Post on 28-Nov-2014
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
Adams ADAMS CO HEALTH & HUMANSVCS
Mental Health and
Substance Abuse
Services $22 $68 $91
MOUNDVIEW MEMORIAL HOSPITAL Independent Lab $399 $138 $538
Rural Health Clinic $1,540 $1,199 $1,595 $3,582 $7,916
MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INCHospital $2,220 $5,823 $15,378 $27,433 $50,854
Physician Group $572 $572
PAMIDA PHARMACY 373 Pharmacy $3,197 $3,868 $3,225 $1,316 $11,606
PHILLIPS ROCHE A CRI PHARMAC Pharmacy $1,481 $1,464 $1,305 $1,656 $5,906
RIVERVIEW REHABILITATION Therapy Group $30 $30
ROCHE A CRI CLINIC SC Physician Group $339 $339
Rural Health Clinic $2,442 $2,270 $490 $118 $5,319
Ashland ASHLAND PATHOLOGY SERVICES Physician Group $709 $472 $565 $119 $1,866
BAD RIVER HEALTH SERVICES
Federally Qualified
Health Clinic (FQHC) $125 $137 $795 $1,058
Physician Group $105 $217 $94 $23 $439
CHEQUAMEGON CLINIC Physician Group $3,735 $2,201 $3,427 $3,821 $13,184
DENNIS SULLIVAN, MD Physician $12 $12
DOUGLAS CO COMMUNITY HLTH Family Planning Clinic $58,830 $246,566 $361,201 $666,598
ENT PROFESSIONAL ASSOCSC Physician Group $61 $61
ESSENTIA HEALTH ASHLAND CLINIC Physician Group $4,660 $4,963 $3,814 $6,668 $20,105
ESSENTIA HEALTH ASHLAND ORTHOPAEDICS CLINICPhysician Group $61 $61
FALL GENERALSURGERY LLC Physician Group $44 $184 $228
HUHN RX DRUGINC Pharmacy $6,912 $5,546 $4,676 $5,811 $22,945
JAMES A HAMP, MD Physician $30 $30
KENNETH N KRUTSCH MD SC Physician Group $78 $78
KENNETH N KRUTSCH, MD Physician $41 $41
KEVIN J MCCLELLAND, MD Physician $108 $108
MAINSTREET CLINIC SC Physician Group $1,534 $1,897 $1,895 $3,934 $9,260
Page 1 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MARJORIE A LINDEMANN, NP Nurse Practitioner $123 $123
MEMORIAL MEDICAL CENTER Independent Lab $389 $582 $432 $421 $1,824
Physician Group $126 $1,331 $1,457
MEMORIAL MEDICAL CENTER INC Hospital $597 $726 $8,665 $28,630 $38,618
NORTHERN WATERS OPHTHALMOLOG Physician Group $217 $217
PAMIDA PHARMACY #390 Pharmacy $1,605 $2,131 $2,181 $2,896 $8,813
THE MEDICINE SHOPPE Pharmacy $6,547 $7,065 $8,094 $6,317 $28,024
THOMAS A GUFFY, MD Physician $52 $52
WAL MART PHARMACY 101672 Pharmacy $4,028 $4,183 $5,721 $7,323 $21,256
WALGREENS #10758 Pharmacy $5,603 $5,603
Barron BARRON COUNTY DHHS Family Planning Clinic $77,760 $109,880 $71,117 $33,685 $292,441
BRANHAM HEALY ORTHOPEDIC Physician Group $116 $116
CUMBERLAND CLINIC Physician Group $1,915 $2,106 $3,136 $2,288 $9,445
CUMBERLAND MEMORIAL HOSPITAL Hospital $641 $685 $1,326
Independent Lab $24 $58 $83
DIAGNOSTIC RADIOLOGY ASSOC Physician Group $35 $156 $121 $312
ECONOFOODS PHARMACY #325 Pharmacy $991 $1,783 $457 $1,363 $4,595
HANDI LIFT INC Transportation $392 $392
JAMES PHARMACY Pharmacy $690 $2,513 $585 $1,246 $5,034
JAMES PHARMACY LTD Pharmacy $3,550 $943 $1,661 $3,014 $9,168
K MART PHARMACY #9704 Pharmacy $3,256 $1,969 $1,367 $2,445 $9,038
LAKEVIEW MEDICAL CENTER Anesthetist $129 $129
LAKEVIEW MEDICAL CTR Hospital $532 $5,954 $10,042 $16,528
LUTHER MIDELFORT NORTHLAND -MHSAnesthetist $253 $253
MARSHFIELD CLINIC CUMBERLAND Independent Lab $11 $43 $54
MARSHFIELD CLINIC LAKE Independent Lab $22 $22
MARSHFIELD CLINIC LAKESWOODS FAMILY CENTERIndependent Lab $10 $21 $31
MARSHFIELD CLINIC PHARMACY Pharmacy $2,839 $2,630 $3,259 $7,377 $16,106
MARSHFIELD CLINIC RICE LAKE CENTERIndependent Lab $831 $675 $808 $51 $2,366
Page 2 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MAYO CLINIC HEALTH SYSTEM NORTHLAND BARRON CLINICPhysician Group $2,362 $1,418 $2,734 $9,708 $16,222
MAYO CLINIC HEALTH SYSTEM NORTHLAND INCHospital $211 $1,449 $2,681 $4,341
MEDICATIONS PLUS PHARMACY Pharmacy $1,246 $869 $237 $1,968 $4,320
OHDE HEALTH MART PHARMACY Pharmacy $3,546 $4,755 $4,140 $10,055 $22,495
OSTERBAUER DRUG LTD Pharmacy $1,305 $643 $676 $1,595 $4,218
SCHNEIDER DRUG Pharmacy $577 $1,180 $1,340 $2,497 $5,594
SHOPKO PHARMACY #2132 Pharmacy $7,890 $7,582 $7,397 $12,417 $35,286
THE APOTHECARY Pharmacy $3,417 $2,622 $3,954 $4,888 $14,881
TURTLE LAKE MEDICAL ASSOC SC Physician Group $30 $30
TURTLE LAKE MEDICAL CLINIC Physician Group $159 $159
WALGREENS #11860 Pharmacy $3,699 $11,393 $15,092
WAL-MART PHARMACY 10-1446 Pharmacy $11,957 $16,396 $16,805 $30,172 $75,331
Bayfield LANGFORD PHARMACY Pharmacy $1,058 $643 $2,505 $2,308 $6,513
RED CLIFF COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $1,556 $1,914 $2,353 $6,966 $12,790
Medical Equipment
Vendor $25 $34 $59
STEPHEN R KREUSER, MD Physician $72 $182 $254
THE LAKES COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $145 $1,515 $1,660
Brown ALLAHYAR JAZAYERI, MD Physician $1,362 $439 $22 $1,824
AURORA BAYCARE MEDICALCTR Hospital $2,204 $1,717 $1,567 $9,296 $14,783
AURORA HEALTH CENTER Physician Group $14,530 $9,996 $11,639 $7,604 $43,768
AURORA MEDICAL GROUP Physician Group $1,119 $1,417 $1,676 $4,684 $8,897
AURORA MEDICAL GROUP INC Physician Group $1,358 $733 $1,768 $9,247 $13,107
AURORA PHARMACY INC Pharmacy $1,608 $2,463 $2,190 $2,744 $9,004
BAYCARE CLINIC LLP Physician Group $235 $338 $195 $1,528 $2,296
BELLIN ANESTHESIA ASSOCIATES SC Physician Group $233 $233
BELLIN HEALTH Independent Lab $10,010 $7,506 $8,426 $10,666 $36,607
Page 3 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
BELLIN HEALTH FASTCARE Physician Group $59 $58 $116
BELLIN HEALTH FASTCARE GREEN BAYPhysician Group $20 $22 $216 $145 $402
BELLIN HEALTH PHARMACY Pharmacy $1,020 $1,368 $1,270 $1,266 $4,925
BELLIN MEMORIAL HOSPITAL Anesthetist $343 $343
Hospital $362 $494 $10,303 $19,788 $30,947
CARDIOLOGY ASSOCIATES OF GREEN BAY, LTDPhysician Group $60 $55 $115
CENTER FOR ASTHMA AND ALLERG Physician Group $30 $30
CLARK W STEVENS MD, MD Physician $2,719 $1,698 $1,002 $5,419
CLINICA HISPANA Physician Group $57 $58 $114
COPPS FOOD CENTER PHARMACY #8107Pharmacy $87 $87
COPPS FOOD CENTER PHARMACY #8111Pharmacy $34 $301 $335
COPPS FOOD CENTER PHARMACY #8186Pharmacy $256 $256
CUB PHARMACY Pharmacy $1,229 $1,131 $681 $3,041
CVS PHARMACY#08535 Pharmacy $959 $1,213 $2,061 $2,682 $6,915
CVS PHARMACY#08541 Pharmacy $1,903 $4,030 $3,454 $3,473 $12,861
CVS PHARMACY#08542 Pharmacy $2,476 $3,399 $1,556 $2,289 $9,720
DANAE C STEELE MD, MD Physician $1,156 $3,280 $160 $4,597
DANIEL J LINEHAN, MD Physician $60 $60
DERMATOLOGY ASSOCIATES OF WISCONSIN SCPhysician Group $92 $299 $391
DERMATOLOGY ASSOCIATESOF WI Physician Group $55 $55
DOUSMAN CLINIC SC Physician Group $139 $120 $312 $231 $803
EDWARD G VOGEL, MD Physician $164 $164
ENDOCRINOLOGYASSOCIATESOFGREEN BAY, SCPhysician Group $60 $60
FMC ASHWAUBENON Physician Group $766 $1,536 $1,136 $2,459 $5,897
FMC ASHWAUBENON INTERNAL MEDICINE AND PEDIATRICSPhysician Group $60 $47 $204 $311
FMC BELLEVUE Physician Group $384 $2,658 $3,043
FMC DE PERE Physician Group $395 $349 $581 $993 $2,318
FMC DENMARK Physician Group $36 $30 $229 $296
FMC EAST DEPERE Physician Group $90 $87 $76 $251 $505
Page 4 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
FMC HOWARD Physician Group $174 $250 $271 $2,473 $3,168
FMC LUXEMBURG Physician Group $66 $26 $57 $77 $225
FMC PEDIATRICS EAST Physician Group $73 $239 $312
FMC PULASKI Physician Group $86 $216 $230 $273 $804
FMC WEBSTER AVE Physician Group $1,608 $1,176 $926 $1,074 $4,783
FMC WRIGHTSTOWN Physician Group $57 $30 $58 $145
GBR SHEBOYGAN LLC Physician Group $37 $37
GREEN BAY ALLERGY ASTHMA AND Physician Group $98 $98
GREEN BAY ONCOLOGY LTD Physician Group $48 $48
GREEN BAY ORTHOPEDICS LTD Physician Group $43 $43
GREEN BAY RADIOLOGY SC Physician Group $25 $62 $361 $447
GREEN BAY SURGICAL CENTER
Ambulatory Surgical
Center (ASC) $207 $930 $1,137
HERBERT F SANDMIRE, MD Physician $204 $217 $421
HERBERT S COUSSONS, MD Physician $386 $182 $304 $873
HOSPITAL DIAGNOSTIC SERVICES Physician Group $30 $30
JOHN B FRAZIER, DDS Dentist $73 $83 $156
JOHN M HALE, MD Physician $26 $26
JOSEPH R DOBSON, DO Physician $142 $55 $197
JUDITH A HARDING, NP Nurse Practitioner $58 $58
K MART PHARMACY 4219 Pharmacy $133 $164 $354 $650
KATHLEEN G STEWARD, NP Nurse Practitioner $58 $58
KIMBERLY M WILLIAMS, NP Nurse Practitioner $163 $163
KRIDER PHARMACY & HOMEHEALTH Pharmacy $141 $115 $68 $371 $695
LINDA S HAEN, NP Nurse Practitioner $43 $43
LOREN P SCHOLL, NP Nurse Practitioner $43 $43
LOUANN WEIX, CRNA Anesthetist $174 $174
MARY A SAUVEY, MD Physician $57 $57
MEGAN E TEMP, MD Physician $183 $558 $503 $1,244
Page 5 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MICHAEL BROCKMAN, MD Physician $22 $22
MICHAEL C O TOOLE, MD Physician $735 $236 $1,034 $2,005
MICHAEL J SMULLEN, MD Physician $111 $111
NARAYAN AMARNANI MD SC Physician Group $19 $22 $199 $240
NEUROLOGY CONSULTANTS OF Physician Group $30 $266 $296
NEW COMMUNITY CLINIC
Federally Qualified
Health Clinic (FQHC) $30 $385 $415
NEW ENT SC Physician Group $174 $174
NEW MOMS SC Physician Group $1,855 $803 $2,658
NEW SURGICAL ASSOCIATES SC Physician Group $66 $66
OB GYN ASSOCIATES LTD Physician Group $73 $3,416 $9,702 $13,191
ORTHOPEDICS AND SPORTS MEDICINE SPECIALISTS OF GREPhysician Group $30 $30 $125 $185
OSCO DRUG #5036 Pharmacy $542 $542
OSCO DRUG #5054 Pharmacy $2,681 $2,681
OSCO DRUG #5055 Pharmacy $906 $906
PAMELA L NILES, NP Nurse Practitioner $242 $242
PATHOLOGY CONSULTANTS OF GREEN BAY, SCPhysician Group $4,065 $4,074 $4,316 $5,830 $18,285
PATHOLOGY PHYSICIANS LTD Physician Group $157 $245 $403
PERI L ALDRICH, MD Physician $80 $80
PHILIP L GOOLSBY, MD Physician $58 $58
PLANNED PARENTHOOD OF WI Family Planning Clinic $44,685 $156,989 $179,784 $225,793 $607,251
PREVEA CLINIC Independent Lab $3,985 $3,737 $3,850 $2,261 $13,834
Physician Group $13,757 $9,792 $6,931 $5,738 $36,218
PREVEA CLINICBEHAVIORALCARE
Mental Health and
Substance Abuse
Services $2,790 $43 $2,833
PREVEA HEALTH Independent Lab $3,350 $3,350
Physician Group $11,036 $11,036
PREVEA REGIONAL SERVICES Independent Lab $11 $11
Page 6 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
PREVEA REGIONAL SERVICES INC Physician Group $95 $132 $227
PULASKI PHARMACY Pharmacy $1,137 $935 $334 $338 $2,744
RADIOLOGY CHARTERED Physician Group $25 $227 $252
RANDI M BURNHAM, NP Nurse Practitioner $60 $60
ROBERT A CAVANAUGH, MD Physician $1,541 $866 $242 $2,649
ROBERT K DEMOTT MD, MD Physician $1,286 $899 $1,163 $3,348
SAM'S PHARMACY 10-8149 Pharmacy $70 $70 $49 $82 $270
SHOPKO EXPRESS #501 Pharmacy $2,006 $1,312 $708 $1,211 $5,237
SHOPKO EXPRESS #502 Pharmacy $2,367 $2,332 $2,050 $2,799 $9,548
SHOPKO EXPRESS #506 Pharmacy $855 $693 $1,548
SHOPKO PHARMACY #2001 Pharmacy $1,472 $1,176 $1,905 $2,000 $6,551
SHOPKO PHARMACY #2002 Pharmacy $3,028 $2,446 $2,255 $5,293 $13,021
SHOPKO PHARMACY #2005 Pharmacy $2,599 $811 $911 $1,663 $5,983
SHOPKO PHARMACY #2177 Pharmacy $1,446 $2,221 $3,667
SHOPKO PHARMACY 2004 Pharmacy $5,166 $4,865 $3,638 $6,071 $19,741
ST MARYS HOSP MED CENTER Hospital $150 $589 $21,010 $10,854 $32,603
ST MARYS HOSPITAL MEDICAL Independent Lab $2,852 $5,900 $7,309 $4,691 $20,752
ST VINCENT HOSPITAL Hospital $678 $9,162 $18,800 $28,640
Independent Lab $4,055 $1,112 $398 $2,529 $8,094
ST VINCENT HOSPITAL CLINICS Physician Group $549 $74 $623
STOWE DRUG STORE Pharmacy $155 $55 $135 $344
STREUS PHARMACY INC Pharmacy $674 $833 $749 $1,700 $3,956
SURGERY SPECIALISTS OFGREEN Physician Group $108 $108
TARGET STORE T-1247 PHARMACY Pharmacy $2,178 $2,006 $1,871 $864 $6,920
TARGET STORE T-1483 PHARMACY Pharmacy $1,704 $1,906 $2,407 $4,042 $10,059
UROLOGY ASSOCIATES OF GREEN BAY,SCPhysician Group $48 $48
WALGREENS #03088 Pharmacy $14,321 $8,934 $8,070 $10,566 $41,891
WALGREENS #03115 Pharmacy $5,688 $6,198 $3,243 $5,461 $20,590
WALGREENS #03133 Pharmacy $8,899 $9,703 $6,477 $4,980 $30,059
Page 7 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS #03253 Pharmacy $6,678 $8,514 $8,550 $8,347 $32,088
WALGREENS #11339 Pharmacy $776 $7,481 $7,750 $16,007
WALGREENS #11576 Pharmacy $538 $3,098 $4,833 $8,469
WALGREENS 05746 Pharmacy $3,775 $3,739 $5,545 $5,128 $18,187
WALGREENS 06569 Pharmacy $2,873 $2,756 $3,109 $5,147 $13,885
WALGREENS 10235 Pharmacy $1,799 $2,473 $2,705 $4,572 $11,548
WAL-MART PHARMACY 10-1453 Pharmacy $9,176 $9,324 $6,877 $15,760 $41,136
WAL-MART PHARMACY 10-1908 Pharmacy $6,907 $4,369 $6,350 $7,522 $25,148
WAL-MART PHARMACY 10-5090 Pharmacy $2,321 $1,820 $2,430 $5,058 $11,628
WISCONSIN OCULOPLASTICSLTD Physician Group $55 $55
WOMENS HEALTH CARE OB GYN SC Physician Group $1,777 $2,218 $1,223 $904 $6,122
WOMENS SPECIALTY CARE Physician Group $2,297 $2,297
YOON W CHUN MD, MD Physician $4,588 $3,275 $939 $8,801
Buffalo CITY DRUG STORE INC Pharmacy $396 $396
KASSEL CITY DRUG LLC Pharmacy $126 $496 $622
MONDOVI HEALTH MART PHARMACY Pharmacy $1,040 $1,070 $1,790 $1,307 $5,207
Burnett BURNETT MEDICAL CENTER Physician Group $26 $61 $87
BURNETT MEDICAL CENTERCLINIC Rural Health Clinic $3,312 $1,824 $1,373 $1,758 $8,267
BURNETT MEDICAL CENTERINC Hospital $496 $1,314 $2,702 $5,941 $10,453
Independent Lab $163 $398 $437 $309 $1,307
COUNTY OF BURNETT Family Planning Clinic $5,544 $3,285 $2,088 $1,177 $12,094
INGALLS FAMILY MEDICINECLINI Physician Group $2,366 $2,285 $1,591 $2,733 $8,976
OLSEN & SON DRUG Pharmacy $5,858 $3,669 $3,958 $2,280 $15,765
WOOD RIVER PHARMACY Pharmacy $6,243 $6,264 $4,369 $4,099 $20,975
YELLOW RIVER PHARMACY Pharmacy $1,515 $3,114 $3,945 $8,574
YELLOW RIVERPHARMACY INC Pharmacy $3,745 $2,749 $6,494
Calumet APOTHECARY SHOP Pharmacy $121 $119 $240
APPLETON CARDIOLOGY THEDACARE Physician Group $94 $78 $172
APPLETON MEDICAL CENTER Hospital $1,227 $3,360 $21,535 $28,356 $54,478
Page 8 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
AURORA PHARMACY INC Pharmacy $221 $190 $506 $916
CALUMET MEDICAL CENTER Hospital $196 $1,615 $1,577 $3,388
Physician Group $289 $289
CALUMET MEDICAL CENTER INC Independent Lab $46 $70 $116
COPPS FOOD CENTER PHARMACY #8123Pharmacy $118 $118
CVS PHARMACY #05186 Pharmacy $2,679 $2,679
FMC BRILLION Physician Group $57 $332 $388
FRANCES E NELSON, NP Nurse Practitioner $12,900 $27,698 $39,140 $3,979 $83,718
IHC CALUMET EMERGENCY PHYSICIANS LLCPhysician Group $30 $30
MORTON PHARMACY Pharmacy $355 $276 $1,471 $2,102
NELSON FAMILYCLINIC LLC Rural Health Clinic $342 $837 $1,179
OCONNOR PHARMACY Pharmacy $203 $65 $943 $397 $1,609
RANDY T THEILER, MD Physician $57 $57
THEDACARE PHYSICIANS HILBERT Physician Group $2,479 $2,479
WALGREENS #13065 Pharmacy $167 $167
WAL-MART PHARMACY 10-2509 Pharmacy $3,007 $4,300 $3,743 $3,963 $15,012
WAL-MART PHARMACY 10-2958 Pharmacy $4,236 $6,083 $5,259 $11,224 $26,802
Chippewa CADOTT MEDICAL CENTER SC Physician Group $205 $249 $90 $544
CADOTT MILLER PHARMACY Pharmacy $1,282 $947 $324 $314 $2,867
CHIPPEWA CLINIC PHARMACY Pharmacy $1,286 $1,286
CLIFFORD T BOWE, MD Physician $22 $657 $679
CORNELL PHARMACY Pharmacy $945 $1,336 $147 $2,427
CORNELL PHARMACY INC Pharmacy $1,476 $2,372 $3,848
EDS HEALTH MART PHARMACY Pharmacy $372 $705 $311 $3,094 $4,482
EDS PHARMACY Pharmacy $351 $351
FAMILY HEALTH ASSOCIATES Physician Group $43 $43
FAMILY HEALTH MEDICAL Physician Group $1,333 $1,569 $1,177 $3,002 $7,082
GROUP HEALTHCHIPPEWA PHARMA Pharmacy $2,273 $2,180 $4,033 $902 $9,388
K MART PHARMACY 3735 Pharmacy $1,920 $1,246 $969 $1,005 $5,139
Page 9 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
KONSELLA DRUG INC Pharmacy $781 $21 $802
KONSELLA HEALTH MART PHARMAC Pharmacy $736 $610 $1,346
MARSHFIELD CLINIC BLOOMER CENTERIndependent Lab $11 $11
MARSHFIELD CLINIC CHIPPEWA FALLS CTR LABIndependent Lab $139 $139
MARSHFIELD CLINIC LAKE HALLIE CENTERPhysician Group $14 $1,280 $1,294
MARSHFIELD CLINIC PHARMACY
Federally Qualified
Health Clinic (FQHC) $5,751 $5,319 $8,040 $7,759 $26,868
MAYO CLINIC HEALTH SYSTEM CHIPPEWA VALLEY BLOOMERPhysician Group $129 $861 $402 $4,253 $5,646
MAYO CLINIC HEALTH SYSTEM CHIPPEWA VALLEY INCHospital $1,631 $1,631
MEDICINE SHOPPE Pharmacy $631 $681 $1,246 $4,937 $7,495
OLV PHARMACY Pharmacy $1,836 $1,086 $1,266 $1,364 $5,552
OUR LADY OF VICTORY HOSPITAL Hospital $305 $1,789 $4,314 $3,957 $10,366
Physician Group $30 $66 $375 $471
PAUL M IPPEL, MD Physician $131 $131
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $567,924 $412,735 $320,137 $29,034 $1,329,830
SHOPKO PHARMACY #2037 Pharmacy $2,325 $2,593 $4,082 $2,477 $11,476
ST JOSEPHS HOSPITAL Hospital $1,808 $5,385 $36,592 $42,525 $86,310
Independent Lab $45 $363 $548 $1,025 $1,982
ST JOSEPHS HOSPITAL PHARMACY Pharmacy $51 $51
WALGREENS 07966 Pharmacy $6,055 $7,418 $5,951 $11,083 $30,508
WAL-MART PHARMACY 10-5373 Pharmacy $3,831 $4,739 $7,535 $12,244 $28,349
Clark CLARK CO FAMILY PLANNING Family Planning Clinic $56,820 $73,204 $54,348 $71,741 $256,113
MARSHFIELD CLINIC COLBY ABBO CENTER LABIndependent Lab $11 $11
MEMORIAL HOSPITAL INC Physician Group $675 $136 $811
MEMORIAL HOSPITAL INC #171 Hospital $1,584 $5,389 $7,907 $14,880
MEMORIAL MEDCTR GREENWOOD Rural Health Clinic $746 $656 $1,120 $1,496 $4,018
MEMORIAL MEDICAL CENTER Rural Health Clinic $1,592 $1,947 $2,186 $2,278 $8,003
MEMORIAL MEDICAL CENTER LABO Independent Lab $183 $198 $211 $674 $1,266
MEMORIAL MEDICAL CTR Rural Health Clinic $3,053 $2,320 $1,663 $3,722 $10,758
Page 10 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
OLV PHARMACY Pharmacy $900 $900
OUR LADY OF VICTORY HOSPITAL Hospital $5,283 $5,283
Physician Group $26 $26
OWEN WITHEE PHARMACY Pharmacy $3,133 $2,895 $3,235 $3,358 $12,621
PAMIDA PHARMACY #324 Pharmacy $2,303 $1,891 $3,337 $3,158 $10,689
SNITEMAN INC Pharmacy $4,234 $4,891 $3,182 $3,900 $16,207
VICTORY MEDICAL GROUP Rural Health Clinic $514 $299 $291 $1,106 $2,210
VICTORY MEDICAL GROUP OWEN Rural Health Clinic $378 $183 $103 $1,112 $1,775
Columbia BRUCE A KRAUS M.D., MD Physician $2,093 $2,093
COLUMBUS COMMUNITY HOSP INC Hospital $3,161 $7,762 $20,743 $11,418 $43,084
COLUMBUS COMMUNITY HOSPITAL Independent Lab $365 $139 $154 $235 $893
Physician Group $537 $649 $688 $450 $2,324
DIVINE SAVIOR HEALTHCARE Hospital $278 $1,518 $6,746 $13,885 $22,426
DIVINE SAVIOR HEALTHCARE INC Independent Lab $105 $234 $445 $448 $1,233
Physician Group $2,925 $3,139 $4,595 $3,862 $14,522
GENE R SORENSEN, DDS Dentist $310 $310 $620
HARRIS PHARMACY INC Pharmacy $841 $828 $1,447 $706 $3,822
JOHN E WALZ, MD Physician $22 $22 $44
K MART PHARMACY 3768 Pharmacy $787 $1,928 $2,963 $2,775 $8,454
LODI MEDICAL CLINIC Physician Group $264 $427 $691
PARDEEVILLE HOMETOWN PHARMACYPharmacy $91 $680 $465 $1,236
PLANNED PARENTHOOD OF WI Family Planning Clinic $123,833 $53,276 $177,109
PORTAGE RADIOLOGY SC Physician Group $12 $57 $70
POYNETTE HOMETOWN PHARMACY Pharmacy $460 $440 $136 $1,036
RANDOLPH HOMETOWN PHARMACY Pharmacy $426 $960 $212 $333 $1,932
RHYME DRUG Pharmacy $28 $30 $58
RIO HOMETOWN PHARMACY Pharmacy $160 $147 $136 $442
SAMUEL POSER, MD Physician $73 $43 $58 $95 $268
SHARROW DRUGS INC Pharmacy $2,104 $867 $919 $420 $4,309
Page 11 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
STEPHEN C PAULK, MD Physician $22 $55 $77
STEWART F TAYLOR JR, MD Physician $22 $22
TRAVEL MART PHARMACY Pharmacy $1,931 $1,032 $1,768 $3,171 $7,902
VILLAGE DRUG Pharmacy $1,351 $323 $1,675
WALGREENS #10396 Pharmacy $352 $1,612 $2,670 $5,585 $10,220
WALGREENS 07732 Pharmacy $4,409 $4,301 $3,532 $7,109 $19,351
WAL-MART PHARMACY 10-1799 Pharmacy $2,808 $6,282 $6,952 $4,976 $21,019
WILZ DRUG INC Pharmacy $1,157 $848 $817 $506 $3,327
Crawford GREAT RIVER COMMUNITY MEDICAL CLINICPhysician Group $497 $497
GUNDERSEN CLINIC LTD Physician Group $1,532 $3,011 $1,853 $6,396
HARTIG DRUG CO INC Pharmacy $1,458 $1,425 $687 $2,222 $5,791
HIMRICHS SNYDER DRUGS Pharmacy $290 $290
KICKAPOO VALLEY MEDICAL Rural Health Clinic $78 $370 $496 $862 $1,806
KICKAPOO VALLEY MEDICALCLINI Physician Group $11 $11 $75 $96
PRAIRIE DU CHIEN MEMORIAL Hospital $1,499 $2,178 $1,846 $5,524
PRAIRIE DU CHIEN MEMORIAL HOSPITALPhysician Group $14 $96 $110
PRAIRIE PHARMACY INC Pharmacy $272 $441 $275 $524 $1,512
PRAIRIE PRESCRIPTION Pharmacy $51 $51
RONALD F FALCH, APNP Anesthetist $158 $158
SOLAR TOWN PHARMACY VMH Pharmacy $120 $441 $102 $995 $1,658
WALGREENS #10682 Pharmacy $1,070 $4,862 $1,705 $2,389 $10,026
WAL-MART PHARMACY 10-0882 Pharmacy $3,045 $2,097 $2,148 $827 $8,117
Dane ACCESS COMMUNITY HEALTH CENTERS
Federally Qualified
Health Clinic (FQHC) $2,285 $5,859 $8,421 $22,231 $38,796
Pharmacy $603 $603
ASSOCIATED PATHOLOGISTS Physician Group $630 $714 $397 $1,665 $3,406
ASSOCIATED PHYSICIANS LLP Physician Group $297 $667 $860 $1,029 $2,854
ASZANI S KUNKLER, NP Nurse Practitioner $121 $30 $151
BELLEVILLE HOMETOWN PHARMACY Pharmacy $764 $327 $154 $434 $1,679
Page 12 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
BERGMANN PHARMACY Pharmacy $130 $130
BERGMANNS PHARMACY INC Pharmacy $1,168 $1,168
BERGMANNS PHARMACY INC Pharmacy $2,122 $453 $512 $3,087
BOARD OF REGENTS UNIV OF WI Independent Lab $699,538 $1,697,002 $1,673,881 $1,861,830 $5,932,251
BONE & JOINTSURGERY ASSOCIA Physician Group $91 $55 $146
COMMUNITY PHARMACY Pharmacy $7,446 $13,669 $6,106 $13,249 $40,470
COPPS FOOD CENTER PHARMACY #8102Pharmacy $322 $88 $218 $629
COPPS FOOD CENTER PHARMACY #8178Pharmacy $191 $24 $534 $789 $1,538
COPPS FOOD CENTER PHARMACY #8180Pharmacy $206 $206
CROSS PLAINSPHARMACY LLC Pharmacy $497 $39 $25 $560
CUB PHARMACY Pharmacy $1,094 $653 $1,239 $148 $3,135
CVS PHARMACY #05584 Pharmacy $1,823 $1,823
DANE CO CYTOLOGY CENTERINC Independent Lab $10,273 $10,811 $11,534 $20,244 $52,863
DAVID L OLIVE, MD Physician $20 $20
DAVIS DUEHR SURGERY CENTER
Ambulatory Surgical
Center (ASC) $724 $724
DEAN HEALTH SYSTEMS INC Anesthetist $268 $107 $255 $631
Physician Group $50,616 $55,438 $58,358 $103,107 $267,519
DEAN MEDICAL CENTER DEPARTMENT OF PSYCHIATRY FISH
Mental Health and
Substance Abuse
Services $22 $66 $88
DEAN PHARMACY Pharmacy $2,292 $3,687 $2,401 $4,823 $13,204
DEFOREST HOMETOWN PHARMACY Pharmacy $846 $806 $1,137 $1,739 $4,528
DOOR CREEK PHARMACY Pharmacy $729 $107 $613 $612 $2,060
DOOR CREEK PHARMACY DEERFIEL Pharmacy $304 $681 $382 $365 $1,732
FORT HEALTHCARE INC Physician Group $137 $48 $234 $419
GHC EAST CLINIC PHARMACY Pharmacy $89 $96 $903 $1,087
GHC HATCHERYHILL PHARMACY Pharmacy $349 $605 $954
GHC PHARMACYCAPITOL Pharmacy $84 $327 $1,728 $2,139
Page 13 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
GHC PHARMACYSAUK TRAILS Pharmacy $51 $270 $321
GHC SCW MAILPHARMACY Pharmacy $447 $447
GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WIPhysician Group $5,020 $2,970 $1,859 $8,083 $17,931
HARRIS PHARMACY Pharmacy $221 $90 $311
HY VEE PHARMACY 1391 Pharmacy $839 $839
JOHN NOON, MD Physician $37 $37
KENNETH H YUSKA Physician $30 $30
MADISON ANESTHESIOLOGY CONSULTANTSPhysician Group $193 $304 $497
MADISON AREA RENAL SPECIALISTS Physician Group $48 $48
MADISON BIRTH CENTER Nurse Practitioner $73 $73
MADISON RADIOLOGISTS SC Physician Group $22 $146 $628 $797
MALLATT PHARMACY Pharmacy $35 $186 $221
MCFARLAND HOMETOWN PHARMACY Pharmacy $212 $216 $482 $278 $1,189
MCGLYNN PHARMACY INC Pharmacy $84 $563 $441 $1,149 $2,237
MEDICINE SHOPPE 0605 LTD Pharmacy $300 $209 $558 $1,068
MERITER HOSPITAL INC Hospital $4,715 $8,889 $47,691 $97,705 $159,000
Physician Group $129 $273 $491 $540 $1,434
MERITER LABORATORIES Independent Lab $1,896 $3,547 $3,839 $7,270 $16,552
MERITER MEDICAL GROUP INC Physician Group $55 $37 $22 $748 $861
MICHAEL H MCDONALD, MD Physician $37 $37
MT HOREB PHARMACY Pharmacy $996 $609 $57 $562 $2,223
NEUHAUSER PHARMACY Pharmacy $320 $542 $891 $33 $1,787
NORTH SHORE RADIOLOGY ASSOCIATES OF MADISON SCPhysician Group $23 $49 $72
NORTHEAST FAMILY PRACTICE Pharmacy $538 $624 $928 $366 $2,456
OCONNELL PHARMACY LTD Pharmacy $546 $198 $216 $960
OREGON HOMETOWN PHARMACY Pharmacy $472 $121 $141 $1,036 $1,771
PETER S KAROFSKY, MD Physician $1,458 $42 $1,500
PICK N SAVE PHARMACY #6390 Pharmacy $169 $148 $318
PINNACLE PHARMACY OF MADISON Pharmacy $19 $19
Page 14 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
PLANNED PARENTHOOD Family Planning Clinic $882,948 $891,764 $314,794 $188,639 $2,278,145
