIC FREEMAN FAMILY PRACTICE GEORGE HAYDEN CAUDILL, PSC GRAND LAKES CLINIC GREEN COUNTY PRIMARY CARE HAROLD PRIMARY CARE HARRODSBURG FAMILY MEDICAL CENTER HICKMAN-FULTON CO MED CLINIC HIGHLANDS PRIMARY CARE HILLTOP PRIMARY CARE, INC HO PHYSICIANS SERVICES CORPORATION HOMETOWN CLINIC HOSKINS MEDICAL CENTER HYDEN ARH CLINIC IMMEDIATE CARE OF EASTERN KENTUCKY

JACKSON PURCHASE PRIMARY CARE MAYFIELD CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 8

Address

City, State and ZIP

Telephone # County Name

117 WEST SOUTH STREET

MUNFORDVILLE, KY 42765

(270)524-7231 Hart

124 DOWELL ROAD 200 MULBERRY STREET, SUITE A

RUSSELL SPRINGS, KY 42642 (270)866-2440 Russell BOONEVILLE, KY 41314 (606)593-6023 Owsley

518 WEST GUM STREET 151 EAST BROADWAY 18 ALEXANDER AVENUE, UNIT 1 34 MARY ALICE LANE 333 KEEN STREET 44 WEST MAIN STREET 47 AKERSVILLE ROAD

MARION, KY 42064 EMINENCE, KY 40019 BEDFORD, KY 40006 FLAT LICK, KY 40935 BURKESVILLE, KY 42717 FORDSVILLE, KY 42343 FOUNTAIN RUN, KY 42133

(270)965-5238 Crittenden (502)845-6288 Henry (502)255-0222 Trimble (606)542-5900 Knox (270)864-3371 Cumberland (270)276-9953 Ohio (270)434-4857 Monroe

430 LIBERTY ROAD 10755 NORTH US HIGHWAY 25 E 1893 RED FOX ROAD 1860 J H O'BRYAN AVENUE 310 INDUSTRIAL PARK ROAD 24 LEFT PENHOOK ROAD 1509 LOUISVILLE ROAD

WEST LIBERTY, KY 41472 GRAY, KY 40734 REDFOX, KY 41847 GRAND RIVERS, KY 42045 GREENSBURG, KY 42743 HAROLD, KY 41635 HARRODSBURG, KY 40330

(606)743-3114 Morgan (606)258-8050 Knox (606)642-3250 Knott (270)362-8246 Livingston (270)299-2247 Green (606)478-8787 Floyd (859)734-5770 Mercer

2003 SOUTH 7TH STREET 100 BRIANNA BOULEVARD, SUITE 100 7617 UPPER JOHNS CREEK ROAD 841 US HWY 25W SOUTH, SUITE 5

HICKMAN, KY 42050 SALYERSVILLE, KY 41465 PHELPS, KY 41553 WILLIAMSBURG, KY 40769

(270)236-3202 Fulton (606)349-6500 Magoffin (606)835-9333 Pike (606)549-0123 Whitley

96 HIGHWAY 80 1120 REUBEN STREET 130 KATE IRELAND DRIVE 1238 MIDDLE FORK ROAD

HYDEN, KY 41749 LONDON, KY 40743 HYDEN, KY 41749 INEZ, KY 41224

(606)672-4878 Leslie (606)862-7000 Laurel (606)672-2901 Leslie (606)298-4000 Martin

1111 MEDICAL CENTER CIRCLE

MAYFIELD, KY 42066

(270)251-4055 Graves

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

183891

*

183838 183495 188934

*

183901

*

183405

*

188954 183430 188913

*

183959 183435

*

183926 183935

*

188914 183960 183492

*

183442 188941

*

188924

*

183487 183923 188900

*

183484

*

* *

* *

*

*

* *

*

* *

* = Non-Deemed

KENTUCKYONE HEALTH PRIMARY CARE ASSOCIATES KENTUCKYONE PRIMARY CARE KIDS KARE PEDIATRICS KNOTT COUNTY CENTER FOR FAMILY HEALTH, LLC KNOTT COUNTY FAMILY HEALTHCARE LAKE CUMBERLAND MEDICAL ASSOCIATES LANCASTER RURAL HEALTH CLINIC LIBERTY FAMILY MEDICAL CENTER LIVING WELL HEALTHCARE, LLC LON E LAFFERTY, MD, PSC LONDON PEDIATRIC AND ADOLESCENT MEDICINE LONDON WOMEN'S CARE, PLLC MADISON FAMILY CLINIC MADISON PRIMARY CARE, LLC MARION PHYSICIANS CLINIC MARSHALL COUNTY SURGICAL & MEDICAL GROUP MARTIN CLINIC MARTIN COUNTY RURAL HEALTH CLINIC, PLLC MCCREARY PRIMARY CARE CENTER, INC MCDANIELS FAMILY CARE MCKEE MEDICAL CLINIC MEDICAL ASSOCIATES OF SOUTHEAST KENTUCKY

MEMORIAL HOSPITAL RED BIRD CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 8

Address

City, State and ZIP

Telephone # County Name

417 RIVER DRIVE

IRVINE, KY 40336

(606)723-0399 Estill

534 HILLCREST DRIVE 420 LORETTO ROAD, SUITE 200 3470 HIGHWAY 80W

BRANDENBURG, KY 40108 LEBANON, KY 40033 EMMALENA, KY 41740

(270)422-5000 Meade (270)699-4638 Marion (606)785-9377 Knott

70 HOLLY HILLS MALL ROAD

HINDMAN, KY 41822

(606)785-9440 Knott

350 HOSPITAL WAY, SUITE 100

SOMERSET, KY 42501

(606)451-2619 Pulaski

230 LEXINGTON STREET, SUITE D 511 MIDDLEBURG STREET 200 NORTH CRAWFORD STREET, SUITE 3 2160 BLACKLOG ROAD, SUITE 120 378 THOMPSON POYNTER ROAD

LANCASTER, KY 40444 LIBERTY, KY 42539 TOMPKINSVILLE, KY 42167

(606)272-3574 Garrard (606)787-5963 Casey (270)407-5052 Monroe

INEZ, KY 41224 LONDON, KY 40741

(606)298-7405 Martin (606)877-3990 Laurel

803 MEYERS-BAKER ROAD, SUITE 200 2161 LEXINGTON ROAD, 1ST FLOOR, SUITE 5

210 ST GEORGE STREET, SUITE 110 308 SOUTH MAIN STREET 619 OLD SYMSONIA ROAD

LONDON, KY 40741 RICHMOND, KY 40475

(606)878-3240 Laurel (859)626-7794 Madison

RICHMOND, KY 40475 MARION, KY 42064 BENTON, KY 42025

(859)626-9766 Madison (270)965-4377 Crittenden (570)527-2411 Marshall

12579 MAIN STREET, SUITE 101 64 KIRK PLAZA

MARTIN, KY 41649 INEZ, KY 41224

(606)285-0681 Floyd (606)886-1173 Martin

65 CENTER AVENUE

WHITLEY CITY, KY 42653

(606)376-2224 McCreary

9798 SOUTH HIGHWAY 259 25 HWY 290, CAMPBELL DRUG BLDG 515 MEMORIAL DRIVE, SUITE 3

MCDANIELS, KY 40152 MC KEE, KY 40447 MANCHESTER, KY 40962

(270)902-4411 Breckinridge (606)287-5162 Jackson (606)599-0169 Clay

53 QUEENDALE CENTER

BEVERLY, KY 40913

(606)599-2525 Bell

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

183479

*

183475

*

183462 183951

*

183459 183833 183491

*

183857 188933

*

183465

*

183450 188950

*

183861 188918 183478

*

183907

*

183880

*

183468

*

188952 183469 188936 183942

*

*

* *

*

*

* *

* * *

* = Non-Deemed

Address

MERCY MEDICAL CLINIC OF LEE 1025 GRAND AVENUE COUNTY

MERCY MEDICAL CLINIC OF POWELL 749 IRVINE ROAD COUNTY MERCY PRIMARY CARE - IRVINE 1100 RICHMOND ROAD METHODIST FAMILY MEDICINE OF 9064 US HIGHWAY 60 WEST STURGIS METHODIST FAMILY PRACTICE 1284 US HWY 60 W MONTICELLO MEDICAL ASSOCIATES ONE SOUTH CREEK DRIVE, SUITE 102 MORGAN COUNTY ARH FAMILY 1084 HIGHWAY 7, SUITE 2 HEALTH

MOUNTAIN AFTER-HOURS CLINIC 1908 NORTH MAIN STREET, SUITE 120 MOUNTAIN FAMILY PRACTICE 90 GARRARD SQUARE CLINIC OF MANCHESTER, INC MUNFORDVILLE PRIMARY CARE 1134 MAIN STREET CLINIC

NEW HORIZONS FAMILY PRACTICE 330 ROLAND AVENUE NEWBORN & KIDS HEALTH CENTER, 215 TREUHAFT BOULEVARD, SUITE 8 INC NORTH GARRARD CENTER 510 NORTH CAMP DICK ROAD ONE HEALTH OHIO COUNTY 1213 NORTH MAIN STREET OWENSBORO HEALTH 101 LEGION DRIVE MUHLENBERG COMMUNITY HOSPITAL FAM PEDIATRIC ASSOCIATES OF 474 VILLAGE LANE, HAZARD VILLAGE HAZARD, LLC SHOPPING CENTER

PEDIATRIC ASSOCIATES OF 156 ISLAND CREEK ROAD PIKEVILLE PHYSICIAN SERVICES OF MEMORIAL 94 MARIE LANGDON DRIVE, SUITE 4 HOSPITAL PINE MOUNTAIN CLINIC, PSC 850 RIVERVIEW POWELL COUNTY CLINIC 68 ELKINS STREET PREFERRED HEALTHCARE, INC 686 SOUTH HIGHWAY 25W PRIMARY CARE CENTERS OF 10897 S KY HIGHWAY 15 EASTERN KENTUCKY

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 8

City, State and ZIP

Telephone # County Name

BEATTYVILLE, KY 41311

(606)464-8806 Lee

CLAY CITY, KY 40312

(606)663-2153 Powell

IRVINE, KY 40336 STURGIS, KY 42459

(606)723-7771 Estill (270)333-4349 Union

MORGANFIELD, KY 42437 MONTICELLO, KY 42633 WEST LIBERTY, KY 41472

(270)389-2323 Union (606)348-3365 Wayne (606)743-3186 Morgan

HAZARD, KY 41701 GARRARD, KY 40941

(606)439-2662 Perry (606)658-6333 Clay

MUNFORDVILLE, KY 42765

(270)524-3641 Hart

OWENTON, KY 40359 BARBOURVILLE, KY 40906

(502)484-4656 Owen (606)277-0173 Knox

LANCASTER, KY 40444 BEAVER DAM, KY 42320 CENTRAL CITY, KY 42330

(859)548-8000 Garrard (270)274-4771 Ohio (270)754-5400 Muhlenberg

HAZARD, KY 41701

(606)487-8300 Perry

PIKEVILLE, KY 41502

(606)432-3221 Pike

MANCHESTER, KY 40962

(606)598-7900 Clay

PINEVILLE, KY 40977 STANTON, KY 40380 WILLIAMSBURG, KY 40769 SCUDDY, KY 41760

(606)337-6047 Bell (606)663-8000 Powell (606)549-5052 Whitley (606)476-2274 Perry

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name

183953

*

183918

*

183947

*

183871

*

188920

*

183934 183476 183467 183483

*

188942

*

183473

*

183961 183878 188907

*

183440 183948

*

183962 183920 183474 183418

*

183417

*

183416

*

* * *

* *

*

* * *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 8

Address

City, State and ZIP

Telephone # County Name

21992 MAIN STREET

HYDEN, KY 41749

(606)672-5200 Leslie

145 CITIZENS LANE, SUITE B

HAZARD, KY 41701

(606)439-1300 Perry

58 WEST HIGHWAY 80, SUITE 2

HINDMAN, KY 41822

(606)785-1300 Knott

210 BLACK GOLD BOULEVARD, SUITE 106 103 KINGDOM COME DRIVE

HAZARD, KY 41701

(606)436-0711 Perry

QUANTUM HEALTHCARE ASSOCIATES OF CUMBERLAND RED RIVER PEDIATRICS 321-C EAST COLLEGE AVENUE ROCKCASTLE FAMILY CARE 160 EAST MAIN STREET ROCKCASTLE FAMILY WELLNESS 140 NEWCOMB AVENUE ROCKCASTLE PEDIATRICS & 140 NEWCOMB AVENUE, SUITE C & D ADOLESCENTS

ROYAL TREATMENT HEALTHCARE, 4671 SOUTH US HIGHWAY 25 EAST INC

SAINT JOSEPH BEREA FAMILY 305 ESTILL STREET MEDICINE SALEM MEDICAL CLINIC 141 HOSPITAL DRIVE SALYERSVILLE MEDICAL CENTER 601 EAST MAPLE STREET SANDY HOOK FAMILY CARE CENTER 1908 NORTH KENTUCKY 7

CUMBERLAND, KY 40823

(606)589-5514 Harlan

STANTON, KY 40380 MOUNT VERNON, KY 40456 MOUNT VERNON, KY 40456 MOUNT VERNON, KY 40456

(606)663-9797 Powell (606)256-7761 Rockcastle (606)256-7761 Rockcastle (606)256-4148 Rockcastle

BIMBLE, KY 40915

(606)546-2598 Knox

BEREA, KY 40403

(859)986-2343 Madison

SALEM, KY 42078 SALYERSVILLE, KY 41465 SANDY HOOK, KY 41171

(270)988-3298 Livingston (606)349-5300 Magoffin (606)738-9339 Elliott

SETON FAMILY HEALTH CENTER SHEPHERDSVILLE FAMILY HEALTH CLINIC, PSC SMITHLAND MEDICAL CLINIC SOUTH FORK MEDICAL CLINIC, PLLC SPRING VIEW CLINIC ST CLAIRE REGIONAL FAMILY MEDICINE-FRENCHBURG ST CLAIRE REGIONAL FAMILY MEDICINE-OLIVE HILL ST CLAIRE REGIONAL FAMILY MEDICINE-OWINGSVILLE

11087 MAIN STREET 130 WEST JOE B HALL AVENUE

MARTIN, KY 41649 (606)285-3690 Floyd SHEPHERDSVILLE, KY 40165 (502)921-1231 Bullitt

205 EAST ADAIR STREET 71 MEDICAL LANE 79 BOB O LINK DRIVE 732 HIGHWAY 36

SMITHLAND, KY 42081 WHITLEY CITY, KY 42653 SPRINGFIELD, KY 40069 FRENCHBURG, KY 40322

(270)928-2146 Livingston (606)376-7212 McCreary (859)336-0771 Washington (606)768-2191 Menifee

155 BRICKLAYER STREET

OLIVE HILL, KY 41164

(606)286-4152 Carter

632 SLATE AVENUE

OWINGSVILLE, KY 40360

(606)674-6386 Bath

PRIMARY CARE CENTERS OF EASTERN KENTUCKY - HYDEN

PRIMARY CARE CENTERS OF EASTERN KY - HAZARD PRIMARY CARE CENTERS OF EASTERN KY - HINDMAN QUANTUM HEALTHCARE

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kentucky CCN

Key Provider Name *

ST CLAIRE REGIONAL FAMILY MEDICINE-SANDY HOOK * 183904 STANFORD MEDICAL PARK IMMEDIATE CARE * 183493 T J HEALTH CAVE CITY * 183970 T J HEALTH COLUMBIA CLINIC * 183998 T J HEALTH COLUMBIA PRIMARY CARE * 183994 T J HEALTH EDMONTON * 183446 T J HEALTH RUSSELL SPRINGS * 188915 T J SAMSON TOMPKINSVILLE CLINIC * 183829 TAYLOR RURAL HEALTH, LLC * 183458 THE MEDICAL CENTER AT SCOTTSVILLE

*

188943 THREE RIVERS IMMEDIATE CARE INEZ * 188945 TOTAL CARE RURAL HEALTH CLINIC * 183406 TRIGG COUNTY PRIMARY CARE CENTER

*

183874 UNITED CLINICS OF KENTUCKY * 188909 UNITED CLINICS OF KENTUCKY BEATTYVILLE * 183486 WARSAW FAMILY PRACTICE * 183427 WAYNE COUNTY HOSPITAL RURAL HEALTH CLINIC * 183954 WAYNESBURG CLINIC, PLLC * 183437 WHEELWRIGHT FAMILY HEALTH CENTER * 183858 WILLIAM COLLINS MD * 183832 WILLIAMSBURG FAMILY MEDICINE CENTER * 183903 WINCHESTER FAMILY PRACTICE, PS * 183937 WINCHESTER, PATTON & BURGESS, PSC Total Providers for this State = 191

183415

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 8 of 8

Address

City, State and ZIP

Telephone # County Name

390 KY HIGHWAY 7 SOUTH

SANDY HOOK, KY 41171

(606)738-5155 Elliott

110 METKER TRAIL

STANFORD, KY 40484

(606)365-3360 Lincoln

440 EAST HAPPY VALLEY STREET 902 WESTLAKE DRIVE, SUITE 101 810 JAMESTOWN STREET

CAVE CITY, KY 42127 COLUMBIA, KY 42728 COLUMBIA, KY 42728

(270)773-2111 Barren (270)384-0451 Adair (270)384-4764 Adair

1704 WEST STOCKTON STREET 2465 LAKEWAY DRIVE 800 NORTH MAIN STREET 805 BURKESVILLE STREET 466 BURNLEY ROAD

EDMONTON, KY 42129 RUSSELL SPRINGS, KY 42642 TOMPKINSVILLE, KY 42167 COLUMBIA, KY 42728 SCOTTSVILLE, KY 42164

(270)432-4800 Metcalfe (270)858-3636 Russell (270)487-0720 Monroe (270)384-1110 Adair (270)618-3700 Allen

94 BOARD WALK

INEZ, KY 41224

(606)298-2660 Martin

121 VIRGINA AVE 214 MAIN STREET

PINEVILLE, KY 40977 CADIZ, KY 42211

(606)337-2381 Bell (270)522-0898 Trigg

219 MOUNTAIN PARKWAY SPUR 1060 GRAND AVENUE

CAMPTON, KY 41301 BEATTYVILLE, KY 41311

(606)668-6932 Wolfe (606)464-0108 Lee

202 FRANKLIN STREET 166 HOSPITAL STREET

WARSAW, KY 41095 MONTICELLO, KY 42633

(859)567-2754 Gallatin (606)348-9343 Wayne

14098 US HIGHWAY 27 SOUTH 1403 KY ROUTE 306, SUITE 102

WAYNESBURG, KY 40489 WHEELWRIGHT, KY 41669

(606)379-6646 Lincoln (606)452-2300 Floyd

109 EAST MAIN STREET 475 NORTH HWY 25 W, SUITE 100

WHITESBURG, KY 41858 WILLIAMSBURG, KY 40769

(606)633-4488 Letcher (606)549-2930 Whitley

4 NORTH HIGHLAND STREET, SUITE A 19 MEDICAL LOOP

WINCHESTER, KY 40391 WHITLEY CITY, KY 42653

(859)744-1445 Clark (606)376-5391 McCreary

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi CCN 253938 258587 253871 258514 253821 258584 258995 258598 258509 258536 258508 258589 258614 253885 253891 258541 253896 258936 258501 253986 258502 253421 258975 258925 253928

Key Provider Name *

Address

ABERDEEN HEALTH CLINIC 501 CHESTNUT STREET AIRPARK FAMILY MEDICAL CLINIC 1056 HOLLAND AVENUE * ALL CARE MISSISSIPPI, LLC 301 WEST JACKSON * ALLIANCE-LAIRD CLINIC 25155 HWY 15 * ANAZIA MEDICAL, INC 120 5TH AVENUE * ANDERSON CHILDREN'S MEDICAL 1400 20TH AVENUE, SUITE D CLINIC * ANDREW GEORGE, MD 25 SOUTH 4TH STREET None ARRINGTON MEDICAL CLINIC 14415 MAIN STREET * ARTHUR E WOOD MEDICAL CLINIC 920 MATTHEW DRIVE * BAPTIST LEAKE MEDICAL CLINIC110 PARK STREET WALNUT GROVE

*

BAPTIST LEAKE PRIMARY CARE 1100 HIGHWAY 16 EAST CENTER * BAPTIST LEAKE WOMEN'S HEALTH 303 WEST FRANKLIN STREET CLINIC None BAPTIST MEDICAL CLINIC 220 HIGHWAY 12 WEST KOSCIUSKO * BAY SPRNGS AFTER HRS & FAM HLT 31 EAST 5TH AVENUE * BOLTON FAMILY CLINIC 115 WEST MADISON STREET * BROOKSVILLE PRIMARY CARE 139 NORTH OLIVER STREET/ P O BOX CLINIC 348 * CAMPBELL FAMILY CLINIC 580 FRIAR'S POINT * CANTON PRIMARY CARE CLINIC 1883 HIGHWAY 43 SOUTH, STE D / P O BOX 819 * CATCHINGS CLINIC 451 BANK STREET/ PO BOX 876 * CENTRAL MS FAMILY HEALTH 905-C SOUTH FRONTAGE ROAD CLINIC * CENTREVILLE CLINIC 178 HIGHWAY 24, SUITE A * CHARLESTON CLINIC 401 CHURCH ST / PO BOX 27 * CHESTNUT MEDICAL CLINIC 502 JACKSON STREET, SUITE 6 * CHILDREN'S CLINIC OXFORD 2888 SOUTH LAMAR None CHILDREN'S INTERNATIONAL 801 WILLIAMS AVENUE MEDICAL GROUP *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 7

City, State and ZIP

Telephone # County Name

ABERDEEN, MS 39730 PHILADELPHIA, MS 39350 OXFORD, MS 38655 UNION, MS 39365 MC COMB, MS 39648 MERIDIAN, MS 39301

(662)369-6131 Monroe (601)656-8545 Neshoba (662)234-6464 Lafayette (601)774-1513 Neshoba (601)789-0390 Pike (601)703-8370 Lauderdale

ROLLING FORK, MS 39159 COFFEEVILLE, MS 38922 WAYNESBORO, MS 39367 WALNUT GROVE, MS 39189

(662)873-0477 Sharkey (662)473-5901 Yalobusha (601)735-7101 Wayne (601)253-0173 Leake

CARTHAGE, MS 39051

(601)267-1470 Leake

CARTHAGE, MS 39051

(601)267-9658 Leake

KOSCIUSKO, MS 39090

(662)290-3150 Attala

BAY SPRINGS, MS 39422 BOLTON, MS 39041 BROOKSVILLE, MS 39739

(601)764-2143 Jasper (601)866-7723 Hinds (662)738-4424 Noxubee

CLARKSDALE, MS 38614 CANTON, MS 39046

(662)624-4316 Coahoma (601)667-3492 Madison

WOODVILLE, MS 39669 MERIDIAN, MS 39301

(601)888-3421 Wilkinson (601)486-4210 Lauderdale

CENTREVILLE, MS 39631 CHARLESTON, MS 38921 ABERDEEN, MS 39730 OXFORD, MS 38655 PICAYUNE, MS 39466

(601)645-5361 Wilkinson (662)647-5816 Tallahatchie (662)369-9525 Monroe (662)234-8286 Lafayette (601)798-5558 Pearl River

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi

Telephone # County Name

MORTON, MS 39117

(601)732-2382 Scott

258599

INTERNATIONAL 3016 HIGHWAY 80 MEDICAL GROUP-MORTON None CHOCTAW MEDICAL CLINIC OF WEIR 780 MAIN STREET

WEIR, MS 39772

(662)547-9407 Choctaw

258609

None CHOCTAW

8613 MS HIGHWAY 12

ACKERMAN, MS 39735

(662)285-4400 Choctaw

321 HIGHWAY 13 SOUTH 14430 MAIN STREET 1123 HWY 35 SOUTH 92 WEST RATLIFF STREET 1755 CR81 14884 HIGWAY 15 110 BAKER STREET, SUITE B

MORTON, MS 39117 COFFEEVILLE, MS 38922 FOREST, MS 39074 LUCEDALE, MS 39452 BLUE MOUNTAIN, MS 38610 DECATUR, MS 39327 INDIANOLA, MS 38751

(601)732-8612 Scott (662)675-2500 Yalobusha (601)469-4771 Scott (601)947-8181 George (662)538-4111 Tippah (601)635-2258 Newton (662)887-7339 Sunflower

344 ARNOLD AVENUE 2514 67TH AVENUE LOOP, SUITE 112

GREENVILLE, MS 38701 MERIDIAN, MS 39307

(662)344-9100 Washington (601)482-4955 Lauderdale

253930

258577 258578 258504 253988 258973 258505 258586 253461 253927 258543 253808 253841 258600 253901 258588 258596 258580 258605 253845 258531 258562

Address

Page 2 of 7

City, State and ZIP

CCN

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

None CHILDRENS

REGIONAL MEDICAL CLINIC-ACKERMAN * CLARK MEDICAL CLINIC * COFFEEVILLE MEDICAL CLINIC * COMMUNITY HEALTH CLINIC * COMMUNITY MEDICAL CENTER * COTTON PLANT FAMILY CLINIC * DECATUR FAMILY MEDICAL None DELTA PRIMARY CARE RURAL HEALTH CLINIC * DELTA REGIONAL HEALTH CLINIC * E C -HEALTHNET FAMILY HEALTH CENTER * EAST CENTRAL MEDICAL CENTERRHC

*

EAST MISSISSIPPI MEDICAL CLINIC

7001 HIGHWAY 614/ MAIL - P.O. BOX 850 HURLEY, MS 39555

9425 EASTSIDE DRIVE, EXTENSION, SUITE A * EAST MISSISSIPPI MEDICAL CLINIC- 4711 POPLAR SPRINGS DRIVE RHC None ECRU MEDICAL CLINIC 202 MAIN STREET * EMS CLINIC 1509 STRONG AVENUE * ENTERPRISE FAMILY MEDICAL 83-A OLD MILL CREEK ROAD CENTER None EUPORA FAMILY MEDICAL CLINIC 1301 VETERAN'S MEMORIAL BLVD * EUPORA PEDIATRIC CLINIC 15 MEDICAL PLAZA None EUPORA PRIMARY CARE CLINIC 70 MEDICAL PLAZA * EVERGREEN FAMILY MEDICAL 4929 HIGHWAY 371 SOUTH CLINIC

*

FAIRCHILD-CLEARMAN MEDICAL 1122 EAST MAIN STREET, SUITE 4 ASSOCIATES RHC * FAMILY CARE EXPRESS 3275 HIGHWAY 49 SUITE E

* = Non-Deemed

(228)588-6622 Jackson

NEWTON, MS 39345

(601)635-3333 Newton

MERIDIAN, MS 39305

(601)485-7777 Lauderdale

ECRU, MS 38841 GREENWOOD, MS 38930 ENTERPRISE, MS 39330

(662)488-7670 Pontotoc (662)455-4411 Leflore (601)704-1020 Clarke

EUROPA, MS 39744 EUROPA, MS 39744 EUPORA, MS 39744 NETTLETON, MS 38858

(662)258-7200 Webster (662)258-4701 Webster (662)258-6221 Webster (662)963-9154 Itawamba

PHILADELPHIA, MS 39350

(601)656-1001 Neshoba

COLLINS, MS 39428

(601)765-6292 Covington

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi CCN 258996 258954 253426 258994 253497 258575 253422 258542 253417 258616 253995 253495 253435 258953 258610 253923 258552 253904 253946

Key Provider Name *

FAMILY CARE MEDICAL CLINIC FAMILY CLINIC OF NEW ALBANY * FAMILY CLINIC OF RIENZI,THE * FAMILY MEDICAL 101, INC * FAMILY MEDICAL ASSOCIATES * FAMILY MEDICAL CLINIC * FAMILY MEDICAL CLINIC OF HOUSTON * FAMILY MEDICAL CLINIC OF OKOLONA * FAMILY MEDICAL CLINIC OF VARDA None FAMILY MEDICAL GROUP OF BUDE * FAMILY MEDICAL GROUP OF MEADVILLE * FAMILY MEDICAL GROUP OF UNION * FAMILY PRACTICE CLINIC MCCOMB * FLORENCE FAMILY CLINIC None FMCH LIBERTY CLINIC * FOREST FAMILY PRACTICE CLINIC * G L H - MAGNOLIA MEDICAL CLINIC * G S V CARE MEDICAL CLINC * GLENDORA CLINIC *

258503 253824 258981

*

253800

*

253911

*

258544

*

253894

*

* *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 7

Address

City, State and ZIP

Telephone # County Name

109 PARKGATE EXT 474 WEST BANKHEAD STREET 82 MAIN STREET BOX 194 101 MIMOSA STREET 701 HOLLY AVENUE 1500 HIGHWAY 19 N 105 HILLCREST DRIVE

TUPELO, MS 38801 NEW ALBANY, MS 38652 RIENZI, MS 38865 BOONEVILLE, MS 38829 COLLINS, MS 39428 MERIDIAN, MS 39307 HOUSTON, MS 38851

(662)840-4175 Lee (662)534-7777 Union (662)462-8600 Alcorn (662)720-4919 Prentiss (601)765-3180 Covington (601)703-1480 Lauderdale (662)456-5008 Chickasaw

521 WEST DRIVE

OKOLONA, MS 38860

(662)447-1405 Chickasaw

310 WEST SWEET POTATO STREET 136 MAIN STREET, N PO BOX 636

VARDAMAN, MS 38878 BUDE, MS 39630 MEADVILLE, MS 39653

(662)682-7555 Calhoun (301)384-2394 Franklin (601)384-3199 Franklin

24345 HIGHWAY 15 1506 HARRISON AVENUE 218 EAST MAIN STREET 1410 MAIN STREET EAST #1 MEDICAL LANE 1413 STRONG AVENUE 400 THIRD AVENUE, HWY 32 WEST CORNER OF GIPSON AVE AND WESTBROOK ST 434 N CAPTAIN GLOSTER DRIVE 2901 HIGHWAY 82 EAST 1237 HIGHWAY 182 EAST CLAYTON VILLAGE

107 CHURCH STREET

UNION, MS 39365 MCCOMB, MS 39648 FLORENCE, MS 39073 LIBERTY, MS 39645 FOREST, MS 39074 GREENWOOD, MS 38930 HOULKA, MS 38850 GLENDORA, MS 38928

(601)774-8211 Neshoba (601)249-2142 Pike (601)845-6602 Rankin (601)657-8820 Amite (601)469-4861 Scott (662)459-1207 Leflore (662)568-2013 Chickasaw (662)375-8878 Tallahatchie

GLOSTER, MS 39638 GREENWOOD, MS 38930 STARKVILLE, MS 39759

(601)225-4711 Amite (662)374-2185 Leflore (662)320-7001 Oktibbeha

BELZONI, MS 39038

(662)247-2105 Humphreys

MOUNT OLIVE, MS 39119

(601)797-3405 Covington

LEAKESVILLE, MS 39451

(601)394-2820 Greene

GREENVILLE, MS 38701

(662)334-1253 Washington

GLOSTER CLINIC GOLDEN AGE CLINIC GOLDEN TRIANGLE RURAL FAMILY HEALTH CENTER GORTON RURAL HEALTH CLINIC, LLC GREEN TREE FAMILY MEDICAL 603 MAIN STREET CENT GREENE COUNTY FAMILY MEDICAL 1017 JACKSON AVENUE CLINIC GREENVILLE PRIMARY CARE CLINIC 2363 HIGHWAY 1 SOUTH

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi CCN

Key Provider Name

258555

*

258566

*

258500 258535

*

258987

*

258601 253940 253812 253813 258547 258525 258902 253958 253418 253949 258523 258591 258615 253814 258608 258510 258526 258962 253490 253889 258904

*

GREENWOOD LEFLORE HOSPITAL AFTER HOURS CLINIC

GREENWOOD LEFLORE WALK IN CLINIC HANCOCK MEDICAL SERVICES HARRISVILLE MEDICAL CLINIC

Page 4 of 7

Address

City, State and ZIP

Telephone # County Name

1601 STRONG AVENUE

GREENWOOD, MS 38930

(662)451-7565 Leflore

706 HIGHWAY 82 W, SUITE B / PO BOX 1410 38935-1410 3068 PORT AND HARBOUR DRIVE 1652 SIMPSON HIGHWAY 469 / P.O. BOX 279

131 HIGHWAY 309 SOUTH

GREENWOOD, MS 38930

(662)459-2181 Leflore

HEALTH 1ST FAMILY MEDICAL CLINIC None HOLCOMB CLINIC 195 HIGHWAY 35 SOUTH * HOLLANDALE FAMILY CARE PC 1257 HIGHWAY 61 SOUTH * HOLMES COUNTY MEDICAL CLINIC- 18295 EMORY ROAD WEST * HOLMES FAMILY MEDICAL CLINIC 239 BOWLING GREEN ROAD * IMMEDIATE CARE FAMILY CLINIC 1710 14TH STREET * INDIANOLA FAMILY MEDICAL GROUP 122 EAST BAKER STREET * INTERNAL MEDICINE CLINIC OF CO 914 SUMRALL ROAD * INTERNAL MEDICINE RHC OF NEW A 300 OXFORD ROAD * ITTA BENA CLINIC 103 BASKET STREET * JACKSON CLINIC 29 SOUTH FOURTH STREET * JEFFERSON DAVIS RURAL HEALTH 1014 ROSE STREET, SUITE A CLINIC * K D H PRIMARY CARE CLINIC 823 GRAND AVENUE None KILMICHAEL FAMILY MEDICAL 301 LAMAR STREET CLINIC * L C TENNIN, JR, MD, PA 122 EAST ACADEMY STREET * LACKEY PEDIATRIC CLINIC 1129 HIGHWAY 35 SOUTH, SUITE 1 * LAUREL PEDIATRIC & ADOLESCENT 234 SOUTH 12TH AVENUE * LAWRENCE COUNTY FAMILY 1135 EAST BROAD STREET PRACTICE * LELAND MEDICAL CLINIC 201 BAKER BLVD * LEXINGTON PRIMARY CARE CLINIC 110 TCHULA STREET * LIFECORE HEALTH GROUP 499 GLOSTER CREEK VILLAGE, SUITE A-3

*

LOUISVILLE MEDICAL ASSOCIATES 564 EAST MAIN STREET

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

BAY SAINT LOUIS, MS 39520 (228)533-9000 Hancock HARRISVILLE, MS 39082 (601)847-7784 Simpson BYHALIA, MS 38611

(662)838-5565 Marshall

HOLCOMB, MS 38940 HOLLANDALE, MS 38748 WEST, MS 39192

(662)229-9787 Grenada (662)827-2214 Washington (662)967-2462 Holmes

LEXINGTON, MS 39095 MERIDIAN, MS 39301 INDIANOLA, MS 38751 COLUMBIA, MS 39429 NEW ALBANY, MS 38652 ITTA BENA, MS 38941 ROLLING FORK, MS 39159 PRENTISS, MS 39474

(662)834-5339 Holmes (601)482-9211 Lauderdale (662)887-2212 Sunflower (601)731-1470 Marion (662)534-8166 Union (662)254-7717 Leflore (662)873-4361 Sharkey (601)792-2200 Jefferson Davis

YAZOO CITY, MS 39194 KILMICHAEL, MS 39747

(662)751-8188 Yazoo (662)258-6221 Montgomery

CANTON, MS 39046 FOREST, MS 39074 LAUREL, MS 39440 MONTICELLO, MS 39654

(601)859-8992 Madison (601)469-3320 Scott (601)649-3520 Jones (601)249-2701 Lawrence

LELAND, MS 38756 LEXINGTON, MS 39095 TUPELO, MS 38801

(662)686-4121 Washington (662)834-1855 Holmes (662)844-1717 Lee

LOUISVILLE, MS 39339

(662)773-7500 Winston

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi CCN 258602 258978 253481 253487 258999 258970 258570 258612 258565 253403 258540 253903 258559 258560 258603 258617 253474 258537 253471 258972 253865 258585 258538 258556 258948 253970 258968

Key Provider Name None LOUISVILLE

MEDICAL CLINIC LOWER CROSSING MEDICAL CLINIC * LUCEDALE OB/GYN CENTER * MACON PRIMARY CLINIC * MADISON CANTON MEDICAL CLINIC * MAGEE AFTER HOURS CLINIC * MAIN STREET MEDICAL CLINIC OF MORTON None MARION GENERAL RURAL HEALTH CLINIC * MARION PRIMARY CARE CENTER * MEDI STAT CLINIC * MEDICAL GROUP OF QUITMAN,THE * MINOR MEDICAL CARE RAYMOND * NESHOBA INTERNAL MEDICINE ASSOCIATES

*

NESHOBA URGENT CARE CLINIC None NEW ALBANY MEDICAL CLINIC * NEWTON FAMILY AND PEDIATRIC CLINIC * NEWTON FAMILY MEDICAL ASSOCIATES * NINA JURNEY'S FAMILY MEDICAL PRACTICE * NORTH HILLS FAMILY MEDICAL CLINIC * NURSE MED I I, INC * NURSE MED INC * OAKLAND MEDICAL CLINIC * ODOM RURAL HEALTH CLINIC * PEARL RIVER FAMILY CLINIC * PEDIATRIC AND ADOLESCENT CLINI * PICAYUNE HEALTH SERVICES * PINNACLE MEDICAL CLINIC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 7

Address

City, State and ZIP

Telephone # County Name

320 HIGHWAY 15 NORTH 670 HIGHWAY 178- SUITES 2&3 92 WEST RATLIFF STREET SUITE B 606 NORTH JEFFERSON STREET 1171 HART ST 376-A SIMPSON HWY 49 347 SOUTH 4TH STREET

LOUISVILLE, MS 39339 SHERMAN, MS 38869 LUCEDALE, MS 39452 MACON, MS 39341 CANTON, MS 39046 MAGEE, MS 39111 MORTON, MS 39117

(662)773-7500 Winston (662)844-7999 Pontotoc (601)947-6000 George (662)726-4231 Noxubee (601)859-9888 Madison (601)849-5321 Simpson (601)732-1524 Scott

1560 SUMRALL ROAD

COLUMBIA, MS 39429

(601)261-2940 Marion

5334 DALE DRIVE 703 ALCORN DRIVE, SUITE 109 603 SOUTH ARCHUSA AVENUE 120 WEST MAIN ST/P O BOX 1223 921 WEST BEACON STREET

MARION, MS 39342 CORINTH, MS 38834 QUITMAN, MS 39355 RAYMOND, MS 39154 PHILADELPHIA, MS 39350

(601)703-0130 Lauderdale (662)286-1499 Alcorn (601)776-2123 Clarke (601)857-2341 Hinds (601)656-6116 Neshoba

1120 EAST MAIN STREET, SUITE 1 400 DOCTORS DRIVE 9427 EASTSIDE DRIVE EXT SUITE A

PHILADELPHIA, MS 39350 NEW ALBANY, MS 38652 NEWTON, MS 39345

(601)663-1360 Neshoba (662)534-5036 Union (601)683-0330 Newton

252 NORTHSIDE DRIVE

NEWTON, MS 39345

(601)683-3117 Newton

502 JACKSON STREET, SUITE 4

ABERDEEN, MS 39730

(662)369-9945 Monroe

4331 HIGHWAY 39 NORTH

MERIDIAN, MS 39305

(601)484-6180 Lauderdale

1031 NORTHRIDGE ROAD 716 SOUTH MAIN STREET 14101 HICKORY STREET 604 SOUTH MAIN STREET 302 HIGHWAY 11 SOUTH 308 HIGHLAND BOULEVARD 2274 HIGHWAY 43 SOUTH 7900 MS HWY 570 WEST

BALDWYN, MS 38824 RIPLEY, MS 38663 OAKLAND, MS 38948 WATER VALLEY, MS 38965 POPLARVILLE, MS 39470 NATCHEZ, MS 39120 PICAYUNE, MS 39466 SUMMIT, MS 39666

(662)365-9305 Lee (662)837-1534 Tippah (662)623-7319 Yalobusha (662)473-1311 Yalobusha (601)403-8284 Pearl River (601)442-7676 Adams (601)798-3964 Pearl River (601)684-7771 Pike

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi CCN 258515 258521 258604 258530 258567 258574 258606 253861 253850 253816 253817 258922 258576 258564 258579 258554 258607 253801 258906 253437 258581 253479 258519 253408 253400 253452

Key Provider Name *

PIONEER FAMILY MEDICAL PIONEER FAMILY MEDICAL OF HAMILTON None PONTOTOC MEDICAL CLINIC * POPLARVILLE FAMILY MEDICAL CLINIC * PREMIER MEDICAL CLINIC * PRIMARY HEALTH CARE None PUCKETT MEDICAL CLINIC * RANKIN RURAL MEDICAL CLINIC * REGION I I I PRIMARY CARE * RIVER REGION RURAL HEALTHMOB1

*

RIVER REGION RURAL HEALTH- S C * RUNNELSTOWN CLINIC * RUSH FAMILY PRACTICE-LAKE * RUSH MEDICAL CLINC-DEKALB * RUSH MEDICAL CLINIC PHILADELPHIA * RUSH MEDICAL CLINICCOLLINSVILLE

*

RUSH MEDICAL GROUP PRIMARY CARE * SARDIS FAMILY MEDICAL CLINIC, INC * SHANNON FAMILY MEDICAL CLINIC LLC * SOUTH CENTRAL ELLISVILLE MED C * SOUTH CENTRAL URGENT CARE * SOUTHWEST FAMILY MEDICINE * STONE COUNTY FAMILY MEDICAL CENTER * SUMNER CLINIC * SUNFLOWER RURAL HEALTH CLINIC * THE DOCTORS CLINIC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 7

Address

City, State and ZIP

Telephone # County Name

502 JACKSON STREET, SUITE 4 40128 HAMILTON ROAD

ABERDEEN, MS 39730 HAMILTON, MS 39746

(662)369-9500 Monroe (662)343-5129 Monroe

345 HIGHWAY 15 NORTH 1222 SOUTH MAIN STREET

PONTOTOC, MS 38863 POPLARVILLE, MS 39470

(662)488-7670 Pontotoc (601)795-9320 Pearl River

300 RAWLS DRIVE, SUITE 600 1080 HIGHWAY 35 SOUTH 6455 HIGHWAY 18 129 CENTER STREET, SUITE B 2434 SOUTH EASON BLVD 2100 HIGHWAY 61 NORTH

MC COMB, MS 39648 FOREST, MS 39074 BRANDON, MS 39042 RICHLAND, MS 39218 TUPELO, MS 38804 VICKSBURG, MS 39183

(601)249-4415 Pike (601)469-3555 Scott (601)824-9490 Rankin (769)233-7141 Rankin (662)844-1717 Lee (601)883-5000 Warren

2200 HIGHWAY 61 NORTH 5034 HWY 29 24489 HIGHWAY 80 14365 HIGHWAY 16 WEST 1106 CENTRAL DRIVE

VICKSBURG, MS 39180 PETAL, MS 39465 LAKE, MS 39092 DE KALB, MS 39328 PHILADELPHIA, MS 39350

(601)883-5000 Warren (601)583-1553 Forrest (601)775-3264 Scott (601)743-4626 Kemper (601)656-6921 Neshoba

9097 COLLINSVILLE ROAD

COLLINSVILLE, MS 39325

(601)626-8374 Lauderdale

1800 12TH STREET

MERIDIAN, MS 39301

(601)703-9265 Lauderdale

124 SOUTH MAIN STREET

SARDIS, MS 38666

(662)487-1064 Panola

219 BROAD STREET

SHANNON, MS 38868

(662)995-2201 Lee

1203 AVENUE B 1430 JEFFERSON STREET 421 MARION AVENUE 144 EAST CENTRAL AVENUE

ELLISVILLE, MS 39437 LAUREL, MS 39441 MCCOMB, MS 39648 WIGGINS, MS 39577

(601)477-8553 Jones (601)425-2273 Jones (601)684-6891 Pike (601)928-6700 Stone

100 N COURT SQUARE 840 NORTH OAK AVENUE 210 BAY AVENUE WEST

SUMNER, MS 38957 RULEVILLE, MS 38771 RICHTON, MS 39476

(662)375-9989 Tallahatchie (662)756-2711 Sunflower (601)788-9222 Perry

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Mississippi CCN

Key Provider Name *

Address

THE WOMAN'S CLINIC 2000 NORTH STATE STREET TOCCOPOLA FAMILY MEDICAL 7908 HWY 334 P O BOX 389 CLINIC * 258518 TRACE FAMILY HEALTH & INTERNAL 1002 EAST MADISON MEDICINE * 258516 TRI LAKES PEDIATRIC CLINIC 435 HWY 6 EAST * 258517 TRI LAKES WOMEN'S CLINIC 225 MEDICAL CENTER DRIVE, SUITE B * 253964 TRI STATE RURAL HEALTH CLINIC 502 ALCORN DRIVE * 253847 TRINITY HEALTH CLINIC 321 SOUTH SHARPE AVENUE * 258568 TYLERTOWN FAMILY CLINIC 200 HOSPITAL DR * 258590 UMMC-GRENADA PRIMARY CARE 965 AVENT DRIVE, SUITE 107 CLINIC

*

258613 VANCLEAVE MEDICAL CENTER 11700 HIGHWAY 57 * 258546 WAYNESBORO FAMILY MEDICINE 951 MATTHEW DRIVE, SUITE A AND OBSTETRICS * 258527 WIGGINS PRIMARY CARE 975 HALL STREET * 258528 WILLIAMS MEDICAL CLINIC 1938 CRESCENT MEADOW DRIVE * 258529 WILLIAMS MEDICAL CLINIC OF POT 39 CENTER ST BOX 40 * 258593 WINSTON MEDICAL CLINIC 923 CHURCH STREET * 258594 WINSTON MEDICAL CLINIC ( 90 EAST MAIN STREET NOXAPATER)

*

253884 WOMEN'S HEALTH CLINIC OF 1401 OAK STREET GRENADA None WOMEN'S PAVILION 253945 551 EAGLE DAY AVENUE None 253929 WOMEN'S PAVILION OF SOUTH MS ( 5003 HARDY STREET, SUITE 350 HATTIESBURG) None WOMEN'S PAVILION OF SOUTH MS, 1242 HIGHWAY 29 NORTH 253878 PLLC * 258937 WOODLAND CLINIC 120 MARKET STREET PO BOX 186 * 253855 YAZOO FAMILY CLINIC 1435 GRAND AVENUE * 258969 YAZOO FAMILY HEALTHCARE PLLC 307 EAST 15TH STREET Total Providers for this State = 177 258977 253820

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 7

City, State and ZIP

Telephone # County Name

CLARKSDALE, MS 38614 TOCCOPOLA, MS 38874

(662)627-7361 Coahoma (662)488-0270 Lafayette

HOUSTON, MS 38851

(662)456-2800 Chickasaw

BATESVILLE, MS 38606 BATESVILLE, MS 38606 CORINTH, MS 38835 CLEVELAND, MS 38732 TYLERTOWN, MS 39667 GRENADA, MS 38901

(662)563-7873 Panola (662)563-7873 Panola (662)287-5216 Alcorn (662)284-3870 Bolivar (601)876-5303 Walthall (662)227-7575 Grenada

VAN CLEAVE, MS 39565 WAYNESBORO, MS 39367

(228)826-1482 Jackson (601)735-2401 Wayne

WIGGINS, MS 39577 HOLLY SPRINGS, MS 38634 POTTS CAMP, MS 38659 LOUISVILLE, MS 39339 NOXAPATER, MS 39346

(601)528-9119 Stone (662)252-1599 Marshall (662)333-6933 Marshall (662)773-3503 Winston (662)733-3503 Winston

GRENADA, MS 38901

(662)226-4010 Grenada

COLUMBIA, MS 39429 HATTIESBURG, MS 39402

(601)736-6137 Marion (601)261-5835 Forrest

ELLISVILLE, MS 39437

(601)719-0003 Jones

WOODLAND, MS 39776 YAZOO CITY, MS 39194 YAZOO CITY, MS 39194

(662)456-0111 Chickasaw (662)746-3555 Yazoo (662)746-2113 Yazoo

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Carolina CCN

Key Provider Name

343411 343931

*

343905 343867 343427

*

343449

*

343444

*

343445

*

343446

*

343918 343970

*

348906

*

343443 343453 343454 343450

*

343452

*

343448 348959

*

348939

*

*

* *

*

* * *

*

* 348957 * 348932 * 343440 * 343441 * = Non-Deemed

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

City, State and ZIP

Telephone # County Name

ANGEL URGENT CARE CENTER 195 FRANKLIN PLAZA BENSON AREA MEDICAL CENTER 3333 NC HWY 242N PO BOX 399 INC BLACK RIVER FAMILY PRACTICE 301 SOUTH CAMPBELL STREET BLACK RIVER HEALTH SERVICES 109 W CHURCH STREET BLUE RIDGE MEDICAL CENTER 800 MEDICAL CAMPUS DRIVE YANCEY CAMPUS CAPE FEAR VALLEY BLADEN 107 DUNHAM STREET MEDICAL ASSOC EXPRESSCARE CAPE FEAR VALLEY- BLADEN 16 3RD STREET MEDICAL ASSOCIATES CAPE FEAR VALLEY-BLADEN 300A EAST MCKAY STREET MEDICAL ASSOCIATES CAPE FEAR VALLEY-BLADEN 1106 W SEABOARD STREET MEDICAL ASSOCIATES CHADBOURN FAMILY PRACTICE P A 104 SEVENTH AVENUE CLECO MEDICAL CENTER OF 808 SCHENCK STREET SHELBY COLUMBUS CO COMMUNITY 15 HILL PLAZA, SUITE A HEALTH CENTER COMMUNITY MEDICINE OLD FORT 32 E MAIN STREET DOSHER MEDCIAL BOLIVIA 3875 BUSINESS 17 E DOSHER MEDICAL HOLDEN BEACH 2930 HOLDEN BEACH ROAD SW DOSHER MEDICAL LONG BEACH 4222 LONG BEACH ROAD SE ROAD DOSHER MEDICAL-SMITHVILLE 1513 N HOWE STREET CROSSING DOSHER MEDICAL/OAK ISLAND 4700 EAST OAK ISLAND DR ARTHUR J ROBINSON MEDICAL C 800 MARTIN LUTHER KING DRIVE

FRANKLIN, NC 28744 BENSON, NC 27504

(828)369-4427 Macon (919)894-2011 Johnston

BURGAW, NC 28425 ATKINSON, NC 28421 BURNSVILLE, NC 28714

(910)259-5721 Pender (910)283-5011 Pender (828)682-0200 Yancey

ELIZABETHTOWN, NC 28337

(910)862-2122 Bladen

DUBLIN, NC 28332

(910)862-3528 Bladen

ELIZABETHTOWN, NC 28337

(910)862-6308 Bladen

BLADENBORO, NC 28320

(919)863-3138 Bladen

CHADBOURN, NC 28431 SHELBY, NC 28150

(910)654-3143 Columbus (704)480-9344 Cleveland

WHITEVILLE, NC 28472

(910)641-0202 Columbus

OLD FORT, NC 28762 BOLIVIA, NC 28422 SUPPLY, NC 28462 SOUTHPORT, NC 28461

(828)659-5741 McDowell (910)253-7990 Brunswick (910)842-5991 Brunswick (910)454-1197 Brunswick

SOUTHPORT, NC 28461

(910)457-9127 Brunswick

OAK ISLAND, NC 28465 LUMBERTON, NC 28359

(910)278-6414 Brunswick (910)738-3957 Robeson

EASTERN CAROLINA GERIATRIC ASSOC & FAM CARE CTR PL FAIRMONT MEDICAL CLINIC FAMILY CARE CENTER FAMILY MEDICINE-GLENWOOD FAMILY MEDICINE-NEBO

105 COMMERCE STREET

POWELLSVILLE, NC 27967

(252)332-6484 Bertie

101 N WALNUT STREET 1668 NC HWY 16 SOUTH 5623 US 221 SOUTH 339 NEBO SCHOOL ROAD

FAIRMONT, NC 28340 TAYLORSVILLE, NC 28681 MARION, NC 28752 NEBO, NC 28761

(910)628-0655 Robeson (828)632-9736 Alexander (828)659-9000 McDowell (828)652-6326 McDowell

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Carolina CCN

Key Provider Name

343431

*

343437

*

343919 343414

*

348944 343422 343963 343964 343447

*

343904 343987 343439

*

343438 343972

*

348951

*

343457

*

343426

*

343462

*

343410

*

343455 343425 343459 343460

*

*

* * * *

* *

*

* * *

* 343458 * = Non-Deemed

FIRSTHEALTH MONTGOMERY MEMORIAL HOSPITAL-FAMILY CA

GRANVILLE INTERNAL MEDICINE & GERIATRICS HARMONY MEDICAL CARE PA HEALTH PLUS OF THE MCDOWELL HOSP HIGHLAND MEDICAL ASSOCIATES HOKE FAMILY MEDICAL CENTER KINGS MOUNTAIN MEDICAL CENTER LAUREL HILL MEDICAL CLINIC LIFEBRITE FAMILY MEDICAL OF DANBURY

MAPLE HILL MEDICAL CENTER MAXTON FAMILY PRACTICE CENTER MCDOWELL OB/GYN MCDOWELL INTERNAL MEDICINE MCDOWELL PEDIATRICS MED FIRST IMMEDIATE CARE AND FAMILY PRACTICE, PA MID CAROLINA FAMILY MEDICINE, PA MISSION COMMUNITY OBSTETRICS AND GYNECOLOGY SPECIA

MISSION COMMUNITY PRIMARY CARE MISSION COMMUNITY PRIMARY CARE-HAYWOOD MISSION HEALTH MAUZY-PHILLIPS CENTER

MISSION WOMEN'S CARE SYLVA MOUNTAIN FAMILY CARE CENTER MURPHY GROUP FAMILY PRACTICE MURPHY GROUP PRACTICE HAYESVILLE MURPHY GROUP PRACTICE OB/GYN

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

Address

City, State and ZIP

Telephone # County Name

522 ALLEN STREET

TROY, NC 27371

(910)571-5510 Montgomery

1032 COLLEGE STREET

OXFORD, NC 27565

(919)693-6541 Granville

3210 HARMONY HWY 472 RANKIN DRIVE

HARMONY, NC 28634 MARION, NC 28752

(704)546-7587 Iredell (828)652-1400 McDowell

165 COOLRIDGE STREET 405 S MAIN STREET 812 W KING STREET 18901 IDA MILL ROAD 1020 HOSPICE DRIVE

HENDERSONVILLE, NC 28792 RAEFORD, NC 28376 KINGS MOUNTAIN, NC 28086 LAUREL HILL, NC 28351 DANBURY, NC 27016

(828)694-3939 Henderson (910)875-5101 Hoke (704)739-5456 Cleveland (910)462-2707 Scotland (336)593-8281 Stokes

4811 NC HWY 53 1001 W DR MARTIN LUTHER KING DR 1633 SUGAR HILL ROAD

MAPLE HILL, NC 28454 MAXTON, NC 28364 MARION, NC 28752

(910)259-6444 Pender (910)844-4077 Robeson (828)659-3621 McDowell

387 US 70 W 718 CORBETT AVENUE

MARION, NC 28752 SWANSBORO, NC 28584

(828)652-6328 McDowell (910)326-5588 Onslow

1038 ALBEMARLE ROAD

TROY, NC 27371

(910)572-1785 Montgomery

125 HOSPITAL DRIVE

SPRUCE PINE, NC 28777

(828)766-3001 Mitchell

11728 SOUTH HIGHWAY

SPRUCE PINE, NC 28777

(828)765-5672 Mitchell

360 HOSPITAL DRIVE

CLYDE, NC 28721

(828)456-9006 Haywood

189 HOSPITAL DRIVE

SPRUCE PINE, NC 28777

(828)765-0170 Mitchell

111 CENTRAL STREET 310 HOSPITAL AVENUE 183B LEDFORD STREET 2076 HIGHWAY 69 SOUTH

SYLVA, NC 28779 JEFFERSON, NC 28640 MURPHY, NC 28906 HAYESVILLE, NC 28904

(828)349-6804 Jackson (336)846-6322 Ashe (828)837-4712 Cherokee (828)389-3608 Clay

75 MEDICAL PARK LANE, SUITE D

MURPHY, NC 28906

(828)837-1332 Cherokee

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Carolina CCN

Key Provider Name

343461

*

343858 343982 343803 343430 343911 348938 348941 343914 343988 343962 343436 348961

*

348952

*

348954

*

348964

*

348960

*

348953

*

348958 343923 343955

*

343951 343400

*

343423

*

343828

*

* * * * * * * * * * *

* *

*

* = Non-Deemed

Address

MURPHY MEDICAL CENTER URGENT 183 A LEDFORD STREET CARE NEWPORT FAMILY PRACTICE 338 HOWARD BLVD PEMBROKE FAMILY PRACTICE 208 RUTH DIAL ST PENSLOW HEALTH CLINIC INC 206 NORTH DYSON STREET PLYMOUTH PRIMARY CARE 1006 US HIGHWAY 64 EAST RIEGELWOOD MEDICAL CLINIC REIGELWOOD SHOPPING CTR HWY 87 RIVERQUEST MEDICAL CARE 258 LOWE ROAD ROANOKE CLINIC 1385 MEDICAL CENTER DRIVE ROSE HILL MEDICAL CENTER 600 S SYCAMORE STREET SCOTLAND URGENT CARE CENTER 205 LAUCHWOOD DRIVE SEAGROVE MEDICAL CLINIC 614 NORTH BROAD STREET SOUTH GRANVILLE PRIMARY CARE 1614 HWY 56 SOUTHEASTERN MEDICAL CLINIC 302 S MAIN STREET BLADENBORO SOUTHEASTERN MEDICAL CLINIC 9928 N W R LATHAN STREET CLARKTON SOUTHEASTERN MEDICAL CLINIC 22401 ANDREW JACKSON HIGHWAY MAXTON SOUTHEASTERN MEDICAL CLINIC 302 MT TABOR ROAD RED SPRINGS SOUTHEASTERN MEDICAL CLINIC 102 NORTH BOND STREET ROWLAND SOUTHEASTERN RED SPRINGS 229 S MAIN STREET FAMILY MEDICINE ST PAULS MEDICAL CLINIC 128 EAST BROAD STREET THE COLUMBIA MEDICAL CENTER 208 NORTH BROAD STREET BOX 189 UPPER CLEVELAND MEDICAL 5009 FALLSTON ROAD CENTER VANCE FAMILY MEDICINE 381 RUIN CREEK RD VIDANT FAMILY MEDICINE 1473 NC HIGHWAY 42-43 WEST PINETOPS VIDANT FAMILY MEDICINE1403 SOUTH KING STREET WINDSOR, A DEPARTMENT OF VI YANCEY COUNTY PRIMARY CARE 202 MEDICAL CAMPUS DRIVE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

City, State and ZIP

Telephone # County Name

MURPHY, NC 28906

(828)837-4712 Cherokee

NEWPORT, NC 28570 PEMBROKE, NC 28372 HOLLY RIDGE, NC 28445 PLYMOUTH, NC 27962 RIEGELWOOD, NC 28456 LUMBERTON, NC 28360 ROANOKE RAPIDS, NC 27870 ROSE HILL, NC 28458 LAURINBURG, NC 28352 SEAGROVE, NC 27341 CREEDMOOR, NC 27522 BLADENBORO, NC 28320

(252)223-5054 Carteret (910)521-4462 Robeson (910)329-7591 Onslow (252)793-7701 Washington (910)655-0021 Columbus (910)735-1234 Robeson (252)537-9176 Halifax (910)289-3027 Duplin (910)277-8300 Scotland (336)873-7248 Randolph (919)575-6103 Granville (910)863-2400 Bladen

CLARKTON, NC 28433

(910)647-1503 Bladen

MAXTON, NC 28364

(910)844-2004 Robeson

RED SPRINGS, NC 28377

(910)843-9991 Hoke

ROWLAND, NC 28383

(910)422-3350 Robeson

RED SPRINGS, NC 28377

(910)843-9991 Robeson

SAINT PAULS, NC 28384 COLUMBIA, NC 27925 LAWNDALE, NC 28090

(910)865-5955 Robeson (252)796-0689 Tyrrell (704)538-8532 Cleveland

HENDERSON, NC 27536 PINETOPS, NC 27864

(252)430-0666 Vance (252)827-5231 Edgecombe

WINDSOR, NC 27983

(252)794-6775 Bertie

BURNSVILLE, NC 28714

(828)682-6118 Yancey

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Carolina CCN

Key Provider Name

Total Providers for this State =

* = Non-Deemed

Address 73

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

City, State and ZIP

Telephone # County Name

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Carolina CCN

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

901 W GREENWOOD STREET, SUITE 6 511 SOUTH MAIN STREET 701 SOUTH MORGAN AVENUE 1816 BOHICKET RD, SUITE F 1213 ELM STREET 1000 PINE STREET W

ABBEVILLE, SC 29620 MULLINS, SC 29574 ANDREWS, SC 29510 JOHNS ISLAND, SC 29455 AYNOR, SC 29511 VARNVILLE, SC 29944

(864)366-9938 Abbeville (843)464-8244 Marion (843)264-5253 Georgetown (843)559-1938 Charleston (843)358-5806 Horry (803)943-5228 Hampton

964 RIBAUT ROAD 880 WEST MOULTRIE STREET, SUITE 102 457 B HIGHWAY 123 BYPASS P O BOX 947 428 - 2 MCNULTY ROAD

BEAUFORT, SC 29902 WINNSBORO, SC 29180

(843)524-5437 Beaufort (803)635-0288 Fairfield

SENECA, SC 29678

(864)888-4464 Oconee

423442 428956 423970 428975 423806 423820

*

428981 423449

* *

ABBEVILLE INTERNAL MEDICINE ADVANCED MEDICAL ASSOCIATES ANDREWS MEDICAL CENTER ANGEL OAK FAMILY MEDICINE, LLC AYNOR FAMILY PRACTICE BEAUFORT MEMORIAL HARRISON PEEPLES HEALTHCARE CTR BEAUFORT PEDIATRICS BLUE GRANITE MEDICAL CENTER

428933

*

BLUE RIDGE PEDIATRICS, LLC

428990

*

BLYTHEWOOD, SC 29016

(803)754-8941 Richland

423457

*

EASLEY, SC 29640

(864)898-1377 Pickens

423428 428980 428979 423877

*

FAIRFAX, SC 29827 BLACKSBURG, SC 29702 GAFFNEY, SC 29340 UNION, SC 29379

(803)632-3421 Allendale (864)839-4325 Cherokee (864)839-4325 Cherokee (864)429-8029 Union

428973 428992

*

BLYTHEWOOD MEDICAL ASSOCIATES CANNON FAMILY PRACTICE 111 WEST ROPER ROAD EASTSIDE CAROLINA MEDICAL ASSOCIATES 1787 ALLENDALE FAIRFAX HWY CAROLINA PEDIATRIC ASSOCIATES 301 WEST PINE STREET CAROLINA PEDIATRIC ASSOCIATES 1610 B N LIMESTONE STREET CAROLINAS HEALTH ASSOCIATES - 801 WEST MAIN STREET FAMILY MEDICINE CHA - UPSTATE PEDIATRICS 407 WEST SOUTH STREET CHA FAMILY PRACTICE ASSOCIATES 429 E MAIN STREET

UNION, SC 29379 UNION, SC 29379

(864)429-8846 Union (864)427-9045 Union

428948 423444

*

1307 N LOGAN STREET 1010 MEDICAL CENTER DR SUITE 240

GAFFNEY, SC 29341 HARDEEVILLE, SC 29927

(864)488-1333 Cherokee (843)784-8293 Jasper

423450 423432 423865 423875 423453 423968

*

10911 N JACOB SMART BOULEVARD, D 595 WCAROLINA AVENUE 907 BELL STREET 51 11TH AVE 6 COLLEGE STREET 105 INDUSTRIAL WAY

RIDGELAND, SC 29936 VARNVILLE, SC 29944 CONWAY, SC 29526 AYNOR, SC 29511 DUE WEST, SC 29639 DARLINGTON, SC 29532

(843)645-1635 Beaufort (803)943-1221 Hampton (843)248-2727 Horry (843)358-3700 Horry (864)379-2345 Abbeville (843)395-0015 Darlington

428998

*

CHEROKEE CHILDREN'S CLINIC, PA COASTAL CAROLINA MEDICAL ASSOCIATES COASTAL MEDICAL ASSOCIATES COASTAL PLAINS PRIMARY CARE CONWAY PEDIATRICS CPG FAMILY MEDICINE DUE WEST FAMILY MEDICINE EASTERN CAROLINA PEDIATRIC ASSOCIATES EDGEFIELD MEDICAL CLINIC, PA

200 RIDGE MEDICAL PLAZA

EDGEFIELD, SC 29824

(803)637-3146 Edgefield

* * * * *

* * *

*

*

* * * * *

* = Non-Deemed

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Carolina CCN

Key Provider Name

423838 423840 423872 423451 423888 423455

*

423456

*

423452 423454

*

423803

*

428969

*

423420

*

423424

*

428988 428995

*

428945

*

428943

*

423852 423889 428989

*

423416

*

423857

*

* * * * *

*

*

* *

* = Non-Deemed

F MARION DWIGHT MD PA FAIRFIELD MEDICAL ASSOCIATES FAMILY HEALTHCARE NEWBERRY FAMILY MEDICINE ASSOCIATES FAMILY MEDICINE ASSOCIATES, LLC GHS CLEMSON-SENECA PEDSCLEMSON

GHS CLEMSON-SENECA PEDSSENECA

GHS LAURENS FAMILY MED-MAIN GHS LAURENS FAMILY MEDICINEGRAY COURT HEALTHWISE FAMILY PRACTICE, LLC

JOHN A MARTIN PRIMARY HEALTH CARE KERSHAWHEALTH HEALTHCARE PLACE AT BETHUNE LAFFITTE & WARREN MEDICAL CENTER

LAKE CITY FAMILY MEDICINE, LLC LANDRUM FAMILY HEALTH CARE LLC LEXINGTON MEDICAL CENTER BATESBURG-LEESVILLE LEXINGTON MEDICAL CENTER SWANSEA MARION MEDICAL GROUP, INC MARION PEDIATRICS MCLEOD FAMILY MEDICINE JOHNSONVILLE MCLEOD FAMILY MEDICINE CTRWILSON MCLEOD FAMILY MEDICINE KINGSTREE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 4

Address

City, State and ZIP

Telephone # County Name

450 NORTH STREET 880 WEST MOULTRIE STEET, SUITE 200 2605 KINARD STREET SUITE 200 901 W GREENWOOD ST STE 9 505 THURGOOD MARSHALL BLVD 208-1 FRONTAGE ROAD

BAMBERG, SC 29003 WINNSBORO, SC 29180 NEWBERRY, SC 29108 ABBEVILLE, SC 29620 KINGSTREE, SC 29556 CLEMSON, SC 29631

(803)245-5168 Bamberg (803)635-6461 Fairfield (803)405-1900 Newberry (864)366-9681 Abbeville (843)355-8380 Williamsburg (864)654-6034 Pickens

109 OMNI DRIVE, SUITE B

SENECA, SC 29672

(864)888-4222 Oconee

106 PARKVIEW DRIVE 9100 HWY 14

LAURENS, SC 29360 GRAY COURT, SC 29645

(864)984-0571 Laurens (864)876-4888 Laurens

154 WREN STREET

BARNWELL, SC 29812

(803)259-3399 Barnwell

56 HWY 321 BYPASS NORTH

WINNSBORO, SC 29180

(803)635-6099 Fairfield

103 SOUTH MAIN STREET

BETHUNE, SC 29009

(803)334-6557 Kershaw

623 NORTH MEMORIAL AVENUE

ALLENDALE, SC 29810

(803)584-2128 Allendale

901 N MATTHEWS ROAD 108 W RUTHERFORD STREET

LAKE CITY, SC 29560 LANDRUM, SC 29356

(843)394-8380 Florence (864)457-2363 Spartanburg

338 EAST COLUMBIA AVE 935 WEST SECOND STREET

BATESBURG-LEESVILLE, SC (803)604-0066 Lexington 29070

SWANSEA, SC 29160 (803)568-2000 Lexington

1205 N MAIN STREET 2845 E HWY 76 , SUITE 4 355 SOUTH GEORGETOWN HIGHWAY

MARION, SC 29571 MULLINS, SC 29574 JOHNSONVILLE, SC 29555

(843)423-0760 Marion (843)431-2720 Marion (843)380-2000 Florence

701 CASHUA FERRY ROAD

DARLINGTON, SC 29532

(803)398-8500 Darlington

512 NELSON BOULEVARD SUITE 200

KINGSTREE, SC 29556

(843)355-5459 Williamsburg

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Carolina CCN

Key Provider Name

873801

*

428927

*

428962

*

428934 423859 428986 423808

*

428919 423846 423878 423431 423817 423443 423436

*

873800 423429

*

423430

*

428928 428976 423828 428926 423826

*

423868

*

428966 423818 423856

*

* * *

* * * * * *

*

* * * *

* *

* = Non-Deemed

MCLEOD FAMILY MEDICINE- DR EAGERTON JR

MCLEOD FAMILY MEDICINE-MARION COUNTY MCLEOD FAMILY PRACTICE TIMMONSVILLE MCLEOD PEDIATRICS-DILLON MEDICAL BUILDING PA #2 MEDICAL CENTER OF SANTEE MONCKS CORNER PEDIATRICS OCONEE PEDIATRICS PAGELAND FAMILY MEDICINE PALMETTO MEDICAL CARE, LLC PALMETTO PRIMARY CARE PATE MEDICAL ASSOCIATES PEACH TREE MEDICAL CENTER PEACH TREE MEDICAL CENTER EDGEFIELD PEDIATRIC ASSOCIATES PA PEE DEE FAMILY PRACTICE JOHNSONVILLE PEE DEE FAMILY PRACTICE LAKE CITY PEE DEE PEDIATRICS PIEDMONT PEDIATRICS R DALE PADGETT MD PA R DALE PADGETT MD RHC RILEY FAMILY PRACTICE ASSOCIATES, PA RMC OBSTETRICS AND GYNECOLOGY RMC PRIMARY CARE RMC PRIMARY CARE BAMBERG RMC PRIMARY CARE BRANCHVILLE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

Address

City, State and ZIP

Telephone # County Name

200 E HOSPITAL STREET

MANNING, SC 29102

(803)433-0439 Clarendon

3032 EAST HIGHWAY 76

MULLINS, SC 29574

(803)464-7111 Marion

755 EAST SMITH STREET

TIMMONSVILLE, SC 29161

(843)346-3900 Florence

705 NORTH 8TH AVENUE SUITE 3A 456 NORTH MAIN STREET 500 BASS DRIVE PO BOX 1190 5000 EPSON PLANTATION DRIVE SUITE B 15579 WELLS HIGHWAY 301 N VAN LINGLE MUNGO BLVD 1002 S MAIN STREET 334 MERCY STREET 116 HOSPITAL SQUARE 906 WEST MAIN STREET 100 RIDGE MEDICAL PLAZA

DILLON, SC 29536 HEMINGWAY, SC 29554 SANTEE, SC 29142 MONCKS CORNER, SC 29461

(843)774-6091 Dillon (803)558-9319 Williamsburg (803)854-3805 Orangeburg (843)761-2000 Berkeley

SENECA, SC 29678 PAGELAND, SC 29728 MULLINS, SC 29574 LAKE CITY, SC 29560 BISHOPVILLE, SC 29010 RIDGE SPRING, SC 29129 EDGEFIELD, SC 29824

