Clinic County Clinic Name Clinic Address Clinic City, Clinic … · 2018-07-10 · Clinic County...

Clinic County Clinic Name Clinic Address Clinic City,

State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name

Participant City Participant

County

Status

Adams

Not Provided 601 Rosary Dr Corning, IA /

Adams

50841 Kopp Bethel Corning Adams Closed -

Unreachable

Adams

Rosary Clinic Hagen Traci Corning Adams Closed -

Enrolled

Appanoose

Not Provided 19876 Saint

Joseph Drive

Centerville, IA /

Appanoose

52544 Parrish Cassie Centerville Appanoose Closed -

Unreachable

Audubon

Not Provided 515 Pacific Ave

Ste 2

Audubon, IA / Cunningham James Kimballton Audubon Closed -

Declined

Benton

Atkins Family Medicine Clinic 52206 VOGLER Stephani

e

Hiawatha Linn Closed -

Enrolled

Benton

Unity Point Shellsburg 52332 Hoffmann Julie Vinton Benton Closed -

Already

Participating

Benton

UNITY POINT SCHELLSBURG HOFFMANN JULIE Vinton Benton Closed -

Enrolled

Benton

Unity Point Shellsburg Hoffmann Julie Shellsburg Benton Closed -

Unreachable

Black Hawk

Covenant Clinic Division 50613 Moore Paula Waterloo Black Hawk Closed -

Unreachable

Black Hawk

COVENANT Clinic 50702 Visokey DR

Davod

Evansdale Black Hawk Closed -

Current

Appointment

Black Hawk

Covenant Midwives and Women's

Health

50702 Goodrich Amber Waterloo Black Hawk Closed -

Unreachable

Black Hawk

Peoples Clinic 50703 Ijaz Kiran Waterloo Black Hawk Closed -

Declined

Black Hawk

Peoples Community Health Clinic 50703 Lame Sarah Waterloo Black Hawk Closed - Intake

Only

Black Hawk

Covenant Clinic Pulmonology Visokey David Evansdale Black Hawk Closed - Intake

Only

Black Hawk

FAM MED WATERLOO UNITYPOINT

CLINIC

Closed -

Unreachable

Black Hawk

FAM MED WATERLOO UNITYPOINT

CLINIC

Waterloo Black Hawk Closed -

Enrolled

Black Hawk

Iowa Dept of Human Services 5100 Prairie

Parkway

Cedar Falls, IA

/

Huwe Cindy Waterloo Black Hawk Closed -

Unreachable

Black Hawk

Not Provided 905 Franklin Waterloo, IA / Berry Carrie Waterloo Black Hawk Closed -

Unreachable

4/14/2017 1:24:12 PM

/QLR Reporting/Production Reports

of 22 gb edits Iowa March 2017 Referral Detail


State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Black Hawk

Peoples Clinic Berry Carrie Waterloo Black Hawk Closed -

Unreachable

Black Hawk

Peoples Community Health Clinic Kane Sarah Waterloo Black Hawk Closed -

Already

Participating

Black Hawk

Peoples Community Health Clinic N/A Berry Carrie Denver Bremer Closed - Intake

Only

Black Hawk

PEOPLES COMMUNITY HEALTH

CLINIC


Enrolled

Black Hawk

Peoples Community Health Clinic Emily Waterloo Black Hawk Closed -

Enrolled

Black Hawk


CLINIC

Closed -

Already

Participating

Black Hawk

Peoples Community Health Clinic Gutz Emily Waterloo Black Hawk Closed -

Already

Participating

Black Hawk


CLINIC


Unreachable

Black Hawk


CLINIC

Evansdale Black Hawk Closed -

Unreachable

Black Hawk

Peoples Community Health Clinic Independence Buchanan Closed - Intake

Only

Black Hawk

Sartori Hsp Iqbal Jamaica Guthrie Closed -

Unreachable

Boone

Not Provided 120 South Story

Street

Boone, IA /

Boone

50036 Kalenak Alexande

r

Boone Boone Closed -

Enrolled

Boone

Cherokee Menta Health Institute Madrid Boone Closed -

Declined

Bremer

Waverly Health Center-Womens Clinic 50677 Rathe Ann Clarksville Butler Closed -

Unreachable

Bremer

Waverly Health Center- Women's Clinic Rathe Ann Nashua Chickasaw Closed -

Enrolled

Buchanan

Not Provided Sinram Erin Independence Buchanan Closed -

Unreachable

Buena Vista

Not Provided 2015 West 5th

Street

Storm Lake, IA

/ Buena Vista

50588 Huisenga Jason Storm Lake Buena Vista Closed -

Enrolled

Butler

Unity Point Clinic Allison 50602 Foxer Montica Parkersburg Butler Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Calhoun

Not Provided 1351 W Main LakeCity, IA / Duncan Pomeroy Calhoun Closed -

Unreachable

Carroll

DMU Family Medicine 3200 Grand Ave Des Moines, IA

/ Carroll

51401 Garner Sheila Closed -

Duplicate

Cass

AMC 1501 E 10th St Atlantic, IA /

Cass

50022 Brend Sarah Anita Cass Closed -

Unreachable

Cass

ATLANTIC MED CTR Cumberland Cass Closed -

Unreachable

Cass

Atlantic Medical Center Atlantic Cass Closed - Intake

Only

Cass

Atlantic Medical Center Robinson Mary Griswold Cass Closed -

Enrolled

Cass

Atlantic Medical Center Robinson Mary Wiota Cass Closed - Intake

Only

Cerro Gordo

Mercy Family Medicine Residency 1000 Fourth

Street S.W.