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $150,462 $130,509 $97,743 $216,744 $595,458
RONALD M WANEK, DDS Dentist $808 $808
SANDRA K ROOF, NP Nurse Practitioner $57 $57
SHAFER PHARMACY INC Pharmacy $89 $89
SHOPKO PHARMACY #2029 Pharmacy $1,398 $487 $989 $931 $3,804
SHOPKO PHARMACY #2032 Pharmacy $212 $280 $829 $126 $1,446
SHOPKO PHARMACY #2034 Pharmacy $264 $264
SHOPKO PHARMACY #2080 Pharmacy $452 $850 $1,030 $332 $2,665
ST MARYS HOSPITAL Hospital $1,048 $695 $41,175 $10,626 $53,545
Independent Lab $2,798 $3,237 $4,436 $6,210 $16,682
STEVEN D PETERSON, DDS Dentist $340 $340
STOUGHTON HOSPITAL ASSN Physician Group $495 $1,046 $910 $1,148 $3,600
STOUGHTON HOSPITAL ASSOC Hospital $1,008 $7,752 $23,433 $32,320 $64,513
TARGET STORE T-1060 PHARMACY Pharmacy $2,517 $2,443 $2,252 $5,749 $12,961
TARGET STORE T-1069 Pharmacy $1,650 $1,961 $1,880 $5,491
TARGET STORE T-2106 PHARMACY Pharmacy $992 $2,075 $1,972 $5,040
TARGET STORE T-2491 PHARMACY Pharmacy $131 $550 $681
TERRY A BURKE, DDS Dentist $193 $730 $923
THOMAS P KUHN, DDS Dentist $954 $1,208 $67 $2,229
UNIV OF WIS HOSPITAL &CL Hospital $1,159 $4,734 $26,215 $84,743 $116,850
UNIVERSITY OF WISCONSIN HOSP Independent Lab $351 $351
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATIONPhysician Group $48,958 $48,448 $19,556 $67,775 $184,736
UNIVERSITY OF WISCONSIN SYSTEMS ADMINISTRATIONPhysician Group $414 $1,388 $742 $1,280 $3,824
UNIVERSITY STATION PHARMACY Pharmacy $88 $87 $175
UW HEALTH CHILDRENS PHARMACY Pharmacy $236 $13 $249
UW HEALTH EAST PHARMACY Pharmacy $161 $123 $283
UW HEALTH ONCOLOGY PHARMACY Pharmacy $29 $29
UW HEALTH OUTPATIENT PHARMAC Pharmacy $278 $240 $312 $669 $1,499
Page 15 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
UW HEALTH PHARMACY SERVICES Pharmacy $24,496 $48,907 $35,707 $31,072 $140,182
UW HEALTH WEST PHARMACY Pharmacy $355 $361 $716
UW MEDICAL FOUNDATION BELLEV Physician Group $666 $103 $769
UW MEDICAL FOUNDATION INC Physician Group $30 $30
UW MEDICAL FOUNDATION NORTHE Physician Group $2,367 $1,466 $3,834
UW MEDICAL FOUNDATION VERONA Physician Group $661 $601 $1,262
UW MEDICAL FOUNDATION WINGRA Physician Group $3,065 $1,625 $4,690
UW SYSTEMS Physician Group $27 $78 $105
UW SYSTEMS NORTHEAST Physician Group $619 $270 $888
UW SYSTEMS WINGRA Physician Group $2,045 $370 $2,415
VERONA HOMETOWN PHARMACY Pharmacy $227 $386 $160 $366 $1,139
VILLAGE PHARMACY & GIFTS Pharmacy $281 $30 $121 $380 $811
WALGREENS #01159 Pharmacy $1,405 $2,990 $5,127 $2,429 $11,951
WALGREENS #02848 Pharmacy $6,595 $5,639 $4,195 $7,669 $24,098
WALGREENS #02967 Pharmacy $4,483 $2,765 $4,129 $6,023 $17,399
WALGREENS #03291 Pharmacy $3,487 $7,489 $4,658 $8,076 $23,710
WALGREENS #03329 Pharmacy $2,943 $2,320 $2,179 $2,131 $9,573
WALGREENS #03343 Pharmacy $4,670 $4,586 $3,634 $7,272 $20,162
WALGREENS #09741 Pharmacy $1,600 $1,863 $2,060 $3,970 $9,493
WALGREENS #10554 Pharmacy $1,182 $1,244 $2,265 $4,691
WALGREENS #10555 Pharmacy $3,917 $3,680 $6,030 $4,009 $17,635
WALGREENS #10573 Pharmacy $1,045 $1,585 $2,786 $5,416
WALGREENS #10925 Pharmacy $2,307 $1,010 $6,631 $9,949
WALGREENS #11648 Pharmacy $674 $1,961 $2,636
WALGREENS #11858 Pharmacy $6,489 $14,221 $20,710
WALGREENS #12603 Pharmacy $170 $3,347 $3,517
WALGREENS 02879 Pharmacy $7,408 $7,127 $9,382 $9,441 $33,359
WALGREENS 03393 Pharmacy $1,348 $1,409 $682 $1,049 $4,488
WALGREENS 04155 Pharmacy $8,912 $13,577 $9,046 $18,279 $49,813
Page 16 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS 04805 Pharmacy $2,667 $3,158 $1,673 $4,310 $11,808
WALGREENS 04830 Pharmacy $2,773 $3,457 $2,421 $1,557 $10,208
WALGREENS 05087 Pharmacy $2,434 $6,688 $7,112 $3,681 $19,916
WALGREENS 05669 Pharmacy $1,274 $1,600 $770 $4,593 $8,236
WALGREENS 06130 Pharmacy $4,420 $10,575 $11,348 $7,786 $34,129
WALGREENS 06132 Pharmacy $4,974 $6,454 $9,859 $9,523 $30,811
WALGREENS 07519 Pharmacy $1,215 $2,257 $2,381 $4,618 $10,472
WALGREENS 07536 Pharmacy $3,252 $3,975 $2,315 $1,399 $10,941
WALGREENS 09740 Pharmacy $3,450 $2,125 $1,830 $3,724 $11,129
WALGREENS04240 Pharmacy $11,105 $14,367 $8,973 $10,986 $45,431
WALGREENS05233 Pharmacy $2,176 $2,742 $1,990 $5,217 $12,125
WAL-MART PHARMACY 10-1138 Pharmacy $1,404 $2,144 $3,698 $3,742 $10,988
WAL-MART PHARMACY 10-1176 Pharmacy $1,694 $954 $1,976 $2,746 $7,370
WAL-MART PHARMACY 10-1267 Pharmacy $898 $785 $1,409 $2,650 $5,742
WAL-MART PHARMACY 10-3857 Pharmacy $518 $3,957 $6,472 $10,947
WAL-MART PHARMACY-10 2335 Pharmacy $1,405 $1,277 $4,998 $3,452 $11,131
WILDWOOD FAMILY CLINIC SC Physician Group $77 $104 $119 $871 $1,171
WILLIAM B HOBBINS, MD Physician $55 $55
WILLIAM E FOWLER, MD Physician $78 $78
WISCONSIN HEART SC Physician Group $94 $78 $30 $101 $303
WISCONSIN PATHOLOGISTS SC Physician Group $276 $325 $119 $691 $1,411
Dodge AGNESIAN PHARMACY BROWNSVILL Pharmacy $570 $570
AGNESIAN PHARMACY MAYVILLE Pharmacy $40 $40
AMERIPATH MILWAUKEE SC Physician Group $2,840 $1,995 $2,062 $1,920 $8,817
AURORA PHARMACY INC Pharmacy $1,308 $444 $1,612 $304 $3,667
AYAZ M SAMADANI MD SC Physician Group $37 $37
BDCH INC MEDICAL CLINICS Physician Group $55 $55
BEAVER DAM COMMUNITY HOSPITALS INCHospital $261 $279 $8,019 $29,461 $38,020
BEAVER DAM ORTHOPAEDICCLINIC Physician Group $30 $30
Page 17 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
BEAVER DAM REFERENCE LAB Independent Lab $1,597 $2,013 $1,348 $1,842 $6,799
BEAVER DAM WOMENS HEALTH LTD Physician Group $3,313 $3,225 $1,248 $3,611 $11,396
CENTRAL OTOLOGIC LTD Physician Group $30 $30
CONSULTANTS LABORATORYOF Independent Lab $21 $32 $33 $85
DIRECTIONS COUNSELING CENTER
Mental Health and
Substance Abuse
Services $100 $100
DOUGLAS E BRICKER, MD Physician $12 $12
FAMILY & SPORTS ORTHOPAEDIC Physician Group $87 $171 $258
IHC-BEAVER DAM EMERGENCY PHYSICIANS, LLCPhysician Group $461 $535 $264 $1,260
INTEGRITY UROLOGIC SC Physician Group $55 $55
JAMES E MEADE, MD Physician $196 $63 $230 $488
JEFFERY A MEADE, MD Physician $30 $30
JULEE R RADTKE, NP Nurse Practitioner $133 $133
KEVIN L OHALLORAN, MD Physician $86 $86
LAEEKHA A ALI, MD Physician $65 $65
MARSHLAND PHARMACY Pharmacy $2,232 $3,336 $2,126 $6,001 $13,695
MEADE MEDICALCLINIC Physician Group $113 $625 $738
METROPOLITANWATERTOWNLLC Physician Group $30 $30
PLANNED PARENTHHOOD OF WISCONSIN, INC.Family Planning Clinic $137,950 $103,321 $100,846 $34,494 $376,612
RADIOLOGY ASSOC BEAVERDAM Physician Group $10 $10 $162 $182
RANDOLPH COMMUNITY CLINIC SC Physician Group $113 $62 $36 $114 $326
SHOPKO PHARMACY #2014 Pharmacy $5,308 $4,138 $3,880 $2,024 $15,350
ST MARYS DEAN VENTURES INC Physician Group $4,009 $4,039 $3,346 $6,693 $18,088
TARA L PASSOW MD INC Physician Group $22 $22
TERRY L TURKE, MD Physician $27 $51 $27 $396 $501
THRIFTY WHITEDRUG #48 Pharmacy $2,336 $3,966 $233 $964 $7,498
UWHP WRMC CENTER FOR WOMEN'S HEALTHPhysician Group $2,146 $1,689 $2,998 $2,295 $9,128
UWHP WRMC DOCTORS COURT CLINIC Physician Group $60 $22 $82
Page 18 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
UWHP WRMC HEART AND VASCULAR CENTERPhysician Group $30 $30
UWHP WRMC INTERNAL MEDICINE CLINICPhysician Group $140 $61 $200
UWHP WRMC JUNEAU CLINIC Physician Group $43 $100 $289 $961 $1,393
VANS CORNER DRUG INC Pharmacy $2,508 $2,841 $893 $6,241
VICTOR W CACERES, MD Physician $221 $138 $190 $167 $715
VILLAGE PHARMACY Pharmacy $226 $226
VITA PARK EYE ASSOCIATES SC Physician Group $74 $74
WALGREENS #11253 Pharmacy $1,694 $3,833 $4,591 $10,118
WALGREENS #11649 Pharmacy $2,414 $4,576 $6,991
WAL-MART PHARMACY 10-1012 Pharmacy $476 $3,272 $4,921 $6,253 $14,922
WAL-MART PHARMACY 10-5463 Pharmacy $100 $1,112 $5,747 $6,960
WATERTOWN EMERGENCY PHYSICIA Physician Group $756 $311 $262 $343 $1,672
WATERTOWN FAMILY PRACTICE Physician Group $204 $30 $112 $916 $1,261
WATERTOWN INTERNAL MEDICINE Physician Group $314 $177 $491
WATERTOWN MEMORIAL HOSPITAL Independent Lab $1,388 $1,851 $1,765 $3,401 $8,405
WATERTOWN REGIONAL MEDICAL CENTER INCHospital $311 $2,335 $17,985 $18,801 $39,433
WAUPUN MEMORIAL HOSPITAL Hospital $244 $751 $2,834 $4,504 $8,333
Door AURORA HEALTH CENTER Physician Group $1,125 $590 $616 $4,000 $6,331
AURORA HEALTHCENTER Rural Health Clinic $126 $220 $346
AURORA NOR DOOR CLINIC Rural Health Clinic $87 $166 $254
AURORA PHARMACY INC Pharmacy $898 $703 $392 $1,624 $3,616
BAY PHARMACY Pharmacy $9,565 $6,993 $3,810 $5,071 $25,439
COMMUNITY CLINIC OF DOOR Family Planning Clinic $12,044 $8,053 $1,480 $21,577
DERMATOLOGY ASSOCIATES OF WISCONSIN SCPhysician Group $95 $193 $288
DOOR CO MEMORIAL HOSPITAL Hospital $3,240 $7,535 $13,886 $13,645 $38,307
DOOR COUNTY MEMORIAL HOSP Physician Group $3,004 $3,105 $3,532 $9,641
DOOR COUNTY MEMORIAL HOSPITA Independent Lab $638 $129 $274 $1,041
Rural Health Clinic $288 $187 $475
DOOR COUNTY MEMORIAL HOSPITAL Rural Health Clinic $5,430 $5,430
Page 19 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
KAREN L BUTLER, MD Physician $830 $94 $22 $937 $1,883
LAKE SIDE SURGICAL ASSOCIATE Physician Group $22 $420 $441
MICHELE GEIGER BRONSKY, NP Nurse Practitioner $27 $27
PAMIDA PHARMACY #653 Pharmacy $2,507 $1,811 $1,061 $5,379
SISTER BAY PHARMACY INC Pharmacy $2,073 $1,678 $3,750
WALGREENS 07635 Pharmacy $6,870 $9,904 $6,816 $5,800 $29,390
WAL-MART PHARMACY 10-1316 Pharmacy $7,793 $9,144 $12,682 $9,072 $38,691
WELLNESS CENTER OF DOOR COUNTY Family Planning Clinic $133,393 $142,079 $173,635 $285,008 $734,115
WELLNESS CENTER OF DOOR COUNTY INCNurse Practitioner $1,033 $1,033
Douglas DOUGLAS CO COMMUNITY HLTH Family Planning Clinic $197,900 $129,879 $327,779
DULUTH CLINICSUPERIOR PHARMA Pharmacy $4,759 $3,629 $5,449 $4,477 $18,313
ESSENTIA HEALTH ST MARYS- SUPERIOR CLINICPhysician Group $2,927 $2,444 $3,524 $4,383 $13,277
FALKS LIGNELLPHARMACY Pharmacy $1,236 $1,907 $1,924 $3,376 $8,442
K MART PHARMACY 7206 Pharmacy $837 $695 $1,567 $1,034 $4,133
LAKE SUPERIOR COMMUNITY HLTH
Federally Qualified
Health Clinic (FQHC) $3,928 $3,052 $3,954 $7,351 $18,285
MARINER MEDICAL CLINIC Physician Group $526 $577 $1,085 $1,238 $3,426
PEOPLES DRUGSTORE Pharmacy $672 $883 $159 $33 $1,747
SMDC CLINICALLABORATORYSUPER Independent Lab $89 $182 $242 $546 $1,058
ST MARYS HOSPITAL OF SUPERIOR Hospital $435 $16,003 $16,438
SUPERIOR CLINIC Physician Group $121 $121
TARGET T 889PHARMACY Pharmacy $3,442 $5,480 $4,176 $2,468 $15,566
WALGREENS#03064 Pharmacy $15,394 $18,603 $21,822 $20,948 $76,766
WAL-MART PHARMACY 10-1447 Pharmacy $3,949 $5,543 $6,615 $5,773 $21,881
Dunn COLFAX HEALTH MART PHARMACY Pharmacy $354 $357 $150 $862
COLFAX PHARMACY Pharmacy $405 $39 $444
DUNN COUNTY PUBLIC HLTH Family Planning Clinic $117,058 $106,879 $101,060 $140,384 $465,381
ERICKSON FAMILY PHARMACY Pharmacy $1,299 $1,590 $1,223 $1,374 $5,485
K MART PHARMACY 3541 Pharmacy $207 $982 $1,866 $1,768 $4,823
Page 20 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
LYNN M MUREL, MD Physician $291 $291
MARSHFIELD CLINIC MENOMONIE Independent Lab $73 $21 $11 $21 $126
MAYO CLINIC HEALTH SYSTEM RED CEDARHospital $1,127 $2,892 $13,645 $14,048 $31,712
MAYO CLINIC HEALTH SYSTEM RED CEDAR- ELMWOOD CLINIPhysician Group $143 $179 $89 $411
MAYO CLINIC HEALTH SYSTEM RED CEDAR- GLENWOOD CITYPhysician Group $43 $153 $94 $554 $843
MEDICINE SHOPPE 1685 Pharmacy $7,577 $10,680 $6,392 $8,763 $33,412
RED CEDAR MEDICAL CENTER Pharmacy $3,964 $3,840 $2,076 $1,928 $11,810
RED CEDAR MEDICAL CENTER INC Independent Lab $47 $287 $335
Physician Group $9,090 $9,259 $8,268 $13,400 $40,017
THE MEDICINE SHOPPE #527 Pharmacy $1,318 $1,663 $498 $1,036 $4,514
UNIVERSITY OF WISCONSIN Family Planning Clinic $102,170 $119,538 $102,864 $82,461 $407,032
WALGREENS 09514 Pharmacy $8,137 $11,891 $21,400 $22,145 $63,574
WAL-MART PHARMACY 10-1819 Pharmacy $8,766 $12,439 $13,108 $18,439 $52,751
Eau Claire BECKY L KAHLER THYSSEN, CNM Nurse Service $5,311 $5,311
CARYN I SCHULZ, MD Physician $30 $30
CHIPPEWA VALLEY ORTHOPEDICS Physician Group $226 $226
DECESARE ORTHOPEDIC CLINIC Physician Group $101 $101
EAU CLAIRE ANESTHESIOLOGISTS LTD Anesthetist $118 $118
Physician Group $84 $84
EAU CLAIRE FAMILY PLANNING Family Planning Clinic $141,205 $149,041 $141,502 $174,648 $606,397
EAU CLAIRE GIASSOCIATES SC Physician Group $22 $22
EAU CLAIRE HEALTH MARTPHARM Pharmacy $12 $478 $2,642 $1,446 $4,578
EAU CLAIRE MEDICAL CLINIC Independent Lab $105 $105
Physician Group $28 $95 $773 $896
EAU CLAIRE PHARMACY Pharmacy $322 $322
EAU CLAIRE WOMENS CARE Physician Group $2,395 $1,905 $2,742 $3,673 $10,715
EDGAR O HICKS, MD Physician $55 $30 $78 $163
GROUP HEALTHOAKWOOD HILLS Pharmacy $1,164 $1,164
GROUP HEALTHPUTNAM PHARMACY Pharmacy $26,439 $26,208 $16,270 $1,998 $70,914
Page 21 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
GROUP HEALTHRIVERVIEW Pharmacy $1,033 $1,033
IRFANE M KHATIB, MD Physician $1,106 $789 $115 $2,010
JAMIE N LAMM, NP Nurse Practitioner $34 $34
JENIFER I BASSETT, MD Physician $95 $95
JOHN C MERRICK, MD Physician $37 $37
K MART PHARMACY 4051 Pharmacy $2,628 $4,316 $2,338 $3,819 $13,100
LINDA POIRIER, NP Nurse Practitioner $3,781 $4,763 $2,267 $10,811
MARSHFIELD CLINIC EAU Independent Lab $2,109 $3,256 $1,985 $5,562 $12,912
MARSHFIELD CLINIC EAU CLAIRE
Ambulatory Surgical
Center (ASC) $207 $207 $414
MARSHFIELD CLINIC OAKWOOD Independent Lab $156 $42 $43 $129 $369
MARSHFIELD CLINIC PHARMACY Pharmacy $13,275 $16,432 $17,719 $21,805 $69,232
MARSHFIELD CLINIC RIVERVIEW CENTER LABIndependent Lab $52 $21 $11 $84
MARSHFIELD CLINIC STRATFORD Independent Lab $23 $23
MAYO CLINIC HEALTH SYSTEM EAU CLAIRE CLINIC INCPhysician Group $3,463 $4,386 $2,609 $22,905 $33,363
MAYO CLINIC HEALTH SYSTEM EAU CLAIRE- LUTHER CAMPUHospital $119 $119 $5,802 $26,857 $32,897
Independent Lab $2,321 $1,758 $2,716 $10,206 $17,001
MAYO CLINIC HEALTH SYSTEM PHARMACY & HOME MEDICALPharmacy $2,918 $3,604 $4,300 $5,975 $16,797
MEDICAL X RAY CONSULTANTS Physician Group $74 $121 $378 $573
NORTHERN PINES EAR NOSE & THROAT SCPhysician Group $48 $48
OAKLEAF SURGICAL HOSPITAL Hospital $66 $7,523 $7,589
OBSTETRICS GYNECOLOGY CLINIC OF EAU CLAIRE SCPhysician Group $260 $785 $1,046
PAIN CLINIC OF NORTHWESTERN Physician Group $28 $135 $500 $663
PATHOLOGY SC Physician Group $3,981 $3,504 $1,491 $3,590 $12,566
PATRICIA T SONTAG, NP Nurse Practitioner $369 $369
PINE GROVE FAMILY PRACTICE Physician Group $176 $159 $378 $901 $1,613
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $31,792 $119,359 $151,151
RICHARD J DANIELS, MD Physician $37 $37
SACRED HEART HOSPITAL Hospital $340 $1,593 $10,086 $27,396 $39,415
Page 22 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
SACRED HEARTHOSPITAL OF THE Independent Lab $5,220 $4,182 $4,532 $5,474 $19,409
SHOPKO PHARMACY #2024 Pharmacy $15,581 $14,861 $13,347 $22,265 $66,054
STEVEN C IMMERMAN, MD Physician $37 $37
STEVEN D STENZEL, MD Physician $302 $967 $95 $1,364
SUSAN J MOMONT, MD Physician $533 $533
TARGET STORE T-1774 PHARMACY Pharmacy $6,254 $7,894 $6,802 $7,974 $28,924
THOMAS P PELLER MD SC Physician Group $92 $92
THOMAS P PELLER, MD Physician $55 $55
U OF WISCONSIN EAU CLAIRE Family Planning Clinic $350,167 $356,332 $406,359 $341,505 $1,454,363
UW MEDICAL FOUNDTION EAU CLA Physician Group $4,966 $3,538 $8,504
VALUE CENTERHEALTH MART PHA Pharmacy $133 $839 $28 $1,001
VALUE CENTERPHARMACY Pharmacy $728 $728
WALGREENS #03497 Pharmacy $27,140 $33,505 $38,284 $49,270 $148,198
WALGREENS 01937 Pharmacy $13,388 $16,976 $16,269 $25,600 $72,233
WALLY SHONG HEALTH MART Pharmacy $179 $705 $1,396 $1,379 $3,659
WAL-MART PHARMACY 10-1669 Pharmacy $4,531 $7,649 $10,413 $13,764 $36,357
WESTERN WISCONSIN UROLOGY Physician Group $11 $141 $152
WILLOW CREEK WOMENS CLINIC Nurse Practitioner $603 $8,113 $8,715
Florence FLORENCE MEDICAL CENTER Physician Group $547 $140 $22 $710
Rural Health Clinic $747 $1,391 $987 $1,336 $4,461
Fond du Lac AGNESIAN PHARMACY Pharmacy $4,272 $3,999 $2,676 $1,864 $12,811
AGNESIAN PHARMACY MERCURY MA Pharmacy $120 $207 $50 $279 $656
AGNESIAN PHARMACY NFDL Pharmacy $631 $257 $33 $922
AGNESIAN PHARMACY WAUPUN Pharmacy $2,338 $1,476 $1,393 $2,157 $7,365
AURORA HEALTH CENTER Physician Group $2,595 $2,300 $1,520 $3,523 $9,938
AURORA PHARMACY INC Pharmacy $1,092 $1,066 $1,375 $793 $4,326
BROWN H OTOPALIK, DDS Dentist $360 $360
CHN MEDICAL CENTER RIPON Physician Group $174 $200 $12 $702 $1,089
CLINIC OF ORTHOPEDIC SURGERY Physician Group $77 $77
Page 23 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CONSULTANTS LABORATORYOF Independent Lab $15,995 $18,908 $20,441 $23,204 $78,548
CONSULTANTS LABORATORYOF WI Independent Lab $21 $137 $53 $211
CONSUMER PRESCRIPTION CENTER Pharmacy $1,127 $776 $348 $2,251
DERMATOLOGY ASSOCIATES OF WISCONSIN SCPhysician Group $563 $563
FOND DU LAC PATHOLOGY CONSUL Physician Group $3,178 $3,696 $2,788 $3,856 $13,518
FOND DU LAC REGIONAL CLINIC Physician Group $19,154 $20,261 $18,501 $36,959 $94,876
K MART PHARMACY 7649 Pharmacy $1,638 $651 $720 $1,312 $4,321
KREMER PHARMACY Pharmacy $590 $134 $476 $1,294 $2,494
PAMIDA PHARMACY 249 Pharmacy $285 $285
PAUL A BOEDER, MD Physician $937 $937
PHARMACY PLUS Pharmacy $2,654 $883 $1,655 $2,580 $7,773
PICK N SAVE PHARMACY #6389 Pharmacy $722 $1,080 $193 $1,995
PLANNED PARENTHOOD OF WISCONSIN, INCFamily Planning Clinic $323,241 $280,287 $152,733 $62,210 $818,471
RIPON DRUG MANAGEMENT ENTERP Pharmacy $2,179 $1,726 $294 $973 $5,171
RIPON MEDICAL CENTER Hospital $510 $1,285 $2,869 $6,487 $11,151
Independent Lab $23 $103 $126
Physician Group $121 $121
SHOPKO PHARMACY #2050 Pharmacy $4,470 $3,126 $3,285 $3,805 $14,685
ST AGNES HOSPITAL Hospital $983 $7,259 $13,370 $14,472 $36,083
TARGET STORE T-0808 PHARMACY Pharmacy $37 $404 $698 $815 $1,955
THE VILLAGE APOTHECARYINC Pharmacy $236 $404 $418 $1,057
WALGREENS #01164 Pharmacy $3,312 $4,292 $4,963 $6,954 $19,522
WALGREENS #10496 Pharmacy $19,696 $21,445 $22,007 $25,254 $88,402
WALGREENS #10927 Pharmacy $2,450 $2,873 $6,437 $11,760
WAL-MART PHARMACY 10-1643 Pharmacy $3,628 $4,881 $6,383 $8,743 $23,635
Forest FOREST COUNTY POTAWATOMI
Federally Qualified
Health Clinic (FQHC) $600 $438 $395 $1,434
PAUL LINDERUD DBA CRANDON REXALL PHARMACYPharmacy $244 $189 $374 $1,636 $2,443
PAUL LINDERUD DBA LAONA PHARMACYPharmacy $463 $762 $721 $781 $2,727
Page 24 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
SOKAOGON CHIPPEWA HEALTH CLINIC
Federally Qualified
Health Clinic (FQHC) $240 $130 $219 $595 $1,184
WOLF RIVER PHARMACY Pharmacy $1,485 $1,205 $73 $1,193 $3,956
Grant BLUFF STREETCLINIC Rural Health Clinic $57 $36 $288 $381
BOHLMAN DRUGSTORE INC Pharmacy $1,927 $2,069 $1,342 $2,004 $7,342
BOSCOBEL AREA HEALTH CARE Hospital $310 $3,533 $2,192 $6,035
Independent Lab $97 $63 $271 $431
Physician Group $367 $79 $446
BOSCOBEL AREAHEALTH CARE Physician Group $30 $80 $302 $412
BOSCOBEL CLINIC SC Physician Group $1,660 $663 $699 $1,474 $4,496
C & M ASSOCIATES INC Anesthetist $47 $47
CARDINS PHARMACY Pharmacy $64 $32 $399 $2,166 $2,661
DAVID C BAINBRIDGE, CRNA Anesthetist $144 $144
DOCTORS PARKPHARMACY Pharmacy $1,046 $336 $106 $328 $1,815
GENE P WEGNER, MD Physician $12 $23 $35
GERT H HASSELHOF, MD Physician $57 $57
GRANT REGIONAL HEALTH CENTER Hospital $387 $1,491 $4,026 $5,904
Independent Lab $134 $137 $38 $308
Physician Group $79 $66 $145
HARTIG DRUG CO #15 Pharmacy $2,644 $2,881 $2,857 $1,667 $10,049
HARTIG DRUG CO INC Pharmacy $4,875 $3,349 $6,693 $6,369 $21,285
HIGH POINT FAMILY MEDICINE Physician Group $143 $132 $251 $526
K MART PHARMACY 3970 Pharmacy $4,957 $5,349 $6,985 $3,416 $20,706
LANCASTER FAMILY MEDICAL Physician Group $308 $444 $63 $277 $1,091
MEENAKSHI R MASKI, MD Physician $198 $77 $86 $492 $853
MUSCODA HEALTH CENTER Rural Health Clinic $27 $172 $116 $884 $1,198
PAMIDA PHARMACY #387 Pharmacy $1,270 $1,386 $1,850 $1,350 $5,857
POTOSI TENNYSON MEDICAL Rural Health Clinic $62 $62
RAVIKANT MASKI, MD Physician $139 $52 $176 $367
Page 25 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
SCOTT A WALKER, MD Physician $30 $30
SOUTHWEST COMMUNITY ACTION Family Planning Clinic $229,566 $211,795 $182,250 $416,158 $1,039,768
SOUTHWEST HEALTH CENTER Hospital $165 $769 $11,977 $16,653 $29,564
Independent Lab $42 $30 $77 $815 $964
Physician Group $65 $179 $264 $507
ST MARYS DEAN VENTURES INC Physician Group $3,163 $6,984 $5,272 $14,172 $29,591
U OF WI PLATTEVILLE STUDENT Family Planning Clinic $66,853 $64,747 $72,522 $65,291 $269,413
WALGREENS #12498 Pharmacy $9,430 $12,655 $22,085
WAL-MART PHARMACY 10-0958 Pharmacy $12,330 $29,386 $33,684 $23,522 $98,922
Green ANGLIN TRANSPORT SERVICES IN Transportation $21 $21
NEW GLARUS HOMETOWN PHARMACY Pharmacy $249 $1,084 $289 $456 $2,077
PINNOW PHARMACY INC Pharmacy $1,902 $2,156 $2,129 $1,797 $7,984
PLANNED PARENTHOOD OF WI Family Planning Clinic $776 $61 $837
SCHULTZ PHARMACY Pharmacy $1,478 $1,142 $486 $884 $3,990
SHOPKO PHARMACY #2120 Pharmacy $4,882 $4,626 $3,028 $2,066 $14,601
THE CLINIC PHARMACY Pharmacy $4,758 $5,047 $4,366 $3,764 $17,934
THE MEDICINEMART Pharmacy $489 $90 $131 $710
THE MONROE CLINIC Physician Group $4,819 $6,042 $4,329 $7,150 $22,341
THE MONROE CLINIC HOSPITAL Pharmacy $183 $195 $378
THE MONROE CLINIC INC Hospital $1,588 $6,045 $8,942 $20,473 $37,048
Independent Lab $342 $342
WALGREENS #11647 Pharmacy $766 $2,078 $2,844
WAL-MART PHARMACY 10-0802 Pharmacy $3,469 $6,235 $6,831 $6,740 $23,276
Green Lake BENTLEY PHARMACIES INC. Pharmacy $1,286 $954 $291 $576 $3,107
BERLIN MEMORIAL HOSPITAL Hospital $1,774 $5,690 $17,476 $12,288 $37,229
Independent Lab $3,942 $2,878 $2,514 $3,061 $12,395
CENTRAL WISCONSIN ANESTHESIO Anesthetist $174 $190 $131 $495
CHN DR GUBITZ Physician Group $124 $124
CHN MEDICAL CENTER BERLIN Physician Group $1,958 $1,930 $3,867 $4,000 $11,754
Page 26 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CHN MEDICAL CENTER GREEN LAKE Physician Group $196 $97 $293
CHN MEDICAL CENTER INTERNAL MEDICINEPhysician Group $150 $528 $678
CHN MEDICAL CENTER MARKESAN Physician Group $279 $72 $16 $36 $403
CHN MEDICAL CENTER PRINCETON Physician Group $57 $87 $1,137 $1,281
CHN MEDICAL CENTER PULMONARY & SLEEPPhysician Group $105 $270 $375
CHN MEDICAL CTR EASTRIDGE Physician Group $343 $313 $105 $647 $1,408
CHN OB/GYN Physician Group $1,749 $377 $2,126
CHN ORTHOPEDICS AND SPORTS MEDICINEPhysician Group $86 $86
CHN RADIOLOGY Physician Group $62 $62
COMMUNITY MEDICAL CENTER OF GREEN LAKE LLCPhysician Group $76 $76
DAVID E RESEN, MD Physician $1,535 $1,181 $719 $239 $3,674
DAVID R JONES, MD Physician $43 $22 $65
FIELD PHARMACY LLC Pharmacy $3,672 $3,487 $3,545 $2,071 $12,774
MARKESAN PHARMACY Pharmacy $1,070 $2,696 $747 $777 $5,290
RIPON MEDICAL CENTER Physician Group $402 $402
ROGERS NELSON AND LO SURGICAL ASSOCIATESPhysician Group $37 $37
WAL-MART PHARMACY 10-1727 Pharmacy $4,250 $6,141 $5,956 $7,651 $23,998
WOMENS HEALTH & RESOURCE CEN Family Planning Clinic $20,748 $19,445 $19,221 $42,186 $101,600
Illinois FHN LEONARD C FERGUSONCANCER Physician Group $48 $48
FREEPORT MEMORIAL HOSPITAL Hospital $32 $32
GAUTAM GUPTA, MD Physician $120 $120
GUY R ABDERHOLDEN, MD Physician $30 $30
NIHAN & MARTIN PHARMACY Pharmacy $58 $58
NORTHPOINTE HEALTH Physician Group $160 $86 $247
QUEST DIAGNOSTICS LLC IL Independent Lab $19,144 $19,866 $24,531 $46,447 $109,989
ROCKFORD HEALTH PHYSICIANS Physician Group $93 $93
SAINT ANTHONY MEDICAL CENTER Hospital $23 $23
SWEDISH AMERICAN HOSPITAL Hospital $113 $113
WALGREENS 02003 Pharmacy $1,496 $503 $610 $200 $2,808
Page 27 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS 02585 Pharmacy $13 $13
WALGREENS 05829 Pharmacy $79 $79
WALGREENS 06001 Pharmacy $282 $264 $774 $432 $1,751
WALGREENS 06002 Pharmacy $19 $11 $30
WALGREENS 3322 Pharmacy $52 $211 $263
WAL-MART PHARMACY 10-5044 Pharmacy $190 $154 $210 $555
WAL-MART PHARMACY 10-5199 Pharmacy $372 $225 $597
WARREN DRUG STORE Pharmacy $149 $97 $40 $287
Iowa BLACKHAWK AREA HEALTH CARE Physician Group $30 $78 $108
CORNER DRUG HOMETOWN PHARMAC Pharmacy $622 $320 $470 $1,159 $2,570