(864)882-7800 Oconee (843)672-6127 Chesterfield (843)245-0613 Marion (843)374-9355 Florence (803)484-9424 Lee (803)685-7355 Saluda (803)637-3630 Edgefield

40 PINNACLE PARKWAY, SUITE 206 625 SOUTH GEORGETOWN HWY PO BOX 180

276 NORTH RON MCNAIR BOULEVARD

ELGIN, SC 29045 JOHNSONVILLE, SC 29555

(803)438-3311 Kershaw (803)386-3106 Florence

LAKE CITY, SC 29560

(843)394-5471 Florence

2845 E HIGHWAY 76, SUITE 5 996 MEDICAL RIDGE ROAD 526 NORTH STREET 1499 JOHN C CALHOUN DRIVE 595 NEWBERRY HWY

MULLINS, SC 29574 CLINTON, SC 29325 BAMBERG, SC 29003 ORANGEBURG, SC 29115 SALUDA, SC 29138

(803)431-2650 Marion (864)833-5654 Laurens (803)245-2433 Bamberg (803)533-0007 Orangeburg (864)445-2500 Saluda

1175 COOK ROAD, SUITE 145

ORANGEBURG, SC 29118

(803)531-2300 Orangeburg

1750 VILLAGE PARK DRIVE 498 NORTH STREET 215 DORANGE ROAD PO BOX 247

ORANGEBURG, SC 29118 BAMBERG, SC 29003 BRANCHVILLE, SC 29432

(803)534-4254 Orangeburg (803)245-5144 Bamberg (803)274-8400 Orangeburg

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Carolina CCN

Key Provider Name *

RMC PRIMARY CARE CAROLINA AVE RMC PRIMARY CARE HOLLY HILL * RMC PRIMARY CARE ST MATTHEWS * SALUDA FAMILY MEDICINE, PA * SINGLETON HEALTH CENTER * ST PAUL'S MEDICAL GROUP, INC * SYCAMORE HEALTH CARE LLC * TRI-COUNTY PEDIATRICS, LLC * WACCAMAW FAMILY MEDICINE * WACCAMAW MEDICAL CENTER * WALTERBORO ADULT & PEDIATRIC MEDICINE, LLC * 428915 WALTERBORO FAMILY PRACTICE ASSOCIATES, PA * 423448 WILLIAMSBURG REGIONAL HEALTH CENTER Total Providers for this State = 87

423883 423821 428907 428978 428964 423891 423871 428987 423870 428958 423804

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

Address

City, State and ZIP

Telephone # County Name

1619 CAROLINA AVE 187 BUNCH FORD RD 725 HARRY C RAYSOR DRIVE SOUTH 102 R L SAWYER, MD DRIVE 1773 VILLAGE PARK DRIVE 7610 HWY 164 7205 BUFORD'S BRIDGE HIGHWAY 815 EAST LIBERTY STREET 9699 OCEAN HWY 1075 NORTH FRASER STREET 447 SPRUCE STREET

ORANGEBURG, SC 29115 HOLLY HILL, SC 29059 SAINT MATTHEWS, SC 29135 SALUDA, SC 29138 ORANGEBURG, SC 29118 HOLLYWOOD, SC 29449 SYCAMORE, SC 29846 YORK, SC 29745 PAWLEYS IS, SC 29585 GEORGETOWN, SC 29440 WALTERBORO, SC 29488

(803)531-7474 Orangeburg (803)496-3312 Orangeburg (803)874-3902 Calhoun (864)445-2173 Saluda (803)535-3600 Orangeburg (843)889-8018 Charleston (803)632-3900 Allendale (803)628-2728 York (843)237-4296 Georgetown (843)527-4442 Georgetown (843)549-6331 Colleton

107 CHURCH ST

WALTERBORO, SC 29488

(803)549-1558 Colleton

500 THURGOOD MARSHALL HWY

KINGSTREE, SC 29556

(843)933-2494 Williamsburg

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Tennessee CCN

Key Provider Name

448968

*

448955

*

448903 443931 448956 448938 448925 448951 443435 443937 448957 448946 443450 443925 448906

*

448942

*

448936

*

443951 443956

*

448971

*

448904

*

443916 448926 448934 443957

*

* * * * * * * * * * * *

*

* * *

* = Non-Deemed

Address

ACCESS MEDICAL CARE OF 4233 HIGHWAY 411 N MONROE COUNTY, PC ADVANCED HEALTH & WELLNESS 8 LEXINGTON DRIVE FAMILY CLINIC ALLCARE MEDICAL PLLC 313 CLEVELAND STREET APPALACHIA HEALTH SERVICES LLC 292 NORTH MAIN STREET ARISTORENAS HEALTH CLINIC 135 WEST MAIN ATHENS FAMILY PRACTICE 711 COOK DRIVE SUITE 100 ATHENS PEDIATRICS PLLC 111 EPPERSON ST ATHENS WOMENS CLINIC, PC 817 COOK DRIVE BAPTIST HICKMAN MEDICAL CLINIC 150 EAST SWAN STREET BEDFORD URGENT CARE 1612 NORTH MAIN STREET, SUITE A BROWNSVILLE FAMILY MEDICINE PA 2290 N WASHINGTON AVENUE CELEBRATION FAMILY CARE PLLC 529 WEST COMMERCE STREET CENTER FOR FAMILY MEDICINE 1615 MCMINNVILLE HWY, SUITE B CHARLES H WILKENS MD PC 131 HOSPITAL LANE, PO BOX 447 CHRISTIAN FAMILY MEDICINE 2017 SOUTH COLLEGE STREET, SUITE C CHRISTIAN FAMILY MEDICINE OF 622 W MARKET STREET BOLIVAR CHRISTIAN FAMILY MEDICINE OF 105 HIGHWAY 431 WEAKLEY COUNTY CHRISTIAN FAMILY MEDICINE, INC 79 HIGHWAY 51 SOUTH COMMUNITY MEDICAL CENTER OF 926 WEST MAIN STREET, PO BOX 1148 MONTEAGLE COMPLETE HEALTHCARE MEDICAL 3170 APPALACHIAN HIGHWAY SUITE 5 CENTER COOKEVILLE MEDICAL CLINIC 402 EAST GORE AVENUE GAINESBORO RHC COOKEVILLE MEDICAL CLINIC RHC 225 NORTH WILLOW AVENUE COVENANT PEDIATRICS 421 OLD RICEVILLE ROAD SUITE 2 CROCKETT MEDICAL CLINIC 58 SOUTH BELLS STREET CUMBERLAND FAMILY CARE OF 817 COLLEGE STREET VANBUREN

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 5

City, State and ZIP

Telephone # County Name

MADISONVILLE, TN 37354

(423)253-4707 Monroe

LEXINGTON, TN 38351

(731)968-2233 Henderson

RIPLEY, TN 38063 JELLICO, TN 37762 ADAMSVILLE, TN 38310 ATHENS, TN 37303 ATHENS, TN 37303 ATHENS, TN 37303 CENTERVILLE, TN 37033 SHELBYVILLE, TN 37160 BROWNSVILLE, TN 38012 LEWISBURG, TN 37091 MANCHESTER, TN 37355 JELLICO, TN 37762 TRENTON, TN 38382

(731)677-3000 Lauderdale (423)784-3600 Campbell (731)632-3373 McNairy (615)516-3283 McMinn (423)745-5955 McMinn (423)745-3394 McMinn (931)729-3091 Hickman (615)555-5555 Bedford (111)222-3333 Haywood (931)270-9729 Marshall (931)728-6205 Coffee (423)784-7269 Campbell (731)749-7444 Gibson

BOLIVAR, TN 38008

(731)635-8189 Hardeman

MARTIN, TN 38237

(731)281-4760 Weakley

RIPLEY, TN 38063 MONTEAGLE, TN 37356

(731)635-8189 Lauderdale (931)924-6006 Grundy

JACKSBORO, TN 37757

(423)566-4748 Campbell

GAINESBORO, TN 38562

(931)268-6899 Jackson

COOKEVILLE, TN 38501 ATHENS, TN 37303 ALAMO, TN 38001 SPENCER, TN 38585

(615)528-8089 Putnam (423)744-8755 McMinn (731)696-5401 Crockett (931)946-2113 Van Buren

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Tennessee CCN 443448 448914 448961 443971 443845 443918 443442 448941 443955 448905 443930 448935 448923 448952 448909 448921 448920 448973 448976 443447 448962 448950 448967 443913 443438 448977

Key Provider Name *

CUMBERLAND RIVER MEDICAL CLINIC * DOVER MEDICAL CLINIC None DRESDEN FAMILY CLINIC LLC * DYERSBURG FAMILY WALK-IN CLINIC, PC

*

EAGLEVILLE MEDICAL GROUP * EAST JACKSON FAMILY MEDICAL CE * ERLANGER BLEDSOE - INTERNAL MEDICINE & PEDIATRICS * FAMILY CARE CLINIC LLC * FAMILY CLINIC OF HENDERSON * FAMILY FIRST MEDICAL CENTER * FAMILY HEALTH CENTER OF ASHLAND CITY * FAMILY HEALTHCARE CLINIC LLC * FAMILY HEALTHCARE OF CAMDEN, INC * FAMILY MEDICINE WEST OF WARTBURG * FAMILY WALK-IN CLINIC * FAMILY WALK-IN CLINIC OF SPARTA * GREENFIELD FAMILY CARE None HALL MEDICAL CLINIC * HCMC PARIS PEDIATRICS * HENDERSON COUNTY MEDICAL GROUP RHC * HIGH FOREST HEALTH GROUP * HOHENWALD MEDICAL CENTER * J HOWARD RUPARD MD * JENNINGS FAMILY MEDICAL CLINIC * JOHNSON COUNTY MEDICAL GROUP None JUST 4 KIDS PEDIATRICS, LLC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 5

Address

City, State and ZIP

Telephone # County Name

102 OLD JEFFERSON STREET

CELINA, TN 38551

(931)243-3576 Clay

133 DR ROBERT H LEE DRIVE 130 E LOCUST ST 2017 SAINT JOHN AVENUE, SUITE B

DOVER, TN 37058 DRESDEN, TN 38225 DYERSBURG, TN 38024

(931)232-5141 Stewart (731)364-3196 Weakley (731)285-6110 Dyer

341 SOUTH MAIN STREET 655 LEXINGTON AVENUE 136 WHEELERTOWN AVANUE

EAGLEVILLE, TN 37060 JACKSON, TN 38301 PIKEVILLE, TN 37367

(615)274-6207 Rutherford (731)425-7900 Madison (423)447-3524 Bledsoe

231 NORTHGATE DR 102 236 NORTH AVENUE 899 HIGHWAY 51 SOUTH 342 FREY STREET

MC MINNVILLE, TN 37110 HENDERSON, TN 38340 COVINGTON, TN 38019 ASHLAND CITY, TN 37015

(931)474-4700 Warren (731)989-5180 Chester (901)476-8886 Tipton (615)792-1199 Cheatham

7065 KNOXVILLE HIGHWAY 350 HOSPITAL DRIVE

OLIVER SPRINGS, TN 37840 CAMDEN, TN 38320

(865)435-3918 Morgan (731)584-3330 Benton

1236 KNOXVILLE HIGHWAY, SUITE 500

WARTBURG, TN 37887

(423)346-5566 Morgan

42 DOOLEY STREET 287 W TURNTABLE RD 801 S MERIDIAN 107 JV MANGUBAT DRIVE 243 JIM ADAMS DRIVE 250 BOSWELL ST

CROSSVILLE, TN 38555 SPARTA, TN 38583 GREENFIELD, TN 38230 WAYNESBORO, TN 38485 PARIS, TN 38242 LEXINGTON, TN 38351

(931)707-7117 Cumberland (931)337-1035 White (731)235-0555 Weakley (931)722-2800 Wayne (731)644-2747 Henry (731)968-2006 Henderson

120 KITTRELL STREET 20 S PARK STREET 883 UNION STREET 364 TENNESSEE AVENUE SOUTH 1901 S SHADY STREET

HOHENWALD, TN 38462 HOHENWALD, TN 38462 SHELBYVILLE, TN 37160 PARSONS, TN 38363 MOUNTAIN CITY, TN 37683

(931)796-1818 Lewis (931)796-7960 Lewis (931)685-1145 Bedford (901)847-6396 Decatur (423)727-1133 Johnson

326 N LOCUST SUITE A

LAWRENCEBURG, TN 38464

(931)762-5437 Lawrence

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Tennessee CCN 448948 448945 443973 448958 443961 448908 448924 443974 448964 443932 448919 443441 448910 448972 448918 448932 448966 448969 443868 448931 448930 443933 448944 448900 448933 448960 443967 443966

Key Provider Name *

JUST 4 KIDS PEDIATRICS, LLC KIDS ARE SPECIAL * KIDZCARE PEDIATRICS * KING FAMILY MEDICAL * KINGSTON FAMILY PRACTICE, PC * LENTZ PEDIATRICS PLC * LEXINGTON FAMILY PRACTICE * LIBERTY MEDICAL CLINIC None LORETTO FAMILY CARE * LYNETTE M ADAMS, MD * MADISON STREET FAMILY CLINIC * MANCHESTER RURAL HEALTH CLINIC * MARTIN CHILDREN'S CLINIC LLC * MEDINA FAMILY PRACTICE * MEDSOUTH MEDICAL CENTER, DYERSBURG * MICHIE MEDICAL CLINIC INC * MID-SOUTH CONVENIENT CARE, PLLC * MOORE MEDICAL CLINIC LLC * MOUNTAIN CITY EXTENDED HOURS H * ONE STOP MEDICAL LLC * ONE STOP MEDICAL, LLC * PAUL E SCATES FAMILY MEDICINE * PAULA VASSAR INC * PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC * PIKEVILLE CLINIC LLC * PIKEVILLE URGENT CARE, PLLC * PIONEER PEDIATRICS PLLC * PLATEAU PEDIATRICS PLC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 5

Address

City, State and ZIP

Telephone # County Name

910 WEST COLLEGE STREET 880 COLLOREDO BLVD 119 EPPERSON STREET 215B HOLLY LANE 820 WEST RACE STREET 10777 HWY 412 WEST 524 S BROAD ST 4944 COLLEGE STREET 722 NORTH MILITARY STREET 1612 NORTH MAIN, SUITE 13 1401 MADISON STREET 482 INTERSTATE DRIVE, SUITE A

PULASKI, TN 38478 SHELBYVILLE, TN 37160 ATHENS, TN 37303 WAVERLY, TN 37185 KINGSTON, TN 37763 LEXINGTON, TN 38351 LEXINGTON, TN 38351 BELLS, TN 38006 LORETTO, TN 38469 SHELBYVILLE, TN 37160 SHELBYVILLE, TN 37160 MANCHESTER, TN 37355

(931)363-0077 Giles (931)685-8111 Bedford (423)745-7500 McMinn (111)222-3333 Humphreys (865)376-3406 Roane (731)968-5558 Henderson (731)651-0300 Henderson (731)663-3530 Crockett (111)222-3333 Lawrence (931)685-2022 Bedford (931)685-2022 Bedford (931)728-4718 Coffee

130 COMMONS DR 605 HWY 45 E S 1700 WOODLAWN AVE

MARTIN, TN 38237 MEDINA, TN 38355 DYERSBURG, TN 38024

(731)681-1577 Weakley (731)783-1234 Gibson (731)287-4500 Dyer

6659 MICHIE PEBBLE HILL RD 521 HIGHWAY 51 NORTH

MICHIE, TN 38357 RIPLEY, TN 38063

(731)632-1783 McNairy (731)635-2000 Lauderdale

600 MAIN STREET JOHNSON CO HLTH CTR, 1901 S SHADY ST 325 GERI STREET 912 WEST COLLEGE STREET 12995 HWY 64, PO BOX 399 1720 E REELFOOT AVE STE 103 1501 BRAYTON AVENUE

FRIENDSHIP, TN 38034 MOUNTAIN CITY, TN 37683

(731)677-3400 Crockett (423)727-1150 Johnson

LAWRENCEBURG, TN 38464 PULASKI, TN 38478 SOMERVILLE, TN 38068 UNION CITY, TN 38261 DYERSBURG, TN 38024

(931)762-9797 Lawrence (931)424-9797 Giles (901)466-0250 Fayette (731)885-6600 Obion (731)285-4111 Dyer

3062 MAIN STREET 344 CHURCH STREET 236 E MAIN ST 3234 MILLER AVENUE

PIKEVILLE, TN 37367 PIKEVILLE, TN 37367 MC MINNVILLE, TN 37110 CROSSVILLE, TN 38555

(423)447-2955 Bledsoe (423)618-3696 Bledsoe (931)815-5457 Warren (931)707-8700 Cumberland

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Tennessee CCN

Key Provider Name *

R SHANE ROBERTS, MD RAINBOW PEDIATRIC PC * RAY MEDICAL * REELFOOT FAMILY WALK- IN CLINIC * REELFOOT FAMILY WALK-IN CLINIC * REELFOOT FAMILY WALK-IN CLINIC * RHEA MEDICAL CENTER PHYSICIAN GROUP * 448922 ROBERSON RIKE CLINIC * 443948 RURAL HEALTH CLINICS OF WEST TN, PLLC

*

443949 RURAL HEALTH CLINICS OF WEST TN, PLLC

*

443950 RURAL HEALTH CLINICS OF WEST TN, PLLC * 448953 SDG PRIMARY AND IMMEDIATE CARE LLC * 448912 SOUTHERN TENNESSEE PRIMARY CARE-MOUNTAIN MEDICAL C

*

443943 SPRING CITY WALK IN MEDICAL CENTER * 443970 SPRINGER MEDICAL ASSOCIATES * 443997 TENNOVA LAFOLLETTE MEDICAL CENTER CLINIC

*

443440 TENNOVA LAFOLLETTE MEDICAL CENTER CLINIC-SOUTH None TENNOVA PRIMARY CARE-HILLVIEW 443449 SOUTH * 448916 TERRELL CLINIC LLC None THE FAMILY CLINIC 448963 * 443968 THE GROVE PRIMARY CARE CLINIC * 448929 THE GROVE PRIMARY CARE CLINIC LLC

*

448954 THE GROVE PRIMARY CARE CLINIC, LLC * 443960 THE RICKARD CLINIC * = Non-Deemed

443935 448965 448947 448913 448940 448937 443451

*

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 5

Address

City, State and ZIP

Telephone # County Name

398 N MAIN STREET 1636 E MAIN STREET 2409 HIGHWAY 70 E 1509 EAST REELFOOT AVENUE 130 E LOCUST STREET 708 EAST COURT STREET 22576 RHEA COUNTY HIGHWAY

DECATUR, TN 37322 HUMBOLDT, TN 38343 DICKSON, TN 37055 UNION CITY, TN 38261 DRESDEN, TN 38225 DYERSBURG, TN 38024 SPRING CITY, TN 37381

(423)334-2222 Meigs (731)784-7833 Gibson (615)740-7322 Dickson (731)442-9306 Obion (731)364-3196 Weakley (731)555-5555 Dyer (111)222-3456 Rhea

768 EVERETT STREET 1716 PARR AVENUE SUITE A

TIPTONVILLE, TN 38079 DYERSBURG, TN 38024

(731)253-3760 Lake (731)253-3683 Dyer

326 ASBURY AVENUE, SUITE 101

RIPLEY, TN 38063

(731)635-2755 Lauderdale

115 WEST TIGRETT STREET

HALLS, TN 38040

(731)836-7700 Lauderdale

201 SOUTH FRONT STREET

HALLS, TN 38040

(731)836-5617 Lauderdale

21 1ST STREET

MONTEAGLE, TN 37356

(931)924-9000 Grundy

126 LAVENDER STREET

SPRING CITY, TN 37381

(423)452-9984 Rhea

16615 HIGHWAY 104 N SUITE B 905 E CENTRAL AVE

LEXINGTON, TN 38351 LAFOLLETTE, TN 37766

(731)968-0660 Henderson (423)907-1600 Campbell

2145 JACKSBORO PIKE

LA FOLLETTE, TN 37766

(423)907-1700 Campbell

1203 INDUSTRIAL PARK RD

SOUTH FULTON, TN 38257

(731)479-2606 Obion

701 EAST REELFOOT AVE SUITE 100 545 PICKWICK STREET 541 WEST PARK PLACE SUITE C 702 S MAIN STREET

UNION CITY, TN 38261 SAVANNAH, TN 38372 HENDERSON, TN 38340 MIDDLETON, TN 38052

(731)885-9687 Obion (731)925-3354 Hardin (731)983-0499 Chester (731)376-1311 Hardeman

9458 HIGHWAY 100

SCOTTS HILL, TN 38374

(231)924-0244 Decatur

557 WEST PARK PLACE

HENDERSON, TN 38340

(731)989-1007 Chester

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Tennessee CCN

Key Provider Name *

TRINITY MEDICAL CLINIC, LLC UNIONVILLE FAMILY PRACTICE * UPPER CUMBERLAND MEDICAL ASSOCIATES PLLC * 443965 UT PRIMARY CARE HEARTLAND * 448927 WALK-IN MEDICAL CLINIC OF LINDEN PLLC * 443969 WARTRACE FAMILY PRACTICE * 448974 WEST FAMILY CARE CLINIC * 448970 WOMEN'S CENTER OF EAST TENNESSEE * 443947 WOMEN'S WELLNESS & MATERNITY CENTER, INC Total Providers for this State = 112

448928 443936 448975

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 5

Address

City, State and ZIP

Telephone # County Name

828 MULERRY AVE 3335 HIGHWAY 41A NORTH 225 N WILLOW AVENUE

SELMER, TN 38375 UNIONVILLE, TN 37180 COOKEVILLE, TN 38501

(731)434-0200 McNairy (931)685-2022 Bedford (931)528-8899 Putnam

309 N BROAD STREET 847 SQUIRREL HOLLOW DR

NEW TAZEWELL, TN 37825 LINDEN, TN 37096

(423)626-7297 Claiborne (931)589-2600 Perry

507 WEST BLACKMAN BLVD 108 EAST DRIVE 135 N MEADOWS DRIVE, SUITE B

WARTRACE, TN 37183 NEWBERN, TN 38059 ATHENS, TN 37303

(931)389-0600 Bedford (731)627-3553 Dyer (423)507-8067 McMinn

3459 HWY 68

MADISONVILLE, TN 37354

(423)442-6624 Monroe

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 148985 143438 783821 143456 143474 143917 148522 148921 148533 148521 148531 148544 148530 148926 143937 148978 148529 143978 143458 143880 143821 783803 148566 143485 148569 148558 148503

Key Provider Name *

AHEARN ASSOCIATES MEDICAL CENTER INC

*

ATWOOD RURAL HEALTH CLINIC * BENTON COMMUNITY HEALTHCARE * BOWEN FAMILY PRACTICE * BOYD-FILLAGER CLINIC * BRIAN W DOSSETT MD LTD * BUSHNELL FAMILY PRACTICE, S C * C C MEDICAL CLINIC * CARLE AT TUSCOLA * CARLE AT WATSEKA * CARLE DANVILLE ON FAIRCHILD None CARLE MATTON ON HURST None CARLINVILLE FAMILY HEALTH CARE * CARLINVILLE FAMILY PRACTICE * CARLINVILLE MEDICAL CLINIC * CARLINVILLE MEDICAL CLINIC INC None CARMI FAMILY CLINIC * CASEY CLINIC * CCH MEDICAL CLINIC * CENTER FOR FAMILY HEALTH MALTA * CENTER FOR MEDICAL ARTS RURAL HEALTH * CENTRALIA FAMILY HEALTH CENTER None CERRO GORDO RURAL HEALTH CLINIC * CISSNA PARK MEDICAL CLINIC None CLAY COUNTY HOSPITAL CISNE MEDICAL CLINIC None CLAY COUNTY HOSPITAL CLAY CITY CLINIC * CLINTON COUNTY RURAL HEALTH

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 10

Address

City, State and ZIP

Telephone # County Name

513 ELLIOTT STREET SUITE 4

KEWANEE, IL 61443

(309)853-2442 Henry

108 S MAIN STREET 203 BAILEY LANE SUITE 1 209 EAST 5TH STREET 712 COLLEGE STREET 1029 N 8TH STREET 1150 N COLE ST 1141 N CHENEY STREET 301 E SOUTHLINE ROAD 1490 E WALNUT STREET, SUITE C 311 WEST FAIRCHILD STREET 2512 HURST DR SUITE 130 20613 NORTH BROAD STREET 15574 ROUTE 108 604 N BROAD ST 125 SOUTH 2ND STREET, PO BOX 25 110A E MAIN STREET 412 NW 3RD, PO BOX 40 929 STABY BURK DRIVE, PO BOX 40 21193 MALTA RD

ATWOOD, IL 61913 BENTON, IL 62812 BOWEN, IL 62316 GREENFIELD, IL 62044 VANDALIA, IL 62471 BUSHNELL, IL 61422 TAYLORVILLE, IL 62568 TUSCOLA, IL 61953 WATSEKA, IL 60970 DANVILLE, IL 61832 MATTOON, IL 61938 CARLINVILLE, IL 62626 CARLINVILLE, IL 62626 CARLINVILLE, IL 62626 GIRARD, IL 62640 NORRIS CITY, IL 62869 CASEY, IL 62420 FLORA, IL 62839 MALTA, IL 60150

(217)578-3814 Douglas (618)438-5670 Franklin (217)842-5211 Hancock (217)368-3051 Greene (618)283-4469 Fayette (309)772-9444 McDonough (217)287-7477 Christian (217)253-5231 Douglas (815)432-8200 Iroquois (217)431-7600 Vermilion (217)258-5900 Coles (217)854-3881 Macoupin (217)854-4319 Macoupin (217)854-9411 Macoupin (217)627-3350 Macoupin (618)378-2067 White (217)932-4061 Clark (618)662-2191 Clay (815)753-9010 DeKalb

2601 W MAIN STREET

CARBONDALE, IL 62901

(618)549-5361 Jackson

1441 WEST BROADWAY

CENTRALIA, IL 62801

(618)532-9050 Marion

407 S JACKSON ST SUITE A

CERRO GORDO, IL 61818

(217)763-6010 Piatt

141 WEST GARFIELD AVENUE 413 PARK STREET

CISSNA PARK, IL 60924 CISNE, IL 62823

(815)457-2146 Iroquois (618)662-2131 Wayne

800 KELLY DRIVE SW

CLAY CITY, IL 62824

(618)662-2131 Clay

9401 HOLY CROSS LANE

BREESE, IL 62230

(618)526-7271 Clinton

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 148570 148502 148553 148554 148552 143488 143486 143429 143484 148508 143948 148545 143975 148987 143465 148993 148924 148524 148523 143878 783801 143877 148556 143404

Key Provider Name *

CLINTON COUNTY RURAL HEALTH CARLYLE * CLINTON COUNTY RURAL HEALTH GERMANTOWN None CLINTON COUNTY RURAL HEALTH NEW BADEN None CLINTON COUNTY RURAL HEALTHCARYLE None CLINTON COUNTY RURAL HEALTHTRENTON * CMH OBLONG RURAL HEALTH * CMH PALESTINE RURAL HEALTH * CMH RURAL HEALTH CLINIC * COMMUNITY MEDICAL CLINIC * COMMUNITY MEDICAL CLINIC OF PANA * COMPREHENSIVE HEALTH CENTER None CONVENIENT CARE * CONVENIENT CARE CLINIC * CORK MEDICAL CENTER * COULTERVILLE MEDICAL CLINIC * COWDEN MEDICAL CLINIC LLC * CRAIG W FURRY, MD None CROSSROADS FAMILY MEDICINE OF MT VERNON None CROSSROADS FAMILY MEDICINE OF WAYNE CITY * DANVILLE PEDIATRIC CENTER * DIETERICH COMMUNITY MEDICAL CENTER * DOCTORS CLINIC, THE * DOWNTOWN FAMILY CLINIC * DR JOHN WARNER HOSP RURAL HLTH

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 10

Address

City, State and ZIP

Telephone # County Name

1110 MULLIKIN STREET

CARLYLE, IL 62231

(618)526-5900 Clinton

205 MUNSTER STREET

GERMANTOWN, IL 62245

(618)523-4541 Clinton

211 E HANOVER ST

NEW BADEN, IL 62265

(618)588-2900 Clinton

14509 STATE ROUTE 127

CARLYLE, IL 62231

(618)594-8924 Clinton

409 E BROADWAY

TRENTON, IL 62293

(618)224-7366 Clinton

1366 EAST 1050TH AVENUE 209 EAST GRAND PRAIRIE 1101 NORTH ALLEN STREET 135 W BROADWAY 101 EAST 9TH STREET, SUITE 105

OBLONG, IL 62449 PALESTINE, IL 62451 ROBINSON, IL 62454 ASTORIA, IL 61501 PANA, IL 62557

(618)592-3119 Crawford (618)586-2153 Crawford (618)544-3699 Crawford (309)329-2926 Fulton (217)562-2544 Christian

1238 COMMERICAL PARK ROAD 1345 S RTE 127 517 N MAIN STREET 408 N 2ND STREET 203 E GRANT 209 EAST ELM STREET, PO BOX 154 20 N WASHINGTON, SUITE 2 209 CROSSROADS PLACE, SUITE 120

METROPOLIS, IL 62960 GREENVILLE, IL 62246 ANNA, IL 62906 MARSHALL, IL 62441 COULTERVILLE, IL 62237 COWDEN, IL 62422 DU QUOIN, IL 62832 MOUNT VERNON, IL 62864

(618)524-2284 Massac (618)665-9390 Bond (618)833-2295 Union (217)826-2361 Clark (618)758-2331 Randolph (217)783-6565 Shelby (618)542-2129 Perry (618)242-3465 Jefferson

1209 ROBINSON ST

WAYNE CITY, IL 62895

(618)895-2050 Wayne

405 SHERIDAN STREET 203 S MAIN STREET PO BOX 182

DANVILLE, IL 61832 DIETERICH, IL 62424

(217)446-3259 Vermilion (217)925-5730 Effingham

402 S PLUM 208 S WASHINGTON STREET 422 WEST WHITE STREET

CARMI, IL 62821 MC LEANSBORO, IL 62859 CLINTON, IL 61727

(618)384-2226 White (618)643-2361 Hamilton (217)935-9571 De Witt

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 143422 783818 148507 143473 143483 148518 783815 143466 148517 148516 148515 143431 143989 143412 143987 148956 148935 148534 148528 148527 148506 143469 148560

Key Provider Name *

EAST ADAMS COUNTY RURAL HEALTH * EFFINGHAM OBSTETRICS & GYNECOLOGY ASSOCIATES LLC * ELDORADO FAMILY MEDICINE CLINIC * ELDORADO PRIMARY CARE * ELMER HUGH TAYLOR CLINIC * EQUALITY FAMILY PRACTICE * FAMILY CARE ASSOCIATES OF EFFINGHAM, SC * FAMILY HEALTH CENTER * FAMILY HEALTHCARE OF FARMER CITY * FAMILY HEALTHCARE OF GIBSON CITY * FAMILY HEALTHCARE OF HOOPESTON * FAMILY MEDICAL CENTER * FAMILY MEDICAL CENTER * FAMILY MEDICAL CENTER * FAMILY MEDICAL CENTER * FAMILY PRACTICE MEDICAL CENTER * FAMILY PRACTICE MEDICAL CENTER, LTD * FAMILY RURAL HEALTH OF LAHARPE * FCH RURAL HEALTH ST ELMO * FCH RURAL HEALTH VANDALIA * FERRELL HOSPITAL FAMILY PRACTICE * FRANKLIN HOSPITAL - FRANKLIN HEALTHCARE CLINIC None GALATIA PRIMARY CARE

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 10

Address

City, State and ZIP

Telephone # County Name

102 PRAIRIE MILLS ROAD

GOLDEN, IL 62339

(217)696-4446 Adams

912 N HENRIETTA PO BOX 784

EFFINGHAM, IL 62401

(217)342-3337 Effingham

1407 LOCUST STREET

ELDORADO, IL 62930

(618)273-2100 Saline

1007 U S ROUTE 45 100 W 15TH STREET 183 WEST LANE STREET 1106 NORTH MERCHANT STREET, PO BOX 665 207 SOUTH BURNS AVENUE 1230 GEORGE ROCK DRIVE

ELDORADO, IL 62930 BEARDSTOWN, IL 62618 EQUALITY, IL 62934 EFFINGHAM, IL 62401

(618)273-7723 Saline (217)322-4321 Cass (618)276-5196 Gallatin (217)342-7000 Effingham

SPARTA, IL 62286 FARMER CITY, IL 61842

(618)443-3084 Randolph (309)928-9192 De Witt

7 DOCTORS PARK

GIBSON CITY, IL 60936

(217)784-5500 Ford

705 S DIXIE HWY

HOOPESTON, IL 60942

(217)728-3553 Vermilion

104 E BUENA VISTA 112 WEST MADISON AVENUE 5383 STATE ROUTE 154 727 E COURT 511 W FAIRCHILD STREET

KANSAS, IL 61933 CHRISMAN, IL 61924 PINCKNEYVILLE, IL 62274 PARIS, IL 61944 DANVILLE, IL 61832

(217)465-8411 Edgar (217)269-2394 Edgar (618)357-2131 Perry (217)465-8411 Edgar (217)431-2025 Vermilion

508 N MAIN STREET

GEORGETOWN, IL 61846

(217)662-2282 Vermilion

501 EAST MAIN STREET

LA HARPE, IL 61450

(217)659-3844 Hancock

515 N MAIN STREET 1442 N 8TH SUITE C 1306 MAPLE STREET

SAINT ELMO, IL 62458 VANDALIA, IL 62471 ELDORADO, IL 62930

(618)829-9200 Fayette (618)283-0266 Fayette (618)297-9665 Saline

201 BAILEY LANE

BENTON, IL 62812

(618)439-3161 Franklin

124 E MAIN ST PO BOX 69

GALATIA, IL 62935

(618)268-4083 Saline

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 148986

Key Provider Name *

GALLATIN COUNTY WELLNESS CENTER *

148918 GENESIS HEALTH GROUP * 143453 GENESIS HEALTH GROUP, ALEDO * 148546 GIBSON AREA HOSPITAL AND HEALTH SERVICES * 148559 GIBSON CITY CLINIC SC * 143859 GILLESPIE FAMILY PRACTICE * 143424 GILMAN CLINIC None GIRARD FAMILY HEALTH CARE 148532 * 143493 GRAHAM MEDICAL GROUP LEWISTON * 143497 GRAHAM MEDICAL GROUP-CUBA * 143494 GRAHAM MEDICAL GROUPFARMINGTON * 143492 GRAHAM SERVICE DBA COLEMAN CLINIC RHC * 143403 GREENE COUNTY RURAL HEALTH CLI *

143491 GREENVILLE FAMILY WELLNESS CENTER * 148513 GREENVILLE MEDICAL ASSOCIATES * 143477 HAMILTON MEMORIAL FAMILY CLINIC *

148957 HAMILTON-WARSAW CLINIC * 143479 HARDIN COUNTY GENERAL HOSPITAL CLINIC * 143457 HAVANA MEDICAL ASSOCIATES * 148966 HEARTLAND PEDIATRICS None HEARTLAND WOMEN'S 783830 HEALTHCARE * 148999 HEARTLAND WOMEN'S HEALTHCARE, LTD * 783816 HEARTLAND WOMEN'S HEALTHCARE, LTD * 783827 HENNEPIN MEDICAL CLINIC * = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 10

Address

City, State and ZIP

Telephone # County Name

5150 HIGHWAY 13

JUNCTION, IL 62954

(618)272-7132 Gallatin

530 12TH STREET 1007 NW 3RD ST 8 DOCTOR'S PARK

ERIE, IL 61250 ALEDO, IL 61231 GIBSON CITY, IL 60936

(309)659-2215 Whiteside (309)582-5301 Mercer (217)784-8580 Ford

222 NORTH SANGAMON AVENUE 715 W BROADWAY 508 E CRESCENT ST 205 SOUTH THIRD STREET 2001 NORTH MAIN ST

GIBSON CITY, IL 60936 GILLESPIE, IL 62033 GILMAN, IL 60938 GIRARD, IL 62640 LEWISTOWN, IL 61542

(217)784-8148 Ford (217)839-4491 Macoupin (815)265-8889 Iroquois (217)627-2222 Macoupin (309)547-9700 Fulton

114 SOUTH 4TH STREET 601 E FORT ST

CUBA, IL 61427 FARMINGTON, IL 61531

(309)785-5156 Fulton (309)245-2428 Fulton

175 SOUTH MAIN STREET

CANTON, IL 61520

(309)647-0201 Fulton

116 N MAIN ST

WHITE HALL, IL 62092

(217)374-2188 Greene

150 HEALTHCARE DRIVE

GREENVILLE, IL 62246

(618)664-9830 Bond

101 HEALTHCARE DRIVE 611 SOUTH MARSHALL AVENUE, PO BOX 429

1102 N COUNTY RD 700 PO BOX 2467, FERRELL ROAD

GREENVILLE, IL 62246 MCLEANSBORO, IL 62859

(618)664-2531 Bond (618)642-2988 Hamilton

WARSAW, IL 62379 ROSICLARE, IL 62982

(217)256-4100 Hancock (618)285-2800 Hardin

615 PROMENADE ST HAVANA, IL 62644 805 WEST DEYOUNG STREET, SUITE B MARION, IL 62959 3130 VETERNAS MEMORIAL DRIVE MOUNT VERNON, IL 62864

(309)543-6600 Mason (618)993-5274 Williamson (314)968-0076 Jefferson

430 NORTH PLEASANT

CENTRALIA, IL 62801

(618)436-8350 Marion

3408 OFFICE PARK DRIVE

MARION, IL 62959

(618)997-5266 Williamson

220 E HIGH ST SUITE 101

HENNEPIN, IL 61327

(815)925-7032 Putnam

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 783813 143448 148500 143446 148520 148519 148917 148972 143905 148977 143482 143425 148551 148996 148564 148565 148561 148562 148563 148537 148539 148550

Key Provider Name *

Address

HIGHLAND PRIORITY CARE 12860 TROXLER AVENUE HOOPESTON MEDICAL CENTER 801 EAST ORANGE STREET * HORIZON HEALTHCARE RHC 213 NW 10TH STREET, SUITE A * HSHS GOOD SHEPHERD FAMILY 200 SOUTH CEDAR STREET HEALTH * HSHS HOLY FAMILY HEALTH 507 W STATE, BOX 450 CENTER * HSHS HOLY FAMILY HEALTH 201 HEALTH CARE DR CENTER * HSHS MEDICAL GROUP FAMILY 400 ROUNTREE ST MEDICINE HILLSBORO

*

HSHS MEDICAL GROUP FAMILY 130 N BROADWAY MEDICINE- TABLE GROVE * HSHS MEDICAL GROUP FAMILY 108 RODEWALD DRIVE MEDICINE-RUSHVILLE * HYGIENIC INSTITUTE FOR LASALLE, 2970 CHARTRES STREET PERU & OGLESBY

*

ILLINI COMMUNITY HOSPITAL RURAL 640 W WASHINGTON ST HEALTH CLINIC * IMH MILFORD CLINIC 34 EAST JONES STREET None IMH MULTI-SPECIALITY PHYSICIANS 200 E FAIRMAN AVENUE CLINIC * IRVINGTON RURAL HEALTH CENTER 205 HURON ST None IVCH MEDICAL CLINIC WOMEN'S 920 WEST ST BLDG B HEALTH CARE CENTER None IVCH MEDICAL GROUP LASALLE 128 BUCKLIN STREET MEDICAL CLINIC None IVCH MEDICAL GROUP OGLESBY 520 W WALNUT STREET MEDICAL CLINIC None IVCH MEDICAL GROUP PERU 710 PEORIA STREET MEDICAL CLINIC None IVCH MEDICAL GROUP PERU 920 WEST ST SUITE 311 PRIMARY CLINIC * JCH MEDICAL GROUP CAROLLTON 523 S MAIN * JCH MEDICAL GROUP HARDIN 106 WATER STREET * JCH MEDICAL GROUP JERSEYVILLE 270 MAPLE SUMMIT RD *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 10

City, State and ZIP

Telephone # County Name

HIGHLAND, IL 62249 HOOPESTON, IL 60942 FAIRFIELD, IL 62837 SHELBYVILLE, IL 62565

(618)651-2810 Madison (217)283-5644 Vermilion (618)842-4617 Wayne (217)774-9640 Shelby

POCAHONTAS, IL 62275

(618)669-2270 Bond

GREENVILLE, IL 62246

(618)664-1380 Bond

HILLSBORO, IL 62049

(217)532-9471 Montgomery

TABLE GROVE, IL 61482

(309)758-5070 Fulton

RUSHVILLE, IL 62681

(217)322-3529 Schuyler

LA SALLE, IL 61301

(815)223-0196 LaSalle

PITTSFIELD, IL 62363

(217)223-8400 Pike

MILFORD, IL 60953 WATSEKA, IL 60970

(815)889-4241 Iroquois (815)432-5411 Iroquois

IRVINGTON, IL 62848 PERU, IL 61354

(618)249-6203 Washington (815)223-2944 LaSalle

LA SALLE, IL 61301

(815)220-7170 LaSalle

OGLESBY, IL 61348

(815)883-3588 LaSalle

PERU, IL 61354

(815)223-3500 LaSalle

PERU, IL 61354

(815)223-9214 LaSalle

CARROLLTON, IL 62016 HARDIN, IL 62047 JERSEYVILLE, IL 62052

(217)942-3326 Greene (618)576-9407 Calhoun (618)498-7108 Jersey

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 148538 148540 143495 143951 143499 148950 143925 143822 143870 148969 143487 783825 143490 148504 143462 143478 143871 783833 148542 148543 148547 143936 148905 143895 148958 148962 148960

Key Provider Name *

JCH MEDICAL GROUP JERSEYVILLE JCH MEDICAL GROUP ROODHOUSE * KIRBY MEDICAL GROUP * LAWRENCE COUNTY HEALTH DEPT RH * LAWRENCE COUNTY MEMORIAL HOSPITAL PRIMARY CARE CLI * LAWRENCE P JENNINGS MD, MSC * LINCOLN RURAL HEALTH * LITCHFIELD FAMILY PRACTICE CTR * LOGAN PRIMARY CARE * LOGAN PRIMARY CARE SERVICES * LOUISIVILLE MEDICAL CLINIC * MARION DIAGNOSTIC CENTER, LLC * MARISSA MEDICAL CLINIC * MARSHALL BROWING HOSPITAL ASSOCIATION * MASON CITY MEDICAL ASSOCIATES * MASSAC MEMORIAL MEDICAL CLINIC * MEDICAL ARTS CLINIC None MEDICAL SERVICES UNLIMITED * MEMORIAL HOSPITAL * MEMORIAL HOSPITAL None MEMORIAL MEDICAL NAUVOO CLINIC

*

MEMORIAL PHYSICANS SERVICES * MEMORIAL PHYSICIAN SERVICES * MEMORIAL PHYSICIANS SERVICES * MICHAEL W ELLIOTT, MD RURAL HEALTH CLINIC

*

MID IL MEDICAL CARE ASSOC * MID ILLINOIS MEDICAL CARE ASSOC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 10

Address

City, State and ZIP

Telephone # County Name

390 MAPLE SUMMIT ROAD PO BOX 279 205 S MORSE STREET 1000 MEDICAL CENTER DRIVE 11362 COUNTRY CLUB ROAD

JERSEYVILLE, IL 62052 ROODHOUSE, IL 62082 MONTICELLO, IL 61856 LAWRENCEVILLE, IL 62439

(618)498-2101 Jersey (217)589-4383 Greene (217)762-6241 Piatt (618)943-3302 Lawrence

2111 LEXINGTON AVENUE

LAWRENCEVILLE, IL 62439

(618)943-7216 Lawrence

1430 COLLEGE DRIVE-SUITE A 100 STAHLNUT DRIVE 1285 FRANCISCAN DRIVE 405 RUSHING DRIVE 502 WEST ST LOUIS STREET 935 BRYANT STREET 3003 CIVIC CIRCLE BLVD STE 200 521 NORTH BORDERS 900 NORTH WASHINGTON

MOUNT CARMEL, IL 62863 LINCOLN, IL 62656 LITCHFIELD, IL 62056 HERRIN, IL 62948 WEST FRANKFORT, IL 62896 LOUISVILLE, IL 62858 MARION, IL 62959 MARISSA, IL 62257 DU QUOIN, IL 62832

(618)262-5113 Wabash (217)735-9955 Logan (217)324-6127 Montgomery (618)942-4640 Williamson (618)937-3400 Franklin (618)665-4500 Clay (618)993-1400 Williamson (618)295-1591 St. Clair (618)542-8958 Perry

122 E ELM STREET 1204 W 10TH STREET

MASON CITY, IL 62664 METROPOLIS, IL 62960

(309)543-8542 Mason (618)524-2176 Massac

19 E SHAWNEE DRIVE, SUITE 2 1404 N 5TH ST 602 WEST SHAWNEETOWN TRAIL 2319 OLD PLANK ROAD 1370 MULHOLLAND ST POC BOX 367

MURPHYSBORO, IL 62966 VANDALIA, IL 62471 STEELEVILLE, IL 62288 CHESTER, IL 62233 NAUVOO, IL 62354

(618)684-2172 Jackson (618)283-2000 Fayette (618)826-2388 Randolph (618)826-4581 Randolph (217)453-6802 Hancock

1 CENTRE DRIVE 800 W STATE STREET 515 N COLLEGE 807 WEST CRAFT STREET

PETERSBURG, IL 62675 JACKSONVILLE, IL 62650 LINCOLN, IL 62656 ROBINSON, IL 62454

(217)632-7761 Menard (217)243-9471 Morgan (217)732-9681 Logan (618)546-5052 Crawford

206 NORTH PEARL 512 N MAPLE ST

TEUTOPOLIS, IL 62467 EFFINGHAM, IL 62401

(217)857-6481 Effingham (217)347-7030 Effingham

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 148955 148959 148511 148557 148526 783807 783806 783804 143981 143863 143886 143855 143435 783814 148968 148514 143440 143461 148567 143445 148535 143408 783817 783835 783834 143976

Key Provider Name *

MID ILLINOIS MEDICAL CARE ASSOCIATES

*

MID-IL MEDICAL CARE ASSOC D/B/A DR EUGENE DUST * MIDWEST HEALTH CLINIC None MIDWEST HEALTH CLINIC OF ELIZABETH None MILFORD MEDICAL CLINIC * MMG AT LACON * MMG AT PRINCEVILLE * MMG-CHILLICOTHE * MORRISON COMM HOSP FAMILY CARE * MT OLIVE FAMILY PRACTICE CENTE * MT STERLING RURAL HEALTH CLINI * MURPHYSBORO FAMILY MEDICINE CL * NEOGA CLINIC * NOKOMIS RURAL HEALTH CLINIC * NORRIS CITY HEALTHCARE CLINIC * OLDER ADULT HEALTH CENTER * ONARGA CLINIC, THE * OSF HOLY FAMILY CLINICS None OSF MEDICAL GROUP WASHINGTON STREET * OSF MEDICAL GROUP-KEWANEE None OSF MEDICAL GROUP/OSF SAINT PAUL MEDICAL CENTER * PAXTON CLINIC,THE * PEDIATRIC GROUP None PEDIATRIC GROUP LLC None PEDIATRIC GROUP LLC * PEMBROKE COMMUNITY HEALTH CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 10

Address

City, State and ZIP

Telephone # County Name

8 NORTH 3RD STREET

ALTAMONT, IL 62411

(217)347-2707 Effingham

900 W TEMPLE AVENUE, STE 205 PO BOX 1209 ONE MEDICAL CENTER DRIVE 117 N MAIN STREET

EFFINGHAM, IL 62401

(217)347-0458 Effingham

GALENA, IL 61036 ELIZABETH, IL 61028

(815)776-7381 Jo Daviess (815)858-2238 Jo Daviess

322 CHICAGO STREET 1112 FIFTH STREET 223 MAIN STREET 525 SWEETBRIAR DRIVE 303 N JACKSON ST

MILFORD, IL 60953 LACON, IL 61540 PRINCEVILLE, IL 61559 CHILLICOTHE, IL 61523 MORRISON, IL 61270

(815)889-4011 Iroquois (309)246-2676 Marshall (309)385-4371 Stark (309)274-2102 Peoria (815)772-4003 Whiteside

115 N POPLAR 521 E MAIN P O BOX 264 628 N 14TH ST

MOUNT OLIVE, IL 62069 MOUNT STERLING, IL 62353 MURPHYSBORO, IL 62966

(217)999-4157 Macoupin (217)773-3963 Brown (618)687-2353 Jackson

650 OAK AVE 105 EAST STATE STREET 110 A EAST MAIN STREET 325 SPRING STREET 912 W SEMINARY AVENUE 1000 WEST HARLEM AVENUE 1404 WASHINGTON STREET

NEOGA, IL 62447 NOKOMIS, IL 62075 NORRIS CITY, IL 62869 RED BUD, IL 62278 ONARGA, IL 60955 MONMOUTH, IL 61462 MENDOTA, IL 61342

(217)895-2222 Cumberland (217)563-2882 Montgomery (618)378-3440 White (618)282-7373 Randolph (815)268-4843 Iroquois (309)734-1400 Warren (815)538-1825 LaSalle

1051 W SOUTH STREET 1405 EAST 12TH STREET

KEWANEE, IL 61443 MENDOTA, IL 61342

(309)852-7700 Henry (815)538-7200 LaSalle

227 N MARKET 3412 OFFICE PARK DRIVE 28 VETERAN'S DRIVE 310 WEST ST LOUIS STREET 3400 S MAIN STREET

PAXTON, IL 60957 MARION, IL 62959 HARRISBURG, IL 62946 WEST FRANKFORT, IL 62896 HOPKINS PARK, IL 60944

(217)379-4864 Ford (618)993-0404 Williamson (618)993-0404 Saline (618)993-0404 Franklin (815)944-5545 Kankakee

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN 148549 143949 143885 148505 143883 148919 148923 783819 148900 783829 148964 148963 143496 143476 143847 148970 148931 143413 148541 148555 148995 143958 143862 783824 783823 143464

Key Provider Name None PERRY

MEMORIAL FAMILY HEALTH CLINIC

*

PHYSICIANS RURAL HEALTH CLINIC * PITTSFIELD RURAL HEALTH AFFILI * PRAIRIE FAMILY MEDICINE & OBSTETRICS * PRIMARY CARE GROUP * QUINCY MEDICAL GROUP * QUINCY MEDICAL GROUP * QUINCY MEDICAL GROUP * QUINCY MEDICAL GROUP BARRY RURAL HEALTH AFFILIATE None RAYMOND RURAL HEALTH * REGIONAL HEALTH PARTNERS LLC * REGIONAL HEALTH PARTNERS LLC * ROSSVILLE MEDICAL CLINIC * RURAL HEALTH CENTER OF ROODHOUSE * RURAL HEALTH CLINIC OF MOULTRIE COUNTY LLC * S B JANI MD, PC * SABEEHA HAQUE ALI MD LLC * SALEM TOWNSHIP HOSPITAL * SARAH BUSH LINCOLN HEALTH CENTER * SBL MARTINSVILLE CLINIC * SIU CARE-A-VAN * * * * *

* = Non-Deemed

SLOAN MEDICAL CLINIC SOUTHERN IL UNIVERSITY FMLY PR SOUTHERN OB/GYN SOUTHERN OB/GYN - HIGHLAND SPARTA COMMUNITY HOSPITAL, NORTH CAMPUS

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 8 of 10

Address

City, State and ZIP

Telephone # County Name

530 PARK AVENUE EAST

PRINCETON, IL 61356

(815)876-4531 Bureau

3307 BROADWAY SUITE 130 320 NORTH MADISON 122 EAST WABASH

MOUNT VERNON, IL 62864 PITTSFIELD, IL 62363 FORREST, IL 61741

(618)244-2560 Jefferson (217)285-9601 Pike (815)657-8707 Livingston

117 EAST CLARK 231 W CHERRY ST 405 E STATE STREET 1025 MAINE STREET 868 MORTIMER ST

HARRISBURG, IL 62946 WINCHESTER, IL 62694 PLEASANT HILL, IL 62366 QUINCY, IL 62301 BARRY, IL 62312

(618)252-8625 Saline (217)742-3117 Scott (217)734-2545 Pike (217)222-6550 Adams (217)335-2343 Pike

801 N OBANNON ST 1258 W SOUTH STREET SUITE 2 101 SOUTH GALENA STREET 619 N CHICAGO STREET 132 WEST LORTON

RAYMOND, IL 62560 KEWANEE, IL 61443 WYOMING, IL 61491 ROSSVILLE, IL 60963 ROODHOUSE, IL 62082

(217)229-3711 Montgomery (309)853-3677 Henry (309)695-6448 Stark (217)748-4141 Vermilion (217)589-4629 Greene

2 WEST ADMAS

SULLIVAN, IL 61951

(217)728-8329 Moultrie

1106 OAK STREET 102 N LOGAN STREET 1201 RICKER ROAD 910 SOUTH VAN BUREN STREET

MOUNT CARMEL, IL 62863 DANVILLE, IL 61832 SALEM, IL 62881 NEWTON, IL 62448

(618)263-6575 Wabash (217)442-5863 Vermilion (618)548-3194 Marion (618)783-3800 Jasper

890 RIDGELAWN ROAD MARTINSVILLE, IL 62442 305 WEST JACKSON STREET, SUITE 200 CARBONDALE, IL 62901

(217)382-4191 Clark (618)536-6621 Jackson

7211 US HWY 45 SOUTH 305 WEST JACKSON 9447 HOLY CROSS LANE 100 WOODCREST DRIVE 1300 NORTH MARKET

(618)252-8625 Saline (618)536-6621 Jackson (618)526-2209 Clinton (618)654-4836 Madison (618)443-4138 Randolph

CARRIER MILLS, IL 62917 CARBONDALE, IL 62901 BREESE, IL 62230 HIGHLAND, IL 62249 SPARTA, IL 62286

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN

Key Provider Name

143489

*

783822

*

143907

*

148947

*

148938

*

148997

*

783812

*

783800

*

143850 143887 148928

*

783802

*

148974 143467 143998 143475

*

148501

*

148568

*

143472

*

148510

*

143454

*

* *

* * *

* = Non-Deemed

SPARTA MEDICAL OFFICE

Address

215 SOUTH BURNS AVENUE, PO BOX 378 SPRINGFIELD CLINIC JACKSONVILLE 610 N WESTGATE RURAL HEALTH SPRINGFIELD CLINIC LLC DBA BRIAN 1280 EAST TREMONT J CADY SPRINGFIELD CLINIC LLP, DBA 20613 N BROAD STREET CARLINVILLE RURAL HLTH SPRINGFIELD CLINIC RURAL 3 DO IT DRIVE HEALTH ALTAMONT SPRINGFIELD CLINIC RURAL 300 NORTH MAPLE HEALTH EFFINGHAM SPRINGFIELD CLINIC RURAL 223 EAST SIXTH STREET HEALTH NEOGA SPRINGFIELD CLINIC RURAL 507 WEST WASHINGTON HEALTH NEWTON SPRINGFIELD CLINIC TAYLORVILLE 1025 S 6TH STREET SPRINGFIELD CLINIC- HILLSBORO 1250 E TREMONT ST SPRINGFILED CLINC RURAL HEALTH 134 SOUTH CHURCH STREET LOUISVILLE ST MARY'S GOOD SAMITAN FAMILY #8 CUSUMANO PLAZA HEALTH CENTER STAUNTON CLINIC, LLC 444 NORTH EDWARDSVILLE STREET STEELVILLE CLINIC #9 STEELVILLE CLINIC SULLIVAN CLINIC 7 HAWTHORNE LANE THOMAS H BOYD RURAL HEALTH 800 SCHOOL STREET CLINIC WABASH GENERAL CONVENIENT 1418 COLLEGE DRIVE CARE WABASH PRIMARY CARE 1123 CHESTNUT STREET ASSOCIATES WASHINGTON COUNTY HEALTH 70 SOUTH GRAND AVENUE CENTER WEST FRANKFORT FAMILY 309 W ST LOUIS STREET HEALTHCARE CLINIC WEST FRANKFORT FAMILY 2553 KEN GRAY BLVD PRACTICE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 9 of 10

City, State and ZIP

Telephone # County Name

SPARTA, IL 62286

(618)443-2297 Randolph

JACKSONVILLE, IL 62650

(217)245-9931 Morgan

HILLSBORO, IL 62049

(217)532-2320 Montgomery

CARLINVILLE, IL 62626

(217)854-5099 Macoupin

ALTAMONT, IL 62411

(618)483-6131 Effingham

EFFINGHAM, IL 62401

(217)342-4151 Effingham

NEOGA, IL 62447

(217)895-2320 Cumberland

NEWTON, IL 62448

(618)783-5094 Jasper

SPRINGFIELD, IL 62703 HILLSBORO, IL 62049 LOUISVILLE, IL 62858

(217)824-8191 Sangamon (217)532-6911 Montgomery (618)665-4612 Clay

MOUNT VERNON, IL 62864

(618)242-7819 Jefferson

STAUNTON, IL 62088 STEELEVILLE, IL 62288 SULLIVAN, IL 61951 CARROLLTON, IL 62016

(618)635-3800 Macoupin (618)965-3466 Randolph (217)728-8441 Moultrie (217)942-3600 Greene

MOUNT CARMEL, IL 62863

(618)263-6331 Wabash

MOUNT CARMEL, IL 62863

(618)263-4376 Wabash

NASHVILLE, IL 62263

(618)327-2200 Washington

WEST FRANKFORT, IL 62896 (618)932-2200 Franklin WEST FRANKFORT, IL 62896 (618)932-3937 Franklin

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Illinois CCN

Key Provider Name *

Address

WEST SALEM MEDICAL CENTER 100 SOUTH MAIN P O BOX 306 WOMEN & FAMILY MEDICAL CENTER 630 LOCUS STREET * WOMENS HEALTH CENTER OF 505 E GRANT STREET SUITE 102 MACOMB Total Providers for this State = 223

148548 143405 783826

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 10 of 10

City, State and ZIP

Telephone # County Name

WEST SALEM, IL 62476 CARTHAGE, IL 62321 MACOMB, IL 61455

(618)456-3727 Edwards (217)357-0617 Hancock (309)833-5959 McDonough

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Indiana

Telephone # County Name

GREENCASTLE, IN 46135 BRAZIL, IN 47834 CAMBRIDGE CITY, IN 47327 CANNELTON, IN 47520 CARLISLE, IN 47838 CLAY CITY, IN 47841

(765)653-8453 Putnam (812)442-2100 Clay (765)478-6108 Wayne (812)547-4176 Perry (812)398-5202 Sullivan (812)939-2126 Clay

PAOLI, IN 47454 MONTGOMERY, IN 47558 MARENGO, IN 47140

(812)723-3944 Orange (812)486-3396 Daviess (812)365-3221 Crawford

LEAVENWORTH, IN 47137

(877)291-6488 Crawford

WASHINGTON, IN 47501 DALE, IN 47523 LOOGOOTEE, IN 47553 WASHINGTON, IN 47501

(812)254-4650 Daviess (812)937-7140 Spencer (812)295-5095 Martin (812)254-7845 Daviess

WASHINGTON, IN 47501 PETERSBURG, IN 47567 BERNE, IN 46711 CLOVERDALE, IN 46120 SULLIVAN, IN 47882

(812)254-6696 Daviess (812)354-1052 Pike (260)589-2312 Adams (765)795-4242 Putnam (812)268-3318 Sullivan

153883

MEDICAL CARE PC 1145 INDIANAPOLIS ROAD BRAZIL FAMILY MEDICINE 115 S MURPHY AVENUE, STE A * CAMBRIDGE CITY FAMILY MEDICINE 1 E CHURCH ST None CANNELTON CLINIC 510 WASHINGTON STREET * CARLISLE MEDICAL CLINIC 8685 OLD HW 41 S * CLAY CITY CENTER FOR FAMILY 315 LANKFORD ST MEDICINE * COMPREHENSIVE HEALTH CARE 420 W LONGEST ST PO BOX 270 * COUNTRY HEALTH CENTER 5066 N 900 E * CRAWFORD COUNTY FAMILY 5604 EAST WHITE OAK LANE HEALTHCARE CENTER * CRAWFORD COUNTY FAMILY 6402 EAST INDUSTRIAL LANE MEDICINE None CULLEN MEDICAL PROFESSIONALS 2005 STATE STREET, SUITE A * DALE FAMILY MEDICINE 4 W VINE ST PO BOX 599 * DAVIESS MARTIN MEDICAL CLINIC 12546 E US HWY 50 * DCH HEALTH PAVILION QUICK CARE 1805 S STATE RD 57 CLINIC * DCH MEDICAL CLINIC 1402 GRAND AVE * DEACONESS CLINIC INC 106 W PIKE AVE * DR ROBERT E JUDGE MD 1521 W MAIN ST None FAMILY MEDICINE OF CLOVERDALE 51 E MARKET STREET * FAMILY PRACTICE ASSOCIATES OF 2229 MARY SHERMAN DR SULLIVAN COUNTY * FOUNDATIONS FAMILY MEDICINE PC 25 W MAIN STREET

AUSTIN, IN 47102

(812)794-8100 Scott

158502

*

420 E MAIN ST PO BOX 118

BROOK, IN 47922

(219)275-2521 Newton

153990

*

492 S BIERMA ST

WHEATFIELD, IN 46392

(219)956-2110 Jasper

158507 153904

*

679 STATE HIGHWAY 145 611 EAST MAIN STREET, STE 110

FRENCH LICK, IN 47432 PETERSBURG, IN 47567

(812)936-6400 Orange (812)354-8426 Pike

158503

*

1402 GRAND AVE

WASHINGTON, IN 47501

(812)257-0383 Daviess

153907 153869 153896 158519 153906 153804 153891 153871 153825 153903 153911 153859 158506 158501 158500 153843 153829 158513 153868

Address

Page 1 of 3

City, State and ZIP

CCN

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

None ACUTE *

*

* = Non-Deemed

FRANCISCAN BROOK HEALTH CENTER

FRANCISCAN WHEATFIELD HEALTH CENTER

FRENCH LICK FAMILY MEDICINE GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES INC GRAND AVENUE PEDIATRICS

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Indiana CCN

Key Provider Name *

Address

GREENE COUNTY GENERAL 1210 NORTH 1000 WEST HOSPITAL LLC * 153837 GREENE COUNTY HEALTH 102 E MAIN ST WORTHINGTON * 153821 JOANNE GUTTMAN MD 11137 US HWY 52 STE B * 153870 JOHN A EGLI MD PC 315 LEHMAN AVE * 153864 KENNETH D WATKINS MD 108 HOSPITAL DR * 153979 KENTLAND CLINIC 303 N 7TH * 153987 KNIGHTSTOWN FAMILY HEALTH 224 W MAIN ST CARE * 153809 KNOX FAMILY PRACTICE 1520 S HEATON ST * 153857 LAPORTE CLINIC COMPANY LLC 104 CULVER ROAD, SUITE 102 * 158508 LOOGOOTEE FAMILY MEDICINE 105 COOPER STREET * 153860 MARTIN COUNTY HEALTH CENTER 229 HIGH ST None MCV PEDIATRICS 153912 528 N 1ST STREET * 153890 MONTGOMERY MEDICAL 542 N 3RD ST ASSOCIATES LLC * 153828 MONTICELLO MEDICAL CENTER 826 N SIXTH ST None NEW CASTLE FAMILY AND INTERNAL 2200 FOREST RIDGE PKWY 153908 MEDICINE * 153863 NEW CASTLE PEDIATRICS 1000 N 16TH ST STE G-10 * 153999 NORTH DAVIESS MEDICAL CLINIC 202 N WEST ST None NORTH PUTNAM FAMILY 158514 440 EAST PAT RADY WAY HEALTHCARE * 158511 OSGOOD PRIMARY CARE 112 N BUCKEYE STREET * 153850 PATOKA FAMILY HEALTH CARE 307 S INDIANA AVE CENTER None PERRY COUNTY FAMILY PRACTICE 18485 STATE ROAD 37 158517 * 153872 PETERSBURG FAMILY MEDICINE 1003 E ILLINOIS ST * 153816 PREMIER HEALTHCARE LLC 1043 N 1000 W None PRIMARY CARE CLINIC 153913 429 S 6TH STREET None PULASKI MEMORIAL HOSPITAL 158512 540 HOSPITAL DRIVE MEDICAL AND SURGICAL GRO None PUTNAM PEDIATRICS AND 158515 1542 S BLOOMINGTON STREET INTERNAL MEDICINE * = Non-Deemed

153886

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

City, State and ZIP

Telephone # County Name

LINTON, IN 47441

(812)847-7005 Greene

WORTHINGTON, IN 47471

(812)875-2000 Greene

BROOKVILLE, IN 47012 TOPEKA, IN 46571 WINCHESTER, IN 47394 KENTLAND, IN 47951 KNIGHTSTOWN, IN 46148

(765)647-3547 Franklin (260)593-2902 LaGrange (765)584-1639 Randolph (219)474-5464 Newton (765)345-5572 Henry

KNOX, IN 46534 KNOX, IN 46534 LOOGOOTEE, IN 47553 SHOALS, IN 47581 VINCENNES, IN 47591 MONTGOMERY, IN 47558

(574)772-2188 Starke (574)772-7918 Starke (812)295-2812 Martin (812)247-2733 Martin (812)882-4434 Knox (812)486-2842 Daviess

MONTICELLO, IN 47960 NEW CASTLE, IN 47362

(574)585-3333 White (765)599-3400 Henry

NEW CASTLE, IN 47362 ODON, IN 47562 BAINBRIDGE, IN 46105

(765)521-0901 Henry (812)636-7300 Daviess (765)522-2556 Putnam

OSGOOD, IN 47037 ENGLISH, IN 47118

(812)689-3424 Ripley (812)338-2924 Crawford

LEOPOLD, IN 47551 PETERSBURG, IN 47567 LINTON, IN 47441 VINCENNES, IN 47591 WINAMAC, IN 46996

(812)843-3038 Perry (812)354-3458 Pike (812)847-4481 Greene (812)885-3703 Knox (574)946-2194 Pulaski

GREENCASTLE, IN 46135

(765)658-2700 Putnam

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Indiana CCN

Key Provider Name *

REDI-CARE INC PC FAMILY PRACTICE * ST LUKE'S MEDICAL MINISTRY PC * ST VINCENT MEDICAL GROUP INC * ST VINCENT MEDICAL GROUP INC * ST VINCENT MEDICAL GROUP INC * ST VINCENT MEDICAL GROUP, INC * ST VINCENT NORTH CLINIC * ST VINCENT SOUTH CLINIC * STROUD MEDICAL * SWITZERLAND COUNTY NURSE MANAGED CLINIC None TELL CITY CLINIC 158516 * 153853 THOMAS L MILLER MD None TROY CLINIC 158518 * 153909 UNION COUNTY HEALTH DEPARTMENT * 153902 VALLEY HEALTH Total Providers for this State = 67

153823 153914 153882 153887 153897 153879 153881 153993 153994 153905 153862

None SCOTTSBURG

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

2120 N DETROIT ST 1465 NORTH GARDNER STREET 1441 N GARDNER 301 N HENRY ST 301 HENRY ST BLDG B 330 WEST DEERFIELD ROAD 409 GREENVILLE AVE 1731 RINGER LN 440 W SONGER LN 1401 MEMORIAL AVENUE, SUITE C 727 US HWY 56 STE 300

LAGRANGE, IN 46761 SCOTTSBURG, IN 47170 SCOTTSBURG, IN 47170 NORTH VERNON, IN 47265 NORTH VERNON, IN 47265 UNION CITY, IN 47390 WINCHESTER, IN 47394 WILLIAMSPORT, IN 47993 VEEDERSBURG, IN 47987 WASHINGTON, IN 47501 VEVAY, IN 47043

(260)463-2468 LaGrange (812)752-0001 Scott (812)752-4055 Scott (812)352-4300 Jennings (812)352-4300 Jennings (317)964-6200 Randolph (765)584-0480 Randolph (765)762-4170 Warren (765)762-4180 Fountain (812)254-4399 Daviess (812)427-4038 Switzerland

109 EAST US HIGHWAY 66 1500 W MAUMEE 315 MAIN STREET 6 WEST SOUTH STREET SUITE 2

TELL CITY, IN 47586 ANGOLA, IN 46703 TROY, IN 47588 LIBERTY, IN 47353

(812)547-3447 Perry (260)665-8494 Steuben (812)547-9552 Spencer (765)458-5393 Union

9529 WEST STATE ROAD 56

FRENCH LICK, IN 47432

(812)936-2425 Orange

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN 233823 238637 233900 238680 238661 238617 238552 238653 238598 238650 238646 233813 238901 238595 238544 238580 238578 238626 233870 238665 238546 238613 238601 238635 238932 238669

Key Provider Name *

Address

ALLEGAN MEDICAL CLINIC PC 551 LINN ST ALMA INTERNAL MEDICINE 200 E WARWICK DRIVE * ALPENA MEDICAL ARTS PC 211 LONG RAPIDS RD None ASPIRUS CRYSTAL FALLS CLINIC 1328 US HIGHWAY 2 None ASPIRUS GRAND VIEW CLINIC N10565 GRAND VIEW LN * ASPIRUS HOUGHTON CLINIC 1000 CEDAR ST * ASPIRUS KEWEENAW LAKE LINDEN 110 CALUMET ST CLINIC None ASPIRUS KEWEENAW LAURIUM 300 HECLA ST WELLNESS * ASPIRUS ONTONAGON FAMILY 601 SOUTH SEVENTH STREET PRACTICE CLINIC None BAY CARE MEDICAL CENTER 1500 SAND POINT RD * BCMH PHYSICIAN GROUP 18341 US HIGHWAY 41 * BEAVER ISLAND RURAL HEALTH 37304 KINGS HIGHWAY CENTER * BOARDMAN FAMILY PRACTICE 4713 PINE STREET * BORGESS FAMILY MEDICINE 345 NAOMI STREET * BORGESS LEE MEDICAL GROUP 520 MAIN STREET SUITE A * BORGESS LEE MEDICAL GROUP 520 MAIN STREET SUITE C * BORGESS LEE MEDICAL GROUP 117 SOUTH BROADWAY STREET * BORGESS LEE MEDICAL GROUP 400 W DIVISION ST DIVISION STREET CLINIC * BORGESS WOMEN'S HEALTH 671 ALLEGAN None BOYNE AREA MEDICAL CENTER 223 N PARK ST * BRONSON LAKEVIEW FAMILY CARE - 319 W DELAWARE ST DECATUR

*

BRONSON LAKEVIEW FAMILY CARE - 52375 N MAIN STREET MATTAWAN

*

BRONSON LAKEVIEW FAMILY CARE - 451 HEALTH PARKWAY PAW PAW * CADILLAC PRIMARY CARE & OB/GYN 7985 MACKINAW TRAIL None CARO HEALTH PLAZA 1525 W CARO ROAD None CASS CITY FAMILY PRACTICE 4675 HILL STREET *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 9

City, State and ZIP

Telephone # County Name

ALLEGAN, MI 49010 ALMA, MI 48801 ALPENA, MI 49707 CRYSTAL FALLS, MI 49920 IRONWOOD, MI 49938 HOUGHTON, MI 49931 LAKE LINDEN, MI 49945

(616)673-8402 Allegan (989)463-5876 Gratiot (989)354-2142 Alpena (906)875-4486 Iron (906)932-1500 Gogebic (906)487-1710 Houghton (906)337-5040 Houghton