Mason City, IA

/ Cerro Gordo

50401 Roy Rency Mason City Cerro Gordo Closed -

Enrolled

Cerro Gordo

Not Provided 1010 4th St ste

340

Mason City, IA

/ Cerro Gordo

50401 Kuhn Hayley Mason City Cerro Gordo Closed -

Enrolled

Cerro Gordo

Not Provided 331 13th St SE Mason City, IA

/ Cerro Gordo

50401 Parekm Preyans

ho

Mason City Cerro Gordo Closed -

Enrolled

Cerro Gordo

Mercy Family Clinic Clear Lake Clear Lake Cerro Gordo Closed - Intake

Only

Cherokee

Cherokee Mental Health Institute 51012 Baughman N/A Cherokee Cherokee Closed -

Unreachable

Cherokee

Cherokee Regional Clinic 300 Sioux valley Cherokee, IA /

Cherokee

51012 Vandelune Christop

her

Aurelia Closed -

Unreachable

Cherokee

Cherokee Regional Clinic 300 Sioux Valley

Dr

Cherokee, IA /

Cherokee

51012 Tentinger Abby Cherokee Closed -

Declined

Cherokee

Cherokee Regional Clinics 300 Sioux Valley

Dr.

Cherokee, IA /

Cherokee

51012 Mogensen-

Kruger

ARNP

Rebecca Quimby Closed -

Unreachable

Cherokee

Cherokee Regional clinid 300 sioux Valley

Dr

Cherokee, IA /

Cherokee

51012 Mogensen-

Kruger

Rebecca Cherokee Closed -

Unreachable

Cherokee

Cherokee Family Practice Cherokee Cherokee Closed -

Declined

Cherokee

CHerokee Family Practice Cherokee Cherokee Closed -

Enrolled

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Cherokee

Cherokee Regional Clinics Rice Timothy Marcus Cherokee Closed -

Unreachable

Cherokee

Cherokee Regional Clinics Rice Timothy Marcus Cherokee Closed -

Enrolled

Clarke

CLARKS COUNTY HOSPITAL Osceola Clarke Closed -

Unreachable

Clinton

Community Health Care 925 S 4th St Clinton, IA /

Clinton

52732 Johnson Brooke Clinton Clinton Closed -

Unreachable

Clinton

COMMUNITY HEALTH CARE 925 SOUTH 4TH

ST

CLINTON, IA /

Clinton

52732 Clinton Clinton Closed -

Enrolled

Clinton

Community Health Care 925 South 4th

Street

Clinton, IA /

Clinton

52732 Fuller Ashley Clinton Clinton Closed -

Unreachable

Clinton

COMMUNITY HEALTH CARE INC 925 SOUTH 4TH

ST

CLINTON, IA /

Clinton

52732 JOHNSON BROOK

E

CHARLOTTE Clinton Closed -

Enrolled

Clinton

Community Health Care, Inc. 925 South 4th

Street

Clinton, IA /

Clinton

52732 Johnson Brook Clinton Clinton Closed -

Enrolled

Clinton

Medical Associates 52732 Kauffman Theresa Clinton Clinton Closed -

Enrolled

Clinton

Not Provided 4800 Utica Ridge

Rd ste 2235

Bettendorf, IA /

Clinton

52732 Mehta Falquni Davenport Scott Closed - Intake

Only

Clinton

Steven Breaux MD PC 52732 Breaux Steven Clinton Clinton Closed -

Unreachable

Clinton

Not Provided 1021 11th st Dewitt, IA /

Clinton

52742 Fowler Steven Eldridge Scott Closed -

Enrolled

Clinton

Mercy Medical Center Clinton Hoff Stephine Clinton Clinton Closed -

Declined

Clinton

Mercy Medical Center Clinton Clinton Clinton Closed -

Enrolled

Dallas

Mercy Clinics 50220 Sohu Steven Yale Guthrie Closed -

Unreachable

Dallas

Not Provided 30 E Hickman Rd Waukee, IA /

Dallas

50263 Engel-

Brower

Hanna West Des

Moines

Polk Closed -

Unreachable

Dallas

Not Provided 25 W Hickman

Rd Ste 100

Waukee, IA /

Dallas

50263 Bowshier Laura Adel Dallas Closed -

Unreachable

Dallas

Mercy Family Care Perry Noble Jason Grinnell Poweshiek Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Delaware

REGIONAL FAMILY HEALTH 52057 gerst dr tim Manchester Delaware Closed -

Declined

Delaware

Regional Family Health 52057 CUMMINGS CLINTO

N

Quasqueton Buchanan Closed -

Declined

Delaware

Regional Family Health Cummings Clinton Quasqueton Buchanan Closed -

Already

Participating

Delaware

Regional Family Health Cummings Clinton Dubuque Dubuque Closed -

Unreachable

Des Moines

CHC/SEIA 52655 HAUENSTEI

N

NAARAH Burlington Des Moines Closed -

Enrolled

Des Moines

CHCI Seia 52655 Ihrig Timothy West

Burlington

Des Moines Closed -

Duplicate

Des Moines

Community Health Center Southeast IA 52655 Zwanziger Rebecca Burlington Des Moines Closed -