DOUGLAS R PALMER, MD Physician $22 $22
EVERETT R LINDSEY, MD Physician $61 $61
GARY J GRUNOW MD, MD Physician $147 $57 $58 $287 $548
GORDON J GRIESHABER MD, MD Physician $30 $181 $211
IVEYS PHARMACY INC Pharmacy $848 $902 $988 $664 $3,401
KENT S KRAMER M D, MD Physician $58 $30 $88
MARK P BISHOP MD, MD Physician $57 $223 $280
MICHELE A ROELLI MD, MD Physician $117 $443 $560
MINERAL POINT MEDICAL CENTER Rural Health Clinic $150 $60 $114 $61 $385
PAMELA K RICE, MD Physician $47 $57 $104
SARAH E FOX MD, MD Physician $132 $132
SWANSON PHARMACY INC Pharmacy $290 $290
UPLAND HILLSHEALTH Hospital $251 $494 $2,430 $2,821 $5,997
UPLAND HILLSHEALTH INC Independent Lab $80 $314 $395
Physician Group $79 $101 $180
WALGREENS #10962 Pharmacy $14 $1,982 $2,126 $2,730 $6,851
WAL-MART PHARMACY 10-0847 Pharmacy $2,423 $5,430 $3,017 $3,595 $14,465
Iowa State DOUGLAS A SCHMID, MD Physician $95 $95
DUBUQUE INTERNAL MEDICINE PC Physician Group $30 $30
Page 28 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
DUBUQUE RADIOLOGICAL ASSOCIATES, PCPhysician Group $22 $22
GUNDERSEN CLINIC LTD Physician Group $25 $25
HARTIG DRUG CO #2 Pharmacy $340 $340
HARTIG DRUG CO #4 Pharmacy $234 $234
HY VEE PHARMACY #3 1162 Pharmacy $225 $225
MEDICAL ASSOCIATES CLINIC PC Physician Group $202 $365 $866 $989 $2,422
MERCY FAMILY PHARMACY EAST Pharmacy $34 $34
PATHOLOGY ASSOCIATES Physician Group $37 $37
UNITED CLINICAL LABORATORIES Independent Lab $84 $207 $479 $351 $1,122
WALGREENS #09708 Pharmacy $191 $438 $469 $1,098
WALGREENS #11942 Pharmacy $142 $142
Iron IRON COUNTY HEALTH DEPARTMENT Family Planning Clinic $21,026 $19,717 $20,921 $33,590 $95,253
IRON COUNTY HUMAN SERVICES
Mental Health and
Substance Abuse
Services $112 $45 $157
MARSHFIELD CLINIC MERCER Independent Lab $10 $22 $22 $54
Physician Group $28 $230 $671 $930
NORTHWOODS FAMILY ORTHO SC Physician Group $22 $22
ROWE WHITE CROSS PHARMACY Pharmacy $3,055 $2,146 $1,898 $412 $7,511
WHITE CROSS PHARMACY Pharmacy $1,541 $1,541
Jackson BLACK RIVER FALLS CLINIC Pharmacy $889 $1,453 $1,534 $1,777 $5,654
BLACK RIVER MEMORIAL HOSP Physician Group $91 $91
BLACK RIVER MEMORIAL HOSPITA Hospital $240 $453 $7,011 $7,703
HO CHUNK HEALTH CARE CENTER
Federally Qualified
Health Clinic (FQHC) $851 $199 $285 $369 $1,704
HO CHUNK HEALTHCARE PHARMACY Pharmacy $279 $279
KROHN CLINICLTD
Mental Health and
Substance Abuse
Services $43 $43
Page 29 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
Physician Group $359 $325 $388 $2,581 $3,654
PAUL E HELSTAD, DPM Podiatrist $30 $30
WAARVIK DRUGS INC Pharmacy $183 $183
WAL-MART PHARMACY 10-1277 Pharmacy $1,605 $1,236 $2,841 $1,922 $7,605
Jefferson AURORA PHARMACY INC Pharmacy $575 $494 $270 $1,568 $2,907
FAMILY MEDICAL CLINIC Physician Group $47 $118 $165
FORT ATKINSON EMERGENCY PHYS Physician Group $27 $86 $207 $319
FORT HEALTHCARE INC Hospital $115 $115 $13,275 $13,213 $26,719
Physician Group $2,923 $1,546 $2,670 $6,548 $13,687
FORT MEMORIAL HOSPITAL Independent Lab $1,696 $1,456 $2,386 $5,920 $11,458
FORT MEMORIAL HOSPITALCRNA Anesthetist $143 $67 $67 $277
JEFFERSON Physician Group $37 $142 $179
JEFFREY A SMITH, MD Physician $37 $37
JOHNSON CREEK Physician Group $154 $235 $95 $483
K MART PHARMACY 9543 Pharmacy $846 $955 $445 $924 $3,170
LAKE MILLS URGENT CARE Physician Group $30 $30 $60
MUELLER DRUGS INC Pharmacy $1,906 $2,587 $1,995 $1,591 $8,080
PICK N SAVE PHARMACY #6888 Pharmacy $96 $55 $151
PLANNED PARENTHOOD OF WI Family Planning Clinic $12,622 $29,469 $42,091
PROHEALTH CARE MEDICAL ASSOCIATESPhysician Group $178 $187 $522 $946 $1,833
RICHARD E NEILS, MD Physician $74 $74
SHOPKO PHARMACY #2019 Pharmacy $753 $593 $655 $827 $2,828
SHOPKO PHARMACY #2051 Pharmacy $762 $934 $1,682 $2,417 $5,795
THOMAS J TACKMAN, MD Physician $60 $60
TUTTLES PHARMACY INC Pharmacy $29 $208 $237
UW HEALTH PARTNERS WATERTOWN REGIONAL MEDICAL CENTPhysician Group $64 $64
UWHP WRMC JOHNSON CREEK CLINIC Physician Group $60 $222 $1,290 $1,572
UWHP WRMC LAKE MILLS CLINIC Physician Group $336 $538 $236 $1,337 $2,447
UWHP WRMC WATERLOO CLINIC Physician Group $190 $526 $715
Page 30 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS #11176 Pharmacy $56 $513 $3,520 $4,088
WALGREENS 01976 Pharmacy $2,682 $3,715 $4,838 $4,052 $15,286
WALGREENS 05136 Pharmacy $3,058 $3,093 $2,545 $4,820 $13,515
WAL-MART PHARMACY 10-1274 Pharmacy $3,224 $13,553 $23,091 $15,308 $55,176
WAL-MART PHARMACY 10-1776 Pharmacy $2,184 $3,521 $1,425 $980 $8,111
WAL-MART PHARMACY 10-3499 Pharmacy $1,387 $1,690 $3,077
ZIMBRIC PHARMACY Pharmacy $800 $122 $399 $2,214 $3,536
Juneau ELROY FAMILYMEDICAL CENTER Physician Group $133 $133
Rural Health Clinic $128 $143 $531 $557 $1,358
GUNDERSEN CLINIC LTD Physician Group $43 $96 $139
GUNDERSEN CLINIC WONEWOC Rural Health Clinic $91 $824 $319 $209 $1,443
HESS MEMORIAL HOSPITALINC Anesthetist $317 $317
Independent Lab $2,806 $4,423 $5,071 $6,736 $19,035
Physician Group $49 $59 $76 $379 $563
JACK A. BESANT,INC. DBA FOX PHARMACYPharmacy $193 $785 $687 $101 $1,766
MILE BLUFF CLINIC Physician Group $4,227 $5,253 $4,378 $6,780 $20,638
Rural Health Clinic $111 $57 $199 $1,864 $2,231
MILE BLUFF MEDICAL CENTER INC Hospital $306 $434 $4,963 $14,568 $20,271
NECEDAH FAMILY MEDICAL CENTER INCRural Health Clinic $63 $30 $113 $552 $759
NECEDAH FAMILY MEDICALCENTER Physician Group $37 $412 $449
NEW LISBON CLINIC Physician Group $659 $1,202 $1,220 $1,125 $4,206
Rural Health Clinic $101 $114 $129 $352 $695
PHILLIPS CLINIC PHARMACY Pharmacy $608 $841 $1,118 $2,566
PHILLIPS DRUG STORE INC Pharmacy $923 $177 $365 $181 $1,645
RAABES PHARMACY SC Pharmacy $1,531 $1,517 $2,683 $1,981 $7,713
WALGREENS 09008 Pharmacy $3,074 $3,855 $2,676 $4,859 $14,465
Kenosha ABDUL G DURRANI MD SC Physician Group $95 $95
AFTAB A ANSARI, MD Physician $37 $37
ALLERGY & ASTHMA CLINIC OF KENOSHAPhysician Group $79 $79
Page 31 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
AMTUL R AHMAD, MD Physician $36 $36
ANITA I INVEISS MD SC Physician Group $22 $433 $455
ANITA I INVEISS, MD Physician $57 $87 $48 $192
AURORA HEALTH CENTER KENOSHA Physician Group $9,522 $4,820 $4,766 $11,442 $30,550
AURORA MEDICAL CENTER Hospital $1,270 $4,273 $27,038 $15,827 $48,408
AURORA MEDICAL GROUP Physician Group $1,808 $612 $798 $4,162 $7,380
AURORA PHARMACY INC Pharmacy $3,635 $6,959 $4,425 $6,263 $21,283
BARBARA S ROBINSON, MD Physician $480 $480
CHILDRENS HOSPITAL OF Hospital $465 $465
CHILDRENS MEDICAL GROUP Physician Group $106 $106
COMPREHENSIVE ORTHOPAEDICS Physician Group $1,319 $1,319
CVS PHARMACY#08774 Pharmacy $1,788 $4,629 $563 $554 $7,533
CVS PHARMACY#08777 Pharmacy $4,762 $5,335 $3,229 $2,820 $16,146
EAR NOSE ANDTHROAT FAMILY C Physician Group $196 $196
FAMILY CARE ASSOCIATES INC Physician Group $276 $276
FARAH SALAHUDDIN, MD Physician $95 $95
GENESIS MEDICAL CENTER OF KENOSHA, SCPhysician Group $22 $94 $398 $513
GOOD VALUE PHARMACY Pharmacy $691 $1,758 $367 $557 $3,373
GOOD VALUE PHARMACY MEDCARE Pharmacy $541 $70 $110 $110 $830
GWENDOLYN M PERRY BRYE, APNP Nurse Practitioner $1,343 $3,043 $2,339 $1,399 $8,123
IHC-KENOSHA RADIOLOGY, LLC Physician Group $12 $268 $1,041 $1,320
JAMES M BURY, MD Physician $48 $48
JAWAID QUDDUS, MD Physician $86 $285 $370
JOHN D DECARLO, MD Physician $57 $30 $87
JUNITH M THOMPSON, MD Physician $321 $458 $779
K MART PHARMACY 3088 Pharmacy $403 $3,532 $3,935
KARL B SCHEIDT MD SC Physician Group $95 $95
KENOSHA COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $560 $522 $1,847 $13,057 $15,986
Page 32 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
KENOSHA COUNTY HEALTH DEPT Family Planning Clinic $123 $151 $247 $376 $897
KENOSHA FAMILY PRACTICE SC Physician Group $117 $95 $212
KENOSHA PATHOLOGY CONSULTANTS Physician Group $315 $866 $244 $2,505 $3,930
KENOSHA RADIOLOGY CENTER LLC Physician Group $36 $36
KENOSHA UROLOGY CLINICSC Physician Group $280 $280
MAJED JANDALI MD SC Physician Group $48 $48
MIDWEST CENTER FOR WOMENS HEALTHPhysician Group $93 $285 $36 $185 $599
MIDWEST PHYS ANES SRVCS SC Physician Group $477 $477
OSCO DRUG #5753 Pharmacy $191 $191
OSCO DRUG #5797 Pharmacy $523 $523
PADDOCK LAKEFAMILY PRACTICE Physician Group $115 $252 $367
PICK N SAVE PHARMACY #6850 Pharmacy $29 $13 $42
PICK N SAVE PHARMACY 6874 Pharmacy $294 $370 $198 $862
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $504,576 $336,144 $169,483 $172,420 $1,182,623
PRADEEP G KUMAR, MD Physician $109 $109
RODRIGO B MATA III MD SC Physician Group $109 $109
SHOPKO PHARMACY NO 2031 Pharmacy $458 $796 $1,083 $1,265 $3,602
SURYA MEDICAL GROUP SC Physician Group $262 $262
TARGET STORE T-2251 PHARMACY Pharmacy $80 $79 $159
TIMOTHY J ZELKO, DO Physician $5,695 $3,561 $1,593 $386 $11,235
UHS PHYSICIAN CLINIC Physician Group $2,401 $3,381 $3,225 $14,572 $23,580
UNITED HOSPITAL SYSTEM INC Hospital $1,572 $4,685 $83,950 $195,823 $286,030
UNITED OCCUPATIONAL MEDICINE & WALK IN SERVICES, LPhysician Group $87 $112 $494 $2,441 $3,134
WALGREENS #03617 Pharmacy $7,929 $8,807 $7,676 $11,092 $35,505
WALGREENS #03738 Pharmacy $4,602 $3,037 $6,372 $6,349 $20,361
WALGREENS #12413 Pharmacy $918 $918
WALGREENS 03153 Pharmacy $6,764 $5,606 $5,784 $7,101 $25,254
WALGREENS 05935 Pharmacy $3,189 $2,094 $3,777 $6,459 $15,520
WALGREENS 07965 Pharmacy $565 $1,448 $1,073 $3,555 $6,641
Page 33 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS 09605 Pharmacy $5,584 $4,685 $3,601 $6,950 $20,820
WALGREENS#00518 Pharmacy $2,835 $1,650 $508 $1,082 $6,075
WAL-MART PHARMACY 10-1167 Pharmacy $3,626 $3,533 $4,814 $4,705 $16,679
Kewaunee AURORA PHARMACY INC Pharmacy $4,659 $3,076 $3,453 $3,221 $14,409
FMC ALGOMA Rural Health Clinic $439 $334 $315 $411 $1,499
FMC KEWAUNEE Rural Health Clinic $432 $240 $177 $400 $1,250
LUXEMBURG MEDICAL CLINIC Physician Group $481 $223 $219 $358 $1,281
LUXEMBURG PHARMACY LLC Pharmacy $2,572 $1,889 $178 $1,462 $6,101
PAMIDA PHARMACY 046 Pharmacy $2,689 $1,545 $809 $37 $5,080
La Crosse CASS STREET PHARMACY Pharmacy $37 $155 $3,178 $1,833 $5,202
CLINIC PHARMACY OF WEST SALEM INCPharmacy $1,357 $495 $1,852
DEGEN BERGLUND Pharmacy $924 $4,068 $9,668 $7,724 $22,385
DEGEN BERGLUND INC Pharmacy $307 $558 $1,162 $1,192 $3,221
DEGEN BERGLUND PHARMACY Pharmacy $29 $29
FRANCISCAN SKEMP HEALTHCARE Independent Lab $65 $379 $4,267 $4,710
FSH HOLMEN CLINIC PHARMACY Pharmacy $1,238 $1,238
GUNDERSEN CLINIC LTD Pharmacy $1,637 $3,342 $2,058 $1,367 $8,404
Physician Group $29,419 $30,141 $31,762 $72,181 $163,503
GUNDERSEN LUTHERAN MEDICAL Independent Lab $7,085 $13,288 $12,527 $18,490 $51,390
Mental Health and
Substance Abuse
Services $55 $55
GUNDERSEN LUTHERAN MEDICAL CENTER INCHospital $1,564 $4,699 $55,532 $61,255 $123,050
K MART PHARMACY 4089 Pharmacy $228 $238 $1,073 $410 $1,949
KAREN H KEIL, MD Physician $55 $55
MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE-LAHospital $137 $137 $13,596 $17,927 $31,796
MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTEPhysician Group $9,040 $4,508 $1,931 $14,063 $29,542
MCHS ONALASKA PHARMACY Pharmacy $379 $424 $472 $231 $1,506
MCHS SKEMP CLINIC PHARMACY Pharmacy $363 $262 $776 $660 $2,060
Page 34 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MCHS ST FRANCIS PHARMACY Pharmacy $208 $208
MICHAEL S MOSLING, DDS Dentist $267 $88 $355
OPTIONS IN REPRODUCTIVECARE Family Planning Clinic $595,281 $621,070 $675,566 $915,717 $2,807,634
PINNACLE PHARMACY OF LACROSS Pharmacy $32 $63 $95
QUILLINS HEALTH Q PHARMACY Pharmacy $407 $84 $483 $975
QUILLINS MAJOR DRUG Pharmacy $1,103 $265 $2,646 $1,497 $5,511
SHOPKO PHARMACY #2007 Pharmacy $1,163 $1,836 $4,674 $5,749 $13,423
SHOPKO PHARMACY #2020 Pharmacy $4,088 $7,509 $9,984 $8,848 $30,428
SHOPKO PHARMACY #2099 Pharmacy $2,447 $4,420 $3,672 $4,761 $15,300
TARGET STORE T-0620 PHARMACY Pharmacy $2,196 $6,189 $2,633 $3,932 $14,950
UNIVERSITY OF WISCONSIN LA C Family Planning Clinic $42,481 $38,992 $28,703 $23,343 $133,519
WALGREENS #03498 Pharmacy $30,339 $50,171 $59,675 $53,803 $193,987
WALGREENS #12455 Pharmacy $464 $464
WALGREENS 09214 Pharmacy $10,900 $20,012 $14,805 $24,684 $70,401
WAL-MART PHARMACY 10-1679 Pharmacy $7,703 $8,858 $9,645 $11,514 $37,719
WAL-MART PHARMACY 10-5127 Pharmacy $5,688 $7,581 $9,518 $13,808 $36,594
WEST SALEM PHARMACY Pharmacy $214 $304 $206 $724
Lafayette ARGYLE CLINIC Physician Group $93 $102 $194
FAMILY HEALTH OF LAFAYETTE COUNTYPhysician Group $636 $156 $314 $341 $1,446
MEM HOSP OF LAFAYETTE COUNTY Hospital $157 $157 $694 $599 $1,607
MEMORIAL HOSPITAL OF LAFAYET Physician Group $256 $256
SHULLSBURG CLINIC Physician Group $114 $166 $174 $84 $538
WHITFORD PHARMACY INC Pharmacy $2,026 $3,644 $3,331 $2,208 $11,210
Langlade ASPIRUS GENERAL CLINIC Physician Group $2,324 $480 $34 $2,838
ASPIRUS GENERAL CLINICELCHO Rural Health Clinic $240 $240
ELCHO PHARMACY INC Pharmacy $222 $222
FREEDOM VANS LLC Transportation $323 $323
GRETCHEN L TOLSMA, NP Nurse Practitioner $251 $30 $282
LAKESIDE PHARMACY Pharmacy $2,301 $1,785 $1,992 $2,547 $8,626
Page 35 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
LANGLADE HOSPITAL Hospital $268 $3,234 $23,329 $26,830
Independent Lab $24 $24
Physician Group $32 $177 $1,304 $1,514
LANGLADE MEMORIAL HOSP GENERAL CLINIC ELCHOPhysician Group $96 $1,540 $457 $829 $2,922
LANGLADE MEMORIAL HOSPGENERA Physician Group $2,034 $4,402 $3,705 $7,964 $18,105
ROBERT W CROMER, MD Physician $66 $99 $258 $423
STEVE A WEBER, DO Physician $26 $244 $270
TOLSMA LLC Nurse Practitioner $120 $120
WALGREENS 06153 Pharmacy $8,077 $6,709 $4,706 $6,761 $26,253
WAL-MART PHARMACY 10-3268 Pharmacy $2,396 $2,189 $1,300 $2,589 $8,474
Lincoln ASPIRUS MERRILL CLINIC Physician Group $418 $808 $380 $1,606
ASPIRUS WAUSAU HOSPITAL MERRILL CLINICPhysician Group $68 $480 $548
AURORA PHARMACY INC Pharmacy $1,072 $1,809 $1,432 $416 $4,728
GOOD SAMARITAN HEALTH CENTER Independent Lab $135 $135
Physician Group $233 $118 $55 $367 $773
GOOD SAMARITAN HEALTH CTR OF MERRILL WISC INCHospital $186 $527 $1,817 $5,634 $8,164
MARSHFIELD CLINIC MERRILL CENTER LABIndependent Lab $166 $211 $237 $344 $958
MARSHFIELD CLINIC PHARMACY Pharmacy $2,495 $2,366 $2,873 $2,918 $10,653
MERRILL HOMETOWN PHARMACY Pharmacy $629 $629
NORTHBAY PHARMACY INC Pharmacy $3,612 $2,549 $1,673 $1,630 $9,465
RADIOLOGY MERRILL SC Physician Group $57 $57
SACRED HEARTHOSPITAL Hospital $531 $2,459 $2,013 $5,003
SACRED HEARTST MARYS HOSPIT Independent Lab $173 $173
STOXEN PHARMACY Pharmacy $518 $39 $228 $1,112 $1,897
WALGREENS #10574 Pharmacy $3,018 $6,078 $5,215 $7,088 $21,399
WAL-MART PHARMACY 10-1366 Pharmacy $3,247 $3,957 $4,662 $5,232 $17,098
Manitowoc AURORA HEALTH CENTER Physician Group $3,416 $5,565 $3,936 $4,732 $17,649
AURORA MEDICAL CENTER OF Hospital $290 $2,861 $1,419 $4,570
AURORA MEDICAL GROUP INC Physician Group $1,399 $1,311 $1,432 $2,145 $6,287
Page 36 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
AURORA PHARMACY INC Pharmacy $618 $1,142 $1,060 $1,926 $4,746
BELLIN HEALTH FAST CARE MANITOWOCPhysician Group $22 $20 $42
COPPS FOOD CENTER PHARMACY Pharmacy $158 $425 $583
COPPS FOOD CENTER PHARMACY #8185Pharmacy $142 $142
CVS PHARMA CY #08545 Pharmacy $3,218 $4,638 $4,375 $5,870 $18,102
DAVID A SATCHELL, MD Physician $12 $12
DAVID E AUGUSTINE, MD Physician $30 $30
DERMATOLOGY ASC OF WI SC Physician Group $33 $102 $881 $1,016
EKATERINA ROMAN, MD Physician $43 $43
EVELYN D SBAR MD, MD Physician $22 $22
EYE CLINIC OF MANITOWOC SC Physician Group $86 $86
FMC MANITOWOC Physician Group $92 $92
HFM FAMILY MEDICINE Physician Group $1,956 $1,725 $1,981 $2,211 $7,873
HFM GASTROENTEROLOGY AND INTERNAL MEDICINEPhysician Group $30 $120 $150
HFM NEUROSCIENCE Physician Group $12 $12
HFM OTOLARYNGOLOGY Physician Group $78 $78
HFM PAIN CLINIC Physician Group $388 $388
HFM PEDIATRICS Physician Group $57 $30 $87
HFM PHARMACY Pharmacy $840 $2,089 $3,665 $2,845 $9,439
HFM TR HEALTH CENTER Physician Group $307 $58 $365
HFM UROLOGY Physician Group $52 $30 $42 $123
HFM WOMENS HEALTH Physician Group $2,792 $5,601 $7,125 $5,337 $20,855
HOLY FAMILY MEDICAL CENTER Independent Lab $3,859 $3,315 $2,384 $1,669 $11,227
HOLY FAMILY MEMORIAL INC Hospital $442 $3,571 $16,261 $5,514 $25,789
Physician Group $1,236 $1,057 $833 $873 $3,998
JAMES J KIYAK, MD Physician $79 $79
JENNIFER A GARVIN CRESS, MD Physician $150 $57 $166 $115 $488
JULIE H MARTIN, MD Physician $87 $30 $117
KARL C LARSON, MD Physician $50 $50
Page 37 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
KIEL PHARMACY Pharmacy $512 $200 $189 $695 $1,595
LAKESHORE ENDOCRINOLOGY Physician Group $48 $48
LAKESHORE ORTHOPAEDICS Physician Group $121 $174 $295
LAKESHORE RADIOLOGY ASC PC Physician Group $37 $37
MANITOWOC PHARMACIES Pharmacy $3,952 $2,141 $1,052 $380 $7,524
MANITOWOC SURGERY CENTER LLC
Ambulatory Surgical
Center (ASC) $724 $25 $749
NOLAN R HETZ, MD Physician $151 $55 $205
ORTHOPAEDIC ASC OF MANITOWOC Physician Group $123 $111 $234
OSCO DRUG#5076 Pharmacy $1,457 $1,457
PATHOLOGY PHYSICIANS HFM Physician Group $287 $287
PLANNED PARENTHOOD OF WISCONSIN, INCFamily Planning Clinic $152,644 $27,769 $118,036 $59,180 $357,629
ROBERT A GAHL, MD Physician $60 $60
RODNEY J HALVORSEN MD, MD Physician $319 $319
SHOPKO PHARMACY #2003 Pharmacy $7,336 $5,332 $5,116 $9,853 $27,637
SUSAN F KOEHLER, APNP Nurse Practitioner $546 $546
THE CANCER CARE CENTER Physician Group $27 $27
THE MEDICINE SHOPPE Pharmacy $814 $1,388 $3,491 $5,295 $10,988
THE MEDICINESHOPPE Pharmacy $1,858 $592 $906 $3,356
WAL MART PHARMACY 101449 Pharmacy $4,126 $5,350 $6,951 $8,545 $24,972
WALGREENS #03104 Pharmacy $8,963 $8,429 $8,752 $15,315 $41,459
WALGREENS 09166 Pharmacy $1,657 $3,233 $2,008 $3,216 $10,115
WOLFE PHARMACY Pharmacy $1,412 $1,246 $731 $1,992 $5,380
Marathon 29 SUPER PHARMACY Pharmacy $2,175 $1,436 $472 $317 $4,401
ASPIRUS BEHAVIORAL MEDICINE CLINICPhysician Group $47 $24 $72
ASPIRUS CLINIC PHARMACY Pharmacy $2,430 $2,304 $2,564 $1,708 $9,006
ASPIRUS DERMATOLOGY CLINIC Physician Group $37 $30 $52 $119
ASPIRUS EDGAR CLINIC Physician Group $87 $164 $30 $281
ASPIRUS ENDOCRINOLOGY CLINIC Physician Group $390 $390
Page 38 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ASPIRUS FAMILY HEALTH SPECIALIST Physician Group $1,010 $1,511 $3,307 $1,910 $7,738
ASPIRUS FAMILY PHYSICIANS Physician Group $368 $428 $323 $1,639 $2,758
ASPIRUS FAMILY WALK IN Physician Group $1,568 $2,976 $3,657 $3,162 $11,364
ASPIRUS FASTCARE CLINIC Nurse Practitioner $36 $136 $91 $263
ASPIRUS FREEMAN ADULT HEALTH Physician Group $57 $117 $429 $603
ASPIRUS HOSPITALIST PROGRAM Physician Group $48 $48
ASPIRUS KRONENWETTER CLINIC Physician Group $1,188 $1,320 $3,021 $2,569 $8,098
ASPIRUS MARATHON CLINIC Physician Group $423 $181 $529 $527 $1,661
ASPIRUS OB GYN ASSOCIATES Physician Group $3,967 $7,927 $8,201 $5,379 $25,475
ASPIRUS OB GYN CLINICS OUTREACH Physician Group $22 $136 $158
ASPIRUS PEDIATRICS Physician Group $88 $88
ASPIRUS PULMONARY AND CRITICAL CAREPhysician Group $30 $42 $108 $181
ASPIRUS REFERENCE LABORATORY Independent Lab $664 $770 $3,736 $7,518 $12,686
ASPIRUS REGIONAL CANCER CENTER Physician Group $126 $126
ASPIRUS RHEUMATOLOGY CLINIC Physician Group $78 $54 $30 $162
ASPIRUS SPECIALISTIST INC Physician Group $27 $27 $54
ASPIRUS SPECIALISTS INC Physician Group $47 $825 $872
ASPIRUS SPINE & NEUROSCIENCES INSTITUTEPhysician Group $192 $192
ASPIRUS WAUSAU HOSPITAL Hospital $485 $76,329 $16,074 $10,886 $103,774
ASPIRUS WAUSAU HOSPITAL FAMILY HEALTH SPECIALISTSPhysician Group $851 $851
ASPIRUS WAUSAU HOSPITAL FAMILY WALK INPhysician Group $1,061 $1,061
ASPIRUS WAUSAU HOSPITAL FREEMAN ADULT HEALTH CLINIPhysician Group $143 $143
ASPIRUS WAUSAU HOSPITAL INC FAMILY PHYSICIANSPhysician Group $320 $320
ASPIRUS WAUSAU HOSPITAL INC MARATHON CLINICPhysician Group $339 $339
ASPIRUS WAUSAU HOSPITAL INC WESTON CLINICPhysician Group $1,018 $1,018
ASPIRUS WAUSAU HOSPITAL INPA Pharmacy $46 $46
ASPIRUS WAUSAU HOSPITAL OB GYN ASSOCIATESPhysician Group $2,975 $2,975
ASPIRUS WAUSAU HOSPITAL WESTHILL MEDICAL SPECIALISPhysician Group $121 $121
ASPIRUS WESTHILL MEDICAL SPECIALISTPhysician Group $47 $208 $179 $55 $489
Page 39 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ASPIRUS WESTON CLINIC Physician Group $1,771 $2,089 $2,753 $3,970 $10,583
ASPIRUS WOMENS HEALTH Nurse Practitioner $115 $282 $397
ASPIRUS WOMENS HEALTH OBSTETRICSPhysician Group $57 $57
ASSOCIATES IN PATHOLOGYSC Independent Lab $10,577 $9,223 $12,568 $9,660 $42,027
AURORA PHARMACY INC Pharmacy $1,154 $1,829 $1,001 $520 $4,505
BONE AND JOINT CLINIC SC Physician Group $237 $237
BREAST CENTER OF CENTRAL WISCONSINPhysician Group $37 $37
BRENDA J BANASZYNSKI, MD Physician $28 $28
CARDIOVASCULAR ASSOCIATES OF Physician Group $61 $61
CENTRAL WI ANESTHESIOLOGY SC Anesthetist $342 $577 $919
CHRISTOPHER J MAGIERA, MD Physician $30 $30
COUNTY MARKET PHARMACY Pharmacy $528 $1,286 $2,169 $1,815 $5,798
EAR NOSE & THROAT ASSOC Physician Group $30 $371 $401
EDGAR BETANCOURT, MD Physician $2,088 $5,217 $7,304
EYE CLINIC OF WISCONSIN SC Physician Group $22 $22
FAMILY PLANNING HEALTHSERVI Family Planning Clinic $1,231,565 $1,141,379 $1,240,988 $1,885,938 $5,499,870
GARY T SWEET JR, MD Physician $37 $37
GASTROINTESTINAL ASSOCIATES Physician Group $248 $248
HOPE CLINIC SC Physician Group $22 $171 $192
MARSHFIELD CLINIC Independent Lab $73 $42 $43 $54 $212
MARSHFIELD CLINIC PHARMACY
Federally Qualified
Health Clinic (FQHC) $37 $875 $1,739 $2,651
Pharmacy $5,791 $5,692 $6,819 $5,505 $23,807
MARSHFIELD CLINIC STRATFORD Independent Lab $63 $63
MARSHFIELD CLINIC WAUSAU Independent Lab $766 $797 $602 $1,510 $3,676
MARSHFIELD CLINIC WAUSAU AMB
Ambulatory Surgical
Center (ASC) $724 $1,447 $1,447 $3,618
MID WISCONSIN EAR NOSE & THROAT PROFESSIONALS SCPhysician Group $257 $257
MINISTRY MEDICAL GROUP Physician Group $112 $127 $593 $832
Page 40 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
NORTH CENTRAL WISCONSIN REHA Physician Group $140 $140
ORTHOPAEDIC ASSOCIATES OF WAUSAU,S.C.Physician Group $47 $61 $108
PABLO E AMADOR, MD Physician $43 $43
PAMIDA PHARMACY 108 Pharmacy $6,442 $5,324 $4,186 $4,798 $20,750
PICK N SAVE PHARMACY #6404 Pharmacy $1,414 $1,414
PRIMARY CONNECTION HEALTH CA
Federally Qualified
Health Clinic (FQHC) $773 $1,396 $2,106 $2,482 $6,757
RADIOLOGY ASSOCIATES OF WAUSAU SCPhysician Group $106 $78 $394 $578
RANDAL C KUMM, MD Physician $30 $30
SAINT CLARESHOSPITAL OF WES Hospital $66 $4,241 $13,419 $17,726
SALLY S MATTINGLY, MD Physician $47 $47
SAM'S PHARMACY 10-6535 Pharmacy $31 $437 $468
SHOPKO PHARMACY #2008 Pharmacy $5,468 $7,375 $3,500 $3,304 $19,647
SHOPKO PHARMACY #2079 Pharmacy $9,454 $9,588 $6,090 $5,436 $30,567
SOUTHSIDE HOMETOWN PHARMACY Pharmacy $45 $45
SOUTHSIDE PHARMACY Pharmacy $1,521 $2,911 $1,854 $1,215 $7,501
ST CLARES HOSPITAL OF WESTON INC Physician Group $127 $127
SURGICAL ASSOCIATES SC Physician Group $89 $559 $648
TARGET STORE T-0364 PHARMACY Pharmacy $5,413 $6,501 $5,495 $5,745 $23,153
THE DIAGNOSTIC & TREATMENT Independent Lab $2,272 $2,825 $3,889 $3,277 $12,262
THE DIAGNOSTIC & TREATMENT CENTERPhysician Group $273 $456 $587 $1,316
TRIGS PHARMACY Pharmacy $210 $1,552 $544 $1,302 $3,607
UROLOGY SPECIALISTS OFWISCO Physician Group $55 $128 $183
UW MEDICAL FOUNDATION Physician Group $36 $36
UW MEDICAL FOUNDATION INC Physician Group $1,097 $657 $1,754
UW SYSTEM Physician Group $408 $431 $839
WAL MART PHARMACY 10 2813 Pharmacy $3,715 $6,094 $8,629 $10,527 $28,966
WALGREENS #09609 Pharmacy $5,550 $5,970 $4,265 $10,218 $26,003
WALGREENS 07009 Pharmacy $14,621 $17,626 $19,132 $22,190 $73,569
Page 41 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WAL-MART PHARMACY 10-2127 Pharmacy $6,263 $5,697 $5,704 $8,836 $26,500
YOUNGS DRUG STORE INC Pharmacy $318 $756 $196 $1,140 $2,411
Marinette ALEXANDER B MAMONOV, MD Physician $58 $58
AURORA MEDICAL GROUP INC Physician Group $2,523 $1,356 $2,422 $5,256 $11,556
AURORA PHARMACY INC Pharmacy $962 $568 $677 $616 $2,823
BAY AREA MEDICAL CENTER Pharmacy $400 $656 $893 $623 $2,572
