COMMERCIAL
AND INDEPENDENTS - PART A & B
COOPERATIVA
DE SEGUROS DE VIDA DE PUERTO RICO
GPO Box 363428
San Juan, Puerto Rico 00936-3428
STREET ADDRESS:
400 Americo Miranda Avenue
San Juan, Puerto Rico 00927
PHONE: 787-758-9733 (switchboard)
FAX: 787-756-8199
PART
A - AGREEMENT NO. HCFA 87-326-1
PART
A PROVIDER SERVICE AREA: Puerto Rico and U.S. Virgin Islands
Gabriel Dolagaray
President
PHONE: 787-758-7854
Jose A. Brull
Vice President
Medicare
PHONE: 787-763-2053
Andrés Rodriguez
Assistant Vice President
Audit and Reimbursement
PHONE: 787-758-8615
Mrs. Alba Cosme de Natal
Assistant Vice President
Medicare Operations
PHONE: 787-764-4060
CONNECTICUT GENERAL
LIFE INSURANCE COMPANY (CGLIC), a CIGNA Company
Hartford, Connecticut 06152
PHONE: 615-782-4576
FAX: 615-244-6242
Internet: www.cigna.com
PART
B - CONTRACT NO. HCFA 91-330-2
DMERC
- CONTRACT No. 50093BPOO4
PART
B JURISDICTION: States of Idaho, North Carolina, Tennessee
DME REGIONAL CARRIER: Alaska, Arizona, California, Guam,
Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota,
Oregon, South Dakota, Utah, Washington, Wyoming
Mr. Edward H. Burrell
Vice President
CGLIC
44 Vantage Way
Nashville, TN 372282
PHONE: 615-782-4571
FAX: 615-782-4695
Email: Ed.Burrell@cigna.com
CLAIMS SYSTEMS
William Swanke
Systems Director
CIGNA
Vantage Way
Metro Exchange Bldg
Nashville, TN 37228
PHONE: 615-782-4672
FAX: 615-782-4491
DURABLE MEDICAL EQUIPMENT
CGLIC
ATTN: Mary C. Moorman
2 Vantage Way
Metro Exchange Bldg.
Nashville, TN 37228
PHONE: 615-782-4599
FAX: 615-782-4626
Idaho, Tennessee, North
Carolina
John Hoey
Director
Customer Service for Idaho, TN, NC
2 Vantage Way
Metro Exchange Bldg.
Nashville, TN 37228
PHONE: 615-782-4484
FAX: 615-782-4473
Darrell Tackett
Director of Claims Technology Idaho, TN, NC
PHONE: 615-782-4525
FAX: 615-782-4628
GROUP
HEALTH INCORPORATED
88 West End Avenue
New York, New York 10023
PHONE: 212-721-1300
FAX: 212-721-0580
PART
B - CONTRACT NO. HCFA 87-320-2
PART
B JURISDICTION: Queens County, New York
Peter S. Moore
Vice President
PHONE: Ext. 400
Lynne Ridgeway
Assistant Vice President
PHONE: Ext 342
Sean Martinez
Director
Community Relations
PHONE: Ext. 356
Jacqueline McNeill
Director
Program Integrity
PHONE: Ext. 310
HAWAII
MEDICAL SERVICE ASSOCIATION
PART
A PROVIDER SERVICE AREA: See Blue Cross of California
PART B JURSDICTION: Blue Cross Blue Shield of North Dakota
UNITED
HEALTH CARE INSURANCE COMPANY
(TRAVELERS)
William McGuire
United Health Care Corporation
President, Chairman and Chief Executive Officer
(REGULAR MAIL)
UNITED HEALTH CARE INSURANCE COMPANY
450 Columbus Boulevard - CT029-05AA
Hartford, CT 06115-0450
(EXPRESS MAIL)
UNITED HEALTH CARE INSURANCE COMPANY
450 Columbus Boulevard - CT029-05AA
Hartford, CT 06103-1801
PHONE: 860-702-6668
FAX: 860-702-6587
Email: medbhtfd@ix.netcom.com
Internet: www.unitedhealthcare.com
PART
B - CONTRACT NO. RRB 92-RRB-006
PART
A - AGREEMENT NO. HCFA 87-301-1
PART
B - CONTRACT NO. HCFA 87-301-2 DMERC - 500-93-BPO-1
PART
A PROVIDER SERVICE AREA: States of Connecticut, Michigan and New York
PART B JURISDICTION: States of Connecticut, Minnesota,