LAURIUM, MI 49913

(906)337-9355 Houghton

ONTONAGON, MI 49953

(906)884-4134 Ontonagon

MUNISING, MI 49862 L' ANSE, MI 49946 BEAVER ISLAND, MI 49782

(906)387-4338 Alger (906)524-6118 Baraga (231)448-2275 Charlevoix

SOUTH BOARDMAN, MI 49680 PLAINWELL, MI 49080 DOWAGIAC, MI 49047 DOWAGIAC, MI 49047 CASSOPOLIS, MI 49031 DOWAGIAC, MI 49047

(231)369-2656 Kalkaska (616)692-6661 Allegan (269)783-3052 Cass (269)783-2080 Cass (269)445-0771 Cass (269)782-2111 Cass

PLAINWELL, MI 49080 BOYNE CITY, MI 49712 DECATUR, MI 49045

(616)685-1777 Allegan (231)582-5314 Charlevoix (616)423-7028 Van Buren

MATTAWAN, MI 49071

(269)657-0243 Van Buren

PAW PAW, MI 49079

(269)657-2550 Van Buren

CADILLAC, MI 49601 CARO, MI 48723 CASS CITY, MI 48726

(231)876-6100 Wexford (989)672-2100 Tuscola (989)872-8303 Tuscola

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN

Key Provider Name None CASS

238603 238672 238541

CITY MEDICAL PRACTICE FOR OBSTETRICS & GYNECOLOGY * CHARLES R BARKER JR DO FAMILY PRACTICE PC * COLOMA MEDICAL CENTER None COLON MEDICAL CLINIC * COMMUNITY CARE CLINIC

238615

*

238649 238688 238917

None CENTER

COMMUNITY HEALTH CENTER PEDIATRIC & ADOLESCENT CTR

*

238605 COMMUNITY MEDICAL CENTER * 238540 DCHS AFTER HOURS CLINIC None DECKERVILLE HEALTHCARE 238666 SERVICES INC

*

238687 DECKERVILLE MAIN STREET CLINIC * 238643 DICKINSON FAMILY AND GERIATRIC CLINIC * 238559 DICKINSON FAMILY PRACTICE CENTER None DICKINSON FAMILY PRACTICE 238654 CENTER-NORWAY None DICKINSON INTERNAL 238656 MEDICINE/NEPHROLOGY CLINIC None DICKINSON OB/GYN CLINIC 238690 * 238634 DICKINSON PEDIATRIC CLINIC * 233869 EASTSIDE FAMILY MEDICAL * 238633 EATON RAPIDS MEDICAL CENTER FAMILY PRACTICE * 238906 FAIRVIEW CLINIC, PLC * 233944 FAMILY HEALTH & WELLNESS * 238577 FAMILY HEALTHCARE OF BROWN CITY None FAMILY HEALTHCARE OF CASS CITY 238671 * 238521 FAMILY MEDICAL CARE BRECKENRIDGE * = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 9

Address

City, State and ZIP

Telephone # County Name

4675 HILL STREET 315 E WARWICK DR STE D

CASS CITY, MI 48726 ALMA, MI 48801

(989)872-8202 Tuscola (989)466-5486 Gratiot

1320 W STATE ST, 3A

BELDING, MI 48809

(616)794-1810 Ionia

6701 PAW PAW AVENUE 111 SAINT JOSEPH STREET 509 OSBORNE BLVD

COLOMA, MI 49038 COLON, MI 49040 SAULT SAINTE MARIE, MI 49783 358 EAST CHICAGO STREET, SUITE 202 COLDWATER, MI 49036

(269)468-0015 Berrien (269)432-3221 St. Joseph (906)635-4401 Chippewa

400 MEDICAL PARK DRIVE 1721 S STEPHENSON AVE 2433 BLACK RIVER ST

WATERVLIET, MI 49098 IRON MOUNTAIN, MI 49801 DECKERVILLE, MI 48427

(269)463-3600 Berrien (906)776-5660 Dickinson (810)376-2835 Sanilac

3532 MAIN STREET 500 MAIN ST

DECKERVILLE, MI 48427 NORWAY, MI 49870

(810)376-3100 Sanilac (906)563-9255 Dickinson

844 PYLE DR

KINGSFORD, MI 49801

(906)774-6383 Dickinson

N1667 US HIGHWAY 8

NORWAY, MI 49870

(906)776-5648 Dickinson

1711 SOUTH STEPHENSON AVE

IRON MOUNTAIN, MI 49801

(906)776-5648 Dickinson

1001 S HEMLOCK ST 1711 S STEPHENSON AVE SUITE 210 8540 105TH AVENUE 1500 S MAIN ST

IRON MOUNTAIN, MI 49801 IRON MOUNTAIN, MI 49801 STANWOOD, MI 49346 EATON RAPIDS, MI 48827

(906)776-5982 Dickinson (906)776-5800 Dickinson (231)972-2710 Mecosta (517)857-4500 Eaton

1910 E MILLER RD 129 W BROWN STREET 4472 MAIN STREET

FAIRVIEW, MI 48621 BEAVERTON, MI 48612 BROWN CITY, MI 48416

(989)848-5644 Oscoda (989)435-2937 Gladwin (810)346-2751 Sanilac

6230 HOSPITAL DRIVE 302 W CHESTNUT

CASS CITY, MI 48726 BRECKENRIDGE, MI 48615

(989)872-2410 Tuscola (989)842-3118 Gratiot

(517)279-5252 Branch

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN 238618 238545 233981 238561 238538 233903 233845 233967 238584 233882 238927 233975 238551 238582 238670 238624 238639 233979 238651 233940 233811 238610 238689 233837 233885 238575 238537

Key Provider Name *

FAMILY MEDICAL CARE ITHACA FAMILY MEDICINE CENTER * GIBSON FAMILY HEALTH CENTER * GRAYLING COMMUNITY HEALTH CENTER

*

HALE ST JOSEPH FAMILY CLINIC * HEALTH SPECIALISTS OF LENAWEE * HILLSDALE MEDICAL ASSOCIATES * HONOR FAMILY PRACTICE * INTERNAL MEDICINE SERVICES * IONIA FAMILY PRACTICE None JONESVILLE HEALTHCARE * KALKASKA MEMORIAL HEALTH CENTER

*

KEWEENAW MEMORIAL LAURIUM CLINIC

*

KINGSTON FAMILY HEALTHCARE None KINGSTON FAMILY PRACTICE * LAKESHORE MEDICAL CENTERSHELBY

*

LONG RAPIDS FAMILY CARE * MACKINAC STRAITS RURAL HEALTH CLINIC None MACKINAW CITY MEDICAL CLINIC * MACKINAW TRAIL PEDIATRICS * MANCELONA FAMILY PRACTICE * MANISTIQUE LAKES FAMILY CLINIC None MARLETTE FAMILY HEALTHCARE * MARQUETTE GENERAL HOSPITAL FAMILY MEDICINE TRENARY

*

MARQUTTE GENERAL HOSPITAL KINGSFORD CLINIC

*

MAYVILLE FAMILY HEALTHCARE * MCKENZIE RURAL HEALTH CLINIC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 9

Address

City, State and ZIP

Telephone # County Name

121 N PINE RIVER STREET 370 EAST CHICAGO STREET 502 W HARRIE ST 1250 E MICHIGAN AVE

ITHACA, MI 48847 COLDWATER, MI 49036 NEWBERRY, MI 49868 GRAYLING, MI 49738

(989)875-5111 Gratiot (517)279-5378 Branch (906)293-9233 Luce (989)348-1212 Crawford

116 S CHURCH 6869 OCCIDENTAL HWY 1456 HUDSON RD 10524 MAIN STREET 740 SOUTH MAIN STREET 330 LOVELL 216 OLDS STREET 419 S CORAL

HALE, MI 48739 TECUMSEH, MI 49286 HILLSDALE, MI 49242 HONOR, MI 49640 CHEBOYGAN, MI 49721 IONIA, MI 48846 JONESVILLE, MI 49250 KALKASKA, MI 49646

(989)728-4334 Iosco (517)423-4777 Lenawee (517)439-0200 Hillsdale (231)325-2277 Benzie (231)627-7118 Cheboygan (616)527-5732 Ionia (517)849-7100 Hillsdale (616)258-7500 Kalkaska

205 OSCEOLA STREET

LAURIUM, MI 49913

(906)337-6560 Houghton

5988 STATE ST 5854 STATE STREET 71 BEVIER ST

KINGSTON, MI 48741 KINGSTON, MI 48741 SHELBY, MI 49455

(989)683-2221 Tuscola (989)683-8065 Tuscola (231)861-2187 Oceana

393 LONG RAPIDS ROAD 1140 NORTH STATE STREET

ALPENA, MI 49707 SAINT IGNACE, MI 49781

(989)356-0504 Alpena (906)643-7999 Mackinac

420 S NICOLET ST 7917 MACKINAW TRAIL 419 W STATE ST W 17530 CO RD 4-42 2750 MAIN STREET, SUITE #2 E 2995 STATE HWY M67

MACKINAW CITY, MI 49701 CADILLAC, MI 49601 MANCELONA, MI 49659 CURTIS, MI 49820 MARLETTE, MI 48453 TRENARY, MI 49891

(231)436-9900 Cheboygan (231)779-9700 Wexford (231)587-9181 Antrim (906)586-3300 Mackinac (989)635-4614 Sanilac (906)446-3336 Alger

800 EAST BOULEVARD

KINGSFORD, MI 49801

(906)774-4000 Dickinson

2180 OHMER ROAD 75 DAWSON STREET

MAYVILLE, MI 48744 SANDUSKY, MI 48471

(989)843-5135 Tuscola (810)648-6160 Sanilac

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN 233846 233852 233850 238921 238918 233861 238623 238627 238678 233872 238645 238681 238640 238644 238642 238659 238641 238625 238522 238558 233935 233937

Key Provider Name *

MCLAREN NORTHERN MICHIGAN ELK RAPIDS FAMILY MEDICI * MEDICS PC * MEDICS PC * MEMORIAL HEALTHCARE * MEMORIAL HEALTHCARE * MENOMINEE MEDICAL CLINIC * MERCY HEALTH PHYSICIAN PARTNERS LAKESHORE MEDICAL

*

MERCY HEALTH PHYSICIAN PARTNERS-HART FAMILY MEDICA None MERCY HEALTH PHYSICIANS PARTNERS-SABLE POINT FAMIL * MI-WI FAMILY PRACTICE ASSOCIATES PC * MIDMICHIGAN HEALTH PARK - MT PLEASANT None MIDMICHIGAN HEALTH PARK - WEST BRANCH * MIDMICHIGAN MEDICAL CLINIC HARRISON

*

MIDMICHIGAN MEDICAL OFFICE FARWELL * MIDMICHIGAN MEDICAL OFFICECLARE None MIDMICHIGAN MEDICAL OFFICES SIXTH/MAPLE * MIDMICHIGAN MEDICAL OFFICESGLADWIN * MIDMICHIGAN URGENT CARE CLARE * MIDMICHIGAN URGENT CARE ALMA * NORDIC MEDICAL CENTER * NORTH REACH HEALTHCARE DAGGETT MEDICAL CLINIC * NORTHERN PINES HEALTH CENTER

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 9

Address

City, State and ZIP

Telephone # County Name

124 AMES

ELK RAPIDS, MI 49629

(231)264-8282 Antrim

220 N ENSLEY 1131 E M-46 1975 W M 21, ST 104 9099 E LANSING ROAD 1100 TENTH ST 905 E COLBY ST

HOWARD CITY, MI 49329 EDMORE, MI 48829 OWOSSO, MI 48867 DURAND, MI 48429 MENOMINEE, MI 49858 WHITEHALL, MI 49461

(231)937-6226 Montcalm (989)427-5070 Montcalm (989)725-8171 Shiawassee (989)288-2651 Shiawassee (906)863-7897 Menominee (231)728-5910 Muskegon

611 EAST MAIN STREET

HART, MI 49420

(231)873-5675 Oceana

5656 US HIGHWAY 10

LUDINGTON, MI 49431

(231)843-2543 Mason

1711 S STEPHENSON AVE SUITE 300

IRON MOUNTAIN, MI 49801

(906)774-1633 Dickinson

4851 E PICKARD ST

MOUNT PLEASANT, MI 48858 (989)775-1610 Isabella

640 COURT STREET

WEST BRANCH, MI 48661

(989)345-8120 Ogemaw

815 N CLARE AVE

HARRISON, MI 48625

(989)539-2114 Clare

2812 W CADILLAC DR

FARWELL, MI 48622

(989)802-5050 Clare

602 BEECH STREET

CLARE, MI 48617

(989)802-8730 Clare

212 W 6TH STREET

CLARE, MI 48617

(989)802-8445 Clare

609 QUARTER STREET

GLADWIN, MI 48624

(989)246-6490 Gladwin

700 WEST 5TH STREET

CLARE, MI 48617

(989)386-9911 Clare

321 WARWICK DRIVE 4243 WEST M-69, BOX 139 106 S SCHOOL RD, BOX 37

ALMA, MI 48801 FELCH, MI 49831 DAGGETT, MI 49821

(989)466-3348 Gratiot (906)246-3800 Dickinson (906)753-2155 Menominee

11293 NORTH M37, SUITE A

BUCKLEY, MI 49620

(231)269-4185 Wexford

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN 233974 238620 238662 238660 238590 238589 238616 238606 238607 233997 233932 233939 233873 233928 233821 238916 238902 233842 233820 233954 238562 233956 238699 233864

Key Provider Name *

OAKLAWN MEDICAL GROUP HOMER OMH MEDICAL GROUP LEWISTON RHC None OMH MEDICAL GROUP-BOYNE VALLEY RHC None OMH MEDICAL GROUP-INDIAN RIVER RHC * OSF MEDICAL GROUP - ESCANABA * OSF MEDICAL GROUP - GLADSTONE * OSF ST FRANCIS HOSPITAL MEDICAL GROUP-POWERS CLINI

*

OTSEGO MEMORIAL HOSPITAL MEDCARE RURAL HEALTH CLIN * OTSEGO MEMORIAL HOSPITAL RURAL HEALTH CLINIC * PEDIATRIC & ADOLESCENT SPECIALISTS

*

PEDIATRIC CENTER OF ADRIAN * PERRY FAMILY PRACTICE * PRESCOTT CLINIC PC * PRIMARY CARE * PRIMARY CARE * PRIMARY CARE ASSOCIATES OF JONESVILLE LLC * PRIMARY CARE INC * PRIMARY CARE, INC * PRIMARY CARE, INC * PRIMARY HEALTH SERVICES, PC * PRUDENVILLE COMMUNITY HEALTH CENTER * RANDALL STREET MEDICAL, PC * READING HEALTH CLINIC * RIVERSIDE MEDICAL ASSOCIATES PC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 9

Address

City, State and ZIP

Telephone # County Name

420 SOUTH HILLSDALE 3040 BOURN STREET

HOMER, MI 49245 LEWISTON, MI 49756

(616)789-8814 Calhoun (989)786-4877 Montmorency

2572 N US HIGHWAY 131

ELMIRA, MI 49730

(989)731-7700 Otsego

3860 S STRAITS HIGHWAY

INDIAN RIVER, MI 49749

(231)238-0581 Cheboygan

3409 LUDINGTON ST 128 MICHIGAN AVE N 15995 MAIN STREET

ESCANABA, MI 49829 GLADSTONE, MI 49837 POWERS, MI 49874

(906)789-4040 Delta (906)428-3273 Delta (906)497-4360 Menominee

1996 WALDEN DRIVE

GAYLORD, MI 49735

(989)731-4111 Otsego

825 NORTH CENTER AVENUE

GAYLORD, MI 49735

(989)731-7708 Otsego

245 S SECOND ST

CARSON CITY, MI 48811

(989)584-3981 Montcalm

770 RIVERSIDE AVE, SUITE 17 3337 W BRITTON RD 125 WASHINGTON STREET 5170 RIFLE RIVER TRAIL 2990 CAMPBELL ROAD 100 E CHICAGO STREET

ADRIAN, MI 49221 PERRY, MI 48872 PRESCOTT, MI 48756 ALGER, MI 48610 ROSE CITY, MI 48654 JONESVILLE, MI 49250

(517)265-8134 Lenawee (517)625-3004 Shiawassee (989)873-3352 Ogemaw (989)873-5323 Ogemaw (989)685-6969 Ogemaw (517)849-9090 Hillsdale

558 LOCKWOOD LANE 2331 PROGRESS, SUITE D, PO BOX 340 1360 NORTH ST HELEN ROAD 505 W LUDINGTON AVENUE 2585 W HOUGHTON LAKE DR

MIO, MI 48647 WEST BRANCH, MI 48661 SAINT HELEN, MI 48656 LUDINGTON, MI 49431 PRUDENVILLE, MI 48651

(989)826-3271 Oscoda (989)345-1184 Ogemaw (989)389-4944 Roscommon (231)843-8452 Mason (517)422-2400 Roscommon

675 WEST RANDALL STREET 143 SOUTH MAIN STREET 560 OSBORN BLVD

COOPERSVILLE, MI 49404 READING, MI 49274 SAULT SAINTE MARIE, MI 49783

(616)837-9777 Ottawa (517)283-1772 Hillsdale (906)632-1800 Chippewa

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN 238573 233998 233977 238588 238565 238682 238631

Key Provider Name *

ROSCOMMON COMMUNITY HEALTH CENTER * SAINT MARY'S STANDISH COMMUNITY HOSP RHC * SCHEURER FAMILY MEDICAL CENTER * SCHOOLCRAFT MEMORIAL HOSPITAL RURAL HEALTH CLINIC * SHERIDAN CARE CLINIC None SMG MUIR * SMG PORTLAND

238591 238698 238533

*

233987

*

238664 238550

*

233996

*

238673 238518 233994 238517 238667 238652 238677

SMG PRACTICE SARANAC SOUTH HAVEN COMMUNITY HOSPITAL COOPER MEDICAL CLIN SOUTH HAVEN COMMUNITY HOSPITAL RHC SOUTHWESTERN MEDICAL CLINIC SPARROW IONIA HOSPITAL

None SMG *

*

SPARROW MEDICAL GROUP GREENVILLE None SPARROW MEDICAL GROUP LYONS * SPARROW MEDICAL GROUPASHLEY * SPARROW MEDICAL GROUPCARSON * SPARROW MEDICAL GROUPITHACA None SPECTRUM HEALTH BIG RAPIDS HOSPITAL FAMILY MEDICIN * SPECTRUM HEALTH BIG RAPIDS HOSPITAL FAMILY MEDICIN None SPECTRUM HEALTH BIG RAPIDS HOSPITAL OBSTETRICS AND

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 9

Address

City, State and ZIP

Telephone # County Name

234 LAKE ST

ROSCOMMON, MI 48653

(989)348-0448 Roscommon

441 WEST CEDAR

STANDISH, MI 48658

(989)846-4521 Arenac

168 N CASEVILLE RD

PIGEON, MI 48755

(989)453-2141 Huron

7870 W US HIGHWAY 2

MANISTIQUE, MI 49854

(906)341-2153 Schoolcraft

303 CONGRESS STREET, SUITE B 1044 HAYDEN RD 9751 EAST GRAND RIVER AVENUE, SUITE 1 1717 EAST CHICAGO ROAD, SUITE 2 107 N BRIDGE ST 520 RAILROAD ST

SHERIDAN, MI 48884 MUIR, MI 48860 PORTLAND, MI 48875

(517)291-5077 Montcalm (989)855-2755 Ionia (517)641-7672 Ionia

STURGIS, MI 49091 SARANAC, MI 48881 BANGOR, MI 49013

(269)651-1471 St. Joseph (616)642-9408 Ionia (269)427-5811 Van Buren

965 S BAILEY AVE

SOUTH HAVEN, MI 49090

(269)639-2810 Van Buren

2002 SOUTH ELEVENTH STREET NILES, MI 49120 550 EAST WASHINGTON STREET SUITE IONIA, MI 48846 101 1014 E WASHINGTON ST GREENVILLE, MI 48838

(269)687-0200 Berrien (616)527-4290 Ionia

505 E BRIDGE STREET 320 S STERLING ST

LYONS, MI 48851 ASHLEY, MI 48806

(989)855-3345 Ionia (989)847-2621 Gratiot

102 S THIRD, SUITE 100

CARSON CITY, MI 48811

(989)584-1308 Montcalm

114 N MAIN ST

ITHACA, MI 48847

(989)875-4166 Gratiot

8354 100TH AVE, STE 1

STANWOOD, MI 49346

(231)972-6000 Mecosta

650 LINDEN STREET, SUITE 1

BIG RAPIDS, MI 49307

(231)796-3200 Mecosta

722 LOCUST STREET

BIG RAPIDS, MI 49307

(231)592-4200 Mecosta

(616)754-7145 Montcalm

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN

Key Provider Name None SPECTRUM

HEALTH FAMILY MEDICINE-PENTWATER None SPECTRUM HEALTH GERBER 238685 MEMORIAL FAMILY MEDICINE * 238632 SPECTRUM HEALTH GERBER MEMORIAL FAMILY MEDICINE-FR * 238572 SPECTRUM HEALTH GERBER MEMORIAL FAMILY MEDICINE-GR

*

233990 SPECTRUM HEALTH GERBER MEMORIAL FAMILY MEDICINE-HE None SPECTRUM HEALTH GERBER 238684 MEMORIAL MULTISPECIALITY * 238636 SPECTRUM HEALTH GERBER MEMORIAL OBSTETRICS AND GYN None SPECTRUM HEALTH LUDINGTON 238683 HOSPITAL FAMILY AND INTE None SPECTRUM HEALTH LUDINGTON 238676 HOSPITAL FAMILY MEDICINE None SPECTRUM HEALTH LUDINGTON 238696 HOSPITAL INTERNAL MEDICI None SPECTRUM HEALTH LUDINGTON 238695 HOSPITAL OBSTETRICS & GY None SPECTRUM HEALTH PENNOCK 238701 FAMILY MEDICINE-GUN LAKE None SPECTRUM HEALTH PENNOCK 238679 FAMILY MEDICINE-IONIA None SPECTRUM HEALTH PENNOCK 238675 FAMILY MEDICINE-LAKE ODESS None SPECTRUM HEALTH PENNOCK 238700 FAMILY, INTERNAL & PEDIATR None SPECTRUM HEALTH PENNOCK 238697 OBSTETRICS & GYNECOLOGY-HA * 238594 SPECTRUM HEALTH REED CITY CAMPUS * 238504 SPECTRUM HEALTH REED CITY HOSPITAL * 238621 SPECTRUM HEALTH REED CITY HOSPITAL TUSTIN FAMILY P * = Non-Deemed

238686

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 9

Address

City, State and ZIP

Telephone # County Name

500 N HANCOCK STREET

PENTWATER, MI 49449

(231)869-7051 Oceana

211 W PINE LAKE DRIVE

NEWAYGO, MI 49337

(231)652-1631 Newaygo

204 W MAIN STREET

FREMONT, MI 49412

(231)924-1800 Newaygo

230 S MAPLE ST

GRANT, MI 49327

(231)834-5995 Newaygo

78 N DIVISION

HESPERIA, MI 49421

(616)854-6415 Oceana

230 W OAK STREET

FREMONT, MI 49412

(231)942-4200 Newaygo

212 S SULLIVAN AVE

FREMONT, MI 49412

(231)924-1212 Newaygo

922 LAWNDALE ST

LUDINGTON, MI 49431

(231)845-2251 Mason

2481 N 72ND AVENUE

HART, MI 49420

(231)873-2163 Oceana

5 N ATKINSON DR, SUITE 207

LUDINGTON, MI 49431

(231)843-3600 Mason

250 N NELSON RD

LUDINGTON, MI 49431

(231)843-6767 Mason

12851 W M-179 HIGHWAY

WAYLAND, MI 49348

(877)377-7322 Allegan

2776 S STATE RD

IONIA, MI 48846

(616)775-7500 Ionia

4294 LAUREL DRIVE

LAKE ODESSA, MI 48849

(616)374-7660 Ionia

1108 WEST GREEN STREET, SUITE 3

HASTINGS, MI 49058

(269)945-0922 Barry

1005 W GREEN STREET, SUITE 301

HASTINGS, MI 49058

(269)945-8080 Barry

5991 S 95TH AVENUE

EVART, MI 49631

(616)734-5561 Osceola

300 N PATTERSON ROAD

REED CITY, MI 49677

(616)832-3271 Osceola

111 EAST CHURCH STREET

TUSTIN, MI 49688

(231)829-3423 Osceola

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN 238668 238648 238691 238647 238614 233985 238570 233986 238534 233991 238911 238608 238604 238566 238574 238597 233906 233835 238599 238506 238655 238602

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 8 of 9

Address

City, State and ZIP

Telephone # County Name

HEALTH UNITED HOSPITAL BELDING FAMILY MED * SPECTRUM HEALTH UNITED HOSPITAL FAMILY MEDICINE None SPECTRUM HEALTH UNITED HOSPITAL INTERNAL MEDICINE None SPECTRUM HEALTH UNITED HOSPITAL LAKEVIEW FAMILY ME * SPRINGPORT MEDICAL CLINIC * ST JOESPH HEALTH SYSTEMS OSCODA HEALHT PARK & AFTE *

ST JOSEPH HEALTH SYSTEM AUGRES FAMILY CLINIC * ST JOSEPH HEALTH SYSTEM INTERNAL MEDICINE CLINIC * ST JOSEPH HEALTH SYSTEM WOMENS CLINIC * ST JOSEPH HURON FAMILY MEDICINE CLINIC * ST JOSEPH PEDIATRICS * ST LOUIS FAMILY CLINIC * STAGG MEDICAL CENTER * STANTON 1ST CARE * STANTON FAMILY CARE CENTER * STURGIS PEDIATRIC AND WOMENS CENTER * SUPERIOR FAMILY MEDICAL ASSOC

1227 W STATE ST

BELDING, MI 48809

(616)794-0940 Ionia

1202 WEST OAK STREET

GREENVILLE, MI 48838

(616)754-2944 Montcalm

707 S GREENVILLE WEST DR

GREENVILLE, MI 48838

(231)832-8509 Montcalm

418 WASHINGTON ST

LAKEVIEW, MI 48850

(989)352-6474 Montcalm

400 EAST MAIN STREET SUITE 200 5935 N HURON ROAD - OSCODA HEALTH PARK

3210 E HURON RD

SPRINGPORT, MI 49284 OSCODA, MI 48750

(517)857-4500 Jackson (989)739-1441 Iosco

AU GRES, MI 48703

(989)876-7104 Arenac

295 MAPLE ST

TAWAS CITY, MI 48763

(989)362-6108 Iosco

25 E M-55

TAWAS CITY, MI 48763

(989)362-2540 Iosco

700 EAST GERMAN STREET

TAWAS CITY, MI 48763

(989)362-4470 Iosco

325 M-55 224 N MILL ST 525 SOUTH CENTER STREET 620 W MAIN STREET 545 N STATE ST 1555 E CHICAGO RD

TAWAS CITY, MI 48763 SAINT LOUIS, MI 48880 HARTFORD, MI 49057 STANTON, MI 48888 STANTON, MI 48888 STURGIS, MI 49091

(989)984-3770 Iosco (989)681-3524 Gratiot (269)621-4063 Van Buren (517)831-7200 Montcalm (517)831-8301 Montcalm (269)651-7114 St. Joseph

550 OSBORN BLVD

(906)632-0370 Chippewa

*

541 LAKE ST 721 SIXTH AVE, SUITE A

SAULT SAINTE MARIE, MI 49783 TAWAS CITY, MI 48764 THREE RIVERS, MI 49093

601 E CHICAGO RD

WHITE PIGEON, MI 49099

(269)483-7624 St. Joseph

711 S HEALTH PARKWAY, SUITE 1

THREE RIVERS, MI 49093

(269)273-8557 St. Joseph

6190 HOSPITAL DRIVE

CASS CITY, MI 48726

(989)872-8503 Tuscola

None SPECTRUM

TAWAS BAY FAMILY PRACTICE THREE RIVERS HEALTH FAMILY CARE THREE RIVER * THREE RIVERS HEALTH FAMILY CARE WHITE PIGEON None THREE RIVERS HEALTH FAMILY, INTERNAL MEDICINE AND * THUMB PEDIATRICS *

* = Non-Deemed

(989)362-3447 Iosco (269)273-9749 St. Joseph

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Michigan CCN

Key Provider Name *

UBLY FAMILY PRACTICE/WALK-IN CLINIC

*

238593 UNION CITY MEDICAL CENTER * 233919 WELLSTON MEDICAL CENTER * 238611 WEST MACKINAC HEALTH CLINIC None WEST SHORE MEDICAL CENTER 238663 PHYSICIAN SERVICES None WEST SHORE MEDICAL CENTER238692 PHYSICIAN SERVICES None WEST SHORE MEDICAL CENTER238693 PHYSICIAN SERVICES * 233808 WHITE PINE FAMILY MEDICINE * 238658 WMH COMMUNITY CARE-KINROSS * 238583 WOMEN'S AND CHILDREN'S HEALTH Total Providers for this State = 195

238586

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 9 of 9

Address

City, State and ZIP

Telephone # County Name

2269 MAIN STREET

UBLY, MI 48475

(989)658-2159 Huron

624 WEST M 60 17081 CABERFAE HWY W 14034 MELVILLE ROAD 1400 E PARKDALE AVE

UNION CITY, MI 49094 WELLSTON, MI 49689 ENGADINE, MI 49827 MANISTEE, MI 49660

(517)741-7989 Branch (616)848-4777 Manistee (906)477-6066 Mackinac (231)398-1840 Manistee

1391 E PARKDALE AVE

MANISTEE, MI 49660

(231)398-1771 Manistee

1293 E PARKDALE AVE, SUITE 1200A

MANISTEE, MI 49660

(231)398-1550 Manistee

261 NORTH MAIN STREET 16523 S WATERTOWER DRIVE 722 SOUTH MAIN STREET

CEDAR SPRINGS, MI 49319 KINCHELOE, MI 49788 CHEBOYGAN, MI 49721

(616)696-2020 Kent (906)495-1344 Chippewa (231)627-1493 Cheboygan

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Minnesota CCN 243467 243470 243413 243456 243465 243454 243451 243477 243466 243996 243979 243416 243461 243405 243997 243475 243464 243471 243474 243472 243468 243449 243463 243462 243859

Key Provider Name *

APPLETON MUNICIPAL HOSPITAL & NH * AVERA MEDICAL GROUP LAKE BENTON * AVERA MEDICAL GROUP TYLER * BROOTEN MEDICAL CENTER * CENTRACARE CLINIC- SAUK CENTRE * CENTRACARE HEALTH SYSTEM MELROSE * CENTRACARE HEALTH SYSTEM LONG PRAIRIE None COTEAU DES PRAIRIES HC SYSTEM BROWNS VALLEY CLINI * CRMC-LONGVILLE * DASSEL MEDICAL CENTER * DAWSON CLINIC * ESSENTIA HEALTH - ADA CLINIC * ESSENTIA HEALTH BAGLEY CLINIC * ESSENTIA HEALTH CHOKIO CLINIC * ESSENTIA HEALTH GRACEVILLE CLINIC * ESSENTIA HEALTH MENAHGA CLINIC * ESSENTIA HEALTH OKLEE CLINIC * ESSENTIA HEALTH PARK RAPIDS CLINIC * ESSENTIA HEALTH WALKER CLINIC * ESSENTIA PELICAN RAPIDS CLINIC * ESSENTIA ST MARYS MAHNOMEN CLINIC * FAMILY MEDICAL CENTER * FIRSTLIGHT HINCKLEY * FIRSTLIGHT PINE CITY * GATEWAY FAMILY CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

30 SOUTH BEHL STREET

APPLETON, MN 56208

(320)289-1580 Swift

109 EAST BENTON STREET

LAKE BENTON, MN 56149

(507)368-4323 Lincoln

240 WILLOW STREET 111 PLEASANT AVENUE PO BOX 69 433 ELM STREET NORTH

TYLER, MN 56178 BROOTEN, MN 56316 SAUK CENTRE, MN 56378

(507)247-5921 Lincoln (320)346-2272 Stearns (320)952-6591 Stearns

525 WEST MAIN STREET

MELROSE, MN 56352

(320)256-4228 Stearns

24 9TH STREET SE

LONG PRAIRIE, MN 56347

(320)732-2131 Todd

404 WEST BROADWAY

BROWNS VALLEY, MN 56219 (320)695-2526 Traverse

180 JORDAN LANE 460 FIFTH STREET NORTH BOX 367 1272 WALNUT STREET 201 9TH STREET WEST 121 CENTRAL STREET WEST 101 MAIN STREET 115 WEST SECOND STREET

LONGVILLE, MN 56655 DASSEL, MN 55325 DAWSON, MN 56232 ADA, MN 56510 BAGLEY, MN 56621 CHOKIO, MN 56221 GRACEVILLE, MN 56240

(218)363-3300 Cass (320)275-3358 Meeker (320)769-4393 Lac qui Parle (218)784-2727 Norman (218)694-6281 Clearwater (320)748-7223 Stevens (320)324-7500 Big Stone

212 ASPEN AVENUE NORTH EAST

MENAHGA, MN 56464

(218)564-4131 Wadena

GOVERNOR STREET & THIRD AVENUE 705 PLEASANT AVENUE

OKLEE, MN 56742 PARK RAPIDS, MN 56470

(218)796-4525 Red Lake (218)732-2800 Hubbard

110 D MICHIGAN AVENUE NORTHWEST WALKER, MN 56484 301 NORTH BROADWAY PELICAN RAPIDS, MN 56572 117 NORTH MAIN STREET MAHNOMEN, MN 56557

(218)547-6900 Cass (218)863-2000 Otter Tail (218)936-5616 Mahnomen

200 SOUTH FIRST AVENUE 620 SANDY LANE ROAD 1425 MAIN STREET NORTH 204 LUNDORFF DRIVE

(320)468-2536 Morrison (320)629-7505 Pine (320)629-7505 Pine (320)245-2250 Pine

PIERZ, MN 56364 HINCKLEY, MN 55037 PINE CITY, MN 55063 SANDSTONE, MN 55072

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Minnesota CCN

Key Provider Name

243861 243437 243856

*

243455 243457 243426 243977 243427

*

243990 243423 243421 243431 243436 243422 243450 243445

*

243434 243975 243976 243417 243446 243409 243987 243469

*

243447 243443

*

243444

*

* *

* * * *

* * * * * * *

* * * * * * *

*

* = Non-Deemed

Address

Page 2 of 4

City, State and ZIP

Telephone # County Name

HINCKLEY, MN 55037 GLENWOOD, MN 56334 SLAYTON, MN 56172

(320)384-6618 Pine (320)634-5157 Pope (507)836-8538 Murray

HENDRICKS, MN 56136 IVANHOE, MN 56142 BOYD, MN 56218 HALLOCK, MN 56728 KARLSTAD, MN 56732

(507)275-3134 Lincoln (507)694-1100 Lincoln (320)769-4323 Lac qui Parle (218)843-3612 Kittson (218)843-3612 Kittson

MADISON, MN 56256 BROWERVILLE, MN 56438 EAGLE BEND, MN 56446 MOTLEY, MN 56466 PILLAGER, MN 56473 STAPLES, MN 56479 BAUDETTE, MN 56623 EAGLE BEND, MN 56446

(320)598-7551 Lac qui Parle (320)594-2231 Todd (218)738-2804 Todd (218)352-6911 Morrison (218)746-4550 Cass (218)894-1033 Todd (218)634-2120 Lake of the (218)738-2804 Todd (320)277-3682 Morrison (320)676-3661 Mille Lacs (320)532-3154 Mille Lacs (507)836-6153 Murray (507)425-2300 Murray (218)745-4211 Marshall (218)278-6634 Koochiching (218)283-4481 Koochiching

250 WHITE OAK DRIVE 131 BIRCH AVENUE WEST

HILLMAN, MN 56338 ISLE, MN 56342 ONAMIA, MN 56359 SLAYTON, MN 56172 FULDA, MN 56131 WARREN, MN 56762 LITTLEFORK, MN 56653 INTERNATIONAL FALLS, MN 56649 RANDALL, MN 56475 HECTOR, MN 55342

420 NORTH MAIN STREET

RENVILLE, MN 56284

(320)329-8395 Renville

GATEWAY FAMILY HEALTH CLINIC 45 LADY LUCK DRIVE, PO BOX 309 GLENWOOD MEDICAL CENTER 417 SOUTH FRANKLIN HEALTH CARE TODAY/AVERA 1444 WEST HIGHWAY #30 HEALTH HENDRICKS CLINIC 501 EAST LINCOLN STREET IVANHOE MEDICAL CENTER 366 EAST GEORGE STREET JOHNSON MEMORIAL BOYD CLINIC 115 3RD STREET KITTSON MEMORIAL CLINIC 1010 SOUTH BIRCH, BOX 700 KITTSON MEMORIAL CLINIC OF 205 ROOSEVELT AVENUE WEST, PO KARLSTAD BOX 199 LAC QUI PARLE CLINIC MADISON 900 SECOND AVE LAKEWOOD CLINIC BROWERVILLE 30535 241ST AVENUE LAKEWOOD CLINIC EAGLE BEND 815 HIGHWAY 71 LAKEWOOD CLINIC MOTLEY 1233 HIGHWAY 10 LAKEWOOD CLINIC PILLAGER 653 PILLSBURY STREET NORTH LAKEWOOD CLINIC STAPLES 49725 COUNTY 83 LAKEWOOD HEALTH CENTER CLINIC 600 MAIN AVENUE SOUTH LONG PRAIRIE MEM HOSPITAL 815 HIGHWAY 71 SOUTH EAGLE VALLEY CLIN MILLE LACS FAMILY CLINIC 26362 370TH AVENUE MILLE LACS FAMILY CLINIC ISLE 375 WEST ISIE STREET MILLE LACS FAMILY CLNC ONAMIA 200 NORTH ELM STREET, PO BOX A MURRAY COUNTY CLINIC 2040 JUNIPER AVENUE MURRAY COUNTY CLINIC FULDA 119 NORTH ST PAUL AVENUE NORTH VALLEY HLTH CTR CLINIC 300 WEST GOOD SAMARITAN DRIVE RAINY LAKE MEDICAL CENTER 912 MAIN STREET RAINY LAKE MEDICAL CENTER RHC 1400 HIGHWAY 71 RANDALL LAKES AREA CLINIC RENVILLE COUNTY HOSPITAL & CLINIC - HECTOR CLINIC RENVILLE COUNTY HOSPITAL & CLINICS RENVILLE CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

(320)749-2877 Morrison (320)848-6294 Renville

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Minnesota CCN

Key Provider Name

243442

*

243428 243429 243438 243430 243458 243459 243460 243406 243441 243407 243419

*

243418 243420 243411 243403 243831 243414 243415 243857 243476 243850

*

243862

*

243846

*

243847 243848 243985 243433

*

* * * * * * * * * *

* * * * * * * * *

* * *

* = Non-Deemed

RENVILLE COUNTY HOSPITAL AND CLINICS - OLIVIA CLIN RIDGEVIEW ARLINGTON CLINIC RIDGEVIEW GAYLORD CLINIC RIDGEVIEW HENDERSON CLINIC RIDGEVIEW WINTHROP CLINIC RIVERVIEW CLINIC RIVERVIEW CLINIC RIVERVIEW CLINIC RIVERWOOD CLINIC AITKIN RIVERWOOD HLTH CC GARRISON RIVERWOOD MCGREGOR CLINIC SANFORD BAGLEY CLEARBROOK CLINIC SANFORD BAGLEY CLINIC SANFORD CLINIC BALATON SANFORD CLINIC CANBY SANFORD CLINIC LAKEFIELD SANFORD CLINIC MOUNTAIN LAKE SANFORD CLINIC TRACY SANFORD CLINIC WESTBROOK SANFORD CLINIC WINDOM SANFORD HEALTH HALSTAD CLINIC SANFORD HEALTH MAHNOMEN CLINIC SANFORD HEALTH PELICAN RAPIDS CLINIC SANFORD HEALTH TWIN VALLEY CLINIC SANFORD HEALTH ULEN CLINIC SANFORD HEALTH WALKER CLINIC SANFORD JACKSON CLINIC SANFORD TRACY WALNUT GROVE CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

Address

City, State and ZIP

Telephone # County Name

100 HEALTHY WAY

OLIVIA, MN 56277

(320)523-1460 Renville

607 WEST CHANDLER 315 4TH STREET 505 MAIN STREET 223 NORTH CARVER 323 SOUTH MINNESOTA STREET 306 NORTH MILL STREET 105 INTERNATIONAL DRIVE SUITE 25 200 BUNKER HILL DRIVE 27278 STATE HIGHWAY 18 2 EAST CENTER AVE PO BOX 340 22 ELM STREET

ARLINGTON, MN 55307 GAYLORD, MN 55334 HENDERSON, MN 56044 WINTHROP, MN 55396 CROOKSTON, MN 56716 FERTILE, MN 56540 RED LAKE FALLS, MN 56750 AITKIN, MN 56431 GARRISON, MN 56450 MCGREGOR, MN 55760 CLEARBROOK, MN 56634

(507)964-2285 Sibley (507)237-5523 Sibley (507)248-3433 Sibley (507)647-5318 Sibley (218)281-9200 Polk (218)945-6695 Polk (218)253-4606 Red Lake (218)927-2157 Aitkin (320)525-3400 Crow Wing (218)768-4011 Aitkin (218)776-3124 Clearwater

1656 CENTRAL STREET WEST HIGHWAY 14E 112 ST OLAF AVENUE 209 MAIN STREET PO BOX 546 308 EIGHTH STREET 251 FIFTH STREET EAST 920 BELL AVENUE 591 2ND AVENUE NORTH 445 1ST STREET EAST 414 WEST JEFFERSON, PO BOX 396

BAGLEY, MN 56621 BALATON, MN 56115 CANBY, MN 56220 LAKEFIELD, MN 56150 MOUNTAIN LAKE, MN 56159 TRACY, MN 56175 WESTBROOK, MN 56183 WINDOM, MN 56101 HALSTAD, MN 56548 MAHNOMEN, MN 56557

(218)694-2384 Clearwater (507)629-3200 Lyon (507)223-7221 Yellow Medicine (507)662-6611 Jackson (507)427-3332 Cottonwood (507)629-3520 Lyon (507)274-6121 Cottonwood (507)831-2223 Cottonwood (218)456-2158 Norman (218)935-2514 Mahnomen

211 EAST MILL STREET

PELICAN RAPIDS, MN 56572

(701)234-6207 Otter Tail

501 2ND STREET NORTHWEST

TWIN VALLEY, MN 56584

(218)584-5142 Norman

108 VIKING AVENUE WEST 614 MICHIGAN AVENUE 1430 NORTH HIGHWAY 830 EIGHTH STREET

ULEN, MN 56585 WALKER, MN 56484 JACKSON, MN 56143 WALNUT GROVE, MN 56180

(218)494-3404 Clay (218)547-3938 Cass (507)847-2200 Jackson (507)859-2157 Redwood

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Minnesota CCN

Key Provider Name *

Address

SANFORD WHEATON 401 12TH STREET NORTH SLEEPY EYE MEDICAL CENTER 400 4TH AVENUE NORTHWEST None SWIFT COUNTY-BENSON HEALTH 1810 MCKINNEY AVENUE SERVICES * 243988 TRI COUNTY HEALTH CARE 401 DOUGLAS AVENUE HENNING CLINIC * 243452 TRI COUNTY HEALTH CARE 232 HIGHWAY 78 NORTH PO BOX 129 OTTERTAIL CLINIC * 243453 TRI COUNTY HEALTH CARE 4 NORTHWEST DEERWOOD AVENUE WADENA CLINIC * 243978 TRI COUNTY HEALTH CARE, BERTHA PO BOX 67, FIRST STREET NORTH CLINIC * 243986 TRI COUNTY HEALTHCARE SEBEKA 106 MINNESOTA AVENUE EAST CLINIC * 243473 TRI COUNTY HOSP VERNDALE 102 FARWELL STREET SOUTH CLINIC Total Providers for this State = 89

243435 243439 243478

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

City, State and ZIP

Telephone # County Name

WHEATON, MN 56296 SLEEPY EYE, MN 56085 BENSON, MN 56215

(320)563-8226 Traverse (507)794-3571 Brown (320)843-2030 Swift

HENNING, MN 56551

(218)583-2953 Otter Tail

OTTERTAIL, MN 56571

(218)367-6262 Otter Tail

WADENA, MN 56482

(218)631-1100 Wadena

BERTHA, MN 56437

(218)924-2250 Todd

SEBEKA, MN 56477

(218)837-5333 Wadena

VERNDALE, MN 56481

(218)445-5990 Wadena

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Ohio CCN 363851 363868 363405 363404 363406 363400 363836 363803 363401 363867 363982 363983 363865 363863 363864 363403 363995 363862 363992 363991 363987

Key Provider Name *

AMJAD RASS, INC FAMILY HEALTH CENTER None AULTMAN ORVILLE DUNLAP FAMILY PHYSICIANS None AULTMAN ORVILLE DUNLAP FAMILY PHYSICIANS None AULTMAN ORVILLE DUNLAP FAMILY PHYSICIANS None CEDARVILLE FAMILY PRACTICE * CHANDRA SHAKER, MD * CLERMONT PEDIATRIC CENTER None COMMUNITY PHYSICIANS OF YELLOW SPRINGS None EDGERTON FAMILY HEALTH CENTER * FAYETTE CTY MEMORIAL HOSP MEDICAL & SURGICAL ASSOC * FCMH MEDICAL AND SURGICAL ASSOCIATES None FPG COUNSELING AND RECOVERY PLUS None FPG COUNSELING AND RECOVERY SERVICE None FPG COUNSELING AND RECOVERY SERVICE None GALION OB/GYN None GCH PHYSICIAN PRACTICE - EAST HILL STREET None GCH PHYSICIAN PRACTICE - GAIUS STREET None GCH PHYSICIAN PRACTICECRESTLINE None GCH PHYSICIAN PRACTICE- MAPLE CREEK MEDICAL CENTER * GCH PHYSICIAN PRACTICES BUCYRUS ROAD CAMPUS None ANTWERP

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

Address

City, State and ZIP

Telephone # County Name

61353 SOUTHGATE PARKWAY 422 WEST RIVER STREET 49 MAPLE STREET

CAMBRIDGE, OH 43725 ANTWERP, OH 45813 APPLE CREEK, OH 44606

(740)435-8585 Guernsey (419)542-5672 Paulding (330)684-5470 Wayne

830 SOUTH MAIN STREET

ORRVILLE, OH 44667

(330)684-2015 Wayne

129 WENGER ROAD N

DALTON, OH 44618

(330)684-5480 Wayne

29 KYLE DRIVE 120 STURGES AVENUE, SUITE 1 3003 HOSPITAL DRIVE 888 DAYTON STREET, SUITE 200

CEDARVILLE, OH 45314 MANSFIELD, OH 44903 BATAVIA, OH 45103 YELLOW SPRINGS, OH 45387

(937)766-2611 Greene (419)522-5454 Richland (513)732-2277 Clermont (937)767-7291 Greene

104 SOUTH WEST STREET

EDGERTON, OH 43517

(419)542-5672 Williams

1450 COLUMBUS AVENUE, SUITE 103

WASHINGTON CH, OH 43160 (740)333-2236 Fayette

1510 COLUMBUS AVENUE, SUITE 230

WASHINGTON CH, OH 43160 (740)333-3333 Fayette

1925 HAYES AVENUE

SANDUSKY, OH 44870

(419)557-5177 Erie

675 BARTSON ROAD

FREMONT, OH 43420

(419)332-5524 Sandusky

292 BENEDICT AVENUE

NORWALK, OH 44857

(419)663-3737 Huron

1200 STATE ROUTE 598 130 HILL STREET

GALION, OH 44833 BUCYRUS, OH 44820

(419)468-0111 Crawford (419)562-3264 Crawford

139 GAIUS STREET

BUCYRUS, OH 44820

(419)562-4677 Crawford

330 NORTH STELZER STREET

CRESTLINE, OH 44827

(419)689-3200 Crawford

1323 EAST MANSFIELD STREET

BUCYRUS, OH 44820

(419)563-0300 Crawford

955 BUCYRUS ROAD

GALION, OH 44833

(419)468-0503 Crawford

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Ohio CCN 363994 363993 363985 363984 363986 363850 363844 363408 363843 363853 363999 363402 363998 363989 363988 363861 363829 363852 363855 363857 363858 363981 363996

Key Provider Name None GCH

PHYSICIAN PRACTICES NEW WASHINGTON CAMPUS None GCH PHYSICIAN PRACTICES, BCH PRIMARY CARE * GCH PHYSICIAN PRACTICES, HOSPITAL CAMPUS * GCH PHYSICIAN PRACTICES, PORTLAND WAY CAMPUS * GCH PHYSICIAN PRACTICES, SELTZER STATION CAMPUS * GENESIS MEDICAL GROUP * GREENFIELD MEDICAL SERVICES None HICKSVILLE FAMILY HEALTH CENTER * HIGHLAND FAMILY HEALTHCARE * KINGS DAUGHTERS MED CTR JACKSON MED SPECIALTIES None MCH PRIMARY CARE CARDINAL CENTER None MCH PRIMARY CARE MOUNT GILEAD None MCH PRIMARY CARE NORTHFIELD * MERCY ALLEN RURAL HEALTH CLINIC LAGRANGE * MERCY ALLEN RURAL HEALTH CLINIC WELLINGTON None ONTARIO PHYSICIAN PRACTICES * PERRY COUNTY FAMILY PRACTICE * POMERENE EXPRESS CARE * PROSPECT FAMILY MEDICINE RURAL HEALTH CLINIC None SHAWNEE FAMILY HEALTH CENTER None SHAWNEE FAMILY HEALTH CENTER * SOUTHWEST REGIONAL MEDICAL CENTER BETHEL RHC None TRINITY MEDICAL GROUP

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

Address

City, State and ZIP

Telephone # County Name

120 WEST MAIN STREET

(419)492-2200 Crawford

629 NORTH SANDUSKY AVENUE

NEW WASHINGTON, OH 44854 BUCYRUS, OH 44820

269 PORTLAND WAY SOUTH

GALION, OH 44833

(419)468-0503 Crawford

270 PORTLAND WAY SOUTH

GALION, OH 44833

(419)468-0503 Crawford

385 NORTH SELTZER

CRESTLINE, OH 44827

(419)468-0503 Crawford

401 LINCOLN PARK DRIVE 1092 WEST JEFFERSON STREET 208 NORTH COLUMBUS STREET

NEW LEXINGTON, OH 43764 GREENFIELD, OH 45123 HICKSVILLE, OH 43526

(740)342-5107 Perry (937)981-1121 Highland (419)542-5672 Defiance

1402 NORTH HIGH STREET 14365 STATE ROUTE 93

HILLSBORO, OH 45133 JACKSON, OH 45640

(937)393-4899 Highland (740)288-7681 Jackson

73 SPORTMAN DRIVE

MARENGO, OH 43334

(419)949-3030 Morrow

900 MEADOW DRIVE

MOUNT GILEAD, OH 43338

(419)947-8001 Morrow

6519 US HIGHWAY 42 105 OPPORTUNITY WAY

MOUNT GILEAD, OH 43338 LAGRANGE, OH 44050

(419)362-6033 Morrow (440)355-4206 Lorain

508 DICKSON STREET, SUITE 2

WELLINGTON, OH 44090

(440)647-2225 Lorain

2981 WEST 4TH STREET 1625 AIRPORT ROAD 4900 OAK STREET 102 EAST WATER STREET

MANSFIELD, OH 44906 NEW LEXINGTON, OH 43764 BERLIN, OH 44610 PROSPECT, OH 43342

(419)462-4561 Richland (740)342-5158 Perry (330)893-1318 Holmes (740)494-2624 Marion

901 WASHINGTON STREET 192 CHESTNUT RIDGE ROAD 210 NORTH UNION STREET

PORTSMOUTH, OH 45662 WEST UNION, OH 45693 BETHEL, OH 45106

(740)354-7770 Scioto (937)544-5581 Adams (513)734-9050 Clermont

819 NORTH FIRST STREET

DENNISON, OH 44621

(740)922-8042 Tuscarawas

(419)563-9865 Crawford

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Ohio CCN

Key Provider Name None TRINITY

MEDICAL GROUP HEALTH CARE INC None TURJOMAN PEDIATRICS * TUSCARAWAS COUNTY GENERAL HEALTH DISTRICT Total Providers for this State = 48

363997 363859 363860 363800

None TRUSTED

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

110 NORTH WALNUT STREET 128 EAST MAIN STREET 8930 OHIO RIVER ROAD 897 EAST IRON AVENUE

GNADENHUTTEN, OH 44629 BAINBRIDGE, OH 45612 WHEELERSBURG, OH 45694 DOVER, OH 44622

(740)254-9443 Tuscarawas (740)634-2013 Ross (740)574-1903 Scioto (330)343-4928 Tuscarawas

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Wisconsin CCN 528569 528570 528535 528560 528559 528537 528536 528538 523810 528554 528501 528517 528562 528563 528571 528573 523984 523991 523865 523864 523866 528555 528572 528523 528534 528533 528540

Key Provider Name None ASPIRUS

BIRNAMWOOD CLINIC ELCHO CLINIC * ASPIRUS GILMAN CLINIC None ASPIRUS GRAND VIEW CLINIC None ASPIRUS MEDFORD CLINIC * ASPIRUS PHILLIPS CLINIC * ASPIRUS PRENTICE CLINIC * ASPIRUS RIB LAKE CLINIC * AURORA NOR DOOR CLINIC * BELLIN HEALTH OCONTO CLINIC * BLAND CLINIC VERNON MEMORIAL HOSPITAL * BURNETT MEDICAL CTR CLINIC None CLEAR LAKE CLINIC None CUMBERLAND HC MEDICAL CLINIC None CUMBERLAND HC TURTLE LAKE CENTER * DURAND CLINIC SOUTH * ELROY FAMILY MEDICAL CENTER * FLORENCE MEDICAL CTR * FMC ALGOMA * FMC KEWAUNEE * FMC OCONTO FALLS None FREDERIC CLINIC None GRANT REGIONAL COMMUNITY CLINIC * GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS * GUNDERSEN BOSCOBEL AREA HSPTL & CLINICS FENNIMORE * GUNDERSEN BOSCOBEL AREA HSPTL AND CLINICS MUSCODA * GUNDERSEN ST JOSEPHS HSPTL AND CLINICS HILLSBORO None ASPIRUS

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

400 RAILROAD ST W10618 CLINIC ST 320 EAST MAIN ST 501 GRANITE ST 143 S GIBSON ST 625 PETERSON AVE 1511 RAILROAD AVE 1121 HIGHWAY 102 2521 S BAY SHORE DR 820 ARBITUS AVE 100 MELBY ST

BIRNAMWOOD, WI 54414 ELCHO, WI 54428 GILMAN, WI 54433 HURLEY, WI 54534 MEDFORD, WI 54451 PHILLIPS, WI 54555 PRENTICE, WI 54556 RIB LAKE, WI 54470 SISTER BAY, WI 54234 OCONTO, WI 54153 WESTBY, WI 54667

(715)449-2539 Marathon (715)275-4011 Langlade (715)447-8293 Taylor (715)561-2255 Iron (715)748-2121 Taylor (715)339-4035 Price (715)428-2521 Price (715)427-5701 Taylor (920)854-2347 Door (920)834-8833 Oconto (608)634-3126 Vernon

257 W ST GEORGE AVE 357 THIRD AVE 1110 7TH AVE 632 US HIGHWAY 8

GRANTSBURG, WI 54840 CLEAR LAKE, WI 54005 CUMBERLAND, WI 54829 CUMBERLAND, WI 54829

(715)463-5317 Burnett (715)263-3100 Polk (715)822-2741 Barron (715)822-2741 Barron

1250 3RD AVE WEST 1515 ACADEMY ST 1010 OLIVE AVE 831 PARKER ST 575 4TH ST 107 E HIGHLAND DR 205 OAK ST WEST 507 S MONROE ST

DURAND, WI 54736 ELROY, WI 53929 FLORENCE, WI 54121 ALGOMA, WI 54201 KEWAUNEE, WI 54216 OCONTO FALLS, WI 54154 FREDERIC, WI 54837 LANCASTER, WI 53813

(715)672-5233 Pepin (608)462-8466 Juneau (715)528-4775 Florence (920)487-3676 Kewaunee (920)388-4640 Kewaunee (920)846-3092 Oconto (715)327-5700 Polk (608)723-3202 Grant

208 PARKER ST

BOSCOBEL, WI 53805

(608)375-2424 Grant

220 LINCOLN AVE

FENNIMORE, WI 53809

(608)822-3737 Grant

525 N WISCONSIN AVE

MUSCODA, WI 53573

(608)739-3138 Grant

400 WATER AVE

HILLSBORO, WI 54634

(608)489-8280 Vernon

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Wisconsin CCN 528551 528552 528553 523996 528556 523999 528526 528516 523998 523981 523979 523980 523828 528541 528543 528518 528521 528519 528520 528513 523990 523829 528530 528532

Key Provider Name *

GUNDERSEN TRI COUNTY HSPTL & CLINICS INDEPENDENCE

*

GUNDERSEN TRI COUNTY HSPTL AND CLINICS BLAIR * GUNDERSEN TRI COUNTY HSPTL AND CLINICS WHITEHALL * HIRSCH CLINIC None INGALLS CLINIC * KICKAPOO VALLEY MEDICAL CLINIC * LAFARGE MEDICAL CLINIC * LUCK CLINIC * MAYO CLINIC HS FRANCISCAN HEALTHCARE * MEMORIAL MEDICAL CTR GREENWOOD

*

MEMORIAL MEDICAL CTR LOYAL * MEMORIAL MEDICAL CTR NEILSVILLE * MILE BLUFF CLINIC * MINISTRY MEDICAL GROUP CRANDON * MINISTRY MEDICAL GROUP LAONA * MINISTRY MEDICAL GROUP OWEN * MINISTRY MEDICAL GROUP STANLEY * MINISTRY MEDICAL GROUP THORP * MOUNDVIEW MEMORIAL CLINIC * MUSCODA HEALTH CENTER * NECEDAH FAMILY MEDICAL CTR * NEW LISBON FAMILY MEDICAL CTR * NORTH SHORE MED CLINIC ALGOMA * NORTH SHORE MED CLINIC FISH CREEK

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 4

Address

City, State and ZIP

Telephone # County Name

35791 OSSEO RD

INDEPENDENCE, WI 54747

(715)985-2351 Trempealeau

420 S PETERSON AVE

BLAIR, WI 54616

(608)989-2505 Trempealeau

18606 ERVIN ST

WHITEHALL, WI 54773

(715)538-4355 Trempealeau

407 S MAIN ST STE 400 7456 MAIN ST 102 SUNSET BLVD 206 N MILL ST 137 1ST AVE 310 W MAIN ST

VIROQUA, WI 54665 WEBSTER, WI 54893 SOLDIERS GROVE, WI 54655 LA FARGE, WI 54639 LUCK, WI 54853 SPARTA, WI 54656

(608)637-3174 Vernon (715)866-4271 Burnett (608)624-5203 Crawford (608)625-2494 Vernon (715)472-2177 Polk (608)269-2132 Monroe

201 S MAIN ST

GREENWOOD, WI 54437

(715)267-3399 Clark

502 E ELM ST 216 SUNSET PLACE

LOYAL, WI 54446 NEILLSVILLE, WI 54456

(715)255-8551 Clark (715)743-3101 Clark

1040 DIVISION ST 400 W GLEN ST

MAUSTON, WI 53948 CRANDON, WI 54520

(608)847-5000 Juneau (715)478-3318 Forest

4876 MILL ST 6 JOHNSON ST 1120 PINE ST

LAONA, WI 54541 OWEN, WI 54460 STANLEY, WI 54768

(715)674-5233 Forest (715)229-2177 Clark (715)644-5530 Chippewa

704 S CLARK ST 402 W LAKE ST 1075 N WISCONSIN AVE 1408 WHEELIHAN AVE 901 W BRIDGE ST 815 JEFFERSON ST

THORP, WI 54771 FRIENDSHIP, WI 53934 MUSCODA, WI 53573 NECEDAH, WI 54646 NEW LISBON, WI 53950 ALGOMA, WI 54201

(715)669-7279 Clark (608)339-6350 Adams (608)739-3113 Grant (608)565-2000 Juneau (608)562-3111 Juneau (920)487-3496 Kewaunee

3711 HIGHWAY 42

FISH CREEK, WI 54212

(920)868-3511 Door

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Wisconsin CCN 528531 528515 523860 523862 523863 528524 528525 528567 528565 528564 528514 528542 528544 528545 528546 528547 528568 528539 528528 528561 528557

Key Provider Name *

Address

NORTH SHORE MED CLINIC 323 SOUTH 18TH AVE STURGEON BAY * NORTH SHORE MED CLINIC 910 MAIN RD WASHINGTON ISLAND * NORTHREACH HEALTHCARE 218 S US HWY 141 CRIVITZ * NORTHREACH HEALTHCARE FAMILY 3123 SHORE DR SUITE 202 CARE * PESHTIGO FAMILY MEDICINE CLINIC 441 FRENCH ST * PLAIN MEDICAL CLINIC 825 MAIN ST * RIVER VALLEY MEDICAL CLINIC 436 SUNRISE DR None RUSK COUNTY MEMORIAL 900 COLLEGE AVENUE W HOSPITAL CLINIC None SOUTHWEST HEALTH CUBA CITY 207 E SKELLY ST CLINIC None SOUTHWEST HEALTH PLATTEVILLE 1450 EAST SIDE ROAD CLINIC * SPRING GREEN MEDICAL CENTER 150 E JEFFERSON ST None ST CLARE MEM HOSPITAL GILLETT 340 N GREEN BAY AVE HEALTH CENTER None ST CLARE MEM HOSPITAL LENA 200 S ROSERA ST HEALTH CENTER None ST CLARE MEM HOSPITAL 14353 HIGHWAY 32 / 64 MOUNTAIN HEALTH CENTER None ST CLARE MEM HOSPITAL OCONTO 835 S MAIN ST FALLS HEALTH CENTER None ST CLARE MEM HOSPITAL SURING 913 E MAIN ST HEALTH CENTER None ST JOSEPHS HEALTH SERVICES 1705 OMAHA ST ELROY * ST JOSEPHS HEALTH SVCS 301 RAILROAD ST WONEWOC CLINIC * STONE LAKE MEDICAL CLINIC 16887 SECOND ST SOUTH None TURTLE LAKE CLINIC 550 MARTIN AVE None UPLAND HILLS HEALTH CLINIC 551 N MAIN ST HIGHLAND

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

City, State and ZIP

Telephone # County Name

STURGEON BAY, WI 54235

(920)746-0510 Door

WASHINGTON ISLAND, WI 54246 CRIVITZ, WI 54114

(920)847-2424 Door

MARINETTE, WI 54143

(715)732-4120 Marinette

PESHTIGO, WI 54157 PLAIN, WI 53577 SPRING GREEN, WI 53588 LADYSMITH, WI 54848

(715)582-9949 Marinette (608)546-4211 Sauk (608)588-2502 Sauk (715)532-5561 Rusk

CUBA CITY, WI 53807

(608)744-2767 Grant

PLATTEVILLE, WI 53818

(608)348-4330 Grant

SPRING GREEN, WI 53588 GILLETT, WI 54124

(608)588-7413 Sauk (920)855-2823 Oconto

LENA, WI 54139

(920)829-6400 Oconto

MOUNTAIN, WI 54149

(715)276-1600 Oconto

OCONTO FALLS, WI 54154

(920)846-8187 Oconto

SURING, WI 54174

(920)842-1147 Oconto

ELROY, WI 53929

(608)462-4116 Juneau

WONEWOC, WI 53968

(608)464-3575 Juneau

STONE LAKE, WI 54876 TURTLE LAKE, WI 54889 HIGHLAND, WI 53543

(715)865-6510 Sawyer (715)986-4101 Barron (608)929-4518 Iowa

(715)854-7477 Marinette

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Wisconsin CCN 528558

Key Provider Name None UPLAND

HILLS HEALTH CLINIC MONTFORT None UPLAND HILLS HEALTH CLINIC 528566 SPRING GREEN * 523989 WAUSAUKEE HEALTH CENTER * 528504 WESTERN WISCONSIN HEALTH Total Providers for this State = 76

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

Address

City, State and ZIP

Telephone # County Name

202 HIGHWAY 18 WEST

MONTFORT, WI 53569

(608)943-6308 Grant

156 W JEFFERSON ST

SPRING GREEN, WI 53588

(608)588-2600 Sauk

536 KENNY DR 1100 BERGSLIEN ST

WAUSAUKEE, WI 54177 BALDWIN, WI 54002

(715)856-6983 Marinette (715)684-3311 St. Croix

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Arkansas CCN

Key Provider Name

043877 043886

None ACCESS

043887 043879

None ACCESS

043885 043432 043490 043853 043457

None ACCESS

None ACCESS

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

MEDICAL CLINIC MEDICAL CLINIC CALICO

3519 HIGHWAY 63 2161 AR 56 HIGHWAY

BLACK ROCK, AR 72415 CALICO ROCK, AR 72519

(870)994-7301 Lawrence (870)916-2000 Izard

MEDICAL CLINIC HARDY MEDICAL CLINIC MARKED

101 WEST MAIN STREET 202 NEWSOME DRIVE

HARDY, AR 72542 MARKED TREE, AR 72365

(870)994-7301 Sharp (870)358-4355 Poinsett

106 NORTH VAN BUREN STREET 400 NORTH FIRST STREET 1003 FRED LAGRONE DRIVE 2425 DAVE WARD DRIVE, #401 110 NORTH NEW YORK STREET

WEINER, AR 72479 YELLVILLE, AR 72687 CROSSETT, AR 71635 CONWAY, AR 72032 BRINKLEY, AR 72021

(870)358-4355 Poinsett (870)449-4221 Marion (870)364-9519 Ashley (501)329-3824 Faulkner (870)734-4405 Monroe

1703 SOUTH WHITEHEAD DRIVE

DE WITT, AR 72042

(870)673-3511 Arkansas

102 WEST FRONT STREET

HAZEN, AR 72064

(870)673-3511 Prairie

1609 NORTH MEDICAL DRIVE

STUTTGART, AR 72160

(870)673-7211 Arkansas

8544 EDGEMOUNT RD

GREERS FERRY, AR 72067

(501)825-6283 Cleburne

221 NE 2ND STREET

ENGLAND, AR 72046

(501)842-3819 Lonoke

200 EAST WALNUT STREET

GURDON, AR 71743

(870)353-2800 Clark

6679 HIGHWAY 7

BISMARCK, AR 71929

(501)865-2755 Hot Spring

10 MONTGOMERY DRIVE

CADDO VALLEY, AR 71923

(870)245-2198 Clark

110 VILLAGE PLACE 2B

FAIRFIELD BAY, AR 72088

(501)887-3212 Van Buren

106 SOUTH SEVENTH STREET

HEBER SPRINGS, AR 72543

(501)362-7538 Cleburne

304 MAIN STREET

PANGBURN, AR 72121

(501)728-4535 White

1484 WEST FIRST STREET NORTH, #2

PRESCOTT, AR 71857

(870)887-0155 Nevada

ROCK None ACCESS

TREE

043492 043489 043480 043990 048505 048504 048508 048507 048510 048506 048512 048511

MEDICAL CLINIC WEINER AHRENS CLINIC * ASHLEY HEALTH SERVICES * BANISTER LIEBLONG CLINIC * BAPTIST HEALTH - FAMILY CLINIC BRINKLEY * BAPTIST HEALTH - FAMILY CLINIC DEWITT * BAPTIST HEALTH - FAMILY CLINIC HAZEN * BAPTIST HEALTH - STUTTGART MEDICAL CLINIC * BAPTIST HEALTH CENTER GREERS FERRY * BAPTIST HEALTH FAMILY CLINIC ENGLAND BHMCS None BAPTIST HEALTH FAMILY CLINIC GURDON None BAPTIST HEALTH FAMILY CLINICBISMARCK None BAPTIST HEALTH FAMILY CLINICCADDO VALLEY None BAPTIST HEALTH FAMILY CLINICFAIRFIELD BAY * BAPTIST HEALTH FAMILY CLINICHEBER SPRINGS None BAPTIST HEALTH FAMILY CLINICPANGBURN None BAPTIST HEALTH FAMILY CLINICPRESCOTT *

* = Non-Deemed

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Arkansas CCN 043456 043829 043982 043868 043869 043870 048513 043424 043851 043497 043831 043494 043808 043812 043495 043455 043867 043463 043448 043864 043479 043486 043875 043872 043854 048501

Key Provider Name *

BAPTIST HEALTH-FAMILY CLINIC CLARENDON

*

BELL-WINSTON CLINIC, PA * CAVE CITY MEDICAL CLINIC * CHI ST VINCENT MEDICAL GROUP HOT SPRINGS * CHI ST VINCENT MEDICAL GROUP HOT SPRINGS * CHI ST VINCENT MEDICAL GROUP HOT SPRINGS None CHICOT MEMORIAL MEDICAL CTR FAMILY MEDICAL CLINIC * CLAUDE PARRISH COMMUNITY HEALTH CLINIC * CLINTON MEDICAL CLINIC * COMMUNITY MEDICAL CENTER CLINIC OF CALICO ROCK * COOPER CLINIC PA * DALLAS COUNTY MEDICAL CENTER FAMILY CLINIC

*

DE PAUL HEALTH CENTER * DECATUR MEDI-CLINIC * DELTA HEALTH SERVICES * DRASCO MEDICAL CLINIC * EARLE FAMILY MEDICAL CLINIC * EUDORA MEDICAL CLINIC * FAMILY CARE CLINIC OF RECTOR * FAMILY HEALTH CARE, LLC * FAMILY MEDICAL CENTER * FERGUSON RURAL HEALTH CLINIC * FORE FAMILY PRACTICE LLC * GREENBRIER CHILDREN'S CLINIC * GREENBRIER FAMILY MEDICINE * HAMBURG HEALTH CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 4

Address

City, State and ZIP

Telephone # County Name

198 SOUTH MAIN STREET

CLARENDON, AR 72029

(870)747-3349 Monroe

626 POPLAR STREET 301 SOUTH MAIN STREET 234 EAST BROADWAY

HELENA, AR 72342 CAVE CITY, AR 72521 GLENWOOD, AR 71943

(870)338-8163 Phillips (870)283-5353 Sharp (870)356-4821 Pike

319 EAST 13TH STREET

MURFREESBORO, AR 71958

(870)285-3118 Pike

320 LUZERNE

MT IDA, AR 71957

(870)867-2175 Montgomery

2729 SOUTH HIGHWAY 65 & 82

LAKE VILLAGE, AR 71653

(870)265-9365 Chicot

131 EAST HIGHWAY 14

LEAD HILL, AR 72644

(870)436-5271 Boone

2526 HWY 65 S, SUITE 203 61 GRASSE STREET

CLINTON, AR 72031 CALICO ROCK, AR 72519

(501)745-4914 Van Buren (870)297-3726 Izard

303 SOUTH 5TH STREET 201 NORTH CLIFTON STREET

PARIS, AR 72855 FORDYCE, AR 71742

(479)963-2132 Logan (870)352-6363 Dallas

145 WEST WATERMAN STREET 346 NORTH MAIN 803 HIGHWAY 65 SOUTH 60 GREERS FERRY ROAD 1605 SECOND STREET 200 SOUTH MAIN STREET 715 EAST NINTH STREET 350 SOUTH MAIN, SUITE 4 1309 WEST MAIN 1641 SOUTH WHITEHEAD DRIVE 307 NORTH MAIN STREET 10 LOIS LANE 110 NORTH BROADVIEW 319 WEST PARKER STREET