Physician Group $239 $166 $382 $786
BAY AREA MEDICAL CENTER INC Hospital $857 $1,951 $18,096 $24,433 $45,337
Independent Lab $5,756 $3,153 $4,333 $5,271 $18,513
BELLIN HEALTH FAST CARE MARINETTEPhysician Group $24 $394 $418
CALVIN D NOGLER, MD Physician $42 $47 $94 $183
CRIVITZ MEDICAL CLINIC Rural Health Clinic $536 $220 $356 $1,249 $2,361
CRIVITZ PHARMACY Pharmacy $3,974 $6,369 $9,720 $7,148 $27,210
DERMATOLOGY ASSOCIATESOF WI Physician Group $275 $275
DIANE E ROELL, NP Nurse Practitioner $30 $30
DR JOHN P BRIODY Physician Group $547 $624 $1,171
FAMILY CARE MEDICAL Rural Health Clinic $1,032 $841 $690 $1,260 $3,823
LIONEL V KURAN, MD Physician $60 $86 $146
MARINETTE COUNTY HEALTH& HUM
Mental Health and
Substance Abuse
Services $104 $104
NORTHEAST PHARMACIES INC Pharmacy $1,939 $1,598 $1,979 $1,603 $7,119
NORTHERN LIGHTS CLINICSC Physician Group $30 $316 $346
NORTHREACH HEALTHCARE LLC Physician Group $8,291 $6,136 $4,614 $4,573 $23,614
PESHTIGO FAMILY PRACTICE Rural Health Clinic $360 $93 $173 $952 $1,578
POUND COMMUNITY MEDICALCLINI Physician Group $11 $11
ROBERT E SONNENBURG, MD Physician $12 $12
SHOPKO PHARMACY #2102 Pharmacy $6,052 $5,002 $5,288 $3,778 $20,121
VALUCARE CENTER Pharmacy $1,637 $1,446 $825 $165 $4,072
Page 42 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
VILLAGE PHARMACY INC Pharmacy $1,643 $2,696 $2,750 $2,623 $9,711
WALGREENS 07634 Pharmacy $5,467 $4,098 $7,296 $5,338 $22,198
WAL-MART PHARMACY 10-2545 Pharmacy $5,243 $5,145 $5,325 $4,009 $19,723
WAUSAUKEE HEALTH CARE Rural Health Clinic $154 $420 $370 $84 $1,029
WAUSAUKEE MEDICAL CLINIC Physician Group $485 $354 $344 $829 $2,012
WISCONSIN MICHIGAN PHYSICIAN Physician Group $96 $96
Marquette AURORA PHARMACY INC Pharmacy $602 $553 $1,155
BENTLEY PHARMACIES INC Pharmacy $161 $697 $697 $2,512 $4,067
BENTLEY PHARMACIES INC Pharmacy $942 $630 $507 $624 $2,702
CHN MEDICAL CENTER MONTELLO Physician Group $697 $629 $56 $109 $1,492
SHAHADA G SHALASH, MD Physician $145 $145
Menominee MENOMINEE TRIBAL CLINIC
Federally Qualified
Health Clinic (FQHC) $2,696 $2,560 $3,609 $10,036 $18,900
WOMENS PERSONAL HEALTHPROGR Family Planning Clinic $194 $84 $278
Michigan AFTER HOURS CLINIC Rural Health Clinic $26 $30 $81 $305 $442
CHARLES N IKNAYAN, MD Physician $22 $22
CVS PHARMACY#08549 Pharmacy $147 $464 $415 $579 $1,605
DANIEL J MCMAHON, MD Physician $103 $103
DCHS ORTHOPEDICS Physician Group $55 $55
DICKINSON COMEMORIAL HOSP Hospital $59 $224 $1,919 $253 $2,456
DICKINSON COUNTY HEALTHCARE Physician Group $102 $221 $322
DICKINSON OB/GYN CLINIC Physician Group $62 $1,402 $877 $2,341
DR HAROLD P CRISSINGER&DR Rural Health Clinic $137 $42 $178
DR RAY H CAMERON Physician Group $30 $30
ELLEN E VANLAANEN, DO Physician $30 $30
ESSENTIA HEALTH IRONWOOD CLINIC Physician Group $105 $105
FMC IRON MOUNTAIN 115 Physician Group $145 $145
FMC KINGSFORD Physician Group $30 $30
FMC NORWAY Physician Group $59 $59
Page 43 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
GRAND VIEW CLINIC Physician Group $2,534 $1,989 $692 $2,843 $8,057
GRAND VIEW HEALTH SYSTEM Physician Group $191 $191
GRAND VIEW HOSPITAL Hospital $122 $520 $364 $64 $1,071
HAROLD P CRISSINGER, MD Physician $11 $11
HENKE & RYAN, P C Rural Health Clinic $338 $87 $52 $476
JAMES A BATTI, MD Physician $60 $60
JOHN GROENEVELD, MD Physician $128 $78 $206
JOHN M COOK, MD Physician $42 $113 $155
JOSEPH T DONOHUE, MD Physician $79 $79
K MART PHARMACY #3832 Pharmacy $636 $21 $251 $907
K MART PHARMACY #3833 Pharmacy $779 $1,151 $1,722 $210 $3,862
K MART PHARMACY 7031 Pharmacy $115 $324 $792 $441 $1,673
KINGSFORD FAMILY PRACTICE CL Rural Health Clinic $91 $50 $97 $91 $328
MARQUETTE GENERAL HOSPITAL Hospital $484 $117 $601
MI WI FAMILYPRACTICE ASSOC Rural Health Clinic $73 $308 $88 $518 $986
MICHELLE E DUNCAN, MD Physician $122 $122
NILAR SHEIN, MD Physician $47 $94 $142
NORTHERN MENOMINEE HEALTH CE
Federally Qualified
Health Clinic (FQHC) $79 $165 $244
NORTHSTAR HEALTH SYSTEM Hospital $22 $22
OSCO DRUG#5086 Pharmacy $261 $261
PATTI L PETERSON, MD Physician $47 $47
PUBLIC HEALTH DELTA & MENOMI Family Planning Clinic $2,129 $4,937 $640 $7,707
RADIOLOGY ASC OF IRON MOUNTA Physician Group $12 $12
RICHARD E BRUNER, DO Physician $57 $55 $112
SHOPKO PHARMACY #2011 Pharmacy $709 $334 $296 $395 $1,735
STEPHEN C SLAJUS, DO Physician $55 $55
TERENCE D RYAN, MD Physician $111 $111
TERRY L STEEGE, NP Nurse Practitioner $58 $58
Page 44 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
THE DRUG STORE OF IRON MOUNTAIN Pharmacy $838 $1,039 $998 $877 $3,752
THE MEDICINESHOPPE 1263 Pharmacy $177 $177
WALGREENS #11953 Pharmacy $183 $304 $486
WALGREENS #11954 Pharmacy $28 $338 $367
WAL-MART PHARMACY 10-2434 Pharmacy $2,933 $1,590 $4,432 $3,982 $12,937
WAL-MART PHARMACY 10-5444 Pharmacy $276 $613 $889
Milwaukee M M C SUNDARAM, MD Physician $30 $30
A2CL SERVICES LLC Independent Lab $12,582 $30,277 $55,066 $126,052 $223,977
AARON C BODNER, MD Physician $57 $57
ABALO NUNYAKPE, MD Physician $95 $95
ACL SERVICESINC Independent Lab $18,849 $18,849
ADVANCED HEALTHCARE SC Physician Group $8,771 $3,018 $11,789
ADVANCED PAIN MANAGEMENT Physician Group $169 $1,840 $8,340 $10,349
AFFILIATED INFECTIOUS DISEASE CONSULTANTS OF WIPhysician Group $42 $42
AIDS RESOURCECENTER OF Physician Group $94 $1,249 $48 $1,391
ALEJANDRO M VINLUAN, MD Physician $69 $69
ALEXANDER A ROMASHKO, MD Physician $55 $55
ALEXANDER T HAWKINS, MD Physician $30 $30
ALFREDO C MILLAN MD SC Physician Group $1,731 $1,211 $56 $2,997
ALFREDO C MILLAN, MD Physician $60 $60
ALL NIGHT TRANSPORT INC Transportation $22 $22
ALLEN H BABBITZ, MD Physician $78 $78
ALLERGY & ASTHMA CLINIC OF W Physician Group $92 $57 $109 $327 $586
ALLERGY RESEARCH AND CARE SC Physician Group $30 $30
ALLIANCE ENTAND HEARING CEN Physician Group $30 $61 $91
ALLISON M RING, MD Physician $55 $55
ALVARO ALEMAN, MD Physician $36 $36
ALVIN F WELLS, MD Physician $148 $148
AMANI A MAGUID, MD Physician $66 $66
Page 45 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
AMERIPATH MILWAUKEE SC Physician Group $1,006 $1,605 $516 $1,060 $4,187
ANESTHESIA ASSOCIATES OF WI RAPIDS SCPhysician Group $184 $184
ANTHONY A FERGUSON MD SC Physician Group $134 $86 $220
ARRHYTHMIA CENTER FOR Physician Group $30 $30
ARTHUR A ARENA, MD Physician $829 $96 $44 $803 $1,772
ASMC PHARMACY Pharmacy $874 $1,623 $2,174 $3,178 $7,848
ASPEN ORTHOPAEDIC & REHAB Physician Group $44 $44
ASSISTED LIVING PHARMACY SER Pharmacy $35 $35
ASSOCIATED OBSTETRICIANS Physician Group $139 $70 $209
ASSOCIATION OF ORTHOPEDIC Physician Group $167 $89 $256
ATHLENE A ALEXIS, MD Physician $158 $158
AURORA ADVANCED HEALTHCARE I Physician Group $2,347 $11,914 $56,190 $70,452
AURORA HEALTH CARE INC Physician Group $409 $1,017 $2,091 $3,517
AURORA HEALTH CARE METRO INC Hospital $3,123 $12,918 $140,204 $47,983 $204,229
Physician Group $8,711 $10,008 $4,286 $41,143 $64,149
AURORA HEALTH CENTER Physician Group $974 $974
AURORA MEDICAL GROUP Physician Group $973 $354 $1,592 $7,243 $10,162
AURORA MEDICAL GROUP ALTERNA Physician Group $332 $329 $494 $1,155
AURORA MEDICAL GROUP ANESTHESIOLOGYPhysician Group $427 $427
AURORA MEDICAL GROUP FRANKLI Physician Group $295 $146 $801 $1,242
AURORA MEDICAL GROUP INC Physician Group $638 $958 $1,596
AURORA MEDICAL GROUP METRO Physician Group $1,594 $1,594
AURORA MEDICAL GROUP MILWAUKEEPhysician Group $5,239 $4,002 $3,913 $11,577 $24,731
AURORA MEDICAL GROUP WOMENS PAVILIONPhysician Group $436 $138 $674 $5,797 $7,045
AURORA PHARMACY INC Pharmacy $17,683 $17,984 $22,540 $32,918 $91,125
AURORA SINAI MEDICAL CENTER Audiologist $48 $48
AURORA ST LUKES FAMILYPRACT Physician Group $343 $181 $3,696 $4,219
AURORA ST LUKES FRANKLIN Physician Group $12 $167 $786 $965
AURORA ST LUKES MEDICAL CENT Audiologist $157 $157
Page 46 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
Physician Group $48 $48
AURORA ST LUKES MEDICAL CTR Hospital $5,483 $8,396 $97,722 $68,720 $180,321
AURORA UW MIDWIFERY CENTER Physician Group $367 $893 $337 $1,597
AURORA WEST ALLIS MEDICAL CE Hospital $848 $4,470 $30,350 $13,633 $49,301
AURORA WISELIVES CLINIC Physician Group $317 $87 $928 $1,331
BABBITZ BURSTEIN AND NASH Physician Group $77 $77
BARRY K GIMBEL MD SC Physician Group $111 $111
BAYLON FAMILY PHYSICIANS LTD Physician Group $2,537 $5,023 $4,279 $8,291 $20,131
BEHAVIORAL HEALTH PHARMACY Pharmacy $28 $28
BEHAVIORAL HEALTH SERVICES
Mental Health and
Substance Abuse
Services $631 $631
BELLIN ANESTHESIA ASSOCIATES SC Physician Group $270 $270
BIOSCRIP PHARMACY INC Pharmacy $245 $870 $1,115
BORKOWF AND BORKOVEC MD SC Physician Group $20 $20
BURLEIGH PHARMACY INC Pharmacy $342 $229 $80 $1,044 $1,695
C M M SUNDARAM MD SC Physician Group $30 $61 $91
CARDIAC RHYTHM SPECIALISTS Physician Group $48 $43 $91
CARDIOTHORACIC SURGERYGROUP Physician Group $48 $48
CARLOS C TAN, MD Physician $22 $22 $44
CARLOS J RODRIGUEZ, MD Physician $120 $120
CARMEN L TERLIZZI III, MD Physician $57 $114 $171
CAROLINA G CONTI MD SC Physician Group $1,261 $846 $650 $1,585 $4,342
CARTER DRUG STORE INC Pharmacy $28 $274 $303
CENTER FOR DIAGNOSTIC IMAGING Physician Group $36 $36
CENTER FOR NEUROLOGICAL DISORDERSPhysician Group $154 $164 $100 $419
CENTER FOR PAIN MANAGEMENT Physician Group $78 $681 $2,010 $2,769
CESARZ NASSIF AND ASSOCIATES Physician Group $37 $37
CHA LEE, MD Physician $79 $118 $230 $427
Page 47 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CHARLES A SCHMITT, MD Physician $176 $176
CHILDRENS HEALTH SYSTEM Physician Group $97 $94 $126 $317
CHILDRENS HOSPITAL OF WI Physician Group $397 $538 $935
CHILDRENS HOSPITAL OF WISCON Hospital $409 $2,644 $12,091 $30,540 $45,683
CHILDRENS MEDICAL GROUP Physician Group $22 $22
CHRIS T WALDO, MD Physician $598 $598
CHRISTINE E KEATING, DO Physician $39 $39
CHRISTINE R BRYKE, MD Physician $48 $48
CITY OF MILWAUKEE HEALTH Independent Lab $50,455 $29,258 $79,714
CLAY J FRANK, MD Physician $55 $55
CLINIC LATINA Physician Group $1,133 $113 $207 $1,055 $2,509
CLINIC OF OBSTETRICS & Physician Group $55 $22 $60 $137
CLINIC OF UROLOGY Physician Group $30 $177 $207
COLUMBIA CENTER INC Hospital $1,112 $423 $1,535
COLUMBIA ST MARYS Hospital $3,252 $3,252
COLUMBIA ST MARYS COLUMBIA C Independent Lab $389 $4,603 $3,611 $8,603
COLUMBIA ST MARYS HOSPITAL Hospital $16,644 $30,766 $143,255 $107,408 $298,072
COMMONWEALTHMEDICAL GROUP Physician Group $237 $170 $136 $543
COMMUNITY OPTIONS FOR RECOVE
Mental Health and
Substance Abuse
Services $101 $101
COMPASSIONATE DOCTORS INC Physician Group $55 $55
COMPREHENSIVECARDIOVASCULAR Physician Group $47 $95 $142
CRAIG A REICH, MD Physician $112 $30 $142
CSM HOSPITAL MILWAUKEE Physician Group $6,923 $7,416 $3,866 $49,615 $67,821
CURTIS A CRIMMINS, MD Physician $91 $91
CVS PHARMACY# 05390 Pharmacy $987 $987
CVS PHARMACY#01267 Pharmacy $218 $383 $924 $1,524
CVS PHARMACY#03394 Pharmacy $617 $1,079 $1,696
Page 48 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CVS PHARMACY#08762 Pharmacy $1,769 $2,043 $289 $1,020 $5,122
CVS PHARMACY#08763 Pharmacy $1,253 $2,025 $2,965 $4,739 $10,982
CVS PHARMACY#08765 Pharmacy $1,665 $537 $2,201
CVS PHARMACY#08766 Pharmacy $1,006 $2,356 $1,566 $405 $5,333
CVS PHARMACY#08767 Pharmacy $493 $698 $475 $1,199 $2,865
CVS PHARMACY#08768 Pharmacy $366 $553 $31 $3,094 $4,044
CVS PHARMACY#08769 Pharmacy $760 $1,921 $4,760 $5,341 $12,782
CVS PHARMACY#08770 Pharmacy $44 $250 $128 $814 $1,236
CVS PHARMACY#08771 Pharmacy $226 $328 $1,924 $1,183 $3,661
CVS PHARMACY#08772 Pharmacy $211 $359 $265 $835
CVS PHARMACY#08773 Pharmacy $1,768 $2,324 $4,601 $2,479 $11,172
CZARINA A HELF, MD Physician $57 $57
DAN FITZGERALD PHARMACY INC Pharmacy $56 $28 $431 $515
DANIEL H ROSLER, MD Physician $143 $143
DAVID ABELSON MD SC Physician Group $1,771 $36 $1,807
DAVID ABELSON, MD Physician $512 $512
DAVID E AMOS, MD Physician $47 $47 $334 $78 $506
DAVID G KAMPER, MD Physician $60 $60
DAVID J SIVERHUS, MD Physician $55 $141 $196
DAVID S HASKELL, MD Physician $174 $174
DAVID W OLSON, MD Physician $30 $464 $494
DEMATTIA MEDICAL GROUPLLC Physician Group $61 $61
DENTAL ASSOCIATES FOX VALLEY Dentist $712 $1,537 $2,248
DEPENDABLE CARE TRANSPORT Transportation $75 $75
DERMATOLOGY SERVICES SC Physician Group $81 $81
DEVANG V GANDHI, MD Physician $36 $94 $130
DONALD J BACCUS, MD Physician $82 $82
DONALD K MIDDLETON MD SC Physician Group $22 $111 $133
DONNA PITTER, MD Physician $39 $67 $106
Page 49 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
DRS KHAN & ALMAS Physician Group $4,217 $2,361 $5,405 $7,513 $19,496
EDITH A MCFADDEN, MD Physician $30 $139 $169
EDWARD J ROSENTHAL, MD Physician $58 $48 $48 $154
EMERGENCY MEDICINE SPECIALISTS Physician Group $272 $272
EMMANUEL S MANUEL MD, MD Physician $48 $48
ENT ASSOCIATES SC Physician Group $10 $10
ENT SPECIALISTS OF MILWAUKEE Physician Group $55 $55
EPILEPSY & SEIZURE CARE SPEC Physician Group $278 $278
ERMED SC Physician Group $31 $31
EVAN K SAUNDERS MD SC Physician Group $228 $47 $275
EYE CARE SPECIALISTS SC Physician Group $47 $55 $516 $1,109 $1,727
FAMILY DOCTORS SC Physician Group $30 $209 $239
FAMILY MEDICINE ASSOCIA Physician Group $87 $87
FAMILY PRACTICE CLINICOF MAY Physician Group $794 $794
FROEDTERT CLINIC PHARMACY Pharmacy $16 $12 $23 $51
FROEDTERT HOSP OUTPAT PHARMA Pharmacy $43 $43 $86
FROEDTERT HOSPITAL Hospital $13,579 $11,524 $242,748 $192,992 $460,843
GARY S HAUKE, MD Physician $751 $751
GEOFFREY NKWAZI, MD Physician $267 $281 $547
GEORGE V CHANDY, MD Physician $114 $94 $207
GERALD L IGNACE INDIAN
Federally Qualified
Health Clinic (FQHC) $72 $30 $364 $909 $1,375
GI ASSOCIATES LLC Physician Group $585 $2,511 $3,096
GOKAY CARE TRANSPORT Transportation $22 $22
GOODS TRANSPORTATION INC Transportation $65 $65
GORAN T RUDIC MD SC Physician Group $136 $72 $208
GOUHAR Y KHAN, MD Physician $1,212 $1,175 $2,387
GREAT LAKES Physician Group $5,563 $3,418 $7,763 $14,660 $31,404
GREAT LAKES NEUROSURGICAL Physician Group $47 $47
Page 50 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
GREATER MILWAUKEE OTOLARYNGOLOGY LLCPhysician Group $61 $444 $505
GREATER MILWAUKEE PLASTIC SU Physician Group $78 $78
GREATER MILWAUKEE SURGICAL Physician Group $30 $30
HAKJOONG KIM, MD Physician $48 $143 $191
HAROLD K RICHES, DO Physician $91 $91
HEALTH CARE FOR THE HOMELESS
Federally Qualified
Health Clinic (FQHC) $912 $297 $2,000 $2,125 $5,334
HEART & VASCULAR SPECIALISTS Physician Group $30 $30
HEART CARE ASSOC Physician Group $120 $120
HISPANIC MEDICAL CENTER Physician Group $145 $145
HLS MEDICAL SERVICES SC Physician Group $407 $491 $1,528 $1,328 $3,753
HYPERBARIC & WOUND CARE ASSOCIATESPhysician Group $71 $71
INFECTIOUS DISEASE SPECIALISTS OF SE WI SCPhysician Group $61 $61
INNOVATIVE PAIN CARE LLC Physician Group $55 $55
ISAAC COGGS HERITAGE HEALTH Pharmacy $1,535 $2,578 $4,112
JAMES ETHINGTON, MD Physician $58 $58
JAMES H BARNETT, MD Physician $99 $99
JAMES H LANGENKAMP, MD Physician $87 $87
JANINE JAMES, MD Physician $167 $48 $214
JAVIER A RINCON, MD Physician $30 $30
JAWAD H KHAN MD SC Physician Group $95 $359 $454
JEFFREY J ANDEREGG, MD Physician $176 $176
JEREMIAS B VINLUAN, MD Physician $1,019 $1,547 $682 $1,733 $4,980
JEWEL OSCO 3618 Pharmacy $475 $475
JOCELYN K EICHE, MD Physician $57 $57
JOHN A ALBERT, MD Physician $51 $93 $63 $207
JOHN C ROGERS, MD Physician $47 $30 $835 $912
JOHN D SUSON, MD Physician $37 $37
JOHN E DANIELS MD SC Physician Group $22 $22
Page 51 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
JOHN J BRENNAN, MD Physician $130 $243 $373
JOSELITO A BAYLON, MD Physician $48 $48
JOSEPH P HERZOG, MD Physician $100 $100
JOSEPH S KOSTRZEWSKI DO SC Physician Group $306 $306
JOSEPH S KOSTRZEWSKI, DO Physician $73 $429 $502
K MART PHARMACY 4395 Pharmacy $13 $338 $351
K MART PHARMACY 3182 Pharmacy $132 $132
K MART PHARMACY 3618 Pharmacy $1,737 $1,737
K MART PHARMACY 4380 Pharmacy $13 $31 $44
K MART PHARMACY 4385 Pharmacy $54 $131 $358 $543
KAREN S WATSON, MD Physician $57 $57
KARIM BAKHTIAR MD SC Physician Group $745 $745
KATHLEEN M TREBIAN, MD Physician $57 $58 $114
KATZOFF RIHAWI SC Physician Group $47 $30 $450 $528
KENNETH D DEMBNY, MD Physician $55 $55
KENNETH S SCHER, MD Physician $108 $108
KEVIN A WEIDMAN, MD Physician $30 $455 $411 $896
KHAN MEDICAL ASSOCIATES SC Physician Group $87 $1,130 $1,217
KHIZZAR SHAUKAT, MD Physician $57 $57
KIM A HANSEN, MD Physician $55 $55
KUMAR V IYER, DDS Dentist $640 $640
KURT R OELKE, MD Physician $172 $47 $22 $240
LAABS INC Pharmacy $141 $12 $105 $259
LABOTTS PHARMACY Pharmacy $46 $46
LAKESHORE MEDICAL CLINIC Physician Group $5,370 $2,397 $4,147 $23,251 $35,166
LATHA RAJA SHANKAR, MD Physician $22 $22
LAWRENCE A STERKIN, MD Physician $79 $79
LAYTON AVENUE DERMATOLOGY Physician Group $177 $689 $866
LEE MEDICAL CLINIC SC Physician Group $58 $58
Page 52 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
LEONARDO APONTE, MD Physician $97 $97
LEWIS CHAMOY, MD Physician $55 $55
LINCOLN HEALTH CENTER Physician Group $905 $219 $1,125
LUCINDA K FENSKE MD SC Physician Group $466 $466
LUCINDA K FENSKE, MD Physician $30 $30
LUTFI T TOMBULOGLU, MD Physician $378 $1,487 $1,865
LUZ STELL MORENO, MD Physician $57 $421 $477
M R SETHI MDSC Physician Group $461 $657 $2,866 $3,984
MADHAVI A PAREKH, MD Physician $87 $22 $109
MADISON MEDICAL AFFILIATES Physician Group $34 $91 $192 $3,918 $4,233
MALA THENAPPAN, MD Physician $55 $55
MAQBOOL ARSHAD, MD Physician $30 $61 $91
MAQSOOD AHMAD, MD Physician $60 $60 $90 $210
MARK E HODGSON, MD Physician $171 $171
MARNI K HEBERT, NP Nurse Practitioner $186 $88 $273
MARQUETTE NEIGHBORHOOD HEALTH CENTERNurse Practitioner $36 $697 $1,408 $4,150 $6,292
MARTIN E SAMUEL, MD Physician $109 $109
MARVIN E SATTLER, MD Physician $61 $61
MASROOR MUNIM, MD Physician $235 $235
MATTHEW B LEE, MD Physician $98 $98
MAURICIO TOVAR, MD Physician $109 $30 $546 $686
MCMC RADIOLOGY LLC Physician Group $36 $140 $175
MCMC URGICARE LLC Physician Group $449 $219 $877 $1,244 $2,790
MCW DEPARTMENT OF PSYCHIATRY
Mental Health and
Substance Abuse
Services $336 $336
MEDICAL CONSULTANTS Physician Group $48 $347 $394
MEDICAL DIAGNOSTIC IMAGING Physician Group $36 $36
MEDICAL MANAGEMENT ASSO Physician Group $808 $368 $152 $1,358 $2,686
Page 53 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MEDPOINT FAMILY CARE CENTER Physician Group $751 $171 $3,673 $2,062 $6,658
MEDPOINT PHARMACY INC Pharmacy $111 $256 $367
METRO NEUROSURGICAL SC Physician Group $348 $348
METROPOLITAN ANESTHESIOLOGISTS SCPhysician Group $295 $295
MICHAEL A DIDION, DO Physician $211 $211
MICHAEL H GILMAN DO SC Physician Group $469 $469 $938
MICHAEL J HAFRAN, MD Physician $30 $30
MICHAEL J KUHN JR, MD Physician $252 $252
MICHAEL N KATZOFF, MD Physician $47 $47
MIDWEST ANESTHESIA CONSULTAN Physician Group $55 $203 $259
MIDWEST AREA PHYSICIANS LLC Physician Group $1,086 $1,086
MIDWEST COMPREHENSIVE PAIN Physician Group $97 $79 $176
MIDWEST NEPHROLOGY ASSOCIATES Physician Group $47 $398 $687 $1,132
MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL,LLCHospital $3,430 $3,430
MIDWEST URGENT MEDICALSERVIC Physician Group $195 $154 $350
MILWAUKEE CARDIAC CARE LLC Physician Group $242 $242 $485
MILWAUKEE CLINIC OF ORTHOPEDIC SURGPhysician Group $30 $22 $52
MILWAUKEE COBEHAVIORAL
Institution for Mental
Disease $3,247 $464 $1,220 $4,931
MILWAUKEE EYECARE ASSOCIATES Optometrist $141 $141
MILWAUKEE HEALTH SERVICES
Federally Qualified
Health Clinic (FQHC) $7,888 $6,313 $31,433 $75,164 $120,798
Physician Group $804 $1,796 $506 $3,106
MILWAUKEE IMMEDIATE CARE CENTERPhysician Group $1,014 $117 $655 $1,785
MILWAUKEE INTERNAL MEDICINE ASSOC INCPhysician Group $264 $264
MILWAUKEE MIDWEST MED BLDG Independent Lab $245 $750 $708 $653 $2,356
MILWAUKEE NEPHROLOGISTS SC Physician Group $95 $286 $381
MILWAUKEE NEUROLOGICALINSTIT Physician Group $61 $61
MILWAUKEE ORTHOPEDIC SPECIAL Physician Group $78 $78
Page 54 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MILWAUKEE PAIN TREATMENT SER Physician Group $791 $791
MILWAUKEE RADIOLOGISTS LTD SC Physician Group $257 $1,241 $1,598 $3,097
MLK HERITAGEHEALTH CENTER Pharmacy $3,678 $8,823 $12,502
MOHAMMAD E RASSOULI, MD Physician $52 $48 $100
MOHAMMED R SETHI, MD Physician $94 $94
MUHAMMAD Y KHAN, MD Physician $30 $30 $48 $108
NEAL H POLLACK, DO Physician $714 $714
NEBOJSA R STEVANOVIC, MD Physician $77 $166 $244
NEURODIAGNOSTIC CLINIC OF MILWAUKEE SCPhysician Group $108 $108
NEUROLOGY ALLIANCE SC Physician Group $270 $270
NEUROLOGY NEURODIAGNOSTIC CENTER SCPhysician Group $101 $101
NEWPORT PHARMACY Pharmacy $242 $106 $75 $422
NOEMI A PRIETO MD SC Physician Group $30 $150 $342 $522
NORMAN D BUEBENDORF, MD Physician $37 $67 $104
NORTH AVENUE FAMILY MEDICAL CENTER LLCPhysician Group $634 $634
NORTH SHORE ORTHOPAEDICS SC Physician Group $48 $48
NORTH SHORE PATHOLOGISTS Physician Group $118 $197 $1,104 $2,196 $3,614
NORTH SHORE UROLOGY SC Physician Group $22 $22
NORTHEAST OB GYN SC Physician Group $93 $93
NOVA MEDICAL CENTER LLC Physician Group $78 $48 $469 $595
OAK CREEK URGENT CARE LLC Physician Group $20 $47 $473 $847 $1,387
OAKWOOD FAMILY MEDICAL CLINIC SCPhysician Group $48 $114 $162
OLUSOJI OYESANYA, MD Physician $971 $971
OMNI FAMILY MEDICAL CLINIC Physician Group $255 $538 $2,468 $7,652 $10,912
ONCOLOGY ALLIANCE SC Physician Group $113 $483 $596
OPHTHALMOLOGY ASSOCIATES SC Physician Group $170 $170
OPTHALMOLOGYASSOCIATES SC Physician Group $116 $116
ORTHOPAEDIC ASSOCIATES OF MILWAUKEE, S.C.Physician Group $55 $22 $136 $212
ORTHOPAEDIC HOSPITAL OF WISCONSINHospital $283 $5,313 $6,753 $12,349
Page 55 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ORTHOPEDIC SURGEONS OFWISCO Physician Group $30 $472 $1,554 $2,056
OSCO DRUG #3604 Pharmacy $489 $489
OSCO DRUG #3608 Pharmacy $98 $98
OSCO DRUG #3642 Pharmacy $453 $453
OSCO DRUG #3645 Pharmacy $389 $389
OSCO DRUG #3648 Pharmacy $42 $42
OSCO DRUG #3653 Pharmacy $285 $285
OSCO DRUG #5704 Pharmacy $434 $434
OSCO DRUG #5714 Pharmacy $281 $281
OSCO DRUG #5717 Pharmacy $608 $608
OSCO DRUG #5718 Pharmacy $65 $65
OSCO DRUG #5719 Pharmacy $68 $68
OSCO DRUG #5741 Pharmacy $100 $100
OSCO DRUG #5743 Pharmacy $394 $394
OSCO DRUG#5701 Pharmacy $672 $672
OSCO DRUG#5706 Pharmacy $78 $78
OSCO DRUG#5732 Pharmacy $25 $25
PAIN MANAGEMENT & TREATMENT Physician Group $746 $523 $1,269
PAIN MANAGEMENT CENTER OF WISCONSIN,S.C.Physician Group $199 $255 $454
PAUL D BURSTEIN, MD Physician $79 $79
PEDIATRIC & ADULT MEDICINE Physician Group $412 $88 $237 $845 $1,582
PEDIATRIC DIAGNOSTIC IMAGING Physician Group $36 $36
PEDIATRIC DIAGNOSTIC IMAGING SC Physician Group $36 $36 $72
PEDIATRIC RADIOLOGIC SERVICE Physician Group $49 $25 $74
PERO G KOMOZEC, MD Physician $36 $36
PHASE II ENTERPRISES Transportation $22 $22
PICK N SAVE PHARMACY #6348 Pharmacy $3,956 $3,956
PICK N SAVE PHARMACY #6366 Pharmacy $89 $34 $135 $257
PICK N SAVE PHARMACY #6416 Pharmacy $193 $193
Page 56 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
PICK N SAVE PHARMACY #6846 Pharmacy $211 $211
PICK N SAVE PHARMACY #6847 Pharmacy $2,917 $2,917
PICK N SAVE PHARMACY #6857 Pharmacy $1,321 $1,321
PICK N SAVE PHARMACY #6862 Pharmacy $461 $461
PICK N SAVE PHARMACY #6864 Pharmacy $1,189 $1,189
PICK N SAVE PHARMACY #6873 Pharmacy $451 $451
PICK N SAVE PHARMACY #6878 Pharmacy $854 $854
PICK N SAVE PHARMACY #6879 Pharmacy $167 $813 $1,203 $418 $2,601
PICK N SAVE PHARMACY #6880 Pharmacy $209 $206 $123 $1,661 $2,200
PICK N SAVE PHARMACY #6882 Pharmacy $140 $1,448 $1,795 $1,015 $4,399
PICK N SAVE PHARMACY #6883 Pharmacy $33 $81 $17 $131
PICK N SAVE PHARMACY #6885 Pharmacy $29 $149 $222 $675 $1,076
PICK N SAVE PHARMACY 6371 Pharmacy $244 $1,060 $1,330 $629 $3,263
PICK N SAVE PHARMACY 6387 Pharmacy $999 $920 $353 $158 $2,430
PLANK ROAD RADIOLOGY Physician Group $47 $47 $94
PLANNED PARENTHOOD OF WI Family Planning Clinic $64,865 $244,258 $309,123
PLANNED PARENTHOOD OF WISC Family Planning Clinic $1,468,879 $1,039,266 $513,652 $151,378 $3,173,176