Unreachable

Des Moines

Community health center southeast

Iowa

52655 Lawer Georgia Burlington Des Moines Closed - Intake

Only

Des Moines

Not Provided 1706 W Agency

Rd

W Burlington,

IA / Des

Moines

52655 Elliott Charissa Burlington Des Moines Closed -

Declined

Des Moines

CHC/SFIA Burlington Des Moines Closed -

Enrolled

Des Moines

Great River Pulmonary Velno Denz Valerie Burlington Des Moines Closed -

Unreachable

Dubuque

Not Provided 8293 Hendricks

ln

Peosta, IA /

Dubuque

52068 Benda Jr Thomas Peosta Dubuque Closed -

Enrolled

Dubuque

REGIONAL FAMILY HEALTH CUMMINGS CLINTO

N

Dubuque Dubuque Closed -

Unreachable

Greene

McFarland Clinic 50129 Gordon Ruth Grand

Junction

Greene Closed -

Enrolled

Greene

McFarland Clinic Gerdes James Jefferson Greene Closed - Intake

Only

Grundy

Not Provided 1506 G Avenue Grundy Center,

IA / Grundy

50638 LaTendresse Charles Grundy Center Grundy Closed -

Enrolled

Hamilton

Not Provided 903 Willson

Avenue

Woodhouse Don Duncombe Webster Closed -

Enrolled

Hardin

Unity Point Southglen FP 7481

Highway65.69

Des Moines, IA

/ Hardin

50230 Jenkins Jennifer Pleasant Hill Polk Closed -

Enrolled

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Harrison

ACH Community Memorial Hospital -

Missouri Valley

631 North 8th

Street

Missouri

Valley, IA /

Harrison

51555 Grady Carrie Missouri Valley Harrison Closed -

Unreachable

Henry

Family Medicine Mt Pleasant 52641 Wagner Julie Winfield Henry Closed -

Unreachable

Henry

Family Medicine Of Mt Pleasant Lockridge Jefferson Closed -

Declined

Henry

IRL FAMILY MEDICINE Winfield Henry Closed -

Already

Participating

Howard

Cresco Medical Center Haas Mary Cresco Howard Closed - Intake

Only

Howard

Cresco Medical Clinic Kammerer Jon Cresco Howard Closed -

Unreachable

Ida

Not Provided 101 2nd Street Ida Grove, IA /

Ida

51445 Blankenship Angela Denison Crawford Closed - Intake

Only

Iowa

OBGYN Assoc. PC Bussrwitz Elizabeth South Amana Iowa Closed -

Unreachable

Jackson

Medical Associates 52060 THOMPSON DR K Baldwin Jackson Closed -

Unreachable

Jackson

Medical Associates fo Muloveketa 52060 Peterson Eric Maquoketa Jackson Closed -

Declined

Jackson

Medical Associates of Maquoketa 52060 Petersen Eric Maquoketa Jackson Closed -

Enrolled

Jasper

Newton Clinic 50208 Unknown Unknow

n

Newton Jasper Closed -

Unreachable

Jasper

Newton Clinic 50208 Yardley Lyndi Newton Jasper Closed -

Unreachable

Jasper

Not Provided 300 n 4th Ave E

ste 200

Newton, IA / 50508 Holloway Jodi Newton Jasper Closed -

Unreachable

Jasper

Not Provided 300 N 4th Ave E Newton, IA / Ruggle paul Closed -

Enrolled

Johnson

IRL East Family Medicine 52241 Kics Valerie Iowa City Johnson Closed -

Enrolled

Johnson

Not Provided 105 East 9th

Street

Coralville, IA /

Johnson

52241 Tandon Anamika North Liberty Johnson Closed -

Unreachable

Johnson

Not Provided 920 E 2nd Ave Coralville, IA /

Johnson

52241 Banu Hussain Iowa City Johnson Closed -

Enrolled

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Johnson

UIHC Internal Medicine IRL 52241 Dirksen Rachael Burlington Des Moines Closed -

Enrolled

Johnson

Not Provided 200 Hawkins

Drive

Iowa City, IA /

Johnson

52242 Newtson Andrea Davenport Scott Closed -

Unreachable

Johnson

Not Provided 200 Hwkins Dr

11911 JPP

Iowa City, IA /

Johnson

52242 Hsiao Shelly Coralville Johnson Closed -

Unreachable

Johnson

Not Provided 200 Hawkins

Drive

Iowa City, IA /

Johnson

52242 Shriver Erin Spragueville Jackson Closed -

Enrolled

Johnson

UIHC Family Med 200 Hawkins Dr 52242 Flint Diana Coralville Johnson Closed -

Already

Participating

Jones

Eastern Iowa Health Center Snitker Sara Anamosa Jones Closed -

Enrolled

Jones

Jones Regional Anamosa Clinic Schepanski Alissa Anamosa Jones Closed -

Enrolled

Keokuk

Not Provided 1314 South

Stuart Street,

Suite B

Sigourney, IA /

Keokuk

52591 Obradovich Lucia Hayesville Keokuk Closed -

Enrolled

Kossuth

KRHC 50511 Venteicher Rachel Algona Kossuth Closed -

Unreachable

Lee

IA Dept of Public Health. 5409 Ave O Ft Madison, IA

/ Lee

52627 Newton Chase Keokuk Lee Closed - Intake

Only

Lee

Not Provided 5409 Avenue O Fort Madison,

IA / Lee

52627 Newton Chase Keokuk Lee Closed -

Unreachable

Lee

Not Provided Newton Chase Donnellson Lee Closed -

Ineligible

Linn

Not Provided 310 Highway 1

Southeast

Mount Vernon,

IA / Linn

52314 Pentico Todd Lisbon Linn Closed -

Unreachable

Linn

Mercy Cardiology Clinic 788 8th Ave SE Cedar Rapids,

IA / Linn

52401 dhaliwal amande

ep

Cedar Rapids Closed -

Unreachable

Linn

Not Provided 600 7th St SE

Ste 101

Cedar Rapids,

IA / Linn

52401 Meeker Monica Fairfax Linn Closed -

Unreachable

Linn

AM Mercy Pulmonary Medicine Center 1201 3rd Ave SE Cedar Rapids,

IA / Linn

52403 Efimov Alexandr

e

CEDAR

RAPIDS

Linn Closed -

Unreachable

Linn