DUMAS, AR 71639 (870)382-4878 Desha DECATUR, AR 72722 (479)752-3233 Benton DUMAS, AR 71639 (870)382-4303 Desha DRASCO, AR 72530 (870)668-3200 Cleburne EARLE, AR 72331 (870)792-8825 Crittenden EUDORA, AR 71640 (870)355-2300 Chicot RECTOR, AR 72461 (870)595-3596 Clay MAMMOTH SPRING, AR 72554 (870)625-3111 Fulton WALNUT RIDGE, AR 72476 (870)886-3211 Lawrence DE WITT, AR 72042 (870)946-3637 Arkansas CAVE CITY, AR 72521 (870)283-5550 Sharp GREENBRIER, AR 72058 (501)679-6796 Faulkner GREENBRIER, AR 72058 (501)679-3551 Faulkner HAMBURG, AR 71646 (870)853-8271 Ashley

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Arkansas CCN 043832 043838 043839 043976 043414 043852 043844 048509 043997 043491 048502 043488 043493 043981 043878 043423 043876 043871 043883 043822 043834 043866 043861 043422 043873 043882

Key Provider Name

Address

*

HOPE MEDICAL CLINIC, INC 145 SHAKERAG ROAD LAKE VILLAGE CLINIC, PA 2918 LOUIS SESSIONS STREET * LAWRENCE COUNTY FAMILY CLINIC, 1210 WEST MAIN PA * MAMMOTH SPRING MEDICAL CLINIC 236 SOUTH MAIN STREET * MARSHALL FAMILY PRACTICE 211 AIRPORT ROAD CLINIC * MAYFLOWER MEDICAL CLINIC 587 HIGHWAY 365 * MCCRORY FAMILY CLINIC, P A 908 NORTH EDMONDS AVENUE * MCGEHEE FAMILY CLINIC 601 HOLLY ST * MELBOURNE MEDICAL CLINIC 1526 EAST MAIN STREET * MERCY CLINIC PRIMARY CARE 128 DANIEL AVENUE BOONEVILLE None MERCY HOSPITAL BOONEVILLE 351 B EAST PRIDDY STREET PRIMARY CARE-MAGAZINE * MERCY HOSPITAL SCOTT CO RURAL 1341 WEST 6TH STREET HEALTH CLINIC * MERCY HOSPITAL WALDRON100 NORTH WALNUT STREET, SUITE A MANSFIELD FAMILY MEDICINE * MIDWAY MEDICAL CLINIC 195 HOSPITAL DRIVE A *

*

MORRILTON MEDICAL CLINIC PA NEWTON COUNTY FAMILY PRACTICE CLINIC * NUTT-WALLEY CLINIC * OZARK MEDICAL CLINIC None OZARK MEDICAL CLINIC - FAIRFIELD BAY * PARAGOULD DOCTORS CLINIC * PIGGOTT FAMILY MEDICAL CENTER * PILLOW CLINIC AT MARVELL * PILLOW CLINIC, PLLC * PLEASANT PLAINS MEDICAL CLINIC * POTTSVILLE PRIMARY CARE None PREMIER CENTRAL PEDIATRICS *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

City, State and ZIP

Telephone # County Name

CLINTON, AR 72031 LAKE VILLAGE, AR 71653 WALNUT RIDGE, AR 72476

(501)745-7161 Van Buren (870)265-5343 Chicot (870)886-3543 Lawrence

MAMMOTH SPRING, AR 72554 (870)625-3228 Fulton MARSHALL, AR 72650 (870)448-3327 Searcy MAYFLOWER, AR 72106 MCCRORY, AR 72101 MC GEHEE, AR 71654 MELBOURNE, AR 72556 BOONEVILLE, AR 72927

(501)470-7413 Faulkner (870)731-1100 Woodruff (870)222-6131 Desha (870)368-4344 Izard (479)675-2800 Logan

MAGAZINE, AR 72943

(479)969-8640 Logan

WALDRON, AR 72958

(479)637-2136 Scott

MANSFIELD, AR 72944

(479)928-4404 Scott (870)257-6000 Sharp

10 HOSPITAL DRIVE 502 WEST COURT STREET

CHEROKEE VILLAGE, AR 72529 MORRILTON, AR 72110 JASPER, AR 72641

110 NORTH CLIFTON STREET 2526 HIGHWAY 65 SOUTH, SUITE 201 383 DAVE CREEK PARKWAY

FORDYCE, AR 71742 CLINTON, AR 72031 FAIRFIELD BAY, AR 72088

(870)352-3525 Dallas (501)745-3388 Van Buren (501)884-6900 Van Buren

4000 LINWOOD DRIVE, SUITE A 425 WEST JACKSON 1008 MAIN STREET 101 SHIRLEY HICKS DRIVE 6200 BATESVILLE BOULEVARD 5395 WEST ASH STREET, SUITE 2 900 SOUTH MAIN STREET

PARAGOULD, AR 72450 PIGGOTT, AR 72454 MARVELL, AR 72366 HELENA, AR 72342 PLEASANT PLAINS, AR 72568 POTTSVILLE, AR 72858 HOPE, AR 71801

(870)239-8503 Greene (870)598-2236 Clay (870)829-2521 Phillips (870)572-5996 Phillips (501)345-2182 Independence (479)880-1118 Pope (870)722-6567 Hempstead

(501)354-0052 Conway (870)446-2203 Newton

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Arkansas CCN

Key Provider Name *

RECTOR MEDICAL CLINIC RIVER VALLEY MEDICINE * SALEM 1ST CARE * ST ELIZABETH HEALTH CENTER * ST VINCENT MEDICAL CLINIC MORRILTON * 043460 STEPHENS COMMUNITY CLINIC None STONE COUNTY PRIMARY CARE 043884 CLINIC * 043467 STRAWBERRY MEDICAL CLINIC * 043874 UAMS FAMILY MEDICAL CLINICMAGNOLIA

*

043402 VALLEY HEALTH SERVICES OF HECTOR None WADLEY RURAL HEALTH CLINIC AT 048503 HOPE * 043856 WAGNER MEDICAL CLINIC * 043863 WEBBER FAMILY PRACTICE * 043865 WEBBER FAMILY PRACTICE * 043859 WK BRADLEY HEALTH CLINIC Total Providers for this State = 88

043826 048500 043975 043802 043477

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

Address

City, State and ZIP

Telephone # County Name

807 EAST 9TH STREET 515 HOLLY STREET 172 HIGHWAY 62 EAST, SUITE 1 407 SOUTH GOULD AVENUE 4 HOSPITAL DRIVE

RECTOR, AR 72461 MC GEHEE, AR 71654 SALEM, AR 72576 GOULD, AR 71643 MORRILTON, AR 72110

(870)595-3527 Clay (870)222-9301 Desha (870)895-1911 Fulton (870)263-4317 Lincoln (501)354-4637 Conway

113 WEST RUBY 2202 EAST MAIN STREET

STEPHENS, AR 71764 MOUNTAIN VIEW, AR 72560

(870)786-9114 Ouachita (870)269-6495 Stone

58 EAST RIVER DRIVE 1617 NORTH WASHINGTON

STRAWBERRY, AR 72469 MAGNOLIA, AR 71753

(870)528-4081 Lawrence (870)562-2588 Columbia

11720 SR 27

HECTOR, AR 72843

(479)284-5001 Pope

302 BILL CLINTON DRIVE

HOPE, AR 71801

(870)777-8115 Hempstead

434 HWY 18 BYPASS 504 PECAN STREET 207 WEST CHESTNUT STREET 409 WOODRUFF STREET

MANILA, AR 72442 HELENA, AR 72342 MARIANNA, AR 72360 BRADLEY, AR 71826

(870)561-3300 Mississippi (870)338-9244 Phillips (870)295-2367 Lee (870)894-3366 Lafayette

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Louisiana CCN 193465 193889 193830 193470 193985 193426 193902 193484 193845 193460 193987 193808 193873 193483 193489 193921 193881 193918 193919 193447 193445 193820 193446

Key Provider Name *

ABBEVILLE GENERAL HOSPITAL CLINIC * ACADIA FAMILY CLINIC * ACADIANA FAMILY PRACTICE ASSOCIATES, L L P * ALLEN PARISH HOSPITAL RURAL MEDICAL CENTER * AMITE RURAL HEALTH CLINIC * ASSUMPTION COMMUNITY HOSPITAL RURAL HEALTH CLINIC * AVOYELLES PEDIATRICS * BASTROP OUTPATIENT RURAL HEALTH CLINIC * BIENVILLE FAMILY CLINIC * BUNKIE GENERAL HOSPITAL FAMILY CARE CLINIC * BUNKIE GENERAL HOSPITAL RURAL HEALTH CLINIC * BUTLER ABSHIRE MEDICAL CLINIC APMC * CHADHA MEDICAL CLINIC * CHATHAM MEDICAL CLINIC None CHATHAM RURAL HEALTH CLINIC None CHENEVERT FAMILY CARE CLINIC * CHILDREN FIRST KIDMED None CHILDREN'S INTERNATIONAL MEDICAL GROUP None CHILDREN'S INTERNATIONAL MEDICAL GROUP * CHRISTUS COUSHATTA RINGGOLD RURAL HEALTH CLINIC * CHRISTUS COUSHATTA RURAL HEALTH CLINIC * CHRISTUS MEDICAL GROUP MARKSVILLE FAMILY CARE CENT * CITIZENS RURAL CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 6

Address

City, State and ZIP

Telephone # County Name

2419 ALONZO STREET

ABBEVILLE, LA 70510

(337)893-2302 Vermilion

1325 WRIGHT AVE SUITE E 1501 BETHIA STREET

CROWLEY, LA 70526 FRANKLIN, LA 70538

(337)788-1081 Acadia (337)828-3507 St. Mary

204 6TH AVENUE

KINDER, LA 70648

(337)738-9494 Allen

409 NW CENTRAL AVE 143 HWY 402

AMITE, LA 70422 NAPOLEONVILLE, LA 70390

(985)748-7141 Tangipahoa (985)369-3600 Assumption

338 MOREAU STREET, SUITE E 510 S WASHINGTON STREET

MARKSVILLE, LA 71351 BASTROP, LA 71220

(318)253-7022 Avoyelles (318)665-9950 Morehouse

1175 PINE STREET 510 S COTTONWOOD STREET

ARCADIA, LA 71001 BUNKIE, LA 71322

(318)263-7970 Bienville (318)346-3339 Avoyelles

109 NORTH LEXINGTON

BUNKIE, LA 71322

(318)346-7283 Avoyelles

926 FRANCES DRIVE

HAYNESVILLE, LA 71038

(318)624-0554 Claiborne

140 WEST FOURTH STREET 804 CHATHAM AVENUE 6619 HWY 34 501 FRONT STREET 1828 WEST THOMAS 2401 WASHINGTON ST

DEQUINCY, LA 70633 CHATHAM, LA 71226 CHATHAM, LA 71226 CHENEYVILLE, LA 71325 HAMMOND, LA 70401 FRANKLINTON, LA 70438

(337)786-5007 Calcasieu (318)249-3200 Jackson (318)649-2743 Jackson (318)279-2300 Rapides (985)419-2250 Tangipahoa (985)795-2228 Washington

106 MIMOSA ST

AMITE, LA 70422

(985)247-2411 Tangipahoa

3342 BIENVILLE ROAD

RINGGOLD, LA 71068

(318)894-9611 Bienville

1633 MARVEL STREET

COUSHATTA, LA 71019

(318)932-2222 Red River

5541 HWY 1

MARKSVILLE, LA 71351

(318)253-6583 Avoyelles

484 COLLINS ROAD

COLUMBIA, LA 71418

(318)649-5300 Caldwell

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Louisiana CCN

Key Provider Name *

COMMUNITY MEDICAL CLINIC COTTONPORT FAMILY CLINIC None CROWVILLE HEALTH CENTER None D C S FAMILY HEALTH CLINIC * D GREGORY BELL, MD AND WILLISKNIGHTON MEDICAL CTR * 193417 DELHI RURAL HEALTH CLINIC None DESOTO HEALTHCARE CENTER INC 193901 * 193448 DESOTO REGIONAL FAMILY MEDICINE - LOGANSPORT * 193480 DESOTO REGIONAL FAMILY MEDICINE - MANSFIELD None DUSON FAMILY HEALTHCARE 193908 * 193467 ELIZABETH FAMILY HEALTH CLINIC * 193977 ELTON RURAL HEALTH CLINIC * 193490 ERATH DELCAMBRE COMMUNITY CARE CLINIC None FAMILY CARE CLINIC 193905 * 193864 FAMILY FIRST MEDICINE, APMC * 193464 FAMILY MEDICAL CLINIC * 193890 FAMILY MEDICINE ASSOCIATES OF MINDEN LLC * 193866 FAMILY MEDICINE CENTER OF RESERVE None FAMILY MEDICINE CLINIC OF 193495 JENNINGS AMERICAN LEGION None FLEUR-DE-LIS COMMUNITY HEALTH 193916 IN CHURCH POINT * 193862 FLEUR-DE-LIS COMMUNITY HEALTH, INC * 193461 FRANKLIN MEDICAL CENTER R H C ST JOSEPH

*

193442 FRANKLIN MEDICAL CENTER R H C TENSAS * 193459 FRANKLIN MEDICAL CENTER R H C WINNSBORO * = Non-Deemed

193409 193869 193488 193920 193895

*

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 6

Address

City, State and ZIP

Telephone # County Name

712 SETTOON STREET 1007 SYCAMORE STREET SUITE B 5745 HIGHWAY 17 19100 DR JOHN LAMBERT DRIVE 1633 MARVEL STREET (POD B)

OAK GROVE, LA 71263 COTTONPORT, LA 71327 WINNSBORO, LA 71295 HAMMOND, LA 70403 COUSHATTA, LA 71019

(318)428-3237 West Carroll (318)876-3696 Avoyelles (318)435-9411 Franklin (985)247-4567 Tangipahoa (318)932-2176 Red River

508 BROADWAY STREET 7356 HIGHWAY 509 808 MAIN STREET

DELHI, LA 71232 MANSFIELD, LA 71052 LOGANSPORT, LA 71049

(318)878-3739 Richland (318)871-1633 De Soto (318)697-2273 De Soto

130 JEFFERSON STREET

MANSFIELD, LA 71052

(318)872-2700 De Soto

9023 CAMERON STREET 504 WEST MAIN STREET 907 MAIN STREET 220 NORTH ROAD

DUSON, LA 70529 ELIZABETH, LA 70638 ELTON, LA 70532 ERATH, LA 70533

(337)873-8244 Lafayette (318)634-5475 Allen (337)584-2237 Jefferson Davis (337)937-5944 Vermilion

107 LELA STREET 902 S VIENNA STREET 300 SCARBOROUGH STREET 1111 HOMER ROAD

MANGHAM, LA 71259 RUSTON, LA 71273 LAKE PROVIDENCE, LA 71254 MINDEN, LA 71055

(318)248-4100 Richland (318)513-1950 Lincoln (318)559-2814 East Carroll (318)377-7500 Webster

147 CENTRAL AVENUE

RESERVE, LA 70084

(985)536-8388 St. John the

1322 ELTON ROAD, SUITE F

JENNINGS, LA 70546

(337)824-8868 Jefferson Davis

711 SOUTH BROADWAY

CHURCH POINT, LA 70525

(337)684-0127 Acadia

376 MAIN STREET

CANKTON, LA 70584

(337)984-2623 St. Landry

448 NEWTON STREET

ST JOSEPH, LA 71366

(318)766-8506 Tensas

104 VERONA STREET

NEWELLTON, LA 71357

(137)467-9949 Tensas

2104-C LOOP ROAD

WINNSBORO, LA 71295

(318)435-4571 Franklin

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Louisiana CCN 193863 193997 193493 193456 193891 193887 193907 193888 193911 193408 193494 193457 193404 193479 193463 193451 193453 193496 193999 193481 193823 193906 193477 193904 193880 193472

Key Provider Name *

Address

GARDINER CENTER HEALTH CLINIC 710 5TH STREET HACKBERRY RURAL HEALTH CLINIC 1020 MAIN STREET None HARDTNER FAMILY CLINIC 1136-A NORTH PINE ROAD * HARDTNER MEDICAL CLINIC 1049 -A NORTH PINE ROAD * HEALTH CARE FIRST MEDICAL 18015 WILLOW STREET CLINIC L L C * HEALTHY STEPS PEDIATRICS 192 STILLY ROAD None HOPE'S CHILDREN & FAMILY CARE 338 MOREAU STREET, SUITE B CLINIC LLC * HUSAM SUKEREK M D 210 HIGHLAND DRIVE None IOTA FAMILY HEALTHCARE,LLC 119 S 5TH STREET * IOWA HEALTH CENTER OF LAKE 203 E MILLER CHARLES MEMORIAL HOSPIT None J A L H PHYSICIAN CLINICS 805 N STATE STREET * JACKSON PARISH HOSPITAL FAMILY 107 WATTS CARE CLINIC * JEANERETTE RURAL HEALTH CLINIC 217 BOURG STREET * JOHNSON BAYOU RURAL HEALTH 6240 GULF BEACH HWY CLINIC * JONESBORO FAMILY CARE CLINIC 121 WATTS STREET SUITES A, B, E, & F * LADY OF THE SEA MEDICAL CLINIC - 144 WEST 134TH PLACE CUT OFF

*

LADY OF THE SEA MEDICAL CLINIC - 13030 HWY 308 LAROSE None LAKE ARTHUR CLINIC OF J A L H 328 KELLOGG STREET * LAKE PROVIDENCE MEDICAL CLINIC 319 NORTH HOOD STREET * LASALLE FAMILY MEDICINE CLINIC 155-A NINTH STREET * LEONARD P NEUMANN JR MD, APMC 800 JOHNSON STREET None LOUISIANA QUICK CARE, L L C 12805 HIGHWAY 28 EAST, SUITE B * MADISON PARISH HOSPITAL RURAL 808 JOHNSON STREET HEALTH CLINIC * MALINDA'S PATIENT CARE 19115 FLORIDA BLVD, SUITE A * MANSURA FAMILY CLINIC 2104 CLECO STREET * MAURICE COMMUNITY CARE CLINIC 207 MILTON ROAD *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 6

City, State and ZIP

Telephone # County Name

GUEYDAN, LA 70542 HACKBERRY, LA 70645 OLLA, LA 71465 OLLA, LA 71465 GROSSE TETE, LA 70740

(337)536-9263 Vermilion (337)762-3762 Cameron (318)495-3131 LaSalle (318)495-3229 LaSalle (225)648-3433 Iberville

PINEVILLE, LA 71360 MARKSVILLE, LA 71351

(318)484-3401 Rapides (318)253-2299 Avoyelles

MANY, LA 71449 IOTA, LA 70543 IOWA, LA 70647

(318)256-5722 Sabine (337)779-6000 Acadia (337)582-7632 Calcasieu

JENNINGS, LA 70546 JONESBORO, LA 71251

(337)824-6150 Jefferson Davis (318)395-2121 Jackson

JEANERETTE, LA 70544 CAMERON, LA 70631

(337)276-7002 Iberia (337)569-2245 Cameron

JONESBORO, LA 71251 CUT OFF, LA 70345

(318)395-0521 Jackson (985)632-6233 Lafourche

LAROSE, LA 70373

(985)798-7021 Lafourche

LAKE ARTHUR, LA 70549 LAKE PROVIDENCE, LA 71254 JENA, LA 71342 TALLULAH, LA 71284 PINEVILLE, LA 71360 TALLULAH, LA 71282

(337)774-0100 Jefferson Davis (318)428-3237 East Carroll (318)992-4275 LaSalle (318)574-4731 Madison (318)466-5151 Rapides (318)574-8584 Madison

ALBANY, LA 70711 MANSURA, LA 71350 MAURICE, LA 70555

(225)567-7150 Livingston (318)964-2551 Avoyelles (337)893-5466 Vermilion

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Louisiana CCN 193486 193811 193909 193487 193476 193485 193917 193478 193810 193482 193412 193984 193876 193856 193883 193912 193886 193900 193836 193813 193832 193838

Key Provider Name *

MER ROUGE OUTPATIENT RURAL HEALTH CLINIC

*

MINDEN FAMILY CARE CENTER None MONTGOMERY FAMILY CLINIC * MOREHOUSE GENERAL HOSPITAL RURAL HEALTH CLINIC

*

NCMC MEDICAL AND SURGICAL CLINIC * NCMC PLAIN DEALING MEDICAL CLINIC None NEWMAN FAMILY CLINIC * NORTH NATCHITOCHES MEDICAL CLINIC * NORTH OAKS OB/GYN RURAL HEALTH CLINIC * NORTH WEBSTER MEDICAL CLINIC * NORTHEAST LOUISIANA HEALTH CENTER * OAK GROVE MEDICAL CLINIC None OUR LADY OF THE LAKE PHYSICIAN GROUP - RIVERSIDE * OUR LADY OF THE LAKE PHYSICIAN GROUP NEW ROADS * PEDIATRIC & ADOLESCENT CLINIC None PELICAN PEDIATRICS, L L C * RAYMOND F SCHNEIDER MEMORIAL CLINIC, LLC * RAYVILLE FAMILY CLINIC * REDDY FAMILY MEDICAL CENTER WHITE CASTLE * REDDY FAMILY MEDICAL CLINIC DONALDSONVILLE * REDDY FAMILY MEDICAL CLINIC PIERRE PART * REDDY FAMILY MEDICAL CLINIC PLAQUEMINE

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 6

Address

City, State and ZIP

Telephone # County Name

220 W DAVENPORT

MER ROUGE, LA 71261

(318)647-3720 Morehouse

208 MORRIS DRIVE 641 ROWENA STREET 420 GUNBY AVE

MINDEN, LA 71055 MONTGOMERY, LA 71454 BASTROP, LA 71220

(318)377-8260 Webster (318)646-3000 Grant (318)283-3601 Morehouse

715 S PINE STREET

VIVIAN, LA 71082

(318)375-3239 Caddo

112 FOREST STREET

PLAIN DEALING, LA 71064

(318)326-7282 Bossier

502 HOSPITAL DRIVE 3194 HWY 71

OAKDALE, LA 71463 CAMPTI, LA 71411

(318)335-2000 Allen (318)476-3991 Natchitoches

15778 MEDICAL ARTS PLAZA

HAMMOND, LA 70403

(985)542-0663 Tangipahoa

106 TRI-STATE DRIVE 256 HIGHWAY 3048

SAREPTA, LA 71071 RAYVILLE, LA 71269

(318)539-1000 Webster (318)728-2046 Richland

708 EAST MAIN 18740 HWY 22

OAK GROVE, LA 71263 MAUREPAS, LA 70449

(318)428-3200 West Carroll (225)698-3435 Livingston

310 DUREL DRIVE

NEW ROADS, LA 70760

(225)713-2400 Pointe Coupee

1806 CARTER STREET 911 WEST MAIN STREET SUITE C 1302 ED BROUSSARD RD

VIDALIA, LA 71373 HOMER, LA 71040 NEW IBERIA, LA 70563

(318)336-7172 Concordia (318)927-3255 Claiborne (337)229-7929 Iberia

1962 JULIA STREET 32985 BOWIE STREET

RAYVILLE, LA 71269 WHITE CASTLE, LA 70788

(318)728-8833 Richland (225)545-3631 Iberville

217 RAIL ROAD AVENUE

DONALDSONVILLE, LA 70346 (225)473-3931 Ascension

3407 HWY 70

PIERRE PART, LA 70339

(985)252-1000 Assumption

58725 BELLEVIEW STREET

PLAQUEMINE, LA 70764

(225)687-6200 Iberville

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Louisiana CCN

Key Provider Name

193850

*

193416

*

193858

*

193441 193833

*

193466 193474

*

193475

*

193401 193851 193871

*

193915 193870 193875 193860 193923 193885 193492 193473 193896 193431 193879 193897 193913

*

*

REDDY FAMILY MEDICAL OF NAPOLEONVILLE

REEVES MEMORIAL MEDICAL CENTER - RHC RIVERPARK MEDICAL CLINICJONESVILLE RIVERSIDE FAMILY CARE CLINIC RURAL HEALTH CLINIC OF LOREAUVILLE S M C DOCTORS CLINIC SABINE MEDICAL CENTER RURAL HEALTH CLINIC #1

SABINE MEDICAL CENTER RURAL HEALTH CLINIC #2 SAVOY FAMILY CARE SHIRLEY MEDICAL CLINIC SIMMESPORT FAMILY CLINIC

* = Non-Deemed

Page 5 of 6

Address

City, State and ZIP

Telephone # County Name

154 HWY 1008

NAPOLEONVILLE, LA 70390

(980)369-9191 Assumption

402 SECOND STREET

BERNICE, LA 71222

(318)285-9069 Union

800 AUDUBON DRIVE

JONESVILLE, LA 71343

(318)339-6388 Catahoula

2004 J MARVIN MAGEE DRIVE 411 SOUTH MAIN STREET

FRANKLINTON, LA 70438 LOREAUVILLE, LA 70552

(985)839-3555 Washington (337)229-8288 Iberia

401 11TH N E 395 S CAPITOL STREET

SPRINGHILL, LA 71075 MANY, LA 71449

(318)539-1700 Webster (318)256-1136 Sabine

1015 OBRIE STREET

ZWOLLE, LA 71486

(318)256-2000 Sabine

EUNICE, LA 70535 JENNINGS, LA 70546 SIMMESPORT, LA 71369

(337)457-3135 St. Landry (337)824-2002 Jefferson Davis (318)941-2336 Avoyelles

ABBEVILLE, LA 70510 GRAMERCY, LA 70052 LA PLACE, LA 70068 VACHERIE, LA 70090 WASHINGTON, LA 70589

(337)422-6240 Vermilion (225)869-9200 St. James (985)652-5475 St. John the (225)265-3061 St. James (337)826-7702 St. Landry

SAINT MARTINVILLE, LA 70582 RAYVILLE, LA 71269 STERLINGTON, LA 71280

(337)394-7774 St. Martin (318)728-4368 Richland (318)665-4543 Ouachita

LIVINGSTON, LA 70754

(225)686-1114 Livingston

LAKE PROVIDENCE, LA 71254 MINDEN, LA 71055 THIBODAUX, LA 70301 ROBERT, LA 70455

(318)559-2404 East Carroll (318)377-8855 Webster (985)446-6381 Lafourche (985)542-2466 Tangipahoa

102 SOUTH 2ND STREET 711 NORTH MAIN ST * 417 NORTH MARTIN LUTHER KING DRIVE None SOUTHCARE MEDICAL, LLC 1305 NORTH STATE STREET * ST JAMES PRIMARY CARE 827 PINE STREET * ST JAMES PRIMARY CARE 502 RUE DE SANTE * ST JOSEPH MEDICAL CLINIC AMC 22080 LA HWY 20 W None ST LANDRY FAMILY HEALTHCARE L 6633 HIGHWAY 10 LC * ST MARTINVILLE MATERNAL-CHILD 1119 N MAIN STREET CLINIC * START COMMUNITY CLINIC 5975 FEDERAL HWY 80 * STERLINGTON OUTPATIENT RURAL 10374 HIGHWAY 165 HEALTH CLINIC

*

STEWART FAMILY MEDICINE & 29565 FROST RD SUITE C AFTER HOURS * THE FAMILY PRACTICE CLINIC 320 NORTH HOOD STREET * THE WOMEN'S CLINIC 427 HOMER ROAD * THIBODAUX MEDICAL CLINIC 931 NORTH CANAL BLVD None TOTAL FAMILY MEDICAL LLC 22601 HWY 190 *

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Louisiana CCN

Key Provider Name *

UNION GENERAL RURAL HEALTH CLINIC None VILLE PLATTE PEDIATRICS, PA 193914 * 193458 VINTON MEDICAL CLINIC * 193843 W K CLAIBORNE REGIONAL HEALTH * 193992 WEST CARROLL MEDICAL CLINIC * 193436 WINTERS CLINIC * 193471 WISNER RURAL HEALTH CLINIC * 193878 WOMEN'S CLINIC * 193898 WOMEN'S CLINIC OF OAKDALE LLC * 193449 ZWOLLE RURAL CLINIC Total Providers for this State = 129

193444

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 6

Address

City, State and ZIP

Telephone # County Name

1025 MARION HWY

FARMERVILLE, LA 71241

(318)368-9745 Union

504 JACK MILLER ROAD SUITE 3 1611 HAMPTON STREET 104 MORRIS CIRCLE 502 ROSS STREET 412 MAIN STREET 3286 OAK STREET 2602 NORTH DRIVE 119 N HOSPITAL DRIVE 2026 OBRIE STREET

VILLE PLATTE, LA 70586 VINTON, LA 70668 HOMER, LA 71040 OAK GROVE, LA 71263 COLUMBIA, LA 71418 WISNER, LA 71378 ABBEVILLE, LA 70510 OAKDALE, LA 71463 ZWOLLE, LA 71486

(337)363-3560 Evangeline (337)589-5951 Calcasieu (318)927-1110 Claiborne (318)428-3237 West Carroll (318)649-6157 Caldwell (318)649-6111 Franklin (337)893-1101 Vermilion (318)335-0260 Allen (318)871-1081 Sabine

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey New Mexico CCN

Key Provider Name *

CARRIZOZO HEALTH CENTER CORONA HEALTH CLINIC None FAMILY HEALTH CENTER OF LEA COUNTY None HOBBS MEDICAL CLINIC 323404 None LOVELACE HEALTH CARE CENTER323403 RURAL HEALTH CLINIC * 323400 LOVINGTON CLINIC * 323401 MEMORIAL FAMILY PRACTICE AT ARTESIA GENERAL HOSP * 323402 RGH CLINIC - PORTALES * 323999 SIERRA VISTA COMMUNITY HEALTH CENTER * 323984 TATUM CLINIC * 323988 VALLEY HEALTH CLINIC OF EASTERN NM Total Providers for this State = 11

323831 323855 323405

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

Address

City, State and ZIP

Telephone # County Name

710 AVENUE E HIGHWAY 54-MAIN STREET 515 EAST MAIN

CARRIZOZO, NM 88301 CORONA, NM 88318 HOBBS, NM 88240

(575)648-2317 Lincoln (575)849-1561 Lincoln (575)396-6611 Lea

1923 NORTH DAL PASO 1112 NORTH MAIN STREET

HOBBS, NM 88240 ROSWELL, NM 88201

(575)396-6611 Lea (575)627-7000 Chaves

1600 NORTH MAIN AVE 702 NORTH 13TH

LOVINGTON, NM 88260 ARTESIA, NM 88210

(575)396-6611 Lea (575)746-3119 Eddy

42121 US HWY 70 800 EAST 9TH AVENUE

PORTALES, NM 88130 T OR C, NM 87901

(575)356-6652 Roosevelt (575)743-1202 Sierra

204 NORTH MAIN 116 EAST SECOND STREET

TATUM, NM 88267 DEXTER, NM 88230

(575)396-6611 Lea (575)734-5817 Chaves

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oklahoma CCN 373862 373490 373473 373482 373999 373875 373459 373868 373422 373402 373408 373828 373464 373468 373400 373819 373479 373478 373465 373860 373480 373823 373489 373488 373994

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

Address

City, State and ZIP

Telephone # County Name

A B C MEDICAL CLINIC, PLLC WOODWARD CLINICS None ALLIANCEHEALTH WOODWARD CLINICS None ALLIANCEHEALTH WOODWARD CLINICS * BUSTER RURAL HEALTH CLINIC * CHEROKEE FAMILY CLINIC * CIMARRON MEMORIAL RURAL HEALTH CLINIC * CLINICO, L L C * COMANCHE COUNTY HOSPITAL AUTHORITY

*

COMMUNITY CLINIC OF BEAVER * COMMUNITY CLINIC OF TURPIN * DOCTORS CLINIC OF DURANT, INC * DRUMRIGHT RURAL HEALTH CLINIC * FAIRFAX RURAL HEALTH CLINIC * FAIRVIEW FAMILY CLINIC * FAMILY CLINIC OF WELEETKA None FAMILY MEDICAL CLINIC None FIVE OAKS FAMILY MEDICAL CLINIC * GRAND LAKE MEDICAL PARK * GREEN COUNTRY MEDICAL CLINIC

1510 SOUTH VIRGINIA 623 AVENUE C

ATOKA, OK 74525 BEAVER, OK 73932

(580)889-3355 Atoka (580)625-2273 Beaver

908 19TH STREET

WOODWARD, OK 73801

(580)256-1789 Woodward

417 SW 7TH ST

MOORELAND, OK 73852

(918)994-2180 Woodward

101 F K BUSTER AVENUE 221 SOUTH GRAND 102 SOUTH ELLIS

CHEYENNE, OK 73628 CHEROKEE, OK 73728 BOISE CITY, OK 73933

(580)497-3333 Roger Mills (580)596-3516 Alfalfa (580)544-3008 Cimarron

103 EAST MAIN 624 SOUTH COBB LAKE

BEGGS, OK 74421 APACHE, OK 73006

(918)267-7000 Okmulgee (580)588-3257 Caddo

718 AVENUE A 104 NORTH HIBBS 1400 BRYAN DRIVE, SUITE 300 610 WEST BYPASS 40 HOSPITAL ROAD 519 EAST STATE ROAD 315 WEST 9TH 104 WALL STREET 2100 W IOWA AVENUE, SUITE A 26300 SOUTH HWY 125 238 WILLOW STREET

(580)625-3477 Beaver (580)778-3966 Beaver (580)924-1700 Bryan (918)382-2300 Creek (918)642-3291 Osage (580)227-2585 Major (405)786-2248 Okfuskee (918)647-8635 Le Flore (405)224-2100 Grady (918)257-8585 Ottawa (918)255-6000 Nowata

None HEAVENER

304 HWY 59 NORTH 108 WEST OHIO 202 W BROADWAY

BEAVER, OK 73932 TURPIN, OK 73950 DURANT, OK 74701 DRUMRIGHT, OK 74030 FAIRFAX, OK 74637 FAIRVIEW, OK 73837 WELEETKA, OK 74880 POTEAU, OK 74953 CHICKASHA, OK 73018 AFTON, OK 74331 SOUTH COFFEYVILLE, OK 74072 HEAVENER, OK 74937 COALGATE, OK 74538 ALLEN, OK 74825

100 MCDOUGAL DRIVE

HOLDENVILLE, OK 74848

(405)379-4202 Hughes

100 MCDOUGAL DRIVE

HOLDENVILLE, OK 74848

(405)379-6631 Hughes

*

None ALLIANCEHEALTH

MEDICAL CLINIC HELTON RURAL HEALTH CLINIC None HOLDENVILLE GENERAL HOSPITAL ALLEN HEALTH CLINIC None HOLDENVILLE GENERAL HOSPITAL PHYSICIAN HEALTH CLIN * HOLDENVILLE GENERAL HOSPITAL RURAL HEALTH CLINIC *

* = Non-Deemed

(918)647-8161 Le Flore (580)927-2334 Coal (580)857-2400 Pontotoc

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oklahoma CCN

Key Provider Name *

Address

HOLDENVILLE GENERAL HOSPITAL 1401 WEST 1ST STREET WEWOKA HEALTH CLINIC * 373833 HUGO RURAL HEALTH CLINIC 1201 EAST JACKSON * 373876 HUSSAINS FAMILY PRACTICE 139 EAST MAIN STREET * 373870 INTEGRIS KINGSTON MEDICAL 701 EAST HIGHWAY 70 CLINIC None JCMH FAMILYCARE MEDICAL CLINIC 114 S LOUIS TITTLE 373484 OF MANGUM None JCMH MEDICAL CLINIC 373486 205 S PARK LANE None JCMH PEDIATRIC CLINIC 373485 101 S PARK LANE, SUITE 100 None JCMH WOMEN'S HEALTH 373483 101 S PARK LANE, SUITE 200 ASSOCIATES * 373878 LAKESIDE RURAL HEALTH CLINIC 113653 OLD HWY 69 * 373873 MEDFORD FAMILY CLINIC 158-B SUNSET DRIVE * 373429 MERCY HEALTH LOVE COUNTY 301 WANDA RURAL HEALTH CLINIC None MERCY HOSPITAL HEALDTON 373472 3472 HOSPITAL ROAD PRIMARY CARE * 373993 MERCY HOSPITAL LOGAN COUNTY - 2919 SOUTH DIVISION STREET GUTHRIE DIVISION * 373990 MERCY HOSPITAL LOGAN COUNTY- 400 SOUTH GRAND CRESCENT PRIMARY CARE * 373830 NOWATA COUNTY RURAL HEALTH 712 EAST OSAGE CLINIC * 373462 PRAGUE FAMILY CLINIC 1322 KLABZUBA AVENUE None QUARTZ MOUNTAIN MEDICAL 373481 3000 N MAIN STREET CENTER * 373463 QUARTZ MOUNTAIN MEDICAL CLINIC 118 LOUIS TITTLE AVE MANGUM * 373442 RINGLING FAMILY CARE 108 S 5TH STREET None ROBISON CLINIC 373487 1415 WATTS ST, SUITE 100 * 373449 RUSH SPRINGS FAMILY MEDICAL 113 SOUTH RUSH CLINIC * 373979 RYAN HEALTH CLINIC 1104 SOUTH 6TH STREET * 373834 RYAN MEDICAL CLINIC, L L C 514 WASHINGTON STREET None SMHA RHC 373470 US HIGHWAY 60 NORTHEAST * = Non-Deemed

373477

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

City, State and ZIP

Telephone # County Name

WEWOKA, OK 74884

(405)257-3396 Seminole

HUGO, OK 74743 WILBURTON, OK 74578 KINGSTON, OK 73439

(580)326-6423 Choctaw (918)465-5727 Latimer (580)564-4944 Marshall

MANGUM, OK 73554

(580)782-3393 Greer

ALTUS, OK 73521 ALTUS, OK 73521 ALTUS, OK 73521

(580)379-6650 Jackson (580)379-6100 Jackson (580)379-6140 Jackson

CHECOTAH, OK 74426 MEDFORD, OK 73759 MARIETTA, OK 73448

(918)618-4766 McIntosh (580)395-2319 Grant (580)276-2400 Love

HEALDTON, OK 73438

(580)229-0701 Carter

GUTHRIE, OK 73044

(405)282-6301 Logan

CRESCENT, OK 73028

(405)969-2818 Logan

NOWATA, OK 74048

(918)273-0140 Nowata

PRAGUE, OK 74864 ALTUS, OK 73521

(405)567-4922 Lincoln (580)471-7019 Jackson

MANGUM, OK 73554

(580)782-2113 Greer

RINGLING, OK 73456 SAYRE, OK 73662 RUSH SPRINGS, OK 73082

(580)662-2316 Jefferson (580)928-2044 Beckham (580)476-2527 Grady

RYAN, OK 73565 RYAN, OK 73565 SEILING, OK 73663

(580)757-2451 Jefferson (580)757-2224 Jefferson (580)922-7361 Dewey

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oklahoma CCN 373443 373824 373471 373469 373854

Key Provider Name *

SNYDER MEDICAL CLINIC ST JOHN CLINIC None THE PAWNEE CLINIC * VICI RURAL HEALTH CLINIC * WATONGA FAMILY CARE *

* 373872 WAYNOKA FAMILY CLINIC None WOODWARD CLINIC 373476 None WOODWARD CLINIC 373474 None WOODWARD CLINIC 373475 Total Providers for this State = 58

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

823 'D' STREET 112 NORTH 5TH STREET 535 6TH STREET 104 WEST BROADWAY STREET 407 NORTH CLARENCE NASH BOULEVARD 503 SOUTH NICKERSON 1818 KANSAS AVENUE 1810 KANSAS AVENUE 1101 HILLCREST DRIVE

SNYDER, OK 73566 BARNSDALL, OK 74002 PAWNEE, OK 74058 VICI, OK 73859 WATONGA, OK 73772

(580)569-2373 Kiowa (918)331-1090 Osage (918)762-3972 Pawnee (580)995-3004 Dewey (580)623-4954 Blaine

WAYNOKA, OK 73860 WOODWARD, OK 73801 WOODWARD, OK 73801 WOODWARD, OK 73801

(580)824-2291 Woods (580)254-3396 Woodward (580)254-3174 Woodward (580)256-3608 Woodward

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 673916 453956 453955 453934 458655 673989 673413 673927 458813 458867 673835 458572 673821 458828 458881 453828 673862 458821 673926 673844 458940 673902 458906 673908 673855 453426 453480 458514

Key Provider Name *

ALFONSO H LUEVANO, MD PA ALICE PEDIATRIC CLINIC * ALPINE MEDICAL CENTER * ALVORD MEDICAL CLINIC * ANDREWS FAMILY MEDICINE * ANSON FAMILY WELLNESS CLINIC None ARCHER CITY RHC None AUSTIN OBGYN * AUSTWELL TIVOLI MEDICAL CLINIC * BALLINGER HOSPITAL CLINIC * BEEVILLE FAMILY PRACTICE LLP * BOGATA MEDICAL CLINIC * BORGER MEDICAL CLINIC * BRADY MEDICAL CLINIC * BRECKENRIDGE MEDICAL CENTER * BRENHAM CLINIC * BRENHAM CLINIC-BELLVILLE * BROWNFIELD REGIONAL MEDICAL CENTER None BSZ MEDICAL PA * BUNA MEDICAL CLINIC * CADENHEAD RURAL HEALTH CLINIC * CAMPBELL CLINIC * CENTER RURAL HEALTH CLINIC * CHILDREN'S CLINIC OF DIMMIT AND ZAVALA PA * CHILDRENS CLINIC OF DIMMIT AND * CHRISTUS FAMILY PRACTICE CENTER - KIRBYVILLE * CHRISTUS FAMILY PRACTICE CENTER JASPER *

CHRISTUS FAMILY PRACTICE CENTER SAM RAYBURN

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 12

Address

City, State and ZIP

Telephone # County Name

302 S 5TH STREET 305 EAST THIRD ST 202 NORTH 2ND ST 115 E BYPASS 287 700 HOSPITAL DRIVE 215 N AVE J 404 E CHESTNUT 301 HIGHWAY 71 W, SUITE 111 106 W WILSON 2001 HUTCHINS AVE, SUITE C 302 S HILLSIDE DRIVE 600 PARIS RD 104 NORTH BRYAN 2010 NINE ROAD 101 S HARTFORD 600 N PARK 235 WEST PALM SUITE 106 703 EAST FELT STREET

CARRIZO SPRINGS, TX 78834 ALICE, TX 78332 ALPINE, TX 79830 ALVORD, TX 76225 ANDREWS, TX 79714 ANSON, TX 79501 ARCHER CITY, TX 76351 BASTROP, TX 78602 TIVOLI, TX 77990 BALLINGER, TX 76821 BEEVILLE, TX 78102 BOGATA, TX 75417 BORGER, TX 79007 BRADY, TX 76825 BRECKENRIDGE, TX 76424 BRENHAM, TX 77833 BELLVILLE, TX 77418 BROWNFIELD, TX 79316

(830)876-9458 Dimmit (361)664-5291 Jim Wells (432)837-5505 Brewster (940)427-2858 Wise (915)523-6624 Andrews (325)823-3209 Jones (940)564-5521 Archer (512)304-0318 Bastrop (361)286-0115 Refugio (325)365-2531 Runnels (361)358-9912 Bee (903)632-5632 Red River (806)274-2986 Hutchinson (325)597-2114 McCulloch (254)559-3363 Stephens (979)836-6153 Washington (979)865-9391 Austin (806)637-1955 Terry

256 MEDICAL DR 35607 HWY 96 SOUTH 1417 NORTH 1ST SUITE A 1517 TEXAS DRIVE 620 TENAHA 1313 VETERANS BLVD, SUITE C

JOURDANTON, TX 78026 BUNA, TX 77612 HASKELL, TX 79521 WEATHERFORD, TX 76086 CENTER, TX 75935 CRYSTAL CITY, TX 78839

(830)769-9900 Atascosa (409)994-9323 Jasper (940)864-2636 Haskell (817)458-3300 Parker (936)598-2716 Shelby (830)374-3118 Zavala

403 SOUTH 7TH STREET 205 E LAVIELLE

CARRIZO SPRINGS, TX 78834 (830)876-9870 Dimmit KIRBYVILLE, TX 75956 (409)423-2217 Jasper

1276 SOUTH PEACHTREE STREET

JASPER, TX 75951

(409)384-5701 Jasper

2427 W RECREATIONAL RD 255

BROOKELAND, TX 75931

(409)698-9600 Sabine

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 458612 458855 458771 673810 673819 458779 673995 673897 453928 673904 458838 458875 458827 673402 458842 458608 458832 458653 453862 458910 673440 673442 673441 458896

Key Provider Name *

CHRISTUS SPOHN FAMILY HEALTH CENTER ROBSTOWN

*

CHRISTUS SPOHN FAMILY HEALTH FREER * CHRISTUS SPOHN HOSPITAL MEDICAL CLINIC-BEEVILLE * CLARENDON FAMILY MEDICAL CENTER

*

CLAUDE FAMILY MEDICAL CLINIC LLC * CLEARFORK HEALTH CENTER * CLIFTON MEDICAL CLINIC * CLINIC FOR FAMILY WELLNESS, PLLC * COASTAL BEND PEDIATRIC CTR * COASTAL MEDICAL CLINIC * COGDELL CLINIC * COGDELL CLINIC BRISCOE COUNTY * COGDELL FAMILY CLINIC * COLEMAN MEDICAL ASSOCIATES * COLLINGSWORTH FAMILY MEDICINE * COLUMBUS MEDICAL CLINIC * COMMUNITY CARE CENTER * COMMUNITY CARE CENTER * COMMUNITY HEALTH CLINIC LLP * COMPLETE HEALTHCARE SERVICE PA * CONNALLY MEMORIAL MEDICAL CENTER None CONNALLY MEMORIAL MEDICAL CENTER None CONNALLY MEMORIAL MEDICAL CENTER * COOKE COUNTY MEDICAL CENTER

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 12

Address

City, State and ZIP

Telephone # County Name

1038 TEXAS YES BLVD

ROBSTOWN, TX 78380

(361)767-1200 Nueces

111 RILEY STREET

FREER, TX 78357

(361)394-7311 Duval

1602 EAST HOUSTON STREET, SUITE A BEEVILLE, TX 78102

(361)358-6249 Bee

ONE MEDICAL CENTER DR POD K

CLARENDON, TX 79226

(806)874-3531 Donley

201 PARKS STREET

CLAUDE, TX 79019

(806)226-5611 Armstrong

774 STATE HWY 70N, PO DRAWER L 201 S AVE T 1645 N 18TH STREET

ROTAN, TX 79546 CLIFTON, TX 76634 MEMPHIS, TX 79245

(325)735-2256 Fisher (254)675-8621 Bosque (806)259-1058 Hall

160 S 13TH ST 1704 JENKINS STREET 320 NORTH MAIN 701 COMMERCE STREET 1700 COGDELL BLVD 310 SOUTH PECOS 2ND FLOOR 1014 15TH STREET 2122 HIGHWAY 71 SOUTH 400 SOUTHWEST 25TH AVENUE 202 SW 25TH AVE, SUITE 300 160 RIVER NORTH BLVD 315 WEST HOUSTON

ARANSAS PASS, TX 78336 ROCKPORT, TX 78382 LOCKNEY, TX 79241 SILVERTON, TX 79257 SNYDER, TX 79549 COLEMAN, TX 76834 WELLINGTON, TX 79095 COLUMBUS, TX 78934 MINERAL WELLS, TX 76067 MINERAL WELLS, TX 76067 STEPHENVILLE, TX 76401 JASPER, TX 75951

(361)758-1984 San Patricio (361)790-9047 Aransas (806)652-3373 Floyd (806)823-2449 Briscoe (432)574-7166 Scurry (915)625-3533 Coleman (806)447-5311 Collingsworth (979)732-2318 Colorado (940)325-7891 Palo Pinto (940)328-7500 Palo Pinto (254)965-2500 Erath (409)384-3430 Jasper

6511 US HIGHHWAY 181 N

FLORESVILLE, TX 78114

(830)393-1747 Wilson

117 DILWORTH PLAZA

POTH, TX 78147

(830)393-1770 Wilson

497 10TH STREET STE 101

FLORESVILLE, TX 78114

(830)393-1630 Wilson

801 N GRAND AVENUE STE 1

GAINESVILLE, TX 76240

(940)668-7231 Cooke

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN

Key Provider Name *

COVENANT FAMILY HEALTHCARE CENTER

*

673992 COVENANT HEALTHCARE CENTER PLAINVIEW * 458830 COVENANT PLAINVIEW MEDICAL CLINIC * 453423 CRANE COUNTY RURAL HEALTH CLINIC

*

673889 CRANE MEDICAL CLINIC PA * 458829 CROSBYTON CLINIC HOSPITAL RURAL HEALTH CLINIC * 673432 CUERO MEDICAL CLINIC * 458816 DALHART FAMILY MEDICINE CLINIC * 673876 DEWEYVILLE RURAL HEALTH CLINIC * 458562 DOCTORS MEDICAL CENTER * 673830 DUBLIN FAMILY MEDICINE * 453944 DUMAS FAMILY PRACTICE * 453819 EAGLE PASS PEDIATRIC HLTH CLIN * 458846 EAST TEXAS MED CNTR CARTHAGE HEALTH CTR * 458714 EAST TEXAS MEDICAL CENTER HENDERSON FAMILY HEALTH * 458763 EAST TEXAS PEDIATRICS * 453832 EDUARDO MORENO M D RHC * 458782 ETMC COMMUNITY HEALTH CLINIC * 458854 ETMC FIRST PHYSICIANS CLINIC * 458852 ETMC FIRST PHYSICIANS CLINIC QUITMAN None ETMC FIRST PHYSICIANS CLINIC 673410 ATHENS * 458892 ETMC FIRST PHYSICIANS CLINIC CENTER II None ETMC FIRST PHYSICIANS CLINIC 673408 CENTER III * 458888 ETMC FIRST PHYSICIANS CLINIC FRANKSTON * = Non-Deemed 673910

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 12

Address

City, State and ZIP

Telephone # County Name

409 8TH ST

ABERNATHY, TX 79311

(806)298-5884 Hale

2222 W 24TH ST SUITE 6

PLAINVIEW, TX 79072

(806)293-5113 Hale

917 GOBER, PO DRAWER A

PADUCAH, TX 79248

(806)492-3581 Cottle

1310 SOUTH ALFORD STREET

CRANE, TX 79731

(432)558-3758 Crane

102 S GASTON ST 710 WEST MAIN

CRANE, TX 79731 CROSBYTON, TX 79322

(432)558-2223 Crane (806)675-7382 Crosby

2500 N ESPLANADE STREET SUITE 102 206 EAST 16TH STREET 2493 HWY 12 E 10201 HWY 16N 305 N PATRICK STREET 120 BEARD AVENUE 2198 EAST GARRISON STREET 409 COTTAGE ROAD SUITE A

CUERO, TX 77954 DALHART, TX 79022 DEWEYVILLE, TX 77614 COMANCHE, TX 76442 DUBLIN, TX 76446 DUMAS, TX 79029 EAGLE PASS, TX 78852 CARTHAGE, TX 75633

(361)275-3466 DeWitt (806)249-5668 Dallam (409)746-7000 Newton (254)879-4910 Comanche (254)445-4900 Erath (806)935-9005 Moore (830)773-1103 Maverick (903)693-6626 Panola

300 WILSON STREET 2E

HENDERSON, TX 75652

(903)655-6536 Rusk

618 S GROVE STE 100 210 S AVE C 315 PROSPECT DR 702 DAVIS ST 108 PARKER ST STE 100

MARSHALL, TX 75670 CRYSTAL CITY, TX 78839 TRINITY, TX 75862 CARTHAGE, TX 75633 QUITMAN, TX 75783

(903)935-5242 Harrison (830)374-2952 Zavala (936)594-3595 Trinity (903)694-2213 Panola (903)763-6322 Wood

2000 SOUTH PALESTINE

ATHENS, TX 75751

(903)676-1134 Henderson

1743 SOUTHVIEW CIRCLE

CENTER, TX 75935

(936)591-8888 Shelby

233 HURST STREET

CENTER, TX 75935

(903)590-4035 Shelby

580 N FRANKSTON HWY

FRANKSTON, TX 75763

(903)876-5888 Anderson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 673444 673400 453447 458891 458850 453977 673403 458547 453863 458617 453812 673841 673416 673913 673880 453849 453403 458707 453984 673920 458605 458905 453818 458895 458540

Key Provider Name None ETMC

FIRST PHYSICIANS CLINIC GRAND SALINE None ETMC FIRST PHYSICIANS CLINIC JACKSONVILLE * ETMC FIRST PHYSICIANS CLINIC MINEOLA * ETMC FIRST PHYSICIANS CLINIC RUSK

*

ETMC FIRST PHYSICIANS HEALTH CLINIC * FALLS COMMUNITY CLINIC None FAMILY CARE CENTER * FAMILY CARE CENTER * FAMILY CARE CLINIC * FAMILY CARE CLINIC * FAMILY HEALTH CENTER L L P * FAMILY HEALTH CENTER OF OZONA None FAMILY HEALTH CLINIC OF SANTO * FAMILY HEALTHCARE- WOODVILLE * FAMILY HEALTHCARE-KIRBYVILLE * FAMILY MEDICAL & SPECIALTY CLINIC * FAMILY MEDICAL ASSOCIATES * FAMILY MEDICAL CLINIC OF HANSFORD * FAMILY MEDICINE CENTER * FAMILY MEDICINE CLINIC * FAMILY MEDICINE OF LEVELLAND * FAMILY MEDICINE RURAL HEALTH CLINIC, PA

*

FAMILY PRACTICE CENTER OF UVALDE * FAMILY PRACTICE CLINIC OF MILLS COUNTY * FAMILY PRACTICE RURAL HEALTH C

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 12

Address

City, State and ZIP

Telephone # County Name

801 N WALDRIP ST

GRAND SALINE, TX 75140

(903)962-7551 Van Zandt

203 NACOGDOCHES ST, STE 280

JACKSONVILLE, TX 75766

(903)541-5378 Cherokee

1220 NORTH PACIFIC STREET

MINEOLA, TX 75773

(903)569-6124 Wood

1325 N DICKINSON DR

RUSK, TX 75785

(903)683-3600 Cherokee

2701 US HWY 271

PITTSBURG, TX 75686

(903)856-4242 Camp

307 LIVE OAK ST 1700 BRAZOS STREET STE A&B 387 WEST IH 10, STE 1 119 EAST ACADEMY 1010 SOUTH MAIN 2768 PHARMACY ROAD 104 NORTH AVENUE H 13965 SOUTH FM 4 920 N MAGNOLIA 1905 N MARGARET AVE 2790 PHARMACY ROAD

MARLIN, TX 76661 ROCKDALE, TX 76567 FORT STOCKTON, TX 79735 DEL RIO, TX 78840 SHAMROCK, TX 79079 RIO GRANDE CITY, TX 78582 OZONA, TX 76943 SANTO, TX 76472 WOODVILLE, TX 75979 KIRBYVILLE, TX 75956 RIO GRANDE CITY, TX 78582

(254)803-3561 Falls (512)446-4535 Milam (432)336-2058 Pecos (830)774-4094 Val Verde (806)256-5148 Wheeler (956)487-5621 Starr (325)392-3788 Crockett (940)769-2303 Palo Pinto (409)283-5556 Tyler (409)420-0816 Jasper (956)487-5621 Starr

997 WEST I 20 705 WEST 7TH

COLORADO CITY, TX 79512 SPEARMAN, TX 79081

(325)728-2693 Mitchell (806)659-2846 Hansford

701 MCCLINTIC DRIVE 2401 WALKER PLACE BLVD 116 JOHN DUPRE DRIVE 207 WEST AVENUE E

GROESBECK, TX 76642 COPPERAS COVE, TX 76522 LEVELLAND, TX 79336 LAMPASAS, TX 76550

(254)729-3411 Limestone (254)547-5516 Coryell (806)894-7900 Hockley (512)556-3621 Lampasas

126 W NOPAL

UVALDE, TX 78801

(830)278-7101 Uvalde

1501 W FRONT STREET

GOLDTHWAITE, TX 76844

(325)648-2850 Mills

400 N BROWN STREET

HAMILTON, TX 76531

(254)386-3102 Hamilton

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 458527 458870 673414 453405 673853 458848 453415 453996 673899 458502 673418 458778 673888 673909 458927 453936 458894 673924 673433 458883 458916 673854 673424 458893 673932 673931 458831 673438

Key Provider Name *

FCHC BREMOND CLINIC FCHC ROSEBUD MEDICAL CLINIC * FIRST IN PEDIATRICS * FLATONIA COMMUNITY CLINIC * FLORESVILLE FAMILY MEDICAL CENTER * FOARD COUNTY MEDICAL CLINIC * FOUR OAKS MEDICAL CLINIC * FOX RURAL HEALTH CLINIC * FRED HEALTH CARE PLLC * FREESTONE HEALTH CLINIC * FRIONA RHC * FRITCH MEDICAL CLINIC * GARFIELD MEDICAL CLINIC * GARFIELD MEDICAL CLINIC * GARFIELD MEDICAL CLINIC * GARNER FIELD FAMILY MEDICINE, PA * GEORGE RURAL HEALTH CLINIC * GOLDEN PLAINS RURAL HEALTH CLINIC

*

GOLIAD FAMILY PRACTICE * GOOD SHEPHERD GLENN GARRETT CLINIC LINDEN * GRACE AND MERCY HEALTH CLINIC * GROVETON FAMILY MEDICAL CLINIC None HAMLIN MEDICAL CLINIC * HARDEMAN COUNTY CLINIC None HEALTH HORIZONS OF EAST TEXAS, INC None HEALTH TEXAS PROVIDER NETWORK * HEREFORD HEALTH CLINIC None HICKMAN RURAL HEALTH CLINIC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 12

Address

City, State and ZIP

Telephone # County Name

201 SOUTH MAIN 312 NORTH STALLWORTH 304 UNIVERSITY SUITE 207 113 W SOUTH MAIN STREET 921 10TH STREET SUITE 111

BREMOND, TX 76629 ROSEBUD, TX 76570 MARSHALL, TX 75670 FLATONIA, TX 78941 FLORESVILLE, TX 78114

(254)746-7264 Robertson (254)803-3561 Falls (903)935-9441 Harrison (512)865-3561 Fayette (830)216-7979 Wilson

200 NORTH FIRST STREET 109 SHULT DR 1001 HWY 83 N 20290 S FM 92 734 WEST COMMERCE 1307 CLEVELAND 700 WEST BROADWAY 205 N COMMERCE STREET 404 E SAN MARCOS ST 408 N GIRAUD 524 E NOPAL ST

CROWELL, TX 79227 COLUMBUS, TX 78934 CHILDRESS, TX 79201 FRED, TX 77616 FAIRFIELD, TX 75840 FRIONA, TX 79035 FRITCH, TX 79036 DILLEY, TX 78017 PEARSALL, TX 78061 COTULLA, TX 78014 UVALDE, TX 78801

(940)684-1515 Foard (979)732-5794 Colorado (940)937-3636 Childress (409)429-9494 Tyler (903)389-2181 Freestone (806)250-2781 Parmer (806)857-2311 Hutchinson (830)965-4466 Frio (830)334-3336 Frio (830)879-2279 La Salle (830)278-4588 Uvalde

511 NORTH MAIN 100 S MCGEE

FORT STOCKTON, TX 79735 BORGER, TX 79007

(432)336-2291 Pecos (806)273-5131 Hutchinson

139 WEST FRANKLIN STREET 402 N KAUFMAN

GOLIAD, TX 77963 LINDEN, TX 75563

(361)645-8235 Goliad (903)756-5581 Cass

100 S E 4TH STREET 110 MAGEE ST 350 NORTHWEST AVENUE F 404 MERCER STREET 1407 EAST MAIN STREET

KERENS, TX 75144 GROVETON, TX 75845 HAMLIN, TX 79520 QUANAH, TX 79252 NACOGDOCHES, TX 75961

(903)396-7217 Navarro (936)642-0841 Trinity (325)597-3611 Jones (940)663-6651 Hardeman (936)715-0027 Nacogdoches

6257 FM 2642

ROYSE CITY, TX 75189

(972)635-9480 Rockwall

540 W 15TH ST 1300 N MAIN AVENUE

HEREFORD, TX 79045 BIG LAKE, TX 76932

(806)364-7512 Deaf Smith (325)884-2561 Reagan

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 458878 673409 453859 453860 458978 458973 673930 673976 673445 458899 673447 453888 673425 673404 458736 673923 458965 458531 673452 458833 673436 673994 453825 673988 458815 458836 673428

Key Provider Name *

Address

HICO CLINIC 104 WALNUT STREET HIGH COUNTRY COMMUNITY RURAL 201 TEXAS BLVD HEALTH CLINIC * HOOD MEDICAL CLINIC 207 TILDEN STREET * HOOD MEDICAL CLINIC OF DILLEY 111 E MILLER * HOOD MEDICAL CLINICS-PEARSALL 325 N CHERRY STR * HUNT REGIONAL MEDICAL 1607 E QUINLAN PARKWAY PARTNERS None HUNT REGIONAL MEDICAL 886 E LENNON, SUITE 100 PARTNERS * HUNTSVILLE MEMORIAL HOSPITAL 125 MEDICAL PARK LANE, SUITE C None HUNTSVILLE MEMORIAL HOSPITAL 3638 HIGHWAY 19 None HUNTSVILLE MEMORIAL HOSPITAL 1613 EAST MAIN STREET None HUNTSVILLE MEMORIAL HOSPITAL 110 HILL AVENUE * INTERNAL MEDICINE CLINIC OF 1042 GARNER FIELD ROAD UVALDE None IOWA PARK CLINIC 405 SE ACCESS ROAD * JACK COUNTY MEDICAL CLINIC 717 MAGNOLIA ST * JACKSON COUNTY MEDICAL CLINIC 1013 A SOUTH WELLS STREET OF EDNA None JASPER FAMILY HEALTH & 492 SPRINGHILL STREET, SUITE B WELLNESS RURAL CLINIC * JOURDANTON FAMILY HEALTH 1540 WEST GOODWIN CENTE * JUNCTION MEDICAL CLINIC 399 REID ROAD None KENEDY FAMILY PRACTICE 113 W MAIN ST * KNOX COUNTY HOSPITAL CLINIC 712 SOUTH 5TH STREET None LAKE WHITNEY MEDICAL CLINIC 202E JEFFERSON AVENUE * LAVACA FAMILY HEALTH CLINIC 1406 N TEXANA STREET * LAVERNIA FAMILY MEDICAL CENTER 402 W CHIHUAHUA STREET * LEVELLAND CLINIC 1804 SOUTH COLLEGE AVENUE * LEVELLAND CLINIC NORTH 103 JOHN DUPREE * LHC FAMILY MEDICINE 1600 SOUTH SUNSET None LIBERTY DAYTON MEDICAL CLINIC 1353 NORTH TRAVIS *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 12

City, State and ZIP

Telephone # County Name

HICO, TX 76457 DALHART, TX 79022

(254)796-4224 Hamilton (806)249-8324 Dallam

COTULLA, TX 78014 DILLEY, TX 78017 PEARSALL, TX 78061 QUINLAN, TX 75474

(830)879-2358 La Salle (830)965-1684 Frio (830)334-8703 Frio (903)356-2144 Hunt

EMORY, TX 75440

(903)473-2060 Rains

HUNTSVILLE, TX 77340 HUNTSVILLE, TX 77320 MADISONVILLE, TX 77864 COLDSPRING, TX 77331 UVALDE, TX 78801

(936)291-3219 Walker (936)291-4514 Walker (936)349-0359 Madison (936)291-4514 San Jacinto (830)278-6681 Uvalde

IOWA PARK, TX 76367 JACKSBORO, TX 76458 EDNA, TX 77957

(940)495-3981 Wichita (940)567-6633 Jack (361)782-7820 Jackson

JASPER, TX 75951

(409)381-5751 Jasper

PLEASANTON, TX 78064

(830)569-6340 Atascosa

JUNCTION, TX 76849 KENEDY, TX 78119 KNOX CITY, TX 79529 WHITNEY, TX 76692 HALLETTSVILLE, TX 77964 LA VERNIA, TX 78121 LEVELLAND, TX 79336 LEVELLAND, TX 79336 LITTLEFIELD, TX 79339 LIBERTY, TX 77575

(325)446-3305 Kimble (830)583-0612 Karnes (940)657-3535 Knox (254)694-2221 Hill (361)798-1200 Lavaca (830)779-3800 Wilson (806)894-3141 Hockley (806)894-2465 Hockley (806)385-6424 Lamb (936)336-7316 Liberty

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 453892 458889 458590 453918 458934 458863 673421 673808 673412 453496 458824 458868 458681 453466 458679 458872 453982 453981 673430 453963 673811 458611 673435 673422 453463 458530 458784 673411

Key Provider Name

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 12

City, State and ZIP

Telephone # County Name

LIBERTY MEDICAL RHC 720 TRAVIS ST LITTLE RIVER HEALTHCARE 708 N CROCKETT CAMERON CLINIC * LITTLE RIVER HEALTHCARE 602 NORTH MAIN ROCKDALE CLINIC * LIVE OAK PROFESSIONAL CENTER 1705 LIVE OAK * LOS FRESNOS MEDICINE 725 OCEAN STREET * LOVETT MEREDITH RURAL HEALTH 306 WEST MAIN STREET CLINIC None LYNN COUNTY HOSPITAL DISTRIC 1809 LOCKWOOD ST FAMILY WELLNESS RURAL * MARATHON HEALTH CENTER 101 SOUTH FIRST None MARATHON RURAL HEALTH CENTER 101 SOUTH POST ROAD

LIBERTY, TX 77575 CAMERON, TX 76520

(936)336-6439 Liberty (254)697-6554 Milam

ROCKDALE, TX 76567

(512)446-4555 Milam

COMMERCE, TX 75428 LOS FRESNOS, TX 78566 OLNEY, TX 76374

(903)886-8818 Hunt (956)233-3443 Cameron (940)564-3546 Young

TAHOKA, TX 79373

(806)998-4533 Lynn

MARATHON, TX 79842 MARATHON, TX 79842

(432)386-4316 Brewster (432)336-4200 Brewster

*

805 LINDSEY 707 S GROVE ST 207 N LAMESA HWY 2500 HWY 305 SOUTH

MARSHALL, TX 75670 MARSHALL, TX 75670 STANTON, TX 79782 MCCAMEY, TX 79752

(903)927-6140 Harrison (903)927-6620 Harrison (432)756-3345 Martin (432)652-8626 Upton

2202 N BRYAN AVENUE 300 W HALSELL 8406 FM 471 SOUTH 1250 STATE HIGHWAY 173 NORTH 3200 AVENUE E 610 SOUTH FIRST ST 105 MEDICAL PLAZA 650 E LENNON 1303 MABEE DRIVE 311 NORTHWEST 8TH STREET 815 N VIRGINIA STREET 305 SANDY CORNER ROAD, SUITE 120 1510 HANNAH VALLEY ROAD 509 N MAPLE ST 110 SOUTH BLISS AVE

LAMESA, TX 79331 (806)872-7494 Dawson DIMMITT, TX 79027 (806)647-2194 Castro CASTROVILLE, TX 78009 (830)538-3035 Medina DEVINE, TX 78016 (830)665-2876 Medina HONDO, TX 78861 (830)426-7444 Medina MULESHOE, TX 79347 (806)272-7544 Bailey SULPHUR SPRINGS, TX 75482 (903)885-3181 Hopkins EMORY, TX 75440 (903)473-7234 Rains STAMFORD, TX 79553 (915)773-5733 Jones SEMINOLE, TX 79360 (432)758-5811 Gaines PORT LAVACA, TX 77979 (361)552-0325 Calhoun EL CAMPO, TX 77437 (409)543-5510 Wharton GOLDTHWAITE, TX 76844 (325)648-2263 Mills MUENSTER, TX 76252 (940)759-2226 Cooke DUMAS, TX 79029 (806)935-6599 Moore

* *

MARSHALL HEALTH CLINIC MARSHALL PEDIATRIC CLINIC * MARTIN COUNTY FAMILY CLINIC * MCCAMEY HOSPITAL RURAL HEALTH * MEDICAL ARTS CLINIC * MEDICAL CENTER OF DIMMITT * MEDICAL CLINIC OF CASTROVILLE * MEDICAL CLINIC OF DEVINE * MEDICAL CLINIC OF HONDO None MEDICAL CLINIC OF MULESHOE * MEMORIAL CLINIC * MEMORIAL CLINIC * MEMORIAL HEALTH CLINIC None MEMORIAL HOSPITAL CLINIC SOUTH None MEMORIAL MEDICAL CLINIC * MID COAST MEDICAL CLINIC * MILLS COUNTY MEDICAL CLINIC * MMH FAMILY HEALTH CLINIC * MOORE COUNTY FAMILY CLINIC *

* = Non-Deemed

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 458809 458897 458898 458968 458652 458835 458970 673918 453876 453460 458865 673405 673443 673895 673900 673826 458820 673834 458548 458639 673423 673434 673999 673427 673802 453870

Key Provider Name *

MORTON RURAL HEALTH CLINIC MOTHER FRANCES HOSPITAL WINNSBORO RHC * MOTLEY COUNTY CLINIC * MOULTON CLINIC * MULESHOE FAMILY CLINIC * MUNDAY CLINIC * NEW BRAUNFELS PEDIATRIC ASSOCI

*

NEWTON FAMILY RURAL HEALTH CLINIC AT JASPER * NOCONA MEDICAL CLINIC PA * NORTHEAST TEXAS RURAL HEALTH CLINIC * NRH CLINIC * NTMC PEDIATRICS None OLTON RURAL HEALTH CLINIC * ONE SOURCE HEALTH CENTER, EARL * ONE SOURCE HEALTH CENTER-SAN SABA * P I MEDICAL DAY AND NIGHT CLIN * PALACIOS MEDICAL CLINIC * PALMER MEDICAL CLINIC * PALO PINTO RHC * PARIS HEALTH CLINIC * PARKSIDE FAMILY CLINIC None PARKVIEW MEDICAL CLINIC OF TEAGUE * PARKVIEW REGIONAL HEALTH CLINI None PARKVIEW RURAL HEALTH CLINIC * PCA GUN BARREL CITY * PCA GREENVILLE *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 8 of 12

Address

City, State and ZIP

Telephone # County Name

210 EAST GRANT 719 W COKE RD MOB 4

MORTON, TX 79346 WINNSBORO, TX 75494

(806)266-5565 Cochran (903)342-0407 Wood

1224 MAIN STREET, PO BOX 136 100 SOUTH PECAN 701 SOUTH 1ST STREET 120 EAST D STREET 1535 E COMMON

MATADOR, TX 79244 MOULTON, TX 77975 MULESHOE, TX 79347 MUNDAY, TX 76371 NEW BRAUNFELS, TX 78130

(806)347-2641 Motley (361)596-4675 Lavaca (806)272-4524 Bailey (940)422-5271 Knox (830)625-9153 Comal