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $219,308 $182,115 $401,423
PRESCRIPTIONS PLUS GOOD VALU Pharmacy $229 $278 $507
PRIMO R TAMAYO, MD Physician $47 $47
PROCARE MEDICAL GROUP Physician Group $5,615 $5,576 $11,321 $31,859 $54,371
PROGRESSIVE COMMUNITY HEALTH CENTERS
Federally Qualified
Health Clinic (FQHC) $882 $2,646 $7,659 $13,768 $24,955
PULMONARY & CRITICAL CARE Physician Group $30 $30
PULMONARY MEDICINE CONSULTAN Physician Group $101 $101
RACHAEL L WEIDERHOLD, DO Physician $30 $58 $88
RADIOLOGY ASSOCIATES OF MILW Physician Group $35 $509 $95 $638
RADIOLOGY SPECIALISTS OF Physician Group $71 $434 $830 $1,335
RAJASHRI S MANOLI, MD Physician $78 $366 $714 $1,159
Page 57 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
RAM K MITTAL, MD Physician $101 $101
RAMON A AGOR, MD Physician $183 $89 $272
RAVI GUPTA, MD Physician $86 $86
RAYMOND W MOY MD SC Physician Group $55 $55
RENEE SINOPOLI, MD Physician $42 $42
RETINA & VITREOUS CONSULTANT Physician Group $48 $48
RHEUMATIC DISEASE Physician Group $11 $11
RICARDO R SINENSE, MD Physician $55 $55
RICHARD A STELIGA, MD Physician $55 $55
RICHARD D DAVENPORT MDAND AS Physician Group $242 $242
RICHARD N EVANS JR, MD Physician $109 $79 $189
RISING PHOENIX HEART INSTITU Physician Group $101 $101
RIVERBEND SERV U PHARMACY Pharmacy $93 $93
RIZWANULLAH ARAIN, MD Physician $1,483 $95 $1,579
ROBERT J FRITZ, MD Physician $290 $480 $526 $676 $1,972
ROESCHENS OMNICARE PHARMACY Pharmacy $100 $100
ROSEANN GUMINA, MD Physician $30 $30
SAMI A ROUMANI, MD Physician $303 $1,225 $1,528
SAMIR MULLICK MD SC Physician Group $191 $363 $468 $946 $1,967
SAM'S PHARMACY 10-6303 Pharmacy $592 $338 $873 $1,803
SAM'S PHARMACY 10-6324 Pharmacy $264 $264
SAM'S PHARMACY 10-8167 Pharmacy $132 $309 $442
SARBJEET S SANDHU, MD Physician $36 $193 $229
SEAN P KEANE, MD Physician $90 $82 $173 $345
SETON PHARMACY Pharmacy $93 $37 $356 $399 $884
SHAFI MEDICAL CENTER SC Physician Group $10,771 $9,983 $7,724 $11,419 $39,896
SHAHIDA R MUNIM, MD Physician $252 $252
SHEEBA A PANNU, MD Physician $58 $58
SHOREVIEW PEDIATRICS SC Physician Group $59 $59
Page 58 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
SIDNEY HERSZENSON, MD Physician $152 $152
SIXTEENTH STREET COMMUNITY
Federally Qualified
Health Clinic (FQHC) $2,616 $1,999 $6,161 $6,616 $17,392
SIXTEENTH STREET COMMUNITY HEALTH CENTER
Federally Qualified
Health Clinic (FQHC) $8,059 $5,303 $13,362
SKYWALK PHARMACY Pharmacy $15 $15
SOUTHEAST SURGICAL SC Physician Group $30 $61 $91
SOUTHEASTERN WI ANESTHESIOLOGY Physician Group $47 $47
SOUTHEASTERNWI INFECTIOUS Physician Group $48 $48
SOUTHSIDE PEDIATRIC ASSOCIAT Physician Group $206 $237 $78 $30 $550
SPORTS MEDICINE AND ORTHOPED Physician Group $289 $289
SRINIVAS R BRAMHADEVI, MD Physician $171 $1,395 $161 $1,727
ST MARYS HOSPITAL OZAUKEE Physician Group $12,049 $12,049
STEPHEN C HINKLE, MD Physician $48 $48
STEPHEN T BAKER, MD Physician $109 $109
STEVEN B GREENMAN, MD Physician $101 $571 $672
STEVEN H GOLDBERG, MD Physician $55 $55
SUHAS K SHELGIKAR, MD Physician $30 $30
SUMMIT ANESTHESIOLOGY LTD Physician Group $176 $326 $501
SUSAN J RIEGG, MD Physician $22 $22
SUSON EYE SPECIALISTS MD SC Physician Group $256 $256
SWAN SERV U PHARMACY Pharmacy $132 $1,056 $697 $1,885
SYED N HASNAIN, MD Physician $467 $114 $219 $799
TAHA MEDICAL CENTER SC Physician Group $412 $412
TAKE CARE HEALTH WISCONSIN SC Nurse Practitioner $1,455 $1,455
TARGET STORE T-0223 PHARMACY Pharmacy $296 $2,252 $3,322 $4,936 $10,806
TARGET STORE T-1895 PHARMACY Pharmacy $875 $1,793 $2,662 $8,079 $13,409
TARGET STORE T-1925 PHARMACY Pharmacy $344 $482 $1,321 $2,980 $5,127
TARGET STORE T-2199 PHARMACY Pharmacy $731 $416 $314 $1,545 $3,006
Page 59 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
TARGET STORE T-2388 PHARMACY Pharmacy $81 $81
TARGET STORE T-2586 PHARMACY Pharmacy $47 $460 $645 $1,152
TARGET T-0024 PHARMACY Pharmacy $523 $191 $123 $743 $1,581
TARGET T-0057 PHARMACY Pharmacy $61 $100 $53 $966 $1,180
THE BOARD OFREGENTS OF THE Family Planning Clinic $645 $1,929 $1,907 $4,971 $9,452
THE MEDICAL COLLEGE OF WISCONSIN INCPhysician Group $48,127 $35,357 $47,587 $87,727 $218,799
THE MEDICAL COLLEGE OFWI IN Family Planning Clinic $1,941 $1,078 $786 $1,301 $5,106
THE MEDICAL COLLEGE OFWISCO Family Planning Clinic $947 $230 $709 $29 $1,915
THE PHARMACYSHOPPE Pharmacy $145 $145
THE SLEEP WELLNESS INSTITUTE Physician Group $61 $408 $469
THERESA PARDOE, DO Physician $52 $52
THOMAS SLOTA, MD Physician $48 $48 $95
THOMPSON'S SERV-U PHARMACY Pharmacy $936 $605 $1,541
THULASIRAMA P RAVICHANDRAN, MD Physician $47 $101 $148
TNT TRANSIT, Transportation $800 $800
TODD J POREMSKI, MD Physician $135 $135
TODD W BURNER, MD Physician $178 $178
TOSA PHARMACY Pharmacy $170 $170
TRINH TRUONG, MD Physician $269 $269
UNION SERV U PHARMACY Pharmacy $44 $44
UNITED DYNACARE LLC Independent Lab $73,188 $77,407 $155,499 $195,393 $501,487
UNITED OCCUPATIONAL MEDICINE & WALK IN SERVICES, LPhysician Group $108 $108
URSULA STAR ADAMCZYK, MD Physician $88 $88
UWM SILVER SPRING NURSING CTR Physician Group $172 $172
VILLARD PRIMARY & SPECIALTY Physician Group $4,256 $3,132 $1,949 $5,377 $14,713
VINCENT G LUBSEY MD SC Physician Group $1,311 $478 $11,119 $4,906 $17,814
VIOLETA A SINGSON, MD Physician $68 $68
WALEED S NAJEEB, MD Physician $22 $22
WALGREENS #00016 Pharmacy $1,900 $3,518 $5,966 $6,977 $18,362
Page 60 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS #00295 Pharmacy $3,799 $3,314 $3,856 $6,862 $17,831
WALGREENS #01460 Pharmacy $859 $242 $998 $3,824 $5,923
WALGREENS #02296 Pharmacy $3,640 $3,250 $3,997 $11,472 $22,359
WALGREENS #02380 Pharmacy $1,663 $1,384 $3,046
WALGREENS #03125 Pharmacy $701 $596 $1,820 $1,101 $4,217
WALGREENS #03578 Pharmacy $3,399 $1,741 $4,507 $12,542 $22,188
WALGREENS #03616 Pharmacy $3,795 $2,411 $1,869 $6,314 $14,389
WALGREENS #04253 Pharmacy $2,201 $2,542 $4,188 $3,988 $12,920
WALGREENS #04537 Pharmacy $12,099 $14,879 $14,911 $27,482 $69,370
WALGREENS #06058 Pharmacy $5,516 $5,529 $9,735 $11,708 $32,488
WALGREENS #07809 Pharmacy $1,104 $2,950 $4,765 $7,144 $15,962
WALGREENS #09066 Pharmacy $994 $896 $2,342 $6,324 $10,556
WALGREENS #09549 Pharmacy $898 $1,355 $3,629 $6,491 $12,372
WALGREENS #10196 Pharmacy $1,139 $2,775 $2,744 $4,581 $11,239
WALGREENS #10873 Pharmacy $3,688 $5,736 $10,578 $15,271 $35,274
WALGREENS #10963 Pharmacy $1,336 $4,915 $6,252
WALGREENS #11237 Pharmacy $28 $793 $4,022 $4,842
WALGREENS #12524 Pharmacy $927 $4,442 $5,369
WALGREENS #12783 Pharmacy $3,692 $3,864 $7,600 $9,371 $24,528
WALGREENS 01942 Pharmacy $319 $1,202 $1,359 $2,778 $5,658
WALGREENS 02911 Pharmacy $799 $2,439 $2,567 $6,373 $12,177
WALGREENS 02925 Pharmacy $3,049 $2,945 $5,792 $8,441 $20,228
WALGREENS 03109 Pharmacy $2,375 $1,310 $3,342 $7,058 $14,085
WALGREENS 03394 Pharmacy $716 $1,472 $3,763 $4,886 $10,837
WALGREENS 03509 Pharmacy $1,513 $203 $2,603 $5,113 $9,432
WALGREENS 03666 Pharmacy $167 $1,195 $1,373 $3,746 $6,481
WALGREENS 03732 Pharmacy $1,029 $896 $1,774 $5,884 $9,583
WALGREENS 04095 Pharmacy $1,131 $1,147 $2,041 $4,268 $8,587
WALGREENS 04254 Pharmacy $3,852 $4,157 $2,144 $4,030 $14,183
Page 61 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS 04350 Pharmacy $3,711 $2,505 $5,412 $6,781 $18,409
WALGREENS 04471 Pharmacy $1,557 $382 $1,624 $3,677 $7,241
WALGREENS 04556 Pharmacy $346 $119 $268 $1,417 $2,150
WALGREENS 04720 Pharmacy $5,730 $3,871 $4,735 $8,845 $23,182
WALGREENS 04774 Pharmacy $1,572 $1,316 $1,236 $6,813 $10,937
WALGREENS 04827 Pharmacy $46 $157 $997 $2,007 $3,208
WALGREENS 04984 Pharmacy $1,827 $1,632 $3,788 $5,022 $12,270
WALGREENS 05231 Pharmacy $1,501 $1,516 $999 $1,652 $5,667
WALGREENS 05459 Pharmacy $663 $1,116 $576 $2,317 $4,672
WALGREENS 05601 Pharmacy $1,061 $2,819 $3,138 $6,185 $13,203
WALGREENS 05884 Pharmacy $799 $518 $1,727 $954 $3,998
WALGREENS 06020 Pharmacy $3,083 $2,247 $2,430 $5,083 $12,842
WALGREENS 07661 Pharmacy $195 $506 $1,016 $1,477 $3,194
WALGREENS 09839 Pharmacy $179 $739 $1,540 $3,125 $5,583
WALGREENS#00649 Pharmacy $1,819 $1,674 $1,717 $5,796 $11,006
WALGREENS#00665 Pharmacy $2,535 $2,893 $5,270 $5,669 $16,368
WALGREENS#01200 Pharmacy $1,371 $1,210 $2,330 $1,799 $6,710
WALGREENS#01336 Pharmacy $3,982 $2,603 $3,605 $2,232 $12,422
WALGREENS#03813 Pharmacy $9,942 $9,485 $17,618 $23,916 $60,961
WALGREENS#03882 Pharmacy $1,513 $2,924 $3,085 $7,141 $14,663
WALGREENS#04887 Pharmacy $2,623 $1,419 $3,000 $5,526 $12,568
WALGREENS#07370 Pharmacy $4,717 $5,681 $7,710 $13,505 $31,613
WALGREENS#07568 Pharmacy $747 $2,671 $2,372 $2,651 $8,440
WALGREENS01652 Pharmacy $2,028 $1,433 $2,783 $5,399 $11,643
WALGREENS01685 Pharmacy $6,009 $8,253 $9,343 $23,231 $46,835
WALGREENS01979 Pharmacy $1,406 $1,406
WALGREENS02182 Pharmacy $2,312 $2,941 $3,106 $5,413 $13,772
WALMART PHARMACY Pharmacy $3,758 $2,861 $2,414 $7,860 $16,892
WAL-MART PHARMACY 10-1394 Pharmacy $1,244 $1,999 $2,635 $5,877
Page 62 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WAL-MART PHARMACY 10-1551 Pharmacy $413 $215 $378 $928 $1,935
WAL-MART PHARMACY 10-2828 Pharmacy $47 $146 $531 $738 $1,463
WAL-MART PHARMACY 10-2936 Pharmacy $77 $477 $1,683 $2,537 $4,775
WAL-MART PHARMACY 10-3496 Pharmacy $195 $937 $1,769 $4,505 $7,406
WALTER A FUHR, MD Physician $58 $58
WALTER BRUMMUND, MD Physician $109 $30 $140
WALTER I MELNYCZENKO, MD Physician $47 $77 $279 $568 $971
WALTER K T WONG, MD Physician $286 $286
WATERTOWER PAIN CONSULTANTS SC Physician Group $78 $78
WAUWATOSA CHILDRENS CLINIC Physician Group $91 $91
WEST ALLIS ORTHOPEDIC CLINIC Physician Group $44 $44
WHEATON FRANCISCAN HEALTHCARE FRANKLIN, INC.Hospital $1,405 $22,945 $24,351
WHEATON FRANCISCAN HEALTHCARE ST FRANCIS INCHospital $376 $786 $52,513 $83,057 $136,731
WHEATON FRANCISCAN HELATHCAR Hospital $145 $30,887 $31,031
WHEATON FRANCISCAN INC - ST JOSEPHHospital $2,909 $10,678 $173,217 $225,692 $412,495
WHEATON FRANCISCAN LABORATOR Independent Lab $4,283 $527 $4,278 $22,065 $31,153
WHEATON FRANCISCAN MEDICAL Physician Group $7,807 $29,467 $45,069 $116,034 $198,378
WHEATON FRANCISCAN PHARMACY Pharmacy $537 $1,048 $530 $627 $2,741
WHEATON FRANCISCAN-THE WISCONSIN HEART HOSPITALHospital $2,540 $2,057 $4,597
WILKES VILLAGE PHARMACY Pharmacy $13 $13 $26
WILLIAM T MCCULLOUGH, MD Physician $30 $30
WISCONSIN AVE MED CLINIC SC Physician Group $412 $412
WISCONSIN BONE & JOINTSC Physician Group $110 $183 $243 $375 $910
WISCONSIN NEUROLOGY CLINIC LLC Physician Group $780 $780
WISCONSIN SURGERY CENTER LLC
Ambulatory Surgical
Center (ASC) $1,447 $1,447
WOMENS CARE CENTER S C Physician Group $259 $295 $555
Minnesota ABBOTT NORTHWESTERN HOSPITAL Hospital $262 $65 $327
ALLINA MEDICAL CLINIC Physician Group $503 $715 $1,217
Page 63 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ALLINA MEDICAL CLINIC HASTIN Physician Group $143 $219 $253 $615
BRIDGET P BAHNEMAN, CNM Nurse Practitioner $30 $30
CENTRAL REGIONAL PATHOLOGY Independent Lab $1,816 $1,946 $770 $1,575 $6,107
CHILDRENS HOSPITALS & CLINIC Physician Group $12 $12
CHILDRENS RESPIRATORY & CRITICAL CARE SPECIALISTSPhysician Group $48 $48
CONSULTING RADIOLOGISTS LTD Physician Group $25 $136 $241 $401
CORNER MEDICAL CENTER PHARMACYPharmacy $22 $76 $99
DC WEST Physician Group $772 $694 $363 $666 $2,495
DENFELD MEDICAL CENTER Physician Group $30 $30
DULUTH CLINIC HERMANTOWN Physician Group $27 $108 $136
DULUTH CLINIC LAKESIDE Physician Group $58 $58 $115
DULUTH CLINIC LTD Physician Group $10,032 $11,808 $11,796 $13,874 $47,510
DULUTH CLINIC PHARMACY Pharmacy $1,314 $513 $700 $815 $3,343
DULUTH CLINICHERMANTOWNPHARM Pharmacy $135 $135
DULUTH CLINICWEST PHARM Pharmacy $121 $210 $180 $511
DULUTH FAMILY PRACTICECENTE Physician Group $155 $155
ECONOFOODS PHARMACY #328 Pharmacy $125 $125
ESSENTIA HEALTH DULUTH Hospital $3,359 $1,822 $2,054 $7,234
ESSENTIA HEALTH ST MARYS MEDICAL CENTERHospital $28 $412 $1,651 $11 $2,102
FAIRVIEW ELLSWORTH CLINIC Physician Group $184 $184
FAIRVIEW LAKES REGIONAL Hospital $24 $24
FAIRVIEW RED WING HOSPITAL Hospital $11 $1,808 $1,819
FAIRVIEW REDWING HEALTH Physician Group $40 $40 $80
FAIRVIEW UNIVERSITY DISCHARGE PHARMACYPharmacy $96 $96
FAMILY MEDICINE OF WINONA PA Physician Group $86 $48 $134
FOND DU LAC CAIR PHARMACY Pharmacy $37 $332 $369
GROUP HEALTHPLAN INC Physician Group $326 $119 $27 $220 $693
HEALTHEAST MEDICAL LABORATOR Independent Lab $49 $85 $775 $909
HEALTHEAST ST JOHNS HOSPITAL Hospital $112 $112
Page 64 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
HEALTHEAST WOODWINDS HOSPITA Hospital $23 $24 $47
HENNEPIN FACULTY ASSOCIATES Physician Group $68 $68
HENRY K BONG, MD Physician $143 $143
HOSPITAL PATHOLOGY ASSOC PA Physician Group $341 $359 $22 $332 $1,053
INDEPENDENT LAB DULUTH Independent Lab $8,251 $12,891 $19,277 $24,921 $65,340
JULIE S CRONK, MD Physician $54 $54
KMART PHARMACY 7214 Pharmacy $396 $733 $1,129
LABORATORY MEDICINE SPECIALI Physician Group $551 $787 $928 $1,531 $3,798
LAKE SUPERIOR COMMUNITY HLTH
Federally Qualified
Health Clinic (FQHC) $147 $448 $260 $324 $1,179
LAKEVIEW COMMUNITY PHARMACY Pharmacy $107 $107
LAKEVIEW HOSPITAL PHARMACY Pharmacy $682 $646 $608 $1,936
LAKEVIEW MEMORIAL HOSPITAL Hospital $12 $51 $140 $39 $243
LCM PATHOLOGISTS PC Independent Lab $1,772 $28 $1,800
MAYO CLINIC Physician Group $60 $213 $108 $1,692 $2,073
MAYO CLINIC HEALTH SYSTEM LAKE CITY-WABASHA CLINICPhysician Group $122 $193 $219 $305 $839
MAYO CLINIC PHARMACY Pharmacy $192 $192
MAYO CLINIC PHARMACY BALDWIN Pharmacy $46 $46
MAYO CLINIC PHARMACY EISENBE Pharmacy $115 $115
MAYO CLINIC PHARMACY NORTHWE Pharmacy $96 $96
MAYO MEDICALLABORATORIES Independent Lab $2,359 $2,110 $2,944 $2,038 $9,451
MEDTOX LABORATORIES INC Independent Lab $196 $771 $967
METROPOLITAN UROLOGIC SPECIALISTS, P.A.Physician Group $30 $41 $71
MIDWEST SPINE INSTITUTE Physician Group $139 $123 $30 $292
MILLER CREEK MEDICAL CLINIC Physician Group $225 $225
MINNESOTA ONCOLOGY HEMATOLOGY PAPhysician Group $47 $88 $136
NADEEM IQBAL, MD Physician $77 $77
NORTHLAND FAMILY PHYSICIANS Physician Group $30 $30
NORTHLAND NEUROLOGY & MYOLOG Physician Group $30 $30
Page 65 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
NORTHLAND OBGYN ASSOC PA Physician Group $1,545 $1,205 $2,364 $3,891 $9,006
ORTHOPAEDIC ASSC OF DULUTH Physician Group $164 $164
PARK NICOLLET METHODIST HOSP Hospital $120 $120
PARKVIEW PHARMACY Pharmacy $257 $257
PETER F BORNSTEIN, MD Physician $48 $48
PHILLIPS EYE INSTITUTE Hospital $368 $368
PS RUDIE MD AND ASSOCIATES Physician Group $135 $86 $220
PS RUDIE MEDICAL CLINIC Physician Group $30 $672 $703
QUEST DIAGNOSTICS LLC IL Independent Lab $2,012 $2,335 $3,038 $2,980 $10,366
RADIOLOGISTS ASSOC IN DULUTH Physician Group $104 $280 $384
RED WING CORNER DRUG Pharmacy $564 $564
REDPHARM DRUG INC Pharmacy $255 $148 $353 $689 $1,445
REGINA MEDICAL CENTER Hospital $29 $672 $701
REGINA MEDICAL GROUP Physician Group $217 $176 $393
REGIONS HOSPITAL Hospital $166 $166
RIVER FALLS AREA HOSPITAL Independent Lab $43 $43
ROBERT O HILDEBRANDT, MD Physician $85 $85
ROCHESTER METHODIST HOSP Hospital $66 $66
SHOPKO PHARMACY #2114 Pharmacy $214 $897 $551 $1,662
ST CROIX ORTHOPAEDICS PA Physician Group $69 $30 $61 $192 $352
ST ELIZABETHHOSPITAL Hospital $82 $82
ST LUKES ANESTHESIA ASSOCIATES Physician Group $94 $94
ST LUKES CARDIOLOGY ASSOCIATES Physician Group $48 $48
ST LUKES DERMATOLOGY ASSOCIATESPhysician Group $136 $136
ST LUKES EMERGENCY SERVICES Physician Group $22 $22 $43
ST LUKES ENDOCRINOLOGY ASSOCIATESPhysician Group $152 $152
ST LUKES GASTROENTEROLOGY ASSOCIATESPhysician Group $79 $48 $127
ST LUKES HOSPITAL Hospital $76 $4,702 $3,149 $325 $8,253
ST LUKES HOSPITAL CRNA Anesthetist $202 $105 $308
Page 66 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ST LUKES HOSPITAL OF DULUTH Independent Lab $2,433 $2,972 $2,181 $4,881 $12,467
ST LUKES INTERNAL MEDICINE ASSOCIATESPhysician Group $30 $30 $60
ST LUKES RHEUMATOLOGY ASSOCIATESPhysician Group $27 $30 $57
ST LUKES URGENT CARE Physician Group $838 $946 $363 $776 $2,922
ST MARYS HOSPITAL Hospital $12 $27 $39
ST PAUL RADIOLOGY PA Physician Group $273 $243 $516
STILLWATER MEDICAL GROUP Physician Group $1,027 $627 $2,957 $2,098 $6,710
SUBURBAN RADIOLOGIC CONSULTA Physician Group $12 $12
TARGET STORE T-0004 PHARMACY Pharmacy $508 $218 $725
TARGET STORE T-0931 PHARMACY Pharmacy $127 $905 $1,586 $1,371 $3,990
TARGET STORE T-1096 PHARMACY Pharmacy $90 $63 $132 $285
TARGET STORE T-1522 PHARMACY Pharmacy $799 $799
THE CHILDRENS HEART CLINIC Physician Group $47 $47
THOMAS A WEBER, MD Physician $22 $22
THREE RIVERSPATHOLOGYPA Physician Group $5,418 $3,696 $1,888 $1,248 $12,250
THRIFTY WHITE DRUG #726 Pharmacy $177 $177
TWIN CITIES DERMATOPATHOLOGY Independent Lab $130 $130
UNITED HOSPITALS INCORPORATE Hospital $160 $160
UNIVERSITY OF MINNESOTA MEDI Hospital $12 $196 $207
UNIVERSITY OFMINNESOTAPHYSIC Physician Group $222 $222
WABASHA PHARMACY Pharmacy $178 $1,504 $58 $1,739
WAL MART PHARMACY 10 1971 Pharmacy $163 $163
WAL MART PHARMACY 10 2367 Pharmacy $393 $13 $406
WALGREENS #02784 Pharmacy $166 $146 $312
WALGREENS #11834 Pharmacy $28 $28
WALGREENS 05048 Pharmacy $455 $226 $313 $76 $1,069
WALGREENS 06916 Pharmacy $386 $1,749 $1,241 $3,376
WALGREENS 07126 Pharmacy $258 $279 $537
WALGREENS 07727 Pharmacy $1,696 $1,926 $1,966 $1,288 $6,876
Page 67 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WAL-MART PHARMACY 10-1472 Pharmacy $377 $377
WAL-MART PHARMACY 10-1861 Pharmacy $211 $435 $114 $761
WAL-MART PHARMACY 10-2643 Pharmacy $768 $768
WAL-MART PHARMACY 10-5397 Pharmacy $821 $821
WILLIAM K SCHWARTAU, MD Physician $12 $12
WINONA CLINIC LTD Physician Group $111 $142 $254
WINONA CLINIC PHARMACY Pharmacy $346 $413 $759
WINONA HEALTH SERVICES Hospital $50 $436 $486
Physician Group $60 $226 $286
Monroe GUNDERSEN CLINIC LTD Physician Group $1,820 $1,164 $1,853 $36 $4,873
JACKSON DRUGCO INC Pharmacy $473 $473
JOEL D ERICKSON, MD Physician $100 $100
LYNNE H POLODNA, NP Nurse Practitioner $57 $22 $79
MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARERural Health Clinic $30 $58 $88
MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE-SPHospital $221 $2,641 $2,861
MEDICINE SHOPPE 1798 Pharmacy $2,119 $2,291 $1,023 $5,432
PHILLIPS TOMAH PHARMACY Pharmacy $307 $349 $511 $1,281 $2,447
SCENIC BLUFFS COMMUNITYHEALT
Federally Qualified
Health Clinic (FQHC) $155 $60 $168 $165 $547
SCENIC BLUFFS HEALTH CENTER Pharmacy $291 $221 $87 $599
SPARTA PHARMACY LLC Pharmacy $227 $182 $282 $691
THE MEDICINE SHOPPE #1798 Pharmacy $1,183 $1,551 $2,734
TOMAH MEMORIAL HOSPITAL Physician Group $158 $158
TOMAH MEMORIAL HOSPITAL INC Hospital $202 $903 $5,108 $6,212
WALGREENS 09168 Pharmacy $3,927 $3,729 $7,568 $6,990 $22,214
WAL-MART PHARMACY 10-0965 Pharmacy $3,374 $3,575 $3,109 $4,963 $15,021
WAL-MART PHARMACY 10-0979 Pharmacy $2,475 $2,294 $2,830 $1,874 $9,472
Oconto BARBARA A PESOLA, NP Nurse Practitioner $128 $128
CMH CENTER FOR WOMENS CARE Physician Group $679 $1,886 $5,592 $8,157
Page 68 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
COMMUNITY MEMORIAL HOSPITAL Hospital $3,662 $5,863 $20,187 $20,283 $49,994
Pharmacy $96 $292 $549 $1,687 $2,624
Physician Group $1,362 $1,361 $1,726 $5,577 $10,026
FMC OCONTO Physician Group $611 $611
Rural Health Clinic $51 $116 $43 $210
FMC OCONTO FALLS Rural Health Clinic $244 $103 $52 $405 $803
FMC SURING Physician Group $57 $58 $133 $248
JUDITH E BOWERS, DO Physician $483 $1,149 $1,632
MEGAN E TEMP, MD Physician $173 $173
NEW WOMENS HEALTHCARE ASSOC Physician Group $327 $95 $421
NEWCAP WHS Family Planning Clinic $251,394 $399,225 $452,780 $751,768 $1,855,167
NICOLET HEALTH CLINIC
Federally Qualified
Health Clinic (FQHC) $955 $1,636 $1,354 $2,522 $6,466
NICOLET PHARMACY INC Pharmacy $1,735 $1,437 $1,044 $2,446 $6,662
OCONTO FALLS PHARMACY Pharmacy $3,719 $2,910 $3,266 $3,073 $12,968
OCONTO HOSPITAL & MEDICAL CE Hospital $292 $422 $7,004 $7,718
OCONTO HOSPITAL & MEDICAL CENTERIndependent Lab $401 $401
OCONTO HOSPITAL AND MEDICAL CLINICPhysician Group $91 $91
OCONTO PHARMACY BF Pharmacy $3,497 $2,234 $1,184 $731 $7,646
PAMIDA PHARMACY 833 Pharmacy $1,259 $561 $867 $1,165 $3,852
PREVEA HEALTH Independent Lab $369 $369
RENATE G MUNARI, MD Physician $132 $132
SUSAN A PATERSON, CNM Nurse Practitioner $818 $818
Oneida ARLENE V KELLETT, NP Nurse Practitioner $188 $188
ASPIRUS RHINELANDER CLINIC Physician Group $84 $762 $1,264 $2,110
ASPIRUS THREE LAKES CLINIC Physician Group $37 $78 $276 $391
BACKES APOTHECARY PHARMACY Pharmacy $730 $871 $567 $427 $2,595
DAVID A KNUFF, MD Physician $49 $49
FAMILY HEALTHSERVICES SC Physician Group $1,153 $1,014 $469 $474 $3,110
Page 69 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
HOWARD YOUNGMEDICAL CENTER Independent Lab $318 $845 $1,163
HOWARD YOUNGMEDICAL CENTER INCHospital $1,643 $3,611 $25,112 $23,756 $54,121
JANET R BOWEN, NP Nurse Practitioner $229 $252 $317 $233 $1,031
JON W POTTER, DO Physician $52 $55 $108
JOSEPH P KIM, MD Physician $55 $22 $77
MARSHFIELD CLINIC MINOCQUA A
Ambulatory Surgical
Center (ASC) $724 $1,447 $2,171
MARSHFIELD CLINIC MINOCQUA C Independent Lab $526 $778 $561 $119 $1,984
Physician Group $2,049 $2,025 $4,074
MARSHFIELD CLINIC PHARMACY Pharmacy $4,280 $4,044 $3,677 $5,396 $17,396
MINISTRY MEDICAL GROUP Physician Group $149 $149
NADINE B BOND, NP Nurse Practitioner $2,819 $1,049 $3,868
NORTHERN WISCONSIN BONE& JOI Physician Group $86 $86
NORTHLAND ORTHOPEDIC ASSOC Physician Group $237 $237
ONEIDA COUNTYHEALTH DEPARTME Family Planning Clinic $157,060 $162,293 $150,765 $163,585 $633,703
PREMIER PHYSICAL MEDICINE AND WELLNESS CLINICPhysician Group $373 $267 $640
REDMAN & GELINAS SC Physician Group $48 $48
ROBERT J AYLESWORTH, MD Physician $22 $22
SACRED HEART ST MARYS HOSPITAL Physician Group $15,575 $18,656 $16,841 $42,108 $93,180
SACRED HEARTST MARYS HOSPIT Independent Lab $1,035 $11 $235 $1,069 $2,350
SHOPKO PHARMACY #2170 Pharmacy $3,862 $2,765 $3,117 $3,758 $13,502
SMH MINISTRYMED GRP RIVERSI Physician Group $43 $43
ST MARYS HOSPITAL Hospital $867 $4,905 $21,875 $39,142 $66,790
Physician Group $85 $85
STOXEN PROFESSIONAL PHARMACY Pharmacy $3,110 $4,401 $2,885 $2,516 $12,913
THREE LAKES PHARMACY Pharmacy $500 $401 $182 $192 $1,275
TRIGS PHARMACY Pharmacy $4,723 $3,572 $3,795 $6,004 $18,093
WALGREENS #01158 Pharmacy $4,141 $2,477 $5,510 $6,782 $18,910
WALGREENS 07880 Pharmacy $5,711 $8,354 $9,339 $10,120 $33,524
Page 70 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WAL-MART PHARMACY 10-1931 Pharmacy $4,497 $3,949 $4,969 $9,896 $23,311
WAL-MART PHARMACY 10-2510 Pharmacy $5,909 $4,270 $2,725 $7,598 $20,502
Other Border ASSOCIATED REGIONAL & UNIVER Independent Lab $49 $49
BOSTWICK LABORATORIES INC Independent Lab $1,568 $1,674 $3,242
DYNACARE NORTHWEST INC Independent Lab $119 $119
GENZYME GENETICS Independent Lab $21 $21
LABONE INC Independent Lab $814 $814
LABORATORY CORPORATIONOF Independent Lab $3,782 $1,472 $1,978 $4,463 $11,695
LABORATORY CORPORATIONOF AM Independent Lab $44 $126 $170
NATIONAL HEALTH LABORATORY Independent Lab $2,242 $830 $3,071
QUEST DIAGNOSTICS Independent Lab $98 $98
QUEST DIAGNOSTICS INC Independent Lab $264 $97 $134 $69 $564
QUEST DIAGNOSTICS NICHOLS INSTITUTE OF VALENCIA INIndependent Lab $49 $49
SANFORD SM USD CLINICAL VIRO Independent Lab $243 $49 $291
Outagamie AASCEND PAIN INSTITUTE SC Physician Group $152 $152
APPLETON AREA ANESTHESIA & PAIN SERVICES, SCPhysician Group $124 $124
ASSOCIATES IN GASTROENTEROLOGY, SCPhysician Group $48 $125 $172
AURORA PHARMACY INC Pharmacy $193 $558 $504 $856 $2,110
BRIAN KIESNOWSKI, MD Physician $90 $90
BRIAN L LOHRBACH, MD Physician $121 $121
BRIAN L VANHOOZEN, DO Physician $103 $58 $152 $312
BUTTE DES MORTS PATHOLOGY SC Physician Group $3,040 $3,108 $3,617 $6,336 $16,101
COMPREHENSIVE PAIN MANAGEMENT OF FOX VALLEYPhysician Group $205 $205
CONSUMER PRESCRIPTION CENTER Pharmacy $2,071 $47 $505 $216 $2,839