AM Mercy Pulmonary Medicine Center 1201 3rd Ave SE Cedar Rapids,

IA / Linn

52403 Efimov Alexandr

e

Cedar Rapids Linn Closed -

Unreachable

Linn

Eastern IA Health Center 52403 Schabilin Rose Cedar Rapids Linn Closed -

Enrolled

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Linn

Eastern IA Health Center 52403 Snitker Sara Cedar Rapids Linn Closed -

Enrolled

Linn

Eastern Iowa Health Center 52403 Bhalala Neel Marion Linn Closed -

Unreachable

Linn

Eastern Iowa Health Center 52403 Snitker Sara Marion Linn Closed -

Current

Appointment

Linn

EIHC 52403 Jindal Prachi Cedar Rapids Linn Closed -

Enrolled

Linn

EIHC 52403 Wilson Amy Hiawatha Linn Closed -

Duplicate

Linn

Northwest Medical 1444 2 Ave SE Cedar Rapids,

IA / Linn

52403 Ramsey Merrilee Cedar Rapids Linn Closed -

Enrolled

Linn

Not Provided 850 4th Ave SE Cedar Rapids,

IA / Linn

52403 Younger Clete Cedar Rapids Linn Closed - Intake

Only

Linn

EASTERN Inna Health Center 52404 BRYNE DAVID Marion Linn Closed -

Unreachable

Linn

Northwest Medical 1444 Second Ave

SE

Cedar Rapids,

IA / Linn

52406 Cedar Rapids Linn Closed -

Enrolled

Linn

Eastern Iowa Health Center Maturu Dr Cedar Rapids Linn Closed -

Unreachable

Linn

Eastern Iowa Health Center N/A Donovan Dr

Jennifer


Enrolled

Linn

Eastern Iowa Health Center Young-

cooper

Jacqueli

ne


Unreachable

Linn

Eastern Iowa Health Center Matura Ramya Marion Linn Closed -

Unreachable

Linn

Eastern Iowa Health Centere Cedar Rapids Linn Closed - Intake

Only

Linn

EIHC Bhalala Neel Cedar Rapids Linn Closed -

Unreachable

Linn

EIHC Hiawatha Linn Closed -

Enrolled

Linn

EIHC Cedar Rapids Linn Closed -

Unreachable

Linn

Not Provided Cree Barbara Newhall Benton Closed -

Declined

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Linn

Not Provided 830 4th Avenue

Southeast, Suite

1

Younger Clete Walker Linn Closed -

Enrolled

Linn

Not Provided 2375 Edgewood

Road SW

Cedar Rapids,

IA /

Kahler Melissa Cedar Rapids Linn Closed - Intake

Only

Linn

OBGYN Bemus Scott Springville Linn Closed -

Unreachable

Linn

The Ghosh Center Harpers Ferry Allamakee Closed -

Enrolled

Linn

The Ghosh Center Closed -

Enrolled

Mahaska

Not Provided 112 S Main St New Sharon,

IA / Mahaska

50207 Smith Lisa Barnes City Mahaska Closed -

Enrolled

Marion

Pleasantville Clinic 104 Washington

St

Pleasantville,

IA / Marion

50225 Booth Brandi Pleasantville Closed -

Enrolled

Marshall

McFarland Clinic PC 50158 Ruopp Megan Marshalltown Marshall Closed -

Unreachable

Marshall

Primary Health 50158 Swinton Tim Eldora Hardin Closed -

Unreachable

Marshall

Primary Health Care 50158 Swinton Tim Marshalltown Marshall Closed -

Unreachable

Marshall

Primary Health Care 50158 Swinton Tim Saint Anthony Marshall Closed -

Unreachable

Marshall

Primary Health Care 50158 Harter Marilyn Marshalltown Marshall Closed -

Unreachable

Marshall

Primary Health Care 50158 Harter Marilyn Marshalltown Marshall Closed -

Enrolled

Marshall

Not Provided 503 3rd ave sw State Center,

IA / Marshall

50247 George Amanda State Center Marshall Closed -

Unreachable

Marshall

CIH Marshalltown Marshalltown Marshall Closed -

Unreachable

Marshall

Primary Health Care Gilman Marshall Closed -

Unreachable

Marshall

Primary Health Care Marshalltown Marshall Closed -

Enrolled

Marshall

Primary Health Care Haverhill Marshall Closed -

Enrolled

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Marshall

primary Health Care Dale Allan Marshalltown Marshall Closed - Intake

Only

Marshall

Primary Health Care Clinic Dale Allen Saint Marys Warren Closed -

Enrolled

Marshall

PRIMARY HEALTHCARE CLENDENIN

G

DEBOR

AH

Marshalltown Marshall Closed -

Unreachable

Mills

CHI Health Clinic 1203 S Locust St Glenwood, IA /

Mills

51534 Kent Robert Emerson Closed -

Unreachable

Mills

Not Provided 1701 Broadway Council Bluff,

IA / Mills

51571 Silver City Mills Closed -

Enrolled

Monona

BURGESS MAPLETON CLINIC 51034 Walker Chad Ricketts Crawford Closed -

Unreachable

Monona

Burgess Mapleton Clinic 51034 Walker Chad Ricketts Crawford Closed -

Unreachable

Monona

Burgess Family Clinic Schenne Jennifer Ute Monona Closed -

Unreachable

Montgomery

Villisca Family Health Center 50864 Martinez Effie Clarinda Page Closed -

Unreachable

Montgomery

Villisca Family Health Center 50864 Martinez Effie Villisca Montgomery Closed -

Unreachable

Muscatine

UICMS Muscatine 52761 Nelson Christina Muscatine Muscatine Closed -

Ineligible

Muscatine

Unity Point Clinic 52761 Cox Lindsay Muscatine Muscatine Closed -

Already

Participating

Muscatine

UNITY POINT CLINIC 52761 PAULSRUD DR

STEVEN

Mediapolis Des Moines Closed -

Enrolled

Muscatine

Unity Point Clinic Family Medicine North Port, IA /

Muscatine

52761 Muscatine Muscatine Closed -

Enrolled

Muscatine

Unity Point Family Medicine at Mulberry 52761 Pohl Ben Muscatine Muscatine Closed - Intake