561 STATE STREET

JASPER, TX 75951

(409)384-8990 Jasper

90 PARK RD 108 SIXTH ST

NOCONA, TX 76255 WINFIELD, TX 75493

(940)825-3333 Montague (903)524-4700 Titus

7571 STATE HWY 153 / PO BOX 185 801 N GRAND AVE STE 4 524 8TH STREET 2005 HWY 183 N

WINTERS, TX 79567 GAINESVILLE, TX 76240 OLTON, TX 79064 EARLY, TX 76802

(325)754-4553 Runnels (940)665-0683 Cooke (806)285-3312 Lamb (915)646-8541 Brown

403 WEST WALLACE

SAN SABA, TX 76877

(915)372-5701 San Saba

1506 HIGHWAY 100, SUITE A 1519 4TH STREET 110 NORTH MAIN STREET 118 S MAIN 2224 BONHAM 1109 E BROADWAY 101 ANTHONY DR

PORT ISABEL, TX 78578 PALACIOS, TX 77465 PALMER, TX 75152 GORDON, TX 76453 PARIS, TX 75460 CUERO, TX 77954 TEAGUE, TX 75860

(956)943-6675 Cameron (361)972-2511 Matagorda (972)449-3555 Ellis (254)693-5211 Palo Pinto (903)139-2299 Lamar (361)275-2800 DeWitt (254)739-5655 Freestone

514 S BONHAM STE G H 307 E 9TH STREET 801 WEST MAIN STREET 4211 JOE RAMSEY BLVD, SUITE 100

MEXIA, TX 76667 WHEELER, TX 79096 GUN BARREL CITY, TX 75147 GREENVILLE, TX 75401

(254)562-9699 Limestone (806)826-5581 Wheeler (903)877-6252 Anderson (903)408-7700 Hunt

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN

Key Provider Name

453871

*

458946 458972 453883 458579

*

673915 673891

*

* * *

PCA GREENVILLE INTERNAL 4803 WESLEY STREET MEDICINE PCA QUINLAN 734 E QUINLAN PARKWAY PCA- PARIS 3150 CLARKSVILLE SUITE 100 PCA-LEONARD 700 E HWY 78 PECOS VALLEY RURAL HEALTH CLIN 2323 TEXAS STREET

673919 673420 453441 458804 453962 673857 458780

PEDIATRIC PRACTICE ASSOCIATION PEDIATRIC PRACTICE ASSOCIATION -RIO GRANDE CITY

*

PEDIATRIC PRACTICE ASSOCIATION -ROMA * PERRYTON HEALTH CENTER * PLAINS CLINIC * PLAINVIEW CHILDREN'S RURAL HEALTH * PORT ISABEL HEALTH CLINIC * PORT LAVACA CLINIC ASSOCIATES * PRESIDIO MEDICAL CENTER * PROVIDENCE FAMILY HEALTH CLINIC-HILLSBORO * PUCKETT FAMILY CLINIC, PC None QUICK CARE CLINIC * REFUGIO RHC * RICE MEDICAL ASSOCIATES * RIO HONDO HEALTH CLINIC * ROBSTOWN HEALTH CENTER * ROBY RURAL HEALTH CLINIC

673439

None ROLLING

458812 458862 673865

*

673893 458750 458810 458956 458923 453957 673912 458913

*

* *

* = Non-Deemed

Address

PLAINS MEMORIAL HOSPITAL RURAL HEALTH CLIN ROMA FAMILY HEALTH CLINIC ROSEBUD RURAL HEALTH CLINIC RURAL FAMILY HEALTHCARE

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 9 of 12

City, State and ZIP

Telephone # County Name

GREENVILLE, TX 75401

(903)454-2246 Hunt

QUINLAN, TX 75474 PARIS, TX 75460 LEONARD, TX 75452 PECOS, TX 79772

(903)408-4848 Hunt (903)782-9206 Lamar (903)587-3331 Fannin (432)447-3551 Reeves

1609 US HWY 83 201 EAST 2ND ST

ZAPATA, TX 78076 (956)765-0770 Zapata RIO GRANDE CITY, TX 78582 (956)488-1200 Starr

1408 GRANT STREET

ROMA, TX 78584

(956)849-4700 Starr

3101 GARRETT DR 602 HWY 214 2202 EDGEMERE

PERRYTON, TX 79070 PLAINS, TX 79355 PLAINVIEW, TX 79072

(806)435-7224 Ochiltree (806)456-6365 Yoakum (806)293-1555 Hale

202 2ND STREET 1200 N VIRGINIA 101 NORTH ERMA 1323 E FRANKLIN STREET STE 105

PORT ISABEL, TX 78578 PORT LAVACA, TX 77979 PRESIDIO, TX 79845 HILLSBORO, TX 76645

(956)943-1774 Cameron (361)552-6721 Calhoun (432)229-4246 Presidio (254)582-7481 Hill

1301 EAST MAIN STREET 1411 N MAIN ST 107 SWIFT ST 610 SOUTH AUSTIN ROAD 29099 HWY 106 327 W AVE J 117 NORTH 1ST NORTH CONCHO BOX 66 201 E ARIZONA AVE

HONEY GROVE, TX 75446 ANDREWS, TX 79714 REFUGIO, TX 78377 EAGLE LAKE, TX 77434 RIO HONDO, TX 78583 ROBSTOWN, TX 78380 ROBY, TX 79543

(903)378-3444 Fannin (432)646-2586 Andrews (361)526-2321 Refugio (409)234-2551 Colorado (956)748-2381 Cameron (361)387-9233 Nueces (325)776-2500 Fisher

SWEETWATER, TX 79556

(325)235-8641 Nolan

128 N FM 3167 320 E AVENUE I 1304 WEST COURT STREET

ROMA, TX 78584 ROSEBUD, TX 76570 NEWTON, TX 75966

(956)849-0674 Starr (254)583-0331 Falls (409)379-2177 Newton

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 673448 458885 673801 673406 458684 458823 673417 673419 458839 458686 458693 458799 458738 453413 453922 458845 458876 458825 458843 673450 458887 458819

Key Provider Name None SABINAL

HEALTH CLINIC SABINE FAMILY MEDICAL CENTER * SAINT JO HEALTHCARE CENTER None SANDERSON RURAL HEALTH CENTER * SANDHILLS FAMILY CLINIC * SCHLEICHER COUNTY FAMILY CLINIC None SCOTT & WHITE CLINIC - JOHNSON CITY None SCOTT & WHITE CLINIC BURNET * SCOTT & WHITE CLINICHORSESHOE BAY * SCOTT & WHITE CLINIC-KINGSLAND * SCOTT & WHITE CLINIC-MARBLE FALLS * SCOTT & WHITE CLINIC-SAN SABA * SCOTT & WHITE FAMILY PRACTICEBRENHAM * SCOTT & WHITE HOERSTER CLINICLLANO * SEARS MEDICAL ASSOCIATES * SEBD CHILDREN'S CARE-A-VAN * SETON BERTRAM HEALTHCARE CENTER * SETON BURNET HEALTHCARE CENTER * SETON HIGHLAND LAKES MARBLE FALLS HEALTH CENTER None SETON KINGSLAND HEALTHCARE CENTER * SETON LAMPASAS HEALTHCARE CENTER * SETON LOCKHART FAMILY HEALTH CENTER *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 10 of 12

Address

City, State and ZIP

Telephone # County Name

517 NORTH CENTER STREET 1111 WORTH ST 108 E BOGGESS 213 PERSIMMONS STREET

SABINAL, TX 78881 HEMPHILL, TX 75948 SAINT JO, TX 76265 SANDERSON, TX 79848

(830)988-2582 Uvalde (409)787-1707 Sabine (940)995-2410 Montague (432)345-2508 Terrell

813 E 4TH STREET 100 NORTH US HIGHWAY 277

MONAHANS, TX 79756 ELDORADO, TX 76936

(432)943-2068 Ward (325)853-2507 Schleicher

208 HALEY RD

JOHNSON CITY, TX 78636

(830)868-4033 Blanco

101 E JACKSON ST 100 PECAN CROSSING

BURNET, TX 78611 HORSESHOE BAY, TX 78657

(830)201-7100 Burnet (830)598-4405 Burnet

105 FM 2342 706 AVENUE G

KINGSLAND, TX 78639 MARBLE FALLS, TX 78654

(325)388-3515 Llano (830)593-8234 Burnet

2005 W WALLACE SUITE 200 539 MEDICAL PARKWAY

SAN SABA, TX 76877 BRENHAM, TX 77833

(325)372-5163 San Saba (979)836-1883 Washington

102 E YOUNG

LLANO, TX 78643

(325)247-4131 Llano

836 E CALIFORNIA ST 300 S COLORADO 160 NORTH LAMPASAS ST

GAINESVILLE, TX 76240 LOCKHART, TX 78644 BERTRAM, TX 78605

(940)665-5566 Cooke (512)376-9690 Caldwell (512)355-2678 Burnet

200 COUNTY RD 340 A SUITE 2

BURNET, TX 78611

(512)715-3009 Burnet

700 HIGHWAY 281

MARBLE FALLS, TX 78654

(830)693-2500 Burnet

525 RANCH ROAD 2900

KINGSLAND, TX 78639

(325)388-6912 Llano

1205 CENTRAL TEXAS EXPRESSWAY

LAMPASAS, TX 76550

(512)556-5362 Lampasas

300 SOUTH COLORADO SUITE A&D

LOCKHART, TX 78644

(830)875-7000 Caldwell

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN 673449 458573 458844 453456 453953 673911 458877 458986 673426 458713 673887 673446 453826 458789 453986 673858 458705 458974 673429 673922 673929 458683 453411 673401 673822 673823 673883 673886

Key Provider Name None SETON

LULING FAMILY MEDICINE CLINIC * SEYMOUR HOSPITAL RHC * SHL CARE-A-VAN * SIEVERS MEDICAL CLINIC * SINTON PEDIATRIC CENTER * SLATON FAMILY MEDICAL CLINIC * SONORA MEDICAL CLINIC * SOUTH PADRE ISLAND PEDS CNTR M * SPUR CLINIC * STARR COUNTY MEMORIAL HOSPITAL RURAL HEALTH CLINIC * STEVE AHMED, MD, PA None STINNETT MEDICAL CLINIC * STOCKDALE FAMILY MEDICAL CENTER

*

STONEWALL MEMORIAL HOSPITAL * STONEWALL RURAL HEALTH CLINIC * TAFT HEALTH CENTER * TCH FAMILY MEDICAL CLINIC * TEARE MEMORIAL CLINIC None TEXLINE HEALTH CLINIC None THE PEDIATRIC CARE CENTER None THE PEDIATRIC CARE CENTER * THROCKMORTON RURAL HEALTH CLINIC * TIMBERLANDS CLINIC None TOLEDO BEND FAMILY MEDICINE * TRINITY CLINIC - CANTON * TRINITY CLINIC - QUITMAN * TRINITY CLINIC HENDERSON * TRINITY CLINIC HOLLY LAKE

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 11 of 12

Address

City, State and ZIP

Telephone # County Name

130 HAYS STREET, STE B

LULING, TX 78648

(830)675-7078 Caldwell

201 STADIUM DRIVE 3201 S WATER STREET 1110 N SARAH DEWITT DRIVE 301 S SAN PATRICIO 235 W GARZA 301 HUDSPETH SUITE B 220E ST MARY STREET

SEYMOUR, TX 76380 BURNET, TX 78611 GONZALES, TX 78629 SINTON, TX 78387 SLATON, TX 79364 SONORA, TX 76950 MATHIS, TX 78368

(940)889-5572 Baylor (830)693-2600 Burnet (830)672-8502 Gonzales (361)364-3355 San Patricio (806)828-1600 Lubbock (325)387-7911 Sutton (361)547-5700 San Patricio

907 E HILL ST 128 N FARM ROAD 3167

SPUR, TX 79370 (806)271-3306 Dickens RIO GRANDE CITY, TX 78582 (210)487-5561 Starr

1700 W FM 700 711 S STEWART AVENUE 601 PERSON ST

BIG SPRING, TX 79720 STINNETT, TX 79083 STOCKDALE, TX 78160

(432)264-1900 Howard (806)878-2271 Hutchinson (830)996-3701 Wilson

1447 MAIN STREET 821 N BROADWAY ST 1210 GREGORY SUITE 2 104 N BEECH STREET 146 PIONEER DRIVE 100 N THIRD ST 4857 W HWY 83 1804 N US HWY 83 802 NORTH MINTER AVE, SUITE B

JAYTON, TX 79528 ASPERMONT, TX 79502 TAFT, TX 78390 WOODVILLE, TX 75979 BOOKER, TX 79005 TEXLINE, TX 79087 ROMA, TX 78584 ZAPATA, TX 78076 THROCKMORTON, TX 76483

(806)237-3405 Kent (940)989-2875 Stonewall (361)528-2595 San Patricio (409)283-2822 Tyler (806)658-4531 Lipscomb (231)924-0244 Dallam (956)849-0104 Starr (956)265-9040 Zapata (940)849-2471 Throckmorton

1050 LOOP 304 EAST 2421 WORTH ST 18780 INTERSTATE 20 502 EGOODE ST, STE 1E 511 N HIGH 5321 FM 14/2869

CROCKETT, TX 75835 HEMPHILL, TX 75948 CANTON, TX 75103 QUITMAN, TX 75783 HENDERSON, TX 75652 HAWKINS, TX 75765

(936)544-7856 Houston (409)787-1416 Sabine (903)567-4841 Van Zandt (903)763-5402 Wood (903)657-7583 Rusk (903)769-2990 Wood

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Texas CCN

Key Provider Name *

TRINITY CLINIC MINEOLA TULIA RURAL HEALTH CLINIC * UNITED CLINICS OF NORTH TEXAS * UNIVERSITY MEDICAL CENTERFABENS

*

453835 UVALDE FAMILY PRACTICE ASSN None UVALDE MEDICAL AND SURGICAL 673437 ASSOCIATES None VAL VERDE HOSPITAL 673431 CORPORATION * 453462 VAN HORN RHC * 458932 VIDOR COMMUNITY HEALTH CLINIC * 453481 WAELDER MEDICAL CLINIC * 458912 WAGNER MEDICAL CLINIC, LLP * 458811 WEST TEXAS MEDICAL CENTER None WHITNEY FAMILY MEDICINE 673933 * 458557 WINKLER COUNTY RURAL HEALTH CLINIC * 458874 WINNIE COMMUNITY CLINIC * 673982 WOODSBORO MEDICAL CLINIC * 458987 YELED SHALOM PEDIATRIC CLINIC None YORKTOWN MEDICAL CLINIC 673451 * 458851 YOUNG COUNTY FAMILY CLINIC Total Providers for this State = 305

673825 458694 453929 458619

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 12 of 12

Address

City, State and ZIP

Telephone # County Name

1302 NORTH PACIFIC 105 HOSPITAL AVE 1010 NORTH MILL STREET 101 POTASIO, PO BOX 3940

MINEOLA, TX 75773 TULIA, TX 79088 BOWIE, TX 76230 FABENS, TX 79838

(903)531-4965 Wood (806)995-4122 Swisher (940)872-1121 Montague (915)764-5000 El Paso

1800 GARNER FIELD ROAD UVALDE, TX 78801 1195 GARNER FIELD ROAD BUILDING B UVALDE, TX 78801 SUITE 500 1801 N BEDELL AVENUE DEL RIO, TX 78840

(830)278-4453 Uvalde (830)278-3086 Uvalde

FM 2185 & EISENHOWER ROAD 1290 HWY 12 401 NORTH AVENUE G# APT9 124 E WOLTERS/2ND STREET 415 NORTH AVENUE F 1314 N BRAZOS STREET 828 MYER LANE

VAN HORN, TX 79855 VIDOR, TX 77662 WAELDER, TX 78959 SHINER, TX 77984 DENVER CITY, TX 79323 WHITNEY, TX 76692 KERMIT, TX 79745

(432)283-2760 Culberson (409)769-7795 Orange (830)788-7280 Gonzales (361)594-3824 Lavaca (806)592-9501 Yoakum (254)694-3621 Hill (432)586-2040 Winkler

538 BROADWAY 120 WOOD AVE 1975 VETERANS BLVD SUITE 5 508 N RIEDEL ST 820 MONTGOMERY ROAD SUITE 202

WINNIE, TX 77665 WOODSBORO, TX 78393 EAGLE PASS, TX 78852 YORKTOWN, TX 78164 GRAHAM, TX 76450

(409)296-6337 Chambers (361)543-5414 Refugio (830)773-9449 Maverick (361)564-9230 DeWitt (940)549-7741 Young

(830)768-9200 Val Verde

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN 168576 168500 163830 168526 168945 168556 168523 168546 163853 168557 163997 163451 168575 168577 163470 168538 163483 168535 168587 163487 163441 163479 163480 163476 163478 163431 163433

Key Provider Name None ADAIR

COUNTY MEDICAL CLINIC STUART * ADAIR COUNTY MEDICAL CLINICGREENFIELD * AKRON FAMILY PRACTICE CLINIC * ANITA MEDICAL CENTER * ANTHON MERCY MEDICAL CLINIC None ATKINS FAMILY MEDICAL CLINIC * ATLANTIC MEDICAL CENTER * AUDUBON FAMILY HEALTH CARE * AUDUBON MEDICAL CLINIC None BELMOND CLINIC * BIRMINGHAM MEDICAL CLINIC * BONAPARTE MEDICAL CLINIC None BOONE COUNTY FAMILY MEDICINE OGDEN None BURGESS CLINIC WHITING * BURGESS FAMILY CLINC - DUNLAP * BURGESS FAMILY CLINIC - MAPLE VALLEY * BURGESS FAMILY CLINIC - SLOAN None C C M H MEDICAL CLINIC None CCMH MEDICAL CLINIC - CITY CENTER * CHEROKEE REGIONAL CLINIC * CHEROKEE REGIONAL CLINICHOLSTEIN * CHI HEALTH CLINIC BEDFORD * CHI HEALTH CLINIC CORNING * CHI HEALTH CLINIC DUNLAP * CHI HEALTH CLINIC LENOX * CHI HEALTH CLINIC LOGAN * CHI HEALTH CLINIC MISSOURI VALLEY

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 7

Address

City, State and ZIP

Telephone # County Name

303 SW 7TH STREET, SUITE B

STUART, IA 50250

(515)523-2513 Adair

609 SOUTHEAST KENT

GREENFIELD, IA 50849

(641)743-6189 Adair

321 MILL STREET 720 MAIN 307 MAIN STREET 401 CARDINAL AVENUE 1501 EAST 10TH, PO BOX 429 515 PACIFIC STREET, SUITE 2 222 BROADWAY 403 FIRST STREET SE 735 N HIGHWAY 1 624 FIRST STREET 320 W WALNUT STREET

AKRON, IA 51001 ANITA, IA 50020 ANTHON, IA 51004 ATKINS, IA 52206 ATLANTIC, IA 50022 AUDUBON, IA 50025 AUDUBON, IA 50026 BELMOND, IA 50421 BIRMINGHAM, IA 52535 BONAPARTE, IA 52620 OGDEN, IA 50212

(712)568-2411 Plymouth (712)762-4462 Cass (712)373-5711 Woodbury (319)446-7800 Benton (712)243-2850 Cass (712)563-4611 Audubon (712)563-4206 Audubon (641)444-3500 Wright (319)498-4370 Van Buren (319)592-3168 Van Buren (515)275-2417 Boone

153 BLAIR STREET 612 IOWA AVENUE 513 SOUTH MUCKEY STREET

WHITING, IA 51063 DUNLAP, IA 51529 MAPLETON, IA 51034

(712)455-2431 Monona (712)643-5880 Harrison (712)882-2234 Monona

409 EVANS 100 MEDICAL PARKWAY, SUITE A 115 N 14TH STREET

SLOAN, IA 51055 DENISON, IA 51442 DENISON, IA 51442

(712)428-4100 Woodbury (712)265-2700 Crawford (712)263-5071 Crawford

300 SIOUX VALLEY DRIVE 112 NORTH KIEL STREET

CHEROKEE, IA 51012 HOLSTEIN, IA 51025

(712)225-6265 Cherokee (712)368-4730 Ida

1502 MADISON STREET 601 ROSARY DRIVE 704 IOWA AVENUE 210 SOUTH MAIN 122 WEST EIGHTH STREET 809 EAST ELM STREET

BEDFORD, IA 50833 CORNING, IA 50841 DUNLAP, IA 51529 LENOX, IA 50851 LOGAN, IA 51546 MISSOURI VALLEY, IA 51555

(712)523-2196 Taylor (641)322-3121 Adams (712)643-2298 Harrison (641)333-2266 Taylor (712)642-3612 Harrison (712)642-2794 Harrison

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN

Key Provider Name

163477 168539 168579 168578 168580 168581

*

163495 168550 168552 168553 168934

*

CHI HEALTH CLINIC WOODBINE CHRISTOPHEL CLINIC None CIH CONRAD CLINIC None CIH MARSHALLTOWN CLINIC None CIH STATE CENTER CLINIC None CIH TAMA TOLEDO CLINIC *

CLARION CLINIC CORNERSTONE FAMILY PRACTICE * CORNERSTONE FAMILY PRACTICE * CORNERSTONE FAMILY PRACTICE * CORRECTIONVILLE MERCY MEDICAL CLINIC * 163438 COVENANT CLINIC - ARLINGTON * 163493 CRESCO MEDICAL CLINIC * 163878 DALLAS CENTER MEDICAL ASSOCIATES None DAVIS COUNTY MEDICAL 168566 ASSOCIATES * 163998 DOUDS MEDICAL CLINIC * 163486 EARLHAM MEDICAL CLINIC * 168534 EXIRA MEDICAL CLINIC * 163890 FAMILY HEALTH CARE OF SIOUXLAND * 163464 FAMILY HEALTH CENTER * 163831 FAMILY MEDICINE CLINIC * 163482 FAMILY PRACTICE CLINIC EMMETSBURG * 163472 FAMILY PRACTICE CLINIC GRAETTINGER * 163417 FAMILY PRACTICE CLINIC WEST BEND * 163452 FARMINGTON MEDICAL CLINIC *

163498 FLOYD COUNTY AREA FAMILY PRACTICE CENTER

* = Non-Deemed *

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 7

Address

City, State and ZIP

Telephone # County Name

518 LINCOLN WAY 312 9TH STREET SW, SUITE 2300 105 N CHURCH STREET 405 E MAIN STREET, FIRST FLOOR 503 3RD AVENUE SW 1307 S BROADWAY STREET, UPPER LEVEL 215 13TH AVENUE SW 101 E WATSON ST 200 MAIN STREET 101 SOUTH WASHINGTON 1120 EAST HIGHWAY 20

WOODBINE, IA 51579 WAVERLY, IA 50677 CONRAD, IA 50621 MARSHALLTOWN, IA 50158 STATE CENTER, IA 50247 TOLEDO, IA 52342

(712)647-2566 Harrison (319)483-1390 Bremer (641)366-2123 Grundy (641)753-2752 Marshall (641)844-2970 Marshall (641)484-5445 Tama

CLARION, IA 50525 GARNAVILLO, IA 52049 GUTTENBERG, IA 52052 EDGEWOOD, IA 52042 CORRECTIONVILLE, IA 51016

(515)532-2836 Wright (563)964-2608 Clayton (563)252-2141 Clayton (563)928-6435 Delaware (712)372-4145 Woodbury

751 MAIN STREET 321 EIGHTH AVENUE WEST 507 14TH STREET

ARLINGTON, IA 50606 CRESCO, IA 52136 DALLAS CENTER, IA 50063

(563)633-6965 Fayette (563)547-2022 Howard (515)992-3711 Dallas

509 N MADISON STREET, SUITE 100

BLOOMFIELD, IA 52537

(641)664-3832 Davis

14204 HIGHWAY 98 125 WEST FIRST STREET 107 SOUTH JEFFERSON STREET 410 MAIN STREET

DOUDS, IA 52551 EARLHAM, IA 50072 EXIRA, IA 50076 MOVILLE, IA 51039

(641)936-7107 Van Buren (515)758-2907 Madison (712)268-5348 Audubon (712)873-5225 Woodbury

309 SOUTH FIFTH AVENUE 1614 DIAMOND STREET PLACE 3201 FIRST STREET

VILLISCA, IA 50864 ONAWA, IA 51040 EMMETSBURG, IA 50536

(712)826-3003 Montgomery (712)423-1525 Monona (712)852-5555 Palo Alto

109 WEST ROBBINS STREET

GRAETTINGER, IA 51342

(712)859-3131 Palo Alto

107 DIVISION STREET

WEST BEND, IA 50597

(515)887-7881 Palo Alto

206 SOUTH FOURTH STREET 1501 SOUTH MAIN STREET, SUITE 6

FARMINGTON, IA 52626 CHARLES CITY, IA 50616

(319)878-4232 Van Buren (641)257-1184 Floyd

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN 163996 168913 163987 163979 163420 163463 163849 168525 163892 168583 168582 168584 168559 163456 163492 168503 163410 168537 168558 168565 168548 168572 168585 163453 163846 163437

Key Provider Name *

FOX RIVER MEDICAL CLINIC FRANCISCAN HEALTHCARE WAUKON * FRANKLIN MEDICAL CENTER-DOWS * FRANKLIN MEDICAL CENTERDUMONT

*

FRANKLIN MEDICAL CENTERHAMPTON * FRANKLIN MEDICAL CENTERLATIMER * GREAT RIVER CLINIC AT WAPELLO * GRISWOLD MEDICAL CENTER * GUNDERSEN LANSING CLINIC * GUNDERSEN PALMER LUTHERAN HOSP & CLIN - POSTVILLE

*

GUNDERSEN PALMER LUTHERAN HOSP & CLIN-WEST UNION * GUNDERSEN PALMER LUTHERAN HOSP & CLINICS-FAYETTE None HAMPTON CLINIC * HARDIN MEDICAL CLINIC * HARTLEY MERCY MEDICAL CLINIC * HAWARDEN REGIONAL HEALTHCARE CLINICS, LLC

*

HEALTH TRUST PHYSICIANS CLINIC * HORN PHYSICIANS CLINIC None HORN PHYSICIANS CLINIC MAPLETON None HORN PHYSICIANS CLINIC ODEBOLT None HUMESTON FAMILY MEDICAL CLINIC None JCHC RURAL HEALTH CLINIC None KEOKUK COUNTY MEDICAL CLINIC * KEOSAUQUA MEDICAL CLINIC * KINGSLEY MERCY MEDICAL CLINIC * KOSSUTH FAMILY HEALTH CENTER *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 7

Address

City, State and ZIP

Telephone # County Name

14983 275TH STREET 105 EAST MAIN STREET

CANTRIL, IA 52542 WAUKON, IA 52172

(319)397-2300 Van Buren (563)568-3449 Allamakee

103 EAST ELLSWORTH STREET 606 SOUTH SECOND STREET

DOWS, IA 50071 DUMONT, IA 50625

(515)852-4113 Wright (641)857-6696 Butler

1720 CENTRAL AVENUE EAST

HAMPTON, IA 50441

(641)456-5050 Franklin

109 SOUTH AKIR STREET

LATIMER, IA 50452

(641)579-6340 Franklin

220 MULBERRY, SUITE A 1109 MORNINGSIDE DRIVE 50 NORTH 4TH STREET 111 SOUTH REYNOLDS

WAPELLO, IA 52653 GRISWOLD, IA 51535 LANSING, IA 52151 POSTVILLE, IA 52162

(319)523-3421 Louisa (712)778-5140 Cass (563)538-4874 Allamakee (563)864-7512 Allamakee

110 JEFFERSON STREET

WEST UNION, IA 52175

(563)422-3817 Fayette

110 KING STREET

FAYETTE, IA 52142

(563)425-3381 Fayette

700 SECOND STREET SE 400 SOUTH DODGE STREET 231 NORTH EIGHTH AVENUE WEST 1122 AVENUE L

HAMPTON, IA 50441 BEDFORD, IA 50833 HARTLEY, IA 51346 HAWARDEN, IA 51023

(641)444-3223 Franklin (712)523-2738 Taylor (712)728-2820 O'Brien (712)551-2522 Sioux

300 WEST HUTCHINS STREET 700 EAST 2ND STREET, SUITE 2 520 MAIN STREET

WINTERSET, IA 50273 IDA GROVE, IA 51445 MAPLETON, IA 51034

(515)462-2950 Madison (712)364-2514 Ida (712)881-4676 Monona

300 S MAPLE STREET 109 BROAD STREET 2000B SOUTH MAIN STREET 1314 SOUTH STUART STREET, SUITE B 304 FRANKLIN ST 111 MAIN STREET 1519 SOUTH PHILLIPS STREET

ODEBOLT, IA 51458 HUMESTON, IA 50123 FAIRFIELD, IA 52556 SIGOURNEY, IA 52591 KEOSAUQUA, IA 52565 KINGSLEY, IA 51028 ALGONA, IA 50511

(712)668-2232 Sac (641)877-6108 Wayne (641)472-4156 Jefferson (641)622-1170 Keokuk (319)293-3171 Van Buren (712)378-2921 Plymouth (515)295-2451 Kossuth

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN

Key Provider Name *

KOSSUTH REGIONAL HEALTH CENTER

*

163469 LENOX MEDICAL CLINIC * 163494 LIME SPRINGS MEDICAL CLINIC * 163435 LINEVILLE MEDICAL CLINIC None LUCAS COUNTY HEALTH CENTER 168560 MEDICAL CLINIC None MADRID FAMILY PRACTICE CLINIC 168574 None MARENGO FAMILY MEDICAL CLINIC 168563 * 168524 MASSENA MEDICAL CENTER * 168516 MCCRARY ROST CLINIC * 163475 MCCRARY ROST CLINIC * 168545 MCCRARY-ROST CLINIC * 168522 MCCRARY-ROST CLINIC * 168951 MEDIAPOLIS MEDICAL CLINIC * 163834 MEDICAL CLINIC * 163833 MEDICAL CLINIC * 163836 MEDICAL CLINIC * 168950 MERCY CARE MONTICELLO * 168949 MERCY CARE TAMA * 168948 MERCY FAMILY CLINIC None MERCY FAMILY MEDICINE OF 168964 TIPTON None MERCY FAMILY MEDICINE OF WEST 168963 BRANCH * 168533 MERCY MEDICAL CLINIC * 163462 MILL CREEK FAMILY PRACTICE * 168536 MONROE COUNTY HOSPITAL CLINIC * 163449 MONROE FAMILY HEALTH CENTER None MOUNT AYR MEDICAL CLINIC 168570 * 168517 MYRTUE MEDICAL CENTER - AVOCA CLINIC

*

168518 MYRTUE MEDICAL CENTER - G E LARSON ELK HORN/KIMBAL * = Non-Deemed

163976

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 7

Address

City, State and ZIP

Telephone # County Name

122 WEST RAMSEY STREET

BANCROFT, IA 50517

(515)885-2336 Kossuth

100 S MAIN STREET 101 WEST MAIN STREET 101 MAIN STREET 1200 N 7TH STREET

LENOX, IA 50851 LIME SPRINGS, IA 52155 LINEVILLE, IA 50147 CHARITON, IA 50049

(641)333-4545 Taylor (563)566-2243 Howard (641)876-2070 Wayne (641)774-3000 Lucas

623 W NORTH STREET 255 W LUCAS STREET 92 SOUTH MAIN STREET 1160 3RD STREET 1800 MAIN STREET 505 EAST LAKE STREET 1351 WEST MAIN STREET 401 N ORCHARD 1219 MAIN STREET 313 MAIN STREET 710 CENTER STREET 619 SOUTH MAIN STREET 402 SIEGAL STREET 115 NORTH MAIN STREET 56 CEDAR STREET

MADRID, IA 50156 MARENGO, IA 52301 MASSENA, IA 50853 LAKE VIEW, IA 51450 GOWRIE, IA 50543 ROCKWELL CITY, IA 50579 LAKE CITY, IA 51449 MEDIAPOLIS, IA 52637 HAMBURG, IA 51640 SIDNEY, IA 51652 TABOR, IA 51653 MONTICELLO, IA 52310 TAMA, IA 52339 BUFFALO CENTER, IA 50424 TIPTON, IA 52772

(515)795-4300 Boone (319)741-6789 Iowa (712)779-3626 Cass (712)657-8555 Sac (515)352-3891 Webster (712)297-8989 Calhoun (712)464-3194 Calhoun (319)394-3177 Des Moines (712)382-2626 Fremont (712)374-2649 Fremont (712)629-2975 Fremont (319)465-5937 Jones (641)484-3333 Tama (641)562-2424 Winnebago (563)886-2195 Cedar

206 COOKSON DRIVE

WEST BRANCH, IA 52358

(319)643-2516 Cedar

19876 ST JOSEPH'S DRIVE 5616 460TH STREET 6580 165TH STREET 100 E SHERMAN 504 N CLEVELAND STREET, SUITE M 510 NORTH ELM STREET

CENTERVILLE, IA 52544 PAULLINA, IA 51046 ALBIA, IA 52531 MONROE, IA 50170 MOUNT AYR, IA 50854 AVOCA, IA 51521

(641)856-8684 Appanoose (712)448-2000 O'Brien (641)932-2134 Monroe (641)259-2155 Jasper (641)464-4470 Ringgold (712)343-6455 Pottawattamie

4022 MAIN STREET

ELK HORN, IA 51531

(712)764-4642 Shelby

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN 168509 168519 168571 168527 163454 168562 163488 163490 163827 168530 168554 168531 168529 168528 163497 168508 168507 168505 168506 168561 168541 168555 168549 168569

Key Provider Name *

MYRTUE MEDICAL CENTER HARLAN CLINIC

*

MYRTUE MEDICAL CENTER SHELBY CLINIC None MYRTUE MEDICAL CENTEREARLING CLINIC * NASHUA CLINIC * OSAGE CLINIC None OTTUMWA MEDICAL CLINIC * PAULLINA MERCY MEDICAL CLINIC * PRIMGHAR MERCY MEDICAL CLINIC * REDFIELD MEDICAL CLINIC * REGIONAL FAMILY HEALTH MANCHESTER * REGIONAL FAMILY HEALTH WINTHROP * REGIONAL FAMILY HEALTH, EDGEWOOD * REGIONAL FAMILY HEALTH, HOPKINTON * REGIONAL FAMILY HEALTH, STRAWBERRY POINT * RICEVILLE CLINIC * SANFORD CLINIC LAKE PARK * SANFORD CLINIC ROCK RAPIDS * SANFORD CLINIC SANBORN * SANFORD CLINIC SHELDON * SANFORD ROCK RAPIDS GEORGE CLINIC None SEYMOUR MEDICAL CLINIC None SHELL ROCK CLINIC None SHENANDOAH PHYSICIANS CLINIC None SHENANDOAH PHYSICIANS CLINIC SIDNEY

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 7

Address

City, State and ZIP

Telephone # County Name

1220 CHATBURN AVENUE

HARLAN, IA 51537

(712)755-5130 Shelby

105 EAST STREET

SHELBY, IA 51570

(712)544-2511 Shelby

100 INDUSTRIAL DRIVE SUITE 101

EARLING, IA 51530

(712)747-5700 Shelby

80 AMHEARST BLVD, SUITE 400 620 NORTH EIGHTH STREET 920 N QUINCY AVENUE 108 EAST GROESBECK AVENUE 240 NORTH RERICK AVENUE 1013 FIRST STREET 709 WEST MAIN STREET

NASHUA, IA 50658 OSAGE, IA 50461 OTTUMWA, IA 52501 PAULLINA, IA 51046 PRIMGHAR, IA 51245 REDFIELD, IA 50233 MANCHESTER, IA 52057

(641)435-4133 Chickasaw (641)732-6100 Mitchell (641)455-5200 Wapello (712)448-2126 O'Brien (712)957-2310 O'Brien (515)833-2301 Dallas (563)927-3232 Delaware

345 1ST STREET SOUTH

WINTHROP, IA 50682

(319)935-3343 Buchanan

702 WEST UNION STREET

EDGEWOOD, IA 52042

(563)928-7191 Clayton

122 FIRST STREET SW

HOPKINTON, IA 52237

(563)926-2922 Delaware

111 EAST MISSION STREET

(563)933-6277 Clayton

109 WESTWARD DRIVE 204 MARKET STREET 803 SOUTH GREEN STREET 321 MAIN STREET 800 OAK STREET, PO BOX 10 101 N MAIN STREET

STRAWBERRY POINT, IA 52076 RICEVILLE, IA 50466 LAKE PARK, IA 51347 ROCK RAPIDS, IA 51246 SANBORN, IA 51248 SHELDON, IA 51201 GEORGE, IA 51237

515 W WALL 1001 MASON WAY 1 JACK FOSTER DRIVE 802 ILLINOIS STREET

SEYMOUR, IA 52590 SHELL ROCK, IA 50670 SHENANDOAH, IA 51601 SIDNEY, IA 51652

(641)898-2898 Wayne (319)885-6530 Butler (712)246-7240 Page (712)374-6005 Fremont

(641)985-2122 Howard (712)382-9559 Dickinson (712)472-3716 Lyon (712)729-3545 O'Brien (712)324-5356 O'Brien (712)475-3393 Lyon

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN 168547 163445 163460 168943 163455 163489 168960 168955 168905 168952 163898 168907 168916 168944 168953 168917 168919 168926 168947 168904

Key Provider Name None SOUTH

CENTRAL IOWA MEDICAL CLINIC * ST ANSGAR CLINIC * STORY MEDICAL CLINIC - ZEARING * STUART MEDICAL CLINIC * SULLY FAMILY HEALTH CENTER * SUTHERLAND MERCY MEDICAL CLINIC None UNITY POINT CLINIC FAMILY MEDICINE KENYON ROAD * UNITYPOINT CLINC FAMILY MEDICINE ROHLF MEMORIAL * UNITYPOINT CLINIC FAMILY MEDICINE ALLISON * UNITYPOINT CLINIC FAMILY MEDICINE BELLE PLAINE * UNITYPOINT CLINIC FAMILY MEDICINE CLARENCE * UNITYPOINT CLINIC FAMILY MEDICINE DENVER * UNITYPOINT CLINIC FAMILY MEDICINE EAGLE GROVE * UNITYPOINT CLINIC FAMILY MEDICINE FONDA * UNITYPOINT CLINIC FAMILY MEDICINE GRUNDY CENTER * UNITYPOINT CLINIC FAMILY MEDICINE HUMBOLDT * UNITYPOINT CLINIC FAMILY MEDICINE LAKE VIEW * UNITYPOINT CLINIC FAMILY MEDICINE LAURENS * UNITYPOINT CLINIC FAMILY MEDICINE MANSON * UNITYPOINT CLINIC FAMILY MEDICINE OELWEIN

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 7

Address

City, State and ZIP

Telephone # County Name

417 S EAST STREET, SUITE 100

CORYDON, IA 50060

(641)872-2063 Wayne

140 WEST FOURTH STREET, SUITE 1 112 WEST MAIN STREET 106 NE SECOND STREET 704 THIRD STREET 108 WEST SECOND STREET

SAINT ANSGAR, IA 50472 ZEARING, IA 50278 STUART, IA 50250 SULLY, IA 50251 SUTHERLAND, IA 51058

(641)736-4401 Mitchell (641)487-7779 Story (515)523-2283 Adair (641)594-3150 Jasper (712)446-2567 O'Brien

800 KENYON ROAD, SUITE S

FORT DODGE, IA 50501

(515)574-6800 Webster

312 9TH STREET SW, SUITE 1200

WAVERLY, IA 50677

(319)352-4340 Bremer

502 LOCUST STREET

ALLISON, IA 50602

(319)267-2759 Butler

105 9TH AVENUE

BELLE PLAINE, IA 52208

(319)444-2840 Benton

411 FIRST AVENUE

CLARENCE, IA 52216

(563)452-3211 Cedar

111 TOWER STREET

DENVER, IA 50622

(319)984-5645 Bremer

115 SOUTH PARK

EAGLE GROVE, IA 50533

(515)448-5185 Wright

101 N MAIN

FONDA, IA 50540

(712)288-4426 Pocahontas

101 EAST J AVENUE, SUITE 120

GRUNDY CENTER, IA 50638

(319)824-6945 Grundy

1010 NORTH 15TH STREET

HUMBOLDT, IA 50548

(515)332-2015 Humboldt

208 MAIN STREET

LAKE VIEW, IA 51450

(712)657-8513 Sac

307 WEST HIGHWAY 10

LAURENS, IA 50554

(712)841-4516 Pocahontas

1303 11TH AVENUE

MANSON, IA 50563

(712)469-3307 Calhoun

124 1ST AVENUE SE

OELWEIN, IA 50662

(563)283-2651 Fayette

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Iowa CCN

Key Provider Name *

UNITYPOINT CLINIC FAMILY MEDICINE PARKERSBURG * 168925 UNITYPOINT CLINIC FAMILY MEDICINE POCAHONTAS * 168918 UNITYPOINT CLINIC FAMILY MEDICINE SAC CITY None UNITYPOINT CLINIC FAMILY 168962 MEDICINE SECOND AVE NORTH * 168900 UNITYPOINT CLINIC FAMILY MEDICINE TIPTON * 163896 UNITYPOINT CLINIC FAMILY MEDICINE VINTON None UNITYPOINT CLINIC PEDIATRICS 168961 FORT DODGE None UNITYPOINT HEALTH JONES 168588 REGIONAL MEDICAL CENTER * 168586 UNITYPOINT HLTH JONES REG MED CTR ANAMOSA CLINIC * 163485 URBANA FAMILY MEDICAL CLINIC * 163468 VAN HORNE FAMILY MEDICAL CLINIC * 168510 VICTOR HEALTH CENTER * 163461 VINTON FAMILY MEDICAL CLINIC * 163400 WALL LAKE MEDICAL CLINIC None 168568 WASHINGTON CO HOSP AND CLINICS FAMILY MEDICINE None WASHINGTON CO HOSP AND 168567 CLINICS FAMILY MEDICINE None WASHINGTON COUNTY HOSPITAL & 168573 CLINICS KALONA CLINIC None WILLIAMSBURG FAMILY MEDICAL 168564 CLINIC * 168540 WOMEN'S CLINIC Total Providers for this State = 170

168903

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 7

Address

City, State and ZIP

Telephone # County Name

502 THIRD STREET

PARKERSBURG, IA 50665

(319)346-2331 Butler

608 NW SEVENTH STREET

POCAHONTAS, IA 50574

(712)335-5632 Pocahontas

301 HIGHLAND AVENUE

SAC CITY, IA 50583

(712)662-7119 Sac

1428 2ND AVENUE NORTH

FORT DODGE, IA 50501

(515)574-6110 Webster

1412 CEDAR STREET

TIPTON, IA 52772

(563)886-2182 Cedar

1803 C AVENUE

VINTON, IA 52349

(319)472-2304 Benton

804 KENYON ROAD, SUITE D

FORT DODGE, IA 50501

(515)574-6855 Webster

740 E OAK STREET

MONTICELLO, IA 52310

(319)465-6702 Jones

1791 HIGHWAY 64 EAST

ANAMOSA, IA 52205

(563)462-3571 Jones

1002 WEST MAIN STREET 205 MAIN STREET

URBANA, IA 52345 VAN HORNE, IA 52346

(319)472-6318 Benton (319)228-8240 Benton

709 2ND STREET 504 NORTH NINTH AVENUE 311 WEST FIRST STREET 444 EAST POLK STREET

VICTOR, IA 52347 VINTON, IA 52349 WALL LAKE, IA 51466 WASHINGTON, IA 52353

(319)647-7511 Iowa (319)472-6300 Benton (712)664-2800 Sac (319)653-6601 Washington

1230 SOUTH IOWA AVENUE, BOX 909

WASHINGTON, IA 52353

(319)653-7291 Washington

207 FIRST STREET, SUITE4

KALONA, IA 52247

(319)656-3700 Washington

498 N HIGHLAND STREET

WILLIAMSBURG, IA 52361

(319)668-6789 Iowa

312 9TH STREET SW, SUITE 2200

WAVERLY, IA 50677

(319)483-4074 Bremer

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN

Key Provider Name *

ALLEN COUNTY REGIONAL CLINIC COMMUNITY CLINIC * ANDERSON CO HOSP FAM CARE CTR

*

173403 ANTHONY PRIMARY CARE CENTER * 178913 ARK CITY CLINIC PA * 173476 ASHLAND HEALTH CENTER * 178923 ASHLEY CLINIC * 178997 ASSOCIATES IN FAMILY CARE, OSAWATOMIE * 178994 ASSOCIATES IN FAMILY CAREPAOLA * 178521 ATCHISON INTERNAL MEDICINE & FAMILY PRACTICE

*

178533 ATTICA RURAL HEALTH CLINIC None AUGUSTA FAMILY PRACTICE 703805 * 178951 AUGUSTA FAMILY PRACTICE * 173416 BLUE RAPIDS MEDICAL CLINIC * 178537 BUCKLIN COMMUNITY CLINIC * 178973 CALDWELL FAMILY CLINIC * 173414 CEDAR VALE RURAL HEALTH CLINIC * 178576 CENTRAL KANSAS FAMILY PRACTICE * 173483 CENTRALIA MEDICAL CLINIC * 178585 CHASE COUNTY FAMILY HEALTH CTR * 178593 CHERRYVALE FAMILY MEDICINE * 178566 CHETOPA COMMUNITY CLINIC * 173478 CHEYENNE COUNTY CLINIC * 173477 CHEYENNE COUNTY CLINIC-ST FRANCIS None CLARA BARTON MEDICAL CLINIC178591 GREAT BEND * 173466 CLARA BARTON RURAL HEALTH CLINIC * = Non-Deemed

178578 178598 173438

None ALTAMONT

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 7

Address

City, State and ZIP

Telephone # County Name

401 SOUTH WASHINGTON 401 S WABASH 536 W FOURTH PO BOX 309

IOLA, KS 66749 ALTAMONT, KS 67330 GARNETT, KS 66032

(620)365-6933 Allen (620)784-5784 Labette (785)448-2674 Anderson

1101 E SPRING ST 510 WEST RADIO LANE 529 W 7TH 505 S PLUMMER 100 EAST MAIN STREET

ANTHONY, KS 67003 ARKANSAS CITY, KS 67005 ASHLAND, KS 67831 CHANUTE, KS 66720 OSAWATOMIE, KS 66064

(620)842-5144 Harper (620)442-2100 Cowley (620)635-2222 Clark (620)431-2500 Neosho (913)755-3044 Miami

2102 BAPTISTE DRIVE STE A

PAOLA, KS 66071

(913)557-5678 Miami

810 RAVEN HILL DRIVE

ATCHISON, KS 66002

(913)367-7300 Atchison

302 N BOTKIN 1230 E 6TH SUITE 2C 1306 STATE STREET 607 LINCOLN ST 101 N FORD AVENUE, BOX 625 415 S OSAGE 508 WASHINGTON STREET 1309 POLK STREET

ATTICA, KS 67009 WINFIELD, KS 67156 AUGUSTA, KS 67010 BLUE RAPIDS, KS 66411 BUCKLIN, KS 67834 CALDWELL, KS 67022 CEDAR VALE, KS 67024 GREAT BEND, KS 67530

(620)254-7272 Harper (620)402-6699 Cowley (316)775-9191 Butler (785)363-7202 Marshall (620)826-3266 Ford (620)845-2516 Sumner (620)758-2221 Chautauqua (620)792-5341 Barton

606 FIRST STREET 411 WALNUT

(785)857-3334 Nemaha (620)273-6131 Chase

203 WEST MAIN STREET 429 MAPLE 221 W 4TH STREET 221 W FIRST STREET

CENTRALIA, KS 66415 COTTONWOOD FALLS, KS 66845 CHERRYVALE, KS 67335 CHETOPA, KS 67336 BIRD CITY, KS 67731 SAINT FRANCIS, KS 67756

1031 JACKSON STREET

GREAT BEND, KS 67530

(620)793-6990 Barton

252 W 9TH

HOISINGTON, KS 67544

(620)653-2386 Barton

(620)336-2131 Montgomery (620)236-7351 Labette (785)734-2306 Cheyenne (785)332-2682 Cheyenne

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN 178596 173856 178595 173982 173404 178549 178603 178587 178968 178564 173433 178958 173485 178999 173498 178925 173402 178538 173497 178544 178917 173469 178586 178508 178580 178579 178594 178966 178511

Key Provider Name *

Address

CLAY CENTER FAMILY PHYSICIANS 609 LIBERTY CLYDE FAMILY PHYSICIANS 815 W CAMPBELL * CLYDE FAMILY PHYSICIANS 815 W CAMPBELL * COFFEY COUNTY MEDICAL CLINIC 309 SANDERS ST * COMMUNITY PHYSICIANS CLINIC 1902 MAY STREET * CONWAY SPRINGS RHC 111 W SPRING AVENUE None CRMC MEDICAL GROUP 1400 WEST 4TH STREET STE 100 None CUNNINGHAM CLINIC 112 N MAIN * DANIEL J SANCHEZ MD PA 1210 N WASHINGTON * DECATUR HEALTH SYSTEMS FAMILY 902 W COLUMBIA PRACTICE CLINIC

*

DEXTER COMMUNITY RHC 204 N MAIN * DONLEY MEMORIAL CLINIC LLC 437 NORTH CEDAR STREET * DOWNTOWN MEDICAL CLINIC 112 E 2ND STREET * DRS MORRIS & HILL MEDICAL CLINIC 1525 MADISON ST SUITE 2 LLC * ECMC RURAL HEALTH CLINIC 216 S MAIN LUCAS * EL DORADO CLINIC PA 700 W CENTRAL SUITE 205 * ELLINWOOD HOSPITAL CLINIC 611 N MAIN * ELLIS FAMILY CARE CENTER 1000 WASHINGTON STREET * ELLSWORTH MEDICAL CLINIC 1602 AYLWARD * EUREKA CLINIC 100 WEST 16TH * F ALLEN MOORHEAD JR MD 709 MAIN STREET * FAMILY CARE CENTER 1100 HIGHLAND DRIVE None FAMILY CARE CENTER SOUTH 309 N PINE * FAMILY CENTER FOR HEALTH CARE 310 E COLLEGE DRIVE None FAMILY HEALTH CENTER 506 THORPE ST None FAMILY HEALTH CENTER 521 MAIN None FAMILY MEDICINE OF WASHINGTON 302 E 2ND STREET COUNTY * FAMILY PRAC ASSOC OF WSTRN KS 120 WEST ROSS BLVD * FAMILY PRACTICE ASSOCIATES 1100 COLUMBINE DRIVE *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 7

City, State and ZIP

Telephone # County Name

CLAY CENTER, KS 67432 LINN, KS 66953 CLYDE, KS 66938 BURLINGTON, KS 66839 MARYSVILLE, KS 66508 CONWAY SPRINGS, KS 67031 COFFEYVILLE, KS 67337 CUNNINGHAM, KS 67035 PLAINVILLE, KS 67663 OBERLIN, KS 67749

(785)632-2181 Clay (785)446-2226 Washington (785)446-2226 Cloud (620)364-5395 Coffey (785)562-3942 Marshall (620)456-2411 Sumner (620)688-6566 Montgomery (620)298-2397 Kingman (785)434-2622 Rooks (785)475-2015 Decatur

DEXTER, KS 67038 KINGMAN, KS 67068 FRANKFORT, KS 66427 FREDONIA, KS 66736

(620)876-5863 Cowley (620)532-3101 Kingman (785)292-4451 Marshall (620)378-2068 Wilson

LUCAS, KS 67648

(785)525-7788 Russell

EL DORADO, KS 67042 ELLINWOOD, KS 67526 ELLIS, KS 67637 ELLSWORTH, KS 67439 EUREKA, KS 67045 NEODESHA, KS 66757 CONCORDIA, KS 66901 COLONY, KS 66015 COLBY, KS 67701 LAKIN, KS 67860 DEERFIELD, KS 67838 WASHINGTON, KS 66968

(316)321-2010 Butler (620)564-2548 Barton (785)726-4956 Ellis (785)810-1177 Ellsworth (620)583-5274 Greenwood (620)325-2200 Wilson (785)243-4272 Cloud (620)852-3600 Anderson (785)462-6184 Thomas (620)355-7550 Kearny (620)426-2990 Kearny (785)519-6111 Washington

DODGE CITY, KS 67801 HOLTON, KS 66436

(620)225-1650 Ford (785)364-2126 Jackson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN

Key Provider Name

178575

*

178523

*

178513 178536 173452 178520

*

178532

*

178552 178569 178515

*

178550 173805 178522

*

173494 173480 173481

*

178547

*

173407 178540 173464 173491 178574

*

178563 178557

*

178517

*

* * *

* *

* *

* *

* * * *

*

* = Non-Deemed

FAMILY PRACTICE ASSOCIATES (WETMORE) FAMILY PRACTICE ASSOCIATES HOYT FARMER CLINIC FOWLER COMMUNITY CLINIC GCH RURAL HEALTH CLINIC GIRARD MEDICAL CENTER OF CHEROKEE GIRARD MEDICAL CENTER OF FRONTENAC GIRARD RURAL HEALTH CLINIC GOAD MEDICAL CLINIC GOODLAND FAMILY HEALTH CENTER GRAHAM COUNTY HOSPITAL CLINIC GREAT BEND CHILDREN'S CLINIC PA GREELEY CO FAMILY PRACTICE CLINIC GREENSBURG FAMILY PRACTICE GRISELL MEMORIAL HOSPITAL RHC GRISELL MEMORIAL HOSPITAL SATELLITE RHC HAMILTON COUNTY FAMILY PRACTICE CLINIC HARPER HOSP MED CLINIC HAVILAND CLINIC HCH FAMILY PRACTICE HCH HIGHLAND CLINIC HEALTH PROFESSIONALS OF WINFIELD HEARTLAND HEALTH CARE CENTER HEARTLAND REGIONAL HEALTH CLINIC HERINGTON AREA HEALTH CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 7

Address

City, State and ZIP

Telephone # County Name

323 SECOND STREET

WETMORE, KS 66550

(785)364-2116 Nemaha

117 WEST 3RD STREET

HOYT, KS 66440

(785)986-6630 Jackson

802 W BROADWAY 404 MAIN ST PO BOX 462 1110 SAINT MARY'S RD 120 NW HIGHWAY 400

STAFFORD, KS 67578 FOWLER, KS 67844 JUNCTION CITY, KS 66441 CHEROKEE, KS 66724

(620)234-6826 Stafford (620)646-5446 Meade (785)762-3388 Geary (620)457-8100 Crawford

1011 N 69 HWY

FRONTENAC, KS 66763

(620)235-1377 Crawford

307 N HOSPITAL DRIVE STE 1, 4, 5 431 W NEW HAMPSHIRE 106 WILLOW STREET

GIRARD, KS 66743 OSBORNE, KS 67473 GOODLAND, KS 67735

(620)724-4659 Crawford (785)346-2510 Osborne (785)890-6075 Sherman

114 E WALNUT ST 1021 EISENHOWER 321 E HARPER

HILL CITY, KS 67642 GREAT BEND, KS 67530 TRIBUNE, KS 67879

(785)421-2191 Graham (620)792-5437 Barton (620)376-4251 Greeley

721 W KANSAS 206 S VERMONT AVE 114 E MAIN

GREENSBURG, KS 67054 RANSOM, KS 67572 NESS CITY, KS 67560

(620)723-2127 Kiowa (785)731-2295 Ness (785)798-2955 Ness

700 N HUSER

SYRACUSE, KS 67878

(620)384-7350 Hamilton

700 W 13TH STREET 106 N MAIN 300 UTAH 2ND FLOOR 415 WEST MAIN 1230 E 6TH AVE STE 1B

HARPER, KS 67058 HAVILAND, KS 67059 HIAWATHA, KS 66434 HIGHLAND, KS 66035 WINFIELD, KS 67156

(620)896-7306 Harper (620)862-5431 Kiowa (785)742-2161 Brown (785)442-3213 Doniphan (620)221-4000 Cowley

511 NE 10TH 514 CLEVELAND STREET

ABILENE, KS 67410 GREAT BEND, KS 67530

(785)263-4131 Dickinson (620)793-7520 Barton

1005 NORTH B STREET

HERINGTON, KS 67449

(785)258-5130 Dickinson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 7

Address

City, State and ZIP

Telephone # County Name (620)947-1421 Marion (785)623-2360 Ellis (785)364-3205 Jackson (785)252-3565 Ellsworth (785)486-2998 Brown (620)374-2650 Elk (620)669-2500 Reno (620)669-6690 Reno (620)669-2500 Reno

178567 173458 173482 173499 173489 178542 178908 173882 703804

*

HILLSBORO CLINIC HMC PEDIATRIC CENTER * HOLTON FAMILY HEALTH CLINIC * HOLYROOD MEDICAL CLINIC * HORTON RURAL HEALTH CLINIC * HOWARD CLINIC * HUTCHINSON CLINIC * HUTCHINSON CLINIC PA INC None HUTCHINSON CLINIC WALK-IN CARE

101 INDUSTRIAL ROAD 2214 CANTERBURY DRIVE SUITE 204 1603 W 4TH STREET 101 S MAIN 1903 EUCLID AVE 118 S WABASH 2101 N WALDRON 1100 N MAIN 24 SOUTH MAIN STREET

178582 178589

*

1415 N PENN AVENUE 1428 SOUTH MAIN, SUITE 4

HILLSBORO, KS 67063 HAYS, KS 67601 HOLTON, KS 66436 HOLYROOD, KS 67450 HORTON, KS 66439 HOWARD, KS 67349 HUTCHINSON, KS 67502 HUTCHINSON, KS 67501 SOUTH HUTCHINSON, KS 67505

INDEPENDENCE, KS 67301 OTTAWA, KS 66067

102 S CENTER

MANKATO, KS 66956

(785)378-3511 Jewell

807 E 4TH 1002 S 4TH STREET 1017 E MARKET STREET 116 N MAPLE

KINSLEY, KS 67547 KIOWA, KS 67070 LA CYGNE, KS 66040 CHERRYVALE, KS 67335

(620)659-3639 Edwards (620)825-4121 Barber (913)757-4575 Linn (620)336-3255 Montgomery

1902 S HWY 59 BLDG E STE 101

PARSONS, KS 67357

(620)820-5800 Labette

209 E LAUREL ST

INDEPENDENCE, KS 67301

(620)577-4310 Montgomery

444 W LONG 538 S C ST PO BOX 212 313 E FRANKLIN 706 W 3RD ST 102 WEST CRESTVIEW CIRCLE SUITE 200 1221 W NOBLE 119 N HART 710 NORTH WALNUT STREET

DIGHTON, KS 67839 LE ROY, KS 66857 LINCOLN, KS 67455 LINN, KS 66953 LOUISBURG, KS 66053

(620)397-5316 Lane (620)964-2264 Coffey (785)524-4474 Lincoln (785)348-5503 Washington (913)837-4299 Miami

173479 173449 178506 178995 178570 178571 178600 173475 173984 173405 178597 178996 178568 178529 178545

*

INDEPENDENCE FAMILY MEDICINE MEDICINE ASSOCIATES OF OTTAWA * JEWELL COUNTY RURAL HEALTH CLINIC * KINSLEY RURAL HEALTH CLINIC * KIOWA DISTRICT HOSP - CLINIC * LA CYGNE FAMILY CARE * LABETTE HEALTH CHERRYVALE CLINIC

*

LABETTE HEALTH FAMILY PRACTICE CLINIC None LABETTE HEALTH INDEPENDENCE CLINIC * LANE COUNTY MEDICAL CLINIC * LEROY MEDICAL CLINIC * LINCOLN COUNTY MEDICAL CLINIC * LINN FAMILY PHYSICIANS * LOUISBURG FAMILY CARE None INTERNAL

* * *

* = Non-Deemed

LYONS MEDICAL CENTER MEADE RURAL HEALTH CLINIC MEDICINE LODGE MEMORIAL HOSPITAL PHYSICIANS CLINIC

(620)331-2400 Montgomery (785)229-8309 Franklin

LYONS, KS 67554 (620)257-5124 Rice MEADE, KS 67864 (620)873-2112 Meade MEDICINE LODGE, KS 67104 (620)930-3704 Barber

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN 178982 173422 173420 173495 178535 173425 178601 178998 703808 173822 178560 178562 178584 178592 178518 173992 173486 178561 173876 178581 178502 178528 178987 178583 173487 178602 178504 178541

Key Provider Name *

Address

MERCY CLINIC - COLUMBUS FAMILY 101 W SYCAMORE MEDICINE

*

MERCY HOSPITAL FORT SCOTT 601 E WASHINGTON ARMA FAMILY MEDICINE * MERCY HOSPITAL FORT SCOTT11155 TUCKER ROAD LINN COUNTY FAMILY MEDIC * MIDWAY CLINIC 604 W 8TH * MINNEOLA COMMUNITY CLINIC 222 MAIN ST PO BOX 127 * MOLINE COMM RURAL HEALTH 200 N PLUM ST CLINIC None MORTON COUNTY MEDICAL CLINIC 411 SUNSET STREET * MOUND CITY FAMILY CARE 302 N 1ST STREET None MUDDY CREEK FAMILY CLINIC LLC 200 WHITE WAY STREET * MULVANE FAMILY CARE CENTER 102 E MAIN * NESS CITY MEDICAL CLINIC 316 CUSTER ST * NEW FRONTIERS HEALTH SERVICES 212 MAPLE AVE None NMRMC ERIE FAMILY CARE CLINIC 13920 HIGHWAY 59 * NMRMC FAMILY MEDICINE 1501 W 7TH STREET * NORTON MEDICAL CLINIC 807 N STATE STREET * O'SHEA MEMORIAL CLINIC 810 WEST BRAMLEY * ONAGA CLINIC 114 W 8TH STREET * OSWEGO COMMUNITY CLINIC 800 BARKER DRIVE SUITE B * OTTAWA FAMILY PHYSICIANS, 1418 S MAIN SUITE 5 CHARTERED

*

PAWNEE VALLEY MEDICAL 713 W 11TH ASSOCIATES * PHILLIPS COUNTY MEDICAL CLINIC 1719 HIGHWAY 183 * PLAINS RURAL HEALTH CLINIC 402 GRAND AVE * PRATT FAMILY PRACTICE 203 WATSON SUITE 200 * PRATT INTERNAL MEDICINE GROUP 420 COUNTRY CLUB RD * RAWLINS CLINIC/ATWOOD 707 GRANT ST None ROLLA MEDICAL CLINIC 415 WASHINGTON * RRH PHYSICIAN'S CLINIC 222 S MAIN * RUSH COUNTY MEDICAL CLINIC 801 LOCUST STREET

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 7

City, State and ZIP

Telephone # County Name

COLUMBUS, KS 66725

(620)429-3636 Cherokee

ARMA, KS 66712

(620)347-4033 Crawford

PLEASANTON, KS 66075

(913)352-8379 Linn

KINSLEY, KS 67547 MINNEOLA, KS 67865 MOLINE, KS 67353

(620)659-2732 Edwards (620)885-4202 Clark (620)647-8109 Elk

ELKHART, KS 67950 MOUND CITY, KS 66056 NETAWAKA, KS 66516 MULVANE, KS 67110 NESS CITY, KS 67560 OAKLEY, KS 67748 ERIE, KS 66733 CHANUTE, KS 66720 NORTON, KS 67654 JETMORE, KS 67854 ONAGA, KS 66521 OSWEGO, KS 67356 OTTAWA, KS 66067

(620)697-2175 Morton (913)795-2203 Linn (785)933-2000 Jackson (316)777-0106 Sumner (785)798-2233 Ness (785)672-3261 Logan (620)244-5105 Neosho (620)432-5588 Neosho (785)877-3305 Norton (620)357-8354 Hodgeman (785)889-4241 Pottawatomie (620)795-2921 Labette (785)242-1620 Franklin

LARNED, KS 67550

(620)804-6007 Pawnee

PHILLIPSBURG, KS 67661 PLAINS, KS 67869 PRATT, KS 67124 PRATT, KS 67124 ATWOOD, KS 67730 ROLLA, KS 67954 RUSSELL, KS 67665 LA CROSSE, KS 67548

(785)543-5211 Phillips (620)563-9313 Meade (620)672-7422 Pratt (620)672-7415 Pratt (785)626-3241 Rawlins (620)593-4242 Morton (785)483-3333 Russell (785)222-2564 Rush

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN 178519 173455 173454 173492 173843 178507 178505 178599 178539 703806 178512 178934 173893 178983 178551 173484 173432 178572 178565 173446 173819 173408 178526 173423 178969 173991 173465

Key Provider Name *

RUSSELL FAMILY MEDICAL CLINIC SATANTA HOSP CLINIC-SATANTA BRANCH * SATANTA HOSP CLINIC-SUBLETTE BRANCH * SCOTT CITY CLINIC * SENECA FAMILY PACTICE PA * SENECA FAMILY PRACTICE PA * SMITH COUNTY FAMILY PRACTICE None SOUTH CENTRAL KANSAS CLINIC LLC * SPEARVILLE MEDICAL CLINIC None SPRING RIVER MEDICAL CLINIC * ST JOHN CLINIC * ST JOHN CLINIC * ST JOHN CLINIC (CANEY) * ST JOHN'S CLINIC-OSWEGO-FAMILY MEDICINE * ST LUKE MEDICAL CLINIC * ST MARYS CLINIC * ST PAUL RURAL HEALTH CLINIC None STANTON COUNTY FAMILY PRACTICE * STERLING MEDICAL CENTER * STEVENS COUNTY RURAL HEALTH CLINIC * SUMNER COUNTY FAMILY CARE CENTER * SYLVAN MEDICAL CLINIC * SYLVIA HEALTH CARE CLINIC * TALLGRASS RURAL HEALTH CLINIC * THE FAMILY PHYSICIANS * TROY MEDICAL CLINIC * ULYSSES FAMILY PHYSICIANS *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 7

Address

City, State and ZIP

Telephone # County Name

410 N MAIN ST 410 S CHEYENNE ST PO BOX 9

RUSSELL, KS 67665 SATANTA, KS 67870

(785)483-3811 Russell (620)649-2771 Haskell

301 SOUTH DERBY

SUBLETTE, KS 67877

(620)675-2686 Haskell

201 ALBERT AVENUE 201 NORTH SIXTH 1600 COMMUNITY DRIVE 119 E PARLIAMENT 515 NORTH SUMMIT STREET

SCOTT CITY, KS 67871 SENECA, KS 66538 SENECA, KS 66538 SMITH CENTER, KS 66967 ARKANSAS CITY, KS 67005

(620)872-2187 Scott (785)336-6107 Nemaha (785)336-6107 Nemaha (785)282-6834 Smith (620)442-4850 Cowley

205 HALL STREET 6524 SE QUAKERVALE RD 609 E FIRST AVE 1505 W 11TH, SUITE C 218 WEST 4TH STREET 805 BARKER DRIVE

SPEARVILLE, KS 67876 RIVERTON, KS 66770 SAINT JOHN, KS 67576 COFFEYVILLE, KS 67337 CANEY, KS 67333 OSWEGO, KS 67356

(620)385-2963 Ford (620)848-2380 Cherokee (620)549-3251 Stafford (620)251-5400 Montgomery (620)879-2182 Montgomery (620)795-2525 Labette

537 S FREEBORN STREET 206 GRAND AVENUE 200 CARROLL 404 N CHESTNUT STREET

MARION, KS 66861 SAINT MARYS, KS 66536 SAINT PAUL, KS 66771 JOHNSON, KS 67855

(620)382-2033 Marion (785)437-3734 Pottawatomie (620)449-2582 Neosho (620)492-1400 Stanton

239 N BROADWAY 1006 S JACKSON PO BOX 10

STERLING, KS 67579 HUGOTON, KS 67951

(620)278-2123 Rice (620)544-8563 Stevens

507 E 16TH STREET SUITE 1

WELLINGTON, KS 67152

(620)326-3301 Sumner

219 N MAIN STREET 200 S MAIN ST 300 NORTH STREET 1408 EAST STREET 311 WEST LOCUST 505 N MAIN STREET

SYLVAN GROVE, KS 67481 SYLVIA, KS 67581 SEDAN, KS 67361 IOLA, KS 66749 TROY, KS 66087 ULYSSES, KS 67880

(785)526-7474 Lincoln (620)486-2985 Reno (620)725-3818 Chautauqua (620)365-3115 Allen (785)985-3504 Doniphan (620)356-1261 Grant

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Kansas CCN

Key Provider Name *

WAKEENEY FAMILY CARE CENTER WALLACE CO FAMILY PRACTICE CLINIC * 178510 WAMEGO FAMILY CLINIC * 173983 WAVERLY MEDICAL CLINIC None WELLSVILLE FAMILY MEDICAL 178590 CLINIC * 173488 WICHITA COUNTY HEALTH CENTER CLINIC * 178500 WILSON MEDICAL CLINIC * 178964 WINFIELD MEDICAL ARTS PA * 178559 YATES CENTER MEDICAL CENTER RURAL HEALTH CLINIC Total Providers for this State = 170

178530 178525

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 7

Address

City, State and ZIP

Telephone # County Name

333 N 14TH STREET 504 EAST 6TH STREET

WA KEENEY, KS 67672 SHARON SPGS, KS 67758

(785)743-2124 Trego (785)852-4230 Wallace

711 GENN DRIVE 302 PEARSON PO BOX 65 424 MAIN STREET

WAMEGO, KS 66547 WAVERLY, KS 66871 WELLSVILLE, KS 66092

(785)458-7420 Pottawatomie (785)733-2667 Coffey (785)883-4863 Franklin

211 E EARL

LEOTI, KS 67861

(620)375-2222 Wichita

2509 N AVE E 3625 QUAIL RIDGE DRIVE 1004 E MADISON

WILSON, KS 67490 WINFIELD, KS 67156 YATES CENTER, KS 66783

(785)658-3688 Ellsworth (620)221-6100 Cowley (620)625-2312 Woodson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name

268593 268921 268671

*

268945 268622

*

268669 268572 268522 263471

*

263449

*

268505 268740

*

793825 268649 268942 263486 268647

*

268694

*

268681 793809 268626

*

268627

*

263488

*

268628

*

* *

*

* * *

* * * *

* *

* = Non-Deemed

Page 1 of 15

City, State and ZIP

Telephone # County Name

A C RURAL HEALTH CLINIC 408 E 7TH, PO BOX 97 A PLUS FAMILY CLINIC 203 EAST 3RD STREET AKEMAN MCBURNEY HEALTH CLINIC 420 WEST FRONT STREET

APPLETON CITY, MO 64724 PORTAGEVILLE, MO 63873 SLATER, MO 65349

(660)476-2121 St. Clair (573)379-2100 New Madrid (660)529-2251 Saline

APOLLO HEALTHCARE, LLC APPLE-KIDS PEDIATRICS

1031 E KARSCH 590 PINE STREET

(573)756-7880 St. Francois (573)883-4455 Ste. Genevieve

APPLEGATE MEDICAL GROUP ARCADIA VALLEY FAMILY CLINIC ARCHIE MEDICAL CLINIC ASH GROVE FAMILY MEDICAL CENTER ASSOCIATED MEDICAL ARTS

125 E LOCKLING 200 ST MARY, BOX 523 709 E PINE ST, PO BOX 48 500 NORTH MEDICAL DRIVE

FARMINGTON, MO 63640 SAINTE GENEVIEVE, MO 63670 BROOKFIELD, MO 64628 PILOT KNOB, MO 63663 ARCHIE, MO 64725 ASH GROVE, MO 65604

(314)564-2486 Montgomery

AUSTIN PLAZA PRIMARY CARE COMMUNITY CARE CENTER BEST MEDICAL LLC BETHANY MEDICAL CLINIC BEYER MEDICAL GROUP BLOOMFIELD MEDICAL CLINIC BLOOMSDALE FAMILY HEALTH CENTER BOLIVAR FAMILY CARE CENTER, LLC BONNE TERRE MEDICAL GROUP BOOTHEEL COUNSELING SERVICES BOOTHEEL PRIMARY CARE CLINIC CARUTHERSVILLE

