BOURBONNAIS, IL DIALYSIS CENTERS KANKAKEE COUNTY DIALYSIS

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1 List of Network Providers Midlevel providers (including nurse practitioners and physician assistants) cannot be selected as Primary Care Physicians. However, you may use the services of a midlevel provider by selecting his or her supervising physician as your designated Primary CarePhysician. Midlevel providers are indicated by italics. BELLEVUE, NE DIALYSIS CLINIC INC BELLEVUE Provider #: NPI #: Twin Creek Dr Bellevue, NE Sarpy County (402) BENTON, IL BENTON DIALYSIS Provider #: NPI #: Route 14 W Benton, IL Franklin County (618) BOURBONNAIS, IL KANKAKEE COUNTY DIALYSIS Provider #: NPI #: William R Latham Sr Dr Ste 104 Bourbonnais, IL Kankakee County (815) CENTRALIA, IL CENTRALIA DIALYSIS Provider #: NPI #: State Route 161 Centralia, IL Marion County (618) CHARLESTON, IL MATTOON DIALYSIS Provider #: NPI #: Development Dr Charleston, IL Coles County (217) DAVENPORT, FL DAVENPORT DIALYSIS CENTER Provider #: NPI #: Highway 27 Ridgeview Plaza Davenport, FL Polk County (863)

2 DECATUR, IL DECATUR EAST WOOD DIALYSIS Provider #: NPI #: E Wood St Decatur, IL Macon County (217) Accreditations: Dept of Human Services MACON COUNTY DIALYSIS Provider #: NPI #: W Mckinley Ave Decatur, IL Macon County (217) Accreditations: Dept of Human Services RCG CENTRAL ILLINOIS- DECATUR Provider #: NPI #: W Hay St Ste 207 Decatur, IL Macon County (217) Accreditations: HCFA DIXON, IL DIXON KIDNEY CENTER Provider #: NPI #: N Galena Ave Dixon, IL Lee County (815) EFFINGHAM, IL EFFINGHAM DIALYSIS Provider #: NPI #: Medical Park Dr Ste 1 Effingham, IL Effingham County (217) EVANSVILLE, IN EAST EVANSVILLE DIALYSIS Provider #: NPI #: Professional Blvd Evansville, IN Vanderburgh County (812) Accreditations: IDPH 2

3 NORTH EVANSVILLE DIALYSIS Provider #: NPI #: W Buena Vista Rd Evansville, IN Vanderburgh County (812) Accreditations: IDPH FREEPORT, IL DRIFTWOOD DIALYSIS Provider #: NPI #: S West Ave Freeport, IL Stephenson County (815) FREEPORT DIALYSIS Provider #: NPI #: S Kunkle Blvd Freeport, IL Stephenson County (815) HUTCHINS PARK, IL ROCKFORD DIALYSIS Provider #: NPI #: N Rockton Ave Hutchins Park, IL Winnebago County (800) INDIANAPOLIS, IN EAGLE HIGHLANDS DIALYSIS Provider #: NPI #: Shore Ter Indianapolis, IN Marion County (317) Accreditations: CLIA JACKSONVILLE, IL JACKSONVILLE DIALYSIS Provider #: NPI #: W Walnut St Jacksonville, IL Morgan County (217) Accreditations: HCFA 3

4 JASPER, IN JASPER DIALYSIS Provider #: NPI #: W 13Th St Ste 105 Jasper, IN Dubois County (812) Accreditations: IDPH LINCOLN, IL LINCOLN DIALYSIS Provider #: NPI #: Th St Lincoln, IL Logan County (217) LITCHFIELD, IL LITCHFIELD DIALYSIS Provider #: NPI #: Saint Francis Way Litchfield, IL Montgomery County (217) Accreditations: HCFA MARION, IL MARION DIALYSIS Provider #: NPI #: S 4Th St Marion, IL Williamson County (618) MINNEAPOLIS, MN DURABLE MEDICAL EQUIPMENT TACTILE SYSTEMS TECHNOLOGY INC Specialty: Durable Medical Equipment Provider #: NPI #: Tyler St Ne Ste 200 Minneapolis, MN Hennepin County (612) MT VERNON, IL MOUNT VERNON DIALYSIS Provider #: NPI #: N Water Tower Pl Mt Vernon, IL Jefferson County (618)

5 NEWBURGH, IN NEWBURGH DIALYSIS Provider #: NPI #: State Route 261 Ste A Newburgh, IN Warrick County (812) Accreditations: IDPH OLNEY, IL OLNEY DIALYSIS Provider #: NPI #: N Boone St Olney, IL Richland County (618) PRINCETON, IN PRINCETON DIALYSIS Provider #: NPI #: Sherman Dr Princeton, IN Gibson County (812) Accreditations: IDPH ROBINSON, IL ROBINSON DIALYSIS Provider #: NPI #: N Allen St Ste B Robinson, IL Crawford County (618) Accreditations: HCFA ROCKFORD, IL CHURCHVIEW DIALYSIS Provider #: NPI #: Ware Ave Rockford, IL Winnebago County (815) CHURCHVIEW DIALYSIS Provider #: NPI #: Churchview Dr Rockford, IL Winnebago County (815) ROXBURY DIALYSIS Provider #: NPI #: Roxbury Rd Rockford, IL Winnebago County (815)