COPPS FOOD CENTER PHARMACY #8118Pharmacy $529 $529
COPPS FOOD CENTER PHARMACY #8187Pharmacy $454 $454
CUB PHARMACY#673 Pharmacy $29 $29
CVS PHARMACY #08525 Pharmacy $2,325 $5,822 $2,107 $3,002 $13,256
DANIEL F WENDELBORN, MD Physician $30 $30
Page 71 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
DAVID J BROOKS, MD Physician $47 $47
DERMATOLOGY ASSOCIATES OF WISCONSIN SCPhysician Group $186 $186
DOUGLAS S YEATMAN, MD Physician $30 $30
FAMILY CARE OF THE FOXCITIES Physician Group $30 $87 $86 $203
FMC SEYMOUR Physician Group $121 $121
FORD PHARMACY Pharmacy $159 $159
FORD PHARMACY NORTH Pharmacy $114 $38 $152
FOX CITIES EYE CLINIC SC Physician Group $134 $134
FOX VALLEY HEMATOLOGY & ONCO Physician Group $121 $48 $536 $704
FOX VALLEY NEPHROLOGY PARTNE Physician Group $149 $149
FOX VALLEY PULMONARY MEDICIN Physician Group $48 $48
FOX VALLEY REPRODUCTIVE MEDICINEPhysician Group $2,671 $2,483 $5,154
FOX VALLEY SURGICAL ASSOCIAT Physician Group $133 $133
HAND AND UPPER EXTREMITY CTR Physician Group $55 $55
IHC-ST ELIZABETH EMERGENCY PHYSICIANS, LLCPhysician Group $22 $27 $49
INTEGRITY MEDICAL GROUP SC Physician Group $83 $83
JERNEGANS HEALTH MART Pharmacy $2,607 $4,573 $1,732 $1,883 $10,795
JON J CHERNEY MD, MD Physician $55 $55
KAGEN ALLERGYCLINIC SC Physician Group $236 $236
KAUKAUNA CLINIC SC Physician Group $249 $339 $678 $676 $1,941
KENT C SCHAEFER, MD Physician $37 $37
KIMBERLY PHARMACY INC Pharmacy $400 $391 $79 $870
LYNN K DAHLKE, NP Nurse Practitioner $74 $74
MICHAEL S FAUDREE, MD Physician $43 $43
MORTON PHARMACY Pharmacy $2,763 $1,203 $1,093 $2,390 $7,448
NEUROSPINE CENTER OF WI SC Physician Group $171 $171
NEW ANESTHESIOLOGY SC Physician Group $79 $79
NEW LONDON FAMILY MEDICAL Hospital $230 $459 $4,748 $10,428 $15,865
Independent Lab $95 $111 $247 $846 $1,298
Page 72 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
NORTH THEDACARE FAMILY MEDICINEPhysician Group $1,654 $1,644 $4,692 $22,497 $30,487
ONEIDA COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $13,829 $20,351 $27,944 $43,685 $105,809
OSCO DRUG #509 Pharmacy $1,483 $1,483
OSTEOPATHIC MEDICINE &PHYSIC Physician Group $236 $30 $266
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $515,140 $384,354 $150,755 $149,115 $1,199,363
PRIMARY CARE ASSOCIATES OF APPLETON, LTDPhysician Group $455 $901 $864 $2,187 $4,407
RADIATION ONCOLOGY SPECIALISTS Physician Group $48 $48
RADIOLOGY ASSOCIATES OF APPLETONPhysician Group $12 $168 $253 $433
SAM'S PHARMACY 10-6321 Pharmacy $238 $535 $773
SEYMOUR PHARMACY TLSMEINC Pharmacy $832 $1,149 $2,328 $1,313 $5,623
SHOPKO PHARMACY #2015 Pharmacy $3,134 $2,724 $3,901 $4,841 $14,601
SHOPKO PHARMACY #2028 Pharmacy $2,367 $4,345 $4,345 $4,181 $15,238
SHOPKO PHARMACY #504 Pharmacy $753 $996 $1,749
SHOPKO PHARMACY #505 Pharmacy $1,619 $1,182 $2,801
ST ELIZABETH HOSPITAL INC Independent Lab $5,636 $7,017 $9,951 $18,660 $41,263
ST ELIZABETHHOSPITAL Hospital $358 $2,243 $15,743 $26,073 $44,417
STEPHEN C DUNGAR, MD Physician $158 $158
TARGET STORE T-1248 PHARMACY Pharmacy $721 $2,012 $1,603 $3,259 $7,596
TCP INTERNAL MED ECH Physician Group $43 $153 $591 $97 $884
THEDA CARE PHYSICIANS Physician Group $739 $1,319 $1,381 $3,439
THEDACARE ORTHOPEDICS PLUS Physician Group $356 $356
THEDACARE PHYSICIANS- BLACK CREEKPhysician Group $101 $101
THEDACARE PHYSICIANS KIMBERLY Physician Group $2,144 $434 $75 $2,652
THEDACARE PHYSICIANS- WEST Physician Group $294 $297 $130 $721
TIMOTHY B RASOR, MD Physician $12 $52 $64
UW MEDICAL FOUNDATION FOX VA Physician Group $1,003 $766 $1,769
UW SYSTEMS Physician Group $252 $186 $47 $485
VALLEY EYE ASSOCIATES Physician Group $99 $99
Page 73 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
VALLEY ORTHOPEDIC CLINIC SC Physician Group $85 $85
VALLEY UROLOGIC ASSOCIATES Physician Group $30 $22 $86 $137
WALGREENS #02921 Pharmacy $10,075 $12,657 $7,703 $6,074 $36,509
WALGREENS #10234 Pharmacy $3,359 $5,426 $3,877 $10,232 $22,895
WALGREENS #10759 Pharmacy $2,792 $4,577 $3,885 $11,254
WALGREENS #12019 Pharmacy $2,164 $2,164
WALGREENS #12693 Pharmacy $7,844 $10,412 $12,276 $13,290 $43,821
WALGREENS 05102 Pharmacy $3,862 $5,184 $5,702 $6,646 $21,394
WALGREENS 07323 Pharmacy $5,476 $5,439 $2,939 $5,461 $19,315
WALGREENS 09682 Pharmacy $1,762 $3,626 $4,387 $5,389 $15,165
WAL-MART PHARMACY 10-1982 Pharmacy $7,794 $5,834 $4,292 $8,767 $26,688
WOMENS CARE OF WISCONSIN Physician Group $1,559 $6,718 $1,377 $1,393 $11,045
WOMENS HEALTH SPECIALISTS SC Physician Group $11,404 $12,485 $13,539 $16,888 $54,316
Out-of-State ALEXIAN BROTHERS MED CTR Hospital $80 $80
AMERIPATH FLORIDA LLC Independent Lab $146 $146
ASCEND CLINICAL LLC Independent Lab $52 $52
AUBURN REGIONAL MEDICAL CENTER Hospital $22 $22
BANNER THUNDERBIRD MEDICAL Hospital $123 $123
BAPTIST MEMORIAL HOSPITAL Hospital $56 $56
BARAGA COUNTY MEMORIAL HOSPITALHospital $13 $13
BAYLOR MEDICAL CENTER AT GRAPEVINEHospital $35 $35
BUFFALO HOSPITAL Hospital $41 $41
CAMBRIDGE MEDICAL CENTER Hospital $433 $433
CENTEGRA HOSPITAL MCHENRY Hospital $11 $11
CGH MEDICAL CENTER Hospital $60 $60
CVS PHARMACY# 05600 Pharmacy $62 $910 $972
FLORIDA HOSPITAL MEDICAL Hospital $121 $121
HALIFAX MEDICAL CENTER Hospital $12 $12
HARDIN MEMORIAL HOSPITAL Hospital $16 $16
Page 74 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
IOWA METHODIST MEDICALCENTE Hospital $11 $11
JACKSON MADISON COUNTY GENERAL HOSPHospital $100 $120 $220
LABORATORY CORPORATIONOF Independent Lab $14 $14
LEESBURG REGIONAL MEDICAL Hospital $2,006 $2,006
MEDICAL DIAGNOSTIC LABORATORIES LLCIndependent Lab $194 $1,175 $7,936 $9,305
MEMORIAL HOSPITAL Hospital $112 $112
MEMORIAL MEDICAL CENTER Hospital $646 $646
MERCY HOSPITAL OF FRANCISCAN Hospital $12 $12
METHODIST HEALTHCARE MEMPHIS Hospital $11 $71 $81
METROSOUTH MEDICAL CENTER Hospital $128 $128
MIDWESTERN REGIONAL Hospital $11 $11
MOUNTAINVIEWHOSPITAL Hospital $310 $310
OUR LAB Independent Lab $107 $107
PORTAGE HOSPITAL Hospital $12 $12
RANDALL S VOLLERTSEN, MD Physician $78 $78
ROSELAND COMMUNITY HOSPITAL Hospital $66 $66
RUSH UNIVERSITY MEDICAL CENT Hospital $61 $61
ST ANTHONY NORTH HOSPITAL Hospital $23 $23
ST FRANCIS HOSPITAL Hospital $31 $31
ST FRANCIS REGIONAL MEDICAL Hospital $12 $20 $32
ST LUKES METHODIST HOSPITAL Hospital $10 $10
ST MICHAELS HOSPITAL Hospital $3,945 $3,945
ST ROSE DOMINICAN DI LIMA Hospital $12 $12
ST VINCENT HOSPITAL HEALTH Hospital $336 $336
SUMMIT MEDICAL CENTER Hospital $12 $12
THE MEDICINE SHOPPE #1855 Pharmacy $618 $1,405 $2,023
THE METHODIST HOSPITALS INC Hospital $12 $12
THE TOLEDO HOSPITAL Hospital $117 $117
TRINITY HOSPITAL Hospital $35 $24 $59
Page 75 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
UNITY HOSPITAL Hospital $100 $100
UNIVERSITY HOSPITAL Hospital $100 $100
VERNON MEMORIAL HEALTHCARE Independent Lab $107 $237 $327 $671
VISTA MEDICAL CENTER EAST Hospital $22 $22
VISTA MEDICAL CENTER WEST Hospital $11 $11
WEST SUBURBAN HOSPITALMED Hospital $12 $12
Ozaukee AURORA MEDICAL GROUP WEST BEND Physician Group $5,770 $1,717 $1,827 $5,391 $14,706
AURORA PHARMACY INC Pharmacy $122 $977 $1,099
CAROL J ESTILL, MD Physician $30 $30
COLUMBIA CENTER INC Hospital $418 $418
CVS PHARMACY#08775 Pharmacy $69 $83 $425 $577
DONALD J MEYER, DO Physician $95 $95
INDIRA MAMMEN, MD Physician $790 $1,136 $794 $2,720
INTERPEDIA SC Physician Group $86 $86
JAIME D CABATINGAN, MD Physician $30 $30
JANICE ALEXANDER RN MD SC Physician Group $20 $322 $342
JANICE H ALEXANDER, MD Physician $47 $57 $104
JOHN F LESKO, MD Physician $109 $109
JULIE A CHICKS, MD Physician $95 $1,667 $1,762
MILWAUKEE ENT CLINIC LTD Physician Group $66 $66
NORTH SHORE DERMATOLOGY SC Physician Group $55 $111 $166
NORTHEAST OB GYN SC Physician Group $112 $32 $144
NORTHSHORE GYNECOLOGY Physician Group $1,826 $1,826
ORTHOPAEDIC ASSOCIATES OF MILWAUKEE, S.C.Physician Group $22 $22
OSCO DRUG #5778 Pharmacy $35 $35
OZAUKEE MEDICAL CENTER Physician Group $30 $30
ROBERT R STUMPF, MD Physician $43 $43
ROYAL MEDICAL TRANSPORTATION Transportation $304 $304
SALVADOR V DELROSARIO, MD Physician $60 $60
Page 76 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
SHOPKO EXPRESS #503 Pharmacy $199 $155 $87 $1,634 $2,075
SHOPKO PHARMACY #2090 Pharmacy $591 $273 $192 $346 $1,401
SMO PHYSICIANS Physician Group $30 $30
ST MARYS HOSPITAL OZAUKEE Hospital $945 $533 $11,110 $10,632 $23,220
Physician Group $762 $602 $918 $2,282
TARGET STORE T-1212 PHARMACY Pharmacy $249 $1,145 $635 $2,029
THIENSVILLE FAMILY HEALTH Physician Group $149 $198 $103 $450
THUROW PRIMARY PREVENTIVE HEALTHCARE SCNurse Practitioner $191 $191
TNJ TRANSPORT LLC Transportation $45 $45
UNITED OCCUPATIONAL MEDICINE & WALK IN SERVICES, LPhysician Group $115 $115
VICTORIA J MONDLOCH, MD Physician $57 $57
WALGREENS Pharmacy $1,656 $2,550 $1,540 $3,863 $9,609
WALGREENS #01988 Pharmacy $774 $828 $427 $3,665 $5,695
WALGREENS #13620 Pharmacy $195 $699 $1,283 $2,410 $4,586
WALGREENS 03448 Pharmacy $1,012 $695 $1,003 $1,023 $3,733
WALGREENS 04884 Pharmacy $31 $597 $258 $2,357 $3,243
WAL-MART PHARMACY 10-1650 Pharmacy $1,214 $1,429 $1,251 $3,019 $6,913
WISCONSIN RADIOLOGY SPECIALISTS SCPhysician Group $155 $717 $748 $1,619
YE OLDE PHARMACY & WELLNESS Pharmacy $244 $394 $638
Pepin CASTLEBERG CLINIC SC Physician Group $263 $151 $180 $86 $679
CHIPPEWA VALLEY HOSPITAL Hospital $1,554 $292 $1,218 $3,064
ECONOFOODS PHARMACY 323 Pharmacy $1,899 $1,403 $1,224 $796 $5,322
HEIKE PHARMACY INC Pharmacy $2,147 $2,686 $2,478 $1,936 $9,246
JANE M POESCHEL, NP Nurse Practitioner $39 $140 $440 $848 $1,466
KENNETH M RUCKER, MD Physician $30 $30
MICHELLE L BANDY, MD Physician $112 $215 $328
PEPIN COUNTYNURSING SERVICE Family Planning Clinic $11,312 $10,704 $11,466 $18,677 $52,159
Pierce ALLINA MEDICAL CLINIC PRESCO Physician Group $308 $308
ECONOFOODS PHARMACY #322 Pharmacy $2,240 $2,464 $3,567 $1,955 $10,226
Page 77 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ELLSWORTH MEDICAL CLINIC Physician Group $60 $305 $365
FAIRVIEW ELLSWORTH CLINIC Physician Group $1,040 $598 $2,668 $2,840 $7,146
FREEMAN DRUGINC Pharmacy $643 $1,161 $1,980 $2,977 $6,760
MOST PHARMACY Pharmacy $1,755 $643 $953 $452 $3,802
PAMIDA PHARMACY #654 Pharmacy $84 $609 $938 $1,630
PIERCE CO REPRODUCTIVE HEALTH Family Planning Clinic $342,034 $301,354 $344,000 $436,680 $1,424,068
RIVER FALLS AREA HOSPITAL Hospital $661 $4,420 $6,218 $9,512 $20,810
RIVER FALLS MEDICAL CLINIC Physician Group $4,716 $5,284 $8,824 $13,349 $32,173
SPRING VALLEY DRUG Pharmacy $381 $1,146 $1,113 $559 $3,198
SPRING VALLEYMEDICAL CLINIC Physician Group $103 $100 $203
VILLAGE PHARMACY Pharmacy $134 $506 $640
Polk AMERY REGIONAL MEDICALCENTE Independent Lab $23 $23
AMERY REGIONAL MEDICALCENTER Hospital $100 $1,296 $2,573 $7,177 $11,147
Physician Group $7,988 $7,801 $4,389 $4,121 $24,299
BALSAM LAKE PHARMACY INC Pharmacy $3,873 $1,289 $14 $1,105 $6,281
BRADLEY S HARLANDER, DDS Dentist $262 $262
CHET JOHNSON& SONS DRUG Pharmacy $2,670 $686 $1,538 $2,328 $7,222
CLINIC PHARMACY OSCEOLA Pharmacy $733 $1,257 $2,993 $3,274 $8,257
JOHNSON DRUGAT ARMC Pharmacy $948 $385 $410 $1,423 $3,165
LADD MEMORIAL HOSPITAL Hospital $1,092 $3,290 $16,433 $10,696 $31,511
Physician Group $30 $295 $325
LUCK MEDICAL CLINIC Rural Health Clinic $87 $178 $185 $1,070 $1,520
LUCK MEDICALCLINIC SC Physician Group $127 $348 $313 $172 $960
LUCK PHARMACY INC Pharmacy $1,057 $475 $76 $50 $1,658
OSCEOLA MEDICAL CENTER Independent Lab $169 $169
Physician Group $2,052 $825 $1,542 $2,195 $6,615
OSCEOLA PHARMACY Pharmacy $37 $79 $105 $220
PAMIDA PHARMACY 228 Pharmacy $636 $515 $1,151
PAUL A HAUGEDDS LTD Dentist $236 $236
Page 78 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
POLK CO HEALTH DEPARTMENT Family Planning Clinic $96,091 $99,018 $110,173 $151,339 $456,621
RENE B MILNER, MD Physician $22 $55 $77
RIVER VALLEYPHARMACY Pharmacy $1,557 $2,187 $1,227 $2,764 $7,734
ST CROIX REGIONAL MEDICAL Physician Group $7,574 $4,556 $7,751 $13,856 $33,737
ST CROIX REGIONAL MEDICAL CE Independent Lab $12 $68 $420 $613 $1,113
ST CROIX REGIONAL MEDICAL CENTER Hospital $1,597 $2,526 $7,539 $12,230 $23,892
ST CROIX VALLEY SURGICAL ASC Physician Group $22 $22
TANGEN DRUG INC Pharmacy $2,181 $1,377 $1,293 $2,143 $6,994
THE MEDICINE SHOPPE #1855 Pharmacy $271 $271
THE MEDICINESHOPPE Pharmacy $2,179 $1,981 $1,950 $6,110
WAL-MART PHARMACY 10-2421 Pharmacy $3,991 $5,802 $2,267 $1,972 $14,031
Portage ASPIRUS ROSHOLT FAMILY Physician Group $30 $30
ASPIRUS STEVENS POINT CLINIC Physician Group $348 $1,088 $2,375 $5,811 $9,622
ASPIRUS STEVENS POINT SENTRY Physician Group $30 $30 $60
AURORA PHARMACY INC Pharmacy $8,164 $6,645 $6,515 $2,788 $24,112
CENTRAL WISCRADIOLOGISTS SC Physician Group $285 $450 $762 $1,497
COPPS FOOD CENTER PHARMACY #8101Pharmacy $391 $391
COPPS FOOD CENTER PHARMACY #8107Pharmacy $1,331 $1,331
COPPS FOOD CENTER PHARMACY #8116Pharmacy $546 $546
JUAN B LOPEZ, MD Physician $22 $22
K MART PHARMACY 7010 Pharmacy $10,377 $9,847 $11,961 $8,204 $40,389
KLASINSKI CLINIC SC Physician Group $78 $78
MINISTRY MEDICAL GROUP
Mental Health and
Substance Abuse
Services $95 $936 $1,031
Physician Group $408 $795 $1,203
MINISTRY MEDICAL GROUP PLOVER FAMILY PRACTICEPhysician Group $1,760 $8,179 $9,939
SAINT MICHAELS HOSPITAL Independent Lab $7,213 $3,905 $2,704 $849 $14,670
SHOPKO PHARMACY #2055 Pharmacy $6,530 $6,757 $10,567 $8,448 $32,303
Page 79 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
SHOPKO PHARMACY #2171 Pharmacy $7,122 $6,665 $8,014 $9,772 $31,574
ST MICHAELS HOSPITAL Hospital $6,867 $36,297 $136,592 $138,273 $318,029
Physician Group $18,843 $21,819 $21,552 $26,660 $88,875
ST MICHAELS HOSPITAL OF STEVENS POINT INCPhysician Group $6,114 $5,309 $4,465 $5,565 $21,453
STEVENS POINT SURGICAL SERVICES SCPhysician Group $472 $472 $943
TRIGS COUNTY MARKET PHARMACY Pharmacy $3,407 $4,176 $2,173 $4,413 $14,168
UNIVERSITY HEALTH SERVICE PH Pharmacy $42,903 $86,581 $116,745 $97,925 $344,154
UWSP STUDENTHEALTH SERVICE Family Planning Clinic $42,318 $64,964 $39,361 $17,175 $163,818
WALGREENS #11278 Pharmacy $4,992 $10,723 $15,852 $31,567
WALGREENS #13074 Pharmacy $378 $378
WALGREENS 06935 Pharmacy $13,723 $21,932 $24,499 $20,736 $80,890
WAL-MART PHARMACY 10-1828 Pharmacy $7,289 $13,728 $16,491 $20,257 $57,765
Price AURORA PHARMACY Pharmacy $450 $1,782 $2,151 $999 $5,381
COPPS FOOD CENTER PHARMACY #8127Pharmacy $1,100 $1,100
FLAMBEAU HOSPITAL Independent Lab $19 $19 $37
FLAMBEAU HOSPITAL INC Anesthetist $245 $245
Hospital $228 $2,249 $4,636 $7,538 $14,651
LAKEVIEW PHARMACY Pharmacy $1,121 $2,099 $2,997 $1,573 $7,791
MEMORIAL HEALTH CENTER CLINICS PRENTICEPhysician Group $778 $1,748 $173 $554 $3,254
PAMIDA PHARMACY 319 Pharmacy $771 $85 $1,145 $1,014 $3,015
PARK FALLS REGIONAL MEDICAL CLINIC SCPhysician Group $218 $34 $456 $708
PARK PHARMACYINC Pharmacy $3,754 $2,580 $2,855 $2,606 $11,795
PRICE COUNTYHEALTH Family Planning Clinic $93,342 $74,280 $88,997 $100,421 $357,040
Racine ADVANCED MEDICAL IMAGING LLC Physician Group $28 $28
ALL SAINTS MEDICAL GROUP Physician Group $15,967 $5,853 $21,820
AURORA HEALTH CENTER RACINE Physician Group $3,049 $1,492 $3,456 $11,017 $19,014
AURORA MEDICAL GROUP Physician Group $3,310 $2,770 $3,223 $12,662 $21,965
AURORA MEMORIAL HOSPITAL OF Hospital $176 $4,577 $4,990 $9,744
AURORA PHARMACY INC Pharmacy $2,594 $3,410 $3,201 $3,243 $12,448
Page 80 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CVS PHARMACY#08776 Pharmacy $2,010 $2,108 $2,292 $3,611 $10,021
D J KONTRA MD AND ASSOCIATES Physician Group $52 $52
DANA R TROTTER MD SC Physician Group $196 $196
EYE CENTER OFRACINE LTD Optometrist $290 $290
EYE CLINIC OFRACINE LTD Physician Group $283 $283
GREAT LAKES DERMATOLOGY Physician Group $454 $454
HAUPER PHARMACY Pharmacy $357 $357
K & S MEDICAL TRANSPORT INC Transportation $54 $54
K MART PHARMACY #9713 Pharmacy $638 $608 $925 $615 $2,786
K MART PHARMACY 3774 Pharmacy $554 $320 $292 $362 $1,529
K MART PHARMACY 3851 Pharmacy $387 $1,616 $2,003
LAKEVIEW PHARMACY OF RACINE Pharmacy $281 $748 $1,363 $1,639 $4,032
MICHAEL A GANZ, MD Physician $22 $22
NORTHWESTERN MEDICAL CENTER SC Physician Group $55 $198 $1,479 $1,732
NUTRITIONAL DESIGNS & PHARMACY Pharmacy $44 $476 $2,361 $2,881
OSCO DRUG #3626 Pharmacy $207 $207
OSCO DRUG #5790 Pharmacy $408 $408
PATRICIO L ILADA IV, MD Physician $173 $173
PICK N SAVE PHARMACY #6414 Pharmacy $65 $65
PICK N SAVE PHARMACY #6863 Pharmacy $13 $13
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $2,275,131 $6,679,236 $8,954,367
RACINE COMMUNITY HEALTH CENTER
Federally Qualified
Health Clinic (FQHC) $55 $55 $460 $3,514 $4,083
RACINE COUNTY PATHOLOGY ASC Physician Group $975 $1,258 $2,924 $4,271 $9,427
SHOPKO PHARMACY #2027 Pharmacy $4,927 $2,930 $5,816 $11,407 $25,080
SOUTHEAST ANESTHESIA CONSULT Physician Group $176 $176 $175 $527
SOUTHEASTERN WI ANESTHESIOLOGY Physician Group $55 $55
SWIFT CARE SC Physician Group $55 $606 $661
THE PHARMACY STATION BURLINGTONPharmacy $1,995 $1,515 $1,201 $1,978 $6,690
Page 81 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
THE PHARMACYSTATION Pharmacy $1,244 $857 $337 $327 $2,765
WALGREENS #02927 Pharmacy $17,019 $14,876 $16,086 $18,635 $66,615
WALGREENS #03022 Pharmacy $5,669 $4,780 $5,098 $5,037 $20,585
WALGREENS #10584 Pharmacy $1,183 $2,383 $4,615 $8,181
WALGREENS 05417 Pharmacy $3,086 $3,537 $5,200 $7,294 $19,117
WALGREENS 06243 Pharmacy $3,155 $3,733 $9,202 $8,967 $25,058
WALGREENS 07437 Pharmacy $6,657 $3,934 $5,519 $9,928 $26,039
WALGREENS 09363 Pharmacy $3,624 $8,187 $4,515 $15,203 $31,529
WALGREENS 09606 Pharmacy $1,914 $2,343 $1,834 $2,657 $8,748
WAL-MART PHARMACY 10-2668 Pharmacy $2,097 $1,015 $1,122 $2,042 $6,276
WAL-MART PHARMACY 10-3488 Pharmacy $1,697 $1,117 $848 $1,016 $4,677
WHEATON FRANCISCAN HEALTHCAR Hospital $2,942 $12,205 $173,227 $209,293 $397,668
Independent Lab $1,408 $2,829 $5,581 $12,024 $21,841
WHEATON FRANCISCAN PHARMACY Pharmacy $2,812 $1,243 $1,875 $3,420 $9,349
Richland JOHN M WENTZ, MD Physician $60 $60
RICHLAND FAMILY PRESCRIPTION Pharmacy $1,249 $1,948 $1,467 $3,399 $8,063
RICHLAND HOSPITAL Independent Lab $98 $576 $674
RICHLAND HOSPITAL INC Hospital $11 $606 $1,170 $6,863 $8,650
RICHLAND MEDICAL CENTER LTD Physician Group $365 $1,537 $928 $3,642 $6,473
THRIFTY WHITE PHARMACY Pharmacy $2,201 $2,403 $3,023 $1,978 $9,604
WAL-MART PHARMACY 10-1007 Pharmacy $3,710 $5,369 $7,469 $7,427 $23,976
Rock AURORA PHARMACY INC Pharmacy $31,296 $17,338 $12,079 $11,775 $72,488
BELOIT AREA COMMUNITY HEALTH CENTER
Federally Qualified
Health Clinic (FQHC) $23,810 $13,195 $10,827 $16,823 $64,655
BELOIT CLINIC Physician Group $15,108 $12,493 $12,211 $9,192 $49,004
BELOIT MEMORIAL HOSPITAL Hospital $104 $32,991 $83,170 $116,265
BELOIT MEMORIAL HOSPITAL INC Independent Lab $19 $17 $29 $64
BELOIT RADIOLOGY LTD Physician Group $37 $156 $508 $701
CUB PHARMACY Pharmacy $1,162 $2,161 $187 $3,510
Page 82 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CVS PHARMACY #08534 Pharmacy $4,632 $7,488 $3,267 $3,738 $19,125
CVS PHARMACY#08550 Pharmacy $523 $935 $1,631 $3,090
CVS PHARMACY#08551 Pharmacy $280 $1,867 $2,885 $2,292 $7,324
DEAN PHARMACY Pharmacy $880 $377 $426 $172 $1,855
EDGERTON HOSPITAL & HEALTH Hospital $303 $1,087 $1,050 $2,440
EDGERTON HOSPITAL & HEALTH S Physician Group $52 $30 $95 $177
EDGERTON HOSPITAL MILTON CLINIC Physician Group $30 $30
EDGERTON PHARMACY Pharmacy $1,362 $472 $1,167 $1,246 $4,246
EVANSVILLE HOMETOWN PHARMACY Pharmacy $625 $2,187 $3,025 $1,472 $7,309
FIRST CHOICEWOMENS HEALTH CENTERFamily Planning Clinic $398,223 $393,236 $350,072 $472,959 $1,614,490
HART ROAD PATHOLOGY SC Physician Group $1,024 $709 $1,056 $2,303 $5,091
HOMECARE PHARMACY LLC Pharmacy $1,413 $490 $1,428 $1,057 $4,387
HOMECARES BELOIT CLINIC Pharmacy $731 $474 $16 $1,221
JANESVILLE COMMUNITY HEALTH CENTER
Federally Qualified
Health Clinic (FQHC) $37 $256 $58 $350
JANESVILLE MEDICAL CENTER Physician Group $170 $115 $180 $465
JONAS J Y LEE, MD Physician $194 $194
K MART PHARMACY 4255 Pharmacy $261 $261
KEALEY PHARMACY & HOMECARE Pharmacy $1,958 $1,381 $371 $1,631 $5,342
KENNETH R BETTS, MD Physician $137 $57 $194
MERCY EAST PHARMACY Pharmacy $758 $670 $433 $419 $2,279
MERCY HEALTH SYSTEM CORP Hospital $318 $913 $7,296 $22,031 $30,558
MERCY HOSPITAL PHYSICIANS Physician Group $502 $502
MERCY MALL PHARMACY Pharmacy $218 $34 $245 $497
MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE
Mental Health and
Substance Abuse
Services $48 $48
MERCY WEST PHARMACY Pharmacy $1,770 $1,770 $921 $624 $5,084
MHS PHYSICIAN SERVICES Physician Group $15,973 $13,632 $22,386 $50,564 $102,554
Page 83 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MILTON PHARMACY Pharmacy $880 $1,542 $498 $587 $3,507
OSCO DRUG #5035 Pharmacy $1,714 $1,714
OSCO DRUG 5089 Pharmacy $147 $147
OSCO DRUG#5087 Pharmacy $222 $222
RIVERVIEW SURGERY CENTER
Ambulatory Surgical
Center (ASC) $1,447 $731 $2,178
ROCK COUNTY HEALTH DEPARTMENT Family Planning Clinic $16 $33 $164 $214
SAM'S PHARMACY 10-4840 Pharmacy $119 $120 $294 $151 $684
SCHNUCKS PHARMACY 758 Pharmacy $954 $2,571 $2,200 $1,851 $7,577
SHOPKO PHARMACY #2030 Pharmacy $1,361 $1,995 $2,427 $3,445 $9,227
SHOPKO PHARMACY 2026 Pharmacy $5,431 $4,561 $5,130 $4,959 $20,080
ST MARYS DEAN VENTURES INC Physician Group $489 $1,114 $788 $2,071 $4,463
STATELINE ANESTHESIOLOGISTS Physician Group $172 $172
TARGET STORE T-0809 PHARMACY Pharmacy $221 $1,900 $2,210 $8,581 $12,911
WAL MART PHARMACY 101305 Pharmacy $1,744 $4,134 $3,218 $5,805 $14,902
WALGREENS #04055 Pharmacy $8,431 $11,289 $15,061 $16,823 $51,604
WALGREENS #11235 Pharmacy $2,654 $4,905 $4,712 $12,270
WALGREENS #11236 Pharmacy $1,450 $3,350 $4,800
WALGREENS #11528 Pharmacy $2,448 $4,536 $6,983
WALGREENS #12136 Pharmacy $941 $1,756 $2,697
WALGREENS #13613 Pharmacy $7,309 $8,163 $6,968 $5,458 $27,898
WALGREENS 06096 Pharmacy $16,809 $15,766 $11,144 $11,902 $55,620
WAL-MART PHARMACY 10-2532 Pharmacy $1,495 $3,903 $8,652 $8,103 $22,152
WEST SIDE MEDICAL CENTER Physician Group $322 $498 $454 $2,706 $3,980
Rusk FLAMBEAU PHARMACY Pharmacy $2,995 $2,573 $1,259 $6,827
MARSHFIELD CLINIC LADYSMITH Independent Lab $105 $105
MARSHFIELD CLINIC PHARMACY
Federally Qualified
Health Clinic (FQHC) $6,122 $7,267 $7,455 $4,951 $25,795
PAMIDA PHARMACY 314 Pharmacy $2,592 $1,950 $1,526 $3,284 $9,352
Page 84 of 114
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Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
RUSK CO CLINIC PHCY Pharmacy $1,603 $1,115 $410 $1,698 $4,826
RUSK CO DEPT HEALTH & HUMAN SERVICESFamily Planning Clinic $15,504 $11,105 $12,022 $15,114 $53,746
RUSK COUNTY MEMORIAL HOSP Hospital $183 $520 $2,022 $2,726
RUSK COUNTY MEMORIAL HOSPITA Physician Group $22 $22
WAL-MART PHARMACY 10-4281 Pharmacy $941 $3,872 $7,197 $12,010
Sauk BALLWEG FAMILY PHARMACY INC Pharmacy $316 $560 $756 $511 $2,143
CORNER DRUG Pharmacy $2,564 $3,369 $1,829 $2,543 $10,305
DEAN PHARMACY Pharmacy $1,263 $655 $1,775 $1,999 $5,693
DELTON FAMILY MEDICAL CENTER Physician Group $220 $628 $741 $1,011 $2,600
DIANA L KRUSE, MD Physician $60 $60
EANNELLI PHARMACY Pharmacy $953 $793 $335 $1,485 $3,567
HALL PHARMACYINC Pharmacy $1,046 $994 $2,040
HISHAM A OSMAN, MD Physician $149 $144 $293
HOCHUNK NATION WELLNESS
Federally Qualified
Health Clinic (FQHC) $345 $236 $79 $130 $790
HOUSE OF WELLNESS PHARMACY Pharmacy $149 $154 $302
K MART PHARMACY 7650 Pharmacy $1,034 $1,592 $524 $688 $3,838
MAIN STREET PHARMACY INC Pharmacy $84 $93 $178
MEDICAL ARTS PHARMACY Pharmacy $5,179 $2,949 $4,335 $4,355 $16,817
MICHAEL D PLOOSTER, MD Physician $340 $340
ORTHOPEDIC ASSOCIATES OF Physician Group $90 $225 $315
PAMIDA PHARMACY 175 Pharmacy $403 $613 $298 $1,313
PLAIN MEDICAL CLINIC Physician Group $11 $11
Rural Health Clinic $73 $73
PRAIRIE CLINIC SC Physician Group $3,542 $1,941 $1,819 $3,331 $10,632
REEDSBURG AREA MEDICAL Anesthetist $269 $171 $440
Hospital $1,205 $2,896 $13,058 $12,854 $30,014