BOOTHEEL PRIMARY CARE CLINIC HAYTI

BOOTHEEL PRIMARY CARE CLINIC KENNETT BOOTHEEL PRIMARY CARE CLINICSTEELE

108 FRIZZELL STREET, SUITE 5 6468 STATE HIGHWAY 77

MONTGOMERY CITY, MO 63361

POTOSI, MO 63664 BENTON, MO 63736

112 UNION STREET 3202 MILLER ST 735 WEST MAIN STREET 101 SOUTH PRAIRIE 255 BODERMAN LANE

LEADINGTON, MO 63601 BETHANY, MO 64424 FREDERICKTOWN, MO 63645 BLOOMFIELD, MO 63825 BLOOMSDALE, MO 63627

(573)431-2253 St. Francois (660)425-3154 Harrison (573)783-8875 Madison (573)568-3838 Stoddard (573)483-9492 Ste. Genevieve

1240 N BUTTERFIELD RD

BOLIVAR, MO 65613

(417)326-6012 Polk

527 BENHAM STREET 760 PLANTATION BLVD 1502 WARD AVE

BONNE TERRE, MO 63628 (573)358-5577 St. Francois SIKESTON, MO 63801 (573)471-0800 New Madrid CARUTHERSVILLE, MO 63830 (573)333-4244 Pemiscot

310 E MAIN STREET

HAYTI, MO 63851

(573)359-2019 Pemiscot

900 STATE ROUTE VV

KENNETT, MO 63857

(573)888-8828 Dunklin

213 SOUTH WALNUT STREET

STEELE, MO 63877

(573)575-4416 Pemiscot

None BENTON

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

504 NORTH STURGEON ST

(660)258-8237 Linn (573)546-7000 Iron (816)430-5777 Cass (417)672-2794 Greene

(573)438-8500 Washington (573)545-3700 Scott

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name

268598

*

268527 263925 268917

*

268904 268553

*

268554

*

268937

*

793830 263405 263984

*

263972 263862

*

793800 268510

*

263474

*

268983 268715

*

268927 268727 268640 268977 268563 793824

* *

*

* *

*

*

BOTHWELL HEALTH CENTER TRUMAN LAKE BOURBON MEDICAL CLINIC BRIDGES MEDICAL SERVICES PC BRIDGES MEDICAL SERVICESBRANSON

BURTON CREEK MEDICAL CLINIC BUTTERFIELD PARK MEDICAL CENTER BUTTERFIELD PARK PEDIATRICS BYRNES MILL MEDICAL CENTER RICHWOODS C&S FAMILY MEDICAL CAMPBELL MEDICAL CLINIC CANTON-LAGRANGE FAMILY PRACTICE CAPE FAMILY MEDICAL CLINIC, LLC CAPE GIRARDEAU COUNTY RURAL HEALTH CLINIC CARUTHERSVILLE CLINIC CASSVILLE MEDICAL CARE ASSOCIATES CCMH MEDICAL MALL CLINIC

CENTRALIA FAMILY HEALTH CLINIC CHARITON VALLEY FAMILY MEDICINE * CHARLESTON FAMILY CARE None CMH OSCEOLA MEDICAL CENTER * CMH WALK-IN-CLINIC * COMMUNITY HEALTH PARTNERS LLP * COMMUNITY MEDICAL ASSOCIATES * COMPASS HEALTH WELLNESS *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 15

Address

City, State and ZIP

Telephone # County Name

1765 COMMERCIAL STREET

WARSAW, MO 65355

(660)438-6800 Benton

240 COLLEGE ROAD, PO BOX 100 PO BOX 1240 1440 STATE HIGHWAY 248, STE O

BOURBON, MO 65441 FORSYTH, MO 65653 BRANSON, MO 65616

(573)732-5140 Crawford (417)546-4200 Taney (417)239-0706 Taney

805 KENTUCKY AVE 1300 N OAKLAND AVENUE STE A

WEST PLAINS, MO 65775 BOLIVAR, MO 65613

(417)256-2111 Howell (417)326-7676 Polk

1195 NORTH OAKLAND AVENUE, SUITE BOLIVAR, MO 65613 2

10649 STATE HIGHWAY A, PO BOX 280 RICHWOODS, MO 63071

(417)777-2121 Polk

65 COUNTY ROAD 527 413 WEST GRAND 1802 ELM STREET

POPLAR BLUFF, MO 63901 CAMPBELL, MO 63933 CANTON, MO 63435

(573)785-4600 Butler (314)246-3220 Dunklin (573)288-5360 Lewis

24 N SPRIGG ST SUITE 1 1121 LINDEN STREET

CAPE GIRARDEAU, MO 63701 (573)332-7992 Cape Girardeau CAPE GIRARDEAU, MO 63703 (573)335-7846 Cape Girardeau

(573)678-2444 Washington

108 WEST 15TH STREET CARUTHERSVILLE, MO 63830 (573)333-0033 Pemiscot 75 SMITHSON DR, SUITE A, PO BOX 568 CASSVILLE, MO 65625 (417)269-2414 Barry 1317 SOUTH 32 HIGHWAY 1021 E HWY 22 413 W 2ND STREET

EL DORADO SPRINGS, MO 64744

CENTRALIA, MO 65240 SALISBURY, MO 65281

(417)876-3333 Cedar (573)682-5588 Boone (660)388-7084 Chariton

400 SOUTH MAIN ST 855 ARDUSER DRIVE 2230 S SPRINGFIELD AVE STE H-J 510 E GAY STREET, SUITE A

CHARLESTON, MO 63834 OSCEOLA, MO 64776 BOLIVAR, MO 65613 WARRENSBURG, MO 64093

(573)331-5510 Mississippi (417)646-5075 St. Clair (417)326-6000 Polk (660)747-1111 Johnson

130 EAST LOCKLING 530 ARDUSER DR

BROOKFIELD, MO 64628 OSCEOLA, MO 64776

(660)258-8237 Linn (417)646-8157 St. Clair

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 793837 793838 263857 268980 263874 263470 268732 268565 268531 263962 263472 268617 268564 268733 268692 263480 268543 268501 268571 268684 263451 263496 268595 263407 263411

Key Provider Name None COMPLETE

FAMILY MEDICINE - LA PLATA None COMPLETE FAMILY MEDICINE LLC * COMPLETE FAMILY MEDICINE LLC LANCASTER

*

COMPREHENSIVE FAMILY HEALTH CARE LLC * CONWAY FAMILY CLINIC * COOPER CO RURAL HEALTH CLINIC * COX FAMILY MEDICINE OF MONETT * COX HEALTH CENTER - AURORA * COX HEALTH CENTER BUFFALO * COX HEALTH CENTER LEBANON * COX HEALTH CENTER MARSHFIELD * COX HEALTH CENTER MT VERNON * COX HEALTH CENTER ROGERSVILLE

*

COX HEALTH CENTER SHELL KNOB * COXHEALTH CENTER BRANSON * COXHEALTH CENTER BRANSON WEST

*

COXHEALTH CENTER CRANE * COXHEALTH CENTER KIMBERLING CITY * COXHEALTH CENTER MOUNTAIN GROVE

*

COXHEALTH CENTER REPUBLIC * COXHEALTH CENTER SEYMOUR * COXHEALTH FAMILY MEDICINE & OBSTETRICS *

COXHEALTH FAMILY MEDICINE BRANSON HWY 248 * CUBA MEDICAL OFFICE * DADE COUNTY FAMILY MEDICAL CENTER

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 15

Address

City, State and ZIP

Telephone # County Name

29934 JULY ROAD

LA PLATA, MO 63549

(660)332-7576 Macon

1611 S BALTIMORE STREET 1000 W WASHINGTON STREET

KIRKSVILLE, MO 63501 LANCASTER, MO 63548

(660)665-7575 Adair (660)665-9038 Schuyler

142 SOUTH WINCHESTER, PO BOX 650 BENTON, MO 63736

(573)545-4484 Scott

301 SOUTH NEWPORT AVE, PO BOX 9 17601 HIGHWAY B, PO BOX 88 307 WEST BENTON 106 COMMERCE, PO BOX 71 119 NORTH ASH 510 E HIGHWAY 32 941 HUBBLE DR, PO BOX 589 10763 HIGHWAY 39, SUITE 200 151 JOHNSTOWN DRIVE

CONWAY, MO 65632 BOONVILLE, MO 65233 MONETT, MO 65708 AURORA, MO 65605 BUFFALO, MO 65622 LEBANON, MO 65536 MARSHFIELD, MO 65706 MOUNT VERNON, MO 65712 ROGERSVILLE, MO 65742

(417)589-2050 Laclede (660)882-7461 Cooper (417)236-2410 Barry (417)269-2400 Lawrence (417)345-2231 Dallas (417)532-8700 Laclede (417)859-2339 Webster (417)269-2460 Lawrence (417)269-2252 Webster

25376 STATE HWY 39, SUITE 301 890 HWY 248 18452 BUSINESS 13

SHELL KNOB, MO 65747 BRANSON, MO 65616 BRANSON WEST, MO 65737

(417)858-6845 Barry (417)269-3721 Taney (417)272-8911 Stone

102 CORTNEY LANE 2 KIMBERLING BVLD

CRANE, MO 65633 (417)723-8537 Stone KIMBERLING CITY, MO 65686 (417)739-2520 Stone

1602 A NORTH MAIN ST

MOUNTAIN GROVE, MO 65711 (417)926-5572 Wright

820 SOUTH ILLINOIS 202 N COMMERCIAL ST 545 N BRANSON LANDING BLVD, SUITE 508

1150 STATE HWY 248, STE 202

REPUBLIC, MO 65738 SEYMOUR, MO 65746 BRANSON, MO 65616

(417)269-1910 Greene (417)935-2213 Webster (417)335-7540 Taney

BRANSON, MO 65616

(417)348-8964 Taney

102 OZARK STREET, SUITE B PO BOX 367

CUBA, MO 65453 GREENFIELD, MO 65661

(573)885-3499 Crawford (417)637-5133 Dade

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name *

Address

DALLAS CO COMM MEDICAL CEN 102 N ASH ST, PO BOX 1730 DENT MEDICAL CLINIC 1010 E SCENIC RIVERS BLVD * DESOTO FAMILY PRACTICE 12 JEFFERSON SQUARE None DEXTER COMMUNITY CARE CENTER 1523 W BUSINESS US HIGHWAY 60 STE 1 * 263440 DEXTER MEDICAL CENTER 610 NORTH ONE MILE ROAD, PO BOX 399 * 263875 DIXON FAMILY PRACTICE AND 206 WEST SECOND, PO BOX 235 INTERNAL MEDICINE LLC * 268537 DOCTOR'S CLINIC 106 WEST 12TH STREET * 268700 EAGLEVILLE MEDICAL CLINIC 12050 12TH STREET * 263460 EASTERN MO HEALTH SERVICES 2305 WEST GEORGIA STREET * 263468 EASTERN MO HEALTH SERVICES 1015 WEST ADAMS STREET * 793834 FAMILIES 1ST OF DESOTO LLC 127 W PRATT * 268734 FAMILY AND OCCUPATIONAL 2200 E CLEVELAND AVE MEDICINE OF MONETT * 268606 FAMILY CARE CLINIC - NURSERY 617 W NURSERY ST STREET

*

268667 FAMILY CARE CLINIC ADRIAN 102 E MAIN STREET * 268646 FAMILY CARE CLINIC HIGH STREET 706 SOUTH HIGH None FAMILY CARE CLINIC RICH HILL 268749 225 N 14TH STREET * 268580 FAMILY HEALTH CARE - POINTE 753 POINTE BASSE DR BASSE * 263418 FAMILY HEALTH CENTER OF EDINA 205 SOUTH FIFTH ST, PO BOX 8 * 793802 FAMILY MEDICAL CENTER OF 1632 MISSOURI AVENUE CARTHAGE

*

268735 FAMILY PRACTICE & OBSTETRICS 813 NORTH LINCOLN, SUITE B OF MONETT * 268743 FAMILY PRACTICE OF CENTRAL 513 BURKARTH RD MISSOURI * 268742 FAMILY PRACTICE OF CENTRAL 1200 WEST 22ND STREET MISSOURI

*

268944 FAMILY PREFERENCE HEALTH CARE 201 W MAIN CLINIC * 263939 FAMILY WALK IN CLINIC OF 205 W 3RD, SUITE 3 MOUNTAIN GROVE, INC * = Non-Deemed

263482 263824 263849 268739

*

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 15

City, State and ZIP

Telephone # County Name

BUFFALO, MO 65662 SALEM, MO 65560 DE SOTO, MO 63020 DEXTER, MO 63841

(417)345-6100 Dallas (573)729-5533 Dent (636)586-6685 Jefferson (573)614-5762 Stoddard

DEXTER, MO 63841

(314)624-3600 Stoddard

DIXON, MO 65459

(573)759-3030 Pulaski

CARUTHERSVILLE, MO 63830 EAGLEVILLE, MO 64442 LOUISIANA, MO 63353 BOWLING GREEN, MO 63334 DE SOTO, MO 63020 MONETT, MO 65708

(573)333-1782 Pemiscot (816)632-2101 Harrison (314)754-4584 Pike (314)324-5300 Pike (636)337-7800 Jefferson (417)236-2600 Barry

BUTLER, MO 64730

(660)200-2004 Bates

ADRIAN, MO 64720 BUTLER, MO 64730 RICH HILL, MO 64779 SAINTE GENEVIEVE, MO 63670 EDINA, MO 63537 CARTHAGE, MO 64836

(816)297-2640 Bates (660)679-3118 Bates (660)200-0700 Bates (314)883-2782 Ste. Genevieve (816)397-2400 Knox (417)358-1500 Jasper

MONETT, MO 65708

(417)354-1500 Barry

WARRENSBURG, MO 64093

(660)747-7751 Johnson

HIGGINSVILLE, MO 64037

(660)584-7751 Lafayette

MATTHEWS, MO 63867

(573)471-1514 New Madrid

MOUNTAIN GROVE, MO 65711 (417)926-7625 Wright

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 268933 263931 263830 263930 268978 268731 268577 263904 268722 268532 263981 268632 263458 268958 268691 263974 268625 268584 268725 268588 268583 263498 268991 263404 263852 793804 793815

Key Provider Name *

FERGUSON MEDICAL GROUP FERGUSON MEDICAL GROUP * FERGUSON MEDICAL GROUP * FERGUSON MEDICAL GROUP * FERGUSON MEDICAL GROUP None FITZGIBBON FAMILY HEALTH * FITZGIBBON PROFESSIONAL BUILDING

*

FOREST CITY FAMILY PRACTICE * FREEMAN NEOSHO PHYSICIAN GROUP * FULTON MEDICAL CLINIC * GAINESVILLE CLINIC * GALLATIN FAMILY MEDICINE * GARDEN CITY FAMILY CLINIC * GIDEON MEDICAL CLINIC * GILMAN CITY MEDICAL CLINIC * GLENNON CARE PEDIATRICS * GOLDEN CITY CLINIC * GOLDEN VALLEY MEDICAL CLINTON None GOLDEN VALLEY MEDICAL OSCEOLA * GOLDEN VALLEY MEDICAL WARSAW * GOLDEN VALLEY MEDICAL WINDSOR * GRAND RIVER MEDICAL CLINIC * HALLSVILLE AREA FAMILY CLINIC * HAMILTON FAMILY HEALTH CENTER * HANNIBAL CLINIC * HANNIBAL CLINIC AT PALMYRA * HANNIBAL CLINIC BOWLING GREEN *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 15

Address

City, State and ZIP

Telephone # County Name

100 EAST OUTER ROAD 1012 NORTH MAIN 112 W COMMERCIAL STREET 320 NORTH LINCOLN STREET 1516 W BUSINESS HWY 60 600 W MORRISON STREET, SUITE 5 2305 S HIGHWAY 65 BUILDING A

SCOTT CITY, MO 63780 SIKESTON, MO 63801 CHARLESTON, MO 63834 EAST PRAIRIE, MO 63845 DEXTER, MO 63841 FAYETTE, MO 65248 MARSHALL, MO 65340

(573)264-2211 Scott (573)471-0330 New Madrid (573)683-4010 Mississippi (573)649-3026 Mississippi (573)614-5007 Stoddard (660)248-2900 Howard (660)886-7800 Saline

1000 NORTH JEFFERSON 336 S JEFFERSON STREET

SAINT JAMES, MO 65559 NEOSHO, MO 64850

(573)265-8840 Phelps (417)455-4200 Newton

850 WEST HOSPITAL DRIVE, SUITE F 404 W STATE HWY 160, PO BOX 426 502 SOUTH MAIN 101 OLD HWY 7, PO BOX 46 100 MAIN STREET 427 MAIN ST 511 ASHLAND, SUITE A 407 MAIN STREET 1602 N 2ND STREET

FULTON, MO 65251 GAINESVILLE, MO 65655 GALLATIN, MO 64640 GARDEN CITY, MO 64747 GIDEON, MO 63848 GILMAN CITY, MO 64642 WARRENTON, MO 63383 GOLDEN CITY, MO 64748 CLINTON, MO 64735

(573)642-5338 Callaway (417)679-4613 Ozark (660)663-3751 Daviess (816)862-6203 Cass (573)448-3165 New Madrid (660)876-5533 Daviess (636)456-0543 Warren (417)537-4311 Barton (660)885-8171 Henry

675 3RD STREET

OSCEOLA, MO 64776

(417)646-2231 St. Clair

1771 COMMERCIAL

WARSAW, MO 65355

(660)438-5193 Benton

100 S TEBO

WINDSOR, MO 65360

(660)647-2147 Henry

815 EAST BROADWAY 501 N ROUTE B 103 NORTH DAVIS 100 MEDICAL DRIVE 1811 S MAIN STREET 710 BUSINESS 61 SOUTH

BRUNSWICK, MO 65236 HALLSVILLE, MO 65255 HAMILTON, MO 64644 HANNIBAL, MO 63401 PALMYRA, MO 63461 BOWLING GREEN, MO 63334

(660)548-3161 Chariton (573)696-0500 Boone (816)583-7839 Caldwell (573)221-5250 Ralls (573)769-2231 Marion (573)324-2063 Pike

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name

268696

*

268515 263869 268934

*

263410 268539 268947 268602 268548 793811 263976

*

268599 263897 268642

*

263912 263914 793807 263988 268666 268665

*

268664

*

263895

*

268918 263960

*

268659 263935

*

* *

* * * * * *

* *

* * * * *

*

*

* = Non-Deemed

HARRISON COUNTY FAMILY HEALTH CENTER HARRISONVILLE MEDICAL CLINIC HARTVILLE MEDICAL CLINIC HAVEN HEALTH CARE MEDICAL CLINIC HEALTH WAY PRIMARY CARE HEDRICK MEDICAL CENTER HERITAGE MEDICAL CLINIC HERMANN MEDICAL ARTS HIGGINSVILLE MEDICAL CLINIC HOLDEN FAMILY CARE, LLC HUMANSVILLE FAMILY CARE CENTER I-70 MEDICAL CLINIC IMMEDIATE CONVENIENT CARE IRON COUNTY HOSPITAL FAMILY CARE CLINIC JACKSON FAMILY CARE JACKSON PHYSICIAN ASSOCIATES JACKSON PRIMARY CARE, LLC JAMESPORT OUTREACH CLINIC JEFFERSON MEDICAL GROUP JEFFERSON MEDICAL GROUP HALE CLINIC JEFFERSON MEDICAL GROUP NORBORNE CLINIC JOSEPH E PEHLMAN FAMILY CLINIC, LLC JOSEPH WILLIAM STAFFORD, JR KENNETT PEDIATRICS AND ADOLESC KINGSVILLE MEDICAL CLINIC KNEIBERT CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 15

Address

City, State and ZIP

Telephone # County Name

2703 MILLER ST, PO BOX 233

BETHANY, MO 64424

(660)425-7443 Harrison

2820 E ROCK HAVEN ROAD, STE 210 275 SOUTH SCHOOL AVENUE 502 WEST STURDIVANT, PO BOX 137

HARRISONVILLE, MO 64701 HARTVILLE, MO 65667 ADVANCE, MO 63730

(816)884-3244 Cass (417)741-7484 Wright (573)722-9191 Stoddard

200 HEALTH WAY 2791 NORTH WASHINGTON STREET 101-1 MAIN STREET 134 WEST SIXTH STREET 3401 PINE STREET 612 E 10TH STREET 201 SOUTH ARTHUR

POTOSI, MO 63664 CHILLICOTHE, MO 64601 CASSVILLE, MO 65625 HERMANN, MO 65041 HIGGINSVILLE, MO 64037 HOLDEN, MO 64040 HUMANSVILLE, MO 65674

(573)438-2240 Washington (660)646-2682 Livingston (417)846-2277 Barry (573)486-5711 Gasconade (660)584-2192 Lafayette (816)732-6010 Johnson (417)754-2223 Polk

105 HOSPITAL DRIVE, BUILDING B 1702 NORTH KINGSHIGHWAY 600 NORTH MAIN

SWEET SPRINGS, MO 65351 (660)335-4700 Saline CAPE GIRARDEAU, MO 63701 (573)339-2000 Cape Girardeau PILOT KNOB, MO 63663 (573)546-0184 Iron

545 BROADRIDGE DRIVE SUITE 200 2130 E JACKSON BLVD 2685 EAST MAIN STREET, SUITE A 409 W AUBERRY GROVE 1502 N JEFFERSON STREET 221 ELM STREET

JACKSON, MO 63755 JACKSON, MO 63755 JACKSON, MO 63755 JAMESPORT, MO 64648 CARROLLTON, MO 64633 HALE, MO 64643

(573)243-8408 Cape Girardeau (573)243-2154 Cape Girardeau (573)204-1400 Cape Girardeau (816)684-6252 Daviess (660)542-9998 Carroll (660)565-2602 Carroll

105 E 2ND STREET

NORBORNE, MO 64668

(660)593-3623 Carroll

1207 NORTH DOUGLAS

MALDEN, MO 63863

(573)276-3884 Dunklin

312 KENTUCKY AVE 211 TEACO ROAD PO BOX 908

WEST PLAINS, MO 65775 KENNETT, MO 63857

(417)757-7076 Howell (583)888-0001 Dunklin

305 EAST PACIFIC STREET 686 LESTER STREET

KINGSVILLE, MO 64061 POPLAR BLUFF, MO 63901

(816)597-3500 Johnson (573)778-7210 Butler

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 268615 268705 268707 268710 268711 268706 268709 268708 268530 263831 263833 268551 268568 263996 268965 263940 268961 793835 268908 268738 268682 263947 268536 263967 268648 263889 268518

Key Provider Name *

LAKE AREA PRIMARY CARE CLINIC LAKE REGIONAL - ELDON * LAKE REGIONAL CLINIC CAMDENTON * LAKE REGIONAL CLINIC - IBERIA * LAKE REGIONAL CLINIC - LAKE OZARK * LAKE REGIONAL CLINIC - MACKS CREEK * LAKE REGIONAL CLINIC - OSAGE BEACH

*

LAKE REGIONAL CLINIC-LAURIE * LANCASTER MEDICAL SERVICES * LEBANON INTERNAL MEDICINE/PEDS * LEWISTOWN RURAL HEALTH CLINIC * LEXINGTON MEDICAL CLINIC * MADISON MEDICAL CENTER RHC * MALDEN MEDICAL CENTER * MANAGED CARE, INC * MANSFIELD CLINIC * MANSFIELD CLINIC DBA PRIME CARE OF AVA * MARBLE HILL MEDICAL CLINIC, LLC * MARIES MEDICAL CLINIC None MAYSVILLE FAMILY HEALTH CLINIC * MEADVILLE MEDICAL CLINIC * MEDICAL ARTS CLINIC * MEDICAL CLINIC OF OWENSVILLE * MEDICAL CLINIC OF WILLOW SPRINGS * MEDICAL ONE CLINIC * MEDSTOP ONE * MEMPHIS MEDICAL SERVICES *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 15

Address

City, State and ZIP

Telephone # County Name

HWY 54 EAST, PO BOX 38 304-A EAST 4TH ST 1930 N BUSINESS ROUTE 5, UNIT 1A

WHEATLAND, MO 65779 ELDON, MO 65026 CAMDENTON, MO 65020

(417)282-5882 Hickory (573)392-5654 Miller (573)346-5624 Camden

2333 HIGHWAY 17 1870 BAGNELL DAM BLVD

IBERIA, MO 65486 LAKE OZARK, MO 65049

(573)793-6900 Miller (573)365-2318 Camden

14298 W US HIGHWAY 54

MACKS CREEK, MO 65786

(573)363-5304 Camden

1057 MEDICAL PARK DRIVE, STE A

OSAGE BEACH, MO 65065

(573)302-3100 Camden

156 MISSOURI BLVD, SUITE B HWY 63 NORTH 120 HOSPITAL DRIVE, SUITE 300

LAURIE, MO 65038 LANCASTER, MO 63548 LEBANON, MO 65536

(573)374-5263 Morgan (660)457-3655 Schuyler (417)533-6746 Laclede

105 EAST QUINCY STREET, PO BOX 98 1026 STATE STREET 611 WEST MAIN PO BOX 431 806 NORTH DOUGLAS 808 HUNTER, SUITE 4 304 WEST COMMERICAL 120 SW 2ND AVE

LEWISTOWN, MO 63452 LEXINGTON, MO 64067 FREDERICKTOWN, MO 63645 MALDEN, MO 63863 SIKESTON, MO 63801 MANSFIELD, MO 65704 AVA, MO 65608

(573)215-2715 Lewis (660)259-2216 Lafayette (573)783-3341 Madison (314)276-3873 Dunklin (557)347-5911 Scott (417)924-3066 Wright (417)683-6790 Douglas

307 BROADWAY STREET 606 HIGHWAY 63 SOUTH 1007 S POLK STREET 101 E HAYWARD 1103 WEST LIBERTY 708 EAST HWY 28 816 E MAIN

MARBLE HILL, MO 63764 VIENNA, MO 65582 MAYSVILLE, MO 64469 MEADVILLE, MO 64659 FARMINGTON, MO 63640 OWENSVILLE, MO 65066 WILLOW SPRINGS, MO 65793

(573)238-0038 Bollinger (573)422-3636 Maries (816)449-2123 DeKalb (660)258-1041 Linn (573)756-6751 St. Francois (573)437-4481 Gasconade (417)469-3116 Howell

29 NW 1ST LANE 3065 WILLIAMS STREET, SUITE 209 450 E SIGLER AVE SUITE A

LAMAR, MO 64759 (417)681-5284 Barton CAPE GIRARDEAU, MO 63703 (573)335-4100 Cape Girardeau MEMPHIS, MO 63555 (660)465-2828 Scotland

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name

268689 263900

*

263839 263870 268979 268984

*

268986

*

263809

*

263945

*

263921

*

263814

*

263806

*

263909

*

263840

*

263819

*

263946

*

263813

*

263920

*

268990

*

*

* * *

* 268924 * 268935 * 263934 * = Non-Deemed

MERCY CARTHAGE PEDIATRICS MERCY CLINIC - EL DORADO SPRINGS MERCY CLINIC - HOUSTON MERCY CLINIC - SALEM MERCY CLINIC EAST COMMUNITIES MERCY CLINIC EAST COMMUNITIESBOURBON MERCY CLINIC EAST COMMUNITIESCUBA MERCY CLINIC FAMILY MEDICINE CUBA MERCY CLINIC FAMILY MEDICINE LEBANON MERCY CLINIC FAMILY MEDICINEBUFFALO MERCY CLINIC FAMILY MEDICINELEBANON MERCY CLINIC FAMILY MEDICINEBIRCH TREE MERCY CLINIC FAMILY MEDICINECASSVILLE MERCY CLINIC FAMILY MEDICINEMOUNTAIN GROVE MERCY CLINIC FAMILY MEDICINEMOUNTAIN VIEW MERCY CLINIC FAMILY MEDICINEREPUBLIC MERCY CLINIC FAMILY MEDICINE-ST ROBERT MERCY CLINIC FAMILY MEDICINESUMMERSVILLE MERCY CLINIC FAMILY MEDICINEWILLOW SPRINGS MERCY CLINIC OB/GYN- LEBANON MERCY CLINIC PEDIATRICS-ROLLA MERCY CLINIC RICHLAND

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 8 of 15

Address

City, State and ZIP

Telephone # County Name

1911 BUENA VISTA AVENUE 309 EAST HOSPITAL ROAD

(417)358-8121 Jasper (417)876-5851 Cedar

1422 SOUTH SAM HOUSTON BLVD 404 W ROLLA ROAD 1326 S SERVICE RD W STE. 200 125 N OLD HWY 66

CARTHAGE, MO 64836 EL DORADO SPRINGS, MO 64744 HOUSTON, MO 65483 SALEM, MO 65560 SULLIVAN, MO 63080 BOURBON, MO 65441

301 THERESA STREET

CUBA, MO 65453

(573)677-2006 Crawford

114 DOWNEY PLACE

CUBA, MO 65453

(573)885-3358 Crawford

331 HOSPITAL DR STE C

LEBANON, MO 65536

(417)533-6500 Laclede

118 W DALLAS

BUFFALO, MO 65622

(417)345-6101 Dallas

120 HOSPITAL DRIVE, SUITE 100

LEBANON, MO 65536

(417)533-6751 Laclede

STATE HIGHWAY 99 & OBANION STREET, PO BOX 229 92 MAIN STREET

BIRCH TREE, MO 65438

(573)292-3214 Shannon

CASSVILLE, MO 65625

(417)847-5225 Barry

120 W 16TH STREET

MOUNTAIN GROVE, MO 65711 (417)926-6111 Wright

104 E HIGHWAY 60

MOUNTAIN VIEW, MO 65548

(417)934-2251 Howell

332 S MAIN AVENUE

REPUBLIC, MO 65738

(417)732-5050 Greene

608 CITY ROUTE 66, PO BOX 914

ST ROBERT, MO 65584

(573)336-5100 Pulaski

149 ROGERS AVENUE

SUMMERSVILLE, MO 65571

(417)932-4119 Texas

1202 EAST MAIN

WILLOW SPRINGS, MO 65793 (417)469-1820 Howell

120 HOSPITAL DRIVE, SUITE 225 LEBANON, MO 65536 1605 MARTIN SPRINGS DRIVE, STE 250 ROLLA, MO 65401 904 SOUTH PINE STREET RICHLAND, MO 65556

(417)967-4445 Texas (573)729-6225 Dent (573)468-3555 Crawford (573)679-2006 Crawford

(417)533-6710 Laclede (573)341-9163 Phelps (573)765-2956 Pulaski

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name

263918

*

263850 263457

*

268506 268663 263479 268701 268687 268545 268688 268690 793812 793842 793829 793823 263487 268591 268660 268528 263492 268611 268513 793813 793840

MERCY CLINIC-BRANSON WEST

MERCY CLINIC-STEELVILLE MERCY HOSP LINCOLN FAMILY MEDICINE AND PSYCHIATRY

*

MERCY HOSPITAL JOPLIN NEOSHO * MERCY HOSPITAL LINCOLN FAMILY MEDICINE ELSBERRY * MERCY HOSPITAL LINCOLN FAMILY MEDICINE TROY * MERCY HOSPITAL LINCOLN FAMILY MEDICINE WINFIELD

*

MERCY HOSPITAL LINCOLN-FAMILY MEDICINE * MERCY MCAULEY CLINIC * MERCY PHYSICIANS FOR WOMEN'S HEALTH * MERCY PRIMARY CARE * MERCY URGENT CARE-BRANSON None MERITAS HEALTH RICHMOND * MIDWEST FAMILY CARE * MIDWEST FAMILY CARE * MISSOURI BAPTIST SULLIVAN MEDICAL OFFICE

*

MISSOURI DELTA EXPRESS CLINIC * MISSOURI DELTA PRIMARY CARE * MO BAPTIST-STEELVILLE OFFICE * MO DELTA MED CTR COMM CARE CTR * MOBERLY RHC * MONROE CITY FAMILY PRACTICE *

*

MORTON VAN ZANTEN CLINIC GROVE MEDICAL AND LASER CENTER PC

None MOUNTAIN

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 9 of 15

Address

City, State and ZIP

Telephone # County Name

18598 STATE HIGHWAY 13, PO BOX 2067 518 PINE STREET 900 EAST CHERRY ST

BRANSON WEST, MO 65737

(417)272-8497 Stone

STEELVILLE, MO 65565 TROY, MO 63379

(573)775-5838 Crawford (636)528-8585 Lincoln

2550 LUSK DR 106 BROADWAY, SUITE 3C

NEOSHO, MO 64850 ELSBERRY, MO 63343

(417)451-2060 Newton (573)898-9100 Lincoln

1003 E CHERRY ST

TROY, MO 63379

(636)528-6755 Lincoln

35 WINFIELD PLAZA

WINFIELD, MO 63389

(636)668-6824 Lincoln

1165 EAST CHERRY STREET

TROY, MO 63379

(636)528-7745 Lincoln

851 E 5TH STREET SUITE 200 1515 HAZEL ST, SUITE 101

WASHINGTON, MO 63090 CARTHAGE, MO 64836

(636)239-8585 Franklin (417)358-8121 Jasper

1515 HAZEL ST 1065 STATE HIGHWAY 248, STE 200 902 WOLLARD BOULEVARD 404 S HOPE 36 DOCTORS PARK 965 MATTOX DR

CARTHAGE, MO 64836 BRANSON, MO 65616 RICHMOND, MO 64085 JACKSON, MO 63755 CAPE GIRARDEAU, MO 63703 SULLIVAN, MO 63080

(417)358-8121 Jasper (417)337-5000 Taney (816)776-2201 Ray (573)204-3900 Cape Girardeau (573)803-1771 Cape Girardeau (573)860-6000 Crawford

1008 NORTH MAIN 135 PLAZA DRIVE, STE 102 510 WEST MAIN, PO BOX AH 1200 EAST MARSHALL

SIKESTON, MO 63801 SIKESTON, MO 63801 STEELVILLE, MO 65565 CHARLESTON, MO 63834

(573)471-1600 New Madrid (573)472-6010 Scott (573)775-4600 Crawford (573)683-2191 Mississippi

1501 UNION AVENUE, SUITE A & B 821 BUSINESS HIGHWAY 24 & 36, PO BOX 305

101 GIESLER DRIVE 601 N BUSCH AVENUE

MOBERLY, MO 65270 MONROE CITY, MO 63456

(660)263-9095 Randolph (573)735-2506 Monroe

OSCEOLA, MO 64776 (417)646-8123 St. Clair MOUNTAIN GROVE, MO 65711 (417)926-6643 Wright

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name *

268597 268695 268748

MOUNTAIN GROVE MEDICAL COMPLEX * MT VERNON CLINIC * NEVADA MEDICAL CLINIC None NEVADA REGIONAL PRIMARY CARE CENTER * NEW MADRID COMMUNITY CARE CENTER * NIXA FAMILY MEDICAL WALK IN CL * NMC - NEW HAMPTON RURAL HEALTH CLINIC

*

NMC - STANBERRY RURAL HEALTH CLINIC None NMC GRANT CITY CLINIC * NORTH HARRISON MEDICAL CLINIC * NORTHEAST REGIONAL MEDICAL GROUP * NRMC NOWCARE CLINIC * OB/GYN SPECIALTY SERVICES * OCH ANDERSON RURAL HEALTH CLINIC * OCH GOODMAN FAMILY CLINIC None OCH JASPER COUNTY CLINIC CARTHAGE CAMPUS * OCH LAWRENCE COUNTY CLINIC None OCH MCDONALD COUNTY CLINIC * OCH PINEVILLE MEDICAL CLINIC

268697

None OCH

268746

*

268726 268609 268672

*

268579 268946 263901 268737 268699 263911 268702 263420 268730 268714 268675 268645 268533 268747 268745 268728

* *

* = Non-Deemed

POLK COUNTY CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 10 of 15

Address

City, State and ZIP

500 N 19TH ST STE A

MOUNTAIN GROVE, MO 65711 (417)926-6955 Wright

1011 SOUTH EAST ST 900 SOUTH ADAMS 627 S ASH STREET SUITE B

MOUNT VERNON, MO 65712 NEVADA, MO 64772 NEVADA, MO 64772

(417)466-7191 Lawrence (417)667-6015 Vernon (417)667-6800 Vernon

615 N MAIN STREET

NEW MADRID, MO 63869

(573)748-2546 New Madrid

103 OLD WOLDERNESS ROAD 304 E LINCOLN WAY

NIXA, MO 65714 NEW HAMPTON, MO 64471

(417)724-0308 Christian (660)439-2060 Harrison

202 EAST MAIN PO BOX 99

STANBERRY, MO 64489

(816)783-2192 Gentry

16 W 4TH STREET, PO BOX 187 16027 LOCUST STREET 1607 S BALTIMORE

GRANT CITY, MO 64456 EAGLEVILLE, MO 64442 KIRKSVILLE, MO 63501

(660)564-3322 Worth (660)867-5111 Harrison (660)785-1122 Adair

345 S BARRETT LANE, STE 2 415-A BURKARTH ROAD 104 EAST MAIN, PO BOX 750

NEVADA, MO 64772 WARRENSBURG, MO 64093 ANDERSON, MO 64831

(417)448-2439 Vernon (660)429-2992 Johnson (417)845-6984 McDonald

125 E MAIN STREET, PO BOX 97 327 EAST AIRPORT DRIVE

GOODMAN, MO 64843 CARTHAGE, MO 64836

(417)364-8300 McDonald (417)237-0604 Jasper

108 S HICKORY 125 MAIN ST 412 US HIGHWAY 71, SUITE J, PO BOX 265 910 E SAN MARTIN ST, BOLIVAR, MO 65613-2893 109 NORTH BROADWAY, PO BOX 160

MOUNT VERNON, MO 65712 NOEL, MO 64854 PINEVILLE, MO 64856

(417)466-4110 Lawrence (417)837-4004 McDonald (417)223-4290 McDonald

BOLIVAR, MO 65613

(417)777-4749 Polk

OCH SOUTHWEST CITY COMM CLINIC OCH SPARTA CLINIC 155 VILLAGE DRIVE, PO BOX 183 OCH WEBSTER COUNTY CLINIC 101 S MAIN OCH WELLPOINTE FAMILY MEDICAL 543 WEST HUBBLE DRIVE CLINIC

Telephone # County Name

SOUTH WEST CITY, MO 64863 (417)762-3287 McDonald SPARTA, MO 65753 ROGERSVILLE, MO 65742 MARSHFIELD, MO 65706

(417)634-4203 Christian (417)753-9404 Greene (417)859-7746 Webster

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 268550 263484 268523 268616 263979 268902 268910 263402 268741 263495 268987 263434 268614 268909 268592 268717 263968

Key Provider Name *

ODESSA MEDICAL GROUP OMC URGENT CARE CLINIC * OZARKS MED CLINIC OF ALTON * OZARKS MEDICAL CENTER MOUNTAIN VIEW * OZARKS MEDICAL CENTER WINONA * PALMYRA CLINIC * PARIS FAMILY MEDICAL CLINIC * PATTONSBURG MED CLINIC None PCMH CLINIC * PCMH RURAL HEALTH CLINIC * PCRMC MEDICAL GROUP INC * PEMISCOT PRIMARY CARE CLINIC * PERRY COUNTY PHYSICIANS SERVICES * PERRY KIDS PEDIATRICS * PERRYVILLE FAMILY CARE CLINIC * PFCC WEST * PHYSICIANS PARK PRIMARY CARE *

263435 263933 268723 268724 268939

*

268586 263929 263485 268552 268581 263446 268676

*

* * * *

* * * * * *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 11 of 15

Address

City, State and ZIP

Telephone # County Name

1280 WEST OLD HWY 40 181 KENTUCKY AVE, SUITE 100 100 MEDICAL DRIVE, PO BOX 468 220 N ELM STREET

ODESSA, MO 64076 WEST PLAINS, MO 65775 ALTON, MO 65606 MOUNTAIN VIEW, MO 65548

(660)633-5774 Lafayette (417)257-5911 Howell (417)778-7227 Oregon (417)111-1111 Howell

1008 HWY 19 NORTH PO BOX 28 6996 COUNTY ROAD 326 102 E MARION 110 N CENTRAL AVE 425 N GALLOWAY ROAD 1926 OAK STREET, PO BOX 389 1050 WEST TENTH STREET 907 EAST REED AVE 206 HOSPITAL LANE, SUITE 201

WINONA, MO 65588 PALMYRA, MO 63461 PARIS, MO 65275 PATTONSBURG, MO 64670 VANDALIA, MO 63382 UNIONVILLE, MO 63565 ROLLA, MO 65401 HAYTI, MO 63851 PERRYVILLE, MO 63775

(314)325-4711 Shannon (573)769-3710 Marion (660)327-4911 Monroe (660)367-4304 Daviess (573)594-2111 Audrain (660)947-7373 Putnam (573)458-3510 Phelps (573)359-3660 Pemiscot (573)547-4899 Perry

PERRYVILLE, MO 63775 PERRYVILLE, MO 63775 PERRYVILLE, MO 63775 POPLAR BLUFF, MO 63901

(573)517-0999 Perry (314)547-7888 Perry (573)339-2000 Perry (573)727-5500 Butler

PIEDMONT, MO 63957 PIEDMONT, MO 63957 LOUISIANA, MO 63353 BOWLING GREEN, MO 63334 PILOT GROVE, MO 65276

(573)223-4800 Wayne (573)223-4233 Wayne (573)754-5555 Pike (573)324-2241 Pike (660)834-5100 Cooper

PLATTSBURG, MO 64477 PLATTSBURG, MO 64477 PLEASANT HILL, MO 64080 PLEASANT HOPE, MO 65725 HAYTI, MO 63851 POLO, MO 64671 POPLAR BLUFF, MO 63901

(816)930-2041 Clinton (816)539-2117 Clinton (816)540-2111 Cass (417)267-2001 Polk (573)359-6162 Pemiscot (660)354-2550 Caldwell (573)778-1277 Butler

210 HOSPITAL LN, SUITE 202 212 HOSPITAL LANE, SUITE 101 1508 EDGEMONT BLVD 225 PHYSICIANS PARK DRIVE, SUITE 400 PIEDMONT FAMILY CLINIC #1 HAL'S PLAZA PIEDMONT PHYSICIAN ASSOCIATES CANYON RD & HWY 34, RT 4 BOX 4515 PIKE MEDICAL CLINIC INC 211 SOUTH THIRD ST PIKE MEDICAL CLINIC INC 905 HWY 161 PILOT GROVE RURAL HEALTH 212 COLLEGE STREET CLINIC

PLATTSBURG FAMILY MEDICINE 214 N MAIN PLATTSBURG MEDICAL CLINIC 214 N MAIN PLEASANT HILL MEDICAL CENTER 1601 N HIGHWAY 7 PLEASANT HOPE FAMILY MED CTR 209 SOUTH MAIN STREET PMHS CONVENIENT CARE CLINIC 946 E REED STREET POLO FAMILY HEALTH CTR 198 N MAIN STREET POPLAR BLUFF MEDICAL CLINIC 2588 N WESTWOOD

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 268919 268685 268698 263421 793836 268651 268996 263826 263473 268995 263836 268959 268670 268941 263425 263892 268956 268556 793839 268713 268960 263942 263450 268512 268538

Key Provider Name *

POPLAR BLUFF PEDIATRIC ASSOCIATES, LLC * POPLAR BLUFF PRIMARY CARE * PORTAGEVILLE COMMUNITY CARE CENTER * PORTAGEVILLE PRIMARY CARE None POTOSI PAIN SOLUTIONS * POTOSI RURAL HEALTH CLINIC * PROFESSIONAL CLINICS DBA CONVENIENT HEALTHCARE * PULASKI MEDICAL CLINIC * PUXICO CLINIC * QUINCY MEDICAL GR, LABELLE RURAL HEALTH AFFILIATE * QUINCY MEDICAL GROUP - CANTON * RANDOLPH COUNTY HEALTH DEPARTMENT * REID MEDICAL CLINIC * REPUBLIC FAMILY MEDICAL WALKIN CLINIC * RICH HILL FAMILY MED CLINIC * RIVER CITY HLTH CLINIC INC * ROLLA FAMILY CLINIC * SAC-OSAGE HOSPITAL TRI-COUNTY CLINIC None SAINT FRANCIS OUTPATIENT CLINIC * SAINT LUKE'S MERCER COUNTY CLINIC * SCHEIDLER RURAL HEALTH CLINIC * SCOTT CITY MEDICAL CLINIC * SE HEALTH CENTER OF RIPLEY COUNTY RURAL HEALTH * SHELBINA FAMILY PRACTICE * SHELDON FAMILY MEDICAL CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 12 of 15

Address

City, State and ZIP

Telephone # County Name

2210 BARRON ROAD, STE, 120

POPLAR BLUFF, MO 63901

(573)785-2002 Butler

2360 KATY LANE 204 E 3RD STREET

POPLAR BLUFF, MO 63901 PORTAGEVILLE, MO 63873

(573)712-2546 Butler (573)379-5467 New Madrid

314 E MAIN STREET 24 SOUTHTOWNE DRIVE #1 KWAN PLAZA 624 OLD ST MARYS RD, SUITE A

PORTAGEVILLE, MO 63873 POTOSI, MO 63664 POTOSI, MO 63664 PERRYVILLE, MO 63775

(314)379-3777 New Madrid (573)438-3733 Washington (573)438-1899 Washington (573)547-3232 Perry

1000 GW LANE 130 E HARBIN PO BOX 7 1000 CENTRAL STREET

WAYNESVILLE, MO 65583 PUXICO, MO 63960 LA BELLE, MO 63447

(573)774-2715 Pulaski (573)222-3556 Stoddard (660)462-3266 Lewis

1100 EAST OUTER ROAD SOUTH 1319 E HIGHWAY 24

CANTON, MO 63435 MOBERLY, MO 65270

(573)288-5949 Lewis (660)263-6643 Randolph

1401 N JEFFERSON ST 281 US HWY 60 WEST

CARROLLTON, MO 64633 REPUBLIC, MO 65738

(660)542-3900 Carroll (417)732-6277 Greene

320 NORTH 14TH ST 224 NORTH FREDERICK ST 1060 SOUTH BISHOP AVENUE 855 ARDUSER DRIVE

RICH HILL, MO 64779 CAPE GIRARDEAU, MO 63701 ROLLA, MO 65401 OSCEOLA, MO 64776

(417)395-2150 Bates (573)332-0121 Cape Girardeau (573)647-1869 Phelps (417)646-8153 St. Clair

1212 SAINT FRANCIS DRIVE 400 N FULLERTON STREET

DEXTER, MO 63841 PRINCETON, MO 64673

(573)614-3600 Stoddard (660)748-4040 Mercer

301 SOUTH BYP 2102 MAIN STREET 109 LEROUX DR

KENNETT, MO 63857 SCOTT CITY, MO 63780 DONIPHAN, MO 63935

(573)888-0900 Dunklin (573)264-0087 Scott (573)996-2136 Ripley

400 SOUTH CENTER 810 W MAIN STREET

SHELBINA, MO 63468 SHELDON, MO 64784

(573)588-4131 Shelby (417)884-5006 Vernon

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 268634 268635 268683 268587 268721 268661 268674 268657 268570 268736 268668 268590 263886 263906 268750 268680 268559 268677 268557 268716 268631 268678

Key Provider Name *

35629 HWY 72, PHYSICIANS OFFICE BLDG 3

*

SMITH STREET MEDICAL CLINIC 117 SMITH AVE * SOUTHEAST HEALTH BERNIE CLINIC 810 N WALNUT * SOUTHEAST HEALTH BLOOMFIELD 1003 HIGHWAY 25 NORTH CLINIC

*

SOUTHEAST HEALTH FAMILY 1 HOSPITAL DRIVE MEDICINE OF DONIPHAN * SOUTHEAST HEALTH MALDEN 500 N DOUGLAS CLINIC * SOUTHEAST PEDIATRICS 25 DOCTORS PARK * SOUTHEAST PRIMARY CARE-MT 817 S MT AUBURN, SUITE 100 AUBURN * SOUTHEASTHEALTH FAMILY 1200 N ONE MILE RD DEXTER MO MEDICINE OF DEXTER 63841-1000 None SOUTHEASTHEALTH FAMILY 2002 KANELL BLVD MEDICINE OF POPLAR BLUFF * SOUTHSIDE MEDICAL CENTER 1120 SOUTH SPRINGFIELD AVENUE * SOUTHWEST MEDICAL ASSOCIATES 1714 WEIN STREET * SPARTA HEALTH CLINIC 515 HUGH AVENUE, PO BOX 449 * SSM GLENNON CARE PEDIATRICS- 164 PROFESSIONAL PARKWAY TROY None SSM HEALTH MEDICAL GROUP 350 COUNTRY MEADOW LANE * SSM HEALTH MEDICAL GROUP 2265 BADNELL DAM BLVD SUITE 103 * SSM HEALTH MEDICAL GROUP 240 PICKERING STREET FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP 221 N MAIN STREET FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP 111 W BATES STREET FAMILY MEDICINE

*

SSM HEALTH MEDICAL GROUP 201 S MAIN STREET FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP 809 MEDICAL PARK DRIVE, STE 101 FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP 100 HIGHWAY 28 W FAMILY MEDICINE

* = Non-Deemed

SMDH FAMILY MEDICINE

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 13 of 15

City, State and ZIP

Telephone # County Name

SALEM, MO 65560

(573)729-6626 Dent

SIKESTON, MO 63801 BERNIE, MO 63822 BLOOMFIELD, MO 63825

(573)471-0200 New Madrid (573)283-5336 Stoddard (573)568-3686 Stoddard

DONIPHAN, MO 63935

(573)996-7148 Ripley

MALDEN, MO 63863

(573)276-2221 Dunklin

CAPE GIRARDEAU, MO 63703 (573)519-4600 Cape Girardeau CAPE GIRARDEAU, MO 63703 (573)519-4500 Cape Girardeau DEXTER, MO 63841

(573)624-7575 Stoddard

POPLAR BLUFF, MO 63901

(573)727-9129 Butler

BOLIVAR, MO 65613 HERMANN, MO 65041 SPARTA, MO 65753 TROY, MO 63379

(417)328-6653 Polk (573)486-2118 Gasconade (417)634-3000 Christian (636)462-5437 Lincoln

FULTON, MO 65251 LAKE OZARK, MO 65049 MONTGOMERY CITY, MO 63361 PARIS, MO 65275

(573)642-4500 Callaway (573)964-5599 Camden (573)564-2101 Montgomery

WELLSVILLE, MO 63384

(573)684-2208 Montgomery

AUXVASSE, MO 65231

(573)386-5959 Callaway

MEXICO, MO 65265

(573)581-8590 Audrain

BELLE, MO 65013

(573)859-3775 Maries

(660)327-4000 Monroe

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN 268703 268562 268686 268558 268560 268555 268589 268540 268542 268693 263915 263943 263851 263439 263896 263983 263977 793843 268520 268718

Key Provider Name *

SSM HEALTH MEDICAL GROUP FAMILY MEDICINE

*

SSM HEALTH MEDICAL GROUP FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP FAMILY MEDICINE

*

SSM HEALTH MEDICAL GROUP FAMILY MEDICINE * SSM HEALTH MEDICAL GROUP INTERNAL MEDICINE * SSM HEALTH MEDICAL GROUP PEDIATRICS

*

SSM HEALTH ST FRANCIS HOSPITAL MEDICAL GROUP * SSM HEALTH ST FRANCIS HOSPITAL MEDICAL GROUP * SSM HEALTH ST FRANCIS HOSPITAL MEDICAL GROUP

*

ST JOHN'S CLINIC - ROLLA FAMILY MEDICINE * ST JOHN'S CLINIC - ST JAMES * ST LUKE'S GREEN HILLS MEDICAL CLINIC

*

STE GENEVIEVE FAMILY HEALTH CLINIC * STEELE FAMILY RURAL HEALTH CLINIC, LLC * STEWARTSVILLE MED CLINIC * STOCKTON FAMILY MEDICAL CENTER None STOCKTON LAKE WALKIN MEDICAL * SULLIVAN CO MEM HOSP PHYS CLIN * SULLIVAN COUNTY MEMORIAL HOSP GREEN CITY CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 14 of 15

Address

City, State and ZIP

Telephone # County Name

875 STATE ROUTE 5

TIPTON, MO 65081

(660)433-5541 Moniteau

204 WEST WASHINGTON STREET

VANDALIA, MO 63382

(573)594-3800 Audrain

801 KIDWELL DR

VERSAILLES, MO 65084

(573)378-5454 Morgan

1223 MAIN STREET

PERRY, MO 63462

(573)565-2213 Ralls

626 E SUMMIT STREET, SUITE L

MEXICO, MO 65265

(573)581-6266 Audrain

600 MEDICAL PARK DRIVE

MEXICO, MO 65265

(573)581-1040 Audrain

3626 S CLARK STREET, STE A

MEXICO, MO 65265

(573)581-5011 Audrain

2016 SOUTH MAIN

MARYVILLE, MO 64468

(660)562-2525 Nodaway

114 E SOUTH HILLS DRIVE

MARYVILLE, MO 64468

(660)562-2525 Nodaway

301 E PRICE AVE STE A

SAVANNAH, MO 64485

(816)432-0006 Andrew

1605 MARTIN SPRINGS DRIVE, STE 230 ROLLA, MO 65401

(573)458-6739 Phelps

107 W ELDON ST 3300 E 10TH ST

SAINT JAMES, MO 65559 TRENTON, MO 64683

(573)265-1818 Phelps (660)359-3939 Grundy

930 PARK DRIVE

(573)883-2782 Ste. Genevieve

216 WEST MAIN STREET, SUITE A

SAINTE GENEVIEVE, MO 63670 STEELE, MO 63877

106 E FOURTH 810 SOUTH ST

STEWARTSVILLE, MO 64490 STOCKTON, MO 65785

(816)669-3225 DeKalb (417)276-5131 Cedar

913 SOUTH STREET 630 WEST THIRD ST 18 WEST 3RD STREET

STOCKTON, MO 65785 MILAN, MO 63556 GREEN CITY, MO 63545

(417)809-8620 Cedar (660)265-5204 Sullivan (660)874-5887 Sullivan

(573)695-2181 Pemiscot

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Missouri CCN

Key Provider Name

268729

*

268603 268630 268535 268653 263438 268658

*

268930

*

793833

*

263970 268567 268644 263871 268650 263414 263969

*

268652 268744

*

268623

*

793827 263926 268643

*

* * * * *

* * * * * *

SULLIVAN COUNTY MEMORIAL HOSP MILAN FAM PRACT CLIN

TCMH - CABOOL MEDICAL CLINIC TCMH FAMILY CLINIC-LICKING TCMH INTERNAL MEDICINE ASSOC TCMH MOUNTAIN GROVE CLINIC THAYER MEDICAL CLINIC THE CLINIC AT WALMART OPERATED BY SOUTHEASTHEALTH

THE MEDICAL CENTER RURAL HEALTH CLINIC THEODOSIA FAMILY MEDICAL CLINIC LLC TINSLEY MEDICAL CLINIC TOTAL FAMILY HEALTH CARE TWIN RIVERS WOMEN'S CENTER VALLEY MEDICAL CLINIC WCMH URGENT CARE WESTWOOD RURAL HLTH CLINIC WILBERS FAMILY CARE CLINIC

City, State and ZIP

Telephone # County Name

210 N MARKET STREET

MILAN, MO 63556

(660)265-4456 Sullivan

500 MAIN STREET, PO BOX 380 233 S MAIN 1337 S SAM HOUSTON BLVD 1905 WEST 19TH STREET HWY 63 & EASTWOOD CTR 2025 W BUSINESS HIGHWAY 60

CABOOL, MO 65689 (417)962-3121 Texas LICKING, MO 65542 (573)674-3011 Texas HOUSTON, MO 65483 (417)967-3311 Texas MOUNTAIN GROVE, MO 65711 (417)926-1770 Wright THAYER, MO 65791 (417)257-6752 Oregon DEXTER, MO 63841 (573)614-4600 Stoddard

902 WOLLARD BLVD

RICHMOND, MO 64085

(816)776-2201 Ray

4900 ST HWY 160 STE 2

THEODOSIA, MO 65761

(417)273-2300 Ozark

2400 LUCY LEE PARKWAY SUITE A 1201 NORTH RUTHERFORD 509 SOUTH BYP 308 SOUTH HARRIS 300 HEALTHWAY 2642 STATE ROUTE 76 111 EAST FIRST ST

(573)686-1144 Butler (660)385-5880 Macon (573)888-0444 Dunklin (417)469-3175 Howell (573)438-0751 Washington (417)469-5124 Howell (573)564-3214 Montgomery

2340 KATY LANE 250 SOUTH HICKMAN 103 2ND STREET

POPLAR BLUFF, MO 63901 MACON, MO 63552 KENNETT, MO 63857 WILLOW SPRINGS, MO 65793 POTOSI, MO 63664 WILLOW SPRINGS, MO 65793 MONTGOMERY CITY, MO 63361 SIKESTON, MO 63801 SAINTE GENEVIEVE, MO 63670 SAINTE GENEVIEVE, MO 63670

POPLAR BLUFF, MO 63901 PUXICO, MO 63960 JAMESPORT, MO 64648

189 IOWA BLVD

TRENTON, MO 64683

(660)359-3899 Grundy

124 WEST JEFFERSON

WYACONDA, MO 63474

(660)479-5553 Clark

WOMEN'S CARE CENTER 1013 NORTH MAIN STREET, STE 101 WELLNESS AT THE PLAZA 120 PLAZA DRIVE

WOMENS HEALTH SPECIALISTS, PC WOODS MEDICAL CLINIC LLC * WRIGHT MEMORIAL JAMESPORT CLINIC

*

268637 WRIGHT MEMORIAL PHYSICIANS GROUP * 268519 WYACONDA MEDICAL SERVICES Total Providers for this State = 367 *

* = Non-Deemed

Page 15 of 15

Address

None WOMEN'S

WOMENS HEALTH CENTER

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

800 STE GENEVIEVE DRIVE

(573)472-7535 Scott (573)883-1199 Ste. Genevieve (573)883-5715 Ste. Genevieve (573)776-7393 Butler (573)222-2292 Stoddard (660)684-6244 Daviess

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nebraska CCN 283499 288520 283473 283472 283438 283474 283976 283475 288539 283814 283427 283428 288521 283460 288507 288509 283466 288528 288524 288523 288527 283498 283480 283832 288538 283836 283476 283977

Key Provider Name *

ADAMS PRIMARY CARE AINSWORTH FAMILY CLINIC * AMH CLEARWATER CLINIC * AMH ELGIN CLINIC * AMH FAMILY PRACTICE * AMH-TILDEN CLINIC * ARAPAHOE MEDICAL CLINIC * ARNOLD MEDICAL CLINIC * ASHLAND FAMILY CLINIC * AVERA MEDICAL GROUP BUTTE * AVERA MEDICAL GROUP CROFTON * AVERA MEDICAL GROUP HARTINGTON * AVERA MEDICAL GROUP LAFLAN * AVERA MEDICAL GROUP NIOBRARA * AVERA MEDICAL GROUP O'NEILL * AVERA MEDICAL GROUP PIERCE * AVERA MEDICAL GROUP VERDIGRE * BANCROFT MEDICAL CLINIC * BEATRICE INTERNAL MEDICINE * BEATRICE MEDICAL CENTER * BEEMER MEDICAL CLINIC * BLUE HILL MEDICAL CLINIC * BOONE COUNTY MEDICAL CLINIC * BRADY RURAL HEALTH CLINIC None BURGESS FAMILY CLINIC-DECATUR * BURWELL FAMILY PRACTICE CLINIC * CALLAWAY MEDICAL CLINIC * CAMBRIDGE MEDICAL CENTER *

*

283864 CEDAR RAPIDS MEDICAL CLINIC * 283489 CHASE COUNTY CLINIC * 283490 CHASE COUNTY CLINIC * = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 6

Address

City, State and ZIP

Telephone # County Name

PO BOX 963, 620 MAIN STREET, SUITE A 913 EAST ZERO STREET 308 NEVADA STREET 101 WEST CEDAR STREET P O BOX 109, 109 WEST 11TH 104 SOUTH CENTER P.O. BOX 389, 305 NEBRASKA AVENUE 104 NORTH BROADWAY STREET 705 N 17TH AVENUE 730 WILSON 203 WEST MAIN STREET 405 WEST DARLENE STREET

ADAMS, NE 68301 AINSWORTH, NE 69210 CLEARWATER, NE 68726 ELGIN, NE 68636 NELIGH, NE 68756 TILDEN, NE 68781 ARAPAHOE, NE 68922 ARNOLD, NE 69120 ASHLAND, NE 68003 BUTTE, NE 68722 CROFTON, NE 68730 HARTINGTON, NE 68739

(402)988-2188 Gage (402)387-1900 Brown (402)485-2277 Antelope (402)843-5444 Antelope (402)887-5440 Antelope (402)368-5520 Antelope (308)962-8495 Furnas (308)848-3259 Custer (402)944-2201 Saunders (402)775-2508 Boyd (402)388-2343 Knox (402)254-3935 Cedar

804 CHASE AVENUE 254-10 PARK AVE APT E, PO BOX 254 300 NORTH 2ND STREET 503 N 6TH STREET 401 JAMES STREET 219 MAIN STREET 4800 HOSPITAL PARKWAY 805 WEST COURT 212 MAIN STREET 102 NORTH PINE 1019 SOUTH 8TH STREET 114 NORTH MAIN STREET 823 S BROADWAY, SUITE 120 410 SOUTH 8TH AVENUE, PO BOX 906 213 EAST KIMBALL STREET P.O. BOX 488, 1305 WEST HIGHWAY 6/34

106 S 3RD STREET 308 NORTH TECUMSEH STREET 600 WEST 12TH STREET

CREIGHTON, NE 68729 NIOBRARA, NE 68760 O' NEILL, NE 68763 PIERCE, NE 68767 VERDIGRE, NE 68783 BANCROFT, NE 68004 BEATRICE, NE 68310 BEATRICE, NE 68310 BEEMER, NE 68716 BLUE HILL, NE 68930 ALBION, NE 68620 BRADY, NE 69123 DECATUR, NE 68020 BURWELL, NE 68823 CALLAWAY, NE 68825 CAMBRIDGE, NE 69022

(402)358-5335 Knox (402)857-3398 Knox (402)336-2900 Holt (402)329-6780 Pierce (402)668-2216 Knox (402)648-7606 Cuming (402)228-3545 Gage (402)228-3366 Gage (402)528-3288 Cuming (402)756-2141 Webster (402)395-5013 Boone (308)584-3770 Lincoln (402)349-5592 Burt (308)346-5544 Garfield (308)836-2294 Custer (308)697-3317 Furnas

CEDAR RAPIDS, NE 68627 WAUNETA, NE 69045 IMPERIAL, NE 69033

(308)358-0615 Boone (308)394-5593 Chase (308)882-7299 Chase

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nebraska CCN 283477 283435 283461 283403 283402 283418 283997 283426 283404 288512 283468 283980 283436 283482 283496 283879 288525 283449 288540 283400 283998 283999 283844 288506 283846 288518 283448 288536

Key Provider Name *

Address

CHERRY COUNTY CLINIC 512 NORTH GREEN STREET CHESTER MEDICAL CLINIC 116 HURON STREET * CHI HEALTH CLINIC CLARKSON 322 PINE STREET * CHI HEALTH CLINIC HOWELLS P O BOX 98, 121 S 6TH STREET * CHI HEALTH CLINIC PLAINVIEW 704 NORTH 3RD STREET, BOX 490 * CHI HEALTH CLINIC SCHUYLER 1721 COLFAX STREET * CHIMNEY ROCK MEDICAL CENTER 320 MAIN * COMMUNITY PHYSICIAN'S CLINIC 100 NORTH 7TH * COTTONWOOD RURAL HEALTH 120 S. 9TH ST. CLINIC * COZAD COMMUNITY MEDICAL P O BOX 86, 1803 PAPIO LANE CLINIC * CRETE AREA MEDICAL CENTER 2910 BETTEN DRIVE * CURTIS MEDICAL CENTER 302 EAST 6TH STREET * DAVENPORT MEDICAL CLINIC 102 NORTH A STREET * DINKLAGE MEDICAL CLINIC 500 EAST DECATUR * EDGAR MEDICAL CLINIC 315 NORTH C STREET, BOX 406 None ELKHORN VALLEY FAMILY MEDICINE 304 E DOUGLAS STREET PC * EMERSON MEDICAL CLINIC 1012 S MAIN ST * FAMILY MEDICINE 3307 N BARADA STREET None FAMILY MEDICINE SPECIALISTS 1105 N ERIE STREET * FCMH CAMPBELL MEDICAL CLINIC 148 SOUTH TAYLOR * FCMH HILDRETH MEDICAL CLINIC 511 HUBBARD * FCMH POOL MEDICAL CLINIC 121 15TH AVE * FILLMORE COUNTY MEDICAL 1840 F STREET CENTER, PC * FORT CALHOUN CLINIC 4929 COUNTY ROAD P43 * FRIEND MEDICAL CLINIC 1210 SECOND STREET * GAGE COUNTY MEDICAL CLINIC 1101 NORTH 10TH STREET * GORDON CLINIC 807 N ASH None GOTHENBURG CLINIC 918 20TH STREET *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 6

City, State and ZIP

Telephone # County Name

VALENTINE, NE 69201 CHESTER, NE 68327 CLARKSON, NE 68629 HOWELLS, NE 68641 PLAINVIEW, NE 68769 SCHUYLER, NE 68661 BAYARD, NE 69334 WYMORE, NE 68466 TEKAMAH, NE 68061

(402)376-3770 Cherry (402)324-7101 Thayer (402)892-3466 Colfax (402)986-1115 Colfax (402)582-4245 Pierce (402)352-3745 Colfax (308)586-1717 Morrill (402)645-3733 Gage (402)374-1585 Burt

COZAD, NE 69130

(308)784-3039 Dawson

CRETE, NE 68333 CURTIS, NE 69025 DAVENPORT, NE 68335 WEST POINT, NE 68788 EDGAR, NE 68935 O' NEILL, NE 68763

(402)826-2102 Saline (308)367-4162 Frontier (402)364-2105 Thayer (402)372-2477 Cuming (402)224-3344 Clay (402)336-4222 Holt

EMERSON, NE 68733 FALLS CITY, NE 68355 LEXINGTON, NE 68850 CAMPBELL, NE 68932 HILDRETH, NE 68947 FRANKLIN, NE 68939 GENEVA, NE 68361

(402)695-2453 Dakota (402)245-4475 Richardson (308)324-8308 Dawson (402)756-8080 Franklin (308)938-4885 Franklin (308)425-6249 Franklin (402)759-4485 Fillmore

FORT CALHOUN, NE 68023 FRIEND, NE 68359 BEATRICE, NE 68310 GORDON, NE 69343 GOTHENBURG, NE 69138

(402)468-4655 Washington (402)947-2021 Saline (402)228-3436 Gage (308)282-1442 Sheridan (308)537-4066 Dawson

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nebraska CCN 283876 283989 288502 283454 283467 283866 283867 283865 288511 288515 288516 283421 288537 283455 283483 283493 288519 283985 283416 288532 283437 283405 288544 288531 288530

Key Provider Name *

GOTHENBURG MEDICAL ARTS RURAL HEALTH CLINIC * GRANT MEDICAL CLINIC * GREATER NEBRASKA MEDICAL & SURGICAL SERV-ALLIANCE * GREATER NEBRASKA MEDICAL & SURGICAL SERV-HEMINGFOR * GREATER NEBRASKA MEDICAL & SURGICAL SERV-HYANNIS * GREATER SANDHILLS FAMILY HEALTHCARE PC * GREATER SANDHILLS FAMILY HEALTHCARE PC * GREATER SANDHILLS FAMILY HEALTHCARE PC * GREELEY MEDICAL CLINIC * HEARTLAND FAMILY MEDICINE * HEARTLAND FAMILY MEDICINE * HENDERSON FAMILY CARE None HOOPER MEDICAL CLINIC * HOWARD COUNTY MEDICAL CLINIC * HOWELLS FAMILY PRACTICE * HUMBOLDT FAMILY MEDICINE * HUMPHREY MEDICAL CLINIC * INDIANOLA MEDICAL CLINIC * KEARNEY COUNTY HEALTH SERVICES None KHS POTTER CLINIC * KIMBALL COUNTY HOSPITAL CLINIC * LEGEND BUTTES HEALTH SERVICESNone LEXINGTON REGIONAL HEALTH CENTER ELWOOD CLINIC * LONE TREE MEDICAL CLINIC * LONE TREE MEDICAL CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 6

Address

City, State and ZIP

Telephone # County Name

619 10TH STREET, P O BOX 389

GOTHENBURG, NE 69138

(308)537-3673 Dawson

912 CENTRAL AVENUE GRANT, NE 69140 2091 BOX BUTTE AVENUE, SUITE 200 & ALLIANCE, NE 69301 SUITE 700 812 LARAMIE AVENUE HEMINGFORD, NE 69348

(308)352-7100 Perkins (308)762-4300 Box Butte

111 NORTH MAIN STREET

HYANNIS, NE 69350

(308)458-2436 Grant

P O BOX 146, 101 E SOUTH STREET

BASSETT, NE 68714

(402)684-2285 Rock

418 E 5TH STREET

ATKINSON, NE 68713

(402)925-2994 Holt

110 W 2ND STREET

STUART, NE 68780

(402)924-3777 Holt

109 WEST OCONNOR AVENUE 811 HOWELL STREET 715 BROWN STREET 1621 FRONT STREET 600 E FULTON STREET, SUITE A 1113 SHERMAN STREET 119 SOUTH 3RD STREET 1120 GRAND AVENUE 303 MAIN STREET 119 SOUTH FOURTH 727 EAST FIRST STREET

GREELEY, NE 68842 OXFORD, NE 68967 ALMA, NE 68920 HENDERSON, NE 68371 HOOPER, NE 68031 ST PAUL, NE 68873 HOWELLS, NE 68641 HUMBOLDT, NE 68376 HUMPHREY, NE 68642 INDIANOLA, NE 69034 MINDEN, NE 68959

(308)428-3018 Greeley (308)824-3288 Furnas (308)928-2103 Harlan (402)723-4512 York (402)654-2221 Dodge (308)754-5447 Howard (402)986-0830 Colfax (402)862-3280 Richardson (402)923-0412 Platte (308)364-9290 Red Willow (308)832-1440 Kearney

922 1/2 SHERMAN STREET 505 SOUTH BURG STREET P.O. BOX 272, 11 PADDOCK ST.