Only

Nebraska

Nebraska Medicine 68198 Darrah Lauren Council Bluffs Pottawattam

ie

Closed -

Already

Participating

Nebraska

ACH BERGAN MERCY MED CTR Closed -

Unreachable

Page

Clarinda Medical Associates 51362 Furst Talisha CLARINDA Page Closed -

Already

Participating 4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Page

Shenandoah Physicians Clinic 51601 Olberding Kauindra Shenandoah Page Closed - Intake

Only

Page

Shenandoah Physicians Clinic 51601 Holmes Connie Shenandoah Page Closed -

Unreachable

Page

SMC Womens Center 300 Pershing Ave Shenandoah,

IA / Page

51601 Prusa Flores Jessica Shenandoah Page Closed -

Unreachable

Page

Clarinda Medical Associates 51632 Furst Talisha Braddyville Page Closed - Intake

Only

Page

Clarinda Medical Associates 51632 Furst Talish Braddyville Page Closed -

Unreachable

Page

Clarinda Medical Associates CMA 51632 Bjorn Michele Clarinda Page Closed -

Current

Appointment

Page

Clannda Regional Health Care Bedford Taylor Closed -

Enrolled

Page

Clarinda Medical Associates Freemen Steven Clarinda Page Closed -

Unreachable

Page

CRHC Clarinda Page Closed - Intake

Only

Page

Shenandoah Medical Center Holmes Connie Shenandoah Page Closed -

Enrolled

Palo Alto

Palo Alto County Health System 3201 1st Street Emmetsburg,

IA / Palo Alto

50536 Prabhakaran Madhan Emmetsburg Closed -

Enrolled

Palo Alto

Palo Alto County Health System 3201 1st Street Emmetsburg,

IA / Palo Alto

50536 Frields Amy Emmetsburg Closed -

Declined

Plymouth

Other 714 Lincoln St Le Mars, IA / Holcomb Sheila Le Mars Plymouth Closed -

Enrolled

Pocahontas

Unity Point Clinic 307 W Hwy 10 Laurens, IA /

Pocahontas

50554 Maurer Kylie Closed -

Unreachable

Polk

Not Provided 8900 NW 86th

ste 100

Johnston, IA /

Polk

50131 Vander Joel Boone Boone Closed - Intake

Only

Polk

Not Provided 320 Watson

Powekk Jr Way

Des Moines, IA

/ Polk

50309 Tiemens Christin Des Moines Polk Closed - Intake

Only

Polk

Not Provided 320 Watson

Powell Jr Way

Des Moines, IA

/ Polk

50309 Steinmann Lori Indianola Warren Closed -

Unreachable

Polk

Mercy Beverdale Clinic 1750 48th St Ste

1

TXS Mornes,

IA / Polk

50310 Callahan Robert Norwalk Warren Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Polk

DMU Family Medicine 3200 Grand Ave Des Moines, IA

/ Polk

50312 Garner Sheila Closed -

Duplicate

Polk

Broadlawns Geriatric Clinic 50314 Bender Robert Johnston Polk Closed -

Unreachable

Polk

Broadlawns Medical Center 50314 Lair Bradley Des Moines Polk Closed -

Enrolled

Polk

Not Provided 1801 Hickman

Road

Des Moines, IA

/ Polk

50314 Matson Christop

her

Des Moines Polk Closed -

Unreachable

Polk

Not Provided 1801 Hickman

Rd

Des Moines, IA

/ Polk

50314 Mathes DES MOINES Polk Closed - Intake

Only

Polk

Primary Health at Mercy 250 Laurel St Des Moines, IA

/ Polk

50314 Gill Vikram Des Moines Polk Closed -

Enrolled

Polk

Mercy South Medical Clinic Triage 6601 SW 9th St Des Moines, IA

/ Polk

50315 Nordstom Lindy Closed -

Unreachable

Polk

Not Provided 6601 SW 8th St Des Moines, IA

/ Polk

50315 Zachary Dennis New Virginia Warren Closed -

Unreachable

Polk

Not Provided 6601 SW 9th St Des Moines, IA

/ Polk

50315 Nordstrom Lindy Des Moines Polk Closed -

Unreachable

Polk

Not Provided 5101 SE 14th ST Des Moines, IA

/ Polk

50320 Young Sheryl Des Moines Polk Closed -

Unreachable

Polk

Not Provided 5900 East

Univeristy, Suite

100

Pleasant Hill,

IA / Polk

50327 Abler Jennifer Des Moines Polk Closed - Intake

Only

Polk

Des Moine University Clinic Crane Amy Des Moines Polk Closed -

Duplicate

Polk

DES MOINES UNIVERSITY CLINIC Des Moines Polk Closed -

Declined

Polk

Not Provided 3509 E 29th St Des Moines, IA

/

Newton

Rosenaw

Mandy Des Moines Polk Closed -

Enrolled

Polk

Not Provided 7481 Hwy 65169 Des Moines, IA

/

Lamberty Amy Des Moines Polk Closed -

Enrolled

Polk

Not Provided Hanson Doug Earlham Madison Closed - Intake

Only

Polk

Parks Area Family Clinic Hatchcroft Michelle Des Moines Polk Closed -

Unreachable

Pottawattamie

All Care Health Center 51501 Aabinda Afeera Council Bluffs Pottawattam

ie

Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Pottawattamie

CHI West Broadway Clinic 51501 Vacek Joyce Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hospital 51501 Willadsen Kent Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hospital 51501 Jones Christian Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Not Provided 1701 W