Mississippi, and Virginia (SPECIAL CLAIMS: Railroad Retirement Board)
DME REGIONAL CARRIER: Connecticut, Delaware, Maine,
Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York,
Pennsylvania
William J. Bannon
Vice President
Government Operations
Mail Route: CT029-05AA
450 Columbus Boulevard
P.O. Box 150450
Hartford, CT 06115-0450
PHONE: 860-702-6691
FAX: 860-702-6587
Christopher A. McGowan
Chief Financial Officer
Government Operations
Mail Route: CT029-05AA
450 Columbus Boulevard
P.O. Box 150450
Hartford CT 06115-0450
PHONE: 860-702-6684
FAX: 860-702-6587
Steve Northway
Director, Contract Administration
Mail Route: CT029-05AA
450 Columbus Boulevard
Hartford, CT 06115-0450
PHONE: 860-702-6622
FAX: 860-702-6587
HOME OFFICE OPERATIONS PART A
Thomas C. Flanigan
Director
Government Operations
Mail Route: CT029-05AA
450 Columbus Boulevard
P.O. Box 150450
Hartford CT 06115-0450
PHONE: 860-702-6669
FAX: 860-702-6587
FIELD OPERATIONS - PART A
John H. Wrynn
Director
P.O. Box 1041
538 Preston Avenue
Meriden, CT 06454-9000
PHONE: 203-639-3230
FAX: 203-639-3202
Email: medact@ix.netcom.com
FIELD OPERATIONS PART B DME,
RRB
Margaret C. Christophy
Director
Government Programs
Mail Route: CT029-05AA
450 Columbus Boulevard
P.O. Box 150450
Hartford, CT 06115-0450
PHONE: 860-702-6667
FAX: 860-702-6587
DURABLE MEDICAL EQUIPMENT
REGIONAL CARRIER (DMERC)
Fred Larson
Director
60 East Main Street
Nanticoke, PA 18634-1685
PHONE: 717-735-9501
FAX: 717-735-9439
Email: DMERCA@IX.NETCOM.COM
MAILING ADDRESS:
Regional A DMERC
P.O. Box 6800
Wilkes-Barre, PA 18773-6800
FIELD OFFICES - PART A
AUDIT/REIMBURSEMENT
CONNECTICUT
Jefferey H. Gagnon
Director
Mail Route: CT031-1000
P.O. Box 104126555
538 Preston Avenue
Meriden CT 06450-1041
PHONE: 203-639-3016
FAX: 203-639-3202
MICHIGAN
David M. Gross
Medicare Manager
Mail Route: MI031-1000
Evergreen Road-Suite1250
Southfield, MI 48076
PHONE: 248-423-2308
FAX: 248-423-2303
NEW YORK
Horace Gardner
Medicare Manager
Mail Route: NY033-1000
2929 Express Drive North
Hauppage, NY 11788
PHONE: 516-232-5800
FAX: 516-348-5802
FIELD OFFICES PART B
CONNECTICUT
Robert Giannini
Director
Mail Route: CT031-1000
P.O. Box 9000
538 Preston Avenue
Meriden, CT 06450-9000
PHONE: 203-639-3025
FAX: 203-639-3018
Email: medbct@ix.netcom.com
VIRGINIA
Ken Kerns
Director
Mail Route: VA033-1000
P.O. Box 26463
300 Arboretum Place
Richmond, VA 23236
PHONE: 804-327-2100
Email: medva@ix.netcom.com
MINNESOTA
Lynette Wheelock
Director
Mail Route: MN030-1000
8120 Penn Avenue South
Bloomington, MN 55431-1394
PHONE: 612-885-2800
FAX: 612-885-2839
Email: medmn@ix.netcom.com
MISSISSIPPI
John Cook
Director
Mail Route: MS030-1000
P.O. Box 22545
Jackson, MS 39225-2545
FOR EXPRESS MAIL:
795 Woodland Parkway, 2nd Floor
Ridgeland, MS 39157
PHONE: 601-977-5750
FAX: 601-956-2738
Email: medms@ix.netcom.com
FIELD
OFFICE RAILROAD MEDICARE
GEORGIA
R. Michael Barlow
Director
Augusta Corporate Center
Mail Route: GA030-1000
Bldg 200-4th Floor
2743 Perimeter Pkwy
Augusta GA 39090-4576
PHONE: 706-855-3130
FAX: 706-855-3132
Email: rrbga@ix.netcom.com
MUTUAL
OF OMAHA INSURANCE COMPANY
P.O. Box 1602
Omaha, Nebraska 68131-3492
STREET ADDRESS:
Mutual of Omaha Plaza
Omaha, Nebraska 68175
PHONE: 402-351-2860
FAX: 402-351 8047
INTERNET: WWW.MUTUALOFOMAHA.COM
PART
A - AGREEMENT NO. HCFA 87-319-1
PART
A PROVIDER SERVICE AREA: Available in all states
Jack A. Dillon
Sr. Vice President
S7--CSO Claims
Omaha, NE 68175
PHONE: 402-351-2587
FAX: 402-351-5783
EMAIL: JACK.DILLON@MUTUALOFOMAHA.COM
Scott J. Manning
Vice President and Director
Medicare
P.O. Box 1604
Omaha, NE 68101
PHONE: 402-351-6947
FAX: 402-351-8796
EMAIL: SCOTT.MANNING@MUTUALOFOMAHA.COM
Elizabeth M. Powers
First Vice President
Medicare Integrity Program & Claims
P.O. Box 1602
Omaha, NE 68101
PHONE: 402-351-2570
FAX: 402-351-5931
EMAIL: LIZ.POWERS@MUTUALOFOMAHA.COM
James Tucker
First Vice President
Financial and Systems & Support
P.O.Box 1602
Omaha, NE 68101
PHONE: 402-351-2268
EMAIL: JAMES.TUCKER@MUTUALOFOMAHA.COM
Shelly Foxworthy
First Vice President Audit & Reimbursement
P.O. Box 1604
Omaha, NE 68101
PHONE: 402-351-5377
FAX: 402-351-8796
EMAIL: SHELLY.FOXWORTHY@MUTUALOFOMAHA.COM
Steve Clausen
First Vice President Medicare Information Systems
P.O. Box 1602
Omaha, NE 68101
PHONE: 402-351-2791
FAX: 402-351-8047
EMAIL: STEVE.CLAUSON@MUTUALOFOMAHA.COM
MUTUAL
OF OMAHA FIELD OFFICES
SACRAMENTO, CA
Mike Bass
Field Audit Manager
Capital Professional Center
2200 B Douglas Blvd.
Suite 275
Roseville, CA 95661
PHONE: 916-774-9275
FAX: 916-774-1112
EMAIL: MIKE.BASS@MUTUALOFOMAHA.COM
LOS ANGELES, CA
Richard N. Eclarin
Field Audit Manager
901 Corporate Center Drive
Suite 405
Monterey Park, CA 91754
PHONE: 213-881-9586
FAX: 213-881-9534
EMAIL: RICK.ECLARIN@MUTUALOFOMAHA.COM
ATLANTA, GA
James Flemming
Field Audit Manager
2400 Herodian Way
Suite 300
Smyrna, GA 30080
PHONE: 404-988-9052
FAX: 404-988-9065
EMAIL: JAMES.FLEMMING@MUTUALOFOMAHA.COM
ST. LOUIS, MO
Mike Connelly
Field Audit Manager
11701 Borman Drive
Suite 220
St. Louis, MO 63146-4193
PHONE: 314-997-6626
FAX: 314-997-6997
EMAIL: MIKE.CONNELLY@MUTUALOFOMAHA.COM
KANSAS CITY,MO
Marilyn Huskamp
Field Audit Manager
10220 North Executive Hills Blvd.
Suite 220
Kansas City, MO 64153
PHONE: 816-891-6500
FAX: 816-891-8817
EMAIL: MARYLIN.HUSKAMP@MUTUALOFOMAHA.COM
DALLAS, TX
Neil A. Milbrandt
Field Audit Manager
14200 Midway Road
Suite 125
Dallas, TX 75244
PHONE: 972-386-4061
FAX: 972-233-9406
EMAIL: NEIL.MILBRANDT@MUTUALOFOMAHA.COM
HARFORD, CT
Gerge PietrI
Field Audit Manager
655 Winding Brook Dr.
Glastonbury, CT 06033
PHONE: 860-659-4300
FAX: 860-659-8065
EMAIL: GEORGE.PIETRI@MUTUALOFOMAHA.COM
CLEARWATER, FL
Cynthia MacDonald
Field Audit Manager
33920 U.S. Highway 19 North, Suite 350
Palm Harbor, FL 34684
PHONE: 813-772-2557
FAX: 813-772-7193
EMAIL: CYNTHIA.MACDONALD@MUTUALOFOMAH.COM