6 STONECREST DIALYSIS Provider #: NPI #: E State St Rockford, IL Winnebago County (815) RUSHVILLE, IL RUSHVILLE DIALYSIS Provider #: NPI #: Sullivan Dr Rushville, IL Schuyler County (217) Accreditations: HCFA SPRINGFIELD, IL SPRINGFIELD CENTRAL DIALYSIS Provider #: NPI #: N Grand Ave W Springfield, IL Sangamon County (217) STERLING, IL WHITESIDE DIALYSIS Provider #: NPI #: E Lincolnway Sterling, IL Whiteside County (815) SYCAMORE, IL CRIMSON RIDGE HOME TRAINING Provider #: NPI #: Hauser Ross Dr Ste 200 Sycamore, IL Dekalb County (815) SYCAMORE DIALYSIS Provider #: NPI #: Gateway Dr Sycamore, IL Dekalb County (815)

7 TAYLORVILLE, IL TAYLORVILLE DIALYSIS Provider #: NPI #: W Spresser St Taylorville, IL Christian County (217) Accreditations: Dept of Human Services TWINSBURG, OH DURABLE MEDICAL EQUIPMENT EDGEPARK Specialty: Durable Medical Equipment Provider #: NPI #: Summit Commerce Park Twinsburg, OH Summit County (800) URBANA, IL CHAMPAIGN URBANA DIALYSIS CENTER Provider #: NPI #: W Park St Ste 100 Urbana, IL Champaign County (217) VANDALIA, IL VANDALIA DIALYSIS Provider #: NPI #: Mattes Ave Vandalia, IL Fayette County (618) VINCENNES, IN VINCENNES DIALYSIS Provider #: NPI #: Willow St Vincennes, IN Knox County (877) WASHINGTON, IN DAVIESS COUNTY DIALYSIS Provider #: NPI #: Ne 14Th St Washington, IN Daviess County (812) Accreditations: IDPH 7

8 Outpatient Mental Health EAST MOLINE, IL MENTAL HEALTH MANLEY, KRISTI A., LMHC Specialty: Mental Health Female E-Prescribe: No Provider #: NPI #: Lutheran Family Services Hubbard Rd East Moline, IL Rock Island County (515) Hospital Affiliation: None Medical Group Affiliation: None Board Certification: None Additional Languages: None PEORIA, IL NEONATOLOGY KUMAR, PRAVEEN, MD Specialty: Neonatology Male E-Prescribe: No Provider #: NPI #: U Of I College Of Medicine 530 Ne Glen Oak Ave Peoria, IL Peoria County (309) Hospital Affiliation: None Medical Group Affiliation: None Board Certification: None Additional Languages: None 8

9 Index B BENTON DIALYSIS...1 C CENTRALIA DIALYSIS... 1 CHAMPAIGN URBANA DIALYSIS CENTER... 7 CHURCHVIEW DIALYSIS... 5, 5 CRIMSON RIDGE HOME TRAINING... 6 D DAVENPORT DIALYSIS CENTER...1 DAVIESS COUNTY DIALYSIS... 7 DECATUR EAST WOOD DIALYSIS... 2 DIALYSIS CLINIC INC BELLEVUE... 1 DIXON KIDNEY CENTER... 2 DRIFTWOOD DIALYSIS... 3 E EAGLE HIGHLANDS DIALYSIS... 3 EAST EVANSVILLE DIALYSIS... 2 EDGEPARK... 7 EFFINGHAM DIALYSIS...2 F FREEPORT DIALYSIS...3 J JACKSONVILLE DIALYSIS... 3 JASPER DIALYSIS... 4 K KANKAKEE COUNTY DIALYSIS...1 KUMAR, PRAVEEN, MD... 8 L LINCOLN DIALYSIS... 4 LITCHFIELD DIALYSIS... 4 M MACON COUNTY DIALYSIS...2 MANLEY, KRISTI A., LMHC... 8 MARION DIALYSIS... 4 MATTOON DIALYSIS... 1 MOUNT VERNON DIALYSIS... 4 N NEWBURGH DIALYSIS... 5 NORTH EVANSVILLE DIALYSIS... 3 O OLNEY DIALYSIS...5 I-1

10 Index P PRINCETON DIALYSIS... 5 R RCG CENTRAL ILLINOIS-DECATUR... 2 ROBINSON DIALYSIS... 5 ROCKFORD DIALYSIS... 3 ROXBURY DIALYSIS...5 RUSHVILLE DIALYSIS... 6 S SPRINGFIELD CENTRAL DIALYSIS... 6 STONECREST DIALYSIS... 6 SYCAMORE DIALYSIS... 6 T TACTILE SYSTEMS TECHNOLOGY INC... 4 TAYLORVILLE DIALYSIS... 7 V VANDALIA DIALYSIS...7 VINCENNES DIALYSIS...7 W WHITESIDE DIALYSIS... 6 I-2