Broadway

Council Bluffs,

IA /

Pottawattamie

51501 Rabadi-

Marar

Diana Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Not Provided 1701 W Bdy Council Bluff,

IA /

Pottawattamie

51501 Rabadi-

Marar

Diana Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Not Provided 1701 W

Broadway

Council Bluff,

IA /

Pottawattamie

51501 Bodalucco Laura Council Bluffs Pottawattam

ie

Closed -

Ineligible

Pottawattamie

Not Provided 1701 W

Broadway

Council Bluff,

IA /

Pottawattamie

51501 Badalucco Laura Carter Lake Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Chi Health Alegent Crghtn Clinic 1751 Madison

Ave

Council Bluffs,

IA /

Pottawattamie

51503 Whalen James Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Heartland Oncology and Hematology 51503 Hassain Sakeer Elk Horn Shelby Closed -

Declined

Pottawattamie

Iowa Dept of Human Services 1001 Risenson

Blvd

Council Bluffs,

IA /

Pottawattamie

51503 Willadsen Kent Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

METHODIST JEANNIE EDMUNSON

HOSP

51503 MCCOO

L

Council Bluffs Pottawattam

ie

Closed -

Declined

Pottawattamie

METHODIST JEANNIE-EDMUNDSON

HOSPITAL

51503 ESMADI DR Clarinda Page Closed - Intake

Only

Pottawattamie

Methodist Jennie Edmundson 51503 Huang Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Methodist Jennie Edmundson Hospital 51503 Armbruster Robert Council Bluffs Pottawattam

ie

Closed -

Declined

Pottawattamie

Methodist Jennie Edmundson Hospital 51503 Haan Jenni Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hospital 51503 Coker Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hospital 933 East Pierce

St

Council Bluffs,

IA /

Pottawattamie

51503 Alvarez Jorge Council Bluffs Closed -

Unreachable

Pottawattamie

METHODIST PHYSICIAN CLINIC 51503 NADIA Council Bluffs Pottawattam

ie

Closed - Invalid

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Pottawattamie

METHODIST PHYSICIANS CLINIC 51503 Rawamitsu Takashi Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

CHI West Broadway Clinc Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Heartland Oncology & Hematology Husain Sakeer Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Heartland Oncology and Hematology Hussain Sakeer Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Methodist Jennie Silver City Mills Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmondson

Hospital/Lung

Jones Christian Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundison Hospital Suedkamp Avoca Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Vogel Angela Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

METHODIST JENNIE EDMUNDSON

HOSP


ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hosp Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hospital N/A Whalen Dr