POTTER, NE 69156 KIMBALL, NE 69145 CRAWFORD, NE 69339

(308)879-0155 Cheyenne (308)235-1966 Kimball (308)665-1770 Dawes

202 SMITH AVENUE

ELWOOD, NE 68937

(402)324-5651 Gosper

2510 18TH AVENUE 901 BROADWAY STREET

CENTRAL CITY, NE 68826 FULLERTON, NE 68638

(308)946-3845 Merrick (308)536-2458 Nance

(308)487-3322 Box Butte

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nebraska CCN 283401 283813 283462 283994 283432 283430 283458 288522 288542 283485 283456 283471 283878 283984 288526 288543 283870 283442 283441 288533 283440 283821 283443 283451 283857 283990 283486

Key Provider Name *

LYONS MERCY MEDICAL CLINIC MAIN STREET MEDICAL CLINIC * MCH PHYSICIANS BLAIR CLINIC * MEMORIAL CLINIC-UTICA * MILFORD FAMILY MEDICAL CENTER * MORRILL COUNTY HOSPITAL CLINIC * NANCE COUNTY MEDICAL CLINIC * NEBRASKA CITY MEDICAL CLINIC None NEWMAN GROVE MEDICAL CLINIC * OAKLAND FAMILY PRACTICE * OAKLAND MERCY MEDICAL CLINIC * ORCHARD MEDICAL CLINIC * PARK STREET MEDICAL CLINIC PC * PAWNEE COUNTY RURAL HEALTH CLINIC * PENDER MEDICAL CLINIC None PHELPS MEDICAL GROUP * PONCA MERCY MEDICAL CLINIC * QUALITY HEALTHCARE SERVICES MEDICAL CLINIC * QUALITY HEALTHCARE SERVICES MEDICAL CLINIC None RANDOLPH FAMILY PRACTICE CLINIC * REGIONAL WEST GARDEN COUNTY CLINIC * REGIONAL WEST PHYSICIANS CLINIC * ROCK COUNTY CLINIC * RUSHVILLE CLINIC * SALINE MEDICAL SPECIALTIES * SAUNDERS MEDICAL CENTER CLINIC * SCRIBNER MEDICAL CLINIC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 6

Address

City, State and ZIP

Telephone # County Name

220 MAIN, BOX 229 313 NORTH WEBSTER, P O BOX 467 812 NORTH 22ND STREET 100 4TH STREET 119 SOUTH C STREET 1320 S STREET 405 BROADWAY STREET 1301 GRUNDEMAN BLVD, SUITE A 104 NORTH 1ST STREET 100 WEST 9TH STREET 211 NORTH ENGDAHL 103 WASHINGTON STREET 505 SOUTH PARK STREET 600 I STREET, P O BOX 433

LYONS, NE 68038 RED CLOUD, NE 68970 BLAIR, NE 68008 UTICA, NE 68456 MILFORD, NE 68405 BRIDGEPORT, NE 69336 FULLERTON, NE 68638 NEBRASKA CITY, NE 68410 NEWMAN GROVE, NE 68758 OAKLAND, NE 68045 OAKLAND, NE 68045 ORCHARD, NE 68764 GENOA, NE 68640 PAWNEE CITY, NE 68420

(402)687-2171 Burt (402)746-2282 Webster (402)426-4611 Washington (402)534-2081 Seward (402)761-3307 Seward (308)262-1755 Morrill (308)536-2446 Nance (402)873-4242 Otoe (402)447-6214 Madison (402)685-5120 Burt (402)685-5116 Burt (402)893-5155 Antelope (402)993-2206 Nance (402)852-2311 Pawnee

100 VALLEY VIEW DRIVE, SUITE 1 1315 TIBBALS STREET 111 2ND STREET 1313 N. CHEYENNE - P O BOX 710

PENDER, NE 68047 HOLDREGE, NE 68949 PONCA, NE 68770 BENKELMAN, NE 69021

(402)385-3033 Thurston (308)995-6111 Phelps (402)755-2231 Dixon (308)423-2151 Dundy

903 BAILEY STREET

STRATTON, NE 69043

(308)276-2411 Hitchcock

106 E WAYNE STREET

RANDOLPH, NE 68771

(402)337-0200 Cedar

1100 WEST 2ND STREET

OSHKOSH, NE 69154

(308)772-3283 Garden

302 CENTER AVENUE

MORRILL, NE 69358

(308)247-3475 Scotts Bluff

801 S STATE STREET 307 CONRAD STREET 969 EAST HIGHWAY 33 1760 COUNTY ROAD J

BASSETT, NE 68714 RUSHVILLE, NE 69360 CRETE, NE 68333 WAHOO, NE 68066

(402)684-2906 Rock (308)327-2757 Sheridan (402)826-3222 Saline (402)443-4191 Saunders

429 MAIN STREET

SCRIBNER, NE 68057

(402)664-3414 Dodge

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nebraska CCN 283409 288513 288514 283481 283863 283478 283479 283494 283470 283433 283996 288501 283446 283434 288504 288541 288500 283872 283424 283463 288529 283465 288534 283408 288503 283488

Key Provider Name *

SEWARD FAMILY MEDICAL CENTER SIDNEY REG MEDICAL CTR PHYSICIANS CLINIC-CHAPPELL * SIDNEY REGIONAL MEDICAL CENTER PHYSICIANS CLINIC * SPALDING MEDICAL CLINIC * ST EDWARD MEDICAL CLINIC * SUPERIOR FAMILY MEDICAL CENTER

*

SUPERIOR FAMILY MEDICAL CENTER

*

SUTTON FAMILY PRACTICE * SYRACUSE MEDICAL CENTER * TCHS BRUNING MEDICAL CLINIC * TECUMSEH FAMILY HEALTH * TEKAMAH MERCY MEDICAL CLINIC * THAYER CO HLTH SVS DESHLER MED * THAYER COUNTY HEALTH SERVICES HEBRON MEDICAL CLINI * THE BEATRICE WOMEN'S AND CHILDREN'S CLINIC * THE FAIRBURY CLINIC * TRENTON REGIONAL MEDICAL CENTER * VALENTINE MEDICAL CLINIC, LLC * VALLEY MEDICAL CLINIC OF BIG SPRINGS * VCHS MEDICAL CLINIC * VCHS MEDICAL CLINIC * VCHS MEDICAL CLINIC None WAUSA MEDICAL CLINIC * WEBSTER COUNTY CLINIC * WEEPING WATER MEDICAL CENTER * WEST HOLT MEDICAL CLINIC *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 6

Address

City, State and ZIP

Telephone # County Name

250 NORTH COLUMBIA 562 VINCENT AVENUE

SEWARD, NE 68434 CHAPPELL, NE 69129

(402)643-4800 Seward (308)874-2255 Deuel

1000 POLE CREEK XING

SIDNEY, NE 69162

(308)254-5544 Cheyenne

151 NORTH CHESTNUT 1102 WATER STREET PO BOX 407, 525 EAST 11TH STREET

SPALDING, NE 68665 SAINT EDWARD, NE 68660 SUPERIOR, NE 68978

(308)497-2485 Greeley (402)678-2232 Boone (402)879-4781 Nuckolls

76 WEST 8TH STREET

NELSON, NE 68961

(402)225-2375 Nuckolls

208 NORTH FRENCH AVENUE 277 EAST 17TH STREET 108 SOUTH FILLMORE 202 HIGH STREET, SUITE 100 1121 SOUTH 13TH STREET 615 4TH STREET

SUTTON, NE 68979 SYRACUSE, NE 68446 BRUNING, NE 68322 TECUMSEH, NE 68450 TEKAMAH, NE 68061 DESHLER, NE 68340

(402)773-2130 Clay (402)269-2411 Otoe (402)353-2055 Thayer (402)335-2811 Johnson (402)685-7590 Burt (402)365-7604 Thayer

120 PARK AVENUE

HEBRON, NE 68370

(402)768-7203 Thayer

4800 HOSPITAL PARKWAY, SUITE 202

BEATRICE, NE 68310

(402)228-3117 Gage

825 22ND ST 406 EAST 1ST STREET

FAIRBURY, NE 68352 TRENTON, NE 69044

(402)729-3361 Jefferson (308)334-5155 Hitchcock

502 N CHERRY STREET PO BOX 299, 100 WEST 3RD

VALENTINE, NE 69201 BIG SPRINGS, NE 69122

(402)376-2200 Cherry (308)889-3376 Deuel

150 NORTH 9TH AVENUE, SUITE B 130 NORTH 6TH STREET, SUITE B 2707 L STREET, SUITE 1 100 N LINCOLN STREET P O BOX 465, 6TH & FRANKLIN STS 204 NORTH RANDOLPH STREET 405 WEST PEARL STREET

BURWELL, NE 68823 LOUP CITY, NE 68853 ORD, NE 68862 WAUSA, NE 68786 RED CLOUD, NE 68970 WEEPING WATER, NE 68463 ATKINSON, NE 68713

(308)346-5442 Garfield (308)745-0324 Sherman (308)728-4200 Valley (402)586-2244 Knox (402)746-5614 Webster (402)267-5330 Cass (402)925-2811 Holt

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nebraska CCN

Key Provider Name

*

WILBER MEDICAL CLINIC 283469 *

283484 WISNER FAMILY PRACTICE * 283868 WITTER FAMILY MEDICINE * 283415 WYMORE MEDICAL CLINIC Total Providers for this State = 141

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 6

Address

City, State and ZIP

Telephone # County Name

203 WEST 4TH STREET 2100 21ST CIRCLE SUITE A 358 S 10TH, P O BOX 110 116 EAST H STREET

WILBER, NE 68465 WISNER, NE 68791 DAVID CITY, NE 68632 WYMORE, NE 68466

(402)821-3293 Saline (402)529-6516 Cuming (402)367-3322 Butler (402)645-3310 Gage

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Colorado CCN 068507 063873 063405 063876 063979 063986 063866 063829 063864 068510 068519 068503 063804 068501 063858 068500 063400 063851 063872 063996 063980 063854 063999 063810 068512 068521

Key Provider Name *

AKRON CLINIC ARKANSAS VALLEY FAMILY PRACTICE LLC None BANNER HEALTH CENTER STERLING * BASIN CLINIC * BRUSH FAMILY CLINIC * BUENA VISTA HEALTH CENTER * BUTTON FAMILY PRACTICE * CENTENNIAL FAMILY HEALTH CENTER * COLORADO PLAINS CLINIC WIGGINS * CONVENIENT CARE CLINIC * CORTEZ PRIMARY CARE CLINIC * CREEDE FAMILY PRACTICE OF RIO GRANDE HOSPITAL * CUSTER COUNTY MEDICAL CENTER * EADS MEDICAL CLINIC * EASTERN PLAINS MEDICAL CLINIC OF CALHAN * FAMILY CARE CLINIC * FAMILY PRACTICE OF HOLYOKE * FLORENCE MEDICAL CENTER * FORT MORGAN PEDIATRIC CLINIC, PC * GRAND RIVER HEALTH CLINIC WEST * GRAND RIVER PRIMARY CARE * HAVENS FAMILY CLINIC * KIT CARSON CLINIC * LAKE CITY AREA MEDICAL CENTER * LAMAR MEDICAL CLINIC * MANCOS VALLEY HEALTH CENTER *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

Address

City, State and ZIP

Telephone # County Name

82 MAIN 2317 SAN JUAN AVE

AKRON, CO 80720 LA JUNTA, CO 81050

(970)345-6336 Washington (719)383-2325 Otero

102 HAYS AVE

STERLING, CO 80751

(970)521-3223 Logan

421 WEST ADAMS ROAD 2400 W EDISON 28374 COUNTY ROAD 317 715 SOUTH 9TH STREET 319 MAIN STREET

NATURITA, CO 81422 BRUSH, CO 80723 BUENA VISTA, CO 81211 CANON CITY, CO 81212 ORDWAY, CO 81063

(970)865-2665 Montrose (970)842-6740 Morgan (719)395-9048 Chaffee (719)269-8820 Fremont (719)267-3503 Crowley

226 MAIN STREET

WIGGINS, CO 80654

(970)483-7283 Morgan

403 KENDELL DRIVE 118 NORTH CHESTNUT 802 RIO GRANDE AVENUE

LAMAR, CO 81052 CORTEZ, CO 81321 CREEDE, CO 81130

(719)336-6767 Prowers (970)564-9777 Montezuma (719)658-0929 Mineral

704 EDWARDS 1211 LUTHER STREET 560 CRYSTOLA STREET

WESTCLIFFE, CO 81252 EADS, CO 81036 CALHAN, CO 80808

(719)783-2380 Custer (719)438-2251 Kiowa (719)347-0100 El Paso

615 FAIRHURST 1001 EAST JOHNSON STREET 501 W 5TH ST 1000 LINCOLN STREET, STE 202

STERLING, CO 80751 HOLYOKE, CO 80734 FLORENCE, CO 81226 FORT MORGAN, CO 80701

(970)521-3223 Logan (970)854-2500 Phillips (719)784-4816 Fremont (970)542-9187 Morgan

201 SIPPERELLE DRIVE 501 AIRPORT ROAD 109 LATIGO LANE, STE C 102 EAST 2ND AVENUE 700 N HENSON STREET 403 KENDALL DRIVE 111 RAILROAD AVE

PARACHUTE, CO 81635 RIFLE, CO 81650 CANON CITY, CO 81212 KIT CARSON, CO 80825 LAKE CITY, CO 81235 LAMAR, CO 81052 MANCOS, CO 81328

(970)285-7046 Garfield (970)625-1100 Garfield (719)276-3211 Fremont (719)962-3501 Cheyenne (970)944-2331 Hinsdale (719)336-6767 Prowers (970)564-2104 Montezuma

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Colorado CCN 063869 063403 063407 063404 068518 068509 063997 063834 063985 068504 063837 063870 063992 068513 068523 063998 068506 063406 068520 068517 063401 063831 063840

Key Provider Name *

Address

MEADOWS FAMILY MEDICAL 115 15TH AVE, PO BOX 3243 CENTER

*

MEEKER FAMILY HEALTH CENTER 345 CLEVELAND STREET None MONTE VISTA RHC OF RIO GRANDE 1033 2ND AVENUE HOSPITAL * MT SAN RAFAEL HOSPITAL HEALTH 400 BENEDICTA STE A CLINIC

*

NORTH PARK MEDICAL CENTER 350 MCKINLEY STREET WALDEN * PAGOSA MOUNTAIN CLINIC 95 SOUTH PAGOSA BLVD * PARKE HEALTH CLINIC 182 16TH ST * PEDIATRIC ASSOCIATION OF CANON 1335 PHAY AVENUE, SUITE A CITY * PRAIRIE VIEW RURAL HEALTH 615 WEST 5TH NORTH CLINIC * RIO GRANDE HOSPITAL CLINIC 0310C COUNTY RD 14 * ROCKY FORD FAMILY HEALTH 1014 ELM AVENUE CENTER * SABATINI PEDIATRICS PC 612 YALE PLACE * SAN LUIS VALLEY HEALTH 115 MAIN STREET ANTONITO CLINIC

*

SAN LUIS VALLEY LA JARA MEDICAL 509 MAIN STREET CLINIC None SLV HEALTH MONTE VISTA 103 CHICO CT COMMUNITY CLINIC * SOUTHEAST COLORADO 900 CHURCH STREET PHYSICIANS CLINIC

*

SOUTHWEST MEMORIAL PRIMARY 33 NORTH ELM STREET CARE None SOUTHWEST SCHOOL-BASED 418 S SLIGO STREET HEALTH CENTER * SOUTHWEST WALK-IN CARE 2095 NORTH DOLORES ROAD, STE C * SPANISH PEAKS FAMILY CLINIC 23400 US HIGHWAY 160 * STRATTON MEDICAL CLINIC 500 NEBRASKA AVENUE * SURFACE CREEK FAMILY PRACTICE 255 SW 8TH AVE * TMC - PRIMARY CARE 500 W PACIFIC AVENUE

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

City, State and ZIP

Telephone # County Name

IDAHO SPRINGS, CO 80452

(303)567-2668 Clear Creek

MEEKER, CO 81641 MONTE VISTA, CO 81144

(970)878-4014 Rio Blanco (719)852-8827 Rio Grande

TRINIDAD, CO 81082

(719)846-2206 Las Animas

WALDEN, CO 80480

(970)723-4255 Jackson

PAGOSA SPRINGS, CO 81147 (970)731-3700 Archuleta BURLINGTON, CO 80807 (719)346-9481 Kit Carson CANON CITY, CO 81212 (719)269-1727 Fremont CHEYENNE WELLS, CO 80810 (719)767-5669 Cheyenne DEL NORTE, CO 81132 ROCKY FORD, CO 81067

(719)657-2418 Rio Grande (719)254-7421 Otero

CANON CITY, CO 81212 ANTONITO, CO 81120

(719)275-3442 Fremont (719)376-2308 Conejos

LA JARA, CO 81140

(719)274-5000 Conejos

MONTE VISTA, CO 81144

(719)589-8194 Rio Grande

SPRINGFIELD, CO 81073

(719)523-6628 Baca

CORTEZ, CO 81321

(970)565-8556 Montezuma

CORTEZ, CO 81321

(970)564-2104 Montezuma

CORTEZ, CO 81321 WALSENBURG, CO 81089 STRATTON, CO 80836 CEDAREDGE, CO 81413 TELLURIDE, CO 81435

(970)564-1037 Montezuma (719)738-4591 Huerfano (719)348-4650 Kit Carson (970)856-3146 Delta (970)728-3848 San Miguel

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Colorado CCN

Key Provider Name

* 063995 VALLEY MEDICAL CLINIC * 063874 WALSH MEDICAL CLINIC * 063868 WASHINGTON COUNTY CLINIC * 063994 YUMA CLINIC Total Providers for this State = 53

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

116 E NINTH STREET 137 KANSAS STREET 482 ADAMS AVENUE 1000 W 8TH AVENUE

JULESBURG, CO 80737 WALSH, CO 81090 AKRON, CO 80720 YUMA, CO 80759

(970)474-3376 Sedgwick (719)324-5253 Baca (970)345-2262 Washington (970)848-4792 Yuma

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Montana CCN

Key Provider Name

273975

*

273986 273818 273414

*

273985 273989 273419 273817 273981 273420 273418 273976 273998 273991 273423 273411 273406 273400 273412 273425 273980 273830 273826 273992 273995 273427 273402 273828

BAIR MEDICAL CLINIC

BAIR MEMORIAL CLINIC BASIN MEDICAL CENTER * BENEFIS TETON RURAL HEALTH CLINIC * BENTON MEDICAL CENTER * BIG SANDY MEDICAL CENTER RHC * BITTERROOT PHYSICIANS CLINIC * BOULDER MEDICAL CLINIC INC * COMMUNITY CLINIC OF FALLON CO * CONVENIENT CARE CLINIC * CORVALLIS FAMILY MEDICINE * DAHL MEMORIAL CLINIC * DANIELS MEMORIAL MEDICAL CLINIC

*

DEER LODGE MEDICAL CENTER * EUREKA HEALTHCARE PRIMARY CARE * GABERT CLINIC * GLASGOW CLINIC, INC * GRANITE COUNTY CLINIC * HARRISON CLINIC * HOLY ROSARY HEALTHCARE RHC * HOT SPRINGS MEDICAL CLINIC None JACK LINCOLN MEMORIAL CLINIC * LIBBY CLINIC * LISTERUD RURAL HEALTH CLINIC * LIVINGSTON HEALTHCARE * LIVINGSTON HEALTHCARE SHIELDS VALLEY CLINIC * MADISON VALLEY CLINIC * MAIN STREET MEDICAL *

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

Address

City, State and ZIP

Telephone # County Name

16 W MAIN 530 3RD ST NW 76 CENTRAL AVE 915 4TH ST NW

WHITE SULPHUR SPRING, MT (406)547-3321 Meagher 59645 HARLOWTON, MT 59036 (406)632-4351 Wheatland STANFORD, MT 59479 (406)566-2773 Judith Basin CHOTEAU, MT 59422 (406)466-5763 Teton

1203 15TH ST 166 MONTANA AVE E 1200 WESTWOOD DR 214 S MAIN 202 S 4TH WEST ST 1200 WESTWOOD DR STE H 1037 MAIN ST 215 SANDY ST 105 5TH AVE E

FORT BENTON, MT 59442 BIG SANDY, MT 59520 HAMILTON, MT 59840 BOULDER, MT 59632 BAKER, MT 59313 HAMILTON, MT 59840 CORVALLIS, MT 59828 EKALAKA, MT 59324 SCOBEY, MT 59263

(406)622-5485 Chouteau (406)378-2189 Chouteau (406)363-1100 Ravalli (406)225-4201 Jefferson (406)778-2833 Fallon (406)363-0597 Ravalli (406)961-4661 Ravalli (406)775-8739 Carter (406)487-2296 Daniels

1100 HOLLENBECK LN 304 OSLOSKI RD

DEER LODGE, MT 59722 EUREKA, MT 59917

(406)846-1722 Powell (406)297-2438 Lincoln

107 DILWORTH 221 5TH AVE S 310 SANSOME 7558 US HWY 287 2600 WILSON ST 209 MAIN ST 341 MONTANA HIGHWAY 135 211 E 2ND ST 301 KNAPP ST 320 ALPENGLOW LANE 309 ELLIOTT ST N

GLENDIVE, MT 59330 GLASGOW, MT 59230 PHILIPSBURG, MT 59858 HARRISON, MT 59735 MILES CITY, MT 59301 HOT SPRINGS, MT 59845 SAINT REGIS, MT 59866 LIBBY, MT 59923 WOLF POINT, MT 59201 LIVINGSTON, MT 59047 WILSALL, MT 59086

(406)345-8900 Dawson (406)228-3400 Valley (406)859-3271 Granite (406)685-3250 Madison (406)233-2600 Custer (406)741-3602 Sanders (406)649-7307 Mineral (406)293-8711 Lincoln (406)653-6501 Roosevelt (406)222-0800 Park (406)578-2580 Park

305 N MAIN 907 MAIN ST

ENNIS, MT 59729 (406)682-4223 Madison THOMPSON FALLS, MT 59873 (406)827-4307 Sanders

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Montana CCN

Key Provider Name

273404 273978 273982

*

273424

*

273408

*

273990

*

273984

*

273987

*

273421 273407 273997 273996 273410

*

273415

*

273416

*

273829 273993 273977 273413 273405 273417 273988

*

273426 273403 273979

*

* *

* * * *

* * * * * *

* *

* = Non-Deemed

MARGO BOWERS HEALTH CENTER MONDAK FAMILY CLINIC MUSSELSHELL CO MEDICAL CENTER NORTH VALLEY PROFESSIONAL CENTER

NORTHERN MONTANA FAMILY MEDICAL CENTER NORTHERN MONTANA SPECIALTY MEDICAL CENTER NORTHERN ROCKIES MEDICAL CLINIC

PHILLIPS COUNTY FAMILY HEALTH CLINIC PHYSICIAN'S CLINIC PIONEER MEDICAL CENTER PLAINS MEDICAL CLINIC PONDERA MEDICAL CENTER CLINIC PRAIRIE COUNTY RURAL HEALTH CLINIC

PROVIDENCE ST JOSEPH MEDICAL CENTER POLSON PROVIDENCE ST JOSEPH MEDICAL CENTER RONAN RAVALLI FAMILY MEDICINE RIVERSIDE FAMILY CLINIC, INC ROOSEVELT MEDICAL CLINIC ROSEBUD HEALTH CARE CLINIC RUBY VALLEY MEDICAL CLINIC SHERIDAN MEMORIAL CLINIC ST LUKE COMMUNITY CLINIC ST IGNATIUS

STILLWATER BILLINGS CLINIC TAMARACK MEDICAL CLINIC THOMPSON FALLS CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

Address

City, State and ZIP

Telephone # County Name

26 E BROAD ST 304 S ELLERY AVE 1202 THIRD ST W

DRUMMOND, MT 59832 FAIRVIEW, MT 59221 ROUNDUP, MT 59072

(406)288-3627 Granite (406)742-5261 Richland (406)323-2301 Musselshell

2165 9TH ST W

COLUMBIA FALLS, MT 59912 (406)892-3208 Flathead

1410 1ST AVE

HAVRE, MT 59501

(406)265-5408 Hill

20 13TH ST W

HAVRE, MT 59501

(406)265-7831 Hill

226 9TH AVE SE

CUT BANK, MT 59427

(406)873-5507 Glacier

311 S 8TH AVE E

MALTA, MT 59538

(406)654-1800 Phillips

1170 WESTWOOD DR STE B 701 STOCK ST 10 KRUGER RD 809 SUNSET BLVD 409 BOWEN

HAMILTON, MT 59840 BIG TIMBER, MT 59011 PLAINS, MT 59859 CONRAD, MT 59425 TERRY, MT 59349

(406)363-5101 Ravalli (406)932-4199 Sweet Grass (406)826-4800 Sanders (406)271-3231 Pondera (406)635-5863 Prairie

6 13TH AVE E

POLSON, MT 59860

(406)883-5680 Lake

63351 U S HWY 93 S

RONAN, MT 59864

(406)676-5680 Lake

411 W MAIN ST 209 1/2 H ST E 818 2ND AVE E 281 N 17TH AVE 210 E CROFOOT ST 440 W LAUREL AVE 330 SIX TRACT LN

HAMILTON, MT 59840 POPLAR, MT 59255 CULBERTSON, MT 59218 FORSYTH, MT 59327 SHERIDAN, MT 59749 PLENTYWOOD, MT 59254 SAINT IGNATIUS, MT 59865

(406)363-5104 Ravalli (406)768-5171 Roosevelt (406)787-6400 Roosevelt (406)346-2916 Rosebud (406)842-5056 Madison (406)765-3700 Sheridan (406)745-2781 Lake

710 N 11TH ST 1208 6TH AVE E 120 POND ST

COLUMBUS, MT 59019 (406)322-5316 Stillwater SUPERIOR, MT 59872 (406)822-4278 Mineral THOMPSON FALLS, MT 59873 (406)827-4442 Sanders

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Montana CCN

Key Provider Name

* 273824 THREE RIVERS CLINIC, LLC * 273994 TRIANGLE HEALTH CARE * 273409 TWIN BRIDGES MEDICAL CLINIC Total Providers for this State = 56

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

16 RAILWAY AVE 418 W MONROE 104 S MADISON ST

THREE FORKS, MT 59752 CHESTER, MT 59522 TWIN BRIDGES, MT 59754

(406)285-3251 Gallatin (406)759-5194 Liberty (406)684-5546 Madison

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Dakota CCN

Key Provider Name

353423 353419 353837 353437

*

353434 353985

*

353428 353979 353413 353852 353405 353995 353412 353449

*

353450

*

353451

*

353452

*

353442

*

353415 353438

*

353402 353407

*

353977

*

353997

*

* * *

*

* * * * * * *

*

*

* = Non-Deemed

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

City, State and ZIP

Telephone # County Name

AMC CLINIC 612 CENTER AVE N AMC ZEELAND CLINIC 203 MAIN STREET AVERA CLINIC OF ELLENDALE 240 MAIN CAVALIER COUNTY MEMORIAL 901 2ND ST HOSPITAL CLINIC CHI ST ALEXIUS HEALTH CLINIC 1177 BORDER LANE CHI ST ALEXIUS HEALTH DICKINSON 95 2ND ST NW FAMILY CLINIC CLINICARE 301 MOUNTAIN ST E STE 2 COOPERSTOWN MEDICAL CENTER 1200 ROBERTS AVE NE CROSBY CLINIC 702 1ST ST SW FAMILY MEDICAL CLINIC 10 9TH AVENUE EAST FIRST CARE HEALTH CENTER 115 VIVIAN ST FOSTER COUNTY MED CTR 820 N 5TH ST GARRISON FAMILY CLINIC 407 3RD AVE SE GLEN ULLIN FAMILY MEDICAL CLINIC 602 ASH AVE

ASHLEY, ND 58413 ZEELAND, ND 58581 ELLENDALE, ND 58436 LANGDON, ND 58249

(701)288-3448 McIntosh (701)423-5403 McIntosh (701)349-3666 Dickey (701)256-6120 Cavalier

WASHBURN, ND 58577 BEACH, ND 58621

(701)462-3396 McLean (701)872-3777 Golden Valley

CAVALIER, ND 58220 COOPERSTOWN, ND 58425 CROSBY, ND 58730 LISBON, ND 58054 PARK RIVER, ND 58270 CARRINGTON, ND 58421 GARRISON, ND 58540 GLEN ULLIN, ND 58631

(701)265-6307 Pembina (701)797-2128 Griggs (701)965-6349 Divide (701)683-4711 Ransom (701)284-7555 Walsh (701)652-2515 Foster (701)463-2245 McLean (701)348-9175 Morton

HEART OF AMERICA JOHNSON CLINIC HEART OF AMERICA JOHNSON CLINIC - DUNSEITH HEART OF AMERICA JOHNSON CLINIC - MADDOCK JACOBSON MEMORIAL HOSPITAL COMMUNITY CLINIC LINTON MEDICAL CENTER MCKENZIE COUNTY HEALTHCARE SYSTEMS CLINIC MILNOR CLINIC MOUNTRAIL COUNTY MEDICAL CENTER RHC NELSON COUNTY HEALTH SYSTEM MCVILLE CLINIC NEW ROCKFORD COMMUNITY CLINIC

800 S MAIN AVE

RUGBY, ND 58368

(701)776-5235 Pierce

215 MAIN ST SE

DUNSEITH, ND 58329

(701)224-5694 Rolette

301 ROOSEVELT AVE

MADDOCK, ND 58348

(701)438-2555 Benson

603 EAST STREET NORTH

ELGIN, ND 58533

(701)584-3338 Grant

511 ELM ST 525 N MAIN ST

LINTON, ND 58552 WATFORD CITY, ND 58854

(701)254-4531 Emmons (701)842-3771 McKenzie

401 MAIN 615 6TH ST SE

MILNOR, ND 58060 STANLEY, ND 58784

(701)427-5300 Sargent (701)638-2505 Mountrail

108 N MAIN ST

MCVILLE, ND 58254

(701)322-4347 Nelson

118 1ST ST S

NEW ROCKFORD, ND 58356

(701)947-2021 Eddy

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Dakota CCN

Key Provider Name

353456

*

353459

*

353455

*

353454 358506 353899

*

353443 353411 353989 353408 353445 353848

*

353822

*

353847 353844 353406 353851

*

353987

*

353986

*

353988 353404

*

353992

*

353978

*

* *

* * * * *

* * *

*

* 353458 * = Non-Deemed

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

City, State and ZIP

Telephone # County Name

NORTHWOOD DEACONESS HEALTH 611 TOWNER AVE CENTER NORTHWOOD DEACONESS HEALTH 308 WHINERY ST CENTER NORTHWOOD DEACONESS HEALTH 4 N PARK ST CENTER NORTHWOOD CLINIC OAKES COMMUNITY CLINIC 1200 N 7TH ST PRESENTATION CLINIC 213 2ND AVE NE RICHARDTON HEALTH CENTER 215 3RD AVE W RICHARDTON CLINIC RURAL HEALTH GACKLE 321 MAIN STREET RURAL HEALTH KULM 4 1ST AVE SE RURAL HEALTH NAPOLEON 420 MAIN RURAL HEALTH WISHEK PO BOX 647 SAKAKAWEA BEULAH CLINIC 1101 3RD AVE NW SANFORD HEALTH ELLENDALE 141 MAIN ST CLINIC SANFORD HEALTH ENDERLIN CLINIC 201 4TH AVE, SUITE 1

LARIMORE, ND 58251

(701)587-6060 Grand Forks

BINFORD, ND 58416

(701)676-2528 Griggs

NORTHWOOD, ND 58267

(701)587-6060 Grand Forks

OAKES, ND 58474 ROLLA, ND 58367 RICHARDTON, ND 58652

(701)742-3600 Dickey (701)477-3161 Rolette (701)974-3372 Stark

GACKLE, ND 58442 KULM, ND 58456 NAPOLEON, ND 58561 WISHEK, ND 58495 BEULAH, ND 58523 ELLENDALE, ND 58436

(701)485-3611 Logan (701)647-2345 LaMoure (701)754-2323 Logan (701)452-2364 McIntosh (701)873-4242 Mercer (701)349-3331 Dickey

ENDERLIN, ND 58027

(701)437-3320 Ransom

SANFORD HEALTH FORMAN CLINIC SANFORD HEALTH LAMOURE CLINIC SOUTHWEST MEDICAL CLINIC ST ANDREW'S BOTTINEAU CLINIC LLC TIOGA MEDICAL CENTER - POWERS LAKE RHC TIOGA MEDICAL CENTER TIOGA RHC TIOGA MEDICAL CENTER-RAY RHC TOWNER COUNTY MEDICAL CENTER TRINITY COMMUNITY CLINIC KENMARE UNITY MEDICAL CENTER/GRAFTON FAMILY CLINIC WALHALLA CLINIC

336 MAIN ST 100 1ST AVE SW 14 6TH AVE SW 314 OHMER ST

FORMAN, ND 58032 LAMOURE, ND 58458 BOWMAN, ND 58623 BOTTINEAU, ND 58318

(701)724-3221 Sargent (701)883-5048 LaMoure (701)523-3226 Bowman (701)228-9400 Bottineau

117 MAIN ST

POWERS LAKE, ND 58773

(701)464-5668 Burke

810 N WELO ST

TIOGA, ND 58852

(701)664-3368 Williams

RAY MALL HIGHWAY 281 NORTH

RAY, ND 58849 CANDO, ND 58324

(701)585-3624 Williams (701)968-4411 Towner

307 1ST AVE NW

KENMARE, ND 58746

(701)385-4283 Ward

155 W 14TH ST

GRAFTON, ND 58237

(701)352-2000 Walsh

301 5TH ST

WALHALLA, ND 58282

(701)549-2711 Pembina

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey North Dakota CCN

Key Provider Name *

WEST RIVER HEALTH CLINIC SCRANTON

*

353982 WEST RIVER HEALTH SERVICES BOWMAN CLINIC * 353980 WEST RIVER HEALTH SERVICES MOTT CLINIC *

353981 WEST RIVER HEALTH SERVICES NEW ENGLAND CLINIC

Total Providers for this State = 52

353983

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

211 MAIN ST

SCRANTON, ND 58653

(701)275-6336 Bowman

608 HWY 12 WEST

BOWMAN, ND 58623

(701)523-3271 Bowman

420 PACIFIC AVE

MOTT, ND 58646

(701)824-2391 Hettinger

820 2ND AVE W

NEW ENGLAND, ND 58647

(701)579-4507 Hettinger

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Dakota CCN

Key Provider Name *

433422 433419

AVERA MEDICAL GROUP CORSICA AVERA MEDICAL GROUP HOWARD * AVERA MEDICAL GROUP MILBANK * AVERA MEDICAL GROUP REVILLO * AVERA MEDICAL GROUP SALEM * AVERA MEDICAL GROUP WAUBAY * AVERA MEDICAL GROUP WILMOT None AVERA MEDICAL GROUP WINNER * AVERA ST BENEDICT CRHC/LAKE ANDES * AVERA ST BENEDICT CRHC/PARKSTON

*

AVERA ST BENEDICT CRHC/TRIPP * BELLE FOURCHE REGIONAL MEDICAL CLINIC * BENNETT COUNTY RURAL HEALTH CLINIC * BLACK HILLS FAMILY HEALTH CLINIC, PC * BON HOMME FAMILY PRACTICEAVON * BON HOMME FAMILY PRACTICETYNDALL * BONESTEEL MEDICAL CLINIC * BOWDLE CLINIC

433433

*

433438

*

433436

*

433407

*

433989

*

433859 433840 433435 433413 433883 433886 433876 433447 433408 433409 433410 433440 433442 433890 433418 433416

*

* = Non-Deemed

BROOKINGS HEALTH SYSTEM ARLINGTON CLINIC

BROOKINGS HEALTH SYSTEM VOLGA MEDICAL CLINIC BROOKINGS HEALTH SYSTEM WHITE MEDICAL CLINIC BURKE MEDICAL CLINIC CAMPBELL COUNTY CLINICHERREID

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 3

Address

City, State and ZIP

Telephone # County Name

265 MAIN STREET 213 S MAIN POST OFFICE BOX 370 803 EAST MILBANK AVE 103 EAST 3RD STREET PO BOX 6 741 S HILL STREET 80 N MAIN STREET PO BOX 215 409 4TH STREET 660 WEST 2ND STREET PO BOX 705 756 E LAKE PO BOX 279

CORSICA, SD 57328 HOWARD, SD 57349 MILBANK, SD 57252 REVILLO, SD 57259 SALEM, SD 57058 WAUBAY, SD 57273 WILMOT, SD 57279 WINNER, SD 57580 LAKE ANDES, SD 57356

(605)946-5411 Douglas (605)772-4426 Miner (605)432-4587 Grant (605)623-4695 Grant (605)425-3038 McCook (605)947-3422 Day (605)938-4351 Roberts (605)842-2443 Tripp (605)487-7878 Charles Mix

401 WEST GLYNN DRIVE

PARKSTON, SD 57366

(605)928-7961 Hutchinson

306 SOUTH MAIN STREET 2200 13TH AVENUE

TRIPP, SD 57376 BELLE FOURCHE, SD 57717

(605)935-7211 Hutchinson (605)723-8970 Butte

102 MAJOR ALLEN

MARTIN, SD 57551

(605)685-1660 Bennett

1100 HWY 71 S SUITE 101

HOT SPRINGS, SD 57747

(605)745-5188 Fall River

130 N MAIN STREET PO BOX 164

AVON, SD 57315

(605)286-3888 Bon Homme

410 WEST 16TH STREET

TYNDALL, SD 57066

(605)589-3322 Bon Homme

314 MELLETTE BONESTEEL, SD 57317 8001 WEST 5TH STREET POST OFFICE BOWDLE, SD 57428 BOX 556

104 W BIRCH POST OFFICE BOX 291 ARLINGTON, SD 57212

(605)654-9021 Gregory (605)285-6832 Edmunds

210 KASAN AVENUE

VOLGA, SD 57071

(605)627-5701 Brookings

302 EAST 5TH STREET

WHITE, SD 57276

(605)629-3333 Brookings

(605)983-3283 Kingsbury

814 JACKSON ST POST OFFICE BOX 358 BURKE, SD 57523

(605)775-2294 Gregory

208 MAIN STREET N BOX 158

(605)437-2304 Campbell

POST OFFICE

HERREID, SD 57632

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Dakota CCN

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 3

Address

City, State and ZIP

Telephone # County Name

433428 433446

*

None COTEAU

512 BROADWAY POST OFFICE BOX 70 116 W MAIN STREET

CENTERVILLE, SD 57014 ROSHOLT, SD 57260

(605)563-2411 Turner (605)537-4244 Roberts

433420

*

205 ORCHARD DRIVE

SISSETON, SD 57262

(605)698-7681 Roberts

433423 433401

*

HOT SPRINGS, SD 57747 FAULKTON, SD 57438

(605)745-5491 Fall River (606)598-6239 Faulk

433429

*

1201 HIGHWAY 71 SOUTH 1300 OAK STREET POST OFFICE BOX 100 212 N PRAIRIE AVENUE

FLANDREAU, SD 57028

(605)997-2471 Moody

433414 433437 433424

*

GEDDES, SD 57342 HILL CITY, SD 57745 KADOKA, SD 57543

(605)337-3197 Charles Mix (605)574-4470 Pennington (605)837-2257 Jackson

433441 433878 438500 433427 433411 433415 433402 433426 433425 433404 433445

*

BRITTON, SD 57430 SALEM, SD 57058 MOBRIDGE, SD 57601 PARKER, SD 57053 PHILIP, SD 57567 PLATTE, SD 57369 ARMOUR, SD 57313 CORSICA, SD 57328 STICKNEY, SD 57375 REDFIELD, SD 57469 MARION, SD 57043

(605)448-5953 Marshall (605)425-2855 McCook (605)845-8225 Walworth (605)297-3888 Turner (605)859-2566 Haakon (605)337-2633 Charles Mix (605)724-2151 Douglas (605)946-5959 Douglas (605)732-4508 Aurora (605)472-0510 Spink (605)648-3559 Turner

433444 433443

*

MENNO, SD 57045 BRIDGEWATER, SD 57319

(605)387-5435 Hutchinson (605)729-2421 McCook

433828 433403 433857 433858 433874

*

BERESFORD, SD 57004 CLEAR LAKE, SD 57226 CLARK, SD 57225 ESTELLINE, SD 57234 IPSWICH, SD 57451

(605)763-3700 Union (605)874-2141 Deuel (605)532-3676 Clark (605)873-2222 Hamlin (605)426-6040 Edmunds

*

* *

* * * * * * * * * *

*

* * * *

* = Non-Deemed

CENTERVILLE MEDICAL CLINIC DES PRAIRIES HEALTH CARE SYS-ROSHOLT CLINIC COTEAU DES PRAIRIES HOSPITAL SISSETON CLINIC FALL RIVER CLINIC FAULKTON AREA MEDICAL CENTER FLANDREAU MEDICAL CLINIC / AVERA HEALTH GEDDES MEDICAL CLINIC HILL CITY CLINIC KADOKA CLINIC

322 MAIN 238 ELM ST POST OFFICE BOX 639 601 CHESTNUT STREET POST OFFICE BOX 460 MARSHAL COUNTY MEDICAL CLINIC 415 9TH ST MCGREEVY CLINIC SALEM 740 SOUTH HILL MOBRIDGE MEDICAL CLINIC 1309 10TH AVENUE WEST PO BOX 580 PARKER MEDICAL CLINIC 100 EAST SANBORN, SUITE #1 PHILIP CLINIC 503 W PINE PO BOX 550 PLATTE MEDICAL CLINIC 612 E 7TH PO BOX 818 PRAIRIE HEALTH CLINIC - ARMOUR 708 8TH STREET PRAIRIE HEALTH CLINIC - CORSICA 230 MAIN STREET PRAIRIE HEALTH CLINIC - STICKNEY 301 MAIN STREET REDFIELD CLINIC 1010 W 1ST PO BOX 590 RURAL MEDICAL CLINICS 307 EAST STATE STREET POST OFFICE BOX 9 RURAL MEDICAL CLINICS 301 S HIGH ST POST OFFICE BOX 307 RURAL MEDICAL CLINICS 208 S MAIN POST OFFICE BOX 17 BRIDGEWATER SANFORD BERESFORD CLINIC 600 W CEDAR STREET SANFORD CLEAR LAKE CLINIC 701 3RD AVENUE S SANFORD CLINIC CLARK 211 N COMMERCIAL ST SANFORD CLINIC ESTELLINE 305 HOSPITAL DRIVE SANFORD CLINIC IPSWICH 110 5TH AVENUE

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey South Dakota CCN

Key Provider Name

433836 433827 433412 433993 433802 433995 433430

*

433987

*

433439

*

* * *

*

* *

SANFORD CLINIC LAKE NORDEN SANFORD CLINIC LENNOX SANFORD CLINIC WEBSTER VIBORG MEDICAL CLINIC WALL REGIONAL MEDICAL CLINIC WEST DAKOTA HEALTH CENTER WEST RIVER HEALTH CLINIC

* = Non-Deemed

Page 3 of 3

Address

City, State and ZIP

Telephone # County Name

512 MAIN STREET POST OFFICE BOX 79 108 S MAIN POST OFFICE BOX 662 101 PEABODY DRIVE PO BOX 381 103 PIONEER PO BOX 337 112 7TH AVENUE 906 MAIN STREET PO BOX 206 103 1ST AVE EAST POST OFFICE BOX 520

401 6TH AVENUE W

LAKE NORDEN, SD 57248 LENNOX, SD 57039 WEBSTER, SD 57274 VIBORG, SD 57070 WALL, SD 57790 TIMBER LAKE, SD 57656 MC LAUGHLIN, SD 57642

(605)785-3633 Hamlin (605)647-2841 Lincoln (605)345-4141 Day (605)326-5201 Turner (605)279-2149 Pennington (605)865-3258 Dewey (605)823-4253 Corson

LEMMON, SD 57638

(605)374-3773 Perkins

WHITE LAKE, SD 57383

(605)337-1529 Aurora

WINNER, SD 57580

(605)842-2626 Tripp

WEST RIVER HEALTH CLINIC LEMMON WHITE LAKE MEDICAL CLINIC AVERA 306 SOUTH JOHNSTON STREET

* 438501 WINNER REGIONAL CLINIC Total Providers for this State = 60

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

825 EAST 8TH STREET SUITE 100

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Utah CCN

Key Provider Name *

Address

BEAVER MEDICAL CLINIC 1059 NORTH 100 WEST BEAVER/ MILFORD MEDICAL CLINIC 850 NORTH MAIN * BLANDING MEDICAL CLINIC 804 NORTH 400 WEST * BRYCE VALLEY CLINIC 25 SOUTH REDROCK DRIVE * CIRCLEVILLE CLINIC 110 SOUTH 100 EAST * COALVILLE HEALTH CENTER 142 SOUTH 50 EAST * DUCHESNE VALLEY MEDICAL CLINIC 50 EAST 200 SOUTH * EMERY MEDICAL CENTER 90 WEST MAIN STREET * GARFIELD MEMORIAL CLINIC 200 NORTH 400 EAST * KAMAS HEALTH CENTER 228 WEST 200 SOUTH * MONUMENT VALLEY HEALTH 4 ROCK CANYON ROAD CENTER * 463813 MOUNTAIN UTAH FAMILY MEDICINE 879 NORTH MAIN * 463820 PAROWAN MEDICAL CLINIC 450 EAST CLINIC WAY * 463993 SAN JUAN CLINIC 380 WEST 100 NORTH, SUITE A Total Providers for this State = 14

463810 463991 463989 463981 463980 463816 463979 463985 463984 463815 463818

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

City, State and ZIP

Telephone # County Name

BEAVER, UT 84713 MILFORD, UT 84751 BLANDING, UT 84511 CANNONVILLE, UT 84718 CIRCLEVILLE, UT 84723 COALVILLE, UT 84017 DUCHESNE, UT 84021 CASTLE DALE, UT 84513 PANGUITCH, UT 84759 KAMAS, UT 84036 MONUMENT VALLEY, UT 84536 RICHFIELD, UT 84701 PAROWAN, UT 84761 MONTICELLO, UT 84535

(435)438-7280 Beaver (435)438-7280 Beaver (435)678-2254 San Juan (435)679-8545 Garfield (435)577-2958 Piute (435)336-4403 Summit (435)738-2426 Duchesne (435)381-2305 Emery (435)676-8842 Garfield (435)783-4385 Summit (435)727-3242 San Juan (435)896-9561 Sevier (435)477-3344 Iron (435)587-5054 San Juan

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Wyoming CCN

Key Provider Name *

BIG HORN CLINIC CASTLE ROCK HOSPITAL DISTRICT * GLENROCK HEALTH CENTER * HULETT CLINIC * MEDICINE BOW HEALTH CENTER * MIDWAY CLINIC * MOORCROFT CLINIC * NEWCASTLE REGIONAL MEDICAL CLINIC * 533984 NORTH BIG HORN HOSPITAL CLINIC * 533987 OREGON TRAILS * 533986 RAWHIDE RURAL HEALTH CLINIC * 533811 RED ROCK FAMILY PRACTICE * 533820 RED ROCK FAMILY PRACTICEWORLAND

*

533989 REGISTER CLIFF RURAL HEALTH CLINIC * 533976 SUNDANCE CLINIC * 533807 UPTON REGIONAL MEDICAL CLINIC Total Providers for this State = 16

533985 533809 533819 533978 533803 533981 533977 533806

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

Address

City, State and ZIP

Telephone # County Name

156 N 6TH STREET PO BOX 219 925 W BIRCH, PO BOX 786 PO BOX 65 PO BOX 37 388 HIGHWAY 20 SOUTH PO BOX 187 1121 WASHINGTON BLVD

BASIN, WY 82410 GREEN RIVER, WY 82935 GLENROCK, WY 82637 HULETT, WY 82720 MEDICINE BOW, WY 82329 BASIN, WY 82410 MOORCROFT, WY 82721 NEWCASTLE, WY 82701

(307)568-2499 Big Horn (307)872-4500 Sweetwater (307)436-9206 Converse (307)467-5281 Crook (307)379-2222 Carbon (307)568-3311 Big Horn (307)756-3414 Crook (307)746-3582 Weston

1115 LANE 12 PO BOX 1648 921 BALLANCEE AVE 120 NORTH C AVE 1125 CHARLES AVENUE

LOVELL, WY 82431 GLENROCK, WY 82637 LUSK, WY 82225 THERMOPOLIS, WY 82443 WORLAND, WY 82401

(307)548-5201 Big Horn (307)436-8838 Converse (307)334-4000 Niobrara (307)864-5534 Hot Springs (307)347-2449 Washakie

650 W WHALEN ST

GUERNSEY, WY 82214

(307)836-3009 Platte

713 OAK STREET PO BOX 676

SUNDANCE, WY 82729 UPTON, WY 82730

(307)283-2476 Crook (307)468-2302 Weston

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Arizona CCN

Key Provider Name

033999 033998

*

038502

*

038503 033830

*

033829

*

033985 033997 038504

*

033987

*

033996

*

038505 033836 038500

*

033984 033831

*

033835

*

033834 033992

*

038501

*

033989 033993 033994

*

*

*

* *

* *

*

*

* *

* = Non-Deemed

Address

BOUSE MEDICAL CLINIC 44031 EAST PLUMOSA ROAD, BOX 866 COMMUNITY HOSPITAL CLINIC 523 ROSE LANE WICKENBURG COMMUNITY HOSPITAL CLINIC26750 B SOUTH SANTA FE ROAD CONGRESS COPPER MOUNTAIN CLINIC 2250 WEST 16TH STREET COPPER QUEEN MEDICAL 101 COLE AVENUE ASSOCIATES-BISBEE COPPER QUEEN MEDICAL 100 EAST 5TH STREET ASSOCIATES-DOUGLAS GREASEWOOD CLINIC PO BOX 457, HIGHWAY 264 KEARNY CLINIC 100 TILBURY DRIVE LA PAZ HEALTHCARE PARKER 601 RIVERSIDE DRIVE, SUITES 3 AND 4 CLINIC LA PAZ MEDICAL SERVICES 150 EAST TYSON ROAD QUARTZSITE PALOMINAS / HEREFORD RURAL 10524 EAST HIGHWAY 92 HEALTH CLINIC PARKER FAMILY PRACTICE 1713 SOUTH KOFA AVENUE, #A PARKER MEDICAL CENTER, LTD 905 SOUTH FIESTA AVENUE PLEASANT VALLEY COMM MEDICAL 124 NORTH TEWKSBURY BOULEVARD CENTER SAGE OUTPATIENT CLINIC PO BOX 457, HIGHWAY 264 SAN LUIS WALK-IN CLINIC - FAMILY & 1896 EAST BABBIT LANE ADULT CENTER SAN LUIS WALK-IN CLINIC URGENT 214 WEST MAIN STREET CARE & FAMILY CENTE SONORAN FAMILY PRACTICE 171 WEST CENTRAL AVENUE SULPHUR SPRINGS MEDICAL 900 WEST SCOTT CENTER SUMMIT HEALTHCARE FAMILY 2352 QUARTER HORSE TRAIL MEDICINE AT BISON RANCH SUNSITES MEDICAL CLINIC 223 NORTH FRONTAGE ROAD SUPERIOR CLINIC 1134 WEST US HIGHWAY 60 TRI-VALLEY MEDICAL CENTER 39726 HARQUAHALA ROAD

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

City, State and ZIP

Telephone # County Name

BOUSE, AZ 85325 WICKENBURG, AZ 85390

(928)851-2177 La Paz (928)668-1833 Maricopa

CONGRESS, AZ 85332

(928)684-5421 Yavapai

SAFFORD, AZ 85546 BISBEE, AZ 85603

(928)348-4006 Graham (520)432-2042 Cochise

DOUGLAS, AZ 85607

(520)364-7650 Cochise

GANADO, AZ 86505 KEARNY, AZ 85237 PARKER, AZ 85344

(928)654-3208 Apache (520)363-5573 Pinal (928)669-5550 La Paz

QUARTZSITE, AZ 85359

(928)927-8747 La Paz

PALOMINAS, AZ 85615

(520)366-0300 Cochise

PARKER, AZ 85344 PARKER, AZ 85344 YOUNG, AZ 85554

(928)669-6299 La Paz (928)669-2225 La Paz (928)462-3435 Gila

GANADO, AZ 86505 SAN LUIS, AZ 85349

(928)755-3411 Apache (928)722-6112 Yuma

SOMERTON, AZ 85350

(928)627-1120 Yuma

COOLIDGE, AZ 85128 WILLCOX, AZ 85643

(520)723-7726 Pinal (520)384-4421 Cochise

OVERGAARD, AZ 85933

(928)535-3616 Navajo

PEARCE, AZ 85625 SUPERIOR, AZ 85173 SALOME, AZ 85348

(520)826-1089 Cochise (520)689-2423 Pinal (928)859-3460 La Paz

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Arizona CCN

Key Provider Name

Total Providers for this State =

* = Non-Deemed

Address 23

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 2

City, State and ZIP

Telephone # County Name

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN

Key Provider Name *

ADVENTIST HEALTH COMMUNITY CARE - AVENAL * 058568 ADVENTIST HEALTH COMMUNITY CARE - DINUBA WEST None ADVENTIST HEALTH COMMUNITY 058690 CARE - MADERA RANCHOS None ADVENTIST HEALTH COMMUNITY 058689 CARE - OAKHURST EAST * 058589 ADVENTIST HEALTH COMMUNITY CARE - REEDLEY CYPRESS None ADVENTIST HEALTH COMMUNITY 058685 CARE - TAFT * 553977 ADVENTIST HEALTH COMMUNITY CARE - TEHACHAPI None ADVENTIST HEALTH COMMUNITY 058672 CARE -DINUBA PLAZA * 058540 ADVENTIST HEALTH COMMUNITY CARE REEDLEY CHILDREN'S * 058610 ADVENTIST HEALTH COMMUNITY CARE- SELMA CENTRAL None ADVENTIST HEALTH COMMUNITY 058665 CARE-AVENAL WEST * 058592 ADVENTIST HEALTH COMMUNITY CARE-CARUTHERS None ADVENTIST HEALTH COMMUNITY 058669 CARE-CARUTHERS EAST * 058596 ADVENTIST HEALTH COMMUNITY CARE-COALINGA * 058552 ADVENTIST HEALTH COMMUNITY CARE-CORCORAN None ADVENTIST HEALTH COMMUNITY 058666 CARE-CORCORAN EAST * 058613 ADVENTIST HEALTH COMMUNITY CARE-DINUBA * 058595 ADVENTIST HEALTH COMMUNITY CARE-FOWLER * 553983 ADVENTIST HEALTH COMMUNITY CARE-HANFORD * = Non-Deemed

058635

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 13

Address

City, State and ZIP

Telephone # County Name

216 E FRESNO STREET

AVENAL, CA 93204

(559)386-5364 Kings

250 W EL MONTE AVENUE

DINUBA, CA 93618

(559)638-8155 Tulare

11976 ROAD 37

MADERA, CA 93636

(559)645-4191 Fresno

49063 ROAD 426, STE C & D

OAKHURST, CA 93644

(559)642-1500 Madera

372 W CYPRESS AVE

REEDLEY, CA 93654

(559)643-8083 Fresno

501 6TH STREET

TAFT, CA 93268

(661)763-5131 Kern

105 WEST E STREET

TEHACHAPI, CA 93561

(661)823-7070 Kern

444 W EL MONTE WAY

DINUBA, CA 93618

(559)591-4166 Tulare

1433 N ACACIA

REEDLEY, CA 93654

(209)638-8155 Fresno

2141 HIGH STREET

SELMA, CA 93662

(559)891-8940 Fresno

337 E KINGS STREET

AVENAL, CA 93204

(559)638-8155 Kings

2440 WEST TAHOE

CARUTHERS, CA 93609

(559)864-3212 Fresno

2357 W TAHOE

CARUTHERS, CA 93609

(559)864-5200 Fresno

155 S 5TH STREET

COALINGA, CA 93210

(559)935-4282 Fresno

1212 HANNA STREET

CORCORAN, CA 93212

(559)992-2800 Kings

1310 HANNA AVENUE, SUITE 1 AND SUITE 3 1451 E EL MONTE WAY

CORCORAN, CA 93212

(559)638-8155 Kings

DINUBA, CA 93618

(559)591-3342 Tulare

119 SOUTH SIXTH STREET

FOWLER, CA 93625

(559)834-1614 Fresno

1025 N DOUTY ST

HANFORD, CA 93230

(559)583-2254 Kings

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 058630 058611 058599 058668 058653 058600 058675 058621 058673 058569 058638 058664 058985 058667 058644 058617 553885 553832 553862

Key Provider Name *

ADVENTIST HEALTH COMMUNITY CARE-HOME GARDEN * ADVENTIST HEALTH COMMUNITY CARE-HURON * ADVENTIST HEALTH COMMUNITY CARE-KERMAN None ADVENTIST HEALTH COMMUNITY CARE-KERMAN CENTRAL * ADVENTIST HEALTH COMMUNITY CARE-KINGSBURG * ADVENTIST HEALTH COMMUNITY CARE-LEMOORE None ADVENTIST HEALTH COMMUNITY CARE-OAKHURST * ADVENTIST HEALTH COMMUNITY CARE-ORANGE COVE None ADVENTIST HEALTH COMMUNITY CARE-OROSI * ADVENTIST HEALTH COMMUNITY CARE-PARLIER NEWMARK * ADVENTIST HEALTH COMMUNITY CARE-REEDLEY None ADVENTIST HEALTH COMMUNITY CARE-REEDLEY JEFFERSON None ADVENTIST HEALTH COMMUNITY CARE-REEDLEY WOMEN'S HE * ADVENTIST HEALTH COMMUNITY CARE-RIVERDALE * ADVENTIST HEALTH COMMUNITY CARE-SANGER * ADVENTIST HEALTH COMMUNITY CARE-SELMA * AMERICAN DESERT MEDICAL CLINICS * ANDERSON MEDICAL ASSOCIATES * ANDERSON WALK-IN MEDICAL CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 13

Address

City, State and ZIP

Telephone # County Name

11899 SHAW PLACE

HANFORD, CA 93230

(559)585-3437 Kings

16916 5TH STREET

HURON, CA 93234

(559)945-9090 Fresno

1000 SOUTH MADERA AVENUE

KERMAN, CA 93630

(559)846-9370 Fresno

275 S MADERA AVENUE, STE 201

KERMAN, CA 93630

(559)846-5240 Fresno

1251 DRAPER STREET

KINGSBURG, CA 93631

(559)897-6610 Fresno

810 E 'D' STREET

LEMOORE, CA 93245

(559)583-2271 Kings

48677 VICTORIA LANE

OAKHURST, CA 93644

(559)683-2711 Madera

1455 PARK BLVD

ORANGE COVE, CA 93646

(559)638-8155 Fresno

41696 ROAD 128

EAST OROSI, CA 93647

(559)528-6966 Tulare

155 S NEWMARK

PARLIER, CA 93648

(559)964-6120 Fresno

811 11TH STREET

REEDLEY, CA 93654

(559)638-3227 Fresno

1150 E WASHINGTON AVENUE

REEDLEY, CA 93654

(559)638-2154 Fresno

550 W CYPRESS AVE

REEDLEY, CA 93654

(559)637-2455 Fresno

3567 MT WHITNEY AVENUE

RIVERDALE, CA 93656

(559)567-7200 Fresno

1939 ACADEMY AVENUE

SANGER, CA 93657

(559)875-6900 Fresno

1041 ROSE AVENUE

SELMA, CA 93662

(559)891-6345 Fresno

6186 ADOBE ROAD

29 PALMS, CA 92277

(760)361-8525 San Bernardino

2830 EAST STREET 3082 MCMURRAY DRIVE

ANDERSON, CA 96007 ANDERSON, CA 96007

(530)365-2545 Shasta (530)365-4412 Shasta

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 058908 058963 058930 058921 058950 053968 058580 553933 058614 058991 058949 553894 058902 058607 058536 553952

Key Provider Name *

APEX MEDICAL GROUP, INC ARVIN MEDICAL CLINIC * AURORA GRACE E HWANG, MD RHC * AVENAL MEDICAL CLINIC * BAART CARTWRIGHT CLINIC * BAECHTEL CREEK MEDICAL CLINIC * BARTON COMMUNITY HEALTH CENTER *

BAUTISTA RURAL MEDICAL CLINICS, INC * BEAR VALLEY RURAL HEALTH CLINIC None BIG SUR HEALTH CENTER * BISHOP FAMILY AND MATERNITY CARE MEDICAL CLINIC * CAL CITY CLINIC *

*

Page 3 of 13

Address

City, State and ZIP

Telephone # County Name

311 WEST I STREET 146 NORTH HILL STREET 835 NORTH SEQUOIA AVENUE 148 EAST KINGS 3103 EAST CARTWRIGHT AVENUE 1245 SOUTH MAIN STREET 2201 SOUTH AVENUE

(209)826-2222 Merced (661)855-4468 Kern (559)562-5177 Tulare (559)386-9000 Kings (559)498-7100 Fresno (707)459-6861 Mendocino (530)543-5620 El Dorado

2570 JENSEN AVENUE, SUITE 106

LOS BANOS, CA 93635 ARVIN, CA 93203 LINDSAY, CA 93247 AVENAL, CA 93204 FRESNO, CA 93725 WILLITS, CA 95490 SOUTH LAKE TAHOE, CA 96150

SANGER, CA 93657

1028 W BIG BEAR BLVD

BIG BEAR CITY, CA 92314

(909)878-8277 San Bernardino

46896 HIGHWAY 1 153-A PIONEER LANE

BIG SUR, CA 93920 BISHOP, CA 93514

(831)667-2580 Monterey (760)872-7059 Inyo

9300 NORTH LOOP BOULEVARD, SUITE A 1415 N ACACIA, SUITE 101 450 EAST BIRCH STREET 495 BIRCH STREET, SUITE A 355 CAMPUS DRIVE, SUITE E

CALIF CITY, CA 93505

(760)373-1256 Kern

REEDLEY, CA 93654 CALEXICO, CA 92231 CALEXICO, CA 92231 HANFORD, CA 93230

(559)638-8187 Fresno (760)768-6262 Imperial (760)357-0508 Imperial (559)584-2721 Kings

CANBY, CA 96015 ATWATER, CA 95301

(530)233-4641 Modoc (209)358-8201 Merced

WATERFORD, CA 95386 MADERA, CA 93638

(209)874-2345 Stanislaus (559)353-6425 Madera

COLUSA, CA 95932 CHOWCHILLA, CA 93610 CHOWCHILLA, CA 93610 GRIDLEY, CA 95948 WOODLAKE, CA 93286 FILLMORE, CA 93015

(530)458-2300 Colusa (559)665-0275 Madera (559)665-3781 Madera (530)846-1400 Butte (559)564-8616 Tulare (805)524-2672 Ventura

CAL FAMILY HEALTH, INC CALEXICO HEALTH CENTER * CALEXICO OUTPATIENT CENTER * CAMPUS FAMILY HEALTH MEDICAL CENTER

*

053888 CANBY FAMILY PRACTICE CLINIC 670 COUNTY ROAD 83 * 553891 CASTLE FAMILY HEALTH CENTER AT 1251 GROVE STREET BLOSS * 053917 CEDAR FAMILY PRACTICE 12700 WELCH STREET * 058603 CHARLIE MITCHELL RURAL HEALTH 41169 GOODWIN WAY, RM 100 CLINIC * 058912 CHILDREN'S CLINIC 348 MARKET STREET, SUITE B * 553925 CHOWCHILLA FAMILY CLINIC 1020 VENTURA BLVD * 058639 CHOWCHILLA MEDICAL CENTER 285 HOSPITAL DRIVE * 553931 CHUK NDULUE MEDICAL OFFICE 135 SPRUCE STREET None 058989 CLINICA EL LAGO, INC 101 NORTH PALM * 058608 CMH CENTER FOR FAMILY HEALTH - 852 VENTURA ST FILLMORE * = Non-Deemed *

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

(559)875-3428 Fresno

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 058609 058654 553916 553927 058504 058591 058676 553866 058901 553869 058539 058588 053965 058693 553817 053940 553898 058514 058947 058598 553928 058929 553808

Key Provider Name *

Address

CMH CENTER FOR FAMILY HEALTH - 242 E HARVARD BLVD STE C SANTA PAULA * COALINGA REGIONAL MEDICAL 1165 PHELPS AVENUE, STE 105 CENTER RURAL HEALTH CLIN * COALINGA VALLEY HEALTH CLINICS 1145 PHELPS AVENUE, STE B INC-COALINGA * COALINGA VALLEY HEALTH CLINICS, 36617 CENTRAL AVENUE, INC-HURON * COMMUNITY MEDICAL CENTER 48677 VICTORIA LANE OAKHURST * CORCORAN DISTRICT HOSPITAL 1310 HANNA AVENUE, SUITE 3 HEALTH CENTER None CORNING RURAL HEALTH CLINIC 155 SOLANO ST * DE ANZA CLINIC 1001 BLAIR STREET * DEL PUERTO HEALTH CENTER 1700 KEYSTONE PACIFIC PARKWAY UNIT B * DELANO DISTRICT MEDICAL 1004 14TH AVENUE CENTER * DELANO REGIONAL MEDICAL 2300 7TH STREET CENTER RURAL HEALTH CLINIC * DELANO WOMEN'S MEDICAL CLINIC 1201 JEFFERSON STREET * DELHI MEDICAL CLINIC 9696 STEPHENS ST None DIGNITY HEALTH SOLANO STREET 2126 SOLANO STREET MEDICAL CLINIC * DINUBA MEDICAL CENTER 247 NORTH L STREET * DINUBA MEDICAL CLINIC 271 N L ST * DINUBA RURAL HEALTH MEDICAL 420 EAST EL MONTE WAY CENTER * DIVIDE WELLNESS CENTER 6065 HIGHWAY 193 * DON PEDRO FAMILY PRACTICE 3191 EL PRADO STREET, SUITE D * DOS PALOS MEMORIAL RURAL 2118 MARGUERITE STREET HEALTH CLINIC * DR NDULUE MEDICAL PRACTICE 620 E STREET * DR OCHOA FAMILY CLINIC 3275 MCCALL AVENUE, STE 102 * DR'S PHILIP OLKIN & C RAY JONES, 3302 RENNER DRIVE MD'S

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 13

City, State and ZIP

Telephone # County Name

SANTA PAULA, CA 93060

(805)652-5490 Ventura

COALINGA, CA 93210

(559)935-6537 Fresno

COALINGA, CA 93210

(559)935-4374 Fresno

HURON, CA 93234

(559)945-9251 Fresno

OAKHURST, CA 93644

(209)683-2992 Madera

CORCORAN, CA 93212

(559)992-5051 Kings

CORNING, CA 96021 CALEXICO, CA 92231 PATTERSON, CA 95363

(530)824-4663 Tehama (760)357-7867 Imperial (209)892-9100 Stanislaus

DELANO, CA 93215

(661)725-5676 Kern

WASCO, CA 93280

(661)758-4184 Kern

DELANO, CA 93215 DELHI, CA 95315 CORNING, CA 96021

(661)721-0737 Kern (209)667-0702 Merced (530)824-4002 Tehama

DINUBA, CA 93618 DINUBA, CA 93618 DINUBA, CA 93618

(559)591-1820 Tulare (559)591-1820 Tulare (559)595-9500 Tulare

GEORGETOWN, CA 95634 LA GRANGE, CA 95329 DOS PALOS, CA 93620

(916)333-2548 El Dorado (209)852-2764 Stanislaus (209)392-6121 Merced

MARYSVILLE, CA 95901 SELMA, CA 93662 FORTUNA, CA 95540

(530)741-2600 Yuba (559)896-3808 Fresno (707)725-3318 Humboldt

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN

Key Provider Name

058967

*

058597

*

058926 058518

*

058663 058606

*

053955 553849 058634 053975 058941

*

058564 058951 053990 058574

*

058573 058548

*

058940

*

058571

*

058656 058585 058604

*

058594

*

058587

*

*

*

* * * *

* * *

*

* *

* = Non-Deemed

EARLIMART SCHOOL BASED COMMUNITY HEALTHCARE CENTER EASTERN PLUMAS HOSPITAL LOYALTON MEDICAL CLINIC EEL VALLEY RURAL HEALTH CLINIC EL CENTRO REGIONAL MEDICAL CTR OUTPATIENT CLINIC EMANUEL FAMILY PRACTICE ESCALON COMMUNITY HEALTH CLINIC EUREKA PEDIATRICS EUREKA PEDIATRICS MCKINLEYVILL FAIRCHILD MEDICAL CLINIC FAMILY CARE FAMILY HEALTH CENTER OF JOSHUA TREE FAMILY HEALTH CENTER RHC FAMILY HEALTH MEDICAL CENTER FAMILY HEALTH SERVICES ANNEX FAMILY MEDICAL CENTER - ANGELS CAMP FAMILY MEDICAL CENTER - ARNOLD FAMILY MEDICAL CENTER COPPEROPOLIS FAMILY MEDICAL CENTER - SAN ANDREAS FAMILY MEDICAL CENTER - VALLEY SPRINGS FAMILY MEDICINE PRACTICE FAMILY PRACTICE ASSOCIATES FEATHER RIVER HOSPITAL FEATHER RIVER HEALTH CENT FEATHER RIVER HOSPITAL CANYON VIEW CLINIC FEATHER RIVER HOSPITAL FAMILY HEALTH

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 13

Address

City, State and ZIP

Telephone # County Name

398 SOUTH CHURCH STREET

EARLIMART, CA 93219

(559)366-1150 Tulare

725 THIRD STREET

LOYALTON, CA 96118

(530)993-1231 Sierra

129 WILDWOOD SUITE E 385 WEST MAIN STREET

RIO DELL, CA 95562 EL CENTRO, CA 92243

(707)764-3139 Humboldt (760)482-9100 Imperial

1010 W LAS PALMAS AVE 2080 MCHENRY AVENUE #200

PATTERSON, CA 95363 ESCALON, CA 95320

(209)895-7100 Stanislaus (209)847-3011 San Joaquin

2800 HARRIS ST 2192 CENTRAL AVENUE SUITE A 475 BRUCE ST 315 EAST 13TH STREET 63532 TWENTY NINE PALMS HWY, SUITE C 41820 GARSTIN DRIVE 1045 5TH STREET 1210 E ALMOND 222 SOUTH MAIN STREET

EUREKA, CA 95501 MCKINLEYVILLE, CA 95521 YREKA, CA 96097 MERCED, CA 95340 JOSHUA TREE, CA 92252

(707)445-8416 Humboldt (209)777-7777 Humboldt (530)842-3507 Siskiyou (209)385-7060 Merced (760)366-7555 San Bernardino

BIG BEAR LAKE, CA 92315 LOS BANOS, CA 93635 MADERA, CA 93637 ANGELS CAMP, CA 95222

(909)878-8246 San Bernardino (559)665-0275 Merced (209)673-5101 Madera (209)736-0813 Calaveras

2182 HIGHWAY 4, SUITE A100 3505 SPRANGLER LANE, SUITE 400

ARNOLD, CA 95223 COPPEROPOLIS, CA 95228

(209)795-4193 Calaveras (209)785-7000 Calaveras

704 MOUNTAIN RANCH ROAD, SUITE 103 - 104 1919 VISTA DEL LAGO DRIVE

SAN ANDREAS, CA 95249

(209)754-4564 Calaveras

VALLEY SPRINGS, CA 95252

(209)772-9538 Calaveras

2721 OLIVE HWY SUITE 9 2721 OLIVE HWY, SUITE 4 5125 SKYWAY

OROVILLE, CA 95966 OROVILLE, CA 95966 PARADISE, CA 95969

(530)538-3020 Butte (530)532-6588 Butte (530)872-2000 Butte

5734 CANYON VIEW DRIVE

PARADISE, CA 95969

(530)876-7179 Butte

5730 CANYON VIEW DRIVE

PARADISE, CA 95969

(530)876-7162 Butte

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN

Key Provider Name

053930 058922

*

553887 053991

*

058684

*

053936 053951 553909

*

058546 058572 053981

*

058970

*

553884 553852 553985 058964 553954 058646

*

058590

*

553846

*

553845 058974 058965 058978 058945

*

*

* *

* *

* * * * *

FIREBAUGH FAMILY HEALTH CLINIC FIRST CARE MEDICAL ASSOCIATES, INC FIRST VALLEY MEDICAL GROUP FOREST ROAD HEALTH AND WELLNESS CENTER FORT BRAGG RURAL HEALTH CENTER FORTUNA FAMILY MEDICAL GROUP FOWLER MEDICAL CENTER INC FRONTIER VILLAGE FAMILY HEALTH CENTER, INC GALT MEDICAL SERVICES GLENN FAMILY MEDICAL GROUP GLENN MEDICAL CENTER FAMILY MEDICAL CENTER GLORIA NELSON CENTER FOR WOMEN AND CHILDREN GONZALES MEDICAL GROUP INC GOOSE LAKE MEDICAL SERVICES GRAEAGLE MEDICAL CLINIC RHC GREEN VALLEY MEDICAL CLINIC HAROLD S BUDHRAM MD INC HAYFORK COMMUNITY HEALTH CLINIC