DENVER, CO
Rick Keegan
Field Audit Manager
Panorama Corporate Center V
9200 E Panorama Circle
Suite 225
Englewood, CO 80112-3481
PHONE: 302-925-0065
FAX: 302-925-0869
EMAIL: RICK.KEEGAN@MUTUALOFOMAHA.COM
CHICAGO, IL
Art Garvida
Field Audit Manager
377 East Butterfield Road
Suite 260
Lombard, IL 60148
PHONE: 630-810-1324
FAX: 630-810-1368
EMAIL: ART.GARVIDA@MUTUALOFOMAHA.COM
NATIONAL
HERITAGE INSURANCE COMPANY
450 W. East Avenue
Chico, CA 95973
PHONE: 530-896-7025
FAX: 530-896-7182
Email: CA.HCFA-DIR@EDS.COM
PART
B - CONTRACT NO. HCFA-96-331-2
PART
B JURISDICTION: State of California (North) (Except San Luis Obispo,
Los Angeles, Ventura, San Diego, Santa Barbara, Orange and Imperial Counties -
See Transamerica Occidental Life Insurance Company),
States of Maine, Massachusetts, New Hampshire, Vermont, Illinois, and Michigan
(claims property - See Wisconsin Physician Service
Jeff Kelly
President
Health Care Strategic Business Unit
EDS - Mailstop A3-1A-07
5400 Legacy Drive
PHONE: 972-604-2312
David M. Bryan
Vice President
Senior Markets and Medicare
EDS - Mailstop A3-1A-34
5400 Legacy Drive
Plano, TX 75024
PHONE: 972-604-6251
FAX: 972-604-2777
CALIFORNIA
(NORTH) EXCEPT SAN LUISOBISPO, LOS ANGELES, VENTURA, SAN DIEGO, SANTA BARBARA,
ORANGE AND IMPERIAL COUNTIES:
PHONE: 530-896-7025
FAX: 530-896-7182
Email: MSUSCHIC.NHICNCAL@EDS.COM
Jeff Broocks
Account Manager
NHIC
450 West East Evenue
Chico, CA 95926
PHONE: 530-896-7081
FAX: 530-896-7182
Dawn Bouttote
Administrative Assistant
PHONE: 916-896-7025
Skip Verser
Controller
PHONE: 916-896-7108
Carolynne Meyer
Claims Services Manager
PHONE: 916-896-7169
Lola Jordan
Customer Service Manager
PHONE: 916-634-7451
Jeff Harrison
Program Safeguards Manager
PHONE: 916-896-7043
Debra Lawry
Systems Support Supervisor
PHONE: 916-896-7109
NEW
ENGLAND: (MAINE, MASSACHUSETTS, NEW HAMPSHIRE, AND VERMONT)
PHONE: 781-741-5256
FAX: 781-741-3211
INTERNET: MEDBOPS@NE.NHIC.EDS.COM
Ann Dalton
Account Manager-NE
NHIC
75 Sgt. WM. Terry Drive
Hingham, MA 02043
PHONE: 781-741-3201
FAX: 781-741-3211
Lynn Gillespie
Administrative Assistant
PHONE: 781-741-3195
Andre Conn
Claims Operations Manager
PHONE: 781-741-3029
Paul Ackerman
Business and Technical Support Manager
PHONE: 781-741-3101
Karen Grasso
Northern NE Operations Manager
PHONE: 207-294-6103
Eileen Guiney
Fraud and Abuse Manager
PHONE: 781-741-3207
Bob Harrington
Customer Service Manager
PHONE: 781-741-3202
Neil Walsh
Program Safeguards Manager
PHONE: 781-741-3202
Charlotte S. Yeh, MD
Medical Director, Medical Policy
PHONE: 781-741-3026
ILLINOIS/MICHIGAN
(Claims Processing)
Patrick Steele
Claims/OCR Manager
PHONE: 618-993-4428
Donna Sampson