James


ie

Closed -

Unreachable

Pottawattamie

Methodist Jennie Edmundson Hospital Council Bluffs Pottawattam

ie

Closed -

Unreachable

Pottawattamie

METHODIST JENNIE EDMUNSON

HOSP

Closed -

Ineligible

Pottawattamie

Not Provided 3135 W

Broadway

Council Bluff,

IA /

Sheppard K Neil Council Bluffs Pottawattam

ie

Closed -

Enrolled

Pottawattamie

Not Provided 1701 West

Broadway

Council Bluffs,

IA /

Marar Isam Council Bluffs Pottawattam

ie

Closed -

Declined

Scott

GHG Bettendorf Health Prep 52722 Daniel Myra Tipton Cedar Closed -

Declined

Scott

Not Provided 4480 Utica

Bridge Rd ste

2236

Bettendorf, IA /

Scott

52722 Menta Falqurs Davenport Scott Closed - Intake

Only

Scott

Not Provided 4311 E 5rd St Davenport, IA /

Scott

52748 Eldridge Scott Closed -

Enrolled

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Scott

COMMUNITY HEALTH 52801 CHARA DR Davenport Scott Closed -

Current

Appointment

Scott

Community Health Care 52801 Misiag Davenport Scott Closed -

Unreachable

Scott

Community Health Care 52801 Javron Sarah Eldridge Scott Closed -

Unreachable

Scott

Community Health Care 52801 Jauron Sarah Davenport Scott Closed -

Unreachable

Scott

Community Health Care 52801 Jauron Sarah Davenport Scott Closed -

Current

Appointment

Scott

Community Health Care 52801 Besch Jackie Davenport Scott Closed -

Unreachable

Scott

Community Health Care 500 W River Dr Davenport, IA /

Scott

52801 Schmidt Carrie Davenport Scott Closed -

Unreachable

Scott

Community Health Care 52801 Besch Jacklyn Davenport Scott Closed -

Unreachable

Scott

Community Health Care 52801 Barkley Stephani

e

Walcott Scott Closed -

Already

Participating

Scott

Community Health Care 52801 Chana Dr Davenport Scott Closed -

Enrolled

Scott

Community Health Care 52801 Metuge Anne Davenport Scott Closed -

Duplicate

Scott

Community Health Care River Drive

Clinic

500 W River Dr Davenport, IA /

Scott

52801 Chana Davenport Scott Closed -

Unreachable

Scott

Community Health Care, Inc. 52801 Sheldon Tami Davenport Scott Closed -

Enrolled

Scott

Community Healthcare 52801 Metuge Anne Davenport Scott Closed -

Unreachable

Scott


Unreachable

Scott


Duplicate

Scott

Not Provided 1820 West 3rd

Street

Davenport, IA /

Scott

52802 Cone Regan Davenport Scott Closed -

Unreachable

Scott

Family Medicne 1805 Brady St Davenport, IA /

Scott

52803 Alston Jessica Davenport Scott Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Scott


Central Park

Avenue

Davenport, IA /

Scott

52804 Woodhouse Cristina Donahue Scott Closed -

Enrolled

Scott

Not Provided 1345 W Central

Park

Davenport, IA /

Scott

52804 Davis Brittany Davenport Scott Closed -

Unreachable

Scott


Central Park

Avenue

Davenport, IA /

Scott

52804 Brokloff Nicole Davenport Scott Closed -

Unreachable

Scott

Not Provided 1351 W

CENTRAL PARK

AVE

DAVENPORT,

/ Scott

52804 Hunemuller Heather Tipton Cedar Closed -

Enrolled

Scott

Vera French Community Mental Health

Center

1441 W Central

Park Ave

Davenport, IA /

Scott

52804 Nelson Genevie

ve

Le Claire Scott Closed -

Unreachable

Scott

Vera French Community Mental Health

Center

1441 W Central

Park Ave

Davenport, IA /

Scott

52804 Nelson Geneviv

e

Le Claire Scott Closed -

Unreachable

Scott

Unity Point Family Medicine 52807 Blechle Kevin Blue Grass Scott Closed -

Unreachable

Scott

UNITY POINT FAMILY MEDICINE 52807 Blechle Kevin DAVENPORT Scott Closed -

Unreachable

Scott

Community Health Care Davenport Scott Closed -

Current

Appointment

Scott

Community Health Care Johnson Brooke Clinton Clinton Closed -

Enrolled

Scott

Community Health Care Clinton Clinton Closed -

Ineligible

Scott

Community Health Care Metuge Anne Davenport Scott Closed -

Unreachable

Scott

COMMUNITY HEALTH CARE BARKLEY STEPHA

NIE

Davenport Scott Closed -

Unreachable

Scott

Community Health Care Jauron Sarah Davenport Scott Closed -

Current

Appointment

Scott

Community Health Care Metuge Anne Davenport Scott Closed -

Unreachable

Scott

Community Health Care Davenport Scott Closed -

Unreachable

Scott

Community Health Center Bisch Jacklyn Davenport Scott Closed -

Already

Participating

Scott

GHG PULMONARY ASSOCIATES WONG HUMPH

REY

Maquoketa Jackson Closed -

Ineligible

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Scott

Unity Point Family Medicine Blechie Dr Kevin Davenport Scott Closed -

Unreachable

Sioux

Sioux Center Health 51250 Koelewyn Jason Sioux Center Sioux Closed -

Enrolled

Story

McFarland Clinic (FMW) 3600 W Lincoln

Way

Ames, IA /

Story

50014 Bohner Scott Ames Closed -

Unreachable

Taylor

Not Provided 408 Dodge Kempf Michelle Bedford Taylor Closed -

Enrolled

Union

Unity Point Family 50801 Gapp April Closed -

Already

Participating

Unknown

Heart of Iowa 25404 Achenbach Andrea Cedar Rapids Linn Closed -

Unreachable

Unknown

La Clinica De La Esperanza 50512 Gunn Kelly Latimer Franklin Closed -

Unreachable

Unknown

CHI HEALTH 51501 Amubuster Janice Council Bluffs Pottawattam

ie

Closed -

Ineligible

Unknown

CHI Health Clinic 68107 Council Bluffs Pottawattam

ie

Closed -

Current

Appointment

Unknown

Alere Closed -

Enrolled

Unknown

AMERIGROUP CRESTON Union Closed -

Unreachable

Unknown

AVERA MED GROUP Sioux City Woodbury Closed -

Unreachable

Unknown

Care for Yourself Waterloo Black Hawk Closed - Intake

Only

Unknown

CHC ISEIA Closed -

Duplicate

Unknown

CHI HEALTH Closed -

Already

Participating

Unknown

CHI Health Clinic Council Bluffs Pottawattam

ie

Closed -

Unreachable

Unknown

CHI Health Clinic Roca Mel Council Bluffs Pottawattam

ie

Closed -

Duplicate

Unknown

Community Health Centers Burlington Des Moines Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Unknown

Covenent Clinic Oelwein Fayette Closed -

Enrolled

Unknown

Covenent Clinic West Union Fayette Closed -

Declined

Unknown

Dr Dunbar Dunbar Dr Sioux City Woodbury Closed -

Unreachable

Unknown

DSM Family Med DSM Family Med Carroll Carroll Closed -

Enrolled

Unknown

EIHZ Marion Linn Closed -

Enrolled

Unknown

Medical Associates Clinton Clinton Closed -

Duplicate

Unknown

medical Clinic PC Durada Michael Sidney Fremont Closed -

Already

Participating

Unknown

MERCY CLINIC Grand

Junction

Greene Closed -

Unreachable

Unknown

MERCY FAM CLINIC Buffalo Center Winnebago Closed - Intake

Only

Unknown

Mercy Family Care Sonn Steven Perry Dallas Closed -

Unreachable

Unknown

Mercy Family Care Sohn Steven Perry Dallas Closed -

Enrolled

Unknown

N/A Ihria Dr

Timothy

Closed -

Unreachable

Unknown

Not Avail Des Moines Polk Closed -

Declined

Unknown

Not Provided Kosters Kay Akron Plymouth Closed -

Unreachable

Unknown

Not Provided Iowa City Johnson Closed -

Unreachable

Unknown

Not Provided Solon Johnson Closed -

Enrolled

Unknown

Not Provided Graettinger Palo Alto Closed -

Enrolled

Unknown

Not Provided Clinton Clinton Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Unknown