11 DISCRIMINATION IS AGAINST THE LAW Health Alliance complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Health Alliance does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Health Alliance: Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact customer service. If you believe that Health Alliance has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Health Alliance Medicare, Member Services, 301 S. Vine Street, Urbana, IL or 316 Fifth Street, Wenatchee, WA 98801, telephone for members in Illinois, Indiana, Iowa and Ohio: ; telephone for members in Washington: TTY: 711, fax: , MemberServices@healthalliance.org. You can file a grievance in person or by mail, fax or . If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, , TTY: Complaint forms are available at LA DISCRIMINACIÓN ES CONTRA LA LEY Health Alliance cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Health Alliance no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo. Health Alliance: Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes: Intérpretes de lenguaje de señas capacitados. Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos). Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes: Intérpretes capacitados. Información escrita en otros idiomas. Si necesita recibir estos servicios, comuníquese con servicio al cliente. Si considera que Health Alliance no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Health Alliance Medicare, Member Services, 301 S. Vine Street, Urbana, IL o 316 Fifth St., Wenatchee, WA 98801; Teléfono para los miembros en Illinois, Indiana, Iowa, y Ohio: , Teléfono para los miembros en Washington: , TTY: 711 o , fax: , correo electrónico: MemberServices@healthalliance.org. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, Member Services está a su disposición para brindársela. También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación: U.S. Department of Health and Human Services 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C , (TDD) Puede obtener los formularios de reclamo en el sitio web ATENCIÓN: Si habla Español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted. IA, IL, IN, OH: Llame , WA Llame: (TTY: 711). 注意 : 如果你講中文, 語言協助服務, 免費的, 都可以給你 IA, IL, IN, OH: 呼叫 , WA: 呼叫 (TTY: 711) cmp-nondiscnotice15mwwacombo-1216

12 UWAGA: Jeśli mówić Polskie, usługi pomocy języka, bezpłatnie, są dostępne dla Ciebie. IA, IL, IN, OH: Zadzwoń , WA: Zadzwoń (TTY: 711). Chú ý: Nếu bạn nói Tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ, miễn phí, có sẵn cho bạn. IA, IL, IN, OH: Gọi , WA: Gọi (TTY: 711). 주의 : 당신이한국어, 무료언어지원서비스를말하는경우사용할수있습니다 IA, IL, IN, OH: 전화 WA: 전화 (TTY: 711). ВНИМАНИЕ: Если вы говорите русский, вставки услуги языковой помощи, бесплатно, доступны для вас. IA, IL, IN, OH: Вызов , WA: Вызов (TTY: 711). Pansin: Kung magsalita ka Tagalog, mga serbisyo ng tulong sa wika, nang walang bayad, ay magagamit sa iyo. IA, IL, IN, OH: Tumawag , WA: Tumawag (TTY: 711). انتباه: ا ذا كنت تتكلم العربية فا ن خدمات المساعدة اللغوية متوفرة لك مجانا. ا يلينوي ا نديانا ا وهايو: اتصل بالرقم ولاية واشنطن: اتصل بالرقم: (ا ذا كنت تعاني من الصمم ا و صعوبة في السمع فاتصل على الرقم 711) Aufmerksamkeit: Wenn Sie Deutsch sprechen, Sprachassistenzdienste sind kostenlos, zur Verfügung. IA, IL, IN, OH: Anruf , WA: Anruf (TTY: 711). ATTENTION: Si vous parlez français, les services d'assistance linguistique, gratuitement, sont à votre disposition. IA, IL, IN, OH: Appelez , WA: Appelez (TTY: 711). ધ ય : તમ વ ત ત જર ત, ભ ષ સહ ય સ વ ઓ, મફત, તમ ર મ ટ ઉપલબ છ. IA, IL, IN, OH: ક લ , WA: ક લ (TTY: 711). 注意 : あなたは日本語無料で言語支援サービスを話す場合はあなたに利用可能です IA, IL, IN, OH: コール WA: コール (TTY: 711) LET OP: Als je spreekt pennsylvania nederlandse, taalkundige bijstand diensten, gratis voor u beschikbaar zijn. IA, IL, IN, OH: Bel , WA: Bel (TTY: 711). УВАГА: Якщо ви говорите український, вставки послуги мовної допомоги, безкоштовно, доступні для вас. IA, IL, IN, OH: Виклик , WA: Виклик (TTY: 711). ATTENZIONE: Se si parla italiano, servizi di assistenza linguistica, a titolo gratuito, sono a vostra disposizione. IA, IL, IN, OH: Chiamare , WA: Chiamare (TTY: 711).

ARLINGTON HGHTS, IL DIALYSIS CENTERS ARLINGTON HEIGHTS RENAL

ARLINGTON HGHTS, IL DIALYSIS CENTERS ARLINGTON HEIGHTS RENAL List of Network Providers Midlevel providers (including nurse practitioners and physician assistants) cannot be selected as Primary Care Physicians. However, you may use the services of a midlevel provider