HAZEL HAWKINS HEALTH CLINIC

HEALTH VALLEY MEDICAL GROUP INC * HIGH DESERT FAMILY MEDICAL CLINIC * HILMAR FAMILY MEDICAL CENTER * HORISONS UNLIMITED None HORISONS UNLIMITED * HORISONS UNLIMITED

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 6 of 13

Address

City, State and ZIP

Telephone # County Name

944 O STREET 750 EAST WALKER STREET SUITE A

FIREBAUGH, CA 93622 ORLAND, CA 95963

(209)659-3011 Fresno (530)865-4400 Glenn

1535 NORTH CHINA LAKE BLVD SUITE A RIDGECREST, CA 93555 193 FAIRVIEW LANE SONORA, CA 95370

(760)446-1691 Kern (209)536-5100 Tuolumne

850 SEQUOIA CIRCLE

FORT BRAGG, CA 95437

(707)964-0259 Mendocino

874 MAIN ST 210 E MERCED 645 ANTELOPE BLVD, SUITE 24

FORTUNA, CA 95540 FOWLER, CA 93625 RED BLUFF, CA 96080

(707)725-3334 Humboldt (209)834-5341 Fresno (530)528-7650 Tehama

387 CIVIC DRIVE 130 NORTH ENRIGHT AVE 1133 W SYCAMORE STREET

GALT, CA 95632 WILLOWS, CA 95988 WILLOWS, CA 95988

(209)745-8080 Sacramento (530)934-4681 Glenn (530)934-8822 Glenn

1500 6TH AVENUE

DELANO, CA 93215

(661)725-1010 Kern

133 FOURTH STREET 535 S MAIN ST 7597 HIGHWAY 89 41689 ROAD 128 5145 SHASTA DAM BLVD 6961 HIGHWAY 3

GONZALES, CA 93926 ALTURAS, CA 96101 GRAEAGLE, CA 96103 OROSI, CA 93647 SHASTA LAKE, CA 96019 HAYFORK, CA 96041

(831)675-3601 Monterey (530)233-2288 Modoc (530)836-1122 Plumas (559)528-1777 Tulare (530)275-5421 Shasta (530)628-5517 Trinity

301 THE ALAMEDA, SUITE B3

(831)623-4615 San Benito

812 EAST D STREET

SAN JUAN BAUTISTA, CA 95045

LEMOORE, CA 93245

7350 CHURCH STREET

YUCCA VALLEY, CA 92284

(760)369-3069 San Bernardino

19901 1ST STREET 101 FRONT STREET 5320 STATE HIGHWAY 49 N 1120 WEST I STREET, SUITE B

HILMAR, CA 95324 CHOWCHILLA, CA 93610 MARIPOSA, CA 95338 LOS BANOS, CA 93635

(209)658-8701 Merced (209)201-2099 Madera (209)383-5200 Mariposa (209)826-1900 Merced

(209)925-1000 Kings

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 058911 058900 058505 553802 058984 058636 553964 553900 058938 058937 058637 058605 053992 058677 058508 058649 058659 058561 553912 053995 553829 553830

Key Provider Name *

HORISONS UNLIMITED HEALTH CARE * HORISONS UNLIMITED HEALTH CARE-GUSTINE * HUMBOLDT FAMILY CARE * IMMEDIATE HEALTH CARE, RHC None IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP * INDIAN VALLEY MEDICAL CLINIC * JAMES CORONA, MD * JAMES OOI, MD * JAVIER AMU, MD, PROFESSIONAL CORPORATION * JOANNE E REID MD INC * JOHN C FREMONT HEALTHCARE DISTRICT NORTHSIDE * JOHN C FREMONT HEALTHCARE DISTRICT-RHC II * JOHN C FREMONT MEDICAL CLINIC * KAWEAH DELTA DINUBA HEALTH CLINIC * KAWEAH DELTA EXETER HEALTH CLINIC * KAWEAH DELTA LINDSAY HEALTH CLINIC * KAWEAH DELTA WOODLAKE HEALTH CLINIC * KERN VALLEY HEALTHCARE DIST RHC * KHUSAL MEHTA, MD RHC * KINGSBURG RURAL HEALTH CLINIC * KRISHNAMOORTHI MD INC, A PROFESSIONAL MEDICAL CORP * KRISHNAMOORTHI MD INC, A PROFESSIONAL MEDICAL CORP

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 7 of 13

Address

City, State and ZIP

Telephone # County Name

2275 F STREET, SUITE 1 & 2

LIVINGSTON, CA 95334

(209)394-8854 Merced

554 5TH STREET

GUSTINE, CA 95322

(209)854-3854 Merced

1733 CENTRAL AVE 1850 WHITSON AVE 608 G STREET

MCKINLEYVILLE, CA 95521 SELMA, CA 93662 BRAWLEY, CA 92227

(707)839-4852 Humboldt (209)896-6666 Fresno (760)351-1011 Imperial

176 HOT SPRINGS ROAD 203 WALKER STREET, SUITE 2 320 SOLANO STREET 1121 F STREET

GREENVILLE, CA 95947 ORLAND, CA 95963 CORNING, CA 96021 REEDLEY, CA 93654

(530)284-6116 Plumas (530)865-6430 Glenn (530)824-3283 Tehama (559)743-7340 Fresno

263 N VILLA AVE 6386 GREELEY HILL ROAD

WILLOWS, CA 95988 COULTERVILLE, CA 95311

(530)934-8700 Glenn (209)878-0155 Mariposa

5186 HOSPITAL ROAD

MARIPOSA, CA 95338

(209)966-3631 Mariposa

5189 HOSPITAL ROAD 355 MONTE VISTA DRIVE, SUITE A

MARIPOSA, CA 95338 DINUBA, CA 93618

(209)966-3631 Mariposa (559)624-2000 Tulare

1014 SAN JUAN AVENUE

EXETER, CA 93221

(559)592-7300 Tulare

839 N SEQUOIA AVENUE

LINDSAY, CA 93247

(559)562-1546 Tulare

180 EAST ANTELOPE AVENUE

WOODLAKE, CA 93286

(559)564-1800 Tulare

4300 BIRCH STREET

LAKE ISABELLA, CA 93240

(760)379-1791 Kern

430 VERMONT AVENUE 1200 SMITH ST 324 F STREET

DINUBA, CA 93618 KINGSBURG, CA 93631 WATERFORD, CA 95386

(559)591-1060 Tulare (209)897-5841 Fresno (209)874-2321 Stanislaus

850 WEST CALIFORNIA STREET

ESCALON, CA 95320

(209)838-2278 San Joaquin

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 058918 553967 058660 058641 553965 058523 058640 553871 058682

Key Provider Name *

LINDSAY FAMILY AND PEDIATRIC CLINIC

*

LUCERNE COMMUNITY CLINIC * MABIE FIRST STREET HEALTHCARE CENTER * MABIE SAN JUAN ROAD HEALTHCARE CENTER

*

MAGALIA-PINES FAMILY PRACTICE MEDICAL CLINIC * MAMMOTH HOSPITAL RURAL HEALTH * MAMMOTH HOSPITAL RURAL HEALTH CLINIC - BRIDGEPORT

*

MARIPOSA FAMILY MEDICINE ASSOCIATES None MARSHALL PEDIATRIC CLINIC

058958 058960 058962

*

058535 058558

*

058562

*

553998

*

053914 058662

*

058650

*

058975

*

* *

*

*

* 053988 * 553949 * = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 8 of 13

Address

City, State and ZIP

Telephone # County Name

825 NORTH SEQUOIA AVENUE

LINDSAY, CA 93247

(559)562-1960 Tulare

6300 E HIGHWAY 20 321 FIRST STREET

LUCERNE, CA 95458 HOLLISTER, CA 95023

(707)274-9299 Lake (831)638-1652 San Benito

991 FOURTH STREET

HOLLISTER, CA 95023

(831)636-3277 San Benito

14662 SKYWAY

MAGALIA, CA 95954

(530)873-1676 Butte

85 SIERRA PARK ROAD

MAMMOTH LAKES, CA 93546 (760)934-3311 Mono

221 TWIN LAKES ROAD

BRIDGEPORT, CA 93517

(760)932-7012 Mono

5300 HWY 49N PO BOX 155

MARIPOSA, CA 95338

(209)966-3672 Mariposa

PLACERVILLE, CA 95667

(530)626-1144 El Dorado

4341 GOLDEN CENTER DRIVE, BUILDING A MARTIN ROCHA MD INC 251 NORTH HIGHWAY 173 SUITE 6 MARYSVILLE CLINIC 527 E STREET MCFARLAND SINGH MEDICAL CLINIC 733 3RD STREET INC MCH MEDICAL CLINIC 29099 HOSPITAL ROAD MEE MEMORIAL HOSPITAL MEDICAL 467 EL CAMINO ROAD CLINIC MEE MEMORIAL HOSPITAL MEDICAL 210 CANAL STREET CLINIC MEMORIAL HOSP LOS BANOS 1253 WEST I STREET RURAL

MENDOTA FAMILY HEALTH CENTER 507 OLLER STREET MERCY LAKE SHASTINA 16337 EVERHART DRIVE COMMUNITY CLINIC MERCY MT SHASTA COMMUNITY 912 PINE ST CLINIC

MICHAEL KOMIN, MD, MEDICAL 1150 EAST LERDO HIGHWAY CORPORATION MODOC MED CTR - FAMILY PRACTIC 229 W MCDOWELL AVE MOUNTAIN VIEW MEDICAL CLINIC 468 VERMONT AVENUE

LAKE ARROWHEAD, CA 92352 (909)336-3670 San Bernardino MARYSVILLE, CA 95901 (530)674-2100 Yuba MC FARLAND, CA 93250 (661)792-3097 Kern LAKE ARROWHEAD, CA 92352 (909)336-3651 San Bernardino GREENFIELD, CA 93927 (831)674-0112 Monterey KING CITY, CA 93930

(831)385-6000 Monterey

LOS BANOS, CA 93635

(209)710-6333 Merced

MENDOTA, CA 93640 WEED, CA 96094

(209)655-4211 Fresno (530)938-2297 Siskiyou

MOUNT SHASTA, CA 96067

(530)926-5105 Siskiyou

SHAFTER, CA 93263

(661)630-5890 Kern

ALTURAS, CA 96101 DINUBA, CA 93618

(916)233-5176 Modoc (559)591-6200 Tulare

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 058935 058629 058952 058953 058578 058553 553978 553982 058942 058936 553911 553935 058581 058601 058686 058582 058661 053971 058583 058986 058674 058678 053845 553825 553810 553867

Key Provider Name *

NEWMAN MEDICAL CLINIC NORTH COAST FAMILY HEALTH CENTER * NORTH VALLEY FAMILY PHYSICIANS MEDICAL GROUP * NORTH VALLEY FAMILY PHYSICIANS MEDICAL GROUP

*

NORTHERN INYO HOSPITAL RURAL HEALTH CLINIC * OAK VIEW FAMILY PRACTICE * OAKDALE COMMUNITY HEALTH CENTER

*

ORCHARD HOSPITAL MEDICAL SPECIALTY CENTER * ORCHARD MEDICAL CENTER * ORLAND CHILDREN'S CENTER * OROSI FAMILY MEDICAL CARE * OROSI RURAL HEALTH CLINIC * OROVILLE FAMILY PRACTICE * OROVILLE HOSPITAL - MEDICAL CLINIC None OROVILLE HOSPITAL PRIMARY CARE PRACTICE * OROVILLE PEDIATRIC PRACTICE * OROVILLE WOMEN'S HEALTH * PATHWAY HEALTHCARE *

Page 9 of 13

Address

City, State and ZIP

Telephone # County Name

1349 MAIN STREET 721 RIVER DRIVE, SUITE A & B & C

NEWMAN, CA 95360 FORT BRAGG, CA 95437

(209)862-3604 Stanislaus (707)964-7241 Mendocino

173 EAST WEBSTER ST

COLUSA, CA 95932

(530)458-8050 Colusa

501 E ST SUITE C

WILLIAMS, CA 95987

(530)473-5255 Colusa

150 PIONEER LANE

BISHOP, CA 93514

(760)873-2849 Inyo

655 N VENTURA AVE 1420 WEST H STREET

OAK VIEW, CA 93022 OAKDALE, CA 95361

(805)649-3750 Ventura (209)848-1743 Stanislaus

284 SPRUCE ST

GRIDLEY, CA 95948

(530)846-5671 Butte

555 SIXTH STREET 203 WALKER ST SUITE 3 12683 AVENUE 416 12572 AVENUE 416, SUITE B 2809 OLIVE HWY, SUITE 380 2767 OLIVE HIGHWAY, ANNEX BUILDING

ORANGE COVE, CA 93646 ORLAND, CA 95963 OROSI, CA 93647 OROSI, CA 93647 OROVILLE, CA 95966 OROVILLE, CA 95966

(559)626-7118 Fresno (530)865-5400 Glenn (559)528-4717 Tulare (559)528-4779 Tulare (530)532-8687 Butte (530)532-8544 Butte

2721 OLIVE HWY, SUITE 12A, 12B & 10

OROVILLE, CA 95966

(530)538-3171 Butte

OROVILLE, CA 95966 OROVILLE, CA 95966 OAKDALE, CA 95361

(530)533-4422 Butte (530)532-8636 Butte (209)848-8410 Stanislaus

OROVILLE, CA 95966 FRAZIER PARK, CA 93222 MOUNT SHASTA, CA 96067 BRAWLEY, CA 92227 BURNEY, CA 96013 PIXLEY, CA 93256 AUBURN, CA 95603 KINGS BEACH, CA 96143

(530)533-0774 Butte (661)242-2592 Kern (530)926-7196 Siskiyou (760)351-4400 Imperial (530)335-3651 Shasta (559)757-2000 Tulare (916)889-7215 Placer (916)546-6356 Placer

2809 OLIVE HIGHWAY, #270 2809 OLIVE HIGHWAY SUITES 260 & 310 190 SOUTH OAK AVENUE, BLDG 2, SUITE 1

*

PEDIATRIC PRACTICE ASSOCIATES 2809 OLIVE HIGHWAY, SUITE 330 None PINE MOUNTAIN HEALTH CENTER 16233 ASKIN DRIVE, SUITE A None PINE STREET CLINIC 408 PINE ST None PIONEERS HEALTH CENTER 751 WEST LEGION ROAD, SUITE 103 * PIT RIVER HEALTH SERVICE, INC 36977 PARK AVENUE, PO BOX 2720 * PIXLEY MEDICAL GROUP 205 EAST DAVIS STREET, DRAWER Y * PLACER COUNTY MEDICAL CLINIC 11583 C AVENUE * PLACER MEDICAL CLINIC - TAHOE PO BOX 1785/8665 SALMON STREET

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California

Telephone # County Name

QUINCY, CA 95971 PORTOLA, CA 96122 PRATHER, CA 93651 OROVILLE, CA 95966 GUSTINE, CA 95322 MADERA, CA 93637

(530)283-2121 Plumas (916)832-4211 Plumas (559)855-6550 Fresno (530)532-8824 Butte (209)854-3728 Merced (559)645-4191 Madera

WILLITS, CA 95490 FORTUNA, CA 95540

(707)459-6115 Mendocino (707)725-9355 Humboldt

FORTUNA, CA 95540 ALDERPOINT, CA 95511

(707)725-6108 Humboldt (707)926-1070 Humboldt

RIDGECREST, CA 93555

(760)446-3551 Kern

OROVILLE, CA 95966 RIVERBANK, CA 95367

(530)538-9410 Butte (209)869-8102 Stanislaus

RIVERBANK, CA 95367

(209)869-0131 Stanislaus

553939

PLUMAS RURAL HEALTH CENTERS 1065 BUCKS LAKE RD PORTOLA MEDICAL/DENTAL CLINIC 480 FIRST AVENUE None PRATHER MEDICAL CLINIC 29424 AUBERRY ROAD * PREMIER HEALTH CENTER 900 ORO DAM BOULEVARD * RAN HEALTH SERVICES INC 489 5TH ST * RANCHOS FAMILY HEALTH 11976 ROAD 37, AVENUE 12 SERVICES None REDWOOD MEDICAL CLINIC 3 MARCELA DR * REDWOOD PEDIATRIC MEDICAL 3305 RENNER DRIVE GROUP * REDWOOD WOMEN'S CENTER P C 3309 RENNER DRIVE * REDWOODS RURAL HEALTH 321 5TH STREET CENTER

*

RIDGECREST REGIONAL HOSPITAL 1111 NORTH CHINA LAKE BOULEVARD, RURAL HEALTH CLINIC SUITE 190 * RIGOBERTO O GUTIERREZ, MD 2809 OLIVE HWY #370 * RIVERBANK COMMUNITY HEALTH 2603 PATTERSON ROAD, SUITE 3 CENTER * RIVERBANK PRIMARY CARE 3227 STANISLAUS ST SUITE A MEDICAL CLINIC, INC * ROBERT RUSHTON, MD RHC 844 S DORA ST * RUNNING SPRINGS RURAL HEALTH 31900 HILLTOP BOULEVARD CLINIC

*

SALAS MEDICAL CLINIC, INC 973 NORTH SEQUOIA AVENUE * SAMUEL DIXON FAMILY HEALTH 30257 SAN MARTINEZ ROAD CENTER, INC * SAN BENITO COMMUNITY HEALTH 930 SUNSET DRIVE BUILDING #3 CLINIC * SAN JOAQUIN PRIME CARE MEDICAL 682 EAST VISALIA ROAD

553822

*

058928

*

553947

*

053989 058522 058990 058584 058983 553943 058680 553836 058957 553879 058655 058913 058528 553859 053969 058632 058934 058946 058512

Address

Page 10 of 13

City, State and ZIP

CCN

Key Provider Name

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017

* *

* = Non-Deemed

UKIAH, CA 95482 (707)462-8603 Mendocino RUNNING SPRINGS, CA 92382 (909)336-9715 San Bernardino LINDSAY, CA 93247 VAL VERDE, CA 91384

(559)562-7799 Tulare (661)257-4008 Los Angeles

HOLLISTER, CA 95023

(831)637-5711 San Benito

FARMERSVILLE, CA 93223

(559)594-4564 Tulare

SAN JOAQUIN PRIME CARE MEDICAL 330 EAST PINE STREET

EXETER, CA 93221

(559)592-2134 Tulare

SAN JOAQUIN PRIME CARE MEDICAL 30924 E KINGS CANYON ROAD CORPORATION

SAN JOAQUIN PRIME CARE MEDICAL 826 EAST MANNING AVENUE CORP

SQUAW VALLEY, CA 93675

(559)332-9399 Fresno

REEDLEY, CA 93654

(559)592-2134 Fresno

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN 553882 058517 553886 553946 058593 553820 058944 553819 058966 553951 058982 553881 553938 553991 058511 058988 553995 058533 058586 058681 058687 053983 058519 553994

Key Provider Name *

Address

SANTA ROSA DEL VALLE MEDICAL 1293 SIXTH STREET GROUP, INC * SCOTT VALLEY RURAL HEALTH CLIN 155 DIGGLES STREET * SEAN R THOMAS, MD, INC 55585 29 PALMS HIGHWAY * SELMA RURAL HEALTH CENTER 2057 HIGH STREET * SENECA HEALTHCARE DISTRICT 199 REYNOLDS ROAD LAKE ALMANOR CLINIC * SEQUOIA FAMILY MEDICAL CENTER 590 W PUTNAM AVE * SESPE MEDICAL INC 552 SESPE AVE * SHAFTER RURAL HEALTH CARE 565 KERN STREET CLINIC * SHASTA FAMILY CARE 725 PINE ST * SHYAM BHASKAR MD INC 1001 VAN DORSTEN AVENUE * SHYAM BHASKAR MD, INC 1425 MAIN STREET * SISKIYOU MEDICAL GROUP DR LA 824 PINE STREET GRO * SOLEDAD MEDICAL CLINIC 600 MAIN STREET * SOUTHERN HUMBOLDT COMMUNITY 509 ELM ST CL * SOUTHERN INYO HOSP DIST CLINIC 510 E LOCUST * SPECIALTY HEALTH CLINIC 57402 29 PALMS HWY SUITE 1 * ST HELENA FAMILY HEALTH 5290 STATE STREET CENTER - KELSEYVILLE * ST HELENA FAMILY HEALTH 15230 LAKESHORE DRIVE CENTER - CLEARLAKE * ST HELENA FAMILY HEALTH 21337 BUSH STREET CENTER - MIDDLETOWN None ST HELENA KONOCTI WELLNESS 9430 - C LAKE STREET CENTER None ST HELENA MEDICAL CARE 18990 COYOTE VALLEY ROAD, SUITE 8, 9, & 10 * SURPRISE VALLEY MEDICAL CLINIC 745 MAIN STREET * SUTTER COAST HEALTH CENTER 785 EAST WASHINGTON BLVD SUITE 10 * SUTTER LAKESIDE FAMILY 5176 HILL ROAD EAST MEDICINE CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 11 of 13

City, State and ZIP

Telephone # County Name

COACHELLA, CA 92236

(760)391-5151 Riverside

ETNA, CA 96027 YUCCA VALLEY, CA 92284 SELMA, CA 93662 CHESTER, CA 96020

(530)467-5393 Siskiyou (760)228-3366 San Bernardino (559)891-9100 Fresno (530)258-2866 Plumas

PORTERVILLE, CA 93257 FILLMORE, CA 93015 SHAFTER, CA 93263

(559)781-4100 Tulare (805)524-2559 Ventura (661)746-4937 Kern

MOUNT SHASTA, CA 96067 CORCORAN, CA 93212 DELANO, CA 93215 MOUNT SHASTA, CA 96067

(530)926-4556 Siskiyou (559)992-2337 Kings (661)778-0920 Kern (530)926-4528 Siskiyou

SOLEDAD, CA 93960 GARBERVILLE, CA 95542

(831)678-2462 Monterey (707)923-3925 Humboldt

LONE PINE, CA 93545 YUCCA VALLEY, CA 92284 KELSEYVILLE, CA 95451

(760)876-1146 Inyo (760)228-1800 San Bernardino (707)279-8813 Lake

CLEARLAKE, CA 95422

(707)994-0407 Lake

MIDDLETOWN, CA 95461

(707)987-3311 Lake

LOWER LAKE, CA 95457

(707)995-5630 Lake

MIDDLETOWN, CA 95461

(707)987-8344 Lake

CEDARVILLE, CA 96104 CRESCENT CITY, CA 95531 LAKEPORT, CA 95453

(916)279-6115 Modoc (707)464-8511 Del Norte (707)262-5088 Lake

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN

Key Provider Name *

SUTTER MEDICAL FOUNDATION PLYMOUTH HEALTH CENTER * 553950 SUTTER NORTH BROWNSVILLE FAMILY PRACTICE CTR None TAYLOR FARMS FAMILY HEALTH 058688 AND WELLNESS CENTER * 553979 TEHACHAPI FAMILY HEALTH CENTER - MOJAVE * 058620 TEHACHAPI FAMILY HEALTH CENTER-CALIFORNIA CITY * 058910 TEHAMA COUNTY HEALTH CENTER CL * 553969 TIPTON MEDICAL CLINIC * 058618 TRINITY COMMUNITY HEALTH CLINIC * 058670 TRONA RURAL HEALTH CLINIC * 058648 TULARE HOSPITAL AND CLINICS HILLMAN CENTER * 058624 UKIAH VALLEY PRIMARY CARE / ADVENTIST * 058622 UKIAH VALLEY PRIMARY CARE / ADVENTIST HEALTH * 058625 UKIAH VALLEY PRIMARY CARE / ADVENTIST HEALTH * 058623 UKIAH VALLEY PRIMARY CARE / ADVENTIST HEALTH * 058626 UKIAH VALLEY PRIMARY CARE / ADVENTIST HEALTH * 058939 UNIVERSAL MEDICAL CENTER, INC * 058977 WAHID MEDICAL CORPORATION None WATERFORD COMMUNITY HEALTH 058679 CENTER None WEIMAR FAMILY CARE 058987 None WEST SIDE FAMILY HEALTH CARE 058992 * 058909 WESTERN SIERRA MEDICAL CENTER * 553929 WESTSIDE MEDICAL GROUP * = Non-Deemed 058969

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 12 of 13

Address

City, State and ZIP

Telephone # County Name

9279 LOCUST STREET

PLYMOUTH, CA 95669

(209)245-6968 Amador

16911 WILLOW GLEN ROAD

BROWNSVILLE, CA 95919

(530)675-2457 Yuba

850 FIFTH STREET

GONZALES, CA 93926

(831)675-3601 Monterey

2041 BELSHAW STREET

MOJAVE, CA 93501

(661)824-4511 Kern

9350 NORTH LOOP BOULEVARD

CALIF CITY, CA 93505

(760)373-1785 Kern

1850 WALNUT ST

RED BLUFF, CA 96080

(530)527-0350 Tehama

575 NORTH THOMPSON ROAD 31 EASTER AVENUE

TIPTON, CA 93272 WEAVERVILLE, CA 96093

(559)762-4147 Tulare (530)623-5541 Trinity

82820 TRONA ROAD 1062 SOUTH K STREET

TRONA, CA 93562 TULARE, CA 93274

(760)499-3902 San Bernardino (559)684-4530 Tulare

260 HOSPITAL DRIVE, STE 102,103,107,201,204 & 209 1165 SOUTH DORA STREET, SUITE B1

UKIAH, CA 95482

(707)468-0491 Mendocino

UKIAH, CA 95482

(707)462-1201 Mendocino

487 S MAIN ST

LAKEPORT, CA 95453

(707)263-4631 Lake

1165 SOUTH DORA STREET, SUITE E1 & UKIAH, CA 95482 E2 1050 NORTH STATE STREET UKIAH, CA 95482

(707)463-8000 Mendocino

1472 B STREET STE A 1108 WARD AVE 12146 YOSEMITE BLVD

(209)394-7614 Merced (209)892-1300 Stanislaus (209)874-9254 Stanislaus

LIVINGSTON, CA 95334 PATTERSON, CA 95363 WATERFORD, CA 95386

(707)468-1471 Mendocino

20601 WEST PAOLI LANE WEIMAR, CA 95736 100 EAST NORTH STREET TAFT, CA 93268 3070 CAMINO HEIGHTS DRIVE, SUITE B CAMINO, CA 95709

(530)296-4417 Placer (661)765-1935 Kern (530)647-9762 El Dorado

1107 O STREET

(559)569-9000 Fresno

FIREBAUGH, CA 93622

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey California CCN

Key Provider Name *

WESTSIDE MEDICAL GROUP OF MENDOTA, INC

*

553988 WILLIAMS URGENT CARE AND MEDICAL CENTER * 058961 WILLOWS FIRSTCARE INC * 553937 WOMENS AND CHILDREN HEALTHCARE *

058976 YUCCA FAMILY MEDICAL CARE INC Total Providers for this State = 280

058916

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 13 of 13

Address

City, State and ZIP

Telephone # County Name

450 OLLER STREET, STE 101

MENDOTA, CA 93640

(559)655-1000 Fresno

501 E STREET SUITE B

WILLIAMS, CA 95987

(530)473-5641 Colusa

460 W SYCAMORE ST WILLOWS, CA 95988 57463 TWENTYNINE PALMS HWY, SUITE YUCCA VALLEY, CA 92284 202

57675 29 PALMS HWY SUITE 111 YUCCA VALLEY, CA 92284

(530)934-3385 Glenn (760)365-0808 San Bernardino (760)365-8500 San Bernardino

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Hawaii CCN

Key Provider Name

Address

*

KAU HOSPITAL RURAL HEALTH CLIN 1 KAMANI STREET 123976 *

123977 MOLOKAI GENERAL HOSPITAL 280 HOME OLU PLACE Total Providers for this State = 2

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

City, State and ZIP

Telephone # County Name

PAHALA, HI 96777 KAUNAKAKAI, HI 96748

(808)928-2050 Hawaii (808)553-5331 Maui

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Nevada CCN

Key Provider Name *

BATTLE MOUNTAIN CLINIC HUMBOLDT GENERAL HOSPITAL RHC * 293982 LINCOLN COUNTY HOSPITAL DISTRICT * 293811 MINDEN FAMILY MEDICINE AND COMPLETE CARE

*

293975 MOUNT GRANT MEDICAL BUILDING * 293981 PERSHING GENERAL HOSP & NURSING HOME PHYSICIAN CTR * 293962 SILVER SPRINGS RURAL HEALTH CENTERS

*

293978 SMITH VALLEY PHYSICIANS CLINIC * 293979 SOUTH LYON MEDICAL CENTERBARNETT CLINIC * 293980 SOUTH LYON PHYSICIANS CLINIC * 293985 TOPAZ RANCH MEDICAL CLINIC * 293977 WILLIAM BEE RIRIE HOSPITAL-RHC Total Providers for this State = 12

293984 293961

*

* = Non-Deemed

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 1

City, State and ZIP

Telephone # County Name

535 SOUTH HUMBOLDT STREET, STE A BATTE MTN, NV 89820 118 E HASKELL STREET WINNEMUCCA, NV 89445

(775)635-2424 Lander (775)623-5222 Humboldt

700 NORTH SPRING STREET

CALIENTE, NV 89008

(775)726-3171 Lincoln

1649 LUCERNE ST UNIT A & B

MINDEN, NV 89423

(775)782-1603 Douglas

1ST & A STREETS/PO BOX 1510 850 SIXTH STREET/PO BOX 661

HAWTHORNE, NV 89415 LOVELOCK, NV 89419

(775)945-2461 Mineral (775)273-2621 Pershing

3595 HWY 50 WEST

SILVER SPRINGS, NV 89429

(775)982-6508 Lyon

445 STATE HWY 338 213 S WHITACRE STREET

WELLINGTON, NV 89444 YERINGTON, NV 89447

(775)465-2587 Lyon (775)463-2301 Lyon

311 SURPRISE STREET 3919 CARTER DR 6 STEPTOE CIRCLE

YERINGTON, NV 89447 WELLINGTON, NV 89444 ELY, NV 89301

(775)463-2301 Lyon (775)783-3096 Lyon (775)289-3001 White Pine

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Idaho CCN 133838 133845 133850 138514 138505 133831 133859 138521 133993 133832 133851 138511 133833 138515 133861 138520 138502 133997 138506 133981 133990 138507 133858 138509 133860 138512 133989 133995

Key Provider Name *

ASSOCIATES IN FAMILY PRACTICE GOODING

*

ASSOCIATES IN FAMILY PRACTICE HAGERMAN * ASSOCIATES IN FAMILY PRACTICE WENDELL * BEAR LAKE FAMILY CARE & OB/GYN * BEAR LAKE INTERNAL MEDICINE * BLACKFOOT MEDICAL CENTER * BONNERS FERRY FAMILY MEDICINE None BOUNDARY COMMUNITY CLINICS * CASCADE FAMILY PRACTICE * CHALLIS AREA HEALTH CENTER * CLAY I CAMPBELL * DRIGGS MEDICAL CLINIC * EMMETT MEDICAL CENTER None FIRST CHOICE URGENT CARE & MEDICAL CLINIC None FOUR PEAKS CLINIC * GOODING FAMILY PHYSICIANS * IDAHO PHYSICIANS CLINIC * KENDRICK CLINIC * LAKEVIEW MEDICAL CLINIC * LOST RIVERS RURAL HEALTH CLINIC * MACKAY CLINIC * MINIDOKA MEDICAL CENTER * MOSCOW MEDICAL, P A * ONEIDA COUNTY CLINIC None PALOUSE PEDIATRICS-MOSCOW * PHYSICIANS & SURGEONS CLINIC OF SHELLEY * PIONEER MEDICAL CLINIC * POTLATCH CLINIC

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 2

Address

City, State and ZIP

Telephone # County Name

425 IDAHO STREET

GOODING, ID 83330

(208)934-5900 Gooding

640 FROGS LANDING

HAGERMAN, ID 83332

(208)837-6161 Gooding

410 NORTH IDAHO STREET

WENDELL, ID 83355

(208)536-5900 Gooding

465 WASHINGTON STREET 166 SOUTH 5TH STREET 1441 PARKWAY DRIVE 6488 CHINOOK ST 6641 KANIKSU STREET 402 LAKE CASCADE PKWY 611 CLINIC ROAD 166 SOUTH 5TH STREET 283 NORTH 1ST EAST 1102 EAST LOCUST 1350 PARKWAY DRIVE

MONTPELIER, ID 83254 MONTPELIER, ID 83254 BLACKFOOT, ID 83221 BONNERS FERRY, ID 83805 BONNERS FERRY, ID 83805 CASCADE, ID 83611 CHALLIS, ID 83226 MONTPELIER, ID 83254 DRIGGS, ID 83422 EMMETT, ID 83617 BLACKFOOT, ID 83221

(208)847-1630 Bear Lake (208)847-1110 Bear Lake (208)785-2600 Bingham (208)267-8779 Boundary (208)267-3141 Boundary (208)382-4285 Valley (208)879-4351 Custer (208)847-3847 Bear Lake (208)354-2302 Teton (208)365-6004 Gem (208)782-2410 Bingham

852 VALLEY CENTRE DRIVE 267 N CANYON DR 98 POPLAR STREET 606 EAST MAIN STREET 300 SOUTH THIRD WEST 551 HIGHLAND DRIVE

DRIGGS, ID 83422 GOODING, ID 83330 BLACKFOOT, ID 83221 KENDRICK, ID 83537 SODA SPRINGS, ID 83276 ARCO, ID 83213

(208)354-4757 Teton (208)934-4446 Gooding (208)785-3800 Bingham (208)289-3841 Latah (208)547-3118 Caribou (208)527-8206 Butte

313 EAST CUSTER STREET 1308 8TH STREET, SUITE 1 213 N MAIN STREET 220 BANNOCK STREET 1420 S BLAINE ST STE 5 275 W LOCUST STREET

MACKAY, ID 83251 RUPERT, ID 83350 MOSCOW, ID 83843 MALAD, ID 83252 MOSCOW, ID 83843 SHELLEY, ID 83274

(208)588-2993 Custer (208)436-4322 Minidoka (208)882-7565 Latah (208)766-2600 Oneida (509)322-2605 Latah (208)357-3960 Bingham

105 CARLE STREET 156 6TH ST

PIERCE, ID 83546 POTLATCH, ID 83855

(208)464-2578 Clearwater (208)875-2380 Latah

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Idaho CCN

Key Provider Name *

POWER COUNTY FAMILY CLINIC SALMON RIVER CLINIC * SHELLEY FAMILY MEDICAL CENTER * ST ALPHONSUS MEDICAL GROUP ELM

*

133835 ST ALPHONSUS MEDICAL GROUP GARRITY * 133825 ST ALPHONSUS MEDICAL GROUP IOWA None ST ALPHONSUS MEDICAL GROUP 138524 FRUITLAND HEALTH PLAZA * 138516 ST LUKE'S CLINIC - SALMON RIVER MEDICAL * 133992 ST LUKE'S CLINIC JEROME FAMILY MEDICINE * 133999 ST LUKE'S TRINITY MOUNTAIN * 138503 ST MARIES FAMILY MEDICINE * 133996 STEELE MEMORIAL CLINIC None SYRINGA KOOSKIA CLINIC 138518 None SYRINGA PRIMARY CARE CLINIC 138517 * 133836 TWO RIVERS MEDICAL CLINIC, P A * 133856 UPPER VALLEY FAMILY MEDICINE * 138510 VICTOR HEALTH CLINIC None WEISER MEMORIAL HOSPITAL 138523 FAMILY MEDICAL PRACTICE None WILLOW VALLEY MEDICAL CENTER 138522 Total Providers for this State = 47

138500 133808 133839 133826

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 2

Address

City, State and ZIP

Telephone # County Name

502 TYHEE ST 1 NIECE AVENUE 210 SOUTH EMERSON 315 EAST ELM STREET

AMERICAN FALLS, ID 83211 STANLEY, ID 83278 SHELLEY, ID 83274 CALDWELL, ID 83605

(208)226-1057 Power (208)774-3565 Custer (208)357-7405 Bingham (208)459-7415 Canyon

1200 GARRITY BOULEVARD

NAMPA, ID 83687

(208)466-9092 Canyon

211 WEST IOWA AVENUE

NAMPA, ID 83686

(208)465-7377 Canyon

910 NW 16TH STREET SUITE 101

FRUITLAND, ID 83619

(208)452-6851 Payette

214 N MAIN STREET

RIGGINS, ID 83549

(208)628-3666 Idaho

132 5TH AVENUE WEST

JEROME, ID 83338

(208)324-5286 Jerome

465 MCKENNA DRIVE 229 8TH STREET 805 MAIN STREET 022 N MAIN ST 722 W NORTH ST 683 EAST THIRD STREET 711 RIGBY LAKE DRIVE 252 SOUTH MAIN STREET 360 E LIBERTY

MOUNTAIN HOME, ID 83647 ST MARIES, ID 83861 SALMON, ID 83467 KOOSKIA, ID 83539 GRANGEVILLE, ID 83530 WEISER, ID 83672 RIGBY, ID 83442 VICTOR, ID 83455 WEISER, ID 83672

(208)587-9703 Elmore (208)245-2591 Benewah (208)756-6212 Lemhi (208)926-4776 Idaho (208)983-8590 Idaho (208)549-0211 Washington (208)745-5021 Jefferson (208)787-9898 Teton (208)549-4424 Washington

47 NORTH 1ST EAST

PRESTON, ID 83263

(208)852-2900 Franklin

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oregon CCN

Key Provider Name

388516

*

388514

*

388504

*

388507

*

388510

*

383807 383887

*

388520 383866 383883 383886 388522 383873 388502

*

388515 383836 383882

*

383895

*

383990 388513 383880 383891

*

383884 383856 383985

*

*

* * * * * *

* *

* * *

* *

* = Non-Deemed

ADVENTIST HEALTH BAYSHORE MEDICAL LINCOLN CITY ADVENTIST HEALTH BAYSHORE MEDICAL PACIFIC CITY ADVENTIST HEALTH TILLAMOOK MEDICAL GROUP ADVENTIST HEALTH TILLAMOOK MEDICAL GROUP BAY OCEAN

ADVENTIST HEALTH TILLAMOOK MEDICAL GROUP MANZANITA ALSEA RURAL HEALTH CARE, INC APPLEGATE VALLEY FAMILY MEDICINE LLC AUMSVILLE MEDICAL CLINIC C SCOTT GRAHAM, DO, PC CANBY HEALTH CARE CLINIC LLC CASCADE DIRECT CARE CASCADE MEDICAL CLINIC CENTER FOR WOMEN & THE FAMILY CHI ST ANTHONY HOSPITAL FAMILY CLINIC CMH PRIMARY CLINIC COASTAL HEALTH PRACTITIONERS COLUMBIA GORGE FAMILY MEDICINE COLUMBIA RIVER WOMEN'S CENTER CURRY FAMILY MEDICAL DUNES FAMILY HEALTH CARE EVERGREEN FAMILY MEDICINE PC EVERGREEN FAMILY MEDICINE SOUTH FAMILY HEALTH ASSOCIATES GIFFORD MEDICAL GOOD SHEPHERD MEDICAL GROUP

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 4

Address

City, State and ZIP

Telephone # County Name

1105 SOUTHWEST JETTY AVENUE SUITE C

38505 BROOTEN RD

LINCOLN CITY, OR 97367

(541)614-0482 Lincoln

PACIFIC CITY, OR 97135

(503)965-6555 Tillamook

1100 THIRD STREET

TILLAMOOK, OR 97141

(503)815-2260 Tillamook

1011 THIRD STREET

TILLAMOOK, OR 97141

(503)815-2260 Tillamook

10445 NEAHKAHNIE CREEK ROAD

MANZANITA, OR 97130

(503)368-6244 Tillamook

201 NORTH 4TH 8600 NEW HOPE ROAD

ALSEA, OR 97324 GRANTS PASS, OR 97527

(541)487-7116 Benton (541)862-2836 Josephine

205 MAIN STREET 620 SOUTH J STREET 703 SE 1ST AVE 750 NW 4TH STREET 1375 N 10TH AVENUE SUITE B 17 SW FRAZER, SUITE 282 3001 ST ANTHONY WAY, SUITE 120

AUMSVILLE, OR 97325 LAKEVIEW, OR 97630 CANBY, OR 97013 PRINEVILLE, OR 97754 STAYTON, OR 97383 PENDLETON, OR 97801 PENDLETON, OR 97801

(503)749-4734 Marion (541)947-2331 Lake (503)266-7687 Clackamas (541)362-8688 Crook (503)769-7546 Linn (541)278-3377 Umatilla (541)278-8183 Umatilla

1639 SE ENSIGN LANE #B 103 3015 WEST DEVILS LAKE ROAD 1750 12TH STREET

WARRENTON, OR 97146 LINCOLN CITY, OR 97367 HOOD RIVER, OR 97031

(503)338-4500 Clatsop (541)994-5591 Lincoln (541)386-5070 Hood River

1810 EAST 19TH STREET, SUITE 209

THE DALLES, OR 97058

(541)296-5657 Wasco

525 MADRONA STREET 620 RANCH ROAD 2570 NW EDENBOWER BLVD STE 100 145 NE BROADWAY ST

PORT ORFORD, OR 97465 REEDSPORT, OR 97467 ROSEBURG, OR 97471 MYRTLE CREEK, OR 97457

(541)332-3861 Curry (541)271-2163 Douglas (541)677-7200 Douglas (541)863-3146 Douglas

600 NW 11TH, SUITE E-15 1050 W ELM AVENUE, SUITE 110 600 NW 11TH STREET

HERMISTON, OR 97838 HERMISTON, OR 97838 HERMISTON, OR 97838

(541)567-6434 Umatilla (541)567-2995 Umatilla (541)567-5305 Umatilla

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oregon CCN

Key Provider Name

388524

*

388527

*

388526

*

388525

*

383848

*

388512

*

383858

*

388518 383987 388517 383867

*

383881

*

388501

*

383999

*

388500

*

383862 383859 383817

*

383802 383996 388506 383863

*

* * *

* *

* * *

* = Non-Deemed

GRANDE RONDE HOSPITAL ELGIN CLINIC GRANDE RONDE HOSPITAL REGIONAL MEDICAL CLINIC GRANDE RONDE HOSPITAL UNION CLINIC GRANDE RONDE HOSPITAL WOMEN'S & CHILDREN'S CLINIC GRANT COUNTY HEALTH DEPARTMENT HARNEY DISTRICT HOSPITAL FAMILY CARE HERMISTON FAMILY PRACTICE AND URGENT CARE

IONE COMMUNITY CLINIC IRRIGON MEDICAL CLINIC LAKE HEALTH DISTRICT LEGACY CLINIC ST HELENS LEGACY MEDICAL GROUP FIRWOOD LEGACY MEDICAL GROUP SILVERTON INTERNAL MEDICINE LEGACY MEDICAL GROUP – MT. ANGEL LEGACY MEDICAL GROUP – WOODBURN HEALTH CENTER LISA CALLAHAN, CPNP MADRAS MEDICAL GROUP MALHEUR MEMORIAL HEALTH CENTER MCKENZIE RIVER CLINIC MCMC FAMILY MEDICINE MCMC PEDIATRICS MILTON-FREEWATER CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 4

Address

City, State and ZIP

Telephone # County Name

580 S 8TH STREET

ELGIN, OR 97827

(541)437-2273 Union

506 4TH STREET

LA GRANDE, OR 97850

(541)663-3138 Union

142 EAST DEARBORN

UNION, OR 97883

(541)963-1842 Union

710 SUNSET DRIVE, SUITE E

LA GRANDE, OR 97850

(541)633-3150 Union

528 EAST MAIN, SUITE E

JOHN DAY, OR 97845

(541)575-0429 Grant

559 W WASHINGTON ST

BURNS, OR 97720

(541)573-2074 Harney

236 E NEWPORT AVENUE

HERMISTON, OR 97838

(541)567-1137 Umatilla

365 W 3RD STREET 220 NORTH MAIN STREET 700 SOUTH J STREET 500 N COLUMBIA RIVER HIGHWAY, SUITE 6 36860 INDUSTRIAL WAY

IONE, OR 97843 IRRIGON, OR 97844 LAKEVIEW, OR 97630 ST HELENS, OR 97051

(541)422-7128 Morrow (541)922-5880 Morrow (541)947-2114 Lake (503)397-0471 Columbia

SANDY, OR 97055

(503)826-0206 Clackamas

693 GLATT CIRCLE

WOODBURN, OR 97071

(503)982-0403 Marion

250 W MARQUIM ST

MOUNT ANGEL, OR 97362

(503)845-2000 Marion

1475 MOUNT HOOD AVE

WOODBURN, OR 97071

(503)982-2174 Marion

1465 B NE 7TH STREET 76 NE 12TH STREET 410 MAIN STREET

GRANTS PASS, OR 97526 MADRAS, OR 97741 NYSSA, OR 97913

(541)471-0100 Josephine (541)475-3874 Jefferson (541)372-2211 Malheur

51730 DEXTER STREET 1620 E 12TH STREET 1935 E 19TH STREET, SUITE 100 10 NE 5TH

BLUE RIVER, OR 97413 THE DALLES, OR 97058 THE DALLES, OR 97058 MILTON FREEWATER, OR 97862

(503)822-3341 Lane (541)296-9151 Wasco (541)296-7677 Wasco (541)938-3314 Umatilla

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oregon CCN

Key Provider Name

Address

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 4

City, State and ZIP

Telephone # County Name

388528

None MOUNTAIN

ENTERPRISE, OR 97828

(541)426-7900 Wallowa

383876

*

BANDON, OR 97411

(541)347-5191 Coos

383853

*

GOLD BEACH, OR 97444

(541)247-7047 Curry

383893

*

COOS BAY, OR 97420

(541)267-5151 Coos

383839

*

VIEW MEDICAL 603 MEDICAL PARKWAY ENTERPRISE

NORTH BEND MEDICAL CENTER 110 E TENTH STREET BANDON NORTH BEND MEDICAL CENTER 94180 SECOND STREET GOLD BEACH NORTH BEND MEDICAL CENTER, INC 1900 WOODLAND DRIVE IMMEDIATE CARE OAK STREET HEALTH CARE CENTER 446 OAK STREET

BROOKINGS, OR 97415

(541)412-8898 Curry

383849

*

51377 OLD PORTLAND ROAD SUITE C

SCAPPOOSE, OR 97056

(503)418-4222 Columbia

383890 383894

*

47815 HWY 58 535 NE 6TH AVENUE

OAKRIDGE, OR 97463 ESTACADA, OR 97023

(541)782-8304 Lane (503)630-8550 Clackamas

383808

*

38843 DEXTER ROAD

DEXTER, OR 97431

(541)937-2134 Lane

383874

*

2461 SW PERKINS AVE

PENDLETON, OR 97801

(541)276-0250 Umatilla

383869 383984 383981 383993 383991 388509

*

218 N PINE STREET 130 THOMPSON AVENUE 727 SOUTH WAHANNA ROAD 1825 E 19TH STREET 825 NW HIGHWAY 101, SUITE A 2870 WEST DEVILS LAKE ROAD

HALFWAY, OR 97834 HEPPNER, OR 97836 SEASIDE, OR 97138 THE DALLES, OR 97058 LINCOLN CITY, OR 97367 LINCOLN CITY, OR 97367

(541)742-5023 Baker (541)676-9133 Morrow (503)717-7000 Clatsop (541)296-1151 Wasco (541)994-3661 Lincoln (541)557-6490 Lincoln

388519 388521 383825 383820 383843 383892 383805 388511

*

OHSU FAMILY MEDICINE AT SCAPPOOSE ORCHID HEALTH ORCHID HEALTH WADE CREEK CLINIC PEACEHEALTH MEDICAL GROUP DEXTER PEDIATRIC SPECIALISTS OF PENDLETON, L L C PINE EAGLE CLINIC PIONEER MEMORIAL CLINIC PROVIDENCE NORTH COAST CLINIC RIVER VIEW CLINIC SAMARITAN COASTAL CLINIC SAMARITAN LINCOLN CITY MEDICAL CENTER SAMARITAN WALDPORT CLINIC SANTIAM MEDICAL CLINIC SHADY COVE CLINIC SHERMAN COUNTY MEDICAL CLINIC SISKIYOU PEDIATRIC CLINIC LLP SNAKE RIVER PEDIATRICS SOUTH GILLIAM HEALTH CENTER ST ALPHONSUS MEDICAL CENTER VALLEY MEDICAL CLINIC

920 SW RANGE DR 280 S FIRST STREET 21990 HIGHWAY 62 110 MAIN STREET 700 SW RAMSEY, SUITE 204 1050 SW 3RD AVE, SUITE 3200 422 NORTH MAIN 3820 17TH STREET

WALDPORT, OR 97394 MILL CITY, OR 97360 SHADY COVE, OR 97539 MORO, OR 97039 GRANTS PASS, OR 97527 ONTARIO, OR 97914 CONDON, OR 97823 BAKER CITY, OR 97814

(541)563-3197 Lincoln (503)897-4100 Linn (541)878-2022 Jackson (541)565-3325 Sherman (541)955-5683 Josephine (541)881-2380 Malheur (541)384-2061 Gilliam (541)523-4465 Baker

*

* * * * *

* * * * * * *

* = Non-Deemed

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Oregon CCN

Key Provider Name *

ST ALPHONSUS MEDICAL GROUPBAKER CLINIC * 388505 ST CHARLES FAMILY CARE PRINEVILLE * 383852 ST LUKE'S CLINIC-EASTERN OREGON MEDICAL ASSOCIATES * 383998 STRAWBERRY WILDERNESS COMMUNITY CLINIC * 388523 SUBLIMITY MEDICAL CLINIC * 383868 TREASURE VALLEY PEDIATRIC CLINIC P C

*

383872 UMPQUA REGIONAL MEDICAL CENTER, LLC

*

383878 URGENTCARE NW-ASTORIA, PC * 383885 VERNONIA HEALTH CENTER * 383994 WATER'S EDGE MEDICAL CLINIC * 383864 WINDING WATERS CLINIC P C ENTERPRISE * 383889 WOODBURN PEDIATRIC CLINIC LLP Total Providers for this State = 83 388508

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 4

Address

City, State and ZIP

Telephone # County Name

3175 POCAHONTAS ROAD

BAKER CITY, OR 97814

(541)523-4415 Baker

384 SE COMBS FLAT ROAD, SUITE 1200 PRINEVILLE, OR 97754

(541)447-6263 Crook

3950 17TH STREET, SUITE A

BAKER CITY, OR 97814

(541)523-1001 Baker

180 FORD ROAD

JOHN DAY, OR 97845

(541)575-0404 Grant

114 SE CHURCH STREET 1219 SW 4TH AVENUE, SUITE 1

SUBLIMITY, OR 97385 ONTARIO, OR 97914

(503)769-2259 Marion (541)889-2668 Malheur

1813 W HARVARD SUITE 201

ROSEBURG, OR 97471

(541)459-3500 Douglas

2120 EXCHANGE ST, SUITE 111 1005 COUGAR STREET 551 LONE PINE BLVD 603 MEDICAL PARKWAY

ASTORIA, OR 97103 VERNONIA, OR 97064 THE DALLES, OR 97058 ENTERPRISE, OR 97828

(503)666-5050 Clatsop (503)429-0622 Columbia (541)296-2353 Wasco (541)426-4502 Wallowa

2050 PROGRESS WAY

WOODBURN, OR 97071

(503)981-5348 Marion

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Washington CCN

Key Provider Name

508550

*

508505 508554 503905 508539 503872 508520 508502

*

503992 508509

*

503900 503897 503868

*

503975 508541 503985 503977 503920 508523 508515

*

508516 508512 508513 503854 508517 508568 508514 508535

*

* * * * * *

*

* *

* * * * * *

* * * * * * *

* = Non-Deemed

ADVENTIST HEALTH MEDICAL GROUP

ANACORTES FAMILY MEDICINE BENTON CITY CLINIC BIRCH BAY FAMILY MEDICINE BIRCH STREET MEDICAL CENTER BLUE MOUNTAIN MEDICAL GROUP BOGACHIEL CLINIC CAMANO COMMUNITY HEALTH CLINIC CASCADE MEDICAL CENTER CASCADE VALLEY DARRINGTON CLINIC

CENTRALIA SPECIALTY CENTER CHEHALIS CHILDRENS CLINIC CHEWELAH ASSOCIATED PHYSICIANS CLALLAM BAY MEDICAL CLINIC CLE ELUM FAMILY MEDICINE CTR COLUMBIA BASIN FAMILY MEDICINE COLUMBIA FAMILY CLINIC CONFLUENCE HEALTH BREWSTER CONFLUENCE HEALTH CASHMERE CONFLUENCE HEALTH EAST WENATCHEE CONFLUENCE HEALTH MOSES LAKE CONFLUENCE HEALTH OMAK CONFLUENCE HEALTH OROVILLE CONFLUENCE HEALTH ROYAL CITY CONFLUENCE HEALTH TONASKET CONFLUENCE HEALTH WATERVILLE CONFLUENCE HEALTH WENATCHEE COULEE CITY CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 1 of 5

Address

City, State and ZIP

Telephone # County Name

1111 S 2ND AVENUE

WALLA WALLA, WA 99362

(509)522-0100 Walla Walla

2511 M AVENUE, SUITE B 701 DALE AVE 8097 HARBORVIEW RD 222 EAST 2ND STREET 1111 S 2ND AVE 390 FOUNDERS WAY 127 N EAST CAMANO DR

ANACORTES, WA 98221 BENTON CITY, WA 99320 BLAINE, WA 98230 GRANDVIEW, WA 98930 WALLA WALLA, WA 99362 FORKS, WA 98331 CAMANO CITY, WA 98292

(360)293-5102 Skagit (800)356-1011 Benton (360)371-5855 Whatcom (509)882-3500 Yakima (509)522-0100 Walla Walla (360)374-6998 Clallam (360)387-5398 Snohomish

817 COMMERCIAL STREET 1190 RIDDLE ST

LEAVENWORTH, WA 98826 DARRINGTON, WA 98241

(509)548-5815 Chelan (360)436-1055 Snohomish

1707 COOKS HILL ROAD 370 S MARKET BLVD 410 EAST KING STREET

CENTRALIA, WA 98531 CHEHALIS, WA 98532 CHEWELAH, WA 99109

(360)740-4001 Lewis (360)748-6693 Lewis (509)935-8711 Stevens

6TH & BOGACHIEL 201 ALPHA WAY 200 NAT WASHINGTON WAY 1012 SOUTH 3RD STREET 418 W MAIN ST 303 COTTAGE AVENUE 100 HIGHLINE DRIVE

CLALLAM BAY, WA 98326 (206)963-2202 Clallam CLE ELUM, WA 98922 (509)674-5331 Kittitas EPHRATA, WA 98823 (509)754-4631 Grant DAYTON, WA 99328 (509)382-2531 Columbia BREWSTER, WA 98812 (509)663-8711 Okanogan CASHMERE, WA 98815 (509)782-1541 Chelan EAST WENATCHEE, WA 98802 (509)884-0614 Douglas

840 EAST HILL DRIVE 916 KOALA AVENUE 1617 MAIN STREET 101 CAMELIA NW 17 SOUTH WESTERN AVENUE 117 S CHELAN AVE 820 NORTH CHELAN AVENUE 130 N ADAMS STREET

MOSES LAKE, WA 98837 OMAK, WA 98841 OROVILLE, WA 98844 ROYAL CITY, WA 99357 TONASKET, WA 98855 DOUGLAS, WA 98858 WENATCHEE, WA 98801 COULEE CITY, WA 99115

(509)765-0216 Grant (509)826-1800 Okanogan (509)476-3631 Okanogan (509)346-1447 Grant (509)486-2174 Okanogan (509)663-8711 Douglas (509)663-8711 Chelan (509)632-5701 Grant

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Washington CCN

Key Provider Name

503981 508533 508529 503885 503919 503881 508556 503904 503863

*

503886

*

508500 508518 503873 508519 503903

*

508548

*

508540 503824

*

503917 508526

*

508525

*

508524

*

508569

*

508553

*

* * * * * * * *

* * * *

*

*

* = Non-Deemed

COULEE FAMILY MEDICINE CURLEW MEDICAL CLINIC DAVENPORT CLINIC DEER PARK FAMILY CARE CLINIC EAST CAMPUS INTERNAL MEDICINE ELLENSBURG PEDIATRICS ELMA FAMILY MEDICINE EVERSON FAMILY MEDICINE FAMILY CARE NETWORK ISLAND FAMILY PHYSICIANS FAMILY HEALTH CARE OF ELLENSBURG FAMILY HEALTH CENTER NEWPORT FAMILY MEDICINE NEWPORT FAMILY MEDICINE OF PORT ANGEL FAMILY PRACTICE CLINIC FERNDALE FAMILY MEDICAL CENTER

FIDALGO MEDICAL ASSOCIATES AT ISLAND HOSPITAL

GRANDVIEW MEDICAL CENTER HARRISON HEALTH PARTNERS FAMILY MEDICAL CENTER HIGHLANDS PEDIATRICS JEFFERSON GENERAL MEDICAL GROUP JEFFERSON HEALTHCARE FAMILY MEDICINE JEFFERSON HEALTHCARE INTERNAL MEDICINE

JOHN HUGHES STUDENT HEALTH CENTER KITTITAS VALLEY HEALTHCARE FAMILY MEDICINE-ELLENSB

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 2 of 5

Address

City, State and ZIP

Telephone # County Name

411 FORTUYN ROAD 9 KETTLE RIVER ROAD 100 THIRD STREET 905 EAST D STREET 1006 N H STREET 611 S CHESTNUT, SUITE E 575 E MAIN STREET BLDG 2 407 E MAIN ST 2511 M AVENUE STE A

GRAND COULEE, WA 99133 CURLEW, WA 99118 DAVENPORT, WA 99122 DEER PARK, WA 99006 ABERDEEN, WA 98520 ELLENSBURG, WA 98926 ELMA, WA 98541 EVERSON, WA 98247 ANACORTES, WA 98221

(509)633-1911 Grant (509)779-4049 Ferry (509)725-7501 Lincoln (509)276-5005 Spokane (360)537-6496 Grays Harbor (509)962-5437 Kittitas (360)482-3711 Grays Harbor (360)966-3441 Whatcom (360)293-9813 Skagit

107 E MOUNTAIN VIEW AVENUE, SUITE #1 714 W PINE STREET BLDG C SOUTH 100 SCOTT AVENUE 240 WEST FRONT STREET, SUITE A 711 EAST COLLINS DR 5580 NORDIC WAY

ELLENSBURG, WA 98926

(509)962-6348 Kittitas

NEWPORT, WA 99156 NEWPORT, WA 99156 PORT ANGELES, WA 98362 GOLDENDALE, WA 98620 FERNDALE, WA 98248

(509)447-2441 Pend Oreille (509)447-3139 Pend Oreille (360)425-7891 Clallam (509)773-4017 Klickitat (360)384-1511 Whatcom

1213 24TH STREET, SUITE 100

ANACORTES, WA 98221

(360)293-4655 Skagit

208 N EUCLID ROAD 461 G STREET SW

GRANDVIEW, WA 98930 FORKS, WA 98331

(509)882-1855 Yakima (360)374-6224 Clallam

615 NORTH F STREET 915 SHERIDAN AVENUE, SUITE B103

ABERDEEN, WA 98520 PT TOWNSEND, WA 98368

(360)533-4599 Grays Harbor (360)385-4848 Jefferson

1010 SHERIDAN AVE SUITE 1

PT TOWNSEND, WA 98368

(360)379-8631 Jefferson

934 SHERIDAN AVENUE

PT TOWNSEND, WA 98368

(360)385-6200 Jefferson

1801 E EDISON AVE

SUNNYSIDE, WA 98944

(509)837-1650 Yakima

716 EAST MANITOBA AVENUE

ELLENSBURG, WA 98926

(509)925-3151 Kittitas

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Washington CCN

Key Provider Name

508545

*

503894 508567 508538 503995 503902 503998 503898 508551

*

508565

*

508566

*

508527

*

508564

*

508549

*

508571

*

503907

*

503858 503877 503850

*

503984 503835 503836 503915 503899

*

* * * * * * *

* *

* * * *

* = Non-Deemed

KITTITAS VALLEY HEALTHCARE INTERNAL MEDICINE L KEITH HANSON PLLC LAKE CHELAN CLINIC, PC LINCOLN AVENUE FAMILY MEDICINE LOPEZ ISLAND MEDICAL CLINIC LYNDEN FAMILY MEDICINE MARK REED HEALTHCARE DISTRICT MARY'S CORNER MEDICAL CLINIC MASON GEN HOSP MOUNTAIN VIEW WOMEN'S HEALTH CENTER MASON GENERAL HOSP OLYMPIC PHYSICIANS, P L L C MASON GENERAL HOSPITAL HOODSPORT FAMILY CLINIC PS MASON GENERAL HOSPITAL OAKLAND BAY PEDIATRICS MASON GENERAL HOSPITAL OLYMPIC PHYSICIANS

MASON GENERAL HOSPITAL SHELTON FAMILY MEDICINE MGH FAMILY HEALTH ANKLE AND FOOT MID-VALLEY COMMUNITY CLINIC PLLC

MID-VALLEY MEDICAL GROUP MORTON MEDICAL CENTER PLLC MOUNTAIN VIEW WOMEN'S HEALTH C NASELLE CLINIC NORTHSHORE MEDICAL GROUP NORTHSHORE MEDICAL GROUP NORTHWEST PEDIATRIC CENTER NORTHWEST PEDIATRIC CENTER INC PS

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 3 of 5

Address

City, State and ZIP

Telephone # County Name

716 E MANITOBA AVENUE

ELLENSBURG, WA 98926

(509)925-6100 Kittitas

520 W INDIAN AVENUE # A 219 EAST JOHNSON 803 E LINCOLN AVENUE 103 WASHBURN 1610 GROVER ST #D-1 157 S HOWARD ST #405 4254 JACKSON HIGHWAY 2300 KATI COURT, SUITE A

BREWSTER, WA 98812 CHELAN, WA 98816 SUNNYSIDE, WA 98944 LOPEZ ISLAND, WA 98261 LYNDEN, WA 98264 SPOKANE, WA 99201 CHEHALIS, WA 98532 SHELTON, WA 98584

(509)689-2525 Okanogan (509)682-2511 Chelan (509)837-6911 Yakima (360)468-2245 San Juan (360)354-1333 Whatcom (360)495-3244 Spokane (360)262-3966 Lewis (360)426-0955 Mason

221 PROFESSIONAL WAY

SHELTON, WA 98584

(360)426-2500 Mason

N 24261 US HWY 101

HOODSPORT, WA 98548

(360)877-0372 Mason

247 PROFFESSIONAL WAY BUILDING

SHELTON, WA 98584

(360)426-3102 Mason

237 PROFESSIONAL WAY

SHELTON, WA 98584

(360)426-2500 Mason

939 MOUNTAIN VIEW DRIVE, SUITE 100 SHELTON, WA 98584

(360)426-2653 Mason

1812 N 13TH LOOP RD

SHELTON, WA 98584

(360)426-3662 Mason

700 S 11TH ST

SUNNYSIDE, WA 98944

(509)839-6822 Yakima

529 JASMINE STREET 531 ADAMS STREET 2300 KATI COURT, SUITE A

OMAK, WA 98841 MORTON, WA 98356 SHELTON, WA 98584

(509)826-1600 Okanogan (360)496-5145 Lewis (360)426-0955 Mason

NORTH VALLEY ROAD 212 SKYLINE DRIVE 875 SW ROCK CREEK DRIVE 18313 PAULSON STREET SW 193 S MARKET BLVD

NASELLE, WA 98638 WHITE SALMON, WA 98672 STEVENSON, WA 98648 ROCHESTER, WA 98579 CHEHALIS, WA 98532

(206)484-7161 Pacific (509)493-2133 Klickitat (509)427-4212 Skamania (360)273-1150 Thurston (360)748-3366 Lewis

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Washington CCN

Key Provider Name

503888 508555

*

503988 508501

*

503906 508558 508562 503883 503922 503837 503924

*

503876 503982 503860

*

503865

*

503976 508511 508528 508522 508557 503983 503839 508536 508559 503909 503997 503901 508570

*

*

*

* * * * * *

* *

* * * * * * * * * * * *

* = Non-Deemed

NW PEDIATRIC CENTER INC PS OCEAN BEACH HOSPITAL & CLINICS WOMENS HEALTH CTR OCEAN BEACH MEDICAL CLINIC ODESSA MEMORIAL HEALTHCARE CENTER

ORCAS FAMILY HEALTH CENTER ORCAS MEDICAL CENTER PLLC PACIFIC FAMILY HEALTH CENTER PALOUSE HEALTH CENTER PALOUSE PEDIATRICS, PULLMAN PE ELL HEALTH CLINIC PEDIATRIC ASSOICATES OF WHIDBEY ISLAND PENINSULA CHILDRENS CLINIC INC POMEROY MEDICAL CLINIC PROVIDENCE NORTHEAST WASHINGTON MEDICAL GROUP PROVIDENCE NORTHEAST WASHINGTON MEDICAL GROUP QUINCY VALLEY CLINIC RANDLE CLINIC REARDAN HEALTH CLINIC REPUBLIC MEDICAL CLINIC RIFFE MEDICAL CENTER RITZVILLE MEDICAL CLINIC ROCHESTER FAMILY MED CLINIC SAMARITAN CLINIC SAMARITAN PARKVIEW PEDIATRICS SAN JUAN HEALTHCARE SOUTH COUNTY MEDICAL CLINIC STECK MEDICAL CENTER SUNNYSIDE COMMUNITY HOSPITAL AND CLINIC

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 4 of 5

Address

City, State and ZIP

Telephone # County Name

1911 COOKS HILL ROAD 167 1ST AVENUE NORTH, PO BOX N

CENTRALIA, WA 98531 ILWACO, WA 98624

(360)736-6778 Lewis (360)642-6300 Pacific

176 FIRST AVENUE NORTH, PO BOX N 510 E AMENDE DRIVE

ILWACO, WA 98624 ODESSA, WA 99159

(360)642-3747 Pacific (509)982-2611 Lincoln

1286 MT BAKER ROAD #B 102 7 DEYE LANE 826 ALDER STREET 235 E MAIN STREET 1205 SE PROFESSIONAL MALL BLVD 402 NORTH MAIN STREET 275 SE CABOT DRIVE

EASTSOUND, WA 98245 EASTSOUND, WA 98245 SOUTH BEND, WA 98586 PALOUSE, WA 99161 PULLMAN, WA 99163 PE ELL, WA 98572 OAK HARBOR, WA 98277

(360)376-7778 San Juan (360)376-2561 San Juan (360)875-5579 Pacific (509)878-8000 Whitman (509)332-2605 Whitman (360)291-3232 Lewis (360)675-5555 Island

902 E CAROLINE 446 PATAHA 840 S MEYERS STREET

PORT ANGELES, WA 98362 POMEROY, WA 99347 KETTLE FALLS, WA 99141

(360)457-8578 Clallam (509)843-1491 Garfield (509)685-7848 Stevens

1200 EAST COLUMBIA

COLVILLE, WA 99114

(509)684-3701 Stevens

908 TENTH AVENUE SW 108 KINDLE ROAD E 550 E BROADWAY 10 ROS CIRCLE 745 WILLIAMS STREET 903 SOUTH ADAMS 18313 PAULSON SW 1550 S PIONEER WAY 615 SOUTH DIVISION 689 AIRPORT CENTER STE B 294843 HIGHWAY 101 1299 BISHOP ROAD 355 CHARDONNAY AVE

QUINCY, WA 98848 RANDLE, WA 98377 REARDAN, WA 99029 REPUBLIC, WA 99166 MOSSYROCK, WA 98564 RITZVILLE, WA 99169 ROCHESTER, WA 98579 MOSES LAKE, WA 98837 MOSES LAKE, WA 98837 FRIDAY HARBOR, WA 98250 QUILCENE, WA 98376 CHEHALIS, WA 98532 PROSSER, WA 99350

(509)787-3531 Grant (360)497-3333 Lewis (509)796-2737 Spokane (509)775-3153 Ferry (360)983-8990 Lewis (509)659-1200 Adams (360)273-8818 Thurston (509)766-4185 Grant (509)766-9450 Grant (360)378-1338 San Juan (360)765-3111 Jefferson (360)748-0211 Lewis (509)781-6366 Benton

CASPER Report 0006D Name and Address Listing For Rural Health Clinic Based on Current Survey Washington CCN

Key Provider Name *

SUNNYSIDE PEDIATRICS SWOFFORD & HALMA CLINIC INC PS * TENINO FAMILY PRACTICE * THE HOQUIAM CLINIC * TULALIP HEALTH CLINIC * VALLEY INTERNAL MEDICINE * VALLEY REGIONAL RHC V * WAITSBURG CLINIC * WALLA WALLA CLINIC * WASHTUCNA MEDICAL CLINIC * WEAVER FAMILY MEDICINE * WHIDBEYHEALTH PRIMARY CARECLINTON * 503996 WHIDBEYHEALTH PRIMARY CAREGOLDIE ST * 508530 WILBUR CLINIC Total Providers for this State = 118

508547 503908 503857 503921 503809 508546 508563 503978 503846 508542 503923 508506

*

* = Non-Deemed

Run Date: 05/24/2017 Job # 57880641 Last Update: 05/23/2017 Page 5 of 5

Address

City, State and ZIP

Telephone # County Name

812 MILLER AVENUE, SUITE C 2303 REITH WAY 273 EAST SUSSEX 815 K STREET 7520 TOTEM BEACH ROAD 2925 ALLEN RD 2705 E LINCOLN AVE 111 PRESTON AVENUE 55 WEST TIETAN 545 SE CHURCH ST 2935 ALLEN RD 11245 STATE ROUTE 525

SUNNYSIDE, WA 98944 SUNNYSIDE, WA 98944 TENINO, WA 98589 HOQUIAM, WA 98550 TULALIP, WA 98271 SUNNYSIDE, WA 98944 SUNNYSIDE, WA 98944 WAITSBURG, WA 99361 WALLA WALLA, WA 99362 WASHTUCNA, WA 99371 SUNNYSIDE, WA 98944 CLINTON, WA 98236

(509)837-7551 Yakima (509)837-3933 Yakima (360)264-5665 Thurston (360)553-2734 Grays Harbor (360)651-4511 Snohomish (509)837-4949 Yakima (509)836-4848 Yakima (509)337-6311 Walla Walla (509)525-3720 Walla Walla (509)646-3290 Adams (509)837-0070 Yakima (360)341-5252 Island

1300 NE GOLDIE STREET

OAK HARBOR, WA 98277

(360)679-5590 Island

109 MAIN STREET

WILBUR, WA 99185

(509)647-5321 Lincoln