Clinic County Clinic Name Clinic Address Clinic City, Clinic · PDF file...

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Transcript of Clinic County Clinic Name Clinic Address Clinic City, Clinic · PDF file...

  • 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

    Page 1 of 22 gb edits Iowa March 2017 Referral Detail

  • 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

    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

    Waterloo Black Hawk Closed -

    Enrolled

    Black Hawk

    Peoples Community Health Clinic Emily Waterloo Black Hawk Closed -

    Enrolled

    Black Hawk

    PEOPLES COMMUNITY HEALTH

    CLINIC

    Closed -

    Already

    Participating

    Black Hawk

    Peoples Community Health Clinic Gutz Emily Waterloo Black Hawk Closed -

    Already

    Participating

    Black Hawk

    PEOPLES COMMUNITY HEALTH

    CLINIC

    Waterloo Black Hawk Closed -

    Unreachable

    Black Hawk

    PEOPLES COMMUNITY HEALTH

    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

    /QLR Reporting/Production Reports

    Page 2 of 22 gb edits Iowa March 2017 Referral Detail

  • 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

    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

    /QLR Reporting/Production Reports

    Page 3 of 22 gb edits Iowa March 2017 Referral Detail

  • 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

    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