Systems/Claims Manager
PHONE: 618-993-4244
Linda Craig
Administrative Assistant
PHONE: 618-993-4342
NATIONWIDE
MUTUAL INSURANCE COMPANY (HOME OFFICE)
P.O. Box 16788
Columbus, Ohio 43216-6788
STREET ADDRESS:
3 Nationwide Plaza
Columbus, Ohio 43215
PHONE: 614-249-7111
FAX: 614-249-3732
Email: cuppy52@nationwide.com
PART
B - CONTRACT NO. HCFA 87-311-2
PART
B JURISDICTION: States of Ohio and West Virginia
D. Richard McFerson
President & CEO
PHONE: 614-249-4637
Galen Barnes
Nationwide Insurance Enterprise
President
PHONE: 614-249-7843
Bill Mabe
Vice President
Ohio Health Operations
PHONE: 614-249-8438
Kim R. Charleston
Associate Vice President
Medicare
PHONE: 614-249-7078
FAX: 614-677-1610
Robert N. Ludwig, M.D.
Associate Medical Director
PHONE: 614-677-5665
Ronald L. Harmon
Medicare Controller
PHONE: 614-249-7083
Mary Ann Coleman
Director
Claims Services
PHONE: 614-249-7135
Jeannine M.
Keating
Director, Provider and Beneficary Services
PHONE: 614-249-4691
FIELD OFFICE ADDRESS:
Claire Spradling
P.O. Box 3183
1207 Quarrier Street
Charleston, WV 25332
PHONE: 304-346-0411
TRANSAMERICA
OCCIDENTAL LIFE INSURANCE COMPANY
MEDICARE OPERATIONS
P.O. Box 54905
Los Angeles, California 90054-0905
STREET ADDRESS:
1149 S. Broadway, 3rd Floor
Los Angeles, California 90015
PHONE: 213-748-2311
FAX: 213-741-6803
Email: T02050@transamerica.com
PART
B - CONTRACT NO. HCFA 87-312-2
PART
B JURISDICTION: State of California (7 Counties: San Luis Obispo,
Ventura, Santa Barbara, Los Angeles, Orange, San Diego, Imperial)
Thomas J. Cusack
President & CEO
PHONE: 213-742-3635
David E. Gooding
Executive Vice President
PHONE: 213-742-3525
George E. Garcia
Vice President and Chief Medicare Officer
PHONE: 213-742-2561
Stephanie Quincey
Second Vice President
Operating Officer
PHONE: 213-742-2569
Barbara Burnett
Process Manager
Customer Service
PHONE: 213-742-2687
Ed Velasco
Process Manager
Audit
PHONE: 213-742-3831
WISCONSIN
PHYSICIANS SERVICE INSURANCE CORPORATION
CLAIMS:
P.O. Box 1787
Madison, Wisconsin 53701
ADMINISTRATION:
P.O. Box 8190
Madison, Wisconsin 53708
STREET ADDRESS:
1601 Engel Street
Madison, Wisconsin 53713
PHONE: 608-221-4711
FAX: 608-223-3614
Email: WPS00951@MADISON.TDS.NET
PART
B - CONTRACT NO. HCFA 87-032-2
PART
B JURISDICTION: State of Wisconsin, Illinois and Michigan
James R. Riordan
President & CEO
PHONE: 608-221-5142
William Bathke
Executive Vice President
PHONE: 608-221-4711, Ext. 3490
Ned Boston
Vice President
PHONE: 608-221-5084
Arnold Krubsack, M.D., Ph.D.
Medicare Medical Director
PHONE: 608-221-5146
Robert H. Luck
Senior Vice President
Claims Operations
PHONE: 608-221-5084
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