REEDSBURG AREA MEDICALCENTE Independent Lab $208 $238 $297 $640 $1,384
REEDSBURG AREA MEDICALCENTER Physician Group $60 $73 $181 $414 $729
Page 85 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
REEDSBURG FAMILY PRESCRIPTION CENTERPharmacy $364 $287 $713 $981 $2,344
REEDSBURG MEMORIAL HOSPITAL Physician Group $30 $30
REEDSBURG PHYSICIANS GROUPSC Physician Group $5,910 $7,766 $4,610 $6,669 $24,955
RIVER VALLEY MEDICAL CLINIC Physician Group $10 $10
RIVER VALLEYMEDICAL CLINIC Rural Health Clinic $97 $43 $70 $210
SAUK CITY PHARMACY Pharmacy $462 $265 $112 $441 $1,280
SAUK PRAIRIE MEMORIAL HOSPITAL Physician Group $431 $464 $30 $121 $1,046
SAUK PRAIRIEMEMORIAL HOSP Hospital $433 $1,842 $5,846 $8,121
SPRING GREENMEDICAL CENTER Rural Health Clinic $78 $463 $117 $658
Therapy Group $92 $92
SPRING GREENPHARMACY INC Pharmacy $2,297 $2,032 $354 $689 $5,371
SPRING MEDICAL ASSOCIATES LL Physician Group $155 $30 $185
ST CLARE HOSPITAL AND HEALTH Hospital $90 $268 $5,345 $11,819 $17,521
Physician Group $261 $81 $61 $1,147 $1,549
ST CLARE LABORATORY Independent Lab $192 $228 $238 $630 $1,288
ST MARYS DEAN VENTURES INC Physician Group $9,807 $10,077 $9,270 $18,669 $47,824
SURGICAL ASSOCIATES Physician Group $112 $22 $37 $171
SURGICAL PARTNERS SC Physician Group $22 $30 $55 $111 $218
TIMOTHY J MCREATH, DDS Dentist $1,166 $1,166
WALGREENS #11277 Pharmacy $159 $2,017 $3,512 $5,687
WALGREENS 06885 Pharmacy $2,382 $5,796 $4,768 $6,311 $19,257
WALGREENS 10237 Pharmacy $9,086 $6,059 $4,779 $6,970 $26,894
WALGREENS#07882 Pharmacy $4,205 $4,595 $5,371 $9,465 $23,635
WAL-MART PHARMACY 10-1396 Pharmacy $3,079 $1,913 $1,761 $3,112 $9,866
WAL-MART PHARMACY 10-3505 Pharmacy $1,340 $790 $1,293 $3,232 $6,655
Sawyer CO OP PHARMACY Pharmacy $621 $1,959 $190 $2,769
DULUTH CLINIC HAYWARD PHARMA Pharmacy $2,956 $2,272 $2,031 $1,868 $9,127
ESSENTIA HEALTH HAYWARD CLINIC Physician Group $6,917 $7,467 $7,961 $10,066 $32,411
FOGARTY SURGICAL SERVICES & FAMILY CAREPhysician Group $246 $678 $175 $580 $1,679
Page 86 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
HAYWARD AREAMEMORIAL HOSP Hospital $169 $163 $1,244 $2,177 $3,752
Physician Group $158 $158
HAYWARD AREAMEMORIAL HOSPIT Independent Lab $60 $34 $53 $147
INHOFF HEALTH MART PHARMACY Pharmacy $2,032 $1,761 $1,601 $5,394
LAC COURTE OREILLES
Federally Qualified
Health Clinic (FQHC) $1,259 $2,377 $3,467 $1,470 $8,573
LAC COURTE OREILLES COMMUNIT
Mental Health and
Substance Abuse
Services $318 $318
PAMIDA PHARMACY #325 Pharmacy $3,329 $3,734 $3,767 $3,186 $14,017
SAWYER COUNTY HEALTH & HUMAN SERVICES SAWYER COUNTFamily Planning Clinic $15,587 $13,928 $10,583 $11,449 $51,547
STONE LAKE RURAL HEALTH CLIN Rural Health Clinic $122 $108 $230
WALGREENS #11857 Pharmacy $2,056 $7,276 $9,332
WAL-MART PHARMACY 10-3245 Pharmacy $3,054 $6,036 $7,873 $11,953 $28,916
Shawano ASPIRUS GENERAL CLINIC Physician Group $71 $71
ASPIRUS WAUSAU HOSPITAL INC WITTENBERG CLINICPhysician Group $135 $135
ASPIRUS WITTENBERG CLINIC Physician Group $37 $228 $265
DREIER PHARMACY & GIFTSHOPP Pharmacy $950 $1,290 $862 $972 $4,074
FMC BONDUEL Physician Group $166 $166
GWIDT PHARMACY INC Pharmacy $1,950 $3,480 $2,721 $1,948 $10,100
K MART PHARMACY 3769 Pharmacy $272 $354 $274 $511 $1,412
LANGLADE MEMORIAL HOSPGENERA Physician Group $284 $560 $69 $332 $1,246
MARSHFIELD CLINIC WITTENBERG Independent Lab $21 $21
PLANNED PARENTHOOD OF WISCONSIN, INCFamily Planning Clinic $128,332 $479,331 $138,238 $40,441 $786,342
SHAWANO MEDICAL CENTER Hospital $252 $505 $5,129 $10,984 $16,870
Physician Group $37 $30 $263 $330
SHAWANO MEDICAL CENTER CLINIC Physician Group $66 $55 $554 $1,218 $1,892
STOCKBRIDGE MUNSEE HEALTH & WELLNESSPharmacy $281 $353 $635
Page 87 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
STOCKBRIDGE MUNSEE HEALTH & WELLNESS CTR
Federally Qualified
Health Clinic (FQHC) $901 $165 $955 $1,860 $3,880
THEDACARE PHARMACY Pharmacy $1,580 $1,495 $771 $916 $4,762
THEDACARE PHYSICIANS SHAWANO Physician Group $3,786 $6,693 $2,292 $12,770
THEDACARE PHYSICIANS TIGERTON Physician Group $481 $481
WALGREENS 07615 Pharmacy $1,936 $2,999 $2,621 $3,275 $10,831
WAL-MART PHARMACY 10-2271 Pharmacy $2,724 $3,144 $5,200 $5,851 $16,917
Sheboygan AURORA MEDICAL GROUP Physician Group $15,821 $9,955 $11,442 $25,676 $62,894
AURORA MEDICAL GROUP INC
Mental Health and
Substance Abuse
Services $11 $11
AURORA PHARMACY INC Pharmacy $5,148 $4,493 $7,397 $8,668 $25,706
AURORA SHEBOYGAN MEMORIAL Hospital $163 $484 $5,021 $2,881 $8,549
AURORA VALLEY VIEW CAMPUS OF Physician Group $189 $189
COULIS CARDIOLOGY Physician Group $59 $61 $120
DEAN A MANCHESKI, MD Physician $115 $115
GARY R SCHERR, MD Physician $79 $79
GEORGE S SCHROEDER, MD Physician $57 $57
GLANDER PRESCRIPTIONS PLUS Pharmacy $88 $183 $115 $598 $983
JAMES R PAWLAK, MD Physician $60 $60
K MART PHARMACY 3831 Pharmacy $518 $589 $1,004 $427 $2,537
K MART PHARMACY 7100 Pharmacy $321 $255 $383 $409 $1,368
KATHERINE C CLEVELAND, MD Physician $48 $48
KATHRYN A GREEN, MD Physician $102 $102
LOUIE COULIS, MD Physician $127 $127
MARSHO FAMILY MEDICAL GROUP Physician Group $2,136 $30 $2,166
MARY E ARENBERG, MD Physician $648 $22 $670
MARY J GENTINE, MD Physician $30 $30
NAN C BROWNE, NP Nurse Practitioner $37 $37
Page 88 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $186,199 $198,025 $193,104 $329,532 $906,860
PLYMOUTH FAMILY PHYSICIANS Physician Group $79 $79
PREVEA SHEBOYGAN HEALTH CENT Physician Group $1,214 $2,649 $3,862
SCOTT M STILLWELL, MD Physician $73 $73
SHEBOYGAN INTERNAL MEDICINE ASSOCIATESPhysician Group $88 $511 $599
SHEBOYGAN ORTHOPAEDIC ASSOCIATES SCPhysician Group $67 $454 $521
SHEBOYGAN WOMENS HEALTH SC Physician Group $2,558 $2,084 $4,642
SHOPKO PHARMACY #2116 Pharmacy $676 $227 $1,488 $2,391
SHORELINE SKIN SPECIALISTS Physician Group $153 $153
ST MARYS HOSPITAL OZAUKEE Physician Group $421 $30 $451
ST NICHOLAS HOSPITAL Hospital $183 $260 $3,536 $19,586 $23,565
Independent Lab $951 $793 $484 $573 $2,801
STEVEN J STAEHLING, MD Physician $65 $65
TARGET STORE T-1880 PHARMACY Pharmacy $1,780 $1,827 $1,426 $1,074 $6,106
THOMAS J ZWEIFEL, DO Physician $122 $122
WALGREEN 06097 Pharmacy $3,838 $2,767 $1,651 $4,212 $12,468
WALGREENS #12020 Pharmacy $1,889 $953 $1,995 $5,910 $10,748
WALGREENS 01497 Pharmacy $1,474 $2,680 $2,225 $4,227 $10,606
WALGREENS06570 Pharmacy $8,012 $9,762 $10,129 $9,098 $37,001
WAL-MART PHARMACY 10-1276 Pharmacy $1,893 $4,515 $2,959 $2,798 $12,166
WAL-MART PHARMACY 10-3324 Pharmacy $100 $2,437 $2,899 $5,436
WAL-MART PHARMACY 10-3497 Pharmacy $1,252 $1,805 $1,445 $3,189 $7,691
St. Croix BALDWIN AREA MEDICAL CENTER INC Hospital $315 $631 $3,951 $5,970 $10,867
BALDWIN AREAMEDICAL CENTER Independent Lab $22 $87 $109
Physician Group $103 $155 $258
BALDWIN CLINIC Rural Health Clinic $1,604 $868 $4,642 $4,873 $11,987
COMMUNITY PHARMACY AT HUDSON Pharmacy $1,308 $1,048 $868 $1,340 $4,565
COUNTY MARKET PHARMACY Pharmacy $536 $773 $452 $183 $1,944
ECONOFOODS PHARMACY #320 Pharmacy $135 $135
Page 89 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ECONOFOODS PHARMACY #321 Pharmacy $5,186 $4,720 $3,415 $3,877 $17,198
ECONOFOODS PHARMACY 344 Pharmacy $1,052 $405 $169 $1,792 $3,419
EILEEN M REARDON, MD Physician $47 $475 $130 $652
HUDSON HOSPITAL & CLINICS Physician Group $37 $37
HUDSON HOSPITAL INC Hospital $715 $4,050 $14,888 $17,405 $37,057
HUDSON MEMORIAL HOSPITAL Anesthetist $143 $143
HUDSON PHYSICIANS Physician Group $2,386 $3,902 $4,953 $6,062 $17,304
MARJORIE J BELISLE, NP Nurse Practitioner $77 $60 $55 $192
MICKLESEN DRUG INC Pharmacy $940 $682 $119 $496 $2,237
NEW RICHMONDCLINIC Physician Group $2,621 $3,309 $3,329 $4,074 $13,332
PAMIDA PHARMACY 315 Pharmacy $2,603 $485 $3,088
SHOPKO PHARMACY #2130 Pharmacy $2,117 $1,873 $872 $2,233 $7,095
SOMERSET DRUG LLC Pharmacy $394 $960 $1,354
ST CROIX CO HEALTH & HUMAN Family Planning Clinic $134,347 $122,823 $134,667 $252,243 $644,080
STEPHANIE L JOHNSON, CNM Nurse Practitioner $338 $223 $560
STILLWATER MEDICAL GROUP Physician Group $114 $290 $436 $1,199 $2,039
TARGET STORE T-1235 PHARMACY Pharmacy $3,232 $2,833 $3,033 $5,696 $14,795
VILLAGE PHARMACY Pharmacy $2,715 $4,606 $7,148 $8,923 $23,393
WALGREENS #10585 Pharmacy $507 $3,964 $6,431 $9,546 $20,447
WAL-MART PHARMACY 10-1365 Pharmacy $1,761 $2,568 $2,701 $4,967 $11,996
WAL-MART PHARMACY 10-5432 Pharmacy $2,385 $3,144 $6,278 $8,856 $20,662
WESTERN WISCONSIN OB GYN Physician Group $881 $755 $1,636
WESTFIELDS HOSPITAL Hospital $1,665 $4,035 $9,079 $14,779
WESTFIELDS HOSPITAL INC Physician Group $58 $257 $314
Taylor K MART PHARMCY 7656 Pharmacy $2,073 $2,601 $1,250 $1,020 $6,944
MEDFORD VALURITE DRUGS Pharmacy $3,553 $2,987 $1,822 $1,421 $9,783
MEDICAL CENTER PHARMACY Pharmacy $4,637 $3,486 $3,980 $5,416 $17,518
MEMORIAL HEALTH CENTER CLINIC RIB LAKEPhysician Group $415 $157 $297 $869
MEMORIAL HEALTH CENTER CLINICS GILMANPhysician Group $100 $147 $1,414 $344 $2,005
Page 90 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MEMORIAL HEALTH CENTER CLINICS MEDFORD BEHAVIORAL
Mental Health and
Substance Abuse
Services $115 $115
MEMORIAL HEALTH CENTERCLINI Physician Group $4,091 $3,262 $3,881 $5,652 $16,885
MEMORIAL HEALTH CENTERINC Hospital $2,572 $746 $10,933 $11,399 $25,650
Independent Lab $716 $825 $1,186 $861 $3,587
Physician Group $276 $143 $35 $65 $518
WAL-MART PHARMACY 10-3643 Pharmacy $527 $2,050 $1,154 $3,731
Trempealeau COLBY HEALTHMART PHARMACY Pharmacy $492 $599 $793 $1,335 $3,218
FRANCISCAN SKEMP ARCADIA Hospital $165 $110 $2,759 $3,034
GALESVILLE PHARMACY Pharmacy $140 $818 $1,664 $1,109 $3,731
GUNDERSEN CLINIC BLAIR Rural Health Clinic $83 $201 $284
GUNDERSEN CLINIC INDEPENDENC Rural Health Clinic $39 $32 $166 $148 $386
GUNDERSEN CLINIC LTD Physician Group $82 $240 $321
GUNDERSEN CLINIC WHITEHALL Rural Health Clinic $441 $313 $37 $248 $1,038
MAYO CLINIC HEALTH SYSTEM OAKRIDGE INCHospital $255 $255
MAYO CLINIC HEALTH SYSTEM OAKRIDGE- OSSEO CLINICPhysician Group $85 $75 $383 $1,081 $1,624
MAYO CLINIC HEALTH SYSTEM PHARMACY & HOME MEDICALPharmacy $223 $497 $231 $553 $1,504
PAMIDA PHARMACY 834 Pharmacy $674 $430 $359 $268 $1,731
STRUM PHARMACY INC Pharmacy $246 $155 $304 $298 $1,003
THE BLAIR PHARMACY Pharmacy $508 $288 $745 $59 $1,600
TRI COUNTY MEMORIAL Physician Group $30 $30
TRI COUNTY MEMORIAL HOSPITAL Hospital $99 $199 $204 $3,356 $3,858
Independent Lab $10 $10
WESTERN DAIRYLAND ECONOMIC OPPORTUNITY COUNCIL INCFamily Planning Clinic $34,675 $62,308 $74,787 $93,500 $265,271
Vernon BLAND CLINICVMH Rural Health Clinic $139 $238 $108 $486
GUNDERSEN CLINIC HILLSBORO Rural Health Clinic $109 $109
GUNDERSEN CLINIC LTD Physician Group $986 $916 $1,003 $33 $2,937
HIRSCH CLINIC VMH Physician Group $548 $10 $134 $406 $1,098
Page 91 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
HIRSCH CLINICVMH Rural Health Clinic $2,916 $1,195 $763 $1,627 $6,501
LAFARGE MEDICAL CLINIC Rural Health Clinic $246 $503 $121 $870
PETERSON PHARMACY INC Pharmacy $823 $1,746 $760 $477 $3,806
ST JOSEPHS HEALTH SERVICES INC Physician Group $360 $235 $436 $431 $1,462
ST JOSEPHS MEMORIAL HOSPITAL Hospital $740 $459 $5,397 $6,596
VERNON MEMORIAL HOSPITAL Hospital $155 $918 $3,883 $3,348 $8,304
VERNON MEMORIAL PHARMACY Pharmacy $42 $42
WALGREENS 10301 Pharmacy $1,270 $2,367 $2,770 $4,936 $11,343
WAL-MART PHARMACY 10-0971 Pharmacy $2,490 $1,642 $1,944 $1,112 $7,188
WESTBY PHARMACY Pharmacy $134 $134
Vilas ASPIRUS LAND O LAKES CLINIC Physician Group $83 $69 $48 $118 $318
ASPIRUS PHARMACY Pharmacy $128 $154 $282
ASPIRUS PHELPS CLINIC Physician Group $24 $22 $46
EAGLE RIVER MEMORIAL HOSPITAL Hospital $678 $802 $4,712 $6,192
LAND O LAKESHEALTH CARE PHARMACYPharmacy $1,155 $155 $664 $769 $2,742
MARSHFIELD CLINIC EAGLE RIVE Independent Lab $11 $11
PETER CHRISTENSEN HEALTH CENTER
Federally Qualified
Health Clinic (FQHC) $4,480 $1,665 $2,347 $1,615 $10,106
PETER CHRISTENSEN HLTHCTR Pharmacy $370 $1,308 $1,678
RIVER NORTH PHARMACY Pharmacy $800 $705 $351 $1,856
ST GERMAIN HEALTH CAREPHARMA Pharmacy $513 $304 $119 $700 $1,636
TERRANCE D MOE, MD Physician $469 $120 $550 $1,139
TRIGS PHARMACY Pharmacy $3,105 $2,893 $1,567 $2,329 $9,895
VILAS COUNTYHEALTH Family Planning Clinic $18,145 $18,145
WALGREENS #12545 Pharmacy $2,123 $2,123
WALL STREET HEALTH CARE PHAR Pharmacy $1,512 $389 $306 $552 $2,759
Walworth ALTERNATIVE HEALTHCAREFAMIL Physician Group $148 $775 $924
AURORA LAKELAND MEDICAL CTR Hospital $169 $368 $5,328 $5,733 $11,599
AURORA MEDICAL GROUP Physician Group $5,302 $3,295 $1,978 $8,364 $18,939
Page 92 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
AURORA PHARMACY INC Pharmacy $623 $352 $203 $2,825 $4,003
CLIFFORD R POPLAR, MD Physician $30 $55 $85
DARIEN MEDICAL CENTER Physician Group $201 $201
E A MCCULLOUGH INC Pharmacy $149 $149
FORT HEALTHCARE INC Physician Group $58 $58
JOHN P HOWLAND, DDS Dentist $310 $186 $496
JULIE R OSBORNE, DO Physician $279 $30 $41 $350
KAMAL S MUZAFFAR, MD Physician $209 $209
MC 5 INC Pharmacy $254 $1,849 $1,541 $820 $4,464
MCCULLOUGH PHARMACY INC Pharmacy $633 $199 $578 $148 $1,558
MERCY WALWORTH HOSPITAL AND MEDICAL CENTERHospital $51 $12 $10,766 $10,829
MERCY WALWORTH PHARMACY Pharmacy $727 $416 $764 $1,078 $2,984
NEIL J RENNICK, DO Physician $57 $30 $87
PHARMACY STATION Pharmacy $2,207 $670 $1,581 $2,674 $7,132
PLANNED PARENTHOOD OF WISCONSIN, INCFamily Planning Clinic $2,466 $37,088 $39,554
PLAZA PHARMACY Pharmacy $431 $1,000 $365 $1,796
REYNOLDS PHARMACY INC Pharmacy $188 $1,263 $2,897 $1,683 $6,031
SHOPKO PHARMACY #2127 Pharmacy $1,650 $1,336 $1,301 $1,600 $5,888
TARGET STORE T-2348 PHARMACY Pharmacy $96 $124 $220
UNIVERSITY HEALTH & COUNSELING Family Planning Clinic $2,870 $62,285 $107,318 $92,188 $264,660
WALGREENS #09210 Pharmacy $1,907 $1,202 $949 $2,829 $6,886
WALGREENS #10714 Pharmacy $67 $1,897 $4,723 $6,688
WALGREENS #12638 Pharmacy $7,939 $26,834 $34,772
WALGREENS 05600 Pharmacy $4,443 $5,588 $4,251 $7,341 $21,623
WAL-MART PHARMACY 10-0910 Pharmacy $1,427 $1,364 $2,305 $4,637 $9,733
WAL-MART PHARMACY 10-3247 Pharmacy $1,863 $1,808 $1,490 $2,093 $7,256
Washburn ESSENTIA HEALTH SPOONER CLINIC Physician Group $5,203 $6,687 $7,849 $17,471 $37,209
INDIANHEAD MEDICAL CENTER Hospital $244 $624 $4,104 $323 $5,295
KATHERINE E PARKINSON, MD Physician $30 $30
Page 93 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
NORTH WOODS COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $2,976 $2,462 $2,400 $2,221 $10,059
Physician Group $807 $807
PARKINSON DERMATOLOGY SC Physician Group $149 $149
RED CROSS PHARMACY Pharmacy $6,919 $7,706 $6,435 $11,094 $32,154
SCHMITZS ECONOMART Pharmacy $1,172 $1,835 $2,121 $1,330 $6,457
SHELL LAKE CLINIC LTD Physician Group $2,941 $3,462 $2,817 $2,340 $11,560
SHELL LAKE PHARMACY Pharmacy $1,384 $2,032 $2,398 $3,825 $9,639
SPOONER HEALTH SYSTEM Hospital $962 $2,554 $4,282 $7,798
WASHBURN COUNTY HEALTHDEPT Family Planning Clinic $45,133 $29,543 $17,258 $30,279 $122,212
Washington AURORA HEALTH CENTER HARTFOR Physician Group $3,965 $6,885 $3,136 $8,753 $22,739
AURORA MEDICAL CENTER OF Hospital $455 $2,413 $3,299 $6,168
AURORA PHARMACY INC Pharmacy $4,925 $2,914 $2,788 $3,371 $13,997
DIAGNOSTIC SERVICES OFWASHINGTON CTYPhysician Group $1,790 $783 $1,603 $1,235 $5,410
DIRK H STEINERT, MD Physician $49 $49
EARL W NEPPLE, MD Physician $48 $48
JEWEL OSCO 3625 Pharmacy $128 $128
K MART PHARMACY 3534 Pharmacy $2,081 $629 $237 $442 $3,389
K MART PHARMACY 9645 Pharmacy $208 $208
KETTLE MORAINE ANESTHESIOLOG Physician Group $29 $98 $127
PAUL V BULLIS, MD Physician $30 $30
PICK N SAVE PHARMACY #6417 Pharmacy $1,153 $1,153
PICK N SAVE PHARMACY #6430 Pharmacy $995 $581 $775 $445 $2,795
PICK N SAVE PHARMACY 6357 Pharmacy $316 $357 $162 $366 $1,201
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $323,006 $255,541 $78,854 $139,241 $796,643
SHOPKO PHARMACY #2018 Pharmacy $1,992 $2,289 $1,634 $3,669 $9,584
ST JOSEPHS COMMUNITY HOSP Hospital $1,424 $2,184 $12,496 $20,170 $36,274
ST JOSEPHS COMMUNITY HOSPITA Independent Lab $1,459 $1,886 $3,322 $4,063 $10,730
ST MARYS HOSPITAL OZAUKEE Physician Group $138 $330 $174 $642
Page 94 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WAL MART PHARMACY 10 1515 Pharmacy $419 $1,564 $1,283 $4,031 $7,296
WAL MART PHARMACY 10 2658 Pharmacy $3,654 $5,489 $2,850 $5,041 $17,035
WALGREENS #11676 Pharmacy $218 $1,249 $2,080 $3,547
WALGREENS #13088 Pharmacy $7,917 $9,277 $12,325 $18,040 $47,559
WALGREENS 05427 Pharmacy $3,593 $1,685 $3,402 $5,857 $14,538
WALGREENS 06960 Pharmacy $4,863 $5,500 $4,484 $3,614 $18,460
WEST BEND CLINIC INC Physician Group $9,095 $13,658 $17,675 $38,763 $79,192
WEST BEND PHARMACY Pharmacy $174 $445 $495 $1,457 $2,570
Waukesha AFFILIATED DERMATOLOGISTS Physician Group $98 $673 $770
ALEXANDER A ROMASHKO MD SC Physician Group $141 $141
AMERIPATH MILWAUKEE SC Physician Group $11 $205 $40 $256
ANEX SC Physician Group $193 $55 $55 $304
ANN M TOUSIGNANT, MD Physician $58 $58
ANNE M RIENDL, MD Physician $476 $476
ANTHONY HOANG, MD Physician $57 $57
ARNAVAZ DUA, MD Physician $48 $48
AURORA HEALTH CENTER Physician Group $20 $60 $210 $1,423 $1,714
AURORA MEDICAL GROUP Physician Group $276 $909 $189 $3,517 $4,891
AURORA PHARMACY Pharmacy $360 $914 $28 $1,427 $2,730
AURORA PHARMACY INC Pharmacy $2,064 $5,548 $2,358 $2,527 $12,496
AURORA QUICKCARE LLC Nurse Practitioner $505 $715 $1,565 $2,785
AURORA ST LUKES NEW BERLIN Physician Group $60 $22 $596 $678
AURORA WILKINSON MEDICAL CLINIC Physician Group $1,905 $2,570 $1,052 $12,505 $18,032
BELLIN ANESTHESIA ASSOCIATES SC Physician Group $37 $111 $55 $203
BRIAN A CHAPMAN, MD Physician $182 $182
BROOKFIELD SURGICAL ASSOC Physician Group $266 $266
CENTER FOR NEUROLOGICAL DISORDERSPhysician Group $78 $48 $126
CHERRI A SCHLEICHER, FNP Nurse Practitioner $148 $148
CHILDRENS MEDICAL GROUP Physician Group $33 $33
Page 95 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CHRISTINA TINGUELY, MD Physician $55 $272 $327
CHRISTOPH KING, DO Physician $30 $30
CHRISTOPHER J HUSSUSSIAN, MD Physician $30 $30
COMMUNITY MEMORIAL HOSPITAL Hospital $129 $762 $7,165 $22,723 $30,780
CVS PHARMACY # 06855 Pharmacy $59 $59
CVS PHARMACY #08947 Pharmacy $26 $26
CVS PHARMACY#08764 Pharmacy $283 $296 $579
DANA J AKIYA, MD Physician $325 $325
DARRYL M PRINCE, MD Physician $114 $61 $175
DERMATOPATHOLOGY OF WISC Independent Lab $195 $155 $66 $2,599 $3,014
DIGESTIVE DISEASE SPECIALIST Physician Group $91 $61 $152
DONALD J LANDGRAF, DO Physician $47 $60 $217 $324
DR ARNAVAZ DUA MD SC Physician Group $143 $143
ELAINE M LIVERMAN, MD Physician $115 $115
ELDON J SWENSON, MD Physician $158 $158
ELIZABETH M DAVIES, MD Physician $30 $78 $125 $513 $747
ELMBROOK INTERNAL MED ASSOC Physician Group $521 $521
EMILY E STODDARD, MD Physician $24 $203 $227
FALLS ANESTHESIA ASSOCIATES SC Physician Group $193 $149 $312 $655
GASTROENTEROLOGY SPECIALISTS Physician Group $101 $101
GENEVIEVE M JONES, MD Physician $48 $48
GREAT LAKES RADIOLOGISTS Physician Group $10 $84 $94
GREATER MILWAUKEE PLASTIC SU Physician Group $12 $101 $113
GREG HEAL, MD Physician $30 $60 $211 $30 $332
GUILLERMO D VARONA, MD Physician $30 $30
HEALTH CENTER PHARMACYWEST Pharmacy $331 $350 $391 $1,072
JAMES A STADLER II, MD Physician $165 $20 $205 $390
JEROME DRUGS BIG BEND Pharmacy $120 $279 $399
JEROME DRUGS INC Pharmacy $242 $306 $547
Page 96 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
JOHN E KELLY, MD Physician $129 $163 $296 $588
JOHN R PHILLIPS, MD Physician $22 $22
JOHN S CANTIERI, MD Physician $99 $59 $158
JOSE S AGPOON, MD Physician $98 $98
JUAN T BIAGTAN, MD Physician $126 $126
K MART PHARMACY 3692 Pharmacy $524 $1,190 $502 $2,216
K MART PHARMACY 4376 Pharmacy $135 $109 $282 $526
KATHY HARTKE, MD Physician $19 $57 $75
KENNETH G CONDON, MD Physician $55 $55
KENNETH W REICHERT II, MD Physician $22 $22
LABORATORY PATHOLOGY Physician Group $104 $104
LABWORKS INC Physician Group $12 $12
LAKE AREA PHYSICAL MEDICINE Physician Group $30 $90 $43 $273 $436
LAKE COUNTRY PATHOLOGISTS SC Physician Group $39 $721 $1,260 $3,725 $5,745
LAKE COUNTRYINSTITUTIONAL Pharmacy $29 $29
LAKESHORE MEDICAL CLINIC Physician Group $87 $57 $457 $2,932 $3,532
LAURA EPPERSON, MD Physician $218 $257 $475
LEIF E ESBENSEN, MD Physician $410 $410
LIFETIME OB GYN LTD Physician Group $1,457 $981 $2,782 $7,571 $12,791
LYNN K DIULIO, MD Physician $58 $58
MARK A WEBER, MD Physician $176 $176
MARK D GROSSKLAUS, MD Physician $43 $43
MARY C FOX, MD Physician $30 $30
MARY M MILBRATH, MD Physician $22 $22
MATTHEW A MEYER, MD Physician $290 $354 $645
MEDICAL ASSOCIATES INC Physician Group $3,961 $2,987 $1,949 $9,337 $18,233
MEDICAL CENTER PHARMACY Pharmacy $323 $65 $388
MEDICAL EYE ASSOC S C Physician Group $153 $153
Page 97 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MENOMONEE FALLS ASC
Ambulatory Surgical
Center (ASC) $724 $731 $1,455
MENOMONEE FALLS MEDICAL Pharmacy $166 $111 $276
METROPOLITAN ANESTHESIOLOGISTS SCPhysician Group $157 $176 $332
MICHAEL LUNDE, MD Physician $48 $48
MIDWEST PHYS ANES SRVCS SC Physician Group $30 $30
MILLER PHARMACY INC Pharmacy $1,362 $627 $487 $433 $2,908
MILWAUKEE ANESTHESIA CONSULTANTS LTDPhysician Group $153 $153
MOHAMMED R SETHI, MD Physician $78 $78
MORELAND MEDICAL CENTER LAB Independent Lab $11 $220 $329 $309 $869
MORELAND OB/GYN ASSOCIATES, S.C. Physician Group $1,359 $2,345 $2,231 $3,851 $9,785
MORELAND PLAZA PHARMACY INC Pharmacy $34 $34
NEURO ASSOC WAUKESHA LTD Physician Group $164 $164
NEW BERLIN PHARMACY INC Pharmacy $370 $259 $629
NEZIH Z HASANOGLU, DO Physician $113 $113
NICOLE L STERNITZKY, MD Physician $1,032 $299 $378 $291 $2,000
NORTHWOODS ANESTHESIA SERVICES SCPhysician Group $37 $196 $233
OB GYN AFFILIATES SC Physician Group $57 $129 $103 $280 $569
OCONOMOWOC MEM HOSP Hospital $298 $904 $4,979 $11,548 $17,730
OCONOMOWOC MEMORIAL HOSPITAL Independent Lab $520 $561 $554 $984 $2,619
ORTHOPAEDIC ASSOCIATES OF WI Physician Group $73 $430 $504
OSCO DRUG #3680 Pharmacy $232 $232
PADMAJA DONIPARTHI MD SC Physician Group $171 $171
PAMELA R HANSON, DDS Dentist $680 $383 $1,063
PATRICIO F VIERNES, MD Physician $48 $48
PICK N SAVE PHARMACY #6312 Pharmacy $47 $105 $152
PICK N SAVE PHARMACY #6315 Pharmacy $389 $389
PICK N SAVE PHARMACY #6369 Pharmacy $392 $392
PICK N SAVE PHARMACY #6384 Pharmacy $44 $44
Page 98 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
PICK N SAVE PHARMACY #6386 Pharmacy $31 $31
PICK N SAVE PHARMACY #6397 Pharmacy $88 $88
PICK N SAVE PHARMACY #6413 Pharmacy $418 $418
PICK N SAVE PHARMACY #6853 Pharmacy $200 $200
PICK N SAVE PHARMACY #6881 Pharmacy $327 $327
PICK N SAVE PHARMACY 6308 Pharmacy $100 $56 $126 $282
PICK N SAVE PHARMACY 6388 Pharmacy $1,235 $1,585 $2,317 $2,916 $8,053
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $364,937 $439,532 $606,713 $2,171 $1,413,354
PRACTICE MANAGEMENT GROUP Physician Group $115 $112 $113 $1,827 $2,167
PRESCRIPTIONCENTER Pharmacy $32 $1,651 $1,683
PROHEALTH CARE MEDICAL ASSOCIATESPhysician Group $3,582 $4,401 $5,900 $18,754 $32,638
PROHEALTH CARE MEDICALCTRS Physician Group $231 $231
RADIOLOGY WAUKESHA SC Physician Group $157 $136 $785 $1,077
RALPH T COMPTON III, MD Physician $13 $13
RENEU WOMENSHEALTH ANDMEDIS Physician Group $246 $44 $380 $670
RICHARD J POLLACK, DO Physician $257 $257
RIESCH SURGICAL SCIENCE LLC Physician Group $61 $61
ROBERT E SCHELLINGER, MD Physician $67 $678 $744
ROGER A LALICH, DO Physician $37 $273 $310
SAM'S PHARMACY 10-8164 Pharmacy $160 $89 $298 $547
SEAN A JOCHIMS, MD Physician $30 $30
SHEKHAR A DAGAM, MD Physician $48 $48
SHERRY L PROWATZKE, MD Physician $58 $58
SHOPKO PHARMACY #2178 Pharmacy $483 $483
SOUTHEASTERN WI ANESTHESIOLOGY Physician Group $223 $176 $186 $585
STANYA SMITH, MD Physician $170 $170
STONES PHARMACY INC Pharmacy $167 $167
SUSSEX FAMILY PRACTICESC Physician Group $137 $468 $605
TARGET STORE T-0863 Pharmacy $393 $181 $1,007 $773 $2,355