Not Provided Burlington Des Moines Closed -

Unreachable

Unknown

Not Provided Des Moines Polk Closed -

Enrolled

Unknown

Not Provided SPENCER Clay Closed -

Unreachable

Unknown

Not Provided Des Moines Polk Closed - Intake

Only

Unknown

Not Provided Marion Linn Closed -

Enrolled

Unknown


Unreachable

Unknown

Not Provided Pleasantville Marion Closed -

Enrolled

Unknown


Unreachable

Unknown

Not Provided Closed -

Unreachable

Unknown

Not Provided Burlington Des Moines Closed -

Declined

Unknown

Not Provided Ottumwa Wapello Closed -

Enrolled

Unknown

Not Provided Dubuque Closed -

Enrolled

Unknown


Unreachable

Unknown

Not Provided Cedar Rapids Linn Closed -

Duplicate

Unknown


Enrolled

Unknown

Not Provided Red Oak Montgomery Closed -

Enrolled

Unknown


Enrolled

Unknown

Not Provided Nashua Chickasaw Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Unknown

Not Provided Des Moines Polk Closed - Intake

Only

Unknown

Not Provided Council Bluffs Pottawattam

ie

Closed - Intake

Only

Unknown

Not Provided Perry Dallas Closed - Intake

Only

Unknown

Not Provided Fort Dodge Webster Closed -

Unreachable

Unknown


Unreachable

Unknown

Not Provided Davenport Scott Closed -

Enrolled

Unknown


Enrolled

Unknown

Not Provided Indianola Warren Closed -

Enrolled

Unknown


Enrolled

Unknown

River Hills Community Health Center Moravia Appanoose Closed -

Unreachable

Unknown

UI Health Ventures Mahony Michael Muscatine Muscatine Closed -

Declined

Unknown

Unity Point Clinic Nichols Muscatine Closed -

Unreachable

Unknown

Unity Point Clinic Hiawatha Linn Closed - Intake

Only

Unknown

UNITY POINT FAM MED Closed -

Unreachable

Unknown

Unity Point Family Medicine Bode Humboldt Closed -

Enrolled

Unknown

Unknown Burlington Des Moines Closed -

Unreachable

Unknown

WBC Council Bluffs Pottawattam

ie

Closed -

Unreachable

Van Buren

VBCH Bonaparte Clinic Nank Kelsey Farmington Van Buren Closed -

Unreachable

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Wapello

MERCY CLINICS 1005 E.

PENNSYLVANIA

Ottumwa, IA /

Wapello

52501 HENDERSO

N

FLORIT

A

Ottumwa Closed -

Unreachable

Wapello

Pella Regional Ottumwa Clinic 920 N Quincy Ottumwa, IA /

Wapello

52501 Kanis S. John Fairfield Jefferson Closed -

Enrolled

Wapello

Ottumwa OBGYN ALANS DR

LINDSE

Y

Closed -

Unreachable

Washington

Not Provided 3056 River

Crossing Court

Riverside, IA /

Washington

52327 Bedell David Iowa City Johnson Closed -

Unreachable

Washington

Rivercrossing 52327 Stillwell Ashley Riverside Washington Closed -

Unreachable

Washington

Rivercrossing Nichols Muscatine Closed -

Enrolled

Washington

RIVERCROSSING Washington Washington Closed -

Enrolled

Wayne

SCIMC 417 SE Street Corydon, IA /

Wayne

50060 Hoch Douglas Centerville Closed -

Enrolled

Webster

CHC 126 N 10th Ft Dodge, IA /

Webster

50501 Chase Lisa Fort Dodge Webster Closed -

Enrolled

Webster

Not Provided 126 North 10th

Street

Fort Dodge, IA

/ Webster

50501 Zigrang Jennifer Fort Dodge Webster Closed -

Enrolled

Webster

Not Provided 126 N 10th St Fort Dodge, IA

/ Webster

50501 Zigrang Jennifer Fort Dodge Webster Closed -

Unreachable

Webster

Webster County Health Dept 50501 Laurens Pocahontas Closed -

Enrolled

Webster

COVENIENT CARE FALY MEDICINE

AND WALK IN CLINIC

51501 Schmidt Wyatt Council Bluffs Pottawattam

ie

Closed -

Enrolled

Winnebago

Mercy Family Clinic Lake Mills Keller Pamela Lake Mills Winnebago Closed -

Unreachable

Wisconsin

WHEATON FRANCISCAN

HEALTHCARE

Jamaica Guthrie Closed - Invalid

Woodbury

Mercy Medical Center - Sioux City 51102 Unknown Unknow

n

Sioux City Woodbury Closed -

Already

Participating

Woodbury

Mercy Medical Center-Sioux City 51102 Sioux City Woodbury Closed - Intake

Only

Woodbury

Not Provided 1021 Nebraska

St

Sioux City, IA /

Woodbury

51102 Greene Dylan Akron Plymouth Closed - Intake

Only

4/14/2017 1:24:12 PM




State / County

Clinic

Zip

Code

Referred By

Last Name

Referred

By First

Name


County

Status

Woodbury

Family Health Care 51104 Peterson Paul Sioux City Woodbury Closed -

Unreachable

Woodbury

FAMILY HEALTH CARE 51104 PETERSON PAUL Sioux City Woodbury Closed - Intake

Only

Woodbury

Family Health Care 51104 Shook Steven Sioux City Woodbury Closed -

Enrolled

Woodbury

Unity Point Pulmonology 51104 S Venketra

man


Enrolled

Woodbury

Unity Point Pulmonology 51104 Sahasranam

an

Venketra

man


Already

Participating

Woodbury

Siouxland Community Health Center of

NE

FaHmo David Sioux City Woodbury Closed -

Enrolled

Woodbury

Unity Point Sunnybrook Neils Ashley Sioux City Woodbury Closed -

Declined

Wright

Not Provided 403 1st St SE Belmond, IA /

Wright

50421 Williams Joy Fort Dodge Webster Closed -

Unreachable

Referral Details

Report

4/14/2017 1:24:12 PM



Clinic County Clinic Name Clinic Address Clinic City, Clinic … · 2018-07-10 · Clinic County...

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