Page 99 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
TARGET STORE T-0864 PHARMACY Pharmacy $22 $1,692 $1,714
TARGET STORE T-1311 PHARMACY Pharmacy $280 $309 $1,171 $1,507 $3,267
TARGET STORE T-2546 PHARMACY Pharmacy $488 $488
TARGET T-0082 PHARMACY Pharmacy $313 $297 $274 $885
THEODORE G GREEN, DO Physician $22 $22
THOMAS G KORKOS MD SC Physician Group $48 $48
THOMAS G KORKOS, MD Physician $55 $55
THOMAS G WITTMANN, MD Physician $22 $169 $190
TIMOTHY G MCAVOY, MD Physician $55 $30 $85
TOBIN DRUG OCONOMOWOC INC Pharmacy $144 $144
UROLOGY ASSOCIATES LTD SC Physician Group $55 $55
VERRE YOUNG EYE CLINICSC Physician Group $48 $48
VICTORIA J MONDLOCH, MD Physician $173 $173
WAL MART PHARMACY 10 1515 Pharmacy $626 $626
WALGREEN 07259 Pharmacy $1,006 $1,109 $1,532 $2,609 $6,255
WALGREENS #03615 Pharmacy $971 $926 $619 $756 $3,272
WALGREENS #05309 Pharmacy $1,484 $1,489 $709 $1,702 $5,384
WALGREENS #11636 Pharmacy $366 $254 $1,925 $2,545
WALGREENS 02752 Pharmacy $215 $815 $842 $3,683 $5,555
WALGREENS 03567 Pharmacy $1,801 $3,117 $2,006 $3,737 $10,662
WALGREENS 04672 Pharmacy $1,283 $1,312 $206 $1,807 $4,609
WALGREENS 04888 Pharmacy $1,357 $1,149 $1,208 $821 $4,536
WALGREENS 05002 Pharmacy $3,078 $3,171 $2,642 $4,895 $13,786
WALGREENS 05281 Pharmacy $1,734 $2,112 $1,005 $2,107 $6,958
WALGREENS 05466 Pharmacy $651 $1,423 $1,636 $1,846 $5,555
WALGREENS 05636 Pharmacy $2,167 $3,216 $2,540 $2,306 $10,229
WALGREENS 07039 Pharmacy $1,239 $1,667 $2,986 $3,461 $9,353
WALGREENS 07143 Pharmacy $114 $652 $829 $209 $1,804
WALGREENS 07603 Pharmacy $1,404 $1,633 $1,193 $1,568 $5,798
Page 100 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS 07731 Pharmacy $3,265 $2,396 $1,581 $1,520 $8,763
WALGREENS 09365 Pharmacy $1,328 $2,076 $1,810 $5,529 $10,743
WALGREENS#03883 Pharmacy $3,052 $6,714 $5,178 $5,137 $20,081
WALGREENS#07797 Pharmacy $340 $391 $779 $852 $2,361
WALGREENS07730 Pharmacy $1,000 $3,316 $1,500 $2,024 $7,840
WAL-MART PHARMACY 10-1571 Pharmacy $860 $1,218 $2,518 $2,333 $6,929
WAL-MART PHARMACY 10-1635 Pharmacy $1,167 $599 $492 $1,926 $4,185
WAL-MART PHARMACY 10-1678 Pharmacy $1,270 $1,402 $2,050 $1,145 $5,866
WAL-MART PHARMACY 10-3322 Pharmacy $862 $274 $1,058 $507 $2,701
WAL-MART PHARMACY 10-5438 Pharmacy $288 $787 $1,107 $2,181
WAUKESHA COUNTY HEALTH& Physician Group $101 $101
WAUKESHA FAMILY PRACTICE CEN Physician Group $70 $159 $686 $3,455 $4,370
WAUKESHA HEART INSTITUTE Physician Group $30 $30
WAUKESHA MEMORIAL HOSPITAL INC Hospital $446 $2,252 $30,323 $74,153 $107,174
WAUKESHA MEMORIAL HOSPITAL L Independent Lab $2,362 $3,170 $3,692 $15,848 $25,072
WAUKESHA PEDIATRIC ASSOCIATE Physician Group $30 $77 $57 $164
WAUKESHA PHARMACY Pharmacy $75 $75
WAUKESHA SURGICAL SPECIALIST Physician Group $74 $74
WEST SUBURBAN CENTER FOR Physician Group $101 $101
WESTWOOD MEDICAL GROUP Physician Group $193 $193
WHEATON FRANCISCAN INC Hospital $254 $4,393 $14,364 $19,010
WHEATON FRANCISCAN MEDICAL Physician Group $91 $91
WHEATON FRANCISCAN PHARMACY Pharmacy $48 $14 $62
WILLIAM A DARLING, MD Physician $30 $30
WISCONSIN EATING DISORDER Physician Group $94 $94
WISCONSIN HEART GROUP SC Physician Group $101 $101
WISCONSIN NEUROSURGERY SC Physician Group $60 $60
WOMENS HEALTHCARE SC Physician Group $909 $314 $1,223
Waupaca AFFINITY MEDICAL GROUPRHC Rural Health Clinic $337 $143 $88 $505 $1,073
Page 101 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ELIZABETH A BARON-KUHN, MD Physician $628 $628
JOHN G HOFFMANN, MD Physician $301 $301
K MART PHARMACY 3750 Pharmacy $1,475 $1,956 $1,202 $2,880 $7,513
KOEPPENS MEDICAL TRANSPORTS Transportation $88 $88
MINISTRY MEDICAL GROUP Physician Group $394 $1,516 $1,910
MINITSTRY MEDICAL GROUP Physician Group $30 $465 $495
PAMIDA PHARMACY 220 Pharmacy $3,399 $2,681 $2,916 $4,460 $13,456
PRESCRIPTIONS PLUS Pharmacy $680 $486 $310 $368 $1,845
RICHARD S VEIGA MD SC Physician Group $358 $358
RICHARD S VEIGA, MD Physician $630 $433 $1,063
RIVERSIDE CLINIC PHARMACY Pharmacy $1,212 $1,926 $1,852 $914 $5,905
RIVERSIDE MEDICAL CENTER Hospital $571 $2,891 $18,721 $11,164 $33,348
Independent Lab $661 $322 $293 $827 $2,103
Physician Group $112 $52 $201 $256 $620
ROBERT L PETERSON, MD Physician $22 $22
STRATTON DRUGINC Pharmacy $1,460 $948 $1,644 $2,461 $6,514
THE MEDICINESHOPPE Pharmacy $223 $32 $255
THEDACARE PHYSICIANS CLINTONVILLEPhysician Group $114 $114
THEDACARE PHYSICIANS IOLA Physician Group $1,870 $59 $1,929
THEDACARE PHYSICIANS WAUPACA Physician Group $1,881 $1,872 $1,611 $6,753 $12,117
TIMOTHY B RASOR, MD Physician $87 $87
WALGREENS #09699 Pharmacy $5,885 $6,316 $9,978 $8,490 $30,669
WALGREENS #11301 Pharmacy $150 $2,948 $3,114 $6,211
WAL-MART PHARMACY 10-1471 Pharmacy $2,535 $2,167 $1,993 $1,246 $7,941
WAUPACA COUNTY DHHS Family Planning Clinic $55,993 $26,868 $80,446 $66,804 $230,112
WAUPACA WOODS PHARMACY Pharmacy $858 $855 $1,288 $982 $3,983
Waushara AURORA PHARMACY INC Pharmacy $764 $794 $3,888 $1,813 $7,259
CHN MEDICAL CENTER REDGRANITE Physician Group $30 $86 $216 $332
CHN MEDICAL CENTER WAUTOMA Physician Group $342 $342
Page 102 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
CHN PHARMACY #1 Pharmacy $3,343 $2,014 $645 $3,829 $9,831
LA CLINICA DE LOS CAMPESINOS
Federally Qualified
Health Clinic (FQHC) $558 $225 $183 $1,041 $2,007
PAMIDA PHARMACY #340 Pharmacy $4,159 $4,652 $3,701 $1,816 $14,327
WAUSHARA FAMILY PHYSICIANS Physician Group $973 $949 $694 $2,760 $5,375
WILD ROSE COMMUNITY MEM HOSP Hospital $335 $157 $3,400 $6,303 $10,194
WILD ROSE COMMUNITY MEMORIAL Independent Lab $97 $159 $317 $573
Winnebago AFFINITY MEDICAL GROUP Physician Group $24,722 $21,663 $26,545 $50,412 $123,342
ALBERT L FISHER, MD Physician $30 $151 $181
ANESTHESIA SERVICES OF THE FOX VALLEY,SCPhysician Group $158 $66 $372 $596
ASSOCIATION OF HOSPITAL ANESTHESIOLOGISTSPhysician Group $182 $182
AURORA MEDICAL CTR OF OSHKOS Hospital $123 $6,644 $3,087 $9,854
AURORA MEDICAL GROU P OSHKOS Physician Group $9,911 $9,920 $11,852 $17,282 $48,964
AURORA PHARMACY INC Pharmacy $2,356 $1,428 $3,145 $2,841 $9,770
CHILDRENS HOSPITAL OF Hospital $400 $351 $751
CVS PHARMACY #05186 Pharmacy $367 $379 $746
DAVID J SCHULTZ, MD Physician $22 $22 $44
DERMATOLOGY ASSOCIATESOF WI Physician Group $884 $884
DIGESTIVE HEALTHCARE SPECIALISTS, SCPhysician Group $22 $22
DILIP K TANNAN, MD Physician $217 $333 $550
EAR NOSE & THROAT SPECIALIST Physician Group $236 $236
FOX CITIES COMMUNITY HEALTH CENTER INC
Federally Qualified
Health Clinic (FQHC) $1,683 $1,000 $2,584 $7,387 $12,654
Mental Health and
Substance Abuse
Services $22 $22
FOX VALLEY PATHOLOGISTS SC Physician Group $2,008 $3,603 $4,954 $7,284 $17,849
FOX VALLEY PLASTIC SURGERY Physician Group $55 $55
FOX VALLEY WOMENS HEALTH SERVICESPhysician Group $1,826 $1,826
Page 103 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
INTERGRATIVE PAIN MANAGEMENT SCPhysician Group $231 $231
JOHN S PUJALS, MD Physician $37 $37
K MART PHARMACY 4254 Pharmacy $1,908 $657 $2,565
KAMALJIT S PAUL, MD Physician $48 $48
KEVIN E WASCO, MD Physician $22 $22
KIRTIDA N RINGWALA, MD Physician $135 $60 $146 $123 $464
LAKESIDE NEUROCARE Physician Group $22 $30 $52
MARY MCDONALDMD SC Physician Group $55 $55
MERCY MEDICAL CENTER OF OSHK Independent Lab $3,097 $3,803 $6,679 $11,254 $24,834
MERCY MEDICAL CENTER OF OSHKOSH INCHospital $1,020 $1,514 $10,427 $23,814 $36,775
MORTON PHARMACY Pharmacy $6,514 $5,511 $4,362 $5,000 $21,387
NEUROSCIENCE GROUP OF NE WI Physician Group $30 $73 $418 $521
NORTHEAST WISCONSIN VISION CENTER, LTDPhysician Group $55 $55
OMRO PHARMACY Pharmacy $1,265 $1,140 $978 $1,950 $5,333
ORTHOPAEDIC SPECIALISTS SC Physician Group $22 $22
PATRICK J BRENNAN, MD Physician $22 $22
PAUL A BOEDER, MD Physician $329 $216 $1,917 $2,463
PICK N SAVE PHARMACY #5378 Pharmacy $763 $763
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $14,912 $73,632 $88,544
RADIOLOGY ASSOCIATES OF THE Physician Group $159 $370 $1,029 $1,558
RAYMOND F GEORGEN, MD Physician $22 $22 $44
ROBERT F MANN, MD Physician $101 $101
ROBERT J HOLLY, MD Physician $22 $22
SHEILA M ANDERSON, MD Physician $225 $225
SHOPKO PHARMACY #2033 Pharmacy $2,516 $1,848 $1,039 $2,592 $7,994
SHOPKO PHARMACY #2042 Pharmacy $6,623 $7,792 $7,347 $5,290 $27,052
SHOPKO PHARMACY #2100 Pharmacy $1,766 $1,906 $1,353 $533 $5,558
ST ELIZABETHSURGERY CENTER
Ambulatory Surgical
Center (ASC) $930 $209 $1,139
Page 104 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
STUDENT HEALTH CENTER Family Planning Clinic $188,521 $205,246 $143,624 $120,453 $657,844
TARGET STORE T-0807 PHARMACY Pharmacy $277 $946 $250 $2,508 $3,981
THEDA CARE PHYSICIANS MENASH Physician Group $1,791 $992 $1,710 $4,493
THEDA CLARK MEDICAL CENTER Hospital $3,843 $2,407 $26,816 $21,651 $54,716
Independent Lab $6,741 $13,816 $16,784 $20,550 $57,892
THEDACARE PHYSICIANS NEENAH- EASTPhysician Group $451 $129 $759 $3,172 $4,512
THEDACARE PHYSICIANS NEENAH- WESTPhysician Group $750 $301 $188 $1,240
THEDACARE PHYSICIANS OSHKOSH Physician Group $575 $656 $251 $1,483
THEDACARE PHYSICIANS PEDIATRICS APPLETONPhysician Group $58 $58
THEDACARE PHYSICIANS- PEDIATRICS NEENAHPhysician Group $155 $155
UROLOGY ASSOC OF WI SC Physician Group $27 $262 $289
VALLEY NEUROLOGY CLINIC SC Physician Group $94 $320 $414
WALGREENS #03851 Pharmacy $2,635 $2,874 $1,626 $3,981 $11,115
WALGREENS #10236 Pharmacy $1,082 $2,368 $1,945 $2,355 $7,750
WALGREENS #3392 Pharmacy $3,520 $3,653 $3,548 $9,048 $19,769
WALGREENS 04533 Pharmacy $9,625 $12,476 $16,358 $19,301 $57,760
WALGREENS 07835 Pharmacy $3,680 $3,473 $3,289 $5,223 $15,665
WALGREENS05280 Pharmacy $18,449 $14,166 $11,362 $17,223 $61,200
WAL-MART PHARMACY 10-1430 Pharmacy $7,596 $8,984 $15,639 $18,995 $51,215
WAL-MART PHARMACY 10-2986 Pharmacy $2,113 $2,399 $3,503 $6,354 $14,368
WOMENS CARE OF WISCONSIN Physician Group $980 $5,356 $8,817 $15,153
Wood ASPIRUS DOCTORS CLINIC Physician Group $7,584 $8,238 $6,910 $10,140 $32,872
AURORA PHARMACY INC Pharmacy $1,019 $738 $688 $645 $3,091
COPPS FOOD CENTER PHARMACY #8121Pharmacy $83 $83
DALY DRUG INC Pharmacy $197 $160 $358
DOCTORS CLINIC OF WIS RAPIDS Physician Group $1,976 $1,976
FAMILY HEALTH CENTER OF MARS Pharmacy $3,940 $5,138 $867 $758 $10,703
HOSPITALIST MEDICINE PHYSICIANS OF WISCONSIN RAPIDPhysician Group $143 $143
JOEL M CARLSON, MD Physician $61 $61
Page 105 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MARSHFIELD CLINIC
Federally Qualified
Health Clinic (FQHC) $141,320 $183,545 $157,605 $270,552 $753,021
Physician Group $77,173 $108,422 $93,117 $128,007 $406,719
MARSHFIELD CLINIC MARSHFIELD
Ambulatory Surgical
Center (ASC) $3,618 $724 $4,342
MARSHFIELD CLINIC MENTAL
Mental Health and
Substance Abuse
Services $134 $48 $581 $763
MARSHFIELD CLINIC PHARMACY
Federally Qualified
Health Clinic (FQHC) $22,040 $20,599 $25,306 $30,615 $98,561
MARSHFIELD CLINIC WISCONSIN Independent Lab $118 $42 $110 $357 $627
MARSHFIELD LAB OUTREACH TRUS Independent Lab $8,170 $13,177 $9,511 $18,601 $49,459
MARSHFIELD MEDICAL CENTER LABORATORYIndependent Lab $125 $256 $340 $544 $1,266
MCDONOUGH ORTHOPAEDIC & SPOR Physician Group $55 $55
PARK AND ASSOCIATES SC Physician Group $394 $433 $827
PHILLIPS NEKOOSA PHARMACY Pharmacy $777 $777
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $20,598 $67,009 $87,606
RIVERVIEW FAMILY CLINIC Physician Group $2,159 $1,875 $1,754 $2,363 $8,151
RIVERVIEW HOSPITAL Independent Lab $3,377 $3,094 $5,280 $4,006 $15,758
RIVERVIEW HOSPITAL OC Physician Group $403 $403
RIVERVIEW HOSPITAL ASSOCIATION Hospital $8,415 $15,750 $81,397 $82,230 $187,793
ROBERT A KAY, DDS Dentist $1,433 $2,894 $1,318 $5,645
SHOPKO PHARMACY #2009 Pharmacy $7,495 $7,912 $9,107 $10,892 $35,406
SHOPKO PHARMACY #2012 Pharmacy $8,080 $7,944 $7,242 $9,328 $32,594
ST JOSEPHS HOSP OUTPATIENT Pharmacy $339 $1,460 $2,636 $2,363 $6,798
ST JOSEPHS HOSPITAL Hospital $260 $4,351 $14,982 $19,593
SURGICAL ASSOCIATES OFWISCO Physician Group $55 $55
WALGREENS #09009 Pharmacy $7,821 $10,456 $12,348 $13,775 $44,399
WALGREENS #13066 Pharmacy $7,628 $14,208 $13,160 $14,188 $49,184
Page 106 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WAL-MART PHARMACY 10-1202 Pharmacy $2,682 $3,952 $5,817 $8,702 $21,152
WISCONSIN RIVER ORTHOPAEDICS Physician Group $233 $233
(blank) ACCESS COMMUNITY HEALTH CENTERS
Federally Qualified
Health Clinic (FQHC) $99 $99
ACL SERVICESINC Independent Lab $218 $218
ADVANCED HEALTHCARE SC Physician Group $172 $172
ALFREDO C MILLAN MD SC Physician Group $30 $30
ALL SAINTS MEDICAL GROUP Physician Group $521 $521
ALLAHYAR JAZAYERI, MD Physician $57 $57
AMERIPATH MILWAUKEE SC Physician Group $936 $936
AMERY REGIONAL MEDICALCENTER Physician Group $467 $467
ANNE M DAYER, MD Physician $22 $22
ASHLAND PATHOLOGY SERVICES Physician Group $39 $39
ASPIRUS DOCTORS CLINIC Physician Group $188 $188
ASPIRUS GENERAL CLINIC Physician Group $125 $125
ASPIRUS KRONENWETTER CLINIC Physician Group $114 $114
ASPIRUS LAND O LAKES CLINIC Physician Group $30 $30
ASPIRUS OB GYN ASSOCIATES Physician Group $486 $486
ASSOCIATES IN PATHOLOGYSC Independent Lab $655 $655
AURORA BAYCARE MEDICALCTR Hospital $6,360 $6,360
AURORA HEALTH CARE INC Physician Group $83 $83
AURORA HEALTH CARE METRO INC Physician Group $72 $72
AURORA HEALTH CENTER Physician Group $481 $481
AURORA HEALTH CENTER HARTFOR Physician Group $22 $22
AURORA HEALTH CENTER KENOSHA Physician Group $2,122 $2,122
AURORA HEALTH CENTER RACINE Physician Group $385 $385
AURORA HEALTHCENTER Rural Health Clinic $165 $165
AURORA MEDICAL GROU P OSHKOS Physician Group $87 $87
AURORA MEDICAL GROUP Physician Group $4,360 $4,360
Page 107 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
AURORA MEDICAL GROUP INC Physician Group $87 $87
AURORA MEDICAL GROUP MILWAUKEEPhysician Group $77 $77
AURORA MEDICAL GROUP WEST BEND Physician Group $44 $44
AURORA NOR DOOR CLINIC Rural Health Clinic $108 $108
AURORA VALLEY VIEW CAMPUS OF Physician Group $22 $22
AURORA WILKINSON MEDICAL CLINIC Physician Group $296 $296
AURORA WISELIVES CLINIC Physician Group $114 $114
BALDWIN CLINIC Rural Health Clinic $131 $131
BELOIT AREA COMMUNITY HEALTH CENTER
Federally Qualified
Health Clinic (FQHC) $30 $30
BELOIT CLINIC Physician Group $120 $120
BOARD OF REGENTS UNIV OF WI Independent Lab $1,484 $1,484
BUTTE DES MORTS PATHOLOGY SC Physician Group $610 $610
CHEQUAMEGON CLINIC Physician Group $30 $30
CHN MEDICAL CENTER BERLIN Physician Group $57 $57
CHN MEDICAL CENTER GREEN LAKE Physician Group $24 $24
CHN MEDICAL CENTER REDGRANITE Physician Group $60 $60
CHN MEDICAL CTR EASTRIDGE Physician Group $11 $11
CHN OB/GYN Physician Group $147 $147
CLARK CO FAMILY PLANNING Family Planning Clinic $1,624 $1,624
CLARK W STEVENS MD, MD Physician $177 $177
CLINIC PHARMACY OF WEST SALEM INCPharmacy $54 $54
COLUMBIA CENTER INC Hospital $4,518 $4,518
CONSULTANTS LABORATORYOF Independent Lab $153 $153
COUNTY OF BURNETT Family Planning Clinic $49 $49
CSM HOSPITAL MILWAUKEE Physician Group $22 $22
DANE CO CYTOLOGY CENTERINC Independent Lab $578 $578
DC WEST Physician Group $30 $30
DEAN HEALTH SYSTEMS INC Physician Group $852 $852
Page 108 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
DIAGNOSTIC RADIOLOGY ASSOC Physician Group $110 $110
DIAGNOSTIC SERVICES OFWASHINGTON CTYPhysician Group $239 $239
DOCTORS CLINIC OF WIS RAPIDS Physician Group $499 $499
DOOR CO MEMORIAL HOSPITAL Hospital $30 $30
DOUGLAS CO COMMUNITY HLTH Family Planning Clinic $882 $882
DULUTH CLINIC LTD Physician Group $436 $436
DUNN COUNTY PUBLIC HLTH Family Planning Clinic $125 $125
ESSENTIA HEALTH DULUTH Hospital $1,408 $1,408
ESSENTIA HEALTH HAYWARD CLINIC Physician Group $47 $47
FAMILY HEALTH OF LAFAYETTE COUNTYPhysician Group $77 $77
FAMILY HEALTHSERVICES SC Physician Group $566 $566
FAMILY PLANNING HEALTHSERVI Family Planning Clinic $6,822 $6,822
FIRST CHOICEWOMENS HEALTH CENTERFamily Planning Clinic $7,757 $7,757
FOND DU LAC PATHOLOGY CONSUL Physician Group $501 $501
FOND DU LAC REGIONAL CLINIC Physician Group $99 $99
GARY R SCHERR, MD Physician $39 $39
GEORGE A NORRIS, MD Physician $79 $79
GRAND VIEW CLINIC Physician Group $57 $57
GRAND VIEW HOSPITAL Hospital $44 $44
GREAT LAKES Physician Group $867 $867
GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WIPhysician Group $207 $207
GUNDERSEN CLINIC LTD Physician Group $898 $898
HAYWARD AREAMEMORIAL HOSP Physician Group $190 $190
HEART CARE ASSOC Physician Group $60 $60
HESS MEMORIAL HOSPITALINC Physician Group $32 $32
HFM WOMENS HEALTH Physician Group $22 $22
HIRSCH CLINICVMH Rural Health Clinic $308 $308
HOCHUNK NATION WELLNESS
Federally Qualified
Health Clinic (FQHC) $19 $19
Page 109 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
HOLY FAMILY MEMORIAL INC Physician Group $261 $261
HOSPITAL PATHOLOGY ASSOC PA Physician Group $44 $44
HUDSON PHYSICIANS Physician Group $512 $512
IRON COUNTY HEALTH DEPARTMENT Family Planning Clinic $138 $138
JEFFREY J ANDEREGG, MD Physician $84 $84
KAREN B HIMMEL, MD Physician $27 $27
KETTLE MORAINE ANESTHESIOLOG Physician Group $222 $222
LABORATORY CORPORATIONOF Independent Lab $346 $346
LABORATORY CORPORATIONOF AM Independent Lab $845 $845
LABWORKS INC Physician Group $101 $101
LAKESHORE MEDICAL CLINIC Physician Group $208 $208
LCM PATHOLOGISTS PC Independent Lab $347 $347
MARINER MEDICAL CLINIC Physician Group $71 $71
MARSHFIELD CLINIC
Federally Qualified
Health Clinic (FQHC) $44,481 $44,481
Independent Lab $10 $10
Physician Group $23,561 $23,561
MARSHFIELD CLINIC EAU Independent Lab $281 $281
MARSHFIELD CLINIC MENOMONIE Independent Lab $31 $31
MARSHFIELD CLINIC MERCER Independent Lab $21 $21
MARSHFIELD CLINIC MERRILL CENTER LABIndependent Lab $21 $21
MARSHFIELD CLINIC MINOCQUA C Independent Lab $227 $227
Physician Group $509 $509
MARSHFIELD CLINIC OAKWOOD Independent Lab $21 $21
MARSHFIELD CLINIC RICE LAKE CENTERIndependent Lab $174 $174
MARSHFIELD CLINIC RIVERVIEW CENTER LABIndependent Lab $42 $42
MARSHFIELD CLINIC WAUSAU Independent Lab $268 $268
MARSHFIELD CLINIC WAUSAU AMB
Ambulatory Surgical
Center (ASC) $724 $724
Page 110 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
MARSHFIELD CLINIC WISCONSIN Independent Lab $21 $21
MARSHFIELD LAB OUTREACH TRUS Independent Lab $1,359 $1,359
MARSHFIELD MEDICAL CENTER LABORATORYIndependent Lab $71 $71
MARSHO FAMILY MEDICAL GROUP Physician Group $90 $90
MAYO CLINIC HEALTH SYSTEM EAU CLAIRE CLINIC INCPhysician Group $413 $413
MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTEPhysician Group $1,550 $1,550
MAYO MEDICALLABORATORIES Independent Lab $50 $50
MEDPOINT FAMILY CARE CENTER Physician Group $82 $82
MEMORIAL HEALTH CENTERCLINI Physician Group $57 $57
MEMORIAL MEDICAL CENTER INC Hospital $23 $23
MEMORIAL MEDICAL CTR Rural Health Clinic $119 $119
MHS PHYSICIAN SERVICES Physician Group $678 $678
MILWAUKEE HEALTH SERVICES
Federally Qualified
Health Clinic (FQHC) $52 $52
MINISTRY MEDICAL GROUP Physician Group $69 $69
NARAYAN BALIGA, MD Physician $193 $193
NATIONAL HEALTH LABORATORY Independent Lab $414 $414
NEW RICHMONDCLINIC Physician Group $51 $51
NEWCAP WHS Family Planning Clinic $535 $535
NORTH SHORE PATHOLOGISTS Physician Group $152 $152
NORTH WOODS COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $75 $75
NORTHREACH HEALTHCARE LLC Physician Group $90 $90
NORTHWOODS ANESTHESIA SERVICES SCPhysician Group $77 $77
OAKLEAF SURGICAL HOSPITAL Hospital $35,034 $35,034
ONEIDA COMMUNITY HEALTH
Federally Qualified
Health Clinic (FQHC) $186 $186
ONEIDA COUNTYHEALTH DEPARTME Family Planning Clinic $57 $57
OPTIONS IN REPRODUCTIVECARE Family Planning Clinic $16,397 $16,397
Page 111 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
PATHOLOGY CONSULTANTS OF GREEN BAY, SCPhysician Group $968 $968
PATHOLOGY PHYSICIANS LTD Physician Group $22 $22
PETER S KAROFSKY, MD Physician $88 $88
PIERCE CO REPRODUCTIVE HEALTH Family Planning Clinic $1,173 $1,173
PLANNED PARENTHHOOD OF WISCONSIN, INC.Family Planning Clinic $2,160 $2,160
PLANNED PARENTHOOD Family Planning Clinic $8,424 $8,424
PLANNED PARENTHOOD OF WI Family Planning Clinic $1,806 $1,806
PLANNED PARENTHOOD OF WISC Family Planning Clinic $17,280 $17,280
PLANNED PARENTHOOD OF WISCONSIN, INCFamily Planning Clinic $7,935 $7,935
PLANNED PARENTHOOD OF WISCONSIN, INC.Family Planning Clinic $20,847 $20,847
POLK CO HEALTH DEPARTMENT Family Planning Clinic $43 $43
PREVEA CLINIC Independent Lab $650 $650
Physician Group $104 $104
PRICE COUNTYHEALTH Family Planning Clinic $6,957 $6,957
PROCARE MEDICAL GROUP Physician Group $36 $36
PROGRESSIVE COMMUNITY HEALTH CENTERS
Federally Qualified
Health Clinic (FQHC) $73 $73
QUEST DIAGNOSTICS LLC IL Independent Lab $1,713 $1,713
SACRED HEART ST MARYS HOSPITAL Physician Group $522 $522
SHAFI MEDICAL CENTER SC Physician Group $108 $108
SHEBOYGAN WOMENS HEALTH SC Physician Group $130 $130
SHOPKO PHARMACY #2018 Pharmacy $30 $30
SOUTHEASTERN WI ANESTHESIOLOGY Physician Group $105 $105
SOUTHWEST COMMUNITY ACTION Family Planning Clinic $3,002 $3,002
ST ELIZABETHSURGERY CENTER
Ambulatory Surgical
Center (ASC) $2,895 $2,895
ST JOSEPHS HEALTH SERVICES INC Physician Group $57 $57
ST LUKES HOSPITAL Hospital $4,850 $4,850
ST LUKES URGENT CARE Physician Group $22 $22
Page 112 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
ST MARYS DEAN VENTURES INC Physician Group $164 $164
ST MARYS DEAN VENTURESINC Rural Health Clinic $22 $22
ST MICHAELS HOSPITAL Hospital $257 $257
Physician Group $1,915 $1,915
ST MICHAELS HOSPITAL OF STEVENS POINT INCPhysician Group $107 $107
STEVEN D STENZEL, MD Physician $57 $57
STUDENT HEALTH CENTER Family Planning Clinic $232 $232
SURGERY & CARE CENTER ST MAR
Ambulatory Surgical
Center (ASC) $724 $724
THE APOTHECARY Pharmacy $37 $37
THE DIAGNOSTIC & TREATMENT Independent Lab $320 $320
THE MEDICAL COLLEGE OF WISCONSIN INCPhysician Group $3,546 $3,546
THE MEDICAL COLLEGE OFWI IN Family Planning Clinic $175 $175
THE MEDICAL COLLEGE OFWISCO Family Planning Clinic $112 $112
THREE RIVERSPATHOLOGYPA Physician Group $2,432 $2,432
U OF WISCONSIN EAU CLAIRE Family Planning Clinic $928 $928
UHS PHYSICIAN CLINIC Physician Group $30 $30
UNITED DYNACARE LLC Independent Lab $85 $85
UNIVERSITY HEALTH SERVICE PH Pharmacy $98 $98
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATIONPhysician Group $408 $408
UW HEALTH OUTPATIENT PHARMAC Pharmacy $381 $381
UW MEDICAL FOUNDATION INC Physician Group $57 $57
UW MEDICAL FOUNDTION EAU CLA Physician Group $100 $100
VALLEY ORTHOPEDIC CLINIC SC Physician Group $22 $22
VILAS COUNTYHEALTH Family Planning Clinic $127 $127
VINCENT G LUBSEY MD SC Physician Group $47 $47
WALGREENS #02927 Pharmacy $43 $43
WALGREENS #03115 Pharmacy $223 $223
WALGREENS #10555 Pharmacy $28 $28
Page 113 of 114
Medicaid Expenditures for the Family Planning Only Benefit Plan
Claims Paid in SFY 2007 through SFY 2010Source: Bus Obj Claims Analysis Universe
Run Date: October 17, 2011
Billing
Provider
County Billing Provider Name Billing Provider Type SFY 2007 SFY 2008 SFY 2009 SFY 2010 Total
WALGREENS #12693 Pharmacy $34 $34
WALGREENS 05636 Pharmacy $30 $30
WALGREENS 07635 Pharmacy $141 $141
WALGREENS 09168 Pharmacy $72 $72
WAL-MART PHARMACY 10-1643 Pharmacy $39 $39
WAL-MART PHARMACY 10-1669 Pharmacy $154 $154
WAL-MART PHARMACY 10-2421 Pharmacy $83 $83
WAL-MART PHARMACY 10-2510 Pharmacy $31 $31
WAL-MART PHARMACY 10-5090 Pharmacy $44 $44
WAL-MART PHARMACY 10-5373 Pharmacy $39 $39
WASHBURN COUNTY HEALTHDEPT Family Planning Clinic $1,786 $1,786
WATERTOWN FAMILY PRACTICE Physician Group $12 $12
WELLNESS CENTER OF DOOR COUNTY Family Planning Clinic $352 $352
WEST BEND CLINIC INC Physician Group $51 $51
WESTERN DAIRYLAND ECONOMIC OPPORTUNITY COUNCIL INCFamily Planning Clinic $10,497 $10,497
WHEATON FRANCISCAN LABORATOR Independent Lab $142 $142
WOMENS HEALTH & RESOURCE CEN Family Planning Clinic $431 $431
YOON W CHUN MD, MD Physician $155 $155
Grand Total $15,822,365 $16,707,743 $20,248,201 $28,804,876 $81,583,185
Page 114 of 114